Statement of Principles concerning MALIGNANT NEOPLASM OF THE URETHRA (Reasonable Hypothesis) (No. 49 of 2016) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986. Dated 22 April 2016 The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of: Professor Nicholas Saunders AO Chairperson Contents 1 Name 2 Commencement 3 Authority 4 Revocation 5 Application 6 Definitions 7 Kind of injury, disease or death to which this Statement of Principles relates 8 Basis for determining the factors 9 Factors that must exist 10 Relationship to service 11 Factors referring to an injury or disease covered by another Statement of Principles Schedule 1 - Dictionary 1 Definitions 1 Name This is the Statement of Principles concerning malignant neoplasm of the urethra (Reasonable Hypothesis) (No. 49 of 2016). 2 Commencement This instrument commences on 23 May 2016. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Revocation The Statement of Principles concerning malignant neoplasm of the urethra No. 1 of 2008, as amended, made under subsections 196B(2) and (8) of the VEA is revoked. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004 applies. 6 Definitions The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument. 7 Kind of injury, disease or death to which this Statement of Principles relates (1) This Statement of Principles is about malignant neoplasm of the urethra and death from malignant neoplasm of the urethra. Meaning of malignant neoplasm of the urethra (2) For the purposes of this Statement of Principles, malignant neoplasm of the urethra means: (a) a primary malignant neoplasm arising from the cells lining the urethra; and (b) includes urethral diverticular carcinoma and urethral melanoma; and (c) excludes malignant neoplasm of the urethral orifice of the bladder, soft tissue sarcoma, carcinoid tumour, non-Hodgkin's lymphoma and Hodgkin's lymphoma. (3) While malignant neoplasm of the urethra attracts ICD‑10‑AM code C68, in applying this Statement of Principles the meaning of malignant neoplasm of the urethra is that given in subsection (2). (4) For subsection (3), a reference to an ICD‑10‑AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD‑10‑AM), Ninth Edition, effective date of 1 July 2015, copyrighted by the Independent Hospital Pricing Authority, ISBN 978‑1‑76007‑020‑5. Death from malignant neoplasm of the urethra (5) For the purposes of this Statement of Principles, malignant neoplasm of the urethra, 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 urethra. Note: terminal event is defined in the Schedule 1 – Dictionary. 8 Basis for determining the factors The Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that malignant neoplasm of the urethra and death from malignant neoplasm of the urethra 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 MRCA. Note: relevant service is defined in the Schedule 1 – Dictionary. 9 Factors that must exist At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting malignant neoplasm of the urethra or death from malignant neoplasm of the urethra with the circumstances of a person's relevant service: (1) for squamous cell carcinoma only, acquiring persistent infection with an oncogenic human papilloma virus (HPV) before the clinical onset of malignant neoplasm of the urethra; Note: oncogenic human papilloma virus (HPV) is defined in the Schedule 1 - Dictionary. (2) being exposed to arsenic as specified before the clinical onset of malignant neoplasm of the urethra, where the first exposure to arsenic occurred at least ten years before the clinical onset of malignant neoplasm of the urethra; Note: being exposed to arsenic as specified is defined in the Schedule 1 - Dictionary. (3) inability to obtain appropriate clinical management for malignant neoplasm of the urethra. 10 Relationship to service (1) The existence in a person of any factor referred to in section 9, must be related to the relevant service rendered by the person. (2) The factor set out in subsection 9(3) applies only to material contribution to, or aggravation of, malignant neoplasm of the urethra where the person's malignant neoplasm of the urethra was suffered or contracted before or during (but did not arise out of) the person's relevant service. 11 Factors referring to an injury or disease covered by another Statement of Principles In this Statement of Principles: (1) if a factor referred to in section 9 applies in relation to a person; and (2) that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(2) of the VEA; then the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time. Schedule 1 - Dictionary Note: See Section 6 1 Definitions In this instrument: being exposed to arsenic as specified means: (a) consuming arsenic containing compounds (for example Fowler's solution) for a cumulative period of at least three months; or (b) consuming drinking water with an average arsenic concentration of at least 50 micrograms per litre for a cumulative period of at least two years; or (c) having clinical evidence of chronic arsenic toxicity. malignant neoplasm of the urethra—see subsection 7(2). MRCA means the Military Rehabilitation and Compensation Act 2004. oncogenic human papilloma virus (HPV) means HPV type 16 or 18. 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 the following: (a) pneumonia; (b) respiratory failure; (c) cardiac arrest; (d) circulatory failure; or (e) cessation of brain function. VEA means the Veterans' Entitlements Act 1986.