Statement of Principles concerning labral tear (Reasonable Hypothesis) (No. 36 of 2017)

Labral tear: The instrument gives a working medical definition in s 7(2). Labral tear is an injury involving tearing of the fibrocartilaginous rim of the hip or shoulder joint, producing local pain and tenderness, with possible popping, clicking, catching, instability or reduced range of motion. Two exclusions are explicit: degenerative labral tears associated with osteoarthritis, and acetabular labral tears associated with femoroacetabular impingement (FAI) syndrome (s 7(2)(b)). Those excluded presentations are therefore outside the causal pathways contemplated by this SOP.

Death from labral tear: s 7(3) extends the condition to include death from a terminal event or condition that was contributed to by the person's labral tear. "Terminal event" is defined in Schedule 1 and expressly includes causes such as pneumonia, respiratory failure, cardiac arrest, circulatory failure and cessation of brain function (Schedule 1).

Relevant service: The Schedule defines the categories of service that qualify as "relevant service" for the instrument’s application. Those categories are the VEA service types (operational, peacekeeping, hazardous, British nuclear test defence service) and MRCA service types (warlike and non‑warlike service) (Schedule 1).

Factors raising a reasonable hypothesis: Section 9 lists four alternative factors, any one of which must exist for the reasonable hypothesis to be raised. They are:

1. Significant physical force applied to or through the affected shoulder or hip joint at the time of clinical onset (s 9(1)).
2. Forceful and repetitive motions of the affected joint involving extremes of the normal range of motion, for at least four hours per week for the month before clinical onset (s 9(2)). The instrument provides examples in notes for shoulder and hip activities, but these are illustrative (Notes to s 9).
3. For hip labral tear only, being in the third trimester of pregnancy within the one week before clinical onset (s 9(3)).
4. Inability to obtain appropriate clinical management for labral tear (s 9(4)).

Relationship requirement: Section 10(1) requires that any factor relied on must be related to the person’s relevant service. Section 10(2) limits the operation of factor 9(4) (inability to obtain appropriate clinical management) to circumstances of material contribution or aggravation where the labral tear was suffered or contracted before or during (but did not arise out of) relevant service.

Cross‑reference mechanism: If a factor in s 9 refers to an injury or disease covered by another Statement of Principles, s 11 requires that the factors in that other Statement apply in accordance with its terms. This creates a harmonisation path where overlapping conditions exist.

Administrative base: The RMA’s view that there is sound medical‑scientific evidence (s 8) is the stated evidential foundation used to create the rule set. The instrument itself does not elaborate the studies or clinical sources that underpin that statement; it converts the RMA’s view into operational factors for claim assessment.

Claimants: The immediate practical effect is on veterans, members of Peacekeeping Forces and members of the Forces to whom sections 120A of the VEA or 338 of the MRCA apply (s 5). The instrument establishes the medical fact patterns that, if proven and related to relevant service, raise a reasonable hypothesis that labral tear (or death from it) is connected to service. Anyone pursuing a claim under the cited statutory provisions for labral tear will be assessed against these factors.

Decision‑makers and assessors: While the instrument does not name decision bodies beyond the RMA, it is made under the VEA (s 3) and therefore is intended to be used by the statutory decision process that deals with VEA/MRCA claims to determine whether the threshold of a reasonable hypothesis is met (see s 5 and s 8). The instrument will guide medical assessment and administrative decision‑making by identifying the minimum factual pathways that can support a linkage to service.

Healthcare providers and treating clinicians: The factors in s 9 are clinical in nature and will require medical records and expert opinion to establish elements such as clinical onset, imaging confirming labral tear, the presence of pain/tenderness, and whether force or repetitive activity was occurring in relevant timeframes. For factor 9(4), proof of inability to access appropriate clinical management will rely on healthcare interaction records.

Record‑keepers and employers: Service records documenting activities, training, deployments and occupational tasks can be used to demonstrate the presence and timing of activities described in s 9(1)-(2). The Schedule’s definition of "relevant service" identifies the service categories against which such records will be matched.

Beneficiaries of death claims: Where death is alleged to have been contributed to by labral tear, next of kin or estate claimants will be affected because s 7(3) and the Schedule’s terminal event definition give a pathway to include death from specified terminal events among compensable outcomes.

Excluded groups: Persons whose presentation is expressly excluded by s 7(2)(b) , degenerative labral tears associated with osteoarthritis, and acetabular labral tears associated with FAI , fall outside the condition the SOP covers. They will not be able to rely on this SOP to raise a reasonable hypothesis linking their condition to relevant service.

Timing groups: The pregnancy‑related factor in s 9(3) narrows affected persons to women in the third trimester within the week before clinical onset of hip labral tear; therefore the SOP creates a narrowly timed pregnancy‑related pathway that affects only that subgroup.

This instrument is framed as a qualifying rule‑set rather than a catalogue of duties, but it imposes functional obligations and rights by defining the circumstances that will support a "reasonable hypothesis" connecting labral tear to service.

Claim threshold rule: A legal threshold is created , at least one of the factors in s 9 must exist and be related to relevant service (s 9; s 10(1)) before a reasonable hypothesis can be said to be raised. That operates as a necessary condition for the claim pathway envisaged by s 5.

Right to include death: The instrument grants a right for a person (or their estate) to have death assessed as part of the labral tear condition where a terminal event or condition was contributed to by the labral tear (s 7(3)). The Schedule lists terminal events that will be relevant when considering cause of death links.

Duty to relate factors to service: Section 10(1) places a substantive linking requirement: the existence of any factor in s 9 must be related to the person’s relevant service. The instrument does not spell out the standard of proof for that relationship; it sets the condition that relationship must exist as part of the SOP framework.

Limitation on remedy for lack of management: Section 10(2) restrains the scope of s 9(4). That factor supports only material contribution to or aggravation of labral tear where the labral tear was suffered or contracted before or during (but did not arise out of) relevant service. In other words, the inability to obtain appropriate clinical management is not an independent ground for a new onset attributed to service; its operation is limited to aggravation or material contribution in pre‑existing conditions.

Cross‑statement application: Section 11 creates a duty for decision‑makers to apply factors from other SOPs where a factor in s 9 refers to an injury or disease that is the subject of another SOP. That gives claimants a right to have overlapping factors assessed under their native SOP terms.

No penalties set: The instrument itself does not create offences, penalties or enforcement sanctions. Its function is evidentiary: to specify what will support a reasonable hypothesis under the VEA/MRCA claims processes. Any procedural duties or sanctions will be those in the parent Acts and their administrative procedures, not in this instrument (see s 3; s 5).

Definitions govern interpretation: The Schedule’s definitions (Schedule 1) operate as interpretive anchors for terms such as "labral tear", "terminal event" and "relevant service". The instrument’s operational duties and rights are therefore shaped by those definitions.

Illustrative examples: The Notes to s 9 give non‑exclusive examples of activities that may amount to the forceful and repetitive motions described in s 9(2). They are not framed as exhaustive lists but as illustrative guidance to interpreters and clinicians.

This instrument does not itself create criminal or civil penalties, nor does it specify an enforcement regime in statutory terms. It is a determinative medical instrument under subsection 196B(2) of the VEA (s 3) and functions as an evidentiary standard used in the statutory compensation and rehabilitation claims process under the VEA and MRCA (s 5). Enforcement therefore occurs indirectly via the decision processes in those Acts, not through penalties specified in this instrument.

Operational enforcement mechanism: The practical "enforcement" of the instrument’s rules will be at the claims assessment stage. Decision‑makers charged with determining whether a reasonable hypothesis exists will apply the factors in s 9, the relationship requirement in s 10, and any applicable cross‑SOP factors under s 11. The instrument thus binds decision‑making via its status as an RMA Statement of Principles, but the text does not prescribe the decision procedure, burden of proof, appeal rights, or sanctions for false claims. Those procedural matters remain governed by the VEA and MRCA frameworks referenced in s 5 and the making power in s 3.

No administrative fines or criminal offences: There is no provision for fines, imprisonment, or regulatory sanctions in the instrument itself. Any adverse outcomes for claimants (for example, denial of a claim) will be administrative decisions under the parent Acts, not penalties imposed by this instrument.

Role of medical evidence and recordkeeping: Although the instrument does not prescribe enforcement steps, the clinical and service‑activity factors it lists (s 9) create evidentiary obligations in practice. Adjudicators will require medical documentation of labral tear, timing of clinical onset, imaging or clinical signs, records of forceful and repetitive activities (timing and intensity), obstetric records for pregnancy timing, and records demonstrating inability to obtain appropriate clinical management where relevant. The instrument’s content therefore indirectly enforces certain record and proof standards by setting the facts a claimant must establish.

Revocation and replacement: Section 4 revokes the earlier 2010 Statement of Principles (No. 94 of 2010). The instrument therefore enforces a legal update: decisions made after commencement will use this SOP rather than the 2010 SOP. The RMA’s authority to make and revoke such SOPs derives from subsection 196B(2) of the VEA (s 3).

Interaction with other SOPs: If a factor in s 9 refers to an injury or disease covered by another SOP, s 11 requires that the other SOP’s factors apply in accordance with its terms. That creates an internal enforcement linkage across SOPs which will affect how decision‑makers apply this instrument where overlap exists.

Primary statutory anchors: The instrument is made under subsection 196B(2) of the VEA (s 3), and it expressly applies to claims to which section 120A of the VEA or section 338 of the MRCA applies (s 5). Those citations locate the SOP within the decision pathways of the VEA and MRCA. The instrument itself does not restate the procedural or merits rules in the parent Acts; it supplies the medical factors used by decision‑makers under those Acts.

Cross‑SOP interaction: Section 11 provides for interaction with other Statements of Principles. Where a factor in s 9 refers to an injury or disease that is the subject of another SOP, the factors in that other SOP apply in accord with its terms. This is an explicit mechanism for resolving overlaps between condition‑specific SOPs and ensures that the most appropriate SOP factors are applied where conditions intersect.

Definitions take statutory terms: The Schedule imports statutory categories of service , operational service, peacekeeping service, hazardous service, British nuclear test defence service under the VEA, and warlike/non‑warlike service under the MRCA (Schedule 1). This aligns the instrument’s scope with the service categories that are recognised by the parent Acts, ensuring consistent boundary drawing between the SOP and the VEA/MRCA statutory concepts.

Exclusions interact substantively: The instrument excludes degenerative labral tears associated with osteoarthritis and acetabular labral tears associated with femoroacetabular impingement syndrome (s 7(2)(b)). Those exclusions will interact with other laws and medical assessments because degenerative disease and FAI‑related presentations may be relevant to other SOPs or to general medical causation assessments under the VEA/MRCA. If those other conditions are the subject of separate SOPs, s 11 may bring those SOPs into play.

Death and terminal events: The instrument includes death linked to labral tear by contribution to a terminal event (s 7(3)). Schedule 1 defines "terminal event" and gives a list of proximate or ultimate causes of death that may be considered (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function). This interacts with the statutory frameworks for service‑related death under the VEA/MRCA: adjudicators assessing death claims will need to consider medical causation between labral tear and a listed terminal event within the scope of the parent Acts.

No procedural change to VEA/MRCA: The instrument does not alter procedural provisions (such as time limits, review or appeal processes) in the VEA or MRCA. It is an evidentiary instrument intended to be applied within the decision procedures and appeal mechanisms those Acts already provide. The instrument therefore interacts by shaping medical causation determinations rather than by altering procedural or remedial law.

Potential interface with non‑SOP medical law: The instrument does not address areas such as general tort, workers' compensation, or health practitioner regulation. It is narrowly made for statutory veterans’ compensation purposes. Any interface with other legal regimes will be factual and evidentiary (for example, clinical records used in multiple contexts), rather than statutory integration provided by this instrument.

This instrument is self‑contained as to its amendment history in the source text. Key dated milestones in the instrument are:

• Date of instrument: The document is dated 30 June 2017 (front matter).
• Commencement: The instrument commences on 31 July 2017 (s 2).
• Revocation of prior SOP: Section 4 revokes the earlier Statement of Principles concerning labral tear No. 94 of 2010 made under subsection 196B(2) of the VEA.

No further amendments, variations, or subsequent instrument numbers are contained in the text provided. The instrument does not record prior amendment steps beyond the revocation of the 2010 SOP and does not list any later changes. Any later amendment or revocation would appear in subsequent instruments or consolidated notices not included in this source text.

The schedule and definitions are part of the original 2017 instrument. The Schedule defines key terms , labral tear (by cross‑reference to s 7(2)), MRCA, relevant service categories, terminal event examples, and VEA , and those definitions are part of the instrument as made (Schedule 1).

Because the instrument revokes an earlier SOP, decision‑makers must apply this 2017 SOP from its commencement date rather than the 2010 SOP for claims within the stated legislative scope (s 4; s 5). The exact scope of transitional handling of claims presented before the commencement date is not addressed in the instrument text; such transitional procedures, if any, would be governed by the parent Acts or administrative practice.

The text of this instrument contains no record of litigation. It does not cite case law, judicial interpretations, or appeal outcomes, nor does it reference any legal proceedings challenging or construing this Statement of Principles.

Because the instrument is an RMA instrument used within the VEA/MRCA system, litigation relating to its application would arise in administrative review or judicial review of decisions made under the VEA or MRCA that rely on the SOP. However, the instrument itself contains no litigation history, no judicial endorsements, and no court‑level constructions included in its text.

Users and practitioners should treat the absence of recorded litigation in the instrument as silence, not as an indication that no cases exist. Any decided cases construing or applying this SOP would need to be located in external case law databases or administrative determination records; they are not provided in the source instrument.

Several practical points of potential interpretive friction arise from the instrument’s text.

Defined exclusions are precise and narrow: The instrument excludes degenerative labral tears associated with osteoarthritis and acetabular labral tears associated with femoroacetabular impingement syndrome (s 7(2)(b)). If a claimant’s imaging shows degenerative change or FAI features, that may remove the SOP as a pathway. Distinguishing degenerative from traumatic tears, and differentiating acetabular tears related to FAI from other tears, will often require detailed imaging reports and specialist opinion. The SOP provides no diagnostic thresholds for when a tear is "degenerative" versus "traumatic", so adjudicators will rely on clinical evidence.

"Clinical onset" is used but not defined: The factors in s 9 repeatedly reference "clinical onset of labral tear" (s 9(1)-(3)). The instrument does not define "clinical onset". In practice, dispute can arise over whether the "clinical onset" refers to the date symptoms commenced, the date of diagnosis, or the date of an identifiable event. The instrument’s silence on this term is a potential source of argument.

Timing thresholds are specific and narrow: For repetitive/forceful motion (s 9(2)) the instrument requires at least four hours per week for one month before clinical onset. That threshold is concrete and could exclude activities that are less frequent but higher intensity, or that exceed four hours per week but only for shorter durations. The Notes provide examples of relevant activities (Notes to s 9), but those are illustrative. Practitioners should be careful to document exact hours and timeframes.

Pregnancy factor is tightly constrained: For hip labral tear, s 9(3) requires being in the third trimester within the one week before clinical onset. That is a very limited temporal window. Claims that allege pregnancy‑related onset outside that one‑week window will not meet this factor.

"Significant physical force" at time of clinical onset: Factor s 9(1) requires significant force applied to or through the joint at the time of clinical onset. That typically suggests an acute event causation pathway. Claimants and clinicians need to align on what constitutes "significant" force and on the temporal link to clinical onset , matters that may be contested if records are imprecise.

Inability to obtain appropriate clinical management is constrained: Factor s 9(4) may seem broad but s 10(2) limits its application to material contribution to, or aggravation of, a labral tear that was suffered or contracted before or during (but did not arise out of) relevant service. It does not operate to create a standalone causal link for a tear that first arose after service where inability to obtain care was the only issue. Proof of inability to obtain "appropriate" management requires contemporaneous documentation of attempts to obtain care, referrals, and reasons why appropriate care was unavailable; the instrument does not define "appropriate clinical management".

Notes are illustrative, not exhaustive: The instrument includes Notes to s 9 listing activities that may be examples of forceful and repetitive motions (e.g., swimming, basketball, rope ladder climbing, loading ammunition) but those examples are not framed as exhaustive. However, reliance on examples without aligning to the four‑hours‑per‑week rule may be insufficient.

Death causation may require an indirect link: s 7(3) allows death to be included where the terminal event was contributed to by the labral tear. The Schedule lists terminal events such as pneumonia and cardiac arrest. Establishing a contribution from a labral tear to such terminal events may be medically and legally challenging and will require detailed causal linking evidence.

Cross‑SOP complexity: Section 11 requires application of other SOPs where s 9 factors refer to conditions covered elsewhere. Practitioners must check whether any factor triggers another SOP and then apply that SOP’s terms in full. Failure to check cross‑references risks misapplication.

Revocation means prior determinations may change: s 4 revokes the 2010 SOP. Decision‑makers must apply the 2017 SOP from its commencement, which could alter outcomes compared with previous decisions relying on the 2010 instrument. The instrument does not state transition arrangements for claims lodged before commencement.

No procedural or evidentiary standards specified: The SOP sets factual gates but does not state the evidentiary standard, burden allocation, or procedural steps. Practitioners must therefore rely on the parent Acts and administrative practice for those matters.

To present a claim that aligns with this SOP, assemble evidence mapped to the instrument’s textual elements and linkage requirements.

1. Establish the diagnosis and clinical onset

• Obtain clinical records that document the labral tear diagnosis, including clinical notes of pain/tenderness, mechanical symptoms (popping, clicking, catching, instability, reduced range of motion) and imaging reports (MRI/arthroscopy) that support the tear diagnosis (s 7(2)(a)). Because "clinical onset" is not defined, provide contemporaneous symptom onset notes, dates of first presentation, and dates of diagnostic imaging to show timing.

2. Match one or more s 9 factors

• Acute force event (s 9(1)): Document the alleged event with service records, incident reports, contemporaneous clinical notation of onset, witness statements and, where possible, objective evidence of force (task descriptions, load information).
• Repetitive forceful motion (s 9(2)): Demonstrate at least four hours per week of forceful, repetitive motions involving extremes of normal range of motion for the month immediately prior to clinical onset. Use duty statements, training logs, rosters, deployment task sheets and affidavits from supervisors. Where possible, quantify hours per week and link them to the relevant joint and timeframe. Include clinical notes linking activity to symptoms.
• Pregnancy pathway (s 9(3)): For hip labral tears, provide obstetric records confirming third trimester status within the week before clinical onset alongside clinical notes on hip symptoms and diagnosis.
• Inability to obtain appropriate clinical management (s 9(4) and s 10(2)): If relying on this factor, document attempts to obtain care while showing the labral tear was suffered or contracted before/during (but not arising out of) relevant service. Provide referral records, appointment logs, correspondence demonstrating inability to access appropriate management, and clinical evidence of aggravation or material contribution due to lack of management.

3. Show relation to relevant service (s 10(1); Schedule 1)

• Link the factor(s) to the service category relied upon. Supply service records demonstrating the person’s relevant service type (operational, peacekeeping, hazardous, British nuclear test defence service under VEA; warlike or non‑warlike service under MRCA , Schedule 1). Tie the timing of the factor(s) to the dates of relevant service activities.

4. Address exclusions

• Provide clinical evidence distinguishing traumatic/acute tears from degenerative tears and demonstrating absence of osteoarthritis‑related degenerative features or FAI anatomy if that is relevant. Because s 7(2)(b) excludes degenerative and FAI‑associated presentations, include specialist orthopaedic opinion if there is any suggestion of degenerative change or impingement.

5. If death is alleged (s 7(3); Schedule 1)

• For death claims, obtain the death certificate, autopsy or coronial reports, and clinical history linking the labral tear to the terminal event(s) listed in the Schedule. Prepare medical causation evidence showing contribution to the terminal event (e.g., immobility resulting from severe pain leading to pneumonia), with expert opinion tying the chain of causation together.

6. Check cross‑SOP references (s 11)

• Review whether any factor in s 9 references conditions covered by other SOPs. If so, gather evidence required by the other SOP and be prepared for the decision‑maker to apply that SOP’s factors in their terms. Cross‑referencing may require additional clinical records or specialist evidence.

7. Present clear chronology and causal narrative

• Because the SOP requires linkage to clinical onset and relevant service, prepare a clear timeline showing service activities, onset of symptoms, diagnostic milestones, treatment attempts, and how any failure to obtain management affected the condition, where applicable.

8. Anticipate contested definitions

• Be ready to explain and support how "clinical onset", "significant physical force", and "appropriate clinical management" are being used in the claimant’s factual narrative. Provide contemporaneous evidence where possible to avoid retrospective contest on timing and severity.

9. Use the SOP’s notes as guidance, not a cap

• The Notes to s 9 list example activities. Use them to frame likely relevant activities (e.g., swimming, rope ladder climbing, loading ammunition) but avoid relying solely on the examples , demonstrate how the claimant’s activities meet the textual test (forceful and repetitive motions at extremes of normal range for at least four hours per week for one month).

10. Prepare for administrative procedure outside the SOP

• The SOP does not set evidentiary standards or appeals pathways. Ensure compliance with procedural requirements under the VEA/MRCA for lodgement, evidence submission, and requests for review, and secure timely expert medical reports to support the SOP‑based factual assertions.

Following these steps will align the claim package to the instrument’s textual criteria (s 7-11 and Schedule 1) and reduce the scope for avoidable evidentiary gaps when decision‑makers apply the SOP.