Statement of Principles concerning sick sinus syndrome (Balance of Probabilities) (No. 67 of 2022) (Cth)

Statement of Principles concerning SICK SINUS SYNDROME (Balance of Probabilities) (No. 67 of 2022) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.

Dated 24 June 2022

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 sick sinus syndrome (Balance of Probabilities) (No. 67 of 2022). 2 Commencement This instrument commences on 25 July 2022. 3 Authority This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning sick sinus syndrome No. 16 of 2014 (Federal Register of Legislation No. F2014L00024) made under subsection 196B(3) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004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 sick sinus syndrome and death from sick sinus syndrome. Meaning of sick sinus syndrome (2) For the purposes of this Statement of Principles, sick sinus syndrome: (a) means a group of cardiac arrhythmias caused by dysfunction of the sinus node, in which persistent or intermittent abnormalities of cardiac impulse formation and propagation cause an atrial rate inappropriate for physiological requirements, resulting in clinical symptoms; and (b) excludes congenital sick sinus syndrome. Note 1: Sick sinus syndrome can manifest as persistent or intermittent sinus bradycardia, sinus pause or sinus arrest, bradycardia-tachycardia syndrome, and other arrhythmias. Note 2: Symptoms of sick sinus syndrome typically include fatigue, lightheadedness, palpitations, presyncope, syncope, dyspnoea on exertion, and chest discomfort. Documented sinus node dysfunction correlates with symptoms. Symptoms are frequently intermittent with gradual progression in frequency and severity. (3) While sick sinus syndrome attracts ICD‑10‑AM code I49.5, in applying this Statement of Principles the meaning of sick sinus syndrome 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 sick sinus syndrome (5) For the purposes of this Statement of Principles, sick sinus syndrome, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's sick sinus syndrome. Note: terminal event is defined in the Schedule 1 - Dictionary. 8 Basis for determining the factors On the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that sick sinus syndrome and death from sick sinus syndrome can be related to relevant service rendered by veterans 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 exist before it can be said that, on the balance of probabilities, sick sinus syndrome or death from sick sinus syndrome is connected with the circumstances of a person's relevant service: (1) having atrial fibrillation or atrial flutter at the time of the clinical onset of sick sinus syndrome; (2) having hypertension at the time of the clinical onset of sick sinus syndrome; (3) having ischaemic heart disease at the time of the clinical onset of sick sinus syndrome; (4) having heart failure at the time of the clinical onset of sick sinus syndrome; (5) having rheumatic fever at the time of the clinical onset of sick sinus syndrome; (6) having pericarditis at the time of the clinical onset of sick sinus syndrome; (7) having cardiomyopathy at the time of the clinical onset of sick sinus syndrome; (8) having non-infectious myocarditis at the time of the clinical onset of sick sinus syndrome; Note 1: Non-infectious myocarditis can be acute or chronic. Note 2: Non-infectious myocarditis can be of autoimmune, infiltrative or immunological origin. Examples of causes of non-infectious myocarditis include immune checkpoint inhibitor therapy and giant cell myocarditis. (9) having viral myocarditis at the time of the clinical onset of sick sinus syndrome; Note 1: Viral myocarditis can be acute or chronic. Note 2: Examples of viral causes of myocarditis include severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), human immunodeficiency virus, group B coxsackieviruses and dengue virus. (10) having a non-viral infection of the myocardium at the time of the clinical onset of sick sinus syndrome; Note 1: A non-viral infection of the myocardium can be caused by bacteria, protozoa, fungi or parasites. Note 2: Examples of non-viral infections of the myocardium include: