Statement of Principles
concerning
 
DUPUYTREN'S DISEASE
No. 57 of 2010
 
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 Dupuytren's disease No. 57 of 2010.
 
Determination
2.         This Statement of Principles is determined by the Repatriation Medical Authority under subsection 196B(2) of the Veterans' Entitlements Act 1986 (the VEA).
 
Kind of injury, disease or death
3.         (a)        This Statement of Principles is about Dupuytren's disease and death from Dupuytren's disease.
(b)              For the purposes of this Statement of Principles, "Dupuytren's disease" means fibrosis of the palmar fascia, characterised by initial thickening and nodules in the palmar skin, which may progress to tendon-like cords and flexural contraction of the digits.
(c)              Dupuytren's disease attracts ICD-10-AM code M72.0.
(d)              In the application of this Statement of Principles, the definition of "Dupuytren's disease" 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 Dupuytren's disease and death from Dupuytren's disease 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 Dupuytren's disease or death from Dupuytren's disease with the circumstances of a person's relevant service is:
 
(a)                smoking at least 10 pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of Dupuytren's disease, and where smoking has ceased, the clinical onset of Dupuytren's disease has occurred within five years of cessation; or
 
(b)               drinking at least 50 kilograms of alcohol within the ten years before the clinical onset of Dupuytren's disease; or
 
(c)                having alcoholic liver disease before the clinical onset of Dupuytren's disease; or
 
(d)               having trauma to the hand, wrist or forearm within the one year before the clinical onset of Dupuytren's disease in that hand; or
 
(e)                for bilateral Dupuytren's disease, having trauma to the hand, wrist or forearm before the clinical onset of Dupuytren’s disease, where Dupuytren’s disease first developed on the side affected by trauma and developed in both hands within the one year following the trauma; or
 
(f)                 having an infection of the hand as specified within the one year before the clinical onset of Dupuytren's disease in that hand; or
 
(g)                for bilateral Dupuytren's disease, having an infection of the hand as specified before the clinical onset of Dupuytren’s disease, where Dupuytren’s disease first developed on the side affected by the infection and developed in both hands within the one year following the infection; or
 
(h)                undertaking tasks involving manual labour on more days than not for at least ten years within the twenty years before the clinical onset of Dupuytren's disease; or
 
(i)                  having diabetes mellitus before the clinical onset of Dupuytren's disease; or
 
(j)                 smoking at least 10 pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of Dupuytren's disease, and where smoking has ceased, the clinical worsening of Dupuytren's disease has occurred within two years of cessation; or
 
(k)               drinking at least 50 kilograms of alcohol within the ten years before the clinical worsening of Dupuytren's disease; or
 
(l)                  having alcoholic liver disease before the clinical worsening of Dupuytren's disease; or
 
(m)              having trauma to the hand, wrist or forearm within the one year before the clinical worsening of Dupuytren's disease in that hand; or
 
(n)                for bilateral Dupuytren's disease, having trauma to the hand, wrist or forearm before the clinical worsening of Dupuytren’s disease, where Dupuytren’s disease first worsened on the side affected by trauma and worsened in both hands within the one year following the trauma; or
 
(o)               having an infection of the hand as specified within the one year before the clinical worsening of Dupuytren's disease in that hand; or
 
(p)               for bilateral Dupuytren's disease, having an infection of the hand as specified before the clinical worsening of Dupuytren’s disease, where Dupuytren’s disease first worsened on the side affected by the infection and worsened in both hands within the one year following the infection; or
 
(q)               undertaking tasks involving manual labour on more days than not for at least ten years within the twenty years before the clinical worsening of Dupuytren's disease; or
 
(r)                 having diabetes mellitus before the clinical worsening of Dupuytren's disease; or
 
(s)                inability to obtain appropriate clinical management for Dupuytren's disease.
 
Factors that apply only to material contribution or aggravation
7.         Paragraphs 6(j) to 6(s) apply only to material contribution to, or aggravation of, Dupuytren's disease where the person's Dupuytren's disease 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:
 
"alcohol" is measured by the alcohol consumption calculations utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink;
 
"alcoholic liver disease" means steatohepatitis or cirrhosis of the liver due to chronic, heavy alcohol consumption;
 
"an infection of the hand as specified" means a significant infection of the palmar surface of the hand, such as flexor tenosynovitis or a palmar abscess;
 
"death from Dupuytren's disease" in relation to a person includes death from a terminal event or condition that was contributed to by the person's Dupuytren's disease;
 
"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), Sixth Edition, effective date of 1 July 2008, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 978 1 74210 016 6;
 
"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 7300 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 7300 cigarettes, or 7.3 kg of smoking tobacco by weight. Tobacco products means either cigarettes, pipe tobacco or cigars smoked, alone or in any combination;
 
"relevant service" means:
(a)                operational service under the VEA;
(b)               peacekeeping service under the VEA;
(c)                hazardous service under the VEA;
(d)               warlike service under the MRCA; or
(e)                non-warlike service under the MRCA;
 
"tasks involving manual labour" means activities entailing prolonged and repetitive manual handling of mechanical equipment or heavy objects in a forceful manner, including using a hand-held, vibrating, percussive, industrial tool and repairing mechanical equipment;
 
"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;
 
"trauma" means a burn, laceration, sprain or crush injury of sufficient severity to warrant medical attention, or a fracture or surgery.
 
Date of effect
10.       This Instrument takes effect from 30 June 2010.
 
Dated this       eighteenth     day of              June  2010
 
 
The Common Seal of the                  )
Repatriation Medical Authority       )
was affixed to this instrument          )
in the presence of:                            )
 
KEN DONALD
CHAIRPERSON