Statement of Principles concerning carpal tunnel syndrome (Reasonable Hypothesis) (No. 93 of 2021) (Cth)

Statement of Principles concerning CARPAL TUNNEL SYNDROME (Reasonable Hypothesis) (No. 93 of 2021) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 20 August 2021

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 carpal tunnel syndrome (Reasonable Hypothesis) (No. 93 of 2021). 2 Commencement This instrument commences on 20 September 2021. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning carpal tunnel syndrome No. 7 of 2013 (Federal Register of Legislation No. F2013L00022) made under subsection 196B(2) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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 carpal tunnel syndrome and death from carpal tunnel syndrome. Meaning of carpal tunnel syndrome (2) For the purposes of this Statement of Principles, carpal tunnel syndrome means an entrapment neuropathy of the median nerve at the wrist producing altered sensation, pain or weakness of the hand. (3) While carpal tunnel syndrome attracts ICD‑10‑AM code G56.0, in applying this Statement of Principles the meaning of carpal tunnel syndrome 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 carpal tunnel syndrome (5) For the purposes of this Statement of Principles, carpal tunnel syndrome, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's carpal tunnel syndrome. 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 carpal tunnel syndrome and death from carpal tunnel syndrome 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 carpal tunnel syndrome or death from carpal tunnel syndrome with the circumstances of a person's relevant service: (1) performing any combination of specified activities with the affected hand or forearm: (a) for an average of at least 8 hours per week; and (b) for a cumulative period of at least 6 months before the clinical onset of carpal tunnel syndrome; and if those activities have ceased before the clinical onset of carpal tunnel syndrome, then that onset occurred within 30 days of cessation; Note: specified activities with the affected hand or forearm is defined in the Schedule 1 - Dictionary. (2) having trauma or surgery to the affected wrist or hand before the clinical onset of carpal tunnel syndrome, which: (a) alters the normal contour of the carpal tunnel; or (b) damages the flexor tendons within the carpal tunnel; Note: trauma to the affected wrist or hand is defined in the Schedule 1 - Dictionary. (3) having oedema involving the affected carpal tunnel at the time of the clinical onset of carpal tunnel syndrome; Note: Examples of situations in which oedema involving the affected carpal tunnel may occur include external burn, fracture, lymphoedema and animal envenomation. (4) being overweight or obese at the time of the clinical onset of carpal tunnel syndrome; Note: being overweight or obese is defined in the Schedule 1 - Dictionary. (5) having amyloidosis at the time of the clinical onset of carpal tunnel syndrome; Note: amyloidosis is defined in the Schedule 1 - Dictionary. (6) having chronic renal failure at the time of the clinical onset of carpal tunnel syndrome; Note: chronic renal failure is defined in the Schedule 1 - Dictionary. (7) having hypothyroidism or Hashimoto thyroiditis at the time of the clinical onset of carpal tunnel syndrome; (8) having acromegaly before the clinical onset of carpal tunnel syndrome; Note: acromegaly is defined in the Schedule 1 - Dictionary. (9) having gout involving the affected wrist or hand at the time of the clinical onset of carpal tunnel syndrome; (10) having a space-occupying lesion in the affected carpal tunnel at the time of the clinical onset of carpal tunnel syndrome; Note: Examples of a space-occupying lesion include neoplasm, ganglion, tenosynovitis and muscle intrusion. (11) having haemorrhage involving the affected carpal tunnel at the time of the clinical onset of carpal tunnel syndrome; Note: Examples of situations in which haemorrhage involving the affected carpal tunnel may occur include haemophilia, von Willebrand's disease and taking anticoagulants. (12) having infection involving the affected carpal tunnel at the time of the clinical onset of carpal tunnel syndrome; Note: Examples of infections that may involve the carpal tunnel include histoplasmosis, tuberculosis and chikungunya fever. (13) having osteoarthritis or inflammatory arthritis involving the affected wrist or hand at the time of the clinical onset of carpal tunnel syndrome; Note: inflammatory arthritis is defined in the Schedule 1 - Dictionary. (14) having diabetes mellitus at the time of the clinical onset of carpal tunnel syndrome; (15) taking an aromatase inhibitor within the 2 years before the clinical onset of carpal tunnel syndrome; Note: Examples of aromatase inhibitors include anastrozole, exemestane and letrozole. (16) taking an immune checkpoint inhibitor within the 2 years before the clinical onset of carpal tunnel syndrome; Note: Examples of immune checkpoint inhibitors include pembrolizumab, nivolumab, ipilimumab and avelumab. (17) being pregnant within the 3 months before the clinical onset of carpal tunnel syndrome; (18) performing any combination of specified activities with the affected hand or forearm: (a) for an average of at least 8 hours per week; and (b) for a cumulative period of at least 6 months before the clinical worsening of carpal tunnel syndrome; and if those activities have ceased before the clinical worsening of carpal tunnel syndrome, then that worsening occurred within 30 days of cessation; Note: specified activities with the affected hand or forearm is defined in the Schedule 1 - Dictionary. (19) having trauma or surgery to the affected wrist or hand before the clinical worsening of carpal tunnel syndrome, which: (a) alters the normal contour of the carpal tunnel; or (b) damages the flexor tendons within the carpal tunnel; Note: trauma to the affected wrist or hand is defined in the Schedule 1 - Dictionary. (20) having oedema involving the affected carpal tunnel at the time of the clinical worsening of carpal tunnel syndrome; Note: Examples of situations in which oedema involving the affected carpal tunnel may occur include external burn, fracture, lymphoedema and animal envenomation. (21) being overweight or obese at the time of the clinical worsening of carpal tunnel syndrome; Note: being overweight or obese is defined in the Schedule 1 - Dictionary. (22) having amyloidosis at the time of the clinical worsening of carpal tunnel syndrome; Note: amyloidosis is defined in the Schedule 1 - Dictionary. (23) having chronic renal failure at the time of the clinical worsening of carpal tunnel syndrome; Note: chronic renal failure is defined in the Schedule 1 - Dictionary. (24) having hypothyroidism or Hashimoto thyroiditis at the time of the clinical worsening of carpal tunnel syndrome; (25) having acromegaly before the clinical worsening of carpal tunnel syndrome; Note: acromegaly is defined in the Schedule 1 - Dictionary. (26) having gout involving the affected wrist or hand at the time of the clinical worsening of carpal tunnel syndrome; (27) having a space-occupying lesion in the affected carpal tunnel at the time of the clinical worsening of carpal tunnel syndrome; Note: Examples of a space-occupying lesion include neoplasm, ganglion, tenosynovitis and muscle intrusion. (28) having haemorrhage involving the affected carpal tunnel at the time of the clinical worsening of carpal tunnel syndrome; Note: Examples of situations in which haemorrhage involving the affected carpal tunnel may occur include haemophilia, von Willebrand's disease and taking anticoagulants. (29) having infection involving the affected carpal tunnel at the time of the clinical worsening of carpal tunnel syndrome; Note: Examples of infections that may involve the carpal tunnel include histoplasmosis, tuberculosis and chikungunya fever. (30) having osteoarthritis or inflammatory arthritis involving the affected wrist or hand at the time of the clinical worsening of carpal tunnel syndrome; Note: inflammatory arthritis is defined in the Schedule 1 - Dictionary. (31) having diabetes mellitus at the time of the clinical worsening of carpal tunnel syndrome; (32) taking an aromatase inhibitor within the 2 years before the clinical worsening of carpal tunnel syndrome; Note: Examples of aromatase inhibitors include anastrozole, exemestane and letrozole. (33) taking an immune checkpoint inhibitor within the 2 years before the clinical worsening of carpal tunnel syndrome; Note: Examples of immune checkpoint inhibitors include pembrolizumab, nivolumab, ipilimumab and avelumab. (34) being pregnant within the 3 months before the clinical worsening of carpal tunnel syndrome; (35) inability to obtain appropriate clinical management for carpal tunnel syndrome. 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(18) to 9(35) apply only to material contribution to, or aggravation of, carpal tunnel syndrome where the person's carpal tunnel syndrome 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.