Reasonable Hypothesis SOP [1] | 93 of 2021 |
Balance of Probabilities SOP [2] | 94 of 2021 |
SOP Bulletin 224 [3]
This condition affects the thumb, index and middle fingers and half of the ring finger. It results in pain and numbness, and weakness in some cases, due to pressure on / entrapment of the median nerve in the wrist.
Diagnosis is based on characteristic clinical history and examination findings. Electrophysiological testing can often be used to help confirm the diagnosis but it is not always required.
The appropriate specialist for this condition is a neurologist or orthopaedic (hand) surgeon.
* another SOP applies
# non-SOP condition
Clinical onset will be when symptoms (pain, parasthesia, weakness) in the hand, in the median nerve distribution, first began.
A clinical course involving periods of remission and exacerbation is common. There may be progression from intermittent to persistent sensory symptoms, and later, to the development of motor symptoms (weakness).
Acromegaly is defined by the RMA as "a chronic disease of adults resulting from hypersecretion of growth hormone after closure of the epiphyses”. The condition is characterised by enlargement of many parts of the skeleton especially the distal portions, the nose, ears, jaws, fingers and toes.
Signs and symptoms
· Soft tissue and bone enlargement
· Fatigue, increased sweating, heat intolerance and weight gain
· Coarsening facial features, oily skin, increased skin tags, voice change, increased tongue size and malocclusion
Establishing onset
Diagnosis can be made from the characteristic clinical findings. X-rays of the skull and hands show enlargement and thickening. Plasma GH (growth hormone) levels are typically elevated in acromegaly. Medical records would usually contain reference to the onset of relevant symptoms or signs of the disease. Therefore, if there is a history of acromegaly dating from a particular time and relevant medical notes cannot be obtained, you should seek medical advice to decide whether the claimed symptoms and treatment can be attributed to acromegaly or to some other condition.
17515 there is some evidence that acromegaly may be a factor in the development or worsening of the condition under consideration.
10714 the veteran has had acromegaly at some time.
17338 the veteran has established the causal connection between acromegaly and VEA service for carpal tunnel syndrome.
17345 the veteran suffered from acromegaly before the clinical onset of the condition under consideration.
17339 the veteran has established the causal connection between acromegaly and VEA service for the clinical onset of carpal tunnel syndrome.
17341 the veteran has established the causal connection between acromegaly and operational service for the clinical onset of carpal tunnel syndrome.
or
17342 the veteran has established the causal connection between acromegaly and eligible service for the clinical onset of carpal tunnel syndrome.
or
7334 the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.
7335 the condition under consideration permanently worsened.
17346 the veteran suffered from acromegaly before the clinical worsening of the condition under consideration.
17340 the veteran has established the causal connection between acromegaly and VEA service for the clinical worsening of carpal tunnel syndrome.
17343 the veteran has established the causal connection between acromegaly and operational service for the clinical worsening of carpal tunnel syndrome.
or
17344 the veteran has established the causal connection between acromegaly and eligible service for the clinical worsening of carpal tunnel syndrome.
10725 the acromegaly is causally related to operational service.
10726 the acromegaly is causally related to eligible service.
10725 the acromegaly is causally related to operational service.
17347 the clinical onset of the condition under consideration occurred prior to that part of operational service to which acromegaly is causally related.
10726 the acromegaly is causally related to eligible service.
17348 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which acromegaly is causally related.
Definition
The RMA has defined amyloidosis to mean the accumulation of insoluble fibrillar proteins (amyloid) in organs or tissues of the body such that vital function is compromised.
General information
Amyloidosis may be associated with chronic diseases, either infectious (tuberculosis, bronchiectasis, osteomyelitis, leprosy) or inflammatory (rheumatoid arthritis, granulomatous ileitis). Amyloid is also associated with multiple myeloma, Hodgkin’s disease, other tumours and familial Mediterranean fever. Amyloidosis may be familial and unassociated with other disease. The precise aetiology of amyloidosis is unknown. It occurs commonly throughout the animal kingdom and man, usually in response to the ageing process. Its true prevalence in the population is not known. Manifestations are non-specific, determined by the organ or system affected. Amyloidosis may be suspected on the basis of symptoms and signs, usually in the presence of other disease, but it can be diagnosed only by biopsy.
Establishing a history of amyloidosis
The clinical presentation of amyloidosis is extremely diverse and no consistent pattern of 'appropriate symptoms' can be specified. If a veteran or member had been found to have amyloidosis this would be recorded in doctors' notes and/or hospital records. Therefore, if a history of amyloidosis is contended, this will need to be confirmed with the veteran's doctor, and, if practicable, a copy of relevant histopathology reports should be obtained.
17516 there is some evidence that amyloidosis may be a factor in the development or worsening of the condition under consideration.
17349 the veteran has suffered from amyloidosis at some time.
17351 the veteran has established the causal connection between amyloidosis and VEA service for carpal tunnel syndrome.
17358 the veteran suffered from amyloidosis at the time of the clinical onset of the condition under consideration.
17352 the veteran has established the causal connection between amyloidosis and VEA service for the clinical onset of carpal tunnel syndrome.
17354 the veteran has established the causal connection between amyloidosis and operational service for the clinical onset of carpal tunnel syndrome.
or
17355 the veteran has established the causal connection between amyloidosis and eligible service for the clinical onset of carpal tunnel syndrome.
or
7334 the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.
7335 the condition under consideration permanently worsened.
17359 the veteran suffered from amyloidosis at the time of the clinical worsening of the condition under consideration.
17353 the veteran has established the causal connection between amyloidosis and VEA service for the clinical worsening of carpal tunnel syndrome.
17356 the veteran has established the causal connection between amyloidosis and operational service for the clinical worsening of carpal tunnel syndrome.
or
17357 the veteran has established the causal connection between amyloidosis and eligible service for the clinical worsening of carpal tunnel syndrome.
17360 the amyloidosis is causally related to operational service.
17361 the amyloidosis is causally related to eligible service.
17360 the amyloidosis is causally related to operational service.
17362 the clinical onset of the condition under consideration occurred prior to that part of operational service to which amyloidosis is causally related.
17361 the amyloidosis is causally related to eligible service.
17363 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which amyloidosis is causally related.
Obesity as a factor for carpal tunnel syndrome
The carpal tunnel syndrome SOP includes a factor of "being obese". This term is defined in the SOP. The RMA has also issued a SOP for morbid obesity. If there is a history of "being obese" but the claim for carpal tunnel syndrome does not succeed via this factor, you will be asked to consider whether there is a history of morbid obesity, as this is an extreme form of obesity.
RMA definition of being obese
In this Statement of Principles the Repatriation Medical Authority has defined being obese as meaning an increase in body weight by way of fat accumulation which results in a Body Mass Index (BMI) of 30 or greater.
The measurement used to define “being obese” is the Body Mass Index (BMI).
The BMI = W/H2 and where:
W is the person’s weight in kilograms and
H is the person’s height in metres.
(For Imperial weights and measures, BMI = wt. in lbs/(ht in inches2) x 703.1).
This definition excludes weight gain not resulting from fat deposition such as gross oedema, peritoneal or pleural effusion, or muscle hypertrophy. "Being obese" develops when energy intake is in excess of expenditure for a sustained period of time.
Establishing the presence of obesity
If it is not possible to obtain specific height/weight measurements, a medical comment that the veteran or member was obese will be sufficient. If height/weight measurements can be obtained, the BMI formula should be applied.
A history of obesity may be documented in the evidence. However, the veteran or member may not have sought medical attention and the condition may not have been recorded in medical records. In addition, doctors' and hospitals' records may have been destroyed or can no longer be obtained.
Therefore, a statement by the veteran about his or her weight at a particular time will generally be accepted, unless there is contradictory evidence. This weight can then be used to calculate whether the veteran was obese at that time.
Type |
Title |
PDF Format |
Word Format |
---|---|---|---|
Claimant Report | Obesity | CR9230.pdf [6] | CR9230.docx [7] |
Medical Report | Obesity | MR9305.pdf [8] | MR9305.docx [9] |
17512 there is some evidence that obesity may be a factor in the development or worsening of the condition under consideration.
587 the veteran has a history of obesity.
17298 the veteran has established the causal connection between the obesity and VEA service for the condition under consideration.
17299 the veteran has established the causal connection between the obesity and VEA service for the clinical onset of the condition under consideration.
17303 the veteran has established the causal connection between the obesity and operational service for the clinical onset of the condition under consideration.
or
17304 the veteran has established the causal connection between the obesity and eligible service for the clinical onset of the condition under consideration.
or
7334 the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.
7335 the condition under consideration permanently worsened.
17300 the veteran has established the causal connection between the obesity and VEA service for the clinical worsening of the condition under consideration.
17305 the veteran has established the causal connection between the obesity and operational service for the clinical worsening of the condition under consideration.
or
17306 the veteran has established the causal connection between the obesity and eligible service for the clinical worsening of the condition under consideration.
17307 the veteran was obese at the time of the clinical onset of the condition under consideration.
591 the obesity was caused by operational service.
or
9004 the veteran has a history of morbid obesity.
9007 the veteran was morbidly obese at the time of the clinical onset of the condition under consideration.
9005 the morbid obesity is causally related to operational service.
17307 the veteran was obese at the time of the clinical onset of the condition under consideration.
3407 the obesity was caused by eligible service.
or
9004 the veteran has a history of morbid obesity.
9007 the veteran was morbidly obese at the time of the clinical onset of the condition under consideration.
9006 the morbid obesity is causally related to eligible service.
17308 the veteran was obese at the time of the clinical worsening of the condition under consideration.
591 the obesity was caused by operational service.
17309 the clinical onset of the condition under consideration occurred prior to that part of operational service which caused the obesity.
or
9004 the veteran has a history of morbid obesity.
9008 the veteran was morbidly obese at the time of the clinical worsening of the condition under consideration.
9005 the morbid obesity is causally related to operational service.
9009 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the morbid obesity is causally related.
17308 the veteran was obese at the time of the clinical worsening of the condition under consideration.
3407 the obesity was caused by eligible service.
17310 the clinical onset of the condition under consideration occurred prior to that part of eligible service which caused the obesity.
or
9004 the veteran has a history of morbid obesity.
9008 the veteran was morbidly obese at the time of the clinical worsening of the condition under consideration.
9006 the morbid obesity is causally related to eligible service.
9010 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the morbid obesity is causally related.
This SOP factor requires daily self propulsion of a manual wheelchair for a minimum of 130 hours (reasonable hypothesis cases) or 260 hours (balance of probabilities cases). It will therefore be necessary to ascertain whether or not the wheelchair was pushed by someone other than the veteran. It will also be necessary to identify the condition which resulted in use of the wheelchair so that a causal relationship with service may be investigated if appropriate.
Type |
Title |
PDF Format |
Word Format |
---|---|---|---|
Claimant Report | Daily Self Propulsion of a Manual Wheelchair | CR9096.pdf | CR9096.docx |
17508 there is some evidence that daily self propulsion of a manual wheelchair may be a factor in the development or worsening of the condition under consideration.
17138 the veteran self propelled a manual wheelchair on a daily basis for at least a cumulative period of 130 hours at some time.
17148 the veteran self propelled a manual wheelchair on a daily basis as a consequence of an illness or injury which is identifiable.
17139 the veteran has established the causal connection between the daily self propulsion of a manual wheelchair and VEA service for carpal tunnel syndrome.
17140 the veteran has established the causal connection between the daily self propulsion of a manual wheelchair and VEA service for the clinical onset of carpal tunnel syndrome.
17143 the veteran has established the causal connection between the daily self propulsion of a manual wheelchair and eligible service for the clinical onset of carpal tunnel syndrome.
or
17142 the veteran has established the causal connection between the daily self propulsion of a manual wheelchair and operational service for the clinical onset of carpal tunnel syndrome.
or
7334 the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.
7335 the condition under consideration permanently worsened.
17141 the veteran has established the causal connection between the daily self propulsion of a manual wheelchair and VEA service for the clinical worsening of carpal tunnel syndrome.
17145 the veteran has established the causal connection between the daily self propulsion of a manual wheelchair and eligible service for the clinical worsening of carpal tunnel syndrome.
or
17144 the veteran has established the causal connection between the daily self propulsion of a manual wheelchair and operational service for the clinical worsening of carpal tunnel syndrome.
31958 the identified illness or injury made a material contribution to the veteran's self propulsion of a manual wheelchair on a daily basis for at least a cumulative period of 130 hours within a period of 120 consecutive days.
31960 the identified illness or injury made a material contribution to the veteran's self propulsion of a manual wheelchair on a daily basis for at least a cumulative period of 130 hours within a period of 120 consecutive days before the clinical onset of the condition under consideration.
31963 where the identified illness or injury made a material contribution to the veteran's self propulsion of a manual wheelchair on a daily basis for at least a cumulative period of 130 hours within a period of 120 consecutive days before the clinical onset of the condition under consideration, that activity ceased more than 30 days before the clinical onset.
17149 the identified illness or injury which materially contributed to the veteran's daily self propulsion of a manual wheelchair is causally related to operational service.
31957 the identified illness or injury made a material contribution to the veteran's self propulsion of a manual wheelchair on a daily basis for at least a cumulative period of 260 hours within a period of 210 consecutive days.
31959 the identified illness or injury made a material contribution to the veteran's self propulsion of a manual wheelchair on a daily basis for at least a cumulative period of 260 hours within a period of 210 consecutive days before the clinical onset of the condition under consideration.
31965 where the identified illness or injury made a material contribution to the veteran's self propulsion of a manual wheelchair on a daily basis for at least a cumulative period of 260 hours within a period of 210 consecutive days before the clinical onset of the condition under consideration, that activity ceased more than 30 days before the clinical onset.
17150 the identified illness or injury which materially contributed to the veteran's daily self propulsion of a manual wheelchair is causally related to eligible service.
31958 the identified illness or injury made a material contribution to the veteran's self propulsion of a manual wheelchair on a daily basis for at least a cumulative period of 130 hours within a period of 120 consecutive days.
31962 the identified illness or injury made a material contribution to the veteran's self propulsion of a manual wheelchair on a daily basis for at least a cumulative period of 130 hours within a period of 120 consecutive days before the clinical worsening of the condition under consideration.
31964 where the identified illness or injury made a material contribution to the veteran's self propulsion of a manual wheelchair on a daily basis for at least a cumulative period of 130 hours within a period of 120 consecutive days before the clinical worsening of the condition under consideration, that activity ceased more than 30 days before the clinical worsening.
17149 the identified illness or injury which materially contributed to the veteran's daily self propulsion of a manual wheelchair is causally related to operational service.
18674 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury that materially contributed to the veteran's daily self propulsion of a manual wheelchair is causally related.
31957 the identified illness or injury made a material contribution to the veteran's self propulsion of a manual wheelchair on a daily basis for at least a cumulative period of 260 hours within a period of 210 consecutive days.
31961 the identified illness or injury made a material contribution to the veteran's self propulsion of a manual wheelchair on a daily basis for at least a cumulative period of 260 hours within a period of 210 consecutive days before the clinical worsening of the condition under consideration.
31966 where the identified illness or injury made a material contribution to the veteran's self propulsion of a manual wheelchair on a daily basis for at least a cumulative period of 260 hours within a period of 210 consecutive days before the clinical worsening of the condition under consideration, that activity ceased more than 30 days before the clinical worsening.
17150 the identified illness or injury which materially contributed to the veteran's daily self propulsion of a manual wheelchair is causally related to eligible service.
18675 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury that materially contributed to the veteran's daily self propulsion of a manual wheelchair is causally related.
Definitions
· A fracture
· Dislocation includes subluxation which is a partial dislocation
The radius is the bone on the outer side or thumb side of the forearm. The lower end of the radius articulates (forms a joint) with the ulna and the carpus (wrist).
The ulna is the inner and larger bone of the forearm, on the side opposite that of the thumb. The lower end of the ulna articulates with the radius and the bones of the carpus.
The carpus (wrist) comprises 8 bones. These carpal bones are:
· Capitate |
· Scaphoid (navicular) |
· Hamate |
· Trapezium |
· Lunate |
· Trapezoid |
· Pisiform |
· Triquetrum |
The 5 metacarpal bones in the hand extend from the carpus (wrist) to the phalanges (fingers).
· Picture of hand and wrist
Picture of hand and wrist
Type |
Title |
PDF Format |
Word Format |
---|---|---|---|
Medical Report | Fracture or Dislocation | MR9121.pdf | MR9121.docx |
17246 the veteran has suffered a fracture or dislocation affecting side and site of the body, as defined in the Statements of Principles for carpal tunnel syndrome, at some time.
25957 the fracture or dislocation affecting side and site of the body, as defined in the Statements of Principles for carpal tunnel syndrome, is an illness or injury which is identifiable. [Default true]
17248 the veteran has established the causal connection between the fracture or dislocation as defined in the Statements of Principles for carpal tunnel syndrome and VEA service for carpal tunnel syndrome.
17257 the veteran suffered the identified illness or injury, a fracture or dislocation affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome, before the clinical onset of the condition under consideration.
17250 the veteran has established the causal connection between the fracture or dislocation as defined in the Statements of Principles for carpal tunnel syndrome and VEA service for the clinical onset of carpal tunnel syndrome.
17253 the veteran has established the causal connection between the fracture or dislocation affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome and operational service for the clinical onset of carpal tunnel syndrome.
or
17254 the veteran has established the causal connection between the fracture or dislocation affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome and eligible service for the clinical onset of carpal tunnel syndrome.
or
7334 the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.
7335 the condition under consideration permanently worsened.
17264 the veteran suffered the identified illness or injury, a fracture or dislocation affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome, before the clinical worsening of the condition under consideration.
17252 the veteran has established the causal connection between the fracture or dislocation as defined in the Statements of Principles for carpal tunnel syndrome and VEA service for the clinical worsening of carpal tunnel syndrome.
17255 the veteran has established the causal connection between the fracture or dislocation affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome and operational service for the clinical worsening of carpal tunnel syndrome.
or
17256 the veteran has established the causal connection between the fracture or dislocation affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome and eligible service for the clinical worsening of carpal tunnel syndrome.
24056 the identified illness or injury, a fracture or dislocation affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome, is causally related to operational service.
24057 the identified illness or injury, a fracture or dislocation affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome, is causally related to eligible service.
24056 the identified illness or injury, a fracture or dislocation affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome, is causally related to operational service.
17270 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury, a fracture or dislocation affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome, is causally related.
24057 the identified illness or injury, a fracture or dislocation affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome, is causally related to eligible service.
17271 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury, a fracture or dislocation affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome, is causally related.
Gout is a recurrent acute arthritis of peripheral joints that results from the deposition, in and about the joints and tendons, of crystals of monosodium urate [MSU]. In rare cases the sacroiliac or cervical spine is involved. The presence of a raised serum urate level is a prerequisite for the development of gout, but, in the absence of arthritis, it does not indicate the clinical onset of gout.
RMA SOP definition of gout
Signs and symptoms
· The onset of gout usually consists of the appearance of exquisitely painful arthritis generally affecting one joint at first, associated with serum urate in excess of 7.0 mg/dL.
· Acute pain, often at night, is usually the first symptom. The pain becomes progressively more severe each hour and is often described as throbbing, crushing, or excruciating.
· Examination reveals swelling, warmth, redness and exquisite tenderness of the affected joint.
· The attack may last a day or two, or up to several weeks, but characteristically resolves completely. Some individuals may never experience another attack. Usually, however, there follows the "inter critical period" during which the sufferer is totally free of symptoms. This period may last from one to forty years. It ends with the occurrence of successive attacks of gouty arthritis, each of which may last longer and resolve less completely than its predecessors.
Establishing onset
If a veteran or member had gout he or she would probably have sought medical attention at the time of clinical onset. Such medical treatment would normally be recorded in doctors' notes and/or hospital records. However, these records may have been destroyed or can no longer be obtained. Therefore, if there is a reliable history of appropriate medical treatment at a particular time, this generally will be accepted, unless there is contradictory evidence. Seek medical advice if it is unclear whether the claimed symptoms and treatment at that time can be attributed to gout rather than to some other condition.
17519 there is some evidence that gout may be a factor in the development or worsening of the condition under consideration.
1894 the veteran has gout.
1895 the veteran has gout in other relevant side and site of the body or wrist.
17381 the veteran has established the causal connection between the gout and VEA service for carpal tunnel syndrome.
17388 the veteran suffered from gout in other relevant side and site of the body or wrist at the time of the clinical onset of the condition under consideration.
17382 the veteran has established the causal connection between the gout and VEA service for the clinical onset of carpal tunnel syndrome.
17384 the veteran has established the causal connection between the gout and operational service for the clinical onset of carpal tunnel syndrome.
or
17385 the veteran has established the causal connection between the gout and eligible service for the clinical onset of carpal tunnel syndrome.
or
7334 the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.
7335 the condition under consideration permanently worsened.
17389 the veteran suffered from gout in other relevant side and site of the body or wrist at the time of the clinical worsening of the condition under consideration.
17383 the veteran has established the causal connection between the gout and VEA service for the clinical worsening of carpal tunnel syndrome.
17386 the veteran has established the causal connection between the gout and operational service for the clinical worsening of carpal tunnel syndrome.
or
17387 the veteran has established the causal connection between the gout and eligible service for the clinical worsening of carpal tunnel syndrome.
1900 the gout is causally related to operational service.
1901 the gout is causally related to eligible service.
1900 the gout is causally related to operational service.
17390 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the gout in other relevant side and site of the body or wrist is causally related.
1901 the gout is causally related to eligible service.
17391 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the gout in other relevant side and site of the body or wrist is causally related.
Definition
The RMA has defined haemodialysis treatment as the removal of certain elements from the blood by virtue of the difference in the rates of their diffusion through a semipermeable membrane by means of a haemodialyser.
Haemodialysis is used in the management of acute or chronic renal failure - ie when there is kidney failure, which may itself be due to another medical condition, such as diabetes mellitus or hypertension. With current techniques, most patients require between 9 and 12 hours of dialysis per week, equally divided into several sessions.
Establishing a history of treatment
If a veteran or member had undergone haemodialysis he or she would have been suffering from a serious medical condition at the time. Such a medical condition, and the haemodialysis treatment would normally be recorded in doctors' notes and/or hospital records. However, these records may have been destroyed or can no longer be obtained. Therefore, if there is a reliable history of haemodialysis at a particular time, this generally will be accepted, unless there is contradictory evidence. Seek medical advice if it is unclear whether the claimed treatment at that time is consistent with haemodialysis rather than some other procedure.
17513 there is some evidence that haemodialysis treatment may be a factor in the development or worsening of the condition under consideration.
14932 the veteran has undergone haemodialysis at some time.
14933 the veteran has undergone haemodialysis for treatment of an illness or injury which is identifiable.
17311 the veteran has established the causal connection between the haemodialysis treatment and VEA service for carpal tunnel syndrome.
17318 the veteran underwent haemodialysis treatment for the identified illness or injury for at least the year before the clinical onset of the condition under consideration.
17312 the veteran has established the causal connection between the haemodialysis treatment and VEA service for the clinical onset of carpal tunnel syndrome.
17314 the veteran has established the causal connection between the haemodialysis treatment and operational service for the clinical onset of carpal tunnel syndrome.
or
17315 the veteran has established the causal connection between the haemodialysis treatment and eligible service for the clinical onset of carpal tunnel syndrome.
or
7334 the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.
7335 the condition under consideration permanently worsened.
17319 the veteran underwent haemodialysis treatment for the identified illness or injury for at least the year before the clinical worsening of the condition under consideration.
17313 the veteran has established the causal connection between the haemodialysis treatment and VEA service for the clinical worsening of carpal tunnel syndrome.
17316 the veteran has established the causal connection between the haemodialysis treatment and operational service for the clinical worsening of carpal tunnel syndrome.
or
17317 the veteran has established the causal connection between the haemodialysis treatment and eligible service for the clinical worsening of carpal tunnel syndrome.
14942 the identified illness or injury, for which haemodialysis was undergone, is causally related to operational service.
14943 the identified illness or injury, for which haemodialysis was undergone, is causally related to eligible service.
14942 the identified illness or injury, for which haemodialysis was undergone, is causally related to operational service.
17320 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury, for which haemodialysis was undergone, is causally related.
14943 the identified illness or injury, for which haemodialysis was undergone, is causally related to eligible service.
17321 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury, for which haemodialysis was undergone, is causally related.
Haemorrhage means bleeding.
Haemorrhage involving the carpal tunnel is not common but may result from trauma, coagulation disorders such as haemophilia, disorders such as acute myeloid leukaemia or synovitis of the wrist or spontaneous bleeding as a result of anticoagulant therapy such as warfarin.
If the veteran had suffered from haemorrhage involving the carpal tunnel, this history would have been identified by the doctor who diagnosed carpal tunnel syndrome.
31879 there is some evidence that haemorrhage may be a factor in the development or worsening of the condition under consideration.
31880 the veteran has had haemorrhage involving the carpal tunnel at some time.
31881 the veteran has had haemorrhage involving the carpal tunnel of side and site of the body at some time.
31882 the veteran had haemorrhage involving the carpal tunnel of side and site of the body as a consequence of an illness or injury which is identifiable.
31883 the veteran has established the causal connection between the haemorrhage involving the carpal tunnel of side and site of the body and VEA service for the condition under consideration.
31890 the veteran was suffering from haemorrhage involving the carpal tunnel of side and site of the body which was caused by the identified illness or injury at the time of the clinical onset of the condition under consideration.
31884 the veteran has established the causal connection between the haemorrhage involving the carpal tunnel of side and site of the body and VEA service for the clinical onset of the condition under consideration.
31886 the veteran has established the causal connection between the haemorrhage involving the carpal tunnel of side and site of the body and operational service for the clinical onset of the condition under consideration.
or
31887 the veteran has established the causal connection between the haemorrhage involving the carpal tunnel of side and site of the body and eligible service for the clinical onset of the condition under consideration.
or
31891 the veteran was suffering from haemorrhage involving the carpal tunnel of side and site of the body which was caused by the identified illness or injury at the time of the clinical worsening of the condition under consideration.
31885 the veteran has established the causal connection between the haemorrhage involving the carpal tunnel of side and site of the body and VEA service for the clinical worsening of the condition under consideration.
31888 the veteran has established the causal connection between the haemorrhage involving the carpal tunnel of side and site of the body and operational service for the clinical worsening of the condition under consideration.
or
31889 the veteran has established the causal connection between the haemorrhage involving the carpal tunnel of side and site of the body and eligible service for the clinical worsening of the condition under consideration.
31892 the identified illness or injury, which caused the haemorrhage involving the carpal tunnel of side and site of the body, is causally related to operational service.
31893 the identified illness or injury, which caused the haemorrhage involving the carpal tunnel of side and site of the body, is causally related to eligible service.
31892 the identified illness or injury, which caused the haemorrhage involving the carpal tunnel of side and site of the body, is causally related to operational service.
31894 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury, which caused the haemorrhage involving the carpal tunnel of side and site of the body, is causally related.
31893 the identified illness or injury, which caused the haemorrhage involving the carpal tunnel of side and site of the body, is causally related to eligible service.
31895 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury, which caused the haemorrhage involving the carpal tunnel of side and site of the body, is causally related.
Inability to obtain appropriate clinical management for carpal tunnel syndrome
Previously, conservative treatment may have involved the injection of steroids into the flexor retinaculum. More recent approaches revolve around rest, or the wearing of a special splint designed to keep the wrist slightly over-extended. If these measures fail, or if there is evidence of loss of nerve conduction, then surgical treatment is undertaken. This involves longitudinal incision of the flexor retinaculum, which effectively relieves the problem.
Inability to obtain appropriate clinical management
Type |
Title |
PDF Format |
Word Format |
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Medical Report | Inability to Obtain Appropriate Clinical Management | GQACM.pdf | GQACM.docx |
11109 the condition under consideration has been accepted on the basis of inability to obtain appropriate clinical management for the condition under consideration.
7066 there is some evidence that an inability to obtain appropriate clinical management for the condition under consideration may be a factor in the worsening of the condition under consideration.
7334 the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.
7335 the condition under consideration permanently worsened.
7378 the veteran was unable to obtain appropriate clinical management for the condition under consideration at some time.
7379 the inability to obtain appropriate clinical management for the condition under consideration contributed to the clinical worsening of the condition under consideration.
11234 the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and VEA service for the clinical worsening of the condition under consideration.
11235 the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and operational service for the clinical worsening of the condition under consideration.
or
11236 the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and eligible service for the clinical worsening of the condition under consideration.
7384 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during operational service.
21084 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during operational service, as a causal result of operational service.
7387 the veteran's inability to obtain appropriate clinical management for the condition under consideration during operational service was due to the veteran's serious default, wilful act or serious breach of discipline.
or
7389 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, because of an illness or injury which is identifiable.
7390 the identified illness or injury which prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related to operational service.
7392 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury that prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related.
7385 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during eligible service.
7386 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during eligible service, as a causal result of eligible service.
7388 the veteran's inability to obtain appropriate clinical management for the condition under consideration during eligible service was due to the veteran's serious default, wilful act or serious breach of discipline.
or
7389 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, because of an illness or injury which is identifiable.
7391 the identified illness or injury which prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related to eligible service.
7393 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury that prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related.
Infections that may involve the carpal tunnel include:
· bacterial infections such as staphylococcus aureus
· viral infections such as rubella virus or vaccine or parvovirus B19 (erythema infectiosum)
· fungal infections such as histoplasmosis; and
· mycobacterial infections such as tuberculosis and leprosy (Hansen's disease).
If the veteran had suffered from such an infection involving the carpal tunnel, this history would have been identified by the doctor who diagnosed carpal tunnel syndrome.
31896 there is some evidence that infection may be a factor in the development or worsening of the condition under consideration.
31897 the veteran has had infection involving the carpal tunnel at some time.
31898 the veteran has had infection involving the carpal tunnel of side and site of the body at some time.
31899 the veteran had infection involving the carpal tunnel of side and site of the body as a consequence of an illness or injury which is identifiable.
31900 the veteran has established the causal connection between the infection involving the carpal tunnel of side and site of the body and VEA service for the condition under consideration.
31908 the veteran was suffering from infection involving the carpal tunnel of side and site of the body which was caused by the identified illness or injury at the time of the clinical onset of the condition under consideration.
31901 the veteran has established the causal connection between the infection involving the carpal tunnel of side and site of the body and VEA service for the clinical onset of the condition under consideration.
31903 the veteran has established the causal connection between the infection involving the carpal tunnel of side and site of the body and operational service for the clinical onset of the condition under consideration.
or
31904 the veteran has established the causal connection between the infection involving the carpal tunnel of side and site of the body and eligible service for the clinical onset of the condition under consideration.
or
31909 the veteran was suffering from infection involving the carpal tunnel of side and site of the body which was caused by the identified illness or injury at the time of the clinical worsening of the condition under consideration.
31902 the veteran has established the causal connection between the infection involving the carpal tunnel of side and site of the body and VEA service for the clinical worsening of the condition under consideration.
31905 the veteran has established the causal connection between the infection involving the carpal tunnel of side and site of the body and operational service for the clinical worsening of the condition under consideration.
or
31907 the veteran has established the causal connection between the infection involving the carpal tunnel of side and site of the body and eligible service for the clinical worsening of the condition under consideration.
31913 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury, which caused the infection involving the carpal tunnel of side and site of the body, is causally related.
31910 the identified illness or injury, which caused the infection involving the carpal tunnel of side and site of the body, is causally related to operational service.
31911 the identified illness or injury, which caused the infection involving the carpal tunnel of side and site of the body, is causally related to eligible service.
31910 the identified illness or injury, which caused the infection involving the carpal tunnel of side and site of the body, is causally related to operational service.
31912 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury, which caused the infection involving the carpal tunnel of side and site of the body, is causally related.
31906 the identified illness or injury for which the veteran has undergone a course of the combined oral contraceptive pill or a progesterone oral contraceptive pill is causally related to eligible service.
Definition
The RMA has defined this to mean one of the following diseases:
(i) rheumatoid arthritis;
(ii) systemic lupus erythematosus;
(iii) systemic sclerosis (which includes circumscribed scleroderma and CREST syndrome (calcinosis, Raynaud’s, oesophageal dysfunction, sclerodactyly, and telangiectasia));
(iv) sicca syndrome (which includes keratoconjunctivitis sicca and Sjogren’s disease);
(v) dermatomyositis;
(vi) polymyositis;
(vii) eosinophilia myalgia syndrome;
(viii) eosinophilic fasciitis;
(ix) multifocal fibrosclerosis;
(x) systemic fibrosclerosing syndrome;
(xi) unspecified diffuse connective tissue disease;
(xii) chondrocalcinosis (also known as pseudogout);
(xiii) arthropathy associated with Reiter’s disease and non-specific urethritis;
(xiv) postdysenteric arthropathy;
(xv) psoriatic arthropathy;
(xvi) arthropathy associated with inflammatory bowel disease;
(xvii) ankylosing spondylitis; or
(xviii) other inflammatory arthritis requiring treatment with methotrexate or penicillamine or azathioprine or gold;
If a veteran or member suffered inflammatory arthritis, this normally would be recorded in doctors' notes and/or hospital records. However, if these records cannot be obtained and there is a reliable history of inflammatory arthritis at a particular time, this generally will be accepted, unless there is contradictory evidence.
17517 there is some evidence that inflammatory arthritis may be a factor in the development or worsening of the condition under consideration.
31914 the veteran has had inflammatory arthritis of the wrist or hand at some time.
17364 the inflammatory arthritis affected other relevant side and site of the body or wrist.
31917 inflammatory arthritis means one of the diseases listed in the Statements of Principles for carpal tunnel syndrome.
17366 the veteran has established the causal connection between inflammatory arthritis and VEA service for carpal tunnel syndrome.
17373 the veteran suffered the identified illness or injury, an inflammatory arthritis affecting other relevant side and site of the body or wrist, at the time of the clinical onset of the condition under consideration.
17367 the veteran has established the causal connection between inflammatory arthritis and VEA service for the clinical onset of carpal tunnel syndrome.
17369 the veteran has established the causal connection between inflammatory arthritis and operational service for the clinical onset of carpal tunnel syndrome.
or
17370 the veteran has established the causal connection between inflammatory arthritis and eligible service for the clinical onset of carpal tunnel syndrome.
or
7334 the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.
7335 the condition under consideration permanently worsened.
17374 the veteran suffered the identified illness or injury, an inflammatory arthritis affecting other relevant side and site of the body or wrist, at the time of the clinical worsening of the condition under consideration.
17368 the veteran has established the causal connection between inflammatory arthritis and VEA service for the clinical worsening of carpal tunnel syndrome.
17371 the veteran has established the causal connection between inflammatory arthritis and operational service for the clinical worsening of carpal tunnel syndrome.
or
17372 the veteran has established the causal connection between inflammatory arthritis and eligible service for the clinical worsening of carpal tunnel syndrome.
17375 the identified illness or injury, an inflammatory arthritis affecting other relevant side and site of the body or wrist, is causally related to operational service.
17376 the identified illness or injury, an inflammatory arthritis affecting other relevant side and site of the body or wrist, is causally related to eligible service.
17375 the identified illness or injury, an inflammatory arthritis affecting other relevant side and site of the body or wrist, is causally related to operational service.
17377 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury, an inflammatory arthritis affecting other relevant side and site of the body or wrist, is causally related.
17376 the identified illness or injury, an inflammatory arthritis affecting other relevant side and site of the body or wrist, is causally related to eligible service.
17378 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury, an inflammatory arthritis affecting other relevant side and site of the body or wrist, is causally related.
Definition
This factor is limited to an injury which does not involve a fracture or a dislocation but which does:
· alter the normal contour of the carpal tunnel; or
· damage the median nerve or flexor tendons within the carpal tunnel.
The wrist is the part of the arm between the forearm and the hand, in the region of the wrist joint. It is also called the carpus.
The carpal tunnel lies between the carpal bones and the flexor retinaculum (an overlying tough band of connective tissue). Because of the strength of the surrounding structures it would take a significant injury to directly alter the normal contour of the carpal tunnel or to damage the median nerve or flexor tendons within the carpal tunnel eg a severe crushing injury or a deep laceration requiring stitches.
If such an injury occurred, medical attention would be needed. However, less significant wrist or hand injuries (ie not necessarily requiring medical attention) may indirectly alter the normal contour of the carpal tunnel or damage the median nerve or flexor tendons through swelling of the surrounding tissues. If the evidence does not clearly establish whether or not an injury to the wrist or hand altered the normal contour of the carpal tunnel or damaged the median nerve or flexor tendons within the carpal tunnel, seek medical advice.
Type |
Title |
PDF Format |
Word Format |
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Claimant Report | Injury to the Wrist or Hand | CR9097.pdf | CR9097.docx |
Medical Report | Injury to the Wrist or Hand | MR9120.pdf | MR9120.docx |
17180 the veteran has suffered an injury affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome at some time.
17181 the veteran has established the causal connection between the injury as defined in the Statements of Principles for carpal tunnel syndrome and VEA service for carpal tunnel syndrome.
17182 the veteran has established the causal connection between the injury as defined in the Statements of Principles for carpal tunnel syndrome and VEA service for the clinical onset of carpal tunnel syndrome.
17184 the veteran has established the causal connection between the injury as defined in the Statements of Principles for carpal tunnel syndrome and operational service for the clinical onset of carpal tunnel syndrome.
or
17185 the veteran has established the causal connection between the injury as defined in the Statements of Principles for carpal tunnel syndrome and eligible service for the clinical onset of carpal tunnel syndrome.
or
7334 the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.
7335 the condition under consideration permanently worsened.
17183 the veteran has established the causal connection between the injury as defined in the Statements of Principles for carpal tunnel syndrome and VEA service for the clinical worsening of carpal tunnel syndrome.
17186 the veteran has established the causal connection between the injury as defined in the Statements of Principles for carpal tunnel syndrome and operational service for the clinical worsening of carpal tunnel syndrome.
or
17187 the veteran has established the causal connection between the injury as defined in the Statements of Principles for carpal tunnel syndrome and eligible service for the clinical worsening of carpal tunnel syndrome.
17190 the veteran has suffered an injury affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome on operational service.
17188 the veteran has suffered an injury affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome on operational service, within the year before the clinical onset of the condition under consideration.
17273 the injury affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome on operational service, within the year immediately before the clinical onset of the condition under consideration, was due to the veteran's serious default, wilful act or serious breach of discipline.
or
17239 the injury affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome was due to an illness or injury which is identifiable.
20269 the injury affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome, caused by the identified illness or injury, occurred within the year before the clinical onset of the condition under consideration.
17240 the identified illness or injury, which caused the injury affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome, is causally related to operational service.
17191 the veteran has suffered an injury affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome on eligible service.
17193 the veteran has suffered an injury affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome on eligible service, as a causal result of eligible service duties.
25464 the veteran has suffered an injury affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome in the course of eligible service duties, within the year before the clinical onset of the condition under consideration.
20277 the injury affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome within the year before the clinical onset of the condition under consideration on eligible service was due to the veteran's serious default, wilful act or serious breach of discipline.
or
17239 the injury affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome was due to an illness or injury which is identifiable.
20269 the injury affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome, caused by the identified illness or injury, occurred within the year before the clinical onset of the condition under consideration.
17241 the identified illness or injury, which caused the injury affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome, is causally related to eligible service.
17190 the veteran has suffered an injury affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome on operational service.
20272 the veteran has suffered an injury affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome on operational service, as a causal result of operational service duties.
17189 the veteran has suffered an injury affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome as a causal result of operational service duties, within the year before the clinical worsening of the condition under consideration.
20273 the injury affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome within the year before the clinical worsening of the condition under consideration on operational service was due to the veteran's serious default, wilful act or serious breach of discipline.
or
17239 the injury affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome was due to an illness or injury which is identifiable.
20270 the injury affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome, caused by the identified illness or injury, occurred within the year before the clinical worsening of the condition under consideration.
17240 the identified illness or injury, which caused the injury affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome, is causally related to operational service.
17242 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury, which caused the injury affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome, is causally related.
17191 the veteran has suffered an injury affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome on eligible service.
17193 the veteran has suffered an injury affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome on eligible service, as a causal result of eligible service duties.
25465 the veteran has suffered an injury affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome as a causal result of eligible service duties within the year before the clinical worsening of the condition under consideration.
20276 the injury affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome within the year before the clinical worsening of the condition under consideration on eligible service was due to the veteran's serious default, wilful act or serious breach of discipline.
or
17239 the injury affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome was due to an illness or injury which is identifiable.
20270 the injury affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome, caused by the identified illness or injury, occurred within the year before the clinical worsening of the condition under consideration.
17241 the identified illness or injury, which caused the injury affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome, is causally related to eligible service.
17243 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury, which caused the injury affecting side and site of the body as defined in the Statements of Principles for carpal tunnel syndrome, is causally related.
Myxoedema means a condition characterised by dry, waxy swelling of the skin and other tissues and associated with primary hypothyroidism. The term myxoedema is sometimes used interchangeably with adult hypothyroidism.
Hypothyroidism
17514 there is some evidence that myxoedema may be a factor in the development or worsening of the condition under consideration.
17322 the veteran has suffered from myxoedema at some time.
31848 myxoedema means a condition characterised by dry, waxy swelling of the skin and other tissues and associated with hypothyroidism.
17324 the veteran has established the causal connection between the myxoedema and VEA service for carpal tunnel syndrome.
17331 the veteran suffered the identified illness or injury, a type of myxoedema, at the time of the clinical onset of the condition under consideration.
17325 the veteran has established the causal connection between the myxoedema and VEA service for the clinical onset of carpal tunnel syndrome.
17327 the veteran has established the causal connection between the myxoedema and operational service for the clinical onset of carpal tunnel syndrome.
or
17328 the veteran has established the causal connection between the myxoedema and eligible service for the clinical onset of carpal tunnel syndrome.
or
7334 the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.
7335 the condition under consideration permanently worsened.
17332 the veteran suffered the identified illness or injury, a type of myxoedema, at the time of the clinical worsening of the condition under consideration.
17326 the veteran has established the causal connection between the myxoedema and VEA service for the clinical worsening of carpal tunnel syndrome.
17329 the veteran has established the causal connection between the myxoedema and operational service for the clinical worsening of carpal tunnel syndrome.
or
17330 the veteran has established the causal connection between the myxoedema and eligible service for the clinical worsening of carpal tunnel syndrome.
8811 the identified illness or injury, a type of hypothyroidism, is causally related to operational service.
8812 the identified illness or injury, a type of hypothyroidism, is causally related to eligible service.
8811 the identified illness or injury, a type of hypothyroidism, is causally related to operational service.
17335 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury, a type of myxoedema, is causally related.
8812 the identified illness or injury, a type of hypothyroidism, is causally related to eligible service.
17336 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury, a type of myxoedema, is causally related.
Definition
The RMA has defined oedema as "the presence of abnormally large amounts of fluid in the intercellular tissue spaces of the body and demonstrated by accumulation of excessive fluid in the subcutaneous tissues."
General information
Oedema may result from a variety of causes including cardiac, hepatic, or renal disease, burns or lymphoedema. Oedema may be localised to an area or it may be systemic.
31859 there is some evidence that oedema may be a factor in the development or worsening of the condition under consideration.
31860 the veteran has had oedema involving the carpal tunnel at some time.
31861 the veteran has had oedema involving the carpal tunnel of side and site of the body at some time.
31862 the veteran had oedema involving the carpal tunnel of side and site of the body as a consequence of an illness or injury which is identifiable.
31863 the veteran has established the causal connection between the oedema involving the carpal tunnel of side and site of the body and VEA service for the condition under consideration.
31872 the veteran was suffering from oedema involving the carpal tunnel of side and site of the body which was caused by the identified illness or injury at the time of the clinical onset of the condition under consideration.
31864 the veteran has established the causal connection between the oedema involving the carpal tunnel of side and site of the body and VEA service for the clinical onset of the condition under consideration.
31866 the veteran has established the causal connection between the oedema involving the carpal tunnel of side and site of the body and operational service for the clinical onset of the condition under consideration.
or
31867 the veteran has established the causal connection between the oedema involving the carpal tunnel of side and site of the body and eligible service for the clinical onset of the condition under consideration.
or
7334 the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.
7335 the condition under consideration permanently worsened.
31873 the veteran was suffering from oedema involving the carpal tunnel of side and site of the body which was caused by the identified illness or injury at the time of the clinical worsening of the condition under consideration.
31865 the veteran has established the causal connection between the oedema involving the carpal tunnel of side and site of the body and VEA service for the clinical worsening of the condition under consideration.
31868 the veteran has established the causal connection between the oedema involving the carpal tunnel of side and site of the body and operational service for the clinical worsening of the condition under consideration.
or
31870 the veteran has established the causal connection between the oedema involving the carpal tunnel of side and site of the body and eligible service for the clinical worsening of the condition under consideration.
31874 the identified illness or injury, which caused the oedema involving the carpal tunnel of side and site of the body, is causally related to operational service.
31875 the identified illness or injury, which caused the oedema involving the carpal tunnel of side and site of the body, is causally related to eligible service.
31874 the identified illness or injury, which caused the oedema involving the carpal tunnel of side and site of the body, is causally related to operational service.
31876 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury, which caused the oedema involving the carpal tunnel of side and site of the body, is causally related.
31875 the identified illness or injury, which caused the oedema involving the carpal tunnel of side and site of the body, is causally related to eligible service.
31877 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury, which caused the oedema involving the carpal tunnel of side and site of the body, is causally related.
Definitions
Note that there are different definitions for repetitive activities depending on whether you are considering a reasonable hypothesis case (operational service) or a balance of probabilities case (eligible service). The definition of forceful activities is the same for both standards of proof.
· Repetitive activities for reasonable hypothesis cases
· Repetitive activities for balance of probabilities cases
· Forceful activities
The SOP factor allows for any combination of repetitive activities or forceful activities with the hand affected by carpal tunnel syndrome.
Physical requirements, duties, and workplace hazards of specific military occupations
Type |
Title |
PDF Format |
Word Format |
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Claimant Report | Repetitive, Forceful or Vibrating Activities | CR9095.pdf | CR9095.docx |
17107 the veteran has established the causal connection between the repetitive or forceful activities and VEA service for carpal tunnel syndrome.
17108 the veteran has established the causal connection between the repetitive or forceful activities and VEA service for the clinical onset of carpal tunnel syndrome.
17114 the veteran has established the causal connection between the repetitive or forceful activities and operational service for the clinical onset of carpal tunnel syndrome.
or
17115 the veteran has established the causal connection between the repetitive or forceful activities and eligible service for the clinical onset of carpal tunnel syndrome.
or
7334 the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.
7335 the condition under consideration permanently worsened.
17109 the veteran has established the causal connection between the repetitive or forceful activities and VEA service for the clinical worsening of carpal tunnel syndrome.
17116 the veteran has established the causal connection between the repetitive or forceful activities and operational service for the clinical worsening of carpal tunnel syndrome.
or
17117 the veteran has established the causal connection between the repetitive or forceful activities and eligible service for the clinical worsening of carpal tunnel syndrome.
24035 the veteran has performed repetitive or forceful activities with other relevant side and site of the body for at least 130 hours within a period of 120 consecutive days at some time.
24036 the veteran has performed repetitive or forceful activities with other relevant side and site of the body for at least 130 hours within a period of 120 consecutive days before the clinical onset of the condition under consideration.
34305 operational service made a material contribution to the requirements of the Statement of Principles for repetitive or forceful activities before the clinical onset of the condition under consideration.
25119 where operational service made a material contribution to the requirements of the Statement of Principles for repetitive or forceful activities before the clinical onset of the condition under consideration, those service-related activities ceased more than 30 days before the onset.þ
or
34311 the veteran performed repetitive or forceful activities with other relevant side and site of the body as a consequence of an illness or injury which is identifiable.
34312 the identified illness or injury made a material contribution to the veteran's performance of repetitive or forceful activities with other relevant side and site of the body for at least 130 hours within a period of 120 consecutive days before the clinical onset of the condition under consideration.
34316 where the identified illness or injury made a material contribution to the requirements of the RH Statement of Principles for repetitive or forceful activities, those activities ceased more than 30 days before the clinical onset of the carpal tunnel syndrome.
34320 the identified illness or injury which materially contributed to the veteran's performance of repetitive or forceful activities with other relevant side and site of the body is causally related to operational service.
24038 the veteran has performed repetitive or forceful activities with other relevant side and site of the body for at least 260 hours within a period of 210 consecutive days at some time.
24040 the veteran has performed repetitive or forceful activities with other relevant side and site of the body for at least 260 hours within a period of 210 consecutive days before the clinical onset of the condition under consideration.
34306 eligible service made a material contribution to the requirements of the Statement of Principles for repetitive or forceful activities before the clinical onset of the condition under consideration.
25121 where eligible service made a material contribution to the requirements of the Statement of Principles for repetitive or forceful activities before the clinical onset of the condition under consideration, those service-related activities ceased more than 30 days before the onset.
or
34311 the veteran performed repetitive or forceful activities with other relevant side and site of the body as a consequence of an illness or injury which is identifiable.
34313 the identified illness or injury made a material contribution to the veteran's performance of repetitive or forceful activities with other relevant side and site of the body for at least 260 hours within a period of 210 consecutive days before the clinical onset of the condition under consideration.
34317 where the identified illness or injury made a material contribution to the requirements of the BOP Statement of Principles for repetitive or forceful activities, those activities ceased more than 30 days before the clinical onset of the carpal tunnel syndrome.
34321 the identified illness or injury which materially contributed to the veteran's performance of repetitive or forceful activities with other relevant side and site of the body is causally related to eligible service.
24035 the veteran has performed repetitive or forceful activities with other relevant side and site of the body for at least 130 hours within a period of 120 consecutive days at some time.
24043 the veteran has performed repetitive or forceful activities with other relevant side and site of the body for at least 130 hours within a period of 120 consecutive days before the clinical worsening of the condition under consideration.
24042 the clinical onset of the condition under consideration occurred before the veteran performed repetitive or forceful activities with other relevant side and site of the body for at least 130 hours within 120 consecutive days.
34307 operational service made a material contribution to the requirements of the Statement of Principles for repetitive or forceful activities before the clinical worsening of the condition under consideration.
25120 where operational service made a material contribution to the requirements of the Statement of Principles for repetitive or forceful activities before the clinical worsening of the condition under consideration, those service-related activities ceased more than 30 days before the worsening.
or
34311 the veteran performed repetitive or forceful activities with other relevant side and site of the body as a consequence of an illness or injury which is identifiable.
34314 the identified illness or injury made a material contribution to the veteran's performance of repetitive or forceful activities with other relevant side and site of the body for at least 130 hours within a period of 120 consecutive days before the clinical worsening of the condition under consideration.
34318 where the identified illness or injury made a material contribution to the requirements of the RH Statement of Principles for repetitive or forceful activities, those activities ceased more than 30 days before the clinical worsening of the carpal tunnel syndrome.
34320 the identified illness or injury which materially contributed to the veteran's performance of repetitive or forceful activities with other relevant side and site of the body is causally related to operational service.
34322 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury that materially contributed to the veteran's performance of repetitive or forceful activities with other relevant side and site of the body is causally related.
24038 the veteran has performed repetitive or forceful activities with other relevant side and site of the body for at least 260 hours within a period of 210 consecutive days at some time.
25415 the veteran has performed repetitive or forceful activities with other relevant side and site of the body for at least 260 hours within a period of 210 consecutive days before the clinical worsening of the condition under consideration.
24045 the clinical onset of the condition under consideration occurred before the veteran performed repetitive or forceful activities with other relevant side and site of the body for at least 260 hours within 210 consecutive days.
34308 eligible service made a material contribution to the requirements of the Statement of Principles for repetitive or forceful activities before the clinical worsening of the condition under consideration.
25122 where eligible service made a material contribution to the requirements of the Statement of Principles for repetitive or forceful activities before the clinical worsening of the condition under consideration, those service-related activities ceased more than 30 days before the worsening.
or
34311 the veteran performed repetitive or forceful activities with other relevant side and site of the body as a consequence of an illness or injury which is identifiable.
34315 the identified illness or injury made a material contribution to the veteran's performance of repetitive or forceful activities with other relevant side and site of the body for at least 260 hours within a period of 210 consecutive days before the clinical worsening of the condition under consideration.
34319 where the identified illness or injury made a material contribution to the requirements of the BOP Statement of Principles for repetitive or forceful activities, those activities ceased more than 30 days before the clinical worsening of the carpal tunnel syndrome.
34321 the identified illness or injury which materially contributed to the veteran's performance of repetitive or forceful activities with other relevant side and site of the body is causally related to eligible service.
34323 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury that materially contributed to the veteran's performance of repetitive or forceful activities with other relevant side and site of the body is causally related.
Definition
The RMA has defined a space occupying lesion in the carpal tunnel as "one of the following entities occupying space within the carpal tunnel:
(a) neoplasm;
(b) aneurysm;
(c) calcification;
(d) cyst; or
(e) ganglion".
Examples of some of these include haemangioma, neuroma of the median nerve, aneurysm of the median artery, synovial sarcoma, tendon sheath fibroma and lipoma.
Establishing a history of space occupying lesion
If a veteran or member had a space occupying lesion in the carpal tunnel he or she would most likely have sought medical attention at some time. Such medical treatment would normally be recorded in doctors' notes and/or hospital records. However, these records may have been destroyed or can no longer be obtained. Therefore, if there is a reliable history of appropriate symptoms and/or medical treatment at a particular time, this generally will be accepted, unless there is contradictory evidence. Seek medical advice if it is unclear whether the claimed symptoms and treatment at that time can be attributed to a space occupying lesion in the carpal tunnel rather than to some other illness or injury.
Type |
Title |
PDF Format |
Word Format |
---|---|---|---|
Medical Report | Space Occupying Lesion in the Carpal Tunnel | MR9123.pdf | MR9123.docx |
17518 there is some evidence that a space occupying lesion in the carpal tunnel may be a factor in the development or worsening of the condition under consideration.
17392 the veteran has suffered from a space occupying lesion in the carpal tunnel of side and site of the body at some time.
17393 a space occupying lesion in the affected carpal tunnel means a neoplasm, an aneurysm, calcification, a cyst or a ganglion occupying space within the carpal tunnel. [Default true]
17394 the veteran has established the causal connection between the space occupying lesion in the affected carpal tunnel and VEA service for carpal tunnel syndrome.
17401 the veteran suffered from the identified illness or injury, a space occupying lesion in the carpal tunnel of side and site of the body at the time of the clinical onset of the condition under consideration.
17395 the veteran has established the causal connection between the space occupying lesion in the affected carpal tunnel and VEA service for the clinical onset of carpal tunnel syndrome.
17397 the veteran has established the causal connection between the space occupying lesion in the affected carpal tunnel and operational service for the clinical onset of carpal tunnel syndrome.
or
17398 the veteran has established the causal connection between the space occupying lesion in the affected carpal tunnel and eligible service for the clinical onset of carpal tunnel syndrome.
or
7334 the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.
7335 the condition under consideration permanently worsened.
17402 the veteran suffered from the identified illness or injury, a space occupying lesion in the carpal tunnel of side and site of the body at the time of the clinical worsening of the condition under consideration.
17396 the veteran has established the causal connection between the space occupying lesion in the affected carpal tunnel and VEA service for the clinical worsening of carpal tunnel syndrome.
17399 the veteran has established the causal connection between the space occupying lesion in the affected carpal tunnel and operational service for the clinical worsening of carpal tunnel syndrome.
or
17400 the veteran has established the causal connection between the space occupying lesion in the affected carpal tunnel and eligible service for the clinical worsening of carpal tunnel syndrome.
17403 the identified illness or injury, a space occupying lesion in the carpal tunnel of side and site of the body, is causally related to operational service.
17404 the identified illness or injury, a space occupying lesion in the carpal tunnel of side and site of the body, is causally related to eligible service.
17403 the identified illness or injury, a space occupying lesion in the carpal tunnel of side and site of the body, is causally related to operational service.
17405 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury, a space occupying lesion in the carpal tunnel of side and site of the body, is causally related.
17404 the identified illness or injury, a space occupying lesion in the carpal tunnel of side and site of the body, is causally related to eligible service.
17406 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury, a space occupying lesion in the carpal tunnel of side and site of the body, is causally related.ý
This factor is limited to surgery which:
· alters the normal contour of the carpal tunnel; or
· damages the median nerve or flexor tendons within the carpal tunnel.
The wrist is the part of the arm between the forearm and the hand, in the region of the wrist joint. It is also called the carpus.
The carpal tunnel lies between the carpal bones and the flexor retinaculum (an overlying tough band of connective tissue).
Any surgical procedure to the wrist or hand would normally be recorded in doctors' notes and/or hospital records. Because it is necessary to identify whether or not the surgery altered the normal contour of the carpal tunnel or damaged the median nerve or flexor tendons within the carpal tunnel, you must seek medical advice if this is not established by the information available.
Type |
Title |
PDF Format |
Word Format |
---|---|---|---|
Medical Report | Surgery to the Wrist or Hand | MR9122.pdf | MR9122.docx |
17511 there is some evidence that surgery which altered the normal contour of the carpal tunnel or damaged the median nerve or flexor tendons within the carpal tunnel may be a factor in the development or worsening of the condition under consideration.
25473 the veteran has undergone surgery to other relevant side and site of the body or wrist which altered the normal contour of the carpal tunnel or damaged the median nerve or flexor tendons within the carpal tunnel of side and site of the body at some time.
17291 the surgery to other relevant side and site of the body or wrist which altered the normal contour of the carpal tunnel or damaged the median nerve or flexor tendons within the carpal tunnel of side and site of the body was for treatment of an illness or injury which is identifiable.
17276 the veteran has established the causal connection between the surgery which altered the normal contour of the carpal tunnel or damaged the median nerve or flexor tendons within the carpal tunnel and VEA service for carpal tunnel syndrome.
25474 the veteran underwent the surgery to other relevant side and site of the body or wrist which altered the normal contour of the carpal tunnel or damaged the median nerve or flexor tendons within the carpal tunnel of side and site of the body, for the identified illness or injury, within the year before the clinical onset of the condition under consideration.
17278 the veteran has established the causal connection between the surgery which altered the normal contour of the carpal tunnel or damaged the median nerve or flexor tendons within the carpal tunnel and VEA service for the clinical onset of carpal tunnel syndrome.
17281 the veteran has established the causal connection between the surgery which altered the normal contour of the carpal tunnel or damaged the median nerve or flexor tendons within the carpal tunnel and operational service for the clinical onset of carpal tunnel syndrome.
or
17282 the veteran has established the causal connection between the surgery which altered the normal contour of the carpal tunnel or damaged the median nerve or flexor tendons within the carpal tunnel and eligible service for the clinical onset of carpal tunnel syndrome.
or
7334 the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.
7335 the condition under consideration permanently worsened.
17290 the veteran underwent the surgery to other relevant side and site of the body or wrist which altered the normal contour of the carpal tunnel or damaged the median nerve or flexor tendons within the carpal tunnel of side and site of the body, for the identified illness or injury, within the year before the clinical worsening of the condition under consideration.
17280 the veteran has established the causal connection between the surgery which altered the normal contour of the carpal tunnel or damaged the median nerve or flexor tendons within the carpal tunnel and VEA service for the clinical worsening of carpal tunnel syndrome.
17283 the veteran has established the causal connection between the surgery which altered the normal contour of the carpal tunnel or damaged the median nerve or flexor tendons within the carpal tunnel and operational service for the clinical worsening of carpal tunnel syndrome.
or
17284 the veteran has established the causal connection between the surgery which altered the normal contour of the carpal tunnel or damaged the median nerve or flexor tendons within the carpal tunnel and eligible service for the clinical worsening of carpal tunnel syndrome.
17292 the identified illness or injury, for which the veteran underwent surgery to other relevant side and site of the body or wrist which altered the normal contour of the carpal tunnel or damaged the median nerve or flexor tendons within the carpal tunnel of side and site of the body, is causally related to operational service.
17293 the identified illness or injury, for which the veteran underwent surgery to other relevant side and site of the body or wrist which altered the normal contour of the carpal tunnel or damaged the median nerve or flexor tendons within the carpal tunnel of side and site of the body, is causally related to eligible service.
17292 the identified illness or injury, for which the veteran underwent surgery to other relevant side and site of the body or wrist which altered the normal contour of the carpal tunnel or damaged the median nerve or flexor tendons within the carpal tunnel of side and site of the body, is causally related to operational service.
17294 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury, for which the veteran underwent surgery to other relevant side and site of the body or wrist which altered the normal contour of the carpal tunnel or damaged the median nerve or flexor tendons within the carpal tunnel of side and site of the body, is causally related.
17293 the identified illness or injury, for which the veteran underwent surgery to other relevant side and site of the body or wrist which altered the normal contour of the carpal tunnel or damaged the median nerve or flexor tendons within the carpal tunnel of side and site of the body, is causally related to eligible service.
17295 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury, for which the veteran underwent surgery to other relevant side and site of the body or wrist which altered the normal contour of the carpal tunnel or damaged the median nerve or flexor tendons within the carpal tunnel of side and site of the body, is causally related.
Activities involving hand-arm vibration include truck driving, operating a sewing machine, using a rock drill and hand-tool operation eg power drills, electric clippers, dentist’s drills and polishers, chain saws, grinders, abraders, buffers and polishers. Information about particular service occupations is contained in Physical requirements, duties, and workplace hazards of specific military occupations
Type |
Title |
PDF Format |
Word Format |
---|---|---|---|
Claimant Report | Repetitive, Forceful or Vibrating Activities | CR9095.pdf | CR9095.docx |
17152 the veteran has established the causal connection between the activities which directly vibrated the hand or forearm and VEA service for carpal tunnel syndrome.
17153 the veteran has established the causal connection between the activities which directly vibrated the hand or forearm and VEA service for the clinical onset of carpal tunnel syndrome.
17157 the veteran has established the causal connection between the activities which directly vibrated the hand or forearm and operational service for the clinical onset of carpal tunnel syndrome.
or
17158 the veteran has established the causal connection between the activities which directly vibrated the hand or forearm and eligible service for the clinical onset of carpal tunnel syndrome.
or
7334 the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.
7335 the condition under consideration permanently worsened.
17154 the veteran has established the causal connection between the activities which directly vibrated the hand or forearm and VEA service for the clinical worsening of carpal tunnel syndrome.
17159 the veteran has established the causal connection between the activities which directly vibrated the hand or forearm and operational service for the clinical worsening of carpal tunnel syndrome.
or
17160 the veteran has established the causal connection between the activities which directly vibrated the hand or forearm and eligible service for the clinical worsening of carpal tunnel syndrome.
24047 the veteran has performed activities where other relevant side and site of the body or forearm was directly vibrated for at least 130 hours within a period of 120 consecutive days at some time.
25453 the veteran has performed activities where other relevant side and site of the body or forearm was directly vibrated for at least 130 hours within a period of 120 consecutive days before the clinical onset of the condition under consideration.
25953 operational service made a material contribution to the requirements of the Statement of Principles for vibrating activities of other relevant side and site of the body or forearm before the clinical onset of the condition under consideration.
24048 where operational service made a material contribution to the requirements of the Statement of Principles for vibrating activities of other relevant side and site of the body or forearm, that service-related activity has ceased more than 30 days before the clinical onset of the carpal tunnel syndrome.
24049 the veteran has performed activities where other relevant side and site of the body or forearm was directly vibrated for at least 260 hours within a period of 210 consecutive days at some time.
25454 the veteran has performed activities where other relevant side and site of the body or forearm was directly vibrated for at least 260 hours within a period of 210 consecutive days before the clinical onset of the condition under consideration.
25455 eligible service made a material contribution to the requirements of the Statement of Principles for vibrating activities of other relevant side and site of the body or forearm before the clinical onset of the condition under consideration.
24051 where eligible service made a material contribution to the requirements of the Statement of Principles for vibrating activities of other relevant side and site of the body or forearm, that service-related activity has ceased more than 30 days before the clinical onset of the carpal tunnel syndrome.
24047 the veteran has performed activities where other relevant side and site of the body or forearm was directly vibrated for at least 130 hours within a period of 120 consecutive days at some time.
25456 the veteran has performed activities where other relevant side and site of the body or forearm was directly vibrated for at least 130 hours within a period of 120 consecutive days before the clinical worsening of the condition under consideration.
24052 the clinical onset of the condition under consideration occurred before the veteran performed activities where other relevant side and site of the body or forearm was directly vibrated for at least 130 hours within 120 consecutive days.
25954 operational service made a material contribution to the requirements of the Statement of Principles for vibrating activities of other relevant side and site of the body or forearm before the clinical worsening of the condition under consideration.
24053 where operational service made a material contribution to the requirements of the Statement of Principles for vibrating activities of other relevant side and site of the body or forearm, that service-related activity has ceased more than 30 days before the clinical worsening of the carpal tunnel syndrome.
24049 the veteran has performed activities where other relevant side and site of the body or forearm was directly vibrated for at least 260 hours within a period of 210 consecutive days at some time.
25460 the veteran has performed activities where other relevant side and site of the body or forearm was directly vibrated for at least 260 hours within a period of 210 consecutive days before the clinical worsening of the condition under consideration.
24054 the clinical onset of the condition under consideration occurred before the veteran performed activities where other relevant side and site of the body or forearm was directly vibrated for at least 260 hours within 210 consecutive days.
25457 eligible service made a material contribution to the requirements of the Statement of Principles for vibrating activities of other relevant side and site of the body or forearm before the clinical worsening of the condition under consideration.
24055 where eligible service made a material contribution to the requirements of the Statement of Principles for vibrating activities of other relevant side and site of the body or forearm, that service-related activity has ceased more than 30 days before the clinical worsening of the carpal tunnel syndrome.
Links
[1] http://www.rma.gov.au/assets/SOP/2021/9eba0d2d0a/093.pdf
[2] http://www.rma.gov.au/assets/SOP/2021/f533296b5d/094.pdf
[3] https://clik.dva.gov.au/system/files/media/SOP%20Bulletin%20224.pdf
[4] https://clik.dva.gov.au/user/login?destination=comment/reply/63341%23comment-form
[5] http://www.rma.gov.au/SOP/alpha_ind/c.htm
[6] https://clik.dva.gov.au/system/files/media/CR9230_7.pdf
[7] https://clik.dva.gov.au/system/files/media/CR9230_7.docx
[8] https://clik.dva.gov.au/system/files/media/MR9305_8.pdf
[9] https://clik.dva.gov.au/system/files/media/MR9305_8.docx