Statement of Principles concerning acute lymphoblastic leukaemia/lymphoblastic lymphoma (Balance of Probabilities) (No. 34 of 2021) (Cth)

Statement of Principles concerning ACUTE LYMPHOBLASTIC LEUKAEMIA/LYMPHOBLASTIC LYMPHOMA (Balance of Probabilities) (No. 34 of 2021) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.

Dated 5 March 2021

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 acute lymphoblastic leukaemia/lymphoblastic lymphoma (Balance of Probabilities) (No. 34 of 2021). 2 Commencement This instrument commences on 5 April 2021. 3 Authority This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning acute lymphoblastic leukaemia No. 76 of 2012 (Federal Register of Legislation No. F2012L02086) made under subsections 196B(3) and (8) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004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 acute lymphoblastic leukaemia/lymphoblastic lymphoma and death from acute lymphoblastic leukaemia/lymphoblastic lymphoma. Meaning of acute lymphoblastic leukaemia/lymphoblastic lymphoma (2) For the purposes of this Statement of Principles, acute lymphoblastic leukaemia/lymphoblastic lymphoma: (a) means a malignant neoplasm characterised by the clonal proliferation of morphologically immature, non-functioning lymphoid cells of B- or T-cell origin, which can present clinically as either a leukaemia or a lymphoma; and (b) excludes: (i) Burkitt leukaemia/lymphoma; (ii) adult T-cell leukaemia/lymphoma; (iii) acute undifferentiated leukaemia; and (iv) indolent T‑lymphoblastic proliferation. Note: Acute lymphoblastic lymphoma and lymphoblastic leukaemia are considered to be tumours of the same lymphoid cell type, and are considered to be a single disease entity with two clinical presentations. Death from acute lymphoblastic leukaemia/lymphoblastic lymphoma (3) For the purposes of this Statement of Principles, acute lymphoblastic leukaemia/lymphoblastic lymphoma, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's acute lymphoblastic leukaemia/lymphoblastic lymphoma. Note: terminal event is defined in the Schedule 1 - Dictionary. 8 Basis for determining the factors On the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that acute lymphoblastic leukaemia/lymphoblastic lymphoma and death from acute lymphoblastic leukaemia/lymphoblastic lymphoma can be related to relevant service rendered by veterans 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 exist before it can be said that, on the balance of probabilities, acute lymphoblastic leukaemia/lymphoblastic lymphoma or death from acute lymphoblastic leukaemia/lymphoblastic lymphoma is connected with the circumstances of a person's relevant service: (1) having received a cumulative equivalent dose of at least 0.05 sievert of ionising radiation to the bone marrow at least two years before the clinical onset of acute lymphoblastic leukaemia/lymphoblastic lymphoma; Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary. (2) taking an alkylating agent or a DNA topoisomerase II inhibitor for the treatment of a malignant neoplasm before the clinical onset of acute lymphoblastic leukaemia/lymphoblastic lymphoma, and: (a) the first exposure occurred at least one year before the clinical onset of acute lymphoblastic leukaemia/lymphoblastic lymphoma; and (b) if exposure ceased before the clinical onset of acute lymphoblastic leukaemia/lymphoblastic lymphoma, then that onset occurred within 20 years of cessation; (3) undergoing organ or tissue transplantation, excluding corneal transplant, before the clinical onset of acute lymphoblastic leukaemia/lymphoblastic lymphoma; Note: organ or tissue transplantation is defined in the Schedule 1 - Dictionary. (4) inability to obtain appropriate clinical management for acute lymphoblastic leukaemia/lymphoblastic lymphoma. 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(4) applies only to material contribution to, or aggravation of, acute lymphoblastic leukaemia/lymphoblastic lymphoma where the person's acute lymphoblastic leukaemia/lymphoblastic lymphoma 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(3) 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.