Statement of Principles concerning aortic aneurysm No. 67 of 1998

Administered by Department of Veterans' Affairs

Legislation au F2008B00690 Not in force Legislative Instrument

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Instrument No.67 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(3) 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. 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 and death from aortic aneurysm can be related to relevant service rendered by veterans 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 exist before it can be said that, on the balance of probabilities, aortic aneurysm or death from aortic aneurysm is connected 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 six 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 six 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) or 70(5)(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) eligible war service (other than operational service); or

(b) defence service (other than hazardous service);

“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 was determined under the Veterans’ Entitlements Act 1986 by the Repatriation Medical Authority on 13 October 1998. This legislative instrument addresses the problem of establishing a causal link between aortic aneurysm and the relevant service of veterans or members of the Australian Defence Force. The determination is based on medical-scientific evidence that suggests a probable connection between aortic aneurysm and relevant service, taking into account various risk factors such as smoking, hypertension, and genetic conditions. The objective is to ensure that veterans who suffer from aortic aneurysm or death due to aortic aneurysm may be recognised as having conditions related to their service, thereby qualifying for certain veterans' entitlements. The Statement of Principles outlines the specific factors that must be present to establish a connection between aortic aneurysm and the relevant service. These factors include various health conditions and exposures that must predate the clinical onset or worsening of the aneurysm. This determination provides clarity and a structured approach to assessing claims related to aortic aneurysm, ensuring that the benefits are appropriately extended to those who meet the specified criteria.

Scope and Application

The Statement of Principles concerning aortic aneurysm, determined by the Repatriation Medical Authority under the Veterans' Entitlements Act 1986, pertains to veterans or members of the Forces who have developed aortic aneurysm or who have died from aortic aneurysm. This Statement of Principles identifies aortic aneurysm as a sac formed by the permanent dilatation of the wall of the thoracic or abdominal aorta, with relevant ICD-9-CM codes ranging from 441.1 to 441.9. The Statement outlines the medical-scientific evidence linking aortic aneurysm and death from aortic aneurysm to relevant service, necessitating that at least one specified factor must be related to the individual's service. These factors encompass various medical conditions and exposures, such as smoking, hypertension, and specific syndromes, that must predate the clinical onset or worsening of the aneurysm. The Statement of Principles also includes provisions for the application of other related Statements of Principles and defines terms used within the context of this particular Statement. The scope of this legislation applies nationally within Australia, providing a clear framework for the assessment and recognition of aortic aneurysm in veterans in relation to their service.

Key Provisions

This legislative instrument (F2008B00690) is a Statement of Principles determined by the Repatriation Medical Authority under the Veterans’ Entitlements Act 1986 (section 196B(3)) concerning aortic aneurysm, specifically for veterans or members of the Forces. The Statement of Principles defines aortic aneurysm as a permanent dilatation of the wall of the thoracic or abdominal aorta, which is coded under ICD-9-CM codes 441.1 to 441.9, excluding dissection of the aorta or false aneurysm of the aorta (section 2(b)). The Authority determined that aortic aneurysm and death from aortic aneurysm are more likely than not related to relevant service rendered by veterans or members of the Forces based on available medical-scientific evidence (section 3). The Statement of Principles outlines several factors that must be related to relevant service for a connection to be established between aortic aneurysm or death from aortic aneurysm and the circumstances of a person’s service. These factors include smoking, hypertension, dyslipidaemia, genetic conditions such as Marfan syndrome or Ehlers-Danlos type IV syndrome, cystic medial necrosis, various forms of aortitis, trauma to the aorta, and other specified conditions (section 5). Some of these factors also apply specifically to the material contribution to, or aggravation of, aortic aneurysm where the aneurysm was suffered or contracted before or during service but not arising out of service (section 6). The Statement of Principles also includes obligations for the parties it governs. It requires that at least one of the specified factors must be related to any relevant service rendered by the person for a connection to be established. The document also specifies that if a relevant factor includes an injury or disease for which there is an existing Statement of Principles, then the factors in that Statement of Principles also apply (section 7). Additionally, the document provides definitions for terms used within the Statement of Principles to ensure clarity and consistency in interpretation (section 8). Breach of the provisions in this legislative instrument could lead to various consequences. However, the specific offences, penalties, or civil/criminal consequences for breach are not explicitly stated in the provided text. In general, breaches of provisions under the Veterans’ Entitlements Act 1986 could result in civil or criminal penalties, depending on the nature and severity of the breach, but these would need to be referred to within the broader legislative framework of the Act.

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

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Sourced from the Federal Register of Legislation at 26 August 2026. For the latest information on Australian Government law please go to https://www.legislation.gov.au.

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