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Statement of Principles concerning mitral valve prolapse No. 44 of 2014

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Statement of Principles
No. 44 of 2014
for the purposes of the
Veterans’ Entitlements Act 1986
Military Rehabilitation and Compensation Act 2004
1.         This Instrument may be cited as Statement of Principles concerning mitral valve prolapse No. 44 of 2014.
2.         The Repatriation Medical Authority under subsection 196B(3) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):
(a)        revokes Instrument No. 12 of 2003 concerning mitral valve prolapse; and
(b)       determines in its place this Statement of Principles.
Kind of injury, disease or death
3.         (a)        This Statement of Principles is about mitral valve prolapse and death from mitral valve prolapse.
(b)               For the purposes of this Statement of Principles, "mitral valve prolapse" means a structural disorder of the mitral valve apparatus in which there is systolic displacement of an abnormally thickened or redundant mitral leaflet into the left atrium, and which has been confirmed by echocardiographic studies.  Mitral valve prolapse is also known as floppy mitral valve.
This definition of mitral valve prolapse excludes:
(i)                  mitral valve displacement or billowing of the anterior mitral valve leaflet identified only in the 4-chamber apical view;
(ii)                isolated mitral regurgitation in the absence of echocardiographic evidence of mitral valve prolapse;
(iii)              mitral valve disorder due to rheumatic heart disease; or
(iv)              flail mitral valve leaflets.
(c)                Mitral valve prolapse attracts ICD-10-AM code I34.1.
(d)       In the application of this Statement of Principles, the definition of "mitral valve prolapse" is that given at paragraph 3(b) above.
Basis for determining the factors
4.         After examining the available sound medical-scientific evidence the Repatriation Medical Authority is of the view that it is more probable than not on the sound medical-scientific evidence available, that the only factor that can be related to the cause of or material contribution to or aggravation of mitral valve prolapse or death from mitral valve prolapse and which can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the Military Rehabilitation and Compensation Act 2004 (the MRCA) is that set out in clause 5.
Factors that must be related to service
5.         The factor that must exist before it can be said that, on the balance of probabilities, in relation to the circumstances of a person’s relevant service causing or materially contributing to or aggravating mitral valve prolapse or death from mitral valve prolapse is inability to obtain appropriate clinical management for mitral valve prolapse.
Other definitions
6.         For the purposes of this Statement of Principles:
"death from mitral valve prolapse" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s mitral valve prolapse;
"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), Eighth Edition, effective date of 1 July 2013, copyrighted by the Independent Hospital Pricing Authority, and having ISBN 978-1-74128-213-9;
"relevant service" means:
(a)                eligible war service (other than operational service) under the VEA;
(b)               defence service (other than hazardous service and British nuclear test defence service) under the VEA; or
(c)                peacetime service under the MRCA;
"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.
7.         This Instrument applies to all matters to which section 120B of the VEA or section 339 of the MRCA applies.
Date of effect
8.         This Instrument takes effect from 7 May 2014.
Dated this  twenty-fourth   day of   April   2014
The Common Seal of the                    )
Repatriation Medical Authority          )
was affixed to this instrument                        )
in the presence of:                               )