Statement of Principles concerning heart block (Balance of Probabilities) (No. 24 of 2022)

Administered by Department of Veterans' Affairs

Legislation au F2022L00277 In force Legislative Instrument

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EXPLANATORY STATEMENT

 

STATEMENT OF PRINCIPLES CONCERNING

HEART BLOCK

(BALANCE OF PROBABILITIES) (NO. 24 OF 2022)

 

VETERANS' ENTITLEMENTS ACT 1986

MILITARY REHABILITATION AND COMPENSATION ACT 2004

 

  1. This is the Explanatory Statement to the Statement of Principles concerning heart block (Balance of Probabilities) (No. 24 of 2022).

Background

2.             The Repatriation Medical Authority (the Authority), under subsection 196B(8) of the Veterans' Entitlements Act 1986 (the VEA), repeals Instrument No. 2 of 2014 (Federal Register of Legislation No. F2014L00005) determined under subsections 196B(3) and (8) of the VEA concerning heart block.

3.             The Authority is of the view that on the sound medical-scientific evidence available it is more probable than not that heart block and death from heart block can be related to particular kinds of service.  The Authority has therefore determined pursuant to subsection 196B(3) of the VEA a Statement of Principles concerning heart block (Balance of Probabilities) (No. 24 of 2022).  This Instrument will in effect replace the repealed Statement of Principles.

Purpose and Operation

4.             The Statement of Principles will be applied in determining claims under the VEA and the Military Rehabilitation and Compensation Act 2004 (the MRCA).

5.             The Statement of Principles sets out the factors that must exist, and which of those factors must be related to the following kinds of service rendered by a person:

 eligible war service (other than operational service) under the VEA;

 defence service (other than hazardous service and British nuclear test defence service) under the VEA;

 peacetime service under the MRCA,

before it can be said that, on the balance of probabilities, heart block or death from heart block is connected with the circumstances of that service.  The Statement of Principles has been determined for the purposes of both the VEA and the MRCA.

6.             This Instrument results from an investigation notified by the Authority in the Government Notices Gazette of 9 March 2021 concerning heart block in accordance with section 196G of the VEA.  The investigation involved an examination of the sound medical-scientific evidence now available to the Authority, including the sound medical-scientific evidence it has previously considered.

7.             The contents of this Instrument are in similar terms as the repealed Instrument.  Comparing this Instrument and the repealed Instrument, the differences include:

  • adopting the latest revised Instrument format, which commenced in 2015;
  • specifying a day of commencement for the Instrument in section 2;
  • revising the definition of 'heart block' in subsection 7(2);
  • revising the reference to 'ICD-10-AM code' in subsection 7(4);
  • new factors in subsections 9(2) and 9(29) concerning having pulmonary thromboembolism;
  • revising the factors in subsections 9(3) and 9(30) concerning having infiltration of the myocardium due to amyloidosis or sarcoidosis;
  • new factors in subsections 9(4) and 9(31) concerning having cardiomyopathy;
  • revising the factors in subsections 9(5) and 9(32) concerning having a benign or malignant neoplasm involving the heart;
  • new factors in subsections 9(6) and 9(33) concerning having a lesion which compresses the atrioventricular node, bundle of His or the bundle branches of the heart;
  • new factors in subsections 9(7) and 9(34) concerning having non-infectious myocarditis;
  • new factors in subsections 9(8) and 9(35) concerning having viral myocarditis;
  • revising the factors in subsections 9(9) and 9(36) concerning having a non-viral infection of the myocardium;
  • revising the factors in subsections 9(10) and 9(37) concerning having infective endocarditis;
  • revising the factors in subsections 9(11) and 9(38) concerning having a mineral or electrolyte abnormality;
  • revising the factors in subsections 9(12) and 9(39) concerning taking a drug;
  • revising the factors in subsections 9(13) and 9(40) concerning taking chloroquine or hydroxychloroquine;
  • new factors in subsections 9(14) and 9(41) concerning having ingested a plant containing cardiac glycosides;
  • revising the factors in subsections 9(15) and 9(42) concerning experiencing penetrating trauma to the heart;
  • revising the factors in subsections 9(16) and 9(43) concerning having a thoracic surgical procedure or an invasive cardiac procedure;
  • new factors in subsections 9(17) and 9(44) concerning experiencing a blunt chest injury;
  • revising the factors in subsections 9(19) and 9(46) concerning having a bone marrow transplant by the inclusion of stem cell transplant;
  • new factors in subsections 9(20) and 9(47) concerning having graft versus host disease after a bone marrow transplant or stem cell transplant;
  • revising the factors in subsections 9(21) and 9(48) concerning undergoing a course of therapeutic radiation for cancer;
  • revising the factors in subsections 9(22) and 9(49) concerning undertaking strenuous physical activity greater than 6 METs;
  • revising the factors in subsections 9(24) and 9(51) concerning having hypertension;
  • revising the factors in subsections 9(25) and 9(52) concerning having an autoimmune disease;
  • new factors in subsections 9(26) and 9(53) concerning having acute rheumatic fever;
  • new factors in subsections 9(27) and 9(54) concerning having rheumatic heart disease;
  • deleting the factors concerning having myocarditis as these are now covered by factors in subsections 9(7) and 9(34) concerning having non-infectious myocarditis, and factors in subsections 9(8) and 9(35) concerning having viral myocarditis;
  • deleting the factors concerning experiencing a powerful, non-penetrating blow to the chest, resulting in injury warranting medical attention, as these are now covered by the factors in subsections 9(17) and 9(44) concerning experiencing a blunt chest injury;
  • deleting the factors concerning having received a cumulative equivalent dose of at least 0.5 sievert of ionising radiation to the heart, as these are now covered by the factors in subsections 9(21) and 9(48) concerning undergoing a course of therapeutic radiation for cancer;
  • deleting the factors concerning being envenomated by a scorpion or snake;
  • new definitions of 'blunt chest injury', 'MRCA', 'specified list of autoimmune diseases', 'specified list of drugs', 'specified list of mineral or electrolyte abnormalities' and 'VEA' in Schedule 1 - Dictionary;
  • revising the definition of 'relevant service' in Schedule 1 - Dictionary; and
  • deleting the definitions of 'a drug or a drug from a class of drugs from the specified list', 'a specified autoimmune disease', 'a specified mineral or electrolyte abnormality', 'an organism from the specified list' and 'cumulative equivalent dose'.

Consultation

8.             Prior to determining this Instrument, the Authority advertised its intention to undertake an investigation in relation to heart block in the Government Notices Gazette of 9 March 2021, and circulated a copy of the notice of intention to investigate to a wide range of organisations representing veterans, service personnel and their dependants.  The Authority invited submissions from the Repatriation Commission, the Military Rehabilitation and Compensation Commission, organisations and persons referred to in section 196E of the VEA, and any person having expertise in the field.  No submissions were received for consideration by the Authority in relation to the investigation.

9.             On 12 October 2021, the Authority wrote to organisations representing veterans, service personnel and their dependants regarding the proposed Instrument and the medical-scientific material considered by the Authority.  This letter emphasised the deletion of factors relating to being envenomated by a scorpion or snake.  The Authority provided an opportunity to the organisations to make representations in relation to the proposed Instrument prior to its determination.  No submissions were received for consideration by the Authority.  Minor changes were made to the proposed Instrument following this consultation process.

Human Rights

10.         This instrument is compatible with the Human Rights and Freedoms recognised or declared in the International Instruments listed in Section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.  A Statement of Compatibility with Human Rights follows.

Finalisation of Investigation

11.         The determining of this Instrument finalises the investigation in relation to heart block as advertised in the Government Notices Gazette of 9 March 2021.

References

12.         A list of references relating to the above condition is available on the Authority's website at: www.rma.gov.au. Any other document referred to in this Statement of Principles is available on request to the Repatriation Medical Authority at the following address:

              

Email:    info@rma.gov.au

Post:      The Registrar

Repatriation Medical Authority

GPO Box 1014

BRISBANE    QLD    4001


Statement of Compatibility with Human Rights

(Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011)

 

Instrument No.:   Statement of Principles No. 24 of 2022

Kind of Injury, Disease or Death: Heart block

 

This Legislative Instrument is compatible with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.

Overview of the Legislative Instrument

1. This Legislative Instrument is determined pursuant to subsection 196B(3) of the Veterans' Entitlements Act 1986 (the VEA) for the purposes of the VEA and the Military Rehabilitation and Compensation Act 2004 (the MRCA).  Part XIA of the VEA requires the determination of these instruments outlining the factors connecting particular kinds of injury, disease or death with service such being determined solely on the available sound medical-scientific evidence.

2. This Legislative Instrument:-

  • facilitates claimants in making, and the Repatriation Commission and the Military Rehabilitation and Compensation Commission in assessing, claims under the VEA and the MRCA respectively, by specifying the circumstances in which medical treatment and compensation can be extended to eligible persons who have heart block;
  • facilitates the review of such decisions by the Veterans' Review Board and the Administrative Appeals Tribunal;
  • outlines the factors which the current sound medical-scientific evidence indicates must exist before it can be said that, on the balance of probabilities, heart block is connected with the circumstances of eligible service rendered by a person, as set out in clause 5 of the Explanatory Statement;
  • replaces Instrument No. 2 of 2014; and
  • reflects developments in the available sound medical-scientific evidence concerning heart block which have occurred since that earlier instrument was determined. 

3. The Instrument is assessed as being a technical instrument which improves the medico-scientific quality of outcomes under the VEA and the MRCA. 

Human Rights Implications

4. This Legislative Instrument does not derogate from any human rights. It promotes the human rights of veterans, current and former Defence Force members as well as other persons such as their dependents, including:

  • the right to social security (Art 9, International Covenant on Economic, Social and Cultural Rights; Art 26, Convention on the Rights of the Child and Art 28, Convention on the Rights of Persons with Disabilities) by helping to ensure that the qualifying conditions for the benefit are 'reasonable, proportionate and transparent'[1];
  • the right to an adequate standard of living (Art 11, ICESCR; Art 27, CRC and Art 28, CRPD) by facilitating the assessment and determination of social security benefits;
  • the right to the enjoyment of the highest attainable standard of physical and mental health (Art 12, ICESCR and Art 25, CRPD), by facilitating the assessment and determination of compensation and benefits in relation to the treatment and rehabilitation of veterans and Defence Force members;
  • the rights of persons with disabilities by facilitating the determination of claims relating to treatment and rehabilitation (Art 26, CRPD); and
  • ensuring that those rights "will be exercised without discrimination of any kind as to race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status" (Art 2, ICESCR).

Conclusion

This Legislative Instrument is compatible with human rights as it does not derogate from and promotes a number of human rights.

 

Repatriation Medical Authority

 

 

 

 

 

 

[1] In General Comment No. 19 (The right to social security), the Committee on Economic, Social and Cultural Rights said (at paragraph 24) this to be one of the elements of ensuring accessibility to social security.

Overview

The Statement of Principles concerning heart block (Balance of Probabilities) (No. 24 of 2022) was enacted by the Repatriation Medical Authority under subsection 196B(8) of the Veterans' Entitlements Act 1986. This legislation addresses the gap in the sound medical-scientific evidence concerning the connection between heart block, death from heart block, and particular kinds of service. The Authority determined this Statement of Principles based on the available evidence, which indicates that it is more probable than not that heart block can be related to certain service circumstances. The primary objective of this legislation is to provide clarity and facilitate the assessment and determination of claims related to heart block under both the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004. This new Statement of Principles aims to replace the previously repealed Instrument No. 2 of 2014 and incorporates the latest available medical-scientific evidence, while also reflecting the updated format for Instruments. The new principles set out the factors that must exist, and which of those factors must be related to eligible war service, defence service, or peacetime service, before it can be said that, on the balance of probabilities, heart block or death from heart block is connected with the circumstances of that service. The Authority consulted with relevant organisations and individuals before determining this Instrument, though no submissions were received. The legislation is compatible with human rights, as it promotes the rights of veterans, current and former Defence Force members, and their dependents.

Scope and Application

The Statement of Principles concerning heart block (Balance of Probabilities) (No. 24 of 2022) applies to individuals claiming benefits under the Veterans' Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA) who have experienced heart block as a result of their service. This instrument identifies the factors that must exist, and which of those factors must be related to specific types of service, to establish a connection between heart block and the service circumstances on the balance of probabilities. The types of service considered include eligible war service (excluding operational service) and defence service (excluding hazardous service and British nuclear test defence service) under the VEA, and peacetime service under the MRCA. The Statement of Principles is applicable nationally, as it pertains to the Commonwealth's legislative framework. There are no specific exclusions or exemptions outlined in this Statement of Principles, but the application of the principles is contingent upon the presence of the specified factors related to the service. The Repatriation Medical Authority may extend or restrict the application of these principles through subordinate instruments. The Statement of Principles also aligns with human rights as it does not infringe upon any human rights and supports the rights of veterans, current and former Defence Force members, and their dependents.

Key Provisions

The main operative sections of the Statement of Principles concerning heart block (Balance of Probabilities) (No. 24 of 2022) under the Veterans' Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA) outline the circumstances in which heart block or death from heart block can be considered related to certain kinds of service. Specifically, section 5 details the kinds of service that can be related to heart block, such as eligible war service, defence service, and peacetime service. Section 7 defines "heart block," while sections 9 through 49 list the various factors that, if present, indicate a probable connection between heart block and the service rendered. These factors include medical conditions, treatments, and other circumstances that may contribute to the development of heart block. The instrument also introduces new definitions and factors reflecting the latest medical-scientific evidence. The obligations imposed by this Act on the parties it governs include the requirement for claimants to demonstrate that their heart block is connected with their service, based on the factors outlined in the Statement of Principles. The Repatriation Medical Authority is tasked with assessing these claims using the criteria set out in the instrument. The Repatriation Commission and the Military Rehabilitation and Compensation Commission must evaluate claims under the VEA and MRCA, respectively, in accordance with the specified factors. Additionally, the instrument mandates that the Authority consult with relevant organisations and consider submissions before determining the Statement of Principles, although no submissions were received in this instance. Any breaches of the provisions in the Statement of Principles may result in legal consequences, though specific offences and penalties are not detailed in the explanatory statement. Generally, under the VEA and MRCA, failure to comply with the requirements for making or assessing claims can lead to civil or administrative penalties. The precise nature of these penalties would depend on the specific breach and the relevant legislative provisions. Additionally, the Statement of Principles itself does not create new criminal offences but rather provides a framework for determining the eligibility of claims based on medical-scientific evidence.

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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.