Statement of Principles concerning femoroacetabular impingement syndrome (Balance of Probabilities) (No. 43 of 2017) (Cth)

Statement of Principles

concerning

FEMOROACETABULAR IMPINGEMENT SYNDROME
(Balance of Probabilities)

(No. 43 of 2017)

The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.

Dated    30 June 2017

The Common Seal of the
Repatriation Medical Authority
was affixed to this instrument
at the direction of:

Professor Nicholas Saunders AO
Chairperson

Contents

1Name........................................................................................................................................... 3

2Commencement........................................................................................................................ 3

3Authority..................................................................................................................................... 3

4Application................................................................................................................................. 3

5Definitions.................................................................................................................................. 3

6Kind of injury, disease or death to which this Statement of Principles relates............... 3

7Basis for determining the factors........................................................................................... 4

8Factors that must exist............................................................................................................. 4

9Relationship to service............................................................................................................. 5

10Factors referring to an injury or disease covered by another Statement of Principles. 5

Schedule 1 - Dictionary............................................................................................. 6

1Definitions.................................................................................................................................. 6

1. Name

This is the Statement of Principles concerning femoroacetabular impingement syndrome (Balance of Probabilities) (No. 43 of 2017).

1. Commencement

This instrument commences on 31 July 2017.

1. Authority

This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.

1. Application

This instrument applies to a claim to which section 120B of the VEA or section 339 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 femoroacetabular impingement syndrome and death from femoroacetabular impingement syndrome.

Meaning of femoroacetabular impingement syndrome

(2)For the purposes of this Statement of Principles, femoroacetabular impingement syndrome means a disorder of the hip due to abnormal contact between the proximal femur and the acetabulum, in the presence of:

(a)relevant symptoms and corresponding clinical signs; and

(b)imaging findings that are consistent with cam morphology or pincer morphology.

Note 1: The primary symptom of femoroacetabular impingement is motion-related or position-related pain in the hip or groin.  Pain may also be felt in the back, buttock or thigh.  In addition to pain, patients may also describe clicking, catching, locking, stiffness, restricted range of motion or giving way of the hip.

Note 2: Clinical signs include hip impingement tests that reproduce the patient's typical pain, a limited range of hip motion, gait abnormalities, and weakness or tenderness of muscles around the hip.

Note 3: This disorder may be associated with a labral tear involving the affected hip.

Note 4: cam morphology and pincer morphology are defined in the Schedule 1 – Dictionary.

Death from femoroacetabular impingement syndrome

(3)For the purposes of this Statement of Principles, femoroacetabular impingement syndrome, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's femoroacetabular impingement syndrome.

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

1. Basis for determining the factors

On the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that femoroacetabular impingement syndrome and death from femoroacetabular impingement syndrome can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA.

Note: relevant service is defined in the Schedule 1 – Dictionary.

1. Factors that must exist

At least one of the following factors must exist before it can be said that, on the balance of probabilities, femoroacetabular impingement syndrome or death from femoroacetabular impingement syndrome is connected with the circumstances of a person's relevant service:

(1)running or jogging an average of at least 60 kilometres per week for the one month before the clinical onset of femoroacetabular impingement syndrome;

(2)undertaking weight bearing exercise involving repeated activity of the hip on the affected side, at a minimum intensity of five METs, for at least six hours per week for the one month before the clinical onset of femoroacetabular impingement syndrome;

Note: MET is defined in the Schedule 1 - Dictionary.

(3)increasing the frequency, duration or intensity of weight bearing activity involving the hip on the affected side by at least 100 percent, to a minimum intensity of five METs for at least four hours per day, within the seven days before the clinical onset of femoroacetabular impingement syndrome;

Note: MET is defined in the Schedule 1 - Dictionary.

(4)running or jogging an average of at least 60 kilometres per week for the one month before the clinical worsening of femoroacetabular impingement syndrome;

(5)undertaking weight bearing exercise involving repeated activity of the hip on the affected side, at a minimum intensity of five METs, for at least six hours per week for the one month before the clinical worsening of femoroacetabular impingement syndrome;

Note: MET is defined in the Schedule 1 - Dictionary.

(6)increasing the frequency, duration or intensity of weight bearing activity involving the hip on the affected side by at least 100 percent, to a minimum intensity of five METs for at least four hours per day, within the seven days before the clinical worsening of femoroacetabular impingement syndrome;

Note: MET is defined in the Schedule 1 - Dictionary.

(7)inability to obtain appropriate clinical management for femoroacetabular impingement syndrome.

1. Relationship to service

(1)The existence in a person of any factor referred to in section 8, must be related to the relevant service rendered by the person.

(2)The factors set out in subsections 8(4) to 8(7) apply only to material contribution to, or aggravation of, femoroacetabular impingement syndrome where the person's femoroacetabular impingement syndrome was suffered or contracted before or during (but did not arise out of) the person's relevant service.

1. 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 8 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(3) 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 5

1. Definitions

In this instrument:

cam morphology means a flattening or convexity at the femoral head neck junction, or a non-spherical femoral head with an abnormal femoral head-neck offset.

femoroacetabular impingement syndrome—see subsection 6(2).

MET means a unit of measurement of the level of physical exertion.  1 MET = 3.5 ml of oxygen/kg of body weight per minute, 1.0 kcal/kg of body weight per hour or resting metabolic rate.

MRCAmeans the Military Rehabilitation and Compensation Act 2004.

pincer morphology means global or focal overcoverage of the femoral head by the acetabulum.

relevant service means:

(a)eligible war service (other than operational service) under the VEA;

(b)defence service (other than hazardous service and British nuclear test defence service) under the VEA; or

(c)peacetime service under the MRCA.

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

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.