Aortic aneurysm and aortic wall disorders — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 21 of 2021

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting aortic aneurysm or an aortic wall disorder or death from aortic aneurysm or an aortic wall disorder with the circumstances of a person's relevant service:

1. (1)
   having hypertension before the clinical onset of aortic aneurysm or an aortic wall disorder;
2. (2)
   being obese for at least five years within the 20 years before the clinical onset of aortic aneurysm or an aortic wall disorder;

   Note: being obese is defined in the Schedule 1 - Dictionary.

3. (3)
   having dyslipidaemia before the clinical onset of aortic aneurysm or an aortic wall disorder;

   Note: dyslipidaemia is defined in the Schedule 1 - Dictionary.

4. (4)
   where smoking has not permanently ceased, having smoked at least one pack-year of tobacco products before the clinical onset of aortic aneurysm or an aortic wall disorder;

   Note: pack-year of tobacco products is defined in the Schedule 1 - Dictionary.

5. (5)
   where smoking has permanently ceased before the clinical onset of aortic aneurysm or an aortic wall disorder: (a) having smoked at least five pack-years of tobacco products; or (b) having smoked at least one pack-year but less than five pack- years of tobacco products, and the clinical onset of aortic aneurysm or an aortic wall disorder has occurred within 20 years of smoking cessation;

   Note: pack-year of tobacco products is defined in the Schedule 1 - Dictionary.

6. (6)
   where exposure to second-hand smoke has not permanently ceased, being exposed to second-hand smoke for at least 1,000 hours before the clinical onset of aortic aneurysm or an aortic wall disorder;

   Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.

7. (7)
   where exposure to second-hand smoke has permanently ceased before the clinical onset of aortic aneurysm or an aortic wall disorder: (a) being exposed to second-hand smoke for at least 5,000 hours; or (b) being exposed to second-hand smoke for at least 1,000 hours but less than 5,000 hours, and the clinical onset of aortic aneurysm or an aortic wall disorder has occurred within five years of the last exposure to second-hand smoke;

   Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.

8. (8)
   having hyperhomocysteinaemia before the clinical onset of aortic aneurysm or an aortic wall disorder;
9. (9)
   having chronic kidney disease before the clinical onset of aortic aneurysm or an aortic wall disorder;

   Note: chronic kidney disease is defined in the Schedule 1 - Dictionary.

10. (10)
    an inability to consume an average of at least 100 grams per day of any combination of fruit and vegetables, for at least five consecutive years within the 20 years before the clinical onset of aortic aneurysm or an aortic wall disorder;
11. (11)
    having infection with human immunodeficiency virus at the time of the clinical onset of aortic aneurysm or an aortic wall disorder;
12. (12)
    having infection of the affected part of the aorta with a bacterial or fungal organism before the clinical onset of aortic aneurysm or an aortic wall disorder;

    Note: Examples of organisms which can cause an aortic aneurysm include Staphylococcus species, Salmonella species, Streptococcus pneumonia, Treponema pallidum (the organism that causes syphilis), and species belonging to the Mycobacterium tuberculosis complex (the organism that causes tuberculosis).

13. (13)
    having autoimmune aortitis or vasculitis before the clinical onset of aortic aneurysm or an aortic wall disorder;

    Note: Examples of autoimmune diseases that may cause aortitis or vasculitis include giant cell arteritis, ankylosing spondylitis, Behcet disease, reactive arthritis, rheumatoid arthritis and systemic lupus erythematosus.

14. (14)
    having trauma to the affected part of the aorta before the clinical onset of aortic aneurysm or an aortic wall disorder;
15. (15)
    having a solid organ transplant before the clinical onset of aortic aneurysm or an aortic wall disorder;
16. (16)
    having non-aneurysmal aortic atherosclerotic disease at the time of the clinical onset of aortic aneurysm or an aortic wall disorder;
17. (17)
    taking a fluoroquinolone antibiotic in the three months before the clinical onset of aortic aneurysm or an aortic wall disorder;
18. (18)
    for aortic wall disorders only: (a) undertaking physical activity of five METs or more within the 24 hours before the clinical onset of an aortic wall disorder; (b) being pregnant within the six weeks before the clinical onset of an aortic wall disorder; (c) having invasion of the affected part of the aorta by a malignant neoplasm at the time of the clinical onset of an aortic wall disorder; (d) having erosion of the affected part of the aorta due to inflammation of a contiguous tissue or organ at the time of the clinical onset of an aortic wall disorder; (e) taking a drug from the specified list of drugs in the 72 hours before the clinical onset of an aortic wall disorder; (f) having infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the time of the clinical onset of an aortic wall disorder;

    Note: MET is defined in the Schedule 1 - Dictionary.

    Note: Examples of inflammatory conditions that can cause erosion of the wall of the aorta are acute and chronic pancreatitis.

    Note: specified list of drugs is defined in the Schedule 1 - Dictionary.

    Note: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus which causes coronavirus disease 2019 (COVID-19).

19. (19)
    having hypertension before the clinical worsening of aortic aneurysm or an aortic wall disorder;
20. (20)
    being obese for at least five years within the 20 years before the clinical worsening of aortic aneurysm or an aortic wall disorder;

    Note: being obese is defined in the Schedule 1 - Dictionary.

21. (21)
    having dyslipidaemia before the clinical worsening of aortic aneurysm or an aortic wall disorder;

    Note: dyslipidaemia is defined in the Schedule 1 - Dictionary.

22. (22)
    where smoking has not permanently ceased, having smoked at least one pack-year of tobacco products before the clinical worsening of aortic aneurysm or an aortic wall disorder;

    Note: pack-year of tobacco products is defined in the Schedule 1 - Dictionary.

23. (23)
    where smoking has permanently ceased before the clinical worsening of aortic aneurysm or an aortic wall disorder: (a) having smoked at least five pack-years of tobacco products; or (b) having smoked at least one pack-year but less than five pack- years of tobacco products, and the clinical worsening of aortic aneurysm or an aortic wall disorder has occurred within 20 years of smoking cessation;

    Note: pack-year of tobacco products is defined in the Schedule 1 - Dictionary.

24. (24)
    where exposure to second-hand smoke has not permanently ceased, being exposed to second-hand smoke for at least 1,000 hours before the clinical worsening of aortic aneurysm or an aortic wall disorder;

    Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.

25. (25)
    where exposure to second-hand smoke has permanently ceased before the clinical worsening of aortic aneurysm or an aortic wall disorder: (a) being exposed to second-hand smoke for at least 5,000 hours; or (b) being exposed to second-hand smoke for at least 1,000 hours but less than 5,000 hours, and the clinical worsening of aortic aneurysm or an aortic wall disorder has occurred within five years of the last exposure to second-hand smoke;

    Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.

26. (26)
    having hyperhomocysteinaemia before the clinical worsening of aortic aneurysm or an aortic wall disorder;
27. (27)
    having chronic kidney disease before the clinical worsening of aortic aneurysm or an aortic wall disorder;

    Note: chronic kidney disease is defined in the Schedule 1 - Dictionary.

28. (28)
    an inability to consume an average of at least 100 grams per day of any combination of fruit and vegetables, for at least five consecutive years within the 20 years before the clinical worsening of aortic aneurysm or an aortic wall disorder;
29. (29)
    having infection with human immunodeficiency virus at the time of the clinical worsening of aortic aneurysm or an aortic wall disorder;
30. (30)
    having infection of the affected part of the aorta with a bacterial or fungal organism before the clinical worsening of aortic aneurysm or an aortic wall disorder;

    Note: Examples of organisms which can cause an aortic aneurysm include Staphylococcus species, Salmonella species, Streptococcus pneumonia, Treponema pallidum (the organism that causes syphilis), and species belonging to the Mycobacterium tuberculosis complex (the organism that causes tuberculosis).

31. (31)
    having autoimmune aortitis or vasculitis before the clinical worsening of aortic aneurysm or an aortic wall disorder;

    Note: Examples of autoimmune diseases that may cause aortitis or vasculitis include giant cell arteritis, ankylosing spondylitis, Behcet disease, reactive arthritis, rheumatoid arthritis and systemic lupus erythematosus.

32. (32)
    having trauma to the affected part of the aorta before the clinical worsening of aortic aneurysm or an aortic wall disorder;
33. (33)
    having a solid organ transplant before the clinical worsening of aortic aneurysm or an aortic wall disorder;
34. (34)
    taking a fluoroquinolone antibiotic in the three months before the clinical worsening of aortic aneurysm or an aortic wall disorder;
35. (35)
    for aortic wall disorders only: (a) undertaking physical activity of five METs or more within the 24 hours before the clinical worsening of an aortic wall disorder; (b) being pregnant within the six weeks before the clinical worsening of an aortic wall disorder; (c) having invasion of the affected part of the aorta by a malignant neoplasm at the time of the clinical worsening of an aortic wall disorder; (d) having erosion of the affected part of the aorta due to inflammation of a contiguous tissue or organ at the time of the clinical worsening of an aortic wall disorder; (e) taking a drug from the specified list of drugs in the 72 hours before the clinical worsening of an aortic wall disorder; (f) having infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the time of the clinical worsening of an aortic wall disorder;

    Note: MET is defined in the Schedule 1 - Dictionary.

    Note: Examples of inflammatory conditions that can cause erosion of the wall of the aorta are acute and chronic pancreatitis.

    Note: specified list of drugs is defined in the Schedule 1 - Dictionary.

    Note: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus which causes coronavirus disease 2019 (COVID-19).

36. (36)
    inability to obtain appropriate clinical management for aortic aneurysm or an aortic wall disorder;

Aggravation-only factors: the factors in subsections 9(19) to 9(36) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.