1Statement of Principles concerning iliotibial band syndrome (Reasonable Hypothesis) (No. 3 of 2019)

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RMA-Red

 

Statement of Principles

concerning

ILIOTIBIAL BAND SYNDROME (Reasonable Hypothesis)

(No. 3 of 2019)

The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

 

Dated 21 December 2018

 

 

 

 

 

 

 

Contents

1 Name

2 Commencement

3 Authority

4 Repeal

5 Application

6 Definitions

7 Kind of injury, disease or death to which this Statement of Principles relates

8 Basis for determining the factors

9 Factors that must exist

10 Relationship to service

11 Factors referring to an injury or disease covered by another Statement of Principles

Schedule 1 - Dictionary

1 Definitions

 

1               Name

This is the Statement of Principles concerning iliotibial band syndrome (Reasonable Hypothesis) (No. 3 of 2019).

2               Commencement

              This instrument commences on 28 January 2019.

3               Authority

This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.

4               Repeal

The Statement of Principles concerning iliotibial band syndrome No. 34 of 2010 (Federal Register of Legislation No. F2010L01050) made under subsection 196B(2) of the VEA is repealed.

5               Application

This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004 applies.

6               Definitions

The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.

7               Kind of injury, disease or death to which this Statement of Principles relates

(1)          This Statement of Principles is about iliotibial band syndrome and death from iliotibial band syndrome.

Meaning of iliotibial band syndrome

(2)          For the purposes of this Statement of Principles, iliotibial band syndrome:

(a)          means a condition of the distal portion of the iliotibial tract where it courses over the lateral femoral epicondyle; and

(b)          is characterised by pain and tenderness over the lateral aspect of the knee which usually worsens with physical activity; and

(c)          excludes proximal iliotibial band syndrome and iliotibial band insertional tendinosis.

(3)          While iliotibial band syndrome attracts ICD‑10‑AM code M76.3, in applying this Statement of Principles the meaning of iliotibial band syndrome is that given in subsection (2).

(4)          For subsection (3), a reference to an ICD-10-AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4.

Death from iliotibial band syndrome

(5)          For the purposes of this Statement of Principles, iliotibial band syndrome, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's iliotibial band syndrome.

Note: terminal event is defined in the Schedule 1 – Dictionary.

8               Basis for determining the factors

The Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that iliotibial band syndrome and death from iliotibial band syndrome can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces under the VEA, or members under the MRCA.

Note: MRCA, relevant service and VEA are defined in the Schedule 1 – Dictionary.

9               Factors that must exist

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting iliotibial band syndrome or death from iliotibial band syndrome with the circumstances of a person's relevant service:

(1)          running or jogging an average of at least 30 kilometres per week for at least the four weeks before the clinical onset of iliotibial band syndrome;

(2)          undertaking weight bearing exercise involving repeated flexion and extension of the affected knee, at a minimum intensity of five METs for at least four hours per week, for at least the four weeks before the clinical onset of iliotibial band syndrome;

Note: MET is defined in the Schedule 1 - Dictionary.               

(3)          increasing the frequency, duration or intensity of weight bearing activity involving the affected knee by at least 100 percent, to a minimum intensity of five METs for at least two hours per day, for at least the seven days before the clinical onset of iliotibial band syndrome;

Note: MET is defined in the Schedule 1 - Dictionary.             

(4)          cycling at a minimum intensity of five METs for at least five hours per week, for at least the four weeks before the clinical onset of iliotibial band syndrome;

Note: MET is defined in the Schedule 1 - Dictionary.

(5)          increasing the frequency, duration or intensity of cycling by at least 100 percent, to a minimum intensity of five METs for at least two hours per day, for at least the seven days before the clinical onset of iliotibial band syndrome;

Note: MET is defined in the Schedule 1 - Dictionary.

(6)          undergoing knee reconstruction surgery with placement of an implant in the distal lateral femur within the one year before the clinical onset of iliotibial band syndrome;

(7)          having weakness or paralysis of an abductor muscle of the hip before the clinical onset of iliotibial band syndrome;

Note: Abductor muscles of the hip are the gluteus medius, gluteus minimus, gluteus maximus and tensor fasciae latae, and weakness may occur following hip injury, hip surgery or diseases that affect the hip joint, such as gluteal tendinopathy.

(8)          having varus malalignment of the knee or varus thrust of the knee before the clinical onset of iliotibial band syndrome;

Note:  varus malalignment of the knee and varus thrust of the knee are defined in the Schedule 1 - Dictionary.

(9)          running or jogging an average of at least 30 kilometres per week for at least the four weeks before the clinical worsening of iliotibial band syndrome;

(10)      undertaking weight bearing exercise involving repeated flexion and extension of the affected knee, at a minimum intensity of five METs for at least four hours per week, for at least the four weeks before the clinical worsening of iliotibial band syndrome;

Note: MET is defined in the Schedule 1 - Dictionary.               

(11)      increasing the frequency, duration or intensity of weight bearing activity involving the affected knee by at least 100 percent, to a minimum intensity of five METs for at least two hours per day, for at least the seven days before the clinical worsening of iliotibial band syndrome;

Note: MET is defined in the Schedule 1 - Dictionary.             

(12)      cycling at a minimum intensity of five METs for at least five hours per week, for at least the four weeks before the clinical worsening of iliotibial band syndrome;

Note: MET is defined in the Schedule 1 - Dictionary.

(13)      increasing the frequency, duration or intensity of cycling by at least 100 percent, to a minimum intensity of five METs for at least two hours per day, for at least the seven days before the clinical worsening of iliotibial band syndrome;

Note: MET is defined in the Schedule 1 - Dictionary.

(14)      undergoing knee reconstruction surgery with placement of an implant in the distal lateral femur within the one year before the clinical worsening of iliotibial band syndrome;

(15)      having weakness or paralysis of an abductor muscle of the hip before the clinical worsening of iliotibial band syndrome;

Note: Abductor muscles of the hip are the gluteus medius, gluteus minimus, gluteus maximus and tensor fasciae latae, and weakness may occur following hip injury, hip surgery or diseases that affect the hip joint, such as gluteal tendinopathy.

(16)      having varus malalignment of the knee or varus thrust of the knee before the clinical worsening of iliotibial band syndrome;

Note:  varus malalignment of the knee and varus thrust of the knee are defined in the Schedule 1 - Dictionary.

(17)      inability to obtain appropriate clinical management for iliotibial band syndrome.

10           Relationship to service

(1)          The existence in a person of any factor referred to in section 9, must be related to the relevant service rendered by the person.

(2)          The factors set out in subsections 9(9) to 9(17) apply only to material contribution to, or aggravation of, iliotibial band syndrome where the person's iliotibial band syndrome was suffered or contracted before or during (but did not arise out of) the person's relevant service.

11           Factors referring to an injury or disease covered by another Statement of Principles

In this Statement of Principles:

(1)          if a factor referred to in section 9 applies in relation to a person; and

(2)          that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(2) of the VEA;

then 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.

 

 

Schedule 1 - Dictionary  

Note:               See Section 6

1               Definitions

In this instrument:

                               iliotibial band syndrome—see subsection 7(2).

                             MET means a unit of measurement of the level of physical exertion.  1 MET = 3.5 ml of oxygen/kg of body weight per minute, 1.0 kcal/kg of body weight per hour or resting metabolic rate.

                                MRCA means the Military Rehabilitation and Compensation Act 2004.

                               relevant service means:

(a)          operational service under the VEA;

(b)          peacekeeping service under the VEA;

(c)          hazardous service under the VEA;

(d)          British nuclear test defence service under the VEA;

(e)          warlike service under the MRCA; or

(f)           non-warlike service under the MRCA.

Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary.

                               terminal event means the proximate or ultimate cause of death and includes the following:

(a)           pneumonia;

(b)           respiratory failure;

(c)           cardiac arrest;

(d)           circulatory failure; or

(e)           cessation of brain function.

                               varus malalignment of the knee means a deformity in which the knees are abnormally separated and the lower extremities are bowed inwardly.  The condition is also known as bowlegged.

                               varus thrust of the knee means dynamic worsening or abrupt onset of varus alignment of knee as the lower limb becomes weight-bearing during gait.

                               VEA means the Veterans' Entitlements Act 1986.