What can I claim secondary to osteonecrosis?
7 conditions in the Repatriation Medical Authority's Statements of Principles list osteonecrosis as a factor. If DVA has accepted your osteonecrosis, each of these has a documented pathway to a further claim.
At a glance
- Accepted conditionOsteonecrosis
- Conditions it may open7
- SourceRMA SoPs
- Chart Review$600 + GST
How a secondary claim works
Some Statement of Principles factors are not about service at all — they name another condition. Where DVA has already accepted your osteonecrosis, and another condition's SoP lists osteonecrosis as a factor, that part of the next claim is already established on your file. How a secondary claim works, in full →
Conditions that list osteonecrosis as a factor
Quoted from the instrument. A pathway existing is not the same as a claim succeeding — each factor carries thresholds your record has to satisfy.
Dental pulp and periapical disease
RH No. 99 of 2021 · BoP No. 100 of 2021
Reasonable Hypothesis — factor (9): “having osteonecrosis of the jaw involving the affected tooth at the time of the clinical onset of dental pulp and periapical disease” [clinical onset] — factor (18): “having osteonecrosis of the jaw involving the affected tooth at the time of the clinical worsening of dental pulp and periapical disease” [worsening]
This factor appears in the Reasonable Hypothesis instrument only, which applies to operational service.
Note: Examples of causes of osteonecrosis of the jaw include sickle-cell disorder and medication-related osteonecrosis.
Malignant neoplasm of bone and articular cartilage
RH No. 66 of 2020 · BoP No. 67 of 2020
Reasonable Hypothesis — factor (3): “having osteonecrosis at the affected site before the clinical onset of malignant neoplasm of bone or articular cartilage” [clinical onset]
This factor appears in the Reasonable Hypothesis instrument only, which applies to operational service.
Note: Osteonecrosis is also known as a bone infarct.
Osteoarthritis
BoP No. 62 of 2017
Balance of Probabilities — factor (11): “having necrosis of the subchondral bone near the affected joint, including that from dysbaric osteonecrosis, before the clinical onset of osteoarthritis in that joint” [clinical onset] — factor (34): “having necrosis of the subchondral bone near the affected joint, including that from dysbaric osteonecrosis, before the clinical worsening of osteoarthritis in that joint” [worsening]
This condition has a Balance of Probabilities instrument only, so the same test applies whatever your service type.
Osteomyelitis
RH No. 23 of 2024 · BoP No. 24 of 2024
Reasonable Hypothesis — factor (10): “having osteonecrosis at the site of osteomyelitis before the clinical onset of osteomyelitis” [clinical onset]
Balance of Probabilities — factor (10): “having osteonecrosis at the site of osteomyelitis before the clinical onset of osteomyelitis” [clinical onset]
Pathological fracture
RH No. 64 of 2024 · BoP No. 65 of 2024
Reasonable Hypothesis — factor (1): “having one of the following medical conditions involving the affected region of bone at the time of clinical onset: (a) benign neoplasm; (b) malignant primary or secondary neoplasm; (c) osteomalacia; (d) osteomyelitis; (e) osteonecrosis; (f) osteoporosis; or (g) Paget disease of bone” [clinical onset]
Balance of Probabilities — factor (1): “having one of the following medical conditions involving the affected region of bone at the time of clinical onset: (a) benign neoplasm; (b) malignant primary or secondary neoplasm; (c) osteomalacia; (d) osteomyelitis; (e) osteonecrosis; (f) osteoporosis; or (g) Paget disease of bone” [clinical onset]
Note: osteomalacia and osteonecrosis are defined in the Schedule 1 - Dictionary.
Pes planus
RH No. 67 of 2021 · BoP No. 68 of 2021
Reasonable Hypothesis — factor (1): “having a fracture or osteonecrosis involving one or more tarsal or metatarsal bones of the medial longitudinal arch of the affected foot before the clinical onset of pes planus” [clinical onset] — factor (13): “having a fracture or osteonecrosis involving one or more tarsal or metatarsal bones of the medial longitudinal arch of the affected foot before the clinical worsening of pes planus” [worsening]
Balance of Probabilities — factor (1): “having a fracture or osteonecrosis involving one or more tarsal or metatarsal bones of the medial longitudinal arch of the affected foot before the clinical onset of pes planus” [clinical onset] — factor (12): “having a fracture or osteonecrosis involving one or more tarsal or metatarsal bones of the medial longitudinal arch of the affected foot before the clinical worsening of pes planus” [worsening]
Note: tarsal or metatarsal bones of the medial longitudinal arch is defined in the Schedule 1 - Dictionary.
Trigeminal neuralgia or trigeminal neuropathy
RH No. 84 of 2024 · BoP No. 85 of 2024
Reasonable Hypothesis — factor (7): “having bisphosphonate-related osteonecrosis of the jaw at the time of clinical onset or clinical worsening of trigeminal neuropathy” [onset and worsening]
Balance of Probabilities — factor (7): “having bisphosphonate-related osteonecrosis of the jaw at the time of clinical onset or clinical worsening of trigeminal neuropathy” [onset and worsening]
Other accepted conditions that also open dental pulp and periapical disease
If any of these is also on your file, it reaches some of the same conditions osteonecrosis does.
What DVA means by osteonecrosis
A claim is tested against the definition first. If the diagnosis on your file does not meet this wording, the factors below never get reached — so it is worth checking that what your doctor wrote matches what the instrument requires.
Osteonecrosis, for the purposes of the Statement of Principles, for the purposes of this Statement of Principles, osteonecrosis: (a) means a disease of bone where death of bone tissue occurs as a result of the temporary or permanent loss of blood supply to bone; and (b) includes dysbaric osteonecrosis.
RH No. 13 of 2020 · BoP No. 14 of 2020 · 25 factors
What could support a claim for osteonecrosis?
The Statement of Principles for osteonecrosis names 5 other conditions among its own factors. If any of these is already accepted on your file, it may be the factor that carries a osteonecrosis claim — quoted here from the instrument.
Fracture
Reasonable Hypothesis — factor (2): “having a fracture, dislocation of a joint or subluxation of a joint of the affected bone within the two years before the clinical onset of osteonecrosis” [clinical onset]
Balance of Probabilities — factor (2): “having a fracture, dislocation of a joint or subluxation of a joint of the affected bone within the two years before the clinical onset of osteonecrosis” [clinical onset]
Cushing syndrome
Reasonable Hypothesis — factor (11): “having Cushing syndrome at the time of the clinical onset of osteonecrosis” [clinical onset]
Balance of Probabilities — factor (11): “having Cushing syndrome at the time of the clinical onset of osteonecrosis” [clinical onset]
Chronic pancreatitis
Reasonable Hypothesis — factor (12): “having acute or chronic pancreatitis at the time of the clinical onset of osteonecrosis” [clinical onset]
Osteomyelitis
Reasonable Hypothesis — factor (15): “having osteomyelitis at the affected site at the time of the clinical onset of osteonecrosis” [clinical onset]
Balance of Probabilities — factor (14): “having osteomyelitis at the affected site at the time of the clinical onset of osteonecrosis” [clinical onset]
Substance use disorder
Reasonable Hypothesis — factor (25): “for osteonecrosis of the jaw only: (a) having diabetes mellitus at the time of the clinical onset of osteonecrosis; (b) having periodontitis, periodontal abscess or dental pulp and apical disease within the three months before the clinical onset of osteonecrosis; (c) having syphilitic palatine gumma at the time of the clinical onset of osteonecrosis; (d) having acute herpes zoster involving the trigeminal nerve within the six months before the clinical onset of osteonecrosis; (e) having substance use disorder, involving cocaine, at the time of the clinical onset of osteonecrosis; (f) having anaemia at the time of the clinical onset of osteonecrosis; (g) being treated with an osteoclast inhibitor for at least six months before the clinical onset of osteonecrosis, where the last dose of the drug was taken within the two years before the clinical onset of osteonecrosis; (h) being treated with an antiangiogenic agent for at least six months before the clinical onset of osteonecrosis, where the last dose of the drug was taken within the two years before the clinical onset of osteonecrosis; or (i) taking desomorphine (krokodil) within the 30 days before the clinical onset of osteonecrosis” [clinical onset]
Balance of Probabilities — factor (24): “for osteonecrosis of the jaw only: (a) having diabetes mellitus at the time of the clinical onset of osteonecrosis; (b) having periodontitis, periodontal abscess or dental pulp and apical disease within the three months before the clinical onset of osteonecrosis; (c) having syphilitic palatine gumma at the time of the clinical onset of osteonecrosis; or (d) having acute herpes zoster involving the trigeminal nerve within the six months before the clinical onset of osteonecrosis; (e) having substance use disorder, involving cocaine, at the time of the clinical onset of osteonecrosis; (f) being treated with an osteoclast inhibitor for at least six months before the clinical onset of osteonecrosis, where the last dose of the drug was taken within the two years before the clinical onset of osteonecrosis; or (g) being treated with an antiangiogenic agent for at least six months before the clinical onset of osteonecrosis, where the last dose of the drug was taken within the two years before the clinical onset of osteonecrosis” [clinical onset]
Reviewed by Dr Thomas Perkins
Founding doctor, Veterans Health Centre · former RAAF aviation medical officer · 13 years working exclusively with ADF members and veterans. Full profile →
Osteonecrosis accepted?
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