Statement of Principles

concerning

RETROCALCANEAL HEEL BURSITIS
(Reasonable Hypothesis)

(No. 88 of 2024)

The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated                18 October 2024.

Professor Terence Campbell AM

Chairperson

by and on behalf of

The Repatriation Medical Authority

Contents

1 Name

2 Commencement

3 Authority

4 Repeal

5 Application

6 Definitions

7 Kind of injury, disease or death to which this Statement of Principles relates

8 Basis for determining the factors

9 Factors that must exist

10 Relationship to service

11 Factors referring to an injury or disease covered by another Statement of Principles

Schedule 1 - Dictionary

1 Definitions

1.                Name

This is the Statement of Principles concerning retrocalcaneal heel bursitis (Reasonable Hypothesis) (No. 88 of 2024).

1.                Commencement

              This instrument commences on 19 November 2024.

1.                Authority

This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.

1.                Repeal

The Statement of Principles concerning Achilles tendinopathy and bursitis (Reasonable Hypothesis) (No. 96 of 2015) (Federal Register of Legislation No. F2015L01336) made under subsection 196B(2) of the VEA is repealed.

1.                Application

This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004 applies.

1.                Definitions

The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.

1.                Kind of injury, disease or death to which this Statement of Principles relates
   1.           This Statement of Principles is about retrocalcaneal heel bursitis and death from retrocalcaneal heel bursitis.

Meaning of retrocalcaneal heel bursitis

1.           For the purposes of this Statement of Principles, retrocalcaneal heel bursitis:
   1.           means inflammation of the deep Achilles bursa located between the distal Achilles tendon and the calcaneus bone; and
   2.           excludes posterior adventitial heel bursitis.

Death from retrocalcaneal heel bursitis

1.           For the purposes of this Statement of Principles, retrocalcaneal heel bursitis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's retrocalcaneal heel bursitis.

Note: terminal event is defined in the Schedule 1 – Dictionary.

1.                Basis for determining the factors

The Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that retrocalcaneal heel bursitis and death from retrocalcaneal heel bursitis can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces under the VEA, or members under the MRCA.

Note: MRCA, relevant service and VEA are defined in the Schedule 1 – Dictionary.

1.                Factors that must exist

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting retrocalcaneal heel bursitis or death from retrocalcaneal heel bursitis with the circumstances of a person's relevant service:

1.           Running or jogging an average of at least 30 kilometres per week for the 4 weeks before clinical onset or clinical worsening;
2.           undertaking weight bearing exercise involving repeated activity of the ankle joint on the affected side for:
   1.           a minimum intensity of 5 METS; and
   2.           for at least 4 hours per week; and
   3.           for at least the 4 weeks before clinical onset or clinical worsening;

Note 1: Examples of weight bearing exercise involving repeated activity of the ankle joint at a minimum intensity of 5 METS include marching, playing basketball, football, volleyball, and track and field (especially those activities that involve jumping).

Note 2: MET (metabolic equivalent) is a unit of measure of the level of physical capability of the cardiorespiratory system. For example, 1 MET = cardiorespiratory effort associated with a person sitting, 3-4 METs = cardiorespiratory effort associated with a person walking at average walking pace (5 km/h) or light gardening.

1.           having one of the following systemic arthritic diseases at the time of  clinical onset or clinical worsening:
   1.           ankylosing spondylitis;
   2.           Behcet syndrome;
   3.           enteropathic spondyloarthropathy (arthritis associated with inflammatory bowel disease);
   4.           gout;
   5.           pseudogout (calcium pyrophosphate dihydrate) or crystal-induced arthropathy from the deposition of calcium hydroxyapatite or calcium oxalate;
   6.            psoriatic arthropathy;
   7.           reactive arthritis;
   8.           rheumatoid arthritis; or
   9.             undifferentiated spondyloarthropathy;
2.           having chronic renal failure within the 10 years before clinical onset or clinical worsening as indicated by:
   1.           a glomerular filtration rate of less than 15 mL/min/1.73 m2 for a period of at least 3 months; or
   2.           undergoing chronic dialysis for renal failure;
3.           having a bacterial infection of the affected retrocalcaneal bursa at the time of clinical onset or clinical worsening;
4.           wearing footwear that causes excessive pressure on the posterior aspect of the heel of the affected foot, at the time of clinical onset or clinical worsening;
5.           inability to obtain appropriate clinical management for retrocalcaneal heel bursitis before clinical worsening.

1.            Relationship to service
   1.           The existence in a person of any factor referred to in section 9, must be related to the relevant service rendered by the person.
   2.           The clinical worsening aspects of factors set out in section 9 apply only to material contribution to, or aggravation of, retrocalcaneal heel bursitis where the person's retrocalcaneal heel bursitis was suffered or contracted before or during (but did not arise out of) the person's relevant service.
2.            Factors referring to an injury or disease covered by another Statement of Principles

In this Statement of Principles:

1.           if a factor referred to in section 9 applies in relation to a person; and
2.           that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(2) of the VEA;

then the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.

Schedule 1 - Dictionary  

Note:               See Section 6

1               Definitions

In this instrument:

                             MRCA means the Military Rehabilitation and Compensation Act 2004.

                             relevant service means:

(a)          operational service under the VEA;

(b)          peacekeeping service under the VEA;

(c)          hazardous service under the VEA;

(d)          British nuclear test defence service under the VEA;

(e)          warlike service under the MRCA; or

(f)           non-warlike service under the MRCA.

Note: MRCA and VEA are defined in the Schedule 1 - Dictionary.

                             retrocalcaneal heel bursitis—see subsection 7(2).

                             terminal event means the proximate or ultimate cause of death and includes the following:

(a)           pneumonia;

(b)           respiratory failure;

(c)           cardiac arrest;

(d)           circulatory failure; or

(e)           cessation of brain function.

                             VEA means the Veterans' Entitlements Act 1986.