Statement of Principles concerning medial tibial stress syndrome (shin splints) (Reasonable Hypothesis) (No. 96 of 2023) (Cth)

Statement of Principles concerning MEDIAL TIBIAL STRESS SYNDROME (SHIN SPLINTS) (Reasonable Hypothesis) (No. 96 of 2023) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 25 October 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 medial tibial stress syndrome (shin splints) (Reasonable Hypothesis) (No. 96 of 2023). 2 Commencement This instrument commences on 28 November 2023. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning shin splints No. 9 of 2015 (Federal Register of Legislation No. F2014L01805) made under subsection 196B(2) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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. 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 medial tibial stress syndrome (shin splints) and death from medial tibial stress syndrome (shin splints). Meaning of medial tibial stress syndrome (shin splints) (2) For the purposes of this Statement of Principles, medial tibial stress syndrome (shin splints): (a) means a bone stress reaction or periosteal inflammation manifesting as exercise-induced pain along the posteromedial aspect of the distal two-thirds of the tibia which typically resolves or reduces with rest; and (b) excludes: (i) fracture, including stress fracture; (ii) lower leg tendinopathies or bursitis; (iii) nerve entrapments (sural or superficial peroneal); (iv) popliteal artery entrapment syndrome; (v) acute sprain and acute strain; and (vi) vascular insufficiency. Death from medial tibial stress syndrome (shin splints) (3) For the purposes of this Statement of Principles, medial tibial stress syndrome (shin splints), in relation to a person, includes death from a terminal event or condition that was contributed to by the person's medial tibial stress syndrome (shin splints). Note: terminal event is defined in the Schedule 1 – Dictionary. 8 Basis for determining the factors The Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that medial tibial stress syndrome (shin splints) and death from medial tibial stress syndrome (shin splints) 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. 9 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 medial tibial stress syndrome (shin splints) or death from medial tibial stress syndrome (shin splints) with the circumstances of a person's relevant service: (1) running or jogging an average of at least 30 kilometres per week for the 4 weeks before the clinical onset or clinical worsening of medial tibial stress syndrome (shin splints); (2) undertaking weight bearing exercise involving repeated activity of the lower leg on the affected side for: (a) a minimum intensity of 5 METS; and (b) for at least 4 hours per week; and for at least the 4 weeks before the clinical onset or clinical worsening of medial tibial stress syndrome (shin splints); Note 1: Examples of weight bearing exercise involving repeated activity of the lower leg at a minimum intensity of 5 METS include marching, sustained brisk walking, playing football, and dancing. Note 2: MET is defined in the Schedule 1 - Dictionary. (3) increasing the frequency, duration or intensity of weight bearing activity involving the lower leg on the affected side: (a) by at least 100 percent; and (b) to a minimum intensity of 5 METs; and (c) for at least 2 hours per day; within the 2 weeks before the clinical onset or clinical worsening of medial tibial stress syndrome (shin splints); Note: MET is defined in the Schedule 1 - Dictionary. (4) having pes planus of the affected limb before the clinical onset or clinical worsening of medial tibial stress syndrome (shin splints); (5) inability to obtain appropriate clinical management for medial tibial stress syndrome (shin splints) before the clinical worsening of medial tibial stress syndrome (shin splints). 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 clinical worsening aspects of factors set out in section 9 apply only to material contribution to, or aggravation of, medial tibial stress syndrome (shin splints) where the person's medial tibial stress syndrome (shin splints) 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(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.