Statement of Principles concerning hypertension (Reasonable Hypothesis) (No. 21 of 2022)

This instrument replaces the earlier Statement of Principles and sets the medical, exposure and timing rules the Repatriation Medical Authority and Department of Veterans’ Affairs will use to decide if a veteran’s hypertension (or death from it) can be reasonably linked to their relevant service. It specifies diagnostic thresholds, listed risk factors (drugs, radiation, chemicals, obesity, alcohol, air pollution, etc.), and temporal windows claimants must meet; claimants carry the evidentiary and medical documentation burden, and government entitlement schemes pay any benefits.

This instrument is a Statement of Principles (SoP) concerning hypertension (Reasonable Hypothesis) (No. 21 of 2022) determined by the Repatriation Medical Authority (RMA) under subsection 196B(2) of the Veterans' Entitlements Act 1986 (VEA) (see s1, s3). It commenced 4 April 2022 (s2) and expressly repeals the earlier hypertension Statement of Principles No. 63 of 2013 (s4). The instrument is framed to apply to claims to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004 (MRCA) apply (s5).

Mechanically, the SoP does three things:

It defines the clinical meaning of “hypertension” for the purpose of claims under the VEA/MRCA, including diagnostic thresholds for clinic, home and ambulatory blood pressure measurement and the inclusion of persons on regular antihypertensive therapy (s7(2), Schedule 1 definitions for ambulatory equivalents).
It sets out the legal threshold used in claims assessment, namely the conditions that must exist for “a reasonable hypothesis” to be raised connecting hypertension (or death from hypertension) with relevant service , specifically, at least one of a list of enumerated factors in section 9 must exist (s8, s9).
It sets temporal and causal boundaries and cross‑references to other SoPs and definitions (s10, s11, Schedule 1, Schedule 2).

The SoP distinguishes between factors that may cause the clinical onset of hypertension and those that may materially contribute to or aggravate pre‑existing hypertension (compare the first set in s9(1)-(25) for onset with s9(26)-(51) for worsening, and the restriction in s10(2)). It also treats “death from hypertension” as including death from a terminal event or condition contributed to by hypertension (s7(5); Schedule 1 defines “terminal event”).

The instrument is explicit about the evidentiary and definitional detail the RMA considers relevant: diagnostic blood pressure cut-offs, BMI and waist circumference thresholds, precise exposure durations (for example for phenoxy acids, TCDD‑contaminated agents and dioxin‑like PCBs), drug lists and dosing/duration thresholds for glucocorticoid therapy (Schedule 1 and Schedule 2). The SoP does not itself create criminal penalties or administrative sanctions; rather it operates as the RMA’s statement of the medical‑scientific basis for raising a reasonable hypothesis in claims processes under the VEA and MRCA (s3, s5, s8).

Throughout, the RMA records its view that there is “sound medical‑scientific evidence” that hypertension and death from hypertension can be related to relevant service (s8). The legal effect is to provide claim assessors with a pre‑specified set of factors which, if established and related to relevant service, will meet the minimum threshold for a reasonable hypothesis connecting the disease or death to service. The instrument contains detailed definitions and thresholds in Schedule 1 and a specified drugs list in Schedule 2 that operationalise those factors.

The SoP rests on a set of interlocking concepts that determine how a claim for hypertension will be evaluated under the VEA/MRCA framework. The primary concepts are: the clinical definition of hypertension; the “reasonable hypothesis” causation threshold; the enumerated causal/exacerbating factors; temporal windows and exposure metrics; and cross‑references to other statements where an identified factor is itself recognised under another SoP.

Clinical definition of hypertension: The SoP defines hypertension as persistently elevated blood pressure diagnosed by a medical practitioner and evidenced by either clinic readings (≥140/90 mmHg), usual home readings (≥135/85 mmHg), equivalent ambulatory thresholds (see Schedule 1), readings above the 95th centile for persons under 18, or the regular administration of antihypertensive therapy (s7(2), Schedule 1). It excludes temporary elevations due to a list of specified acute conditions and medications (s7(2)(b)).

Reasonable hypothesis threshold: The SoP is constructed so that, for a reasonable hypothesis to be raised linking hypertension (or death from hypertension) with relevant service, at least one of the factors in section 9 must exist (s9). The instrument thereby operationalises the RMA’s view of the minimum evidential nexus between disease and service. Section 8 records the RMA’s view that there is sound medical‑scientific evidence supporting relationships between these listed factors and hypertension.

Enumerated factors: Section 9 lists discrete factors that will, if present and related to relevant service, raise a reasonable hypothesis. These include clinical conditions (chronic kidney disease, diabetes, renal artery stenosis), lifestyle metrics over defined periods (BMI thresholds maintained for 5 years, average alcohol consumption of ≥250 grams/week for ≥6 months, average salt consumption ≥9 grams/day for ≥1 year), exposures to chemical agents and radiation (phenoxy herbicides, TCDD contamination, dioxin‑like PCBs, ambient PM2.5, cumulative whole‑body ionising radiation ≥0.5 sievert), specific medical treatments (solid organ/stem cell/bone marrow transplant; glucocorticoid therapy meeting precise dose/time thresholds; receiving certain drugs specified in Schedule 2 or Specified List 1 or 2), and functional limitations or service‑related access issues (inability to do >3 METs activity for ≥1 year; inability to obtain appropriate clinical management for hypertension) (s9, Schedule 1, Schedule 2).

Onset v. worsening v. death: The SoP distinguishes factors applying to clinical onset of hypertension from those referring to clinical worsening or aggravation of hypertension (compare s9(1)-(25) and s9(26)-(51)). Section 10(2) makes clear that the worsening factors (s9(26)-(51)) apply only to material contribution or aggravation where the person’s hypertension was suffered or contracted before or during (but did not arise out of) relevant service.

Primary affected parties

Veterans and former members of the Forces who lodge claims under the VEA or MRCA for hypertension or death from hypertension. The instrument applies explicitly to claims to which section 120A of the VEA or section 338 of the MRCA applies (s5).
Dependants or survivors making a claim for death from hypertension, since the instrument defines “hypertension” to include death from a terminal event or condition contributed to by hypertension (s7(5); Schedule 1 defines “terminal event”).

Government bodies and decision‑makers

The Repatriation Medical Authority (RMA) is the instrument‑making body (s3) and has produced the SoP as the RMA’s statement of the medical‑scientific evidence basis (s8). The instrument will be used by claims assessors within the Department of Veterans’ Affairs and related decision‑making bodies administering entitlements under the VEA/MRCA, because it applies to claims under those Acts (s5). The SoP itself does not set administrative procedures for decision‑makers, but it is the RMA’s authoritative medical framework for raising a reasonable hypothesis.

Medical practitioners and allied health

Treating clinicians: general practitioners, specialists and other medical practitioners will be asked to provide diagnostic evidence to meet the SoP’s defined clinical thresholds , clinic, home and ambulatory blood pressure readings, documentation of antihypertensive therapy, diagnosis of listed comorbidities (chronic kidney disease, diabetes, endocrine disorders, sleep apnoea), evidence of transplants or cancer therapies, and medication histories (s7(2), s9, Schedule 1, Schedule 2).
Clinicians may be asked to calculate cumulative glucocorticoid exposure using the equivalent glucocorticoid table in Schedule 1 and to provide evidence of dose rates, duration, and any interacting medications (Schedule 1 definitions of “equivalent glucocorticoid therapy” and “equivalent inhaled glucocorticoid”).

Employers, superannuation and insurers

Private insurers and superannuation funds adjudicating disability or income protection claims will find the SoP a relevant frame for establishing causal connection to service in contexts where military service is an element of claim or entitlement. The instrument’s exposure, treatment and diagnostic thresholds may be adopted as evidentiary benchmarks.

Parties affected by narrow, technical provisions

This instrument is not a statute that imposes criminal sanctions; instead it sets out the RMA’s medical‑scientific framework to be applied in administrative claims under the VEA and MRCA. The SoP thereby creates the following practical duties and rights relevant to claims processing and evidence submission.

Duty to use the SoP in applicable claims contexts

Application duty: The SoP applies to claims to which s120A of the VEA or s338 of the MRCA apply (s5). Decision makers assessing those claims will use this SoP as the RMA’s statement of the medical factors that, if established and linked to relevant service, raise a “reasonable hypothesis” of service connection (s8, s9). The instrument defines the framework for medical causation assessments in those contexts.

Duty on claimants to establish factors

Minimum evidentiary duty: For a “reasonable hypothesis” to be raised linking hypertension (or death from hypertension) to relevant service, at least one of the factors in s9 must as a minimum exist and be related to relevant service (s9, s10(1)). This places a practical duty on claimants (or their representatives) to assemble evidence of at least one specified factor and to demonstrate the link to service.

Duty to relate factors to relevant service

Causation linkage: The existence of any factor in s9 must be related to the claimant’s relevant service (s10(1)). Where a factor concerns an injury or disease that is the subject of a separate SoP, section 11 requires that the other SoP’s factors apply according to its current terms, creating a duty to consider overlapping SoPs where applicable.

Duty to apply temporal and quantitative thresholds

For many factors the SoP imposes specific duration, dose or temporal windows: eg, being overweight or obese for at least 5 years before clinical onset (s9(1)), alcohol ≥250 g/week for ≥6 months before onset (s9(2)), salt ≥9 g/day for ≥1 year before onset (s9(3)), cumulative exposure to phenoxy acid herbicides of at least 1,000 hours within a consecutive 10 years with first exposure at least 5 years before onset and with a cessation window up to 25 years (s9(22)). These quantitative thresholds are definitive in raising the minimum required factual predicate.

Duty on medical practitioners for accurate clinical evidence

Clinicians diagnosing hypertension and documenting its onset, readings and management will effectively determine whether the clinical thresholds in s7(2) and the Schedule 1 ambulatory equivalents are met. Practitioners may also be asked to quantify drug dosages and durations, compute cumulative glucocorticoid doses using Schedule 1 equivalences, and document co‑morbidities such as chronic kidney disease, diabetes or endocrine disorders.

This instrument is not drafted as a penal or enforcement statute. It is a Statement of Principles made by the Repatriation Medical Authority under s196B(2) of the VEA and functions as the RMA’s authoritative medical framework for assessing causation in claims governed by specified provisions of the VEA and MRCA (s3, s5, s8). The SoP does not itself create offences, fines or criminal penalties, nor does it prescribe administrative sanctions for non‑compliance.

Enforcement in practice will occur through the claims and administrative decision‑making processes under the VEA and MRCA. The SoP supplies the medical‑scientific criteria that must be met, as a minimum, to raise a reasonable hypothesis of service connection (s9). How those criteria are enforced or given effect is a matter of the adjudicative framework created by the VEA and MRCA, and the usual review rights and administrative procedures that apply to decisions under those Acts. The instrument itself contains no procedural or appeal provisions.

Mechanics of use by decision makers

Claims assessors will enforce the SoP by requiring claimants to provide evidence documenting the presence of at least one enumerated factor and its relation to relevant service (s9, s10). The kinds of evidence that will typically be sought include medical records (blood pressure readings, diagnoses, drug prescriptions, transfusion/transplantation and therapy records), service records detailing tasks and exposures, environmental monitoring or dosimetry reports (for ionising radiation or PM2.5), and any relevant specialist reports.

No penalties for false statements in the SoP

The instrument does not set out penalties for false statements or fraudulent claims. Any legal consequence for false or misleading statements in claims would stem from provisions of the VEA, MRCA or general criminal law, none of which are reproduced within this instrument.

Administrative review and potential judicial oversight

While the SoP itself does not describe appeal routes, decisions made under the VEA/MRCA that apply the SoP will fall within the existing appeal and review mechanisms of those Acts. The instrument does not purport to alter statutory review rights; it supplies the medical criteria that decision makers use in applying the statutory entitlement provisions.

Operational risks and enforcement complexity

The SoP creates enforcement complexity for administrators because it requires reconstruction and verification of exposures that may be historical, remote or technically complex (eg, cumulative equivalent dose calculations for ionising radiation referencing an external ARPANSA guide, or demonstrating cumulative herbicide exposure of 1,000 hours within a 10‑year period) (Schedule 1, s9(22)-(24), s9(21)). The SoP therefore shifts enforcement effort into evidentiary verification rather than into sanctioning behaviour.

Direct statutory linkage

The SoP is made under subsection 196B(2) of the VEA (s3) and is expressly directed to claims that fall under section 120A of the VEA or section 338 of the MRCA (s5). Those references embed the SoP within the statutory regime governing veteran entitlements and military rehabilitation and compensation. The instrument therefore interacts directly with the substantive entitlement provisions and decision‑making processes in the VEA and MRCA even though those Acts are not reproduced in the instrument.

Cross‑application to other SoPs

Section 11 provides a mechanism for interaction among Statements of Principles. If a s9 factor refers to an injury or disease that itself has a separate SoP, “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.” This creates an explicit interaction: where, for example, a listed endocrine disorder or kidney disease is governed by another SoP, the assessor must apply that SoP’s factors and possibly its thresholds or definitions (s11). This can produce hierarchical or composite application of multiple SoPs in a single claim.

Use of external technical methodology

The Schedule 1 definition of “cumulative equivalent dose” explicitly references a methodological guide produced by the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) for dose calculation, as in force on 2 August 2017 (Schedule 1). This imports an external technical standard for ionising radiation dose reconstruction. The SoP therefore interacts with administrative technical guidance and potentially with records that track radiation exposure (eg, service dosimetry records, occupational exposure monitoring).

Medical regulatory and practice interaction

The SoP’s clinical definitions and numerical thresholds (blood pressure cut‑offs, BMI formula, glucocorticoid equivalence table, specific drug lists) interact with medical practice standards and records. Clinicians documenting hypertension will effectively be operating within the SoP’s thresholds when providing evidence for claims. The SoP defines which diagnostic readings are legally significant within the VEA/MRCA claims context (s7(2), Schedule 1), even where clinical practice guidelines may use different thresholds for treatment decisions.

Interaction with environmental and occupational law evidence

This instrument records a single explicit amendment step within its text: the repeal of the prior Statement of Principles concerning hypertension No. 63 of 2013 (Federal Register of Legislation No. F2013L01652), which was made under subsections 196B(2) and (8) of the VEA (s4). The current instrument replaced that earlier SoP and commenced 4 April 2022 (s2). No other amendments, prior versions, or amendment history is recorded within the instrument itself.

Key historical actions recorded in the instrument

Determination date and commencement: The document is dated 4 March 2022 and states commencement on 4 April 2022 (s2 and instrument header). This indicates the instrument was adopted on 4 March and took effect one month later.
Repeal of prior instrument: s4 expressly repeals the SoP No. 63 of 2013. No transitional provisions or grandfathering clauses are set out in the present instrument text, so the earlier SoP was superseded on commencement.

Absence of further legislative amendment detail

The instrument contains no schedule of historical amendments other than the repeal entry. It does not list prior amendments to the 2013 instrument or indicate whether any elements of the prior SoP were carried forward unchanged. The instrument itself is presented as a single consolidated instrument (title, contents, body, Schedules).

References to external methodological instruments

The Schedule 1 definition of “cumulative equivalent dose” references an external methodology document (“Guide to calculation of ‘cumulative equivalent dose’ ... as in force on 2 August 2017”). That reference is not an amendment history for this SoP, but it fixes the external methodological version relied upon for ionising radiation dose calculations. Any change to that external guidance after 2 August 2017 would require the decision maker to note that the SoP references that specific version for its purposes, potentially affecting dose reconstructions for claims.

Implications for future amendment

Because the SoP cross‑references other SoPs (s11) and external technical guidance (Schedule 1), future amendments to those instruments or guides could alter how factors are applied in practice, even without amendment to this instrument. Conversely, future RMA determinations could amend or replace this SoP, as occurred in 2022 when No. 63 of 2013 was repealed.

Practical note for claimants and advisers

The instrument contains no references to litigation, judicial decisions, or case law. It does not cite any administrative appeals or judicial review outcomes. The document is a Statement of Principles formulated under the Repatriation Medical Authority’s statutory power in subsection 196B(2) of the VEA (s3), and it records the RMA’s view that “there is sound medical‑scientific evidence” connecting hypertension and death from hypertension to relevant service (s8). The instrument does not record or reference legal challenges to that view.

Potential litigation contexts (procedural observation)

Administrative decisions made by applying this SoP in the adjudication of VEA or MRCA claims would be subject to the existing statutory review mechanisms and judicial review avenues under the relevant Acts. The SoP is evidence of the RMA’s medical position; claimants or the Department could challenge how it is applied in an individual claim via the statutory merits review and judicial review processes attached to decisions under the VEA/MRCA. The instrument itself does not specify or alter those procedural review rights.
Where the SoP requires technical reconstructions (for example, cumulative equivalent dose for ionising radiation referencing ARPANSA methodology), disputes may arise about the application of that methodology or the underlying factual inputs (service records, dosimetry files). Those scientific determinations could be the subject of expert evidence in review proceedings, but no such cases are recorded in the instrument.

Absence of named cases

The instrument names no cases and contains no annotated citations to judicial authority. The only external references are to classification systems (ICD‑10‑AM, Schedule 1) and to an ARPANSA guide for dose calculation (Schedule 1). The ICD‑10‑AM citation links hypertension to ICD codes I10 or I15 but clarifies that the SoP’s meaning is the definition given in s7(2) (s7(3)-(4)).

Practical implication for litigators and reviewers

Because the SoP itself is a policy/medical framework, litigation arising out of its application will primarily involve contesting the factual application of the SoP to individual claimants (eg, whether a claimant’s exposure met the 1,000‑hour rule, or whether a glucocorticoid regimen meets the equivalent dose/duration threshold, or whether a factor was related to relevant service under s10). The instrument gives clear thresholds and definitions that can be litigated as matters of fact and specialist evidence in review proceedings, but there is no litigation history recorded in the text to indicate how courts or tribunals have interpreted these specific provisions.

This instrument contains numerous technical and evidentiary details that can materially affect whether a reasonable hypothesis is raised. The following are practical “gotchas” , specific drafting points that commonly generate disputes or that require careful evidentiary work because their operation is exacting and technical.

Diagnostic thresholds vs clinical practice

The SoP defines hypertension specifically for claims: clinic ≥140/90 mmHg, home ≥135/85 mmHg, ambulatory averages with distinct 24‑hour/day/night thresholds (Schedule 1), or regular antihypertensive therapy (s7(2), Schedule 1). Clinical guidelines in practice may use different thresholds for diagnosis, treatment targets or risk stratification. For claims, the SoP thresholds control. Practitioners must ensure reported readings meet the SoP metric and that documentation shows whether readings were clinic, home or ambulatory.

Exclusions for temporary elevations

The SoP excludes temporary elevations from acute renal failure, neurogenic hypertension, eclampsia, pre‑eclampsia, gestational hypertension and medications (s7(2)(b)). If a claimant’s elevated readings can be attributed to these conditions, the SoP excludes them unless other qualifying factors can be shown.

Onset vs aggravation distinction and s10(2)

The instrument separates onset factors (s9(1)-(25)) from worsening factors (s9(26)-(51)). Section 10(2) restricts the worsening factors to cases where hypertension existed before or during service but did not arise out of service. Mis‑classification of onset v. aggravation can be decisive. Claimants and advisers should document timing of first diagnosis precisely.

“Related to relevant service” requirement (s10(1))

The presence of a listed factor is not sufficient without a demonstrated relationship to relevant service. For exposures and treatments that occurred after discharge, or outside service tasks, a causal link to relevant service must be established separately.

Strict quantitative exposure windows and latency rules

Several exposures have specific cumulative and latency conditions. For example, phenoxy herbicides and TCDD‑contaminated agents require a cumulative 1,000 hours within a consecutive 10‑year period, first exposure at least 5 years before onset and any cessation to be within 25 years of onset (s9(22)-(24)). These precise numerical thresholds are hard lines for a “reasonable hypothesis” and are often difficult to prove from historical records alone.

This section sets out a practical checklist for claimants, treating clinicians, legal representatives and case officers to assemble evidence that aligns with the SoP’s thresholds and definitions. The SoP requires proof that at least one enumerated factor existed and was related to relevant service (s9, s10(1)); compliance therefore means assembling documentary, clinical and service evidence that maps to the instrument’s precise metrics.

Establish the clinical diagnosis per SoP thresholds (s7(2), Schedule 1)

Obtain documented blood pressure readings with dates and measurement context (clinic, home, ambulatory). For clinic readings, ensure the records show readings ≥140/90 mmHg; for home readings ≥135/85 mmHg; for ambulatory consider a 24‑hour average, daytime and nighttime averages per Schedule 1 ambulatory equivalents. If the claimant is on regular antihypertensive therapy, obtain prescription records and clinician notes confirming the reason for therapy.

Pinpoint date of clinical onset or clinical worsening

Determine and document the date of first diagnosis or clinical worsening. The SoP applies different factors depending on onset versus worsening and timing (s9 sets different paragraphs for onset and worsening; s10(2) limits worsening factors to pre‑existing hypertension). Record earliest clinician notes that confirm sustained elevated blood pressure or start of antihypertensive therapy.

Map the claimant’s facts to the s9 factor list

Review s9 in full and identify which factor(s) the claimant can plausibly satisfy. Common examples and the required evidence:
- Overweight/obesity for ≥5 years: assemble serial BMI or waist circumference records showing BMI ≥25 or waist >94 cm (males) or >80 cm (females) for the required period (s9(1), Schedule 1).
- Alcohol ≥250 g/week for ≥6 months: collect contemporaneous clinical notes, substance use assessments, allied health/dietitian notes, or other corroborating records (s9(2)).
- Salt ≥9 g/day for ≥1 year: dietitian notes, nutrition assessments, prescriptions for sodium‑containing medicines where relevant, or other records (s9(3), Schedule 1 note about sodium‑containing medications).
- Diabetes mellitus ≥5 years: obtain diabetes diagnosis date, HbA1c records, specialist notes (s9(6)).
- Chronic kidney disease: provide GFR records, albuminuria evidence, imaging or biopsy reports as per Schedule 1 definition (s9(7), Schedule 1).

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RMA-Red

Statement of Principles

concerning

HYPERTENSION (Reasonable Hypothesis)

(No. 21 of 2022)

The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 4 March 2022

The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:<br>
<br>Professor Terence Campbell AM<br>Chairperson<br>

Contents

1 Name

2 Commencement

3 Authority

4 Repeal

5 Application

6 Schedules

7 Kind of injury, disease or death to which this Statement of Principles relates

8 Basis for determining the factors

9 Factors that must exist

10 Relationship to service

11 Factors referring to an injury or disease covered by another Statement of Principles

Schedule 1 - Dictionary

1 Definitions

Schedule 2 - Drugs

1 Specified Drugs

1 Name

This is the Statement of Principles concerning hypertension (Reasonable Hypothesis) (No. 21 of 2022).

2 Commencement

This instrument commences on 4 April 2022.

3 Authority

This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.

4 Repeal

The Statement of Principles concerning hypertension No. 63 of 2013 (Federal Register of Legislation No. F2013L01652) made under subsections 196B(2) and (8) of the VEA is repealed.

5 Application

This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004 applies.

6 Schedules

Any item in a Schedule to this Instrument has effect according to its terms.

7 Kind of injury, disease or death to which this Statement of Principles relates

(1) This Statement of Principles is about hypertension and death from hypertension.

Meaning of hypertension

(2) For the purposes of this Statement of Principles, hypertension:

(a) means persistently elevated blood pressure, where that persistent elevation in blood pressure has been diagnosed by a medical practitioner and evidenced by:

(i) a usual clinic blood pressure reading of greater than or equal to 140 mmHg systolic or greater than or equal to 90 mmHg diastolic, or equivalent levels using ambulatory blood pressure measurement; or

(ii) a usual home blood pressure reading of greater than or equal to 135 mmHg systolic or greater than or equal to 85 mmHg diastolic; or

(iii) for persons aged under 18 years, a usual systolic or diastolic blood pressure reading of greater than or equal to the 95th centile for age and sex; or

(iv) the regular administration of antihypertensive therapy to reduce blood pressure; and

(b) excludes temporary elevations in blood pressure from conditions such as acute renal failure, neurogenic hypertension, eclampsia, pre-eclampsia, gestational hypertension and medications.

Note: equivalent levels using ambulatory blood pressure measurement is defined in the Schedule 1 - Dictionary.

(3) While hypertension attracts ICD‑10‑AM code I10 or I15, in applying this Statement of Principles the meaning of hypertension is that given in subsection (2).

(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.

Death from hypertension

(5) For the purposes of this Statement of Principles, hypertension, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's hypertension.

Note: terminal event is defined in the Schedule 1 - Dictionary.

8 Basis for determining the factors

The Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that hypertension and death from hypertension 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.

Note: MRCA, relevant service and VEA are defined in the Schedule 1 - Dictionary.

9 Factors that must exist

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 hypertension or death from hypertension with the circumstances of a person's relevant service:

(1) being overweight or obese for at least the 5 years before the clinical onset of hypertension;

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

(2) consuming an average of at least 250 grams of alcohol per week for a continuous period of at least the 6 months before the clinical onset of hypertension;

Note: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.

(3) consuming an average of at least 9 grams (150 millimoles) of salt per day for at least the 1 year before the clinical onset of hypertension;

Note: Sodium-containing medications may contribute to daily salt intake. Sodium-containing medications include the effervescent or soluble version of standard medicines, such as acetaminophen, ascorbic acid, aspirin, calcium carbonate, ibuprofen, sodium bicarbonate and zinc sulphate.

(4) having renal artery stenosis at the time of the clinical onset of hypertension;

Note: Causes of renal artery stenosis include renal artery atherosclerotic disease and fibromuscular dysplasia.

(5) having a solid organ, stem cell or bone marrow transplant before the clinical onset of hypertension;

(6) having diabetes mellitus for at least the 5 years before the clinical onset of hypertension;

(7) having chronic kidney disease at the time of the clinical onset of hypertension;

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

(8) having an endocrine disorder from the specified list of endocrine disorders at the time of the clinical onset of hypertension;

Note: specified list of endocrine disorders is defined in the Schedule 1 - Dictionary.

(9) having sleep apnoea at the time of the clinical onset of hypertension;

(10) having extrinsic compression of the renal parenchyma from a haematoma or mass at the time of the clinical onset of hypertension;

(11) having:

(a) an aneurysm of the renal artery; or

(b) an arteriovenous fistula involving the blood supply of the kidney; or

before the clinical onset of hypertension;

(12) having a clinically significant disorder of mental health as specified at the time of the clinical onset of hypertension;

Note: clinically significant disorder of mental health as specified is defined in the Schedule 1 – Dictionary.

(13) having gout or hyperuricaemia at the time of the clinical onset of hypertension;

Note: hyperuricaemia is defined in the Schedule 1 – Dictionary.

(14) taking a drug specified in the Schedule 2 - Drugs of this Instrument, where that drug cannot be ceased or substituted, for a continuous period of at least the 28 days before the clinical onset of hypertension;

(15) taking a drug from the Specified List 1 of drugs at the time of the clinical onset of hypertension;

Note: Specified List 1 of drugs is defined in the Schedule 1 - Dictionary.

(16) having glucocorticoid therapy as specified before the clinical onset of hypertension, and if the glucocorticoid therapy as specified has ceased or decreased before the clinical onset of hypertension, then that onset occurred within 30 days of cessation or reduction of therapy;

Note: glucocorticoid therapy as specified is defined in the Schedule 1 - Dictionary.

(17) taking medroxyprogesterone acetate or megestrol acetate for a malignant disease or human immunodeficiency virus infection:

(a) for at least 28 days before the clinical onset of hypertension; and

(b) if treatment has ceased before the clinical onset of hypertension, then that onset occurred within 30 days of cessation;

(18) inability to undertake any physical activity greater than 3 METs for at least the 1 year before the clinical onset of hypertension;

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

(19) being exposed to arsenic as specified before the clinical onset of hypertension;

Note: being exposed to arsenic as specified is defined in the Schedule 1 - Dictionary.

(20) undergoing a course of therapeutic radiation for cancer, where the whole body was in the field of radiation, at least 1 year before the clinical onset of hypertension;

(21) having received a cumulative equivalent dose of at least 0.5 sievert of ionising radiation to the whole body at least 1 year before the clinical onset of hypertension;

Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary.

(22) inhaling, ingesting or having cutaneous contact with the phenoxy acid herbicides 2,4-dichlorophenoxyacetic acid (2,4-D) or 2,4,5-trichlorophenoxyacetic acid (2,4,5-T):

(a) for a cumulative period of at least 1,000 hours within a consecutive period of 10 years, before the clinical onset of hypertension; and

(b) where the first exposure occurred at least 5 years before the clinical onset of hypertension; and

if that exposure has ceased before the clinical onset of hypertension, then that onset occurred within 25 years of cessation;

(23) inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD):

(a) for a cumulative period of at least 1,000 hours within a consecutive period of 10 years, before the clinical onset of hypertension; and

(b) where the first exposure occurred at least 5 years before the clinical onset of hypertension; and

if that exposure has ceased before the clinical onset of hypertension, then that onset occurred within 25 years of cessation;

Note: inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD) is defined in the Schedule 1 - Dictionary.

(24) inhaling, ingesting or having cutaneous contact with a dioxin-like polychlorinated biphenyl:

(a) for a cumulative period of at least 1,000 hours within a consecutive period of 10 years, before the clinical onset of hypertension; and

(b) where the first exposure occurred at least 5 years before the clinical onset of hypertension; and

if that exposure has ceased before the clinical onset of hypertension, then that onset occurred within 25 years of cessation;

Note: inhaling, ingesting or having cutaneous contact with a dioxin-like polychlorinated biphenyl is defined in the Schedule 1 – Dictionary.

(25) inhaling ambient, chronically polluted air as specified for at least 1 year, within the 2 years before the clinical onset of hypertension;

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

(26) being overweight or obese for at least the 5 years before the clinical worsening of hypertension;

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

(27) consuming an average of at least 250 grams of alcohol per week for a continuous period of at least the 6 months before the clinical worsening of hypertension;

Note: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.

(28) consuming an average of at least 9 grams (150 millimoles) of salt per day for at least the 1 year before the clinical worsening of hypertension;

(29) having renal artery stenosis at the time of the clinical worsening of hypertension;

Note: Causes of renal artery stenosis include renal artery atherosclerotic disease and fibromuscular dysplasia.

(30) having a solid organ, stem cell or bone marrow transplant before the clinical worsening of hypertension;

(31) having diabetes mellitus for at least the 5 years before the clinical worsening of hypertension;

(32) having chronic kidney disease at the time of the clinical worsening of hypertension;

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

(33) having an endocrine disorder from the specified list of endocrine disorders at the time of the clinical worsening of hypertension;

Note: specified list of endocrine disorders is defined in the Schedule 1 - Dictionary.

(34) having sleep apnoea at the time of the clinical worsening of hypertension;

(35) having extrinsic compression of the renal parenchyma from a haematoma or mass at the time of the clinical worsening of hypertension;

(36) having:

(a) an aneurysm of the renal artery; or

(b) an arteriovenous fistula involving the blood supply of the kidney; or

before the clinical worsening of hypertension;

(37) having a clinically significant disorder of mental health as specified at the time of the clinical worsening of hypertension;

Note: clinically significant disorder of mental health as specified is defined in the Schedule 1 – Dictionary.

(38) having gout or hyperuricaemia at the time of the clinical worsening of hypertension;

Note: hyperuricaemia is defined in the Schedule 1 – Dictionary.

(39) taking a drug specified in the Schedule 2 - Drugs of this Instrument, where that drug cannot be ceased or substituted, for a continuous period of at least the 28 days before the clinical worsening of hypertension;

(40) taking a drug from the Specified List 1 of drugs at the time of the clinical worsening of hypertension;

Note: Specified List 1 of drugs is defined in the Schedule 1 - Dictionary.

(41) having glucocorticoid therapy as specified before the clinical worsening of hypertension, and if the glucocorticoid therapy as specified has ceased or decreased before the clinical worsening of hypertension, then that worsening occurred within 30 days of cessation or reduction of therapy;

Note: glucocorticoid therapy as specified is defined in the Schedule 1 - Dictionary.

(42) taking medroxyprogesterone acetate or megestrol acetate for a malignant disease or human immunodeficiency virus infection:

(a) for at least 28 days before the clinical worsening of hypertension; and

(b) if treatment has ceased before the clinical worsening of hypertension, then that worsening occurred within 30 days of cessation;

(43) inability to undertake any physical activity greater than 3 METs for at least the 1 year before the clinical worsening of hypertension;

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

(44) being exposed to arsenic as specified before the clinical worsening of hypertension;

Note: being exposed to arsenic as specified is defined in the Schedule 1 - Dictionary.

(45) undergoing a course of therapeutic radiation for cancer, where the whole body was in the field of radiation, at least 1 year before the clinical worsening of hypertension;

(46) having received a cumulative equivalent dose of at least 0.5 sievert of ionising radiation to the whole body at least 1 year before the clinical worsening of hypertension;

Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary.

(47) inhaling, ingesting or having cutaneous contact with the phenoxy acid herbicides 2,4-dichlorophenoxyacetic acid (2,4-D) or 2,4,5-trichlorophenoxyacetic acid (2,4,5-T):

(a) for a cumulative period of at least 1,000 hours within a consecutive period of 10 years, before the clinical worsening of hypertension; and

(b) where the first exposure occurred at least 5 years before the clinical worsening of hypertension; and

if that exposure has ceased before the clinical worsening of hypertension, then that worsening occurred within 25 years of cessation;

(48) inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD):

(a) for a cumulative period of at least 1,000 hours within a consecutive period of 10 years, before the clinical worsening of hypertension; and

(b) where the first exposure occurred at least 5 years before the clinical worsening of hypertension; and

if that exposure has ceased before the clinical worsening of hypertension, then that worsening occurred within 25 years of cessation;

Note: inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD) is defined in the Schedule 1 - Dictionary.

(49) inhaling, ingesting or having cutaneous contact with a dioxin-like polychlorinated biphenyl:

(a) for a cumulative period of at least 1,000 hours within a consecutive period of 10 years, before the clinical worsening of hypertension; and

(b) where the first exposure occurred at least 5 years before the clinical worsening of hypertension; and

if that exposure has ceased before the clinical worsening of hypertension, then that worsening occurred within 25 years of cessation;

Note: inhaling, ingesting or having cutaneous contact with a dioxin-like polychlorinated biphenyl is defined in the Schedule 1 – Dictionary.

(50) inhaling ambient, chronically polluted air as specified for at least 1 year, within the 2 years before the clinical worsening of hypertension;

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

(51) inability to obtain appropriate clinical management for hypertension.

10 Relationship to service

(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.

(2) The factors set out in subsections 9(26) to 9(51) apply only to material contribution to, or aggravation of, hypertension where the person's hypertension was suffered or contracted before or during (but did not arise out of) the person's relevant service.

11 Factors referring to an injury or disease covered by another Statement of Principles

In this Statement of Principles:

(1) if a factor referred to in section 9 applies in relation to a person; and

(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;

then 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.

Schedule 1 - Dictionary

Note: See Section 6

1 Definitions

In this instrument:

acromegaly means a chronic disease of adults resulting from excessive production of growth hormone after closure of the epiphyses.

albuminuria means an albumin to creatinine ratio of at least 3 mg/mmol.

ambient, chronically polluted air as specified means air with average annual concentrations of particulate matter with an aerodynamic diameter of < 2.5 µm (PM2.5) exceeding 10 µg/m3.

being exposed to arsenic as specified means:

(a) consuming drinking water with an average arsenic concentration of at least 50 micrograms per litre for a cumulative period of at least 10 years; or

(b) consuming drinking water resulting in a cumulative total arsenic exposure equivalent to having consumed drinking water containing at least 50 micrograms per litre for at least 10 years; or

being overweight or obese means:

(a) having a Body Mass Index (BMI) of 25 or greater; or

(b) for males, having a waist circumference exceeding 94 centimetres; or

Note: BMI is also defined in the Schedule 1 - Dictionary.

BMI means W/H2 where:

(a) W is the person's weight in kilograms; and

(b) H is the person's height in metres.

chronic kidney disease means:

(a) having a glomerular filtration rate of less than 60 mL/min/1.73 m2 for at least 3 months; or

(b) having albuminuria for at least 3 months; or

(c) having kidney damage, as evidenced by renal biopsy, imaging studies, urinary sediment abnormalities or other markers of abnormal renal function; or

(d) having had a kidney transplant.

Note: albuminuria is also defined in the Schedule 1 - Dictionary.

clinically significant disorder of mental health as specified means one of the following conditions, which is of sufficient severity to warrant ongoing management:

(a) agoraphobia;

(b) anxiety disorder;

(d) obsessive-compulsive disorder;

(e) panic disorder;

(f) posttraumatic stress disorder;

(g) social anxiety disorder; or

(h) specific phobia.

Note 1: Management of the condition may involve regular visits (for example, at least monthly) to a psychiatrist, counsellor or general practitioner.

Note 2: To warrant ongoing management does not require that any actual management was received or given for the condition.

cumulative equivalent dose means the total dose of ionising radiation received by the particular organ or tissue from external exposure, internal exposure or both, apart from normal background radiation exposure in Australia, calculated in accordance with the methodology set out in Guide to calculation of 'cumulative equivalent dose' for the purpose of applying ionising radiation factors contained in Statements of Principles determined under Part XIA of the Veterans' Entitlements Act 1986 (Cth), Australian Radiation Protection and Nuclear Safety Agency, as in force on 2 August 2017.

Note 1: Examples of circumstances that might lead to exposure to ionising radiation include being present during or subsequent to the testing or use of nuclear weapons, undergoing diagnostic or therapeutic medical procedures involving ionising radiation, and being a member of an aircrew, leading to increased levels of exposure to cosmic radiation.

Note 2: For the purpose of dose reconstruction, dose is calculated as an average over the mass of a specific tissue or organ. If a tissue is exposed to multiple sources of ionising radiation, the various dose estimates for each type of radiation must be combined.

equivalent glucocorticoid therapy means a glucocorticoid in the following table, at the doses specified in the table, or a therapeutically equivalent dose of another glucocorticoid:

Glucocorticoid	Minimum cumulative<br>dose (milligram)	Minimum average<br>rate (milligram/day)
betamethasone	45	1.5
cortisone	1,875	62.5
dexamethasone	55	1.8
methylprednisolone	300	10
paramethasone	150	5
prednisolone	375	12.5
prednisone	375	12.5
triamcinolone	300	10

equivalent inhaled glucocorticoid means:

(a) 2,000 micrograms of beclometasone;

(b) 1,600 micrograms of ciclesonide;

(d) 1,000 micrograms of fluticasone furoate;

(e) 10,000 micrograms of triamcinolone; or

(f) a therapeutically equivalent dose of another inhaled glucocorticoid.

equivalent levels using ambulatory blood pressure measurement means:

(a) an average 24 hour blood pressure measurement of greater than or equal to 130 mmHg systolic or greater than or equal to 80 mmHg diastolic; or

(b) an average daytime (awake) blood pressure measurement of greater than or equal to 135 mmHg systolic or greater than or equal to 85 mmHg diastolic; or

(c) an average nighttime (asleep) blood pressure measurement of greater than or equal to 120 mmHg systolic or greater than or equal to 70 mmHg diastolic.

glucocorticoid therapy as specified means:

(a) applying a high or very high potency topical glucocorticoid to at least 30% of total skin surface area, daily, for at least 6 months; or

(b) inhaling at least 4,000 micrograms of budesonide, or equivalent inhaled glucocorticoid, daily, for at least 6 months; or

(i) hydrocortisone, orally or by injection:

to a cumulative dose of at least 1,500 milligrams; and
at a minimum dose rate averaging 50 milligrams per day; or

(ii) equivalent glucocorticoid therapy, orally or by injection; or

(d) using a glucocorticoid concurrently with a drug, daily, for at least 4 weeks, where that drug can inhibit the activity of the metabolising enzyme cytochrome P450 3A4 by at least 30% (moderate to strong inhibition); or

(e) using a glucocorticoid concurrently with a drug from the Specified List 2 of drugs, daily, for at least 4 weeks; or

(f) using a clobetasol containing oral preparation, daily, for at least 4 weeks; or

(g) using glucocorticoid containing enemas, daily, for at least 6 months.

Note: equivalent glucocorticoid therapy, equivalent inhaled glucocorticoid, high or very high potency topical glucocorticoid and Specified List 2 of drugs are also defined in the Schedule 1 – Dictionary.

high or very high potency topical glucocorticoid means:

(a) betamethasone dipropionate 0.05%;

(b) betamethasone valerate 0.1%;

(d) diflucortolone valerate 0.1%;

(e) fluocinolone acetonide 0.025%;

(f) methylprednisolone 0.1%;

(g) mometasone 0.1%;

(h) triamcinolone acetonide 0.5%; or

(i) another topical glucocorticoid of equivalent potency.

hyperparathyroidism means an excess level of parathyroid hormone.

hypertension—see subsection 7(2).

hyperuricaemia means having a serum urate level persistently greater than 0.40 millimoles per litre.

inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD) means any of the following:

(a) decanting or spraying;

(b) cleaning or maintaining equipment used to apply;

(d) handling or sawing timber treated with;

(e) being in an environment shrouded in dust from timber treated with; or

(f) using cutting oils contaminated with;

one of the following chemicals:

(i) 2,4,5-trichlorophenoxyacetic acid;

(ii) 2,4,5-trichlorophenoxypropionic acid;

(iii) 2,4,5-trichlorophenol;

(iv) 2-(2,4,5-trichlorophenoxy)-ethyl 2,2-dichloropropionate;

(v) o,o-dimethyl-o-(2,4,5-trichlorophenyl)-phosphorothioate;

(vi) pentachlorophenol;

(vii) 2,3,4,6-tetrachlorophenol;

(viii) 2,4,6-trichlorophenol;

(ix) 1,3,5-trichloro-2-(4-nitrophenoxy)benzene;

(x) 2,4-dichloro-1-(4-nitrophenoxy)benzene; or

(xi) 2,4-dichloro-1-(3-methoxy-4-nitrophenoxy)-benzene.

inhaling, ingesting or having cutaneous contact with a dioxin-like polychlorinated biphenyl means any of the following:

(a) applying, using or removing cutting oils containing a dioxin-like polychlorinated biphenyl;

(b) applying, using or removing dielectric fluids in electrical capacitors or electrical transformers containing a dioxin-like polychlorinated biphenyl;

(c) applying, using or removing hydraulic fluids or heat transfer material containing a dioxin-like polychlorinated biphenyl;

(d) applying, using or removing insulation material, electrical cable, ventilation gaskets, soundproofing material, missile launch tubes, banding and sheet rubber, surface coatings or steel containing a dioxin-like polychlorinated biphenyl;

(e) applying, using or removing metal coatings (such as on the hulls of ships) or heat resistant paint containing a dioxin-like polychlorinated biphenyl;

(f) applying, using or removing sealants containing a dioxin-like polychlorinated biphenyl;

(g) living in an area heavily polluted with a dioxin-like polychlorinated biphenyl due to waste incineration of materials or fires containing a dioxin-like polychlorinated biphenyl;

(h) shovelling or sweeping of debris contaminated with a dioxin-like polychlorinated biphenyl;

(i) working in the dismantling of ships, submarines or other structures containing a dioxin-like polychlorinated biphenyl;

(j) working in the recycling of electronic equipment containing a dioxin-like polychlorinated biphenyl; or

(k) undertaking work involving incineration of waste materials or fires containing a dioxin-like polychlorinated biphenyl.

MET means a unit of measurement of the level of physical exertion. 1 MET = 3.5 ml of oxygen/kg of body weight per minute, 1.0 kcal/kg of body weight per hour, or resting metabolic rate.

MRCA means the Military Rehabilitation and Compensation Act 2004.

paraganglioma means a neoplasm of chromaffin tissue which is associated with excess secretion of catecholamines, and is located in an extra-adrenal sympathetic ganglion.

phaeochromocytoma means a neoplasm of chromaffin tissue which is associated with excess secretion of catecholamines, and is located in the adrenal medulla.

primary hyperaldosteronism means a syndrome associated with excess production of the major adrenal mineralocorticoid, aldosterone.

relevant service means:

(a) operational service under the VEA;

(b) peacekeeping service under the VEA;

(d) British nuclear test defence service under the VEA;

(e) warlike service under the MRCA; or

(f) non-warlike service under the MRCA.

Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary.

Specified List 1 of drugs means:

(a) alkylating agents including cyclophosphamide;

(b) bromocriptine mesylate;

(d) cyclosporine A;

(e) docetaxel;

(f) erythropoietins including epoetin alfa, epoetin beta, darbepoetin alfa and methoxy polyethylene glycol-epoetin beta;

(g) ibrutinib;

(h) mammalian target of rapamycin inhibitors including sirolimus and everolimus;

(i) monoamine oxidase inhibitors including phenelzine, tranylcypromine and selegiline;

(j) physostigmine;

(k) proteasome inhibitors including bortezomib and carfilzomib;

(l) tacrolimus; or

(m) vascular endothelial growth factor (VEGF) inhibitors.

Note: Vascular endothelial growth factor (VEGF) inhibitors include monoclonal antibodies, such as bevacizumab and ramucirumab; the fusion molecule aflibercept; and tyrosine kinase inhibitors, such as cabozantinib, sorafenib, sunitinib and vandetanib.

Specified List 2 of drugs means:

(a) amprenavir;

(b) atazanavir;

(d) clarithromycin;

(e) darunavir;

(f) delavirdine;

(g) erythromycin;

(h) fosamprenavir;

(i) indinavir;

(j) isoniazid;

(k) itraconazole;

(l) ketoconazole;

(m) lopinavir;

(n) nelfinavir;

(o) posaconazole;

(p) ritonavir;

(q) saquinavir;

(r) telaprevir;

(s) telithromycin;

(t) tipranavir; or

(u) voriconazole.

specified list of endocrine disorders means:

(a) a renin-secreting neoplasm;

(b) acromegaly;

(d) hyperparathyroidism;

(e) hyperthyroidism, including goitre or Graves disease that has resulted in hyperthyroidism;

(f) hypothyroidism, including Hashimoto thyroiditis that has resulted in hypothyroidism;

(g) phaeochromocytoma or paraganglioma;

(h) primary hyperaldosteronism; or

(i) thyrotoxicosis.

Note: acromegaly, hyperparathyroidism, phaeochromocytoma, paraganglioma and primary hyperaldosteronism are also defined in the Schedule 1 - Dictionary.

terminal event means the proximate or ultimate cause of death and includes the following:

(a) pneumonia;

(b) respiratory failure;

(d) circulatory failure; or

(e) cessation of brain function.

VEA means the Veterans' Entitlements Act 1986.

Schedule 2 - Drugs

Note: See Section 6, Subsections 9(14) and 9(39)

1 Specified Drugs

abiraterone	2. acetaminophen (paracetamol)	3. acetylcholinesterase inhibitors including donepezil, galantamine and rivastigmine
4. androgen receptor blockers including flutamide, bicalutamide, darolutamide and enzalutamide	5. androgens including the anabolic steroids stanozolol and nandrolone	6. antiretroviral therapy
7. cholesteryl ester transfer protein inhibitors	8. clozapine	9. combined hormonal contraceptives
10. cyclizine	11. disulfiram	12. gonadotrophin releasing hormone agonists including goserelin and leuprorelin
13. gonadotrophin releasing hormone antagonists including degarelix	14. leflunomide	15. lithium
16. metoclopramide	17. mineralocorticoids including fludrocortisone	18. non-steroidal anti-inflammatory drugs excluding aspirin
19. olanzapine	20. oral oestrogen-containing hormonal replacement therapy	21. psychostimulants including amphetamines and methylphenidate
22. sibutramine	23. serotonin-norepinephrine re-uptake inhibitors including venlafaxine, duloxetine, desvenlafaxine and levomilnacipran	24. sympathomimetics including mirabegron, nasal decongestants, oral decongestants and 10% phenylephrine eye drops
25. systemic anti-fungal agents including itraconazole and posaconazole	26. thioridazine	27. tricyclic antidepressants
28. tropisetron	29. tumour necrosis factor inhibitors

Note 1: Examples of nasal decongestants at Item 24 include oxymetazoline, phenylephrine, tramazoline and xylometazoline.

Note 2: Examples of oral decongestants at Item 24 include phenylephrine and pseudoephedrine.

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Statement of Principles

concerning

HYPERTENSION (Reasonable Hypothesis)

(No. 21 of 2022)

The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 4 March 2022

The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:<br>
<br>Professor Terence Campbell AM<br>Chairperson<br>