Chronic obstructive pulmonary disease

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.

RH No. 17 of 2023 · BoP No. 18 of 202360 factors

Meaning of chronic obstructive pulmonary disease: For the purposes of this Statement of Principles, chronic obstructive pulmonary disease: (a) means a chronic progressive inflammatory pathology occurring with different proportions of involvement of the airways, lung parenchyma and vasculature; and (b) includes: (i) chronic bronchitis; (ii) emphysema; and (iii) persistent airflow limitation; and (c) excludes: (i) asbestosis; (ii) asthma; (iii) bronchiectasis; (iv) bronchiolitis obliterans; (v) fibrosing interstitial lung disease and other fibrosing lung disease; (vi) hypersensitivity pneumonitis (extrinsic allergic alveolitis); and (vii) surgical, traumatic or localised emphysema.

Reasonable Hypothesis (RH) — Statement of Principles No. 17 of 2023

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 chronic obstructive pulmonary disease or death from chronic obstructive pulmonary disease with the circumstances of a person's relevant service:

(1)
having smoked tobacco products: (a) in an amount of at least 5 pack-years before the clinical onset of chronic obstructive pulmonary disease; and (b) if smoking has ceased before the clinical onset of chronic obstructive pulmonary disease, then that onset occurred within 20 years of cessation;
Note: one pack-year is defined in the Schedule 1 - Dictionary.
(2)
being exposed to second-hand smoke: (a) for at least 10,000 hours before the clinical onset of chronic obstructive pulmonary disease; and (b) if exposure to second-hand smoke has ceased before the clinical onset of chronic obstructive pulmonary disease, then that onset occurred within 20 years of cessation;
Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.
(3)
having smoked cannabis: (a) in an amount of at least 10 joint-years before the clinical onset of chronic obstructive pulmonary disease; and (b) if smoking has ceased before the clinical onset of chronic obstructive pulmonary disease, then that onset occurred within 20 years of cessation;
Note: joint-years of cannabis is defined in the Schedule 1 - Dictionary.
(4)
inhaling smoke from the combustion of polluting fuels in an enclosed space: (a) for a cumulative period of at least 5,000 hours before the clinical onset of chronic obstructive pulmonary disease; and (b) if that exposure has ceased, the clinical onset of chronic obstructive pulmonary disease has occurred within 20 years of cessation;
Note: polluting fuels is defined in the Schedule 1 - Dictionary.
(5)
inhaling a respiratory tract irritant from the specified list of respiratory tract irritants resulting in: (a) signs and symptoms of severe acute lower respiratory damage requiring medical attention within 48 hours after exposure; and (b) the persistence of respiratory symptoms and signs for at least one week after exposure, within the 10 years before the clinical onset of chronic obstructive pulmonary disease;
Note: specified list of respiratory tract irritants is defined in the Schedule 1 - Dictionary.
(6)
inhaling vapour, gas, or fumes of a substance from the specified list of substances in an enclosed space: (a) for a cumulative period of at least 10,000 hours before the clinical onset of chronic obstructive pulmonary disease; and (b) if that exposure has ceased, the clinical onset of chronic obstructive pulmonary disease has occurred within 20 years of cessation;
Note: specified list of substances is defined in the Schedule 1 - Dictionary.
(7)
inhaling vapour, gas, or fumes of a substance from the specified list of substances, in an open environment: (a) for a cumulative period of at least 20 000 hours before the clinical onset of chronic obstructive pulmonary disease; and (b) if that exposure has ceased, the clinical onset of chronic obstructive pulmonary disease has occurred within 20 years of cessation;
Note: specified list of substances is defined in the Schedule 1 - Dictionary.
(8)
inhaling organic or inorganic dust at a concentration of greater than 5 milligrams per cubic metre: (a) for a cumulative period of at least 10,000 hours before the clinical onset of chronic obstructive pulmonary disease; and (b) if that exposure has ceased, the clinical onset of chronic obstructive pulmonary disease has occurred within 20 years of cessation;
Note: dust is defined in the Schedule 1 - Dictionary.
(9)
inhaling ambient polluted air as specified: (a) for a cumulative period of at least 70,000 hours before the clinical onset of chronic obstructive pulmonary disease; and (b) if that exposure has ceased, the clinical onset of chronic obstructive pulmonary disease has occurred within 20 years of cessation;
Note: ambient polluted air as specified is defined in the Schedule 1 - Dictionary.
(10)
having infection with human immunodeficiency virus before the clinical onset of chronic obstructive pulmonary disease;
(11)
having pulmonary tuberculosis at least 1 year before the clinical onset of chronic obstructive pulmonary disease;
Note: pulmonary tuberculosis is defined in the Schedule 1 - Dictionary.
(12)
having alpha-1 antitrypsin deficiency at the time of the clinical onset of chronic obstructive pulmonary disease;
(13)
having asthma before the clinical onset of chronic obstructive pulmonary disease;
(14)
having bronchiectasis before the clinical onset of chronic obstructive pulmonary disease;
(15)
having smoked tobacco products: (a) in an amount of at least 1 pack-year before the clinical worsening of chronic obstructive pulmonary disease; and (b) if smoking has ceased before the clinical worsening of chronic obstructive pulmonary disease, then that worsening occurred within 20 years of cessation;
Note: one pack-year is defined in the Schedule 1 - Dictionary.
(16)
being exposed to second-hand smoke: (a) for at least 10,000 hours before the clinical worsening of chronic obstructive pulmonary disease; and (b) if exposure to second-hand smoke has ceased before the clinical worsening of chronic obstructive pulmonary disease, then that worsening occurred within 20 years of cessation;
Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.
(17)
having smoked cannabis: (a) in an amount of at least 10 joint-years before the clinical worsening of chronic obstructive pulmonary disease; and (b) if smoking has ceased before the clinical worsening of chronic obstructive pulmonary disease, then that worsening occurred within 20 years of cessation;
Note: joint-years of cannabis is defined in the Schedule 1 - Dictionary.
(18)
inhaling smoke from the combustion of polluting fuels in an enclosed space: (a) for a cumulative period of at least 5,000 hours before the clinical worsening of chronic obstructive pulmonary disease; and (b) if that exposure has ceased, the clinical worsening of chronic obstructive pulmonary disease has occurred within 20 years of cessation;
Note: polluting fuels is defined in the Schedule 1 - Dictionary.
(19)
inhaling a respiratory tract irritant from the specified list of respiratory tract irritants resulting in: (a) signs and symptoms of severe acute lower respiratory damage requiring medical attention within 48 hours after exposure; and (b) the persistence of respiratory symptoms and signs for at least one week after exposure, within the 10 years before the clinical worsening of chronic obstructive pulmonary disease;
Note: specified list of respiratory tract irritants is defined in the Schedule 1 - Dictionary.
(20)
inhaling vapour, gas, or fumes of a substance from the specified list of substances in an enclosed space: (a) for a cumulative period of at least 10,000 hours before the clinical worsening of chronic obstructive pulmonary disease; and (b) if that exposure has ceased, the clinical worsening of chronic obstructive pulmonary disease has occurred within 20 years of cessation;
Note: specified list of substances is defined in the Schedule 1 - Dictionary.
(21)
inhaling vapour, gas, or fumes of a substance from the specified list of substances, in an open environment: (a) for a cumulative period of at least 20 000 hours before the clinical worsening of chronic obstructive pulmonary disease; and (b) if that exposure has ceased, the clinical worsening of chronic obstructive pulmonary disease has occurred within 20 years of cessation;
Note: specified list of substances is defined in the Schedule 1 - Dictionary.
(22)
inhaling organic or inorganic dust at a concentration of greater than 5 milligrams per cubic metre: (a) for a cumulative period of at least 10,000 hours before the clinical worsening of chronic obstructive pulmonary disease; and (b) if that exposure has ceased, the clinical worsening of chronic obstructive pulmonary disease has occurred within 20 years of cessation;
Note: dust is defined in the Schedule 1 - Dictionary.
(23)
inhaling ambient polluted air as specified: (a) for a cumulative period of at least 70,000 hours before the clinical worsening of chronic obstructive pulmonary disease; and (b) if that exposure has ceased, the clinical worsening of chronic obstructive pulmonary disease has occurred within 20 years of cessation;
Note: ambient polluted air as specified is defined in the Schedule 1 - Dictionary.
(24)
having infection with human immunodeficiency virus before the clinical worsening of chronic obstructive pulmonary disease;
(25)
having at least 2 episodes of acute viral or bacterial lower respiratory tract infection requiring medical treatment within the 1 year before the clinical worsening of chronic obstructive pulmonary disease;
Note: lower respiratory tract is defined in the Schedule 1 - Dictionary.
(26)
having pulmonary tuberculosis at least 1 year before the clinical worsening of chronic obstructive pulmonary disease;
Note: pulmonary tuberculosis is defined in the Schedule 1 - Dictionary.
(27)
having alpha-1 antitrypsin deficiency at the time of the clinical worsening of chronic obstructive pulmonary disease;
(28)
having asthma before the clinical worsening of chronic obstructive pulmonary disease;
(29)
having bronchiectasis before the clinical worsening of chronic obstructive pulmonary disease;
(30)
having gastro-oesophageal reflux disease, with erosive oesophagitis or oesophageal stricture within 2 years before the clinical worsening of chronic obstructive pulmonary disease;
(31)
inability to obtain appropriate clinical management for chronic obstructive pulmonary disease;

Aggravation-only factors: the factors in subsections 9(15) to 9(31) 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. 18 of 2023

29 factors

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

(1)
having smoked tobacco products: (a) in an amount of at least 5 pack-years before the clinical onset of chronic obstructive pulmonary disease; and (b) if smoking has ceased before the clinical onset of chronic obstructive pulmonary disease, then that onset occurred within 20 years of cessation;
Note: one pack-year is defined in the Schedule 1 - Dictionary.
(2)
having been exposed to second-hand smoke: (a) for at least 20,000 hours before the clinical onset of chronic obstructive pulmonary disease; and (b) if exposure to second-hand smoke has ceased before the clinical onset of chronic obstructive pulmonary disease, then that onset occurred within 20 years of cessation;
Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.
(3)
having smoked cannabis: (a) in an amount of at least 20 joint-years before the clinical onset of chronic obstructive pulmonary disease; and (b) if smoking has ceased before the clinical onset of chronic obstructive pulmonary disease, then that onset occurred within 20 years of cessation;
Note: joint-years of cannabis is defined in the Schedule 1 - Dictionary.
(4)
inhaling smoke from the combustion of polluting fuels in an enclosed space: (a) for a cumulative period of at least 10,000 hours before the clinical onset of chronic obstructive pulmonary disease; and (b) if that exposure has ceased, the clinical onset of chronic obstructive pulmonary disease has occurred within 20 years of cessation;
Note: polluting fuels is defined in the Schedule 1 - Dictionary.
(5)
inhaling a respiratory tract irritant from the specified list of respiratory tract irritants resulting in: (a) signs and symptoms of severe acute lower respiratory damage requiring medical attention within 48 hours after exposure; and (b) the persistence of respiratory symptoms and signs for at least one week after exposure, within the 5 years before the clinical onset of chronic obstructive pulmonary disease;
Note: specified list of respiratory tract irritants is defined in the Schedule 1 - Dictionary.
(6)
inhaling vapour, gas, or fumes of a substance from the specified list of substances in an enclosed space: (a) for a cumulative period of at least 20,000 hours before the clinical onset of chronic obstructive pulmonary disease; and (b) if that exposure has ceased, the clinical onset of chronic obstructive pulmonary disease has occurred within 10 years of cessation;
Note: specified list of substances is defined in the Schedule 1 - Dictionary.
(7)
inhaling vapour, gas, or fumes of a substance from the specified list of substances, in an open environment: (a) for a cumulative period of at least 40 000 hours before the clinical onset of chronic obstructive pulmonary disease; and (b) if that exposure has ceased, the clinical onset of chronic obstructive pulmonary disease has occurred within 10 years of cessation;
Note: specified list of substances is defined in the Schedule 1 - Dictionary.
(8)
inhaling organic or inorganic dust at a concentration of greater than 5 milligrams per cubic metre: (a) for a cumulative period of at least 20,000 hours before the clinical onset of chronic obstructive pulmonary disease; and (b) if that exposure has ceased, the clinical onset of chronic obstructive pulmonary disease has occurred within 10 years of cessation;
Note: dust is defined in the Schedule 1 - Dictionary.
(9)
having infection with human immunodeficiency virus before the clinical onset of chronic obstructive pulmonary disease;
(10)
having pulmonary tuberculosis at least 1 year before the clinical onset of chronic obstructive pulmonary disease;
Note: pulmonary tuberculosis is defined in the Schedule 1 - Dictionary.
(11)
having alpha-1 antitrypsin deficiency at the time of the clinical onset of chronic obstructive pulmonary disease;
(12)
having asthma before the clinical onset of chronic obstructive pulmonary disease;
(13)
having bronchiectasis before the clinical onset of chronic obstructive pulmonary disease;
(14)
having smoked tobacco products: (a) in an amount of at least 1 pack-year before the clinical worsening of chronic obstructive pulmonary disease; and (b) if smoking has ceased before the clinical worsening of chronic obstructive pulmonary disease, then that worsening occurred within 10 years of cessation;
Note: one pack-year is defined in the Schedule 1 - Dictionary.
(15)
being exposed to second-hand smoke: (a) for at least 20,000 hours before the clinical worsening of chronic obstructive pulmonary disease; and (b) if exposure to second-hand smoke has ceased before the clinical worsening of chronic obstructive pulmonary disease, then that worsening occurred within 20 years of cessation;
Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.
(16)
having smoked cannabis: (a) in an amount of at least 20 joint-years before the clinical worsening of chronic obstructive pulmonary disease; and (b) if smoking has ceased before the clinical worsening of chronic obstructive pulmonary disease, then that worsening occurred within 20 years of cessation;
Note: joint-years of cannabis is defined in the Schedule 1 - Dictionary.
(17)
inhaling smoke from the combustion of polluting fuels in an enclosed space: (a) for a cumulative period of at least 10,000 hours before the clinical worsening of chronic obstructive pulmonary disease; and (b) if that exposure has ceased, the clinical worsening of chronic obstructive pulmonary disease has occurred within 20 years of cessation;
Note: polluting fuels is defined in the Schedule 1 - Dictionary.
(18)
inhaling a respiratory tract irritant from the specified list of respiratory tract irritants resulting in: (a) signs and symptoms of severe acute lower respiratory damage requiring medical attention within 48 hours after exposure; and (b) the persistence of respiratory symptoms and signs for at least one week after exposure, within the 5 years before the clinical worsening of chronic obstructive pulmonary disease;
Note: specified list of respiratory tract irritants is defined in the Schedule 1 - Dictionary.
(19)
inhaling vapour, gas, or fumes of a substance from the specified list of substances in an enclosed space: (a) for a cumulative period of at least 20,000 hours before the clinical worsening of chronic obstructive pulmonary disease; and (b) if that exposure has ceased, the clinical worsening of chronic obstructive pulmonary disease has occurred within 10 years of cessation;
Note: specified list of substances is defined in the Schedule 1 - Dictionary.
(20)
inhaling vapour, gas, or fumes of a substance from the specified list of substances, in an open environment: (a) for a cumulative period of at least 40,000 hours before the clinical worsening of chronic obstructive pulmonary disease; and (b) if that exposure has ceased, the clinical worsening of chronic obstructive pulmonary disease has occurred within 10 years of cessation;
Note: specified list of substances is defined in the Schedule 1 - Dictionary.
(21)
inhaling organic or inorganic dust at a concentration of greater than 5 milligrams per cubic metre: (a) for a cumulative period of at least 20,000 hours before the clinical worsening of chronic obstructive pulmonary disease; and (b) if that exposure has ceased, the clinical worsening of chronic obstructive pulmonary disease has occurred within 10 years of cessation;
Note: dust is defined in the Schedule 1 - Dictionary.
(22)
having infection with human immunodeficiency virus before the clinical worsening of chronic obstructive pulmonary disease;
(23)
having at least 4 episodes of acute viral or bacterial lower respiratory tract infection requiring medical treatment within the 1 year before the clinical worsening of chronic obstructive pulmonary disease;
Note: lower respiratory tract is defined in the Schedule 1 - Dictionary.
(24)
having pulmonary tuberculosis at least 1 year before the clinical worsening of chronic obstructive pulmonary disease;
Note: pulmonary tuberculosis is defined in the Schedule 1 - Dictionary.
(25)
having alpha-1 antitrypsin deficiency at the time of the clinical worsening of chronic obstructive pulmonary disease;
(26)
having asthma before the clinical worsening of chronic obstructive pulmonary disease;
(27)
having bronchiectasis before the clinical worsening of chronic obstructive pulmonary disease;
(28)
having gastro-oesophageal reflux disease, with erosive oesophagitis or oesophageal stricture at the time of the clinical worsening of chronic obstructive pulmonary disease;
(29)
inability to obtain appropriate clinical management for chronic obstructive pulmonary disease;

Aggravation-only factors: the factors in subsections 9(14) to 9(29) 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.

Chronic obstructive pulmonary disease — DVA SoP factors