Statement of Principles concerning aortic stenosis (Reasonable Hypothesis) (No. 13 of 2022) (Cth)

Statement of Principles concerning AORTIC STENOSIS (Reasonable Hypothesis) (No. 13 of 2022) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 24 December 2021

The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:

Professor Terence Campbell AM Chairperson

Contents 1 Name 2 Commencement 3 Authority 4 Repeal 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 aortic stenosis (Reasonable Hypothesis) (No. 13 of 2022). 2 Commencement This instrument commences on 31 January 2022. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning aortic stenosis No. 21 of 2013 (Federal Register of Legislation No. F2013L00718) made under subsections 196B(2) and (8) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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 aortic stenosis and death from aortic stenosis. Meaning of aortic stenosis (2) For the purposes of this Statement of Principles, aortic stenosis: (a) means obstruction of the blood flow across the aortic valve due to thickening and calcification of the aortic valve; and (b) excludes: (i) aortic stenosis due to rheumatic heart disease; (ii) congenital stenosis of the aortic valve; and (iii) obstruction to blood flow across the aortic valve due to narrowing of the supravalvular or subvalvular regions. Note 1: Symptoms of aortic stenosis typically include shortness of breath or chest pain on exertion, dizziness and fainting (syncope). Note 2: Aortic stenosis is usually confirmed by echocardiography and demonstration of a significant pressure gradient (a maximum aortic velocity of at least 2 metres/second). (3) While aortic stenosis attracts ICD‑10‑AM code I35.0 or I35.2, in applying this Statement of Principles the meaning of aortic stenosis 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), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4. Death from aortic stenosis (5) For the purposes of this Statement of Principles, 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. 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 aortic stenosis and death from aortic stenosis 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: MRCA, relevant service and VEA are 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 aortic stenosis or death from aortic stenosis with the circumstances of a person's relevant service: (1) having infective endocarditis before the clinical onset of aortic stenosis; (2) having a systemic autoimmune connective tissue disease before the clinical onset of aortic stenosis; Note: Examples of systemic autoimmune connective tissue diseases are systemic lupus erythematosus, rheumatoid arthritis, scleroderma and Sjögren syndrome. (3) having chronic kidney disease at the time of the clinical onset of aortic stenosis; Note: chronic kidney disease is defined in the Schedule 1 - Dictionary. (4) having hypertension before the clinical onset of aortic stenosis; (5) having dyslipidaemia before the clinical onset of aortic stenosis; Note: dyslipidaemia is defined in the Schedule 1 - Dictionary. (6) having diabetes mellitus before the clinical onset of aortic stenosis; (7) being overweight or obese for at least 5 years within the 20 years before the clinical onset of aortic stenosis; Note: being overweight or obese is defined in the Schedule 1 - Dictionary. (8) having smoked tobacco products: (a) in amount of at least 10 pack-years before the clinical onset of aortic stenosis; and (b) if smoking has ceased before the clinical onset of aortic stenosis, then that onset occurred within 20 years of cessation; Note: one pack-year is defined in the Schedule 1 - Dictionary. (9) having received a cumulative equivalent dose of at least 0.5 sievert of ionising radiation to the heart before the clinical onset of aortic stenosis; Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary. (10) undergoing a course of therapeutic radiation for cancer, where the heart was in the field of radiation, before the clinical onset of aortic stenosis; (11) having primary hyperparathyroidism before the clinical onset of aortic stenosis; (12) having Paget's disease of bone before the clinical onset of aortic stenosis; (13) having infective endocarditis before the clinical worsening of aortic stenosis; (14) having a systemic autoimmune connective tissue disease before the clinical worsening of aortic stenosis; Note: Examples of systemic autoimmune connective tissue diseases are systemic lupus erythematosus, rheumatoid arthritis, scleroderma and Sjögren syndrome. (15) having chronic kidney disease at the time of the clinical worsening of aortic stenosis; Note: chronic kidney disease is defined in the Schedule 1 - Dictionary. (16) having hypertension before the clinical worsening of aortic stenosis; (17) having dyslipidaemia before the clinical worsening of aortic stenosis; Note: dyslipidaemia is defined in the Schedule 1 - Dictionary. (18) having diabetes mellitus before the clinical worsening of aortic stenosis; (19) being overweight or obese for at least 5 years within the 20 years before the clinical worsening of aortic stenosis; Note: being overweight or obese is defined in the Schedule 1 - Dictionary. (20) having smoked tobacco products: (a) in amount of at least 10 pack-years before the clinical worsening of aortic stenosis; and (b) if smoking has ceased before the clinical worsening of aortic stenosis, then that worsening occurred within 20 years of cessation; Note: one pack-year is defined in the Schedule 1 - Dictionary. (21) having received a cumulative equivalent dose of at least 0.5 sievert of ionising radiation to the heart before the clinical worsening of aortic stenosis; Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary. (22) undergoing a course of therapeutic radiation for cancer, where the heart was in the field of radiation, before the clinical worsening of aortic stenosis; (23) having primary hyperparathyroidism before the clinical worsening of aortic stenosis; (24) having Paget's disease of bone before the clinical worsening of aortic stenosis; (25) being pregnant within the 6 weeks before the clinical worsening of aortic stenosis; (26) for symptomatic or severe aortic stenosis only, having surgery requiring a general, spinal or epidural anaesthetic within the 30 days before the clinical worsening of aortic stenosis; Note: severe aortic stenosis is defined in the Schedule 1 - Dictionary. (27) inability to obtain appropriate clinical management for aortic stenosis. 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(13) to 9(27) 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 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.