Statement of Principles concerning popliteal cyst (Reasonable Hypothesis) (No. 31 of 2018) (Cth)

Statement of Principles concerning POPLITEAL CYST (Reasonable Hypothesis) (No. 31 of 2018) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 2 March 2018

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 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 popliteal cyst (Reasonable Hypothesis) (No. 31 of 2018). 2 Commencement This instrument commences on 2 April 2018. 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 popliteal cyst and death from popliteal cyst. Meaning of popliteal cyst (2) For the purposes of this Statement of Principles, popliteal cyst means a swelling in the popliteal fossa due to enlargement of the gastrocnemius-semimembranosus bursa, where the swelling is associated with clinical manifestations. Note: Clinical manifestations of a popliteal cyst include a palpable swelling or mass behind the knee, posterior knee pain, knee stiffness, tightness in the popliteal region and limitation of range of motion of the affected knee joint. Pain and swelling may be worsened by prolonged standing or activity. Popliteal cysts may enlarge, dissect or rupture, sometimes resulting in compression or inflammation of adjacent structures. (3) While popliteal cyst attracts ICD‑10‑AM code M66.0 or M71.2, in applying this Statement of Principles the meaning of popliteal cyst 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), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4. Death from popliteal cyst (5) For the purposes of this Statement of Principles, popliteal cyst, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's popliteal cyst. 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 popliteal cyst and death from popliteal cyst 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 popliteal cyst or death from popliteal cyst with the circumstances of a person's relevant service: (1) having an injury or disease which causes synovitis of the affected knee joint at the time of the clinical onset of popliteal cyst; Note: Examples of an injury or disease which can cause synovitis of the affected knee joint include: (a) an acute meniscal tear of the knee; (b) calcium pyrophosphate deposition disease (pseudogout); (c) dialysis-related amyloidosis; (d) gout; (e) internal derangement of the knee; (f) Lyme disease; (g) osteoarthritis; (h) pigmented villonodular synovitis; (i) psoriatic arthropathy; (j) reactive arthritis; (k) rheumatoid arthritis; (l) sarcoidosis; and (m) tuberculosis. (2) having a partial or total knee replacement before the clinical onset of popliteal cyst; (3) having an injury or disease which causes synovitis of the affected knee joint at the time of the clinical worsening of popliteal cyst; Note: Examples of an injury or disease which can cause synovitis of the affected knee joint include: (a) an acute meniscal tear of the knee; (b) calcium pyrophosphate deposition disease (pseudogout); (c) dialysis-related amyloidosis; (d) gout; (e) internal derangement of the knee; (f) Lyme disease; (g) osteoarthritis; (h) pigmented villonodular synovitis; (i) psoriatic arthropathy; (j) reactive arthritis; (k) rheumatoid arthritis; (l) sarcoidosis; and (m) tuberculosis. (4) having a partial or total knee replacement before the clinical worsening of popliteal cyst; (5) for clinical worsening of a popliteal cyst manifesting as rupture of a popliteal cyst only, undertaking physical activity at a minimum intensity of five METS at the time of the clinical worsening of popliteal cyst; Note: MET is defined in the Schedule 1 - Dictionary. (6) inability to obtain appropriate clinical management for popliteal cyst. 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(3) to 8(6) apply only to material contribution to, or aggravation of, popliteal cyst where the person's popliteal cyst 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.