Statement of Principles
concerning
 
MALIGNANT NEOPLASM OF THE PANCREAS
No. 73 of 2013
 
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 pancreas No. 73 of 2013.
Determination
2.         The Repatriation Medical Authority under subsection 196B(2) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):
(a)        revokes Instrument No. 45 of 2005 concerning malignant neoplasm of the pancreas; 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 pancreas and death from malignant neoplasm of the pancreas.
(b)               For the purposes of this Statement of Principles, "malignant neoplasm of the pancreas" means a primary malignant neoplasm arising from the cells of the exocrine pancreas. This definition excludes soft tissue sarcoma, carcinoid tumour, endocrine tumours, non-Hodgkin’s lymphoma and Hodgkin’s lymphoma.
(c)                Malignant neoplasm of the pancreas attracts ICD-10-AM code C25.0, C25.1, C25.2, C25.3, C25.7 or C25.8.
(d)               In the application of this Statement of Principles, the definition of "malignant neoplasm of the pancreas" 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 pancreas and death from malignant neoplasm of the pancreas 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 pancreas or death from malignant neoplasm of the pancreas with the circumstances of a person’s relevant service is:
(a)                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 pancreas, and
(i)                  smoking commenced at least five years before the clinical onset of malignant neoplasm of the pancreas; and
(ii)                where smoking has ceased, the clinical onset of malignant neoplasm of the pancreas has occurred within 20 years of cessation; or
(b)               the oral use of smokeless tobacco on more days than not, for at least 20 years before the clinical onset of malignant neoplasm of the pancreas, and where the oral use of smokeless tobacco has ceased, the clinical onset of malignant neoplasm of the pancreas has occurred within 20 years of cessation; or
(c)                having diabetes mellitus for at least five years before the clinical onset of malignant neoplasm of the pancreas; or
(d)               having chronic pancreatitis for at least two years before the clinical onset of malignant neoplasm of the pancreas; or
(e)                inhaling, ingesting or having cutaneous contact with DDT on more days than not for a cumulative period of at least one year, at least ten years before the clinical onset of malignant neoplasm of the pancreas; or
(f)                being obese for at least five years within the 30 years before the clinical onset of malignant neoplasm of the pancreas; or
(g)               undergoing a partial gastrectomy at least 20 years before the clinical onset of malignant neoplasm of the pancreas; or
(h)               having received a cumulative dose of at least 0.1 sievert of ionising radiation to the affected site, from internal deposition of a substance which emits alpha particles, at least five years before the clinical onset of malignant neoplasm of the pancreas; or
(i)                 having cholelithiasis or having undergone a cholecystectomy at least two years before the clinical onset of malignant neoplasm of the pancreas; or
(j)                 inability to obtain appropriate clinical management for malignant neoplasm of the pancreas.
Factors that apply only to material contribution or aggravation
7.         Paragraph 6(j) applies only to material contribution to, or aggravation of, malignant neoplasm of the pancreas where the person’s malignant neoplasm of the pancreas 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 thirty 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;
"DDT" means a complex synthetic mixture in which para,para'-dichlorodiphenyltrichloroethane predominates;
"death from malignant neoplasm of the pancreas" 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 pancreas;
"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 DDT" means:
(a)                being involved in the manufacture of DDT;
(b)               being sprayed with DDT;
(c)                cleaning or maintaining equipment used to apply DDT;
(d)               decanting or spraying DDT; or
(e)                wearing or handling clothes contaminated with DDT;
"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)                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;
"smokeless tobacco" means tobacco products without combustion or pyrolysis at the time of use, including chewing tobacco and tobacco snuff;
"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 13 November 2013.
Dated this   first   day of  November   2013
The Common Seal of the                    )
Repatriation Medical Authority          )
was affixed to this instrument                        )
in the presence of:                               )
PROFESSOR NICHOLAS SAUNDERS AO
CHAIRPERSON