Statement of Principles concerning chronic myeloid leukaemia (Reasonable Hypothesis) (No. 57 of 2023) (Cth)

Statement of Principles concerning CHRONIC MYELOID LEUKAEMIA (Reasonable Hypothesis) (No. 57 of 2023) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 24 April 2023.

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 chronic myeloid leukaemia (Reasonable Hypothesis) (No. 57 of 2023). 2 Commencement This instrument commences on 23 May 2023. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning chronic myeloid leukaemia No. 47 of 2014 (Federal Register of Legislation No. F2014L00479) made under subsections 196B(2) and (8) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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 chronic myeloid leukaemia and death from chronic myeloid leukaemia. Meaning of chronic myeloid leukaemia (2) For the purposes of this Statement of Principles, chronic myeloid leukaemia: (a) means a malignant neoplasm of the blood with a predominant overpopulation of the myeloid cells and the presence of a Philadelphia chromosome or a BCR-ABL1 gene or BCR-ABL1 gene product; and (b) excludes: (i) atypical chronic myeloid leukaemia; (ii) chronic eosinophilic leukaemia; (iii) chronic neutrophilic leukaemia; (iv) leukemoid reactions; and (v) myelomonocytic leukaemia. Note 1: Chronic myeloid leukemia is also known as chronic granulocytic leukaemia, chronic myeloblastic leukaemia, chronic myelocytic leukaemia and chronic myelogenous leukaemia. Note 2: Symptoms of chronic myeloid leukaemia can include fatigue, weight loss, excess sweating, abdominal fullness, abdominal discomfort, and bleeding episodes, but 20-50% can also be diagnosed in an asymptomatic state by incidental blood testing. (3) While chronic myeloid leukaemia attracts ICD‑10‑AM code C92.1, in applying this Statement of Principles the meaning of chronic myeloid leukaemia 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 chronic myeloid leukaemia (5) For the purposes of this Statement of Principles, chronic myeloid leukaemia, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's chronic myeloid leukaemia. 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 chronic myeloid leukaemia and death from chronic myeloid leukaemia 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 1 of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting chronic myeloid leukaemia or death from chronic myeloid leukaemia with the circumstances of a person's relevant service: (1) having received a cumulative equivalent dose of at least 0.01 sievert of ionising radiation to the bone marrow at least 1 year before the clinical onset of chronic myeloid leukaemia; Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary. (2) undergoing ablative treatment with radioactive iodine for thyroid cancer before the clinical onset of chronic myeloid leukaemia, where the first exposure occurred at least 1 year before the clinical onset of chronic myeloid leukaemia; (3) being obese for at least 10 years within the 20 years before the clinical onset of chronic myeloid leukaemia; Note: being obese is defined in the Schedule 1 - Dictionary. (4) being exposed to benzene as specified: (a) for a cumulative total of at least 2,500 hours within a continuous period of 5 years before the clinical onset of chronic myeloid leukaemia; and (b) where the first exposure in that period occurred at least 5 years before the clinical onset of chronic myeloid leukaemia; and (c) where the last exposure in that period occurred within the 30 years before the clinical onset of chronic myeloid leukaemia; Note: being exposed to benzene as specified is defined in the Schedule 1 - Dictionary. (5) receiving greater than 10 ppm-years of cumulative exposure to benzene before the clinical onset of chronic myeloid leukaemia, and: (a) where the first exposure occurred at least 10 years before the clinical onset of chronic myeloid leukaemia; and (b) where the last exposure occurred within the 30 years before the clinical onset of chronic myeloid leukaemia; Note: ppm-years is defined in the Schedule 1 - Dictionary. (6) having received a kidney transplant before the clinical onset of chronic myeloid leukaemia; (7) inability to obtain appropriate clinical management for chronic myeloid leukaemia. 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(7) applies only to material contribution to, or aggravation of, chronic myeloid leukaemia where the person's chronic myeloid leukaemia 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.