Carotid artery disease — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 54 of 2020

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 carotid artery disease or death from carotid artery disease with the circumstances of a person's relevant service:

1. (1)
   having hypertension before the clinical onset of carotid artery disease;
2. (2)
   having diabetes mellitus before the clinical onset of carotid artery disease;
3. (3)
   being obese for at least five years within the 20 years before the clinical onset of carotid artery disease;

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

4. (4)
   having dyslipidaemia before the clinical onset of carotid artery disease;

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

5. (5)
   where smoking has not permanently ceased, having smoked at least one pack-year of tobacco products before the clinical onset of carotid artery disease;

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

6. (6)
   where smoking has permanently ceased before the clinical onset of carotid artery disease: (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 carotid artery disease has occurred within 20 years of smoking cessation;

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

7. (7)
   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 carotid artery disease;

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

8. (8)
   where exposure to second-hand smoke has permanently ceased before the clinical onset of carotid artery disease: (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 carotid artery disease 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.

9. (9)
   having hyperhomocysteinaemia before the clinical onset of carotid artery disease;
10. (10)
    an inability to undertake any physical activity greater than three METs for at least five years within the 20 years before the clinical onset of carotid artery disease;

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

11. (11)
    having chronic kidney disease before the clinical onset of carotid artery disease;

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

12. (12)
    undergoing a course of therapeutic radiation for cancer, where the affected artery was in the field of radiation, before the clinical onset of carotid artery disease;
13. (13)
    having received a cumulative equivalent dose of at least 0.5 sievert of ionising radiation to the affected artery before the clinical onset of carotid artery disease;

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

14. (14)
    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 carotid artery disease;
15. (15)
    having infection with human immunodeficiency virus or hepatitis C virus before the clinical onset of carotid artery disease;
16. (16)
    having periodontitis for at least the two years before the clinical onset of carotid artery disease;
17. (17)
    having infection of the affected artery with a bacterial or fungal organism before the clinical onset of carotid artery disease;
18. (18)
    having an autoimmune disease of the affected artery before the clinical onset of carotid artery disease;

    Note: Examples of autoimmune diseases that may cause carotid artery disease are ankylosing spondylitis, antiphospholipid syndrome, Behcet disease, inflammatory bowel disease, psoriatic arthropathy, rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis.

19. (19)
    having a neoplasm infiltrating the affected segment of the artery at the time of the clinical onset of carotid artery disease;
20. (20)
    being exposed to arsenic as specified before the clinical onset of carotid artery disease;

    Note: being exposed to arsenic as specified is defined in the Schedule 1 - Dictionary.

21. (21)
    having obstructive sleep apnoea for at least the one year before the clinical onset of carotid artery disease;
22. (22)
    for dissection of the internal carotid artery only, being within the 30 days postpartum at the time of the clinical onset of carotid artery disease;
23. (23)
    for aneurysm, dissection or arteriovenous fistula only, having trauma to the affected segment of the artery before the clinical onset of carotid artery disease;

    Note: trauma to the affected segment of the artery is defined in the Schedule 1 - Dictionary.

24. (24)
    for dissection only: (a) having trauma to the neck or the base of the skull within the six months before the clinical onset of carotid artery disease; (b) taking a fluoroquinolone antibiotic within the 30 days before the clinical onset of carotid artery disease;

    Note: trauma to the neck or the base of the skull is defined in the Schedule 1 - Dictionary.

25. (25)
    for aneurysm or dissection of the common or internal carotid artery only, taking a drug from the specified list of drugs within the four days before the clinical onset of carotid artery disease;

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

26. (26)
    having hypertension before the clinical worsening of carotid artery disease;
27. (27)
    having diabetes mellitus before the clinical worsening of carotid artery disease;
28. (28)
    being obese for at least five years within the 20 years before the clinical worsening of carotid artery disease;

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

29. (29)
    having dyslipidaemia before the clinical worsening of carotid artery disease;

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

30. (30)
    where smoking has not permanently ceased, having smoked at least one pack-year of tobacco products before the clinical worsening of carotid artery disease;

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

31. (31)
    where smoking has permanently ceased before the clinical worsening of carotid artery disease: (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 carotid artery disease has occurred within 20 years of smoking cessation;

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

32. (32)
    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 carotid artery disease;

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

33. (33)
    where exposure to second-hand smoke has permanently ceased before the clinical worsening of carotid artery disease: (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 carotid artery disease 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.

34. (34)
    having hyperhomocysteinaemia before the clinical worsening of carotid artery disease;
35. (35)
    an inability to undertake any physical activity greater than three METs for at least five years within the 20 years before the clinical worsening of carotid artery disease;

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

36. (36)
    having chronic kidney disease before the clinical worsening of carotid artery disease;

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

37. (37)
    undergoing a course of therapeutic radiation for cancer, where the affected artery was in the field of radiation, before the clinical worsening of carotid artery disease;
38. (38)
    having received a cumulative equivalent dose of at least 0.5 sievert of ionising radiation to the affected artery before the clinical worsening of carotid artery disease;

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

39. (39)
    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 carotid artery disease;
40. (40)
    having infection with human immunodeficiency virus or hepatitis C virus before the clinical worsening of carotid artery disease;
41. (41)
    having periodontitis for at least the two years before the clinical worsening of carotid artery disease;
42. (42)
    having infection of the affected artery with a bacterial or fungal organism before the clinical worsening of carotid artery disease;
43. (43)
    having an autoimmune disease of the affected artery before the clinical worsening of carotid artery disease;

    Note: Examples of autoimmune diseases that may cause carotid artery disease are ankylosing spondylitis, antiphospholipid syndrome, Behcet disease, inflammatory bowel disease, psoriatic arthropathy, rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis.

44. (44)
    having a neoplasm infiltrating the affected segment of the artery at the time of the clinical worsening of carotid artery disease;
45. (45)
    being exposed to arsenic as specified before the clinical worsening of carotid artery disease;

    Note: being exposed to arsenic as specified is defined in the Schedule 1 - Dictionary.

46. (46)
    having obstructive sleep apnoea for at least the one year before the clinical worsening of carotid artery disease;
47. (47)
    for dissection of the internal carotid artery only, being within the 30 days postpartum at the time of the clinical worsening of carotid artery disease;
48. (48)
    for aneurysm, dissection or arteriovenous fistula only, having trauma to the affected segment of the artery before the clinical worsening of carotid artery disease;

    Note: trauma to the affected segment of the artery is defined in the Schedule 1 - Dictionary.

49. (49)
    for dissection only: (a) having trauma to the neck or the base of the skull within the six months before the clinical worsening of carotid artery disease; (b) taking a fluoroquinolone antibiotic within the 30 days before the clinical worsening of carotid artery disease;

    Note: trauma to the neck or the base of the skull is defined in the Schedule 1 - Dictionary.

50. (50)
    for aneurysm or dissection of the common or internal carotid artery only, taking a drug from the specified list of drugs within the four days before the clinical worsening of carotid artery disease;

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

51. (51)
    inability to obtain appropriate clinical management for carotid artery disease;

Aggravation-only factors: the factors in subsections 9(26) to 9(51) 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.