{"id":"F2019L00241","name":"Statement of Principles concerning de Quervain tendinopathy (Balance of Probabilities) (No. 42 of 2019)","slug":"statement-of-principles-concerning-de-quervain-tendinopathy-balance-of-probabilities-no-42-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439957,"registerId":"F2019L00241-fast-fetch-1775955776604","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning de Quervain tendinopathy (Balance of Probabilities) (No. 42 of 2019)","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\nDE QUERVAIN TENDINOPATHY (Balance of Probabilities)\n\n(No. 42 of 2019)\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 1 March 2019\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 Nicholas Saunders AO
Chairperson
|\n\n\n \n\n \n\n\nContents\n\n1 Name\n\n2 Commencement\n\n3 Authority\n\n4 Application\n\n5 Definitions\n\n6 Kind of injury, disease or death to which this Statement of Principles relates\n\n7 Basis for determining the factors\n\n8 Factors that must exist\n\n9 Relationship to service\n\n10 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 de Quervain tendinopathy (Balance of Probabilities) (No. 42 of 2019).\n\n2 Commencement\n\n This instrument commences on 25 March 2019.\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n4 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\n5 Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n6 Kind of injury, disease or death to which this Statement of Principles relates\n\n(1) This Statement of Principles is about de Quervain tendinopathy and death from de Quervain tendinopathy.\n\nMeaning of de Quervain tendinopathy\n\n(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.\n\n(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).\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 de Quervain tendinopathy\n\n(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.\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n7 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 de Quervain tendinopathy and death from de Quervain tendinopathy 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\n8 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, de Quervain tendinopathy or death from de Quervain tendinopathy is connected with the circumstances of a person's relevant service:\n\n(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;\n\nNote: forceful activities and repetitive activities are defined in the Schedule 1 - Dictionary. \n\n(2) having acute trauma involving the affected wrist or tendon, within the one year before the clinical onset of de Quervain tendinopathy;\n\nNote: Examples of acute trauma include, but are not limited to, a laceration, puncture, heavy blow, fracture and crush injury.\n\n(3) being treated with or using growth hormone within the one year before the clinical onset of de Quervain tendinopathy;\n\n(4) being treated with a fluoroquinolone antibiotic within the six months before the clinical onset of de Quervain tendinopathy;\n\nNote: Examples of fluoroquinolone antibiotics include, but are not limited to, ciprofloxacin, moxifloxacin, norfloxacin and ofloxacin.\n\n(5) being treated with an aromatase inhibitor within the one year before the clinical onset of de Quervain tendinopathy;\n\nNote: Examples of aromatase inhibitors include, but are not limited to, anastrozole, exemestane and letrozole.\n\n(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;\n\nNote: forceful activities and repetitive activities are defined in the Schedule 1 - Dictionary. \n\n(7) having acute trauma involving the affected wrist or tendon, within the one year before the clinical worsening of de Quervain tendinopathy;\n\nNote: Examples of acute trauma include, but are not limited to, a laceration, puncture, heavy blow, fracture and crush injury.\n\n(8) being treated with or using growth hormone within the one year before the clinical worsening of de Quervain tendinopathy;\n\n(9) being treated with a fluoroquinolone antibiotic within the six months before the clinical worsening of de Quervain tendinopathy;\n\nNote: Examples of fluoroquinolone antibiotics include, but are not limited to, ciprofloxacin, moxifloxacin, norfloxacin and ofloxacin.\n\n(10) being treated with an aromatase inhibitor within the one year before the clinical worsening of de Quervain tendinopathy;\n\nNote: Examples of aromatase inhibitors include, but are not limited to, anastrozole, exemestane and letrozole.\n\n(11) inability to obtain appropriate clinical management for de Quervain tendinopathy.\n\n9 Relationship to service\n\n(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.\n\n(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.\n\n10 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 8 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 5\n\n1 Definitions\n\nIn this instrument:\n\n de Quervain tendinopathy—see subsection 6(2).\n\n forceful activities means tasks requiring the generation of force by the hand which:\n\n(a) are equivalent to lifting or carrying loads of more than three kilograms; or\n\n(b) involve lifting or carrying an object in the hand greater than one kilogram in excess of ten times per hour.\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 repetitive activities means:\n\n(a) bending or twisting of the hand or wrist at least 50 times an hour; or\n\n(b) carrying out the same or similar movements in the hand or wrist at least 50 times an hour.\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 VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":false,"description":"The instrument defines criteria for linking de Quervain tendinopathy to relevant service for claims under the VEA and MRCA (see s.4 and s.6). It is self-contained and specifies who is covered and the factual thresholds required; the text does not indicate an expansion or narrowing of beneficiary categories beyond those Acts."},"complexity_factors":["Multiple precise temporal thresholds and exposure minima (e.g. cumulative 500 hours in six months; trauma within one year) introduce granular evidentiary demands (see s.8(1),(6),(2),(7)).","Distinction between causation (arising out of service) and material contribution/aggravation where pre-existing condition is worsened during service (s.9(2)).","Quantitative, technical definitions for \"forceful activities\" and \"repetitive activities\" with specific weight and repetition cutoffs (Schedule 1).","Inclusion of medical treatments as risk factors (growth hormone, fluoroquinolone antibiotics, aromatase inhibitors) requires verification from prescribing/medical records (s.8(3)-(5),(8)-(10)).","Cross-reference mechanism to other Statements of Principles creates dependency on the terms of other instruments (s.10).","Application to death via contribution to a terminal event expands proof to causal contribution to proximate/ultimate cause of death (s.6(5)).","\"Inability to obtain appropriate clinical management\" is a loosely framed factor that may increase evidentiary and adjudicative uncertainty (s.8(11)).","Legal standard is balance of probabilities but the instrument anchors the decision to \"sound medical‑scientific evidence\", creating a mixed legal-medical assessment (s.7)."],"plain_english_summary":"**What this does:** This Statement of Principles sets the medical and service-related conditions under which de Quervain tendinopathy (a painful entrapment of thumb/wrist tendons) is accepted as connected to relevant service for claims under the Veterans' Entitlements Act and the Military Rehabilitation and Compensation Act. It uses the balance of probabilities test. \n**Who it affects and why it matters:** Veterans and current/former members claiming compensation: meeting specified exposure, trauma or treatment criteria links the condition to service and therefore to entitlement 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"},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument maintains its original narrow scope. It addresses a single specific medical condition (de Quervain tendinopathy) and establishes the causal factors required to link it to veterans' service. The structure follows the standard template for Repatriation Medical Authority Statements of Principles without mission creep into broader policy areas."},"complexity_factors":["Moderate cross-referencing between the main body and Schedule 1 (Dictionary) for defined terms","Dual structure covering both 'clinical onset' (new condition) and 'clinical worsening' (aggravation) with parallel but slightly different rules","Specific quantitative thresholds requiring calculation (500 hours within 6 months, 50 movements per hour, weight thresholds of 1kg/3kg)","Conditional logic in section 9(2) restricting certain factors to pre-existing conditions only","Nested definitions requiring lookup (e.g., 'relevant service' defined in Dictionary, which itself references VEA and MRCA definitions)","Incorporation of external medical classification system (ICD-10-AM Tenth Edition) by specific edition and ISBN","Circular reference risk: section 10 creates potential infinite loop where factors can refer to other Statements of Principles which may refer back"],"plain_english_summary":"This instrument sets when veterans and current/former defence members can get compensation for de Quervain tendinopathy. The Repatriation Medical Authority treats the condition as service‑related only if the claimant proves, on the balance of probabilities, certain gateway factors existed before onset or worsening.\n\nThose factors include things like heavy/repetitive wrist use, a recent acute wrist injury, exposure to specific medications, or lack of access to treatment. It therefore determines who qualifies for DVA or MRCA benefits."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-de-quervain-tendinopathy-balance-of-probabilities-no-42-of-2019","history":"/api/acts/statement-of-principles-concerning-de-quervain-tendinopathy-balance-of-probabilities-no-42-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-de-quervain-tendinopathy-balance-of-probabilities-no-42-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-de-quervain-tendinopathy-balance-of-probabilities-no-42-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-de-quervain-tendinopathy-balance-of-probabilities-no-42-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-de-quervain-tendinopathy-balance-of-probabilities-no-42-of-2019/documents"}}