Instrument No.33 of 2001
Revocation and Determination
of
Statement of Principles
concerning
CHONDROMALACIA PATELLAE
ICD 10-AM-CODE: M22.4
Veterans’ Entitlements Act 1986
1. The Repatriation Medical Authority under subsection 196B(2) of the Veterans’ Entitlements Act 1986 (the Act):
(a) revokes Instrument No.320 of 1995; and
(b) determines in its place the following Statement of Principles.
Kind of injury, disease or death
2. (a) This Statement of Principles is about chondromalacia patellae and death from chondromalacia patellae.
(b) For the purposes of this Statement of Principles, “chondromalacia patellae” means softening, fibrillation or erosion of the articular cartilage of the patella associated with recurrent or chronic patellofemoral pain, attracting ICD-10-AM code M22.4, but excluding osteoarthrosis of the patellofemoral joint.
Basis for determining the factors
3. The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that chondromalacia patellae and death from chondromalacia patellae can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces.
Factors that must be related to service
4. Subject to clause 6, at least one of the factors set out in clause 5 must be related to any relevant service rendered by the person.
Factors
5. The factors that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting chondromalacia patellae or death from chondromalacia patellae with the circumstances of a person’s relevant service are:
(a) suffering direct trauma to the patella of the affected knee within the six months immediately before the clinical onset of chondromalacia patellae; or
(b) suffering an injury to the affected knee resulting in meniscal damage or permanent ligamentous instability within the six months immediately before the clinical onset of chondromalacia patellae; or
(c) suffering abnormal tracking of the patella of the affected knee at the time of the clinical onset of chondromalacia patellae; or
(d) running for at least six hours per week for at least four consecutive weeks before the clinical onset of chondromalacia patellae and where such activity has ceased the clinical onset of chondromalacia patellae has occurred within four weeks of cessation; or
(e) suffering direct trauma to the patella of the affected knee within the six months immediately before the clinical worsening of chondromalacia patellae; or
(f) suffering an injury to the affected knee resulting in meniscal damage or permanent ligamentous instability within the six months immediately before the clinical worsening of chondromalacia patellae; or
(g) suffering abnormal tracking of the patella of the affected knee at the time of the clinical worsening of chondromalacia patellae; or
(h) inability to obtain appropriate clinical management for chondromalacia patellae.
Factors that apply only to material contribution or aggravation
6. Paragraphs 5(e) to 5(h) apply only to material contribution to, or aggravation of, chondromalacia patellae where the person’s chondromalacia patellae was suffered or contracted before or during (but not arising out of) the person’s relevant service; paragraph 8(1)(e), 9(1)(e), 70(5)(d) or 70(5A)(d) of the Act refers.
Inclusion of Statements of Principles
7. In this Statement of Principles if a relevant factor applies and that factor includes an injury or disease in respect of which there is a Statement of Principles then the factors in that last mentioned Statement of Principles apply in accordance with the terms of that Statement of Principles.
Other definitions
8. For the purposes of this Statement of Principles:
“abnormal tracking of the patella” means aberrant movement or position of the patella relative to the femoral condyles in the course of knee flexion or extension resulting from one of the following:
(i) angulation or rotation deformities involving the knee joint; or
(ii) patella alta (a high riding patella); or
(iii) lateral angulation of the patellar ligament relative to the line of action of the quadriceps muscles of 20 degrees; or
(iv) subluxation of the patella;
“death from chondromalacia patellae” in relation to a person includes death from a terminal event or condition that was contributed to by the person’s chondromalacia patellae;
“direct trauma to the patella” means a blow to the kneecap causing immediate patellar pain that persists for at least 24 hours unless alleviated by analgesia;
“ICD-10-AM code” means a number assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, 10th revision, Australian Modification (ICD-10-AM), Second Edition, effective date of 1 July 2000, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 1 86487 271 3;
“relevant service” means:
(a) operational service; or
(b) peacekeeping service; or
(c) hazardous service;
“terminal event” means the proximate or ultimate cause of death and includes:
(a) pneumonia;
(b) respiratory failure;
(c) cardiac arrest;
(d) circulatory failure; or
(e) cessation of brain function.
Application
9. This Instrument applies to all matters to which section 120A of the Act applies.
Dated this Twenty-fourth day of May 2001
The Common Seal of the )
Repatriation Medical Authority )
was affixed to this instrument )
in the presence of )
KEN DONALD
CHAIRMAN