{"id":"F2021L00603","name":"Statement of Principles concerning malignant neoplasm of the oral cavity, oropharynx and hypopharynx (Reasonable Hypothesis) (No. 65 of 2021)","slug":"f2021l00603","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440851,"registerId":"F2021L00603-fast-fetch-1775956331379","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning malignant neoplasm of the oral cavity, oropharynx and hypopharynx (Reasonable Hypothesis) (No. 65 of 2021)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 20.2\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n\n\n \n\nStatement of Principles\n\nconcerning\n\nMALIGNANT NEOPLASM OF THE ORAL CAVITY, OROPHARYNX AND HYPOPHARYNX (Reasonable Hypothesis)\n\n(No. 65 of 2021)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n \n\nDated 21 May 2021\n\n \n\n \n\n \n\n \n\n \n\n| The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:
|\n| --- |\n|
Professor Nicholas Saunders AO
Chairperson
|\n\n\n \n\n \n\n\nContents\n\n1 Name\n\n2 Commencement\n\n3 Authority\n\n4 Repeal\n\n5 Application\n\n6 Definitions\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n8 Basis for determining the factors\n\n9 Factors that must exist\n\n10 Relationship to service\n\n11 Factors referring to an injury or disease covered by another Statement of Principles\n\nSchedule 1 - Dictionary\n\n1 Definitions\n\n \n\n\n\n\n1 Name\n\nThis is the Statement of Principles concerning malignant neoplasm of the oral cavity, oropharynx and hypopharynx (Reasonable Hypothesis) (No. 65 of 2021).\n\n2 Commencement\n\n This instrument commences on 21 June 2021.\n\n3 Authority\n\nThis instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning malignant neoplasm of the oral cavity, oropharynx and hypopharynx No. 1 of 2013 (Federal Register of Legislation No. F2013L00016) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004 applies.\n\n6 Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n(1) This Statement of Principles is about malignant neoplasm of the oral cavity, oropharynx and hypopharynx and death from malignant neoplasm of the oral cavity, oropharynx and hypopharynx.\n\nMeaning of malignant neoplasm of the oral cavity, oropharynx and hypopharynx\n\n(2) For the purposes of this Statement of Principles, malignant neoplasm of the oral cavity, oropharynx and hypopharynx:\n\n(a) means a primary malignancy of the mucosa of the oral cavity, oropharynx or hypopharynx, which is the region that extends posteriorly from the lips (excluding the vermilion border and the skin of the lips) to the upper borders of the larynx and oesophagus, including the alveolar ridge, buccal mucosa, floor of the mouth, gums, hard and soft palate and tongue; and\n\n(b) excludes:\n\n(i) carcinoid tumour;\n\n(ii) Hodgkin's lymphoma;\n\n(iii) malignant neoplasm of the major or minor salivary glands or salivary gland ducts;\n\n(iv) non-Hodgkin lymphoma; and\n\n(v) soft tissue sarcoma.\n\nDeath from malignant neoplasm of the oral cavity, oropharynx or hypopharynx\n\n(3) For the purposes of this Statement of Principles, malignant neoplasm of the oral cavity, oropharynx or hypopharynx, 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 oral cavity, oropharynx or hypopharynx.\n\nNote: terminal event is defined in the Schedule 1 - Dictionary.\n\n8 Basis for determining the factors\n\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that malignant neoplasm of the oral cavity, oropharynx or hypopharynx and death from malignant neoplasm of the oral cavity, oropharynx or hypopharynx 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.\n\nNote: MRCA, relevant service and VEA are defined in the Schedule 1 - Dictionary.\n\n9 Factors that must exist\n\nAt 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 the oral cavity, oropharynx or hypopharynx or death from malignant neoplasm of the oral cavity, oropharynx or hypopharynx with the circumstances of a person's relevant service:\n\n(1) having smoked tobacco products:\n\n(a) in an amount of at least 2.5 pack-years before the clinical onset of malignant neoplasm of the oral cavity, oropharynx or hypopharynx; and\n\n(b) commencing at least 5 years before the clinical onset of malignant neoplasm of the oral cavity, oropharynx or hypopharynx; and\n\nif smoking has ceased before the clinical onset of malignant neoplasm of the oral cavity, oropharynx or hypopharynx, then that onset occurred within 15 years of cessation;\n\nNote: one pack-year is defined in the Schedule 1 - Dictionary.\n\n(2) having been exposed to second-hand smoke:\n\n(a) for at least 5,000 hours before the clinical onset of malignant neoplasm of the oral cavity, oropharynx or hypopharynx; and\n\n(b) commencing at least 5 years before the clinical onset of malignant neoplasm of the oral cavity, oropharynx or hypopharynx; and\n\nif exposure to second-hand smoke has ceased before the clinical onset of malignant neoplasm of the oral cavity, oropharynx or hypopharynx, then that onset occurred within 15 years of cessation;\n\nNote: having been exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.\n\n(3) the oral use of smokeless tobacco:\n\n(a) on more days than not; and\n\n(b) for at least 5 years before the clinical onset of malignant neoplasm of the oral cavity, oropharynx or hypopharynx; and\n\nif the oral use of smokeless tobacco has ceased before the clinical onset of malignant neoplasm of the oral cavity, oropharynx or hypopharynx, then that onset occurred within 15 years of cessation;\n\nNote: smokeless tobacco is defined in the Schedule 1 - Dictionary.\n\n(4) chewing betel quid or areca nut:\n\n(a) in an amount of at least one betel quid or areca nut per day for a continuous period of at least 1 year before the clinical onset of malignant neoplasm of the oral cavity, oropharynx or hypopharynx; and\n\n(b) commencing at least 5 years before the clinical onset of malignant neoplasm of the oral cavity, oropharynx or hypopharynx; and\n\nif chewing of betel quid or areca nut has ceased before the clinical onset of malignant neoplasm of the oral cavity, oropharynx or hypopharynx, then that onset occurred within 15 years of cessation;\n\n(5) consuming maté:\n\n(a) on more days than not; and\n\n(b) for at least 5 years before the clinical onset of malignant neoplasm of the oral cavity, oropharynx or hypopharynx; and\n\nif consumption of maté has ceased before the clinical onset of malignant neoplasm of the oral cavity, oropharynx or hypopharynx, then that onset occurred within 15 years of cessation;\n\n(6) consuming alcohol:\n\n(a) in an amount of at least 50 kilograms within any 10 year period; and\n\n(b) at least 5 years before the clinical onset of malignant neoplasm of the oral cavity, oropharynx or hypopharynx; and\n\nif consumption of alcohol has ceased before the clinical onset of malignant neoplasm of the oral cavity, oropharynx or hypopharynx, then that onset occurred within 40 years of cessation;\n\nNote: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.\n\n(7) inhaling respirable asbestos fibres in an enclosed space at the time material containing asbestos was being applied, removed, cut, drilled, dislodged or disturbed: \n\n(a) for a cumulative period of at least 1,000 hours before the clinical onset of malignant neoplasm of the oral cavity, oropharynx or hypopharynx; and\n\n(b) where the first inhalation of asbestos fibres commenced at least 5 years before the clinical onset of malignant neoplasm of the oral cavity, oropharynx or hypopharynx;\n\nNote: Disturbance of debris or dust contaminated with asbestos fibres already present in an enclosed space may result in exposure to respirable asbestos fibres.\n\n(8) inhaling respirable asbestos fibres in an open environment at the time material containing asbestos was being applied, removed, cut, drilled, dislodged or disturbed: \n\n(a) for a cumulative period of at least 3,000 hours before the clinical onset of malignant neoplasm of the oral cavity, oropharynx or hypopharynx; and\n\n(b) where the first inhalation of asbestos fibres commenced at least 5 years before the clinical onset of malignant neoplasm of the oral cavity, oropharynx or hypopharynx;\n\nNote: Disturbance of debris or dust contaminated with asbestos fibres already present in an open environment may result in exposure to respirable asbestos fibres.\n\n(9) being exposed to mustard gas at least 5 years before the clinical onset of malignant neoplasm of the oral cavity, oropharynx or hypopharynx; \n\n(10) acquiring persistent infection of the oral cavity epithelium or oropharyngeal epithelium with human papilloma virus type 16 or 18 before the clinical onset of malignant neoplasm of the oral cavity, oropharynx or hypopharynx;\n\n(11) having infection with human immunodeficiency virus before the clinical onset of malignant neoplasm of the oral cavity, oropharynx or hypopharynx;\n\n(12) taking an immunosuppressive drug for organ or tissue transplantation at least 3 years before the clinical onset of malignant neoplasm of the oral cavity, oropharynx or hypopharynx.\n\nNote: organ or tissue transplantation is defined in the Schedule 1 - Dictionary.\n\n(13) being obese for at least 5 years within the 20 years before the clinical onset of malignant neoplasm of the oral cavity, oropharynx or hypopharynx;\n\nNote: being obese is defined in the Schedule 1 - Dictionary.\n\n(14) an inability to consume an average of at least 100 grams per day of any combination of fruits and vegetables, for a period of at least 5 consecutive years within the 20 years before the clinical onset of malignant neoplasm of the oral cavity, oropharynx or hypopharynx;\n\n(15) having periodontitis for at least 5 years within the 20 years before the clinical onset of malignant neoplasm of the oral cavity, oropharynx or hypopharynx;\n\n(16) for malignant neoplasm of the oral cavity only, having an oral lesion at the affected site, from the specified list of oral lesions, for at least the 1 year before the clinical onset of malignant neoplasm of the oral cavity;\n\nNote: specified list of oral lesions is defined in the Schedule 1 - Dictionary.\n\n(17) for malignant neoplasm of the oral cavity only, having an oral lesion caused by systemic lupus erythematosus for at least the 1 year before the clinical onset of malignant neoplasm of the oral cavity;\n\n(18) inability to obtain appropriate clinical management for malignant neoplasm of the oral cavity, oropharynx or hypopharynx.\n\n10 Relationship to service\n\n(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.\n\n(2) The factor set out in subsection 9(18) applies only to material contribution to, or aggravation of, malignant neoplasm of the oral cavity, oropharynx or hypopharynx where the person's malignant neoplasm of the oral cavity, oropharynx or hypopharynx was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n\n11 Factors referring to an injury or disease covered by another Statement of Principles\n\nIn this Statement of Principles:\n\n(1) if a factor referred to in section 9 applies in relation to a person; and\n\n(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;\n\nthen 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.\n\n \n\n \n\nSchedule 1 - Dictionary \n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\n being obese means having a Body Mass Index (BMI) of 30 or greater.\n\nNote: BMI is also defined in the Schedule 1 - Dictionary.\n\n BMI means W/H2 where:\n\n(a) W is the person’s weight in kilograms; and\n\n(b) H is the person’s height in metres.\n\n having been exposed to second-hand smoke means having been in an enclosed space and inhaling smoke from burning tobacco products or smoke that has been exhaled by another person who is smoking.\n\n malignant neoplasm of the oral cavity, oropharynx and hypopharynx—see subsection 7(2).\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n one pack-year means the amount of tobacco consumed in smoking 20 cigarettes per day for a period of 1 year, or an equivalent amount of tobacco products.\n\nNote 1: An equivalent amount of tobacco products is 7,300 grams of smoking tobacco by weight, either in cigarettes, pipe tobacco or cigars, or a combination of same. For pipe tobacco, cigars or combinations of multiple tobacco types, 1 gram of tobacco is considered to be equal to one cigarette.\n\nNote 2: Pack-years are calculated by dividing the number of cigarettes smoked per day by 20 and multiplying this number by the number of years the person has smoked. For example, smoking 10 cigarettes per day for 10 years is equal to 5 pack-years, and smoking 40 cigarettes per day for 10 years is equal to 20 pack-years.\n\n organ or tissue transplantation means the transplantation of:\n\n(a) all or part of an organ or tissue; or\n\n(b) a substance obtained from an organ or tissue.\n\n relevant service means:\n\n(a) operational service under the VEA;\n\n(b) peacekeeping service under the VEA;\n\n(c) hazardous service under the VEA;\n\n(d) British nuclear test defence service under the VEA;\n\n(e) warlike service under the MRCA; or\n\n(f) non-warlike service under the MRCA.\n\nNote: MRCA and VEA are also defined in the Schedule 1 - Dictionary.\n\n smokeless tobacco means tobacco products without combustion or pyrolysis at the time of use, including chewing tobacco and tobacco snuff.\n\n specified list of oral lesions means:\n\n(a) erythroplakia;\n\n(b) leukoplakia;\n\n(c) lichen planus;\n\n(d) oral lichenoid lesions;\n\n(e) oral submucous fibrosis; or\n\n(f) proliferative verrucous leukoplakia.\n\n terminal event means the proximate or ultimate cause of death and includes the following:\n\n(a) pneumonia;\n\n(b) respiratory failure;\n\n(c) cardiac arrest;\n\n(d) circulatory failure; or\n\n(e) cessation of brain function.\n\n VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"},"kimi_summary":{"content_quality":"ok","complexity_score":6,"scope_assessment":{"changed":false,"description":"This is a standard RMA Statement of Principles replacement (repealing No. 1 of 2013). The scope remains tightly focused on establishing causal connections between specific throat/mouth cancers and military service. While the specific risk factors have been updated based on evolving medical evidence (adding factors like obesity, poor diet, periodontitis, and specific oral lesions), this represents the RMA's core statutory function rather than scope creep. The instrument does not expand beyond its original purpose of determining liability for veterans' compensation claims."},"complexity_factors":["18 distinct causal factors with multi-part cumulative thresholds (e.g., '2.5 pack-years', '5,000 hours', '50 kilograms within any 10 year period')","Temporal requirements layered onto most factors: minimum 5-year latency periods, cessation windows (15 or 40 years), and lookback periods (20 years for obesity, diet, periodontitis)","Location-specific sub-conditions: factors 16 and 17 apply 'for malignant neoplasm of the oral cavity only', creating conditional logic within the list","Cross-referencing architecture: section 11 incorporates other Statements of Principles by reference, creating interdependent liability determinations","Nested definitions: 12 defined terms in Schedule 1, including mathematical formulas (BMI calculation) and unit conversions (pack-years to grams)","Dual statutory framework application: instrument applies to both VEA and MRCA claims with different service definitions","Exclusion clauses in the disease definition (section 7(2)(b)) that carve out 5 specific cancer types from scope"],"plain_english_summary":"This instrument tells the Repatriation Medical Authority how to decide if oral, oropharyngeal or hypopharyngeal cancer in veterans or defence members (or their families’ post‑death claims) can be linked to service. It applies a “reasonable hypothesis” standard — a plausible medical link, not proof beyond doubt.\n\nA claim requires at least one of the document’s specified risk factors to be present and tied to service (examples include smoking, alcohol, asbestos, HPV). It thus governs who taxpayers compensate and makes claim thresholds more veteran‑favourable."},"flash_summary":{"complexity_score":7,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the 2013 Statement of Principles (s4) and replaces it with the current list of qualifying factors and thresholds; it applies to claims under section 120A of the VEA or section 338 of the MRCA (s5). The text itself shows a change in the operative Statement, but whether substantive scope shifts from the earlier instrument cannot be determined from this instrument alone without comparing both texts."},"complexity_factors":["Multiple quantitative exposure thresholds that require calculation (eg. tobacco pack‑years in s9(1) and Schedule; 5,000 hours for second‑hand smoke in s9(2); 1,000/3,000 hours for asbestos in s9(7)‑(8)).","Temporal qualification and cessation windows for many factors (eg. commencement at least 5 years before clinical onset and specific post‑cessation limits in s9(1)‑(9), s9(6)).","Variety of risk sources and medical conditions with different evidentiary needs (eg. HPV types 16/18 at s9(10); HIV at s9(11); post‑transplant immunosuppression at s9(12)).","Clinical definitions and measurements embedded in the Schedule (eg. BMI definition and 'being obese' in Schedule; one pack‑year definition in Schedule).","Condition‑specific provisions (eg. oral‑site lesions and lupus references limited to oral cavity in s9(16)‑(17)).","Cross‑reference to other Statements of Principles where a factor overlaps another certified condition (s11), requiring cross‑instrument consistency and review.","Discretion and causation linkage requirement: every listed factor must be related to the person’s relevant service (s10(1)), creating an evidentiary link between exposure and service.","Inclusion of non‑exposure factors such as inability to obtain appropriate clinical management (s9(18)), which requires assessment of service‑related access and timing (s10(2)).","Repeal of the prior 2013 Statement (s4) and application limited to claims under specific statutory sections (s5), meaning administrators must apply this instrument to a defined claim set."],"plain_english_summary":"This Statement of Principles lists the specific medical and exposure factors that, if present, create a reasonable hypothesis that malignant tumours of the oral cavity, oropharynx or hypopharynx are related to a person’s relevant military service. It applies to veterans and other service members making claims under the VEA or MRCA and sets precise thresholds (eg. pack‑years, hours of second‑hand smoke, asbestos exposure, infections, obesity, alcohol) and time windows that decision makers must consider for entitlement."}},"importantCases":[],"_links":{"self":"/api/acts/f2021l00603","history":"/api/acts/f2021l00603/history","analysis":"/api/acts/f2021l00603/analysis","conflicts":"/api/acts/f2021l00603/conflicts","importantCases":"/api/acts/f2021l00603/important-cases","documents":"/api/acts/f2021l00603/documents"}}