Statement of Principles concerning carpal tunnel syndrome No. 89 of 2001 (Cth)
Instrument No.89 of 2001
Revocation and Determination
of
Statement of Principles
concerning
CARPAL TUNNEL SYNDROME
ICD-10-AM CODE: G56.0
Veterans’ Entitlements Act 1986
The Repatriation Medical Authority under subsection 196B(2) of the Veterans’ Entitlements Act 1986 (the Act):
(a) revokes Instrument No.71 of 1997; and
(b) determines in its place the following Statement of Principles.
Kind of injury, disease or death
(a) This Statement of Principles is about carpal tunnel syndrome and death from carpal tunnel syndrome.
(b) 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, attracting ICD-10-AM code G56.0.
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.
Factors that must be related to service
Subject to clause 6, at least one of the factors set out in clause 5 must be related to any relevant service rendered by the person.
Factors
The factors that 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 are:
(a)performing any combination of repetitive activities or forceful activities with the affected hand for at least 130 hours within a period of 120 consecutive days before the clinical onset of carpal tunnel syndrome, and where the repetitive or forceful activities have not ceased more than 30 days before the clinical onset of carpal tunnel syndrome; or
(b)daily self propulsion of a manual wheelchair for at least a cumulative period of 130 hours within a period of 120 consecutive days before the clinical onset of carpal tunnel syndrome, and where the self propulsion of a manual wheelchair has not ceased more than 30 days before the clinical onset of carpal tunnel syndrome; or
(c)performing activities where the affected hand or forearm is directly vibrated for at least 130 hours within a period of 120 consecutive days before the clinical onset of carpal tunnel syndrome, and where those activities have not ceased more than 30 days before the clinical onset of carpal tunnel syndrome; or
(d)suffering an injury to the affected wrist or hand which does not involve a fracture or a dislocation but which does:
(i) alter the normal contour of the carpal tunnel; or
(ii) damage the median nerve or flexor tendons within the carpal tunnel,
within the year before the clinical onset of carpal tunnel syndrome; or
(e)suffering a fracture or dislocation to the lower radius, the lower ulna, a carpal bone, or a metacarpal bone of the affected side which:
(i) alters the normal contour of the carpal tunnel; or
(ii) damages the median nerve or flexor tendons within the carpal tunnel,
before the clinical onset of carpal tunnel syndrome; or
(f)undergoing surgery to the affected wrist or hand which:
(i) alters the normal contour of the carpal tunnel; or
(ii)damages the median nerve or flexor tendons within the carpal tunnel,
within the year before the clinical onset of carpal tunnel syndrome; or
(g)being obese at the time of the clinical onset of carpal tunnel syndrome; or
(h)undergoing haemodialysis treatment for at least the year before the clinical onset of carpal tunnel syndrome; or
(j)suffering from myxoedema at the time of the clinical onset of carpal tunnel syndrome; or
(k)suffering from acromegaly before the clinical onset of carpal tunnel syndrome; or
(m)suffering from amyloidosis at the time of the clinical onset of carpal tunnel syndrome; or
(n)suffering from gout in the affected wrist or hand at the time of the clinical onset of carpal tunnel syndrome; or
(o)suffering from a space occupying lesion in the affected carpal tunnel at the time of the clinical onset of carpal tunnel syndrome; or
(p)suffering from oedema involving the affected carpal tunnel at the time of the clinical onset of carpal tunnel syndrome; or
(q)suffering from haemorrhage involving the affected carpal tunnel at the time of the clinical onset of carpal tunnel syndrome; or
(r)suffering from infection involving the affected carpal tunnel at the time of the clinical onset of carpal tunnel syndrome; or
(s)suffering from inflammatory arthritis of the affected wrist or hand at the time of the clinical onset of carpal tunnel syndrome; or
(t)performing any combination of repetitive activities or forceful activities with the affected hand for at least 130 hours within a period of 120 consecutive days before the clinical worsening of carpal tunnel syndrome, and where the repetitive or forceful activities have not ceased more than 30 days before the clinical worsening of carpal tunnel syndrome; or
(u)daily self propulsion of a manual wheelchair for at least a cumulative period of 130 hours within a period of 120 consecutive days before the clinical worsening of carpal tunnel syndrome, and where the self propulsion of a manual wheelchair has not ceased more than 30 days before the clinical worsening of carpal tunnel syndrome; or
(v)performing activities where the affected hand or forearm is directly vibrated for at least 130 hours within a period of 120 consecutive days before the clinical worsening of carpal tunnel syndrome, and where those activities have not ceased more than 30 days before the clinical worsening of carpal tunnel syndrome; or
(w)suffering an injury to the affected wrist or hand which does not involve a fracture or a dislocation but which does:
(i)alter the normal contour of the carpal tunnel; or
(ii)damage the median nerve or flexor tendons within the carpal tunnel,
within the year before the clinical worsening of carpal tunnel syndrome; or
(x)suffering a fracture or dislocation to the lower radius, the lower ulna, a carpal bone, or a metacarpal bone of the affected side which:
(i)alters the normal contour of the carpal tunnel; or
(ii)damages the median nerve or flexor tendons within the carpal tunnel,
before the clinical worsening of carpal tunnel syndrome; or
(y)undergoing surgery to the affected wrist or hand which:
(i)alters the normal contour of the carpal tunnel; or
(ii)damages the median nerve or flexor tendons within the carpal tunnel,
within the year before the clinical worsening of carpal tunnel syndrome; or
(z)being obese at the time of the clinical worsening of carpal tunnel syndrome; or
(za)undergoing haemodialysis treatment for at least the year before the clinical worsening of carpal tunnel syndrome;
(zb)suffering from myxoedema at the time of the clinical worsening of carpal tunnel syndrome; or
(zc)suffering from acromegaly before the clinical worsening of carpal tunnel syndrome; or
(zd)suffering from amyloidosis at the time of the clinical worsening of carpal tunnel syndrome; or
(ze)suffering from gout in the affected wrist or hand at the time of the clinical worsening of carpal tunnel syndrome; or
(zf)suffering from a space occupying lesion in the affected carpal tunnel at the time of the clinical worsening of carpal tunnel syndrome; or
(zg)suffering from oedema involving the affected carpal tunnel at the time of the clinical worsening of carpal tunnel syndrome; or
(zh)suffering from haemorrhage involving the affected carpal tunnel at the time of the clinical worsening of carpal tunnel syndrome; or
(zi)suffering from infection involving the affected carpal tunnel at the time of the clinical worsening of carpal tunnel syndrome; or
(zj)suffering from inflammatory arthritis of the affected wrist or hand at the time of the clinical worsening of carpal tunnel syndrome; or
(zk)inability to obtain appropriate clinical management for carpal tunnel syndrome.
Factors that apply only to material contribution or aggravation
Paragraphs 5(t) to 5(zk) 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 not arising out of) the person’s relevant service; paragraph 8(1)(e), 9(1)(e), 70(5)(d) or 70(5A)(d) of the Act refers.
Inclusion of Statements of Principles
In this Statement of Principles if a relevant factor applies and that factor includes an injury or disease in respect of which there is a Statement of Principles then the factors in that last mentioned Statement of Principles apply in accordance with the terms of that Statement of Principles.
Other definitions
For the purposes of this Statement of Principles:
“acromegaly” means a chronic disease of adults due to hypersecretion of the pituitary growth hormone and characterised by enlargement of many parts of the skeleton especially the distal portions, the nose, ears, jaws, fingers and toes;
“amyloidosis” means the accumulation of insoluble fibrillar proteins (amyloid) in organs or tissues of the body such that vital function is compromised;
“being obese” means an increase in body weight by way of fat accumulation which results in a Body Mass Index (BMI) of 30 or greater.
The BMI = W/H2 and where:
W is the person’s weight in kilograms and
H is the person’s height in metres;
“death from 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;
“forceful activities” mean:
(i)tasks requiring the generation of force by the hand of more than 3 kg, or
(ii) holding or carrying an object in the hand greater than 1 kg in excess of ten times per hour;
“gout” means a metabolic condition characterised by hyperuricaemia, tissue deposition of urate crystals and clinical manifestations, which manifestations include acute inflammatory arthritis, tenosynovitis, bursitis, cellulitis, chronic erosive arthritis, or periarticular or subcutaneous urate deposits;
“haemodialysis treatment” means the removal of certain elements from the blood by virtue of the difference in the rates of their diffusion through a semipermeable membrane by means of a haemodialyzer;
“ICD-10-AM code” means a number assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, 10th revision, Australian Modification (ICD-10-AM), Second Edition, effective date of 1 July 2000, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 1 86487 271 3;
“inflammatory arthritis” means one of the following diseases:
(i)rheumatoid arthritis;
(ii)systemic lupus erythematosus;
(iii)systemic sclerosis (which includes circumscribed scleroderma and CREST syndrome);
(iv)sicca syndrome (which includes keratoconjunctivitis sicca and Sjogren’s disease);
(v)dermatomyositis;
(vi)polymyositis;
(vii)eosinophilia myalgia syndrome;
(viii)eosinophilic fasciitis;
(ix)multifocal fibrosclerosis;
(x)systemic fibrosclerosing syndrome;
(xi)unspecified diffuse connective tissue disease;
(xii)chondrocalcinosis (also known as pseudogout);
(xiii)arthropathy associated with Reiter’s disease and nonspecific urethritis;
(xiv)postdysenteric arthropathy;
(xv)psoriatic arthropathy;
(xvi)arthropathy associated with inflammatory bowel disease;
(xvii)ankylosing spondylitis; or
(xviii)other inflammatory arthritis requiring treatment with methotrexate or penicillamine or azathioprine or gold;
“myxoedema” means a condition characterised by dry, waxy swelling of the skin and other tissues and associated with hypothyroidism;
“oedema” means the presence of abnormally large amounts of fluid in the intercellular tissue spaces of the body and demonstrated by accumulation of excessive fluid in the subcutaneous tissues;
“relevant service” means:
(a) operational service; or
(b) peacekeeping service; or
(c) hazardous service;
“repetitive activities” mean:
(i)bending or twisting of the hand or wrist; or
(ii)carrying out the same or similar movements in the hand or wrist;
at least 50 times an hour;
“space occupying lesion in the affected carpal tunnel” means one of the following entities occupying space within the carpal tunnel:
(a) neoplasm;
(b) aneurysm;
(c) calcification;
(d) cyst; or
(e) ganglion;
“terminal event” means the proximate or ultimate cause of death and includes:
(a) pneumonia;
(b) respiratory failure;
(c) cardiac arrest;
(d) circulatory failure; or
(e) cessation of brain function.
Application
This Instrument applies to all matters to which section 120A of the Act applied.
Dated this Twentieth day of November 2001
The Common Seal of the )
Repatriation Medical Authority )
was affixed to this instrument )
in the presence of: )
KEN DONALD
CHAIRMAN
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