Statement of Principles
concerning
 
RENAL ARTERY ATHEROSCLEROTIC DISEASE
No. 103 of 2011
 
for the purposes of the
 
Veterans’ Entitlements Act 1986
and
Military Rehabilitation and Compensation Act 2004
 
Title
1.         This Instrument may be cited as Statement of Principles concerning renal artery atherosclerotic disease No. 103 of 2011.
 
Determination
2.         The Repatriation Medical Authority under subsection 196B(3) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):
(a)        revokes Instrument No. 33 of 1999, as amended by Instrument No. 25 of 2002, concerning renal artery atherosclerotic disease; and
(b)        determines in their place this Statement of Principles.
 
Kind of injury, disease or death
3.         (a)        This Statement of Principles is about renal artery atherosclerotic disease and death from renal artery atherosclerotic disease.
(b)              For the purposes of this Statement of Principles, "renal artery atherosclerotic disease" means atherosclerosis of the renal arteries, causing a partial or complete occlusion of a renal artery, and together with one of the following clinical manifestations, namely acute, moderate to severe or poorly controlled hypertension, persistent renal impairment, acute pulmonary oedema or chronic heart failure; or where treatment occurs.
(c)              Renal artery atherosclerotic disease attracts ICD-10-AM code I70.1.
(d)              In the application of this Statement of Principles, the definition of "renal artery atherosclerotic disease" is that given at paragraph 3(b) above.
 
Basis for determining the factors
4.         On the sound medical-scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that renal artery atherosclerotic disease and death from renal artery atherosclerotic disease 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).
 
Factors that must be related to service
5.         Subject to clause 7, at least one of the factors set out in clause 6 must be related to the relevant service rendered by the person.
 
Factors
6.         The factor that must exist before it can be said that, on the balance of probabilities, renal artery atherosclerotic disease or death from renal artery atherosclerotic disease is connected with the circumstances of a person’s relevant service is:
 
(a)                smoking at least 20 pack-years of cigarettes or the equivalent thereof in other tobacco products, before the clinical onset of renal artery atherosclerotic disease; or
 
(b)               having hypertension for a period of at least ten years before the clinical onset of renal artery atherosclerotic disease; or
 
(c)                having diabetes mellitus before the clinical onset of renal artery atherosclerotic disease; or
 
(d)               having dyslipidaemia before the clinical onset of renal artery atherosclerotic disease; or
 
(e)                having hyperhomocysteinaemia before the clinical onset of renal artery atherosclerotic disease; or
 
(f)                having received a cumulative equivalent dose of at least 1.0 sievert of ionising radiation to the renal artery before the clinical onset of renal artery atherosclerotic disease; or
 
(g)               undergoing a course of therapeutic radiation, where the renal artery was in the field of radiation, before the clinical onset of renal artery atherosclerotic disease; or
 
(h)               smoking at least 20 pack-years of cigarettes or the equivalent thereof in other tobacco products, before the clinical worsening of renal artery atherosclerotic disease; or
 
(i)                 having hypertension for a period of at least ten years before the clinical worsening of renal artery atherosclerotic disease; or
 
(j)                 having diabetes mellitus before the clinical worsening of renal artery atherosclerotic disease; or
 
(k)               having dyslipidaemia before the clinical worsening of renal artery atherosclerotic disease; or
 
(l)                 having hyperhomocysteinaemia before the clinical worsening of renal artery atherosclerotic disease; or
 
(m)             having received a cumulative equivalent dose of at least 1.0 sievert of ionising radiation to the renal artery before the clinical worsening of renal artery atherosclerotic disease; or
 
(n)               undergoing a course of therapeutic radiation, where the renal artery was in the field of radiation, before the clinical worsening of renal artery atherosclerotic disease; or
 
(o)               being treated with an angiotensin converting enzyme inhibitor or an angiotensin receptor blocker, within the 28 days before the clinical worsening of renal artery atherosclerotic disease; or
 
(p)               inability to obtain appropriate clinical management for renal artery atherosclerotic disease.
 
Factors that apply only to material contribution or aggravation
7.         Paragraphs 6(h) to 6(p) apply only to material contribution to, or aggravation of, renal artery atherosclerotic disease where the person’s renal artery atherosclerotic disease was suffered or contracted before or during (but not arising out of) the person’s relevant service.
 
Inclusion of Statements of Principles
8.                  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 as in force from time to time.
 
Other definitions
9.                  For the purposes of this Statement of Principles:
 
"a course of therapeutic radiation" means one or more fractions (treatment portions) of ionising radiation administered with the aim of achieving palliation or cure with gamma rays, x-rays, alpha particles or beta particles;
 
"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;
 
"death from renal artery atherosclerotic disease" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s renal artery atherosclerotic disease;
 
"dyslipidaemia" generally means evidence of a persistently abnormal lipid profile after the accurate evaluation of serum lipids following a 12 hour overnight fast, and estimated on a minimum of two occasions as a:
(a)        total serum cholesterol level greater than or equal to 5.5 millimoles per litre (mmol/L);
(b)        serum triglyceride level greater than or equal to 2.0 mmol/L; or
(c)        having a high density lipoprotein cholesterol level less than 1.0 mmol/L;
 
"hyperhomocysteinaemia" means a condition characterised by an excess of homocysteine in the blood;
 
"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), Seventh Edition, effective date of 1 July 2010, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 978 1 74210 154 5;
 
"pack-years of cigarettes, or the equivalent thereof in other tobacco products" means a calculation of consumption where one pack-year of cigarettes equals twenty tailor-made cigarettes per day for a period of one calendar year, or 7300 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 7300 cigarettes, or 7.3 kilograms of smoking tobacco by weight. Tobacco products means either cigarettes, pipe tobacco or cigars smoked, alone or in any combination;
 
"relevant service" means:
(a)        eligible war service (other than operational service) under the VEA; or
(b)       defence service (other than hazardous 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.
 
Application
10.       This Instrument applies to all matters to which section 120B of the VEA or section 339 of the MRCA applies.
 
Date of effect
11.       This Instrument takes effect from 31 August 2011.
 
Dated this   nineteenth   day of   August   2011
 
 
The Common Seal of the                    )
Repatriation Medical Authority          )
was affixed to this instrument                        )
in the presence of:                               )
 
KEN DONALD
CHAIRPERSON