{"id":"F2023L00011","name":"Statement of Principles concerning atrial fibrillation and atrial flutter (Balance of Probabilities) (No. 2 of 2023)","slug":"statement-of-principles-concerning-atrial-fibrillation-and-atrial-flutter-balance-of-probabilities-n","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":103685,"registerId":"commonwealth-F2023L00011-current","compilationNumber":null,"startDate":"2026-04-03","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning atrial fibrillation and atrial flutter (Balance of Probabilities) (No. 2 of 2023)","content":"![RMA Australian Government Coat of Arms](image.001.jpeg)\n\nStatement of Principles\n\nconcerning\n\nATRIAL FIBRILLATION AND ATRIAL FLUTTER  \n(Balance of Probabilities)\n\n(No. 2 of 2023)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\nDated 23 December 2022\n\n| The Common Seal of theRepatriation Medical Authoritywas affixed to this instrumentat the direction of: |\n| ------------------------------------------------------------------------------------------------------ |\n| Professor Terence Campbell AMChairperson                                                               |\n\n  \n\nContents\n\n1 Name....................................................3\n\n2 Commencement.............................................3\n\n3 Authority..................................................3\n\n4 Repeal...................................................3\n\n5 Application................................................3\n\n6 Definitions................................................3\n\n7 Kind of injury, disease or death to which this Statement of Principles relates.....3\n\n8 Basis for determining the factors..................................4\n\n9 Factors that must exist.........................................4\n\n10 Relationship to service.........................................11\n\n11 Factors referring to an injury or disease covered by another Statement of Principles.12\n\nSchedule 1 - Dictionary..............................................13\n\n1 Definitions................................................13\n\n  \n\n1.  Name\n\nThis is the Statement of Principles concerning atrial fibrillation and atrial flutter (Balance of Probabilities) (No. 2 of 2023).\n\n1.  Commencement\n\nThis instrument commences on 23 January 2023.\n\n1.  Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n1.  Repeal\n\nThe Statement of Principles concerning atrial fibrillation and atrial flutter No. 50 of 2014 (Federal Register of Legislation No. F2014L00482) made under subsection 196B(3) of the VEA is repealed.\n\n1.  Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004 applies.\n\n1.  Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n1.  Kind of injury, disease or death to which this Statement of Principles relates\n    1.  This Statement of Principles is about atrial fibrillation and atrial flutter and death from atrial fibrillation and atrial flutter.\n\nMeaning of atrial fibrillation and atrial flutter\n\n1.  For the purposes of this Statement of Principles:\n    1.  atrial fibrillation means a disorder of cardiac rhythm, in which there is disorganised, rapid, and irregular atrial electrical activation, resulting in loss of organised atrial mechanical contraction and an irregular, usually rapid ventricular rate.\n    2.  atrial flutter:\n        1.  means a disorder of cardiac rhythm in which there is rapid and regular atrial electrical activation caused by a re-entry circuit within the right atrium, resulting in a regular, rapid atrial rate; and\n        2.  a characteristic electrocardiographic appearance of a uniform and regular continuous sawtooth wave-form.\n\n> Note 1: Atrial fibrillation and atrial flutter can be paroxysmal, persistent or permanent disorders, with variable electrocardiographic and clinical features. Ventricular rates in atrial flutter are typically 150 beats per minute.\n\n> Note 2: Symptoms of atrial fibrillation or atrial flutter typically include palpitations, fatigue, lightheadedness, and mild shortness of breath. Less common problems include significant dyspnoea, angina, hypotension, anxiety and syncope.\n\n> Note 3: Atrial fibrillation and atrial flutter can occur alone or in combination.\n\n1.  While atrial fibrillation and atrial flutter attract ICD‑10‑AM code I48, in applying this Statement of Principles the meaning of atrial fibrillation and atrial flutter is that given in subsection (2).\n2.  For subsection (3), a reference to an ICD-10-AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4.\n\nDeath from atrial fibrillation and atrial flutter\n\n1.  For the purposes of this Statement of Principles, atrial fibrillation and atrial flutter, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's atrial fibrillation and atrial flutter.\n\n> Note: terminal event is defined in the Schedule 1 – Dictionary.\n\n1.  Basis for determining the factors\n\nOn the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that atrial fibrillation and atrial flutter and death from atrial fibrillation and atrial flutter can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA.\n\n> Note: MRCA, relevant service and VEA are defined in the Schedule 1 – Dictionary.\n\n1.  Factors that must exist\n\nAt least one of the following factors must exist before it can be said that, on the balance of probabilities, atrial fibrillation and atrial flutter or death from atrial fibrillation and atrial flutter is connected with the circumstances of a person's relevant service:\n\n1.  having valvular heart disease at the time of the clinical onset of atrial fibrillation or atrial flutter;\n\n> Note 1: valvular heart disease is defined in the schedule 1 Dictionary.\n\n1.  having ischaemic heart disease at the time of the clinical onset of atrial fibrillation or atrial flutter;\n2.  having non-infectious myocarditis at the time of the clinical onset of atrial fibrillation or atrial flutter;\n\n> Note 1: Non-infectious myocarditis can be acute or chronic.\n\n> Note 2: Non-infectious myocarditis can be of autoimmune, infiltrative or immunological origin. Examples of causes of non-infectious myocarditis include immune checkpoint inhibitor therapy and giant cell myocarditis.\n\n1.  having viral myocarditis at the time of the clinical onset of atrial fibrillation or atrial flutter;\n\n> Note 1: Viral myocarditis can be acute or chronic.\n\n> Note 2: Examples of viral causes of myocarditis include severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and dengue virus.\n\n1.  having a non-viral infection of the myocardium at the time of the clinical onset of atrial fibrillation or atrial flutter;\n\n> Note: Examples of causes of non-viral infection of the myocardium include Borrelia burgdorferi and leptospirosis.\n\n1.  having pericarditis at the time of the clinical onset of atrial fibrillation or atrial flutter;\n2.  having cardiomyopathy at the time of the clinical onset of atrial fibrillation or atrial flutter;\n3.  having heart failure at the time of the clinical onset of atrial fibrillation or atrial flutter;\n4.  having hypertension before the clinical onset of atrial fibrillation or atrial flutter;\n5.  having pulmonary thromboembolism within the 30 days before the clinical onset of atrial fibrillation or atrial flutter;\n6.  having a thyroid condition from the specified list of thyroid conditions at the time of the clinical onset of atrial fibrillation or atrial flutter;\n\n> Note: specified list of thyroid conditions is defined in the Schedule 1 – Dictionary.\n\n1.  consuming an average of at least 150 grams of alcohol per week for a continuous period of at least the 5 years before the clinical onset of atrial fibrillation or atrial flutter;\n\n> Note: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.\n\n1.  binge drinking within the 2 days before the clinical onset of atrial fibrillation or atrial flutter;\n\n> Note: binge drinking is defined in the Schedule 1 – Dictionary.\n\n1.  having a thoracic surgical procedure or an invasive cardiac procedure within the 1 year before the clinical onset of atrial fibrillation or atrial flutter;\n\n> Note 1: Examples of thoracic surgical procedures include vascular, mediastinal, pulmonary and chest wall surgery.\n\n> Note 2: Examples of invasive cardiac procedures include:\n\n1.  coronary artery bypass grafting;\n2.  heart transplant;\n3.  open heart surgery; and\n4.  transcatheter aortic valve implantation.\n\n1.  having a non-cardiothoracic surgical procedure involving general or regional anaesthesia, within the 30 days before the clinical onset of atrial fibrillation or atrial flutter;\n\n> Note: Examples of non-cardiothoracic surgical procedures include emergency or elective orthopaedic and abdominal surgery and neurosurgery.\n\n1.  having chronic obstructive pulmonary disease at the time of the clinical onset of atrial fibrillation or atrial flutter;\n2.  having asthma of sufficient severity to require maintenance therapy at the time of the clinical onset of atrial fibrillation or atrial flutter;\n3.  undertaking strenuous physical activity greater than 6 METs, for an average of at least 20 hours per week for a continuous period of at least the 5 years before the clinical onset of atrial fibrillation or atrial flutter;\n\n> Note: MET is defined in the Schedule 1 – Dictionary.\n\n1.  inability to undertake any physical activity greater than 3 METs for at least the 1 year before the clinical onset of atrial fibrillation and atrial flutter;\n\n> Note: MET is defined in the Schedule 1 - Dictionary.\n\n1.  having sick sinus syndrome at the time of the clinical onset of atrial fibrillation or atrial flutter;\n2.  having a benign or malignant neoplasm involving the cardiac atrium at the time of the clinical onset of atrial fibrillation or atrial flutter;\n\n> Note: A neoplasm involving the cardiac atrium can be primary or metastatic. An example of a primary neoplasm involving the heart is cardiac lymphoma.\n\n1.  having a non-neoplastic lesion involving the cardiac atrium at the time of the clinical onset of atrial fibrillation or atrial flutter;\n\n> Note: Examples of non-neoplastic lesions which can involve the cardiac atrium include cardiac tamponade and coronary artery aneurysm.\n\n1.  having a malignant neoplasm, excluding non-melanotic malignant neoplasm of the skin, at the time of the clinical onset of atrial fibrillation or atrial flutter;\n2.  undergoing a course of therapeutic radiation for cancer, where the heart was in the field of radiation, before the clinical onset of atrial fibrillation or atrial flutter;\n3.  having diabetes mellitus for at least the 5 years before the clinical onset of atrial fibrillation or atrial flutter;\n4.  experiencing penetrating trauma to the heart within the 1 year before the clinical onset of atrial fibrillation or atrial flutter;\n5.  having a spinal cord injury before the clinical onset of atrial fibrillation or atrial flutter;\n\n> Note: spinal cord injury is defined in the Schedule 1 – Dictionary.\n\n1.  having sepsis, or an injury or illness requiring admission to an intensive care unit or mechanical ventilation within the 30 days before the clinical onset of atrial fibrillation or atrial flutter;\n\n> Note: sepsis is defined in the Schedule 1 – Dictionary.\n\n1.  having infiltration of the myocardium due to amyloidosis or sarcoidosis at the time of the clinical onset of atrial fibrillation or atrial flutter;\n2.  having an autoimmune or inflammatory disease from the specified list of autoimmune or inflammatory diseases at the time of the clinical onset of atrial fibrillation or atrial flutter;\n\n> Note: specified list of autoimmune or inflammatory diseases is defined in the Schedule 1 - Dictionary.\n\n1.  being overweight or obese for at least the 5 years before the clinical onset of atrial fibrillation or atrial flutter;\n\n> Note: being overweight or obese is defined in the Schedule 1 - Dictionary.\n\n1.  having obstructive sleep apnoea at the time of the clinical onset of atrial fibrillation or atrial flutter;\n2.  having smoked tobacco products in an amount of at least 10 pack-years before the clinical onset of atrial fibrillation or atrial flutter; and if smoking has ceased before the clinical onset of atrial fibrillation or atrial flutter, then that onset occurred within 5 years of cessation;\n\n> Note: one pack-year is defined in the Schedule 1 - Dictionary.\n\n1.  having chronic renal failure at the time of the clinical onset of atrial fibrillation or atrial flutter;\n\n> Note: chronic renal failure is defined in the Schedule 1 - Dictionary.\n\n1.  having systemic chemotherapy for a malignant disease at the time of the clinical onset of atrial fibrillation or atrial flutter;\n\n> Note: Examples of systemic chemotherapy for malignant disease include:\n\n> Note: (a) anthracyclines including doxorubicin;\n\n> Note: (b) HER2 inhibitors including trastuzumab; and\n\n> Note: (c) tyrosine kinase inhibitors including ibrutinib.\n\n1.  having glucocorticoid therapy as specified before the clinical onset of atrial fibrillation or atrial flutter, and if the glucocorticoid therapy as specified has ceased or decreased before the clinical onset of atrial fibrillation or atrial flutter, then that onset occurred within 30 days of cessation of therapy;\n\n> Note: glucocorticoid therapy as specified is defined in the Schedule 1 - Dictionary.\n\n1.  taking a drug from the specified list of drugs within the 7 days before the clinical onset of atrial fibrillation or atrial flutter;\n\n> Note: specified list of drugs is defined in the Schedule 1 - Dictionary.\n\n1.  having valvular heart disease at the time of the clinical worsening of atrial fibrillation or atrial flutter;\n\n> Note 1: valvular heart disease is defined in the schedule 1 Dictionary.\n\n1.  having ischaemic heart disease at the time of the clinical worsening of atrial fibrillation or atrial flutter;\n2.  having non-infectious myocarditis at the time of the clinical worsening of atrial fibrillation or atrial flutter;\n\n> Note 1: Non-infectious myocarditis can be acute or chronic.\n\n> Note 2: Non-infectious myocarditis can be of autoimmune, infiltrative or immunological origin. Examples of causes of non-infectious myocarditis include immune checkpoint inhibitor therapy and giant cell myocarditis.\n\n1.  having viral myocarditis at the time of the clinical worsening of atrial fibrillation or atrial flutter;\n\n> Note 1: Viral myocarditis can be acute or chronic.\n\n> Note 2: Examples of viral causes of myocarditis include severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and dengue virus.\n\n1.  having a non-viral infection of the myocardium at the time of the clinical worsening of atrial fibrillation or atrial flutter;\n\n> Note: Examples of causes of non-viral infection of the myocardium include Borrelia burgdorferi and leptospirosis.\n\n1.  having pericarditis at the time of the clinical worsening of atrial fibrillation or atrial flutter;\n2.  having cardiomyopathy at the time of the clinical worsening of atrial fibrillation or atrial flutter;\n3.  having heart failure at the time of the clinical worsening of atrial fibrillation or atrial flutter;\n4.  having hypertension before the clinical worsening of atrial fibrillation or atrial flutter;\n5.  having pulmonary thromboembolism within the 30 days before the clinical worsening of atrial fibrillation or atrial flutter;\n6.  having a thyroid condition from the specified list of thyroid conditions at the time of the clinical worsening of atrial fibrillation or atrial flutter;\n\n> Note: specified list of thyroid conditions is defined in the Schedule 1 – Dictionary.\n\n1.  consuming an average of at least 150 grams of alcohol per week for a continuous period of at least the 5 years before the clinical worsening of atrial fibrillation or atrial flutter;\n\n> Note: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.\n\n1.  binge drinking within the 2 days before the clinical worsening of atrial fibrillation or atrial flutter;\n\n> Note: binge drinking is defined in the Schedule 1 – Dictionary.\n\n1.  having a thoracic surgical procedure or an invasive cardiac procedure within the 1 year before the clinical worsening of atrial fibrillation or atrial flutter;\n\n> Note 1: Examples of thoracic surgical procedures include vascular, mediastinal, pulmonary and chest wall surgery.\n\n> Note 2: Examples of invasive cardiac procedures include:\n\n> Note: coronary artery bypass grafting;\n\n> Note: heart transplant;\n\n> Note: open heart surgery; and\n\n> Note: transcatheter aortic valve implantation.\n> 1.  having a non-cardiothoracic surgical procedure involving general or regional anaesthesia, within the 30 days before the clinical worsening of atrial fibrillation or atrial flutter;\n\n> Note: Examples of non-cardiothoracic surgical procedures include emergency or elective orthopaedic and abdominal surgery and neurosurgery.\n\n1.  having chronic obstructive pulmonary disease at the time of the clinical worsening of atrial fibrillation or atrial flutter;\n2.  having asthma of sufficient severity to require maintenance therapy at the time of the clinical worsening of atrial fibrillation or atrial flutter;\n3.  undertaking strenuous physical activity greater than 6 METs, for an average of at least 20 hours per week for a continuous period of at least the 5 years before the clinical worsening of atrial fibrillation or atrial flutter;\n\n> Note: MET is defined in the Schedule 1 – Dictionary.\n\n1.  inability to undertake any physical activity greater than 3 METs for at least the 1 year before the clinical worsening of atrial fibrillation or atrial flutter;\n\n> Note: MET is defined in the Schedule 1 - Dictionary.\n\n1.  having sick sinus syndrome at the time of the clinical worsening of atrial fibrillation or atrial flutter;\n2.  having a benign or malignant neoplasm involving the cardiac atrium at the time of the clinical worsening of atrial fibrillation or atrial flutter;\n\n> Note: A neoplasm involving the cardiac atrium can be primary or metastatic. An example of a primary neoplasm involving the heart is cardiac lymphoma.\n\n1.  having a non-neoplastic lesion involving the cardiac atrium at the time of the clinical worsening of atrial fibrillation or atrial flutter;\n\n> Note: Examples of non-neoplastic lesions which can involve the cardiac atrium include cardiac tamponade and coronary artery aneurysm.\n\n1.  having a malignant neoplasm, excluding non-melanotic malignant neoplasm of the skin, at the time of the clinical worsening of atrial fibrillation or atrial flutter;\n2.  undergoing a course of therapeutic radiation for cancer, where the heart was in the field of radiation, before the clinical worsening of atrial fibrillation or atrial flutter;\n3.  having diabetes mellitus for at least the 5 years before the clinical worsening of atrial fibrillation or atrial flutter;\n4.  experiencing penetrating trauma to the heart within the 1 year before the clinical worsening of atrial fibrillation or atrial flutter;\n5.  having a spinal cord injury before the clinical worsening of atrial fibrillation or atrial flutter;\n\n> Note: spinal cord injury is defined in the Schedule 1 – Dictionary.\n\n1.  having sepsis, or an injury or illness requiring admission to an intensive care unit or mechanical ventilation within the 30 days before the clinical worsening of atrial fibrillation or atrial flutter;\n\n> Note: sepsis is defined in the Schedule 1 – Dictionary.\n\n1.  having infiltration of the myocardium due to amyloidosis or sarcoidosis at the time of the clinical worsening of atrial fibrillation or atrial flutter;\n2.  having an autoimmune or inflammatory disease from the specified list of autoimmune or inflammatory diseases at the time of the clinical worsening of atrial fibrillation or atrial flutter;\n\n> Note: specified list of autoimmune or inflammatory diseases is defined in the Schedule 1 - Dictionary.\n\n1.  being overweight or obese for at least the 5 years before the clinical worsening of atrial fibrillation or atrial flutter;\n\n> Note: being overweight or obese is defined in the Schedule 1 - Dictionary.\n\n1.  having obstructive sleep apnoea at the time of the clinical worsening of atrial fibrillation or atrial flutter;\n2.  having smoked tobacco products in an amount of at least 10 pack-years before the clinical worsening of atrial fibrillation or atrial flutter; and if smoking has ceased before the clinical worsening of atrial fibrillation or atrial flutter, then that worsening occurred within 5 years of cessation;\n\n> Note: one pack-year is defined in the Schedule 1 - Dictionary.\n\n1.  having chronic renal failure at the time of the clinical worsening of atrial fibrillation or atrial flutter;\n\n> Note: chronic renal failure is defined in the Schedule 1 - Dictionary.\n\n1.  having systemic chemotherapy for a malignant disease at the time of the clinical worsening of atrial fibrillation or atrial flutter;\n\n> Note: Examples of systemic chemotherapy for malignant disease include:\n\n> Note: (a) anthracyclines including doxorubicin;\n\n> Note: (b) HER2 inhibitors including trastuzumab; and\n\n> Note: (c) tyrosine kinase inhibitors including ibrutinib.\n\n1.  having glucocorticoid therapy as specified before the clinical worsening of atrial fibrillation or atrial flutter, and if the glucocorticoid therapy as specified has ceased or decreased before the clinical worsening of atrial fibrillation or atrial flutter, then that worsening occurred within 30 days of cessation of therapy;\n\n> Note: glucocorticoid therapy as specified is defined in the Schedule 1 - Dictionary.\n\n1.  taking a drug from the specified list of drugs:\n\n(a) as prescribed for ongoing use; and\n\n(b) within the 7 days before the clinical worsening of atrial fibrillation or atrial flutter;\n\n> Note: specified list of drugs is defined in the Schedule 1 - Dictionary.\n\n1.  inability to obtain appropriate clinical management for atrial fibrillation and atrial flutter.\n\n1.  Relationship to service\n    1.  The existence in a person of any factor referred to in section 9, must be related to the relevant service rendered by the person.\n    2.  The factors set out in subsections 9(38) to 9(75) apply only to material contribution to, or aggravation of, atrial fibrillation and atrial flutter where the person's atrial fibrillation and atrial flutter was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n2.  Factors referring to an injury or disease covered by another Statement of Principles\n\nIn this Statement of Principles:\n\n1.  if a factor referred to in section 9 applies in relation to a person; and\n2.  that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(3) of the VEA;\n\nthen the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.\n\nSchedule 1 \\- Dictionary\n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\natrial fibrillation and atrial flutter—see subsection 7(2).\n\nbeing overweight or obese means:\n\n(a) having a Body Mass Index (BMI) of 25 or greater; or\n\n(b) for males, having a waist circumference exceeding 94 centimetres; or\n\n(c) for females, having a waist circumference exceeding 80 centimetres.\n\n> Note: BMI is also defined in the Schedule 1 - Dictionary.\n\nbinge drinking means consumption of large amounts of alcohol in a short space of time resulting in acute alcohol intoxication.\n\n> Note: Acute alcohol intoxication typically occurs when there is consumption of:\n\n> Note: (a) 4 or more standard alcoholic drinks by an adult female within a 2 hour time period; or\n\n> Note: (b) 5 or more standard alcoholic drinks by an adult male within a 2 hour time period; or\n\n> Note: (c) sufficient alcohol as would result in a blood alcohol concentration greater than 0.1 gram of alcohol per 100 millilitres of blood.\n\nBMI means W/H2 where:\n\n(a) W is the person's weight in kilograms; and\n\n(b) H is the person's height in metres.\n\nchronic renal failure means:\n\n(a) having a glomerular filtration rate of less than 15 mL/min/1.73 m2 for a period of at least 3 months; or\n\n(b) a need for renal replacement therapy (dialysis or transplantation) for treatment of complications of decreased glomerular filtration rate which would otherwise increase the risk of morbidity and mortality; or\n\n(c) undergoing chronic dialysis.\n\nequivalent glucocorticoid therapy means a glucocorticoid in the following table, at the doses specified in the table, or a therapeutically equivalent dose of another glucocorticoid:\n\n| Glucocorticoid     | Minimum cumulativedose (milligram) | Minimum averagerate (milligram/day) |\n| ------------------ | ---------------------------------- | ----------------------------------- |\n| betamethasone      | 45                                 | 1.5                                 |\n| cortisone          | 1 875                              | 62.5                                |\n| dexamethasone      | 55                                 | 1.8                                 |\n| methylprednisolone | 300                                | 10                                  |\n| paramethasone      | 150                                | 5                                   |\n| prednisolone       | 375                                | 12.5                                |\n| prednisone         | 375                                | 12.5                                |\n| triamcinolone      | 300                                | 10                                  |\n\nglucocorticoid therapy as specified means taking:\n\n(a) hydrocortisone, orally or by injection:\n\n(i) to a cumulative dose of at least 1,500 milligrams; and\n\n(ii) at a minimum dose rate averaging 50 milligrams per day; or\n\n(b) equivalent glucocorticoid therapy, orally or by injection.\n\nNote: equivalent glucocorticoid therapy is also defined in the Schedule 1 – Dictionary.\n\nMET means a unit of measurement of the level of physical exertion. 1 MET = 3.5 ml of oxygen/kg of body weight per minute, or 1.0 kcal/kg of body weight per hour, or resting metabolic rate.\n\nMRCA means the Military Rehabilitation and Compensation Act 2004.\n\none pack-year means the amount of tobacco consumed in smoking 20 cigarettes per day for a period of 1 year, or an equivalent amount of tobacco products.\n\n> Note 1: An equivalent amount of tobacco products is 7,300 grams of smoking tobacco by weight, either in cigarettes, pipe tobacco or cigars, or a combination of same. For pipe tobacco, cigars or combinations of multiple tobacco types, 1 gram of tobacco is considered to be equal to one cigarette.\n\n> Note 2: Pack-years are calculated by dividing the number of cigarettes smoked per day by 20 and multiplying this number by the number of years the person has smoked. For example, smoking 10 cigarettes per day for 10 years is equal to 5 pack-years, and smoking 40 cigarettes per day for 10 years is equal to 20 pack-years.\n\nrelevant service means:\n\n(a) eligible war service (other than operational service) under the VEA;\n\n(b) defence service (other than hazardous service and British nuclear test defence service) under the VEA; or\n\n(c) peacetime service under the MRCA.\n\n> Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary.\n\nsepsis means life-threatening organ dysfunction caused by an overwhelming host response to infection.\n\nspecified list of drugs means:\n\n(a) adenosine;\n\n(b) dobutamine; or\n\n(c) milrinone.\n\nspecified list of thyroid conditions means:\n\n(a) hyperthyroidism; including goitre or Graves disease which has resulted in hyperthyroidism;\n\n(b) subclinical hyperthyroidism; or\n\n(c) thyrotoxicosis.\n\n> Note: subclinical hyperthyroidism is also defined in the Schedule 1 – Dictionary.\n\nspinal cord injury means an injury to the long tracts of the spinal cord resulting in permanent motor or sensory deficits below the level of the lesion.\n\nspecified list of autoimmune or inflammatory diseases means:\n\n(a) ankylosing spondylitis or another autoimmune inflammatory spondyloarthritis;\n\n(b) coeliac disease;\n\n(c) giant cell arteritis;\n\n(d) inflammatory bowel disease;\n\n(e) psoriasis;\n\n(f) rheumatoid arthritis;\n\n(g) systemic lupus erythematosus; or\n\n(h) systemic sclerosis (scleroderma).\n\nsubclinical hyperthyroidism means having normal free thyroxine (FT4) and total triiodothyronine (T3) levels in conjunction with a thyrotropin (TSH) level persistently below the normal range in the absence of factors known to suppress TSH.\n\nterminal event means the proximate or ultimate cause of death and includes the following:\n\n(a) pneumonia;\n\n(b) respiratory failure;\n\n(c) cardiac arrest;\n\n(d) circulatory failure; or\n\n(e) cessation of brain function.\n\nvalvular heart disease means haemodynamically significant stenosis or incompetence of one or more cardiac valves.\n\n> Note: An example of a cause of haemodynamically significant valvular heart disease is rheumatic heart disease.\n\nVEA means the Veterans' Entitlements Act 1986.","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals and replaces the 2014 Statement of Principles. It preserves the same statutory application (claims under section 120B of the VEA and section 339 of the MRCA) but updates and expands the listed causal factors, adds specific quantitative thresholds (alcohol, smoking, BMI, METs), a glucocorticoid equivalent dosing table, a specified drugs list and examples (including SARS‑CoV‑2), and clarifies temporal windows for onset and worsening."},"complexity_factors":["Large numbered list of discrete factors (many medical conditions, exposures and events) that can establish causation (section 9).","Multiple temporal thresholds tied to different factors (e.g. within 7 days, 30 days, 1 year, 5 years) increasing evidentiary parsing.","Technical medical definitions and measurements (BMI, METs, glomerular filtration rate, sepsis, terminal event, valvular disease) requiring clinical interpretation (Schedule 1).","Specified quantitative thresholds for exposures and treatments (150 g alcohol/week over 5 years; 10 pack‑years and 5‑year cessation window; glucocorticoid cumulative/daily dosing table).","Separate rules for clinical onset versus clinical worsening of the condition, and distinct applicability for pre‑existing conditions (subsections on material contribution/aggravation).","Cross‑references to other Statements of Principles and to VEA/MRCA claim provisions (relationship to service, application, and repeal of the 2014 instrument).","Lists of specified drugs, thyroid and autoimmune conditions and examples (including SARS‑CoV‑2 and certain chemotherapies) that narrow or expand causal pathways.","Evidentiary standard is statutory ('balance of probabilities') which frames the decisionmaker's application of these factors.","Potential administrative complexity for decisionmakers in weighing combinations of factors, exclusions and linked Statements of Principles."],"plain_english_summary":"This Statement of Principles (No. 2 of 2023) replaces the 2014 version and sets medical criteria under the Veterans' Entitlements Act to decide, on the balance of probabilities, when atrial fibrillation, atrial flutter or death from those conditions is connected to a person's relevant military service. It defines clinical terms and lists specific causal factors and time limits — medical conditions, procedures, drugs, alcohol and smoking thresholds, activity and treatment histories — that, if present, establish a service connection for veterans and members claiming compensation or rehabilitation."},"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"},"kimi_summary":{"content_quality":"ok","complexity_score":7,"scope_assessment":{"changed":false,"description":"The legislation maintains its original purpose as a medical determination instrument for a specific cardiac condition. While it updates medical science (adding COVID-19, modern cancer therapies, updated ICD-10-AM references), it does not expand beyond its core function of establishing service connection criteria for atrial fibrillation/flutter in the veterans compensation scheme. The 2023 revision appears to be a routine medical update rather than scope creep."},"complexity_factors":["74 distinct medical factors across clinical onset and clinical worsening scenarios, many with nearly identical wording requiring careful parsing","Multiple defined terms in Schedule 1 Dictionary (approximately 20+ defined terms including technical medical measurements like METs, BMI calculations, and glucocorticoid equivalent dosing tables)","Complex temporal requirements with varying lookback periods: 2 days (binge drinking), 7 days (specified drugs), 30 days (surgery/sepsis), 1 year (thoracic surgery/trauma/inactivity), 5 years (alcohol/smoking/diabetes/obesity/physical activity)","Nested conditional logic in factors 9(38) and 9(75) requiring both ongoing prescription status AND 7-day proximity for drug-related worsening","Cross-referencing mechanism in section 11 that incorporates other Statements of Principles dynamically ('as in force from time to time')","Dual threshold requirements for certain factors (e.g., glucocorticoid therapy requires both cumulative dose AND minimum daily rate)","Mathematical formulas embedded in definitions (BMI = W/H², pack-year calculations, MET equivalents)","Gender-specific measurements (waist circumference differs for males/females in obesity definition)","Extensive use of inclusive notes and examples that expand rather than limit interpretation","Specific pharmaceutical dosing tables with therapeutic equivalence calculations"],"plain_english_summary":"This Statement of Principles sets the medical rules for deciding, on the balance of probabilities, whether atrial fibrillation or atrial flutter is connected to Australian military service. It replaces a 2014 version with updated evidence and applies to veterans and current/former defence members seeking compensation or care.\n\nHighly prescriptive, it links clinical onset or worsening to a range of medical, lifestyle and treatment factors and uses exact timeframes and measurement thresholds to guide entitlement decisions."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-atrial-fibrillation-and-atrial-flutter-balance-of-probabilities-n","history":"/api/acts/statement-of-principles-concerning-atrial-fibrillation-and-atrial-flutter-balance-of-probabilities-n/history","analysis":"/api/acts/statement-of-principles-concerning-atrial-fibrillation-and-atrial-flutter-balance-of-probabilities-n/analysis","conflicts":"/api/acts/statement-of-principles-concerning-atrial-fibrillation-and-atrial-flutter-balance-of-probabilities-n/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-atrial-fibrillation-and-atrial-flutter-balance-of-probabilities-n/important-cases","documents":"/api/acts/statement-of-principles-concerning-atrial-fibrillation-and-atrial-flutter-balance-of-probabilities-n/documents"}}