Ulnar neuropathy at the elbow — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 65 of 2017

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 ulnar neuropathy at the elbow or death from ulnar neuropathy at the elbow with the circumstances of a person's relevant service:

1. (1)
   having a fracture of the bones of the affected elbow, including fracture of the medial epicondyle of the humerus, before the clinical onset of ulnar neuropathy at the elbow;
2. (2)
   having trauma to the affected elbow within the two years before the clinical onset of ulnar neuropathy at the elbow;

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

3. (3)
   performing repetitive and forceful activities involving flexion and extension of the affected elbow: (a) for a cumulative period of at least 90 hours, within a continuous period of six months before the clinical onset of ulnar neuropathy at the elbow; and (b) where the repetitive and forceful activities have not ceased more than 30 days before the clinical onset of ulnar neuropathy at the elbow; Compilation No. 1 Compilation date: 25/05/2020 Authorised Version F2020C00421 registered 25/05/2020;

   Note: Examples of repetitive and forceful activities include lifting, moving or carrying a load greater than ten kilograms, using hand saws or using large, hand-held power machinery, climbing vertical ladders, ammunitioning, using a hand-held piece of equipment such as a jackhammer or shovel, and overhead throwing.

4. (4)
   holding a tool, device or instrument in position, with the wrist in an extended position and the affected elbow in a flexed position: (a) for a cumulative period of at least 90 hours, within a continuous period of six months before the clinical onset of ulnar neuropathy at the elbow; and (b) where this activity has not ceased more than 30 days before the clinical onset of ulnar neuropathy at the elbow;
5. (5)
   using the affected elbow as a support in a posture that is required as part of the activity being performed: (a) with the forearm pronated on a hard surface, or holding the arm with the elbow flexed by 30° or more; and (b) for a cumulative period of at least 90 hours, within a continuous period of six months before the clinical onset of ulnar neuropathy at the elbow; and (c) where this activity has not ceased more than 30 days before the clinical onset of ulnar neuropathy at the elbow;

   Note: Examples of using the elbow as a support include bicycling in the aero position, firing a hand-held weapon, or being required to adopt this posture due to undertaking activity in a cramped or confined space.

6. (6)
   having a surgical procedure under general anaesthesia, within the two months before the clinical onset of ulnar neuropathy at the elbow;
7. (7)
   having a surgical procedure to the affected elbow, including elbow arthroscopy, within the one year before the clinical onset of ulnar neuropathy at the elbow;
8. (8)
   being hospitalised, or confined to bed in a supine position, for at least two days within the 30 days before the clinical onset of ulnar neuropathy at the elbow;
9. (9)
   daily self-propulsion of a manual wheelchair: (a) for a cumulative period of at least 60 hours within a continuous period of six months before the clinical onset of ulnar neuropathy at the elbow; and (b) where this activity has not ceased more than 30 days before the clinical onset of ulnar neuropathy at the elbow;
10. (10)
    having paraplegia at the time of the clinical onset of ulnar neuropathy at the elbow; Compilation No. 1 Compilation date: 25/05/2020 Authorised Version F2020C00421 registered 25/05/2020;
11. (11)
    using elbow or forearm crutches: (a) for a cumulative period of at least 60 hours within a continuous period of six months before the clinical onset of ulnar neuropathy at the elbow; and (b) where this activity has not ceased more than 30 days before the clinical onset of ulnar neuropathy at the elbow;
12. (12)
    having an inflammatory or degenerative joint disease from the specified list of inflammatory and degenerative joint diseases, involving the affected elbow, at the time of the clinical onset of ulnar neuropathy at the elbow;

    Note: specified list of inflammatory and degenerative joint diseases is defined in the Schedule 1 - Dictionary.

13. (13)
    having amyloidosis at the time of the clinical onset of ulnar neuropathy at the elbow;

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

14. (14)
    having haemodialysis or peritoneal dialysis for at least the one year before the clinical onset of ulnar neuropathy at the elbow;
15. (15)
    having a cerebrovascular accident with hemiplegia, excluding transient ischaemic attack or transient symptoms with infarction, before the clinical onset of ulnar neuropathy at the elbow;
16. (16)
    having an external burn to the affected arm requiring hospitalisation, within the five years before the clinical onset of ulnar neuropathy at the elbow;
17. (17)
    being pregnant within the three months before the clinical onset of ulnar neuropathy at the elbow;
18. (18)
    having an infection involving the affected ulnar nerve in the region of the elbow at the time of the clinical onset of ulnar neuropathy at the elbow;

    Note: Examples of an infection involving the affected ulnar nerve include Mycobacterium leprae (leprosy) and tuberculosis.

19. (19)
    smoking at least ten pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of ulnar neuropathy at the elbow, and: (a) smoking commenced at least five years before the clinical onset of ulnar neuropathy at the elbow; and (b) where smoking has ceased, the clinical onset of ulnar neuropathy at the elbow has occurred within five years of cessation; Compilation No. 1 Compilation date: 25/05/2020 Authorised Version F2020C00421 registered 25/05/2020;

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

20. (20)
    having a lesion as specified at the elbow that compresses or displaces the affected ulnar nerve at the time of the clinical onset of ulnar neuropathy at the elbow;

    Note: lesion as specified is defined in the Schedule 1 - Dictionary.

21. (21)
    having diabetes mellitus at the time of the clinical onset of ulnar neuropathy at the elbow;
22. (22)
    having acromegaly before the clinical onset of ulnar neuropathy at the elbow;

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

23. (23)
    having a fracture of the bones of the affected elbow, including fracture of the medial epicondyle of the humerus, before the clinical worsening of ulnar neuropathy at the elbow;
24. (24)
    having trauma to the affected elbow within the two years before the clinical worsening of ulnar neuropathy at the elbow;

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

25. (25)
    performing repetitive and forceful activities involving flexion and extension of the affected elbow: (a) for a cumulative period of at least 90 hours, within a continuous period of six months before the clinical worsening of ulnar neuropathy at the elbow; and (b) where the repetitive and forceful activities have not ceased more than 30 days before the clinical worsening of ulnar neuropathy at the elbow;

    Note: Examples of repetitive and forceful activities include lifting, moving or carrying a load greater than ten kilograms, using hand saws or using large, hand-held power machinery, climbing vertical ladders, ammunitioning, using a hand-held piece of equipment such as a jackhammer or shovel, and overhead throwing.

26. (26)
    holding a tool, device or instrument in position, with the wrist in an extended position and the affected elbow in a flexed position: (a) for a cumulative period of at least 90 hours, within a continuous period of six months before the clinical worsening of ulnar neuropathy at the elbow; and (b) where this activity has not ceased more than 30 days before the clinical worsening of ulnar neuropathy at the elbow; Compilation No. 1 Compilation date: 25/05/2020 Authorised Version F2020C00421 registered 25/05/2020;
27. (27)
    using the affected elbow as a support in a posture that is required as part of the activity being performed: (a) with the forearm pronated on a hard surface, or holding the arm with the elbow flexed by 30° or more; and (b) for a cumulative period of at least 90 hours, within a continuous period of six months before the clinical worsening of ulnar neuropathy at the elbow; and (c) where this activity has not ceased more than 30 days before the clinical worsening of ulnar neuropathy at the elbow;

    Note: Examples of using the elbow as a support include bicycling in the aero position, firing a hand-held weapon, or being required to adopt this posture due to undertaking activity in a cramped or confined space.

28. (28)
    having a surgical procedure under general anaesthesia, within the two months before the clinical worsening of ulnar neuropathy at the elbow;
29. (29)
    having a surgical procedure to the affected elbow, including elbow arthroscopy, within the one year before the clinical worsening of ulnar neuropathy at the elbow;
30. (30)
    being hospitalised, or confined to bed in a supine position, for at least two days within the 30 days before the clinical worsening of ulnar neuropathy at the elbow;
31. (31)
    daily self-propulsion of a manual wheelchair: (a) for a cumulative period of at least 60 hours within a continuous period of six months before the clinical worsening of ulnar neuropathy at the elbow; and (b) where this activity has not ceased more than 30 days before the clinical worsening of ulnar neuropathy at the elbow;
32. (32)
    having paraplegia at the time of the clinical worsening of ulnar neuropathy at the elbow;
33. (33)
    using elbow or forearm crutches: (a) for a cumulative period of at least 60 hours within a continuous period of six months before the clinical worsening of ulnar neuropathy at the elbow; and (b) where this activity has not ceased more than 30 days before the clinical worsening of ulnar neuropathy at the elbow;
34. (34)
    having an inflammatory or degenerative joint disease from the specified list of inflammatory and degenerative joint diseases, involving the affected elbow, at the time of the clinical worsening of ulnar neuropathy at the elbow; Compilation No. 1 Compilation date: 25/05/2020 Authorised Version F2020C00421 registered 25/05/2020;

    Note: specified list of inflammatory and degenerative joint diseases is defined in the Schedule 1 - Dictionary.

35. (35)
    having amyloidosis at the time of the clinical worsening of ulnar neuropathy at the elbow;

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

36. (36)
    having haemodialysis or peritoneal dialysis for at least the one year before the clinical worsening of ulnar neuropathy at the elbow;
37. (37)
    having a cerebrovascular accident with hemiplegia, excluding transient ischaemic attack or transient symptoms with infarction, before the clinical worsening of ulnar neuropathy at the elbow;
38. (38)
    having an external burn to the affected arm requiring hospitalisation, within the five years before the clinical worsening of ulnar neuropathy at the elbow;
39. (39)
    being pregnant within the three months before the clinical worsening of ulnar neuropathy at the elbow;
40. (40)
    having an infection involving the affected ulnar nerve in the region of the elbow at the time of the clinical worsening of ulnar neuropathy at the elbow;

    Note: Examples of an infection involving the affected ulnar nerve include Mycobacterium leprae (leprosy) and tuberculosis.

41. (41)
    smoking at least ten pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of ulnar neuropathy at the elbow, and: (a) smoking commenced at least five years before the clinical worsening of ulnar neuropathy at the elbow; and (b) where smoking has ceased, the clinical worsening of ulnar neuropathy at the elbow 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.

42. (42)
    having a lesion as specified at the elbow that compresses or displaces the affected ulnar nerve at the time of the clinical worsening of ulnar neuropathy at the elbow;

    Note: lesion as specified is defined in the Schedule 1 - Dictionary.

43. (43)
    having diabetes mellitus at the time of the clinical worsening of ulnar neuropathy at the elbow; Compilation No. 1 Compilation date: 25/05/2020 Authorised Version F2020C00421 registered 25/05/2020;
44. (44)
    having acromegaly before the clinical worsening of ulnar neuropathy at the elbow;

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

45. (45)
    inability to obtain appropriate clinical management for ulnar neuropathy at the elbow;

Aggravation-only factors: the factors in subsections 8(23) to 8(45) 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.