Statement of Principles
concerning
DEEP VEIN THROMBOSIS
No. 75 of 2008
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 deep vein thrombosis No. 75 of 2008.
Determination
2. The Repatriation Medical Authority under subsection 196B(3)
and (8) of the Veterans’ Entitlements Act 1986 (the VEA):
(a) revokes Instrument No. 6 of 2001, as amended by
Instrument No. 39 of 2004, concerning deep vein thrombosis; and
(b) determines
in their place this Statement of Principles.
Kind of injury, disease
or death
3. (a) This
Statement of Principles is about deep vein thrombosis and death from
deep vein thrombosis.
(b)
For the purposes of this Statement
of Principles, "deep vein thrombosis" means an aggregation of
blood factors, primarily platelets and fibrin with entrapment of cellular
elements, that forms in the deep venous system, and causes vascular obstruction
at the point of its formation, but excludes retinal, cerebral, pulmonary,
hepatic, renal, portal and mesenteric thrombosis.
(c)
Deep vein thrombosis attracts
ICD-10-AM code I80.1, I80.2, I80.8, I82.2 or I82.8.
(d)
In the application of this
Statement of Principles, the definition of "deep vein thrombosis" 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 deep vein thrombosis and death from deep vein thrombosis 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, deep vein thrombosis or death from deep
vein thrombosis is connected with the circumstances of a person’s relevant
service is:
(a)
having surgery requiring a
general, spinal or epidural anaesthetic, within the 90 days before the clinical
onset of deep vein thrombosis; or
(b)
having trauma to the affected vein
within the 90 days before the clinical onset of deep vein thrombosis; or
(c)
being immobile for at least four
consecutive hours within the 30 days before the clinical onset of deep vein
thrombosis; or
(d)
being an inpatient in a hospital
or a resident in a nursing home, within the 90 days before the clinical onset
of deep vein thrombosis; or
(e)
having :
(i)
a significant head injury;
(ii)
a spinal cord injury;
(iii)
a fracture to the spinal column,
pelvic bone, femur or tibia; or
(iv)
an injury to the affected limb
requiring treatment with a cast,
within the 90 days before the clinical onset of deep
vein thrombosis; or
(f)
having congestive cardiac failure within the 90 days before
the clinical onset of deep vein thrombosis; or
(g)
having a malignant neoplasm at the
time of the clinical onset of deep vein thrombosis; or
(h)
being treated with a cytotoxic
agent for a malignant disease within the 90 days before the clinical onset of
deep vein thrombosis; or
(i)
being treated with thalidomide or
lenalidomide, for a malignant disease, within the 90 days before the clinical
onset of deep vein thrombosis; or
(j)
having a myeloproliferative
disease at the time of the clinical onset of deep vein thrombosis; or
(k)
having a space occupying lesion
causing venous compression of:
(i)
the affected vein; or
(ii)
a vein draining the affected vein,
at the time of the clinical onset of deep
vein thrombosis; or
(l)
having systemic lupus
erythematosus at the time of the clinical onset of deep vein thrombosis; or
(m)
having dysfibrinogenaemia at the
time of the clinical onset of deep vein thrombosis; or
(n)
having Buerger’s disease at the
time of the clinical onset of deep vein thrombosis; or
(o)
having Behçet’s disease at the
time of the clinical onset of deep vein thrombosis; or
(p)
having hyperhomocysteinaemia at
the time of the clinical onset of deep vein thrombosis; or
(q)
having protein C deficiency,
protein S deficiency, antithrombin III deficiency or activated protein C
resistance, at the time of the clinical onset of deep vein thrombosis; or
(r)
having paroxysmal nocturnal
haemoglobinuria at the time of the clinical onset of deep vein thrombosis; or
(s)
having antiphospholipid antibody
syndrome at the time of the clinical onset of deep vein thrombosis; or
(t)
having a myocardial infarction
within the 90 days before the clinical onset of deep vein thrombosis; or
(u)
having an aneurysm of the affected
vein at the time of the clinical onset of deep vein thrombosis; or
(v)
being obese at the time of the
clinical onset of deep vein thrombosis; or
(w)
using combined oestrogen-progestin
contraception for a period of at least three weeks within the 90 days before
the clinical onset of deep vein thrombosis; or
(x)
having hormone replacement therapy
for a period of at least three weeks within the 90 days before the clinical
onset of deep vein thrombosis; or
(y)
being treated with a selective
oestrogen receptor modulator within the 90 days before the clinical onset of
deep vein thrombosis; or
(z)
having heparin-induced
thrombocytopaenia at the time of the clinical onset of deep vein thrombosis; or
(aa)
using erythropoietin within the 90
days before the clinical onset of deep vein thrombosis; or
(bb)
being pregnant or being within the
90 days postpartum, at the time of the clinical onset of deep vein thrombosis;
or
(cc)
for deep vein thrombosis in a
lower limb or the pelvis only, having paralysis of either or both lower limbs
at the time of the clinical onset of deep vein thrombosis; or
(dd)
for deep vein thrombosis in a
lower limb only, having varicose veins in the affected lower limb at the time
of the clinical onset of deep vein thrombosis; or
(ee)
for deep vein thrombosis in a
lower limb only, having superficial vein thrombosis of the affected lower limb
at the time of the clinical onset of deep vein thrombosis; or
(ff)
inability to obtain appropriate
clinical management for deep vein thrombosis.
Factors that apply only
to material contribution or aggravation
7. Paragraph 6(ff) applies only to material contribution
to, or aggravation of, deep vein thrombosis where the person’s deep vein
thrombosis 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 selective oestrogen receptor modulator" means a non-steroidal compound which exerts selective
agonist or antagonist effects on various oestrogen target tissues and includes
tamoxifen, raloxifene, toremifene and droloxifene;
"activated protein C resistance" means a condition where there is a reduced response
to the anticoagulant activity of activated protein C and is characterised by
reduced prolongation of the activated partial thromboplastin time in response
to added protein C;
"antiphospholipid antibody syndrome" means the presence of antiphospholipid antibodies or
lupus anticoagulant antibodies plus one or more of the following clinical
manifestations: venous thrombosis, arterial thrombosis, foetal loss or
thrombocytopaenia;
"antithrombin III" means a protein of normal plasma and extravascular
sites that inactivates thrombin and thus inhibits blood coagulation;
"Behçet’s disease" means a chronic, inflammatory, multisystem,
autoimmune disorder presenting with recurrent oral and genital ulcerations as
well as ocular involvement;
"being immobile" means at least gross diminution
of movement of a lower limb associated with sitting or reclining;
"being
obese" means an increase in body
weight by way of fat accumulation which results in a Body Mass Index (BMI) of
thirty 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;
"congestive cardiac failure" means congestion in the peripheral circulation or
congestion of the lungs or both, due to reduced stroke volume;
"death from deep vein thrombosis" in relation to a person includes death from a terminal
event or condition that was contributed to by the person’s deep vein
thrombosis;
"dysfibrinogenaemia" means a condition where there is both
normal and mutant fibrinogen in the blood plasma;
"hormone replacement therapy" means administration of oestrogen preparations often
in combination with progesterone to offset a hormone deficiency following
surgically induced or naturally occurring menopause;
"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), Sixth Edition, effective date of 1 July 2008, copyrighted
by the National Centre for Classification in Health, Sydney, NSW, and having
ISBN 978 1 74210 016 6;
"malignant neoplasm" means cancer of any part of the body, excluding
non-metastatic non-melanotic malignant neoplasm of the skin. The cancer may be
present but undiagnosed at the time of the clinical onset of deep vein
thrombosis;
"myeloproliferative disease" means family of disorders, including polycythaemia
vera, idiopathic myelofibrosis and essential thrombocytosis, characterised by
increased blood cell production which arise in a clonal manner from
abnormalities at the level of the haematopoietic stem cell;
"paralysis of either or both lower limbs" means loss or impairment of motor function of either
or both lower limbs, occurring in conditions such as stroke or spinal cord
injury;
"paroxysmal nocturnal haemoglobinuria" means a chronic acquired blood cell dysplasia in which
there is proliferation of a clone of stem cells producing erythrocytes,
platelets and granulocytes that are abnormally susceptible to lysis by
complement; it is characterised by the presence of free haemoglobin in the
urine, intravascular haemolysis and venous thrombosis;
"protein C deficiency" means a deficiency of a vitamin K dependent plasma
protein that, when activated, inhibits the clotting cascade at the levels of
factor V and factor VIII;
"protein S deficiency" means a deficiency of a vitamin K dependent plasma
protein that inhibits blood clotting by serving as a cofactor for activated
protein C;
"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;
"significant
head injury" means trauma
to the head resulting in:
(a)
a skull fracture; or
(b)
loss of consciousness with
retrograde amnesia; or
(c)
leakage of blood and/or
cerebrospinal fluid from the external auditory canal or from the nostril;
"spinal cord injury" means an injury to the long tracts of the spinal cord
resulting in motor or sensory deficits below the level of the lesion;
"superficial vein thrombosis" means thrombosis of the greater or lesser saphenous
veins or their tributaries;
"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;
"trauma to the affected vein" means injury to the affected vein by:
(a)
injection, cannulation or incision
of the affected vein;
(b)
therapeutic radiation to the
region of the affected vein; or
(c)
a crush injury to the affected
vein.
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 5 November
2008.
Notes to Statement of Principles concerning deep vein
thrombosis (Instrument No. 75 of 2008)
The Statement of Principles concerning deep vein thrombosis
(Instrument No. 75 of 2008) 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
|
Title
|
Date of notification
in Gazette or FRLI registration
|
Date of
commencement
|
Application, saving or
transitional provisions
|
|
Statement
of Principles concerning deep vein thrombosis (Instrument No. 75 of 2008)
|
27 October 2008
|
5 November 2008
|
|
|
Amendment
of Statement of Principles concerning deep vein thrombosis (Instrument No. 46
of 2009)
|
23 June 2009
|
1 July 2009
|
|
Table
of Amendments
|
ad. = added or inserted am. = amended
rep. = repealed rs. = repealed and substituted
|
|
Provision affected
|
How affected
|
|
Clause 6(p)
|
rs. Instrument No.46 of 2009
|
|
Clause 9 –
"hyperhomocystinaemia"
|
rep. Instrument No.46 of 2009
|
|
Clause 9 –
"hyperhomocysteinaemia"
|
ad. Instrument No.46 of 2009
|