Statement of Principles concerning   ROTATOR CUFF SYNDROME No. 40 of 2006   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 rotator cuff syndrome No. 40 of 2006.   Determination 2.                  The Repatriation Medical Authority under subsection 196B(3) and (8) of the Veterans’ Entitlements Act 1986 (the VEA): (a)       revokes Instrument No. 84 of 1997 and (b)       determines in its place this Statement of Principles.   Kind of injury, disease or death 3.         (a)        This Statement of Principles is about rotator cuff syndrome and death from rotator cuff syndrome. (b)              For the purposes of this Statement of Principles, “rotator cuff syndrome” means an inflammatory or degenerative disorder of the musculotendinous cuff of the shoulder joint (comprising supraspinatus, infraspinatus, subscapularis and teres minor) or the long head of biceps and their associated bursae (subacromial and/or subdeltoid bursae).  This definition includes supraspinatus syndrome, subacromial impingement syndrome, rotator cuff impingement syndrome, tendonitis of the long head of biceps and calcifying tendonitis of the shoulder.  This definition excludes adhesive capsulitis of the shoulder. (c)              Rotator cuff syndrome attracts ICD-10-AM codes M75.1, M75.2, M75.3, M75.4 or M75.5. (d)              In the application of this Statement of Principles, the definition of “rotator cuff syndrome” is that given at paragraph 3(b) above.   Basis for determining the factors 4.         On the sound medical-scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that rotator cuff syndrome and death from rotator cuff syndrome can be related to relevant service rendered by veterans 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 exist before it can be said that, on the balance of probabilities, rotator cuff syndrome or death from rotator cuff syndrome is connected with the circumstances of a person’s relevant service is:   (a)               having an injury to the affected shoulder within the 30 days before the clinical onset of rotator cuff syndrome; or   (b)              performing repetitive or sustained activities of the affected shoulder when the shoulder on the affected side is abducted or flexed by at least 60 degrees for at least 160 hours within a period of 210 consecutive days, before the clinical onset of rotator cuff syndrome and where the clinical onset of rotator cuff syndrome occurs within the 30 days following the last such activity in that period; or   (c)              having dialysis-related amyloidosis before the clinical onset of rotator cuff syndrome; or   (d)              regularly using the upper limbs for transfer for a continuous period of at least the one year before the clinical onset of rotator cuff syndrome; or   (e)              having anatomical narrowing of the subacromial space on the affected side at the time of the clinical onset of rotator cuff syndrome; or   (f)               having excess laxity of the shoulder joint on the affected side for a period of at least the one year before the clinical onset of rotator cuff syndrome; or   (g)              having an infection of the subacromial bursa on the affected side at the time of the clinical onset of rotator cuff syndrome; or   (h)              having rheumatoid arthritis involving the shoulder joint or associated bursae on the affected side before the clinical onset of rotator cuff syndrome; or   (i)                having gout involving the affected shoulder at the time of the clinical onset of rotator cuff syndrome; or   (j)                having an injury to the affected shoulder within the 30 days before the clinical worsening of rotator cuff syndrome; or   (k)              performing repetitive or sustained activities of the affected shoulder when the shoulder on the affected side is abducted or flexed by at least 60 degrees for at least 160 hours within a period of 210 consecutive days, before the clinical worsening of rotator cuff syndrome and where the clinical worsening of rotator cuff syndrome occurs within the 30 days following the last such activity in that period;   (l)                having dialysis-related amyloidosis before the clinical worsening of rotator cuff syndrome;   (m)            regularly using the upper limbs for transfer for a continuous period of at least the one year before the clinical worsening of rotator cuff syndrome; or   (n)              having anatomical narrowing of the subacromial space on the affected side at the time of the clinical worsening of rotator cuff syndrome; or   (o)              having excess laxity of the shoulder joint on the affected side for a period of at least the one year before the clinical worsening of rotator cuff syndrome; or   (p)              having an infection of the subacromial bursa on the affected side at the time of the clinical worsening of rotator cuff syndrome; or   (q)              having rheumatoid arthritis involving the shoulder joint or associated bursae on the affected side before the clinical worsening of rotator cuff syndrome; or   (r)               having gout involving the affected shoulder at the time of the clinical worsening of rotator cuff syndrome; or   (s)               inability to obtain appropriate clinical management for rotator cuff syndrome.   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, rotator cuff syndrome where the person’s rotator cuff syndrome 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:   “an injury to the affected shoulder” means an injury to the shoulder region that causes the development, within the 24 hours of the injury being sustained, of pain, tenderness, and altered mobility or range of movement of the shoulder joint.  These symptoms and signs must last for a continuous period of at least ten days following their onset; save for where medical intervention for the injury to that shoulder has occurred and that medical intervention involves either: (a)              immobilisation of the shoulder by splinting, or similar external agent; or (b)              injection of corticosteroids or local anaesthetics into that shoulder; or (c)              surgery to that shoulder;   “anatomical narrowing of the subacromial space” means an acquired reduction in the space between the acromion and the upper end of the humerus.  Causes would include: (a)               malunited fractures of the acromion, clavicle or greater tuberosity; or (b)              osteophytes or tumours projecting into the subacromial space; or (c)              sutures, pins, or wires from previous surgery;   “death from rotator cuff syndrome” in relation to a person includes death from a terminal event or condition that was contributed to by the person’s rotator cuff syndrome;   “dialysis-related amyloidosis” means beta2-microglobulin amyloidosis secondary to long-term haemodialysis or continuous ambulatory peritoneal dialysis;   “excess laxity of the shoulder joint” means acquired excess instability of the glenohumeral joint as demonstrated by clinical testing or imaging, following shoulder dislocations or tears involving the glenoid labrum or glenohumeral ligaments;   “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), Fifth Edition, effective date of 1 July 2006, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 1 86487 772 3;   “regularly using the upper limbs for transfer” means the use by a person of their upper limbs to transfer themselves (for example, from chair to bed), due to their inability to use their lower limbs for mobilisation (for example, paraplegia).  It does not mean the temporary use of a wheelchair, such as when recovering from a fracture or a sprain involving a lower limb;   “relevant service” means: (a)     eligible war service (other than operational service) under the VEA; or (b)     defence service (other than hazardous service) under the VEA; or (c)          peacetime 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 120B of the VEA or section 339 of the MRCA applies.   Date of effect 11.       This Instrument takes effect from 30 August 2006.   Dated this       seventeenth            day of              August               2006     The Common Seal of the                              ) Repatriation Medical Authority                   ) was affixed to this instrument                      ) in the presence of:                                        )   KEN DONALD CHAIRPERSON