{"id":"F2024L01695","name":"Statement of Principles concerning traumatic brachial plexopathy (Balance of Probabilities) (No. 2 of 2025)","slug":"statement-of-principles-concerning-traumatic-brachial-plexopathy-balance-of-probabilities-no-2-of-20","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442676,"registerId":"F2024L01695-fast-fetch-1775957629435","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning traumatic brachial plexopathy (Balance of Probabilities) (No. 2 of 2025)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n![RMA Australian Government Coat of Arms](image.001.jpeg)\n\n \n\nStatement of Principles\n\nconcerning\n\nTRAUMATIC BRACHIAL PLEXOPATHY  (Balance of Probabilities)\n\n(No. 2 of 2025)\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    17 December 2024.\n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\nProfessor Terence Campbell AM\n\nChairperson\n\nby and on behalf of\n\nThe Repatriation Medical Authority\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\n\n\n1.                Name\n\n\nThis is the Statement of Principles concerning traumatic brachial plexopathy (Balance of Probabilities) (No. 2 of 2025).\n\n1.                Commencement\n\n\n              This instrument commences on 28 January 2025.\n\n1.                Authority\n\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n1.                Application\n\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\n1.                Definitions\n\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n1.                Kind of injury, disease or death to which this Statement of Principles relates\n  1.           This Statement of Principles is about traumatic brachial plexopathy and death from traumatic brachial plexopathy.\n\n\nMeaning of traumatic brachial plexopathy\n\n1.           For the purposes of this Statement of Principles, traumatic brachial plexopathy:\n  1.           means a physical injury to the brachial plexus; and\n  2.           excludes:\n    1.             Parsonage-Turner syndrome (neuralgic amyotrophy);\n    2.          radiation induced plexus injury;\n    3.        thoracic outlet syndrome;\n    4.         cervical radiculopathy or myelopathy; and\n    5.           upper limb mononeuritis multiplex.\n\n\nNote: There are a separate set of SoPs for thoracic outlet syndrome that may also be applicable.\n\nDeath from traumatic brachial plexopathy\n\n1.           For the purposes of this Statement of Principles, traumatic brachial plexopathy, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's traumatic brachial plexopathy.\n\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n1.                Basis for determining the factors\n\n\nOn the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that traumatic brachial plexopathy and death from traumatic brachial plexopathy 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\n1.                Factors that must exist\n\n\nAt least one of the following factors must exist before it can be said that, on the balance of probabilities, traumatic brachial plexopathy or death from traumatic brachial plexopathy is connected with the circumstances of a person's relevant service:\n\n1.           having trauma to the upper chest, shoulder or neck of the affected side within the 1 year before clinical onset or clinical worsening;\n\n\nNote 1: trauma to the upper chest, shoulder or neck is defined in the Schedule 1 – Dictionary.\n\nNote 2: Examples of trauma involving traction and or compression to the brachial plexus include blows to the upper chest and shoulder causing injury, injuries from motor vehicle accidents, a fall from height resulting in injury, or sports injuries,\n\nNote 3: Examples of types of penetrating injury to the upper chest, shoulder or neck include gunshot wounds or laceration injuries from knives or glass.\n\nNote 4: Examples of surgery that may cause trauma to the upper chest, shoulder or neck include surgery for clavicle fracture, brachial plexus nerve block, catheterisation of the subclavian or internal jugular veins, and axillary arteriography.\n\nNote 5: Delayed onset of traumatic brachial plexopathy may occur as a result of the response to injury, including the formation of callus around fractures and the development of scar tissue.\n\n1.           having malposition of the head, neck, or shoulders in any of the following circumstances within the 24 hours before clinical onset or clinical worsening:\n  1.           surgery under general anaesthesia;\n  2.           prone positioning in an intensive care unit;\n  3.           reduced conscious state;\n\n\nNote 1: Examples of types of surgery that can cause malposition of the head, neck, or shoulders include surgery in the prone position such as oesophagectomy or spinal surgery or surgery involving the Trendelenburg position such as abdominal or pelvic laparoscopy.\n\nNote 2: Examples of malposition of the head, neck, or shoulders with reduced conscious state include sleep associated with alcohol or drug induced intoxication (“Friday or Saturday night palsy”) or head injury.\n\n1.           having a median sternotomy within the 7 days before clinical onset or clinical worsening;\n\n\nNote: Examples where median sternotomy is performed include coronary artery bypass graft, cardiac valve surgery, surgery to the thoracic aorta, thoracic operations (retrosternal goitre, oesophagectomy), neurosurgical procedures where access to thoracic vertebral bodies or discs is required, and in emergency thoracotomy for penetrating trauma.\n\n1.           having an electrical injury to the brachial plexus within the 24 hours before clinical onset or clinical worsening;\n\n\n1.           carrying a load of at least 20 kilograms where the bulk of the load is supported by the shoulders, for at least 2 hours within the 24 hours before clinical onset or clinical worsening;\n\n\nNote: Examples of a load include a loaded backpack, body armour, rifle, ammunition, communication systems or sandbags. Where more than one type of load is combined the combined weight must exceed 20kgs.\n\n1.           carrying a load of at least 10 kilograms where the bulk of the load is supported by one shoulder, for at least 2 hours within the 24 hours before clinical onset or clinical worsening;\n\n\nNote: Examples of a load include a loaded backpack, body armour, rifle, ammunition, communication systems or sandbags. Where more than one type of load is combined the combined weight must exceed 10kgs.\n\n1.           inability to obtain appropriate clinical management for traumatic brachial plexopathy before clinical worsening.\n\n\n1.                Relationship to service\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  2.           The clinical worsening aspects of factors set out in section 8 apply only to material contribution to, or aggravation of, traumatic brachial plexopathy where the person's traumatic brachial plexopathy was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n2.            Factors referring to an injury or disease covered by another Statement of Principles\n\n\nIn this Statement of Principles:\n\n1.           if a factor referred to in section 8 applies in relation to a person; and\n2.           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\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\nSchedule 1 - Dictionary  \n\nNote:               See Section 5\n\n1               Definitions\n\nIn this instrument:\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 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 to the upper chest, shoulder or neck means traction, compression, penetrating injury or surgery to the affected upper chest, shoulder or neck region.\n\n                               traumatic brachial plexopathy—see subsection 6(2).\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":4,"scope_assessment":{"changed":false,"description":"This is a standard, purpose-built Statement of Principles (SoP) that performs exactly its intended function under the Veterans' Entitlements Act. It establishes causation criteria for a specific medical condition (traumatic brachial plexopathy) without expanding into broader policy areas. The structure mirrors other SoPs in the veterans' compensation scheme."},"complexity_factors":["Moderate cross-referencing between the Veterans' Entitlements Act 1986 and Military Rehabilitation and Compensation Act 2004","7 distinct causal factors with varying time windows (24 hours, 7 days, 1 year) creating conditional logic","Specific quantitative thresholds (10kg, 20kg, 2 hours) requiring precise factual determination","5 explicit exclusions in the definition requiring differentiation from similar conditions","Nested definitions requiring reference to Schedule 1 Dictionary for 6 key terms","Dual application framework — distinguishes between initial onset claims and 'clinical worsening' claims with different rules","Incorporation by reference of other Statements of Principles for related conditions"],"plain_english_summary":"This instrument sets when traumatic brachial plexopathy is treated as service‑related for compensation and rehabilitation, applying a \"balance of probabilities\" test. It affects veterans and current/former defence personnel claiming under VEA or MRCA, covering non‑operational and eligible war/defence service.\n\nIt identifies specific service‑linked triggers (trauma, surgical or ICU positioning, electrical injury, load carriage, or delayed treatment) and excludes other diagnoses, creating narrow but clear gateways that determine entitlement to benefits and care."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":false,"description":"The instrument itself defines its scope: it applies to claims under the VEA or MRCA for traumatic brachial plexopathy and related death, and it expressly excludes a set of non‑traumatic plexus conditions. The text contains no statement that it alters or narrows a prior instrument’s scope; it sets specific qualifying events, temporal limits and exclusions for determining connection to relevant service."},"complexity_factors":["Technical medical terminology and diagnostic boundaries (traumatic brachial plexopathy versus Parsonage-Turner syndrome, radiation injury, thoracic outlet syndrome, cervical radiculopathy, mononeuritis multiplex).","Multiple, discrete temporal thresholds for causative events (1 year, 24 hours, 7 days) that must be demonstrated.","Quantitative exposure rules (weight and duration thresholds for shoulder-supported loads) requiring specific factual proof.","Interplay with other Statements of Principles: some factors may refer claims to other SoPs as in force.","Legal evidentiary standard is 'balance of probabilities' and factors must be shown to be related to relevant service (VEA/MRCA definitions).","Potentially open-ended factor ('inability to obtain appropriate clinical management') introduces administrative judgment and evidentiary assessment."],"plain_english_summary":"This Statement of Principles sets the medical criteria for deciding, on the balance of probabilities, whether traumatic brachial plexopathy (and death contributed to by it) is connected with a person’s relevant military service for claims under the VEA or MRCA. It identifies specific qualifying events (for example, trauma to the upper chest/shoulder/neck, malpositioning during surgery or ICU care, median sternotomy, electrical injury, carrying heavy shoulder loads, or failure to obtain appropriate management), specifies time limits for those factors, and excludes certain other plexus conditions."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-traumatic-brachial-plexopathy-balance-of-probabilities-no-2-of-20","history":"/api/acts/statement-of-principles-concerning-traumatic-brachial-plexopathy-balance-of-probabilities-no-2-of-20/history","analysis":"/api/acts/statement-of-principles-concerning-traumatic-brachial-plexopathy-balance-of-probabilities-no-2-of-20/analysis","conflicts":"/api/acts/statement-of-principles-concerning-traumatic-brachial-plexopathy-balance-of-probabilities-no-2-of-20/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-traumatic-brachial-plexopathy-balance-of-probabilities-no-2-of-20/important-cases","documents":"/api/acts/statement-of-principles-concerning-traumatic-brachial-plexopathy-balance-of-probabilities-no-2-of-20/documents"}}