Statement of Principles concerning acute articular cartilage tear (Reasonable Hypothesis) (No. 21 of 2019)

The SOP organises a small set of interlocking concepts that together determine when acute articular cartilage tear can be said, on the reasonable hypothesis standard, to be related to a person’s relevant service.

Definition of the condition: Acute articular cartilage tear is defined as an injury involving tearing or damage to the articular (hyaline) cartilage of a joint causing a sudden onset of pain and tenderness (s 7(2)(a)). The instrument explicitly excludes chronic tears and degenerative tears of articular cartilage from the concept (s 7(2)(b)). The accompanying note states that acute tears may be accompanied by swelling, bruising, or loss of functional ability occurring within the 24 hours following the injury, which signals a temporal clinical expectation for the acute presentation (s 7(2) note).

Death linked to the condition: The SOP includes death from acute articular cartilage tear where the death resulted from a terminal event or condition that was contributed to by the acute tear (s 7(3)). The Schedule defines "terminal event" broadly to include several proximate causes such as pneumonia, respiratory failure, cardiac arrest, circulatory failure, and cessation of brain function (Schedule 1).

Basis for the SOP: The Authority states its view that there is sound medical-scientific evidence indicating that acute articular cartilage tear and death from it can be related to relevant service by veterans and service members under the VEA and MRCA (s 8). That is the evidentiary base the RMA relies upon to issue the SOP; the text does not reproduce the underlying studies or evidence, but records the Authority’s view.

Causal threshold and factors: The SOP is explicit about the standard and the minimum factual predicate. It prescribes that at least one of three enumerated factors must exist before a reasonable hypothesis connecting acute articular cartilage tear (or death from it) and relevant service can be said to have been raised (s 9). The three factors are:

1. A significant physical force applied to or through the affected joint at the time of clinical onset (s 9(1));
2. Intra-articular surgery of the affected joint at the time of clinical onset (s 9(2)), with a note giving examples of processes involved during such surgery (drill, anchor suture, intra‑articular infusion pump);
3. Inability to obtain appropriate clinical management for the tear (s 9(3)).

Relationship to service: The SOP does not accept factors in abstract. It requires that any factor relied upon be related to the person’s relevant service (s 10(1)). There is a specific limitation on factor 9(3): it applies only to material contribution or aggravation where the tear was suffered or contracted before or during, but did not arise out of, relevant service (s 10(2)). Thus the SOP treats inability to obtain treatment as an amplifying or aggravating factor rather than a standalone causal event for tears arising within service.

Cross-reference to other SOPs: The SOP anticipates that factors may reference injuries or diseases already the subject of other SOPs. If so, those other SOPs' factors apply in accordance with their terms as in force from time to time (s 11). That mechanism integrates this instrument into the broader SOP framework.

Definitions and scope: The Schedule supplies key statutory definitions. "Relevant service" is defined by listing categories under both the VEA and MRCA (operational, peacekeeping, hazardous, British nuclear test defence service under the VEA; warlike and non‑warlike under the MRCA) (Schedule 1). The definitions anchor the scope of persons and service types covered by the SOP.

Mechanistic takeaways: The document operates as a medical-scientific rule list that translates into an evidentiary gate: at least one factor, related to relevant service, must be established to meet the reasonable hypothesis test for linking the condition to service. The SOP also sets temporal and substantive limits: acute presentation expectations (24 hours note), exclusion of degenerative or chronic changes, and a narrow, conditional application of the "inability to obtain appropriate clinical management" factor where the injury predates or coincides with but does not arise out of service.

The instrument applies to claims made under the legislative frameworks referenced , specifically, to a claim to which section 120A of the Veterans’ Entitlements Act 1986 or section 338 of the Military Rehabilitation and Compensation Act 2004 applies (s 5). The Schedule defines "relevant service" in terms that identify the categories of service covered: operational service, peacekeeping service, hazardous service and British nuclear test defence service under the VEA, and warlike and non‑warlike service under the MRCA (Schedule 1). That definition identifies the classes of service and therefore the cohort of persons whose claims may be governed by this SOP.

Who is directly implicated:

• Veterans and members of the Forces whose claims fall within the sections cited in s 5, and whose service falls within the Schedule’s enumerated relevant service categories. The instrument is addressed to those decision processes and thus materially affects claimants in those classes (s 8; Schedule 1).
• Decision-makers and administrators who determine entitlement under the VEA and MRCA frameworks, because the document supplies the medical threshold the Repatriation Medical Authority has determined for assessing causation. The SOP is a rule used by adjudicators to assess whether a reasonable hypothesis has been raised; it therefore affects the evidentiary framing and burden at the claims stage (s 3; s 5; s 9).

Indirectly affected parties:

• Medical practitioners and orthopaedic surgeons who provide clinical evidence for claims, because the SOP identifies clinical features (sudden onset pain and tenderness, symptoms within 24 hours) and operative procedures (intra-articular surgery, with examples) that are relevant to causal assessment (s 7(2) note; s 9(2) note).
• Service record holders and unit medical officers, insofar as service-related events (application of significant physical force to a joint, surgical interventions during service, or instances where appropriate clinical management was unavailable) are factors required to be linked to relevant service under s 10.
• Administrators of compensation or rehabilitation under the VEA and MRCA, because the SOP may alter which claims are accepted or rejected based on whether the enumerated factors and their connection to service are established.

Not affected or limited groups:

• Individuals whose presentation is chronic or degenerative in nature are excluded from this SOP’s definition and hence from its specific causal framework (s 7(2)(b)). Claims alleging chronic degenerative cartilage disease will not be governed by this SOP’s acute-tear factors.
• The instrument does not itself create payment entitlements, set rates, or provide a mechanism for enforcement; it is a determinative medical rule used within the existing statutory compensation/entitlement frameworks. The SOP therefore does not directly impose financial liabilities or criminal penalties; such outcomes arise only through the application of the VEA/MRCA (s 5).

Geographic and temporal application:

• The SOP commenced on 25 March 2019 and replaces the prior SOP No. 53 of 2010 (s 2; s 4). It therefore applies to claims to which the cited sections of the VEA/MRCA apply from the commencement date onwards according to those statutes and their procedural rules.

In short, the instrument affects claimants with acute articular cartilage tears and those adjudicating their claims under the specified provisions of the VEA and MRCA. It narrows the medical-factual universe to acute, sudden-onset tears, specifies three classes of factors that can establish a reasonable hypothesis of service connection, and ties those factors to the enumerated forms of relevant service.

This instrument itself does not create statutory duties in the criminal or civil penalty sense; rather, it prescribes the medical-factual criteria that must be met for a reasonable hypothesis connecting acute articular cartilage tear, or death from such a tear, and relevant service for the purposes of claims under the VEA and MRCA (s 3; s 5; s 9). Nevertheless, it imposes operational duties on decision-makers and creates rights for claimants in the adjudicative sense.

Duties for decision-makers and administrators:

• Apply the SOP when assessing whether a reasonable hypothesis has been raised connecting acute articular cartilage tear to service for claims that fall within the operation of s 120A of the VEA or s 338 of the MRCA (s 5). The instrument is to be used as the medical-scientific benchmark in those determinations (s 3; s 8).
• Require that at least one of the factors listed in s 9 exist before concluding that a reasonable hypothesis is raised (s 9(1)). Decision-makers must therefore examine and find one or more of the listed factual/clinical situations (significant physical force, intra‑articular surgery at clinical onset, or inability to obtain appropriate clinical management).
• Ensure that any factor relied upon is related to the person’s relevant service (s 10(1)). This imposes a duty to assess the nexus between the enumerated factor and the person’s particular category of relevant service as defined in Schedule 1.

Rights and expectations for claimants:

• Claimants whose cases meet the SOP’s criteria have the procedural right, within the VEA/MRCA processes, to have their condition treated as one for which a reasonable hypothesis of service connection can be made. In practical terms, once a claimant establishes the existence of at least one of the factors and its relation to relevant service, the SOP supplies the medical basis the RMA regards as sufficient to raise a reasonable hypothesis (s 9; s 10).
• For death cases, if the death was contributed to by the acute tear via a terminal event as defined in the Schedule, that linkage falls within the SOP (s 7(3); Schedule 1).

Limitations and conditional applications:

• The SOP clarifies that the "inability to obtain appropriate clinical management" factor (s 9(3)) applies only in the specific circumstance where the tear was suffered or contracted before or during, but did not arise out of, relevant service (s 10(2)). This limits the duty of decision-makers to accept inability-to-treat as a causal or aggravating factor in other circumstances.
• The SOP excludes chronic and degenerative cartilage tears from its definition of the condition (s 7(2)(b)), meaning claimants with chronic degenerative pathology do not have a right under this SOP to have their condition considered under these acute-care factors.

Cross‑reference duty:

• Where a factor in this SOP refers to an injury or disease covered by another SOP, decision-makers must apply the factors in that other SOP as it stands from time to time (s 11). This creates a duty to reference and apply the current terms of other related SOPs.

Procedural and evidentiary consequences:

• While the SOP does not prescribe the specific documents or forms of evidence required, it sets the parameters for what must be established clinically and temporally. The duty of claimants and decision-makers is therefore to frame their case and evaluate the presence and service relation of the enumerated factors.

Absence of penalties:

• The instrument contains no penalty provisions or sanctions. The substantive obligations are therefore administrative and evidentiary: to show a factor listed in s 9 and that it is related to relevant service as defined in the Schedule.

In sum, the SOP sets binding medical-factual criteria for adjudicators to apply in claims under the VEA and MRCA, establishes conditional rights for claimants whose cases meet those criteria, and imposes duties on decision-makers to apply the SOP and, where relevant, other SOPs referred to in s 11.

The instrument does not create or prescribe criminal, civil or administrative penalties within its text. It is a Statement of Principles, and the document’s provisions define medical-factual criteria rather than offences or fines. There are three principal enforcement-related implications to extract from the text.

No direct sanctioning power in the SOP: The SOP does not specify any penalties, enforcement mechanisms, or regulatory sanctions for non-compliance by individuals or providers. It neither establishes offences nor prescribes monetary penalties or corrective orders (entire instrument; compare s 3-11; Schedule 1).

Administrative effect via VEA/MRCA: The SOP’s enforcement effect is indirect and administrative. It is a medical-scientific tool prescribed by the Repatriation Medical Authority for use in the adjudication of claims under the VEA and MRCA (s 3; s 5). Enforcement in practice therefore occurs within the decision-making, claims-acceptance, and entitlement frameworks in those Acts, where compliance with the SOP’s criteria will inform acceptance or rejection of claims, and thereby affect entitlement to compensation, rehabilitation or other statutory benefits. The SOP itself, however, contains none of those entitlement rules , the VEA and MRCA contain the operative rules for payments and remedial processes.

Decision-maker standards and review: Because the SOP sets the minimum factors that must be present to raise a reasonable hypothesis, it functions as a standard that administrative decision-makers are to apply. The instrument therefore can be expected to feature in internal review or external review processes under the VEA/MRCA insofar as a decision-maker’s failure to apply the SOP correctly would be a relevant legal issue in a merits or judicial review. The SOP does not specify review routes or remedies; those are provided by the VEA and MRCA and related administrative law mechanisms rather than by the SOP itself.

No private enforcement mechanism in the SOP: The instrument does not create a private right to enforce the SOP against third parties such as medical practitioners, employers, or units. Its operation is confined to the evidentiary and causal assessments within the statutory claims processes to which it applies.

Practical enforcement risks and consequences:

• For claimants, the practical consequence of failing to establish one of the enumerated factors or its relation to relevant service is administrative: the claim may not meet the reasonable hypothesis standard and therefore may be refused under the governing entitlement framework.
• For decision-makers, non‑application or misapplication of the SOP could expose determinations to challenge under the review and appeal mechanisms of the VEA and MRCA or judicial review on public law grounds, but these mechanisms themselves are external to the SOP.

In summary, the SOP contains no penalties or independent enforcement. Its force is as an evidentiary and medical-scientific benchmark to be applied within the statutory claim processes and associated administrative review mechanisms of the VEA and MRCA.

The instrument explicitly situates itself within the statutory architecture of the Veterans’ Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA). The interaction is multi-layered and set out in several provisions and the Schedule.

Statutory basis and reach: The SOP is made under subsection 196B(2) of the VEA (s 3). It applies to claims to which section 120A of the VEA or section 338 of the MRCA applies (s 5). Those cross-references indicate that the SOP is intended to be used in the adjudication of claims governed by those statutory provisions. The SOP itself does not reproduce the operative entitlement, procedural or remedial provisions of those Acts; it supplements them with a medical causation standard determined by the Repatriation Medical Authority (s 3; s 5).

Definitions tie to VEA and MRCA: The Schedule defines "relevant service" by enumerating categories that draw directly from the VEA and MRCA frameworks: operational service, peacekeeping service, hazardous service, British nuclear test defence service (VEA), and warlike and non-warlike service (MRCA) (Schedule 1). By doing so the SOP aligns its scope to the statutory categories of service that determine which individuals and service contexts are within the scope of the parent Acts.

Cross-SOP applicability: Section 11 requires application of the factors in other SOPs when a factor in this SOP refers to an injury or disease that is already covered by a different Statement of Principles. The text mandates that "the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time" (s 11). This is an explicit legal mechanism for co‑ordination among SOPs, ensuring that overlapping medical conditions are governed by the current terms of their respective SOPs. It therefore creates a dynamic link between this instrument and other SOPs determined under subsection 196B(2) of the VEA.

Relationship with claims, evidence and decision-making: While this SOP dictates the medical-factual factors required to raise a reasonable hypothesis of service connection, the VEA and MRCA determine the legal consequences once that hypothesis is raised, including entitlement, rehabilitation, compensation and the procedural paths for appeal or review. The SOP’s role is therefore evidence-shaping rather than entitlement-defining. Decision-makers must apply this SOP in the evidence assessment stage under the broader legal frameworks of the VEA and MRCA (s 5; s 9; s 10).

Temporal and repeal interactions: The SOP expressly repeals the prior Statement of Principles concerning acute articular cartilage tear No. 53 of 2010 (s 4). This repeal creates a temporal interaction: claims assessed after the commencement date (25 March 2019) will be assessed under this instrument rather than the 2010 instrument, subject to any transitional provisions in the VEA/MRCA frameworks or other legal instruments (s 2; s 4). The SOP itself does not set out transitional provisions; any transition would be managed by the parent statutes’ procedures and administrative practice.

No interaction with other non-specified laws in the text: The instrument does not mention other health, occupational safety, workers’ compensation or tort laws. It does not purport to displace or interact with those regimes. The SOP is framed narrowly as an evidentiary medical statement for the VEA/MRCA claims processes; any interaction with other legal regimes would depend on those regimes’ own rules and is not addressed in this instrument.

In summary, the instrument interacts with other laws primarily by operating as an evidentiary and medical rule within, and subordinate to, the VEA and MRCA. It cross-references service categories in the Schedule, replaces an earlier SOP, and requires co‑ordination with other SOPs where factors overlap. It does not create standalone legal rights or obligations outside the VEA/MRCA claims processes.

The instrument contains its own short amendment and commencement history within the text. The relevant facts recorded by the instrument are these.

New instrument and commencement:

• The Statement of Principles concerning acute articular cartilage tear (Reasonable Hypothesis) (No. 21 of 2019) was dated 1 March 2019 and commenced on 25 March 2019 (cover page; s 2). The instrument was made under subsection 196B(2) of the VEA (s 3).

Repeal of prior instrument:

• The instrument expressly repeals the earlier Statement of Principles concerning acute articular cartilage tear No. 53 of 2010 (Federal Register of Legislation No. F2010L01666) enacted under subsection 196B(2) of the VEA (s 4). The repeal is unconditional in the text: the 2010 instrument is rescinded by the making of this instrument.

No further amendments recorded within the text:

• The instrument itself does not record any subsequent amendments, modifications, or saving/transitional provisions beyond the commencement date and repeal. It does not include a schedule of prior amendments or legislative history beyond the replacement of the 2010 SOP.

Dynamic link to future SOPs:

• Section 11 establishes that, where a factor in this SOP refers to an injury or disease that is covered by another SOP determined under subsection 196B(2) of the VEA, the factors in that other SOP apply in accordance with its terms as in force from time to time. This creates a continuing interaction that allows the practical operation of this instrument to be affected by later amendments to other SOPs.

Administrative signature and sealing:

• The instrument bears the Common Seal of the Repatriation Medical Authority, affixed at the direction of the Chairperson, Professor Nicholas Saunders AO, which is the formal attestation of the instrument (cover page signature block). This provides the standard administrative provenance and indicates the issuing authority.

No transitional detail in the instrument:

• The SOP contains no express transitional provisions specifying how claims spanning the repeal date are to be handled, nor does it provide guidance on retroactivity or the application to claims lodged prior to 25 March 2019. Any such transitional rules would therefore need to be sought in the parent statutes or administrative practice outside this instrument.

In short, the amendment history recorded by the instrument is narrowly confined: the 2019 SOP replaced and repealed the 2010 SOP, and it commenced on 25 March 2019. There are no further amendments or transitional clauses recorded within the instrument itself.

The instrument does not record any litigation history. The text contains no references to judicial decisions, appeals, or legal challenges concerning this Statement of Principles. It mentions the prior Statement of Principles (No. 53 of 2010), and that instrument is expressly repealed by the present instrument (s 4), but the document does not reference any court or tribunal cases in relation to either the 2010 instrument or the 2019 replacement.

Consequences for analysis and review:

• Because the instrument contains no litigation history, there is no reporter-cited authority within the text that interprets or applies this SOP. Any legal interpretation or challenge that has occurred post‑commencement is not reflected in the instrument itself. The absence of litigation material in the instrument means that those seeking case law or appellate interpretation must refer to decisions under the VEA/MRCA or administrative review bodies outside the instrument text.

What is present in the instrument that is relevant to litigation risk:

• The SOP sets out clear, narrow factors and a standard (reasonable hypothesis) that will be applied by decision-makers. In litigation or review processes under the VEA or MRCA, the questions likely to arise would be whether a decision-maker properly applied the SOP’s requirements (for example, requiring at least one of the factors in s 9 and ensuring the factor was related to relevant service under s 10). The instrument itself, however, does not set out any adjudicative or interpretive commentary or precedent.

Practical implication of absent litigation references:

• Practitioners, reviewers and claimants must therefore rely on the statutory framework of the VEA and MRCA, administrative practice, and any external case law concerning the application of Statements of Principles more generally. The SOP provides the medical-scientific criteria; interpretive disputes about those criteria’s application will be resolved under the wider legal framework and, if litigated, in decisions not recorded in this document.

In summary, there is no litigation history included within this instrument. It is a determinative medical statement issued by the Repatriation Medical Authority, and any litigation or review concerning its application would be external to the instrument and not reflected in its text.

Several specific features of the instrument can have unexpected or counter‑intuitive consequences if not carefully observed. These are factual, structural and procedural traps that arise from the wording of the SOP itself.

1. Narrow definition of "acute" and explicit exclusions (s 7(2)):

• The SOP applies only to "acute articular cartilage tear" defined as a sudden onset of pain and tenderness accompanying tearing or damage of hyaline cartilage (s 7(2)(a)). It expressly excludes chronic tears and degenerative tears (s 7(2)(b)). A claim based on degenerative or chronic pathology will therefore fall outside the criteria set out here and will not be assisted by this SOP. Practitioners must ensure the claimed condition fits the acute definition before relying on this SOP.

2. Temporal clinical expectation in the note (s 7(2) note):

• The accompanying note indicates that acute tears "may be accompanied by" symptoms occurring within the 24 hours following the injury. That sets an expected temporal window for the acute presentation. Where clinical onset is delayed beyond that window, there may be a factual dispute about whether the presentation was truly acute for the purposes of this SOP.

3. Minimal but exclusive list of factors (s 9):

• The SOP requires that at least one of the three listed factors exist before a reasonable hypothesis can be said to have been raised (s 9). The three factors are narrowly framed: significant physical force at clinical onset, intra‑articular surgery at clinical onset (with examples in the note), or inability to obtain appropriate clinical management. Absent at least one of these, the SOP does not provide a medical link. Claims relying on other alleged mechanisms of injury may not find support in this SOP.

4. Conditional application of the "inability to obtain appropriate clinical management" factor (s 10(2)):

• The inability-to-obtain-treatment factor (s 9(3)) applies only in the situation where the tear was suffered or contracted before or during, but did not arise out of, relevant service (s 10(2)). That means inability to obtain care is framed as material contribution or aggravation in a narrow factual scenario. It is not a free-standing mechanism for linking a tear to service if the tear arose out of service or if the timing does not meet the limited condition.

5. Requirement to relate factors to relevant service (s 10(1)):

• Any factor relied upon must be related to the person’s relevant service (s 10(1)). The Schedule limits relevant service to specific categories (Schedule 1). Evidence of a factor, without a clear link to these categories of service, will not satisfy the SOP. That may be a practical problem for persons whose service history is complex or who served in multiple capacities.

6. Cross-reference to other Statements (s 11):

• If a factor in the SOP refers to an injury or disease covered by another SOP, those other SOPs apply as in force from time to time (s 11). This introduces the potential for shifting benchmarks when other SOPs are amended. A practitioner relying on an external SOP must check its current terms rather than assume static application.

7. Repeal of the 2010 SOP (s 4) and no transitional provisions:

• The SOP repeals the 2010 instrument (s 4) and commenced on 25 March 2019 (s 2). The text does not provide transitional rules for claims spanning the repeal. There may therefore be administrative uncertainty about which SOP applies to claims initiated around the commencement date, and that uncertainty will depend on external procedural rules within the VEA/MRCA not set out here.

8. Death linkage requires contribution by the tear to a defined terminal event (s 7(3); Schedule 1):

• For death cases, the death must be "from a terminal event or condition that was contributed to by the person's acute articular cartilage tear" (s 7(3)). The Schedule lists examples of terminal events (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function). The contribution requirement means causal chains must be demonstrated: a terminal event named in the Schedule must be shown to have been contributed to by the tear.

9. Absence of procedural or evidentiary specification:

• The SOP does not specify the forms of evidence, documentation, or procedures required to establish the factors or the link to service. That leaves procedural detail to the VEA/MRCA frameworks and administrative practice, which can produce practical uncertainty for claimants and practitioners about how best to present evidence that one of the factors exists and is related to relevant service.

10. Limited scope for non-service injuries aggravated by service:

• The SOP treats inability to obtain appropriate clinical management as a factor of material contribution or aggravation only in narrowly defined circumstances (s 10(2)). For injuries that arose outside service but were aggravated during service, careful factual mapping is needed to ensure the correct application of s 9(3) and s 10(2).

Those "gotchas" are all textual features of the SOP. Observing them is essential to avoid misapplying the instrument and to ensure correct framing of claims and responses.

The instrument sets out what must be demonstrated to raise a reasonable hypothesis that acute articular cartilage tear (or death from it) is connected to relevant service. Compliance therefore means ensuring that the elements the SOP prescribes are established and that their relationship to relevant service is addressed. The SOP itself is silent on procedural mechanics; it defines the substantive medical-factual gates. Compliance advice below therefore focuses on the concrete elements the instrument requires.

1. Confirm the condition falls within the SOP’s definition (s 7(2)):

• Establish that the condition alleged is an acute articular cartilage tear, meaning it involved tearing or damage of articular (hyaline) cartilage resulting in sudden onset of pain and tenderness (s 7(2)(a)). Do not attempt to apply this SOP to chronic or degenerative cartilage pathology, which are explicitly excluded (s 7(2)(b)). Note the SOP’s clinical expectation that acute tears may be accompanied by swelling, bruising, or loss of function within 24 hours of the injury (s 7(2) note), and address whether that acute temporal presentation is present in the case.

2. Ensure at least one of the factors in s 9 is present:

• The SOP requires the existence of at least one of the following: a. Significant physical force applied to or through the affected joint at the time of the clinical onset (s 9(1)); b. Intra-articular surgery of the affected joint at the time of the clinical onset (s 9(2)). The note lists examples of intra‑articular surgical processes, including use of a drill, placing an anchor suture and inserting an intra-articular infusion pump, which can be relevant to showing surgery was intra‑articular in nature; and c. Inability to obtain appropriate clinical management for the acute tear (s 9(3)).

3. Relate the identified factor to relevant service (s 10(1)):

• Any factor relied on must be related to the person’s relevant service as defined in the Schedule (Schedule 1). Establish the nexus between the factor and the categories of relevant service (operational, peacekeeping, hazardous, British nuclear test defence service under the VEA; warlike and non‑warlike under the MRCA). The SOP requires that the existence of the factor be connected to the circumstances of relevant service.

4. Observe the limitation on the "inability to obtain appropriate clinical management" factor (s 10(2)):

• If relying on s 9(3), confirm that the tear was suffered or contracted before or during, but did not arise out of, the relevant service. The factor in s 9(3) applies only to material contribution to, or aggravation of, the condition in that particular timing and causal scenario.

5. For death cases, show the tear contributed to a terminal event (s 7(3); Schedule 1):

• If the claim concerns death from the tear, the SOP requires that the death be from a terminal event or condition that was contributed to by the acute articular cartilage tear (s 7(3)). The Schedule lists example terminal events (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function). Ensure the causal chain between the tear and the terminal event is addressed.

6. Check for overlap with other SOPs (s 11):

• If any factor in this SOP refers to an injury or disease that is the subject of another SOP, apply the factors of that SOP as in force from time to time (s 11). Confirm that any cross-referenced SOP is the current version and that its requirements are met.

7. Be mindful of the timing and the repeal (s 2; s 4):

• This SOP commenced on 25 March 2019 and replaced the 2010 SOP (s 2; s 4). For claims that span the commencement, confirm which SOP the decision-maker is applying and whether any transitional administrative rules under the VEA/MRCA apply.

8. Frame submissions to the decision-maker around the SOP’s prescribed gates:

• The SOP sets the medical-factual gates that raise a reasonable hypothesis. Present the case to adjudicators under the VEA/MRCA in terms of the SOP’s factors and the required relation to relevant service (s 9; s 10). The SOP does not specify how evidence should be presented; it specifies what must be established substantively.

9. Anticipate cross-checks by the decision-maker:

• Decision-makers will assess whether the factor exists and whether it is related to relevant service. Where a factor references an injury/disease covered elsewhere, decision-makers will consult the other SOP. Ensure submissions address both the primary factor and any linked SOPs invoked by s 11.

10. Understand the scope of the SOP and avoid misapplication:

• Do not try to rely on this SOP for chronic degenerative cartilage conditions (s 7(2)(b)), nor assume that inability to obtain treatment will apply in every factual scenario , it is constrained by s 10(2).

The SOP itself does not prescribe documentary formats or procedural steps for lodging or proving claims; those processes are governed by the VEA and MRCA. Compliance therefore means structuring the clinical and service nexus evidence to align with the instrument’s substantive requirements: acute presentation, at least one of the enumerated factors, and a clear relation to relevant service as defined in the Schedule.