Statement of Principles concerning sprain and strain (Balance of Probabilities) (No. 28 of 2020)

The Statement rests on discrete, interlocking concepts: legally operative definitions of sprain and strain; an evidentiary standard; enumerated causal factors; the temporal relationship between event and clinical onset or worsening; the requirement that factors be related to relevant service; and interaction rules when other Statements of Principles cover the same injury or disease.

Definitions and timing: Sprain is defined as tearing or stretching of one or more joint ligaments, and strain as tearing or stretching of a muscle or tendon, with either condition requiring the onset of pain and tenderness at the site within 24 hours following the injury (s 7(2)(a), 7(3)(a)). Each definition expressly includes complete tear or rupture (s 7(2)(b), 7(3)(b)). Each definition contains an exclusion: sprain excludes recurrent sprain due to joint instability, and strain excludes drug‑induced disease of tendons or muscles (s 7(2)(c), 7(3)(c)). Death from sprain or strain is incorporated where a terminal event or condition was contributed to by the sprain or strain (s 7(4)); the Schedule lists particular terminal events (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function).

Evidentiary posture: The instrument states the Authority’s view on the sound medical‑scientific evidence available, that it is more probable than not that sprain or strain (and resulting death) can be related to relevant service (s 8). This establishes the balance of probabilities standard which governs how the Statement will be applied to claims under the VEA/MRCA referral points identified in s 5.

Causal factors and temporal specification: Section 9 requires at least one enumerated factor to be present before a connection on the balance of probabilities can be established. The factors are event‑driven and temporally specific: they require significant physical force applied to/through the affected joint or forceful stretching/high intensity use of a muscle/tendon at the time of clinical onset or clinical worsening (s 9(1)-(4)). The Statement separately lists inability to obtain appropriate clinical management as a factor (s 9(5)). The instrument’s Notes provide examples of activities constituting significant physical force or high intensity use but are illustrative rather than prescriptive.

Relationship to service and prior conditions: Section 10 requires that the factor(s) exist in relation to the person’s relevant service (s 10(1)). Subsections 9(3)-9(5) (factors dealing with clinical worsening or inability to obtain appropriate care) are expressly limited to cases where the person’s sprain or strain was suffered or contracted before or during, but did not arise out of, their relevant service (s 10(2)). That is, these factors are intended to cover material contribution or aggravation of pre‑existing sprain/strain in particular circumstances.

Interaction with other Statements of Principles: Section 11 establishes that where a factor in s 9 refers to an injury or disease covered by another Statement of Principles made under subsection 196B(3) of the VEA, then the factors in that other Statement apply according to its terms, as in force from time to time. This supplies a cross‑reference mechanism so that overlapping conditions are determined under the relevant SOP.

Scope of “relevant service”: The Schedule defines “relevant service” narrowly to the enumerated categories (eligible war service other than operational service; defence service other than hazardous service and British nuclear test defence service; peacetime service under the MRCA). Those exclusions matter for whether a factor can be said to be related to relevant service per s 10(1).

Taken together, the instrument is structured to convert discrete clinical events, temporally verified symptoms and particular service types into the threshold evidence the Authority will treat as sufficient to establish a service connection on the balance of probabilities. Its operation is mechanistic: definitions, required timing, enumerated factors, linkage to relevant service, and cross‑application rules.

Primary affected parties are threefold: claimants (veterans and members of the Forces who assert entitlement under the VEA or MRCA), medical practitioners and treating clinicians who supply clinical records and expert opinions, and the decision‑makers and administrators who process VEA/MRCA claims and apply Repatriation Medical Authority Statements of Principles.

Claimants and potential claimants. The Statement applies to claims to which section 120B of the VEA or section 339 of the MRCA applies (s 5). While the instrument does not set out the content of those statutory claim pathways, it effectively prescribes the causal criteria claimants must meet for sprain, strain or death from those conditions to be considered connected with relevant service. Claimants whose circumstances or records do not align with the timing and factor requirements (for example, no record of pain/tenderness within 24 hours, or no identifiable significant physical force event) will face evidentiary gaps in meeting the Statement’s threshold. Also, the Schedule’s definition of “relevant service” restricts the categories of service that can be relied upon: eligible war service except operational service, defence service except hazardous and British nuclear test defence service, and peacetime service under the MRCA. Individuals whose service falls outside those categories cannot rely on this Statement to establish a service connection.

Clinicians and medical record‑keepers. The definitions in s 7(2)-(3) make contemporaneous clinical findings relevant: onset of pain and tenderness within 24 hours is a condition of the definition. Clinicians’ documentation of symptoms, timing, mechanism of injury (falls, collisions, lifting, etc.), and management will therefore be consequential. The instrument also recognises inability to obtain appropriate clinical management as a factor (s 9(5)); clinicians and health administrators may be called upon to document attempts or failures to obtain care.

Decision‑makers and administrators. The Repatriation Medical Authority has issued the Statement under its subsection 196B(3) power (s 3), and administrators applying the VEA/MRCA claim provisions referenced in s 5 will use the Statement as the medical standard for sprain and strain claims. The instrument requires assessment against the balance of probabilities standard and the specified factors; decision‑makers must verify that at least one s 9 factor exists and that it is related to the person’s relevant service per s 10. The instrument also requires consideration of whether a factor refers to an injury/disease covered by another SOP, in which case that other Statement’s factors apply (s 11).

Other indirectly affected parties include legal representatives and expert witnesses. Lawyers preparing claims or advising on entitlement will need to map clinical histories to the narrow definitions and factors in this Statement. Expert medical witnesses will be asked to opine specifically on whether an event satisfies “significant physical force” or “forceful stretching/high intensity use” and whether symptoms began within 24 hours, as required by s 7 and s 9.

Finally, the instrument affects the body of precedential SOPs that structure VEA/MRCA medical causation assessments. It replaces SoP No. 95 of 2011 (s 4), so any ongoing claims or adjudicative materials that previously relied on the 2011 Statement will need to be reconciled with the 2020 Statement where applicable.

This Statement itself does not create novel statutory duties or criminal penalties. It functions as a determinative medical standard the Repatriation Medical Authority has issued under its statutory power. Nevertheless, the instrument creates clear procedural obligations for claim assessment and describes the rights of the Authority to adopt its medical‑scientific view.

Obligations on decision‑makers: Administrators and decision‑makers assessing claims under the VEA or MRCA pathways specified in s 5 must apply the Authority’s Statement when determining whether sprain, strain or death from those conditions is connected with relevant service. The instrument prescribes that “at least one of the following factors must exist before it can be said that, on the balance of probabilities, sprain or strain or death from sprain or strain is connected with the circumstances of a person’s relevant service” (s 9(1) preamble). That language sets a threshold evidentiary duty: verify presence of at least one enumerated factor and that it is linked to relevant service (s 10(1)). Decision‑makers must also observe the temporal constraints: the specified factors must coincide with clinical onset or clinical worsening as defined (s 9(1)-(4), s 7).

Duty to consider interactions with other SOPs: If a s 9 factor references an injury or disease covered by another Statement of Principles, the decision‑maker must apply the factors in that other Statement as in force (s 11). This creates a duty to identify overlapping SOPs and follow their terms instead of or in addition to the current Statement.

Documentation and evidential expectations placed on clinicians and claimants: In practical terms, to meet the Statement’s conditions claimants should ensure the medical records substantiate the timing (pain and tenderness within 24 hours), the nature of the event (significant physical force or forceful stretching/high intensity use), and the relationship of that event to their relevant service as defined in the Schedule (s 7, s 9, s 10). Where a claimant alleges inability to obtain appropriate clinical management (s 9(5)), evidence of attempts to obtain care, system failures or lack of access will be pertinent.

Authority’s evidentiary position and right to set medical standard: Section 8 records the Authority’s view, based on sound medical‑scientific evidence, that it is more probable than not that sprain or strain and death from those conditions can be related to relevant service. This is an exercise of the Authority’s statutory function under s 196B(3) of the VEA (s 3). The Authority thereby establishes the medical-legal standard that tribunals and decision‑makers will use in assessing causal connection for the conditions within this Statement’s scope.

Limitations and exclusions as operative constraints: The instrument places operative limits on what fall within the terms “sprain” and “strain.” Recurrent sprain due to joint instability is excluded (s 7(2)(c)). Drug‑induced disease of tendons or muscles is excluded for strain (s 7(3)(c)). The Schedule narrows “relevant service” to certain categories (Schedule 1). Those exclusions impose substantive constraints on claim rights: if the claimant’s condition falls within an exclusion, the Statement does not support a finding of service connection for that condition under this instrument.

No penal or enforcement provisions included: The instrument does not create enforcement mechanisms or penalties; it provides criteria for the assessment of connection between injury/disease and service. Any sanctions, administrative consequences or appeal pathways would be those provided under the VEA, MRCA or associated administrative processes, which are not detailed in this Statement.

The Statement is a non‑punitive, medical‑causal instrument and does not prescribe criminal or civil penalties, fines or enforcement mechanisms in its text. It functions as the Repatriation Medical Authority’s Statement of Principles under subsection 196B(3) of the Veterans’ Entitlements Act 1986 (s 3), establishing criteria for determining whether sprain, strain or death from those conditions can be related to relevant service on the balance of probabilities (s 8-9). It does not itself set out adjudicative remedies, administrative sanctions, compliance inspections or enforcement procedures.

Operational enforcement is indirect: the practical effect of the Statement is to govern the medical standard used by decision‑makers when adjudicating claims referenced in s 5 (those to which section 120B of the VEA or section 339 of the MRCA applies). If a decision‑maker adheres to this Statement when evaluating medical causation, the Statement will influence entitlement outcomes under those statutory schemes. The Statement’s role is therefore evidentiary and determinative in assessing causation; it does not, on its face, provide for penalties for non‑compliance by claimants, clinicians or administrators.

Administrative accountability and review processes for adverse decisions are not specified in the instrument. Any administrative enforcement, review, internal reconsideration or merits or judicial review procedures are governed by the VEA, MRCA or other relevant statutes and regulations, not by this Statement. The Statement itself does not expand or limit those processes in its text.

Because the Statement narrows or specifies the medical criteria (for example, insisting on documented onset of pain/tenderness within 24 hours, s 7(2)(a), 7(3)(a), and requiring at least one s 9 factor), claimants who cannot establish those elements will find that adjudicators relying on this Statement may decline to find the required service connection. The practical consequence is a denial of entitlement under the statutory scheme, not a penalty imposed by the Statement itself.

In sum, the instrument contains no enforcement or penalty clauses. Its effect is to supply a medical causation standard that shapes entitlement determinations under VEA/MRCA claim processes; any enforcement, penalties or review mechanisms are located in those statutes and in the administrative processes that implement them.

The Statement is an instrument made under subsection 196B(3) of the Veterans' Entitlements Act 1986 (s 3). Its legal working relationship with other laws is primarily as a medical standard used in determining compensatory or entitlements claims under the VEA and MRCA regimes. The instrument explicitly applies to claims to which section 120B of the VEA and section 339 of the MRCA apply (s 5). The text does not restate or alter substantive entitlement rules in the VEA or MRCA; rather, it prescribes the medical criteria decision‑makers should apply when assessing causal connection for sprain and strain within those statutory claim routes.

Repeal and replacement: The Statement repeals an earlier Statement of Principles concerning sprain and strain No. 95 of 2011 (s 4). That repeal means, from its commencement date (25 May 2020, s 2), adjudicators should apply this 2020 Statement instead of the 2011 Statement when evaluating relevant claims. Any statutory or regulatory processes referencing the now‑repealed Statement will reference this instrument for sprain/strain causation criteria going forward.

Cross‑Statement interaction: Section 11 provides a specific mechanism for interaction with other Statements of Principles. If a s 9 factor in this Statement refers to an injury or disease covered by another Statement made under subsection 196B(3) of the VEA, then the factors in that other Statement apply in accordance with that Statement’s terms as in force from time to time (s 11). This requires decision‑makers to identify overlapping SOPs and to apply the applicable Statement’s factors, creating a hierarchy or cross‑reference regime where multiple SOPs can interact.

Limits set by definitions and exclusions: The Schedule defines “relevant service” narrowly and excludes certain service types (for example, operational service within eligible war service; hazardous service and British nuclear test defence service within defence service), which limits the population and circumstances to which the Statement can be applied (Schedule 1). Parties and adjudicators must therefore align the service type relied upon with the Schedule’s categories when invoking this Statement in a claim. If relevant service per the Schedule is not established, the Statement’s criteria cannot be used to establish service connection.

No express amendments to VEA/MRCA substantive law: The Statement does not amend or purport to override substantive provisions of the VEA or MRCA. It operates as a subordinate instrument clarifying the medical causal test for particular conditions, to be used within the statutory framework of those Acts. Any substantive rights, remedies, or appeal avenues remain those set out in the VEA, MRCA and applicable administrative law, which are not altered in the Statement.

Administrative application and evidentiary effect: The Statement’s role in the legal ecosystem is to supply an evidentiary standard that administrative decision‑makers should use when considering whether the medical facts satisfy the causal connection necessary under the statutory schemes. Where another legal instrument, SOP or statute provides overlapping coverage, s 11 requires the other SOP’s factors to be applied in accordance with its terms. The Statement, therefore, interacts with other laws and instruments by providing a fixed medical benchmark for causation that decision‑makers are to apply in conjunction with the statutory processes and any other relevant SOPs.

The document itself records a limited amendment history within its text. It is the Statement of Principles concerning sprain and strain (Balance of Probabilities) (No. 28 of 2020) and is dated 24 April 2020, with commencement on 25 May 2020 (s 1, s 2). The Statement expressly repeals the prior Statement of Principles concerning sprain and strain No. 95 of 2011 (Federal Register of Legislation No. F2011L01727) (s 4). There are no other amendments, schedules of amendment, or transitional provisions included in the instrument.

Because the instrument is a stand‑alone Statement issued under subsection 196B(3) of the VEA (s 3), any future changes to its text would be effected by the Repatriation Medical Authority by issuing a new Statement under the same statutory power, or by amending or repealing it in similar fashion. The instrument contains a provision (s 11) to accommodate the operation of other Statements of Principles as they may be “in force from time to time,” which anticipates that SOPs are periodically updated and that this Statement must be applied together with other SOPs where appropriate.

The Schedule specifically defines MRCA and VEA and lists the components of “relevant service” as applicable from the instrument’s commencement. The instrument does not include retrospective amendment clauses or transitional rules for claims made before its commencement date; it simply repeals the 2011 Statement, signalling that decisions made from 25 May 2020 should apply the 2020 Statement. The text does not set out how outstanding or in‑progress claims are to be transitioned; therefore practitioners will need to examine the administering statutory scheme (VEA or MRCA) for any procedural rules about application of superseding SOPs to pending claims.

In short, the immediate amendment history recorded in the instrument is a single, explicit repeal of the 2011 Statement and the establishment of the 2020 Statement with the stated commencement date. No other amendment entries, revision notes or historical iterations are included in the provided text.

The instrument file contains no litigation history. It is a Statement of Principles issued by the Repatriation Medical Authority under subsection 196B(3) of the Veterans' Entitlements Act 1986 (s 3). The text does not reference any judicial decisions, administrative tribunal rulings, or challenges about its validity, nor does it list cases or precedents. The Schedule and body of the Statement contain only definitions, operative factors, exclusions, and application provisions.

If litigation has occurred or will occur about the correct interpretation or application of this Statement, that material is not present in the instrument itself. The Statement does, however, establish an evidentiary framework and definitions which will be used by decision‑makers considering claims under the VEA/MRCA pathways identified in s 5. Any legal challenges about the Statement’s interpretation, application to particular facts, or compatibility with the enabling statute would be pursued in the courts or appropriate tribunals under the statutory review mechanisms provided by the broader legislative framework; those processes and any existing judicial history are not recorded in this document.

Practitioners seeking litigation materials, judicial consideration of similar SOPs, or precedential authority should consult tribunal and court databases and the administrative record of the VEA/MRCA decisions outside this instrument. The Statement itself contains no case law citations, no recorded appeals, and no internal notes about disputed interpretations in litigation.

1. Timing requirement: The definitions of sprain and strain require onset of pain and tenderness at the injured site within 24 hours following the injury (s 7(2)(a), 7(3)(a)). That is an exacting temporal threshold. Clinical records that do not document symptom onset within this 24‑hour window risk putting the claimant outside the Statement’s definitional scope, even where an injury event is recorded. Practitioners should not assume delayed‑onset pain entries will satisfy the definition.

2. Exclusions are operative: Sprain excludes “recurrent sprain due to joint instability” (s 7(2)(c)), and strain excludes “drug‑induced disease of tendons or muscles” (s 7(3)(c)). If the clinical history indicates chronic instability leading to recurrent sprains, or if the condition is attributable to drug‑induced tendon/muscle disease, the Statement does not support a finding of service connection for that condition.

3. Narrow list of causal factors: The instrument is explicit that at least one enumerated s 9 factor must exist for service connection to be established on the balance of probabilities (s 9(1)). The listed factors are event‑based and must coincide with clinical onset or clinical worsening (s 9(1)-(4)). Ordinary overuse or chronic degenerative processes absent a discrete significant force or high intensity use event, or absence of documented inability to obtain appropriate clinical management, may fail to satisfy the threshold.

4. “Clinical worsening” vs “arise out of”: Subsections 9(3)-9(5) apply only to material contribution to, or aggravation of, sprain or strain where the person’s sprain or strain was suffered or contracted before or during, but did not arise out of, the person’s relevant service (s 10(2)). This creates a potentially counterintuitive result: if the sprain or strain itself “arose out of” service (that is, it arose out of the relevant service as the primary event), then subsections 9(3)-(5) do not apply. Practitioners must distinguish whether the claim concerns an original service‑arising injury or a pre‑existing condition aggravated by service.

5. Link to “relevant service” is required: Any s 9 factor must be related to the person’s relevant service (s 10(1)). The Schedule’s definition of relevant service excludes certain service categories (for example, operational service within eligible war service, hazardous service, and British nuclear test defence service in the defence service limb). Claims relying on service types outside the Schedule cannot use this Statement to establish causation.

6. “Examples” in Notes are not operative law: The instrument includes Notes giving examples (falls, lifting weights, running, etc.) to illustrate significant physical force or high intensity use, but these examples do not expand the legal criteria beyond the text of s 9. Decision‑makers should be alert that examples are guidance, not exhaustive lists.

7. Death connection limited to listed terminal events: Death from sprain or strain is included only where the sprain or strain contributed to a terminal event as defined in the Schedule (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function) (s 7(4); Schedule 1). Claims that assert death from other intermediate causes will not fall within the Statement’s specified list unless the conditions in the Schedule are met.

8. Interaction with other SOPs: If a s 9 factor refers to a condition covered by another SOP, that other Statement’s factors apply as in force from time to time (s 11). Practitioners must check for overlapping SOPs and apply the other Statement’s criteria where relevant, rather than assuming this Statement alone governs causation.

9. Repeal of prior Statement: The 2011 Statement is repealed by s 4. Where a claim was prepared under the 2011 Statement, counsel should reassess evidence against the 2020 Statement’s definitions and factors to identify any gaps created by the change.

10. No penalty language: The Statement does not prescribe sanctions or penalties. Its principal effect is to set an evidentiary standard that affects entitlement determinations; it does not itself provide procedural remedies or enforcement mechanisms.

These “gotchas” tend to create evidentiary and strategic risks for claimants and advisers. The instrument channels adjudication toward short‑term, event‑centred, and well‑documented injuries and places weight on timely clinical documentation, clear linkage to the relevant category of service, and knowledge of exclusions and overlapping SOPs.

For claimants and representatives

• Align clinical evidence with the definitional timing requirements. The definitions of sprain and strain require onset of pain and tenderness at the site within 24 hours of the injury (s 7(2)(a), s 7(3)(a)). To satisfy the Statement’s criteria, obtain contemporaneous medical records or credible contemporaneous accounts (primary care notes, emergency department records, incident reports) that precisely document timing of symptom onset.

• Establish an enumerated s 9 factor. The Statement requires at least one factor in s 9 to be present (s 9(1)). Gather documentation that links the injury event to one of those factors: evidence of a significant physical force applied to the affected joint (falls, collisions, lifting, jumping; see s 9(1) and its Note), evidence of forceful stretching/high intensity use of a muscle/tendon (lifting weights, push‑ups, running; see s 9(2) and its Note), documentation of a clinical worsening that coincided with such an event (s 9(3)-(4)), or evidence that the claimant was unable to obtain appropriate clinical management (s 9(5)).

• Demonstrate relationship to relevant service. Section 10(1) requires that the s 9 factor be related to the person’s relevant service. Use service records, duty logs, exercise reports, and unit incident reports to link the event to the specific kind of relevant service identified in the Schedule. Ensure that the type of service relied upon fits within the Schedule’s definition of relevant service, which excludes certain service categories.

• Address exclusions explicitly. If there is any history of joint instability, recurrent sprains, or drug exposure causing tendinopathy, obtain expert medical opinion addressing whether the exclusion applies (sprain exclusion s 7(2)(c); strain exclusion s 7(3)(c)). If the claim concerns death, ensure the terminal event raised is one of those listed in the Schedule and that a clinician can provide an opinion about the contribution of the sprain/strain to that terminal event (s 7(4); Schedule 1).

• Consider overlapping SOPs. If the causal factor reasonably references an injury or disease covered by another Statement of Principles, identify that SOP and gather evidence aligned with that SOP’s factors (s 11). Claims involving multiple medical conditions may require synthesised medical evidence addressing each relevant SOP.

For clinicians and treating providers

• Document timing and mechanism with precision. The 24‑hour onset rule and the event‑based nature of the factors make contemporaneous recording of symptom onset, the mechanism of injury, and the immediate clinical findings critical (s 7(2)(a), s 7(3)(a), s 9). Use clear language describing the event, force involved and immediate symptoms.

• Record management attempts and access barriers. Where inability to obtain appropriate clinical management is claimed (s 9(5)), document attempts to access care, reasons for non‑access or delay, and the clinical consequences of delayed or absent treatment.

• Provide focused causation opinions. If requested to produce an expert opinion for an entitlement claim, address whether the clinical history meets the Statement’s definitions and whether a specified s 9 factor was present and related to relevant service. Address excluded causes where relevant.

For decision‑makers and administrators

• Apply the balance of probabilities standard as framed. The Authority states its view that, on the sound medical‑scientific evidence available, it is more probable than not that sprain or strain and death from those conditions can be related to relevant service (s 8). Use that posture as the threshold for applying the Statement’s factors to claims under the statutory routes named in s 5.

• Verify the presence of at least one s 9 factor and its relation to relevant service. Before finding a service connection under this Statement, ensure at least one enumerated factor is present and demonstrably linked to the person’s relevant service (s 9, s 10(1)). For clinical worsening or inability to obtain treatment factors, confirm that the underlying condition pre‑existed or was contracted before/during but did not arise out of service (s 10(2)).

• Check for other applicable SOPs. Where a s 9 factor refers to an injury/disease covered by another Statement of Principles, apply that other Statement’s factors as in force (s 11). Maintain an updated register of SOPs to identify overlaps.

• Respect exclusions and terminal event definitions. Confirm that the claimed condition does not fall within an exclusion (s 7(2)(c), s 7(3)(c)) and that any death claimed to be related to sprain/strain involves a listed terminal event with evidence of contribution (s 7(4); Schedule 1).

Practical steps and documentation checklist

• Incident documentation: date, time, mechanism, witnesses, service context linking event to relevant service category.
• Medical records: earliest presentation notes, objective findings (tenderness, swelling), imaging or surgical reports if available, documentation of onset within 24 hours.
• Treatment records: where inability to obtain care is alleged, evidence of attempts, referral rejections, geographic or administrative barriers, and clinical deterioration attributable to lack of care.
• Service records: deployment, duty logs, training records, exercise orders demonstrating the event occurred in the course of the relevant service category set out in the Schedule.
• Expert report(s): opinion addressing definitional elements (24‑hour onset, significant physical force, forceful stretching/high intensity use), exclusions, contribution to terminal events (if applicable), and whether the s 9 factor is related to relevant service per s 10(1).

By following these concrete, document‑centred steps, parties and administrators align evidentiary material with the Statement’s tight definitional and factor thresholds, thereby reducing the risk of the Statement being treated as unmet in adjudication.