Aortic stenosis — DVA SoP factors

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.