Statement of Principles
concerning
 
MALIGNANT NEOPLASM OF THE PROSTATE
No. 53 of 2014
 
for the purposes of the
 
Veterans’ Entitlements Act 1986
and
Military Rehabilitation and Compensation Act 2004
Title
1.         This Instrument may be cited as Statement of Principles concerning malignant neoplasm of the prostate No. 53 of 2014.
Determination
2.         The Repatriation Medical Authority under subsection 196B(2) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):
(a)        revokes Instrument No. 28 of 2005, as amended by Instrument No. 77 of 2012, concerning malignant neoplasm of the prostate; and
(b)        determines in their place this Statement of Principles.
Kind of injury, disease or death
3.         (a)        This Statement of Principles is about malignant neoplasm of the prostate and death from malignant neoplasm of the prostate.
(b)               For the purposes of this Statement of Principles, "malignant neoplasm of the prostate" means a primary malignant neoplasm arising from the cells of the prostate gland.  This definition excludes prostatic intraepithelial neoplasia, soft tissue sarcoma, carcinoid tumour, non-Hodgkin’s lymphoma and Hodgkin’s lymphoma.
(c)                Malignant neoplasm of the prostate attracts ICD-10-AM code C61.
(d)               In the application of this Statement of Principles, the definition of "malignant neoplasm of the prostate" is that given at paragraph 3(b) above.
Basis for determining the factors
4.         The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that malignant neoplasm of the prostate and death from malignant neoplasm of the prostate 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 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.
Factors
6.         The factor that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting malignant neoplasm of the prostate or death from malignant neoplasm of the prostate with the circumstances of a person’s relevant service is:
(a)                inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD) for a cumulative period of at least 1 000 hours, at least five years before the clinical onset of malignant neoplasm of the prostate; or
(b)               being:
(i)         on land in Vietnam; or
(ii)        at sea in Vietnamese waters; or
(iii)             on board a vessel and consuming potable water supplied on that vessel, when the water supply had been produced by evaporative distillation of estuarine Vietnamese waters;
for a cumulative period of at least 30 days, at least five years before the clinical onset of malignant neoplasm of the prostate; or
(c)                increasing animal fat consumption by at least 40 percent and to at least 50 grams per day, and maintaining these levels for at least five years within the 25 years before the clinical onset of malignant neoplasm of the prostate; or
(d)               drinking at least 200 kilograms of alcohol within any ten year period within the 20 years before the clinical onset of malignant neoplasm of the prostate; or
(e)                smoking at least 20 pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of malignant neoplasm of the prostate, and where smoking has ceased, the clinical worsening of malignant neoplasm of the prostate has occurred within ten years of cessation; or
(f)                being obese for a continuous period of at least five years before the clinical worsening of malignant neoplasm of the prostate; or
(g)               inability to obtain appropriate clinical management for malignant neoplasm of the prostate.
Factors that apply only to material contribution or aggravation
7.         Paragraphs 6(e) to 6(g) apply only to material contribution to, or aggravation of, malignant neoplasm of the prostate where the person’s malignant neoplasm of the prostate 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.
Other definitions
9.         For the purposes of this Statement of Principles:
"animal fat" means fat contained in or derived from:
(a)                dairy products;
(b)               eggs; or
(c)                meat, other flesh or offal from animals (including birds but excluding seafood);
"alcohol" is measured by the alcohol consumption calculations utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink;
"being:
(i)         on land in Vietnam; or
(ii)        at sea in Vietnamese waters;" means service in at least one of the areas and at the times described in Items 4 and 8 of Schedule 2 of the VEA;
"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 malignant neoplasm of the prostate" 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 prostate;
"estuarine Vietnamese waters" means at least one of the waterways or harbours in the relevant areas described in Items 4 and 8 of Schedule 2 of the Veterans’ Entitlements Act 1986;
"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;
"inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD)" means:
(a)                decanting or spraying;
(b)               cleaning or maintaining equipment used to apply;
(c)                being sprayed with;
(d)               handling or sawing timber treated with;
(e)                being in an environment shrouded in dust from timber treated with; or
(f)                using cutting oils contaminated with;
one of the following chemicals:
(i)                 2,4,5-trichlorophenoxyacetic acid;
(ii)               2,4,5-trichlorophenoxypropionic acid;
(iii)             2,4,5-trichlorophenol;
(iv)             2-(2,4,5-trichlorophenoxy)-ethyl 2,2-dichloropropionate;
(v)               o,o-dimethyl-o-(2,4,5-trichlorophenyl)-phosphorothioate;
(vi)             pentachlorophenol;
(vii)           2,3,4,6-tetrachlorophenol;
(viii)         2,4,6-trichlorophenol;
(ix)             1,3,4-trichloro-2-(4-nitrophenoxy)benzene;
(x)               2,4-dichloro-1-(4-nitrophenoxy)benzene; or
(xi)             2,4-dichloro-1-(3-methoxy-4-nitrophenoxy)-benzene;
"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;
"potable water" means water used for drinking water, food preparation and beverage production;
"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:
(a)                pneumonia;
(b)               respiratory failure;
(c)                cardiac arrest;
(d)               circulatory failure; or
(e)                cessation of brain function.
Application
10.       This Instrument applies to all matters to which section 120A of the VEA or section 338 of the MRCA applies.
Date of effect
11.       This Instrument takes effect from 14 May 2014.
Dated this  eighth   day of   May   2014
The Common Seal of the                    )
Repatriation Medical Authority          )
was affixed at the direction of:          )
PROFESSOR NICHOLAS SAUNDERS AO
CHAIRPERSON