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No. 41 of 2019 Determinations/Veterans' Entitlements as made
This instrument is the Statement of Principles concerning de Quervain tendinopathy (Reasonable Hypothesis).
Administered by: Veterans' Affairs
Registered 04 Mar 2019
Tabling HistoryDate
Tabled HR02-Apr-2019
Tabled Senate02-Apr-2019
Table of contents.

RMA-Red

 

Statement of Principles

concerning

DE QUERVAIN TENDINOPATHY
(Reasonable Hypothesis)

(No. 41 of 2019)

The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

 

Dated      1 March 2019

 

 

 

 

 

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........................................................................................................................................... 3

2          Commencement........................................................................................................................ 3

3          Authority..................................................................................................................................... 3

4          Application................................................................................................................................. 3

5          Definitions.................................................................................................................................. 3

6          Kind of injury, disease or death to which this Statement of Principles relates............... 3

7          Basis for determining the factors........................................................................................... 4

8          Factors that must exist............................................................................................................. 4

9          Relationship to service............................................................................................................. 5

10        Factors referring to an injury or disease covered by another Statement of Principles. 5

Schedule 1 - Dictionary............................................................................................. 6

1          Definitions.................................................................................................................................. 6

 

 


 

1               Name

This is the Statement of Principles concerning de Quervain tendinopathy (Reasonable Hypothesis) (No. 41 of 2019).

2               Commencement

This instrument commences on 25 March 2019.

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 de Quervain tendinopathy and death from de Quervain tendinopathy.

Meaning of de Quervain tendinopathy

(2)          For the purposes of this Statement of Principles, de Quervain tendinopathy means entrapment of one or both tendons in the first extensor compartment of the radial side of the wrist, producing localised pain and tenderness that is exacerbated by movement of the thumb or wrist.

(3)          While de Quervain tendinopathy attracts ICD‑10‑AM code M65.4, in applying this Statement of Principles the meaning of de Quervain tendinopathy 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 de Quervain tendinopathy

(5)          For the purposes of this Statement of Principles, de Quervain tendinopathy, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's de Quervain tendinopathy.

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 de Quervain tendinopathy and death from de Quervain tendinopathy 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 de Quervain tendinopathy or death from de Quervain tendinopathy with the circumstances of a person's relevant service:

(1)          performing repetitive activities or forceful activities using the affected hand or wrist, for a cumulative period of at least 500 hours within the six months before the clinical onset of de Quervain tendinopathy;

Note:  forceful activities and repetitive activities are defined in the Schedule 1 - Dictionary.

(2)          having acute trauma involving the affected wrist or tendon, within the one year before the clinical onset of de Quervain tendinopathy;

Note:  Examples of acute trauma include, but are not limited to, a laceration, puncture, heavy blow, fracture and crush injury.

(3)          being treated with or using growth hormone within the one year before the clinical onset of de Quervain tendinopathy;

(4)          being treated with a fluoroquinolone antibiotic within the six months before the clinical onset of de Quervain tendinopathy;

Note:  Examples of fluoroquinolone antibiotics include, but are not limited to, ciprofloxacin, moxifloxacin, norfloxacin and ofloxacin.

(5)          being treated with an aromatase inhibitor within the one year before the clinical onset of de Quervain tendinopathy;

Note:  Examples of aromatase inhibitors include, but are not limited to, anastrozole, exemestane and letrozole.

(6)          performing repetitive activities or forceful activities using the affected hand or wrist, for a cumulative period of at least 500 hours within the six months before the clinical worsening of de Quervain tendinopathy;

Note:  forceful activities and repetitive activities are defined in the Schedule 1 - Dictionary.

(7)          having acute trauma involving the affected wrist or tendon, within the one year before the clinical worsening of de Quervain tendinopathy;

Note:  Examples of acute trauma include, but are not limited to, a laceration, puncture, heavy blow, fracture and crush injury.

(8)          being treated with or using growth hormone within the one year before the clinical worsening of de Quervain tendinopathy;

(9)          being treated with a fluoroquinolone antibiotic within the six months before the clinical worsening of de Quervain tendinopathy;

Note:  Examples of fluoroquinolone antibiotics include, but are not limited to, ciprofloxacin, moxifloxacin, norfloxacin and ofloxacin.

(10)      being treated with an aromatase inhibitor within the one year before the clinical worsening of de Quervain tendinopathy;

Note:  Examples of aromatase inhibitors include, but are not limited to, anastrozole, exemestane and letrozole.

(11)      inability to obtain appropriate clinical management for de Quervain tendinopathy.

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(6) to 8(11) apply only to material contribution to, or aggravation of, de Quervain tendinopathy where the person's de Quervain tendinopathy 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.

 


 

Schedule 1 - Dictionary  

Note: See Section 5

1               Definitions

 In this instrument:

                             de Quervain tendinopathy—see subsection 6(2).

                             forceful activities means tasks requiring the generation of force by the hand which:

(a)           are equivalent to lifting or carrying loads of more than three kilograms; or

(b)          involve lifting or carrying an object in the hand greater than one kilogram in excess of ten times per hour.

                             MRCA means the Military Rehabilitation and Compensation Act 2004.

                             relevant service means:

(a)           operational service under the VEA;

(b)          peacekeeping service under the VEA;

(c)           hazardous service under the VEA;

(d)          British nuclear test defence service under the VEA;

(e)           warlike service under the MRCA; or

(f)           non-warlike service under the MRCA.

Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary.

                             repetitive activities means:

(a)           bending or twisting of the hand or wrist at least 50 times an hour; or

(b)          carrying out the same or similar movements in the hand or wrist at least 50 times an hour.

                             terminal event means the proximate or ultimate cause of death and includes the following:

(a)           pneumonia;

(b)          respiratory failure;

(c)           cardiac arrest;

(d)          circulatory failure; or

(e)           cessation of brain function.

                             VEA means the Veterans' Entitlements Act 1986.