Instrument No.65 of 2002
Revocation and Determination
of
Statement of Principles
concerning
ATHEROSCLEROTIC PERIPHERAL VASCULAR DISEASE
ICD-10-AM CODE: I70.2
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.87 of 1995; 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 atherosclerotic peripheral vascular disease and death from atherosclerotic peripheral vascular disease.
(b) For the purposes of this Statement of Principles, “atherosclerotic peripheral vascular disease” means partial or total occlusion of the arterial supply to the extremities caused by atherosclerosis and which results in any of the following clinical manifestations:
(i) intermittent claudication;
(ii) rest pain;
(iii) reduced arterial pulsation;
(iv) bruit over a narrowed artery;
(v) signs of chronic limb ischaemia (subcutaneous atrophy, hair loss, thickened nails, smooth and shiny skin, coolness, pallor, cyanosis, or dependent rubor);
(vi) ulceration;
(vii) necrosis;
(viii) gangrene;
(ix) ischaemic neuritis; or
(x) ankle-brachial systolic blood pressure index of 0.9 or less.
Atherosclerotic peripheral vascular disease attracts ICD-10-AM code I70.2
Basis for determining the factors
3. The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that atherosclerotic peripheral vascular disease and death from atherosclerotic peripheral vascular disease 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 atherosclerotic peripheral vascular disease or death from atherosclerotic peripheral vascular disease 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 atherosclerotic peripheral vascular disease and where smoking has ceased, the clinical onset has occurred within 20 years of cessation; or
(b) suffering from diabetes mellitus before the clinical onset of atherosclerotic peripheral vascular disease; or
(c) the presence of hypertension before the clinical onset of atherosclerotic peripheral vascular disease; or
(d) the presence of dyslipidaemia before the clinical onset of atherosclerotic peripheral vascular disease; or
(e) suffering from hyperhomocystinaemia before the clinical onset of atherosclerotic peripheral vascular disease; or
(f) suffering from chronic renal disease before the clinical onset of atherosclerotic peripheral vascular disease; or
(g) undergoing a course of therapeutic radiation to the affected region before the clinical onset of atherosclerotic peripheral vascular disease; or
(h) 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 atherosclerotic peripheral vascular disease and where smoking has ceased, the clinical worsening has occurred within 20 years of cessation; or
(i) suffering from diabetes mellitus before the clinical worsening of atherosclerotic peripheral vascular disease; or
(j) the presence of hypertension before the clinical worsening of atherosclerotic peripheral vascular disease; or
(k) the presence of dyslipidaemia before the clinical worsening of atherosclerotic peripheral vascular disease; or
(l) suffering from hyperhomocystinaemia before the clinical worsening of atherosclerotic peripheral vascular disease; or
(m) suffering from chronic renal disease before the clinical worsening of atherosclerotic peripheral vascular disease; or
(n) undergoing a course of therapeutic radiation to the affected region before the clinical worsening of atherosclerotic peripheral vascular disease; or
(o) inability to maintain good foot hygiene before the clinical worsening of atherosclerotic peripheral vascular disease; or
(p) suffering trauma to the lower limbs before the clinical worsening of atherosclerotic peripheral vascular disease; or
(q) an inability to undertake more than a mildly strenuous level of physical activity for at least the five years immediately before the clinical worsening of atherosclerotic peripheral vascular disease; or
(r) inability to obtain appropriate clinical management for atherosclerotic peripheral vascular disease.
Factors that apply only to material contribution or aggravation
6. Paragraphs 5(h) to 5(r) apply only to material contribution to, or aggravation of, atherosclerotic peripheral vascular disease where the person’s atherosclerotic peripheral vascular disease 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;
“an inability to undertake more than a mildly strenuous level of physical activity” means the presence of an incapacity which prevents any physical activity greater than 3 METS, where a “MET” is a unit of measurement of the level of physical exertion. 1 MET = 3.5 ml of oxygen/kg of body weight per minute or, 1.0 kcal/kg of body weight per hour, or resting metabolic rate. (A MET approximates to the energy required to rest quietly in bed. A 70 kg man would use about 3 METS when walking at 4 km per hour.);
“chronic renal disease” means renal injury of a sustained nature that is not reversible and leads to destruction of nephron mass and is associated with a demonstrable functional abnormality of the kidney which raises the level of creatinine;
“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;
“death from atherosclerotic peripheral vascular disease” in relation to a person includes death from a terminal event or condition that was contributed to by the person’s atherosclerotic peripheral vascular disease;
“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:
total serum cholesterol level greater than or equal to 5.5 mmol/L; or
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.
“hyperhomocystinaemia” means a condition characterised by an excess of homocystine in the blood;
“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;
“relevant service” means:
(a) operational service; or
(b) peacekeeping service; or
(c) hazardous service;
“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.
Application
9. This Instrument applies to all matters to which section 120A of the Act applied.
Dated this Tenth day of October 2002
The Common Seal of the )
Repatriation Medical Authority )
was affixed to this instrument )
in the presence of: )
KEN DONALD
CHAIRMAN