Thoracic outlet syndrome — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 47 of 2022

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 thoracic outlet syndrome or death from thoracic outlet syndrome with the circumstances of a person's relevant service:

1. (1)
   performing repetitive and forceful activities involving the affected arm and shoulder: (a) for an average of at least 40 hours per month; and (b) for a cumulative period of at least 3 months before the clinical onset of thoracic outlet syndrome; and if those activities have ceased before the clinical onset of thoracic outlet syndrome, then that onset occurred within 2 months of cessation;

   Note: Examples of repetitive and forceful activities include lifting or carrying heavy loads, overhead throwing, swimming, rowing and playing musical instruments.

2. (2)
   having trauma involving the upper chest, shoulder or neck of the affected side within the 1 year before the clinical onset of thoracic outlet syndrome;

   Note: Examples of types of trauma that can cause neurovascular compression in the thoracic outlet include fractures of the clavicle or the first rib and blows to the upper chest and shoulder. Delayed onset of thoracic outlet syndrome may occur as a result of the response to injury, including the formation of callus around fractures and the development of scar tissue.

   Note: trauma involving the upper chest, shoulder or neck of the affected side is defined in the Schedule 1 - Dictionary.

3. (3)
   having surgery involving the upper chest, shoulder or neck of the affected side within the 1 year before the clinical onset of thoracic outlet syndrome;

   Note: Examples of types of surgery that can cause neurovascular compression in the thoracic outlet include manipulation of fractures of the clavicle or the first rib, surgery involving the clavicle or the first rib, and surgery involving the chest wall.

4. (4)
   having an acquired space-occupying lesion involving the affected thoracic outlet at the time of the clinical onset of thoracic outlet syndrome;

   Note: Examples of acquired space-occupying lesions that can involve the thoracic outlet include neoplasms, hypertrophied shoulder girdle muscles, fibrous scar tissue resulting from chronic inflammation, haematomas, cysts and bony callus.

5. (5)
   for venous thoracic outlet syndrome or arterial thoracic outlet syndrome only, being at an altitude of at least 3,000 metres for a continuous period of at least 24 hours within the 30 days before the clinical onset of venous thoracic outlet syndrome or arterial thoracic outlet syndrome;

   Note: venous thoracic outlet syndrome and arterial thoracic outlet syndrome are defined in the Schedule 1 - Dictionary.

6. (6)
   for venous thoracic outlet syndrome only, having creation of an arteriovenous fistula in the arm of the affected side within the 2 years before the clinical onset of venous thoracic outlet syndrome;

   Note: venous thoracic outlet syndrome is defined in the Schedule 1 - Dictionary.

7. (7)
   performing repetitive and forceful activities involving the affected arm and shoulder: (a) for an average of at least 40 hours per month; and (b) for a cumulative period of at least 3 months before the clinical worsening of thoracic outlet syndrome; and if those activities have ceased before the clinical worsening of thoracic outlet syndrome, then that worsening occurred within 2 months of cessation;

   Note: Examples of repetitive and forceful activities include lifting or carrying heavy loads, overhead throwing, swimming, rowing and playing musical instruments.

8. (8)
   having trauma involving the upper chest, shoulder or neck of the affected side within the 1 year before the clinical worsening of thoracic outlet syndrome;

   Note: Examples of types of trauma that can cause neurovascular compression in the thoracic outlet include fractures of the clavicle or the first rib and blows to the upper chest and shoulder. Delayed onset of thoracic outlet syndrome may occur as a result of the response to injury, including the formation of callus around fractures and the development of scar tissue.

   Note: trauma involving the upper chest, shoulder or neck of the affected side is defined in the Schedule 1 - Dictionary.

9. (9)
   having surgery involving the upper chest, shoulder or neck of the affected side within the 1 year before the clinical worsening of thoracic outlet syndrome;

   Note: Examples of types of surgery that can cause neurovascular compression in the thoracic outlet include manipulation of fractures of the clavicle or the first rib, surgery involving the clavicle or the first rib, and surgery involving the chest wall.

10. (10)
    having an acquired space-occupying lesion involving the affected thoracic outlet at the time of the clinical worsening of thoracic outlet syndrome;

    Note: Examples of acquired space-occupying lesions that can involve the thoracic outlet include neoplasms, hypertrophied shoulder girdle muscles, fibrous scar tissue resulting from chronic inflammation, haematomas, cysts and bony callus.

11. (11)
    for venous thoracic outlet syndrome or arterial thoracic outlet syndrome only, being at an altitude of at least 3,000 metres for a continuous period of at least 24 hours within the 30 days before the clinical worsening of venous thoracic outlet syndrome or arterial thoracic outlet syndrome;

    Note: venous thoracic outlet syndrome and arterial thoracic outlet syndrome are defined in the Schedule 1 - Dictionary.

12. (12)
    for venous thoracic outlet syndrome only, having creation of an arteriovenous fistula in the arm of the affected side within the 2 years before the clinical worsening of venous thoracic outlet syndrome;

    Note: venous thoracic outlet syndrome is defined in the Schedule 1 - Dictionary.

13. (13)
    inability to obtain appropriate clinical management for thoracic outlet syndrome;

Aggravation-only factors: the factors in subsections 8(7) to 8(13) 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.