Statement of Principles concerning malignant neoplasm of the larynx (Balance of Probabilities) (No. 42 of 2022) (Cth)

Statement of Principles concerning MALIGNANT NEOPLASM OF THE LARYNX (Balance of Probabilities) (No. 42 of 2022) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.

Dated 29 April 2022

The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:

Professor Terence Campbell AM 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 the larynx (Balance of Probabilities) (No. 42 of 2022). 2 Commencement This instrument commences on 30 May 2022. 3 Authority This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning malignant neoplasm of the larynx No. 62 of 2013 (Federal Register of Legislation No. F2013L01650) made under subsection 196B(3) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004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 malignant neoplasm of the larynx and death from malignant neoplasm of the larynx. Meaning of malignant neoplasm of the larynx (2) For the purposes of this Statement of Principles, malignant neoplasm of the larynx: (a) means a primary malignancy of the mucosa of the larynx, which extends from the lower border of the hypopharynx to the upper border of the trachea; and (b) excludes: (i) carcinoid tumour; (ii) Hodgkin's lymphoma; (iii) non-Hodgkin lymphoma; and (iv) soft tissue sarcoma. Note: The larynx is divided anatomically into three sections: the supraglottis, glottis and subglottis (infraglottis). (3) While malignant neoplasm of the larynx attracts ICD‑10‑AM code C32, in applying this Statement of Principles the meaning of malignant neoplasm of the larynx 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 the larynx (5) For the purposes of this Statement of Principles, malignant neoplasm of the larynx, 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 larynx. 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 malignant neoplasm of the larynx and death from malignant neoplasm of the larynx 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, malignant neoplasm of the larynx or death from malignant neoplasm of the larynx is connected with the circumstances of a person's relevant service: (1) having smoked tobacco products: (a) in an amount of at least 3 pack-years before the clinical onset of malignant neoplasm of the larynx; and (b) commencing at least 10 years before the clinical onset of malignant neoplasm of the larynx; and if smoking has ceased before the clinical onset of malignant neoplasm of the larynx, then that onset occurred within 15 years of cessation; Note: one pack-year is defined in the Schedule 1 - Dictionary. (2) having been exposed to second-hand smoke: (a) for at least 10,000 hours before the clinical onset of malignant neoplasm of the larynx; and (b) commencing at least 10 years before the clinical onset of malignant neoplasm of the larynx; and if exposure to second-hand smoke has ceased before the clinical onset of malignant neoplasm of the larynx, then that onset occurred within 15 years of cessation; Note: having been exposed to second-hand smoke is defined in the Schedule 1 - Dictionary. (3) inhaling respirable asbestos fibres in an enclosed space, at the time material containing asbestos was being applied, removed, cut, drilled, dislodged or disturbed: (a) for a cumulative period of at least 2,000 hours before the clinical onset of malignant neoplasm of the larynx; and (b) where the first inhalation of asbestos fibres commenced at least 10 years before the clinical onset of malignant neoplasm of the larynx; Note: Disturbance of debris or dust contaminated with asbestos fibres already present in an enclosed space may result in exposure to respirable asbestos fibres. (4) inhaling respirable asbestos fibres in an open environment, at the time material containing asbestos was being applied, removed, cut, drilled, dislodged or disturbed: (a) for a cumulative period of at least 6,000 hours before the clinical onset of malignant neoplasm of the larynx; and (b) where the first inhalation of asbestos fibres commenced at least 10 years before the clinical onset of malignant neoplasm of the larynx; Note: Disturbance of debris or dust contaminated with asbestos fibres already present in an open environment may result in exposure to respirable asbestos fibres. (5) inhaling smoke from the combustion of coal or other fossil fuel in an enclosed space: (a) for a cumulative period of at least 15,000 hours before the clinical onset of malignant neoplasm of the larynx; and (b) commencing at least 10 years before the clinical onset of malignant neoplasm of the larynx; (6) consuming alcohol: (a) in an amount of at least 150 kilograms within any 10 year period; and (b) at least 5 years before the clinical onset of malignant neoplasm of the larynx; and if consumption of alcohol has ceased before the clinical onset of malignant neoplasm of the larynx, then that onset occurred within 40 years of cessation; Note: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink. (7) inhaling mist from sulphuric, nitric or hydrochloric acid: (a) for a cumulative period of at least 10,000 hours before the clinical onset of malignant neoplasm of the larynx; and (b) where inhalation of the mist commenced at least 10 years before the clinical onset of malignant neoplasm of the larynx; Note: mist is defined in the Schedule 1 - Dictionary. (8) undergoing solid organ transplantation, excluding corneal transplant, before the clinical onset of malignant neoplasm of the larynx; (9) having infection with human immunodeficiency virus before the clinical onset of malignant neoplasm of the larynx; (10) acquiring persistent infection of the laryngeal epithelium with human papillomavirus type 16 or 18 before the clinical onset of malignant neoplasm of the larynx; (11) consuming maté: (a) on more days than not; and (b) for at least 10 years before the clinical onset of malignant neoplasm of the larynx; and if consumption of maté has ceased before the clinical onset of malignant neoplasm of the larynx, then that onset occurred within 10 years of cessation; (12) having gastro-oesophageal reflux disease for at least the 10 years before the clinical onset of malignant neoplasm of the larynx; (13) inhaling opium on average at least weekly for at least 10 years before the clinical onset of malignant neoplasm of the larynx; Note: opium is defined in the Schedule 1 - Dictionary. (14) inability to obtain appropriate clinical management for malignant neoplasm of the larynx. 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(14) applies only to material contribution to, or aggravation of, malignant neoplasm of the larynx where the person's malignant neoplasm of the larynx 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.