Statement of Principles concerning adhesive capsulitis of the shoulder (Reasonable Hypothesis) (No. 72 of 2020)

The central concept is the "reasonable hypothesis". Under sections 120A and 120B of the VEA, an SoP sets out the factors that must as a minimum exist before a reasonable hypothesis can be found. The hypothesis is a connecting link between the claimed condition and the person's service, grounded in medical-scientific evidence. The SoP itself does not prove or disprove service connection; it merely provides the framework. "Clinical onset" refers to the first manifestation of the condition that would allow a diagnosis. "Clinical worsening" means a material deterioration of an existing condition. The instrument treats onset and worsening as distinct factual questions, each with its own set of factors. The condition itself is defined by a combination of clinical features and duration, not by a diagnostic code. Subsection 7(3) notes that the ICD-10-AM code is M75.0 but says "in applying this Statement of Principles the meaning ... is that given in subsection (2)". This means a mere coding in medical records is insufficient; the clinical features and 28-day duration must be independently established. "Relevant service" is defined in the Schedule 1 Dictionary to cover only operational service, peacekeeping service, hazardous service, and British nuclear test defence service under the VEA, plus warlike and non-warlike service under the MRCA. This excludes peacetime service, which is a different category under the VEA (defence service) and has its own SoP regime under section 196B(3). "Terminal event" is defined to mean the proximate or ultimate cause of death, including pneumonia, respiratory failure, cardiac arrest, circulatory failure, or cessation of brain function. This means a claim for death from adhesive capsulitis requires that the condition contributed to one of those terminal events. The "specified list of thyroid diseases" includes Graves' disease, Hashimoto's thyroiditis, hyperthyroidism and thyrotoxicosis, and hypothyroidism. Notably, non-specific thyroid abnormalities are not captured; the condition must fall within one of the four listed subcategories. "Dyslipidaemia" is defined by specific lipid thresholds: HDL less than 1.0 mmol/L, LDL greater than 4.0 mmol/L, triglycerides greater than or equal to 2.0 mmol/L, total cholesterol greater than 5.5 mmol/L, or regular administration of drug therapy to normalise lipid levels. This means a diagnosis of "dyslipidaemia" in medical notes is not enough; the blood test values or pharmacological treatment must meet these precise cut-offs. "Significant injury involving the arm or shoulder" is defined as an injury that results in substantial pain, swelling, tenderness and immobilisation of the arm or shoulder. The instrument provides non-exhaustive examples: fracture of humerus, scapula or clavicle, fracture of a bone of the arm, penetrating injury to the shoulder joint, dislocation of the shoulder or arm joint, and significant injuries to soft tissues. The word "significant" imports a clinical judgement that goes beyond minor sprains.

The SoP directly governs claims made by veterans, members of Peacekeeping Forces, and members of the Forces under the VEA, as well as members covered by the Military Rehabilitation and Compensation Act 2004 (MRCA). Its application is triggered by section 5, which says the instrument applies to "a claim to which section 120A of the VEA or section 338 of the MRCA applies." This means it affects all compensation claims for adhesive capsulitis of the shoulder under those Acts, regardless of whether the condition was first suffered during service or later. The instrument does not affect claims made under the Safety, Rehabilitation and Compensation Act 1988 (Comcare scheme) or under workers' compensation legislation; those regimes have their own medical criteria. Within the DVA system, the SoP binds delegates and the Veterans' Review Board when assessing whether a reasonable hypothesis exists. It also influences the opinions of medical practitioners preparing reports for such claims, because the factors require specific clinical findings and timings. For example, a doctor must confirm that a surgical procedure occurred within six months before clinical onset, not just that the person had surgery. The instrument indirectly affects treating practitioners by requiring them to document the 28-day duration and the presence of severe functional restriction for both active and passive motion. This imposes an evidentiary burden that may not arise in ordinary clinical management. The SoP also affects the Repatriation Medical Authority itself, which is required to review and, where necessary, revoke or replace SoPs as medical-scientific evidence develops. The repeal of the 2012 SoP and replacement with this 2020 version means that any claim lodged before 30 November 2020 that had not been finally determined would be subject to the old 2012 SoP if the claim was made before the new one commenced, but after the commencement date the new SoP applies. The instrument also affects family members who may claim dependent or bereavement benefits if a veteran dies from adhesive capsulitis. The death provision in subsection 7(5) requires that the condition contributed to a terminal event; this means a death certificate listing frozen shoulder as a contributing condition will not automatically suffice unless one of the listed terminal events (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function) is also present. The SoP does not affect civilians, even if they suffer from adhesive capsulitis, because the service connection requirement is fundamental.

The primary duty imposed by the instrument is on the Repatriation Medical Authority (RMA) to determine SoPs based on "sound medical-scientific evidence" (subsection 196B(2) VEA), and the instrument itself declares at section 8 that such evidence exists. The RMA's duty is ongoing: it must keep SoPs under review and amend or replace them when the evidence changes. For decision-makers (delegates of the Reputation Commission or MRCA), the duty is to apply the SoP when assessing a claim for adhesive capsulitis. Under section 120A of the VEA, a reasonable hypothesis cannot be found unless the SoP's factors are satisfied. This means the decision-maker must check each of the 23 factors and determine whether at least one exists and is related to the person's relevant service. The decision-maker has a duty to consider the dictionary definitions strictly: the clinical definition of adhesive capsulitis, the lipid thresholds for dyslipidaemia, the list of thyroid diseases, and the definition of significant injury. They cannot accept a diagnosis or factor at face value if the underlying criteria are not met. For claimants, the right is to have a hypothesis considered if they raise one or more factors that are supported by evidence. Claimants also have the right to rely on factor 23 (inability to obtain appropriate clinical management), which is a residual category that does not require a specific medical event or condition but rather a systemic or personal barrier to treatment. However, the instrument does not define "inability to obtain appropriate clinical management", creating interpretive room. Claimants have the right to refer to other SoPs under section 11; for example, if they rely on diabetes as a factor, they can use the diabetes SoP to establish that the diabetes is service-related. Claimants also have the right to argue that the 28-day duration requirement is met even if medical records do not explicitly document 28 days, as long as the clinical picture supports it. Conversely, decision-makers have a duty to seek further evidence if the duration is unclear. The SoP does not create any right to compensation; it is procedural. It operates as a threshold test, and if no factor exists, the claim must be rejected regardless of other evidence. The instrument also imposes a duty on the decision-maker to apply the temporal windows precisely: a surgical procedure at five months and 29 days before onset satisfies factor 2; one at six months and one day does not. The same precision applies to each factor. There is no duty on the RMA to list every possible factor; the instrument is limited to factors supported by sound medical-scientific evidence, and the RMA has discretion to include or exclude factors accordingly.

The instrument itself contains no penalty provisions. It is a legislative instrument that operates within the broader compensation framework, and enforcement is indirect. If a claimant fabricates evidence to satisfy a factor, they may be subject to criminal penalties under the Criminal Code Act 1995 (Cth) for providing false or misleading information to a Commonwealth officer, or under relevant provisions of the VEA or MRCA concerning fraud. The practical enforcement mechanism is the claims assessment process: the decision-maker scrutinises each factor and can request further medical evidence, specialist reports, or imaging studies. If the decision-maker is not satisfied that a factor exists, the claim is refused. The claimant can then seek internal review by the Veterans' Review Board or external review by the Administrative Appeals Tribunal. In those forums, the SoP is the binding legal framework, and the tribunal cannot depart from its terms. The SoP does not confer any enforcement power on the RMA; once made, it takes effect as delegated legislation and is binding on all decision-makers. There is no penalty for a decision-maker who misapplies the SoP, though such misapplication may be grounds for judicial review under the Administrative Decisions (Judicial Review) Act 1977. An error could result in the decision being set aside and remitted, but the SoP itself imposes no sanction. The instrument also does not contain any offence for failing to comply with its definitions. However, if a medical practitioner knowingly provides a report that misstates the timing of an injury or the duration of symptoms to satisfy a factor, that may constitute professional misconduct or a breach of the Health Practitioner Regulation National Law. For claimants, the main risk is that a claim succeeds based on a factor that does not actually exist, resulting in a payment to which the person is not entitled. The Commonwealth may then seek recovery of that payment under overpayment provisions in the VEA or MRCA, plus statutory interest. There is no penalty because the person is not deemed to have committed an offence; it is simply a debt. The only pecuniary penalty in the broader scheme is that false statements made in connection with a claim can attract fines or imprisonment, but those penalties derive from the parent Acts, not this SoP. In summary, the SoP's enforcement relies entirely on the accuracy of medical records and the rigour of the assessment process.

The SoP operates squarely within the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004. Section 5 explicitly states it applies to claims under section 120A of the VEA and section 338 of the MRCA. Those provisions require that a reasonable hypothesis cannot be found unless the relevant SoP is satisfied. This means the SoP effectively modifies the standard of proof: even if general medical evidence suggests a service connection, the specific factors in the SoP must be met. The interaction with other SoPs is governed by section 11: any factor that refers to an injury or disease covered by another SoP (for example, diabetes mellitus, Parkinson's disease, thyroid disease) must be assessed according to that other SoP as in force from time to time. This creates a chain of references. A claimant relying on diabetes as a factor under factor 6 must also satisfy the diabetes SoP, which itself will have its own factors for establishing a reasonable hypothesis connecting diabetes to service. This can become complex in practice, because the diabetes SoP will define diabetes differently and set its own temporal windows. The instrument also interacts with the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM). Subsection 7(4) references the Tenth Edition effective 1 July 2017. While the ICD code is only for informational purposes, in practice decision-makers often rely on hospital discharge summaries or GP records that code M75.0. However, subsection 7(3) makes clear that the code is not determinative; the clinical definition in subsection 7(2) overrides. The interaction with state and territory workers' compensation schemes is nil: those schemes are not bound by Commonwealth SoPs. The SoP also does not interact with the general law of negligence or tort; it is purely a compensation tool. There is no interaction with the Health Insurance Act 1975 or Medicare; a veteran can receive Medicare treatment for adhesive capsulitis without any reference to the SoP. However, the SoP may influence the content of medical reports prepared for other purposes: a specialist asked to assess a veteran for any purpose may inadvertently include the 28-day duration language, potentially affecting other claims. The instrument also interacts with the Veterans' Entitlements (Income Support) legislative framework only indirectly: if the condition is accepted as service-related, the veteran may be eligible for disability pension or compensation, which then affects income support means testing. But the SoP does not determine those cascading effects; it is confined to the initial element of causation. Finally, the SoP interacts with the Administrative Appeals Tribunal Act 1975 through review processes, and with the Judiciary Act 1903 through the possibility of constitutional challenges, though none are currently known.

The instrument itself does not have an amendment history beyond its commencement. It was made on 30 October 2020 and commenced on 30 November 2020. It repealed and replaced the Statement of Principles concerning adhesive capsulitis of the shoulder No. 7 of 2012 (Federal Register of Legislation No. F2012L00014). That earlier SoP was made under the same parent Acts. The differences between the 2012 and 2020 versions are not detailed in the current instrument, but the fact of repeal indicates that the RMA determined that new medical-scientific evidence existed, warranting a fresh determination. The instrument's basis for determining factors (section 8) states "there is sound medical-scientific evidence that indicates that adhesive capsulitis of the shoulder and death from adhesive capsulitis of the shoulder can be related to relevant service" - this is the standard finding. It is likely that the 2020 version updated the factors to reflect more recent epidemiological studies, perhaps adding or removing certain associated conditions or adjusting temporal windows. Notably, the 2020 version includes dyslipidaemia as a factor (factors 9 and 20), which may have been added based on newer evidence linking lipid abnormalities to frozen shoulder. The instrument also includes highly active antiretroviral therapy (HAART) as a factor (factors 10 and 21), reflecting recognition of a potential iatrogenic link. These could have been absent from the 2012 SoP. The dictionary definitions have also been refined: the "specified list of thyroid diseases" now includes Graves' disease, Hashimoto's thyroiditis, hyperthyroidism, thyrotoxicosis, and hypothyroidism. It is possible the previous SoP had a broader or narrower list. The instrument does not include any savings or transitional provisions for claims that were pending when it commenced, but section 5's operation would mean that claims under section 120A VEA or section 338 MRCA are subject to the SoP in force at the time the claim is decided, not when it was lodged, unless a separate administrative direction exists. This is a standard feature of these instruments. There have been no subsequent amendments to this instrument as of the time of writing; the Register would show any further amendments if they occurred.

This specific instrument (No. 72 of 2020) has not been the subject of any reported litigation. The source does not reference any cases, and there are no known Federal Court or Administrative Appeals Tribunal decisions that directly interpret the 2020 SoP. However, earlier SoPs for adhesive capsulitis have been considered in AAT decisions. A search of published AAT decisions would likely show that the 2012 SoP was frequently argued, particularly the definition of "significant injury involving the arm or shoulder" and the temporal window for surgical procedures. The current SoP's new factors (dyslipidaemia, HAART) have not yet been judicially tested. The absence of litigation on the 2020 SoP suggests either that it is relatively uncontroversial in its wording or that few claims have been made under it. Litigation could arise on several points: the meaning of "severe functional restriction of both active and passive shoulder motion" - whether this requires formal goniometric measurement or can be clinically assessed; the definition of "paralysis of the affected shoulder" - does this mean complete paralysis or significant motor weakness? The dictionary definition of "paralysis" is not provided, so this is left to medical evidence. Another potential dispute is the requirement that a "significant injury" results in "substantial pain, swelling, tenderness and immobilisation". The word "and" suggests all four features must be present, but medical reality may see swelling absent in some significant injuries. Litigation could test whether a fracture without documented swelling still qualifies. The factor for "inability to obtain appropriate clinical management" (factor 23) is particularly open-ended. It could be argued in cases where a veteran's remote posting or service conditions prevented timely treatment. The word "appropriate" implies a normative standard and could be litigated extensively. The terminal event definition may also be disputed: does the condition need to directly cause the terminal event, or is a contribution sufficient? Subsection 7(5) says "contributed to", which is a broad causation standard. The interaction with other SoPs under section 11 could spawn litigation about whether a factor that is not itself related to service can still be used if the underlying SoP is not satisfied. The instrument itself provides no guidance on the order of analysis; the decision-maker must first establish the factor, then determine if that factor is related to service, and then if the underlying SoP allows it. In practice, litigation risk is moderate, but the instrument has remained stable.

Several traps exist for the unwary. First, the 28-day duration requirement is strict. If a patient presents with acute pain and stiffness, that resolves by day 20, then recurs at day 30, the condition may not meet the continuous 28-day requirement unless the symptoms persist. Medical records must show symptoms lasting at least 28 consecutive days. Second, the definition of "significant injury involving the arm or shoulder" requires the injury to result in "substantial pain, swelling, tenderness and immobilisation" - all four elements must be present. Many soft tissue injuries cause pain and tenderness but not necessarily obvious swelling. The examples include fracture and dislocation, which would typically cause swelling, but a rotator cuff tear might not. Claimants may assume any injury qualifies. Third, temporal windows are tight and must be calculated precisely. For a surgical procedure, it must occur within six months before the clinical onset. If the surgery was six months and one week before, factor 2 does not apply. Similarly, for paralysis, the window is one year. The instrument does not allow any tolerance. Fourth, factor 23 "inability to obtain appropriate clinical management" is deceptively broad. It may cover situations where a veteran was deployed to a remote area and could not access physiotherapy or corticosteroid injections. However, to rely on this factor, the claimant must prove that the inability to obtain clinical management actually contributed to the clinical worsening - and that the worsening is not simply the natural progression of the condition. The instrument does not define "appropriate clinical management", so the bar may be high. Fifth, the dictionary definition of "dyslipidaemia" includes a threshold for drug therapy: "the regular administration of drug therapy to normalise blood lipid levels". This means that a person with normal lipids on statins still qualifies, even if their untreated lipids were normal. Conversely, a person with elevated lipids who is not on therapy must meet the specific numeric thresholds. Sixth, the SoP distinguishes between onset and worsening, and the worsening factors apply only where the condition was "suffered or contracted before or during (but did not arise out of) the person's relevant service". This excludes cases where the condition first arose after service; in those cases, only the onset factors can be used. Seventh, the instrument does not define "paralysis". In the AAT, this may be interpreted to require complete loss of motor function, which is rare. Partial weakness (paresis) would not satisfy factors 3 or 14. Eighth, the thyroid disease list is closed: only Graves', Hashimoto's, hyperthyroidism, thyrotoxicosis, and hypothyroidism qualify. Subclinical hypothyroidism does not count. Ninth, the alcohol or other common exposures do not appear as factors. A claimant who drank heavily during service cannot rely on that unless it contributed to dyslipidaemia, diabetes, or another factor. Tenth, the instrument does not allow a factor based on a family history of frozen shoulder; only the listed factors count.

For a legal practitioner representing a veteran claimant, the first step is to obtain a formal diagnosis of adhesive capsulitis that meets the SoP's definition. This requires medical evidence confirming shoulder pain, stiffness, and severe functional restriction of both active and passive motion, persisting for at least 28 days. The report should explicitly state the duration. Next, identify which factor or factors in section 9 might apply, and collect evidence supporting the existence of that factor within the relevant temporal window. For a surgical procedure, obtain the operative report and admission dates. For a significant injury, obtain emergency department records or imaging that shows substantial pain, swelling, tenderness and immobilisation. For diabetes or thyroid disease, obtain the diagnosis date and confirm it was present at the time of clinical onset or worsening. For dyslipidaemia, obtain the blood test results that meet the numeric thresholds or evidence of medication. For HAART, confirm the medication history. For phenobarbital or primidone, obtain the prescription records. For paralysis, obtain a neurologist report. For malignant neoplasm, obtain biopsy or imaging results. For rotator cuff syndrome, obtain ultrasound or MRI evidence. For Parkinson's disease, obtain a neurologist's diagnosis. For factor 23, gather evidence of barriers to clinical management, such as posting reports, medical officer records showing attempts to access treatment, or service documents indicating unavailability of specialist care. The factor must be related to relevant service: assemble the person's service records to show the period of operational, peacekeeping, hazardous, British nuclear test, warlike or non-warlike service, and demonstrate a causal or temporal link between that service and the factor. For example, a significant arm injury sustained during a training exercise on warlike service directly links. For diabetes, show that the diabetes was itself related to service via the diabetes SoP. The practitioner should also check the definition of "relevant service" to ensure the claim falls within one of the six categories; if the service was peacetime (defence service) only, this SoP does not apply, and the separate standard under subsection 196B(3) VEA applies. For a death claim, obtain a death certificate and medical report confirming that adhesive capsulitis contributed to one of the terminal events listed in the dictionary: pneumonia, respiratory failure, cardiac arrest, circulatory failure, or cessation of brain function. Ensure the medical report traces the causal chain. For aggravation claims, confirm that the condition existed before or during service but did not arise out of service, and then show that a worsening factor (factors 12 to 22) occurred after the condition was present. The decision-maker will need to be satisfied that the degradation was material, not just a natural fluctuation. Finally, prepare a statement of the hypothesis that explicitly names the factor, the temporal connection, and the service relationship. This should be in writing, signed by the claimant or representative, and supported by all medical and service documents. The assessment can then proceed under the reasonable hypothesis standard.