Statement of Principles concerning multiple osteochondromatosis (Reasonable Hypothesis) (No. 43 of 2023)

The instrument revolves around a small set of tightly defined legal and medical concepts that determine whether a “reasonable hypothesis” exists connecting multiple osteochondromatosis to relevant service. Key concepts are defined in the instrument itself and in the Schedule.

• Multiple osteochondromatosis. The instrument defines the condition as “a genetic disorder of bone growth which typically involves the presence of multiple, benign cartilage‑capped bone tumours (osteochondromas or exostoses) that grow outward from the metaphyses of long bones,” and expressly excludes synovial osteochondromatosis and enchondromatosis (s 7(2)(a)-(b)). The instrument clarifies that the ICD‑10‑AM code Q78.6 is only a cross‑reference and that the statutory definition controls application (s 7(3)-(4)).

• Death from multiple osteochondromatosis. Death is included where a terminal event or condition was contributed to by the person’s multiple osteochondromatosis (s 7(5)). “Terminal event” is defined in the Schedule and includes proximate or ultimate causes such as pneumonia, respiratory failure, cardiac arrest, circulatory failure and cessation of brain function (Schedule 1).

• Relevant service. The Schedule specifies the categories of service that count as “relevant service” for the instrument’s application: 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).

• Factor(s) that must exist. The Statement sets out a single qualifying factor: inability to obtain appropriate clinical management for multiple osteochondromatosis (s 9(1)). The statutory link to relevant service is required: any s 9 factor relied on must be related to the person’s relevant service (s 10(1)). For purposes of material contribution or aggravation, the factor in s 9(1) applies only where the condition pre‑existed or was contracted before or during, but did not arise out of, service (s 10(2)). That is a temporal and causal limitation on the factor’s scope.

• Interaction with other Statements of Principles. If the s 9 factor refers to an injury or disease already covered by another Statement of Principles under subsection 196B(2) of the VEA, the factors in that other Statement apply as in force (s 11). This creates a mechanism for cross‑reference when overlap exists.

The Repatriation Medical Authority records, as its foundational proposition, that there is sound medical‑scientific evidence supporting a possible relation between the disease (and death from it) and relevant service (s 8). The instrument therefore operates as the Authority’s clinical/legal template for adjudication of claims involving multiple osteochondromatosis and related deaths under the VEA/MRCA claim provisions identified in s 5.

Primary actors affected by the Statement are claimants (veterans and former members of the Forces) and decision‑makers under the VEA and MRCA who adjudicate entitlement to service‑related compensation or benefits. The instrument explicitly applies to claims to which section 120A of the VEA or section 338 of the MRCA applies (s 5). The Schedule defines “relevant service” categories that specify the types of service which, if rendered by a person, bring them within the instrument’s application (Schedule 1). These categories are 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).

Who pays. The instrument does not itself set rates, payments, or administrative costs. It establishes the medical/causal threshold that decision‑makers will use when assessing entitlement to VEA/MRCA benefits in claims involving multiple osteochondromatosis or death from it. Therefore the practical effect is that claimants seeking a nexus between their condition (or death of a relative) and relevant service will need to satisfy the requirements set out in the Statement; affected payments, if any, will be determined under the VEA or MRCA once the “reasonable hypothesis” threshold is met (s 3, s 5). The instrument does not alter statutory scheme for benefits, only the Statement of Principles applied in medical causation assessments.

Who decides. The Repatriation Medical Authority made the Statement under the statutory power (s 3). In claims adjudication, the relevant decision‑makers (typically by administrative officers within the Department or tribunal processes governed by the VEA/MRCA framework) will apply this Statement in assessing whether a reasonable hypothesis has been raised. The instrument does not itself describe processing steps, evidentiary burden, or review mechanisms; it supplies the medical causation template that decision‑makers must use when considering causal links between service and condition or death.

Ancillary professionals. Treating clinicians, medical experts, and records custodians will be affected because the key factor is the claimant’s “inability to obtain appropriate clinical management” (s 9(1)). Medical records, attendance records, referral histories, letters from providers, and contemporaneous evidence about access to specialist treatment will be central in applications. If the s 9 factor refers to an injury/disease covered by another Statement, evidence and factors from that other Statement will also be engaged (s 11).

Third parties. The instrument may indirectly affect service providers who are asked to give evidence about whether appropriate clinical management was available to a veteran during or after relevant service. The instrument creates a legal framework that makes access to clinical management a determinative factor for causal linkage in claims involving this condition.

This Statement of Principles creates legal effects by specifying what must exist for a “reasonable hypothesis” to be raised connecting multiple osteochondromatosis (or death from it) to relevant service. It does not itself impose criminal or civil duties, but it defines the legal criteria decision‑makers will apply in entitlement determinations under the VEA and MRCA claim sections cited in s 5.

Rights and entitlements triggered. Where the medical/causal threshold in this Statement is satisfied, claimants proceed within the statutory entitlement mechanisms of the VEA or MRCA. The Statement does not specify the benefits, but it provides the causation gateway that must be traversed for the statutory schemes to consider awarding entitlements linked to service‑related injury or disease. Section 7(5) expressly includes death from the condition if the disease contributed to a terminal event; that expands the class of claims to include survivorship or death‑related claims where contribution to death can be established.

Duty to show the factor exists. For a claim to succeed under this Statement a claimant must show at least one of the factors in s 9. There is only one listed factor: inability to obtain appropriate clinical management for multiple osteochondromatosis (s 9(1)). Section 10(1) requires that the existence of any factor referred to in s 9 must be related to the person’s relevant service. That places a connection burden on claimants: they must demonstrate both that the factor existed and that it was related to relevant service.

Temporal and causal limitation on aggravation. Section 10(2) specifies that the s 9(1) factor “applies only to material contribution to, or aggravation of, multiple osteochondromatosis where the person's multiple osteochondromatosis was suffered or contracted before or during (but did not arise out of) the person's relevant service.” This means that when the claim is one of material contribution or aggravation, rather than of origination out of service, the relevant fact pattern is limited to pre‑existing or earlier contracted disease; the Statement therefore distinguishes between causation models (arising out of, aggravated by, materially contributed to) and constrains s 9(1) to certain temporal circumstances.

Interpretive duties for decision‑makers. The instrument does not define “appropriate clinical management.” That term is central and undefined in the text of the Statement, which places interpretive duties on decision‑makers and medical assessors to determine, on the available evidence, what counts as “appropriate” and whether an inability to obtain it existed and was related to service (s 9(1), s 10(1)). Section 11 requires decision‑makers to treat factors in other Statements where the s 9 factor refers to an injury/disease covered by another Statement, which adds an obligation to cross‑check and apply the current versions of other Statements.

Notification and evidentiary duties. The Statement does not provide procedural steps such as document disclosure, timeframes or evidence standards. Practitioners should be aware that the Statement shapes the medical issues to be addressed in evidence, which in turn determines what clinical documentation, provider statements and service records will be relevant when exercising statutory duties under the VEA and MRCA claim processes referenced in s 5.

The instrument itself does not create bespoke penalties, fines or criminal offences. It is a Statement of Principles made under subsection 196B(2) of the VEA (s 3) intended to be used for determining whether a reasonable hypothesis has been raised in claims under section 120A of the VEA or section 338 of the MRCA (s 5). Enforcement and penalties, if any, fall within the broader VEA and MRCA statutory frameworks, not within this Statement.

How enforcement operates in practice. The Statement is a substantive evidentiary benchmark for administrative decision‑makers assessing entitlement. If a decision‑maker concludes the s 9 factor is absent or not related to relevant service as required by s 10(1)-(2), the claim will not meet the causation threshold under this Statement and will be refused under the relevant statutory decision‑making provisions in the VEA or MRCA. Any recourse or review of that administrative decision will be through the appeal and review mechanisms provided by the VEA/MRCA legal framework; the Statement does not itself specify appeal mechanisms or remedies.

No standalone compliance sanctions. There is no provision in the text that imposes penalties on practitioners, providers, or claimants for failing to produce evidence or for other conduct; the instrument limits itself to setting causation factors. Administrative consequences arise from the decision‑making processes that apply these factors. Where a claim is unsuccessful because the factor in s 9 is not established, the practical consequence is denial of entitlements under the VEA/MRCA; that is a statutory outcome rather than a penalty under the Statement.

Discretion and potential inconsistency. Because the key term “appropriate clinical management” is not defined in the Statement, adjudicators and medical assessors will have discretion in its application. That discretion can produce variability in outcomes; the instrument offers no prescriptive enforcement regime to standardise assessments, apart from the Reference to other Statements under s 11 where cross‑application is relevant. Any challenge to a decision applying this Statement will therefore proceed within the ordinary administrative and judicial review channels available under the VEA/MRCA schemes and Australian administrative law, none of which are altered by the Statement itself.

The Statement is made under the VEA (s 3) and is expressly directed at claims within the VEA or MRCA statutory frameworks (s 5). It is a subordinate instrument that supplies the medical causation template required by subsection 196B(2) of the VEA. Interaction with other laws and instruments occurs in several concrete ways set out in the Statement.

Reference to VEA and MRCA claim provisions. The Statement applies to claims to which section 120A of the VEA or section 338 of the MRCA applies (s 5). It does not alter or replace the substantive entitlements in those Acts; rather, it provides the clinical causation test to be applied in adjudicating whether a reasonable hypothesis exists linking multiple osteochondromatosis (or death from it) to relevant service. Any determination of entitlement, assessment of benefits, or procedural steps for claims will proceed under the VEA or MRCA statutory provisions and implementing regulations or procedural guidelines, using this Statement as the medical causation lens.

Interaction with other Statements of Principles. Section 11 creates an explicit interaction mechanism: if a factor in s 9 refers to an injury or disease for which another Statement of Principles exists under subsection 196B(2) of the VEA, then the factors in that other Statement apply as in force from time to time (s 11). This requires adjudicators to cross‑reference the current versions of other Statements when overlap arises. The net effect is an interlocking system of Statements where one Statement may trigger or import factors from another.

ICD‑10‑AM cross‑reference. The instrument notes that multiple osteochondromatosis attracts ICD‑10‑AM code Q78.6 but clarifies that the operative meaning for claims is the statutory definition in s 7(2), not merely the ICD code (s 7(3)-(4)). The instrument thereby ensures that medical codification is informative but subordinate to the textual definition provided in the Statement.

Definitions and statutory terms. The Schedule defines “relevant service,” “terminal event,” MRCA and VEA (Schedule 1). Adjudicators must therefore apply the Statement using those defined terms. The definitions determine which categories of service activate the instrument’s application. Because the Schedule references both VEA and MRCA categories, the Statement straddles both Acts and must be read in the statutory context of either Act depending on the claim.

No conflict‑resolution clause. The Statement contains no standalone conflict‑resolution provision that would displace inconsistent statutory provisions; rather, it functions within the VEA/MRCA frameworks. If a question arises about inconsistency between this Statement and primary legislation, the primary legislation will prevail; that is a general principle of statutory interpretation and hierarchy, and this Statement does not alter that interaction.

Administrative processes and evidentiary standards. The Statement does not specify procedural evidence standards, time limits, or administrative process rules. Those aspects remain governed by the VEA, the MRCA, and any relevant procedural regulations. Practitioners must therefore map the medical causation requirements of this Statement onto the procedural and evidentiary rules of the primary statutes when preparing claims, adducing evidence and challenging decisions.

This instrument is Statement of Principles No. 43 of 2023 concerning multiple osteochondromatosis (Reasonable Hypothesis). It is dated 24 April 2023 and commences on 23 May 2023 (s 2). Section 4 expressly repeals the earlier Statement of Principles concerning multiple osteochondromatosis No. 43 of 2015, Federal Register of Legislation No. F2015L00008, which had been made under subsection 196B(2) of the VEA. The instrument thereby replaces the prior iteration.

The instrument records the authority for the replacement: it was made under subsection 196B(2) of the VEA (s 3). The instrument itself does not set out a history of amendments beyond this repeal and replacement. No other amendments, transitional arrangements, or savings provisions are contained in the text. Practitioners should therefore treat the 2023 Statement as the operative Statement from its commencement date and be aware that the earlier 2015 Statement has been repealed in full (s 4).

No further amendment log or versioning is included in the text. The instrument’s Schedule identifies the definitions used, but there is no separate set of notes detailing what changed from the 2015 instrument to the 2023 instrument. The only explicit change recorded is the repeal of the 2015 Statement (s 4) and the issue of the 2023 Statement dated 24 April 2023 (instrument header). Users who need to track the practical differences between the 2015 and 2023 versions must therefore compare the texts directly; the instrument does not offer an explanatory memorandum or clause‑by‑clause amendment table within the document itself.

Practitioners should also note the instrument’s citation as No. 43 of 2023. Any administrative guidance, departmental publications, or tribunal practice directions that refer to the applicable Statement of Principles after 23 May 2023 will be expected to reflect this 2023 version rather than the repealed 2015 Statement. Where a claim straddles the repeal date, the relevant primary statutes and administrative practice should be consulted to determine which Statement applies to a specific claim timeline, but that procedural mapping is not provided in the instrument text.

The text of this instrument does not record any litigation history. It contains no references to prior adjudicative decisions, court rulings, or tribunal determinations concerning multiple osteochondromatosis or the application of earlier Statements of Principles. The instrument is a Statement of Principles made under subsection 196B(2) of the VEA dated 24 April 2023 and commencing 23 May 2023 (s 2-3), and it repeals the earlier No. 43 of 2015 Statement (s 4). Beyond those facts, the instrument itself does not include a litigation or case history section.

Because the instrument is silent on litigation, practitioners should not infer outcomes or precedent from this document alone. If judicial or tribunal decisions interpreting previous Statements or issues of causation for multiple osteochondromatosis exist, they are not discussed here and are not part of the instrument’s text. Parties relying on or responding to claims under this Statement should therefore undertake independent research into any external legal authorities, tribunal determinations and administrative cases that may interpret the concepts used in the Statement , for example, how tribunals or courts have construed “reasonable hypothesis,” “appropriate clinical management,” or the temporal limits for material contribution and aggravation. The Statement itself supplies only the medical causation factors and definitions; it does not provide judicial interpretation.

Where challenge proceedings are contemplated, the Statement’s effect is to set the medical criteria that administrative decision‑makers must apply. Any litigation or review that follows an adverse decision will, in practice, engage the Statement as the medical causation standard in the relevant claim. The instrument provides the substrate for those adjudications going forward from its commencement date, but it does not report prior litigation outcomes or provide interpretive guidance from courts or tribunals.

The instrument contains a number of discrete features and textual limitations that can create pitfalls for claimants, practitioners and decision‑makers if they are not closely observed.

1. Narrow list of qualifying factors. Only one factor is listed in s 9: inability to obtain appropriate clinical management for multiple osteochondromatosis. Where a claimant cannot identify evidence that matches that precise formulation, a reasonable hypothesis under this Statement will not be raised. The limited catalogue contrasts with Statements that specify multiple alternative factors; here the single factor is the gateway.

2. “Appropriate clinical management” is undefined. The central determinative phrase in s 9(1) , “inability to obtain appropriate clinical management” , is not defined anywhere in the instrument. That absence gives rise to adjudicative discretion and potential variability in outcomes because decision‑makers and medical assessors must determine what counts as “appropriate” on the available evidence. Practitioners must anticipate contested interpretations about the standard of care, availability of specialists, geographic or temporal access constraints, and whether management that was available would have been “appropriate” for the disease at the relevant times.

3. Temporal constraint for material contribution or aggravation. Section 10(2) confines the application of s 9(1) to material contribution or aggravation scenarios where the condition was suffered or contracted before or during, but did not arise out of, relevant service. In other words, if a claimant’s condition actually arose out of service (i.e. originated because of service), s 9(1) is not the applicable pathway for material contribution/aggravation. Practitioners must map the factual theory of the claim (origin, aggravation, material contribution) onto the temporal constraint in s 10(2) to avoid mis‑pleading the type of causal link the Statement allows.

4. Exclusions for certain disorders. The instrument explicitly excludes synovial osteochondromatosis and enchondromatosis from the definition of multiple osteochondromatosis (s 7(2)(b)). Medical evidence must be explicit about diagnosis and exclude these conditions where appropriate. Referencing only an ICD code (Q78.6) is not sufficient because s 7(3) stresses that the statutory definition overrides the code cross‑reference. Practitioners should ensure diagnostic terminology in medical reports matches the statutory definition in s 7(2).

5. Death cases require contribution to a terminal event. For deaths, the Statement only covers situations where a terminal event or condition was contributed to by multiple osteochondromatosis (s 7(5)). It is not enough to show presence of the disease at death; causative contribution to the proximate or ultimate cause of death must be established. The Schedule’s list of terminal events (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function) is illustrative and determinative for the Statement’s purposes, so medico‑legal reports must speak to contribution to those kinds of terminal events where relevant.

6. Cross‑reference to other Statements can complicate matters. If the s 9 factor refers to an injury or disease covered by another Statement, that other Statement’s factors apply “as in force from time to time” (s 11). Practitioners must review the current versions of any cross‑referenced Statements because those Statements may be amended independently. Failing to apply the latest version could lead to misapplication of factors.

7. ICD code is subsidiary. The instrument’s explicit statement that the statutory definition controls despite the ICD‑10‑AM code Q78.6 (s 7(3)-(4)) means that reliance on coding alone is inadequate. Medical reports should express the disease in the terms of s 7(2), not only by diagnostic code.

8. No procedural detail or definitions of evidentiary standards. The Statement supplies the causal template but leaves evidentiary process, standards and administrative procedure to the VEA/MRCA frameworks. Practitioners must translate the medical factors into evidence admissible and persuasive under the procedural rules that govern the claim, even though those rules are not contained in the Statement.

9. Repeal of prior Statement. The 2015 Statement has been repealed (s 4). If earlier claims were assessed under the 2015 Statement, cross‑checking the older text may be necessary to address transitional or precedent issues, but the 2023 Statement is the operative instrument after commencement.

10. Potential for narrow success pathways. Taken together, the single factor rule, the undefined standard of “appropriate clinical management,” and the temporal constraints mean that many factual permutations will fall outside the Statement’s scope unless evidence is framed to match the specific textual requirements. That increases the importance of careful medico‑legal drafting aligned to the Statement.

For claimants, representatives and decision‑makers, compliance with the Statement is a matter of assembling and presenting the right factual and medical material so that the single qualifying factor in s 9(1) and the service linkage in s 10(1) are established on the evidence.

1. Identify the applicable statutory claim route. Confirm that the claim is one to which section 120A of the VEA or section 338 of the MRCA applies (s 5). The Statement is only operative for claims within those statutory pathways. Prepare submissions and evidence with reference to the procedural requirements of the governing statute.

2. Establish diagnosis in statutory terms. Ensure medical reports state that the person has multiple osteochondromatosis as defined in s 7(2): a genetic disorder of bone growth typically involving multiple benign cartilage‑capped bone tumours (osteochondromas or exostoses) arising from metaphyses of long bones. Explicitly exclude synovial osteochondromatosis and enchondromatosis where appropriate (s 7(2)(b)). Do not rely solely on ICD coding: s 7(3)-(4) makes the textual definition decisive.

3. For death claims, link disease to terminal event. Where the claim concerns death, medical evidence must link multiple osteochondromatosis to a terminal event or condition that was contributed to by the disease (s 7(5)). Use the Schedule’s definition of “terminal event” (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function) as the explanatory frame for cause‑of‑death opinions (Schedule 1).

4. Prove the qualifying factor: inability to obtain appropriate clinical management. The instrument requires at least one factor from s 9 to exist; here practitioners must show that the claimant could not obtain appropriate clinical management for multiple osteochondromatosis (s 9(1)). Because “appropriate clinical management” is not defined, evidence should cover:

   • contemporaneous medical records showing referrals, waitlists, missed appointments or denials of treatment;

   • correspondence from public hospitals, specialist clinics or treating doctors indicating unavailability of recommended treatment or specialist assessment at relevant times;

   • geographic, temporal or service‑related barriers to access that would explain inability to obtain care;

   • evidence describing what management would have been clinically appropriate at the relevant period (expert opinion) and why such management was unavailable to the veteran.

5. Connect the factor to relevant service. Section 10(1) requires the asserted factor to be related to relevant service. Use service records, postings, service medical records, and contemporaneous documentation to demonstrate how the inability to obtain appropriate clinical management was connected to the person’s relevant service as defined in the Schedule (operational, peacekeeping, hazardous, British nuclear test defence service under the VEA, or warlike/non‑warlike service under the MRCA). For claims that argue material contribution or aggravation, ensure the disease’s temporal relationship to service fits s 10(2): the disease must have been suffered or contracted before or during, but not arising out of, service to use s 9(1) for material contribution/aggravation.

6. Consider cross‑referenced Statements. If the asserted inability to obtain appropriate clinical management refers to an injury or disease that is itself covered by another Statement of Principles, identify and apply the factors from that other Statement as required by s 11. Check the current versions of any cross‑referenced Statements because they apply “as in force from time to time” (s 11).

7. Prepare expert opinion carefully. Because the Statement places emphasis on clinical management and contribution to terminal events (for deaths), obtain medical expert reports that:

   • address the statutory definitions in s 7 and the Schedule;

   • explain, with reference to usual standards of care, what management would have been appropriate and why it was unavailable to the veteran;

   • discuss causation in terms that map to the Statement’s language: inability to obtain appropriate clinical management, and relation to relevant service;

   • for death claims, give an opinion on whether multiple osteochondromatosis contributed to the terminal event specified.

8. Documentation and chronology. Provide a clear chronology tying service events, onset/diagnosis dates, treatment attempts, referrals, hospital admissions, and any barriers to treatment. Use service records to demonstrate the timing and nature of “relevant service” per Schedule 1 definitions.

9. Anticipate challenges on “appropriateness.” Because the Statement does not define “appropriate clinical management,” adjudicators may query whether a less resource‑intensive management approach would have satisfied that standard. Anticipate and address potential factual or expert disputes by documenting why particular levels of care or specialist interventions were clinically indicated and unavailable.

10. Review prior Statements and repeal implications. The 2015 Statement has been repealed (s 4). If older evidence or decisions are relevant to the claim, compare the 2015 and 2023 texts to ensure the claim is pleaded under the operative 2023 Statement. Prepare submissions that reconcile any discrepancies between earlier adjudications and the current Statement.

11. Procedural compliance. Map the medical evidentiary package to the procedural filing, disclosure and time limits set out in the VEA or MRCA claim processes (not contained in the Statement). The Statement shapes what medical issues will decide causation; compliance with procedural rules in the principal Acts remains essential.

12. Keep records of access attempts. Because the determinative factor is inability to obtain management, gather contemporaneous evidence of attempts to access care , phone logs, emails, referral declines, waiting list notices, and statements from treating institutions , to document the unavailability or inappropriateness of management at the relevant times.

By aligning medical evidence and factual narrative to the narrow textual criteria in the Statement , diagnosis under s 7(2), the single factor in s 9(1), and the service relationship in s 10(1)-(2) , claimants and advisers will place the claim in the form that decision‑makers are instructed to apply. The Statement contains no procedural checklists; successful compliance therefore depends on translating the Statement’s medical definitions into the evidentiary formats required by the VEA/MRCA claim processes.