Carpal tunnel syndrome — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 93 of 2021

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting carpal tunnel syndrome or death from carpal tunnel syndrome with the circumstances of a person's relevant service:

1. (1)
   performing any combination of specified activities with the affected hand or forearm: (a) for an average of at least 8 hours per week; and (b) for a cumulative period of at least 6 months before the clinical onset of carpal tunnel syndrome; and if those activities have ceased before the clinical onset of carpal tunnel syndrome, then that onset occurred within 30 days of cessation;

   Note: specified activities with the affected hand or forearm is defined in the Schedule 1 - Dictionary.

2. (2)
   having trauma or surgery to the affected wrist or hand before the clinical onset of carpal tunnel syndrome, which: (a) alters the normal contour of the carpal tunnel; or (b) damages the flexor tendons within the carpal tunnel;

   Note: trauma to the affected wrist or hand is defined in the Schedule 1 - Dictionary.

3. (3)
   having oedema involving the affected carpal tunnel at the time of the clinical onset of carpal tunnel syndrome;

   Note: Examples of situations in which oedema involving the affected carpal tunnel may occur include external burn, fracture, lymphoedema and animal envenomation.

4. (4)
   being overweight or obese at the time of the clinical onset of carpal tunnel syndrome;

   Note: being overweight or obese is defined in the Schedule 1 - Dictionary.

5. (5)
   having amyloidosis at the time of the clinical onset of carpal tunnel syndrome;

   Note: amyloidosis is defined in the Schedule 1 - Dictionary.

6. (6)
   having chronic renal failure at the time of the clinical onset of carpal tunnel syndrome;

   Note: chronic renal failure is defined in the Schedule 1 - Dictionary.

7. (7)
   having hypothyroidism or Hashimoto thyroiditis at the time of the clinical onset of carpal tunnel syndrome;
8. (8)
   having acromegaly before the clinical onset of carpal tunnel syndrome;

   Note: acromegaly is defined in the Schedule 1 - Dictionary.

9. (9)
   having gout involving the affected wrist or hand at the time of the clinical onset of carpal tunnel syndrome;
10. (10)
    having a space-occupying lesion in the affected carpal tunnel at the time of the clinical onset of carpal tunnel syndrome;

    Note: Examples of a space-occupying lesion include neoplasm, ganglion, tenosynovitis and muscle intrusion.

11. (11)
    having haemorrhage involving the affected carpal tunnel at the time of the clinical onset of carpal tunnel syndrome;

    Note: Examples of situations in which haemorrhage involving the affected carpal tunnel may occur include haemophilia, von Willebrand's disease and taking anticoagulants.

12. (12)
    having infection involving the affected carpal tunnel at the time of the clinical onset of carpal tunnel syndrome;

    Note: Examples of infections that may involve the carpal tunnel include histoplasmosis, tuberculosis and chikungunya fever.

13. (13)
    having osteoarthritis or inflammatory arthritis involving the affected wrist or hand at the time of the clinical onset of carpal tunnel syndrome;

    Note: inflammatory arthritis is defined in the Schedule 1 - Dictionary.

14. (14)
    having diabetes mellitus at the time of the clinical onset of carpal tunnel syndrome;
15. (15)
    taking an aromatase inhibitor within the 2 years before the clinical onset of carpal tunnel syndrome;

    Note: Examples of aromatase inhibitors include anastrozole, exemestane and letrozole.

16. (16)
    taking an immune checkpoint inhibitor within the 2 years before the clinical onset of carpal tunnel syndrome;

    Note: Examples of immune checkpoint inhibitors include pembrolizumab, nivolumab, ipilimumab and avelumab.

17. (17)
    being pregnant within the 3 months before the clinical onset of carpal tunnel syndrome;
18. (18)
    performing any combination of specified activities with the affected hand or forearm: (a) for an average of at least 8 hours per week; and (b) for a cumulative period of at least 6 months before the clinical worsening of carpal tunnel syndrome; and if those activities have ceased before the clinical worsening of carpal tunnel syndrome, then that worsening occurred within 30 days of cessation;

    Note: specified activities with the affected hand or forearm is defined in the Schedule 1 - Dictionary.

19. (19)
    having trauma or surgery to the affected wrist or hand before the clinical worsening of carpal tunnel syndrome, which: (a) alters the normal contour of the carpal tunnel; or (b) damages the flexor tendons within the carpal tunnel;

    Note: trauma to the affected wrist or hand is defined in the Schedule 1 - Dictionary.

20. (20)
    having oedema involving the affected carpal tunnel at the time of the clinical worsening of carpal tunnel syndrome;

    Note: Examples of situations in which oedema involving the affected carpal tunnel may occur include external burn, fracture, lymphoedema and animal envenomation.

21. (21)
    being overweight or obese at the time of the clinical worsening of carpal tunnel syndrome;

    Note: being overweight or obese is defined in the Schedule 1 - Dictionary.

22. (22)
    having amyloidosis at the time of the clinical worsening of carpal tunnel syndrome;

    Note: amyloidosis is defined in the Schedule 1 - Dictionary.

23. (23)
    having chronic renal failure at the time of the clinical worsening of carpal tunnel syndrome;

    Note: chronic renal failure is defined in the Schedule 1 - Dictionary.

24. (24)
    having hypothyroidism or Hashimoto thyroiditis at the time of the clinical worsening of carpal tunnel syndrome;
25. (25)
    having acromegaly before the clinical worsening of carpal tunnel syndrome;

    Note: acromegaly is defined in the Schedule 1 - Dictionary.

26. (26)
    having gout involving the affected wrist or hand at the time of the clinical worsening of carpal tunnel syndrome;
27. (27)
    having a space-occupying lesion in the affected carpal tunnel at the time of the clinical worsening of carpal tunnel syndrome;

    Note: Examples of a space-occupying lesion include neoplasm, ganglion, tenosynovitis and muscle intrusion.

28. (28)
    having haemorrhage involving the affected carpal tunnel at the time of the clinical worsening of carpal tunnel syndrome;

    Note: Examples of situations in which haemorrhage involving the affected carpal tunnel may occur include haemophilia, von Willebrand's disease and taking anticoagulants.

29. (29)
    having infection involving the affected carpal tunnel at the time of the clinical worsening of carpal tunnel syndrome;

    Note: Examples of infections that may involve the carpal tunnel include histoplasmosis, tuberculosis and chikungunya fever.

30. (30)
    having osteoarthritis or inflammatory arthritis involving the affected wrist or hand at the time of the clinical worsening of carpal tunnel syndrome;

    Note: inflammatory arthritis is defined in the Schedule 1 - Dictionary.

31. (31)
    having diabetes mellitus at the time of the clinical worsening of carpal tunnel syndrome;
32. (32)
    taking an aromatase inhibitor within the 2 years before the clinical worsening of carpal tunnel syndrome;

    Note: Examples of aromatase inhibitors include anastrozole, exemestane and letrozole.

33. (33)
    taking an immune checkpoint inhibitor within the 2 years before the clinical worsening of carpal tunnel syndrome;

    Note: Examples of immune checkpoint inhibitors include pembrolizumab, nivolumab, ipilimumab and avelumab.

34. (34)
    being pregnant within the 3 months before the clinical worsening of carpal tunnel syndrome;
35. (35)
    inability to obtain appropriate clinical management for carpal tunnel syndrome;

Aggravation-only factors: the factors in subsections 9(18) to 9(35) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.