{"id":"F2021L01169","name":"Statement of Principles concerning carpal tunnel syndrome (Balance of Probabilities) (No. 94 of 2021)","slug":"statement-of-principles-concerning-carpal-tunnel-syndrome-balance-of-probabilities-no-94-of-2021","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440968,"registerId":"F2021L01169-fast-fetch-1775956408714","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning carpal tunnel syndrome (Balance of Probabilities) (No. 94 of 2021)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 20.2\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n\n\n \n\nStatement of Principles\n\nconcerning\n\nCARPAL TUNNEL SYNDROME (Balance of Probabilities)\n\n(No. 94 of 2021)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n \n\nDated 20 August 2021\n\n \n\n \n\n \n\n \n\n \n\n| The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:
|\n| --- |\n|
Professor Terence Campbell AM
Chairperson
|\n\n\n \n\n \n\n\nContents\n\n1 Name\n\n2 Commencement\n\n3 Authority\n\n4 Repeal\n\n5 Application\n\n6 Definitions\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n8 Basis for determining the factors\n\n9 Factors that must exist\n\n10 Relationship to service\n\n11 Factors referring to an injury or disease covered by another Statement of Principles\n\nSchedule 1 - Dictionary\n\n1 Definitions\n\n \n\n\n\n\n1 Name\n\nThis is the Statement of Principles concerning carpal tunnel syndrome (Balance of Probabilities) (No. 94 of 2021).\n\n2 Commencement\n\n This instrument commences on 20 September 2021.\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning carpal tunnel syndrome No. 8 of 2013 (Federal Register of Legislation No. F2013L00023) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004 applies.\n\n6 Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n(1) This Statement of Principles is about carpal tunnel syndrome and death from carpal tunnel syndrome.\n\nMeaning of carpal tunnel syndrome\n\n(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.\n\n(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).\n\n(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.\n\nDeath from carpal tunnel syndrome\n\n(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.\n\nNote: terminal event is defined in the Schedule 1 - Dictionary.\n\n8 Basis for determining the factors\n\nOn the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that carpal tunnel syndrome and death from carpal tunnel syndrome can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA.\n\nNote: MRCA, relevant service and VEA are defined in the Schedule 1 - Dictionary.\n\n9 Factors that must exist\n\nAt least one of the following factors must exist before it can be said that, on the balance of probabilities, carpal tunnel syndrome or death from carpal tunnel syndrome is connected with the circumstances of a person's relevant service:\n\n(1) performing any combination of specified activities with the affected hand or forearm:\n\n(a) for an average of at least 8 hours per week; and\n\n(b) for a cumulative period of at least 6 months before the clinical onset of carpal tunnel syndrome; and\n\nif those activities have ceased before the clinical onset of carpal tunnel syndrome, then that onset occurred within 30 days of cessation;\n\nNote: specified activities with the affected hand or forearm is defined in the Schedule 1 - Dictionary.\n\n(2) having trauma or surgery to the affected wrist or hand before the clinical onset of carpal tunnel syndrome, which:\n\n(a) alters the normal contour of the carpal tunnel; or\n\n(b) damages the flexor tendons within the carpal tunnel;\n\nNote: trauma to the affected wrist or hand is defined in the Schedule 1 - Dictionary.\n\n(3) having oedema involving the affected carpal tunnel at the time of the clinical onset of carpal tunnel syndrome;\n\nNote: Examples of situations in which oedema involving the affected carpal tunnel may occur include external burn, fracture, lymphoedema and animal envenomation.\n\n(4) being overweight or obese at the time of the clinical onset of carpal tunnel syndrome;\n\nNote: being overweight or obese is defined in the Schedule 1 - Dictionary.\n\n(5) having amyloidosis at the time of the clinical onset of carpal tunnel syndrome;\n\nNote: amyloidosis is defined in the Schedule 1 - Dictionary.\n\n(6) having chronic renal failure at the time of the clinical onset of carpal tunnel syndrome;\n\nNote: chronic renal failure is defined in the Schedule 1 - Dictionary.\n\n(7) having acromegaly before the clinical onset of carpal tunnel syndrome;\n\nNote: acromegaly is defined in the Schedule 1 - Dictionary.\n\n(8) having gout involving the affected wrist or hand at the time of the clinical onset of carpal tunnel syndrome;\n\n(9) having a space-occupying lesion in the affected carpal tunnel at the time of the clinical onset of carpal tunnel syndrome;\n\nNote: Examples of a space-occupying lesion include neoplasm, ganglion, tenosynovitis and muscle intrusion.\n\n(10) having haemorrhage involving the affected carpal tunnel at the time of the clinical onset of carpal tunnel syndrome;\n\nNote: Examples of situations in which haemorrhage involving the affected carpal tunnel may occur include haemophilia, von Willebrand’s disease and taking anticoagulants.\n\n(11) having infection involving the affected carpal tunnel at the time of the clinical onset of carpal tunnel syndrome;\n\nNote: Examples of infections that may involve the carpal tunnel include histoplasmosis, tuberculosis and chikungunya fever.\n\n(12) having osteoarthritis or inflammatory arthritis involving the affected wrist or hand at the time of the clinical onset of carpal tunnel syndrome;\n\nNote: inflammatory arthritis is defined in the Schedule 1 - Dictionary.\n\n(13) having diabetes mellitus at the time of the clinical onset of carpal tunnel syndrome;\n\n(14) taking an aromatase inhibitor within the 2 years before the clinical onset of carpal tunnel syndrome;\n\nNote: Examples of aromatase inhibitors include anastrozole, exemestane and letrozole.\n\n(15) taking an immune checkpoint inhibitor within the 2 years before the clinical onset of carpal tunnel syndrome;\n\nNote: Examples of immune checkpoint inhibitors include pembrolizumab, nivolumab, ipilimumab and avelumab.\n\n(16) being pregnant within the 3 months before the clinical onset of carpal tunnel syndrome;\n\n(17) performing any combination of specified activities with the affected hand or forearm:\n\n(a) for an average of at least 8 hours per week; and\n\n(b) for a cumulative period of at least 6 months before the clinical worsening of carpal tunnel syndrome; and\n\nif those activities have ceased before the clinical worsening of carpal tunnel syndrome, then that worsening occurred within 30 days of cessation;\n\nNote: specified activities with the affected hand or forearm is defined in the Schedule 1 - Dictionary.\n\n(18) having trauma or surgery to the affected wrist or hand before the clinical worsening of carpal tunnel syndrome, which:\n\n(a) alters the normal contour of the carpal tunnel; or\n\n(b) damages the flexor tendons within the carpal tunnel;\n\nNote: trauma to the affected wrist or hand is defined in the Schedule 1 - Dictionary.\n\n(19) having oedema involving the affected carpal tunnel at the time of the clinical worsening of carpal tunnel syndrome;\n\nNote: Examples of situations in which oedema involving the affected carpal tunnel may occur include external burn, fracture, lymphoedema and animal envenomation.\n\n(20) being overweight or obese at the time of the clinical worsening of carpal tunnel syndrome;\n\nNote: being overweight or obese is defined in the Schedule 1 - Dictionary.\n\n(21) having amyloidosis at the time of the clinical worsening of carpal tunnel syndrome;\n\nNote: amyloidosis is defined in the Schedule 1 - Dictionary.\n\n(22) having chronic renal failure at the time of the clinical worsening of carpal tunnel syndrome;\n\nNote: chronic renal failure is defined in the Schedule 1 - Dictionary.\n\n(23) having acromegaly before the clinical worsening of carpal tunnel syndrome;\n\nNote: acromegaly is defined in the Schedule 1 - Dictionary.\n\n(24) having gout involving the affected wrist or hand at the time of the clinical worsening of carpal tunnel syndrome;\n\n(25) having a space-occupying lesion in the affected carpal tunnel at the time of the clinical worsening of carpal tunnel syndrome;\n\nNote: Examples of a space-occupying lesion include neoplasm, ganglion, tenosynovitis and muscle intrusion.\n\n(26) having haemorrhage involving the affected carpal tunnel at the time of the clinical worsening of carpal tunnel syndrome;\n\nNote: Examples of situations in which haemorrhage involving the affected carpal tunnel may occur include haemophilia, von Willebrand’s disease and taking anticoagulants.\n\n(27) having infection involving the affected carpal tunnel at the time of the clinical worsening of carpal tunnel syndrome;\n\nNote: Examples of infections that may involve the carpal tunnel include histoplasmosis, tuberculosis and chikungunya fever.\n\n(28) having osteoarthritis or inflammatory arthritis involving the affected wrist or hand at the time of the clinical worsening of carpal tunnel syndrome;\n\nNote: inflammatory arthritis is defined in the Schedule 1 - Dictionary.\n\n(29) having diabetes mellitus at the time of the clinical worsening of carpal tunnel syndrome;\n\n(30) taking an aromatase inhibitor within the 2 years before the clinical worsening of carpal tunnel syndrome;\n\nNote: Examples of aromatase inhibitors include anastrozole, exemestane and letrozole.\n\n(31) taking an immune checkpoint inhibitor within the 2 years before the clinical worsening of carpal tunnel syndrome;\n\nNote: Examples of immune checkpoint inhibitors include pembrolizumab, nivolumab, ipilimumab and avelumab.\n\n(32) being pregnant within the 3 months before the clinical worsening of carpal tunnel syndrome;\n\n(33) inability to obtain appropriate clinical management for carpal tunnel syndrome.\n\n10 Relationship to service\n\n(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.\n\n(2) The factors set out in subsections 9(17) to 9(33) 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.\n\n11 Factors referring to an injury or disease covered by another Statement of Principles\n\nIn this Statement of Principles:\n\n(1) if a factor referred to in section 9 applies in relation to a person; and\n\n(2) that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(3) of the VEA;\n\nthen 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.\n\n \n\n \n\nSchedule 1 - Dictionary \n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\n acromegaly means a chronic disease of adults resulting from hypersecretion of growth hormone after closure of the epiphyses.\n\n amyloidosis means the accumulation of insoluble fibrillar proteins in organs or tissues of the body such that vital function is compromised.\n\nNote: Diseases that can be associated with amyloidosis include myeloma and chronic inflammatory diseases or chronic infectious diseases, such as inflammatory bowel disease, rheumatoid arthritis and tuberculosis.\n\n being overweight or obese means:\n\n(a) having a Body Mass Index (BMI) of 25 or greater; or\n\n(b) for males, having a waist circumference exceeding 94 centimetres;\n\n(c) for females, having a waist circumference exceeding 80 centimetres.\n\nNote: BMI is also defined in the Schedule 1 - Dictionary.\n\n BMI means W/H2 where:\n\n(a) W is the person's weight in kilograms; and\n\n(b) H is the person's height in metres.\n\n carpal tunnel syndrome—see subsection 7(2).\n\n chronic renal failure means:\n\n(a) having a glomerular filtration rate of less than 15 mL/min/1.73 m2 for a period of at least three months; or\n\n(b) a need for renal replacement therapy (dialysis or transplantation) for treatment of complications of decreased glomerular filtration rate which would otherwise increase the risk of morbidity and mortality; or\n\n(c) undergoing chronic dialysis.\n\n inflammatory arthritis means an autoimmune inflammatory disease which is associated with the development of arthritis.\n\nNote: Types of inflammatory arthritis include rheumatoid arthritis, systemic sclerosis, Sjögren syndrome, sarcoidosis, and other inflammatory arthritis requiring treatment with a disease modifying agent or a biological agent.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n relevant service means:\n\n(a) eligible war service (other than operational service) under the VEA;\n\n(b) defence service (other than hazardous service and British nuclear test defence service) under the VEA; or\n\n(c) peacetime service under the MRCA.\n\nNote: MRCA and VEA are also defined in the Schedule 1 - Dictionary.\n\n \n\n specified activities with the affected hand or forearm means:\n\n(a) repetitive activities using the affected hand, involving either:\n\n(i) bending or twisting of the hand or wrist at least 50 times per hour; or\n\n(ii) carrying out the same or similar movements in the hand or wrist at least 50 times per hour; or\n\n(b) forceful activities requiring the generation of force by the affected hand:\n\n(i) equivalent to lifting or carrying loads of more than 3 kilograms; or\n\n(ii) involving lifting or carrying an object in the hand greater than 1 kilogram in excess of 10 times per hour; or\n\n(c) activities where the affected hand or forearm is directly vibrated; or\n\n(d) activities where the affected hand is used for weight-bearing.\n\nNote 1: Forceful activities requiring generation of force by the hand include the use of crutches or other walking aids and hand propulsion of wheelchairs.\n\nNote 2: Activities where the hand may be used for weight-bearing include transfers from a wheelchair to a chair or bed, and the use of crutches or other walking aids.\n\n terminal event means the proximate or ultimate cause of death and includes the following:\n\n(a) pneumonia;\n\n(b) respiratory failure;\n\n(c) cardiac arrest;\n\n(d) circulatory failure; or\n\n(e) cessation of brain function.\n\n trauma to the affected wrist or hand means a discrete event involving the application of significant physical force to or through the affected wrist or hand, that causes:\n\n(a) damage to the wrist or hand; and\n\n(b) the development, within 24 hours of the event occurring, of symptoms and signs of pain and tenderness, and either altered mobility or range of movement of the wrist or hand. In the case of sustained unconsciousness or the masking of pain by analgesic medication, these symptoms and signs must appear on return to consciousness or the withdrawal of the analgesic medication; and\n\n(c) the persistence of these symptoms and signs for a period of at least 7 days following their onset, save for where medical intervention for the trauma to that wrist or hand has occurred and that medical intervention involves one of the following:\n\n(i) immobilisation of the wrist or hand by splinting or similar external agent;\n\n(ii) injection of a corticosteroid or local anaesthetic into that wrist or hand; or\n\n(iii) surgery to that wrist or hand.\n\nNote: Examples of trauma include laceration, sprain, crush injury, fracture, dislocation, and a thermal, electrical or chemical burn.\n\n VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":true,"description":"Section 4 expressly repeals the 2013 Statement of Principles (No. 8 of 2013) and replaces it with the current instrument. The new instrument re‑states the definition of carpal tunnel syndrome, sets quantitative exposure thresholds and enumerates a revised list of medical risk factors and timing rules (see ss7–9 and Schedule 1). The repeal (s4) therefore alters the formal governing Statement; whether substantive scope (breadth of covered exposures or conditions) has increased or decreased requires side‑by‑side comparison with the repealed instrument, which is not provided here."},"complexity_factors":["Repeal and replacement of prior instrument (s4) requiring comparison to earlier instrument for change analysis","Multiple, discrete causal and temporal tests (onset vs clinical worsening) with identical exposure thresholds (s9(1) and s9(17))","Quantitative exposure thresholds for work activities (average ≥8 hours/week; cumulative ≥6 months; activity frequency/force criteria in Schedule 1)","Numerous medical risk factors and conditions listed as alternative causal paths (s9(3)–(16), s9(19)–(32))","Detailed medical definitions and diagnostic thresholds in Schedule 1 (BMI, chronic renal failure, trauma, acromegaly, amyloidosis, inflammatory arthritis)","Cross‑references to other Statements of Principles where overlapping conditions exist (s11)","Service‑connection requirement that factors must be related to relevant service, and distinction between 'suffered or contracted' and 'material contribution/aggravation' (s10(1)–(2))","Evidentiary and administrative burden on claimants to prove exposure, timing and medical diagnoses (implicates record and clinical evidence)","Use of ICD‑10‑AM coding for reference but a bespoke definition adopted for CTS (s7(2)–(4))","Specific short‑term timing rules for exposure cessation relative to onset/worsening (30‑day rule in s9(1) and s9(17))"],"plain_english_summary":"This instrument replaces the 2013 Statement and sets the medical rules the Repatriation Medical Authority uses to decide, on the balance of probabilities, whether carpal tunnel syndrome (CTS) or death from CTS is connected to a veteran’s or member’s relevant service. It lists specific clinical definitions, work‑exposure thresholds (hours, duration, task types), medical risk factors and timing rules that claimants must meet to have CTS treated as service‑related under the VEA or MRCA."},"kimi_summary":{"content_quality":"ok","complexity_score":5,"scope_assessment":{"changed":false,"description":"This instrument maintains the established scope of Repatriation Medical Authority Statements of Principles. It replaces the 2013 version (No. 8 of 2013) with updated medical factors but does not expand beyond the original purpose of determining service connection for carpal tunnel syndrome claims. The structure remains consistent with other SOPs: defining the condition, listing onset and aggravation factors, and providing technical definitions. The addition of newer medical factors (such as immune checkpoint inhibitors and aromatase inhibitors) reflects updated medical knowledge rather than scope creep."},"complexity_factors":["33 distinct factors with parallel structure (factors 1-16 for onset, 17-32 for worsening, plus 33 for clinical management)","Multiple defined terms in Schedule 1 (approximately 12 formal definitions including nested definitions like BMI within 'being overweight or obese')","Precise quantitative thresholds throughout (8 hours/week, 6 months, 30 days, 50 times/hour, 3kg/1kg loads, BMI 25, waist measurements 94cm/80cm, GFR <15 mL/min)","Conditional timing requirements ('within 30 days of cessation', 'within 2 years before', 'within 3 months before')","Cross-references to other Statements of Principles for related conditions (section 11)","Dual legislative framework application (VEA and MRCA with different service definitions)","Technical medical terminology requiring definition (acromegaly, amyloidosis, aromatase inhibitors, immune checkpoint inhibitors)","Exception clauses in definitions (e.g., trauma definition allows for medical intervention interrupting the 7-day symptom persistence rule)"],"plain_english_summary":"This instrument updates the medical rules for deciding when carpal tunnel syndrome is service-related for veterans and current/former defence members, replacing the 2013 guidance. It applies a balance-of-probabilities test and lists 33 factors (e.g., repetitive hand/wrist work, wrist trauma, medical conditions, or service-related worsening) that can link the condition to service.\n\nIt functions as a checklist for clinicians and decision-makers to ensure consistent, evidence-based compensation and treatment decisions."},"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-carpal-tunnel-syndrome-balance-of-probabilities-no-94-of-2021","history":"/api/acts/statement-of-principles-concerning-carpal-tunnel-syndrome-balance-of-probabilities-no-94-of-2021/history","analysis":"/api/acts/statement-of-principles-concerning-carpal-tunnel-syndrome-balance-of-probabilities-no-94-of-2021/analysis","conflicts":"/api/acts/statement-of-principles-concerning-carpal-tunnel-syndrome-balance-of-probabilities-no-94-of-2021/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-carpal-tunnel-syndrome-balance-of-probabilities-no-94-of-2021/important-cases","documents":"/api/acts/statement-of-principles-concerning-carpal-tunnel-syndrome-balance-of-probabilities-no-94-of-2021/documents"}}