Statement of Principles concerning Scheuermann’s disease (kyphosis) (Reasonable Hypothesis) (No. 45 of 2025)

The instrument is short and builds on a few discrete legal-medical concepts. Each concept appears in the body or the Schedule and is the operative language for claim evaluation.

• Statement of Principles and statutory authority. The RMA determines SOPs under s 196B(2) of the VEA (s 3). The SOP records the RMA’s view that “there is sound medical-scientific evidence” that the disease and death from it can be related to relevant service (s 8). That formulation indicates the SOP’s role as a medical-scientific basis used in statutory claims processes.

• Operative clinical definition. Scheuermann’s disease (kyphosis) is defined in s 7(2) by structural criteria (necrosis and regeneration in growth centres of thoracic or thoracolumbar vertebrae; anterior wedging of at least 5 degrees in one or more consecutive vertebrae) and clinical manifestations (postural deformity and/or subacute thoracic pain). The SOP excludes postural kyphosis (s 7(2)(c)). The instrument notes that, although the ICD‑10‑AM code M42.0 is associated with the condition, the legal meaning for claims is the SOP text (s 7(3)-(4)).

• Reasonable hypothesis and required factors. The SOP uses the operational test “reasonable hypothesis” and prescribes the minimum evidentiary factors that must exist to establish that test for this condition (s 9). The two enumerated factors are: engaging in strenuous physical activity for the five years before clinical worsening (s 9(1)); and inability to obtain appropriate clinical management for the disease before clinical worsening (s 9(2)). The instrument includes a non-exhaustive explanatory note on what “strenuous physical activity” can include, giving examples such as weightlifting, skiing, rugby, bricklaying and construction (note to s 9(1)).

• Temporal concept of clinical worsening. The Schedule defines “clinical worsening” as a backward-looking point in time from the date a registered medical practitioner first confirms signs or symptoms, to the date at which the signs or symptoms were permanently present, as assessed by a registered medical practitioner (Schedule 1, definition of “clinical worsening”). The SOP therefore embeds a particular timing rule for the worsening factors.

• Relevant service categories. The Schedule defines “relevant service” to include the categories under the VEA (operational, peacekeeping, hazardous, British nuclear test defence service) and the MRCA (warlike service and non-warlike service) (Schedule 1, definition of “relevant service”).

• Death and terminal events. The SOP treats death from Scheuermann’s disease as included where a terminal event or condition was contributed to by the person’s Scheuermann’s disease (s 7(5)). “Terminal event” is defined in the Schedule and includes conditions such as pneumonia, respiratory failure, cardiac arrest and cessation of brain function (Schedule 1).

• Interaction with other SOPs. If a factor in s 9 refers to an injury or disease that is the subject of another SOP, that other SOP applies as in force from time to time (s 11).

These core concepts determine what needs to be alleged and proved, and shape the type and timing of medical and non-medical evidence that will be relevant in a claim.

The instrument applies to claims made under specific statutory provisions. The Application section states that the SOP applies to a claim to which section 120A of the VEA or section 338 of the MRCA applies (s 5). Those cross-references mean the SOP is engaged in the statutory claims regimes governed by the VEA and the MRCA; the instrument itself does not set out benefit entitlements, administrative decision-making procedures, or payers, but it provides the medical criteria used within those claims frameworks.

Directly affected persons are therefore claimants who invoke Scheuermann’s disease (kyphosis) or death from it in proceedings or applications that fall within the statutory scopes of s 120A of the VEA or s 338 of the MRCA (s 5). The Schedule’s definition of “relevant service” (Schedule 1) identifies which kinds of service are relevant to the SOP: operational service, peacekeeping service, hazardous service and British nuclear test defence service under the VEA, and warlike and non-warlike service under the MRCA. Any person whose service falls into those statutory categories, and who claims Scheuermann’s disease or death from it, will be subject to this SOP’s medical criteria.

Administratively, the Repatriation Medical Authority is the body making the instrument (s 3). The SOP’s contents will be used by decision-makers applying the VEA and MRCA statutory provisions; the instrument itself does not name those decision-makers, nor does it specify procedures or evidentiary rules beyond the factors and definitions it provides (s 5, s 9, Schedule 1).

Practitioners representing claimants or respondents need to note that the SOP requires at least one prescribed factor to exist before a reasonable hypothesis can be said to be raised (s 9). That places evidentiary burdens on claimants to produce medical and non-medical evidence aligned with the SOP’s factors and definitions, such as clinical records establishing dates of presentation and permanent presence of signs for the “clinical worsening” concept (Schedule 1).

Finally, if a factor invoked refers to an injury or disease already covered by another SOP, then that other SOP applies (s 11). That linkage affects how multi-morbidity or comorbid injuries are argued and which medical statements are relied upon.

This instrument creates no statutory duties or rights in the sense of criminal offences or private law obligations. Instead, it operates as a medical-scientific statement that guides the operation of statutory claims. The key operative effects for duties and rights in the claims context are implicit in how the SOP sets thresholds and definitions used by the VEA and MRCA claims processes.

Rights affected

• Right to have a reasonable hypothesis considered under the statutory claim processes that reference the SOP. The SOP specifies the minimum factors that must exist to raise a reasonable hypothesis linking Scheuermann’s disease or death from it to relevant service (s 9). Claimants have the right to rely on the SOP’s definitions and factors when advancing such a hypothesis in claims under s 120A of the VEA or s 338 of the MRCA (s 5).

Duties and evidentiary expectations

• Duty on the claimant to adduce evidence matching the SOP’s factors. Because the SOP requires that “at least one” of the listed factors must exist before a reasonable hypothesis is raised (s 9), claimants will need to provide evidence that a factor is present. The SOP’s Schedule defines what is meant by “clinical worsening” and “relevant service”, so medical records and service records will be necessary to establish temporal and service-related elements (Schedule 1).

• Duty to show the factor is related to relevant service. Section 10(1) requires that any factor relied upon must be related to the person’s relevant service. The SOP thereby imposes an evidentiary requirement to connect the factor to the specific kind of service listed in the Schedule.

• Limitation on application of worsening factors. Section 10(2) circumscribes the class of claims for which the “worsening” factors apply: they are confined 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. Practically, that rule requires claimants to demonstrate the disease’s chronology relative to service and whether the claim is framed as aggravation rather than primary causation.

Interaction with other SOPs

• Duty to consult and apply other SOPs when relevant. Section 11 states that if a factor in s 9 refers to an injury or disease covered by another SOP, that other SOP applies. Parties must therefore identify any overlapping SOPs and ensure the correct SOP factors are invoked.

Procedural rights and duties under VEA and MRCA

• The SOP does not itself set appeal or review rights. Those remain the province of the VEA and MRCA provisions to which the SOP applies. The SOP provides the medical-scientific predicate used in those statutory decision-making and review processes.

In short, the SOP allocates the evidentiary tasks: it specifies what must be shown medically and temporally to establish a reasonable hypothesis in claims that invoke Scheuermann’s disease or death from it under the referenced statutory provisions, but it does not itself create or alter statutory entitlement rules beyond supplying the medical criteria.

The Statement of Principles is an administrative medical instrument and does not create criminal offences, civil penalties, or direct enforcement mechanisms within its text. There are no penalty provisions, fines, or enforcement sanctions specified in the instrument. Its regulatory effect is functional: it provides the medical-scientific criteria applied within the claims regimes of the VEA and the MRCA.

How the instrument operates in enforcement terms is therefore indirect and procedural. The SOP sets the conditions for raising a “reasonable hypothesis” that the disease or death is related to relevant service (s 9). The SOP’s criteria will be applied by the decision-making processes established under the VEA and MRCA when considering entitlement to benefits, compensation, rehabilitation or related outcomes tied to those statutes. Any enforcement,such as the granting, refusal, review or appeal of benefits,flows from the statutory mechanisms of the VEA and MRCA, not from the SOP itself. The instrument identifies the statutory hooks explicitly: it applies to claims to which s 120A of the VEA or s 338 of the MRCA apply (s 5).

Because the SOP prescribes evidentiary factors and defines terms such as “clinical worsening”, it shapes what evidence is material and thereby affects administrative determinations. Practical enforcement consequences include:

• Acceptance or rejection of a claimant’s connection-of-cause arguments based on whether at least one factor is established and related to relevant service (s 9, s 10).

• Reliance on the SOP’s definitions and cross-references when a factor implicates another medical condition covered by a separate SOP (s 11).

• Use of the SOP’s definition of death from Scheuermann’s disease for cases where a terminal event was contributed to by the condition (s 7(5) and Schedule 1).

The instrument itself does not prescribe how assessors are to evaluate evidence, nor does it provide procedural or penalty rules for false claims or non-compliance. Those matters remain with the VEA and MRCA frameworks and the administrative law processes that govern decisions made under them.

The SOP is expressly situated within the VEA and MRCA statutory frameworks. The instrument is made under subsection 196B(2) of the VEA (s 3), and it applies to claims covered by s 120A of the VEA or s 338 of the MRCA (s 5). Those cross-references determine where the SOP will be invoked in law.

Interaction with the VEA and MRCA

• The SOP provides the medical-scientific basis used when decision-makers apply the statutory tests in the VEA and MRCA provisions specified. The SOP does not alter the substantive statutory entitlements in those Acts; rather, it specifies the medical conditions and factors that constitute a “reasonable hypothesis” of service connection for Scheuermann’s disease in the context of claims processed under the cited sections.

• The Schedule’s definition of “relevant service” mirrors the categories used across the two statutes. It identifies operational, peacekeeping, hazardous and British nuclear test defence service under the VEA, alongside warlike and non-warlike service under the MRCA (Schedule 1). The SOP therefore slots into the established statutory categories that define eligible service for claims.

Interaction with other Statements of Principles

• Section 11 provides explicit interaction rules where a factor in s 9 refers to an injury or disease for which a separate SOP exists. In such cases the other SOP applies “in accordance with the terms of that Statement of Principles as in force from time to time.” That language establishes a hierarchy or sequencing rule: overlapping issues are to be resolved through the specific SOP relevant to the referenced injury or disease, as that SOP stands at the time.

Use of ICD coding and clinical definition

• The SOP notes the association with ICD‑10‑AM code M42.0, but makes clear that the operative definition for claims is the textual clinical definition in subsection 7(2) (s 7(3)-(4)). That choice limits the legal effect of external classification systems to a referential role; the SOP establishes its own definitional standard regardless of coding schemes.

Temporal scope and repeal

• The instrument repeals the earlier 2016 SOP for Scheuermann’s disease (s 4). Any claims falling under the statutory sections specified from the Commencement date will engage the new SOP rather than the prior instrument.

Matters outside the SOP

• The instrument does not address administrative procedures such as evidentiary rules, review rights, appeal mechanisms, or provision of benefits. Those remain governed by the VEA, MRCA and associated regulations and administrative law. The SOP therefore interacts with other laws by supplying medical criteria and definitions that feed into the statutory decision-making and review processes.

In sum, the SOP provides a definitional and evidentiary input into the statutory schemes of the VEA and MRCA, interacts with other SOPs through express cross-reference, and consciously displaces the prior 2016 SOP from its operative role after commencement.

This Statement of Principles is a discrete instrument that records a replacement of an earlier SOP. The instrument is dated 15 April 2025 and commences on 19 May 2025 (cover page and s 2). Section 4 expressly repeals the Statement of Principles concerning Scheuermann’s disease No. 75 of 2016 (Federal Register of Legislation No. F2016L01344), which had been made under the same subsection of the VEA (s 4). The instrument does not itself contain any transitional or savings provisions; the text simply records repeal.

No other amendments, variations or savings are noted within the instrument. The instrument’s Schedule includes the definitions that are current in this Statement of Principles; any changes to those definitions would require a further SOP determined under subsection 196B(2) of the VEA. Section 11 contemplates that other SOPs may be “in force from time to time”, indicating that future SOPs on other conditions may change the applied framework where factors in this instrument refer to those other conditions.

Because the SOP is made under the statutory power in subsection 196B(2) of the VEA, any future amendments, replacements or repeals will also be effected by instruments made under that authority. The instrument itself does not provide a history of earlier amendments beyond the single repeal identified. For practitioners this means that the operative medical criteria for Scheuermann’s disease are those in this 2025 instrument from 19 May 2025 forward, and that historical claims must be checked against the SOP that was in force at the relevant dates if chronology matters.

The instrument contains no references to litigation, court decisions, tribunal determinations or judicial construction of the SOP itself. It does not cite any case law. The Repatriation Medical Authority records in s 8 that it is of the view there is “sound medical-scientific evidence” relating the condition to relevant service, but the instrument does not translate that view into or cite any judicial findings.

Because the SOP is an administrative medical statement rather than a statute, its legal standing in dispute resolution will be as a material source of medical-scientific criteria applied under the VEA and MRCA processes. The text contains no litigation history, no mention of appeals or challenges to the prior 2016 SOP, and no guidance on how courts or tribunals should treat the SOP beyond the statutory cross-references that bring it into play. Practitioners seeking litigation-relevant history will therefore need to consult decisions under the VEA and MRCA schemes outside this document; nothing in the instrument itself provides that material.

This instrument contains a number of drafting specifics that can catch claimants, their representatives and decision-makers if not attended to closely. The following matters are grounded in the instrument text and require practical attention.

• Minimum factor requirement. The SOP requires that “at least one” of the listed factors must exist before a reasonable hypothesis can be said to be raised (s 9). Having multiple factual assertions about service or clinical course will not substitute for meeting one of the enumerated factors. Practitioners must match evidence to the listed factors, not to general claims of increased pain or dysfunction.

• Temporal construct of “clinical worsening”. The Schedule defines “clinical worsening” as a point backwards in time running from the date of presentation to a registered medical practitioner first confirming signs or symptoms, to the date at which signs or symptoms were permanently present (Schedule 1). That backward-looking construct means the claimant must establish both the date of first medical confirmation and the date of permanent presence of signs to fix the relevant five‑year window for the “strenuous physical activity” factor. Missing or imprecise clinical records on dates of first confirmation or permanence will complicate applying the five-year window.

• Narrow scope of “worsening” factors. Section 10(2) restricts the “worsening” factors to claims of material contribution or aggravation where the disease was suffered or contracted before or during, but did not arise out of, the person’s relevant service. This limitation can be easily overlooked. If a claimant alleges that the disease “arose out of” service, the worsening factors in s 9 may not be the correct analytical route. Careful pleading and evidence of the disease chronology relative to service is therefore essential.

• Definition takes precedence over ICD code. The instrument notes the ICD‑10‑AM code M42.0, but expressly states that in applying the SOP the meaning is that given in subsection 7(2) (s 7(3)-(4)). As a result, mere recitation of an ICD code in medical records will not automatically satisfy the SOP; the specific clinical criteria (anterior wedging of at least 5 degrees, etc.) must be demonstrated.

• Ambiguity in “inability to obtain appropriate clinical management”. The second factor in s 9(2) is expressed as inability to obtain appropriate clinical management before clinical worsening. The SOP does not provide a precise statutory test or standards for “appropriate clinical management”. The note on clinical worsening gives timing guidance but does not define “appropriate”. This leaves scope for dispute about what constitutes appropriate care and what evidence will prove inability to obtain it. Documentary evidence of referrals, wait times, geographic remoteness, or systemic barriers will be material, but the SOP provides no prescriptive checklist.

• Cross-application to other SOPs. Section 11 requires that if a factor refers to a disease covered by another SOP, that other SOP applies. This can create complexity where multiple conditions or injuries are invoked. Parties must identify whether a referenced injury or disease has its own SOP and then apply its terms as in force, which may change over time.

• Death and terminal event causation. The SOP includes death from Scheuermann’s disease where a terminal event was contributed to by the disease (s 7(5)). Terminal events are defined broadly to include pneumonia, respiratory failure, cardiac arrest, circulatory failure and cessation of brain function (Schedule 1). Establishing that the disease “contributed to” a terminal event requires medical causation evidence tying the disease to the proximate or ultimate cause of death.

• Repeal timing. The 2016 SOP is expressly repealed (s 4). If a claim spans periods before and after commencement, practitioners must be careful which SOP’s tests apply at the relevant decision dates. The instrument does not include express transitional rules in the text.

Being attentive to these drafting specifics will shape how evidence is framed, which expert opinions are sought, and how timelines are established in claims.

The SOP’s operative requirements set out what evidence and procedural steps are likely necessary to raise a reasonable hypothesis connecting Scheuermann’s disease or death from it to relevant service for claims to which s 120A of the VEA or s 338 of the MRCA apply (s 5). The following tasks are grounded in the instrument’s definitions and factors.

1. Confirm the diagnosis against the SOP definition (s 7(2))

• Secure medical imaging and clinical records that evidence anterior wedging of at least 5 degrees in one or more consecutive vertebrae and records of the clinical manifestations identified in s 7(2), namely postural deformity and/or subacute thoracic pain.
• Note that although the ICD‑10‑AM code M42.0 is referenced, the SOP requires the textual definition. Confirm the treating practitioner’s records explicitly address the structural and symptomatic criteria in s 7(2) (s 7(3)-(4)).

2. Fix the relevant dates using the “clinical worsening” construct (Schedule 1)

• Obtain the date of first presentation to a registered medical practitioner who first confirmed the signs and/or symptoms, and obtain clinical assessments that identify the date at which the signs and/or symptoms were permanently present.
• Use those dates to calculate the backward-looking point and to establish the five-year window for the “strenuous physical activity” factor (s 9(1); Schedule 1 definition of “clinical worsening”).

3. Assemble evidence for the enumerated factors (s 9)

• Strenuous physical activity factor: Collect contemporaneous records showing sustained, repetitive strenuous activity in the five years before clinical worsening. Examples the SOP provides include competitive or high-load sports (weightlifting, skiing, rugby) and manual occupations (bricklaying, construction). Evidence can include employment records, training logs, rosters, declarations, photographs, or witness statements that demonstrate the nature, intensity and duration of the activity (s 9(1) and note).
• Inability to obtain appropriate clinical management factor: Obtain records showing attempts to access care, referral pathways, waiting lists, correspondence, geographic or logistical constraints, and any contemporaneous clinical notes indicating delayed or absent management prior to clinical worsening (s 9(2)). Because the SOP does not define “appropriate clinical management”, thorough documentary evidence is advisable.

4. Link the factor to the person’s relevant service (s 10(1) and Schedule 1)

• Produce service records to show the claimant’s category of relevant service as defined in the Schedule (operational, peacekeeping, hazardous, British nuclear test defence service under the VEA; warlike or non-warlike service under the MRCA).
• Demonstrate how the factor relied on was related to the service. For example, if alleging strenuous physical activity, show that the activity was part of or a consequence of the relevant service period, training or role.

5. Distinguish aggravation from primary causation where necessary (s 10(2))

• If advancing a material contribution or aggravation argument, ensure the disease was suffered or contracted before or during, but did not arise out of, relevant service, as required by s 10(2). If the claim alleges the disease arose out of service, do not attempt to rely on the “worsening” factors as the primary route without addressing the textual limitation.

6. If a factor refers to another condition, identify the other SOP (s 11)

• Check whether any injury or disease referenced in the factor is the subject of another SOP. If so, apply that SOP’s terms as in force, and obtain the relevant medical evidence and expert opinion aligned to that SOP’s criteria.

7. Where death is claimed, obtain medicolegal causation evidence (s 7(5) and Schedule 1)

• For death claims, obtain a cause of death certificate, autopsy or coroner’s findings where applicable, and medical opinions that address whether the decedent’s Scheuermann’s disease contributed to the terminal event. Use the Schedule’s terminal event list to guide evidence collection.

8. Expert evidence and opinion

• Retain registered medical practitioners or specialists who can opine against the SOP’s definitional elements and on the connection between the enumerated factors, clinical worsening and relevant service. Experts should address the SOP’s text directly, including timing, structural criteria, and whether inability to obtain appropriate management was present.

9. Document chronology and contemporaneous attempts to obtain care

• Because the SOP uses time-sensitive constructs, contemporaneous clinical notes, referrals, correspondence and service records are crucial. Where records are incomplete, statutory presumptions or secondary evidence under the VEA/MRCA regimes may be relevant, but the SOP itself requires factual foundations matching its definitions.

10. Be alert to repeal and version timing

• The 2016 SOP has been repealed and replaced by this 2025 SOP (s 4). Confirm which SOP was in force at the relevant date for the claim, and frame evidence and pleadings accordingly.

Following these steps will align evidence to the SOP’s textual requirements rather than to general assertions of service connection. The SOP’s narrowly defined factors and timing rules mean precision in documenting dates, activities, clinical findings and attempts to secure care is central to raising the reasonable hypothesis the instrument requires.