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

Administered by Department of Veterans' Affairs

Legislation au F2021L01167 In force Legislative Instrument

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EXPLANATORY STATEMENT

 

STATEMENT OF PRINCIPLES CONCERNING

CARPAL TUNNEL SYNDROME

(REASONABLE HYPOTHESIS) (NO. 93 OF 2021)

 

VETERANS' ENTITLEMENTS ACT 1986

MILITARY REHABILITATION AND COMPENSATION ACT 2004

 

  1. This is the Explanatory Statement to the Statement of Principles concerning carpal tunnel syndrome (Reasonable Hypothesis) (No. 93 of 2021).

Background

2.             The Repatriation Medical Authority (the Authority), under subsection 196B(8) of the Veterans' Entitlements Act 1986 (the VEA), repeals Instrument No. 7 of 2013 (Federal Register of Legislation No. F2013L00022) determined under subsection 196B(2) of the VEA concerning carpal tunnel syndrome.

3.             The 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 particular kinds of service.  The Authority has therefore determined pursuant to subsection 196B(2) of the VEA a Statement of Principles concerning carpal tunnel syndrome (Reasonable Hypothesis) (No. 93 of 2021).  This Instrument will in effect replace the repealed Statement of Principles.

Purpose and Operation

4.             The Statement of Principles will be applied in determining claims under the VEA and the Military Rehabilitation and Compensation Act 2004 (the MRCA).

5.             The Statement of Principles sets out the factors that must as a minimum exist, and which of those factors must be related to the following kinds of service rendered by a person:

 operational service under the VEA;

 peacekeeping service under the VEA;

 hazardous service under the VEA;

 British nuclear test defence service under the VEA;

 warlike service under the MRCA;

 non-warlike service under the MRCA,

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 that service.  The Statement of Principles has been determined for the purposes of both the VEA and the MRCA.

6.             This Instrument results from an investigation notified by the Authority in the Government Notices Gazette of 23 April 2020 concerning carpal tunnel syndrome in accordance with section 196G of the VEA.  The investigation involved an examination of the sound medical-scientific evidence now available to the Authority, including the sound medical-scientific evidence it has previously considered.

7.             The contents of this Instrument are in similar terms as the repealed Instrument.  Comparing this Instrument and the repealed Instrument, the differences include:

  • adopting the latest revised Instrument format, which commenced in 2015;
  • specifying a day of commencement for the Instrument in section 2;
  • revising the definition of 'carpal tunnel syndrome' in subsection 7(2);
  • revising the reference to 'ICD-10-AM code' in subsection 7(4);
  • new factors in subsections 9(1) and 9(18) concerning performing any combination of specified activities with the affected hand or forearm;
  • new factors in subsections 9(2) and 9(19) concerning having trauma or surgery to the affected wrist or hand;
  • revising the factors in subsections 9(3) and 9(20) concerning having oedema involving the affected carpal tunnel, by the inclusion of a note;
  • revising the factors in subsections 9(4) and 9(21) concerning being overweight or obese;
  • revising the factors in subsections 9(5) and 9(22) concerning having amyloidosis, by the inclusion of a note;
  • new factors in subsections 9(6) and 9(23) concerning having chronic renal failure;
  • revising the factors in subsections 9(7) and 9(24) concerning having hypothyroidism or Hashimoto thyroiditis;
  • revising the factors in subsections 9(8) and 9(25) concerning having acromegaly, by the inclusion of a note;
  • revising the factors in subsections 9(9) and 9(26) concerning having gout involving the affected wrist or hand;
  • revising the factors in subsections 9(10) and 9(27) concerning having a space-occupying lesion in the affected carpal tunnel, by the inclusion of a note;
  • revising the factors in subsections 9(11) and 9(28) concerning having haemorrhage involving the affected carpal tunnel, by the inclusion of a note;
  • revising the factors in subsections 9(12) and 9(29) concerning having infection involving the affected carpal tunnel, by the inclusion of a note;
  • new factors in subsections 9(13) and 9(30) concerning having osteoarthritis or inflammatory arthritis involving the affected wrist or hand;
  • revising the factors in subsections 9(15) and 9(32) concerning taking an aromatase inhibitor;
  • new factors in subsections 9(16) and 9(33) concerning taking an immune checkpoint inhibitor;
  • deleting the factors concerning performing any combination of repetitive activities or forceful activities with the affected hand, as these are now covered by the factors in subsections 9(1) and 9(18) concerning performing any combination of specified activities with the affected hand or forearm;
  • deleting the factors concerning performing activities where the affected hand or forearm is directly vibrated, as these are now covered by the factors in subsections 9(1) and 9(18) concerning performing any combination of specified activities with the affected hand or forearm;
  • deleting the factors concerning daily self-propulsion of a manual wheelchair, as these are now covered by the factors in subsections 9(1) and 9(18) concerning performing any combination of specified activities with the affected hand or forearm;
  • deleting the factors concerning having an injury to the affected wrist or hand which does not involve a fracture or a dislocation, as these are now covered by the factors in subsections 9(2) and 9(19) concerning having trauma or surgery to the affected wrist or hand;
  • deleting the factors concerning having a fracture or dislocation to the distal radius, the distal ulna, a carpal bone or a metacarpal bone of the affected side, as these are now covered by the factors in subsections 9(2) and 9(19) concerning having trauma or surgery to the affected wrist or hand;
  • deleting the factors concerning having surgery to the affected wrist or hand, as these are now covered by the factors in subsections 9(2) and 9(19) concerning having trauma or surgery to the affected wrist or hand;
  • deleting the factors concerning having an external burn involving the affected wrist or palm requiring hospitalisation, as these are now covered by the factors in subsections 9(2) and 9(19) concerning having trauma or surgery to the affected wrist or hand;
  • deleting the factors concerning undergoing haemodialysis or peritoneal dialysis, as these are now covered by the factors in subsections 9(6) and 9(23) concerning having chronic renal failure;
  • deleting the factors concerning having inflammatory arthritis of the affected wrist or hand, as these are now covered by the factors in subsections 9(13) and 9(30) concerning having osteoarthritis or inflammatory arthritis involving the affected wrist or hand;
  • deleting the factors concerning having osteoarthritis of the affected wrist, carpus or trapezio-metacarpal joint of the thumb, as these are now covered by the factors in subsections 9(13) and 9(30) concerning having osteoarthritis or inflammatory arthritis involving the affected wrist or hand;
  • new definitions of 'being overweight or obese', 'BMI', 'chronic renal failure', 'MRCA', 'specified activities with the affected hand or forearm', 'trauma to the affected wrist or hand' and 'VEA' in Schedule 1 - Dictionary;
  • revising the definitions of 'acromegaly', 'amyloidosis', 'inflammatory arthritis' and 'relevant service' in Schedule 1 - Dictionary; and
  • deleting the definitions of 'aromatase inhibitor', 'being obese', 'forceful activities', 'oedema', 'repetitive activities' and 'space-occupying lesion in the affected carpal tunnel'.

Consultation

8.             Prior to determining this Instrument, the Authority advertised its intention to undertake an investigation in relation to carpal tunnel syndrome in the Government Notices Gazette of 23 April 2020, and circulated a copy of the notice of intention to investigate to a wide range of organisations representing veterans, service personnel and their dependants.  The Authority invited submissions from the Repatriation Commission, the Military Rehabilitation and Compensation Commission, organisations and persons referred to in section 196E of the VEA, and any person having expertise in the field.  No submissions were received for consideration by the Authority in relation to the investigation.

9.             On 22 April 2021, the Authority wrote to organisations representing veterans, service personnel and their dependants regarding the proposed Instrument and the medical-scientific material considered by the Authority.  This letter emphasised the deletion of factors relating to having hypothyroidism at the time of the clinical onset of carpal tunnel syndrome and having hypothyroidism at the time of the clinical worsening of carpal tunnel syndrome from the balance of probabilities Statement of Principles.  The Authority provided an opportunity to the organisations to make representations in relation to the proposed Instrument prior to its determination.  No submissions were received for consideration by the Authority.  Minor changes were made to the proposed Instrument following this consultation process.

Human Rights

10.         This instrument is compatible with the Human Rights and Freedoms recognised or declared in the International Instruments listed in Section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.  A Statement of Compatibility with Human Rights follows.

Finalisation of Investigation

11.         The determining of this Instrument finalises the investigation in relation to carpal tunnel syndrome as advertised in the Government Notices Gazette of 23 April 2020.

References

12.         A list of references relating to the above condition is available on the Authority's website at: www.rma.gov.au. Any other document referred to in this Statement of Principles is available on request to the Repatriation Medical Authority at the following address:

              

Email:    info@rma.gov.au

Post:      The Registrar

Repatriation Medical Authority

GPO Box 1014

BRISBANE    QLD    4001

 


Statement of Compatibility with Human Rights

(Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011)

 

Instrument No.:   Statement of Principles No. 93 of 2021

Kind of Injury, Disease or Death: Carpal tunnel syndrome

 

This Legislative Instrument is compatible with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.

Overview of the Legislative Instrument

1. This Legislative Instrument is determined pursuant to subsection 196B(2) of the Veterans' Entitlements Act 1986 (the VEA) for the purposes of the VEA and the Military Rehabilitation and Compensation Act 2004 (the MRCA).  Part XIA of the VEA requires the determination of these instruments outlining the factors connecting particular kinds of injury, disease or death with service such being determined solely on the available sound medical-scientific evidence.

2. This Legislative Instrument:-

  • facilitates claimants in making, and the Repatriation Commission and the Military Rehabilitation and Compensation Commission in assessing, claims under the VEA and the MRCA respectively, by specifying the circumstances in which medical treatment and compensation can be extended to eligible persons who have carpal tunnel syndrome;
  • facilitates the review of such decisions by the Veterans' Review Board and the Administrative Appeals Tribunal;
  • outlines the factors which the current sound medical-scientific evidence indicates must as a minimum exist, before it can be said that a reasonable hypothesis has been raised, connecting carpal tunnel syndrome with the circumstances of eligible service rendered by a person, as set out in clause 5 of the Explanatory Statement;
  • replaces Instrument No. 7 of 2013; and
  • reflects developments in the available sound medical-scientific evidence concerning carpal tunnel syndrome which have occurred since that earlier instrument was determined. 

3. The Instrument is assessed as being a technical instrument which improves the medico-scientific quality of outcomes under the VEA and the MRCA. 

Human Rights Implications

4. This Legislative Instrument does not derogate from any human rights. It promotes the human rights of veterans, current and former Defence Force members as well as other persons such as their dependents, including:

  • the right to social security (Art 9, International Covenant on Economic, Social and Cultural Rights; Art 26, Convention on the Rights of the Child and Art 28, Convention on the Rights of Persons with Disabilities) by helping to ensure that the qualifying conditions for the benefit are 'reasonable, proportionate and transparent'[1];
  • the right to an adequate standard of living (Art 11, ICESCR; Art 27, CRC and Art 28, CRPD) by facilitating the assessment and determination of social security benefits;
  • the right to the enjoyment of the highest attainable standard of physical and mental health (Art 12, ICESCR and Art 25, CRPD), by facilitating the assessment and determination of compensation and benefits in relation to the treatment and rehabilitation of veterans and Defence Force members;
  • the rights of persons with disabilities by facilitating the determination of claims relating to treatment and rehabilitation (Art 26, CRPD); and
  • ensuring that those rights "will be exercised without discrimination of any kind as to race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status" (Art 2, ICESCR).

Conclusion

This Legislative Instrument is compatible with human rights as it does not derogate from and promotes a number of human rights.

 

Repatriation Medical Authority

 

 

 

 

 

 

[1] In General Comment No. 19 (The right to social security), the Committee on Economic, Social and Cultural Rights said (at paragraph 24) this to be one of the elements of ensuring accessibility to social security.

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Sourced from the Federal Register of Legislation at 26 August 2026. For the latest information on Australian Government law please go to https://www.legislation.gov.au.