Statement of Principles concerning hallux valgus (Reasonable Hypothesis) (No. 25 of 2024)

The instrument hinges on a few core legal and medical concepts, each given operative meaning in the instrument itself.

• Statement of Principles and legal source: The instrument is a Statement of Principles made under s196B(2) of the VEA (s3). It is therefore a legislatively-enabled administrative instrument that prescribes the factors that raise a "reasonable hypothesis" linking a disease or death to service. The instrument replaces the earlier 2015 Statement (s4).

• Scope of application: The instrument applies to claims that fall under section 120A of the VEA or section 338 of the MRCA (s5). The Schedule defines "relevant service" to include operational, peacekeeping, hazardous and British nuclear test defence service under the VEA, and warlike and non-warlike service under the MRCA (Schedule 1 definitions).

• Medical condition defined: "Hallux valgus" is defined for this instrument as a symptomatic deformity of the foot with lateral deviation of the great toe at the first metatarsophalangeal joint, often with a medial bony prominence or bunion over the first metatarsal head and neck (s7(2)). This is the threshold clinical description that the rest of the instrument references.

• Death from condition: "Death from hallux valgus" includes cases where a terminal event or condition was contributed to by the person's hallux valgus (s7(3)). The Schedule defines "terminal event" as proximate or ultimate causes of death including pneumonia, respiratory failure, cardiac arrest, circulatory failure, or cessation of brain function (Schedule 1).

• Reasonable hypothesis and factors: The legal test imposed is that at least one specified factor must exist before it can be said that a reasonable hypothesis has been raised connecting hallux valgus (or death from it) with relevant service (s9). The factors are a mix of exposure criteria (footwear), comorbid disease states (rheumatoid arthritis, gout, calcium pyrophosphate deposition disease), structural foot conditions (pes planus, acquired loss of certain bones), tumour presence, trauma to the forefoot with defined clinical sequelae and timing, and inability to obtain appropriate clinical management (s9).

• Temporal and causal constraints: Several factors are expressly subject to temporal conditions relative to "clinical onset" or "clinical worsening" of the hallux valgus, with explicit durations and lookback periods (for example, footwear criterion: at least 7 hours per day, on more days than not, for at least 18 months before clinical onset/worsening; trauma criterion: trauma within 5 years before clinical onset/worsening with specified sign-onset and persistence requirements) (s9(1), s9(7); Schedule 1 trauma definition).

• Interaction with other Statements: Where a factor in s9 refers to an injury or disease covered by a different Statement of Principles made under s196B(2) of the VEA, that separate Statement's factors apply according to its terms (s11). This creates an interlocking application model between Statements.

• Relationship to service clarifications: Section 10 requires that any factor relied upon must be related to the person’s relevant service (s10(1)). Section 10(2) expressly limits "clinical worsening" aspects of factors to situations where the hallux valgus was suffered or contracted before or during, but did not arise out of, the person's relevant service; that is, clinical worsening provisions apply only where the condition did not arise out of service but pre-existed or was contracted before/during service and was materially contributed to or aggravated thereafter (s10(2)).

These concepts define the instrument’s legal mechanics: what the condition is, what counts as death from it, which claimants are in scope, which factors can raise the reasonable hypothesis, what temporal constraints apply, and how the Statement interacts with other Statements of Principles.

The instrument applies to persons who make claims under the specified provisions: claims to which section 120A of the VEA or section 338 of the MRCA applies (s5). The Schedule's definition of "relevant service" identifies the categories of service that are within the scope of the instrument: 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). The Repatriation Medical Authority’s statement of view in s8 frames the instrument as addressing veterans, members of Peacekeeping Forces, or members of the Forces under the VEA, and members under the MRCA, because the Authority considers there is sound medical‑scientific evidence that hallux valgus and death from it can be related to such relevant service (s8).

Practical parties affected include:

• Claimants: Individuals with hallux valgus (or who died from hallux valgus) seeking an assessment that the condition is connected to relevant service. To have a reasonable hypothesis established, a claimant must show that at least one factor in s9 is present and that the factor is related to their relevant service (s9, s10(1)).

• Medical assessors and decision-makers: Officials or medical panels applying Statements of Principles to determine whether a reasonable hypothesis exists for the purposes of claims under the VEA and MRCA will use the factors in s9 and the definitions in the Schedule to assess evidence and timing. Section 11 requires referencing other Statements when factors relate to injuries or diseases covered elsewhere.

• Administrators of benefits under the VEA or MRCA: Agencies processing claims under s120A of the VEA or s338 of the MRCA will be required to apply this Statement’s criteria when assessing whether service connection has been plausibly raised.

• Treating clinicians and forensic medical experts: Clinicians providing medical evidence must address the specific diagnostic definition of hallux valgus (s7(2)), whether death was contributed to by hallux valgus (s7(3)), the existence and timing of any of the s9 factors, and whether those factors can be linked to relevant service. The Schedule’s precise trauma definition, footwear exposure specification and timing windows will guide what clinical details are material.

The instrument therefore concentrates procedural and evidentiary focus on claimants and the professionals who provide the evidence. It narrows the universe of plausible causal pathways to those enumerated in s9 and delegates the application of cross-covered injuries to the respective Statements referred to by s11. It also imposes specific temporal tests that will determine whether pre-existing disease, comorbidity or discrete traumatic events are legally relevant as contributors to clinical onset or worsening of hallux valgus (s9, s10).

The instrument itself does not create new statutory entitlements to payments or specify benefit levels. Instead it prescribes the evidentiary and causal criteria that must be met to raise a "reasonable hypothesis" linking hallux valgus, or death from it, to relevant service. That has the following legal effects on duties and rights within the existing claim processes under the VEA and MRCA.

Duties imposed on decision processes and parties

• Duty to apply the Statement when assessing reasonable hypothesis: Decision-makers must apply the Statement of Principles as part of the statutory framework for determining whether a nexus between hallux valgus (or death from it) and service has been plausibly raised for claims that fall under s120A of the VEA or s338 of the MRCA (s3, s5). The instrument sets the specific factors that "must as a minimum" exist (s9).

• Duty to establish relation to relevant service: For any factor in s9 to be of legal effect, the existence of that factor must be related to the person's relevant service (s10(1)). The applicant bears the evidential burden of establishing both the factor and its relation to relevant service in the claim process.

• Duty to apply other Statements where referenced: If a factor in s9 refers to an injury or disease covered by another Statement of Principles, the factors in that other Statement apply according to its terms (s11). Decision-makers must therefore identify and apply relevant cross-Statements.

Rights conferred or clarified

• Right to have a claim judged against specified medical criteria: Claimants have the procedural right to have the presence or absence of the s9 factors determined and weighed in assessing whether a reasonable hypothesis is raised. The instrument fixes the catalogue of factors and their temporal conditions that are legally material for hallux valgus claims (s9).

• Right to have death assessed as contributed to by hallux valgus: The instrument extends the scope to include "death from hallux valgus" where a terminal event or condition was contributed to by hallux valgus (s7(3) and Schedule 1 definition of "terminal event"). That creates the legal basis to consider contribution to terminal events as a service connection issue.

Limited or conditional rights

• Clinical worsening limitation: The instrument distinguishes between "clinical onset" and "clinical worsening" and limits the applicability of the clinical worsening aspects of factors to material contribution or aggravation where the hallux valgus was suffered or contracted before or during, but did not arise out of, relevant service (s10(2)). This creates a conditional right for claimants with pre-existing hallux valgus who allege aggravation related to service, but not for those whose hallux valgus arose out of service.

• Temporal limits and specificity: The statute imposes explicit temporal thresholds and clinical criteria for factors (for example footwear exposure minimum hours/duration, trauma with onset/persistence requirements) that will constrain whether the claimant's evidence can satisfy the "at least one factor" requirement (s9; Schedule 1 trauma definition). These specifics convert clinical and exposure histories into legal thresholds.

No criminal penalties or direct duty to provide care

• The instrument does not create offences, sanctions or administrative penalties. It also does not in itself impose a statutory duty to provide treatment or other services; rather it sets criteria for establishing a service-connection hypothesis in the claims process.

In sum, the instrument sets duties for decision-makers to apply specified factors and for claimants to establish those factors and their relation to relevant service. It grants claimants the right to have their case judged against a fixed set of medically-described factors and temporal rules, but also narrows the universe of legally effective causal pathways to those enumerated and conditioned in s9 and s10.

The instrument does not create offences, monetary penalties, or criminal sanctioning powers. Its enforcement mechanism is procedural and administrative: the Statement of Principles supplies the operative medical and causal criteria that must be applied in claim assessments under the VEA and MRCA (s3, s5, s9). Compliance is therefore enforced through the administration of entitlements and adjudication of claims, not through separate penal or regulatory enforcement regimes.

Operational enforcement channels implicit in the instrument

• Claims administration and adjudication: The Statement’s factors will be applied by decision-makers considering claims under s120A of the VEA or s338 of the MRCA (s5). If a claimant cannot show that at least one of the enumerated factors exists and is related to relevant service, the decision-maker may find that the requisite reasonable hypothesis has not been raised. The consequence is an administrative decision against the claimant on the issue of service connection; the instrument itself does not spell out appeal routes, but its role is evidentiary within the statutory claim processes established by the VEA and MRCA.

• Interactions with other Statements: Section 11 requires that where a factor in s9 refers to an injury or disease already covered by another Statement of Principles, the other Statement applies in accordance with its terms (s11). This can result in enforcement or application differences arising from the terms of the other Statement and requires decision-makers to cross-reference and apply multiple Statements as necessary.

Absence of statutory civil or criminal penalty provisions

• No penalty sections: The instrument contains no provisions imposing fines, imprisonment, administrative penalties, compliance notices, or enforcement powers against practitioners, claimants, or service providers. It is confined to determining principles that guide the raising of a reasonable hypothesis in claims.

Practical enforcement effect

• The practical effect is that a failure to satisfy the instrument’s factors will reduce a claimant’s prospects of establishing service connection, whereas satisfying the factors will establish that a reasonable hypothesis has been raised and so may shift the burden or progression of the claim within the VEA/MRCA process. The instrument therefore operates as a substantive evidentiary gate within those administrative processes rather than through distinct enforcement measures.

In short, enforcement is indirect and administrative: the instrument’s provisions are enforced by decision-makers applying them in claims processes, not by separate penal measures in the instrument itself.

The instrument is explicitly made under subsection 196B(2) of the Veterans' Entitlements Act 1986 (s3), and it declares it applies to claims to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004 (MRCA) applies (s5). Those cross-references define the statutory ambit in which this Statement of Principles is intended to operate. The instrument also contains an internal cross-reference mechanism that binds the application of other Statements where factors in s9 refer to injuries or diseases dealt with in separate Statements (s11).

Specified interactions within the instrument

• Source and scope: Because the instrument is a Statement of Principles under s196B(2) of the VEA (s3), it functions as part of the statutory machinery that determines whether a disease or death can be reasonably hypothesised as connected to relevant service for the purposes of the VEA and MRCA claim provisions identified in s5. The instrument does not alter those Acts themselves; instead it prescribes medical criteria used in their application.

• Relevant service categories: The Schedule defines "relevant service" by reference to services under the VEA and MRCA (Schedule 1). That means the instrument is tied to the definitions and coverage of those Acts; for example, whether a period of service qualifies as "operational", "peacekeeping" or "warlike" will be determined by the VEA or MRCA frameworks, and that determination will affect whether the Statement applies in a given claim.

• Cross-Statements of Principles: Section 11 requires that when a factor in s9 refers to an injury or disease already covered by another Statement made under s196B(2) of the VEA, the factors in the other Statement apply according to that Statement's terms (s11). This creates an internal hierarchy or network of Statements: for certain co-morbid conditions or injuries, decision-makers must draw on the specialised Statement for that condition rather than rely solely on the factors in this Statement. The instrument therefore operates in concert with, and sometimes defers to, other Statements.

Matters not addressed or left to other laws and processes

• Treatment entitlements and benefits: The instrument does not itself provide or specify entitlements to treatment or compensation. Entitlements and benefit calculation will still be governed by the VEA and MRCA and associated regulations and administrative practice. The Statement only bears on whether the necessary causal connection has been plausibly raised.

• Procedural rules and appeals: The Statement does not set out appeals processes, evidentiary burdens in detail, or procedural timeframes; those procedural aspects remain governed by the VEA, MRCA and their administrative mechanisms.

• Interaction with general medical or civil law: The Statement is a statutory evidentiary instrument for claims under the cited veterans’ legislation. It does not purport to affect private law causes of action, workers compensation schemes, or other non-VEA/MRCA statutory frameworks; application in such fora would depend on those forums’ own statutory and evidentiary regimes.

In summary, the instrument is a component within the VEA/MRCA statutory framework that prescribes medical and temporal criteria for raising a reasonable hypothesis of service connection. It interacts with the VEA and MRCA through express application clauses (s5) and with other Statements via s11, but it does not itself create benefit rules, procedural appeal rights, or cross-apply outside the statutory claim environments specified.

This Statement of Principles is identified as No. 25 of 2024 and is dated 22 February 2024 (instrument heading and signature page). Section 2 states that the instrument commences on 26 March 2024. Section 4 expressly repeals the prior Statement of Principles concerning hallux valgus (No. 98 of 2015) (Federal Register of Legislation No. F2015L01334) that was made under subsection 196B(2) of the VEA. The instrument therefore represents a replacement of the 2015 Statement with the 2024 Statement.

Documented changes within this instrument itself

• Repeal: The only explicit amendment action recorded in this instrument is the repeal of the 2015 Statement (s4). The instrument does not catalogue the textual differences between the 2015 and 2024 Statements within its own text. It simply replaces the earlier instrument.

Temporal effect

• Commencement and operational date: The new Statement takes effect on 26 March 2024 (s2). Claims that are assessed on or after that date and that fall under s120A of the VEA or s338 of the MRCA will be evaluated by reference to this Statement and not the earlier 2015 Statement, subject to any transitional or savings provisions that may exist in connected laws or policies; however, such transitional provisions are not contained in this instrument itself.

Absence of prior amendments recorded within text

• No schedule of prior amendments: The instrument does not include a schedule of amendments or earlier versions. It simply states its date, commencement date, and the prior instrument that it repeals (s4).

Interplay with other Statements that may themselves be amended

• Cross-reference implication: Section 11 requires application of other Statements where relevant. Those other Statements may themselves be subject to amendment or repeal over time. The instrument’s operation therefore partly depends on the current terms of other Statements at the time of decision-making (s11).

In short, the instrument replaces the 2015 Statement on hallux valgus with a new Statement effective 26 March 2024 and records that repeal. The text does not record any other historical changes or earlier amendment iterations.

The instrument itself does not record any litigation history. There are no cases, appeals, tribunal decisions, or judicial interpretations mentioned in the text. The document is a Statement of Principles made by the Repatriation Medical Authority and contains no account of judicial consideration, nor does it name any judicial decisions or precedents.

What the instrument states and does not state

• No cases cited: The instrument contains no references to litigation, case law, determinations, or judicial statements. It is purely an administrative instrument setting out medical and temporal factors.

• Implication for disputes: While the instrument will necessarily be applied in contested claims under the VEA and MRCA processes, any litigation, tribunal decisions, or judicial review about the application or interpretation of this Statement would appear in external legal records. The instrument itself does not provide a litigation record or describe litigative outcomes.

How to treat absence of litigation history in the instrument

• Evidence of application will come via decisions in the VEA/MRCA claim processes and possibly via judicial review or appeals after implementation. Those outcomes are external to the instrument and are not recorded in this document.

Because the instrument contains no litigation references, practitioners and researchers seeking jurisprudential guidance will need to consult tribunal and court decisions applying this Statement once claims are decided under it. The instrument provides the normative criteria that those decisions will interpret; the instrument itself does not report any history of judicial interpretation.

The instrument contains several precise formulations, temporal thresholds and cross-references that create specific evidentiary and interpretive pitfalls for claimants, clinicians, and decision-makers. These are matters to watch closely when preparing claims or adjudicating them.

1. Strict temporal and quantitative exposure thresholds

• Footwear criterion specificity: The footwear factor (s9(1)) requires "wearing footwear that causes substantial lateral deviation of the great toe of the affected foot, for at least 7 hours per day, on more days than not for a period of at least 18 months before the clinical onset or clinical worsening of hallux valgus." The combination of daily-hour minimum, frequency ("on more days than not"), and duration (18 months) converts ordinary service footwear histories into a legal threshold that requires precise documentation. Loose or anecdotal statements about footwear will not, by themselves, meet this threshold unless they can be mapped onto these specific temporal and intensity requirements.

2. Trauma definition is narrowly prescriptive

• Trauma timing and clinical sequelae: The Schedule defines "trauma to the affected forefoot" as a discrete event involving significant force that causes damage and the development, within 24 hours, of symptoms/signs and persistence for at least 7 days unless specific medical interventions occurred (Schedule 1 trauma definition). If symptoms appeared later than 24 hours, or if signs did not persist seven days, the event may not meet the instrument’s trauma definition. There is a carve-out where sustained unconsciousness or analgesic masking delays manifest signs, but this requires that symptoms and signs appear on return to consciousness or withdrawal of analgesics. That is a detailed clinical timeline that may be difficult to prove retrospectively.

3. Requirement that factors be related to relevant service

• Relation requirement: Section 10(1) requires that the existence of any factor in s9 be related to the person's relevant service. That is an additional evidentiary step beyond merely establishing the presence of a factor. For example, a claimant who had rheumatoid arthritis before service must show that the arthritis factor is related to their relevant service in the sense required by the claims process; the Statement itself does not elaborate the standard of "related", leaving that to the statutes and decision-makers.

4. Clinical onset versus clinical worsening, and the limitation in s10(2)

• Clinical worsening conditionality: Section 10(2) confines the clinical-worsening aspects of the factors in s9 to situations where the person’s hallux valgus was suffered or contracted before or during, but did not arise out of, the person's relevant service. That distinction matters: if the hallux valgus actually arose out of service (i.e. originated because of service), the "clinical worsening" pathways in s9 may not apply. Practitioners must therefore carefully characterise whether the condition arose out of service or merely pre-existed and was aggravated.

5. "Inability to obtain appropriate clinical management" is undefined

• Vagueness risk: Factor s9(8) , "inability to obtain appropriate clinical management for hallux valgus before the clinical worsening of hallux valgus" , is not defined in the Schedule and offers no objective thresholds. This creates potential dispute about what constitutes "appropriate clinical management" and how inability to obtain it is demonstrated. The absence of a definition increases adjudicative discretion and evidentiary unpredictability.

6. Cross-references to other Statements may complicate claims

• Interconnected Statements: If a factor in s9 refers to an injury or disease covered by another Statement, decision-makers are to apply that other Statement's factors (s11). Identifying which external Statements apply may be non-trivial in complex medical presentations and can create procedural complexity and the need to marshal evidence that addresses multiple Statements’ criteria.

7. Death from hallux valgus uses "contribution" to terminal events

• Proving contribution: Section 7(3) extends the Statement to death where a terminal event or condition was contributed to by hallux valgus (s7(3)). The Schedule defines terminal events narrowly (for example, pneumonia, respiratory failure, cardiac arrest) (Schedule 1). Demonstrating that hallux valgus contributed to such terminal events may be challenging and will hinge on medical causation evidence that links a foot deformity to systemic terminal causes.

8. No guidance on evidentiary standards or burden distribution

• Procedural uncertainty: The instrument states the factors that must exist but does not set out procedural evidentiary rules, thresholds for probative weight, or how competing medical evidence is to be resolved. Those matters remain within the VEA/MRCA claim processes, which may lead to disputes over what evidence suffices for a given factor.

9. Repeal of the 2015 Statement

• Transitional issues: The 2015 Statement is repealed (s4). Claims that were assessed under the 2015 criteria may be reopened or reassessed depending on procedural rules in the VEA/MRCA frameworks. The instrument contains no transitional provisions, so practitioners should check the relevant claims rules under the VEA/MRCA for transitional handling.

In sum, the instrument creates precise legal thresholds and technical definitions that can be advantageous for predictability but also create several evidentiary pitfalls. The footwear and trauma criteria are especially prescriptive; the undefined "inability to obtain appropriate clinical management" invites debate; and the clinical onset/worsening and relevance-to-service requirements add conditional complexity.

For claimants, clinicians and decision-makers working with hallux valgus claims under s120A of the VEA or s338 of the MRCA, the instrument sets out discrete evidentiary tasks. Compliance means ensuring that the claim addresses, with appropriate documentation and time-framed evidence, the specific factors and definitions the Statement enunciates.

1. Identify the correct claim framework and apply the Statement

• Confirm that the claim falls under s120A of the VEA or s338 of the MRCA so the Statement applies (s5). If it does, the Statement’s factors are the operative catalogue for raising a reasonable hypothesis connecting hallux valgus or death from it to relevant service.

2. Map the clinical presentation to the instrument’s diagnostic definition

• Ensure medical records and expert reports explicitly reference the definition of hallux valgus used in the instrument: symptomatic deformity of the foot with lateral deviation of the great toe at the first metatarsophalangeal joint and commonly a medial bunion (s7(2)). Expert opinions should state whether the patient’s clinical findings meet that definition.

3. Establish at least one s9 factor with timing linked to clinical onset/worsening

• Footwear exposure (s9(1)): Document hours per day, typical patterns ("on more days than not") and cumulative period (minimum 18 months), and demonstrate the timing relative to the clinical onset or worsening. Service records, deployment logs, duty statements, issued footwear details, and contemporaneous accounts can help establish the 7 hours/day for 18 months threshold.

• Pre-existing disease factors (s9(2)-(5)): For rheumatoid arthritis, gout, calcium pyrophosphate deposition disease, pes planus, or acquired loss of specified bones, provide medical imaging, rheumatology or orthopaedic notes, and dates showing the condition existed before the clinical onset or worsening of hallux valgus.

• Tumour factor (s9(6)): Document imaging and pathology showing a tumour involving the listed anatomical sites at the time of clinical onset or worsening.

• Trauma factor (s9(7) and Schedule 1 trauma definition): For trauma, document the discrete traumatic event, evidence of significant force, the development of symptoms/signs within 24 hours, persistence for at least 7 days (or evidence of the specified medical interventions that can alter the persistence requirement), and ensure the event occurred within 5 years before clinical onset or worsening. Ambulance, emergency department records, contemporaneous notes, and imaging are particularly material here.

• Inability to obtain appropriate clinical management (s9(8)): Where this factor is relied upon, provide contemporaneous records of attempts to access care, referrals, waiting lists, correspondence showing refusal or unavailability of treatment, and clinical notes demonstrating consequence for disease progression. Because "appropriate clinical management" is not defined in the Statement, detailed factual evidence about what care was sought and denied or unavailable will be necessary.

4. Demonstrate the relationship of the factor to relevant service

• For any of the s9 factors to be legally effective, the claimant must show the factor was related to their relevant service (s10(1)). This requires linking the exposure, event or condition to the precise nature, timing and location of the claimant’s service. Service records, duty statements, equipment issuance records, operational logs, and contemporaneous medical documentation from service will be relevant.

5. Deal with clinical worsening limitations

• If asserting clinical worsening rather than initial onset, check s10(2): clinical worsening aspects of s9 apply only if the hallux valgus was suffered or contracted before or during, but did not arise out of, service. Prepare medical chronology and opinion evidence that distinguishes whether the hallux valgus arose out of service or merely pre-existed and was aggravated by service. The distinction matters for which pathways are available.

6. Cross-reference other Statements where necessary

• If any factor in s9 refers to an injury or disease covered by another Statement of Principles, consult and address the criteria set out in that other Statement as s11 requires their application. For example, if a factor points to an injury that has its own Statement, integrate that Statement’s factors and definitions into evidence preparation.

7. Prepare expert medical opinion to address causation and contribution to terminal events

• For death claims under s7(3), assemble medical evidence that addresses whether hallux valgus contributed to a terminal event (as defined in the Schedule: pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function). Experts should link the foot condition causally or contributory to the terminal event where that is asserted.

8. Anticipate and pre-empt evidentiary challenges

• Given the instrument’s precise thresholds and some undefined terms (for example "appropriate clinical management"), produce contemporaneous records, clear timelines, and rationale linking physical findings and service exposures. Where retrospective proof is required, corroborating service logs, contemporaneous complaints, and credible witness statements are likely to be necessary.

9. Attention to procedural timing and repeal

• Be aware that the 2015 Statement has been repealed (s4) and that the 2024 Statement commences on 26 March 2024 (s2). For claims spanning the repeal date, check administrative practice and claim rules under the VEA/MRCA for transitional handling; although the instrument itself does not state transitional provisions, claims processed after commencement will be assessed under the 2024 Statement.

10. Document all factual and clinical assertions expressly against the Statement’s language

• When preparing submissions or reports, quote the relevant clause language (for example s9(1) footwear wording or Schedule 1 trauma elements) and explain how the evidence meets each element. Given the instrument’s prescriptive structure, meeting each sub-element in the text is the practical method to show compliance.

Following these steps aligns evidence and medico-legal argument with the instrument’s specific factors and definitions and reduces the risk that a claim will fail for lack of alignment with the Statement’s prescribed elements.