{"id":"F2023L00171","name":"Statement of Principles concerning mitral valve prolapse (Reasonable Hypothesis) (No. 15 of 2023)","slug":"statement-of-principles-concerning-mitral-valve-prolapse-reasonable-hypothesis-no-15-of-2023","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441733,"registerId":"F2023L00171-fast-fetch-1775956962058","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 (Reasonable Hypothesis) (No. 15 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 (Reasonable Hypothesis)\n\n(No. 15 of 2023)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) 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 (Reasonable Hypothesis) (No. 15 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning mitral valve prolapse No. 43 of 2014 (Federal Register of Legislation No. F2014L00471) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that mitral valve prolapse and death from mitral valve prolapse can be related to relevant service rendered by veterans, members of Peacekeeping Forces, 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 as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting mitral valve prolapse or death from mitral valve prolapse 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(2) 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) operational service under the VEA;\n\n(b) peacekeeping service under the VEA;\n\n(c) hazardous service under the VEA;\n\n(d) British nuclear test defence service under the VEA;\n\n(e) warlike service under the MRCA; or\n\n(f) non-warlike 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 address only mitral valve prolapse under the 'reasonable hypothesis' standard, with the same single causal factor (inability to obtain clinical management). The scope has not expanded beyond the original intent of providing a limited pathway for aggravation claims where pre-existing MVP was worsened by lack of treatment during service."},"complexity_factors":["Very short instrument (approximately 1,500 words)","Only 7 defined terms in the Dictionary","Single causal factor in section 9 (inability to obtain appropriate clinical management)","Clear exclusion criteria in section 7(2)(b) listing 4 specific exclusions","Simple conditional structure: one factor + relationship to service requirement","Cross-references limited to definitions and related legislation (VEA, MRCA)","No nested exceptions or complex temporal calculations beyond 'before or during' service"],"plain_english_summary":"This rulebook sets the sole legal pathway for Australian veterans and defence personnel to claim compensation for mitral valve prolapse (MVP): it applies only where MVP existed before or during service and was worsened because the person could not obtain proper medical treatment while serving. It replaces the 2014 version.\n\nBecause the factor is very narrow, most veterans with MVP will not meet the test and so will not have MVP accepted as service-related under this Statement of Principles."},"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"},"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":true,"description":"This instrument repeals the prior 2014 Statement (4) and replaces it with a Statement that (a) narrows the medical definition of mitral valve prolapse and lists explicit exclusions (7(2)), (b) limits the connecting factor to inability to obtain appropriate clinical management (9(1)), and (c) confines material contribution/aggravation treatment to cases where MVP pre‑existed or was contracted before/during but did not arise out of service (10(2)). It applies to claims under the VEA and MRCA (5)."},"complexity_factors":["Narrow, technical definition of mitral valve prolapse requiring echocardiographic confirmation (7(2)(a))","Explicit exclusions that remove related diagnoses from coverage (7(2)(b)(i)-(iv))","Only one listed causal factor—'inability to obtain appropriate clinical management'—limits routes to causation (9(1))","Application limited to material contribution or aggravation of pre‑existing or pre‑service MVP (10(2))","Interaction with other Statements of Principles where factors overlap, requiring cross‑reference (11)","Repeal of the 2014 Statement and replacement may change claim framing (4)","Instrumental applicability tied to particular claim provisions of the VEA and MRCA, affecting jurisdictional scope (5)","Definition of death from MVP includes terminal events with listed proximate causes, broadening death coverage mechanics (7(5); Schedule 1)"],"plain_english_summary":"This instrument repeals the 2014 Statement and replaces it with the medical standard for linking mitral valve prolapse (MVP) to defence service. It defines MVP narrowly (requires echocardiographic confirmation and excludes several other valve/connective‑tissue causes) and lists one causal pathway: inability to obtain appropriate clinical management connected to relevant service.\n\nIt applies to veterans and service members claiming under the VEA or MRCA and requires claimants to produce clinical evidence and show a service‑related failure to access care to raise a reasonable hypothesis."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-mitral-valve-prolapse-reasonable-hypothesis-no-15-of-2023","history":"/api/acts/statement-of-principles-concerning-mitral-valve-prolapse-reasonable-hypothesis-no-15-of-2023/history","analysis":"/api/acts/statement-of-principles-concerning-mitral-valve-prolapse-reasonable-hypothesis-no-15-of-2023/analysis","conflicts":"/api/acts/statement-of-principles-concerning-mitral-valve-prolapse-reasonable-hypothesis-no-15-of-2023/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-mitral-valve-prolapse-reasonable-hypothesis-no-15-of-2023/important-cases","documents":"/api/acts/statement-of-principles-concerning-mitral-valve-prolapse-reasonable-hypothesis-no-15-of-2023/documents"}}