{"id":"F2023L00172","name":"Statement of Principles concerning mitral valve prolapse (Balance of Probabilities) (No. 16 of 2023)","slug":"statement-of-principles-concerning-mitral-valve-prolapse-balance-of-probabilities-no-16-of-2023","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441732,"registerId":"F2023L00172-fast-fetch-1775956962056","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning mitral valve prolapse (Balance of Probabilities) (No. 16 of 2023)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 22.10.0\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n\n\n \n\nStatement of Principles\n\nconcerning\n\nMITRAL VALVE PROLAPSE (Balance of Probabilities)\n\n(No. 16 of 2023)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n \n\nDated 27 February 2023\n\n \n\n \n\n \n\n \n\n \n\n| The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:
|\n| --- |\n|
Professor Terence Campbell AM
Chairperson
|\n\n\n \n\n \n\n\nContents\n\n1 Name\n\n2 Commencement\n\n3 Authority\n\n4 Repeal\n\n5 Application\n\n6 Definitions\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n8 Basis for determining the factors\n\n9 Factors that must exist\n\n10 Relationship to service\n\n11 Factors referring to an injury or disease covered by another Statement of Principles\n\nSchedule 1 - Dictionary\n\n1 Definitions\n\n \n\n\n\n\n1 Name\n\nThis is the Statement of Principles concerning mitral valve prolapse (Balance of Probabilities) (No. 16 of 2023).\n\n2 Commencement\n\n This instrument commences on 27 March 2023.\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning mitral valve prolapse No. 44 of 2014 (Federal Register of Legislation No. F2014L00473) made under subsection/s 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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\n6 Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n(1) This Statement of Principles is about mitral valve prolapse and death from mitral valve prolapse.\n\nMeaning of mitral valve prolapse\n\n(2) For the purposes of this Statement of Principles, mitral valve prolapse:\n\n(a) means a degenerative, structural disorder of the mitral valve apparatus in which there is systolic displacement of an abnormally thickened or redundant mitral leaflet into the left atrium, and where this disorder has been confirmed by echocardiographic studies; and\n\n(b) excludes:\n\n(i) flail mitral valve leaflet;\n\n(ii) inherited connective tissue disorders including Marfan syndrome;\n\n(iii) isolated mitral regurgitation in the absence of echocardiographic evidence of mitral valve prolapse; and\n\n(iv) mitral valve disorder due to rheumatic heart disease.\n\nNote 1: Mitral valve prolapse is also known as Barlow syndrome, Barlow disease or floppy mitral valve syndrome.\n\nNote 2: The diagnosis of mitral valve prolapse does not include displacement or billowing of the anterior mitral valve leaflet identified only in the 4-chamber apical view.\n\n(3) While mitral valve prolapse attracts ICD‑10‑AM code I34.1, in applying this Statement of Principles the meaning of mitral valve prolapse is that given in subsection (2).\n\n(4) 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 mitral valve prolapse\n\n(5) For the purposes of this Statement of Principles, mitral valve prolapse, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's mitral valve prolapse.\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n8 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 mitral valve prolapse and death from mitral valve prolapse can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA.\n\nNote: MRCA, relevant service and VEA are defined in the Schedule 1 – Dictionary.\n\n9 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, mitral valve prolapse or death from mitral valve prolapse is connected with the circumstances of a person's relevant service:\n\n(1) inability to obtain appropriate clinical management for mitral valve prolapse.\n\n10 Relationship to service\n\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\n(2) The factor set out in subsection 9(1) applies only to material contribution to, or aggravation of, mitral valve prolapse where the person's mitral valve prolapse was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n\n11 Factors referring to an injury or disease covered by another Statement of Principles\n\nIn this Statement of Principles:\n\n(1) if a factor referred to in section 9 applies in relation to a person; and\n\n(2) 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\n \n\n \n\nSchedule 1 - Dictionary \n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\n mitral valve prolapse—see subsection 7(2).\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n relevant 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\nNote: MRCA and VEA are also defined in the Schedule 1 - Dictionary.\n\n terminal 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\n VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":3,"scope_assessment":{"changed":false,"description":"This instrument maintains the same narrow scope as its 2014 predecessor. It continues to recognise only one factor (inability to obtain appropriate clinical management) for connecting mitral valve prolapse to service, reflecting the consistent medical-scientific view that this condition is not causally related to military service. The 2023 revision appears to be a standard reissue with updated legislative references and formatting rather than an expansion of scope."},"complexity_factors":["Single operative factor in section 9 (only one pathway to establish connection to service)","Precise medical definition with four specific exclusions in subsection 7(2)","Limited cross-referencing — only refers to other Statements of Principles in section 11 and standard definitions in Schedule 1","Conditional limitation in section 10(2) restricting the factor to aggravation of pre-existing conditions only","Short length (approximately 1,500 words) with only 6 defined terms in the Dictionary","Clear structure following standard Repatriation Medical Authority template"],"plain_english_summary":"This instrument replaces the 2014 rules and narrowly defines mitral valve prolapse for compensation—requiring ultrasound confirmation and excluding some related conditions—and sets a single link to service: inability to obtain appropriate treatment for a pre‑existing or service‑aggravated condition. It affects veterans and current/former defence members claiming under the VEA or MRCA for peacetime/non‑operational war service. It matters because there is no recognised service‑caused onset; claims succeed only if service blocked needed treatment, making awards difficult."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"The instrument expressly repeals the prior Statement (s4) and replaces it with a narrowly defined regime: MVP is defined by echocardiographic confirmation with listed exclusions (s7), and the only listed pathway for service connection is inability to obtain appropriate clinical management (s9), applied where MVP pre‑existed or arose during but did not arise out of service (s10(2)). This shifts scope toward a more specified, constrained set of qualifying circumstances."},"complexity_factors":["Narrow medical definition requiring echocardiographic confirmation and explicit exclusions (s7(2)-(4))","Only one listed causation factor — inability to obtain appropriate clinical management — which concentrates evidentiary focus (s9(1))","Conditional application limited to cases where MVP existed before or during, but did not arise out of, service (s10(2))","Requirement to show connection on the balance of probabilities and concepts such as 'material contribution' and 'aggravation' create evidentiary and interpretive questions (s8, s10(2))","Interaction with other Statements of Principles where overlapping injuries/diseases are involved (s11)","Explicit repeal of the prior Statement may require reassessment of existing claims (s4)","Restricted application to claims under VEA and MRCA, narrowing administrative scope (s5)"],"plain_english_summary":"This instrument replaces the earlier Statement and sets how mitral valve prolapse (MVP) and death from MVP can be linked to veterans’ service for VEA and MRCA claims. It defines MVP narrowly (echocardiographic confirmation; specified exclusions) and makes “inability to obtain appropriate clinical management” the sole listed factor for connection on the balance of probabilities. The factor applies only where MVP pre‑existed or arose during—but did not arise out of—service. (See ss.5–10.)"},"flash_summary_failed":{"failed":true,"reason":"Unauthenticated. Configure AI_GATEWAY_API_KEY or use a provider module. Learn more: https://ai-sdk.dev/unauthenticated-ai-gateway","source":"analysis-cron"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-mitral-valve-prolapse-balance-of-probabilities-no-16-of-2023","history":"/api/acts/statement-of-principles-concerning-mitral-valve-prolapse-balance-of-probabilities-no-16-of-2023/history","analysis":"/api/acts/statement-of-principles-concerning-mitral-valve-prolapse-balance-of-probabilities-no-16-of-2023/analysis","conflicts":"/api/acts/statement-of-principles-concerning-mitral-valve-prolapse-balance-of-probabilities-no-16-of-2023/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-mitral-valve-prolapse-balance-of-probabilities-no-16-of-2023/important-cases","documents":"/api/acts/statement-of-principles-concerning-mitral-valve-prolapse-balance-of-probabilities-no-16-of-2023/documents"}}