Reasonable Hypothesis SOP [1] | 56 of 2020 |
Balance of Probabilities SOP [2] | 57 of 2020 |
SOP Bulletin 216 [3]
This SOP applies to atherosclerosis of a renal artery that either requires treatment or results in clinical manifestations in the form of: acute pulmonary oedema; chronic heart failure; persistent renal impairment; or hypertension that is either moderate to severe, or poorly controlled (i.e. difficult to control).
Renal artery atherosclerotic disease needs to be distinguished from other causes of chronic kindney disease and other causes of secondary hypertension. The diagnosis requires imaging showing significant stenosis (typically > 60%) of a renal artery. CT angiography or MRI angiography are the preferred imaging methods. Duplex doppler ultrasound can also be used but is inconclusive if the test is negative. The condition is often unilateral.
The relevant medical specialist is a nephrologist.
* another SOP applies
The condition is likely to present with a deterioration in renal function (often rapid), or with onset or worsening of hypertension (particularly rapid development of severe hypertension). It may also cause acute pulmonary oedema (fluid in the lungs) or be found in connection with chronic heart failure. The condition can also be found incidentally from radiological imaging (with contrast) performed for another reason.
Effective treatment options are available in the form of medical (drug) therapy and control of risk factors, stenting, and surgery. The outcomes are variable, with improvement in some, stabilisation in others and progression to end stage renal disease in a further proportion.
Place holder node for Rulebase for renal artery atherosclerotic disease
Renal artery atherosclerotic disease - Cigar smoking Factor
Last reviewed for CCPS 20 August 2008.
Investigative Documents
Claimant Report - Smoking [CRD905] [5] Claimant Report - Smoking [CRV905] Preliminary questions [29923]
4915 [7] the veteran has ever smoked cigars. 29953 — the veteran has established the causal connection between the cigar smoking and VEA service for renal artery atherosclerotic disease. 29922 — the veteran has established the causal connection between the cigar smoking and VEA service for the clinical onset of renal artery atherosclerotic disease. 29924 — the veteran has established the causal connection between the cigar smoking and operational service for the clinical onset of renal artery atherosclerotic disease. or 29925 — the veteran has established the causal connection between the cigar smoking and eligible service for the clinical onset of renal artery atherosclerotic disease. or 29954 — the veteran has established the causal connection between the cigar smoking and VEA service for the clinical worsening of renal artery atherosclerotic disease. 29955 — the veteran has established the causal connection between the cigar smoking and operational service for the clinical worsening of renal artery atherosclerotic disease. or 29956 — the veteran has established the causal connection between the cigar smoking and eligible service for the clinical worsening of renal artery atherosclerotic disease. Clinical onset and operational service [29924] 4921 — the veteran has some period or periods of cigar smoking that are causally related to operational service. [11] Clinical onset and eligible service [29925] 4922 — the veteran has some period or periods of cigar smoking that are causally related to eligible service. [13] Clinical worsening and operational service [29955] 4921 — the veteran has some period or periods of cigar smoking that are causally related to operational service. [15] Clinical worsening and eligible service [29956] 4922 — the veteran has some period or periods of cigar smoking that are causally related to eligible service. [18]
Renal artery atherosclerotic disease - Cigarette smoking Factor
Last reviewed for CCPS 20 August 2008.
Investigative Documents
Claimant Report - Smoking [CRD905] [5] Claimant Report - Smoking [CRV905] Preliminary questions [29916] 29947 — the veteran has established the causal connection between the cigarette smoking and VEA service for renal artery atherosclerotic disease. 29917 — the veteran has established the causal connection between the cigarette smoking and VEA service for the clinical onset of renal artery atherosclerotic disease. 29918 — the veteran has established the causal connection between the cigarette smoking and operational service for the clinical onset of renal artery atherosclerotic disease. or 29919 — the veteran has established the causal connection between the cigarette smoking and eligible service for the clinical onset of renal artery atherosclerotic disease. or 29948 — the veteran has established the causal connection between the cigarette smoking and VEA service for the clinical worsening of renal artery atherosclerotic disease. 29949 — the veteran has established the causal connection between the cigarette smoking and operational service for the clinical worsening of renal artery atherosclerotic disease. or 29950 — the veteran has established the causal connection between the cigarette smoking and eligible service for the clinical worsening of renal artery atherosclerotic disease. Clinical onset and operational service [29918] 3116 — the veteran has some period or periods of cigarette smoking that are causally related to operational service. [23] Clinical onset and eligible service [29919] 3521 — the veteran has some period or periods of cigarette smoking that are causally related to eligible service. [24] Clinical worsening and operational service [29949] 3116 — the veteran has some period or periods of cigarette smoking that are causally related to operational service. [25] Clinical worsening and eligible service [29950] 3521 — the veteran has some period or periods of cigarette smoking that are causally related to eligible service. [28]
Renal artery atherosclerotic disease - Diabetes mellitus Factor
Last reviewed for CCPS 20 August 2008.
Preliminary questions [29941]
489 — the veteran has diabetes mellitus.
10547 [31] the veteran has insulin dependent diabetes mellitus (type 1). or 30268 — the veteran has established the causal connection between the diabetes mellitus and VEA service for the condition under consideration. 30269 — the veteran has established the causal connection between this diabetes mellitus and VEA service for the clinical onset of the condition under consideration. 30282 — the veteran has established the causal connection between this diabetes mellitus and operational service for the clinical onset of the condition under consideration. or 30283 — the veteran has established the causal connection between this diabetes mellitus and eligible service for the clinical onset of the condition under consideration. or 30270 — the veteran has established the causal connection between this diabetes mellitus and VEA service for the clinical worsening of the condition under consideration. 30284 — the veteran has established the causal connection between this diabetes mellitus and operational service for the clinical worsening of the condition under consideration. or 30285 — the veteran has established the causal connection between this diabetes mellitus and eligible service for the clinical worsening of the condition under consideration. Clinical onset and operational service [30282] 17527 — the identified illness or injury, a type of diabetes mellitus, is causally related to operational service. [35] [36] Clinical onset and eligible service [30283] 17528 — the identified illness or injury, a type of diabetes mellitus, is causally related to eligible service. [37] [36] Clinical worsening and operational service [30284] 17527 — the identified illness or injury, a type of diabetes mellitus, is causally related to operational service. [38] [36] Clinical worsening and eligible service [30285] 17528 — the identified illness or injury, a type of diabetes mellitus, is causally related to eligible service. [40] [36]
Renal artery atherosclerotic disease - Dyslipidaemia Factor
Last reviewed for CCPS 20 August 2008.
Preliminary questions [29976]
29977 [43] there is some evidence that dyslipidaemia may be a factor in the development or worsening of the condition under consideration.
7927 [43] the veteran has had dyslipidaemia at some time.
29978 — the veteran has established the causal connection between the dyslipidaemia and VEA service for renal artery atherosclerotic disease.
7929 [44] the veteran had dyslipidaemia before the clinical onset of the condition under consideration. 29981 — the veteran has established the causal connection between the dyslipidaemia and VEA service for the clinical onset of renal artery atherosclerotic disease. 29983 — the veteran has established the causal connection between the dyslipidaemia and operational service for the clinical onset of renal artery atherosclerotic disease. or 29984 — the veteran has established the causal connection between the dyslipidaemia and eligible service for the clinical onset of renal artery atherosclerotic disease. or 29989 — the veteran has established the causal connection between the dyslipidaemia and VEA service for the clinical worsening of renal artery atherosclerotic disease. 29985 — the veteran has established the causal connection between the dyslipidaemia and operational service for the clinical worsening of renal artery atherosclerotic disease. or 29986 — the veteran has established the causal connection between the dyslipidaemia and eligible service for the clinical worsening of renal artery atherosclerotic disease. Clinical onset and operational service [29983] 25967 — the dyslipidaemia is causally related to operational service. [46] [47] Clinical onset and eligible service [29984] 25968 — the dyslipidaemia is causally related to eligible service. [48] [47] Clinical worsening and operational service [29985] 25967 — the dyslipidaemia is causally related to operational service. [49] [47] Clinical worsening and eligible service [29986] 25968 — the dyslipidaemia is causally related to eligible service. [51] [47]
Renal artery atherosclerotic disease - Hypertension Factor
Last reviewed for CCPS 20 August 2008.
Preliminary questions [29934]
317 [54] the veteran has hypertension. 29935 — the veteran has established the causal connection between the hypertension and VEA service for the clinical onset of renal artery atherosclerotic disease. 29937 — the veteran has established the causal connection between the hypertension and eligible service for the clinical onset of renal artery atherosclerotic disease. or 29936 — the veteran has established the causal connection between the hypertension and operational service for the clinical onset of renal artery atherosclerotic disease. Clinical onset and operational service [29936] 334 — the hypertension is causally related to operational service. [56] [57] Clinical onset and eligible service [29937]
934 — the hypertension is causally related to eligible service. [60] [57]
Renal artery atherosclerotic disease - No appropriate clinical management for renal artery atherosclerotic disease Factor
Last reviewed for CCPS 20 August 2008.
Investigative Documents
Medical Report - Inability to Obtain Appropriate Clinical Management - [GQACM] Preliminary questions [32609] 11109 — the condition under consideration has been accepted on the basis of inability to obtain appropriate clinical management for the condition under consideration.
7334 [62] 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 [63] 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. [68] [69] 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. [68] [69]
Renal artery atherosclerotic disease - Pipe smoking Factor
Last reviewed for CCPS 20 August 2008.
Investigative Documents
Claimant Report - Smoking [CRD905] [5] Claimant Report - Smoking [CRV905] Preliminary questions [29926]
4880 [77] the veteran has ever smoked pipe tobacco. 29959 — the veteran has established the causal connection between the pipe smoking and VEA service for renal artery atherosclerotic disease. 29927 — the veteran has established the causal connection between the pipe smoking and VEA service for the clinical onset of renal artery atherosclerotic disease. 29928 — the veteran has established the causal connection between the pipe smoking and operational service for the clinical onset of renal artery atherosclerotic disease. or 29929 — the veteran has established the causal connection between the pipe smoking and eligible service for the clinical onset of renal artery atherosclerotic disease. or 29960 — the veteran has established the causal connection between the pipe smoking and VEA service for the clinical worsening of renal artery atherosclerotic disease. 29961 — the veteran has established the causal connection between the pipe smoking and operational service for the clinical worsening of renal artery atherosclerotic disease. or 29962 — the veteran has established the causal connection between the pipe smoking and eligible service for the clinical worsening of renal artery atherosclerotic disease. Clinical onset and operational service [29928] 4911 — the veteran has some period or periods of pipe smoking that are causally related to operational service. [79] Clinical onset and eligible service [29929] 4913 — the veteran has some period or periods of pipe smoking that are causally related to eligible service. [80] Clinical worsening and operational service [29961] 4911 — the veteran has some period or periods of pipe smoking that are causally related to operational service. [81] Clinical worsening and eligible service [29962] 4913 — the veteran has some period or periods of pipe smoking that are causally related to eligible service. [84]
Renal artery atherosclerotic disease - Smoking tobacco products - material contribution Factor
Last reviewed for CCPS 20 August 2008.
Preliminary questions [39818]
30303 [87] the veteran has smoked cigarettes, cigars or pipe tobacco at some time. 39819 — the veteran has established the causal connection between smoking tobacco products and VEA service for renal artery atherosclerotic disease. 39820 — the veteran has established the causal connection between smoking tobacco products and VEA service for the clinical onset of renal artery atherosclerotic disease. 39822 — the veteran has established the causal connection between smoking tobacco products and operational service for the clinical onset of renal artery atherosclerotic disease. or 39823 — the veteran has established the causal connection between smoking tobacco products and eligible service for the clinical onset of renal artery atherosclerotic disease. or 39821 — the veteran has established the causal connection between smoking tobacco products and VEA service for the clinical worsening of renal artery atherosclerotic disease. 39824 — the veteran has established the causal connection between smoking tobacco products and operational service for the clinical worsening of renal artery atherosclerotic disease. or 39825 — the veteran has established the causal connection between smoking tobacco products and eligible service for the clinical worsening of renal artery atherosclerotic disease. Clinical onset and operational service [39822] Clinical onset and eligible service [39823] Clinical worsening and operational service [39824] Clinical worsening and eligible service [39825]
Renal artery atherosclerotic disease - Treatment with oral angiotensin converting enzyme (ACE) inhibitors Factor
Last reviewed for CCPS 20 August 2008.
Preliminary questions [29991]
39834 [99] there is some evidence that treatment with oral angiotensin converting enzyme (ACE) inhibitors may be a factor in the worsening of the condition under consideration.
29993 [99] the veteran has been treated with oral angiotensin converting enzyme (ACE) inhibitors at some time.
7334 [62] 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 treated with oral angiotensin converting enzyme (ACE) inhibitors for an illness or injury which is identifiable. the veteran was being treated with oral angiotensin converting enzyme (ACE) inhibitors for the identified illness or injury after the clinical onset of the condition under consideration and within 28 days immediately before its clinical worsening. 29996 — the veteran has established the causal connection between the treatment with oral angiotensin converting enzyme (ACE) inhibitors and VEA service for the clinical worsening of renal artery atherosclerotic disease. 29997 — the veteran has established the causal connection between the treatment with oral angiotensin converting enzyme (ACE) inhibitors and operational service for the clinical worsening of renal artery atherosclerotic disease. or 29998 — the veteran has established the causal connection between the treatment with oral angiotensin converting enzyme (ACE) inhibitors and eligible service for the clinical worsening of renal artery atherosclerotic disease. Clinical worsening and operational service [29997] 29999 — the identified illness or injury, for which treatment with oral angiotensin converting enzyme (ACE) inhibitors was given, is causally related to operational service. [101] [102] Clinical worsening and eligible service [29998] 30000 — the identified illness or injury, for which treatment with oral angiotensin converting enzyme (ACE) inhibitors was given, is causally related to eligible service. [104] [102]
Links
[1] http://www.rma.gov.au/assets/SOP/2020/7a7b06c9dd/056.pdf
[2] http://www.rma.gov.au/assets/SOP/2020/052339caeb/057.pdf
[3] https://clik.dva.gov.au/system/files/media/SOP%20Bulletin%20216.pdf
[4] https://clik.dva.gov.au/user/login?destination=comment/reply/64056%23comment-form
[5] https://clik.dva.gov.au/ccpsclaimant-115
[6] clikpopup://CCPS/Cigar smoking
[7] clikpopup://CCPS/Ever smoked cigars
[8] clikpopup://CCPS/reject4915No
[9] clikpopup://CCPS/Reject/OnsetAfterService
[10] clikpopup://CCPS/Reject/NoPermanentWorsening
[11] clikpopup://CCPS/reject27034No
[12] https://clik.dva.gov.au/ccpsg014rc
[13] clikpopup://CCPS/reject27035No
[14] https://clik.dva.gov.au/ccpsg014rc-0
[15] clikpopup://CCPS/reject27036No
[16] clikpopup://CCPS/Onset of RAAD prior to operational service to which cigar smoking is causally related
[17] clikpopup://CCPS/reject9196No
[18] clikpopup://CCPS/reject27038No
[19] clikpopup://CCPS/Onset of RAAD prior to eligible service to which cigar smoking is causally related
[20] clikpopup://CCPS/reject9197No
[21] clikpopup://CCPS/Cigarette smoking
[22] clikpopup://CCPS/reject5803No
[23] https://clik.dva.gov.au/reasons-decision-24
[24] clikpopup://CCPS/reject27023No
[25] clikpopup://CCPS/reject27024No
[26] https://clik.dva.gov.au/29916-cigarette-smoking
[27] clikpopup://CCPS/reject9188No
[28] clikpopup://CCPS/reject39816No
[29] clikpopup://CCPS/Onset of RAAD prior to eligible service to which cigarette smoking is causally related
[30] clikpopup://CCPS/reject9189No
[31] https://clik.dva.gov.au/ccpsc002rc-20
[32] https://clik.dva.gov.au/reasons-decision-197
[33] clikpopup://CCPS/reject10548No
[34] clikpopup://CCPS/reject3441No
[35] clikpopup://CCPS/reject7903No
[36] clikpopup://CCPS/reject17527,17528No
[37] clikpopup://CCPS/reject17528No
[38] clikpopup://CCPS/reject17527No
[39] clikpopup://CCPS/Onset of RAAD before op service to which diabetes related
[40] clikpopup://CCPS/reject26450No
[41] clikpopup://CCPS/Onset of RAAD before el service to which diabetes related
[42] clikpopup://CCPS/reject26451No
[43] https://clik.dva.gov.au/ccpsf059rc-4
[44] clikpopup://CCPS/Had dyslipidaemia before onset of RAAD
[45] clikpopup://CCPS/reject7929No
[46] clikpopup://CCPS/reject7930No
[47] clikpopup://CCPS/reject25967,25968No
[48] clikpopup://CCPS/reject25968No
[49] clikpopup://CCPS/reject25967No
[50] clikpopup://CCPS/Onset of RAAD before Op service to which dyslipidaemia related
[51] clikpopup://CCPS/reject7939No
[52] clikpopup://CCPS/Onset of RAAD before El service to which dyslipidaemia related
[53] clikpopup://CCPS/reject7940No
[54] https://clik.dva.gov.au/ccpsg020rc
[55] clikpopup://CCPS/reject317No
[56] clikpopup://CCPS/reject29939No
[57] clikpopup://CCPS/reject334,934No
[58] clikpopup://CCPS/Had hypertension for 10 years before onset of RAAD
[59] clikpopup://CCPS/reject29940No
[60] clikpopup://CCPS/reject934No
[61] https://clik.dva.gov.au/ccpsother-31
[62] https://clik.dva.gov.au/node/68636
[63] clikpopup://CCPS/RAAD/ACM %C2%96 contributed to worsening
[64] clikpopup://CCPS/ACM/NoContribution
[65] clikpopup://CCPS/ACM/NotOpService
[66] clikpopup://CCPS/ACM/NotOperDuties
[67] clikpopup://CCPS/rejectwilful
[68] clikpopup://CCPS/ACM/NoIllness
[69] clikpopup://CCPS/reject7390,7391No
[70] clikpopup://CCPS/RAAD/ACM %C2%96 onset prior to operational service
[71] clikpopup://CCPS/ACM/OnsetFailOper
[72] clikpopup://CCPS/ACM/NotEligService
[73] clikpopup://CCPS/ACM/NotEligDuties
[74] clikpopup://CCPS/RAAD/ACM %C2%96 onset prior to eligible service
[75] clikpopup://CCPS/ACM/OnsetFailElig
[76] clikpopup://CCPS/Pipe smoking
[77] clikpopup://CCPS/Ever smoked pipe tobacco
[78] clikpopup://CCPS/reject4880No
[79] clikpopup://CCPS/reject27048No
[80] clikpopup://CCPS/reject27049No
[81] clikpopup://CCPS/reject27050No
[82] clikpopup://CCPS/Onset of RAAD prior to operational service to which pipe smoking is causally related
[83] clikpopup://CCPS/reject9204No
[84] clikpopup://CCPS/reject39817No
[85] clikpopup://CCPS/Onset of RAAD prior to eligible service to which pipe smoking is causally related
[86] clikpopup://CCPS/reject9205No
[87] clikpopup://CCPS/Smoked cigarettes, pipe tobacco or cigars at some time
[88] clikpopup://CCPS/reject30303No
[89] clikpopup://CCPS/reject39826No
[90] clikpopup://CCPS/reject39830No
[91] clikpopup://CCPS/reject39827No
[92] clikpopup://CCPS/reject39831No
[93] clikpopup://CCPS/reject39828No
[94] clikpopup://CCPS/reject39832No
[95] clikpopup://CCPS/reject33454No
[96] clikpopup://CCPS/reject39829No
[97] clikpopup://CCPS/reject39833No
[98] clikpopup://CCPS/reject33459No
[99] https://clik.dva.gov.au/standard-commentary
[100] clikpopup://CCPS/reject29994No
[101] clikpopup://CCPS/reject29995No
[102] clikpopup://CCPS/reject29999,30000No
[103] clikpopup://CCPS/Onset of RAAD before Op service to which illness treated with ACE inhibitors related
[104] clikpopup://CCPS/reject30003No
[105] clikpopup://CCPS/Onset of RAAD before El service to which illness treated with ACE inhibitors related
[106] clikpopup://CCPS/reject30002No