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SoP Library › Aortic stenosis

Statement of Principles

Aortic stenosis — DVA SoP factors

Every factor in the Repatriation Medical Authority Statements of Principles for Aortic stenosis. DVA can only accept a claim for Aortic stenosis if at least one of these factors is met and connected to your service. Reasonable Hypothesis (RH) applies to operational service; Balance of Probabilities (BoP) applies to peacetime service.

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Source: Repatriation Medical Authority Statements of Principles as held by the Veterans Health Centre. SoPs are amended and replaced regularly; always confirm the current instrument at rma.gov.au before relying on it.

Aortic stenosis

RH No. 13 of 2022 · BoP No. 14 of 202250 factors

Meaning of aortic stenosis: For the purposes of this Statement of Principles, aortic stenosis: (a) means obstruction of the blood flow across the aortic valve due to thickening and calcification of the aortic valve; and (b) excludes: (i) aortic stenosis due to rheumatic heart disease; (ii) congenital stenosis of the aortic valve; and (iii) obstruction to blood flow across the aortic valve due to narrowing of the supravalvular or subvalvular regions.

Reasonable Hypothesis (RH) — Statement of Principles No. 13 of 2022

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 stenosis or death from aortic stenosis with the circumstances of a person's relevant service:

  1. (1)
    having infective endocarditis before the clinical onset of aortic stenosis;
  2. (2)
    having a systemic autoimmune connective tissue disease before the clinical onset of aortic stenosis;

    Note: Examples of systemic autoimmune connective tissue diseases are systemic lupus erythematosus, rheumatoid arthritis, scleroderma and Sjögren syndrome.

  3. (3)
    having chronic kidney disease at the time of the clinical onset of aortic stenosis;

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

  4. (4)
    having hypertension before the clinical onset of aortic stenosis;
  5. (5)
    having dyslipidaemia before the clinical onset of aortic stenosis;

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

  6. (6)
    having diabetes mellitus before the clinical onset of aortic stenosis;
  7. (7)
    being overweight or obese for at least 5 years within the 20 years before the clinical onset of aortic stenosis;

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

  8. (8)
    having smoked tobacco products: (a) in amount of at least 10 pack-years before the clinical onset of aortic stenosis; and (b) if smoking has ceased before the clinical onset of aortic stenosis, then that onset occurred within 20 years of cessation;

    Note: one pack-year is defined in the Schedule 1 - Dictionary.

  9. (9)
    having received a cumulative equivalent dose of at least 0.5 sievert of ionising radiation to the heart before the clinical onset of aortic stenosis;

    Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary.

  10. (10)
    undergoing a course of therapeutic radiation for cancer, where the heart was in the field of radiation, before the clinical onset of aortic stenosis;
  11. (11)
    having primary hyperparathyroidism before the clinical onset of aortic stenosis;
  12. (12)
    having Paget's disease of bone before the clinical onset of aortic stenosis;
  13. (13)
    having infective endocarditis before the clinical worsening of aortic stenosis;
  14. (14)
    having a systemic autoimmune connective tissue disease before the clinical worsening of aortic stenosis;

    Note: Examples of systemic autoimmune connective tissue diseases are systemic lupus erythematosus, rheumatoid arthritis, scleroderma and Sjögren syndrome.

  15. (15)
    having chronic kidney disease at the time of the clinical worsening of aortic stenosis;

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

  16. (16)
    having hypertension before the clinical worsening of aortic stenosis;
  17. (17)
    having dyslipidaemia before the clinical worsening of aortic stenosis;

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

  18. (18)
    having diabetes mellitus before the clinical worsening of aortic stenosis;
  19. (19)
    being overweight or obese for at least 5 years within the 20 years before the clinical worsening of aortic stenosis;

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

  20. (20)
    having smoked tobacco products: (a) in amount of at least 10 pack-years before the clinical worsening of aortic stenosis; and (b) if smoking has ceased before the clinical worsening of aortic stenosis, then that worsening occurred within 20 years of cessation;

    Note: one pack-year is defined in the Schedule 1 - Dictionary.

  21. (21)
    having received a cumulative equivalent dose of at least 0.5 sievert of ionising radiation to the heart before the clinical worsening of aortic stenosis;

    Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary.

  22. (22)
    undergoing a course of therapeutic radiation for cancer, where the heart was in the field of radiation, before the clinical worsening of aortic stenosis;
  23. (23)
    having primary hyperparathyroidism before the clinical worsening of aortic stenosis;
  24. (24)
    having Paget's disease of bone before the clinical worsening of aortic stenosis;
  25. (25)
    being pregnant within the 6 weeks before the clinical worsening of aortic stenosis;
  26. (26)
    for symptomatic or severe aortic stenosis only, having surgery requiring a general, spinal or epidural anaesthetic within the 30 days before the clinical worsening of aortic stenosis;

    Note: severe aortic stenosis is defined in the Schedule 1 - Dictionary.

  27. (27)
    inability to obtain appropriate clinical management for aortic stenosis;

Aggravation-only factors: the factors in subsections 9(13) to 9(27) 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.

Balance of Probabilities (BoP) — Statement of Principles No. 14 of 2022

23 factors

At least one of the following factors must exist before it can be said that, on the balance of probabilities, aortic stenosis or death from aortic stenosis is connected with the circumstances of a person's relevant service:

  1. (1)
    having infective endocarditis before the clinical onset of aortic stenosis;
  2. (2)
    having a systemic autoimmune connective tissue disease before the clinical onset of aortic stenosis;

    Note: Examples of systemic autoimmune connective tissue diseases are systemic lupus erythematosus, rheumatoid arthritis, scleroderma and Sjögren syndrome.

  3. (3)
    having chronic kidney disease at the time of the clinical onset of aortic stenosis;

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

  4. (4)
    having hypertension before the clinical onset of aortic stenosis;
  5. (5)
    having dyslipidaemia before the clinical onset of aortic stenosis;

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

  6. (6)
    having diabetes mellitus before the clinical onset of aortic stenosis;
  7. (7)
    being overweight or obese for at least 5 years within the 20 years before the clinical onset of aortic stenosis;

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

  8. (8)
    having smoked tobacco products: (a) in amount of at least 15 pack-years before the clinical onset of aortic stenosis; and (b) if smoking has ceased before the clinical onset of aortic stenosis, then that onset occurred within 20 years of cessation;

    Note: one pack-year is defined in the Schedule 1 - Dictionary.

  9. (9)
    having received a cumulative equivalent dose of at least 1.0 sievert of ionising radiation to the heart before the clinical onset of aortic stenosis;

    Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary.

  10. (10)
    undergoing a course of therapeutic radiation for cancer, where the heart was in the field of radiation, before the clinical onset of aortic stenosis;
  11. (11)
    having infective endocarditis before the clinical worsening of aortic stenosis;
  12. (12)
    having a systemic autoimmune connective tissue disease before the clinical worsening of aortic stenosis;

    Note: Examples of systemic autoimmune connective tissue diseases are systemic lupus erythematosus, rheumatoid arthritis, scleroderma and Sjögren syndrome.

  13. (13)
    having chronic kidney disease at the time of the clinical worsening of aortic stenosis;

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

  14. (14)
    having hypertension before the clinical worsening of aortic stenosis;
  15. (15)
    having dyslipidaemia before the clinical worsening of aortic stenosis;

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

  16. (16)
    having diabetes mellitus before the clinical worsening of aortic stenosis;
  17. (17)
    being overweight or obese for at least 5 years within the 20 years before the clinical worsening of aortic stenosis;

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

  18. (18)
    having smoked tobacco products: (a) in amount of at least 15 pack-years before the clinical worsening of aortic stenosis; and (b) if smoking has ceased before the clinical worsening of aortic stenosis, then that worsening occurred within 20 years of cessation;

    Note: one pack-year is defined in the Schedule 1 - Dictionary.

  19. (19)
    having received a cumulative equivalent dose of at least 1.0 sievert of ionising radiation to the heart before the clinical worsening of aortic stenosis;

    Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary.

  20. (20)
    undergoing a course of therapeutic radiation for cancer, where the heart was in the field of radiation, before the clinical worsening of aortic stenosis;
  21. (21)
    being pregnant within the 6 weeks before the clinical worsening of aortic stenosis;
  22. (22)
    for symptomatic or severe aortic stenosis only, having surgery requiring a general, spinal or epidural anaesthetic within the 30 days before the clinical worsening of aortic stenosis;

    Note: severe aortic stenosis is defined in the Schedule 1 - Dictionary.

  23. (23)
    inability to obtain appropriate clinical management for aortic stenosis;

Aggravation-only factors: the factors in subsections 9(11) to 9(23) 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.

A VHC Diagnostic Assessment addresses each of these factors one by one against your service record and clinical history. See how a VHC DVA claim works, see all fees ($600 + GST per stage) or book an appointment.

About Dr Thomas Perkins

One doctor. Every report.

Founding doctor of the Veterans Health Centre in Ipswich, Queensland, and one of Australia's most experienced practitioners in veterans' medicolegal medicine.

Dr Perkins has spent more than thirteen years working exclusively with current and former ADF members — treating their conditions, writing their reports and navigating the DVA system alongside them. With over 100,000 claims submitted and 2,000 Permanent Impairment Assessments completed, he has seen precisely what separates an accepted claim from a rejected one at every level, from initial liability to the Veterans' Review Board.

Every chart review, diagnostic assessment, impairment rating and appeal that leaves this clinic is personally overseen by Dr Perkins. No template, no locum, no hand-off.

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