Statement of Principles concerning rotator cuff syndrome (Reasonable Hypothesis) (No. 109 of 2022) (Cth)

Statement of Principles concerning ROTATOR CUFF SYNDROME (Reasonable Hypothesis) (No. 109 of 2022) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 21 October 2022.

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 rotator cuff syndrome (Reasonable Hypothesis) (No. 109 of 2022). 2 Commencement This instrument commences on 21 November 2022. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning rotator cuff syndrome No. 100 of 2014 (Federal Register of Legislation No. F2014L01376) made under subsections 196B(2) and (8) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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 rotator cuff syndrome and death from rotator cuff syndrome. Meaning of rotator cuff syndrome (2) For the purposes of this Statement of Principles, rotator cuff syndrome: (a) means a clinically symptomatic inflammatory or degenerative disorder of the rotator cuff of the shoulder joint or the long head of biceps and their associated bursae; and (b) includes: (i) calcifying tendonitis of the shoulder; (ii) rotator cuff tear or rupture; (iii) rotator cuff impingement syndrome; (iv) rotator cuff tendinopathy or tendonitis; (v) subacromial impingement syndrome; (vi) supraspinatus syndrome; or (vii) tendonitis of the long head of the biceps; and (c) excludes adhesive capsulitis of the shoulder. Note 1: The rotator cuff is the musculotendinous cuff of the shoulder joint comprising supraspinatus, infraspinatus, subscapularis and teres minor muscles. Associated bursae include the subacromial or subdeltoid bursae. Note 2: Rotator cuff syndrome is characterised by persistent pain and tenderness in the shoulder that usually worsens when the arm is abducted into an overhead position. (3) While rotator cuff syndrome attracts ICD‑10‑AM codes M75.1, M75.2, M75.3, M74.4 or M74.5 in applying this Statement of Principles the meaning of rotator cuff 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 rotator cuff syndrome (5) For the purposes of this Statement of Principles, rotator cuff syndrome, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's rotator cuff 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 rotator cuff syndrome and death from rotator cuff 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 rotator cuff syndrome or death from rotator cuff syndrome with the circumstances of a person's relevant service: (1) having an injury to the affected shoulder within the 3 months before the clinical onset of rotator cuff syndrome; Note 1: Examples of activities or circumstances that can cause an injury to the affected shoulder include a fall, a violent pull or sudden traction injury, sports injury, a blow or direct trauma to the shoulder, lifting weights, and improperly administered vaccination to the shoulder. Note 2: injury to the affected shoulder is defined in the Schedule 1 – Dictionary. (2) undergoing a surgical procedure involving the affected shoulder joint before the clinical onset of rotator cuff syndrome; (3) performing any combination of: (a) repetitive or sustained activities of the affected shoulder when the shoulder on the affected side is abducted or flexed by at least 60 degrees; or (b) forceful activities with the affected upper limb; for at least 80 hours within a period of 120 consecutive days before the clinical onset of rotator cuff syndrome, and where the repetitive or sustained or forceful activities have not ceased more than 30 days before the clinical onset of rotator cuff syndrome; Note: forceful activities are defined in the Schedule 1 - Dictionary. (4) performing repetitive or sustained activities of the affected shoulder when the shoulder on the affected side is abducted or flexed by at least 60 degrees for at least 2,000 hours within the 10 years before the clinical onset of rotator cuff syndrome; Note: Sports that require overhead activities (for example, tennis, swimming, and volleyball) often involve abduction or flexion of the shoulder by at least 60 degrees. (5) lifting or carrying loads of at least 20 kilograms using the upper limb of the affected side for at least 200 hours within the 10 years before the clinical onset of rotator cuff syndrome; (6) using a hand-held, vibrating, percussive, heavy industrial tool with the affected upper limb, for at least 2,000 hours within the 10 years before the clinical onset of rotator cuff syndrome; (7) having dialysis-related amyloidosis before the clinical onset of rotator cuff syndrome; Note: dialysis-related amyloidosis is defined in the Schedule 1 - Dictionary. (8) regularly using the upper limbs for weight-bearing for a continuous period of at least the 1 year before the clinical onset of rotator cuff syndrome; Note: Examples of circumstances in which the upper limbs may regularly be used for weight-bearing include transfers from a wheelchair to a chair or bed, and the use of crutches or other walking aids. (9) having anatomical narrowing of the subacromial space on the affected side at the time of the clinical onset of rotator cuff syndrome; Note: anatomical narrowing of the subacromial space is defined in the Schedule 1 - Dictionary. (10) having joint instability of the affected shoulder, or dislocation or subluxation of the affected shoulder joint before the clinical onset of rotator cuff syndrome; (11) having an infection of the subacromial bursa or subdeltoid bursa of the affected shoulder at the time of the clinical onset of rotator cuff syndrome; (12) having an autoimmune disease from the specified list of autoimmune diseases, involving the shoulder joint or associated bursae of the affected side, before the clinical onset of rotator cuff syndrome; Note: specified list of autoimmune diseases is defined in the Schedule 1 - Dictionary. (13) having gout involving the affected shoulder at the time of the clinical onset of rotator cuff syndrome; (14) having acquired scapular dyskinesis of the affected side at the time of the clinical onset of rotator cuff syndrome; Note: acquired scapular dyskinesis is defined in the Schedule 1 – Dictionary. (15) having smoked at least 20 pack-years of tobacco products before the clinical onset of rotator cuff syndrome; Note: one pack-year is defined in the Schedule 1 – Dictionary. (16) having diabetes mellitus before the clinical onset of rotator cuff syndrome; (17) having dyslipidaemia before the clinical onset of rotator cuff syndrome; Note: dyslipidaemia is defined in the Schedule 1 – Dictionary. (18) taking a glucocorticoid drug as specified before the clinical onset of rotator cuff syndrome; Note: taking a glucocorticoid drug as specified is defined in the Schedule 1 – Dictionary. (19) taking a fluoroquinolone antibiotic within the 60 days before the clinical onset of rotator cuff syndrome; (20) taking an aromatase inhibitor for at least 4 weeks within the 2 years before the clinical onset of rotator cuff syndrome; Note: Examples of aromatase inhibitors include anastrozole, exemestane and letrozole. (21) having an injury to the affected shoulder within the 3 months before the clinical worsening of rotator cuff syndrome; Note 1: Examples of activities or circumstances that can cause an injury to the affected shoulder include a fall, a violent pull or sudden traction injury, sports injury, a blow or direct trauma to the shoulder, lifting weights, and improperly administered vaccination to the shoulder. Note 2: injury to the affected shoulder is defined in the Schedule 1 – Dictionary. (22) undergoing a surgical procedure involving the affected shoulder joint before the clinical worsening of rotator cuff syndrome; (23) performing any combination of: (a) repetitive or sustained activities of the affected shoulder when the shoulder on the affected side is abducted or flexed by at least 60 degrees; or (b) forceful activities with the affected upper limb; for at least 80 hours within a period of 120 consecutive days before the clinical worsening of rotator cuff syndrome, and where the repetitive or sustained or forceful activities have not ceased more than 30 days before the clinical worsening of rotator cuff syndrome; Note: forceful activities are defined in the Schedule 1 - Dictionary. (24) performing repetitive or sustained activities of the affected shoulder when the shoulder on the affected side is abducted or flexed by at least 60 degrees for at least 2,000 hours within the 10 years before the clinical worsening of rotator cuff syndrome; Note: Sports that require overhead activities (for example, tennis, swimming, and volleyball) often involve abduction or flexion of the shoulder by at least 60 degrees. (25) lifting or carrying loads of at least 20 kilograms using the upper limb of the affected side for at least 200 hours within the 10 years before the clinical worsening of rotator cuff syndrome; (26) using a hand-held, vibrating, percussive, heavy industrial tool with the affected upper limb, for at least 2,000 hours within the 10 years before the clinical worsening of rotator cuff syndrome; (27) having dialysis-related amyloidosis before the clinical worsening of rotator cuff syndrome; Note: dialysis-related amyloidosis is defined in the Schedule 1 - Dictionary. (28) regularly using the upper limbs for weight-bearing for a continuous period of at least the 1 year before the clinical worsening of rotator cuff syndrome; Note: Examples of circumstances in which the upper limbs may regularly be used for weight-bearing include transfers from a wheelchair to a chair or bed, and the use of crutches or other walking aids. (29) having anatomical narrowing of the subacromial space on the affected side at the time of the clinical worsening of rotator cuff syndrome; Note: anatomical narrowing of the subacromial space is defined in the Schedule 1 - Dictionary. (30) having joint instability of the affected shoulder, or dislocation or subluxation of the affected shoulder joint before the clinical worsening of rotator cuff syndrome; (31) having an infection of the subacromial bursa or subdeltoid bursa of the affected shoulder at the time of the clinical worsening of rotator cuff syndrome; (32) having an autoimmune disease from the specified list of autoimmune diseases, involving the shoulder joint or associated bursae of the affected side, before the clinical worsening of rotator cuff syndrome; Note: specified list of autoimmune diseases is defined in the Schedule 1 - Dictionary. (33) having gout involving the affected shoulder at the time of the clinical worsening of rotator cuff syndrome; (34) having acquired scapular dyskinesis of the affected side at the time of the clinical worsening of rotator cuff syndrome; Note: acquired scapular dyskinesis is defined in the Schedule 1 – Dictionary. (35) having smoked at least 20 pack-years of tobacco products before the clinical worsening of rotator cuff syndrome; Note: one pack-year is defined in the Schedule 1 – Dictionary. (36) having diabetes mellitus before the clinical worsening of rotator cuff syndrome; (37) having dyslipidaemia before the clinical worsening of rotator cuff syndrome; Note: dyslipidaemia is defined in the Schedule 1 – Dictionary. (38) taking a glucocorticoid drug as specified before the clinical worsening of rotator cuff syndrome; Note: taking a glucocorticoid drug as specified is defined in the Schedule 1 – Dictionary. (39) taking a fluoroquinolone antibiotic within the 60 days before the clinical worsening of rotator cuff syndrome; (40) taking an aromatase inhibitor for at least 4 weeks within the 2 years before the clinical worsening of rotator cuff syndrome; Note: Examples of aromatase inhibitors include anastrozole, exemestane and letrozole. (41) inability to obtain appropriate clinical management for rotator cuff 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(21) to 9(41)apply only to material contribution to, or aggravation of, rotator cuff syndrome where the person's rotator cuff 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.