Statement of Principles concerning thoracolumbar spondylosis (Balance of Probabilities) (No. 14 of 2023) (Cth)

Statement of Principles concerning THORACOLUMBAR SPONDYLOSIS (Balance of Probabilities) (No. 14 of 2023) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.

Dated 27 February 2023.

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

Professor Terence Campbell AM Chairperson

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 thoracolumbar spondylosis (Balance of Probabilities) (No. 14 of 2023). 2 Commencement This instrument commences on 27 March 2023. 3 Authority This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning thoracic spondylosis No. 65 of 2014 (Federal Register of Legislation No. F2014L00929) made under subsections 196B(3) and (8) of the VEA is repealed. The Statement of Principles concerning lumbar spondylosis No. 63 of 2014 (Federal Register of Legislation No. F2014L00930) made under subsections 196B(3) and (8) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004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. 6 Definitions The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument. 7 Kind of injury, disease or death to which this Statement of Principles relates (1) This Statement of Principles is about thoracolumbar spondylosis and death from thoracolumbar spondylosis. (2) This Statement of Principles applies to thoracolumbar spondylosis that has been diagnosed on the basis of: (a) clinical manifestations of local pain and stiffness, or symptoms and signs of thoracolumbar cord or thoracolumbar nerve root compression; and (b) imaging evidence of degenerative change, including disc space narrowing or osteophytes. Note: imaging evidence of degenerative change is defined in the Schedule 1 Dictionary. It will usually be the case that the date of the imaging evidence of degenerative change is after the date of clinical onset. (3) For the purposes of this Statement of Principles "thoracolumbar spondylosis" means a degenerative joint disorder affecting the thoracolumbar vertebrae or intervertebral discs including spondylosis at the thoracolumbar and lumbosacral junctions. (4) The definition of thoracolumbar spondylosis given at subsection (3) excludes diffuse idiopathic skeletal hyperostosis, Scheuermann disease and bulging of an intervertebral disc in the absence of other signs of disc degeneration. (5) Other commonly associated features of thoracolumbar spondylosis include facet joint arthritis, bone hypertrophy and spinal stenosis. (6) thoracolumbar spondylosis attracts ICD‑10‑AM codes M47.14, M47.15, M47.16, M47.17, M47.24, M47.25, M47.26, M47.27, M47.84, M47.85, M47.86, M47.87, M47.94, M47.95, M47.96, M47.97 or M51.3, in applying this Statement of Principles the meaning of thoracolumbar spondylosis is that given in subsection (3). (7) In this Statement of Principles, the definition of "thoracolumbar spondylosis" is that given at subsection (3). (8) For subsection (6), a reference to an ICD-10-AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4. Death from thoracolumbar spondylosis (9) For the purposes of this Statement of Principles, thoracolumbar spondylosis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's thoracolumbar spondylosis. Note: terminal event is defined in the Schedule 1 – Dictionary. 8 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 thoracolumbar spondylosis and death from thoracolumbar spondylosis can be related to relevant service rendered by veterans 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. 9 Factors that must exist At least one of the following factors must exist before it can be said that, on the balance of probabilities, thoracolumbar spondylosis or death from thoracolumbar spondylosis is connected with the circumstances of a person's relevant service: (1) having an inflammatory joint disease from the specified list of inflammatory joint diseases, in the thoracolumbar spine before the clinical onset of thoracolumbar spondylosis; Note: specified list of inflammatory joint diseases is defined in the Schedule 1 - Dictionary. (2) having non-viral infection of the affected joint, resulting in inflammation within that joint, at least 6 months before the clinical onset of thoracolumbar spondylosis; (3) having an intra-articular fracture of the spine, at the level of, or adjacent to, the affected joint, at least 6 months before the clinical onset of thoracolumbar spondylosis; (4) having a spinal condition from the specified list of spinal conditions, affecting the thoracolumbar spine for at least the 6 months before the clinical onset of thoracolumbar spondylosis; Note: specified list of spinal conditions is defined in the Schedule 1 - Dictionary. (5) having undergone a spinal fusion, immediately above or below the affected joint, at least 6 months before the clinical onset of thoracolumbar spondylosis; Note: spinal fusion is defined in the Schedule 1 - Dictionary. (6) for lumbar spondylosis only, having leg length inequality for at least the 5 years before the clinical onset of thoracolumbar spondylosis; Note: leg length inequality is defined in the Schedule 1 - Dictionary. (7) having a depositional joint disease from the specified list of depositional joint diseases, in the thoracolumbar spine before the clinical onset of thoracolumbar spondylosis; Note: specified list of depositional joint diseases is defined in the Schedule 1 – Dictionary. (8) having trauma to the thoracolumbar spine at least 6 months before the clinical onset of thoracolumbar spondylosis, and where the trauma to the thoracolumbar spine occurred within the 20 years before the clinical onset of thoracolumbar spondylosis; Note: trauma to the thoracolumbar spine is defined in the Schedule 1 - Dictionary. (9) having a penetrating injury to an intervertebral disc before the clinical onset of thoracolumbar spondylosis at the level of, or adjacent to, the intervertebral disc injury; Note: penetrating injury to an intervertebral disc is defined in the Schedule 1 - Dictionary. (10) having a thoracolumbar intervertebral disc prolapse at least 6 months before the clinical onset of thoracolumbar spondylosis at the level of the intervertebral disc prolapse; (11) lifting loads of at least 20 kilograms while bearing the weight through the thoracolumbar spine: (a) to a cumulative total of at least 150,000 kilograms within any 10 year period before the clinical onset of thoracolumbar spondylosis; and (b) where the clinical onset of thoracolumbar spondylosis occurred within the 25 years following that period; (12) carrying loads of at least 20 kilograms while bearing the weight through the thoracolumbar spine: (a) to a cumulative total of at least 3,800 hours within any 10 year period before the clinical onset of thoracolumbar spondylosis; and (b) where the clinical onset of thoracolumbar spondylosis occurred within the 25 years following that period; (13) for lumbar spondylosis only, flying in an engine powered aircraft as operational aircrew, for a cumulative total of at least 2,000 hours within the 25 years before the clinical onset of thoracolumbar spondylosis; (14) being obese for at least 10 years within the 25 years before the clinical onset of thoracolumbar spondylosis; Note: being obese is defined in the Schedule 1 – Dictionary. (15) having acromegaly involving the thoracolumbar spine before the clinical onset of thoracolumbar spondylosis; Note: acromegaly is defined in the Schedule 1 - Dictionary. (16) having Paget's disease of bone involving the thoracolumbar spine before the clinical onset of thoracolumbar spondylosis; (17) having an inflammatory joint disease from the specified list of inflammatory joint diseases, in the thoracolumbar spine before the clinical worsening of thoracolumbar spondylosis; Note: specified list of inflammatory joint diseases is defined in the Schedule 1 - Dictionary. (18) having non-viral infection of the affected joint, resulting in inflammation within that joint, at least 6 months before the clinical worsening of thoracolumbar spondylosis; (19) having an intra-articular fracture of the spine, at the level of, or adjacent to, the affected joint, at least 6 months before the clinical worsening of thoracolumbar spondylosis; (20) having a spinal condition from the specified list of spinal conditions, affecting the thoracolumbar spine for at least the 6 months before the clinical worsening of thoracolumbar spondylosis; Note: specified list of spinal conditions is defined in the Schedule 1 - Dictionary. (21) having undergone a spinal fusion, immediately above or below the affected joint, at least 6 months before the clinical worsening of thoracolumbar spondylosis; Note: spinal fusion is defined in the Schedule 1 - Dictionary. (22) for lumbar spondylosis only, having leg length inequality for at least the 5 years before the clinical worsening of thoracolumbar spondylosis; Note: leg length inequality is defined in the Schedule 1 - Dictionary. (23) having trauma to the thoracolumbar spine at least 6 months before the clinical worsening of thoracolumbar spondylosis, and where the trauma to the thoracolumbar spine occurred within the 20 years before the clinical worsening of thoracolumbar spondylosis; Note: trauma to the thoracolumbar spine is defined in the Schedule 1 - Dictionary. (24) having a depositional joint disease from the specified list of depositional joint diseases, in the thoracolumbar spine before the clinical worsening of thoracolumbar spondylosis; Note: specified list of depositional joint diseases is defined in the Schedule 1 – Dictionary. (25) having a penetrating injury to an intervertebral disc before the clinical worsening of thoracolumbar spondylosis at the level of, or adjacent to, the intervertebral disc injury; Note: penetrating injury to an intervertebral disc is defined in the Schedule 1 - Dictionary. (26) having a thoracolumbar intervertebral disc prolapse at least 6 months before the clinical worsening of thoracolumbar spondylosis at the level of the intervertebral disc prolapse; (27) lifting loads of at least 20 kilograms while bearing the weight through the thoracolumbar spine: (a) to a cumulative total of at least 150,000 kilograms within any 10 year period before the clinical worsening of thoracolumbar spondylosis; and (b) where the clinical worsening of thoracolumbar spondylosis occurred within the 25 years following that period; (28) carrying loads of at least 20 kilograms while bearing the weight through the thoracolumbar spine: (a) to a cumulative total of at least 3,800 hours within any 10 year period before the clinical worsening of thoracolumbar spondylosis; and (b) where the clinical worsening of thoracolumbar spondylosis occurred within the 25 years following that period; (29) for lumbar spondylosis only, flying in an engine powered aircraft as operational aircrew, for a cumulative total of at least 2,000 hours within the 25 years before the clinical worsening of thoracolumbar spondylosis; (30) being obese for at least 10 years within the 25 years before the clinical worsening of thoracolumbar spondylosis; Note: being obese is defined in the Schedule 1 – Dictionary. (31) having acromegaly involving the thoracolumbar spine before the clinical worsening of thoracolumbar spondylosis; Note: acromegaly is defined in the Schedule 1 - Dictionary. (32) having Paget's disease of bone involving the thoracolumbar spine before the clinical worsening of thoracolumbar spondylosis; (33) inability to obtain appropriate clinical management for thoracolumbar spondylosis. 10 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 factors set out in subsections 9(17) to 9(33) apply only to material contribution to, or aggravation of, thoracolumbar spondylosis where the person's thoracolumbar spondylosis was suffered or contracted before or during (but did not arise out of) the person's relevant service. 11 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(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.