Instrument No.55 of 2002

Revocation and Determination

of

Statement of Principles

concerning

AORTIC STENOSIS

ICD-10-AM codeS: I35.0, I35.2

Veterans’ Entitlements Act 1986

1.         The Repatriation Medical Authority under subsection 196B(3) of the Veterans’ Entitlements Act 1986 (the Act):

(a)       revokes Instrument No.6 of 2000; and

(b)       determines in its place the following Statement of Principles.

Kind of injury, disease or death

2.         (a)       This Statement of Principles is about aortic stenosis and death from aortic stenosis.

(b)       For the purposes of this Statement of Principles, “aortic stenosis” means obstruction to flow across the aortic valve during left ventricular systole.  This definition excludes:

(i)                aortic stenosis due to rheumatic heart disease;

(ii)             aortic valve sclerosis or aortic valve calcification that does not lead to obstruction of blood flow across the aortic valve;

(iii)           obstruction to flow across the aortic valve from narrowing of the supravalvular or subvalvular regions; and

(iv)            congenital stenosis of aortic valve.

Aortic stenosis attracts ICD-10-AM code I35.0 or I35.2.

Basis for determining the factors

3.         On the sound medical-scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that aortic stenosis and death from aortic stenosis can be related to relevant service rendered by veterans or members of the Forces.

Factors that must be related to service

4.         Subject to clause 6, at least one of the factors set out in clause 5 must be related to any relevant service rendered by the person.

Factors

5.         The factors that must exist before it can be said that, on the balance of probabilities, aortic stenosis or death from aortic stenosis is connected with the circumstances of a person’s relevant service are:

(a)       suffering from infective endocarditis before the clinical onset of aortic stenosis; or

(b)       suffering from systemic lupus erythematosus before the clinical onset of aortic stenosis; or

(c)       undergoing a course of therapeutic radiation involving the mediastinum or the chest wall region overlying the heart before the clinical onset of aortic stenosis; or

(d)              suffering from chronic renal failure requiring renal dialysis or renal transplantation before the clinical onset of aortic stenosis; or

(e)              suffering from infective endocarditis before the clinical worsening of aortic stenosis; or

(f)        suffering from systemic lupus erythematosus before the clinical worsening of aortic stenosis; or

(g)       undergoing a course of therapeutic radiation involving the mediastinum or the chest wall region overlying the heart before the clinical worsening of aortic stenosis; or

(h)       suffering from chronic renal failure requiring renal dialysis or renal transplantation before the clinical worsening of aortic stenosis; or

(i)        inability to obtain appropriate clinical management for aortic stenosis.

Factors that apply only to material contribution or aggravation

6.         Paragraphs 5(e) to 5(i) apply only to material contribution to, or aggravation of, aortic stenosis where the person’s aortic stenosis was suffered or contracted before or during (but not arising out of) the person’s relevant service; paragraph 8(1)(e), 9(1)(e) or 70(5)(d) of the Act refers.

Inclusion of Statements of Principles

7.         In this Statement of Principles if a relevant factor applies and that factor includes an injury or disease in respect of which there is a Statement of Principles then the factors in that last mentioned Statement of Principles apply in accordance with the terms of that Statement of Principles.

Other definitions

8.         For the purposes of this Statement of Principles:

“a course of therapeutic radiation” means one or more fractions (treatment portions) of ionising radiation administered with the aim of achieving palliation or cure with gamma rays, x-rays, alpha particles or beta particles;

“death from aortic stenosis” in relation to a person includes death from a terminal event or condition that was contributed to by the person’s aortic stenosis;

“ICD-10-AM code” means a number assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, 10th revision, Australian Modification (ICD-10-AM), Third Edition, effective date of 1 July 2002, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 1 86487 413 9.  Where in this Statement of Principles an ICD code is referenced, such reference is not to constrain or limit the proper meaning of the definition or words preceding the alphanumeric code reference;

“infective endocarditis” means inflammation of the endocardium caused by infection with microorganisms;

“relevant service” means:

(a)       eligible war service (other than operational service); or

(b)              defence service (other than hazardous service);

“systemic lupus erythematosus” means a connective tissue disease in which cells are damaged by pathogenic autoantibodies and immune complexes;

“terminal event” means the proximate or ultimate cause of death and includes:

(a)       pneumonia;

(b)       respiratory failure;

(c)              cardiac arrest;

(d)              circulatory failure; or

(e)              cessation of brain function.

Application

9.         This Instrument applies to all matters to which section 120B of the Act applies.

Dated this       Sixth         day of              August               2002

The Common Seal of the                              )

Repatriation Medical Authority                   )

was affixed to this instrument                      )

in the presence of:                                        )

KEN DONALD

CHAIRMAN