What can I claim secondary to myocarditis?
5 conditions in the Repatriation Medical Authority's Statements of Principles list myocarditis as a factor. If DVA has accepted your myocarditis, each of these has a documented pathway to a further claim.
At a glance
- Accepted conditionMyocarditis
- Conditions it may open5
- SourceRMA SoPs
- Chart Review$600 + GST
How a secondary claim works
Some Statement of Principles factors are not about service at all — they name another condition. Where DVA has already accepted your myocarditis, and another condition's SoP lists myocarditis as a factor, that part of the next claim is already established on your file. How a secondary claim works, in full →
Conditions that list myocarditis as a factor
Quoted from the instrument. A pathway existing is not the same as a claim succeeding — each factor carries thresholds your record has to satisfy.
Atrial fibrillation and atrial flutter
RH No. 1 of 2023 · BoP No. 2 of 2023
Reasonable Hypothesis — factor (3): “having non-infectious myocarditis at the time of the clinical onset of atrial fibrillation or atrial flutter” [clinical onset] — factor (4): “having viral myocarditis at the time of the clinical onset of atrial fibrillation or atrial flutter” [clinical onset] — factor (47): “having non-infectious myocarditis at the time of the clinical worsening of atrial fibrillation or atrial flutter” [worsening] — factor (48): “having viral myocarditis at the time of the clinical worsening of atrial fibrillation or atrial flutter” [worsening]
Balance of Probabilities — factor (3): “having non-infectious myocarditis at the time of the clinical onset of atrial fibrillation or atrial flutter” [clinical onset] — factor (4): “having viral myocarditis at the time of the clinical onset of atrial fibrillation or atrial flutter” [clinical onset] — factor (40): “having non-infectious myocarditis at the time of the clinical worsening of atrial fibrillation or atrial flutter” [worsening] — factor (41): “having viral myocarditis at the time of the clinical worsening of atrial fibrillation or atrial flutter” [worsening]
Note: Non-infectious myocarditis can be acute or chronic.
Note: Viral myocarditis can be acute or chronic.
Cardiomyopathy
RH No. 57 of 2024 · BoP No. 58 of 2024
Reasonable Hypothesis — factor (2): “having myocarditis before clinical onset or at the time of clinical worsening” [onset and worsening]
Balance of Probabilities — factor (2): “having myocarditis before clinical onset or at the time of clinical worsening” [onset and worsening]
Heart block
RH No. 23 of 2022 · BoP No. 24 of 2022
Reasonable Hypothesis — factor (7): “having non-infectious myocarditis at the time of the clinical onset of heart block” [clinical onset] — factor (8): “having viral myocarditis at the time of the clinical onset of heart block” [clinical onset] — factor (40): “having non-infectious myocarditis at the time of the clinical worsening of heart block” [worsening] — factor (41): “having viral myocarditis at the time of the clinical worsening of heart block” [worsening]
Balance of Probabilities — factor (7): “having non-infectious myocarditis at the time of the clinical onset of heart block” [clinical onset] — factor (8): “having viral myocarditis at the time of the clinical onset of heart block” [clinical onset] — factor (34): “having non-infectious myocarditis at the time of the clinical worsening of heart block” [worsening] — factor (35): “having viral myocarditis at the time of the clinical worsening of heart block” [worsening]
Note: Non-infectious myocarditis can be acute or chronic.
Note: Viral myocarditis can be acute or chronic.
Pericarditis
RH No. 90 of 2023 · BoP No. 91 of 2023
Reasonable Hypothesis — factor (13): “having myocarditis at the time of the clinical onset or clinical worsening of pericarditis” [onset and worsening]
Balance of Probabilities — factor (13): “having myocarditis at the time of the clinical onset or clinical worsening of pericarditis” [onset and worsening]
Sick sinus syndrome
RH No. 66 of 2022 · BoP No. 67 of 2022
Reasonable Hypothesis — factor (8): “having non-infectious myocarditis at the time of the clinical onset of sick sinus syndrome” [clinical onset] — factor (9): “having viral myocarditis at the time of the clinical onset of sick sinus syndrome” [clinical onset] — factor (33): “having non-infectious myocarditis at the time of the clinical worsening of sick sinus syndrome” [worsening] — factor (34): “having viral myocarditis at the time of the clinical worsening of sick sinus syndrome” [worsening]
Balance of Probabilities — factor (8): “having non-infectious myocarditis at the time of the clinical onset of sick sinus syndrome” [clinical onset] — factor (9): “having viral myocarditis at the time of the clinical onset of sick sinus syndrome” [clinical onset] — factor (26): “having non-infectious myocarditis at the time of the clinical worsening of sick sinus syndrome” [worsening] — factor (27): “having viral myocarditis at the time of the clinical worsening of sick sinus syndrome” [worsening]
Note: Non-infectious myocarditis can be acute or chronic.
Note: Viral myocarditis can be acute or chronic.
Other accepted conditions that also open atrial fibrillation and atrial flutter
If any of these is also on your file, it reaches some of the same conditions myocarditis does.
What DVA means by myocarditis
A claim is tested against the definition first. If the diagnosis on your file does not meet this wording, the factors below never get reached — so it is worth checking that what your doctor wrote matches what the instrument requires.
Myocarditis, for the purposes of the Statement of Principles, for the purposes of this Statement of Principles, myocarditis: (a) means an inflammation of the heart muscle (myocardium); and (b) excludes inflammation associated with coronary artery disease. (3) While myocarditis attracts ICD-10-AM codes I40, I41, I01.2, I09.0, I51.4, in applying this Statement of Principles the meaning of myocarditis 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), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4.
Note the exclusion. This instrument expressly excludes inflammation associated with coronary artery disease. A diagnosis of that is not a diagnosis of myocarditis, and a claim framed the wrong way fails on the definition before any factor is considered.
RH No. 17 of 2024 · BoP No. 18 of 2024 · 25 factors
What could support a claim for myocarditis?
The Statement of Principles for myocarditis names 7 other conditions among its own factors. If any of these is already accepted on your file, it may be the factor that carries a myocarditis claim — quoted here from the instrument.
Tuberculosis
Reasonable Hypothesis — factor (5): “having tuberculosis before clinical onset or clinical worsening” [onset and worsening]
Balance of Probabilities — factor (5): “having tuberculosis before clinical onset or clinical worsening” [onset and worsening]
Acute rheumatic fever
Reasonable Hypothesis — factor (6): “having acute rheumatic fever at the time of clinical onset or clinical worsening” [onset and worsening]
Balance of Probabilities — factor (6): “having acute rheumatic fever at the time of clinical onset or clinical worsening” [onset and worsening]
Polyarteritis nodosa
Reasonable Hypothesis — factor (7): “having one of the following vasculitides: (a) Behcet disease; (b) eosinophilic granulomatosis with polyangiitis (Churg Strauss syndrome); (c) giant cell (temporal) arteritis; (d) granulomatosis with polyangiitis (Wegener granulomatosis); (e) Kawasaki disease; (f) polyarteritis nodosa; or (g) Takayasu arteritis; at the time of clinical onset or clinical worsening” [onset and worsening]
Balance of Probabilities — factor (7): “having one of the following vasculitides: Behcet disease; eosinophilic granulomatosis with polyangiitis (Churg Strauss syndrome); giant cell (temporal) arteritis; granulomatosis with polyangiitis (Wegener granulomatosis); Kawasaki disease; polyarteritis nodosa; or Takayasu arteritis; at the time of clinical onset or clinical worsening” [onset and worsening]
Systemic lupus erythematosus
Reasonable Hypothesis — factor (8): “having one of the following systemic inflammatory diseases: (a) antiphospholipid syndrome; (b) coeliac disease; (c) dermatomyositis; (d) Graves disease; (e) Hashimoto disease; (f) IgG4-related disease; (g) inflammatory bowel disease; (h) mixed connective tissue disease; (i) polymyositis; (j) psoriatic arthritis; (k) rheumatoid arthritis; (l) scleroderma (progressive systemic sclerosis); (m) Sjögren syndrome; or (n) systemic lupus erythematosus; at the time of clinical onset or clinical worsening” [onset and worsening]
Balance of Probabilities — factor (8): “having one of the following systemic inflammatory diseases: antiphospholipid syndrome; coeliac disease; dermatomyositis; Graves disease; Hashimoto disease; inflammatory bowel disease; polymyositis; rheumatoid arthritis; scleroderma (progressive systemic sclerosis); Sjögren syndrome; or systemic lupus erythematosus; at the time of clinical onset or clinical worsening” [onset and worsening]
Acute pancreatitis
Reasonable Hypothesis — factor (9): “having acute pancreatitis at the time of clinical onset or clinical worsening” [onset and worsening]
Smallpox
Reasonable Hypothesis — factor (18): “having smallpox vaccine within the 4 weeks before clinical onset or clinical worsening” [onset and worsening]
Balance of Probabilities — factor (17): “having smallpox vaccine within the 4 weeks before clinical onset or clinical worsening” [onset and worsening]
Alcohol use disorder
Reasonable Hypothesis — factor (25): “having an alcohol use disorder at the time of clinical onset or clinical worsening” [onset and worsening]
Balance of Probabilities — factor (24): “having an alcohol use disorder at the time of clinical onset or clinical worsening” [onset and worsening]
Reviewed by Dr Thomas Perkins
Founding doctor, Veterans Health Centre · former RAAF aviation medical officer · 13 years working exclusively with ADF members and veterans. Full profile →
Myocarditis accepted?
Contact us for more information.