{"id":"F2019L00242","name":"Statement of Principles concerning de Quervain tendinopathy (Reasonable Hypothesis) (No. 41 of 2019)","slug":"statement-of-principles-concerning-de-quervain-tendinopathy-reasonable-hypothesis-no-41-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439961,"registerId":"F2019L00242-fast-fetch-1775955778812","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 (Reasonable Hypothesis) (No. 41 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 (Reasonable Hypothesis)\n\n(No. 41 of 2019)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) 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 (Reasonable Hypothesis) (No. 41 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 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\nThe 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.\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 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:\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(2) 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) operational service under the VEA;\n\n(b) peacekeeping service under the VEA;\n\n(c) hazardous service under the VEA;\n\n(d) British nuclear test defence service under the VEA;\n\n(e) warlike service under the MRCA; or\n\n(f) non-warlike 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":5,"scope_assessment":{"changed":false,"description":"This instrument does not change who is within the statutory class of potential claimants; it prescribes the medical/evidentiary thresholds the Authority will use for claims under section 120A of the VEA or section 338 of the MRCA (s.4). It defines the condition and death-from-condition (s.6), lists specific qualifying factors and timeframes (s.8), and limits some factors to material contribution/aggravation of pre-existing disease (s.9(2))."},"complexity_factors":["Application limited to statutory claims under the VEA/MRCA (s.4) and uses statutory authority (s.3).","A clinical definition is set aside from the ICD code (s.6(2)–(4)), requiring medical interpretation.","Quantitative exposure thresholds (500 cumulative hours in 6 months; s.8(1),(6)) and movement frequencies (≥50 times/hour; Schedule).","Multiple temporal windows for causation: 6 months for some factors, 1 year for others (s.8).","Drug- and treatment-related causal factors listed explicitly (growth hormone, fluoroquinolones, aromatase inhibitors; s.8(3)–(5),(8)–(10)).","Distinction between primary causation and material contribution/aggravation for pre-existing disease (s.9(2)).","Inclusion of death via terminal events with a defined list (s.6(5); Schedule).","Interaction with other Statements of Principles where factors refer to other injuries/diseases (s.10).","Non-medical factor (inability to obtain appropriate clinical management) as a qualifying element (s.8(11)), raising evidentiary and administrative considerations.","Reliance on defined terms and examples in the Schedule increases cross-reference burden for decision-makers and claimants (Schedule)."],"plain_english_summary":"This Statement of Principles sets the medical and evidentiary rules the Repatriation Medical Authority uses to decide whether de Quervain tendinopathy (and death from it) can be reasonably connected to a person’s relevant military service. It applies to claims under the VEA or MRCA and gives a clinical definition plus discrete qualifying factors — for example specified exposure thresholds for repetitive or forceful use, recent trauma, certain drugs, or failure to obtain appropriate clinical care — that must be met to raise a reasonable hypothesis."},"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":3,"scope_assessment":{"changed":false,"description":"This instrument maintains its original narrow scope. It addresses only de Quervain tendinopathy and its relationship to military service, consistent with the Repatriation Medical Authority's standard practice of issuing separate Statements of Principles for individual conditions. There is no evidence of scope creep; the document does not expand into unrelated medical conditions or broader policy areas."},"complexity_factors":["Straightforward structure with only 10 main sections plus a short dictionary","Limited cross-referencing—primarily internal references to the Dictionary and defined terms","Clear, enumerated list of 11 specific factors in section 8 with minimal conditional logic","Simple temporal requirements (e.g., 'within the six months before', 'within the one year before')","Only 7 defined terms in the Dictionary, with concrete, measurable definitions (e.g., specific kilogram thresholds for 'forceful activities', specific repetition rates for 'repetitive activities')","No nested exceptions or complex provisos—section 9(2) contains the only substantive limitation, clearly delineating when factors 6-11 apply","Single-purpose instrument focused on one specific medical condition"],"plain_english_summary":"This Statement of Principles sets the medical criteria used to decide whether de Quervain tendinopathy is linked to Australian military service, affecting veterans, current and former defence members, and peacekeepers. \n\nIt explains the kinds of service-related causes (for example, repetitive or forceful wrist use, acute wrist injuries, certain medications, or lack of timely treatment) that can meet the legal threshold for compensation decisions."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-de-quervain-tendinopathy-reasonable-hypothesis-no-41-of-2019","history":"/api/acts/statement-of-principles-concerning-de-quervain-tendinopathy-reasonable-hypothesis-no-41-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-de-quervain-tendinopathy-reasonable-hypothesis-no-41-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-de-quervain-tendinopathy-reasonable-hypothesis-no-41-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-de-quervain-tendinopathy-reasonable-hypothesis-no-41-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-de-quervain-tendinopathy-reasonable-hypothesis-no-41-of-2019/documents"}}