{"id":"F2021L00604","name":"Statement of Principles concerning malignant neoplasm of the oral cavity, oropharynx and hypopharynx (Balance of Probabilities) (No. 66 of 2021)","slug":"f2021l00604","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440849,"registerId":"F2021L00604-fast-fetch-1775956331346","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 (Balance of Probabilities) (No. 66 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 (Balance of Probabilities)\n\n(No. 66 of 2021)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) 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 (Balance of Probabilities) (No. 66 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(3) 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. 2 of 2013 (Federal Register of Legislation No. F2013L00017) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 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\nOn 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 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 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 exist before it can be said that, on the balance of probabilities, malignant neoplasm of the oral cavity, oropharynx or hypopharynx or death from malignant neoplasm of the oral cavity, oropharynx or hypopharynx is connected 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 5 pack-years before the clinical onset of malignant neoplasm of the oral cavity, oropharynx or hypopharynx; and\n\n(b) commencing at least 10 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 10 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 10,000 hours before the clinical onset of malignant neoplasm of the oral cavity, oropharynx or hypopharynx; and\n\n(b) commencing at least 10 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 10 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 10 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 10 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 10 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 10 years of cessation;\n\n(5) consuming maté:\n\n(a) on more days than not; and\n\n(b) for at least 10 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 10 years of cessation;\n\n(6) consuming alcohol:\n\n(a) in an amount of at least 100 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) 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(8) having infection with human immunodeficiency virus before the clinical onset of malignant neoplasm of the oral cavity, oropharynx or hypopharynx;\n\n(9) 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(10) 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(11) 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(12) 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(12) 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(3) 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 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) eligible war service (other than operational service) under the VEA;\n\n(b) defence service (other than hazardous service and British nuclear test defence service) under the VEA; or\n\n(c) peacetime 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\n \n","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":5,"scope_assessment":{"changed":false,"description":"This is a standard replacement Statement of Principles updating medical evidence from the 2013 version. It maintains the same fundamental scope—determining service connection for specific head and neck cancers under veterans' compensation law. While the specific risk factors have been updated based on current medical science (particularly around HPV and immunosuppression), the instrument has not expanded beyond its original purpose of establishing medical criteria for these specific cancers."},"complexity_factors":["Multiple nested temporal conditions (e.g., 'commencing at least 10 years before' plus 'if ceased, then within 10 years of cessation')","12 distinct factors with varying specificity and sub-conditions","Specialised medical terminology requiring definitions (erythroplakia, leukoplakia, proliferative verrucous leukoplakia, etc.)","Cross-references to other Statements of Principles in section 11","Dual legislative framework application (VEA and MRCA with different service definitions)","Quantified exposure thresholds requiring calculation (pack-years, 10,000 hours, 100kg alcohol, 10,000 standard drinks conversion)","Anatomical precision in scope (includes mucosa of specific regions, excludes vermilion border, excludes specific cancer types)","Factor-specific limitations (factors 10 and 11 apply to oral cavity only; factor 12 has special application rules in section 10(2))"],"plain_english_summary":"This instrument tells when veterans and current/former defence members can claim compensation for primary mucosal cancers of the oral cavity, oropharynx and hypopharynx: if at least one listed risk factor (for example, smoking, HPV, heavy alcohol use, or service-related second‑hand smoke) applied and that factor is connected to their military service, the condition is accepted on the balance of probabilities. It excludes non‑mucosal cancers (e.g. salivary gland, lymphoma) and updates the 2013 guidance affecting entitlements under the Veterans' Entitlements Act and MRCA."},"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the 2013 Statement (s4) and replaces it with a version that enumerates detailed, quantitative risk factors and temporal limits for establishing a service connection (see s9 and Schedule 1). The replacement therefore alters scope by making eligibility depend on specified thresholds and clarified definitions; exact point‑by‑point differences from the 2013 instrument are not contained in this text, but the repeal-and-replace indicates a substantive change in how claims are assessed."},"complexity_factors":["Multiple quantitative thresholds that require calculation (pack‑years, 10,000 hours second‑hand smoke, alcohol in kilograms over 10 years) (see s9(1),(2),(6), Schedule 1).","Numerous temporal conditions and cessation windows (eg. commencement ≥10 years before onset; varying cessation periods: 10 years for smoking/second‑hand smoke, 40 years for alcohol) (see s9).","Interplay between medical criteria and proof of connection to relevant service—each factor must be related to the person's relevant service (see s10).","Cross‑reference to other Statements of Principles when a factor refers to another injury/disease (see s11), creating dependency on external instruments.","Technical medical terms and specified inclusions/exclusions for the condition (definition and exclusions in s7(2)–(3)).","Operational definitions in the Schedule that affect calculations and scope (eg. one pack‑year conversion notes, definition of second‑hand smoke, specified oral lesions).","Legal standard of proof is the balance of probabilities, but the instrument largely prescribes medical thresholds, leaving medical assessment and evidentiary gathering to decision‑makers (see s8).","Repeal and replacement of a prior instrument (s4) may require practitioners to map old evidence to new thresholds."],"plain_english_summary":"This Statement of Principles replaces the 2013 instrument and sets the medical rules for linking malignant neoplasms of the oral cavity, oropharynx and hypopharynx (and death from them) to a person’s VEA or MRCA service. It lists specific qualifying risk factors and precise timing and dosage thresholds (for example, pack‑years of smoking, hours of second‑hand smoke, years of smokeless tobacco or maté use, alcohol kilograms, HPV/HIV infection, immunosuppression, certain oral lesions, or lack of appropriate clinical management)."},"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"}},"importantCases":[],"_links":{"self":"/api/acts/f2021l00604","history":"/api/acts/f2021l00604/history","analysis":"/api/acts/f2021l00604/analysis","conflicts":"/api/acts/f2021l00604/conflicts","importantCases":"/api/acts/f2021l00604/important-cases","documents":"/api/acts/f2021l00604/documents"}}