REPATRIATION MEDICAL AUTHORITY
INSTRUMENT NO. 91 of 2007
VETERANS’ ENTITLEMENTS ACT 1986
MILITARY REHABILITATION AND COMPENSATION ACT 2004
EXPLANATORY NOTES FOR TABLING
- The Repatriation Medical Authority (the Authority), under subsection 196B(8) of the Veterans' Entitlements Act 1986 (the VEA) revokes Instrument No. 300 of 1995 concerning congenital hallux valgus and Instrument No. 47 of 1998 concerning acquired hallux valgus, determined under subsection 196B(2) of the VEA.
2. The Authority is of the view that there is sound medical-scientific evidence that indicates that hallux valgus and death from hallux valgus can be related to particular kinds of service. The Authority has therefore determined pursuant to subsection 196B(2) of the VEA a Statement of Principles, Instrument No. 91 of 2007 concerning hallux valgus. This Instrument will in effect replace the revoked Statements of Principles.
3. The provisions of the Military Rehabilitation and Compensation Act 2004 (the MRCA) relating to claims for compensation commenced on 1 July 2004. Claims under section 319 of the MRCA for acceptance of liability for a service injury sustained, a service disease contracted or service death on or after 1 July 2004 are determined by the Military Rehabilitation and Compensation Commission by reference to Statements of Principles issued by the Authority pursuant to the VEA.
4. The Statement of Principles sets out the factors that must as a minimum exist, and which of those factors must be related to the following kinds of service rendered by a person:
operational service under the VEA;
peacekeeping service under the VEA;
hazardous service under the VEA;
warlike service under the MRCA;
non-warlike service under the MRCA,
before it can be said that a reasonable hypothesis has been raised connecting hallux valgus or death from hallux valgus, with the circumstances of that service.
5. This new instrument results from investigations notified by the Authority in the Government Notices Gazette of 15 June 2005 concerning congenital hallux valgus and acquired hallux valgus, in accordance with section 196G of the Act. The investigations involved an examination of the sound medical-scientific evidence now available to the Authority, including the sound medical-scientific evidence it has previously considered.
6. The contents of the new Instrument are in similar terms as the revoked Instruments. Comparing the new and the revoked Instruments, the differences include:
- adopting the latest revised Instrument format, which commenced in 2005;
- deleting the ICD code from the Instrument header;
- revising the definition of 'hallux valgus' in clause 3;
- revising factors 6(a) and 6(g) concerning 'ill-fitting footwear';
- revising factors 6(b) and 6(h) concerning 'inflammatory, depositional or infective arthrosis';
- revising factor 6(j) concerning 'amputation';
- new factors 6(e) and 6(k) concerning 'surgery';
- new factors 6(f) and 6(l) concerning 'trauma';
- revising definitions of 'amputation of the second toe or the second metatarsal head'; 'death from hallux valgus' and 'relevant service' in clause 9;
- deleting definitions of 'amputation'; 'congenital hallux valgus'; 'ICD code'; 'ICD-9-CM code'; 'osteoarthrosis' and 'pes planus' from clause 9;
- new definitions of 'surgery to affected region' and 'trauma to the affected forefoot' in clause 9; and
- specifying a date of effect for the Instrument in clause 11.
7. Further changes to the format of the Instrument reflect the commencement of the MRCA and clarify that pursuant to subsection 196B(3A) of the VEA, the Statement of Principles has been determined for the purposes of both the VEA and the MRCA.
8. Prior to determining this instrument, the Authority advertised its intention to undertake investigations in relation to congenital hallux valgus and acquired hallux valgus in the Government Notices Gazette of 15 June 2005, and circulated a copy of the notice of intention to investigate to a wide range of organisations representing veterans, service personnel and their dependants. The Authority invited submissions from the Repatriation Commission, organisations and persons referred to in section 196E of the VEA, and any person having expertise in the field. No submissions were received for consideration by the Authority during the investigations.
9. On 8 June 2007, the Authority wrote to organisations representing veterans, service personnel and their dependants regarding the proposed Instrument and the medical-scientific material considered by the Authority. This letter emphasised the deletion of the onset factor relating to pes planus from the balance of probability Statement of Principles. The Authority provided an opportunity to the organisations to make representations in relation to the proposed instrument prior to its determination. No submissions were received for consideration by the Authority.
10. The determining of this new instrument finalises the investigations in relation to congenital hallux valgus and acquired hallux valgus as advertised in the Government Notices Gazette of 15 June 2005.
11. A list of references relating to the above condition is available, on written request, from the Repatriation Medical Authority Secretariat.
Overview
The Repatriation Medical Authority Instrument No. 91 of 2007 is an instrument made under the Veterans' Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA). This instrument was introduced to address the issue of hallux valgus, a condition affecting the big toe, in relation to military service. The Authority, acting under subsection 196B(2) of the VEA, revoked two previous instruments concerning congenital and acquired hallux valgus and issued a new Statement of Principles, Instrument No. 91 of 2007. This instrument establishes the minimum factors required to connect hallux valgus or death from hallux valgus with specific types of military service, such as operational, peacekeeping, hazardous, warlike, and non-warlike service. The Authority conducted investigations and considered sound medical-scientific evidence before determining this new instrument, which replaces the revoked instruments and aligns with the latest revised Instrument format. The Authority sought and received no submissions from relevant organisations or individuals during the investigation and prior to the determination of the instrument.
Scope and Application
The Repatriation Medical Authority Instrument No. 91 of 2007, which concerns hallux valgus, applies to veterans and service personnel who have rendered specific kinds of service, including operational, peacekeeping, hazardous, warlike, and non-warlike service, as defined under the Veterans' Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA). The Instrument outlines the medical-scientific evidence and specific factors that must be present to establish a connection between hallux valgus or death from hallux valgus and the circumstances of the service rendered, effectively replacing the previously revoked Statements of Principles concerning congenital and acquired hallux valgus. This new Instrument, determined under subsection 196B(2) of the VEA, is applicable on a national level, aligning with the provisions of the VEA and the MRCA for claims concerning injuries or diseases sustained on or after 1 July 2004. While no submissions were received during the investigation phase, the Authority provided opportunities for representation on the proposed Instrument before its determination.
Key Provisions
The Repatriation Medical Authority (RMA) has revoked two previous instruments, Instrument No. 300 of 1995 concerning congenital hallux valgus and Instrument No. 47 of 1998 concerning acquired hallux valgus, under subsection 196B(8) of the Veterans' Entitlements Act 1986 (VEA). In their place, the RMA has issued a new Statement of Principles, Instrument No. 91 of 2007, which also concerns hallux valgus. This new instrument replaces the previous ones and is grounded on the latest medical-scientific evidence. It is to be applied in conjunction with the Military Rehabilitation and Compensation Act 2004 (MRCA), which governs claims for compensation from 1 July 2004. The new instrument outlines the conditions under which a reasonable hypothesis may be raised that hallux valgus or death from hallux valgus is related to particular kinds of service, including operational, peacekeeping, hazardous, warlike, and non-warlike service. The instrument's format has been updated to align with the MRCA and to clarify its applicability under both the VEA and the MRCA.
The Statement of Principles sets out the factors that must exist to link hallux valgus or death from hallux valgus with service, specifically operational, peacekeeping, hazardous, warlike, or non-warlike service. The new instrument incorporates the latest medical-scientific evidence, revises definitions, and updates the list of factors considered in determining the connection between the condition and service. For instance, it revises definitions and factors related to footwear, arthrosis, amputation, surgery, and trauma, and introduces new factors concerning surgery and trauma. Additionally, it deletes certain definitions and ICD codes that are no longer relevant. The instrument specifies a date of effect, clarifying when it comes into force.
The obligations imposed by this new instrument on the parties and entities it governs primarily revolve around the submission of accurate and complete medical and service information to support claims related to hallux valgus. Claimants must provide evidence that aligns with the factors outlined in the Statement of Principles, such as documentation proving the nature of their service, medical records showing the presence of hallux valgus, and evidence linking the condition to their service. The RMA is obligated to evaluate these submissions against the criteria set out in the new instrument, ensuring that the claims are assessed fairly and in accordance with the latest medical-scientific evidence.
The new instrument also specifies the consequences for non-compliance or breaches of the provisions outlined. While the explanatory notes do not detail specific offences or penalties, breaches of the requirements under the VEA or MRCA can lead to civil or criminal consequences. For instance, providing false or misleading information in support of a claim can result in penalties under the VEA, which may include fines or other legal repercussions. Additionally, failure to adhere to the conditions set out in the Statement of Principles may lead to the denial of compensation claims. The maximum penalties for offences under the VEA and MRCA can vary, but they may include fines and, in some cases, imprisonment, depending on the severity of the breach.