{"id":"F2023L01428","name":"Statement of Principles concerning pericarditis (Balance of Probabilities) (No. 91 of 2023)","slug":"statement-of-principles-concerning-pericarditis-balance-of-probabilities-no-91-of-2023","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442141,"registerId":"F2023L01428-fast-fetch-1775957229513","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning pericarditis (Balance of Probabilities) (No. 91 of 2023)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n\n\n \n\nStatement of Principles\n\nconcerning\n\nPERICARDITIS (Balance of Probabilities)\n\n(No. 91 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 25 October 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:
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Professor Terence Campbell AM
Chairperson
|\n\n\n \n\n \n\n\nContents\n\n1 Name\n\n2 Commencement\n\n3 Authority\n\n4 Application\n\n5 Definitions\n\n6 Kind of injury, disease or death to which this Statement of Principles relates\n\n7 Basis for determining the factors\n\n8 Factors that must exist\n\n9 Relationship to service\n\n10 Factors referring to an injury or disease covered by another Statement of Principles\n\nSchedule 1 - Dictionary...............................................8\n\n1 Definitions................................................8\n\n \n\n\n\n\n1 Name\n\nThis is the Statement of Principles concerning pericarditis (Balance of Probabilities) (No. 91 of 2023).\n\n2 Commencement\n\n This instrument commences on 28 November 2023.\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n4 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\n5 Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n6 Kind of injury, disease or death to which this Statement of Principles relates\n\n(1) This Statement of Principles is about pericarditis and death from pericarditis.\n\nMeaning of pericarditis\n\n(2) For the purposes of this Statement of Principles, pericarditis:\n\n(a) means an inflammation of the pericardium; and\n\n(b) includes:\n\n(i) acute pericarditis;\n\n(ii) chronic pericarditis;\n\n(iii) recurrent pericarditis; and\n\n(iv) constrictive pericarditis; and\n\n(c) excludes haemorrhage from pericardial injury not associated with pericardial inflammation.\n\n(3) While pericarditis attracts ICD‑10‑AM codes I30, I31.0, I31.1, I01.0, and I09.2, in applying this Statement of Principles the meaning of pericarditis 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 pericarditis\n\n(5) For the purposes of this Statement of Principles, pericarditis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's pericarditis.\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n7 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 pericarditis and death from pericarditis 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\n8 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, pericarditis or death from pericarditis is connected with the circumstances of a person's relevant service:\n\n(1) having open heart surgery within the 20 years before the clinical onset or clinical worsening of pericarditis;\n\n(2) having a pacemaker, or defibrillator lead insertion within the 20 years before the clinical onset or clinical worsening of pericarditis;\n\n(3) having a cardiac ablation procedure to treat cardiac dysrhythmia within the 4 weeks before the clinical onset or clinical worsening of pericarditis;\n\n(4) having sclerosants such as talc, and tetracyclines directly introduced into the pericardial sac before the clinical onset or clinical worsening of pericarditis;\n\n(5) having penetrating or blunt trauma to the heart within the 20 years before the clinical onset or clinical worsening of pericarditis;\n\n(6) having electrical injury affecting the heart within the 20 years before the clinical onset or clinical worsening of pericarditis;\n\n(7) having a peptic ulcer that erodes the pericardium at the time of the clinical onset or clinical worsening of pericarditis;\n\n(8) undergoing a course of therapeutic radiation for cancer, where the heart was in the field of radiation, within the 20 years before the clinical onset or clinical worsening of pericarditis;\n\n(9) having a pericardial infection at the time of the clinical onset or clinical worsening of pericarditis;\n\n(10) having a systemic viral infection within the 4 weeks before the clinical onset or clinical worsening of pericarditis;\n\n(11) having tuberculosis before the clinical onset or clinical worsening of pericarditis;\n\n(12) having an infection of the structures contiguous with the pericardium at the time of the clinical onset or clinical worsening of pericarditis;\n\nNote: Infections reported to spread to the pericardium from anatomical sites contiguous with the pericardium include empyema, and amoebic liver abscess.\n\n(13) having myocarditis at the time of the clinical onset or clinical worsening of pericarditis;\n\n(14) having acute rheumatic fever at the time of the clinical onset or clinical worsening of pericarditis;\n\n(15) having one of the following vasculitides:\n\n(a) Behcet's disease;\n\n(b) eosinophilic granulomatosis with polyangiitis (Churg Straus syndrome);\n\n(c) giant cell (temporal) arteritis;\n\n(d) granulomatosis with polyangiitis (Wegener's granulomatosis);\n\n(e) microscopic polyangiitis;\n\n(f) polyarteritis nodosa; or\n\n(g) Takayasu's arteritis;\n\nat the time of the clinical onset or clinical worsening of pericarditis;\n\n(16) having one of the following systemic inflammatory diseases:\n\n(a) Addison disease with type 2 autoimmune polyglandular syndrome;\n\n(b) ankylosing spondylitis and seronegative spondyloarthropathies;\n\n(c) dermatomyositis;\n\n(d) IgG4-related disease;\n\n(e) inflammatory bowel disease;\n\n(f) mixed connective tissue disease;\n\n(g) polymyositis;\n\n(h) rheumatoid arthritis;\n\n(i) scleroderma (progressive systemic sclerosis);\n\n(j) Sjögren's syndrome; or\n\n(k) systemic lupus erythematosus;\n\nat the time of the clinical onset or clinical worsening of pericarditis;\n\n(17) having a heart transplant, lung transplant, kidney transplant or haematopoietic cell transplant before the clinical onset or clinical worsening of pericarditis;\n\n(18) having a myocardial infarction within the 4 weeks before the clinical onset or clinical worsening of pericarditis;\n\n(19) having a dissection of the ascending aorta at the time of the clinical onset or clinical worsening of pericarditis;\n\n(20) having a pulmonary infarction at the time of the clinical onset or clinical worsening of pericarditis;\n\n(21) having pancreatitis at the time of the clinical onset or clinical worsening of pericarditis;\n\n(22) having a benign or malignant cancer involving the pericardium at the time of the clinical onset or clinical worsening of pericarditis;\n\n(23) having a malignant neoplasm with a paraneoplastic pericarditis at the time of the clinical onset or clinical worsening of pericarditis;\n\n(24) having sarcoidosis or amyloidosis at the time of the clinical onset or clinical worsening of pericarditis;\n\n(25) having acute or chronic renal failure at the time of the clinical onset or clinical worsening of pericarditis;\n\nNote: Pericarditis can occur in patients who are undergoing haemodialysis or peritoneal dialysis. Chronic renal failure is equivalent to a stage 5 chronic kidney disease with a glomerular filtration rate <15 ml/min/1.73 m2.\n\n(26) taking a drug from the specified list at the time of the clinical onset or clinical worsening of pericarditis;\n\nNote: drug from the specified list is defined in the Schedule1- Dictionary.\n\n(27) taking a drug which is associated in the individual with the development of pericarditis during drug therapy; and either:\n\n(a) the improvement of pericarditis within one month of discontinuing or tapering drug therapy; or\n\n(b) the redevelopment of pericarditis on rechallenge with the same drug; and\n\nwhere taking the drug continued for at least the 7 days before the clinical onset of pericarditis;\n\n(28) having a COVID-19 mRNA vaccine within the 4 weeks before the clinical onset or clinical worsening of pericarditis;\n\n(29) having smallpox vaccine within the 4 weeks before the clinical onset or clinical worsening of pericarditis;\n\n(30) having asbestosis or asbestos related pleural plaques before the clinical onset or clinical worsening of pericarditis;\n\n(31) inhaling respirable asbestos fibres in an enclosed space at the time material containing asbestos was being applied, removed, cut, drilled, dislodged or disturbed:\n\n(a) for a cumulative period of at least 1,500 hours before the clinical onset of pericarditis; and\n\n(b) where the first inhalation of asbestos fibres commenced at least 10 years before the clinical onset of pericarditis;\n\nNote: Disturbance of debris or dust contaminated with asbestos fibres already present in an enclosed space may result in exposure to respirable asbestos fibres.\n\n(32) inhaling respirable asbestos fibres in an open environment at the time material containing asbestos was being applied, removed, cut, drilled, dislodged or disturbed:\n\n(a) for a cumulative period of at least 5,000 hours before the clinical onset of pericarditis; and\n\n(b) where the first inhalation of asbestos fibres commenced at least 10 years before the clinical onset of pericarditis;\n\nNote: Disturbance of debris or dust contaminated with asbestos fibres already present in an open environment may result in exposure to respirable asbestos fibres.\n\n(33) inability to obtain appropriate clinical management for pericarditis before the clinical worsening of pericarditis.\n\n9 Relationship to service\n\n(1) The existence in a person of any factor referred to in section 8, must be related to the relevant service rendered by the person.\n\n(2) The clinical worsening aspects of factors apply only to material contribution to, or aggravation of, pericarditis where the person's pericarditis was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n\n10 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 8 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\nSchedule 1 - Dictionary \n\nNote: See Section 5\n\n1 Definitions\n\nIn this instrument:\n\n drug from the specified list means:\n\n(a) 5-fluorouracil;\n\n(b) amiodarone;\n\n(c) anthracyclines including doxorubicin, daunorubicin, idarubicin, epirubicin and mitoxantrone;\n\n(d) anticoagulants;\n\n(e) bromocriptine;\n\n(f) cabergoline;\n\n(g) clozapine;\n\n(h) cromolyn sodium;\n\n(i) cyclophosphamide;\n\n(j) cyclosporine;\n\n(k) cytarabine/cytosine arabinoside;\n\n(l) dantrolene;\n\n(m) GM-CSF/granulocyte macrophage colony stimulating factor;\n\n(n) hydantoins;\n\n(o) hydralazine;\n\n(p) immune checkpoint inhibitors including ipilimumab, nivolumab, pembrolizumab, atexolizumab, avelumab, dostarlimab, and durvalumab;\n\n(q) intravesicular BCG;\n\n(r) isoniazid;\n\n(s) mesalazine/mesalamine/5-aminosalicylic acid;\n\n(t) methyldopa;\n\n(u) methysergide;\n\n(v) minoxidil;\n\n(w) penicillins;\n\n(x) pergolide;\n\n(y) phenylbutazone;\n\n(z) phenytoin;\n\n(aa) practolol;\n\n(bb) procainamide;\n\n(cc) psicofuranine;\n\n(dd) reserpine;\n\n(ee) rifampicin;\n\n(ff) Streptokinase;\n\n(gg) streptomycin;\n\n(hh) sulfa drugs;\n\n(ii) thiazides;\n\n(jj) thrombolytic agents;\n\n(kk) tocainide;\n\n(ll) tryptophan;\n\n(mm) tumour necrosis alpha antagonists; or\n\n(nn) tyrosine kinase inhibitors.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n pericarditis—see subsection 6(2).\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 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":{"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":false,"description":"The instrument defines the scope narrowly to pericarditis and death from pericarditis for claims under the VEA and MRCA (s4, s6). It does not indicate an expansion beyond that subject matter; rather it specifies qualifying factors, temporal limits and definitional material (s6, s8, Schedule 1). Where factors intersect with other Statements of Principles, those other instruments govern those conditions (s10)."},"complexity_factors":["Large number of discrete medical, procedural and exposure factors with varied time windows and thresholds (s8(1)–(33)).","Distinction between clinical onset and clinical worsening, and limits on when worsening aspects apply (s8, s9(2)).","Requirement that any listed factor be related to the person's 'relevant service'—introduces causal and evidentiary linkage (s9(1)).","Cross-reference to other Statements of Principles when a factor refers to an injury/disease covered elsewhere (s10).","Extensive defined drug list and drug-related causation rules in the Schedule that impose evidentiary triggers (Schedule 1: 'drug from the specified list').","Inclusion/exclusion rules and ICD‑10‑AM coding reference that affect diagnostic classification and proof (s6(2)–(4), Schedule 1).","Incorporation of death-from-disease via 'terminal event' definition adds consideration of proximate/ultimate cause (s6(5), Schedule 1).","Operative tie-in to claims regimes under two statutes (VEA and MRCA), requiring administrative application of the factors (s3–4)."],"plain_english_summary":"This Statement of Principles sets out when pericarditis (and death from it) can be treated as connected with a veteran's or service member's relevant service for VEA or MRCA claims. It lists specific medical conditions, procedures, exposures and time limits — at least one qualifying factor, related to the person’s relevant service, must exist for a connection to be found on the balance of probabilities. The Repatriation Medical Authority supplies the applicable definitions and drug list."},"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":4,"scope_assessment":{"changed":false,"description":"This instrument appears to be a standard Statement of Principles issued under the Veterans' Entitlements Act 1986. It follows the established template and scope for determining service connection of specific medical conditions. The inclusion of COVID-19 mRNA vaccines (factor 28) reflects updated medical evidence rather than scope creep, as vaccine-related adverse events fall within the traditional remit of military service health considerations."},"complexity_factors":["33 distinct causal factors with varying timeframes (4 weeks, 20 years, or no time limit)","Specific quantitative thresholds for asbestos exposure (1,500 hours enclosed/5,000 hours open, 10-year latency)","38 defined drugs in the 'specified list' requiring precise identification","Cross-references to other Statements of Principles for related conditions","Dual application framework (VEA and MRCA with different service definitions)","Distinction between 'clinical onset' and 'clinical worsening' with different rules for each","Medical terminology requiring specialist knowledge (vasculitides, systemic inflammatory diseases, ICD-10-AM codes)"],"plain_english_summary":"This Statement of Principles sets when pericarditis (inflammation around the heart) is accepted as related to Australian military service for veterans and current/former ADF members. It identifies 33 medical factors that can establish causation on the balance of probabilities and covers new cases and deaths. \n\nIts findings guide DVA decision-makers and determine veterans’ eligibility for medical treatment, compensation and disability pensions by reflecting current medical evidence on causes of pericarditis."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-pericarditis-balance-of-probabilities-no-91-of-2023","history":"/api/acts/statement-of-principles-concerning-pericarditis-balance-of-probabilities-no-91-of-2023/history","analysis":"/api/acts/statement-of-principles-concerning-pericarditis-balance-of-probabilities-no-91-of-2023/analysis","conflicts":"/api/acts/statement-of-principles-concerning-pericarditis-balance-of-probabilities-no-91-of-2023/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-pericarditis-balance-of-probabilities-no-91-of-2023/important-cases","documents":"/api/acts/statement-of-principles-concerning-pericarditis-balance-of-probabilities-no-91-of-2023/documents"}}