Statement of Principles concerning aortic stenosis Instrument No. 54 of 2002

Administered by Department of Veterans' Affairs

Legislation au F2005B02088 Not in force Legislative Instrument

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Instrument No.54 of 2002

 

Revocation and Determination

of

Statement of Principles

concerning

 

AORTIC STENOSIS

 

ICD-10-AM CODES: I35.0, I35.2

 

Veterans’ Entitlements Act 1986

 

 

1. The Repatriation Medical Authority under subsection 196B(2) of the Veterans’ Entitlements Act 1986 (the Act):

 

(a) revokes Instrument No.5 of 2000; and

 

(b) determines in its place the following Statement of Principles.

 

Kind of injury, disease or death

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

 

(b)              For the purposes of this Statement of Principles, “aortic stenosis” means obstruction to flow across the aortic valve during left ventricular systole.  This definition excludes:

(i)                aortic stenosis due to rheumatic heart disease;

(ii)              aortic valve sclerosis or aortic valve calcification that does not lead to obstruction of blood flow across the aortic valve;

(iii)           obstruction to flow across the aortic valve from narrowing of the supravalvular or subvalvular regions; and

(iv)            congenital stenosis of aortic valve.

 

Aortic stenosis attracts ICD-10-AM code I35.0 or I35.2.

 

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 stenosis and death from aortic stenosis 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 stenosis or death from aortic stenosis with the circumstances of a person’s relevant service are:

 

(a) suffering from infective endocarditis before the clinical onset of aortic stenosis; or

 

(b) suffering from systemic lupus erythematosus before the clinical onset of aortic stenosis; or

 

(c) undergoing a course of therapeutic radiation involving the mediastinum or the chest wall region overlying the heart before the clinical onset of aortic stenosis; or

 

(d)              suffering from chronic renal failure requiring renal dialysis or renal transplantation before the clinical onset of aortic stenosis; or

 

(e)               the presence of hypertension at the time of the clinical onset of aortic stenosis; or

 

(f) suffering from infective endocarditis before the clinical worsening of aortic stenosis; or

 

(g) suffering from systemic lupus erythematosus before the clinical worsening of aortic stenosis; or

 

(h)              undergoing a course of therapeutic radiation involving the mediastinum or the chest wall region overlying the heart before the clinical worsening of aortic stenosis; or

 

(i)                suffering from chronic renal failure requiring renal dialysis or renal transplantation before the clinical worsening of aortic stenosis; or

 

(j)                the presence of  hypertension at the time of the clinical worsening of aortic stenosis; or

 

(k) inability to obtain appropriate clinical management for aortic stenosisaortic stenosis.

 

Factors that apply only to material contribution or aggravation

6. Paragraphs 5(f) to 5(k) 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 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:

 

“a course of therapeutic radiation” means one or more fractions (treatment portions) of ionising radiation administered with the aim of achieving palliation or cure with gamma rays, x-rays, alpha particles or beta particles;

 

“death from 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;

 

“ICD-10-AM code” means a number assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, 10th revision, Australian Modification (ICD-10-AM), Third Edition, effective date of 1 July 2002, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 1 86487 413 9.  Where in this Statement of Principles an ICD code is referenced, such reference is not to constrain or limit the proper meaning of the definition or words preceding the alphanumeric code reference;

 

“infective endocarditis” means inflammation of the endocardium caused by infection with microorganisms;

 

“relevant service” means:

(a) operational service; or

(b) peacekeeping service; or

(c)               hazardous service;

 

“systemic lupus erythematosus” means a connective tissue disease in which cells are damaged by pathogenic autoantibodies and immune complexes;

 

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

(a) pneumonia;

(b) respiratory failure;

(c) cardiac arrest;

(d) circulatory failure; or

(d)              cessation of brain function.

 

 

Application

9. This Instrument applies to all matters to which section 120A of the Act applied.

 

 

Dated this Sixth day of  August   2002

 

 

The Common Seal of the    )

Repatriation Medical Authority   )

was affixed to this instrument  )

in the presence of:    )

 

KEN DONALD

CHAIRMAN

Overview

The Revocation and Determination of Statement of Principles concerning Aortic Stenosis ICD-10-AM Codes: I35.0, I35.2 instrument of 2002, enacted under the Veterans’ Entitlements Act 1986, was introduced to address the need for a precise and up-to-date Statement of Principles regarding aortic stenosis and its relation to the service of veterans, members of Peacekeeping Forces, or members of the Forces. This legislative instrument revokes the previous Instrument No. 5 of 2000 and establishes new criteria for determining the connection between aortic stenosis and relevant military service. The Repatriation Medical Authority, under subsection 196B(2) of the Act, determines the factors that must be related to service to establish a reasonable hypothesis connecting aortic stenosis or death from aortic stenosis with the circumstances of a person’s relevant service, ensuring that the assessment process remains medically and scientifically sound. The policy objective is to provide a clear framework for assessing claims related to aortic stenosis, ensuring that veterans and their families receive the appropriate recognition and support for service-related conditions.

Scope and Application

The Veterans’ Entitlements Act 1986, as amended, governs the provision of benefits and services to Australian veterans, members of Peacekeeping Forces, or members of the Australian Defence Force. The Act is administered by the Repatriation Medical Authority, which has the power to issue and revoke Statements of Principles regarding injuries, diseases, or deaths that may be related to relevant service. The Act applies to persons who have served in operational, peacekeeping, or hazardous service, and it covers a broad range of conditions, including aortic stenosis as outlined in the Statement of Principles. The Act's scope extends to all matters governed by section 120A of the Act, which pertains to the determination of whether a particular condition is connected to relevant service. The Act also specifies certain exclusions, such as aortic stenosis due to rheumatic heart disease or congenital stenosis of the aortic valve, and it incorporates definitions relevant to the determination of these conditions, including the use of ICD-10-AM codes. The application of the Act can be further extended or restricted by subordinate instruments, which may provide additional guidelines or modifications to the principal legislation.

Key Provisions

The legislative instrument revokes Instrument No.5 of 2000 and establishes a new Statement of Principles regarding aortic stenosis and death from aortic stenosis under the Veterans’ Entitlements Act 1986 (section 1). The definition of aortic stenosis for the purposes of this Statement excludes cases due to rheumatic heart disease, sclerosis or calcification without obstruction, and congenital stenosis, as well as those caused by supravalvular or subvalvular narrowing (section 2). The Repatriation Medical Authority asserts that there is medical-scientific evidence linking aortic stenosis and death from it to relevant service rendered by veterans and members of peacekeeping or military forces (section 3). To connect aortic stenosis or death from it to the service circumstances, at least one factor from clause 5 must be related to the service, subject to clause 6 (section 4). These factors include specific medical conditions or treatments that must have occurred before the clinical onset or worsening of aortic stenosis (section 5). Certain factors apply only to cases where the aortic stenosis was present before or during service but not arising out of it (section 6). If a relevant factor involves an injury or disease with an existing Statement of Principles, the terms of that Statement apply (section 7). Additional definitions clarify terms such as "course of therapeutic radiation," "infective endocarditis," and "relevant service" (section 8). This Statement of Principles applies to all matters to which section 120A of the Act applied (section 9). The Act imposes several obligations on the parties involved. The Repatriation Medical Authority is tasked with determining Statements of Principles and ensuring they reflect sound medical-scientific evidence. Veterans and others seeking to claim benefits under this Statement must provide evidence linking their aortic stenosis to their service. This may include medical records or other documentation demonstrating the presence of one of the specified factors before or during service. Medical practitioners and other experts may be required to provide opinions or reports on the medical history and circumstances of the claimant's service. The Act also requires the Repatriation Medical Authority to review and revise Statements of Principles as necessary, based on new evidence or changes in medical understanding. The Veterans’ Entitlements Act 1986 and associated regulations include provisions for offences and penalties in the event of breaches. While the specific legislative instrument does not detail offences or penalties, the Act generally provides for civil and criminal penalties for fraud, misrepresentation, or other breaches related to the administration of veterans' entitlements. For example, knowingly providing false or misleading information to obtain benefits can result in fines and imprisonment. The exact penalties depend on the nature and severity of the offence but can include substantial fines and terms of imprisonment for serious or repeated offences. In civil matters, penalties might include the recovery of overpaid benefits and interest. The precise penalties are determined by the courts based on the specific circumstances of the case and relevant laws in place at the time of the offence.

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