Statement of Principles concerning plantar fasciitis (Balance of Probabilities) (No. 83 of 2023)

Plantar fasciitis is defined in section 7(2) as meaning “a painful inflammatory or degenerative condition of the plantar fascia of the foot” and excludes plantar fibromatosis. The clinical note describes typical manifestations: pain in the inferior heel that is worse with first steps in the morning or after a period of inactivity, with tenderness of the inferior heel. This definition is crucial because it sets the condition’s scope; a person with plantar fibromatosis rather than plantar fasciitis cannot rely on this SoP.

Factors (section 9) are the eleven specified circumstances that, when related to relevant service, allow connection. They include trauma within seven days, infection, running or jogging at least 30 km per week for two months, repetitive weight-bearing exercise of at least 5 METs and four hours per week for two months, a 200% or more increase in weight-bearing activity within seven days, prolonged standing on hard surfaces for five hours per day for twelve months, being overweight or obese (BMI ≥25), a systemic arthritic disease, an acquired biomechanical abnormality, inadequate footwear, and inability to obtain appropriate clinical management. Each factor has precise temporal or quantitative thresholds that must be met , for example, running 30 km per week is a bright-line test, not a guideline.

Related to relevant service is the connective requirement in section 10(1). Even if a factor is present, it must be causally linked to the person’s service. The Sch 1 dictionary defines “relevant service” as 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. This means the SoP does not apply to operational service or hazardous service; different SoPs and different standards govern those.

Clinical onset and clinical worsening are two distinct events. Factors can be connected to either the initial onset or a worsening of the condition after service. Section 10(2) limits the worsening aspect: the clinical worsening factors apply only to material contribution to or aggravation of plantar fasciitis where the condition was suffered or contracted before or during (but did not arise out of) the person’s relevant service. This prevents double-counting if the condition itself was caused by service.

MET is defined as a unit of measurement of physical exertion: 1 MET = 3.5 ml of oxygen/kg of body weight per minute, or 1.0 kcal/kg of body weight per hour, or resting metabolic rate. This definition is critical for factors (4) and (5) that require intensity of at least 5 METs , a threshold that corresponds to moderate activity like brisk walking or light jogging. Claimants cannot simply assert “exercise”; they must meet a quantifiable metabolic cost.

Systemic arthritic disease includes a closed list: ankylosing spondylitis, enteropathic spondyloarthropathy, psoriatic arthropathy, reactive arthritis, undifferentiated spondyloarthropathy, gout, pseudogout, and other crystal-induced arthropathy. This list is exhaustive. A person with rheumatoid arthritis, for example, would not fall under this factor unless they also have one of the listed conditions.

Biomechanical abnormality means injury or disease resulting in overpronation or underpronation, or decreased ankle or forefoot flexibility. The abnormality must be “acquired” according to factor (9), so congenital anatomical variations are excluded unless they arise from injury or disease.

Terminal event is defined for death from plantar fasciitis: pneumonia, respiratory failure, cardiac arrest, circulatory failure, or cessation of brain function. The condition must have contributed to such an event for the death to be covered (section 7(3)).

The primary affected persons are veterans and members of the Australian Defence Force who rendered “relevant service” as defined , that is, non-operational service under the VEA or peacetime service under the MRCA. This SoP does not apply to veterans who served operationally (e.g., warlike service) or who rendered hazardous service or British nuclear test defence service; those categories fall under different instruments and often a different standard of proof (reasonable hypothesis). The instrument therefore affects a narrower cohort: those who served but not in active combat, such as peacetime ADF members, or veterans whose service was eligible war service but not operational.

The second group affected are decision-makers within the Department of Veterans’ Affairs (DVA) and the Military Rehabilitation and Compensation Commission. They must apply the factor list as a mandatory gate. If a claimant satisfies none of the eleven factors, the claim must be refused on the basis that the connection cannot be found on the balance of probabilities, regardless of other medical opinions. This reduces administrative discretion but also means that even a plausible causal story that does not fit any listed factor is insufficient. For example, a veteran who develops plantar fasciitis after a single long march of 25 km in one day without meeting the two-month duration for recurrent weight-bearing activity may fail factor (3) or (4) and may be unable to point to any other factor.

Medical practitioners who assess veterans for compensation are affected because they must provide evidence that fits one of the factor categories. A doctor’s report that says “the condition is likely related to service” without addressing, say, the precise weekly running distance or the MET intensity of exercise, will not suffice. The instrument imposes an evidentiary burden on the claimant to produce quantifiable data (e.g., training logs, medical records of BMI, diagnosis of systemic arthritic disease).

Legal practitioners and advocates for veterans must navigate the detailed definitions and temporal thresholds. They need to identify which factor best matches the veteran’s history and then prove that factor’s elements , including the relationship to service. The SoP does not say that merely having the factor automatically grants the claim; the factor must still be related to service. For instance, being overweight or obese (factor (7)) is a factor, but obesity often has no causal link to service. The connection requirement in section 10(1) can be a significant barrier.

Oblique affected parties include the RMA itself, which must update these instruments periodically based on new evidence, and the broader veterans’ compensation system, which must manage the compliance costs of applying bright-line tests across thousands of claims.

The instrument creates no new duties or rights directly; it is a rule of evidence that operates within the claim-assessment framework of the VEA and MRCA. The key duty it imposes on the claimant is to establish that at least one of the factors in section 9 exists and is related to relevant service. The right it confers is that if a factor is satisfied and related to service, the decision-maker must accept the connection on the balance of probabilities , provided no contrary medical evidence outweighs it (though the SoP is presumptive). In effect, the SoP creates a rebuttable presumption of connection when a factor exists; the decision-maker cannot reject the claim solely by saying “insufficient evidence” if the factor requirements are met.

The duty on the RMA under subsection 196B(3) is to determine the SoP “on the sound medical-scientific evidence available.” Section 8 of the instrument notes that the RMA is of the view that it is more probable than not that plantar fasciitis can be related to relevant service. This is a statement of basis, not a duty. The RMA must also update the SoP when evidence changes, but that is a statutory function.

The decision-maker’s duty is to apply the SoP strictly. They cannot supplement the list of factors or relax the quantitative thresholds. For example, a factor requiring running at least 30 km per week for two months cannot be satisfied by 25 km per week. The decision-maker also must address the clinical worsening aspect only where the condition predated service and did not arise out of it (section 10(2)). This imposes a chronological analysis.

The claimant’s right to a fair assessment includes the right to rely on any factor even if not expressly referenced in the medical report, provided the evidence supports it. The SoP is a tool for both sides; a claimant may try multiple factors.

Additionally, section 11 incorporates other SoPs by reference: if a factor in this SoP refers to an injury or disease for which another SoP exists (e.g., systemic arthritic disease has its own SoP likely), then the factors in that other SoP apply in accordance with its terms as in force from time to time. This creates a layered duty to cross-reference multiple instruments.

There is no right to challenge the SoP itself within the claim process; judicial review of the RMA’s determination is available but limited to procedural or jurisdictional error.

This instrument does not impose penalties. It is not a criminal or civil penalty provision. Enforcement is indirect: if a claimant or decision-maker misapplies the SoP, the consequence is an incorrect determination of a compensation claim, not a fine or sanction. For example, if a decision-maker ignores a factor that is clearly met, the claimant can seek internal review or appeal to the Administrative Appeals Tribunal (AAT) or the Federal Court. The penalty is effectively the denial or delay of benefits, which can be corrected on review.

If a claimant fraudulently claims a factor (e.g., fabricates a training log), they may face consequences under the general law for false statements in relation to Commonwealth compensation (such as criminal prosecution under the Criminal Code for obtaining a financial advantage by deception). But the SoP itself does not specify any penalty.

For administrators, failure to apply the SoP correctly may lead to adverse review outcomes and potentially merits-based criticism, but no personal penalties attach to the instrument.

The instrument interacts with the VEA enforcement provisions indirectly. The VEA contains general offences for making false or misleading statements, but the SoP merely filters what evidence is sufficient. So the main “enforcement” is that claims must be rejected if no factor is established, which acts as a gatekeeper.

This SoP is made under subsection 196B(3) of the VEA, which requires the RMA to determine SoPs for specific injuries, diseases, or death. The VEA provides the overarching statutory framework for veterans’ entitlements, including the standard of proof (balance of probabilities for non-operational service under section 120B) and the requirement to apply SoPs. The SoP also operates under section 339 of the MRCA for peacetime service claims.

The instrument expressly repeals the previous SoP No. 52 of 2015, meaning any claims determined after commencement (26 September 2023) must use this version. However, section 5 says the instrument applies to claims to which section 120B of the VEA or section 339 of the MRCA applies. That section references the standard of proof provisions, not the date of claim. So even if a claim was lodged before commencement but not yet determined, the decision-maker should apply the current SoP in force at the time of decision unless transitional provisions say otherwise (the instrument is silent on transitional application beyond “applies to a claim” , but typically the SoP in force at date of decision governs).

Section 11 creates an interaction with other SoPs: if a factor (e.g., factor (8) systemic arthritic disease) refers to a condition for which another SoP has been determined under subsection 196B(3), 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 means a claimant attempting to satisfy factor (8) must also prove that the systemic arthritic disease itself is connected to service through its own SoP, unless the condition already exists unrelated to service. For example, a veteran with gout (a systemic arthritic disease under the definition) may need to satisfy both this SoP for plantar fasciitis and the SoP for gout if the gout is claimed to be service-related. However, if the gout is accepted as a pre-existing condition not related to service, factor (8) may still be satisfied as long as the gout existed at the time of clinical onset or worsening, and that factor alone is present , the gout does not need to be service related. The wording of factor (8) merely requires “having a systemic arthritic disease at the time of the clinical onset or clinical worsening.” It does not require that the systemic arthritic disease itself is service-related. So the interaction is limited to cases where the claimant tries to argue that the systemic arthritic disease itself arose from service and is using its SoP to support that claim. Section 11 is a cross-reference mechanism to avoid duplication.

Further interaction with the common law: the SoP displaces the general forensic approach of medical expert opinion on causation; it is a legislative instrument and must be applied as a binding rule, not as a mere guideline. The Veterans’ Entitlements Act 1986 provides for SoPs to be binding on decision-makers and tribunals, so there is no room for a more generous interpretation.

Other potential interactions: if a claim involves both operational and non-operational service, different SoPs (or no SoP for operational service) may apply concurrently.

The instrument contains only one piece of amendment history: it repeals the Statement of Principles concerning plantar fasciitis No. 52 of 2015 (Federal Register of Legislation No. F2015L00258), made under subsection 196B(3) of the VEA. No earlier versions are referenced. The current instrument is No. 83 of 2023, dated 25 August 2023, commencing 26 September 2023. There is no indication of any amendments between 2015 and 2023 , only a replacement.

The 2015 version would have had its own list of factors and definitions. A thorough comparison is not possible without the 2015 text, but typical changes in SoP revisions include adding new factors (e.g., the factor for inadequate footwear in factor (10) may be new), adjusting thresholds (e.g., increasing the running distance from 25 km to 30 km), or clarifying definitions. The repeal of the 2015 version means the 2015 version no longer has any legal effect for claims determined after commencement.

The instrument does not include any transitional provisions for claims made before commencement but still pending. The general rule under administrative law is that the decision-maker applies the law in force at the time of decision, so pending claims would likely need to be decided under the 2023 SoP. However, the claimant might have had legitimate expectations based on the 2015 version. No saving provisions are provided.

This is a standalone SoP; there is no amendment bill or parliament oversight because it is a legislative instrument made by an authority under delegated power. It is subject to tabling and disallowance in Parliament but that is generic.

The instrument itself provides no litigation history. It is a new instrument with no judicial consideration. However, the legal environment around SoPs generally has been litigated in the Federal Court, the Full Federal Court, and the High Court. Key cases have dealt with issues such as the standard of review, the meaning of “sound medical-scientific evidence,” the requirement for the RMA to consider all relevant evidence, and the binding nature of SoPs. For example, Repatriation Commission v Gorton (2001) and Repatriation Commission v Hill (2002) established that the RMA can base factors on epidemiological studies and need not wait for absolute proof. Another line of cases, such as Lees v Repatriation Commission (2002), concerned the meaning of “clinical onset.” The High Court in Minister for Immigration and Multicultural Affairs v Eshetu (1999) and other cases on jurisdictional error have been applied in the SoP context.

The specific factor for plantar fasciitis in the 2015 version may have been considered in AAT or Federal Court decisions, but this instrument does not cite any. Claimants challenging a decision under this SoP would likely argue that a factor was not properly considered, that quantitative thresholds are arbitrary, or that the RMA failed to consider relevant medical evidence when setting factors. Given the bright-line nature of factors, litigation will likely focus on whether a particular activity meets the definition (e.g., what constitutes “repetitive weight bearing” or “prolonged weight bearing on a hard surface”). The exclusion of plantar fibromatosis could also be litigated if a diagnosis is disputed.

No class actions are known in this area; litigation is mostly individual claims.

Several traps exist for claimants and their advisors. The first is the precise definition of plantar fasciitis itself: it excludes plantar fibromatosis (a benign fibrous tumour of the plantar fascia). A misdiagnosis or an overlapping condition could scuttle a claim.

Quantitative thresholds are unforgiving. Factor (3) requires running or jogging at least 30 km per week for at least two months. A claimant who runs 29 km per week does not satisfy it. Factor (4) requires a minimum intensity of 5 METs and four hours per week for two months. The MET value is not a subjective feeling but an objective measurement based on oxygen consumption. A person walking slowly at 2 METs would not meet it even if they did it for ten hours. Factor (5) requires a 200% increase in frequency, duration or intensity, to a minimum of 5 METs and at least two hours per day, within seven days. This is extremely steep; doubling or tripling an existing training load is rare and potentially dangerous. Most claimants will not meet this.

Prolonged weight bearing under factor (6) requires at least five hours per day on a hard surface, on more days than not, for 12 months. Occasional long days are insufficient; the pattern must be habitual. “Hard surface” is not defined but likely includes concrete, asphalt, or tiles. Claimants who worked on cushioned surfaces like grass or rubber flooring may not qualify.

Being overweight or obese (factor (7)) uses BMI of 25 or greater. BMI is calculated as weight in kilograms divided by height in metres squared. A claimant who has a BMI of 24.9 at the time of clinical onset does not meet this factor, even if they are close. The timing is critical: the BMI must be at the time of clinical onset or worsening, not at some other point.

Inability to obtain appropriate clinical management (factor (11)) applies only to clinical worsening, not to clinical onset. This means a claimant whose condition worsened because they could not get proper treatment can satisfy this factor if the worsening is material (section 10(2) requires material contribution). However, the inability must be related to service. For example, if a veteran was posted to a remote location with no physiotherapy, the inability may be service-related. But if the veteran simply chose not to seek treatment, that is unlikely to count.

Related to service (section 10) is the biggest trap. Even if a factor exists, it must be related to the person’s relevant service. For example, a veteran who becomes obese after service due to a civilian lifestyle cannot use factor (7) unless the obesity itself is linked to service (e.g., caused by a service injury that limits mobility). The SoP does not automatically deem the factor related; the claimant must prove a causal chain.

Cross-referencing other SoPs (section 11) can create hidden requirements. If a factor refers to a disease that has its own SoP (e.g., systemic arthritic disease), then in a claim where the systemic arthritic disease itself is alleged to be service-related, the claimant must satisfy that other SoP. But even if it is not alleged, the decision-maker may still need to check the other SoP to determine if the condition qualifies.

Terminal event definition: death must be contributed to by plantar fasciitis via one of the listed terminal events. If death results from a fall caused by plantar fasciitis pain, that may not be covered unless the fall leads to, say, pneumonia.

Clinical worsening only from outside service: if the plantar fasciitis arose out of service (i.e., was caused by service), then section 10(2) precludes using clinical worsening factors for that same condition; the worsening is already part of the original claim.

Plantar fasciitis from trauma within seven days (factor (1)): trauma must be to the plantar aspect of the affected foot. A bruise on the top of the foot or an ankle sprain does not count.

Compliance with this SoP is not about obeying a regulatory command; it is about navigating the evidentiary pathway to a successful claim. For a claimant (veteran or member), compliance means ensuring that medical and historical evidence aligns with at least one factor in section 9 and that the factor is demonstrably related to relevant service.

Step one: Identify the relevant service. Confirm that the service is eligible war service (other than operational), defence service (other than hazardous or British nuclear test), or peacetime service. If the service is operational or hazardous, this SoP does not apply; a different SoP or the reasonable hypothesis standard governs.

Step two: Establish the precise timing of clinical onset and any clinical worsening. Obtain medical records that show the date of first symptoms and diagnosis. The factors often require specific windows (e.g., within seven days before onset, for two months before onset). If the onset date is uncertain, claimants should gather contemporaneous evidence such as medical appointments, sick leave records, or personal diaries.

Step three: Match the facts to a factor. For factor (1) (trauma), document any injury to the sole of the foot within seven days before onset. For factor (3) (running or jogging), keep or reconstruct training logs showing average weekly distance of at least 30 km for two months. Consider using GPS watch data or club records. For factor (4) (repetitive weight-bearing exercise), calculate MET values. Common activities at 5 METs or above include brisk walking (4-5 METs), jogging (7 METs), soccer (8 METs), tennis (6 METs), marching (5-7 METs). Document the number of hours per week for at least two months. For factor (6) (prolonged standing), provide evidence of work duties or service activities involving standing on hard surfaces for five hours per day, more days than not, for 12 months. Rosters, duty statements, or witness statements can help.

For factor (7) (overweight/obese), calculate BMI at the date of clinical onset or worsening. A nurse or doctor can measure height and weight. For factor (8) (systemic arthritic disease), a diagnosis by a rheumatologist of one of the listed conditions is required. For factor (9) (biomechanical abnormality), a podiatric or orthopaedic assessment documenting overpronation or decreased flexibility.

Factor (10) (inadequate footwear) requires showing that footwear lacked adequate cushioning during weight-bearing exercise within seven days before onset. This may require specifying the type and condition of shoes.

Factor (11) (inability to obtain appropriate clinical management) is only for clinical worsening. Evidence should show that appropriate treatment was not available due to service circumstances, or that the person could not access it (e.g., no physiotherapy at a remote base), and that this inability materially worsened the condition.

Step four: Relate the factor to service. For each factor, explain how it arose from or during relevant service. For example, the running or jogging in factor (3) must be done as part of military physical training, not during civilian recreation. If a veteran runs 30 km per week in civilian life after discharge, that does not help unless the condition onset or worsened during service. The SoP does not require the factor to be solely due to service, but there must be a connection. A causal chain may need to be described: e.g., “I was required to stand guard duty on concrete for six hours a day for 12 months of my defence service, and that prolonged weight bearing caused the plantar fasciitis.”

Step five: Gather supporting documents. This includes service records, medical reports, training logs, BMI records, podiatry assessments, and witness statements. The decision-maker will apply the factors strictly, so each quantitative threshold must be proved on the balance of probabilities. Expert medical opinion can support the diagnosis and the causal link but cannot override a missing numeric requirement.

Step six: Seek advice. Given the complexity, claimants should consult a veterans’ advocate or a solicitor experienced in military compensation. Mistakes in calculating METs or interpreting “hard surface” could cost the claim. The SoP is a legislative instrument, so any legal advice should reference the actual factors and definitions.

For administrators (DVA and the Commission), compliance means processing claims by systematically checking each factor against the evidence. They must not add factors not listed or relax requirements. They should also be aware of the cross-reference in section 11 to other SoPs where relevant. Record-keeping of the analysis is essential to withstand merits review. The SoP provides certainty; deviation invites errors of law.