Compilations—Agency prepared template

RMA-Red

Statement of Principles

concerning

ISCHAEMIC HEART DISEASE
(Reasonable Hypothesis)

(No. 1 of 2016)

The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans’ Entitlements Act 1986.

Dated 18 December 2015

Contents

1 Name

3 Authority

5 Application

6 Definitions

7 Kind of injury, disease or death to which this Statement of Principles relates

8 Basis for determining the factors

9 Factors that must exist

10 Relationship to service

11 Factors referring to an injury or disease covered by another Statement of Principles

Schedule 1 - Dictionary

1 Definitions

1 Name

This is the Statement of Principles concerning ischaemic heart disease (Reasonable Hypothesis) (No. 1 of 2016).

3 Authority

This instrument is made under subsection 196B(2) of the Veterans’ Entitlements Act 1986.

5 Application

This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004 applies.

6 Definitions

The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.

7 Kind of injury, disease or death to which this Statement of Principles relates

(1) This Statement of Principles is about ischaemic heart disease and death from ischaemic heart disease.

Meaning of ischaemic heart disease

(2) For the purposes of this Statement of Principles, ischaemic heart disease means a cardiac disability characterised by insufficient blood flow to the muscle tissue of the heart due to atherosclerosis, thrombosis, vasospasm or dissection of the coronary arteries.

(3) While ischaemic heart disease attracts ICD‑10‑AM code I20 to I25, in applying this Statement of Principles the meaning of ischaemic heart disease is that given in subsection (2).

(4) For subsection (3), a reference to an ICD‑10‑AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD‑10‑AM), Ninth Edition, effective date of 1 July 2015, copyrighted by the Independent Hospital Pricing Authority, ISBN 978‑1‑76007‑020‑5.

Death from ischaemic heart disease

(5) For the purposes of this Statement of Principles, ischaemic heart disease, in relation to a person, includes death from a terminal event or condition that was contributed to by the person’s ischaemic heart disease.

Note: terminal event is defined in the Schedule 1 – Dictionary.

8 Basis for determining the factors

The Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that ischaemic heart disease and death from ischaemic heart disease 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 MRCA.

Note: relevant service is defined in the Schedule 1 – Dictionary.

9 Factors that must exist

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting ischaemic heart disease or death from ischaemic heart disease with the circumstances of a person’s relevant service:

(1) having hypertension before the clinical onset of ischaemic heart disease;

(2) having diabetes mellitus before the clinical onset of ischaemic heart disease;

(3) being obese for at least five years before the clinical onset of ischaemic heart disease;

Note: being obese is defined in the Schedule 1 - Dictionary.

(4) having dyslipidaemia before the clinical onset of ischaemic heart disease;

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

(5) where smoking has not ceased prior to the clinical onset of ischaemic heart disease:

(a) smoking an average of at least three cigarettes per day, or the equivalent thereof in other tobacco products, for at least the one year before the clinical onset of ischaemic heart disease; or

(b) smoking at least one half pack-year of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of ischaemic heart disease;

Note: cigarettes per day, or the equivalent thereof in other tobacco products and pack-year of cigarettes, or the equivalent thereof in other tobacco products are defined in the Schedule 1 - Dictionary.

(6) where smoking has ceased prior to the clinical onset of ischaemic heart disease:

(a) smoking at least one half pack-year but less than five pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of ischaemic heart disease, and the clinical onset of ischaemic heart disease has occurred within five years of smoking cessation;

(b) smoking at least five pack-years but less than 20 pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of ischaemic heart disease, and the clinical onset of ischaemic heart disease has occurred within 20 years of smoking cessation; or

(c) smoking at least 20 pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of ischaemic heart disease;

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

(7) where exposure to second-hand smoke has not ceased, being exposed to second-hand smoke for at least 1 000 hours before the clinical onset of ischaemic heart disease;

Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.

(8) where exposure to second-hand smoke has ceased:

(a) being exposed to second-hand smoke for at least 1 000 hours but less than 5 000 hours before the clinical onset of ischaemic heart disease, and the clinical onset of ischaemic heart disease has occurred within five years of the last exposure to second-hand smoke; or

(b) being exposed to second-hand smoke for at least 5 000 hours before the clinical onset of ischaemic heart disease;

Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.

(9) where the use of chewing tobacco has not ceased, using chewing tobacco on more days than not for at least one year before the clinical onset of ischaemic heart disease;

(10) where the use of chewing tobacco has ceased:

(a) using chewing tobacco on more days than not for at least one year but less than five years before the clinical onset of ischaemic heart disease, and the clinical onset of ischaemic heart disease has occurred within five years of ceasing to use chewing tobacco; or

(b) using chewing tobacco on more days than not for at least five years before the clinical onset of ischaemic heart disease;

(11) an inability to undertake any physical activity greater than three METs for at least the five years before the clinical onset of ischaemic heart disease;

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

(12) being sedentary for a cumulative total of at least ten hours per day on more days than not for at least the five years before the clinical onset of ischaemic heart disease;

Note: being sedentary is defined in the Schedule 1 - Dictionary.

(13) having hyperhomocysteinaemia before the clinical onset of ischaemic heart disease;

(14) having chronic kidney disease before the clinical onset of ischaemic heart disease;

Note: chronic kidney disease is defined in the Schedule 1 - Dictionary.

(15) having hypothyroidism or Hashimoto's thyroiditis with hypothyroidism for at least two years within the ten years before the clinical onset of ischaemic heart disease;

(16) inhaling or having cutaneous contact with Otto fuel or explosive products containing nitroglycerine, nitroglycol, trinitrotoluene or dinitrotoluene, where the last inhalation or cutaneous contact occurred not more than 14 days before the clinical onset of ischaemic heart disease;

(17) having received a cumulative equivalent dose of at least 0.5 sievert of ionising radiation to the heart at least one year before the clinical onset of ischaemic heart disease;

Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary.

(18) undergoing a course of therapeutic radiation for cancer, where the heart was in the field of radiation, before the clinical onset of ischaemic heart disease;

(19) having a clinically significant disorder of mental health as specified for at least the five years before the clinical onset of ischaemic heart disease;

Note: clinically significant disorder of mental health as specified is defined in the Schedule 1 - Dictionary.

(20) using a combined oral contraceptive pill for at least the 21 days before the clinical onset of ischaemic heart disease;

(21) being treated with a drug, or a drug from a class of drugs, from Specified List 1 of drugs, where that drug cannot be ceased or substituted, at the time of the clinical onset of ischaemic heart disease;

Note: Specified List 1 of drugs is defined in the Schedule 1 - Dictionary.

(22) using a drug belonging to the non-steroidal anti-inflammatory class of drugs, excluding aspirin, paracetamol and topical non-steroidal anti-`inflammatory drugs, for a continuous period of at least three days before the clinical onset of ischaemic heart disease, where the last dose of the drug within that period was taken within the seven days before the clinical onset of ischaemic heart disease;

(23) having bilateral orchiectomy before the clinical onset of ischaemic heart disease;

(24) having antiandrogen therapy as specified for at least the seven days before the clinical onset of ischaemic heart disease;

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

(25) inhaling, ingesting or having cutaneous contact with the phenoxy acid herbicides 2,4-dichlorophenoxyacetic acid (2,4-D) or 2,4,5-trichlorophenoxyacetic acid (2,4,5-T), for a cumulative period of at least 1 000 hours within a consecutive period of ten years, before the clinical onset of ischaemic heart disease, where the first exposure occurred at least five years before the clinical onset of ischaemic heart disease, and where that exposure has ceased, the clinical onset of ischaemic heart disease occurred within 25 years after cessation;

(26) inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD), for a cumulative period of at least 1 000 hours within a consecutive period of ten years, before the clinical onset of ischaemic heart disease, where the first exposure occurred at least five years before the clinical onset of ischaemic heart disease, and where that exposure has ceased, the clinical onset of ischaemic heart disease occurred within 25 years after cessation;

Note: inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD) is defined in the Schedule 1 - Dictionary.

(27) having thrombosis of a coronary artery as a result of being in a hypercoagulable state as specified at the time of the clinical onset of ischaemic heart disease;

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

(28) inhaling ambient chronically polluted air as specified for at least 1 000 hours within the five years before the clinical onset of ischaemic heart disease;

Note: ambient chronically polluted air as specified is defined in the Schedule 1 - Dictionary.

(29) an inability to consume an average of at least 100 grams per day of vegetables or fruits, for at least the five years before the clinical onset of ischaemic heart disease;

(30) an inability to consume an average of at least 100 grams of fish per fortnight for at least the five years before the clinical onset of ischaemic heart disease;

(31) consuming an average daily intake of at least 12 grams (200 millimoles) of salt for at least the five years before the clinical onset of ischaemic heart disease;

(32) having periodic, heavy alcohol consumption for the one year before the clinical onset of ischaemic heart disease;

Note: alcohol and periodic, heavy alcohol consumption are defined in the Schedule 1 - Dictionary.

(33) having obstructive sleep apnoea for at least the one year before the clinical onset of ischaemic heart disease;

Note: obstructive sleep apnoea is defined in the Schedule 1 - Dictionary.

(34) an inability to sleep for an average of at least five hours daily for at least the one year before the clinical onset of ischaemic heart disease;

(35) undertaking night shift work on at least 250 occasions over a continuous period, for at least the five years before the clinical onset of ischaemic heart disease;

Note: night shift work is defined in the Schedule 1 - Dictionary.

(36) working long hours over a continuous period for at least the five years before the clinical onset of ischaemic heart disease;

Note: long hours is defined in the Schedule 1 - Dictionary.

(37) being infected with human immunodeficiency virus for at least five years before the clinical onset of ischaemic heart disease;

(38) having periodontitis for at least the five years before the clinical onset of ischaemic heart disease;

(39) having infective endocarditis or syphilis involving the coronary arteries at the time of the clinical onset of ischaemic heart disease;

(40) undergoing a procedure involving catheterisation of the affected coronary artery within the five years before the clinical onset of ischaemic heart disease;

(41) having an autoimmune disease from the specified list of autoimmune diseases at the time of the clinical onset of ischaemic heart disease;

Note: specified list of autoimmune diseases is defined in the Schedule 1 - Dictionary.

(42) having gout or hyperuricaemia at the time of the clinical onset of ischaemic heart disease;

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

(43) for angina, acute myocardial infarction or sudden death from ischaemic heart disease only:

(a) undertaking physical activity of five METs or more within the 24 hours before the clinical onset of ischaemic heart disease;

(b) experiencing a category 1A stressor within the 48 hours before the clinical onset of ischaemic heart disease;

(d) experiencing an acute, severe, emotional stressor within the 24 hours before the clinical onset of ischaemic heart disease;

(e) experiencing the death of a significant other within the 12 months before the clinical onset of ischaemic heart disease;

(f) using a drug from Specified List 2 of drugs within the 24 hours before the clinical onset of ischaemic heart disease;

(g) having an episode of acute cholinergic poisoning from exposure to an organophosphorus ester within the seven days before the clinical onset of ischaemic heart disease;

(h) being exposed to:

(i) an environment of extreme heat during a heatwave; or

(ii) an environment of extreme cold during a cold snap; or

(iii) an abrupt alteration of temperature by ten degrees Celsius or more, to extreme heat or to extreme cold;

for a period of at least six hours within the seven days before the clinical onset of ischaemic heart disease;

(i) inhaling ambient highly polluted air as specified for at least two hours within the seven days before the clinical onset of ischaemic heart disease;

(j) being envenomated by a snake, scorpion, wasp, bee, hornet, spider, fish or jellyfish within the 24 hours before the clinical onset of ischaemic heart disease;

(k) having an acute hypersensitivity reaction involving the coronary arteries as a result of being exposed to a drug, food or environmental agent from the specified list within the 24 hours before the clinical onset of ischaemic heart disease;

(ka) having infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within the 30 days before the clinical onset of ischaemic heart disease;

(l) having influenza or a lower respiratory tract infection within the 30 days before the clinical onset of ischaemic heart disease; or

(m) being pregnant within the six weeks before the clinical onset of ischaemic heart disease;

Note 1: SARS-CoV-2 is the virus which causes coronavirus disease 2019 (COVID-19).

Note 2: acute cholinergic poisoning; acute, severe, emotional stressor; ambient highly polluted air as specified; category 1A stressor; category 1B stressor; cold snap; drug, food or environmental agent from the specified list; extreme cold; extreme heat; heatwave; organophosphorus ester; MET; significant other and Specified List 2 of drugs are defined in the Schedule 1 - Dictionary.

(44) having hypertension before the clinical worsening of ischaemic heart disease;

(45) having diabetes mellitus before the clinical worsening of ischaemic heart disease;

(46) being obese for at least five years before the clinical worsening of ischaemic heart disease;

Note: being obese is defined in the Schedule 1 - Dictionary.

(47) having dyslipidaemia before the clinical worsening of ischaemic heart disease;

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

(48) where smoking has not ceased prior to the clinical worsening of ischaemic heart disease:

(a) smoking an average of at least three cigarettes per day, or the equivalent thereof in other tobacco products, for at least the one year before the clinical worsening of ischaemic heart disease; or

(b) smoking at least one half pack-year of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of ischaemic heart disease;

(49) where smoking has ceased prior to the clinical worsening of ischaemic heart disease:

(a) smoking at least one half pack-year but less than five pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of ischaemic heart disease, and the clinical worsening of ischaemic heart disease has occurred within five years of smoking cessation;

(b) smoking at least five pack-years but less than 20 pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of ischaemic heart disease, and the clinical worsening of ischaemic heart disease has occurred within 20 years of smoking cessation; or

(c) smoking at least 20 pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of ischaemic heart disease;

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

(50) where exposure to second-hand smoke has not ceased, being exposed to second-hand smoke for at least 1 000 hours before the clinical worsening of ischaemic heart disease;

Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.

(51) where exposure to second-hand smoke has ceased:

(a) being exposed to second-hand smoke for at least 1 000 hours but less than 5 000 hours before the clinical worsening of ischaemic heart disease, and the clinical worsening of ischaemic heart disease has occurred within five years of the last exposure to second-hand smoke; or

(b) being exposed to second-hand smoke for at least 5 000 hours before the clinical worsening of ischaemic heart disease;

Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.

(52) where the use of chewing tobacco has not ceased, using chewing tobacco on more days than not for at least one year before the clinical worsening of ischaemic heart disease;

(53) where the use of chewing tobacco has ceased:

(a) using chewing tobacco on more days than not for at least one year but less than five years before the clinical worsening of ischaemic heart disease, and the clinical worsening of ischaemic heart disease has occurred within five years of ceasing to use chewing tobacco; or

(b) using chewing tobacco on more days than not for at least five years, before the clinical worsening of ischaemic heart disease;

(54) an inability to undertake any physical activity greater than three METs for at least the five years before the clinical worsening of ischaemic heart disease;

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

(55) being sedentary for a cumulative total of at least ten hours per day on more days than not for at least the five years before the clinical worsening of ischaemic heart disease;

Note: being sedentary is defined in the Schedule 1 - Dictionary.

(56) having hyperhomocysteinaemia before the clinical worsening of ischaemic heart disease;

(57) having chronic kidney disease before the clinical worsening of ischaemic heart disease;

Note: chronic kidney disease is defined in the Schedule 1 - Dictionary.

(58) having hypothyroidism or Hashimoto's thyroiditis with hypothyroidism for at least two years within the ten years before the clinical worsening of ischaemic heart disease;

(59) inhaling or having cutaneous contact with Otto fuel or explosive products containing nitroglycerine, nitroglycol, trinitrotoluene or dinitrotoluene, where the last inhalation or cutaneous contact occurred not more than 14 days before the clinical worsening of ischaemic heart disease;

(60) having received a cumulative equivalent dose of at least 0.5 sievert of ionising radiation to the heart at least one year before the clinical worsening of ischaemic heart disease;

Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary.

(61) undergoing a course of therapeutic radiation for cancer, where the heart was in the field of radiation, before the clinical worsening of ischaemic heart disease;

(62) having a clinically significant disorder of mental health as specified for at least the five years before the clinical worsening of ischaemic heart disease;

Note: clinically significant disorder of mental health as specified is defined in the Schedule 1 - Dictionary.

(63) using a combined oral contraceptive pill for at least the 21 days before the clinical worsening of ischaemic heart disease;

(64) being treated with a drug, or a drug from a class of drugs, from Specified List 1 of drugs, where that drug cannot be ceased or substituted, at the time of the clinical worsening of ischaemic heart disease;

Note: Specified List 1 of drugs is defined in the Schedule 1 - Dictionary.

(65) using a drug belonging to the non-steroidal anti-inflammatory class of drugs, excluding aspirin, paracetamol and topical non-steroidal anti-inflammatory drugs, for a continuous period of at least three days before the clinical worsening of ischaemic heart disease, where the last dose of the drug within that period was taken within the seven days before the clinical worsening of ischaemic heart disease;

(66) having bilateral orchiectomy before the clinical worsening of ischaemic heart disease;

(67) having antiandrogen therapy as specified for at least the seven days before the clinical worsening of ischaemic heart disease;

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

(68) inhaling, ingesting or having cutaneous contact with the phenoxy acid herbicides 2,4-dichlorophenoxyacetic acid (2,4-D) or 2,4,5-trichlorophenoxyacetic acid (2,4,5-T), for a cumulative period of at least 1 000 hours within a consecutive period of ten years, before the clinical worsening of ischaemic heart disease, where the first exposure occurred at least five years before the clinical worsening of ischaemic heart disease, and where that exposure has ceased, the clinical worsening of ischaemic heart disease occurred within 25 years after cessation;

(69) inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD), for a cumulative period of at least 1 000 hours within a consecutive period of ten years, before the clinical worsening of ischaemic heart disease, where the first exposure occurred at least five years before the clinical worsening of ischaemic heart disease, and where that exposure has ceased, the clinical worsening of ischaemic heart disease occurred within 25 years after cessation;

Note: inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD) is defined in the Schedule 1 - Dictionary.

(70) having thrombosis of a coronary artery as a result of being in a hypercoagulable state as specified at the time of the clinical worsening of ischaemic heart disease;

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

(71) inhaling ambient chronically polluted air as specified for at least 1 000 hours within the five years before the clinical worsening of ischaemic heart disease;

Note: ambient chronically polluted air as specified is defined in the Schedule 1 - Dictionary.

(72) an inability to consume an average of at least 100 grams per day of vegetables or fruits, for at least the five years before the clinical worsening of ischaemic heart disease;

(73) an inability to consume an average of at least 100 grams of fish per fortnight for at least the five years before the clinical worsening of ischaemic heart disease;

(74) consuming an average daily intake of at least 12 grams (200 millimoles) of salt for at least the five years before the clinical worsening of ischaemic heart disease;

(75) having periodic, heavy alcohol consumption for the one year before the clinical worsening of ischaemic heart disease;

Note: alcohol and periodic, heavy alcohol consumption are defined in the Schedule 1 - Dictionary.

(76) having obstructive sleep apnoea for at least the one year before the clinical worsening of ischaemic heart disease;

Note: obstructive sleep apnoea is defined in the Schedule 1 - Dictionary.

(77) an inability to sleep for an average of at least five hours daily for at least the one year before the clinical worsening of ischaemic heart disease;

(78) undertaking night shift work on at least 250 occasions over a continuous period, for at least the five years before the clinical worsening of ischaemic heart disease;

Note: night shift work is defined in the Schedule 1 - Dictionary.

(79) working long hours over a continuous period for at least the five years before the clinical worsening of ischaemic heart disease;

Note: long hours is defined in the Schedule 1 - Dictionary.

(80) being infected with human immunodeficiency virus for at least five years before the clinical worsening of ischaemic heart disease;

(81) having periodontitis for at least the five years before the clinical worsening of ischaemic heart disease;

(82) having infective endocarditis or syphilis involving the coronary arteries at the time of the clinical worsening of ischaemic heart disease;

(83) undergoing a procedure involving catheterisation of the affected coronary artery within the five years before the clinical worsening of ischaemic heart disease;

(84) having an autoimmune disease from the specified list of autoimmune diseases at the time of the clinical worsening of ischaemic heart disease;

Note: specified list of autoimmune diseases is defined in the Schedule 1 - Dictionary.

(85) having gout or hyperuricaemia at the time of the clinical worsening of ischaemic heart disease;

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

(86) for acute myocardial infarction or sudden death from ischaemic heart disease only:

(a) undertaking physical activity of five METs or more within the 24 hours before the clinical worsening of ischaemic heart disease;

(b) experiencing a category 1A stressor within the 48 hours before the clinical worsening of ischaemic heart disease;

(d) experiencing an acute, severe, emotional stressor within the 24 hours before the clinical worsening of ischaemic heart disease;

(e) experiencing the death of a significant other within the 12 months before the clinical worsening of ischaemic heart disease;

(f) using a drug from Specified List 2 of drugs within the 24 hours before the clinical worsening of ischaemic heart disease;

(g) having an episode of acute cholinergic poisoning from exposure to an organophosphorus ester within the seven days before the clinical worsening of ischaemic heart disease;

(h) being exposed to:

(i) an environment of extreme heat during a heatwave; or

(ii) an environment of extreme cold during a cold snap; or

(iii) an abrupt alteration of temperature by ten degrees Celsius or more, to extreme heat or to extreme cold;

for a period of at least six hours within the seven days before the clinical worsening of ischaemic heart disease;

(i) inhaling ambient highly polluted air as specified for at least two hours within the seven days before the clinical worsening of ischaemic heart disease;

(j) being envenomated by a snake, scorpion, wasp, bee, hornet, spider, fish or jellyfish within the 24 hours before the clinical worsening of ischaemic heart disease;

(ka) having infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within the 30 days before the clinical worsening of ischaemic heart disease;

(l) having influenza or a lower respiratory tract infection within the 30 days before the clinical worsening of ischaemic heart disease; or

(m) being pregnant within the six weeks before the clinical worsening of ischaemic heart disease;

Note 1: SARS-CoV-2 is the virus which causes coronavirus disease 2019 (COVID-19).

(87) inability to obtain appropriate clinical management for ischaemic heart disease.

10 Relationship to service

(1) The existence in a person of any factor referred to in section 9, must be related to the relevant service rendered by the person.

(2) The factors set out in subsections 9(44) to 9(87) apply only to material contribution to, or aggravation of, ischaemic heart disease where the person’s ischaemic heart disease was suffered or contracted before or during (but did not arise out of) the person’s relevant service.

11 Factors referring to an injury or disease covered by another Statement of Principles

In this Statement of Principles:

(1) if a factor referred to in section 9 applies in relation to a person; and

(2) that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(2) of the VEA;

then the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.

Schedule 1 - Dictionary

Note: See Section 6

1 Definitions

In this instrument:

acute cholinergic poisoning means symptoms and signs due to the inhibition of acetylcholinesterase enzyme activity which occur within the 24 hours following exposure. These symptoms and signs are: acute paralysis, overwhelming bronchial secretions, bradycardia, gastrointestinal distress, miosis, lacrimation or diarrhoea.

acute, severe, emotional stressor means an event which causes a sudden, intense emotional or psychological response, such as an emergency incident or an emotionally charged situation.

alcohol is measured by the alcohol consumption calculations utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink.

alcohol intoxication means recent ingestion of alcohol, accompanied by the following signs or symptoms:

(a) clinically significant problematic behavioural or psychological changes (for example, inappropriate sexual or aggressive behaviour, mood lability, impaired judgment) that developed during, or shortly after, alcohol ingestion; and

(b) one or more of the following signs or symptoms developing during, or shortly after, alcohol use:

(i) slurred speech;

(ii) incoordination;

(iii) unsteady gait;

(iv) nystagmus;

(v) impairment in attention or memory; or

(vi) stupor or coma.

ambient chronically polluted air as specified means air with average annual concentrations of particulate matter with an aerodynamic diameter of < 2.5 µm (PM2.5) exceeding 8 µg/m3.

ambient highly polluted air as specified means air with 24 hour average concentrations of:

(a) particulate matter with an aerodynamic diameter of < 2.5 µm (PM2.5) exceeding 25 µg/m3; or

(b) particulate matter with an aerodynamic diameter of < 10 µm (PM10) exceeding 50 µg/m3.

amphetamines as specified means any one of the following drugs:

(a) 3,4-methylenedioxymethamphetamine (ecstasy);

(b) crystal methamphetamine (ice);

(d) paramethoxymethamphetamine.

antiandrogen therapy as specified means one of the following drugs:

(a) androgen receptor blockers (including cyproterone acetate, flutamide and bicalutamide); or

(b) gonadotrophin releasing hormone agonists (including goserelin and leuprorelin).

being exposed to second-hand smoke means being in an enclosed space and inhaling smoke from burning tobacco products or smoke that has been exhaled by a person who is smoking.

being obese means:

(a) having a Body Mass Index (BMI) of 30 or greater; or

(b) for males, having a waist circumference exceeding 102 centimetres; or

Note: BMI is also defined in the Schedule 1 - Dictionary.

being sedentary means waking behaviour characterised by an average energy expenditure of 1.5 METs or less while in a sitting or reclining posture.

BMI means W/H2 and where:

(a) W is the person's weight in kilograms; and

(b) H is the person's height in metres.

category 1A stressor means one of the following severe traumatic events:

(a) experiencing a life-threatening event;

(b) being subject to a serious physical attack or assault including rape and sexual molestation; or

category 1B stressor means one of the following severe traumatic events:

(a) killing or maiming a person;

(b) being an eyewitness to a person being killed or critically injured;

(d) participating in the clearance of a corpse or a critically injured casualty; or

(e) viewing a corpse or a critically injured casualty as an eyewitness.

Note: corpse and eyewitness are also defined in the Schedule 1 - Dictionary.

chronic kidney disease means having a glomerular filtration rate of less than 60 mL/min/1.73 m2 for a period of at least three months, or the presence of irreversible kidney damage.

cigarettes per day, or the equivalent thereof in other tobacco products means either cigarettes, pipe tobacco or cigars, alone or in any combination, where one tailor-made cigarette approximates one gram of tobacco; or one gram of cigar, pipe or other smoking tobacco.

clinically significant disorder of mental health as specified means one of the following conditions, which is of sufficient severity to warrant ongoing management, which may involve regular visits (for example, at least monthly) to a psychiatrist, counsellor or general practitioner:

(a) agoraphobia;

(b) anxiety disorder;

(d) panic disorder;

(e) posttraumatic stress disorder;

(f) schizophrenia; or

(g) social anxiety disorder.

cold snap means three or more days of unusually low maximum and minimum temperatures.

corpse means the human remains or body parts of one or more persons who have met a violent or horrific death.

Note: Examples of a violent or horrific death may include death due to suicide, gunshot, improvised explosive devices, natural and technological disasters, terrorist attacks or motor vehicle accidents. Seeing a closed body bag or viewing a body in an open-casket coffin are excluded from this definition.

cumulative equivalent dose means the total dose of ionising radiation received by the particular organ or tissue from external exposure, internal exposure or both, apart from normal background radiation exposure in Australia, calculated in accordance with the methodology set out in Guide to calculation of 'cumulative equivalent dose' for the purpose of applying ionising radiation factors contained in Statements of Principles determined under Part XIA of the Veterans' Entitlements Act 1986 (Cth), Australian Radiation Protection and Nuclear Safety Agency, as in force on 2 August 2017.

Note 1: Examples of circumstances that might lead to exposure to ionising radiation include being present during or subsequent to the testing or use of nuclear weapons, undergoing diagnostic or therapeutic medical procedures involving ionising radiation, and being a member of an aircrew, leading to increased levels of exposure to cosmic radiation.

Note 2: For the purpose of dose reconstruction, dose is calculated as an average over the mass of a specific tissue or organ. If a tissue is exposed to multiple sources of ionising radiation, the various dose estimates for each type of radiation must be combined.

drug, food or environmental agent from the specified list means:

(a) beta-lactam antibiotics;

(b) histidine contaminated fish (scombroid syndrome);

(d) succinylated gelatin (Gelofusine); or

(e) other drug, food or agent where there is evidence of an associated systemic allergic reaction.

dyslipidaemia means persistently abnormal blood lipid levels, diagnosed by a medical practitioner and evidenced by:

(a) a total serum cholesterol level greater than 5.5 mmol/L; or

(b) a serum low density lipoprotein level greater than 4.0 mmol/L; or

(d) the regular administration of drug therapy to normalise blood lipid levels.

extreme cold means zero degrees Celsius or below.

extreme heat means 40 degrees Celsius or above.

eyewitness means a person who experiences an incident first hand and can give direct evidence of it. This excludes persons exposed only to public broadcasting or mass media coverage of the incident.

heatwave means three or more days of unusually high maximum and minimum temperatures.

hypercoagulable state as specified means any one of the following:

(a) acquired activated protein C resistance;

(b) acquired antithrombin III deficiency;

(d) acquired protein C deficiency;

(e) acquired protein S deficiency;

(f) antiphospholipid syndrome;

(g) aplastic anaemia;

(h) disseminated intravascular coagulation;

(i) essential thrombocythaemia;

(j) haemolytic uraemic syndrome;

(k) heparin-induced thrombocytopaenia;

(l) hyperfibrinogenaemia;

(m) hyperproteinaemia;

(n) hyperviscosity syndrome;

(o) immune thrombocytopaenic purpura;

(p) myeloma;

(q) myeloproliferative disease;

(r) nephrotic syndrome;

(s) paroxysmal nocturnal haemoglobinuria;

(t) polycythaemia vera;

(u) secondary thrombocytosis; or

(v) sickle cell disorder.

hyperuricaemia means having a serum urate level persistently greater than 0.40 mmol/L.

inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD) means:

(a) decanting or spraying;

(b) cleaning or maintaining equipment used to apply;

(d) handling or sawing timber treated with;

(e) being in an environment shrouded in dust from timber treated with; or

(f) using cutting oils contaminated with:

one of the following chemicals:

(i) 2,4,5-trichlorophenoxyacetic acid;

(ii) 2,4,5-trichlorophenoxypropionic acid;

(iii) 2,4,5-trichlorophenol;

(iv) 2-(2,4,5-trichlorophenoxy)-ethyl 2,2-dichloropropionate;

(v) o,o-dimethyl-o-(2,4,5-trichlorophenyl)-phosphorothioate;

(vi) pentachlorophenol;

(vii) 2,3,4,6-tetrachlorophenol;

(viii) 2,4,6-trichlorophenol;

(ix) 1,3,4-trichloro-2-(4-nitrophenoxy)benzene;

(x) 2,4-dichloro-1-(4-nitrophenoxy)benzene; or

(xi) 2,4-dichloro-1-(3-methoxy-4-nitrophenoxy)-benzene.

ischaemic heart disease—see subsection 7(2).

long hours means an average of at least 50 hours per week, or an average of at least ten hours per day.

MRCA means the Military Rehabilitation and Compensation Act 2004.

MET means a unit of measurement of the level of physical exertion. 1 MET = 3.5 ml of oxygen/kg of body weight per minute, 1.0 kcal/kg of body weight per hour or resting metabolic rate.

night shift work means working for at least three hours between 12 AM and 5 AM.

obstructive sleep apnoea means a type of sleep apnoea characterised on sleep study by repetitive apnoea or hypopnoea in the presence of respiratory effort during sleep, where there are at least five apnoea or hypopnoea episodes per hour of sleep.

organophosphorus ester means an agent used to inhibit acetylcholinesterase, and includes the organophosphate pesticides chlorpyrifos, dichlorvos, EPN (ethyl p-nitrophenyl theonobenzenephosphonate), leptophos, methamidophos, mipafox (diisopropyl phosphorofluoridate), omethoate, parathion, TOCP (tri-ortho-cresyl phosphate), trichlorfon and trichlornat.

pack-year of cigarettes, or the equivalent thereof in other tobacco products means a calculation of consumption where one pack-year of cigarettes equals 20 tailor-made cigarettes per day for a period of one calendar year, or 7 300 cigarettes. One tailor-made cigarette approximates one gram of tobacco or one gram of cigar or pipe tobacco by weight. One pack-year of tailor-made cigarettes equates to 7.3 kilograms of smoking tobacco by weight. Tobacco products mean cigarettes, pipe tobacco or cigars, smoked alone or in any combination.

periodic, heavy alcohol consumption means sessions of heavy alcohol drinking to the point of alcohol intoxication at least once a month.

Note: alcohol intoxication is also defined in the Schedule 1 - Dictionary.

relevant service means:

(a) operational service under the VEA;

(b) peacekeeping 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.

significant other means a person who has a close family bond or a close personal relationship and is important or influential in one's life.

Specified List 1 of drugs means:

(a) antipsychotics;

(b) aromatase inhibitors;

(d) capecitabine;

(e) dextroamphetamine;

(f) docetaxel;

(g) ephedrine;

(h) ergotamine;

(i) erlotinib;

(j) fluorouracil;

(k) macrolide antibiotics;

(l) methylphenidate;

(m) paclitaxel;

(n) phentermine;

(o) pseudoephedrine;

(p) sorafenib; or

(q) triptans, including sumatriptan.

Specified List 2 of drugs means:

(a) amphetamines as specified;

(b) cocaine;

(d) marijuana.

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

specified list of autoimmune diseases means:

(a) ankylosing spondylitis;

(b) Behcet disease;

(d) eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome);

(e) giant cell (temporal) arteritis;

(f) IgA vasculitis (Henoch-Schönlein purpura);

(g) microscopic polyangiitis;

(h) mucocutaneous lymph node syndrome (Kawasaki disease);

(i) non-specific autoimmune vasculitis;

(j) polyarteritis nodosa;

(k) polymyositis;

(l) psoriasis;

(m) psoriatic arthritis;

(n) rheumatoid arthritis;

(o) Sjögren syndrome;

(p) systemic lupus erythematosus;

(q) systemic sclerosis;

(r) Takayasu arteritis;

(s) thromboangiitis obliterans (Buerger disease); or

(t) granulomatosis with polyangiitis (Wegener granulomatosis).

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

(a) pneumonia;

(b) respiratory failure;

(d) circulatory failure; or

(e) cessation of brain function.

VEA means the Veterans' Entitlements Act 1986.

Endnotes

Endnote 1—About the endnotes

The endnotes provide information about this compilation and the compiled law.

The following endnotes are included in every compilation:

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

Abbreviation key—Endnote 2

The abbreviation key sets out abbreviations that may be used in the endnotes.

Legislation history and amendment history—Endnotes 3 and 4

Amending laws are annotated in the legislation history and amendment history.

The legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.

The amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.

Misdescribed amendments

A misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.

If a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history.

Endnote 2—Abbreviation key

	o = order(s)
ad = added or inserted	Ord = Ordinance
am = amended	orig = original
amdt = amendment	par = paragraph(s)/subparagraph(s)
c = clause(s)	/sub‑subparagraph(s)
C[x] = Compilation No. x	pres = present
Ch = Chapter(s)	prev = previous
def = definition(s)	(prev…) = previously
Dict = Dictionary	Pt = Part(s)
disallowed = disallowed by Parliament	r = regulation(s)/rule(s)
Div = Division(s)
exp = expires/expired or ceases/ceased to have	reloc = relocated
effect	renum = renumbered
F = Federal Register of Legislation	rep = repealed
gaz = gazette	rs = repealed and substituted
LA = Legislation Act 2003	s = section(s)/subsection(s)
LIA = Legislative Instruments Act 2003	Sch = Schedule(s)
(md) = misdescribed amendment can be given	Sdiv = Subdivision(s)
effect	SLI = Select Legislative Instrument
(md not incorp) = misdescribed amendment	SR = Statutory Rules
cannot be given effect	Sub‑Ch = Sub‑Chapter(s)
mod = modified/modification	SubPt = Subpart(s)
No. = Number(s)	underlining = whole or part not
	commenced or to be commenced

Endnote 3—Legislation history

Name	Registration	Commencement
Statement of Principles concerning ischaemic heart disease (Reasonable Hypothesis) (No. 1 of 2016)	4 January 2016 F2016L00001	25 January 2016
Veterans' Entitlements (Statements of Principles—Cumulative Equivalent Dose) Amendment Determination 2017 (No. 58 of 2017)	22 August 2017 F2017L01067	18 September 2017
Veterans' Entitlements (Statements of Principles—Category 1B Stressor) Amendment Determination 2018 (No. 87 of 2018)	28 August 2018 F2018L01188	24 September 2018
Amendment Statement of Principles concerning ischaemic heart disease (Reasonable Hypothesis) (No. 55 of 2021)	27 April 2021 F2021L00490	24 May 2021
Amendment Statement of Principles concerning ischaemic heart disease (Reasonable Hypothesis) (No. 97 of 2021)	23 August 2021 F2021L001170	20 September 2021

Name

Registration

Commencement

Application, saving and transitional provisions

Statement of Principles concerning ischaemic heart disease (Reasonable Hypothesis) (No. 1 of 2016)

4 January 2016

F2016L00001

25 January 2016

Veterans' Entitlements (Statements of Principles—Cumulative Equivalent Dose) Amendment Determination 2017 (No. 58 of 2017)

22 August 2017

F2017L01067

18 September 2017

Veterans' Entitlements (Statements of Principles—Category 1B Stressor) Amendment Determination 2018 (No. 87 of 2018)

28 August 2018

F2018L01188

24 September 2018

Amendment Statement of Principles concerning ischaemic heart disease (Reasonable Hypothesis) (No. 55 of 2021)

27 April 2021

F2021L00490

24 May 2021

Amendment Statement of Principles concerning ischaemic heart disease (Reasonable Hypothesis) (No. 97 of 2021)

23 August 2021

F2021L001170

20 September 2021

Endnote 4—Amendment history

Provision affected	How affected
Section 2………………. Section 4………………. Schedule 1 – Dictionary – cumulative equivalent dose…………………….	rep LA s 48D rep LA s 48C rs. No. 58 of 2017
Schedule 1 – Dictionary – category 1B stressor..	rs. No. 87 of 2018
Schedule 1 – Dictionary – eyewitness…………...	rs. No. 87 of 2018
Schedule 1 – Dictionary – corpse………….……..	ad. No. 87 of 2018
Subsection 9(43)……....	am No. 55 of 2021
Subsection 9(86).……...	am No. 55 of 2021
Subsection 9(41)……....	rs. No. 97 of 2021
Subsection 9(84).……...	rs. No. 97 of 2021
Schedule 1 – Dictionary – specified autoimmune collagen vascular disease…….…………...	rep No. 97 of 2021
Schedule 1 – Dictionary – specified list of autoimmune diseases...	ad No. 97 of 2021