Statement of Principles concerning plantar fibromatosis (Reasonable Hypothesis) (No. 21 of 2023) (Cth)

Statement of Principles concerning PLANTAR FIBROMATOSIS (Reasonable Hypothesis) (No. 21 of 2023) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 24 April 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 Application 5 Definitions 6 Kind of injury, disease or death to which this Statement of Principles relates 7 Basis for determining the factors 8 Factors that must exist 9 Relationship to service 10 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 plantar fibromatosis (Reasonable Hypothesis) (No. 21 of 2023). 2 Commencement This instrument commences on 23 May 2023. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 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. 5 Definitions The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument. 6 Kind of injury, disease or death to which this Statement of Principles relates (1) This Statement of Principles is about plantar fibromatosis and death from plantar fibromatosis. Meaning of plantar fibromatosis (2) For the purposes of this Statement of Principles, plantar fibromatosis: (a) means a benign, progressive fibroproliferative disease of the plantar fascia and the digital fascia of the foot, which causes puckering and thickening of the plantar skin and nodule and cord formation in the fascia that may progress to contracture of the digits; and (b) excludes: (i) plantar fasciitis; (ii) plantar fascial tear; (iii) hyperplastic wound scarring; and (iv) soft tissue benign or malignant neoplasia. Note: plantar fibromatosis is also known as Ledderhose disease or morbus Ledderhose. Death from plantar fibromatosis (3) For the purposes of this Statement of Principles, plantar fibromatosis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's plantar fibromatosis. Note: terminal event is defined in the Schedule 1 – Dictionary. 7 Basis for determining the factors The Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that plantar fibromatosis and death from plantar fibromatosis 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. 8 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 plantar fibromatosis or death from plantar fibromatosis with the circumstances of a person's relevant service: (1) having alcohol use disorder at the time of the clinical onset of plantar fibromatosis; (2) having alcoholic liver cirrhosis at the time of the clinical onset of plantar fibromatosis; (3) having diabetes mellitus before the clinical onset of plantar fibromatosis; (4) having epilepsy at the time of the clinical onset of plantar fibromatosis; (5) taking phenobarbital or primidone regularly for the treatment of epilepsy: (a) for a continuous period of at least 2 years before the clinical onset of plantar fibromatosis; and (b) where this treatment has ceased, the clinical onset of plantar fibromatosis has occurred within the 1 year of cessation; (6) taking vemurafenib within the 2 years before the clinical onset of plantar fibromatosis; (7) having trauma to the affected foot within the 1 year before the clinical onset of plantar fibromatosis; Note: trauma is defined in the Schedule 1 –Dictionary. (8) having alcohol use disorder at the time of the clinical worsening of plantar fibromatosis; (9) having alcoholic liver cirrhosis at the time of the clinical worsening of plantar fibromatosis; (10) having diabetes mellitus before the clinical worsening of plantar fibromatosis; (11) having epilepsy at the time of the clinical worsening of plantar fibromatosis; (12) taking phenobarbital or primidone regularly for the treatment of epilepsy: (a) for a continuous period of at least 2 years before the clinical worsening of plantar fibromatosis; and (b) where this treatment has ceased, the clinical worsening of plantar fibromatosis has occurred within the 1 year of cessation; (13) taking vemurafenib within the 2 years before the clinical worsening of plantar fibromatosis; (14) having trauma to the affected foot within the 1 year before the clinical worsening of plantar fibromatosis; Note: trauma is defined in the Schedule 1 –Dictionary. (15) inability to obtain appropriate clinical management for plantar fibromatosis. 9 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(8) to 8(15) apply only to material contribution to, or aggravation of, plantar fibromatosis where the person's plantar fibromatosis was suffered or contracted before or during (but did not arise out of) the person's relevant service. 10 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(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.