Last reviewed for CCPS 24 May 2007.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	A Category 1A Stressor - Cerebrovascular Accident	CR9131.pdf [4]	CR9131.docx [5]

 Preliminary questions [25367]

30471 there is some evidence that a category 1A stressor may be a factor in the development of the condition under consideration, a cerebrovascular accident.

25398 the veteran experienced a category 1A stressor within the 1 year before the clinical onset of the condition under consideration, a cerebrovascular accident.

25400  the veteran has established the causal connection between the category 1A stressor and operational service for the clinical onset of cerebrovascular accident.

Clinical onset and operational service [25400]

25402 on operational service, the veteran experienced a category 1A stressor within the 1 year before the clinical onset of the condition under consideration, a cerebrovascular accident.

25403 the veteran's experience of a category 1 A stressor on operational service within the 1 year before the clinical onset of the condition under consideration, a cerebrovascular accident, was due to the veteran's serious default, wilful act or serious breach of discipline.

or

25404 the veteran experienced a category 1A stressor within the 1 year before the clinical onset of the condition under consideration, a cerebrovascular accident, because of an illness or injury which is identifiable.

35946  the identified illness or injury that caused the category 1A stressor is causally related to operational service.

Cerebral ischaemia - A disease of the cerebral vessels Factor

The RMA has specified that only the following diseases of the cerebral vessels apply in the context of the CVA SOPs:

• Cerebral amyloid angiopathy
• Cerebral venous thrombosis
• Intravascular lymphomatosis
• Moyamoya disease
• Sneddon's syndrome

Several of these specified diseases are caused by other (underlying) medical conditions.  If necessary, seek medical advice about the appropriate diagnosis for the underlying disorder.

Investigative Documents

Type	Title	PDF Format	Word Format
Medical Report	A Disease of the Cerebral Vessels - Cerebrovascular Accident	MR9360.pdf [6]	MR9360.docx [7]

Preliminary questions [37113]

37114 there is some evidence that a disease of the cerebral vessels from the specified list may be a factor in the development of the condition under consideration, a cerebrovascular accident.

37115 the veteran has had a disease of the cerebral vessels from the specified list at some time.

37116 a disease of the cerebral vessels from the specified list is due to an illness or injury which is identifiable.

37117 the veteran had the identified illness or injury, a disease of the cerebral vessels from the specified list, at the time of the clinical onset of the condition under consideration, a cerebrovascular accident.

37118  the veteran has established the causal connection between a disease of the cerebral vessels and VEA service for the clinical onset of cerebrovascular accident.

37119   the veteran has established the causal connection between a disease of the cerebral vessels and operational service for the clinical onset of cerebrovascular accident.

or

37120   the veteran has established the causal connection between a disease of the cerebral vessels and eligible service for the clinical onset of cerebrovascular accident.

Clinical onset and operational service [37119]

37121  the identified illness or injury, a disease of the cerebral vessels from the specified list, is causally related to operational service.

Clinical onset and eligible service [37120]

37122  the identified illness or injury, a disease of the cerebral vessels from the specified list, is causally related to eligible service.

Last reviewed for CCPS 24 May 2007.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Use of a Specified Drug	CR9265.pdf [8]	CR9265.docx [9]
Medical Report	Use of a Specified Drug	MR9344.pdf [10]	MR9344.docx [11]

Preliminary questions [12575]

12648 there is some evidence that using a drug from the specified list may be a factor in the development of the condition under consideration, a cerebrovascular accident.

12650 the veteran used a drug from the specified list within the 72 hours before the clinical onset of the condition under consideration, a cerebrovascular accident.

12652  the veteran has established the causal connection between using a drug from the specified list and VEA service for the clinical onset of cerebrovascular accident.

12653   the veteran has established the causal connection between using a drug from the specified list and operational service for the clinical onset of cerebrovascular accident.

or

12654   the veteran has established the causal connection between using a drug from the specified list and eligible service for the clinical onset of cerebrovascular accident.

Clinical onset and operational service [12653]

12655 on operational service, the veteran used a drug from the specified list within the 72 hours before the clinical onset of the condition under consideration, a cerebrovascular accident.

12658 the veteran's use of a drug from the specified list on operational service within the 72 hours before the clinical onset of the condition under consideration, a cerebrovascular accident, was due to the veteran's serious default, wilful act or serious breach of discipline.

or

12660 the veteran's use of a drug from the specified list within the 72 hours before the clinical onset of the condition under consideration, a cerebrovascular accident, was due to an illness or injury which is identifiable.

37125  the identified illness or injury which caused the veteran to use a drug from the specified list is causally related to operational service.

Clinical onset and eligible service [12654]

38759 on eligible service, the veteran used a drug from the specified list within the 72 hours before the clinical onset of the condition under consideration, a cerebrovascular accident.

38760 the veteran's use of a drug from the specified list on eligible service within the 72 hours before the clinical onset of the condition under consideration, a cerebrovascular accident, was due to the veteran's serious default, wilful act or serious breach of discipline.

38761 the veteran's use of a drug from the specified list on eligible service within the 72 hours before the clinical onset of the condition under consideration, a cerebrovascular accident, occurred as a causal result of eligible service.

or

12660 the veteran's use of a drug from the specified list within the 72 hours before the clinical onset of the condition under consideration, a cerebrovascular accident, was due to an illness or injury which is identifiable.

37126  the identified illness or injury which caused the veteran to use a drug from the specified list is causally related to eligible service.

Last reviewed for CCPS 24 May 2007.

Investigative Documents

Type	Title	PDF Format	Word Format
Medical Report	Potential Source of Cerebral Embolus	MR9066.pdf [12]	MR9066.docx [13]

Preliminary questions [12582]

37884 the veteran has had a potential source of cerebral embolus as specified in the Statement of Principles for cerebrovascular accident at some time.

37885  a potential source of cerebral embolus as specified in the Statement of Principles for cerebrovascular accident is an illness or injury which is identifiable.

25420 the veteran had the identified illness or injury, a potential source of cerebral embolus, at the time of the clinical onset of the condition under consideration, a cerebrovascular accident.

12749  the veteran has established the causal connection between the potential source of cerebral embolus and VEA service for the clinical onset of cerebrovascular accident.

12750   the veteran has established the causal connection between the potential source of cerebral embolus and operational service for the clinical onset of cerebrovascular accident.

or

12751   the veteran has established the causal connection between the potential source of cerebral embolus and eligible service for the clinical onset of cerebrovascular accident.

Clinical onset and operational service [12750]

12752  the identified illness or injury, a potential source of cerebral embolus, is causally related to operational service.

Clinical onset and eligible service [12751]

12753  the identified illness or injury, a potential source of cerebral embolus, is causally related to eligible service.

Cerebral ischaemia - Alcohol consumption Factor

The alcohol factor for cerebrovascular accident requires average weekly consumption of specified amounts of alcohol over a period of at least the one year immediately before onset.As part of the investigation of this factor you will be asked to consider whether VEA service made a material contribution to the specified amounts during this relevant period. In considering this question you should have regard to:

• Guideline for claims assessors on smoking and alcohol related conditions and military service [14]and also
• AN02/2000, an Advisory Note concerning Alcohol Habituation [15].

A material contribution by service can be made in a number of ways:

• an amount was consumed during service, as a causal result of service;

• an amount was consumed because of a service-related medical condition, either during service or after service, or both.  For example: as part of alcohol dependence or alcohol abuse; or as part of another psychiatric condition; or as "self medication" for a medical condition.

The Repatriation Commission also agreed that arguments put to delegates that are outside the Guideline must still be considered for substance and medical and scientific support.  However the Commission did not agree that the temporal connection of service life with alcohol consumption is enough to establish ‘habit’ as the cause of alcohol use.

“Habituation” is often an argument advanced to connect service conditions with post service alcohol consumption.

A search by the RMA for sound medical scientific evidence bearing on "habituation" revealed only one epidemiological study (as at April 2000) that bears on the ‘habituation’ issue, that is, whether a “habit” of alcohol drinking continues from the service environment into the community after discharge from service.  In fact that paper suggested that not only was there no association with military service there is some evidence that military service produces the opposite effect.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Alcohol Consumption	CRD904.pdf [16]	CRD904.docx [17]
Claimant Report	Alcohol Consumption	CRV904.pdf [18]	CRV904.docx [19]
Medical Report	Alcohol Consumption	MR9244.pdf [20]	MR9244.docx [21]

 Preliminary questions [12571]

25671 the veteran has regularly consumed alcohol (contained within alcoholic drinks) at some time.

12616  the veteran has established the causal connection between the alcohol consumption and VEA service for the clinical onset of cerebrovascular accident.

12617   the veteran has established the causal connection between the alcohol consumption and operational service for the clinical onset of cerebrovascular accident.

or

12618   the veteran has established the causal connection between the alcohol consumption and eligible service for the clinical onset of cerebrovascular accident.

Clinical onset and operational service [12617]

25673 the veteran drank an average of at least 250 grams of alcohol per week for at least the one year before the clinical onset of the condition under consideration.

25674 operational service made a material contribution to the veteran drinking an average of at least 250 grams of alcohol per week for at least the one year before the clinical onset of the condition under consideration.

25675 the veteran's drinking of an average of at least 250 grams of alcohol per week for at least the one year before the clinical onset of the condition under consideration, which was materially contributed by operational service, was due to the veteran's serious default, wilful act or serious breach of discipline.

Clinical onset and eligible service [12618]

25680 the veteran drank an average of at least 300 grams of alcohol per week for at least the one year before the clinical onset of the condition under consideration.

25681 eligible service made a material contribution to the veteran drinking an average of at least 300 grams of alcohol per week for at least the one year before the clinical onset of the condition under consideration.

25683 the veteran's drinking of an average of at least 300 grams of alcohol per week for at least the one year before the clinical onset of the condition under consideration, which was materially contributed by eligible service, was due to the veteran's serious default, wilful act or serious breach of discipline.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Being in an Atmosphere with a Visible Tobacco Smoke Haze	CRD901.pdf [22]	CRD901.docx [23]
Claimant Report	Being in an Atmosphere with a Visible Tobacco Smoke Haze	CRV901.pdf [24]	CRV901.docx [25]

 Preliminary questions [37185]

31767 there is some evidence that being in an atmosphere with a visible tobacco smoke haze may be a factor in the development of the condition under consideration.

4926     the veteran has been in an atmosphere with a visible tobacco smoke haze in an enclosed space. [Default true]

18187 the veteran has been in an atmosphere with a visible tobacco smoke haze in an enclosed space for at least 5000 hours.

4932     the veteran was in an atmosphere with a visible tobacco smoke haze in an enclosed space for at least 5000 hours before the clinical onset of the condition under consideration.

37186  the veteran has established the causal connection between the exposure to tobacco smoke and operational service for the clinical onset of cerebrovascular accident.

Clinical onset and operational service [37186]

37187 where the veteran was in an atmosphere with a visible tobacco smoke haze in an enclosed space for at least 5000 hours before the clinical onset of the condition under consideration, the last such exposure ended within the five years before the clinical onset of the condition under consideration.

37883 operational service made a material contribution to the veteran being in an atmosphere with a visible tobacco smoke haze in an enclosed space for at least 5000 hours where the last such exposure ended within the five years before the clinical onset of the condition under consideration.

Cerebral ischaemia - Being pregnant or undergoing childbirth or being within the puerperal period Factor

'Being pregnant' refers to being in the condition of having a developing embryo or foetus in the body.

'Undergoing childbirth' (also known as labour) is the act or process of giving birth to a child. There are 3 stages of labour - the first stage begins with the onset of regular uterine contractions and ends when the cervix is fully dilated, the second stage is the time from complete cervical dilation to delivery of the foetus and the third stage begins after delivery of the infant and ends with delivery of the placenta.

'Puerperal period' is defined by the RMA to mean 'the 42 days following a birth' and commences from the end of the third stage of labour.

Preliminary questions [12574]

12644 there is some evidence that being pregnant, undergoing childbirth or being within the puerperal period may be a factor in the development of the condition under consideration, a cerebrovascular accident.

1169     the veteran is a woman.

37123 the veteran was pregnant or undergoing childbirth or within the puerperal period at the time of the clinical onset of the condition under consideration, a cerebrovascular accident.

12645  the veteran has established the causal connection between the pregnancy and VEA service for the clinical onset of cerebrovascular accident.

12646   the veteran has established the causal connection between the pregnancy and operational service for the clinical onset of cerebrovascular accident.

or

12647   the veteran has established the causal connection between the pregnancy and eligible service for the clinical onset of cerebrovascular accident.

Clinical onset and operational service [12646]

12797 as a causal result of operational service, the veteran was pregnant or undergoing childbirth or within the puerperal period at the time of the clinical onset of the condition under consideration, a cerebrovascular accident.

12799 the veteran being pregnant or undergoing childbirth or being within the puerperal period at the time of the clinical onset of the condition under consideration, a cerebrovascular accident, as a result of operational service, was due to the veteran's serious default, wilful act or serious breach of discipline.

Clinical onset and eligible service [12647]

12798 as a causal result of eligible service, the veteran was pregnant or undergoing childbirth or within the puerperal period at the time of the clinical onset of the condition under consideration, a cerebrovascular accident.

12800 the veteran being pregnant or undergoing childbirth or being within the puerperal period at the time of the clinical onset of the condition under consideration, a cerebrovascular accident, as a result of eligible service, was due to the veteran's serious default, wilful act or serious breach of discipline.

Cerebral ischaemia - Cerebral infection Factor

The Repatriation Medical Authority (RMA) has defined a cerebral infection to mean:

• cerebral abscess;  or
• cerebral helminthic infection (cysticercosis, schistosomiasis, sparganosis); or
• cerebral protozoal infection (malaria);  or
• encephalitis;
• intracerebral fungal infection (aspergillosis or mucormycosis);  or
• meningitis.

Signs and symptoms

Symptoms of cerebral infection include sudden fever, headache, vomiting, abnormal visual sensitivity to light, stiff neck, confusion, drowsiness, clumsiness, unsteady gait, and irritability.  In more serious cases there can be loss of consciousness, poor responsiveness, seizures, muscle weakness, sudden severe dementia, memory loss, withdrawal from social interaction, and impaired judgement.  Symptoms may last for 1-2 weeks and result in a full recovery or leave some permanent impairment.  In severe cases death may result within 48 hours of onset.

Establishing onset

A veteran or member with cerebral infection would require significant medical attention at the time.  Such medical treatment would be expected to be recorded in the service or hospital records.  If these cannot be obtained, a reliable history of cerebral infection at a particular time will generally be accepted, unless there is contradictory evidence.  Obtain medical advice if it is unclear whether the claimed symptoms and treatment at that time can be attributed to one of the cerebral infections specified by the RMA rather than to some other condition.

Investigative Documents

Type	Title	PDF Format	Word Format
Medical Report	Cerebral Infection - Cerebrovascular Accident	MR9358.pdf [26]	MR9358.docx [27]

Preliminary questions [25369]

25371 there is some evidence that cerebral infection may be a factor in the development of the condition under consideration, a cerebrovascular accident.

25372  cerebral infection means one of the infections listed in the definition of such an infection in the Statements of Principles for cerebrovascular accident.

25373 the veteran suffered from the identified illness or injury, a cerebral infection, at the time of the clinical onset of the condition under consideration, a cerebrovascular accident.

25374  the veteran has established the causal connection between cerebral infection and VEA service for the clinical onset of cerebrovascular accident.

25375   the veteran has established the causal connection between cerebral infection and operational service for the clinical onset of cerebrovascular accident.

or

25376   the veteran has established the causal connection between cerebral infection and eligible service for the clinical onset of cerebrovascular accident.

Clinical onset and operational service [25375]

25377  the identified illness or injury, a cerebral infection, is causally related to operational service.

Clinical onset and eligible service [25376]

25378  the identified illness or injury, a cerebral infection, is causally related to eligible service.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Smoking	CRD905.pdf [30]	CRD905.docx [31]
Claimant Report	Smoking	CRV905.pdf [32]	CRV905.docx [33]

Preliminary questions [12577]

22889 there is some evidence that cigar smoking may be a factor in the development of the condition under consideration.

4915     the veteran has ever smoked cigars.

12669  the veteran has established the causal connection between the cigar smoking and VEA service for the clinical onset of cerebrovascular accident.

12670   the veteran has established the causal connection between the cigar smoking and operational service for the clinical onset of cerebrovascular accident.

4921     the veteran has some period or periods of cigar smoking that are causally related to operational service.

or

12671   the veteran has established the causal connection between the cigar smoking and eligible service for the clinical onset of cerebrovascular accident.

4922     the veteran has some period or periods of cigar smoking that are causally related to eligible service.

Clinical onset and operational service [12670]

37870 the veteran had ceased smoking cigars before the clinical onset of the condition under consideration, a cerebrovascular accident.

37168  the veteran has established the causal connection between the cigar smoking which had ceased and operational service for the clinical onset of the condition under consideration, a cerebrovascular accident.

37172 the veteran smoked an average of at least four cigars per day for at least five years before the clinical onset of the condition under consideration, a cerebrovascular accident.

or

12672 the veteran smoked an average of at least one cigar per day for at least five years before the clinical onset of cerebrovascular accident with at least some smoking being maintained in the ten years before the clinical onset of the condition under consideration, a cerebrovascular accident.

or

37169  the veteran has established the causal connection between the cigar smoking which had not ceased and operational service for the clinical onset of the condition under consideration, a cerebrovascular accident.

37171 the veteran smoked at least one pack year of cigars before the clinical onset of the condition under consideration, a cerebrovascular accident.

or

37170 the veteran smoked an average of at least one cigar per day for at least the one year before the clinical onset of the condition under consideration, a cerebrovascular accident.

Clinical onset and eligible service [12671]

37870 the veteran had ceased smoking cigars before the clinical onset of the condition under consideration, a cerebrovascular accident.

37875  the veteran has established the causal connection between the cigar smoking which had ceased and eligible service for the clinical onset of the condition under consideration, a cerebrovascular accident.

37909 the veteran smoked an average of at least four eligible service cigars per day for at least five years before the clinical onset of the condition under consideration, a cerebrovascular accident.

or

12673 the veteran smoked an average of at least one cigar per day for at least five years before the clinical onset of cerebrovascular accident with at least some smoking being maintained in the five years before the clinical onset of the condition under consideration, a cerebrovascular accident.

or

37876  the veteran has established the causal connection between the cigar smoking which had not ceased and eligible service for the clinical onset of the condition under consideration, a cerebrovascular accident.

37908 the veteran smoked at least one pack year of eligible service cigars before the clinical onset of the condition under consideration, a cerebrovascular accident.

or

37907 the veteran smoked an average of at least one eligible service cigar per day for at least the one year before the clinical onset of the condition under consideration, a cerebrovascular accident.

Last reviewed for CCPS 24 May 2007.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Smoking	CRD905.pdf [30]	CRD905.docx [31]
Claimant Report	Smoking	CRV905.pdf [32]	CRV905.docx [33]

Preliminary questions [12576]

5803     the veteran has ever smoked cigarettes.

12664  the veteran has established the causal connection between the cigarette smoking and VEA service for the clinical onset of cerebrovascular accident.

12665   the veteran has established the causal connection between the cigarette smoking and operational service for the clinical onset of cerebrovascular accident.

3116     the veteran has some period or periods of cigarette smoking that are causally related to operational service.

or

12666   the veteran has established the causal connection between the cigarette smoking and eligible service for the clinical onset of cerebrovascular accident.

3521     the veteran has some period or periods of cigarette smoking that are causally related to eligible service.

Clinical onset and operational service [12665]

37162 the veteran had ceased smoking cigarettes before the clinical onset of the condition under consideration, a cerebrovascular accident.

37163  the veteran has established the causal connection between the cigarette smoking which had ceased and operational service for the clinical onset of the condition under consideration, a cerebrovascular accident.

37167 the veteran smoked an average of at least twenty cigarettes per day for at least five years before the clinical onset of the condition under consideration, a cerebrovascular accident.

or

12667 the veteran smoked an average of at least five cigarettes per day for at least five years before the clinical onset of cerebrovascular accident with at least some smoking being maintained in the ten years before the clinical onset of the condition under consideration, a cerebrovascular accident.

or

37164  the veteran has established the causal connection between the cigarette smoking which had not ceased and operational service for the clinical onset of the condition under consideration, a cerebrovascular accident.

37166 the veteran smoked at least one pack year of cigarettes before the clinical onset of the condition under consideration, a cerebrovascular accident.

or

37165 the veteran smoked an average of at least five cigarettes per day for at least the one year before the clinical onset of the condition under consideration, a cerebrovascular accident.

Clinical onset and eligible service [12666]

37162 the veteran had ceased smoking cigarettes before the clinical onset of the condition under consideration, a cerebrovascular accident.

37873  the veteran has established the causal connection between the cigarette smoking which had ceased and eligible service for the clinical onset of the condition under consideration, a cerebrovascular accident.

37906 the veteran smoked an average of at least twenty eligible service cigarettes per day for at least five years before the clinical onset of the condition under consideration, a cerebrovascular accident.

or

12668 the veteran smoked an average of at least five cigarettes per day for at least five years before the clinical onset of cerebrovascular accident with at least some smoking being maintained in the five years before the clinical onset of the condition under consideration, a cerebrovascular accident.

or

37874  the veteran has established the causal connection between the cigarette smoking which had not ceased and eligible service for the clinical onset of the condition under consideration, a cerebrovascular accident.

37905 the veteran smoked at least one pack year of eligible service cigarettes before the clinical onset of the condition under consideration, a cerebrovascular accident.

or

37904 the veteran smoked an average of at least five eligible service cigarettes per day for at least the one year before the clinical onset of the condition under consideration, a cerebrovascular accident.

Last reviewed for CCPS 24 May 2007.

Preliminary questions [12581]

12946 there is some evidence that ingesting the combined oral contraceptive pill may be a factor in the development of the condition under consideration, a cerebrovascular accident.

1169     the veteran is a woman.

8844     the veteran has ingested a combined oral contraceptive pill at some time.

12791 the veteran ingested a combined oral contraceptive pill for a continuous period of at least the 21 days before the clinical onset of the condition under consideration, a cerebrovascular accident.

12792  the veteran has established the causal connection between ingesting a combined oral contraceptive pill and VEA service for the clinical onset of cerebrovascular accident.

12793   the veteran has established the causal connection between ingesting a combined oral contraceptive pill and operational service for the clinical onset of cerebrovascular accident.

or

12794   the veteran has established the causal connection between ingesting a combined oral contraceptive pill and eligible service for the clinical onset of cerebrovascular accident.

Clinical onset and operational service [12793]

35788 as a causal result of operational service, the veteran ingested a combined oral contraceptive pill for a continuous period of at least the 21 days before the clinical onset of the condition under consideration, a cerebrovascular accident.

or

25623 the veteran's ingestion of a combined oral contraceptive pill for a continuous period of at least the 21 days before the clinical onset of the condition under consideration, a cerebrovascular accident, was for treatment of an illness or injury which is identifiable.

12795  the identified illness or injury, for which the veteran was treated with the combined oral contraceptive pill, is causally related to operational service.

Clinical onset and eligible service [12794]

35789 as a causal result of eligible service, the veteran ingested a combined oral contraceptive pill for a continuous period of at least the 21 days before the clinical onset of the condition under consideration, a cerebrovascular accident.

or

25623 the veteran's ingestion of a combined oral contraceptive pill for a continuous period of at least the 21 days before the clinical onset of the condition under consideration, a cerebrovascular accident, was for treatment of an illness or injury which is identifiable.

12796  the identified illness or injury, for which the veteran was treated with the combined oral contraceptive pill, is causally related to eligible service.

Last reviewed for CCPS 24 May 2007.

Preliminary questions [37105]

37106 there is some evidence that depressive disorder may be a factor in the development of the condition under consideration, a cerebrovascular accident.

21802 the veteran had depressive disorder at some time.

39978  depressive disorder means a major depressive episode, recurrent major depressive disorder, dysthymic disorder, depressive disorder not otherwise specified, substance-induced mood disorder with depressive features, or mood disorder due to a general medical condition with depressive features, or with major depressive-like episodes.

37107 the veteran had the identified illness or injury within the 90 days before the clinical onset of the condition under consideration, a cerebrovascular accident.

37108  the veteran has established the causal connection between depressive disorder and operational service for the clinical onset of cerebrovascular accident.

Clinical onset and operational service [37108]

22451  the identified illness or injury is causally related to operational service.

Last reviewed for CCPS 24 May 2007.

Preliminary questions [12579]

489        the veteran has diabetes mellitus.

10547 the veteran has insulin dependent diabetes mellitus (type 1).

or

10548 the veteran has non-insulin dependent diabetes mellitus (type 2).

28495 the veteran had the identified illness or injury at the time of the clinical onset of the condition under consideration.

12680  the veteran has established the causal connection between the diabetes mellitus and VEA service for the clinical onset of condition under consideration.

12681   the veteran has established the causal connection between the diabetes mellitus and operational service for the clinical onset of condition under consideration.

or

12682   the veteran has established the causal connection between the diabetes mellitus and eligible service for the clinical onset of condition under consideration.

Clinical onset and operational service [12681]

17527  the identified illness or injury, a type of diabetes mellitus, is causally related to operational service.

Clinical onset and eligible service [12682]

17528  the identified illness or injury, a type of diabetes mellitus, is causally related to eligible service.

Cerebral ischaemia - Disease of the precerebral artery Factor

The RMA has defined "precerebral artery" as meaning "extracerebral arteries supplying the brain, including the carotid artery, vertebral artery, basilar artery and ascending aorta".

Disease of the artery includes atherosclerosis, dissection, thrombosis, aneurysm or other pathological process of that artery.

Seek medical advice if it is not clear whether or not the diseased artery supplied the area of cerebral ischaemia.

Investigative Documents

Type	Title	PDF Format	Word Fotmat
Medical Report	Disease of the Precerebral Artery Supplying the Area of Cerebral Ischaemia - Cerebrovascular Accident	MR9150.pdf [35]	MR9150.docx [36]

 Preliminary questions [25370]

25390 there is some evidence that disease of the precerebral artery supplying the area of cerebral ischaemia may be a factor in the development of the condition under consideration, a cerebrovascular accident.

25391 the veteran has had disease of the precerebral artery supplying the area of cerebral ischaemia at some time.

25417  disease of the precerebral artery means a disease of the extracerebral arteries supplying the brain, including the carotid artery, vertebral artery, basilar artery and ascending aorta. [Default true]

25418 the veteran had the identified illness or injury, a disease of the precerebral artery supplying the area of cerebral ischaemia, at the time of the clinical onset of the condition under consideration, a cerebrovascular accident.

25392  the veteran has established the causal connection between disease of the precerebral artery supplying the area of cerebral ischaemia and VEA service for the clinical onset of cerebrovascular accident.

25393   the veteran has established the causal connection between disease of the precerebral artery supplying the area of cerebral ischaemia and operational service for the clinical onset of cerebrovascular accident.

or

25394   the veteran has established the causal connection between disease of the precerebral artery supplying the area of cerebral ischaemia and eligible service for the clinical onset of cerebrovascular accident.

Clinical onset and operational service [25393]

25396  the identified illness or injury, a disease of the precerebral artery supplying the area of cerebral ischaemia, is causally related to operational service.

Clinical onset and eligible service [25394]

25397  the identified illness or injury, a disease of the precerebral artery supplying the area of cerebral ischaemia, is causally related to eligible service.

Last reviewed for CCPS 24 May 2007.

Preliminary questions [12580]

36315 there is some evidence that dyslipidaemia may be a factor in the development of the condition under consideration.

7927   the veteran has had dyslipidaemia at some time.

37184 the veteran had the dyslipidaemia before the clinical onset of the condition under consideration, a cerebrovascular accident.

12685  the veteran has established the causal connection between the dyslipidaemia and VEA service for the clinical onset of cerebrovascular accident.

12686   the veteran has established the causal connection between the dyslipidaemia and operational service for the clinical onset of cerebrovascular accident.

or

12687   the veteran has established the causal connection between the dyslipidaemia and eligible service for the clinical onset of cerebrovascular accident.

Clinical onset and operational service [12686]

25967  the dyslipidaemia is causally related to operational service.

Clinical onset and eligible service [12687]

25968  the dyslipidaemia is causally related to eligible service.

Cerebral ischaemia - Envenomation by an animal Factor

For cerebrovascular accident, envenomation (poisoning) by an animal may occur by way of a bite or sting by a snake, scorpion, box jellyfish, bee or wasp.

Preliminary questions [37151]

37152 there is some evidence that envenomation by a snake, scorpion, box jellyfish, bee or wasp may be a factor in the development of the condition under consideration, a cerebrovascular accident.

37153 the veteran was envenomated by a snake, scorpion, box jellyfish, bee or wasp within the 24 hours before the clinical onset of the condition under consideration, a cerebrovascular accident.

37154  the veteran has established the causal connection between envenomation by an animal and VEA service for the clinical onset of cerebrovascular accident.

37155   the veteran has established the causal connection between envenomation by an animal and operational service for the clinical onset of cerebrovascular accident.

or

37156   the veteran has established the causal connection between envenomation by an animal and eligible service for the clinical onset of cerebrovascular accident.

Clinical onset and operational service [37155]

37157 on operational service, the veteran was envenomated by a snake, scorpion, box jellyfish, bee or wasp within the 24 hours before the clinical onset of the condition under consideration, a cerebrovascular accident.

37160 the veteran's envenomation by a snake, scorpion, box jellyfish, bee or wasp on operational service within the 24 hours before the clinical onset of the condition under consideration, a cerebrovascular accident, was due to the veteran's serious default, wilful act or serious breach of discipline.

Clinical onset and eligible service [37156]

37158 on eligible service, the veteran was envenomated by a snake, scorpion, box jellyfish, bee or wasp within the 24 hours before the clinical onset of the condition under consideration, a cerebrovascular accident.

37159 as a causal result of eligible service, the veteran was envenomated by a snake, scorpion, box jellyfish, bee or wasp within the 24 hours before the clinical onset of the condition under consideration, a cerebrovascular accident.

37161 the veteran's envenomation by a snake, scorpion, box jellyfish, bee or wasp on eligible service within the 24 hours before the clinical onset of the condition under consideration, a cerebrovascular accident, was due to the veteran's serious default, wilful act or serious breach of discipline.

Cerebral ischaemia - Exertional heat stroke Factor

The RMA has defined this term to mean 'life-threatening central nervous system and multiple organ dysfunction from complications of hyperthermia which may manifest suddenly during extreme physical exertion in a hot environment'.

Preliminary questions [37140]

37141 there is some evidence that exertional heat stroke may be a factor in the development of the condition under consideration, a cerebrovascular accident.

37142 the veteran had exertional heat stroke at the time of the clinical onset of the condition under consideration, a cerebrovascular accident.

37143  the veteran has established the causal connection between exertional heat stroke and VEA service for the clinical onset of cerebrovascular accident.

37144   the veteran has established the causal connection between exertional heat stroke and operational service for the clinical onset of cerebrovascular accident.

or

37145   the veteran has established the causal connection between exertional heat stroke and eligible service for the clinical onset of cerebrovascular accident.

Clinical onset and operational service [37144]

37146 on operational service, the veteran had exertional heat stroke at the time of the clinical onset of the condition under consideration, a cerebrovascular accident.

37149 the veteran's exertional heat stroke on operational service at the time of the clinical onset of the condition under consideration, a cerebrovascular accident, was due to the veteran's serious default, wilful act or serious breach of discipline.

Clinical onset and eligible service [37145]

37147 on eligible service, the veteran had exertional heat stroke at the time of the clinical onset of the condition under consideration, a cerebrovascular accident.

37148 as a causal result of eligible service, the veteran had exertional heat stroke at the time of the clinical onset of the condition under consideration, a cerebrovascular accident.

37150 the veteran's exertional heat stroke on eligible service at the time of the clinical onset of the condition under consideration, a cerebrovascular accident, was due to the veteran's serious default, wilful act or serious breach of discipline.

Last reviewed for CCPS 24 May 2007.

Investigative Documents

Type	Title	PDF Format	Word Format
Medical Report	Acute Hypotensive Episode - Cerebrovascular Accident	MR9207.pdf [37]	MR9207.docx [38]

Preliminary questions [28334]

28335 there is some evidence that an acute hypotensive episode may be a factor in the development of the condition under consideration, a cerebrovascular accident.

28337 the veteran experienced an acute hypotensive episode within the 24 hours before the clinical onset of the condition under consideration, a cerebrovascular accident.

28338 the acute hypotensive episode that the veteran experienced within the 24 hours before the clinical onset of the condition under consideration, a cerebrovascular accident, occurred as a result of an illness or injury which is identifiable.

28339  the veteran has established the causal connection between the acute hypotensive episode and VEA service for the clinical onset of cerebrovascular accident.

28340   the veteran has established the causal connection between the acute hypotensive episode and operational service for the clinical onset of cerebrovascular accident.

or

28341   the veteran has established the causal connection between the acute hypotensive episode and eligible service for the clinical onset of cerebrovascular accident.

Clinical onset and operational service [28340]

28342  the identified illness or injury which caused the acute hypotensive episode is causally related to operational service.

Clinical onset and eligible service [28341]

28343  the identified illness or injury which caused the acute hypotensive episode is causally related to eligible service.

Cerebral ischaemia - Haematological disorder associated with a hypercoagulable state Factor

This means a blood disorder which results in an abnormally increased tendency to develop blood clots.

The following list contains the conditions defined by the RMA as being haematological disorders associated with a hypercoagulable state:

•  antiphospholipid antibody syndrome; or
•  disseminated intravascular coagulation; or
•  heparin-induced thrombocytopenia and thrombosis; or
•  hyperproteinaemia; or
•  hyperviscosity syndrome; or
•  inherited coagulation protein disorders associated with hypercoagulability; or
•  myeloproliferative disease; or
•  primary or secondary polycythaemia; or
•  primary or secondary thrombocytosis; or
•  sickle cell disease or sickle cell trait; or
•  thrombotic thrombocytopaenic purpura.

If a veteran or member had one of these haematological disorders he or she would have needed significant medical attention at some time. Such medical treatment would normally be recorded in doctors' notes and/or hospital records. However, if these records cannot be obtained, a reliable history of appropriate medical treatment at a particular time will generally be accepted, unless there is contradictory evidence. Seek medical advice if it is unclear whether the claimed symptoms and treatment at that time can be attributed to one of these haematological disorders rather than to some other condition.

Investigative Documents

Type	Title	PDF Format	Word Format
Medical Report	Haematological Disorders Associated with a Hypercoagulable State	MR9067.pdf [39]	MR9067.docx [40]

Preliminary questions [12587]

12951 there is some evidence that a haematological disorder from the specified list associated with a hypercoagulable state may be a factor in the development of the condition under consideration, a cerebrovascular accident.

12754 the veteran has had a haematological disorder from the specified list associated with a hypercoagulable state at some time.

12755 the haematological disorder from the specified list associated with a hypercoagulable state is an illness or injury which is identifiable. [Default true]

25422 the veteran had the identified illness or injury, a haematological disorder associated with a hypercoagulable state, at the time of the clinical onset of the condition under consideration, a cerebrovascular accident.

12757  the veteran has established the causal connection between the haematological disorder associated with a hypercoagulable state and VEA service for the clinical onset of cerebrovascular accident.

12758   the veteran has established the causal connection between the haematological disorder associated with a hypercoagulable state and operational service for the clinical onset of cerebrovascular accident.

or

12759   the veteran has established the causal connection between the haematological disorder associated with a hypercoagulable state and eligible service for the clinical onset of cerebrovascular accident.

Clinical onset and operational service [12758]

12760  the identified illness or injury, a haematological disorder associated with a hypercoagulable state, is causally related to operational service.

Clinical onset and eligible service [12759]

12761  the identified illness or injury, a haematological disorder associated with a hypercoagulable state, is causally related to eligible service.

Last reviewed for CCPS 24 May 2007.

Preliminary questions [37203]

37204 there is some evidence that hormone replacement therapy may be a factor in the development of the condition under consideration, a cerebrovascular accident.

1169   the veteran is a woman.

37202 the veteran was postmenopausal at the time of the clinical onset of cerebrovascular accident.

36719 the veteran has had hormone replacement therapy at some time.

37206 the veteran had hormone replacement therapy for treatment of an illness or injury which is identifiable.

37205 for treatment of the identified illness or injury, the veteran had hormone replacement therapy for a period of at least the 21 days before the clinical onset of the condition under consideration, a cerebrovascular accident.

37207  the veteran has established the causal connection between hormone replacement therapy and VEA service for the clinical onset of cerebrovascular accident.

37208   the veteran has established the causal connection between hormone replacement therapy and operational service for the clinical onset of cerebrovascular accident.

or

37209   the veteran has established the causal connection between hormone replacement therapy and eligible service for the clinical onset of cerebrovascular accident.

Clinical onset and operational service [37208]

37210 the identified illness or injury for which the veteran had hormone replacement therapy is causally related to operational service.

Clinical onset and eligible service [37209]

37211 the identified illness or injury for which the veteran had hormone replacement therapy is causally related to eligible service.

Cerebral ischaemia - Hyperhomocysteinaemia Factor

Definition

The RMA defines hyperhomocysteinaemia to mean "a condition characterised by an excess of homocysteine in the blood".

General information

Homocysteine is an amino acid (one of the chemical compounds that forms proteins).  Everyone produces it, mainly from eating animal products.  Normally the substance is converted into other non-damaging amino acids.  If the normal homocysteine disposal systems are faulty then homocystine can form.  This homocystine can then build up in the blood and appear in the urine.

The potential artery-damaging effects of elevated total homocysteine (tHcy) levels were suggested for many years before the substance was finally recognised as a risk factor for atherosclerotic disease.

Hyperhomocystinaemia can be due to inherited enzyme defects, various dietary deficiencies (folate and vitamins B6 and B12) or chronic renal failure.  In its most common form caused by deficiency of the enzyme cystathionine-beta-synthetase, affected individuals are normal at birth, but can develop lens subluxation, lengthening and weakening of long bones, and variable degrees of mental retardation.  These manifest during childhood and adolescence.

The presence of hyperhomocystinaemia is demonstrated by a blood test and would be commented on in the medical records.

Preliminary questions [28351]

28352 there is some evidence that hyperhomocysteinaemia may be a factor in the development of the condition under consideration, a cerebrovascular accident.

7987   the veteran has had hyperhomocysteinaemia at some time.

28353 the veteran had hyperhomocysteinaemia before the clinical onset of the condition under consideration, a cerebrovascular accident.

28354  the veteran has established the causal connection between the hyperhomocysteinaemia and VEA service for the clinical onset of cerebrovascular accident.

28355   the veteran has established the causal connection between the hyperhomocysteinaemia and operational service for the clinical onset of cerebrovascular accident.

or

28356   the veteran has established the causal connection between the hyperhomocysteinaemia and eligible service for the clinical onset of cerebrovascular accident.

Clinical onset and operational service [28355]

7992   the hyperhomocysteinaemia is causally related to operational service.

Clinical onset and eligible service [28356]

7993    the hyperhomocysteinaemia is causally related to eligible service.

Cerebral ischaemia - Hypertension Factor

Definition

Hypertension is high blood pressure.  Hypertension was also sometimes called hyperpiesia or hyperpiesis up until the 1950's.  Blood pressure is usually recorded as two figures - the top figure records the systolic pressure and the lower figure records the diastolic pressure (eg 130/80 records a systolic pressure of 130 and a diastolic pressure of 80).

Note:  The definition means that hypertension cannot be diagnosed on the basis of one elevated blood pressure reading.  There must be a number of high readings.  When treatment is given, blood pressure readings may return to normal.  However, a person with 'normal' blood pressure readings can still be suffering from hypertension if he or she is undergoing treatment for hypertension.

Establishing the onset of hypertension

This disease is significant and, if it has been detected, it will have been documented by a medical officer.  However, doctors' notes and hospitals' records may have been destroyed or can no longer be obtained.  If this is the case, the person's statement that hypertension was detected at a particular time should generally be accepted, however, if these records cannot be obtained, a reliable history of hypertension at a particular time will generally be accepted, unless there is contradictory evidence.  Obtain medical advice if it is unclear whether the claimed symptoms and treatment at that time can be attributed to hypertension rather than to some other condition.

Preliminary questions [12569]

317       the veteran has hypertension.

12602 the veteran had hypertension at the time of the clinical onset of the condition under consideration, a cerebrovascular accident.

12597  the veteran has established the causal connection between the hypertension and VEA service for the clinical onset of cerebrovascular accident.

12598   the veteran has established the causal connection between the hypertension and operational service for the clinical onset of cerebrovascular accident.

or

12599   the veteran has established the causal connection between the hypertension and eligible service for the clinical onset of cerebrovascular accident.

Clinical onset and operational service [12598]

334        the hypertension is causally related to operational service.

Clinical onset and eligible service [12599]

934        the hypertension is causally related to eligible service.

Cerebral ischaemia - Inability to obtain appropriate clinical management for cerebrovascular accident Factor

Appropriate clinical management for cerebrovascular accident includes identification, control and limitation of the disease process, promotion of optimal function and institution of preventative measures. Treatment may involve medication such as anticoagulation and/or surgery such as angioplasty.

Inability to obtain appropriate clinical management

Investigative Documents

Type	Title	PDF Format	Word Format
Medical Report	Inability to Obtain Appropriate Clinical Management	GQACM.pdf [41]	GQACM.docx [42]

Preliminary questions [12592]

11109  the condition under consideration has been accepted on the basis of inability to obtain appropriate clinical management for the condition under consideration.

7066     there is some evidence that an inability to obtain appropriate clinical management for the condition under consideration may be a factor in the worsening of the condition under consideration.

7334     the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.

7335     the condition under consideration permanently worsened.

7378     the veteran was unable to obtain appropriate clinical management for the condition under consideration at some time.

7379     the inability to obtain appropriate clinical management for the condition under consideration contributed to the clinical worsening of the condition under consideration.

11234   the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and VEA service for the clinical worsening of the condition under consideration.

11235  the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and operational service for the clinical worsening of the condition under consideration.

or

11236  the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and eligible service for the clinical worsening of the condition under consideration.

Clinical worsening and operational service [11235]

7384      the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during operational service.

21084   the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during operational service, as a causal result of operational service.

7387      the veteran's inability to obtain appropriate clinical management for the condition under consideration during operational service was due to the veteran's serious default, wilful act or serious breach of discipline.

or

7389      the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, because of an illness or injury which is identifiable.

7390      the identified illness or injury which prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related to operational service.

7392      the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury that prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related.

Clinical worsening and eligible service [11236]

7385     the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during eligible service.

7386     the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during eligible service, as a causal result of eligible service.

7388     the veteran's inability to obtain appropriate clinical management for the condition under consideration during eligible service was due to the veteran's serious default, wilful act or serious breach of discipline.

or

7389     the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, because of an illness or injury which is identifiable.

7391     the identified illness or injury which prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related to eligible service.

7393     the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury that prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related.

Last reviewed for CCPS 24 May 2007.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Inability to Undertake Physical Activity	CR9147.pdf [43]	CR9147.docx [44]
Medical Report	Inability to Undertake Physical Activity	MR9045.pdf [45]	MR9045.docx [46]

Preliminary questions [12570]

12942 there is some evidence that an inability to undertake any physical activity greater than 3 METs may be a factor in the development of the condition under consideration, a cerebrovascular accident.

33535 the veteran has been unable to undertake any physical activity greater than 3 METs for at least 5 years at some time.

33536 the veteran was unable to undertake any physical activity greater than 3 METs for at least 5 years as a result of an illness or injury which is identifiable.

12606  the veteran has established the causal connection between the inability to undertake any physical activity greater than 3 METs and VEA service for the clinical onset of cerebrovascular accident.

12608   the veteran has established the causal connection between the inability to undertake any physical activity greater than 3 METs and eligible service for the clinical onset of cerebrovascular accident.

or

12607   the veteran has established the causal connection between the inability to undertake any physical activity greater than 3 METs and operational service for the clinical onset of cerebrovascular accident.

Clinical onset and operational service [12607]

25620 the identified illness or injury made a material contribution to the veteran's inability to undertake any physical activity greater than 3 METs for at least the five years before the clinical onset of the condition under consideration, a cerebrovascular accident.

33538  the identified illness or injury which prevented the veteran from undertaking any physical activity greater than 3 METs is causally related to operational service.

Clinical onset and eligible service [12608]

7979    the identified illness or injury made a material contribution to the veteran's inability to undertake any physical activity greater than 3 METs for at least seven years.

25621  the identified illness or injury made a material contribution to the veteran's inability to undertake any physical activity greater than 3 METs for at least the seven years before the clinical onset of the condition under consideration, a cerebrovascular accident.

33537  the identified illness or injury which prevented the veteran from undertaking any physical activity greater than 3 METs is causally related to eligible service.

Cerebral ischaemia - Intravenous immunoglobulin Factor

Intravenous immunoglobulin is frequently abbreviated as IVIg or IgG (for intravenous gamma globulin).  Immune globulin products from human plasma were first used in 1952 to treat immune deficiency.  Initially, immune globulin products were administered by intramuscular injection.  Intravenous immune globulin was initially shown to be effective in autoimmune idiopathic thrombocytopenic purpura (ITP) in 1981 (Imbach, 1981).

IVIG is used to treat a variety of autoimmune, infectious, and idiopathic diseases.  IVIG is an approved treatment for graft versus host disease and ITP.  It is accepted for use in persons with Kawasaki disease, Guillain-Barré syndrome, and polymyositis/dermatomyositis.

Preliminary questions [37192]

37193 there is some evidence that treatment with intravenous immunoglobulin may be a factor in the development of the condition under consideration, a cerebrovascular accident.

37194 the veteran has been treated with intravenous immunoglobulin at some time.

37195 the veteran was treated with intravenous immunoglobulin within the 72 hours before the clinical onset of the condition under consideration, a cerebrovascular accident.

37196  the veteran was treated with intravenous immunoglobulin for an illness or injury which is identifiable within the 72 hours before the clinical onset of the condition under consideration, a cerebrovascular accident.

37199  the veteran has established the causal connection between treatment with intravenous immunoglobulin and VEA service for the clinical onset of cerebrovascular accident.

37200   the veteran has established the causal connection between treatment with intravenous immunoglobulin and operational service for the clinical onset of cerebrovascular accident.

or

37201   the veteran has established the causal connection between treatment with intravenous immunoglobulin and eligible service for the clinical onset of cerebrovascular accident.

Clinical onset and operational service [37200]

37197  the identified illness or injury, for which the veteran was treated with intravenous immunoglobulin within the 72 hours before the clinical onset of the condition under consideration, a cerebrovascular accident, is causally related to operational service.

Clinical onset and eligible service [37201]

37198  the identified illness or injury, for which the veteran was treated with intravenous immunoglobulin within the 72 hours before the clinical onset of the condition under consideration, a cerebrovascular accident, is causally related to eligible service.

Cerebral ischaemia - Nephrotic syndrome Factor

The RMA states that nephrotic syndrome "means a kidney disease characterised by massive proteinuria with varying degrees of oedema, hypoalbuminaemia, lipiduria and hyperlipidaemia."

Nephrotic syndrome may be due to primary renal disease, such as glomerulonephritis, but it is also associated with a vast array of other conditions such as diabetes, SLE, leukaemias, lymphomas, Hodgkin's lymphoma, multiple myeloma, carcinoma, melanoma, insect stings, snake venoms, bacterial and viral infections.

If a veteran had nephrotic syndrome he or she would have needed significant medical attention at some time.  Such medical treatment would normally be recorded in doctors' notes and/or hospital records.  However, these records may have been destroyed or can no longer be obtained.

Preliminary questions [28357]

28358 there is some evidence that nephrotic syndrome may be a factor in the development of the condition under consideration, a cerebrovascular accident.

28359 the veteran has had nephrotic syndrome at some time.

28360 the veteran had nephrotic syndrome at the time of the clinical onset of the condition under consideration, a cerebrovascular accident.

28361 the veteran had nephrotic syndrome at the time of the clinical onset of the condition under consideration, a cerebrovascular accident, as a result of an illness or injury which is identifiable.

28362  the veteran has established the causal connection between the nephrotic syndrome and VEA service for the clinical onset of cerebrovascular accident.

28363   the veteran has established the causal connection between the nephrotic syndrome and operational service for the clinical onset of cerebrovascular accident.

or

28364   the veteran has established the causal connection between the nephrotic syndrome and eligible service for the clinical onset of cerebrovascular accident.

Clinical onset and operational service [28363]

28365  the identified illness or injury which caused the nephrotic syndrome is causally related to operational service.

Clinical onset and eligible service [28364]

28366  the identified illness or injury which caused the nephrotic syndrome is causally related to eligible service.

Cerebral ischaemia - Obstruction of an artery Factor

The factor, which applies only to cerebral ischaemia, requires the obstruction to be due to pressure from an extra-arterial source and to be located in one of the following arteries:

• vertebral
• common carotid
• internal carotid
• cerebral

Pressure from an extra-arterial source may arise from osteophytes (bony spurs), tumours or foreign bodies.  Seek medical advice if the evidence is unclear.

Investigative Documents

Type	Title	PDF Format	Word Format
Medical Report	Obstruction of an Artery - Cerebrovascular Accident	MR9363.pdf [47]	MR9363.docx [48]

Preliminary questions [18165]

20879 there is some evidence that obstruction of an artery may be a factor in the development of the condition under consideration.

18181 the veteran has had obstruction of a vertebral artery, common carotid artery, internal carotid artery or a cerebral artery, due to pressure from an extra-arterial source, at some time.

18183 the veteran had obstruction of a vertebral artery, common carotid artery, internal carotid artery or a cerebral artery, due to pressure from an extra-arterial source, at the time of the clinical onset of the condition under consideration.

37226 the obstruction of a vertebral artery, common carotid artery, internal carotid artery or a cerebral artery, due to pressure from an extra-arterial source, at the time of the clinical onset of the condition under consideration, was a consequence of an illness or injury which is identifiable.

18184  the veteran has established the causal connection between obstruction of an artery and VEA service for the clinical onset of cerebrovascular accident.

18185   the veteran has established the causal connection between obstruction of an artery and operational service for the clinical onset of cerebrovascular accident.

or

18186   the veteran has established the causal connection between obstruction of an artery and eligible service for the clinical onset of cerebrovascular accident.

Clinical onset and operational service [18185]

3471     the identified illness or injury, which caused the obstruction of a vertebral artery, common carotid artery, internal carotid artery or a cerebral artery, due to pressure from an extra-arterial source, at the time of the clinical onset of the condition under consideration, is causally related to operational service.

Clinical onset and eligible service [18186]

3473     the identified illness or injury, which caused the obstruction of a vertebral artery, common carotid artery, internal carotid artery or a cerebral artery, due to pressure from an extra-arterial source, at the time of the clinical onset of the condition under consideration, is causally related to eligible service.

Last reviewed for CCPS 24 May 2007.

Preliminary questions [25368]

25382 there is some evidence that panic disorder may be a factor in the development of the condition under consideration, a cerebrovascular accident.

21800 the veteran has had panic disorder at some time.

25384 the veteran had panic disorder at the time of the clinical onset of the condition under consideration, a cerebrovascular accident.

25386  the veteran has established the causal connection between panic disorder and operational service for the clinical onset of cerebrovascular accidentÊ

Clinical onset and operational service [25386]

25388  the panic disorder is causally related to operational service.

Last reviewed for CCPS 24 May 2007.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Smoking	CRD905.pdf [30]	CRD905.docx [31]
Claimant Report	Smoking	CRV905.pdf [32]	CRV905.docx [33]

Preliminary questions [12578]

22895 there is some evidence that pipe smoking may be a factor in the development of the condition under consideration.

4880     the veteran has ever smoked pipe tobacco.

12674  the veteran has established the causal connection between the pipe smoking and VEA service for the clinical onset of cerebrovascular accident.

12675   the veteran has established the causal connection between the pipe smoking and operational service for the clinical onset of cerebrovascular accident.

4911     the veteran has some period or periods of pipe smoking that are causally related to operational service.

or

12676   the veteran has established the causal connection between the pipe smoking and eligible service for the clinical onset of cerebrovascular accident.

4913     the veteran has some period or periods of pipe smoking that are causally related to eligible service.

Clinical onset and operational service [12675]

37871 the veteran had ceased smoking pipe tobacco before the clinical onset of the condition under consideration, a cerebrovascular accident.

37173  the veteran has established the causal connection between the pipe smoking which had ceased and operational service for the clinical onset of the condition under consideration, a cerebrovascular accident.

37177 the veteran smoked an average of at least 20 grams of pipe tobacco per day for at least five years before the clinical onset of the condition under consideration, a cerebrovascular accident.

or

12677 the veteran smoked an average of at least five grams of pipe tobacco per day for at least five years before the clinical onset of cerebrovascular accident with at least some smoking being maintained in the ten years before the clinical onset of the condition under consideration, a cerebrovascular accident.

or

37174  the veteran has established the causal connection between the pipe smoking which had not ceased and operational service for the clinical onset of the condition under consideration, a cerebrovascular accident.

37176 the veteran smoked at least one pack year of pipe tobacco before the clinical onset of the condition under consideration, a cerebrovascular accident.

or

37175 the veteran smoked an average of at least five grams of pipe tobacco per day for at least the one year before the clinical onset of the condition under consideration, a cerebrovascular accident.

Clinical onset and eligible service [12676]

37871 the veteran had ceased smoking pipe tobacco before the clinical onset of the condition under consideration, a cerebrovascular accident.

37877  the veteran has established the causal connection between the pipe smoking which had ceased and eligible service for the clinical onset of the condition under consideration, a cerebrovascular accident.

37912 the veteran smoked an average of at least 20 grams of eligible service pipe tobacco per day for at least five years before the clinical onset of the condition under consideration, a cerebrovascular accident.

or

12678 the veteran smoked an average of at least five grams of pipe tobacco per day for at least five years before the clinical onset of cerebrovascular accident with at least some smoking being maintained in the five years before the clinical onset of the condition under consideration, a cerebrovascular accident.

or

37878  the veteran has established the causal connection between the pipe smoking which had not ceased and eligible service for the clinical onset of the condition under consideration, a cerebrovascular accident.

37911 the veteran smoked at least one pack year of eligible service pipe tobacco before the clinical onset of the condition under consideration, a cerebrovascular accident.

or

37910 the veteran smoked an average of at least five grams of eligible service pipe tobacco per day for at least the one year before the clinical onset of the condition under consideration, a cerebrovascular accident.

Cerebral ischaemia - Serotonergic drugs Factor

Serotonergic drugs used in combination or in overdose can lead to a clinical condition known as Serotonin syndrome.  The syndrome is caused by excessive central nervous system and peripheral serotonergic activity.  A combination of agents increasing serotonin by different mechanisms, such as by inhibition of serotonin uptake and serotonin metabolism, is associated with a high risk of the syndrome.  The syndrome often occurs within 24 hours of a change of treatment (increase in dose or addition of another serotonergic agent) and the evolution of symptoms is rapid.  Such symptoms may include confusion, convulsions, hypertension, hallucinations or delirium.  The table below highlights examples of serotonergic drugs reported by the Therapeutic Goods Administration (TGA) as causing serotonin syndrome.

Last reviewed for CCPS 24 May 2007.

Investigative Documents

Type	Title	PDF Format	Word Format
Medical report	Serotonergic Drugs - Cerebrovascular Accident	MR9361.pdf [49]	MR9361.docx [50]

Preliminary questions [37127]

37128 there is some evidence that taking serotonergic drugs as specified may be a factor in the development of the condition under consideration, a cerebrovascular accident.

37130 the veteran took serotonergic drugs as specified in the Statements of Principles for cerebrovascular accident within the 24 hours before the clinical onset of the condition under consideration, a cerebrovascular accident.

37137  the veteran has established the causal connection between taking serotonergic drugs as specified and VEA service for the clinical onset of cerebrovascular accident.

37138   the veteran has established the causal connection between taking serotonergic drugs as specified and operational service for the clinical onset of cerebrovascular accident.

or

37139   the veteran has established the causal connection between taking serotonergic drugs as specified and eligible service for the clinical onset of cerebrovascular accident.

Clinical onset and operational service [37138]

37131 on operational service, the veteran took serotonergic drugs as specified in the Statements of Principles for cerebrovascular accident within the 24 hours before the clinical onset of the condition under consideration, a cerebrovascular accident.

37132 the veteran's use of serotonergic drugs as specified in the Statements of Principles for cerebrovascular accident on operational service within the 24 hours before the clinical onset of the condition under consideration, a cerebrovascular accident, was due to the veteran's serious default, wilful act or serious breach of discipline.

or

37133 the veteran took serotonergic drugs as specified in the Statements of Principles for cerebrovascular accident within the 24 hours before the clinical onset of the condition under consideration, a cerebrovascular accident, for treatment of an illness or injury which is identifiable.

37135  the identified illness or injury, for which the veteran took serotonergic drugs as specified in the Statements of Principles for cerebrovascular accident within the 24 hours before the clinical onset of the condition under consideration, a cerebrovascular accident, is causally related to operational service.

Clinical onset and eligible service [37139]

37133 the veteran took serotonergic drugs as specified in the Statements of Principles for cerebrovascular accident within the 24 hours before the clinical onset of the condition under consideration, a cerebrovascular accident, for treatment of an illness or injury which is identifiable.

37136  the identified illness or injury, for which the veteran took serotonergic drugs as specified in the Statements of Principles for cerebrovascular accident within the 24 hours before the clinical onset of the condition under consideration, a cerebrovascular accident, is causally related to eligible service.

Last reviewed for CCPS 24 May 2007.

Preliminary questions [37218]

37219 there is some evidence that sleep apnoea may be a factor in the development of the condition under consideration, a cerebrovascular accident.

30766 the veteran has suffered from sleep apnoea at some time.

37220 the veteran had sleep apnoea at the time of the clinical onset of the condition under consideration, a cerebrovascular accident.

37221  the veteran has established the causal connection between sleep apnoea and VEA service for the clinical onset of cerebrovascular accident.

37222   the veteran has established the causal connection between sleep apnoea and operational service for the clinical onset of cerebrovascular accident.

or

37223   the veteran has established the causal connection between sleep apnoea and eligible service for the clinical onset of cerebrovascular accident.

Clinical onset and operational service [37222]

37224  the veteran's sleep apnoea is causally related to operational service.

Clinical onset and eligible service [37223]

37225  the veteran's sleep apnoea is causally related to eligible service.

Last reviewed for CCPS 24 May 2007.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Smoking	CRD905.pdf [30]	CRD905.docx [31]
Claimant Report	Smoking	CRV905.pdf [32]	CRV905.docx [33]

Preliminary questions [34192]

30303 the veteran has smoked cigarettes, cigars or pipe tobacco at some time.

34193  the veteran has established the causal connection between smoking tobacco products and VEA service for the clinical onset of cerebrovascular accident.

34194   the veteran has established the causal connection between smoking tobacco products and operational service for the clinical onset of cerebrovascular accident.

or

34195   the veteran has established the causal connection between smoking tobacco products and eligible service for the clinical onset of cerebrovascular accident.

Clinical onset and operational service [34194]

37872 the veteran had ceased smoking tobacco products before the clinical onset of the condition under consideration, a cerebrovascular accident.

37879  the veteran has established the causal connection between smoking tobacco products which had ceased and operational service for the clinical onset of the condition under consideration, a cerebrovascular accident.

34199 the veteran smoked an average of at least twenty cigarettes per day or the equivalent thereof in other tobacco products for at least five years before the clinical onset of the condition under consideration, a cerebrovascular accident.

37726 smoking as a causal result of operational service made a material contribution to smoking an average of at least twenty cigarettes per day or the equivalent thereof in other tobacco products for at least five years before the clinical onset of the condition under consideration, a cerebrovascular accident.

or

34196 the veteran smoked an average of at least five cigarettes per day or the equivalent thereof in other tobacco products for at least five years before the clinical onset of the condition under consideration, a cerebrovascular accident.

34197 where the veteran smoked an average of at least five cigarettes per day or the equivalent thereof in other tobacco products for at least five years before the clinical onset of the condition under consideration, a cerebrovascular accident, the clinical onset of the condition under consideration occurred within ten years of cessation.

37728 smoking as a causal result of operational service made a material contribution to smoking an average of at least five cigarettes per day or the equivalent thereof in other tobacco products for at least five years before the clinical onset of the condition under consideration, a cerebrovascular accident.

or

37880  the veteran has established the causal connection between smoking tobacco products which had not ceased and operational service for the clinical onset of the condition under consideration, a cerebrovascular accident.

37181 the veteran smoked at least one pack year of cigarettes or the equivalent thereof in other tobacco products before the clinical onset of the condition under consideration, a cerebrovascular accident.

37724 smoking as a causal result of operational service made a material contribution to smoking at least one pack year of cigarettes or the equivalent thereof in other tobacco products before the clinical onset of the condition under consideration, a cerebrovascular accident.

or

37178 the veteran smoked an average of at least five cigarettes per day or the equivalent thereof in other tobacco products for at least the one year before the clinical onset of the condition under consideration, a cerebrovascular accident.

37182 smoking as a causal result of operational service made a material contribution to smoking an average of at least five cigarettes per day or the equivalent thereof in other tobacco products for at least the one year before the clinical onset of the condition under consideration, a cerebrovascular accident.

Clinical onset and eligible service [34195]

37872 the veteran had ceased smoking tobacco products before the clinical onset of the condition under consideration, a cerebrovascular accident.

37881  the veteran has established the causal connection between smoking tobacco products which had ceased and eligible service for the clinical onset of the condition under consideration, a cerebrovascular accident.

34199 the veteran smoked an average of at least twenty cigarettes per day or the equivalent thereof in other tobacco products for at least five years before the clinical onset of the condition under consideration, a cerebrovascular accident.

37727 smoking as a causal result of eligible service made a material contribution to smoking an average of at least twenty cigarettes per day or the equivalent thereof in other tobacco products for at least five years before the clinical onset of the condition under consideration, a cerebrovascular accident.

or

34196 the veteran smoked an average of at least five cigarettes per day or the equivalent thereof in other tobacco products for at least five years before the clinical onset of the condition under consideration, a cerebrovascular accident.

34198 where the veteran smoked an average of at least five cigarettes per day or the equivalent thereof in other tobacco products for at least five years before the clinical onset of the condition under consideration, a cerebrovascular accident, the clinical onset of the condition under consideration occurred within five years of cessation.

37729 smoking as a causal result of eligible service made a material contribution to smoking an average of at least five cigarettes per day or the equivalent thereof in other tobacco products for at least five years before the clinical onset of the condition under consideration, a cerebrovascular accident.

or

37882  the veteran has established the causal connection between smoking tobacco products which had not ceased and eligible service for the clinical onset of the condition under consideration, a cerebrovascular accident.

37181 the veteran smoked at least one pack year of cigarettes or the equivalent thereof in other tobacco products before the clinical onset of the condition under consideration, a cerebrovascular accident.

37725 smoking as a causal result of eligible service made a material contribution to smoking at least one pack year of cigarettes or the equivalent thereof in other tobacco products before the clinical onset of the condition under consideration, a cerebrovascular accident.

or

37178 the veteran smoked an average of at least five cigarettes per day or the equivalent thereof in other tobacco products for at least the one year before the clinical onset of the condition under consideration, a cerebrovascular accident.

37183 smoking as a causal result of eligible service made a material contribution to smoking an average of at least five cigarettes per day or the equivalent thereof in other tobacco products for at least the one year before the clinical onset of the condition under consideration, a cerebrovascular accident.

Last reviewed for CCPS 24 May 2007.

Preliminary questions [28344]

23515 there is some evidence that a course of therapeutic radiation to the head or neck may be a factor in the development of the condition under consideration.

11429 the veteran has undergone a course of therapeutic radiation to the head or neck at some time.

28345 the veteran underwent a course of therapeutic radiation to the head or neck before the clinical onset of the condition under consideration, a cerebrovascular accident.

28350 the veteran underwent a course of therapeutic radiation to the head or neck before the clinical onset of the condition under consideration, a cerebrovascular accident, for treatment of an illness or injury which is identifiable.

28346  the veteran has established the causal connection between the therapeutic radiation to the head or neck and VEA service for the clinical onset of cerebrovascular accident.

28347   the veteran has established the causal connection between the therapeutic radiation to the head or neck and operational service for the clinical onset of cerebrovascular accident.

or

28348   the veteran has established the causal connection between the therapeutic radiation to the head or neck and eligible service for the clinical onset of cerebrovascular accident.

Clinical onset and operational service [28347]

11438  the identified illness or injury for which the course of therapeutic radiation to the head or neck was undergone is causally related to operational service.

Clinical onset and eligible service [28348]

11439  the identified illness or injury for which the course of therapeutic radiation to the head or neck was undergone is causally related to eligible service.

Cerebral ischaemia - Trauma to the neck or the base of the skull Factor

The RMA definition of trauma to the neck or the base of the skull means either:

• a non-penetrating injury, involving extension, rotation, hyperflexion or compression of the neck;
• a penetrating injury to the neck or the base of the skull; or
• an injury resulting in fracture or dislocation of the cervical spine.

Additional information

This could include a direct blow to the spine or the base of the skull, or the application of force such as severe whiplash where the unsupported head has been subject to sudden over-extension in a motor vehicle accident (hit from behind), sudden forcible extension as in a diving accident, forceful manipulation of the neck (eg chiropractic manipulation) or electroconvulsive therapy without muscle relaxants. The neck is the region of the spine from the base of the skull to the nape of the neck - vertebrae C1 to C7.

If a veteran or member had a trauma to the neck or base of the skull as defined by the RMA it is likely that he or she would have sought medical attention at that time. Such medical treatment would normally be recorded in doctors' notes and/or hospital records. However, if these records cannot be obtained, a reliable history of appropriate medical treatment or symptoms at a particular time, generally will be accepted, unless there is contradictory evidence. Seek medical advice if it is unclear whether the claimed trauma to the neck or base of the skull at that time is medically feasible.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Trauma to the Neck or Base of the Skull - Cerebrovascular Accident	CR9076.pdf [51]	CR9076.docx [52]
Medical Report	Trauma to the Neck or Base of the Skull - Cerebrovascular Accident	MR9104.pdf [53]	MR9104.docx [54]

Preliminary questions [12585]

20878 there is some evidence that a trauma to the neck or the base of the skull may be a factor in the development of the condition under consideration, a cerebrovascular accident.

20715 the veteran has had trauma to the neck or the base of the skull as defined in the Statements of Principles for cerebrovascular accident at some time.

18168 the veteran had trauma to the neck or the base of the skull as defined in the Statements of Principles for cerebrovascular accident within the one year before the clinical onset of the condition under consideration, a cerebrovascular accident.

18169  the veteran has established the causal connection between the trauma to the neck or the base of the skull and VEA service for the clinical onset of cerebrovascular accident.

18170   the veteran has established the causal connection between the trauma to the neck or the base of the skull and operational service for the clinical onset of cerebrovascular accident.

or

18171   the veteran has established the causal connection between the trauma to the neck or the base of the skull and eligible service for the clinical onset of cerebrovascular accident.

Clinical onset and operational service [18170]

18173 on operational service, the veteran had trauma to the neck or the base of the skull as defined in the Statements of Principles for cerebrovascular accident within the one year before the clinical onset of the condition under consideration, a cerebrovascular accident.

18174 the trauma to the neck or the base of the skull on operational service as defined in the Statements of Principles for cerebrovascular accident within the one year before the clinical onset of the condition under consideration, a cerebrovascular accident, was due to the veteran's serious default, wilful act or serious breach of discipline.

or

18175 the trauma to the neck or the base of the skull as defined in the Statements of Principles for cerebrovascular accident within the one year before the clinical onset of the condition under consideration, a cerebrovascular accident, was due to an illness or injury which is identifiable.

20716  the identified illness or injury which caused the trauma to the neck or the base of the skull as defined in the Statements of Principles for cerebrovascular accident is causally related to operational service.

Clinical onset and eligible service [18171]

18177 on eligible service, the veteran had trauma to the neck or the base of the skull as defined in the Statements of Principles for cerebrovascular accident within the one year before the clinical onset of the condition under consideration, a cerebrovascular accident.

18178 as a causal result of eligible service, the veteran had trauma to the neck or the base of the skull as defined in the Statements of Principles for cerebrovascular accident within the one year before the clinical onset of the condition under consideration, a cerebrovascular accident.

18179 the trauma to the neck or the base of the skull on eligible service as defined in the Statements of Principles for cerebrovascular accident within the one year before the clinical onset of the condition under consideration, a cerebrovascular accident, was due to the veteran's serious default, wilful act or serious breach of discipline.

or

18175 the trauma to the neck or the base of the skull as defined in the Statements of Principles for cerebrovascular accident within the one year before the clinical onset of the condition under consideration, a cerebrovascular accident, was due to an illness or injury which is identifiable.

20717  the identified illness or injury which caused the trauma to the neck or the base of the skull as defined in the Statements of Principles for cerebrovascular accident is causally related to eligible service.

Last reviewed for CCPS 24 May 2007.

Preliminary questions [37213]

16833 there is some evidence that treatment with tamoxifen may be a factor in the development of the condition under consideration.

14054 the veteran has been treated with tamoxifen at some time.

14056 the treatment with tamoxifen was given for an illness or injury which is identifiable.

37212 for the identified illness or injury, the veteran was treated with tamoxifen for a continuous period of at least the 21 days before the clinical onset of the condition under consideration, a cerebrovascular accident.

37214  the veteran has established the causal connection between the identified illness or injury for which the treatment with tamoxifen was given and VEA service for the clinical onset of cerebrovascular accident.

37215   the veteran has established the causal connection between the identified illness or injury for which the treatment with tamoxifen was given and operational service for the clinical onset of cerebrovascular accident.

or

37216   the veteran has established the causal connection between the identified illness or injury for which the treatment with tamoxifen was given and eligible service for the clinical onset of cerebrovascular accident.

Clinical onset and operational service [37215]

14060  the identified illness or injury for which the treatment with tamoxifen was given is causally related to operational service.

Clinical onset and eligible service [37216]

14061  the identified illness or injury for which the treatment with tamoxifen was given is causally related to eligible service.

Last reviewed for CCPS 24 May 2007.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Nonsteroidal Anti-Inflammatory Drugs (excluding Aspirin)	CR9266.pdf [55]	CR9266.docx [56]
Medical Report	Treatment with NSAIDs (excluding Aspirin)	MR9345.pdf [57]	MR9345.docx [58]

Preliminary questions [37188]

36394 there is some evidence that a drug belonging to the nonsteroidal anti-inflammatory class of drugs, excluding aspirin, may be a factor in the development of the condition under consideration.

36395 the veteran used a drug as specified in the reasonable hypothesis Statement of Principles before the clinical onset of the condition under consideration.

36396 the veteran's use of a drug as specified in the reasonable hypothesis Statement of Principles was materially contributed to by treatment of an injury or illness which is identifiable.

37189  the veteran has established the causal connection between using a drug belonging to the nonsteroidal anti-inflammatory class of drugs, excluding aspirin, and VEA service for the clinical onset of cerebrovascular accident.

37190   the veteran has established the causal connection between using a drug belonging to the nonsteroidal anti-inflammatory class of drugs, excluding aspirin, and operational service for the clinical onset of cerebrovascular accident.

or

37191   the veteran has established the causal connection between treatment with a drug belonging to the selective cyclo-oxygenase 2 inhibitor class of drugs and eligible service for the clinical onset of cerebrovascular accident.

Clinical onset and operational service [37190]

36399  the identified illness or injury, for which the veteran used a drug belonging to the nonsteroidal anti-inflammatory class of drugs, excluding aspirin, is causally related to operational service.

Clinical onset and eligible service [37191]

36752 for treatment of the identified illness or injury, the veteran was treated with a drug belonging to the selective cyclo-oxygenase 2 inhibitor class of drugs for a period specified in the balance of probabilities Statement of Principles before the clinical onset of the condition under consideration.

36405  the identified illness or injury, for which the veteran was treated with a drug belonging to the selective cyclo-oxygenase 2 inhibitor class of drugs, is causally related to eligible service.

Cerebral ischaemia - Vasculitis affecting the cerebral arteries Factor

Vasculitis is a process characterised by inflammation of the blood vessels.  The cerebral arteries are arteries within the brain.  Cerebral arteries exclude the precerebral arteries such as the carotid and vertebrobasilar arteries.  The inflammatory process compromises the cavity of the affected blood vessels, resulting in ischaemia of the tissues being supplied by these blood vessels.

Inflammation of the cerebral arteries may be the primary or secondary manifestation of a disease which may not necessarily be confined to the cerebral arteries.  The following inflammatory conditions may be associated with vasculitis affecting the cerebral arteries:

• Allergic granulomatous angiitis
• Behcet's disease
• Giant-cell Arteritis
• Polyarteritis nodosa (PAN)
• Serum sickness
• Sjogren's syndrome
• Spatz-Lindenberg disease
• Systemic lupus erythematosus
• Wegener's granulomatosis

Seek medical advice if unsure whether or not the veteran's condition involved vasculitis of the cerebral arteries.

Investigative Documents

Type	Title	PDF Format	Word Format
Medical Report	Vasculitis Affecting the Cerebral Arteries - Cerebrovascular Accident	MR9359.pdf [59]	MR9359.docx [60]

Preliminary questions [12573]

12945 there is some evidence that vasculitis affecting the cerebral arteries may be a factor in the development of the condition under consideration, a cerebrovascular accident.

37110 the veteran has had vasculitis affecting the cerebral arteries at some time.

25634  vasculitis affecting the cerebral arteries means inflammation of the blood vessels including the cerebral arteries. [Default true]

25419 the veteran had the identified illness or injury, vasculitis affecting the cerebral arteries, at the time of the clinical onset of the condition under consideration, a cerebrovascular accident.

12639  the veteran has established the causal connection between vasculitis affecting the cerebral arteries and VEA service for the clinical onset of cerebrovascular accident.

12640   the veteran has established the causal connection between vasculitis affecting the cerebral arteries and operational service for the clinical onset of cerebrovascular accident.

or

12641   the veteran has established the causal connection between vasculitis affecting the cerebral arteries and eligible service for the clinical onset of cerebrovascular accident.

Clinical onset and operational service [12640]

37111  the identified illness or injury, vasculitis affecting the cerebral arteries, is causally related to operational service.

Clinical onset and eligible service [12641]

37112  the identified illness or injury, vasculitis affecting the cerebral arteries, is causally related to eligible service.