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Statement of Principles

Vascular neurocognitive disorder — DVA SoP factors

Every factor in the Repatriation Medical Authority Statements of Principles for Vascular neurocognitive disorder. DVA can only accept a claim for Vascular neurocognitive disorder 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.

Vascular neurocognitive disorder

RH No. 9 of 2023 · BoP No. 10 of 202366 factors

Meaning of vascular neurocognitive disorder: For the purposes of this Statement of Principles, vascular neurocognitive disorder means a chronic vascular disorder of the brain, meeting the following clinical diagnostic criteria (derived from DSM- 5-TR): A. Evidence of major neurocognitive disorder or mild neurocognitive disorder. B. The clinical features are consistent with a vascular aetiology, as suggested by either of the following: (i) onset of the cognitive deficits is temporally related to one or more documented cerebrovascular events; or (ii) evidence for decline is prominent in complex attention (including processing speed) and frontal-executive function. C. There is evidence of the presence of cerebrovascular disease from history, physical examination, and/or neuroimaging considered sufficient to account for the neurocognitive deficits. D. Vascular neurocognitive disorder includes: (i) acquired diffuse white matter disease (Binswanger disease); (ii) multi-infarct dementia; (iii) post-stroke dementia; (iv) strategic infarct dementia; (v) subcortical ischaemic vascular dementia; (vi) dementia, major neurocognitive disorder or mild neurocognitive disorder due to vascular disease, including atherosclerosis; (vii) vascular

Reasonable Hypothesis (RH) — Statement of Principles No. 9 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 vascular neurocognitive disorder or death from vascular neurocognitive disorder with the circumstances of a person's relevant service:

  1. (1)
    having a cerebrovascular accident or subarachnoid haemorrhage before the clinical onset of vascular neurocognitive disorder;
  2. (2)
    having a specified disease of the cerebral vessels, in the presence of neuroimaging (magnetic resonance imaging or computed tomography) findings of cerebral white matter lesions, haemorrhage or infarction, before the clinical onset of vascular neurocognitive disorder;

    Note: specified disease of the cerebral vessels is defined in the Schedule 1 - Dictionary.

    Note: neuroimaging (magnetic resonance imaging or computed tomography) findings is defined in the Schedule 1 - Dictionary.

  3. (3)
    having hypertension before the clinical onset of vascular neurocognitive disorder;
  4. (4)
    having dyslipidaemia before the age of 65 years, and before the clinical onset of vascular neurocognitive disorder;

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

  5. (5)
    having sick sinus syndrome, atrial fibrillation or atrial flutter, at the time of the clinical onset of vascular neurocognitive disorder;
  6. (6)
    having hyperhomocysteinaemia before the clinical onset of vascular neurocognitive disorder;

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

  7. (7)
    having carotid artery disease, ischaemic heart disease or heart failure before the clinical onset of vascular neurocognitive disorder;
  8. (8)
    having cardiac surgery within the 12 months before the clinical onset of vascular neurocognitive disorder;
  9. (9)
    having diabetes mellitus for at least the 5 years before the clinical onset of vascular neurocognitive disorder;
  10. (10)
    having smoked tobacco products: (a) in an amount of at least 10 pack-years before the clinical onset of vascular neurocognitive disorder; and (b) commencing at least 5 years before the clinical onset of vascular neurocognitive disorder; and if smoking has ceased before the clinical onset of vascular neurocognitive disorder, then that onset occurred within 20 years of cessation;

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

  11. (11)
    an inability to undertake any physical activity greater than 3 METs for at least 5 years within the 20 years before the clinical onset of vascular neurocognitive disorder;

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

  12. (12)
    being obese for at least 5 years within the 20 years before the clinical onset of vascular neurocognitive disorder;

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

  13. (13)
    having depressive disorder at least 5 years before the clinical onset of vascular neurocognitive disorder;
  14. (14)
    having posttraumatic stress disorder at least 5 years before the clinical onset of vascular neurocognitive disorder;
  15. (15)
    having chronic kidney disease before the clinical onset of vascular neurocognitive disorder;

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

  16. (16)
    inhaling ambient, chronically polluted air as specified for at least 1,000 hours within the 5 years before the clinical onset of vascular neurocognitive disorder;

    Note: ambient, chronically polluted air as specified is defined in the Schedule 1 - Dictionary.

  17. (17)
    having at least one migraine per year for at least 5 years before the clinical onset of vascular neurocognitive disorder;
  18. (18)
    having moderate to severe traumatic brain injury at least 5 years before the clinical onset of vascular neurocognitive disorder;
  19. (19)
    having orthostatic hypotension at least once a year for at least 5 years in the 20 years before the clinical onset of vascular neurocognitive disorder;

    Note: orthostatic hypotension is defined in the Schedule 1 - Dictionary.

  20. (20)
    having a cerebrovascular accident or subarachnoid haemorrhage before the clinical worsening of vascular neurocognitive disorder;
  21. (21)
    having a specified disease of the cerebral vessels, in the presence of neuroimaging (magnetic resonance imaging or computed tomography) findings of cerebral white matter lesions, haemorrhage or infarction, before the clinical worsening of vascular neurocognitive disorder;

    Note: specified disease of the cerebral vessels is defined in the Schedule 1 - Dictionary.

    Note: neuroimaging (magnetic resonance imaging or computed tomography) findings is defined in the Schedule 1 - Dictionary.

  22. (22)
    having hypertension before the clinical worsening of vascular neurocognitive disorder;
  23. (23)
    having dyslipidaemia before the age of 65 years, and before the clinical worsening of vascular neurocognitive disorder;

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

  24. (24)
    having sick sinus syndrome, atrial fibrillation or atrial flutter, at the time of the clinical worsening of vascular neurocognitive disorder;
  25. (25)
    having hyperhomocysteinaemia before the clinical worsening of vascular neurocognitive disorder;

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

  26. (26)
    having carotid artery disease, ischaemic heart disease or heart failure before the clinical worsening of vascular neurocognitive disorder;
  27. (27)
    having cardiac surgery within the 12 months before the clinical worsening of vascular neurocognitive disorder;
  28. (28)
    having diabetes mellitus for at least the 5 years before the clinical worsening of vascular neurocognitive disorder;
  29. (29)
    having smoked tobacco products: (a) in an amount of at least 10 pack-years before the clinical worsening of vascular neurocognitive disorder; and (b) commencing at least 5 years before the clinical worsening of vascular neurocognitive disorder; and if smoking has ceased before the clinical worsening of vascular neurocognitive disorder, then that worsening occurred within 20 years of cessation;

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

  30. (30)
    an inability to undertake any physical activity greater than 3 METs for at least 5 years within the 20 years before the clinical worsening of vascular neurocognitive disorder;

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

  31. (31)
    being obese for at least 5 years within the 20 years before the clinical worsening of vascular neurocognitive disorder;

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

  32. (32)
    having depressive disorder at least 5 years before the clinical worsening of vascular neurocognitive disorder;
  33. (33)
    having posttraumatic stress disorder at least 5 years before the clinical worsening of vascular neurocognitive disorder;
  34. (34)
    having chronic kidney disease before the clinical worsening of vascular neurocognitive disorder;

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

  35. (35)
    inhaling ambient, chronically polluted air as specified for at least 1,000 hours within the 5 years before the clinical worsening of vascular neurocognitive disorder;

    Note: ambient, chronically polluted air as specified is defined in the Schedule 1 - Dictionary.

  36. (36)
    having at least one migraine per year for at least 5 years before the clinical worsening of vascular neurocognitive disorder;
  37. (37)
    having moderate to severe traumatic brain injury at least 5 years before the clinical worsening of vascular neurocognitive disorder;
  38. (38)
    having orthostatic hypotension at least once a year for at least 5 years in the 20 years before the clinical worsening of vascular neurocognitive disorder;

    Note: orthostatic hypotension is defined in the Schedule 1 - Dictionary.

  39. (39)
    inability to obtain appropriate clinical management for vascular neurocognitive disorder;

Aggravation-only factors: the factors in subsections 9(20) to 9(39) 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. 10 of 2023

27 factors

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

  1. (1)
    having a cerebrovascular accident or subarachnoid haemorrhage before the clinical onset of vascular neurocognitive disorder;
  2. (2)
    having a specified disease of the cerebral vessels, in the presence of neuroimaging (magnetic resonance imaging or computed tomography) findings of cerebral white matter lesions, haemorrhage or infarction, before the clinical onset of vascular neurocognitive disorder;

    Note: specified disease of the cerebral vessels is defined in the Schedule 1 - Dictionary.

    Note: neuroimaging (magnetic resonance imaging or computed tomography) findings is defined in the Schedule 1 - Dictionary.

  3. (3)
    having hypertension at least 5 years before the clinical onset of vascular neurocognitive disorder;
  4. (4)
    having sick sinus syndrome, atrial fibrillation or atrial flutter, at the time of the clinical onset of vascular neurocognitive disorder;
  5. (5)
    having carotid artery disease, ischaemic heart disease or heart failure before the clinical onset of vascular neurocognitive disorder;
  6. (6)
    having cardiac surgery within the 12 months before the clinical onset of vascular neurocognitive disorder;
  7. (7)
    having diabetes mellitus for at least the 5 years before the clinical onset of vascular neurocognitive disorder;
  8. (8)
    having smoked tobacco products: (a) in an amount of at least 20 pack-years before the clinical onset of vascular neurocognitive disorder; and (b) commencing at least 5 years before the clinical onset of vascular neurocognitive disorder; and if smoking has ceased before the clinical onset of vascular neurocognitive disorder, then that onset occurred within 20 years of cessation;

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

  9. (9)
    an inability to undertake any physical activity greater than 3 METs for at least 5 years within the 20 years before the clinical onset of vascular neurocognitive disorder;

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

  10. (10)
    having depressive disorder at least 5 years before the clinical onset of vascular neurocognitive disorder;
  11. (11)
    having chronic kidney disease before the clinical onset of vascular neurocognitive disorder;

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

  12. (12)
    inhaling ambient, chronically polluted air as specified for at least 2,000 hours within the 5 years before the clinical onset of vascular neurocognitive disorder;

    Note: ambient, chronically polluted air as specified is defined in the Schedule 1 - Dictionary.

  13. (13)
    having moderate to severe traumatic brain injury at least 5 years before the clinical onset of vascular neurocognitive disorder;
  14. (14)
    having a cerebrovascular accident or subarachnoid haemorrhage before the clinical worsening of vascular neurocognitive disorder;
  15. (15)
    having a specified disease of the cerebral vessels, in the presence of neuroimaging (magnetic resonance imaging or computed tomography) findings of cerebral white matter lesions, haemorrhage or infarction, before the clinical worsening of vascular neurocognitive disorder;

    Note: specified disease of the cerebral vessels is defined in the Schedule 1 - Dictionary.

    Note: neuroimaging (magnetic resonance imaging or computed tomography) findings is defined in the Schedule 1 - Dictionary.

  16. (16)
    having hypertension at least 5 years before the clinical worsening of vascular neurocognitive disorder;
  17. (17)
    having sick sinus syndrome, atrial fibrillation or atrial flutter, at the time of the clinical worsening of vascular neurocognitive disorder;
  18. (18)
    having carotid artery disease, ischaemic heart disease or heart failure before the clinical worsening of vascular neurocognitive disorder;
  19. (19)
    having cardiac surgery within the 12 months before the clinical worsening of vascular neurocognitive disorder;
  20. (20)
    having diabetes mellitus for at least the 5 years before the clinical worsening of vascular neurocognitive disorder;
  21. (21)
    having smoked tobacco products: (a) in an amount of at least 20 pack-years before the clinical worsening of vascular neurocognitive disorder; and (b) commencing at least 5 years before the clinical worsening of vascular neurocognitive disorder; and if smoking has ceased before the clinical worsening of vascular neurocognitive disorder, then that onset occurred within 20 years of cessation;

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

  22. (22)
    an inability to undertake any physical activity greater than 3 METs for at least 5 years within the 20 years before the clinical worsening of vascular neurocognitive disorder;

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

  23. (23)
    having depressive disorder at least 5 years before the clinical worsening of vascular neurocognitive disorder;
  24. (24)
    having chronic kidney disease before the clinical worsening of vascular neurocognitive disorder;

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

  25. (25)
    inhaling ambient, chronically polluted air as specified for at least 2,000 hours within the 5 years before the clinical worsening of vascular neurocognitive disorder;

    Note: ambient, chronically polluted air as specified is defined in the Schedule 1 - Dictionary.

  26. (26)
    having moderate to severe traumatic brain injury at least 5 years before the clinical worsening of vascular neurocognitive disorder;
  27. (27)
    inability to obtain appropriate clinical management for vascular neurocognitive disorder;

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

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

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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.

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