Dupuytren disease — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 9 of 2019

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 Dupuytren disease or death from Dupuytren disease with the circumstances of a person's relevant service:

1. (1)
   smoking at least ten pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of Dupuytren disease, and: (a) smoking commenced at least five years before the clinical onset of Dupuytren disease; and (b) where smoking has ceased, the clinical onset of Dupuytren disease has occurred within five years of cessation;

   Note: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary.

2. (2)
   consuming an average of at least 200 grams per week of alcohol, for at least five consecutive years within the ten years before the clinical onset of Dupuytren disease;

   Note: Alcohol consumption is calculated utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink.

3. (3)
   having alcohol use disorder at the time of the clinical onset of Dupuytren disease;
4. (4)
   having cirrhosis of the liver or steatohepatitis before the clinical onset of Dupuytren disease;
5. (5)
   having trauma to the hand, wrist or forearm of the affected side, within the one year before the clinical onset of Dupuytren disease;

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

   Note: Examples of trauma include, but are not limited to, laceration, sprain or crush injury, fracture or surgery, and a thermal, electrical or chemical burn.

6. (6)
   having a clinically significant infection involving the palmar surface of the affected hand, within the three months before the clinical onset of Dupuytren disease;

   Note: clinically significant infection involving the palmar surface of the affected hand is defined in the Schedule 1 - Dictionary.

7. (7)
   for bilateral Dupuytren disease only: (a) having trauma to the hand, wrist or forearm before the clinical onset of Dupuytren disease, and where: (i) Dupuytren disease first developed on the side affected by trauma; and (ii) Dupuytren disease developed in both hands within the one year following the trauma; or (b) having a clinically significant infection involving the palmar surface of the affected hand before the clinical onset of Dupuytren disease, and where: (i) Dupuytren disease first developed on the side affected by the infection; and (ii) Dupuytren disease developed in both hands within the three months following the infection;

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

   Note: Examples of trauma include, but are not limited to, laceration, sprain or crush injury, fracture or surgery, and a thermal, electrical or chemical burn.

   Note: clinically significant infection involving the palmar surface of the affected hand is defined in the Schedule 1 - Dictionary.

8. (8)
   performing any combination of: (a) repetitive, strenuous or forceful activities using the affected hand; or (b) activities using a hand-held, vibrating or percussive tool in the affected hand; for a cumulative period of at least 10 000 hours before the clinical onset of Dupuytren disease, and where these activities have ceased, the clinical onset of Dupuytren disease has occurred within five years of cessation; involving repetitive, strenuous or forceful activities such as tennis, rock climbing, hockey or baseball;

   Note: Examples of repetitive, strenuous or forceful activities include, but are not limited to, handling, lifting, moving or carrying a load greater than ten kilograms; using large, hand-held power machinery; lifting, digging or shovelling; and participating in sports.

   Note: Examples of a hand-held, vibrating or percussive tool include, but are not limited to, screwdrivers, drills, chainsaws, jackhammers, boring machines and punching machines.

9. (9)
   having diabetes mellitus before the clinical onset of Dupuytren disease;
10. (10)
    having epilepsy at the time of the clinical onset of Dupuytren disease;
11. (11)
    having psoriasis involving the palm of the affected hand at the time of the clinical onset of Dupuytren disease;
12. (12)
    being treated with vemurafenib within the two years before the clinical onset of Dupuytren disease;
13. (13)
    receiving an average of at least 100 milligrams of phenobarbital (phenobarbitone) per day for the treatment of epilepsy: (a) for a continuous period of at least two years before the clinical onset of Dupuytren disease; and (b) where this treatment has ceased, the clinical onset of Dupuytren disease has occurred within one year of cessation;
14. (14)
    smoking at least ten pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of Dupuytren disease, and: (a) smoking commenced at least five years before the clinical worsening of Dupuytren disease; and (b) where smoking has ceased, the clinical worsening of Dupuytren disease has occurred within five years of cessation;

    Note: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary.

15. (15)
    consuming an average of at least 200 grams per week of alcohol, for at least five consecutive years within the ten years before the clinical worsening of Dupuytren disease;

    Note: Alcohol consumption is calculated utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink.

16. (16)
    having alcohol use disorder at the time of the clinical worsening of Dupuytren disease;
17. (17)
    having cirrhosis of the liver or steatohepatitis before the clinical worsening of Dupuytren disease;
18. (18)
    having trauma to the hand, wrist or forearm of the affected side, within the one year before the clinical worsening of Dupuytren disease;

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

    Note: Examples of trauma include, but are not limited to, laceration, sprain or crush injury, fracture or surgery, and a thermal, electrical or chemical burn.

19. (19)
    having a clinically significant infection involving the palmar surface of the affected hand, within the three months before the clinical worsening of Dupuytren disease;

    Note: clinically significant infection involving the palmar surface of the affected hand is defined in the Schedule 1 - Dictionary.

20. (20)
    for bilateral Dupuytren disease only: (a) having trauma to the hand, wrist or forearm before the clinical worsening of Dupuytren disease, and where: (i) Dupuytren disease first worsened on the side affected by trauma; and (ii) Dupuytren disease worsened in both hands within the one year following the trauma; or (b) having a clinically significant infection involving the palmar surface of the affected hand before the clinical worsening of Dupuytren disease, and where: (i) Dupuytren disease first worsened on the side affected by the infection; and (ii) Dupuytren disease worsened in both hands within the three months following the infection;

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

    Note: Examples of trauma include, but are not limited to, laceration, sprain or crush injury, fracture or surgery, and a thermal, electrical or chemical burn.

    Note: clinically significant infection involving the palmar surface of the affected hand is defined in the Schedule 1 - Dictionary.

21. (21)
    performing any combination of: (a) repetitive, strenuous or forceful activities using the affected hand; or (b) activities using a hand-held, vibrating or percussive tool in the affected hand; for a cumulative period of at least 10 000 hours before the clinical worsening of Dupuytren disease, and where these activities have ceased, the clinical worsening of Dupuytren disease has occurred within five years of cessation;

    Note: Examples of repetitive, strenuous or forceful activities include, but are not limited to, handling, lifting, moving or carrying a load greater than ten kilograms; using large, hand-held power machinery; lifting, digging or shovelling; and participating in sports involving repetitive, strenuous or forceful activities such as tennis, rock climbing, hockey or baseball.

    Note: Examples of a hand-held, vibrating or percussive tool include, but are not limited to, screwdrivers, drills, chainsaws, jackhammers, boring machines and punching machines.

22. (22)
    having diabetes mellitus before the clinical worsening of Dupuytren disease;
23. (23)
    having epilepsy at the time of the clinical worsening of Dupuytren disease;
24. (24)
    having psoriasis involving the palm of the affected hand at the time of the clinical worsening of Dupuytren disease;
25. (25)
    being treated with vemurafenib within the two years before the clinical worsening of Dupuytren disease;
26. (26)
    receiving an average of at least 100 milligrams of phenobarbital (phenobarbitone) per day for the treatment of epilepsy: (a) for a continuous period of at least two years before the clinical worsening of Dupuytren disease; and (b) where this treatment has ceased, the clinical worsening of Dupuytren disease has occurred within one year of cessation;
27. (27)
    inability to obtain appropriate clinical management for Dupuytren disease;

Aggravation-only factors: the factors in subsections 9(14) to 9(27) 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.