{"id":"F2019L00008","name":"Statement of Principles concerning Dupuytren disease (Balance of Probabilities) (No. 10 of 2019)","slug":"statement-of-principles-concerning-dupuytren-disease-balance-of-probabilities-no-10-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439898,"registerId":"F2019L00008-fast-fetch-1775955742338","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning Dupuytren disease (Balance of Probabilities) (No. 10 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\nDUPUYTREN DISEASE (Balance of Probabilities)\n\n(No. 10 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 21 December 2018\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 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 Dupuytren disease (Balance of Probabilities) (No. 10 of 2019).\n\n2 Commencement\n\n This instrument commences on 28 January 2019.\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 Dupuytren's disease No. 58 of 2010 (Federal Register of Legislation No. F2010L01671) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 Dupuytren disease and death from Dupuytren disease.\n\nMeaning of Dupuytren disease\n\n(2) For the purposes of this Statement of Principles, Dupuytren disease means a benign, progressive fibroproliferative disease of the palmar and digital fascia, which causes puckering and thickening of palmar skin and the formation of nodules and cords in the palmar and digital fascia, and which may progress to flexion contracture of the digits.\n\n(3) While Dupuytren disease attracts ICD‑10‑AM code M72.0, in applying this Statement of Principles the meaning of Dupuytren disease 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 Dupuytren disease\n\n(5) For the purposes of this Statement of Principles, Dupuytren disease, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's Dupuytren disease.\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 Dupuytren disease and death from Dupuytren disease 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, Dupuytren disease or death from Dupuytren disease is connected with the circumstances of a person's relevant service:\n\n(1) smoking at least ten pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of Dupuytren disease, and:\n\n(a) smoking commenced at least five years before the clinical onset of Dupuytren disease; and\n\n(b) where smoking has ceased, the clinical onset of Dupuytren disease has occurred within five years of cessation;\n\nNote: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary. \n\n(2) consuming an average of at least 200 grams per week of alcohol, for at least five consecutive years within the ten years before the clinical onset of Dupuytren disease;\n\nNote: Alcohol consumption is calculated utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink. \n\n(3) having alcohol use disorder at the time of the clinical onset of Dupuytren disease;\n\n(4) having alcoholic liver disease before the clinical onset of Dupuytren disease;\n\nNote: alcoholic liver disease is defined in the Schedule 1 - Dictionary.\n\n(5) having trauma to the hand, wrist or forearm of the affected side, within the one year before the clinical onset of Dupuytren disease;\n\nNote 1: trauma is defined in the Schedule 1 - Dictionary.\n\nNote 2: Examples of trauma include, but are not limited to, laceration, sprain or crush injury, fracture or surgery, and a thermal, electrical or chemical burn.\n\n(6) having a clinically significant infection involving the palmar surface of the affected hand, within the three months before the clinical onset of Dupuytren disease;\n\nNote: clinically significant infection involving the palmar surface of the affected hand is defined in the Schedule 1 - Dictionary. \n\n(7) for bilateral Dupuytren disease only:\n\n(a) having trauma to the hand, wrist or forearm before the clinical onset of Dupuytren disease, and where:\n\n(i) Dupuytren disease first developed on the side affected by trauma; and\n\n(ii) Dupuytren disease developed in both hands within the one year following the trauma; or\n\nNote 1: trauma is defined in the Schedule 1 - Dictionary.\n\nNote 2: Examples of trauma include, but are not limited to, laceration, sprain or crush injury, fracture or surgery, and a thermal, electrical or chemical burn.\n\n(b) having a clinically significant infection involving the palmar surface of the affected hand before the clinical onset of Dupuytren disease, and where:\n\n(i) Dupuytren disease first developed on the side affected by the infection; and\n\n(ii) Dupuytren disease developed in both hands within the three months following the infection;\n\nNote: clinically significant infection involving the palmar surface of the affected hand is defined in the Schedule 1 - Dictionary. \n\n(8) performing any combination of:\n\n(a) repetitive, strenuous or forceful activities using the affected hand; or\n\n(b) activities using a hand-held, vibrating or percussive tool in the affected hand;\n\nfor a cumulative period of at least 10 000 hours before the clinical onset of Dupuytren disease, and where these activities have ceased, the clinical onset of Dupuytren disease has occurred within five years of cessation;\n\nNote 1: Examples of repetitive, strenuous or forceful activities include, but are not limited to, handling, lifting, moving or carrying a load greater than ten kilograms; using large, hand-held power machinery; lifting, digging or shovelling; and participating in sports involving repetitive, strenuous or forceful activities such as tennis, rock climbing, hockey or baseball.\n\nNote 2: Examples of a hand-held, vibrating or percussive tool include, but are not limited to, screwdrivers, drills, chainsaws, jackhammers, boring machines and punching machines. \n\n(9) having diabetes mellitus before the clinical onset of Dupuytren disease;\n\n(10) having epilepsy at the time of the clinical onset of Dupuytren disease;\n\n(11) being treated with vemurafenib within the two years before the clinical onset of Dupuytren disease;\n\n(12) smoking at least ten pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of Dupuytren disease, and:\n\n(a) smoking commenced at least five years before the clinical worsening of Dupuytren disease; and\n\n(b) where smoking has ceased, the clinical worsening of Dupuytren disease has occurred within five years of cessation;\n\nNote: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary. \n\n(13) consuming an average of at least 200 grams per week of alcohol, for at least five consecutive years within the ten years before the clinical worsening of Dupuytren disease;\n\nNote: Alcohol consumption is calculated utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink. \n\n(14) having alcohol use disorder at the time of the clinical worsening of Dupuytren disease;\n\n(15) having alcoholic liver disease before the clinical worsening of Dupuytren disease;\n\nNote: alcoholic liver disease is defined in the Schedule 1 - Dictionary.\n\n(16) having trauma to the hand, wrist or forearm of the affected side, within the one year before the clinical worsening of Dupuytren disease;\n\nNote 1: trauma is defined in the Schedule 1 - Dictionary.\n\nNote 2: Examples of trauma include, but are not limited to, laceration, sprain or crush injury, fracture or surgery, and a thermal, electrical or chemical burn.\n\n(17) having a clinically significant infection involving the palmar surface of the affected hand, within the three months before the clinical worsening of Dupuytren disease;\n\nNote: clinically significant infection involving the palmar surface of the affected hand is defined in the Schedule 1 - Dictionary. \n\n(18) for bilateral Dupuytren disease only:\n\n(a) having trauma to the hand, wrist or forearm before the clinical worsening of Dupuytren disease, and where:\n\n(i) Dupuytren disease first worsened on the side affected by trauma; and\n\n(ii) Dupuytren disease worsened in both hands within the one year following the trauma; or\n\nNote 1: trauma is defined in the Schedule 1 - Dictionary.\n\nNote 2: Examples of trauma include, but are not limited to, laceration, sprain or crush injury, fracture or surgery, and a thermal, electrical or chemical burn.\n\n(b) having a clinically significant infection involving the palmar surface of the affected hand before the clinical worsening of Dupuytren disease, and where:\n\n(i) Dupuytren disease first worsened on the side affected by the infection; and\n\n(ii) Dupuytren disease worsened in both hands within the three months following the infection;\n\nNote: clinically significant infection involving the palmar surface of the affected hand is defined in the Schedule 1 - Dictionary. \n\n(19) performing any combination of:\n\n(a) repetitive, strenuous or forceful activities using the affected hand; or\n\n(b) activities using a hand-held, vibrating or percussive tool in the affected hand;\n\nfor a cumulative period of at least 10 000 hours before the clinical worsening of Dupuytren disease; and where these activities have ceased, the clinical worsening of Dupuytren disease has occurred within five years of cessation;\n\nNote 1: Examples of repetitive, strenuous or forceful activities include, but are not limited to, handling, lifting, moving or carrying a load greater than ten kilograms; using large, hand-held power machinery; lifting, digging or shovelling; and participating in sports involving repetitive, strenuous or forceful activities such as tennis, rock climbing, hockey or baseball.\n\nNote 2: Examples of a hand-held, vibrating or percussive tool include, but are not limited to, screwdrivers, drills, chainsaws, jackhammers, boring machines and punching machines. \n\n(20) having diabetes mellitus before the clinical worsening of Dupuytren disease;\n\n(21) having epilepsy at the time of the clinical worsening of Dupuytren disease;\n\n(22) being treated with vemurafenib within the two years before the clinical worsening of Dupuytren disease;\n\n(23) inability to obtain appropriate clinical management for Dupuytren disease.\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(12) to 9(23) apply only to material contribution to, or aggravation of, Dupuytren disease where the person's Dupuytren disease 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 alcoholic liver disease means steatohepatitis or cirrhosis of the liver due to chronic, heavy alcohol consumption.\n\n clinically significant infection involving the palmar surface of the affected hand means an infection such as flexor tenosynovitis or a palmar abscess.\n\n Dupuytren disease—see subsection 7(2).\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n pack-years of cigarettes, or the equivalent thereof in other tobacco products means a calculation of consumption where one pack-year of cigarettes equals twenty tailor-made cigarettes per day for a period of one calendar year, or 7 300 cigarettes. One tailor-made cigarette approximates one gram of tobacco or one gram of cigar or pipe tobacco by weight. One pack-year of tailor-made cigarettes equates to 7.3 kilograms of smoking tobacco by weight. Tobacco products mean cigarettes, pipe tobacco or cigars, smoked alone or in any combination.\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 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 means a significant injury, resulting in symptoms and signs lasting for at least seven days, or which is of sufficient severity to warrant medical attention.\n\n VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"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":6,"scope_assessment":{"changed":false,"description":"This is a standard replacement Statement of Principles that maintains the established scope of the Repatriation Medical Authority's determinations. It repeals and replaces the 2010 version (No. 58 of 2010) without expanding into new substantive areas. The structure—covering onset factors, worsening factors, and service connection requirements—follows the standard template for RMA Statements of Principles. The specific risk factors listed (smoking, alcohol, trauma, vibration exposure, diabetes, etc.) reflect current medical evidence but do not represent a broadening beyond the instrument's original purpose of establishing service connection criteria for this specific disease."},"complexity_factors":["23 distinct factors with intricate temporal requirements (e.g., 'within five years of cessation', 'at least five consecutive years within the ten years before')","Nested conditional logic in factors 7 and 18 for bilateral disease, requiring both sequential development and specific timing","Cross-references to external classification systems (ICD-10-AM Tenth Edition) and other Statements of Principles","Mathematical conversion requirements for pack-years (7,300 cigarettes = 1 pack-year; 7.3kg tobacco weight equivalence)","Dual application structure—factors 1-11 for initial onset, factors 12-23 for clinical worsening, with different service connection rules in section 10(2)","Defined terms in Schedule 1 that modify common meanings (e.g., 'trauma' requires symptoms lasting 7+ days or medical attention)","Specific exclusionary note in section 10(2) limiting worsening factors to pre-existing disease not arising from service"],"plain_english_summary":"The Repatriation Medical Authority sets medical criteria linking Dupuytren disease to military service: if one of 23 listed risk factors (e.g., smoking, alcohol, trauma, repetitive hand work, certain illnesses or treatments) is proven on the balance of probabilities and connected to service, affected veterans and current/former defence members may qualify for compensation. This replaces the 2010 guidance and is the legal basis for accepting or denying Dupuytren claims."},"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":true,"description":"This version broadens and refines the scope compared with the earlier 2010 Statement it repeals (s4). Notable scope changes include: (1) explicit and parallel coverage of both \"clinical onset\" and \"clinical worsening\" with repeated factor lists for each outcome (s9(1)–(23)); (2) explicit rules allowing material contribution or aggravation to be accepted where disease existed before or during (but did not arise out of) service (s10(2)); (3) addition of a treatment‑related trigger (treatment with vemurafenib within two years) (s9(11)/(22)); (4) addition of an inability to obtain appropriate clinical management as a factor for clinical worsening (s9(23)); and (5) detailed quantitative thresholds (pack‑years, alcohol grams/week, 10,000 cumulative hours) and strict temporal windows that refine eligibility. Collectively, these changes expand the instrument from only addressing first occurrence in some earlier formulations to also governing aggravation/worsening and add new, specific exposure and treatment triggers."},"complexity_factors":["Single main defined condition but two clinical end‑points: clinical onset and clinical worsening (repeated factor lists)","23 enumerated factors with many mirrored as onset/worsening variants (s9(1)–(23))","Nested conditions for bilateral disease with temporal sequencing (s9(7) and s9(18))","Quantitative thresholds requiring calculations: pack‑years for tobacco, 200 g/week alcohol, 10,000 cumulative hours of hand exposure (s9; Schedule 1 definitions)","Multiple short, strict temporal windows (e.g. trauma within 1 year; infection within 3 months; smoking started ≥5 years before onset; onset within 5 years of cessation)","Cross-reference to other Statements of Principles if a factor refers to another covered disease (s11), creating dependency on other instruments","Several defined terms in Schedule 1 (e.g. alcoholic liver disease, clinically significant infection, trauma, pack‑years, relevant service, terminal event)","Repeals and replaces prior instrument (s4), requiring comparison to prior wording for some cases","Requirement that factors be related to \"relevant service\" adds an additional legal nexus step (s10)","Combination of medical, occupational and pharmaceutical triggers (including vemurafenib) increases domain knowledge needed for correct application"],"plain_english_summary":"**What this instrument does (mechanics)\n\n- Defines the illness the instrument covers as Dupuytren disease (a non-cancerous, progressive thickening and puckering of the palmar fascia that can lead to bent fingers) and includes death where Dupuytren disease contributed (see s7).\n\n- Says when and to which claims it applies: this Statement of Principles (SoP) is used for claims under the Veterans' Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA) (s5). The Repatriation Medical Authority (RMA) made it under the VEA (s3).\n\n- Repeals the prior Dupuytren SoP from 2010 and replaces it (s4).\n\n- Lists the factual, medical and exposure factors that must be present before a decision-maker can, on the balance of probabilities, link Dupuytren disease (or death from it) to a person’s relevant service (s9). These factors are the objective tests the RMA considers sufficient to establish a connection. Key examples include:\n - Smoking: at least 10 pack‑years, started at least five years before clinical onset (and if smoking has stopped, onset must be within five years of cessation) (s9(1) and s9(12)). The instrument defines how to calculate \"pack‑years\" (Schedule 1).\n - Alcohol: an average of at least 200 g of alcohol per week for five consecutive years within the ten years before clinical onset (s9(2) and s9(13)); or alcohol use disorder or alcoholic liver disease (s9(3)–(4) and s9(14)–(15)). The instrument uses the Australian standard of 10 g alcohol per standard drink to calculate amounts.\n - Trauma or clinically significant infection of the palmar surface of the affected hand within strict time windows before onset or worsening (trauma within one year; infection within three months) (s9(5)–(6) and s9(16)–(17)). The instrument defines \"trauma\" and gives examples (Schedule 1).\n - Occupational/physical exposure: a cumulative 10,000 hours of repetitive, forceful or vibrating-tool use with the affected hand before onset (s9(8) and s9(19)); if these activities have ceased, onset/worsening must occur within five years of cessation.\n - Medical/other conditions: diabetes mellitus, epilepsy, or having been treated with the cancer drug vemurafenib within two years before onset or clinical worsening (s9(9)–(11) and s9(20)–(22)).\n - An inability to obtain appropriate clinical management for Dupuytren disease is listed as a factor for clinical worsening (s9(23)).\n\n- Distinguishes between \"clinical onset\" and \"clinical worsening\" and repeats most exposure/condition tests for both outcomes; some factors are specific to bilateral disease and require particular temporal patterns (s9(7) and s9(18)).\n\n- Requires that any factor relied on be related to the person's \"relevant service\" (s10(1)). It also clarifies that the list of factors for worsening or material contribution apply only where the disease existed before or during (but did not arise out of) relevant service (s10(2)).\n\n- If a listed factor refers to an injury or disease already covered by another SoP, that other SoP governs how that factor is applied (s11).\n\nWhy the RMA says it matters (stated basis)\n\n- The RMA states that, on available medical/scientific evidence, it is more probable than not that Dupuytren disease (and death from it) can be related to relevant service (s8). The SoP therefore sets the evidentiary and causal criteria decision-makers should use when assessing claims.\n\nHow this operates in practice and what it implies (testing the RMA's claim against costs, incentives and implementation mechanics)\n\n- Who decides: The RMA makes the SoP (s3). Administrative decision-makers (the Department of Veterans' Affairs or MRCA decision bodies) use the SoP as the medical/causal benchmark when deciding entitlement claims (see s5 and s11). The instrument itself does not pay benefits; it sets the medical link standard used in statutory claims.\n\n- Who pays (practical effect): If a claim succeeds under the VEA or MRCA using this SoP as the causal test, the relevant compensation or pension liabilities under those Acts may follow. The financial obligation therefore rests with the statutory scheme that pays successful claims (implicit from application to VEA/MRCA claims, s5).\n\n- Behavioural and evidentiary effects on claimants: The SoP imposes concrete, often quantitative thresholds (pack‑years; 200 g/week alcohol; 10,000 cumulative hours of hand strain; strict timing windows for trauma or infection). That structure tends to shift the burden onto claimants to prove exposure histories within those thresholds — which requires occupational records, medical records, or credible testimony. Where exposures are imprecise or undocumented (for example, historical alcohol consumption, cumulative hours of repetitive work, or infections treated outside hospital records), establishing the specified tests may be difficult in practice.\n\n- Compliance and administrative cost: Decision-makers will need to verify temporal limits (e.g. \"within one year before clinical onset\") and dosage thresholds. This verification increases administrative and medical‑evidence costs (obtaining records, expert reports). The requirement that some factors be \"related to relevant service\" (s10(1)) adds an investigative step to connect exposure timing/location to service periods.\n\n- Incentives and substitution effects: The SoP distinguishes between causal links that give rise to disease during service and those that materially contribute to or aggravate pre-existing disease. By explicitly listing factors that can constitute material contribution/aggravation (s9(12)–(23) and s10(2)), the instrument allows claims where disease pre-existed service but worsened in connection with service. That can broaden the universe of payable claims compared with an instrument that only recognises disease first occurring in service.\n\n- Concentrated benefits, diffuse costs: Benefits flow to successful claimants who meet the listed factors. The fiscal cost of additional awards is borne by the statutory schemes (VEA/MRCA). The SoP’s specific thresholds (e.g. vemurafenib as a trigger, s9(11)/(22)) can create concentrated eligibility for small groups exposed to particular treatments.\n\n- Bureaucratic discretion and cross-references: The SoP defers to other SoPs where a listed factor refers to another injury/disease (s11). That creates an interdependent web of Statements of Principles decision-makers must consult and may introduce layering of criteria and potential inconsistency if other SoPs change.\n\nPractical traps and implementation risks\n\n- Temporal windows (e.g. onset within five years of smoking cessation; trauma within one year; infection within three months) are narrow and may exclude legitimate causal narratives if documentary proof of timing is lacking (s9).\n\n- The 10,000-hour cumulative threshold for hand exposure is a high, quantified bar that will be straightforward to connect to some occupations but hard to prove for informal or intermittent work (s9(8)/(19)).\n\n- Medical nomenclature and ICD code reference are included (s7(3)–(4)), but the SoP’s legal meaning of Dupuytren disease is the definition in s7(2), not merely the ICD code.\n\nBottom line (concise)\n\n- This RMA instrument replaces the 2010 Dupuytren SoP, defines Dupuytren disease for claims, and sets a list of specific medical exposures, conditions and timing rules that, if proved and related to relevant service, allow a decision-maker to accept a causal connection on the balance of probabilities (see s3, s4, s7–s11). It tightens disputes into a set of quantifiable tests (smoking, alcohol, trauma, infection, occupational hours, diabetes, epilepsy, certain drugs, inability to obtain treatment) that determine whether service can be said to have caused or materially worsened the disease. The practical effect is to create clear evidentiary thresholds that claimants must meet to obtain benefits under the VEA or MRCA."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-dupuytren-disease-balance-of-probabilities-no-10-of-2019","history":"/api/acts/statement-of-principles-concerning-dupuytren-disease-balance-of-probabilities-no-10-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-dupuytren-disease-balance-of-probabilities-no-10-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-dupuytren-disease-balance-of-probabilities-no-10-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-dupuytren-disease-balance-of-probabilities-no-10-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-dupuytren-disease-balance-of-probabilities-no-10-of-2019/documents"}}