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Statement of Principles concerning ischaemic heart disease (Reasonable Hypothesis) (No. 1 of 2016)

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Statement of Principles
concerning
ISCHAEMIC HEART DISEASE
(Reasonable Hypothesis)
(No. 1 of 2016)
The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans’ Entitlements Act 1986.
 
Dated 18 December         2015
 
 
 
 
 
The Common Seal of the
Repatriation Medical Authority
was affixed to this instrument
at the direction of:
 
 
 
 
Professor Nicholas Saunders AO
Chairperson
 
  
Contents
1          Name........................................................................................................................................... 3
2          Commencement........................................................................................................................ 3
3          Authority..................................................................................................................................... 3
4          Revocation................................................................................................................................. 3
5          Application................................................................................................................................. 3
6          Definitions.................................................................................................................................. 3
7          Kind of injury, disease or death to which this Statement of Principles relates............... 3
8          Basis for determining the factors........................................................................................... 4
9          Factors that must exist............................................................................................................. 4
10        Relationship to service............................................................................................................. 15
11        Factors referring to an injury or disease covered by another Statement of Principles. 15
Schedule 1 - Dictionary........................................................................................... 17
1          Definitions.................................................................................................................................. 17
 
 
(a)            
1               Name
This is the Statement of Principles concerning ischaemic heart disease (Reasonable Hypothesis) (No. 1 of 2016).
2               Commencement
This instrument commences on 25 January 2016.
3               Authority
This instrument is made under subsection 196B(2) of the Veterans’ Entitlements Act 1986.
4               Revocation
The Statement of Principles concerning ischaemic heart disease No. 89 of 2007, as amended, made under subsections 196B(2) and (8) of the VEA is revoked.
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 ischaemic heart disease and death from ischaemic heart disease.
Meaning of ischaemic heart disease
(2)          For the purposes of this Statement of Principles, ischaemic heart disease means a cardiac disability characterised by insufficient blood flow to the muscle tissue of the heart due to atherosclerosis, thrombosis, vasospasm or dissection of the coronary arteries.
(3)          While ischaemic heart disease attracts ICD‑10‑AM code I20 to I25, in applying this Statement of Principles the meaning of ischaemic heart 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), Ninth Edition, effective date of 1 July 2015, copyrighted by the Independent Hospital Pricing Authority, ISBN 978‑1‑76007‑020‑5.
Death from ischaemic heart disease
(5)          For the purposes of this Statement of Principles, ischaemic heart disease, in relation to a person, includes death from a terminal event or condition that was contributed to by the person’s ischaemic heart 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 ischaemic heart disease and death from ischaemic heart 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: relevant service is 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 ischaemic heart disease or death from ischaemic heart disease with the circumstances of a person’s relevant service:
(1)          having hypertension before the clinical onset of ischaemic heart disease;
(2)          having diabetes mellitus before the clinical onset of ischaemic heart disease;
(3)          being obese for at least five years before the clinical onset of ischaemic heart disease;
Note: being obese is defined in the Schedule 1 - Dictionary.
(4)          having dyslipidaemia before the clinical onset of ischaemic heart disease;
Note: dyslipidaemia is defined in the Schedule 1 - Dictionary.
(5)          where smoking has not ceased prior to the clinical onset of ischaemic heart disease:
(a)           smoking an average of at least three cigarettes per day, or the equivalent thereof in other tobacco products, for at least the one year before the clinical onset of ischaemic heart disease; or
(b)          smoking at least one half pack-year of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of ischaemic heart disease;
Note: cigarettes per day, or the equivalent thereof in other tobacco products and pack-year of cigarettes, or the equivalent thereof in other tobacco products are defined in the Schedule 1 - Dictionary.
(6)          where smoking has ceased prior to the clinical onset of ischaemic heart disease:
(a)           smoking at least one half pack-year but less than five pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of ischaemic heart disease, and the clinical onset of ischaemic heart disease has occurred within five years of smoking cessation;
(b)          smoking at least five pack-years but less than 20 pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of ischaemic heart disease, and the clinical onset of ischaemic heart disease has occurred within 20 years of smoking cessation; or
(c)           smoking at least 20 pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of ischaemic heart disease;
Note: pack-year of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary.
(7)          where exposure to second-hand smoke has not ceased, being exposed to second-hand smoke for at least 1 000 hours before the clinical onset of ischaemic heart disease;
Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.
(8)          where exposure to second-hand smoke has ceased:
(a)           being exposed to second-hand smoke for at least 1 000 hours but less than 5 000 hours before the clinical onset of ischaemic heart disease, and the clinical onset of ischaemic heart disease has occurred within five years of the last exposure to second-hand smoke; or
(b)          being exposed to second-hand smoke for at least 5 000 hours before the clinical onset of ischaemic heart disease;
Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.
(9)          where the use of chewing tobacco has not ceased, using chewing tobacco on more days than not for at least one year before the clinical onset of ischaemic heart disease;
(10)      where the use of chewing tobacco has ceased:
(a)           using chewing tobacco on more days than not for at least one year but less than five years before the clinical onset of ischaemic heart disease, and the clinical onset of ischaemic heart disease has occurred within five years of ceasing to use chewing tobacco; or
(b)          using chewing tobacco on more days than not for at least five years before the clinical onset of ischaemic heart disease;
(11)      an inability to undertake any physical activity greater than three METs for at least the five years before the clinical onset of ischaemic heart disease;
Note: MET is defined in the Schedule 1 - Dictionary.
(12)      being sedentary for a cumulative total of at least ten hours per day on more days than not for at least the five years before the clinical onset of ischaemic heart disease;
Note: being sedentary is defined in the Schedule 1 - Dictionary.
(13)      having hyperhomocysteinaemia before the clinical onset of ischaemic heart disease;
(14)      having chronic kidney disease before the clinical onset of ischaemic heart disease;
Note: chronic kidney disease is defined in the Schedule 1 - Dictionary.
(15)      having hypothyroidism or Hashimoto's thyroiditis with hypothyroidism for at least two years within the ten years before the clinical onset of ischaemic heart disease;
(16)      inhaling or having cutaneous contact with Otto fuel or explosive products containing nitroglycerine, nitroglycol, trinitrotoluene or dinitrotoluene, where the last inhalation or cutaneous contact occurred not more than 14 days before the clinical onset of ischaemic heart disease;
(17)      having received a cumulative equivalent dose of at least 0.5 sievert of ionising radiation to the heart at least one year before the clinical onset of ischaemic heart disease;
Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary.
(18)      undergoing a course of therapeutic radiation for cancer, where the heart was in the field of radiation, before the clinical onset of ischaemic heart disease;
(19)      having a clinically significant disorder of mental health as specified for at least the five years before the clinical onset of ischaemic heart disease;
Note: clinically significant disorder of mental health as specified is defined in the Schedule 1 - Dictionary.
(20)      using a combined oral contraceptive pill for at least the 21 days before the clinical onset of ischaemic heart disease;
(21)      being treated with a drug, or a drug from a class of drugs, from Specified List 1 of drugs, where that drug cannot be ceased or substituted, at the time of the clinical onset of ischaemic heart disease;
Note: Specified List 1 of drugs is defined in the Schedule 1 - Dictionary.
(22)      using a drug belonging to the non-steroidal anti-inflammatory class of drugs, excluding aspirin, paracetamol and topical non-steroidal anti-`inflammatory drugs, for a continuous period of at least three days before the clinical onset of ischaemic heart disease, where the last dose of the drug within that period was taken within the seven days before the clinical onset of ischaemic heart disease;
(23)      having bilateral orchiectomy before the clinical onset of ischaemic heart disease;
(24)      having antiandrogen therapy as specified for at least the seven days before the clinical onset of ischaemic heart disease;
Note: antiandrogen therapy as specified is defined in the Schedule 1 - Dictionary.
(25)      inhaling, ingesting or having cutaneous contact with the phenoxy acid herbicides 2,4-dichlorophenoxyacetic acid (2,4-D) or 2,4,5-trichlorophenoxyacetic acid (2,4,5-T), for a cumulative period of at least 1 000 hours within a consecutive period of ten years, before the clinical onset of ischaemic heart disease, where the first exposure occurred at least five years before the clinical onset of ischaemic heart disease, and where that exposure has ceased, the clinical onset of ischaemic heart disease occurred within 25 years after cessation;
(26)      inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD), for a cumulative period of at least 1 000 hours within a consecutive period of ten years, before the clinical onset of ischaemic heart disease, where the first exposure occurred at least five years before the clinical onset of ischaemic heart disease, and where that exposure has ceased, the clinical onset of ischaemic heart disease occurred within 25 years after cessation;
Note: inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD) is defined in the Schedule 1 - Dictionary.
(27)      having thrombosis of a coronary artery as a result of being in a hypercoagulable state as specified at the time of the clinical onset of ischaemic heart disease;
Note: hypercoagulable state as specified is defined in the Schedule 1 - Dictionary.
(28)      inhaling ambient chronically polluted air as specified for at least 1 000 hours within the five years before the clinical onset of ischaemic heart disease;
Note: ambient chronically polluted air as specified is defined in the Schedule 1 - Dictionary.
(29)      an inability to consume an average of at least 100 grams per day of vegetables or fruits, for at least the five years before the clinical onset of ischaemic heart disease;
(30)      an inability to consume an average of at least 100 grams of fish per fortnight for at least the five years before the clinical onset of ischaemic heart disease;
(31)      consuming an average daily intake of at least 12 grams (200 millimoles) of salt for at least the five years before the clinical onset of ischaemic heart disease;
(32)      having periodic, heavy alcohol consumption for the one year before the clinical onset of ischaemic heart disease;
Note: alcohol and periodic, heavy alcohol consumption are defined in the Schedule 1 - Dictionary.
(33)      having obstructive sleep apnoea for at least the one year before the clinical onset of ischaemic heart disease;
Note: obstructive sleep apnoea is defined in the Schedule 1 - Dictionary.
(34)      an inability to sleep for an average of at least five hours daily for at least the one year before the clinical onset of ischaemic heart disease;
(35)      undertaking night shift work on at least 250 occasions over a continuous period, for at least the five years before the clinical onset of ischaemic heart disease;
Note: night shift work is defined in the Schedule 1 - Dictionary.
(36)      working long hours over a continuous period for at least the five years before the clinical onset of ischaemic heart disease;
Note: long hours is defined in the Schedule 1 - Dictionary.
(37)      being infected with human immunodeficiency virus for at least five years before the clinical onset of ischaemic heart disease;
(38)      having periodontitis for at least the five years before the clinical onset of ischaemic heart disease;
(39)      having infective endocarditis or syphilis involving the coronary arteries at the time of the clinical onset of ischaemic heart disease;
(40)      undergoing a procedure involving catheterisation of the affected coronary artery within the five years before the clinical onset of ischaemic heart disease;
(41)      having a specified autoimmune collagen vascular disease at the time of the clinical onset of ischaemic heart disease;
Note: specified autoimmune collagen vascular disease is defined in the Schedule 1 - Dictionary.
(42)      having gout or hyperuricaemia at the time of the clinical onset of ischaemic heart disease;
Note: hyperuricaemia is defined in the Schedule 1 - Dictionary.
(43)      for angina, acute myocardial infarction or sudden death from ischaemic heart disease only:
(a)           undertaking physical activity of five METs or more within the 24 hours before the clinical onset of ischaemic heart disease;
(b)          experiencing a category 1A stressor within the 48 hours before the clinical onset of ischaemic heart disease;
(c)           experiencing a category 1B stressor within the 48 hours before the clinical onset of ischaemic heart disease;
(d)          experiencing an acute, severe, emotional stressor within the 24 hours before the clinical onset of ischaemic heart disease;
(e)           experiencing the death of a significant other within the 12 months before the clinical onset of ischaemic heart disease;
(f)           using a drug from Specified List 2 of drugs within the 24 hours before the clinical onset of ischaemic heart disease;
(g)          having an episode of acute cholinergic poisoning from exposure to an organophosphorus ester within the seven days before the clinical onset of ischaemic heart disease;
(h)          being exposed to:
(i)            an environment of extreme heat during a heatwave; or
(ii)          an environment of extreme cold during a cold snap; or
(iii)        an abrupt alteration of temperature by ten degrees Celsius or more, to extreme heat or to extreme cold;
for a period of at least six hours within the seven days before the clinical onset of ischaemic heart disease;
(i)            inhaling ambient highly polluted air as specified for at least two hours within the seven days before the clinical onset of ischaemic heart disease;
(j)            being envenomated by a snake, scorpion, wasp, bee, hornet, spider, fish or jellyfish within the 24 hours before the clinical onset of ischaemic heart disease;
(k)          having an acute hypersensitivity reaction involving the coronary arteries as a result of being exposed to a drug, food or environmental agent from the specified list within the 24 hours before the clinical onset of ischaemic heart disease;
(l)            having influenza or a lower respiratory tract infection within the 30 days before the clinical onset of ischaemic heart disease; or
(m)        being pregnant within the six weeks before the clinical onset of ischaemic heart disease;
Note: acute cholinergic poisoning; acute, severe, emotional stressor; ambient highly polluted air as specified; category 1A stressor; category 1B stressor; cold snap; drug, food or environmental agent from the specified list; extreme cold; extreme heat; heatwave; organophosphorus ester; MET; significant other and Specified List 2 of drugs are defined in the Schedule 1 - Dictionary.
(44)      having hypertension before the clinical worsening of ischaemic heart disease;
(45)      having diabetes mellitus before the clinical worsening of ischaemic heart disease;
(46)      being obese for at least five years before the clinical worsening of ischaemic heart disease;
Note: being obese is defined in the Schedule 1 - Dictionary.
(47)      having dyslipidaemia before the clinical worsening of ischaemic heart disease;
Note: dyslipidaemia is defined in the Schedule 1 - Dictionary.
(48)      where smoking has not ceased prior to the clinical worsening of ischaemic heart disease:
(a)           smoking an average of at least three cigarettes per day, or the equivalent thereof in other tobacco products, for at least the one year before the clinical worsening of ischaemic heart disease; or
(b)          smoking at least one half pack-year of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of ischaemic heart disease;
Note: cigarettes per day, or the equivalent thereof in other tobacco products and pack-year of cigarettes, or the equivalent thereof in other tobacco products are defined in the Schedule 1 - Dictionary.
(49)      where smoking has ceased prior to the clinical worsening of ischaemic heart disease:
(a)           smoking at least one half pack-year but less than five pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of ischaemic heart disease, and the clinical worsening of ischaemic heart disease has occurred within five years of smoking cessation;
(b)          smoking at least five pack-years but less than 20 pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of ischaemic heart disease, and the clinical worsening of ischaemic heart disease has occurred within 20 years of smoking cessation; or
(c)           smoking at least 20 pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of ischaemic heart disease;
Note: pack-year of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary.
(50)      where exposure to second-hand smoke has not ceased, being exposed to second-hand smoke for at least 1 000 hours before the clinical worsening of ischaemic heart disease;
Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.
(51)      where exposure to second-hand smoke has ceased:
(a)           being exposed to second-hand smoke for at least 1 000 hours but less than 5 000 hours before the clinical worsening of ischaemic heart disease, and the clinical worsening of ischaemic heart disease has occurred within five years of the last exposure to second-hand smoke; or
(b)          being exposed to second-hand smoke for at least 5 000 hours before the clinical worsening of ischaemic heart disease;
Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.
(52)      where the use of chewing tobacco has not ceased, using chewing tobacco on more days than not for at least one year before the clinical worsening of ischaemic heart disease;
(53)      where the use of chewing tobacco has ceased:
(a)           using chewing tobacco on more days than not for at least one year but less than five years before the clinical worsening of ischaemic heart disease, and the clinical worsening of ischaemic heart disease has occurred within five years of ceasing to use chewing tobacco; or
(b)          using chewing tobacco on more days than not for at least five years, before the clinical worsening of ischaemic heart disease;
(54)      an inability to undertake any physical activity greater than three METs for at least the five years before the clinical worsening of ischaemic heart disease;
Note: MET is defined in the Schedule 1 - Dictionary.
(55)      being sedentary for a cumulative total of at least ten hours per day on more days than not for at least the five years before the clinical worsening of ischaemic heart disease;
Note: being sedentary is defined in the Schedule 1 - Dictionary.
(56)      having hyperhomocysteinaemia before the clinical worsening of ischaemic heart disease;
(57)      having chronic kidney disease before the clinical worsening of ischaemic heart disease;
Note: chronic kidney disease is defined in the Schedule 1 - Dictionary.
(58)      having hypothyroidism or Hashimoto's thyroiditis with hypothyroidism for at least two years within the ten years before the clinical worsening of ischaemic heart disease;
(59)      inhaling or having cutaneous contact with Otto fuel or explosive products containing nitroglycerine, nitroglycol, trinitrotoluene or dinitrotoluene, where the last inhalation or cutaneous contact occurred not more than 14 days before the clinical worsening of ischaemic heart disease;
(60)      having received a cumulative equivalent dose of at least 0.5 sievert of ionising radiation to the heart at least one year before the clinical worsening of ischaemic heart disease;
Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary.
(61)      undergoing a course of therapeutic radiation for cancer, where the heart was in the field of radiation, before the clinical worsening of ischaemic heart disease;
(62)      having a clinically significant disorder of mental health as specified for at least the five years before the clinical worsening of ischaemic heart disease;
Note: clinically significant disorder of mental health as specified is defined in the Schedule 1 - Dictionary.
(63)      using a combined oral contraceptive pill  for at least the 21 days before the clinical worsening of ischaemic heart disease;
(64)      being treated with a drug, or a drug from a class of drugs, from Specified List 1 of drugs, where that drug cannot be ceased or substituted, at the time of the clinical worsening of ischaemic heart disease;
Note: Specified List 1 of drugs is defined in the Schedule 1 - Dictionary.
(65)      using a drug belonging to the non-steroidal anti-inflammatory class of drugs, excluding aspirin, paracetamol and topical non-steroidal anti-inflammatory drugs, for a continuous period of at least three days before the clinical worsening of ischaemic heart disease, where the last dose of the drug within that period was taken within the seven days before the clinical worsening of ischaemic heart disease;
(66)      having bilateral orchiectomy before the clinical worsening of ischaemic heart disease;
(67)      having antiandrogen therapy as specified for at least the seven days before the clinical worsening of ischaemic heart disease;
Note: antiandrogen therapy as specified is defined in the Schedule 1 - Dictionary.
(68)      inhaling, ingesting or having cutaneous contact with the phenoxy acid herbicides 2,4-dichlorophenoxyacetic acid (2,4-D) or 2,4,5-trichlorophenoxyacetic acid (2,4,5-T), for a cumulative period of at least 1 000 hours within a consecutive period of ten years, before the clinical worsening of ischaemic heart disease, where the first exposure occurred at least five years before the clinical worsening of ischaemic heart disease, and where that exposure has ceased, the clinical worsening of ischaemic heart disease occurred within 25 years after cessation;
(69)      inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD), for a cumulative period of at least 1 000 hours within a consecutive period of ten years, before the clinical worsening of ischaemic heart disease, where the first exposure occurred at least five years before the clinical worsening of ischaemic heart disease, and where that exposure has ceased, the clinical worsening of ischaemic heart disease occurred within 25 years after cessation;
Note: inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD) is defined in the Schedule 1 - Dictionary.
(70)      having thrombosis of a coronary artery as a result of being in a hypercoagulable state as specified at the time of the clinical worsening of ischaemic heart disease;
Note: hypercoagulable state as specified is defined in the Schedule 1 - Dictionary.
(71)      inhaling ambient chronically polluted air as specified for at least 1 000 hours within the five years before the clinical worsening of ischaemic heart disease;
Note: ambient chronically polluted air as specified is defined in the Schedule 1 - Dictionary.
(72)      an inability to consume an average of at least 100 grams per day of vegetables or fruits, for at least the five years before the clinical worsening of ischaemic heart disease;
(73)      an inability to consume an average of at least 100 grams of fish per fortnight for at least the five years before the clinical worsening of ischaemic heart disease;
(74)      consuming an average daily intake of at least 12 grams (200 millimoles) of salt for at least the five years before the clinical worsening of ischaemic heart disease;
(75)      having periodic, heavy alcohol consumption for the one year before the clinical worsening of ischaemic heart disease;
Note: alcohol and periodic, heavy alcohol consumption are defined in the Schedule 1 - Dictionary.
(76)      having obstructive sleep apnoea for at least the one year before the clinical worsening of ischaemic heart disease;
Note: obstructive sleep apnoea is defined in the Schedule 1 - Dictionary.
(77)      an inability to sleep for an average of at least five hours daily for at least the one year before the clinical worsening of ischaemic heart disease;
(78)      undertaking night shift work on at least 250 occasions over a continuous period, for at least the five years before the clinical worsening of ischaemic heart disease;
Note: night shift work is defined in the Schedule 1 - Dictionary.
(79)      working long hours over a continuous period for at least the five years before the clinical worsening of ischaemic heart disease;
Note: long hours is defined in the Schedule 1 - Dictionary.
(80)      being infected with human immunodeficiency virus for at least five years before the clinical worsening of ischaemic heart disease;
(81)      having periodontitis for at least the five years before the clinical worsening of ischaemic heart disease;
(82)      having infective endocarditis or syphilis involving the coronary arteries at the time of the clinical worsening of ischaemic heart disease;
(83)      undergoing a procedure involving catheterisation of the affected coronary artery within the five years before the clinical worsening of ischaemic heart disease;
(84)      having a specified autoimmune collagen vascular disease at the time of the clinical worsening of ischaemic heart disease;
Note: specified autoimmune collagen vascular disease is defined in the Schedule 1 - Dictionary.
(85)      having gout or hyperuricaemia at the time of the clinical worsening of ischaemic heart disease;
Note: hyperuricaemia is defined in the Schedule 1 - Dictionary.
(86)      for acute myocardial infarction or sudden death from ischaemic heart disease only:
(a)           undertaking physical activity of five METs or more within the 24 hours before the clinical worsening of ischaemic heart disease;
(b)          experiencing a category 1A stressor within the 48 hours before the clinical worsening of ischaemic heart disease;
(c)           experiencing a category 1B stressor within the 48 hours before the clinical worsening of ischaemic heart disease;
(d)          experiencing an acute, severe, emotional stressor within the 24 hours before the clinical worsening of ischaemic heart disease;
(e)           experiencing the death of a significant other within the 12 months before the clinical worsening of ischaemic heart disease;
(f)           using a drug from Specified List 2 of drugs within the 24 hours before the clinical worsening of ischaemic heart disease;
(g)          having an episode of acute cholinergic poisoning from exposure to an organophosphorus ester within the seven days before the clinical worsening  of ischaemic heart disease;
(h)          being exposed to:
(i)            an environment of extreme heat during a heatwave; or
(ii)          an environment of extreme cold during a cold snap; or
(iii)        an abrupt alteration of temperature by ten degrees Celsius or more, to extreme heat or to extreme cold;
for a period of at least six hours within the seven days before the clinical worsening of ischaemic heart disease;
(i)            inhaling ambient highly polluted air as specified for at least two hours within the seven days before the clinical worsening of ischaemic heart disease;
(j)            being envenomated by a snake, scorpion, wasp, bee, hornet, spider, fish or jellyfish within the 24 hours before the clinical worsening of ischaemic heart disease;
(k)          having an acute hypersensitivity reaction involving the coronary arteries as a result of being exposed to a drug, food or environmental agent from the specified list within the 24 hours before the clinical worsening of ischaemic heart disease;
(l)            having influenza or a lower respiratory tract infection within the 30 days before the clinical worsening of ischaemic heart disease; or
(m)        being pregnant within the six weeks before the clinical worsening of ischaemic heart disease;
Note: acute cholinergic poisoning; acute, severe, emotional stressor; ambient highly polluted air as specified; category 1A stressor; category 1B stressor; cold snap; drug, food or environmental agent from the specified list; extreme cold; extreme heat; heatwave; organophosphorus ester; MET; significant other and Specified List 2 of drugs are defined in the Schedule 1 - Dictionary.
(87)      inability to obtain appropriate clinical management for ischaemic heart 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(44) to 9(87) apply only to material contribution to, or aggravation of, ischaemic heart disease where the person’s ischaemic heart 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:
                               acute cholinergic poisoning means symptoms and signs due to the inhibition of acetylcholinesterase enzyme activity which occur within the 24 hours following exposure.  These symptoms and signs are: acute paralysis, overwhelming bronchial secretions, bradycardia, gastrointestinal distress, miosis, lacrimation or diarrhoea.
                               acute, severe, emotional stressor means an event which causes a sudden, intense emotional or psychological response, such as an emergency incident or an emotionally charged situation.
                               alcohol is measured by the alcohol consumption calculations utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink.
                               alcohol intoxication means recent ingestion of alcohol, accompanied by the following signs or symptoms:
(a)           clinically significant problematic behavioural or psychological changes (for example, inappropriate sexual or aggressive behaviour, mood lability, impaired judgment) that developed during, or shortly after, alcohol ingestion; and
(b)          one or more of the following signs or symptoms developing during, or shortly after, alcohol use:
(i)            slurred speech;
(ii)          incoordination;
(iii)        unsteady gait;
(iv)        nystagmus;
(v)          impairment in attention or memory; or
(vi)        stupor or coma.
                               ambient chronically polluted air as specified means air with average annual concentrations of particulate matter with an aerodynamic diameter of < 2.5 µm (PM2.5) exceeding 8 µg/m3.
                               ambient highly polluted air as specified means air with 24 hour average concentrations of:
(a)           particulate matter with an aerodynamic diameter of < 2.5 µm (PM2.5) exceeding 25 µg/m3; or
(b)          particulate matter with an aerodynamic diameter of < 10 µm (PM10) exceeding 50 µg/m3.
                               amphetamines as specified means any one of the following drugs:
(a)           3,4-methylenedioxymethamphetamine (ecstasy);
(b)          crystal methamphetamine (ice);
(c)           methamphetamine (speed); or
(d)          paramethoxymethamphetamine.
                               antiandrogen therapy as specified means one of the following drugs:
(a)           androgen receptor blockers (including cyproterone acetate, flutamide and bicalutamide); or
(b)          gonadotrophin releasing hormone agonists (including goserelin and leuprorelin).
                               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 a person who is smoking.
                               being obese means:
(a)           having a Body Mass Index (BMI) of 30 or greater; or
(b)          for males, having a waist circumference exceeding 102 centimetres; or
(c)           for females, having a waist circumference exceeding 88 centimetres.
Note: BMI is also defined in the Schedule 1 - Dictionary.
                               being sedentary means waking behaviour characterised by an average energy expenditure of 1.5 METs or less while in a sitting or reclining posture.
                               BMI means W/H2 and where:
                               W is the person's weight in kilograms; and
                               H is the person's height in metres.
                               category 1A stressor means one of the following severe traumatic events:
(a)           experiencing a life-threatening event;
(b)          being subject to a serious physical attack or assault including rape and sexual molestation; or
(c)           being threatened with a weapon, being held captive, being kidnapped, or being tortured.
                               category 1B stressor means one of the following severe traumatic events:
(a)           being an eyewitness to a person being killed or critically injured;
(b)          viewing corpses or critically injured casualties as an eyewitness;
(c)           being an eyewitness to atrocities inflicted on another person or persons;
(d)          killing or maiming a person; or
(e)           being an eyewitness to or participating in, the clearance of critically injured casualties.
Note: eyewitness is also defined in the Schedule 1 - Dictionary.
                               chronic kidney disease means having a glomerular filtration rate of less than 60 mL/min/1.73 m2 for a period of at least three months, or the presence of irreversible kidney damage.
                               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.
                               cold snap means three or more days of unusually low maximum and minimum temperatures.
                               clinically significant disorder of mental health as specified means one of the following conditions, which is of sufficient severity to warrant ongoing management, which may involve regular visits (for example, at least monthly) to a psychiatrist, counsellor or general practitioner:
(a)           agoraphobia;
(b)          anxiety disorder;
(c)           depressive disorder;
(d)          panic disorder;
(e)           posttraumatic stress disorder;
(f)           schizophrenia; or
(g)          social anxiety disorder.
                               cumulative equivalent dose means the total dose of ionising radiation received by the particular organ or tissue.  The formula used to calculate the cumulative equivalent dose allows doses from multiple types of ionising radiation to be combined, by accounting for their differing biological effect.  The unit of equivalent dose is the sievert.  For the purposes of this Statement of Principles, the calculation of cumulative equivalent dose excludes doses received from normal background radiation, but includes therapeutic radiation, diagnostic radiation, cosmic radiation at high altitude, radiation from occupation-related sources and radiation from nuclear explosions or accidents.
                               drug, food or environmental agent from the specified list means:
(a)           beta-lactam antibiotics;
(b)          histidine contaminated fish (scombroid syndrome);
(c)           latex;
(d)          succinylated gelatin (Gelofusine); or
(e)           other drug, food or agent where there is evidence of an associated systemic allergic reaction.
                               dyslipidaemia means persistently abnormal blood lipid levels, diagnosed by a medical practitioner and evidenced by:
(a)           a total serum cholesterol level greater than 5.5 mmol/L; or
(b)          a serum low density lipoprotein level greater than 4.0 mmol/L; or
(c)           a serum high density lipoprotein cholesterol level less than 1.0 mmol/L; or
(d)          the regular administration of drug therapy to normalise blood lipid levels.
                               extreme cold means zero degrees Celsius or below.
                               extreme heat means 40 degrees Celsius or above.
                               eyewitness means a person who observes an incident first hand and can give direct evidence of it.  This excludes a person exposed only to media coverage of the incident.
                               heatwave means three or more days of unusually high maximum and minimum temperatures.
                               hypercoagulable state as specified means any one of the following:
(a)           acquired activated protein C resistance;
(b)          acquired antithrombin III deficiency;
(c)           acquired dysfibrinogenaemia;
(d)          acquired protein C deficiency;
(e)           acquired protein S deficiency;
(f)           antiphospholipid syndrome;
(g)          aplastic anaemia;
(h)          disseminated intravascular coagulation;
(i)            essential thrombocythaemia;
(j)            haemolytic uraemic syndrome;
(k)          heparin-induced thrombocytopaenia;
(l)            hyperfibrinogenaemia;
(m)        hyperproteinaemia;
(n)          hyperviscosity syndrome;
(o)          immune thrombocytopaenic purpura;
(p)          myeloma;
(q)          myeloproliferative disease;
(r)            nephrotic syndrome;
(s)           paroxysmal nocturnal haemoglobinuria;
(t)            polycythaemia vera;
(u)          secondary thrombocytosis; or
(v)          sickle cell disorder.
                               hyperuricaemia means having a serum urate level persistently greater than 0.40 mmol/L.
                               inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD) means:
(a)           decanting or spraying;
(b)          cleaning or maintaining equipment used to apply;
(c)           being sprayed with;
(d)          handling or sawing timber treated with;
(e)           being in an environment shrouded in dust from timber treated with; or
(f)           using cutting oils contaminated with:
                               one of the following chemicals:
(i)            2,4,5-trichlorophenoxyacetic acid;
(ii)          2,4,5-trichlorophenoxypropionic acid;
(iii)        2,4,5-trichlorophenol;
(iv)        2-(2,4,5-trichlorophenoxy)-ethyl 2,2-dichloropropionate;
(v)          o,o-dimethyl-o-(2,4,5-trichlorophenyl)-phosphorothioate;
(vi)        pentachlorophenol;
(vii)      2,3,4,6-tetrachlorophenol;
(viii)    2,4,6-trichlorophenol;
(ix)        1,3,4-trichloro-2-(4-nitrophenoxy)benzene;
(x)          2,4-dichloro-1-(4-nitrophenoxy)benzene; or
(xi)        2,4-dichloro-1-(3-methoxy-4-nitrophenoxy)-benzene.
                               ischaemic heart disease—see subsection 7(2).
                               long hours means an average of at least 50 hours per week, or an average of at least ten hours per day.
                               MRCA means the Military Rehabilitation and Compensation Act 2004.
                               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.
                               night shift work means working for at least three hours between 12 AM and 5 AM.
                               obstructive sleep apnoea means a type of sleep apnoea characterised on sleep study by repetitive apnoea or hypopnoea in the presence of respiratory effort during sleep, where there are at least five apnoea or hypopnoea episodes per hour of sleep.
                               organophosphorus ester means an agent used to inhibit acetylcholinesterase, and includes the organophosphate pesticides chlorpyrifos, dichlorvos, EPN (ethyl p-nitrophenyl theonobenzenephosphonate), leptophos, methamidophos, mipafox (diisopropyl phosphorofluoridate), omethoate, parathion, TOCP (tri-ortho-cresyl phosphate), trichlorfon and trichlornat.
                               pack-year of cigarettes, or the equivalent thereof in other tobacco products means a calculation of consumption where one pack-year of cigarettes equals 20 tailor-made cigarettes per day for a period of one calendar year, or 7 300 cigarettes.  One tailor-made cigarette approximates one gram of tobacco or one gram of cigar or pipe tobacco by weight.  One pack-year of tailor-made cigarettes equates to 7.3 kilograms of smoking tobacco by weight.  Tobacco products mean cigarettes, pipe tobacco or cigars, smoked alone or in any combination.
                               periodic, heavy alcohol consumption means sessions of heavy alcohol drinking to the point of alcohol intoxication at least once a month.
Note: alcohol intoxication is also defined in the Schedule 1 - Dictionary.
                               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.
                               significant other means a person who has a close family bond or a close personal relationship and is important or influential in one's life.
                               specified autoimmune collagen vascular disease means:
(a)           ankylosing spondylitis;
(b)          Behcet's syndrome;
(c)           dermatomyositis;
(d)          eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome);
(e)           giant cell (temporal) arteritis;
(f)           Henoch-Schönlein purpura;
(g)          microscopic polyangiitis;
(h)          mucocutaneous lymph node syndrome (Kawasaki's disease);
(i)            non-specific autoimmune vasculitis;
(j)            polyarteritis nodosa;
(k)          polymyositis;
(l)            rheumatoid arthritis;
(m)        Sjögren's syndrome;
(n)          systemic lupus erythematosus;
(o)          systemic sclerosis;
(p)          Takayasu's arteritis;
(q)          thromboangiitis obliterans (Buerger's disease); or
(r)            Wegener's granulomatosis.
                               Specified List 1 of drugs means:
(a)           antipsychotics;
(b)          aromatase inhibitors;
(c)           bevacizumab;
(d)          capecitabine;
(e)           dextroamphetamine;
(f)           docetaxel;
(g)          ephedrine;
(h)          ergotamine;
(i)            erlotinib;
(j)            fluorouracil;
(k)          macrolide antibiotics;
(l)            methylphenidate;
(m)        paclitaxel;
(n)          phentermine;
(o)          pseudoephedrine;
(p)          sorafenib; or
(q)          triptans, including sumatriptan.
                               Specified List 2 of drugs means:
(a)           amphetamines as specified;
(b)          cocaine;
(c)           D-lysergic acid diethylamide (LSD); or
(d)          marijuana.
Note: amphetamines as specified is also defined in the Schedule 1 - Dictionary.
                               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.
                               VEA means the Veterans' Entitlements Act 1986.