Statement of Principles
concerning
MALIGNANT NEOPLASM OF THE GALLBLADDER
(No. 89 of 2015)
The Repatriation Medical Authority determines the following Statement of Principles.
Dated 19 June 2015
The Common Seal of the
Repatriation Medical Authority
was affixed to this instrument
at the direction of:
Professor Nicholas Saunders AO
Chairperson
Contents
1 Name........................................................................................................................................... 3
2 Commencement........................................................................................................................ 3
3 Authority..................................................................................................................................... 3
4 Revocation................................................................................................................................. 3
5 Application................................................................................................................................. 3
6 Definitions.................................................................................................................................. 3
7 Kind of injury, disease or death to which this Statement of Principles relates............... 3
8 Basis for determining the factors........................................................................................... 4
9 Factors that must exist............................................................................................................. 4
10 Relationship to service............................................................................................................. 5
11 Factors referring to an injury or disease covered by another Statement of Principles. 5
Schedule 1 - Dictionary............................................................................................. 6
1 Definitions.................................................................................................................................. 6
1 Name
This is the Statement of Principles concerning malignant neoplasm of the gallbladder (No. 89 of 2015).
2 Commencement
This instrument commences on 20 July 2015.
3 Authority
This instrument is made under subsection 196B(2) of the Veterans’ Entitlements Act 1986.
4 Revocation
The Statement of Principles concerning malignant neoplasm of the gallbladder No. 67 of 2007, as amended, made under subsections 196B(2) and (8) of the VEA is revoked.
5 Application
This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004 applies.
6 Definitions
The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.
7 Kind of injury, disease or death to which this Statement of Principles relates
(1) This Statement of Principles is about malignant neoplasm of the gallbladder and death from malignant neoplasm of the gallbladder.
Meaning of malignant neoplasm of the gallbladder
(2) For the purposes of this Statement of Principles, malignant neoplasm of the gallbladder:
(a) means a primary malignancy arising from the cells of the gallbladder; and
(b) excludes soft tissue sarcoma, carcinoid tumour, non-Hodgkin's lymphoma and Hodgkin's lymphoma.
(3) While malignant neoplasm of the gallbladder attracts ICD‑10‑AM code C23, in applying this Statement of Principles the meaning of malignant neoplasm of the gallbladder is that given in subsection (2).
(4) For subsection (3), a reference to an ICD‑10‑AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD‑10‑AM), Ninth Edition, effective date of 1 July 2015, copyrighted by the Independent Hospital Pricing Authority, ISBN 978‑1‑76007‑020‑5.
Death from malignant neoplasm of the gallbladder
(5) For the purposes of this Statement of Principles, malignant neoplasm of the gallbladder, in relation to a person, includes death from a terminal event or condition that was contributed to by the person’s malignant neoplasm of the gallbladder.
Note: terminal event is defined in the Schedule 1 – Dictionary.
8 Basis for determining the factors
The Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that malignant neoplasm of the gallbladder and death from malignant neoplasm of the gallbladder can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces under the VEA, or members under the MRCA.
Note: relevant service is defined in the Schedule 1 – Dictionary.
9 Factors that must exist
At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting malignant neoplasm of the gallbladder or death from malignant neoplasm of the gallbladder with the circumstances of a person’s relevant service:
(1) having cholelithiasis before the clinical onset of malignant neoplasm of the gallbladder;
(2) being a chronic typhoid carrier before the clinical onset of malignant neoplasm of the gallbladder;
(3) having primary sclerosing cholangitis before the clinical onset of malignant neoplasm of the gallbladder;
Note: primary sclerosing cholangitis is defined in the Schedule 1 – Dictionary.
(4) having received a cumulative equivalent dose of at least 0.1 sievert of ionising radiation to the gallbladder at least five years before the clinical onset of malignant neoplasm of the gallbladder;
Note: cumulative equivalent dose is defined in the Schedule 1 – Dictionary.
(5) having porcelain gallbladder before the clinical onset of malignant neoplasm of the gallbladder;
Note: porcelain gallbladder is defined in the Schedule 1 – Dictionary.
(6) being obese for at least five years within the 20 years before the clinical onset of malignant neoplasm of the gallbladder;
Note: being obese is defined in the Schedule 1 – Dictionary.
(7) having diabetes mellitus for at least five years before the clinical onset of malignant neoplasm of the gallbladder;
(8) smoking at least ten pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of malignant neoplasm of the gallbladder, and:
(a) smoking commenced at least five years before the clinical onset of malignant neoplasm of the gallbladder; and
(b) where smoking has ceased, the clinical onset of malignant neoplasm of the gallbladder has occurred within 20 years of cessation;
Note: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary.
(9) inability to obtain appropriate clinical management for malignant neoplasm of the gallbladder.
10 Relationship to service
(1) The existence in a person of any factor referred to in section 9 must be related to the relevant service rendered by the person.
(2) The factor set out in subsection 9(9) applies only to material contribution to, or aggravation of, malignant neoplasm of the gallbladder where the person’s malignant neoplasm of the gallbladder was suffered or contracted before or during (but did not arise out of) the person’s relevant service.
11 Factors referring to an injury or disease covered by another Statement of Principles
In this Statement of Principles:
(1) if a factor referred to in section 9 applies in relation to a person; and
(2) that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(2) of the VEA;
then the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.
Schedule 1 - Dictionary
Note: See Section 6
1 Definitions
In this instrument:
being obese means having a Body Mass Index (BMI) of 30 or greater.
The BMI = W/H2 and where:
W is the person's weight in kilograms; and
H is the person's height in metres.
cumulative equivalent dose means the total dose of ionising radiation received by the particular organ or tissue. The formula used to calculate the cumulative equivalent dose allows doses from multiple types of ionising radiation to be combined, by accounting for their differing biological effect. The unit of equivalent dose is the sievert. For the purposes of this Statement of Principles, the calculation of cumulative equivalent dose excludes doses received from normal background radiation, but includes therapeutic radiation, diagnostic radiation, cosmic radiation at high altitude, radiation from occupation-related sources and radiation from nuclear explosions or accidents.
malignant neoplasm of the gallbladder—see subsection 7(2).
MRCA means the Military Rehabilitation and Compensation Act 2004.
pack-years of cigarettes, or the equivalent thereof in other tobacco products means a calculation of consumption where one pack-year of cigarettes equals twenty tailor-made cigarettes per day for a period of one calendar year or 7 300 cigarettes. One tailor-made cigarette approximates one gram of tobacco or one gram of cigar or pipe tobacco by weight. One pack-year of tailor-made cigarettes equates to 7.3 kilograms of smoking tobacco by weight. Tobacco products mean cigarettes, pipe tobacco or cigars, smoked alone or in any combination.
porcelain gallbladder means intramural calcification of the gallbladder commonly associated with chronic cholecystitis.
primary sclerosing cholangitis means an autoimmune disorder characterised by a progressive, inflammatory, sclerosing process in the bile ducts.
relevant service means:
(a) operational service under the VEA;
(b) peacekeeping service under the VEA;
(c) hazardous service under the VEA;
(d) British nuclear test defence service under the VEA;
(e) warlike service under the MRCA; or
(f) non-warlike service under the MRCA.
terminal event means the proximate or ultimate cause of death and includes the following:
(a) pneumonia;
(b) respiratory failure;
(c) cardiac arrest;
(d) circulatory failure; or
(e) cessation of brain function.
VEA means the Veterans' Entitlements Act 1986.
