Statement of Principles concerning malignant neoplasm of bone and articular cartilage (Reasonable Hypothesis) (No. 66 of 2020) (Cth)

Statement of Principles concerning MALIGNANT NEOPLASM OF BONE AND ARTICULAR CARTILAGE (Reasonable Hypothesis) (No. 66 of 2020) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 28 August 2020

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 Repeal 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 bone and articular cartilage (Reasonable Hypothesis) (No. 66 of 2020). 2 Commencement This instrument commences on 28 September 2020. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning malignant neoplasm of bone and articular cartilage No. 106 of 2011 (Federal Register of Legislation No. F2011L01742) made under subsections 196B(2) and (8) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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 bone and articular cartilage and death from malignant neoplasm of bone and articular cartilage. Meaning of malignant neoplasm of bone and articular cartilage (2) For the purposes of this Statement of Principles, malignant neoplasm of bone and articular cartilage: (a) means a primary malignant neoplasm arising in bone or articular cartilage; and (b) includes: (i) chondrosarcoma of bone or articular cartilage; (ii) Ewing sarcoma; and (iii) osteosarcoma; and (c) excludes: (i) malignant neoplasms of haematopoietic tissue within bones; (ii) metastatic lesions within bone or articular cartilage arising from other primary malignant neoplasms; and (iii) soft tissue sarcoma. (3) While malignant neoplasm of bone and articular cartilage attracts ICD‑10‑AM code C40 or C41, in applying this Statement of Principles the meaning of malignant neoplasm of bone and articular cartilage 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), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4. Death from malignant neoplasm of bone and articular cartilage (5) For the purposes of this Statement of Principles, malignant neoplasm of bone and articular cartilage, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's malignant neoplasm of bone and articular cartilage. 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 bone and articular cartilage and death from malignant neoplasm of bone and articular cartilage 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: MRCA, relevant service and VEA are 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 bone and articular cartilage or death from malignant neoplasm of bone and articular cartilage with the circumstances of a person's relevant service: (1) having received a cumulative equivalent dose of at least 0.1 sievert of ionising radiation to the affected region at least two years before the clinical onset of malignant neoplasm of bone or articular cartilage; Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary. (2) having Paget's disease of bone at the affected site before the clinical onset of malignant neoplasm of bone or articular cartilage; (3) having osteonecrosis at the affected site before the clinical onset of malignant neoplasm of bone or articular cartilage; Note: Osteonecrosis is also known as a bone infarct. (4) having chronic osteomyelitis at the affected site before the clinical onset of malignant neoplasm of bone or articular cartilage; (5) having giant cell tumour of bone at the affected site before the clinical onset of malignant neoplasm of bone or articular cartilage; (6) undergoing stem cell or bone marrow transplantation before the clinical onset of malignant neoplasm of bone or articular cartilage; (7) taking growth hormone for at least three months before the clinical onset of malignant neoplasm of bone or articular cartilage; (8) taking an anthracycline chemotherapeutic agent at least five years before the clinical onset of malignant neoplasm of bone or articular cartilage; (9) taking denosumab for at least three months before the clinical onset of malignant neoplasm of bone or articular cartilage, and where taking denosumab has permanently ceased, the clinical onset of malignant neoplasm of bone or articular cartilage has occurred within two years of cessation; (10) inability to obtain appropriate clinical management for malignant neoplasm of bone or articular cartilage. 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(10) applies only to material contribution to, or aggravation of, malignant neoplasm of bone and articular cartilage where the person's malignant neoplasm of bone and articular cartilage 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.