Statement of Principles
concerning
MALIGNANT NEOPLASM OF THE LUNG
No. 92 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 lung No. 92 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. 17 of 2006 concerning malignant neoplasm of the lung; and
(b) determines in its place this Statement of Principles.
Kind of injury, disease or death
3. (a) This Statement of Principles is about malignant neoplasm of the lung and death from malignant neoplasm of the lung.
(b) For the purposes of this Statement of Principles, "malignant neoplasm of the lung" means a primary malignant neoplasm arising from the respiratory epithelium of the trachea, bronchus, bronchioles or alveoli. This definition excludes soft tissue sarcoma, non-Hodgkin’s lymphoma, Hodgkin’s lymphoma, carcinoid tumour and mesothelioma.
(c) Malignant neoplasm of the lung attracts ICD-10-AM code C33 or C34.
(d) In the application of this Statement of Principles, the definition of "malignant neoplasm of the lung" 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 lung and death from malignant neoplasm of the lung 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 lung or death from malignant neoplasm of the lung with the circumstances of a person’s relevant service is:
(a) smoking at least one half of a pack-year of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of malignant neoplasm of the lung, where smoking commenced at least five years before the clinical onset of malignant neoplasm of the lung; or
(b) being in an atmosphere with a visible tobacco smoke haze in an enclosed space:
(i) for at least 5 000 hours before the clinical onset of malignant neoplasm of the lung; and
(ii) where the first exposure to that atmosphere commenced at least five years before the clinical onset of malignant neoplasm of the lung; or
(c) inhaling respirable asbestos fibres in an enclosed space:
(i) at the time material containing respirable asbestos fibres was being applied, removed, dislodged, cut or drilled; and
(ii) where the first inhalation of respirable asbestos fibres commenced at least five years before the clinical onset of malignant neoplasm of the lung; or
(d) inhaling respirable asbestos fibres in an open environment:
(i) for a cumulative period of at least 1 000 hours before the clinical onset of malignant neoplasm of the lung; and
(ii) at the time material containing respirable asbestos fibres was being applied, removed, dislodged, cut or drilled; and
(iii) where the first inhalation of respirable asbestos fibres commenced at least five years before the clinical onset of malignant neoplasm of the lung; or
(e) 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 lung; or
(f) inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD):
(i) for a cumulative period of at least 1 000 hours before the clinical onset of malignant neoplasm of the lung; and
(ii) where the first exposure occurred at least five years before the clinical onset of malignant neoplasm of the lung; or
(g) being within 100 metres of an industrial coke oven for a cumulative period of at least 4 500 hours, at least five years before the clinical onset of malignant neoplasm of the lung; or
(h) being heavily exposed to diesel engine exhaust for a cumulative period of at least 10 000 hours, at least five years before the clinical onset of malignant neoplasm of the lung; or
(i) being exposed to mustard gas at least five years before the clinical onset of malignant neoplasm of the lung; or
(j) drinking at least 350 kilograms of alcohol within a continuous 25 year period before the clinical onset of malignant neoplasm of the lung; or
(k) having received a cumulative equivalent dose of at least 0.1 sievert of ionising radiation to the lung, at least five years before the clinical onset of malignant neoplasm of the lung; or
(l) being exposed to at least 20 Working Level Months of radon in an enclosed space, before the clinical onset of malignant neoplasm of the lung, where the first exposure to radon occurred at least five years before the clinical onset of malignant neoplasm of the lung; or
(m) having a pulmonary disease from the specified list at least five years before the clinical onset of malignant neoplasm of the lung; or
(n) working as a painter for a cumulative period of at least 5 000 hours before the clinical onset of malignant neoplasm of the lung, where the first inhalation occurred at least five years before the clinical onset of malignant neoplasm of the lung; or
(o) inhaling respirable crystalline silica dust in an enclosed space:
(i) for a cumulative period of at least 1 500 hours before the clinical onset of malignant neoplasm of the lung; and
(ii) at the time material containing crystalline silica was being produced, excavated, drilled, cut or ground, or used in construction, manufacturing, cleaning or blasting; and
(iii) where the first inhalation of respirable crystalline silica dust commenced at least five years before the clinical onset of malignant neoplasm of the lung; or
(p) inhaling respirable crystalline silica dust in an open environment:
(i) for a cumulative period of at least 3 000 hours before the clinical onset of malignant neoplasm of the lung; and
(ii) at the time material containing crystalline silica was being produced, excavated, drilled, cut or ground, or used in construction, manufacturing, cleaning or blasting; and
(iii) where the first inhalation of respirable crystalline silica dust commenced at least five years before the clinical onset of malignant neoplasm of the lung; or
(q) inhaling fumes, vapours or dusts of a metal or metalloid from the specified list:
(i) for a cumulative period of at least 1 500 hours before the clinical onset of malignant neoplasm of the lung; and
(ii) where the first inhalation of fumes, vapours or dusts occurred at least five years before the clinical onset of malignant neoplasm of the lung; or
(r) inhaling fumes of bis(chloromethyl)ether or chloromethyl methyl ether:
(i) for a cumulative period of at least 1 500 hours before the clinical onset of malignant neoplasm of the lung; and
(ii) where the first inhalation of fumes occurred at least five years before the clinical onset of malignant neoplasm of the lung; or
(s) having berylliosis at the time of the clinical onset of malignant neoplasm of the lung; or
(t) smoking at least ten joint-years of cannabis, or the equivalent in other cannabis products, before the clinical onset of malignant neoplasm of the lung, where smoking commenced at least five years before the clinical onset of malignant neoplasm of the lung; or
(u) being exposed to arsenic as specified before the clinical onset of malignant neoplasm of the lung, where the first exposure to arsenic occurred at least ten years before the clinical onset of malignant neoplasm of the lung; or
(v) inhaling smoke from the combustion of coal, wood, charcoal or another solid biomass fuel while in an enclosed space with a visible smoke haze:
(i) for a cumulative period of at least 7 500 hours before the clinical onset of malignant neoplasm of the lung; and
(ii) where the first inhalation of smoke commenced at least five years before the clinical onset of malignant neoplasm of the lung; or
(w) inhaling ambient polluted air as specified:
(i) for a cumulative period of at least 35 000 hours before the clinical onset of malignant neoplasm of the lung; and
(ii) where the first inhalation of ambient polluted air occurred at least five years before the clinical onset of malignant neoplasm of the lung; or
(x) inhaling soot, whilst engaged in the cleaning of chimneys or flues:
(i) for a cumulative period of at least 1 500 hours before the clinical onset of malignant neoplasm of the lung; and
(ii) where the first inhalation of soot occurred at least five years before the clinical onset of malignant neoplasm of the lung; or
(y) inhaling mist from a strong inorganic acid:
(i) for a cumulative period of at least 1 500 hours before the clinical onset of malignant neoplasm of the lung; and
(ii) where the first inhalation of mist from a strong inorganic acid commenced at least five years before the clinical onset of malignant neoplasm of the lung; or
(z) inhaling fumes in an enclosed space, while working in a specified industry or manufacturing process generating high concentrations of volatile polycyclic aromatic hydrocarbons:
(i) for a cumulative period of at least 1 500 hours before the clinical onset of malignant neoplasm of the lung; and
(ii) where the first inhalation of fumes occurred at least five years before the clinical onset of malignant neoplasm of the lung; or
(aa) inhaling fumes of a chemical substance from the specified list involving exposure to high levels of volatile polycyclic aromatic hydrocarbons:
(i) for a cumulative period of at least 1 500 hours before the clinical onset of malignant neoplasm of the lung; and
(ii) where the first inhalation of fumes occurred at least five years before the clinical onset of malignant neoplasm of the lung; or
(bb) inhaling fumes generated during iron and steel founding or in rubber production, while in an enclosed space in immediate proximity to production facilities:
(i) for a cumulative period of at least 1 500 hours before the clinical onset of malignant neoplasm of the lung; and
(ii) where the first inhalation of fumes occurred at least five years before the clinical onset of malignant neoplasm of the lung; or
(cc) receiving MOPP at least five years before the clinical onset of malignant neoplasm of the lung; or
(dd) in current smokers only, receiving 20 milligrams of beta-carotene supplement daily for a continuous period of at least three years, before the clinical onset of malignant neoplasm of the lung; or
(ee) being infected with human immunodeficiency virus before the clinical onset of malignant neoplasm of the lung; or
(ff) having scleroderma at least three years before the clinical onset of malignant neoplasm of the lung; or
(gg) inability to obtain appropriate clinical management for malignant neoplasm of the lung.
Factors that apply only to material contribution or aggravation
7. Paragraph 6(gg) applies only to material contribution to, or aggravation of, malignant neoplasm of the lung where the person’s malignant neoplasm of the lung 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:
"a chemical substance from the specified list" means:
(a) coal tar pitch or concentrated coal tar distillates;
(b) creosote; or
(c) molten bitumen during roofing and mastic-asphalt work;
"a metal or metalloid from the specified list" means:
(a) arsenic and inorganic arsenic compounds;
(b) beryllium and beryllium compounds;
(c) cadmium and cadmium compounds;
(d) cobalt metal with tungsten carbide;
(e) hexavalent chromium (chromium VI) compounds; or
(f) mixtures that include nickel metal and nickel compounds;
"a pulmonary disease from the specified list" means:
(a) bacterial pneumonia;
(b) chronic obstructive pulmonary disease; or
(c) pulmonary tuberculosis;
"a specified industry or manufacturing process" means:
(a) aluminium production;
(b) coal gasification; or
(c) coke production;
"alcohol" is measured by the alcohol consumption calculations utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink;
"ambient polluted air as specified" means air with annual average levels of:
(a) particulates with an aerodynamic diameter
