Reasonable Hypothesis [1] | 37 of 2021 |
Balance of Probabilities [2] | 38 of 2021 |
SOP Bulletin 219 [3]
This SOP covers blood clots that have lodged in the lungs, having broken off from: the deep veins draining the limbs; the right side of the heart; or the veins draining other organs (e.g. liver, kidney).
Clinical manifestations depend on the size and number of the clots. They may be asymptomatic, or cause acute shortness of breath, pleuritic chest pain, or, if large enough, sudden death.
This is a complicated diagnosis normally requiring arterial blood gases, and a Lung scintiscan, also known as a Ventilation Perfusion scan or V/Q scan. Diagnosis may also be made using spiral CT angiography, or at autopsy.
The relevant medical specialist is an emergency physician or a respiratory physician.
Pulmonary embolism due to other than a blood clot (all non-SOP conditions), i.e.:
The presentation can be anywhere from no symptoms to shock or sudden death. An acute presentation with rapid onset of shortness of breath and/or pleuritic chest pain is most common, but symptoms can also be mild and non-specific. Diagnosis can be delayed by days or weeks after the initial event. With chronic recurrent pulmonary embolism the first sign may be the detection of pulmonary hypertension years later.
The only SOP worsening factor is for inability to obtain appropriate clinical managment. This factor is most likely to be relevant in the immediate period (hours to weeks) following an embolism, where appropriate treatment could potentially prevent recurrences and complications.
Place holder node for Rulebase for pulmonary thromboembolism
Pulmonary thromboembolism - Deep vein thrombosis Factor
Last reviewed for CCPS 23 March 2001.
Preliminary questions [30299]
30368 [5] there is some evidence that deep vein thrombosis may be a factor in the development of the condition under consideration.
30305 [5] the veteran has suffered from deep vein thrombosis at some time.
30306 — the veteran has established the causal connection between the deep vein thrombosis and VEA service for the clinical onset of pulmonary thromboembolism.
30307 — the veteran has established the causal connection between the deep vein thrombosis and eligible service for the clinical onset of pulmonary thromboembolism.
or
30308 — the veteran has established the causal connection between the deep vein thrombosis and operational service for the clinical onset of pulmonary thromboembolism.
Clinical onset and operational service [30308]
30311 [6] the veteran was suffering from deep vein thrombosis within the 180 days immediately before the clinical onset of the condition under consideration. 30312 — the deep vein thrombosis is causally related to operational service. [7] [8] Clinical onset and eligible service [30307]
30310 — the deep vein thrombosis is causally related to eligible service. [11] [8]
Pulmonary thromboembolism - No appropriate clinical management for pulmonary thromboembolism Factor
Last reviewed for CCPS 23 March 2001.
Investigative Documents
Medical Report - Inability to Obtain Appropriate Clinical Management - [GQACM] Preliminary questions [32597] 11109 — the condition under consideration has been accepted on the basis of inability to obtain appropriate clinical management for the condition under consideration.
7334 [13] the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service. the condition under consideration permanently worsened. the veteran was unable to obtain appropriate clinical management for the condition under consideration at some time.
7379 [16] 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] or 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. [21] [22] Clinical worsening and eligible service [11236] or 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. [21] [22]
Pulmonary thromboembolism - Smoking cigarettes or other tobacco products Factor
Last reviewed for CCPS 23 March 2001.
Investigative Documents
Claimant Report - Smoking [CRD905] [29] Claimant Report - Smoking [CRV905] Preliminary questions [30302] 30330 — the veteran has established the causal connection between the smoking of cigarettes or other tobacco products and VEA service for the clinical onset of pulmonary thromboembolism. 30331 — the veteran has established the causal connection between the smoking of cigarettes or other tobacco products and operational service for the clinical onset of pulmonary thromboembolism. or 30332 — the veteran has established the causal connection between the smoking of cigarettes or other tobacco products and eligible service for the clinical onset of pulmonary thromboembolism. Clinical onset and operational service [30331] Clinical onset and eligible service [30332]
Pulmonary thromboembolism - Thrombus within the right atrium or right ventricle Factor
Last reviewed for CCPS 23 March 2001.
Preliminary questions [30301]
30323 [36] there is some evidence that thrombus within the right atrium or right ventricle may be a factor in the development of the condition under consideration.
30322 [36] the veteran has suffered from thrombus within the right atrium or right ventricle at some time.
39815 [37] the thrombus within the right atrium or right ventricle was due to an illness or injury which is identifiable. as a result of the identified illness or injury, the veteran was suffering from thrombus within the right atrium or right ventricle at the time of the clinical onset of the condition under consideration. [39]
30325 — the veteran has established the causal connection between the thrombus within the right atrium or right ventricle and VEA service for the clinical onset of pulmonary thromboembolism.
30326 — the veteran has established the causal connection between the thrombus within the right atrium or right ventricle and operational service for the clinical onset of pulmonary thromboembolism.
or
30327 — the veteran has established the causal connection between the thrombus within the right atrium or right ventricle and eligible service for the clinical onset of pulmonary thromboembolism.
Clinical onset and operational service [30326]
30328 — the identified illness or injury, which caused the thrombus within the right atrium or right ventricle, is causally related to operational service. [40] [41]
Clinical onset and eligible service [30327]
30329 — the identified illness or injury, which caused the thrombus within the right atrium or right ventricle, is causally related to eligible service. [42] [41]
Pulmonary thromboembolism - Venous thrombosis Factor
Last reviewed for CCPS 23 March 2001.
Preliminary questions [30300]
30369 [43] there is some evidence that venous thrombosis may be a factor in the development of the condition under consideration.
30313 [43] the veteran has suffered from venous thrombosis at some time.
30314 [44] the venous thrombosis is an illness or injury which is identifiable. 30315 — the veteran has established the causal connection between the venous thrombosis and VEA service for the clinical onset of pulmonary thromboembolism. 30316 — the veteran has established the causal connection between the venous thrombosis and eligible service for the clinical onset of pulmonary thromboembolism. or 30317 — the veteran has established the causal connection between the venous thrombosis and operational service for the clinical onset of pulmonary thromboembolism. Clinical onset and operational service [30317] 30321 — the identified illness or injury, a venous thrombosis, is causally related to operational service. [46] [47] Clinical onset and eligible service [30316]
30319 — the identified illness or injury, a venous thrombosis, is causally related to eligible service. [50] [47]
Links
[1] http://www.rma.gov.au/assets/SOP/2021/c1388b94ab/037.pdf
[2] http://www.rma.gov.au/assets/SOP/2021/0c555c6208/038.pdf
[3] https://clik.dva.gov.au/system/files/media/SOP%20Bulletin%20219.pdf
[4] https://clik.dva.gov.au/user/login?destination=comment/reply/64043%23comment-form
[5] https://clik.dva.gov.au/ccpsg025rc
[6] clikpopup://CCPS/Deep vein thrombosis in 180 days before onset of pulmonary thromboembolism
[7] clikpopup://CCPS/reject30311No
[8] clikpopup://CCPS/reject30312,30310No
[9] https://clik.dva.gov.au/30299-deep-vein-thrombosis
[10] clikpopup://CCPS/reject30309No
[11] clikpopup://CCPS/reject30310No
[12] https://clik.dva.gov.au/ccpsother-31
[13] https://clik.dva.gov.au/node/68785
[14] clikpopup://CCPS/Reject/OnsetAfterService
[15] clikpopup://CCPS/Reject/NoPermanentWorsening
[16] clikpopup://CCPS/Pulmonary thromboembolism/ACM - contributed to worsening
[17] clikpopup://CCPS/ACM/NoContribution
[18] clikpopup://CCPS/ACM/NotOpService
[19] clikpopup://CCPS/ACM/NotOperDuties
[20] clikpopup://CCPS/rejectwilful
[21] clikpopup://CCPS/ACM/NoIllness
[22] clikpopup://CCPS/reject7390,7391No
[23] clikpopup://CCPS/Pulmonary thromboembolism/ACM - onset prior to operational service
[24] clikpopup://CCPS/ACM/OnsetFailOper
[25] clikpopup://CCPS/ACM/NotEligService
[26] clikpopup://CCPS/ACM/NotEligDuties
[27] clikpopup://CCPS/Pulmonary thromboembolism/ACM - onset prior to eligible service
[28] clikpopup://CCPS/ACM/OnsetFailElig
[29] https://clik.dva.gov.au/ccpsclaimant-115
[30] clikpopup://CCPS/Smoked cigarettes, pipe tobacco or cigars at some time
[31] clikpopup://CCPS/reject30303No
[32] clikpopup://CCPS/reject30333No
[33] clikpopup://CCPS/reject30335No
[34] clikpopup://CCPS/reject30334No
[35] clikpopup://CCPS/reject30336No
[36] https://clik.dva.gov.au/standard-commentary-17
[37] clikpopup://CCPS/Thrombus within the right atrium or right ventricle due to identifiable illness or injury
[38] clikpopup://CCPS/reject39815No
[39] clikpopup://CCPS/reject30324No
[40] clikpopup://CCPS/reject30328No
[41] clikpopup://CCPS/reject30328,30329No
[42] clikpopup://CCPS/reject30329No
[43] https://clik.dva.gov.au/ccpsg025rc-0
[44] clikpopup://CCPS/Venous thrombosis is an illness or injury
[45] clikpopup://CCPS/reject30314No
[46] clikpopup://CCPS/reject30320No
[47] clikpopup://CCPS/reject30321,30319No
[48] clikpopup://CCPS/Venous thrombosis in 90 days before onset of pulmonary thromboembolism
[49] clikpopup://CCPS/reject30318No
[50] clikpopup://CCPS/reject30319No