Statement of Principles
concerning
HALLUX VALGUS
(Reasonable Hypothesis)
(No. 98 of 2015)
The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans’ Entitlements Act 1986.
Dated 21 August 2015
The Common Seal of the
Repatriation Medical Authority
was affixed to this instrument
at the direction of:
Professor Nicholas Saunders AO
Chairperson
Contents
1 Name........................................................................................................................................... 3
2 Commencement........................................................................................................................ 3
3 Authority..................................................................................................................................... 3
4 Revocation................................................................................................................................. 3
5 Application................................................................................................................................. 3
6 Definitions.................................................................................................................................. 3
7 Kind of injury, disease or death to which this Statement of Principles relates............... 3
8 Basis for determining the factors........................................................................................... 4
9 Factors that must exist............................................................................................................. 4
10 Relationship to service............................................................................................................. 5
11 Factors referring to an injury or disease covered by another Statement of Principles. 5
Schedule 1 - Dictionary............................................................................................. 7
1 Definitions.................................................................................................................................. 7
1 Name
This is the Statement of Principles concerning hallux valgus (Reasonable Hypothesis) (No. 98 of 2015).
2 Commencement
This instrument commences on 21 September 2015.
3 Authority
This instrument is made under subsection 196B(2) of the Veterans’ Entitlements Act 1986.
4 Revocation
The Statement of Principles concerning hallux valgus No. 91 of 2007 made under subsection 196B(2) of the VEA is revoked.
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 hallux valgus and death from hallux valgus.
Meaning of hallux valgus
(2) For the purposes of this Statement of Principles, hallux valgus means a deformity of the foot, where the great toe is deflected laterally towards the other toes, and often causing a bony prominence or bunion to develop over the medial aspect of the metatarsal head and neck.
(3) While hallux valgus attracts ICD‑10‑AM code M20.1, in applying this Statement of Principles the meaning of hallux valgus is that given in subsection (2).
(4) For subsection (3), 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), Ninth Edition, effective date of 1 July 2015, copyrighted by the Independent Hospital Pricing Authority, ISBN 978‑1‑76007‑020‑5.
Death from hallux valgus
(5) For the purposes of this Statement of Principles, hallux valgus, in relation to a person, includes death from a terminal event or condition that was contributed to by the person’s hallux valgus.
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 hallux valgus and death from hallux valgus 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: relevant service is 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 hallux valgus or death from hallux valgus with the circumstances of a person’s relevant service:
(1) wearing footwear that causes lateral deviation of the great toe of the affected foot, on more days than not for a period of at least 18 months before the clinical onset of hallux valgus;
(2) having an inflammatory, depositional or infective arthrosis of the first metatarsophalangeal joint of the affected foot, before the clinical onset of hallux valgus;
(3) having pes planus of the affected foot before the clinical onset of hallux valgus;
(4) having amputation of the second toe or the second metatarsal head of the affected foot, before the clinical onset of hallux valgus;
Note: amputation of the second toe or the second metatarsal head is defined in the Schedule 1 - Dictionary.
(5) having a tumour that involves the second metatarsal bone before the clinical onset of hallux valgus;
(6) having surgery as specified to the affected region within the five years before the clinical onset of hallux valgus;
Note: surgery as specified is defined in the Schedule 1 - Dictionary.
(7) having trauma to the affected forefoot within the five years before the clinical onset of hallux valgus;
Note: trauma to the affected forefoot is defined in the Schedule 1 - Dictionary.
(8) wearing footwear that causes lateral deviation of the great toe of the affected foot, on more days than not for a period of at least 18 months before the clinical worsening of hallux valgus;
(9) having an inflammatory, depositional or infective arthrosis of the first metatarsophalangeal joint of the affected foot, before the clinical worsening of hallux valgus;
(10) having pes planus of the affected foot before the clinical worsening of hallux valgus;
(11) having amputation of the second toe or the second metatarsal head of the affected foot, before the clinical worsening of hallux valgus;
Note: amputation of the second toe or the second metatarsal head is defined in the Schedule 1 - Dictionary.
(12) having a tumour that involves the second metatarsal bone before the clinical worsening of hallux valgus;
(13) having surgery as specified to the affected region within the five years before the clinical worsening of hallux valgus;
Note: surgery as specified is defined in the Schedule 1 - Dictionary.
(14) having trauma to the affected forefoot within the five years before the clinical worsening of hallux valgus;
Note: trauma to the affected forefoot is defined in the Schedule 1 - Dictionary.
(15) inability to obtain appropriate clinical management for hallux valgus.
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(8) to 9(15) apply only to material contribution to, or aggravation of, hallux valgus where the person’s hallux valgus 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.
Schedule 1 - Dictionary
Note: See Section 6
1 Definitions
In this instrument:
amputation of the second toe or the second metatarsal head means loss of one or more of the phalanges of the second digit of the foot or the head of the second metatarsal.
hallux valgus—see subsection 7(2).
MRCA means the Military Rehabilitation and Compensation Act 2004.
relevant service means:
(a) operational service under the VEA;
(b) peacekeeping service under the VEA;
(c) hazardous service under the VEA;
(d) British nuclear test defence service under the VEA;
(e) warlike service under the MRCA; or
(f) non-warlike service under the MRCA.
surgery as specified means surgery resulting in:
(a) excision of sesamoid bone under the first metatarsal head;
(b) instability of the first metatarsophalangeal joint;
(c) lengthening of the first metatarsal in relation to the second metatarsal; or
(d) shortening of the second metatarsal in relation to the first metatarsal.
terminal event means the proximate or ultimate cause of death and includes the following:
(a) pneumonia;
(b) respiratory failure;
(c) cardiac arrest;
(d) circulatory failure; or
(e) cessation of brain function.
trauma to the affected forefoot means a discrete injury to the affected forefoot that results in:
(a) disruption of the first metatarsophalangeal joint capsule;
(b) disruption of the sesamoid complex of the hallux;
(c) fracture resulting in shortening of the second metatarsal;
(d) tarso-metatarsal joint complex injury; or
(e) tear of the medial collateral ligament of the first metatarsophalangeal joint.
VEA means the Veterans' Entitlements Act 1986.
