{"id":"F2019L00238","name":"Statement of Principles concerning trigger finger (Balance of Probabilities) (No. 40 of 2019)","slug":"statement-of-principles-concerning-trigger-finger-balance-of-probabilities-no-40-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439956,"registerId":"F2019L00238-fast-fetch-1775955776603","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning trigger finger (Balance of Probabilities) (No. 40 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\nTRIGGER FINGER (Balance of Probabilities)\n\n(No. 40 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 trigger finger (Balance of Probabilities) (No. 40 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 trigger finger and death from trigger finger.\n\nMeaning of trigger finger\n\n(2) For the purposes of this Statement of Principles, trigger finger, also known as stenosing flexor tenosynovitis, means a tendon entrapment of one or more digits, where enlargement of the tendon or narrowing of its flexor pulley sheath leads to the tendon being unable to slide smoothly within the sheath.\n\nNote: Trigger finger typically presents with catching and locking during flexion or extension of the affected digit.\n\n(3) While trigger finger attracts ICD‑10‑AM code M65.3, in applying this Statement of Principles the meaning of trigger finger 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 trigger finger\n\n(5) For the purposes of this Statement of Principles, trigger finger, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's trigger finger.\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 trigger finger and death from trigger finger 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, trigger finger or death from trigger finger is connected with the circumstances of a person's relevant service:\n\n(1) performing repetitive activities or forceful activities using the affected hand, for a cumulative period of at least 500 hours within the six months before the clinical onset of trigger finger;\n\nNote: forceful activities and repetitive activities are defined in the Schedule 1 - Dictionary. \n\n(2) having acute trauma involving the affected tendon or tendon sheath, within the one year before the clinical onset of trigger finger;\n\nNote: Examples of acute trauma include, but are not limited to, a laceration, puncture, heavy blow, fracture and crush injury.\n\n(3) having diabetes mellitus before the clinical onset of trigger finger;\n\n(4) having a space occupying lesion involving the affected tendon or tendon sheath at the time of the clinical onset of trigger finger;\n\nNote: Examples of a space occupying lesion include, but are not limited to, amyloid deposit, gouty tophus, granuloma and post-surgery adhesion.\n\n(5) being treated with an aromatase inhibitor within the one year before the clinical onset of trigger finger;\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, for a cumulative period of at least 500 hours within the six months before the clinical worsening of trigger finger;\n\nNote: forceful activities and repetitive activities are defined in the Schedule 1 - Dictionary. \n\n(7) having acute trauma involving the affected tendon or tendon sheath, within the one year before the clinical worsening of trigger finger;\n\nNote: Examples of acute trauma include, but are not limited, to a laceration, puncture, heavy blow, fracture and crush injury.\n\n(8) having diabetes mellitus before the clinical worsening of trigger finger;\n\n(9) having a space occupying lesion involving the affected tendon or tendon sheath at the time of the clinical worsening of trigger finger;\n\nNote: Examples of a space occupying lesion include, but are not limited to, amyloid deposit, gouty tophus, granuloma and post-surgery adhesion.\n\n(10) being treated with an aromatase inhibitor within the one year before the clinical worsening of trigger finger;\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 trigger finger.\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, trigger finger where the person's trigger finger 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 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 at least 50 times an hour; or\n\n(b) carrying out the same or similar movements in the hand 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 trigger finger—see subsection 6(2).\n\n VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard Statement of Principles instrument with focused scope. It addresses exactly what its title suggests: establishing the medical connection criteria for trigger finger specifically. There is no evidence of scope creep—the instrument maintains the traditional RMA format covering definition, factors for onset, factors for worsening, and service relationship requirements without expanding into unrelated areas."},"complexity_factors":["Moderate cross-referencing between main sections and Schedule 1 dictionary (6 defined terms)","Dual application framework covering two different Acts (VEA and MRCA) with different service definitions","Parallel structure for onset vs. worsening factors (subsections 8(1)-5 for onset, 8(6)-10 for worsening) creating repetition","Specific quantitative thresholds requiring calculation (500 hours over 6 months, 50 movements per hour, 3kg/1kg weight limits)","Conditional logic in section 9(2) restricting certain factors to aggravation cases only","Nested definitions (e.g., 'relevant service' has 3 sub-categories, 'terminal event' has 5 examples)","Incorporation by reference to external classification system (ICD-10-AM Tenth Edition)"],"plain_english_summary":"This instrument sets the medical rules the Department of Veterans’ Affairs uses to decide whether Australian veterans and current/former defence members can get compensation for trigger finger. It defines the condition and applies the balance‑of‑probabilities test to service connection.\n\nClaimants must prove, on that standard, that their trigger finger is linked to one of the specified service‑related factors; without meeting those criteria, claims will be denied."},"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"},"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":false,"description":"The instrument itself defines its scope: it applies to trigger finger (and death contributed to by it) for claims under the VEA and MRCA and specifies the factors and thresholds for establishing service connection. The text does not state that it narrows or expands statutory coverage beyond setting those evidentiary criteria; no earlier version or prior scope is provided in this instrument to demonstrate a change."},"complexity_factors":["Technical medical definition and ICD-10-AM reference for trigger finger (s6(2)–(4))","Quantified exposure thresholds (≥500 cumulative hours in six months) for repetitive/forceful activities (s8(1), s8(6); Schedule 1)","Multiple temporal windows and distinctions between clinical onset and clinical worsening (s8, s9(2))","Variety of causal pathways listed (trauma, diabetes, space‑occupying lesions, aromatase inhibitors, treatment access) requiring different evidence types (s8(2)–(5), s8(7)–(10), s8(11))","A vague, evidentiary criterion—'inability to obtain appropriate clinical management'—that may generate disputes over proof and standards of care (s8(11))","Interplay with other Statements of Principles when a factor refers to another injury/disease, requiring cross‑reference and updating (s10)","Legal standard and administrative application: 'balance of probabilities' causation and requirement that factors be related to relevant service under statutory schemes (s7, s4, s9(1))","Defined numeric tests for 'forceful' and 'repetitive' activities in the Dictionary creating precise but potentially contentious measurement criteria (Schedule 1)"],"plain_english_summary":"This Statement of Principles says when trigger finger (stenosing flexor tenosynovitis) — and death to which it contributed — can be treated as connected with a person's relevant service for claims under the VEA or MRCA. It lists specific medical and exposure conditions (for example, repetitive or forceful hand use quantified as at least 500 cumulative hours in six months, acute trauma within one year, diabetes, certain lesions, aromatase inhibitor use, or lack of appropriate clinical management) and links those factors to clinical onset or worsening."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-trigger-finger-balance-of-probabilities-no-40-of-2019","history":"/api/acts/statement-of-principles-concerning-trigger-finger-balance-of-probabilities-no-40-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-trigger-finger-balance-of-probabilities-no-40-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-trigger-finger-balance-of-probabilities-no-40-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-trigger-finger-balance-of-probabilities-no-40-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-trigger-finger-balance-of-probabilities-no-40-of-2019/documents"}}