Statement of Principles concerning aortic aneurysm No. 66 of 1998

Administered by Department of Veterans' Affairs

Legislation au F2008B00689 Not in force Legislative Instrument

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Instrument No.66 of 1998

Determination

Statement of Principles

concerning

AORTIC ANEURYSM

ICD-9-CM CODES: 441.1 - 441.9

Veterans’ Entitlements Act 1986

1. This Statement of Principles is determined by the Repatriation Medical Authority under subsection 196B(2) of the Veterans’ Entitlements Act 1986 (the Act).

Kind of injury, disease or death

2. (a) This Statement of Principles is about aortic aneurysm and death from aortic aneurysm.

(b) For the purposes of this Statement of Principles, “aortic aneurysm” means a sac formed by the permanent dilatation of the wall of the thoracic or abdominal aorta, attracting an ICD-9-CM code in the range 441.1 to 441.9. This definition excludes dissection of the aorta or false aneurysm of the aorta.

Basis for determining the factors

3. The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that aortic aneurysm and death from aortic aneurysm can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces.

Factors that must be related to service

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

Factors

5. The factors that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting aortic aneurysm or death from aortic aneurysm with the circumstances of a person’s relevant service are:

(a) smoking at least five cigarettes per day or the equivalent thereof in other tobacco products, for at least three years before the clinical onset of aortic aneurysm; or

(b) suffering from hypertension before the clinical onset of aortic aneurysm; or

(d) suffering from Marfan syndrome or Ehlers-Danlos type IV syndrome before the clinical onset of aortic aneurysm; or

(e) suffering from cystic medial necrosis before the clinical onset of aortic aneurysm; or

(f) suffering from infective aortitis before the clinical onset of aortic aneurysm; or

(g) undergoing therapy with BCG vaccine resulting in tuberculous aortitis, and where this therapy has been administered within the five years immediately before the clinical onset of aortic aneurysm; or

(h) suffering from tertiary syphilis before the clinical onset of aortic aneurysm; or

(j) suffering trauma to the aorta before the clinical onset of aortic aneurysm which has occurred at the site of the trauma; or

(k) suffering from rheumatic aortitis before the clinical onset of aortic aneurysm; or

(m) suffering from Takayasu’s arteritis or giant cell arteritis before the clinical onset of aortic aneurysm; or

(n) suffering from coarctation of the aorta before the clinical onset of aortic aneurysm; or

(o) smoking at least five cigarettes per day or the equivalent thereof in other tobacco products, for at least three years before the clinical worsening of aortic aneurysm; or

(p) suffering from hypertension which developed before the clinical worsening of aortic aneurysm; or

(q) suffering from dyslipidaemia which developed before the clinical worsening of aortic aneurysm; or

(r) suffering from Marfan syndrome or Ehlers-Danlos type IV syndrome before the clinical worsening of aortic aneurysm; or

(s) suffering from cystic medial necrosis before the clinical worsening of aortic aneurysm; or

(t) suffering from infective aortitis before the clinical worsening of aortic aneurysm; or

(u) undergoing therapy with BCG vaccine resulting in tuberculous aortitis, and where this therapy has been administered within the five years immediately before the clinical worsening of aortic aneurysm; or

(v) suffering from tertiary syphilis before the clinical worsening of aortic aneurysm; or

(w) suffering trauma to the aorta before the clinical worsening of aortic aneurysm which has occurred at the site of the trauma; or

(x) suffering from rheumatic aortitis before the clinical worsening of aortic aneurysm; or

(y) suffering from Takayasu’s arteritis or giant cell arteritis before the clinical worsening of aortic aneurysm; or

(z) suffering from coarctation of the aorta before the clinical worsening of aortic aneurysm; or

(za) inability to obtain appropriate clinical management for aortic aneurysm.

Factors that apply only to material contribution or aggravation

6. Paragraphs 5(o) to 5(za) apply only to material contribution to, or aggravation of, aortic aneurysm where the person’s aortic aneurysm was suffered or contracted before or during (but not arising out of) the person’s relevant service; paragraph 8(1)(e), 9(1)(e), 70(5)(d) or 70(5A)(d) of the Act refers.

Inclusion of Statements of Principles

7. 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.

Other definitions

8. For the purposes of this Statement of Principles:

“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 by weight;

“coarctation of the aorta” means a localised malformation characterised by deformity of the aortic media, causing narrowing of the lumen of the aorta;

“cystic medial necrosis” means changes in the medial layer of the aorta, consisting of degeneration and necrosis of elastic and muscle fibres, mucoid infiltration, and cyst formation;

“death from aortic aneurysm” in relation to a person includes death from a terminal event or condition that was contributed to by the person’s aortic aneurysm;

“dyslipidaemia” generally means evidence of a persistently abnormal lipid profile after the accurate evaluation of serum lipids following a 12 hour overnight fast, and estimated on a minimum of two occasions as a:

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

(b) fasting serum triglyceride level greater than or equal to 2.0 mmol/L together with high density lipoprotein cholesterol level less than 0.9 mmol/L;

Note: the source for this definition is: NHF Australia, Guide to Plasma Lipids for Doctors;

Current Therapeutics, Vol 33 Supplement 1, 1992.

“Ehlers-Danlos type IV syndrome” means a disorder of connective tissue involving defects in the structure, synthesis or secretion of one type of procollagen and has prominent vascular manifestations;

“giant cell arteritis” means chronic inflammatory disease of the large and medium sized-systemic arteries, and which includes temporal or cranial arteritis;

“hypertension” means elevated baseline blood pressure, evidenced by:

(a) a usual blood pressure reading where the systolic reading is greater than or equal to 140 mmHg and/ or where the diastolic reading is greater than or equal to 90 mmHg; or

(b) administration of antihypertensive therapy;

“ICD-9-CM code” means a number assigned to a particular kind of injury or disease in the Australian Version of The International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM), effective date of 1 July 1996, copyrighted by the National Coding Centre, Faculty of Health Sciences, University of Sydney, NSW, and having ISBN 0 642 24447 2;

“infective aortitis” means the infection of the aortic wall by bacteria or fungi, and resultant inflammation within the aortic wall;

“Marfan syndrome” means a disorder of connective tissue characterised by long, thin extremities associated with other skeletal changes, reduced vision as a result of dislocation of the lenses and aortic aneurysms that typically begin at the base of the aorta;

“relevant service” means:

(a) operational service; or

(b) peacekeeping service; or

“rheumatic aortitis” means inflammation of the aorta associated with any one of the following diseases, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, Reiter’s syndrome, Behcet’s syndrome, relapsing polychondritis and inflammatory bowel disorders;

“Takayasu’s arteritis” means an inflammatory disease of the aorta and its major arteries often resulting in occlusion and involves a panarteritis;

“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;

“tertiary syphilis” means the last stage of syphilis which develops soon after the lesions of secondary syphilis resolve or many years later, and is characterised by destructive lesions involving many organs and tissues such as mucocutaneous, musculoskeletal, cardiovascular or central nervous system lesions;

“trauma to the aorta” means that the wall of the aorta has been damaged as the result of either penetrating or blunt major thoracic or abdominal trauma. Most injuries occur as a result of motor vehicle accidents, falls from a height, crushing injuries, or gunshot wound;

“tuberculous aortitis” means the infection of the aortic wall by Mycobacteria, and resultant inflammation within the aortic wall;

“undergoing therapy with BCG vaccine” means treatment with the Bacille Calmette-Guerin vaccine for cancer. The Bacille Calmette-Guerin vaccine is made from a strain of Mycobacterium bovis.

Dated this Thirteenth day of October 1998

The Common Seal of the )

Repatriation Medical Authority )

was affixed to this instrument )

in the presence of )

KEN DONALD

CHAIRMAN

Overview

The Statement of Principles concerning Aortic Aneurysm (ICD-9-CM codes: 441.1 - 441.9) under the Veterans’ Entitlements Act 1986 was determined by the Repatriation Medical Authority in 1998. This Statement addresses the medical-scientific evidence linking aortic aneurysm and death from aortic aneurysm with relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Armed Forces. The objective is to establish a framework for assessing claims related to these conditions, requiring at least one of the specified factors to be related to the service in question. This legislative instrument aims to ensure that veterans and relevant service personnel who suffer from aortic aneurysm or death from such conditions due to their service can access appropriate entitlements and benefits under the Act. The Repatriation Medical Authority determined this Statement of Principles to fill a gap in recognising the service-related causes of aortic aneurysm and related deaths, thereby supporting the policy objective of providing comprehensive healthcare and compensation to those affected by their military service. This legal instrument is a critical step in ensuring that veterans and service members receive the recognition and support they need for service-related health conditions.

Scope and Application

The Statement of Principles under the Veterans’ Entitlements Act 1986, concerning aortic aneurysm and death from aortic aneurysm, applies to veterans, members of Peacekeeping Forces, or members of the Forces who have served and subsequently developed aortic aneurysm or died from it. The conditions and factors outlined in the Statement of Principles are specifically tailored to those individuals who have experienced relevant service. The Act extends to the Commonwealth jurisdiction, providing a legislative framework for the recognition and entitlement assessment of veterans' health conditions related to their service. There are no explicit exclusions or exemptions mentioned in this Statement of Principles, although it does specify a range of preconditions that must be met for the condition to be considered related to service. The application of this Statement of Principles can be further detailed or expanded through subordinate instruments, although the primary document does not specify such extensions or restrictions.

Key Provisions

The Statement of Principles, as determined under subsection 196B(2) of the Veterans’ Entitlements Act 1986, pertains to aortic aneurysm and death from aortic aneurysm (section 1). This Statement of Principles applies to veterans, members of Peacekeeping Forces, or members of the Forces who have suffered aortic aneurysm or death from it, as defined under the ICD-9-CM codes 441.1 to 441.9, but excludes dissection of the aorta or false aneurysm of the aorta (section 2). The Repatriation Medical Authority has determined that there is sound medical-scientific evidence linking aortic aneurysm and death from aortic aneurysm with relevant service rendered by these individuals (section 3). The Statement of Principles stipulates that at least one of the specified factors must be related to the person’s relevant service (section 4). The factors that must exist to establish a connection between aortic aneurysm or death from aortic aneurysm and the person’s relevant service include various conditions such as smoking, hypertension, dyslipidaemia, Marfan syndrome, Ehlers-Danlos type IV syndrome, cystic medial necrosis, infective aortitis, therapy with BCG vaccine resulting in tuberculous aortitis, tertiary syphilis, trauma to the aorta, rheumatic aortitis, Takayasu’s arteritis, giant cell arteritis, coarctation of the aorta, and inability to obtain appropriate clinical management for aortic aneurysm (section 5). Certain factors apply only to material contribution to, or aggravation of, aortic aneurysm where the aneurysm was suffered or contracted before or during (but not arising out of) the person’s relevant service (section 6). If a relevant factor includes an injury or disease in respect of which there is a Statement of Principles, the factors in that last mentioned Statement of Principles apply in accordance with its terms (section 7). Additional definitions are provided for terms such as "cigarettes per day or the equivalent thereof in other tobacco products," "coarctation of the aorta," "cystic medial necrosis," "death from aortic aneurysm," "dyslipidaemia," "Ehlers-Danlos type IV syndrome," "giant cell arteritis," "hypertension," "ICD-9-CM code," "infective aortitis," "Marfan syndrome," "relevant service," "rheumatic aortitis," "Takayasu’s arteritis," "terminal event," "tertiary syphilis," "trauma to the aorta," "tuberculous aortitis," and "undergoing therapy with BCG vaccine" (section 8). The Statement of Principles imposes obligations on veterans, members of Peacekeeping Forces, or members of the Forces by requiring them to demonstrate that their aortic aneurysm or death from aortic aneurysm is connected to their relevant service by establishing the presence of at least one of the specified factors (section 4). These individuals must provide evidence that supports the existence of one or more of the factors listed in section 5, thereby establishing a reasonable hypothesis connecting their condition to their service (section 5). Furthermore, if a relevant factor includes an injury or disease for which there is another Statement of Principles, the additional requirements of that Statement must also be met (section 7). The Statement of Principles serves as a guideline for the Repatriation Medical Authority in determining whether the conditions of the affected individuals are related to their service. Breach of the provisions of the Veterans’ Entitlements Act 1986 or failure to comply with the obligations and requirements set forth in the Statement of Principles may result in civil or criminal consequences. The Act itself does not explicitly state any offences, penalties, or consequences for breach; however, general provisions of the Act and other applicable legislation may impose penalties for fraud, misrepresentation, or other breaches related to veterans' entitlements. Penalties for such breaches can include fines, imprisonment, or both, depending on the severity and nature of the offence. It is essential for affected individuals to adhere to the requirements of the Statement of Principles and provide accurate and truthful information to ensure the proper administration of veterans' entitlements.

Area of Law: Veterans’ Law
Instrument: Legislative Instrument
Concepts: Definitions & Interpretation; Licensing & Registration; Reporting & Disclosure Obligations

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