What can I claim secondary to pericarditis?
2 conditions in the Repatriation Medical Authority's Statements of Principles list pericarditis as a factor. If DVA has accepted your pericarditis, each of these has a documented pathway to a further claim.
At a glance
- Accepted conditionPericarditis
- Conditions it may open2
- 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 pericarditis, and another condition's SoP lists pericarditis 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 pericarditis 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 (6): “having pericarditis at the time of the clinical onset of atrial fibrillation or atrial flutter” [clinical onset] — factor (50): “having pericarditis at the time of the clinical worsening of atrial fibrillation or atrial flutter” [worsening]
Balance of Probabilities — factor (6): “having pericarditis at the time of the clinical onset of atrial fibrillation or atrial flutter” [clinical onset] — factor (43): “having pericarditis at the time of the clinical worsening of atrial fibrillation or atrial flutter” [worsening]
Sick sinus syndrome
RH No. 66 of 2022 · BoP No. 67 of 2022
Reasonable Hypothesis — factor (6): “having pericarditis at the time of the clinical onset of sick sinus syndrome” [clinical onset] — factor (31): “having pericarditis at the time of the clinical worsening of sick sinus syndrome” [worsening]
Balance of Probabilities — factor (6): “having pericarditis at the time of the clinical onset of sick sinus syndrome” [clinical onset] — factor (24): “having pericarditis at the time of the clinical worsening of sick sinus syndrome” [worsening]
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 pericarditis does.
What DVA means by pericarditis
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.
Pericarditis, for the purposes of the Statement of Principles, for the purposes of this Statement of Principles, pericarditis: (a) means an inflammation of the pericardium; and (b) includes: (i) acute pericarditis; (ii) chronic pericarditis; (iii) recurrent pericarditis; and (iv) constrictive pericarditis; and (c) excludes haemorrhage from pericardial injury not associated with pericardial inflammation. (3) While pericarditis attracts ICD-10-AM codes, I30, I31.0, I31.1, I01.0, and I09.2, in applying this Statement of Principles the meaning of pericarditis 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 haemorrhage from pericardial injury not associated with pericardial inflammation. A diagnosis of that is not a diagnosis of pericarditis, and a claim framed the wrong way fails on the definition before any factor is considered.
RH No. 90 of 2023 · BoP No. 91 of 2023 · 33 factors
What could support a claim for pericarditis?
The Statement of Principles for pericarditis names 9 other conditions among its own factors. If any of these is already accepted on your file, it may be the factor that carries a pericarditis claim — quoted here from the instrument.
Electrical injury
Reasonable Hypothesis — factor (6): “having electrical injury affecting the heart within the 20 years before the clinical onset or clinical worsening of pericarditis” [onset and worsening]
Balance of Probabilities — factor (6): “having electrical injury affecting the heart within the 20 years before the clinical onset or clinical worsening of pericarditis” [onset and worsening]
Tuberculosis
Reasonable Hypothesis — factor (11): “having tuberculosis before the clinical onset or clinical worsening of pericarditis” [onset and worsening]
Balance of Probabilities — factor (11): “having tuberculosis before the clinical onset or clinical worsening of pericarditis” [onset and worsening]
Myocarditis
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]
Acute rheumatic fever
Reasonable Hypothesis — factor (14): “having acute rheumatic fever at the time of the clinical onset or clinical worsening of pericarditis” [onset and worsening]
Balance of Probabilities — factor (14): “having acute rheumatic fever at the time of the clinical onset or clinical worsening of pericarditis” [onset and worsening]
Microscopic polyangiitis
Reasonable Hypothesis — factor (15): “having one of the following vasculitides: (a) Behcet's disease; (b) eosinophilic granulomatosis with polyangiitis (Churg Straus syndrome); (c) giant cell (temporal) arteritis; (d) granulomatosis with polyangiitis (Wegener's granulomatosis); (e) microscopic polyangiitis; (f) polyarteritis nodosa; or (g) Takayasu's arteritis; at the time of the clinical onset or clinical worsening of pericarditis” [onset and worsening]
Balance of Probabilities — factor (15): “having one of the following vasculitides: (a) Behcet's disease; (b) eosinophilic granulomatosis with polyangiitis (Churg Straus syndrome); (c) giant cell (temporal) arteritis; (d) granulomatosis with polyangiitis (Wegener's granulomatosis); (e) microscopic polyangiitis; (f) polyarteritis nodosa; or (g) Takayasu's arteritis; at the time of the clinical onset or clinical worsening of pericarditis” [onset and worsening]
Systemic lupus erythematosus
Reasonable Hypothesis — factor (16): “having one of the following systemic inflammatory diseases: (a) Addison disease with type 2 autoimmune polyglandular syndrome; (b) ankylosing spondylitis and seronegative spondyloarthropathies; (c) dermatomyositis; (d) IgG4-related disease; (e) inflammatory bowel disease; (f) mixed connective tissue disease; (g) polymyositis; (h) rheumatoid arthritis; (i) scleroderma (progressive systemic sclerosis); (j) Sjögren's syndrome; or (k) systemic lupus erythematosus; at the time of the clinical onset or clinical worsening of pericarditis” [onset and worsening]
Balance of Probabilities — factor (16): “having one of the following systemic inflammatory diseases: (a) Addison disease with type 2 autoimmune polyglandular syndrome; (b) ankylosing spondylitis and seronegative spondyloarthropathies; (c) dermatomyositis; (d) IgG4-related disease; (e) inflammatory bowel disease; (f) mixed connective tissue disease; (g) polymyositis; (h) rheumatoid arthritis; (i) scleroderma (progressive systemic sclerosis); (j) Sjögren's syndrome; or (k) systemic lupus erythematosus; at the time of the clinical onset or clinical worsening of pericarditis” [onset and worsening]
Sarcoidosis
Reasonable Hypothesis — factor (24): “having sarcoidosis or amyloidosis at the time of the clinical onset or clinical worsening of pericarditis” [onset and worsening]
Balance of Probabilities — factor (24): “having sarcoidosis or amyloidosis at the time of the clinical onset or clinical worsening of pericarditis” [onset and worsening]
Smallpox
Reasonable Hypothesis — factor (30): “having smallpox vaccine within the 4 weeks before the clinical onset or clinical worsening of pericarditis” [onset and worsening]
Balance of Probabilities — factor (29): “having smallpox vaccine within the 4 weeks before the clinical onset or clinical worsening of pericarditis” [onset and worsening]
Pleural plaque
Reasonable Hypothesis — factor (31): “having asbestosis or asbestos related pleural plaques before the clinical onset or clinical worsening of pericarditis” [onset and worsening]
Balance of Probabilities — factor (30): “having asbestosis or asbestos related pleural plaques before the clinical onset or clinical worsening of pericarditis” [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 →
Pericarditis accepted?
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