Statement of Principles
No. 36 of 2014
for the purposes of the
Veterans’ Entitlements Act 1986
Military Rehabilitation and Compensation Act 2004
1. This Instrument may be cited as Statement of Principles concerning Hodgkin's lymphoma No. 36 of 2014.
2. The Repatriation Medical Authority under subsection 196B(3) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):
(a) revokes Instrument No. 29 of 2004 concerning Hodgkin's lymphoma; and
(b) determines in its place this Statement of Principles.
Kind of injury, disease or death
3. (a) This Statement of Principles is about Hodgkin's lymphoma and death from Hodgkin's lymphoma.
(b) For the purposes of this Statement of Principles, "Hodgkin's lymphoma" means a monoclonal lymphoid neoplasm derived from B lymphocytes and characterised by the presence of mononuclear Hodgkin cells and multinucleated Reed-Sternberg cells in the classical variant, or by lymphocytic and histiocytic Reed-Sternberg cell variants in the nodular lymphocyte predominant variant. Hodgkin's lymphoma is also known as Hodgkin’s disease or Hodgkin lymphoma.
(c) Hodgkin's lymphoma attracts ICD-10-AM code C81.
(d) In the application of this Statement of Principles, the definition of "Hodgkin's lymphoma" is that given at paragraph 3(b) above.
Basis for determining the factors
4. On the sound medical-scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that Hodgkin's lymphoma and death from Hodgkin's lymphoma can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the Military Rehabilitation and Compensation Act 2004 (the MRCA).
Factors that must be related to service
5. Subject to clause 7, at least one of the factors set out in clause 6 must be related to the relevant service rendered by the person.
6. The factor that must exist before it can be said that, on the balance of probabilities, Hodgkin's lymphoma or death from Hodgkin's lymphoma is connected with the circumstances of a person’s relevant service is:
(a) being infected with human immunodeficiency virus before the clinical onset of Hodgkin’s lymphoma; or
(b) being infected with Epstein-Barr virus before the clinical onset of Hodgkin’s lymphoma; or
(c) smoking at least 15 pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of Hodgkin's lymphoma, and
(i) smoking commenced at least ten years before the clinical onset of Hodgkin's lymphoma; and
(ii) where smoking has ceased, the clinical onset of Hodgkin's lymphoma has occurred within ten years of cessation; or
(d) having an autoimmune disease from the specified list before the clinical onset of Hodgkin’s lymphoma; or
(e) undergoing stem cell, bone marrow or solid organ transplantation before the clinical onset of Hodgkin's lymphoma; or
(f) for Richter's syndrome only, having chronic lymphocytic leukaemia/small lymphocytic lymphoma at the time of the clinical onset of Hodgkin’s lymphoma; or
(g) being obese for a continuous period of at least five years within the 20 years before the clinical onset of Hodgkin's lymphoma; or
(h) inability to obtain appropriate clinical management for Hodgkin's lymphoma.
Factors that apply only to material contribution or aggravation
7. Paragraph 6(h) applies only to material contribution to, or aggravation of, Hodgkin's lymphoma where the person’s Hodgkin's lymphoma was suffered or contracted before or during (but not arising out of) the person’s relevant service.
Inclusion of Statements of Principles
8. In this Statement of Principles if a relevant factor applies and that factor includes an injury or disease in respect of which there is a Statement of Principles then the factors in that last mentioned Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.
9. For the purposes of this Statement of Principles:
"an autoimmune disease from the specified list" means:
(a) coeliac disease;
(b) immune thrombocytopaenic purpura;
(c) rheumatoid arthritis;
(e) Sjogren’s syndrome; or
(f) systemic lupus erythematosus;
"being infected with Epstein-Barr virus" means serological evidence of infection with Epstein-Barr virus;
"being obese" means an increase in body weight by way of fat accumulation which results in 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;
"death from Hodgkin's lymphoma" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s Hodgkin's lymphoma;
"ICD-10-AM code" means a number assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM), Eighth Edition, effective date of 1 July 2013, copyrighted by the Independent Hospital Pricing Authority, and having ISBN 978-1-74128-213-9;
"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;
"relevant service" means:
(a) eligible war service (other than operational service) under the VEA;
(b) defence service (other than hazardous service and British nuclear test defence service) under the VEA; or
(c) peacetime service under the MRCA;
"Richter's syndrome" means a form of high-grade large cell lymphoma, characterised by systemic symptoms, rapid tumour growth and extra-nodal involvement, which develops in patients with chronic lymphocytic leukaemia;
"terminal event" means the proximate or ultimate cause of death and includes:
(b) respiratory failure;
(c) cardiac arrest;
(d) circulatory failure; or
(e) cessation of brain function.
10. This Instrument applies to all matters to which section 120B of the VEA or section 339 of the MRCA applies.
Date of effect
11. This Instrument takes effect from 7 May 2014.
Dated this twenty-fourth day of April 2014
The Common Seal of the )
Repatriation Medical Authority )
was affixed to this instrument )
in the presence of: )
PROFESSOR NICHOLAS SAUNDERS AO