Statement of Principles concerning aortic aneurysm and aortic wall disorders (Balance of Probabilities) (No. 22 of 2021)

Statement of Principles concerning aortic aneurysm and aortic wall disorders (Balance of Probabilities) (No. 22 of 2021)

made under subsection 196B(3) of the

Veterans' Entitlements Act 1986

Compilation No. 1  

Compilation date:   19 September 2022

Includes amendments up to: Veterans' Entitlements (Statements of Principles—definition of "one pack-year") Amendment Determination 2022 (No. 94 of 2022) (F2022L01128)

The day of commencement of this Amendment Determination is 19 September 2022.

About this compilation

This compilation

This is a compilation of the Statement of Principles concerning aortic aneurysm and aortic wall disorders (Balance of Probabilities) (No. 22 of 2021) that shows the text of the law as amended and in force on 19 September 2022.

The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.

Uncommenced amendments

The effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register (www.legislation.gov.au). The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.

Application, saving and transitional provisions for provisions and amendments

If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.

Modifications

If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.

Self‑repealing provisions

If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.

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

Endnotes

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history..........................................

1               Name

This is the Statement of Principles concerning aortic aneurysm and aortic wall disorders (Balance of Probabilities) (No. 22 of 2021).

3               Authority

This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.

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 aortic aneurysm and aortic wall disorders and death from aortic aneurysm and aortic wall disorders.

Meaning of aortic aneurysm and aortic wall disorders

(2)          For the purposes of this Statement of Principles:

(a)          aortic aneurysm means permanent dilatation of the wall of the thoracic or abdominal aorta; and

(b)          aortic wall disorders means:

(i)            aortic dissection;

(ii)         aortic intramural haematoma;

(iii)       false aneurysm of the aorta;

(iv)        periaortic haematoma;

(v)          rupture of the aorta; and

(vi)        symptomatic penetrating aortic ulcer.

Note 1: Aortic dissection can arise in an aortic aneurysm or can occur without a preceding aortic aneurysm.

Note 2: aortic dissection, false aneurysm of the aorta and symptomatic penetrating aortic ulcer are defined in the Schedule 1 - Dictionary.

(3)          While aortic aneurysm and aortic wall disorders attract ICD‑10‑AM code I71, in applying this Statement of Principles the meaning of aortic aneurysm and aortic wall disorders 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 aneurysm and aortic wall disorders

(5)          For the purposes of this Statement of Principles, aortic aneurysm or an aortic wall disorder, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's aortic aneurysm or aortic wall disorder.

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 aortic aneurysm or an aortic wall disorder and death from aortic aneurysm or an aortic wall disorder 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, aortic aneurysm or an aortic wall disorder or death from aortic aneurysm or an aortic wall disorder is connected with the circumstances of a person's relevant service:

(1)          having hypertension before the clinical onset of aortic aneurysm or an aortic wall disorder;

(2)          having dyslipidaemia before the clinical onset of aortic aneurysm or an aortic wall disorder;

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

(3)          where smoking has not permanently ceased, having smoked at least one pack-year of tobacco products before the clinical onset of aortic aneurysm or an aortic wall disorder;

Note: one pack-year is defined in the Schedule 1 - Dictionary.

(4)          where smoking has permanently ceased before the clinical onset of aortic aneurysm or an aortic wall disorder:

(a)          having smoked at least five pack-years of tobacco products; or

(b)          having smoked at least one pack-year but less than five pack-years of tobacco products, and the clinical onset of aortic aneurysm or an aortic wall disorder has occurred within 20 years of smoking cessation;

Note: one pack-year is defined in the Schedule 1 - Dictionary.

(5)          where exposure to second-hand smoke has not permanently ceased, being exposed to second-hand smoke for at least 1,000 hours before the clinical onset of aortic aneurysm or an aortic wall disorder;

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

(6)          where exposure to second-hand smoke has permanently ceased before the clinical onset of aortic aneurysm or an aortic wall disorder:

(a)          being exposed to second-hand smoke for at least 5,000 hours; or

(b)          being exposed to second-hand smoke for at least 1,000 hours but less than 5,000 hours, and the clinical onset of aortic aneurysm or an aortic wall disorder has occurred within five years of the last exposure to second-hand smoke;

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

(7)          having hyperhomocysteinaemia before the clinical onset of aortic aneurysm or an aortic wall disorder;

(8)          an inability to consume an average of at least 100 grams per day of any combination of fruit and vegetables, for at least five consecutive years within the 20 years before the clinical onset of aortic aneurysm or an aortic wall disorder;

(9)          having infection with human immunodeficiency virus at the time of the clinical onset of aortic aneurysm or an aortic wall disorder;

(10)      having infection of the affected part of the aorta with a bacterial or fungal organism before the clinical onset of aortic aneurysm or an aortic wall disorder;

Note: Examples of organisms which can cause an aortic aneurysm include Staphylococcus species, Salmonella species, Streptococcus pneumonia, Treponema pallidum (the organism that causes syphilis), and species belonging to the Mycobacterium tuberculosis complex (the organism that causes tuberculosis).

(11)      having autoimmune aortitis or vasculitis before the clinical onset of aortic aneurysm or an aortic wall disorder;

Note: Examples of autoimmune diseases that may cause aortitis or vasculitis include giant cell arteritis, ankylosing spondylitis, Behcet disease, reactive arthritis, rheumatoid arthritis and systemic lupus erythematosus.

(12)      having trauma to the affected part of the aorta before the clinical onset of aortic aneurysm or an aortic wall disorder;

(13)      having non-aneurysmal aortic atherosclerotic disease at the time of the clinical onset of aortic aneurysm or an aortic wall disorder;

(14)      taking a fluoroquinolone antibiotic in the three months before the clinical onset of aortic aneurysm or an aortic wall disorder;

(15)      for aortic wall disorders only:

(a)          undertaking physical activity of five METs or more within the 24 hours before the clinical onset of an aortic wall disorder;

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

(b)          being pregnant within the six weeks before the clinical onset of an aortic wall disorder;

(c)          having invasion of the affected part of the aorta by a malignant neoplasm at the time of the clinical onset of an aortic wall disorder;

(d)          having erosion of the affected part of the aorta due to inflammation of a contiguous tissue or organ at the time of the clinical onset of an aortic wall disorder;

Note: Examples of inflammatory conditions that can cause erosion of the wall of the aorta are acute and chronic pancreatitis.

(e)          taking a drug from the specified list of drugs in the 72 hours before the clinical onset of an aortic wall disorder;

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

(16)      having hypertension before the clinical worsening of aortic aneurysm or an aortic wall disorder;

(17)      having dyslipidaemia before the clinical worsening of aortic aneurysm or an aortic wall disorder;

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

(18)      where smoking has not permanently ceased, having smoked at least one pack-year of tobacco products before the clinical worsening of aortic aneurysm or an aortic wall disorder;

Note: one pack-year is defined in the Schedule 1 - Dictionary.

(19)      where smoking has permanently ceased before the clinical worsening of aortic aneurysm or an aortic wall disorder:

(a)          having smoked at least five pack-years of tobacco products; or

(b)          having smoked at least one pack-year but less than five pack-years of tobacco products, and the clinical worsening of aortic aneurysm or an aortic wall disorder has occurred within 20 years of smoking cessation;

Note: one pack-year is defined in the Schedule 1 - Dictionary.

(20)      where exposure to second-hand smoke has not permanently ceased, being exposed to second-hand smoke for at least 1,000 hours before the clinical worsening of aortic aneurysm or an aortic wall disorder;

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

(21)      where exposure to second-hand smoke has permanently ceased before the clinical worsening of aortic aneurysm or an aortic wall disorder:

(a)          being exposed to second-hand smoke for at least 5,000 hours; or

(b)          being exposed to second-hand smoke for at least 1,000 hours but less than 5,000 hours, and the clinical worsening of aortic aneurysm or an aortic wall disorder has occurred within five years of the last exposure to second-hand smoke;

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

(22)      having hyperhomocysteinaemia before the clinical worsening of aortic aneurysm or an aortic wall disorder;

(23)      an inability to consume an average of at least 100 grams per day of any combination of fruit and vegetables, for at least five consecutive years within the 20 years before the clinical worsening of aortic aneurysm or an aortic wall disorder;

(24)      having infection with human immunodeficiency virus at the time of the clinical worsening of aortic aneurysm or an aortic wall disorder;

(25)      having infection of the affected part of the aorta with a bacterial or fungal organism before the clinical worsening of aortic aneurysm or an aortic wall disorder;

Note: Examples of organisms which can cause an aortic aneurysm include Staphylococcus species, Salmonella species, Streptococcus pneumonia, Treponema pallidum (the organism that causes syphilis), and species belonging to the Mycobacterium tuberculosis complex (the organism that causes tuberculosis).

(26)      having autoimmune aortitis or vasculitis before the clinical worsening of aortic aneurysm or an aortic wall disorder;

Note: Examples of autoimmune diseases that may cause aortitis or vasculitis include giant cell arteritis, ankylosing spondylitis, Behcet disease, reactive arthritis, rheumatoid arthritis and systemic lupus erythematosus.

(27)      having trauma to the affected part of the aorta before the clinical worsening of aortic aneurysm or an aortic wall disorder;

(28)      taking a fluoroquinolone antibiotic in the three months before the clinical worsening of aortic aneurysm or an aortic wall disorder;

(29)      for aortic wall disorders only:

(a)          undertaking physical activity of five METs or more within the 24 hours before the clinical worsening of an aortic wall disorder;

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

(b)          being pregnant within the six weeks before the clinical worsening of an aortic wall disorder;

(c)          having invasion of the affected part of the aorta by a malignant neoplasm at the time of the clinical worsening of an aortic wall disorder;

(d)          having erosion of the affected part of the aorta due to inflammation of a contiguous tissue or organ at the time of the clinical worsening of an aortic wall disorder;

Note: Examples of inflammatory conditions that can cause erosion of the wall of the aorta are acute and chronic pancreatitis.

(e)          taking a drug from the specified list of drugs in the 72 hours before the clinical worsening of an aortic wall disorder;

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

(30)      inability to obtain appropriate clinical management for aortic aneurysm or an aortic wall disorder.

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(16) to 9(30) apply only to material contribution to, or aggravation of aortic aneurysm or an aortic wall disorder where the person's aortic aneurysm or aortic wall disorder 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(3) 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:

                             aortic aneurysm and aortic wall disorders—see subsection 7(2).

                             aortic dissection means separation of the layers of the aortic wall due to an intimal tear.

                             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 another person who is smoking.

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

(a)          a serum high density lipoprotein cholesterol level less than 1.0 mmol/L; or

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

(c)          a serum triglyceride level greater than or equal to 2.0 mmol/L; or

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

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

                             false aneurysm of the aorta, also known as pseudoaneurysm, means a breach in the wall of the aorta such that blood leaks through the aortic wall but is contained by the adventitia or surrounding perivascular soft tissue.

                             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.

                             MRCA means the Military Rehabilitation and Compensation Act 2004.

                             one pack-year means the amount of tobacco consumed in smoking 20 cigarettes per day for a period of 1 year, or an equivalent amount of tobacco products.

Note 1: An equivalent amount of tobacco products is 7,300 grams of smoking tobacco by weight, either in cigarettes, pipe tobacco or cigars, or a combination of same. For pipe tobacco, cigars or combinations of multiple tobacco types, 1 gram of tobacco is considered to be equal to one cigarette.

Note 2: Pack-years are calculated by dividing the number of cigarettes smoked per day by 20 and multiplying this number by the number of years the person has smoked. For example, smoking 10 cigarettes per day for 10 years is equal to 5 pack-years, and smoking 40 cigarettes per day for 10 years is equal to 20 pack-years.

                             relevant service means:

(a)          eligible war service (other than operational service) under the VEA;

(b)          defence service (other than hazardous service and British nuclear test defence service) under the VEA; or

(c)          peacetime service under the MRCA.

Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary.

                             specified list of drugs means:

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

(b)          amphetamine;

(c)          cocaine;

(d)          crystal methamphetamine (ice); or

(e)          methamphetamine (speed).

                             symptomatic penetrating aortic ulcer means penetration of the aortic wall resulting in clinical manifestations of sudden onset of chest or back pain, haemodynamic instability, intramural haematoma, aortic dissection, aortic aneurysm or aortic rupture.

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

(a)           pneumonia;

(b)           respiratory failure;

(c)           cardiac arrest;

(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

Endnote 3—Legislation history

Endnote 4—Amendment history