Statement of Principles
concerning
MALIGNANT NEOPLASM OF THE SMALL INTESTINE
No. 1 of 2015
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 small intestine No. 1 of 2015.
Determination
2. The Repatriation Medical Authority under subsection 196B(2) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):
(a) revokes Instrument No. 40 of 2004 concerning malignant neoplasm of the small intestine; 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 small intestine and death from malignant neoplasm of the small intestine.
(b) For the purposes of this Statement of Principles, "malignant neoplasm of the small intestine" means a primary malignant neoplasm arising from the epithelial cells of the small intestine. The small intestine is defined as the proximal portion of the intestine comprising the duodenum, jejunum and ileum, excluding the pyloric opening of the stomach and the ileocaecal junction. This definition excludes soft tissue sarcoma, carcinoid tumour, non-Hodgkin’s lymphoma and Hodgkin’s lymphoma.
(c) Malignant neoplasm of the small intestine attracts ICD-10-AM code C17.
(d) In the application of this Statement of Principles, the definition of "malignant neoplasm of the small intestine" 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 small intestine and death from malignant neoplasm of the small intestine 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 small intestine or death from malignant neoplasm of the small intestine with the circumstances of a person’s relevant service is:
(a) having Crohn’s disease of the small intestine before the clinical onset of malignant neoplasm of the small intestine; or
(b) having coeliac disease before the clinical onset of malignant neoplasm of the small intestine; or
(c) having an adenoma of the small intestine before the clinical onset of malignant neoplasm of the small intestine; or
(d) for adenocarcinoma involving an ileostomy or ileal pouch only, having an ileostomy or ileal pouch for at least two years before the clinical onset of malignant neoplasm of the small intestine; or
(e) being obese for at least ten years before the clinical onset of malignant neoplasm of the small intestine; or
(f) inability to obtain appropriate clinical management for malignant neoplasm of the small intestine.
Factors that apply only to material contribution or aggravation
7. Paragraph 6(f) applies only to material contribution to, or aggravation of, malignant neoplasm of the small intestine where the person’s malignant neoplasm of the small intestine 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:
"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;
"Crohn's disease" means a type of inflammatory bowel disease characterised by chronic granulomatous inflammation which may extend through all layers of the gastrointestinal tract wall;
"death from malignant neoplasm of the small intestine" 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 small intestine;
"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;
"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 27 January 2015.
Dated this nineteenth day of December 2014
The Common Seal of the )
Repatriation Medical Authority )
was affixed at the direction of: )
PROFESSOR NICHOLAS SAUNDERS AO
CHAIRPERSON
