Traumatic brachial plexopathy — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 1 of 2025

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 traumatic brachial plexopathy or death from traumatic brachial plexopathy with the circumstances of a person's relevant service:

1. (1)
   having trauma to the upper chest, shoulder or neck of the affected side within the 1 year before clinical onset or clinical worsening;

   Note: trauma to the upper chest, shoulder or neck is defined in the Schedule 1 - Dictionary.

   Note: Examples of trauma involving traction and or compression to the brachial plexus include blows to the upper chest and shoulder causing injury, injuries from motor vehicle accidents, a fall from height resulting in injury, or sports injuries,.

   Note: Examples of types of penetrating injury to the upper chest, shoulder or neck include gunshot wounds or laceration injuries from knives or glass.

   Note: Examples of surgery that may cause trauma to the upper chest, shoulder or neck include surgery for clavicle fracture, brachial plexus nerve block, catheterisation of the subclavian or internal jugular veins, and axillary arteriography.

   Note: Delayed onset of traumatic brachial plexopathy may occur as a result of the response to injury, including the formation of callus around fractures and the development of scar tissue.

2. (2)
   having malposition of the head, neck, or shoulders in any of the following circumstances within the 24 hours before clinical onset or clinical worsening: (a) surgery under general anaesthesia; (b) prone positioning in an intensive care unit; (c) reduced conscious state;

   Note: Examples of types of surgery that can cause malposition of the head, neck, or shoulders include surgery in the prone position such as oesophagectomy or spinal surgery or surgery involving the Trendelenburg position such as abdominal or pelvic laparoscopy.

   Note: Examples of malposition of the head, neck, or shoulders with reduced conscious state include sleep associated with alcohol or drug induced intoxication (“Friday or Saturday night palsy”) or head injury.

3. (3)
   having a median sternotomy within the 7 days before clinical onset or clinical worsening;

   Note: Examples where median sternotomy is performed include coronary artery bypass graft, cardiac valve surgery, surgery to the thoracic aorta, thoracic operations (retrosternal goitre, oesophagectomy), neurosurgical procedures where access to thoracic vertebral bodies or discs is required, and in emergency thoracotomy for penetrating trauma.

4. (4)
   having an electrical injury to the brachial plexus within the 24 hours before clinical onset or clinical worsening;
5. (5)
   carrying a load of at least 20 kilograms where the bulk of the load is supported by the shoulders, for at least 2 hours within the 24 hours before clinical onset or clinical worsening;

   Note: Examples of a load include a loaded backpack, body armour, rifle, ammunition, communication systems or sandbags. Where more than one type of load is combined the combined weight must exceed 20kgs.

6. (6)
   carrying a load of at least 10 kilograms where the bulk of the load is supported by one shoulder, for at least 2 hours within the 24 hours before clinical onset or clinical worsening;

   Note: Examples of a load include a loaded backpack, body armour, rifle, ammunition, communication systems or sandbags. Where more than one type of load is combined the combined weight must exceed 10kgs.

7. (7)
   inability to obtain appropriate clinical management for traumatic brachial plexopathy before clinical worsening;