Statement of Principles concerning malignant neoplasm of the lung (Balance of Probabilities) (No. 87 of 2023) (Cth)

Statement of Principles concerning MALIGNANT NEOPLASM OF THE LUNG (Balance of Probabilities) (No. 87 of 2023) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.

Dated 25 August 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 malignant neoplasm of the lung (Balance of Probabilities) (No. 87 of 2023). 2 Commencement This instrument commences on 26 September 2023. 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 lung No. 93 of 2014 (Federal Register of Legislation No. F2014L01384) made under subsections 196B(3) and (8) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004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 malignant neoplasm of the lung and death from malignant neoplasm of the lung. Meaning of malignant neoplasm of the lung (2) For the purposes of this Statement of Principles, malignant neoplasm of the lung: (a) means a primary malignant neoplasm arising from the epithelial cells of the trachea, bronchus, bronchioles or alveoli; and (b) includes: (i) adenocarcinoma of the lung; (ii) carcinoma in situ of the lung; (iii) large cell carcinoma of the lung; (iv) lymphoepithelial carcinoma of the lung; (v) non-small cell carcinoma of the lung; (vi) small cell carcinoma of the lung; and (vii) squamous cell carcinoma of the lung; and (c) excludes: (i) carcinoid tumours; (ii) haematolymphoid tumours including non-Hodgkin lymphoma and Hodgkin lymphoma; (iii) malignant melanoma; (iv) mesenchymal tumours including soft tissue sarcoma; (v) mesothelioma; and (vi) metastatic cancer from other primary sites. (3) While malignant neoplasm of the lung attracts ICD‑10‑AM codes C33, C44, D02.1 and D02.2, in applying this Statement of Principles the meaning of malignant neoplasm of the lung 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 lung (5) For the purposes of this Statement of Principles, malignant neoplasm of the lung, 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 lung. 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 lung and death from malignant neoplasm of the lung 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 lung or death from malignant neoplasm of the lung is connected with the circumstances of a person's relevant service: (1) having smoked tobacco products: (a) in an amount of at least 0.5 pack-year before the clinical onset of malignant neoplasm of the lung; and (b) commencing at least 10 years before the clinical onset of malignant neoplasm of the lung; Note: one pack-year is defined in the Schedule 1 - Dictionary. (2) having been exposed to second-hand smoke: (a) for at least 5,000 hours before the clinical onset of malignant neoplasm of the lung; and (b) commencing at least 10 years before the clinical onset of malignant neoplasm of the lung; 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, where the first inhalation of asbestos fibres commenced at least 10 years before the clinical onset of malignant neoplasm of the lung; 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 1,000 hours before the clinical onset of malignant neoplasm of the lung; and (b) where the first inhalation of asbestos fibres commenced at least 10 years before the clinical onset of malignant neoplasm of the lung; 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 high concentrations of polycyclic aromatic hydrocarbons, through work involving a specified industry, manufacturing process or substance: (a) for a cumulative period of at least 3,500 hours before the clinical onset of malignant neoplasm of the lung; and (b) where the first inhalation of polycyclic aromatic hydrocarbons occurred at least 10 years before the clinical onset of malignant neoplasm of the lung; Note: polycyclic aromatic hydrocarbons and specified industry, manufacturing process or substance are defined in the Schedule 1 – Dictionary. (6) being heavily exposed to diesel engine exhaust for a cumulative period of at least 15,000 hours, at least 10 years before the clinical onset of malignant neoplasm of the lung; Note: being heavily exposed to diesel engine exhaust is defined in the Schedule 1 dictionary. (7) being exposed to mustard gas at least 10 years before the clinical onset of malignant neoplasm of the lung; (8) having received a cumulative equivalent dose of at least 0.5 sievert of ionising radiation to the lung at least 10 years before the clinical onset of malignant neoplasm of the lung; Note: cumulative equivalent dose is defined in the Schedule 1 – Dictionary. (9) inhaling radon gas in an enclosed space for at least 40 Working Level Months, before the clinical onset of malignant neoplasm of the lung, where the first exposure to radon occurred at least 10 years before the clinical onset of malignant neoplasm of the lung; Note: Working Level Month is defined in the Schedule 1 – Dictionary. (10) having a pulmonary disease at least 5 years before the clinical onset of malignant neoplasm of the lung; Note: pulmonary disease is defined in the Schedule 1 – Dictionary. (11) working as a painter for a cumulative period of at least 10,000 hours before the clinical onset of malignant neoplasm of the lung, where that work began at least 10 years before the clinical onset of malignant neoplasm of the lung; Note: working as a painter is defined in the Schedule 1 – Dictionary. (12) inhaling respirable crystalline silica dust at the time material containing respirable crystalline silica dust was being produced, excavated, drilled, cut, ground or polished, or used in construction, manufacturing, cleaning or blasting: (a) for a cumulative period of at least 3,000 hours before the clinical onset of malignant neoplasm of the lung; and (b) where the first inhalation of respirable crystalline silica dust commenced at least 10 years before the clinical onset of malignant neoplasm of the lung; (13) having acute silicosis before the clinical onset of malignant neoplasm of the lung; Note: acute silicosis is defined in the Schedule 1 - Dictionary. (14) inhaling fumes, vapours or dusts of a metal or metalloid from the specified list: (a) for a cumulative period of at least 3,500 hours before the clinical onset of malignant neoplasm of the lung; and (b) where the first inhalation of fumes, vapours or dusts occurred at least 10 years before the clinical onset of malignant neoplasm of the lung; Note: metal or metalloid from the specified list is defined in the Schedule 1 – Dictionary. (15) inhaling fumes of bis(chloromethyl)ether or chloromethyl methyl ether: (a) for a cumulative period of at least 3,500 hours before the clinical onset of malignant neoplasm of the lung; and (b) where the first inhalation of fumes occurred at least 10 years before the clinical onset of malignant neoplasm of the lung; (16) having berylliosis before the clinical onset of malignant neoplasm of the lung; Note: berylliosis is defined in the Schedule 1 - Dictionary. (17) being exposed to arsenic as specified before the clinical onset of malignant neoplasm of the lung, where the first exposure to arsenic occurred at least 10 years before the clinical onset of malignant neoplasm of the lung; Note: being exposed to arsenic as specified is defined in the Schedule 1 – Dictionary. (18) inhaling smoke from the combustion of coal, wood, charcoal, or another solid biomass 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 lung; and (b) commencing at least 10 years before the clinical onset of malignant neoplasm of the lung; (19) inhaling ambient, chronically polluted air as specified: (a) for a cumulative period of at least 70,000 hours before the clinical onset of malignant neoplasm of the lung; and (b) where the first inhalation of ambient chronically polluted air occurred at least 10 years before the clinical onset of malignant neoplasm of the lung; Note: ambient, chronically polluted air as specified is defined in the Schedule 1 – Dictionary. (20) inhaling mist from sulphuric, nitric or hydrochloric acid: (a) for a cumulative period of at least 3,500 hours before the clinical onset of malignant neoplasm of the lung; and (b) where inhalation of the mist commenced at least 10 years before the clinical onset of malignant neoplasm of the lung; Note: mist is defined in the Schedule 1 – Dictionary. (21) inhaling fumes generated in rubber production, while in an enclosed space in immediate proximity to production facilities: (a) for a cumulative period of at least 3,500 hours before the clinical onset of malignant neoplasm of the lung; and (b) where the first inhalation of fumes occurred at least 10 years before the clinical onset of malignant neoplasm of the lung; (22) taking a chemotherapy regimen with procarbazine or mechlorethamine (nitrogen mustard) at least 5 years before the clinical onset of malignant neoplasm of the lung; Note: a chemotherapy regimen with procarbazine or mechlorethamine includes MOPP (a combination of mechlorethamine, oncovin (vincristine), procarbazine and prednisone). (23) having systemic sclerosis at least 3 years before the clinical onset of malignant neoplasm of the lung; (24) inhaling opium smoke or ingesting opium on average at least weekly for at least 10 years before the clinical onset of malignant neoplasm of the lung; Note: opium is defined in the Schedule 1 – Dictionary. (25) using manual welding equipment for welding metal: (a) for a cumulative period of at least 3,500 hours before the clinical onset of malignant neoplasm of the lung; and (b) where that use began at least 10 years before the clinical onset of malignant neoplasm of the lung; (26) inability to obtain appropriate clinical management for malignant neoplasm of the lung before the clinical worsening of malignant neoplasm of the lung. 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(26) applies only to material contribution to, or aggravation of, malignant neoplasm of the lung where the person's malignant neoplasm of the lung 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.