Statement of Principles
concerning
 
PLANTAR FASCIITIS
No. 20 of 2007
 
for the purposes of the
 
Veterans’ Entitlements Act 1986
and
Military Rehabilitation and Compensation Act 2004
           
Title
1.                  This Instrument may be cited as Statement of Principles concerning plantar fasciitis No. 20 of 2007.
 
Determination
2.                  The Repatriation Medical Authority under subsection 196B(3) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):
(a)       revokes Instrument No. 4 of 2000, as amended by Instrument No. 48 of 2003, concerning plantar fasciitis; and
(b)       determines in their place this Statement of Principles.
 
Kind of injury, disease or death
3.         (a)        This Statement of Principles is about plantar fasciitis and death from plantar fasciitis.
(b)              For the purposes of this Statement of Principles, "plantar fasciitis" means a painful inflammatory or degenerative condition of the plantar fascia of the foot.
 
Basis for determining the factors
4.         On the sound medical-scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that plantar fasciitis and death from plantar fasciitis can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the Military Rehabilitation and Compensation Act 2004 (the MRCA).
 
Factors that must be related to service
5.         Subject to clause 7, at least one of the factors set out in clause 6 must be related to the relevant service rendered by the person.
 
Factors
6.         The factor that must exist before it can be said that, on the balance of probabilities, plantar fasciitis or death from plantar fasciitis is connected with the circumstances of a person’s relevant service is:
 
(a)               experiencing trauma to the plantar aspect of the affected foot within the seven days before the clinical onset of plantar fasciitis; or
 
(b)              having an infection involving the plantar fascia at the time of the clinical onset of plantar fasciitis; or
 
(c)              running on average at least 20 kilometres per week for the six months before the clinical onset of plantar fasciitis; or
 
(d)              undertaking weight bearing exercise on the affected foot, at a rate of at least five METs, that involves repeated lifting of the affected foot, for a continuous period of at least one hour, at least once per week over a period of at least the six months before the clinical onset of plantar fasciitis; or
 
(e)              increasing the frequency, duration, or intensity of weight bearing activity involving the affected foot by at least 200 percent, to a minimum intensity of five METs for at least two hours per day, within the seven days before the clinical onset of plantar fasciitis; or
 
(f)               undergoing prolonged weightbearing on the affected foot while on a hard surface for at least five hours per day, on more days than not, for the twelve months before the clinical onset of plantar fasciitis; or
 
(g)              having a Body Mass Index (BMI) of at least 30, at the time of the clinical onset of plantar fasciitis; or
 
(h)              having a systemic arthritic disease at the time of the clinical onset of plantar fasciitis; or
 
(i)                having an injury or disease that has resulted in a specified biomechanical abnormality involving the affected foot before the clinical onset of plantar fasciitis; or
 
(j)                wearing inappropriate footwear during weight bearing exercise which involves the affected foot within the seven days before the clinical onset of plantar fasciitis; or
 
(k)              experiencing trauma to the plantar aspect of the affected foot within the seven days before the clinical worsening of plantar fasciitis; or
 
(l)                having an infection involving the plantar fascia at the time of the clinical worsening of plantar fasciitis; or
 
(m)            running on average at least 20 kilometres per week for the six months before the clinical worsening of plantar fasciitis; or
 
(n)              undertaking weight bearing exercise on the affected foot, at a rate of at least five METs, that involves repeated lifting of the affected foot, for a continuous period of at least one hour, at least once per week over a period of at least the six months before the clinical worsening of plantar fasciitis; or
 
(o)              increasing the frequency, duration, or intensity of weight bearing activity involving the affected foot by at least 200 percent, to a minimum intensity of five METs for at least two hours per day, within the seven days before the clinical worsening of plantar fasciitis; or
 
(p)              undergoing prolonged weightbearing on the affected foot while on a hard surface for at least five hours per day, on more days than not, for the twelve months before the clinical worsening of plantar fasciitis; or
 
(q)              having a Body Mass Index (BMI) of at least 30, at the time of the clinical worsening of plantar fasciitis; or
 
(r)               having a systemic arthritic disease at the time of the clinical worsening of plantar fasciitis; or
 
(s)               having an injury or disease that has resulted in a specified biomechanical abnormality involving the affected foot before the clinical worsening of plantar fasciitis; or
 
(t)                wearing inappropriate footwear during weight bearing exercise which involves the affected foot within the seven days before the clinical worsening of plantar fasciitis; or
 
(u)              inability to obtain appropriate clinical management for plantar fasciitis.
 
Factors that apply only to material contribution or aggravation
7.         Paragraphs 6(k) to 6(u) apply only to material contribution to, or aggravation of, plantar fasciitis where the person’s plantar fasciitis was suffered or contracted before or during (but not arising out of) the person’s relevant service.
 
Inclusion of Statements of Principles
8.                  In this Statement of Principles if a relevant factor applies and that factor includes an injury or disease in respect of which there is a Statement of Principles then the factors in that last mentioned Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.
 
Other definitions
9.                  For the purposes of this Statement of Principles:
 
"a specified biomechanical abnormality" means overpronation or underpronation, or decreased ankle or forefoot flexibility;
 
"a systemic arthritic disease" means:
(a)               ankylosing spondylitis;
(b)              crystal-induced arthropathy;
(c)              enteropathic spondyloarthropathy;
(d)              psoriatic arthropathy;
(e)              reactive arthropathy; or
(f)               undifferentiated spondyloarthropathy;
 
"Body Mass Index (BMI)" means W/H2 where:
(a)                   W is the person’s weight in kilograms and
(b)                   H is the person’s height in metres;
 
"crystal-induced arthropathy" means arthropathy resulting from the deposition of monosodium urate, calcium pyrophosphate dihydrate, calcium hydroxyapatite, or calcium oxalate;
 
"death from plantar fasciitis" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s plantar fasciitis;
 
"ICD-10-AM code" means a number assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, 10th revision, Australian Modification (ICD-10-AM), Fifth Edition, effective date of 1 July 2006, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 1 86487 772 3;
 
"inappropriate footwear" means footwear that results in excess pronation;
 
"MET” means a unit of measurement of the level of physical exertion.  1 MET = 3.5 ml of oxygen/kg of body weight per minute or, 1.0 kcal/kg of body weight per hour, or resting metabolic rate;
 
"reactive arthropathy" means a sterile inflammatory peripheral arthropathy developing after infection at a site distant from the affected joint or joints;
 
"relevant service" means:
(a)     eligible war service (other than operational service) under the VEA; or
(b)     defence service (other than hazardous service) under the VEA; or
(c)          peacetime service under the MRCA;
 
"terminal event" means the proximate or ultimate cause of death and includes:
(a)     pneumonia;
(b)     respiratory failure;
(c)     cardiac arrest;
(d)     circulatory failure; or
(e)          cessation of brain function;
 
"trauma to the plantar aspect of the affected foot" means an injury to the affected fascia that causes the development, within the 24 hours of the injury being sustained, of pain and tenderness, swelling or altered mobility of the affected foot.
Application
10.       This Instrument applies to all matters to which section 120B of the VEA or section 339 of the MRCA applies.
 
Date of effect
11.       This Instrument takes effect from 10 January 2007.
 
Dated this   eighteenth         day of              December    2006
 
 
The Common Seal of the                              )
Repatriation Medical Authority                   )
was affixed to this instrument                      )
in the presence of:                                        )
 
KEN DONALD
CHAIRPERSON