Statement of Principles concerning Scheuermann’s disease (kyphosis) (Balance of Probabilities) (No. 46 of 2025)

This instrument is a Statement of Principles determined by the Repatriation Medical Authority under subsection 196B(3) of the Veterans' Entitlements Act 1986. It sets out the medical definition, the causal framework and the specific factor or factors that must exist before, on the balance of probabilities, Scheuermann’s disease (kyphosis) or death from that disease can be regarded as connected with a person’s relevant service for the purposes of claims under the VEA or the Military Rehabilitation and Compensation Act 2004 (MRCA) (see the Authority clause and Application clause). It commences on 19 May 2025 and repeals the earlier Statement of Principles No. 76 of 2016 (Federal Register F2016L01343) (Commencement; Repeal).

Mechanically, the instrument performs three functions. First, it provides a statutory definition of Scheuermann’s disease (kyphosis) for claim-assessment purposes that departs from simple reliance on an ICD‑10‑AM code by prescribing specific clinical features (subsection 7(2)). Second, it identifies the single non-exhaustive factor that must exist before the disease or a death from it may be connected with relevant service: inability to obtain appropriate clinical management for the condition before clinical worsening (section 9). Third, it sets limits on the circumstances in which that factor can operate: the factor applies only to material contribution to, or aggravation of, the disease where the disease was suffered or contracted before or during relevant service but did not arise out of the service (subsection 10(2)). For death claims, the instrument extends the meaning of Scheuermann’s disease to include death from a terminal event or condition that the disease contributed to, with a defined list of terminal events in the Schedule (see Death from Scheuermann’s disease (kyphosis) and Schedule 1).

The instrument also explains evidentiary reference points for timing by defining clinical worsening as a backwards-looking period from the date of presentation at which a registered medical practitioner first confirms signs or symptoms to the date at which signs or symptoms became permanently present, as assessed by a registered medical practitioner (Schedule 1). It cross-references other Statements of Principles where factors refer to injuries or diseases covered elsewhere (section 11). In short, the instrument replaces the 2016 Statement, provides a tightly worded medical definition and a single statutory causal factor, constrains the circumstances in which that factor operates, and prescribes how timing and death attribution are to be considered.

The instrument is structured around a few tightly specified medical and causal concepts. The statutory meaning of Scheuermann’s disease is set out in subsection 7(2). It is defined as a disease of children and adolescents involving necrosis and regeneration in the growth centres of the thoracic or thoracolumbar vertebrae, characterised by a rigid hyperkyphosis due to anterior wedging of at least 5 degrees in one or more consecutive vertebrae, and clinical manifestations of postural deformity and/or subacute thoracic pain. The definition expressly excludes postural kyphosis. The instrument also notes that although the condition attracts ICD‑10‑AM code M42.0, the operative meaning for the Statement is the statutory description in subsection 7(2), not the code alone (subsection 7(3) and the following note).

Death from Scheuermann’s disease is included, but only where the disease contributed to a terminal event or condition; terminal event is defined in Schedule 1 and explicitly includes pneumonia, respiratory failure, cardiac arrest, circulatory failure and cessation of brain function (Death from Scheuermann’s disease (kyphosis); Schedule 1). That links death claims to proximate or ultimate causes that are clinically plausible sequelae.

Causation in this instrument is established on the balance of probabilities but conditional on a threshold factor. The Repatriation Medical Authority states it is of the view that, on available sound medical‑scientific evidence, it is more probable than not that Scheuermann’s disease and death from it can be related to relevant service (Basis for determining the factors). Nevertheless, the instrument specifies that, before a connection can be accepted on the balance of probabilities, a particular factor must exist (section 9). That factor is inability to obtain appropriate clinical management for Scheuermann’s disease before clinical worsening. The Schedule provides the operative meaning of clinical worsening: the period backwards from the date of presentation to a registered medical practitioner who first confirms signs or symptoms, to the date when signs or symptoms were permanently present, as assessed by a registered medical practitioner (Schedule 1).

The instrument distinguishes types of service by reference to the Schedule definition of relevant service, which includes eligible war service (other than operational service), defence service (other than hazardous service and British nuclear test defence service) under the VEA, and peacetime service under the MRCA. It also includes a relationship clause that conditions the operation of the factor: the factor in section 9 applies only to material contribution to, or aggravation of, Scheuermann’s disease where the condition was suffered or contracted before or during the person’s relevant service, but did not arise out of that service (subsection 10(2)). Finally, the instrument provides a mechanism to import factors from other Statements of Principles where a factor refers to an injury or disease covered elsewhere (section 11).

The instrument affects several classes of actors directly and indirectly, as set out in the text. Primary persons affected are veterans, former members and current members of the Forces who submit claims to which section 120B of the VEA or section 339 of the MRCA applies, because the instrument applies to those claims (Application). The Schedule defines relevant service for the instrument and thereby delimits the cohort of service exposures that can be assessed under this Statement (Schedule 1). The instrument therefore governs the medical causation threshold for claims by people whose service falls within eligible war service (other than operational), defence service (other than hazardous and British nuclear test defence), or peacetime service under the MRCA.

Medical practitioners are affected in a practical evidentiary role. The definition of clinical worsening is expressly predicated on a registered medical practitioner’s confirmation of symptoms and an assessment as to when signs or symptoms were permanently present (Schedule 1). That means claimant medical records, practitioner notes and assessments will be primary evidence used to establish timing and the existence of the required factor. Registered medical practitioners are therefore functional gatekeepers of the timing evidence embedded in the instrument.

Decision makers who process VEA and MRCA claims are affected because they must apply the Statement when determining whether Scheuermann’s disease or death from it is connected with service for the purposes of the Acts to which the Statement applies. The instrument itself is made under s196B(3) authority, indicating that it is intended to be applied to entitlements determined under the VEA framework; while the instrument does not explicitly name the Department or agency that will apply it, its Application clause ties it to statutory claims under VEA and MRCA.

Claim outcomes, including eligibility for benefits or compensation under the VEA or MRCA where Scheuermann’s disease is at issue, will be affected indirectly. The instrument narrows or specifies the medical criteria and the causal factor that must be met; that changes the evidentiary and legal pathway by which claimants may succeed. It also affects the administrators of medical records and appointment systems where a claimant alleges inability to obtain appropriate clinical management; those administrative records may become material evidence.

Finally, other Statements of Principles and their users are affected because section 11 mandates that, where a factor refers to an injury or disease covered by another Statement, the factors in that other Statement apply in accordance with its terms. That creates interdependence among Statements and requires claim handlers to cross‑check applicable SoPs.

The instrument does not create criminal offences or prescribe fines; rather, it creates duties of proof and delineates the features that must be present before a medical connection to relevant service can be accepted on the balance of probabilities. The central legal duty imposed by the instrument is procedural and evidentiary: before a finding of connection can be made in respect of Scheuermann’s disease (kyphosis) or death from it, the factor specified in section 9 must exist. The instrument states that “the following factor must exist before it can be said that, on the balance of probabilities, Scheuermann’s disease (kyphosis) or death from Scheuermann’s disease (kyphosis) is connected with the circumstances of a person’s relevant service” (section 9). That establishes a threshold requirement for claimants and for decision makers applying the VEA and MRCA claims processes.

There is also a duty implicit on decision makers to relate any factor relied upon to the person’s relevant service. Section 10(1) requires that the existence of a factor referred to in section 9 must be related to the relevant service rendered by the person. This functions as a legal constraint on causation findings: the factor is not sufficient in isolation; there must be a nexus to relevant service as defined in the Schedule.

Subsection 10(2) imposes an additional constraint on how the factor operates: it applies only to material contribution to, or aggravation of, the disease where the disease was suffered or contracted before or during, but did not arise out of, the person’s relevant service. This allocates the instrument’s causal mechanism to a defined class of pre‑existing or pre‑dated conditions that are materially worsened by an inability to access appropriate management during or after relevant service. This shapes the rights of claimants: a claimant whose Scheuermann’s disease arose out of service is excluded from having the section 9 factor applied in the context of material contribution or aggravation under subsection 10(2). The instrument therefore affects rights to claim connection in ways that depend on timing and the nature of the relationship between disease onset and service.

For death claims, the instrument gives claimants and decision makers an explicit right to consider deaths where a terminal event identified in the Schedule was contributed to by Scheuermann’s disease; it defines terminal events that may be used to link death to the disease. That creates an entitlement pathway for death‑related claims where contribution can be shown.

The Statement also imposes a duty of interpretative primacy: where a factor in this Statement refers to an injury or disease covered by another Statement, the factors in that other Statement apply “in accordance with the terms of that Statement” (section 11). This requires decision makers and claimants to consult multiple Statements and follow their operative wording.

The Statement of Principles itself does not create statutory penalties, enforcement mechanisms or criminal sanctions. It is a subordinate instrument made under subsection 196B(3) of the Veterans' Entitlements Act 1986 and functions as a determinative medical framework for causation in VEA and MRCA claims (Authority). The instrument contains no fines, civil penalties, enforcement powers, or compliance penalties within its text. It sets evidentiary and causal thresholds that are applied in administrative decision making over claims, rather than prescribing sanctioning regimes.

Enforcement in practical terms will be administrative, not penal. The instrument is designed to be applied by claim examiners and medical assessors when deciding whether, on the balance of probabilities, Scheuermann’s disease or death from that disease is connected with a person’s relevant service; the Application clause links the Statement to claims under section 120B of the VEA or section 339 of the MRCA. Those sections lie outside the instrument itself and will govern procedural aspects such as lodging claims, appeals and review rights under the parent Acts. The Statement thus functions as a rule of medical law: it will be enforced through the decision‑making processes and review mechanisms that are available under the VEA and MRCA statutory regimes rather than by the Statement directly.

Because the instrument repeals an earlier Statement (the 2016 Statement No. 76) (Repeal), there will be practical enforcement implications around transitional application. The instrument takes effect from its commencement date (19 May 2025), meaning decisions made after that date should be made with reference to the new Statement where it applies. The text does not state transitional arrangements or explicit savings provisions; any transitional application will therefore be governed by the administrative practices and statutory frameworks of the VEA and MRCA claims processes.

Finally, the instrument places evidentiary emphasis on registered medical practitioner confirmation and assessment for timing and permanency of signs and symptoms (Schedule 1). Enforcement of the Statement’s standards will therefore turn on the availability, quality and interpretation of medical records, practitioner statements and expert opinions within the administrative and review pathways of the relevant Acts. The instrument itself provides the substantive criteria; the parent Acts provide the procedural routes for enforcement, review and, where appropriate, appeal.

The Statement is a subordinate instrument under the Veterans' Entitlements Act 1986, made pursuant to subsection 196B(3) and intended to be applied within the statutory frameworks of the VEA and the Military Rehabilitation and Compensation Act 2004 (Authority; Application). Its Application clause expressly limits its operation to claims that fall within section 120B of the VEA or section 339 of the MRCA. The instrument does not reproduce those sections, so interaction with procedural and remedial rules, including time limits, review rights and entitlement mechanics, is governed by the parent Acts. Decision makers must therefore apply this Statement as part of the statutory causation assessment embedded in the VEA and MRCA claims processes.

The instrument expressly cross‑references other Statements of Principles. Section 11 provides that where a factor in this Statement applies and that factor refers to an injury or disease that is the subject of another Statement, then the factors in that other Statement apply according to its terms. This creates a textual and operational linkage among Statements. It means that where comorbidities or referred conditions are involved, claim assessment will require consulting multiple Statements and applying them in sequence or combination as required by their terms.

The instrument references the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD‑10‑AM) and notes the ICD code M42.0 is associated with Scheuermann’s disease (kyphosis), but it also clarifies that for the purposes of the Statement the meaning is the statutory definition in subsection 7(2) (subsection 7(3) and following note). That emphasises that the statutory text takes precedence over a code listing. The citation includes the effective edition date (1 July 2017) and copyright holder, but the instrument does not import the ICD text as the operative definition.

There is an express interaction with the statutory definitions of MRCA, VEA and relevant service contained in the Schedule. The Schedule’s definition of relevant service aligns the Statement to distinct categories of service recognised by the parent Acts and thereby determines which service exposures are captured. Where other legal instruments or policies attach consequences to those service categories, this Statement will operate within that legal architecture.

Because the instrument repeals the prior 2016 Statement (Repeal), it interacts with existing administrative decisions and precedents that were made under the repealed instrument. The instrument does not itself set out transitional provisions or savings clauses; how prior decisions, outstanding claims or appeals are managed will therefore be a function of the administrative application of the parent Acts and any relevant rules on the operation of repeal and replacement instruments.

This Statement of Principles is identified as No. 46 of 2025 and is dated 15 April 2025 (front matter). It commences on 19 May 2025 (Commencement). The instrument explicitly repeals the Statement of Principles concerning Scheuermann’s disease No. 76 of 2016 (Federal Register of Legislation No. F2016L01343) (Repeal). The instrument does not record any other amendments to itself or to other instruments; it replaces the 2016 Statement in full as of its commencement date.

The instrument cites its enabling provision, subsection 196B(3) of the Veterans' Entitlements Act 1986, as the authority under which the Repatriation Medical Authority made the Statement (Authority). The instrument therefore sits in the statutory lineage of Statements of Principles issued under the VEA and is one in a series of such instruments periodically updated when the Repatriation Medical Authority considers a change in the sound medical‑scientific evidence warrants alteration of the determinative factors. The instrument does not include an explicit amending clause for other instruments beyond the express repeal of the 2016 Statement.

Because the instrument repeals and replaces the previous Statement, questions of the application of the prior Statement to claims lodged before commencement or to ongoing litigation will be governed by the parent Acts and administrative practice. The text does not itself prescribe transitional savings or retrospective application, nor does it provide a schedule of amendments or versioning beyond the identification of the repealed instrument. Users seeking to understand the full amendment pathway will need to note the dates: the Repatriation Medical Authority dated the instrument on 15 April 2025 and placed it into operation on 19 May 2025.

No other amendments, corrigenda, or modifications are recorded within the instrument. The Schedule and the body of the Statement operate as the operative text from the commencement date onward, replacing the prior Statement and its terms as the determinative medical standard for Scheuermann’s disease in VEA and MRCA claim assessments from that date.

The instrument, as provided, contains no record of litigation. It is a newly issued Statement dated 15 April 2025 with commencement on 19 May 2025 and replaces the 2016 Statement (Repeal). The text does not identify any court decisions, tribunal determinations, or judicial review proceedings that have challenged or construed this exact Statement. Therefore, within the four corners of the instrument, there is no recorded litigation history to cite.

The absence of litigation history in the instrument means there are no reported judicial interpretations of its specific definitions, the meaning of the statutory factor in section 9, the temporal concept of clinical worsening as defined in the Schedule, or the application of subsection 10(2) limiting the factor to conditions that were suffered or contracted before or during, but did not arise out of, relevant service. Where disputes arise concerning the application of the Statement in individual claims, they will be addressed through the procedural and review mechanisms available under the VEA and MRCA frameworks; any judicial or tribunal decisions that subsequently interpret the Statement will be part of a litigation history accruing after commencement.

Practically, the lack of precedent is a risk and a feature: decision makers and practitioners must apply the text without the benefit of prior authoritative judicial gloss specific to this Statement. That increases the importance of precise evidentiary records and expert medical opinion tailored to the Statement’s definitions, because the administrative decisions will set the initial course for any merits or judicial review proceedings. Where factors in this Statement refer to other injuries or diseases governed by other Statements, existing litigation on those other Statements may provide interpretive guidance, but no such cross‑references or cases are contained in the instrument itself.

In short, as of the instrument’s date and commencement the litigation history is nil in respect of this specific Statement. Any future case law will be generated by disputes over its application to particular claims under the VEA and MRCA, and those future decisions will be necessary to build an interpretive body of law around the Statement’s operation.

The instrument contains several drafting features that are likely to produce practical pitfalls if not attended to carefully. First, the statutory definition of Scheuermann’s disease is textual and specific; it expressly excludes postural kyphosis and requires anterior wedging of at least 5 degrees in one or more consecutive vertebrae plus clinical manifestations of postural deformity and/or subacute thoracic pain (subsection 7(2)). Therefore, a claimant whose presentation is described only as postural kyphosis or who does not meet the anatomically specified wedge criterion may not fall within the Statement’s definition even if coded as M42.0 in the ICD index. The instrument emphasises that the statutory definition controls even though the ICD code is noted (subsection 7(3) and note).

Second, the single factor that must exist is inability to obtain appropriate clinical management before clinical worsening (section 9). That is a compound requirement: claimants must show both lack of access to appropriate management and that the lack occurred prior to clinical worsening as defined in the Schedule. The Schedule defines clinical worsening by reference to two practitioner milestones: (a) date of presentation to a registered medical practitioner first confirming signs or symptoms and (b) the date at which signs or symptoms were permanently present, as assessed by a registered medical practitioner. Those two dates and the practitioner assessments that underlie them are factual anchors. Absent contemporaneous practitioner records confirming first presentation and an assessment as to when signs became permanent, claimants may struggle to prove the necessary timing.

Third, subsection 10(2) limits the application of the factor to material contribution to, or aggravation of, Scheuermann’s disease where the disease was suffered or contracted before or during but did not arise out of the person’s relevant service. That limitation requires careful pleading and proof of onset timing relative to service. If a claimant alleges the condition arose out of service, this particular factor will not apply for material contribution or aggravation under subsection 10(2). The drafting therefore creates an evidentiary bifurcation: the factor is aimed at pre‑existing or pre‑dated disease materially worsened by lack of management during service exposure, not disease caused by service.

Fourth, the instrument does not state what constitutes “appropriate clinical management”. That phrase will be a locus of contention. The Statement leaves decisions about what is “appropriate” to medical judgment and to the assessment of medical evidence in the claims process. Practitioners and decision makers must therefore produce or seek medical opinion evidence that states whether proposed or attempted management met relevant clinical standards, and whether access was realistically prevented. The instrument itself provides no list of accepted treatments or access standards.

Compliance, in the context of this Statement, means assembling and presenting the medical and service evidence required by the instrument so that decision makers can determine whether the statutory factor exists and whether it is related to the person’s relevant service as required by section 10. The instrument identifies specific evidentiary anchors; compliance steps should therefore be data‑driven and document‑oriented.

1. Establish the statutory diagnosis using the Statement’s definition. Provide imaging and clinical records demonstrating anterior wedging of at least 5 degrees in one or more consecutive thoracic or thoracolumbar vertebrae, and evidence of clinical manifestations,postural deformity and/or subacute thoracic pain,so that the condition can be assessed against the statutory elements in subsection 7(2). Do not rely solely on an ICD code. The Statement instructs that the operative meaning is the statutory text, not the code alone (subsection 7(3)).

2. Prove the timing of onset and permanence under the Schedule’s clinical worsening definition. The Schedule frames clinical worsening as the backwards period from (a) the date of presentation to a registered medical practitioner first confirming the signs/symptoms to (b) the date at which signs/symptoms were permanently present, as assessed by a registered medical practitioner. To meet this, collate contemporaneous medical records showing the date of first confirmation by a registered medical practitioner and any assessments indicating when signs became permanent. If possible, obtain practitioner statements that explicitly address these two dates and the assessment of permanence because the Schedule makes practitioner confirmation and assessment the operative evidence.

3. Document inability to obtain appropriate clinical management. Because the sole required factor is inability to obtain appropriate clinical management before clinical worsening, compliance requires evidence about access to care. Gather appointment logs, referral letters, waitlist records, correspondence with medical facilities, evidence of refused treatment, proof of geographic or service‑related barriers, or other administrative records showing attempts to obtain care and the reasons care was not appropriately delivered in the relevant timeframe. Obtain medical opinions stating that the management sought was clinically appropriate and would have plausibly prevented clinical worsening had it been delivered. Remember that the Statement does not define “appropriate clinical management”; clinical expert evidence will therefore be necessary to establish both appropriateness and the causal import of not receiving it.