Statement of Principles concerning hypertension No. 36 of 2003

Statement of Principles

concerning

HYPERTENSION

Instrument No. 36 of 2003 as amended

made under section 196B(3) of the

Veterans’ Entitlements Act 1986

This compilation was prepared on 18 January 2008 taking into account Amendment of Statement of Principles concerning HYPERTENSION (Instrument No. 12 of 2008)

Prepared by the Repatriation Medical Authority Secretariat, Brisbane

Revocation and Determination

of

Statement of Principles

concerning

HYPERTENSION

Veterans’ Entitlements Act 1986

1. The Repatriation Medical Authority under subsection 196B(3) of the Veterans’ Entitlements Act 1986 (the Act):

(a) revokes Instrument No.32 of 2001; 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 hypertension and death from hypertension.

(b)              For the purposes of this Statement of Principles, “hypertension” means permanently elevated blood pressure, evidenced by:

(i) a usual blood pressure reading where the systolic reading is greater than or equal to 140 mmHg or where the diastolic reading is greater than or equal to 90 mmHg; or

(ii) the regular administration of antihypertensive therapy to reduce blood pressure,

This definition excludes temporary elevations in blood pressure from conditions such as acute renal failure, neurogenic hypertension, eclampsia, pre-eclampsia or medications.

(c)               Hypertension attracts ICD-10-AM codes I10 or I15.

(d)              In the application of this Statement of Principles, the definition of “hypertension” is that given at para 2(b) above.

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 hypertension and death from hypertension 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, hypertension or death from hypertension is connected with the circumstances of a person’s relevant service are:

(a)               being obese at the time of the clinical onset of hypertension; or

(b)              consuming an average of at least 500 grams of alcohol per week for a continuous period of at least the six months before the clinical onset of hypertension; or

(c)               ingesting at least 15 grams (250 mmol) of salt supplements per day on average for a continuous period of at least six months immediately before the clinical onset of hypertension; or

(d)              suffering from renal artery stenosis at the time of the clinical onset of hypertension; or

(e)               suffering from chronic renal failure at the time of the clinical onset of hypertension; or

(f)                having undergone renal transplantation at the time of the clinical onset of hypertension; or

(g)              suffering from a chronic renal disease or injury at the time of the clinical onset of hypertension; or

(h)              suffering from a renin-secreting neoplasm at the time of the clinical onset of hypertension; or

(i)                suffering from:

(i)                Cushing’s syndrome,

(ii)              primary aldosteronism,

(iii)           phaeochromocytoma,

(iv)            hypothyroidism,

(v)              acromegaly, or

(vi)            primary hyperparathyroidism

at the time of the clinical onset of hypertension; or

(j)                suffering from a collagen vascular disease with renal involvement at the time of the clinical onset of hypertension; or

(k)              undergoing treatment with a drug for a condition for which the drug cannot be ceased or substituted and which drug has caused an increase in blood pressure, at the time of the clinical onset of hypertension; or

(l)                suffering from sleep apnoea at the time of the clinical onset of hypertension; or

(m)            an inability to undertake more than a mildly strenuous level of physical activity for at least the five years immediately before the clinical onset of hypertension; or

(n)              being obese at the time of the clinical worsening of hypertension; or

(o)              consuming an average of at least 500 grams of alcohol per week for a continuous period of at least the six months before the clinical worsening of hypertension; or

(p)              ingesting at least 15 grams (250 mmol) of salt supplements per day on average for a continuous period of at least six months immediately before the clinical worsening of hypertension; or

(q)              suffering from chronic renal failure at the time of the clinical worsening of hypertension; or

(r)                having undergone renal transplantation at the time of the clinical worsening of hypertension; or

(s)               suffering from a chronic renal disease or injury at the time of the clinical worsening of hypertension; or

(t)                suffering from a renin-secreting neoplasm at the time of the clinical worsening of hypertension; or

(u)              suffering from:

(i)                Cushing’s syndrome,

(ii)              primary aldosteronism,

(iii)           phaeochromocytoma,

(iv)            hypothyroidism,

(v)              acromegaly, or

(vi)            primary hyperparathyroidism

at the time of the clinical worsening of hypertension; or

(v)              suffering from a collagen vascular disease with renal involvement at the time of the clinical worsening of hypertension; or

(w)            undergoing treatment with a drug for a condition for which the drug cannot be ceased or substituted and which drug has caused an increase in blood pressure, at the time of the clinical worsening of hypertension; or

(x)              suffering from sleep apnoea at the time of the clinical worsening of hypertension; or

(y)              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 hypertension; or

(z)               inability to obtain appropriate clinical management for hypertension.

Factors that apply only to material contribution or aggravation

6. Paragraphs 5(n) to 5(z) apply only to material contribution to, or aggravation of, hypertension where the person’s hypertension 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:

“a mildly strenuous level of physical activity” means 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;

“acromegaly” means a chronic disease of adults resulting from hypersecretion of growth hormone after closure of the epiphyses; 

“alcohol” is measured by the alcohol consumption calculations utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink;

“being obese” means an increase in body weight by way of fat accumulation which results in a Body Mass Index (BMI) of 30 or greater.

The BMI = W/H2 and where:

W is the person’s weight in kilograms and

H is the person’s height in metres;

“chronic renal failure” means irreversible kidney damage which leads to impaired renal function;

“chronic renal disease or injury” means chronic irreversible renal damage from conditions such as

(i)                analgesic nephropathy;

(ii)              chronic glomerulonephritis;

(iii)           chronic pyelonephritis;

(iv)            diabetic nephrosclerosis;

(v)              obstructive nephropathy;

(vi)            polycystic kidney disease;

(vii)         renal ischaemia/infarction;

(viii)       renal scarring; or

(ix)            renal tuberculosis;

“collagen vascular disease” means an autoimmune disorder which causes vasculitis;

“death from hypertension” in relation to a person includes death from a terminal event or condition that was contributed to by the person’s hypertension;

“hypothyroidism” means the functional state resulting from insufficiency of thyroid hormones;

“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;

“phaeochromocytoma” means a neoplasm of chromaffin tissue usually located in the adrenal medulla or sympathetic ganglion, which produces, stores and secretes catecholamines;

“primary aldosteronism” means a syndrome associated with hypersecretion of the major adrenal mineralocorticoid, aldosterone;

“primary hyperparathyroidism” means increased levels of parathyroid hormone secretion (mostly by parathyroid adenomas) which is not a secondary response to hypocalcaemia;

“relevant service” means:

(a) eligible war service (other than operational service); or

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

“renal artery stenosis” means at least 50% narrowing of the lumen of a renal artery, and which produces clinical manifestations which are poorly controlled hypertension, renal impairment or acute pulmonary oedema;

“salt supplements” means salt added to food when cooking or eating, or salt contained in salt tablets;

“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 120B of the Act applied.

Notes to Statement of Principles concerning hypertension (Instrument No. 36 of 2003)

The Statement of Principles concerning hypertension (Instrument No. 36 of 2003) in force under section 196B(3) of the Veterans’ Entitlements Act 1986, as shown in this compilation is amended as indicated in the Tables below.

Table of Instruments

Table of Amendments