Statement of Principles concerning labral tear (Balance of Probabilities) (No. 37 of 2017)

The SoP frames a small set of legal and medical concepts that decision‑makers and advisers must attend to when assessing claims that involve labral tear.

Definition of the condition

• "Labral tear" is defined functionally and anatomically: tearing of the fibrocartilaginous rim of the hip or shoulder joint producing local pain and tenderness, optionally accompanied by mechanical symptoms such as popping, clicking, catching, instability or reduced range of motion (s 7(2)(a)). The instrument excludes degenerative labral tears associated with osteoarthritis and acetabular labral tears associated with femoroacetabular impingement syndrome (s 7(2)(b)). The exclusion is part of the operative definition, not an interpretive note.

Death included as consequence

• The SoP treats "labral tear" as including death from a terminal event or condition that the labral tear contributed to (s 7(3)). The Schedule lists examples of "terminal event" (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function). The inclusion of death clarifies that where a specified terminal event was contributed to by labral tear, the SoP applies.

Causal standard and evidentiary role

• The Authority states its medical‑scientific view that, on the balance of probabilities, labral tear can be related to relevant service (s 8). The practical effect is that the SoP supplies the factors that must be present before a connection with service can be accepted on that standard for claims under the cited statutory provisions (s 5, s 9).

Exposure and timing concepts

• The SoP repeatedly depends on timing: "at the time of the clinical onset of labral tear" is used in the force factor (s 9(1)), and the repetitive motion factor requires performance "for at least four hours per week for the one month before the clinical onset" (s 9(2)). The hip pregnancy factor requires being "in the third trimester of pregnancy within the one week before the clinical onset" (s 9(3)). The instrument therefore elevates clinical onset timing as a threshold evidentiary fact.

Service nexus and scope of "relevant service"

• The SoP requires that any factor relied on be "related to the relevant service rendered by the person" (s 10(1)). The Schedule defines "relevant service" narrowly in terms of certain statutory categories: eligible war service (other than operational service) under the VEA; defence service (other than hazardous service and British nuclear test defence service) under the VEA; or peacetime service under the MRCA (Schedule 1). The SoP thus targets a defined population of service types for causation analysis.

Cross‑references to other SoPs

• Section 11 requires that where a factor in this instrument "refers to an injury or disease in respect of which a Statement of Principles has been determined" under s 196B(3) of the VEA, then the factors in that other SoP "apply in accordance with the terms of that Statement of Principles as in force from time to time." This makes the labral tear SoP part of a network of SoPs that can cross‑invoke each other.

Examples and non‑exhaustive lists

• The instrument contains explanatory notes listing illustrative activities that may meet the "forceful and repetitive motions" description for shoulder and hip (s 9(2) Note 1 and Note 2). These notes are examples; the operative clause still requires proof of the factor as described.

Excluded pathologies as limiting concepts

• The express exclusions for degenerative tears associated with osteoarthritis and acetabular labral tears associated with femoroacetabular impingement syndrome (s 7(2)(b)) mean that a claimant whose diagnosis fits those categories falls outside the SoP's scope. The instrument does not define osteoarthritis or femoroacetabular impingement syndrome; it excludes those causal or pathophysiological variants from the SoP.

Primary affected persons

• The immediate, explicit target group is persons making claims "to which section 120B of the VEA or section 339 of the MRCA applies" (s 5). The text does not elaborate on the content of those sections, but the instrument's scope is limited to claims within the statutory claim streams identified by those cross‑references. In practice, this will mean veterans, former members or serving members whose service falls within the Schedule's definition of "relevant service" and who lodge claims under the specified provisions.

Decision‑makers and administrators

• The Repatriation Medical Authority (RMA) is the author of the SoP (s 3). The instrument is designed to be used by statutory decision‑makers who apply the VEA and the MRCA provisions referenced in s 5. While the instrument does not name those decision‑making bodies, it formally supplies the medical framework those decision processes will consult for determining whether labral tear is connected with relevant service.

Medical experts

• Practising clinicians and medico‑legal experts who prepare reports for claims falling within the identified statutory provisions are materially affected. The SoP prescribes the diagnosis boundaries, exposure thresholds and timing language that medical evidence must engage with, for instance the requirement to show "clinical onset" and to exclude degenerative or FAI‑related tears (s 7(2), s 9).

Service providers and record keepers

• Military administrative units and Defence health services that maintain service and medical records will be indirectly affected because proving the presence and nexus of the s 9 factors depends on contemporaneous service and clinical documentation (s 9, s 10). The instrument also affects claims advisers and legal representatives who must assemble appropriate evidence within the framework the SoP sets out.

Persons not covered

• Individuals whose labral pathology is degenerative and associated with osteoarthritis or is an acetabular labral tear associated with femoroacetabular impingement syndrome are expressly excluded from coverage under this SoP (s 7(2)(b)). Claims based solely on those pathologies must look to other legal avenues or SoPs, if any exist.

Temporal boundary

• The instrument applies from its commencement date of 31 July 2017 (s 2) and revokes the previous SoP No. 95 of 2010 (s 4). Persons with claims lodged after commencement that rely on the labral tear SoP will be assessed against this version; the revocation means the earlier SoP no longer governs.

The Statement of Principles is a medical‑evidentiary instrument; it does not itself create duties in the form of procedural obligations or criminal sanctions. Nevertheless, it alters the evidentiary rights and practical obligations of claimants and the expectations of decision‑makers in specific ways.

Entitlement‑related right to have causation assessed against the SoP

• For claims within the cross‑referenced statutory sections (s 5), the SoP furnishes the factors that must exist before it can be said, on the balance of probabilities, that labral tear or death from labral tear is "connected with the circumstances of a person's relevant service" (s 9). In that sense, a claimant has the right to have their claim assessed against the factors listed in s 9 and the definitions in s 7 and the Schedule.

Obligation to demonstrate specified factors

• The SoP places a practical burden on claimants to adduce evidence proving at least one of the listed factors (s 9). These are factual predicates: significant physical force applied to or through the joint at the time of clinical onset (s 9(1)); forceful and repetitive motions involving extremes of the range of motion for at least four hours per week for the one month before clinical onset (s 9(2)); for hip tears, being in the third trimester within one week before clinical onset (s 9(3)); inability to obtain appropriate clinical management (s 9(4)). The claimant must show these were related to their relevant service (s 10(1)).

Need to show timing of clinical onset

• The SoP repeatedly uses the phrase "clinical onset" (s 9(1)-(3)). Practically, that requires claimants to identify and document the timing when symptoms or signs first manifested in a clinically recognisable way. That is an evidentiary demand on medical records, contemporaneous reports, or retrospective clinical opinion.

Limits on the inability‑to‑obtain‑treatment factor

• If a claimant relies on s 9(4) (inability to obtain appropriate clinical management) as the factor linking labral tear to relevant service, subsection 10(2) restricts that factor's operation to cases where the labral tear was "suffered or contracted before or during (but did not arise out of) the person's relevant service" and the factor materially contributed to, or aggravated, the labral tear. In practice, that narrows the set of claimants who can rely on service‑related failure of access to care.

Cross‑SoP reference duty

• Section 11 requires that where a factor in s 9 refers to an injury or disease for which another SoP exists, the factors in that other SoP "apply in accordance with the terms of that Statement of Principles as in force from time to time." That creates a duty on decision‑makers and advisers to identify overlapping or referenced SoPs and to apply their factors consistently.

No statutory penalties or compliance sanctions in the instrument

• The SoP contains no provisions imposing civil or criminal penalties on individuals or institutions for non‑compliance. It is an authoritative medical instrument for evidentiary assessment; enforcement of its use occurs through the statutory claim processes to which it applies (s 5), not through punitive clauses within the instrument.

Interpretive rights and limits

• Claimants have the right to contest the application of the SoP in their factual circumstances, for instance on whether a tear falls within the definitional exclusions (s 7(2)(b)) or whether the exposure thresholds in s 9 are met. The instrument itself does not specify appeal routes or procedural steps; those are governed by the VEA and MRCA infrastructure to which the SoP attaches.

The SoP contains no penalty provisions and does not itself create an enforcement regime. The instrument is a technical medical standard intended for use in statutory determinations. The following points flow directly from the text.

Absence of internal sanctions

• Nowhere does the instrument impose fines, imprisonment, administrative penalties, or enforceable compliance conditions on individuals or organisations. It is not phrased as a regulatory instrument with enforcement arms; it is a Statement of Principles about the relationship of a medical condition to relevant service (whole instrument).

Enforcement through statutory claim processes

• The instrument applies to claims addressed under particular statutory provisions (s 5). Enforcement of adherence to the SoP in practice therefore occurs through the decision‑making and review processes established by the VEA and the MRCA. The SoP supplies the medical factors that decision‑makers will apply as part of their determinations; any sanction for failing to apply it would be a matter arising from judicial or administrative review processes under those Acts, not from the SoP itself. The instrument does not specify which body adjudicates claims or reviews decisions.

Authority to issue the SoP

• The instrument is made under subsection 196B(3) of the VEA (s 3). That statute gives the Repatriation Medical Authority the power to determine Statements of Principles; the SoP records that it was "determined" under that authority. The RMA's statutory authority is the source of the SoP's weight as a medical standard in claims assessment.

Revocation as internal corrective mechanism

• The instrument revokes the earlier SoP (No. 95 of 2010) in s 4. Revocation is the mechanism by which the RMA replaces prior medical positions with a new one; this is an internal update rather than an enforcement measure.

Practical consequence for decision‑makers

• Decision‑makers who adjudicate relevant claims will be expected to apply the SoP's factors when assessing causal connection. While the SoP does not prescribe the decision‑making process or sanctions for non‑application, failure to apply the SoP correctly could be a ground for review or challenge within the statutory framework. The instrument does not set out review procedures itself.

Evidentiary, not coercive, function

• Overall, the instrument functions as a binding medical reference for relevant statutory claims, shaping outcomes through evidentiary thresholds rather than by direct sanctions. The SoP's force is therefore procedural and evidentiary within the VEA/MRCA claim processes.

This SoP explicitly situates itself within the statutory architectures of the VEA and the MRCA and interacts with other Statements of Principles. The instrument's text supplies the primary intersections.

Statutory application points

• The instrument applies to claims to which section 120B of the VEA or section 339 of the MRCA applies (s 5). The SoP therefore operates as part of the legal machinery of those statutory claim routes. The instrument does not reproduce or amend those sections; it simply identifies by cross‑reference the class of claims for which its medical factors are intended.

Authority source

• The Repatriation Medical Authority made the instrument under subsection 196B(3) of the VEA (s 3). That subsection is the RMA's statutory authorisation to determine medical Statements of Principles. The SoP's legal status derives from that statutory delegation.

Revocation of earlier SoP

• Section 4 revokes the earlier Statement of Principles concerning labral tear No. 95 of 2010. That is a direct interaction with the RMA's own prior outputs. After commencement, the earlier SoP is no longer in force; decision‑makers must apply this instrument instead.

Cross‑SoP references

• Section 11 creates inter‑SoP dependencies. If a factor in this SoP refers to an injury or disease addressed by another SoP, then the factors in that other SoP "apply in accordance with the terms of that Statement of Principles as in force from time to time" (s 11). This yields two practical interactions: overlapping pathologies require cross‑reference to the controlling SoP, and updates to other SoPs can change how referenced factors in s 9 are to be treated.

Definitions linked to broader statutes

• The Schedule defines "relevant service" in terms of service categories under the VEA and the MRCA (Schedule 1). That ties the SoP to statutory definitions outside the instrument. The instrument also uses the terms MRCA and VEA as defined in the Schedule (Schedule 1).

Inclusions/exclusions that affect legal categorisation

• The exclusion of degenerative labral tears associated with osteoarthritis and acetabular labral tears associated with femoroacetabular impingement syndrome (s 7(2)(b)) means that for legal classification of a claim, medical characterisation of the tear is decisive: if a claim involves an excluded pathology, this SoP does not apply and another legal path must be sought.

Interaction with claim causation tests

• The instrument repeatedly frames its application in terms of the balance of probabilities (s 8, s 9). It thus interacts with general legal causation and evidentiary standards used under the VEA and MRCA administrative decision frameworks. The SoP provides the medical thresholds that must be proved to meet the statutory causation standard; how that interacts with procedural law for evidence and review is governed by the VEA and MRCA themselves, not by the SoP text.

No explicit interaction with criminal or occupational health law

• The instrument contains no provisions linking it to occupational health, workers' compensation, or criminal statutes. It is confined to the VEA/MRCA claim context as specified in s 5 and the Schedule.

The instrument is self‑contained about its immediate amendment history. Relevant points from the text:

• This instrument is Statement of Principles No. 37 of 2017 concerning labral tear (s 1 and heading). It is dated 30 June 2017 (front matter).

• Commencement is set at 31 July 2017 (s 2). That establishes the effective date when this SoP replaces prior versions.

• Revocation of prior labral tear SoP: Section 4 expressly revokes the Statement of Principles concerning labral tear No. 95 of 2010, which had been made under subsection 196B(3) of the VEA. The instrument therefore supersedes the No. 95 of 2010 instrument from its commencement date.

• Authority and source: The instrument is made under subsection 196B(3) of the VEA (s 3). The document records it was determined by the Repatriation Medical Authority and bears the common seal and a signed attestation by the Chairperson, Professor Nicholas Saunders AO (front matter).

• No further amendments are recorded in the text. The instrument does not include transitional provisions, savings clauses, or staged commencement: it simply states the commencement date and the revocation of the previous instrument (s 2, s 4).

• The Schedule provides definitional amendments by incorporation: the Schedule defines "relevant service", "terminal event", and references the MRCA and VEA. There are no retroactive amendment clauses specified.

Practical implication of the amendment mechanics

• Because the SoP revokes the earlier 2010 instrument, all claims subject to the VEA/MRCA provisions referenced (s 5) and lodged after the commencement will be assessed under this instrument. The instrument does not provide a transitional rule for claims made around the commencement date; the text implies immediate substitution.

• The instrument gives no schedule for future amendment; any further changes would be effected by the RMA under its statutory powers, but such changes are not in this instrument.

The Statement of Principles document itself contains no litigation history, no citations to cases, and no references to any judicial decisions. The instrument states the Repatriation Medical Authority's clinical and scientific view (s 8) and provides the operative factors for causation (s 9) but does not record any litigation arising from previous versions or from this instrument.

What the text discloses

• The front matter and the body of the SoP list the authorising provision, the date, and the revocation of the earlier instrument (s 3, s 4). It contains no annotation of legal proceedings, no references to judicial interpretation, and no summary of disputes.

Consequences for researchers and litigators

• Because the instrument includes no litigation references, anyone seeking to understand how tribunals and courts have applied or reviewed this SoP must consult external case law and administrative review decisions under the VEA and MRCA. The SoP itself gives no pointer to that material.

• The cross‑SoP mechanism in s 11 suggests potential factual complexity where multiple SoPs may be invoked. If disputes arise about which SoP applies or about interpretation of "clinical onset", "significant physical force", "extremes of the normal range of motion", or "inability to obtain appropriate clinical management", those matters would likely be litigated in claim review routes. The instrument, however, contains no record of such litigation.

The instrument contains several features that commonly surprise advisers and claimants if not read carefully. These are literal and practical limitations arising from the text.

Narrow definitional exclusions

• The SoP excludes degenerative tears associated with osteoarthritis and acetabular labral tears associated with femoroacetabular impingement syndrome (s 7(2)(b)). If a claimant’s labral pathology is characterised as one of those excluded variants, the SoP does not apply. A medical report that fails to address whether the tear is degenerative or FAI‑related leaves an evidentiary gap.

"Clinical onset" is pivotal but not defined

• The factors in s 9 hinge on the timing of the "clinical onset" of labral tear. The instrument does not define "clinical onset", so claimants must rely on contemporaneous clinical records or retrospective expert opinion to fix the date. Different clinicians may interpret "clinical onset" variably (first symptom, first presentation, first medical diagnosis), and that variability can determine whether exposure thresholds were met.

Single‑factor sufficiency

• The SoP requires that "at least one" of the factors in s 9 exist (s 9 introductory wording). That means a single qualifying factor suffices to meet the SoP's threshold, provided it is related to relevant service (s 10(1)). However, the textual requirement for relation to service must still be met.

Repetitive motion exposure threshold is specific and narrow

• The repetitive motion factor requires forceful and repetitive motions involving extremes of the normal range of motion, "for at least four hours per week for the one month before the clinical onset" (s 9(2)). Shorter periods, lower intensity, or cumulative exposure over longer periods do not meet the literal threshold. Advisers should note the precision of the exposure window and gather documentary proof that fits that formula.

Examples are illustrative, not exhaustive

• The notes in s 9(2) list examples of activities (e.g. swimming, basketball, line handling, rope ladder climbing for shoulder; golf, hockey, rowing, running for the hip). These are given as examples only. A claimant performing a different activity could still satisfy the factor if the activity meets the descriptive elements. However, reliance on activities not listed will require explicit medico‑legal explanation mapping actions to the SoP language.

Pregnancy factor is tightly time‑bound

• For hip labral tear, being in the third trimester "within the one week before the clinical onset" is the factor (s 9(3)). That is a narrow temporal window: only pregnancies reaching the third trimester in the week prior to clinical onset will satisfy this factor.

"Inability to obtain appropriate clinical management" is vague and limited

• The s 9(4) factor is not defined. Moreover, s 10(2) restricts its application to labral tears suffered or contracted before or during, but not arising out of, relevant service, and where the inability to obtain care materially contributed to or aggravated the labral tear. The SoP leaves open what evidentiary standard or documentary proof will be accepted to show inability to obtain care. That creates uncertainty and evidentiary risk.

Service nexus must be shown

• Section 10(1) requires that any factor relied on "must be related to the relevant service rendered by the person." Even if a factor per s 9 is proven, the connection to relevant service remains a separate factual question. The Schedule's restrictive definition of "relevant service" narrows the pool of qualifying service types, which may exclude operational service and hazardous service categories (Schedule 1).

Cross‑SoP referencing can create complexity

• If a factor refers to an injury or disease governed by another SoP, s 11 makes that other SoP applicable "as in force from time to time". This means that amendments to other SoPs can change the way a labral tear claim is assessed, and claimants and advisers must track multiple instruments.

No procedural guidance for borderline cases

• The SoP supplies no guidance on how to resolve borderline clinical classifications (degenerative versus traumatic), no standards for expert evidence, and no transitional treatment of claims straddling the revocation date. Those process questions are left to the VEA/MRCA claim frameworks.

Death coverage examples are limited

• The Schedule lists examples of terminal events. A death that involves a terminal event not enumerated may still be the "proximate or ultimate cause of death" but the Schedule's examples may influence how decision‑makers and experts frame the causal chain. Clarity about whether a labral tear "contributed to" the terminal event requires careful medical causation analysis.

For claimants, advisers, medical experts and decision‑makers, compliance is about aligning evidence and reasoning with the specific textual elements of the SoP.

1. Confirm statutory applicability

• Before applying the SoP, confirm that the claim is one "to which section 120B of the VEA or section 339 of the MRCA applies" (s 5). If not, this instrument is not the correct SoP.

2. Establish the diagnosis within the SoP definition

• Secure clinical records and imaging reports that specifically document tearing of the fibrocartilaginous rim of the hip or shoulder joint with the symptoms listed in s 7(2)(a). The medical evidence should also explicitly address whether the tear is degenerative or associated with osteoarthritis, or is an acetabular labral tear associated with femoroacetabular impingement syndrome, which are excluded (s 7(2)(b)). Where the clinical record is silent, obtain an expert opinion addressing these classification issues.

3. Fix the clinical onset date

• Document the "clinical onset" date with as much specificity as possible. This may require contemporaneous GP or specialist notes, emergency department records, diagnostic imaging dates, or a retrospective expert opinion that explains why the symptom history supports a particular onset date. The timing is essential for s 9 factors that use windows anchored to clinical onset.

4. Prove at least one s 9 factor and its relation to service

• Collect evidence tailored to the factor relied on:

  • For s 9(1) (significant physical force at time of clinical onset): obtain witness statements, incident reports, duty notes, and contemporaneous medical records that identify the forceful event coinciding with clinical onset.

  • For s 9(2) (forceful and repetitive motions): assemble service task lists, rosters, training logs and diaries showing activities reaching the specified intensity and duration (at least four hours per week for the month before clinical onset). Use the s 9(2) example activities as drafting cues but be ready to map other activities to the SoP language medically.

  • For s 9(3) (third trimester hip tears): obtain obstetric records that show gestation timing and align the third trimester timeline with clinical onset within one week.

  • For s 9(4) (inability to obtain appropriate clinical management): document attempts to obtain care, records of service health facility capacity, referrals turned down, logistical barriers, or other contemporaneous evidence showing inability to obtain appropriate management. Remember s 10(2) restricts this factor to labral tears suffered or contracted before or during relevant service but not arising out of it; evidence must be assembled accordingly.

• For each factor, obtain a medical causation statement that links the factor to the labral tear on the balance of probabilities and also addresses how the factor is "related to the relevant service rendered" (s 10(1)).

5. Address relationship to "relevant service"

• The Schedule defines relevant service narrowly. Assemble service records showing the type of service (eligible war service other than operational, defence service other than hazardous or British nuclear test defence service, or peacetime service under the MRCA) and link the exposure or event to that period of service. If a factor occurred outside the service period, establish how it is nonetheless related to the relevant service as required by s 10(1).

6. Check for cross‑SoP dependencies

• If any factor depends upon an injury or disease covered by another SoP, identify that other SoP and apply its factors "as in force from time to time" (s 11). Obtain the relevant current SoP and ensure evidence addresses its requirements.

7. Prepare medico‑legal reports to the SoP language

• Ask medical experts to address the SoP explicitly: confirm that the tear fits the SoP definition; state the clinical onset; identify which s 9 factor(s) the expert considers satisfied; explain how the factor relates to the relevant service; and comment on whether death (if relevant) involved a terminal event that the labral tear contributed to (s 7(3) and Schedule 1).

8. Anticipate evidentiary gaps and plan remedies

• Where contemporaneous documentation is lacking, obtain robust retrospective expert opinion that explains, with reference to the SoP criteria, why the facts fall within the instrument. For the "inability to obtain appropriate clinical management" factor, gather administrative records from Defence health services demonstrating access problems, if available.

9. Decision‑maker recording and reasoning

• Decision‑makers applying the SoP should record which s 9 factor they accept, how the clinical onset date was fixed, how the factor was linked to relevant service (s 10), and whether any referenced SoPs were applied under s 11. Where a factor is not met, explain which element of the factor failed and why.

10. Track SoP updates

• Because s 11 imports other SoPs "as in force from time to time", and the RMA may in future amend SoPs, advisers should periodically check the RMA website or official registers for updated instruments that could affect cross‑references or definitions.

Following these steps aligns evidence and analysis to the instrument's specific textual demands, reduces the risk of unaddressed definitional exclusions, and frames medico‑legal reports in the language the Repatriation Medical Authority has set out as determinative.