Statement of Principles

concerning

MITRAL VALVE PROLAPSE

No. 43 of 2014

for the purposes of the

Veterans’ Entitlements Act 1986

and

Military Rehabilitation and Compensation Act 2004

Title

1. This Instrument may be cited as Statement of Principles concerning mitral valve prolapse No. 43 of 2014.

Determination

2. The Repatriation Medical Authority under subsection 196B(2) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):

(a) revokes Instrument No. 11 of 2003 concerning mitral valve prolapse; and

(b) determines in its place this Statement of Principles.

Kind of injury, disease or death

3. (a) This Statement of Principles is about mitral valve prolapse and death from mitral valve prolapse.

(b)               For the purposes of this Statement of Principles, "mitral valve prolapse" means a structural disorder of the mitral valve apparatus in which there is systolic displacement of an abnormally thickened or redundant mitral leaflet into the left atrium, and which has been confirmed by echocardiographic studies.  Mitral valve prolapse is also known as floppy mitral valve.

This definition of mitral valve prolapse excludes:

(i)                 mitral valve displacement or billowing of the anterior mitral valve leaflet identified only in the 4-chamber apical view;

(ii)               isolated mitral regurgitation in the absence of echocardiographic evidence of mitral valve prolapse;

(iii)             mitral valve disorder due to rheumatic heart disease; or

(iv)             flail mitral valve leaflets.

(c)                Mitral valve prolapse attracts ICD-10-AM code I34.1.

(d)               In the application of this Statement of Principles, the definition of "mitral valve prolapse" is that given at paragraph 3(b) above.

Basis for determining the factors

4. The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that mitral valve prolapse and death from mitral valve prolapse can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces under the VEA, or members under the Military Rehabilitation and Compensation Act 2004 (the MRCA).

Factors that must be related to service

5. Subject to clause 7, at least one of the factors set out in clause 6 must be related to the relevant service rendered by the person.

Factors

6. The factor that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting mitral valve prolapse or death from mitral valve prolapse with the circumstances of a person’s relevant service is:

(a)                flying in high performance aircraft for a cumulative total of at least 500 hours within any ten year period before the clinical worsening of mitral valve prolapse; or

(b)               inability to obtain appropriate clinical management for mitral valve prolapse.

Factors that apply only to material contribution or aggravation

7. Paragraphs 6(a) to 6(b) apply only to material contribution to, or aggravation of, mitral valve prolapse where the person’s mitral valve prolapse was suffered or contracted before or during (but not arising out of) the person’s relevant service.

Inclusion of Statements of Principles

8. 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 as in force from time to time.

Other definitions

9. For the purposes of this Statement of Principles:

"death from mitral valve prolapse" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s mitral valve prolapse;

"G force" means the ratio of the applied acceleration of the aircraft to the acceleration due to gravity, for example, 4G = 4 x 9.81m/s2;

"high performance aircraft" means an aircraft capable of routinely sustaining a positive G force of four or more;

"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), Eighth Edition, effective date of 1 July 2013, copyrighted by the Independent Hospital Pricing Authority, and having ISBN 978-1-74128-213-9;

"relevant service" means:

(a)                operational service under the VEA;

(b)               peacekeeping service under the VEA;

(c)                hazardous service under the VEA;

(d)               British nuclear test defence service under the VEA;

(e)                warlike service under the MRCA; or

(f)                 non-warlike service under the MRCA;

"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

10. This Instrument applies to all matters to which section 120A of the VEA or section 338 of the MRCA applies.

Date of effect

11. This Instrument takes effect from 7 May 2014.

Dated this  twenty-fourth   day of   April   2014

The Common Seal of the  )

Repatriation Medical Authority )

was affixed to this instrument  )

in the presence of:   )

PROFESSOR NICHOLAS SAUNDERS AO

CHAIRPERSON