Statement of Principles
concerning
EPICONDYLITIS
No. 7 of 2015
for the purposes of the
Veterans’ Entitlements Act 1986
and
Military Rehabilitation and Compensation Act 2004
Title
1. This Instrument may be cited as Statement of Principles concerning epicondylitis No. 7 of 2015.
Determination
2. The Repatriation Medical Authority under subsection 196B(2) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):
(a) revokes Instrument No. 52 of 2004 concerning epicondylitis; and
(b) determines in its place this Statement of Principles.
Kind of injury, disease or death
3. (a) This Statement of Principles is about epicondylitis and death from epicondylitis.
(b) For the purposes of this Statement of Principles, "epicondylitis" means an acquired condition characterised by pain and tenderness in the soft tissue attached to the medial or lateral epicondyle of the elbow, with exacerbation of pain by use of the muscles of the forearm.
(c) Epicondylitis attracts ICD-10-AM code M77.0 or M77.1.
(d) In the application of this Statement of Principles, the definition of "epicondylitis" is that given at paragraph 3(b) above.
Basis for determining the factors
4. The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that epicondylitis and death from epicondylitis 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 Military Rehabilitation and Compensation Act 2004 (the MRCA).
Factors that must be related to service
5. Subject to clause 7, at least one of the factors set out in clause 6 must be related to the relevant service rendered by the person.
Factors
6. The factor that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting epicondylitis or death from epicondylitis with the circumstances of a person’s relevant service is:
(a) performing forceful activities with the hand or forearm on the affected side, in combination with:
(i) repetitive activities with the hand or forearm on the affected side; or
(ii) sustained activities with the forearm on the affected side;
for at least one hour per day, on more days than not, over a period of at least the one month before the clinical onset of epicondylitis; or
(b) having a sudden alteration of loading pattern as specified for a continuous period of at least one hour, within the three days before the clinical onset of epicondylitis; or
(c) undergoing treatment with fluoroquinolone antibiotics within the 14 days before the clinical onset of epicondylitis; or
(d) performing forceful activities with the hand or forearm on the affected side, in combination with:
(i) repetitive activities with the hand or forearm on the affected side; or
(ii) sustained activities with the forearm on the affected side;
for at least one hour per day, on more days than not, over a period of at least the one month before the clinical worsening of epicondylitis; or
(e) having a sudden alteration of loading pattern as specified for a continuous period of at least one hour, within the three days before the clinical worsening of epicondylitis; or
(f) inability to obtain appropriate clinical management for epicondylitis.
Factors that apply only to material contribution or aggravation
7. Paragraphs 6(d) to 6(f) apply only to material contribution to, or aggravation of, epicondylitis where the person’s epicondylitis was suffered or contracted before or during (but not arising out of) the person’s relevant service.
Inclusion of Statements of Principles
8. In this Statement of Principles if a relevant factor applies and that factor includes an injury or disease in respect of which there is a Statement of Principles then the factors in that last mentioned Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.
Other definitions
9. For the purposes of this Statement of Principles:
"death from epicondylitis" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s epicondylitis;
"having a sudden alteration of loading pattern as specified" means suddenly increasing the frequency, duration or intensity of forceful and repetitive or sustained activities with the hand or forearm on the affected side by at least 100 percent and to a minimum intensity of at least five METs. Examples of such activities include using a rowing machine, carrying objects of at least ten kilograms, vigorous gardening, using heavy power tools or carpentry;
"ICD-10-AM code" means a number assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM), Eighth Edition, effective date of 1 July 2013, copyrighted by the Independent Hospital Pricing Authority, and having ISBN 978-1-74128-213-9;
"MET" means a unit of measurement of the level of physical exertion. 1 MET = 3.5 ml of oxygen/kg of body weight per minute, 1.0 kcal/kg of body weight per hour or resting metabolic rate;
"relevant service" means:
(a) operational service under the VEA;
(b) peacekeeping service under the VEA;
(c) hazardous service under the VEA;
(d) British nuclear test defence service under the VEA;
(e) warlike service under the MRCA; or
(f) non-warlike service under the MRCA;
"terminal event" means the proximate or ultimate cause of death and includes:
(a) pneumonia;
(b) respiratory failure;
(c) cardiac arrest;
(d) circulatory failure; or
(e) cessation of brain function.
Application
10. This Instrument applies to all matters to which section 120A of the VEA or section 338 of the MRCA applies.
Date of effect
11. This Instrument takes effect from 27 January 2015.
Dated this nineteenth day of December 2014
The Common Seal of the )
Repatriation Medical Authority )
was affixed at the direction of: )
PROFESSOR NICHOLAS SAUNDERS AO
CHAIRPERSON
