Statement of Principles concerning carotid artery disease (Reasonable Hypothesis) (No. 54 of 2020)

Statement of Principles concerning carotid artery disease (Reasonable Hypothesis) (No. 54 of 2020)

made under subsection 196B(2) 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 carotid artery disease (Reasonable Hypothesis) (No. 54 of 2020) 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If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.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 carotid artery disease (Reasonable Hypothesis) (No. 54 of 2020).

3               Authority

This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.

5               Application

This instrument applies to a claim to which section 120A of the VEA or section 338 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 carotid artery disease and death from carotid artery disease.

Meaning of carotid artery disease

(2)          For the purposes of this Statement of Principles, carotid artery disease:

(a)          means an occlusion, stenosis, aneurysm, dissection or arteriovenous fistula of the common, internal or external carotid artery that warrants medical treatment; and

(b)          includes carotid atherosclerosis and non-atherosclerotic carotid artery disease.

(3)          While carotid artery disease attracts ICD‑10‑AM code I65.2, I70.8, I72.0 or I77.0, in applying this Statement of Principles the meaning of carotid artery disease 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 carotid artery disease

(5)          For the purposes of this Statement of Principles, carotid artery disease, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's carotid artery disease.

Note: terminal event is defined in the Schedule 1 - Dictionary.

8             Basis for determining the factors

The Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that carotid artery disease and death from carotid artery disease can be related to relevant service rendered by veterans, members of Peacekeeping Forces, 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 as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting carotid artery disease or death from carotid artery disease with the circumstances of a person's relevant service:

(1)          having hypertension before the clinical onset of carotid artery disease;

(2)          having diabetes mellitus before the clinical onset of carotid artery disease;

(3)          being obese for at least five years within the 20 years before the clinical onset of carotid artery disease;

Note: being obese is defined in the Schedule 1 - Dictionary.

(4)          having dyslipidaemia before the clinical onset of carotid artery disease;

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

(5)          where smoking has not permanently ceased, having smoked at least one pack-year of tobacco products before the clinical onset of carotid artery disease;

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

(6)          where smoking has permanently ceased before the clinical onset of carotid artery disease:

(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 carotid artery disease has occurred within 20 years of smoking cessation;

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

(7)          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 carotid artery disease;

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

(8)          where exposure to second-hand smoke has permanently ceased before the clinical onset of carotid artery disease:

(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 carotid artery disease 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.

(9)          having hyperhomocysteinaemia before the clinical onset of carotid artery disease;

(10)      an inability to undertake any physical activity greater than three METs for at least five years within the 20 years before the clinical onset of carotid artery disease;

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

(11)      having chronic kidney disease before the clinical onset of carotid artery disease;

Note: chronic kidney disease is defined in the Schedule 1 - Dictionary.

(12)      undergoing a course of therapeutic radiation for cancer, where the affected artery was in the field of radiation, before the clinical onset of carotid artery disease;

(13)      having received a cumulative equivalent dose of at least 0.5 sievert of ionising radiation to the affected artery before the clinical onset of carotid artery disease;

Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary.

(14)      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 carotid artery disease;

(15)      having infection with human immunodeficiency virus or hepatitis C virus before the clinical onset of carotid artery disease;

(16)      having periodontitis for at least the two years before the clinical onset of carotid artery disease;

(17)      having infection of the affected artery with a bacterial or fungal organism before the clinical onset of carotid artery disease;

(18)      having an autoimmune disease of the affected artery before the clinical onset of carotid artery disease;

Note: Examples of autoimmune diseases that may cause carotid artery disease are ankylosing spondylitis, antiphospholipid syndrome, Behcet disease, inflammatory bowel disease, psoriatic arthropathy, rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis.

(19)      having a neoplasm infiltrating the affected segment of the artery at the time of the clinical onset of carotid artery disease;

(20)      being exposed to arsenic as specified before the clinical onset of carotid artery disease;

Note: being exposed to arsenic as specified is defined in the Schedule 1 - Dictionary.

(21)      having obstructive sleep apnoea for at least the one year before the clinical onset of carotid artery disease;

(22)      for dissection of the internal carotid artery only, being within the 30 days postpartum at the time of the clinical onset of carotid artery disease;

(23)      for aneurysm, dissection or arteriovenous fistula only, having trauma to the affected segment of the artery before the clinical onset of carotid artery disease;

Note: trauma to the affected segment of the artery is defined in the Schedule 1 - Dictionary.

(24)      for dissection only:

(a)          having trauma to the neck or the base of the skull within the six months before the clinical onset of carotid artery disease;

Note: trauma to the neck or the base of the skull is defined in the Schedule 1 - Dictionary.

(b)          taking a fluoroquinolone antibiotic within the 30 days before the clinical onset of carotid artery disease;

(25)      for aneurysm or dissection of the common or internal carotid artery only, taking a drug from the specified list of drugs within the four days before the clinical onset of carotid artery disease;

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

(26)      having hypertension before the clinical worsening of carotid artery disease;

(27)      having diabetes mellitus before the clinical worsening of carotid artery disease;

(28)      being obese for at least five years within the 20 years before the clinical worsening of carotid artery disease;

Note: being obese is defined in the Schedule 1 - Dictionary.

(29)      having dyslipidaemia before the clinical worsening of carotid artery disease;

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

(30)      where smoking has not permanently ceased, having smoked at least one pack-year of tobacco products before the clinical worsening of carotid artery disease;

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

(31)      where smoking has permanently ceased before the clinical worsening of carotid artery disease:

(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 carotid artery disease has occurred within 20 years of smoking cessation;

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

(32)      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 carotid artery disease;

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

(33)      where exposure to second-hand smoke has permanently ceased before the clinical worsening of carotid artery disease:

(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 carotid artery disease 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.

(34)      having hyperhomocysteinaemia before the clinical worsening of carotid artery disease;

(35)      an inability to undertake any physical activity greater than three METs for at least five years within the 20 years before the clinical worsening of carotid artery disease;

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

(36)      having chronic kidney disease before the clinical worsening of carotid artery disease;

Note: chronic kidney disease is defined in the Schedule 1 - Dictionary.

(37)      undergoing a course of therapeutic radiation for cancer, where the affected artery was in the field of radiation, before the clinical worsening of carotid artery disease;

(38)      having received a cumulative equivalent dose of at least 0.5 sievert of ionising radiation to the affected artery before the clinical worsening of carotid artery disease;

Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary.

(39)      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 carotid artery disease;

(40)      having infection with human immunodeficiency virus or hepatitis C virus before the clinical worsening of carotid artery disease;

(41)      having periodontitis for at least the two years before the clinical worsening of carotid artery disease;

(42)      having infection of the affected artery with a bacterial or fungal organism before the clinical worsening of carotid artery disease;

(43)      having an autoimmune disease of the affected artery before the clinical worsening of carotid artery disease;

Note: Examples of autoimmune diseases that may cause carotid artery disease are ankylosing spondylitis, antiphospholipid syndrome, Behcet disease, inflammatory bowel disease, psoriatic arthropathy, rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis.

(44)      having a neoplasm infiltrating the affected segment of the artery at the time of the clinical worsening of carotid artery disease;

(45)      being exposed to arsenic as specified before the clinical worsening of carotid artery disease;

Note: being exposed to arsenic as specified is defined in the Schedule 1 - Dictionary.

(46)      having obstructive sleep apnoea for at least the one year before the clinical worsening of carotid artery disease;

(47)      for dissection of the internal carotid artery only, being within the 30 days postpartum at the time of the clinical worsening of carotid artery disease;

(48)      for aneurysm, dissection or arteriovenous fistula only, having trauma to the affected segment of the artery before the clinical worsening of carotid artery disease;

Note: trauma to the affected segment of the artery is defined in the Schedule 1 - Dictionary.

(49)      for dissection only:

(a)          having trauma to the neck or the base of the skull within the six months before the clinical worsening of carotid artery disease;

Note: trauma to the neck or the base of the skull is defined in the Schedule 1 - Dictionary.

(b)          taking a fluoroquinolone antibiotic within the 30 days before the clinical worsening of carotid artery disease;

(50)      for aneurysm or dissection of the common or internal carotid artery only, taking a drug from the specified list of drugs within the four days before the clinical worsening of carotid artery disease;

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

(51)      inability to obtain appropriate clinical management for carotid artery disease.

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(26) to 9(51) apply only to material contribution to, or aggravation of, carotid artery disease where the person's carotid artery disease 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(2) 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:

                             abnormality of kidney structure or function means:

(a)          having a glomerular filtration rate of less than 60 mL/min/1.73 m2; or

(b)          having kidney damage, as evidenced by renal biopsy, imaging studies, albuminuria, urinary sediment abnormalities or other markers of abnormal renal function; or

(c)          having had a kidney transplant.

                             being exposed to arsenic as specified means:

(a)          consuming drinking water with an average arsenic concentration of at least 50 micrograms per litre for a cumulative period of at least ten years; or

(b)          consuming drinking water resulting in a cumulative total arsenic exposure equivalent to having consumed drinking water containing at least 50 micrograms per litre for at least ten years; or

(c)          having clinical evidence of chronic arsenic toxicity.

                             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.

                             being obese means having a Body Mass Index (BMI) of 30 or greater.

Note: BMI is also defined in the Schedule 1 - Dictionary.

                             BMI means W/H2 where:

(a)          W is the person's weight in kilograms; and

(b)          H is the person's height in metres.

                             carotid artery disease—see subsection 7(2).

                             chronic kidney disease means an abnormality of kidney structure or function that has been present for at least three months.

Note: abnormality of kidney structure or function is also defined in the Schedule 1 - Dictionary.

                             cumulative equivalent dose means the total dose of ionising radiation received by the particular organ or tissue from external exposure, internal exposure or both, apart from normal background radiation exposure in Australia, calculated in accordance with the methodology set out in Guide to calculation of 'cumulative equivalent dose' for the purpose of applying ionising radiation factors contained in Statements of Principles determined under Part XIA of the Veterans' Entitlements Act 1986 (Cth), Australian Radiation Protection and Nuclear Safety Agency, as in force on 2 August 2017.

Note 1: Examples of circumstances that might lead to exposure to ionising radiation include being present during or subsequent to the testing or use of nuclear weapons, undergoing diagnostic or therapeutic medical procedures involving ionising radiation, and being a member of an aircrew, leading to increased levels of exposure to cosmic radiation.

Note 2: For the purpose of dose reconstruction, dose is calculated as an average over the mass of a specific tissue or organ. If a tissue is exposed to multiple sources of ionising radiation, the various dose estimates for each type of radiation must be combined.

                             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.

                             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)          operational service under the VEA;

(b)          peacekeeping service under the VEA;

(c)          hazardous service under the VEA;

(d)          British nuclear test defence service under the VEA;

(e)          warlike service under the MRCA; or

(f)           non-warlike 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);

(e)          D-lysergic acid diethylamide (LSD);

(f)           ergot compounds including ergometrine and ergotamine; or

(g)          methamphetamine (speed).

                             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.

                             trauma to the affected segment of the artery means:

(a)          a blunt trauma resulting in soft tissue injury adjacent to the affected segment of the artery; or

(b)          a penetrating trauma, including surgery, to the affected segment of the artery.

                             trauma to the neck or the base of the skull means:

(a)          non-penetrating injury, involving extension, rotation, hyperflexion or compression of the neck; or

(b)          injury resulting in fracture or dislocation of the cervical spine.

                             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