{"id":"F2025L00155","name":"Statement of Principles concerning malignant neoplasm of the endometrium (Balance of Probabilities) (No. 32 of 2025)","slug":"f2025l00155","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442741,"registerId":"F2025L00155-fast-fetch-1775957688206","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 endometrium (Balance of Probabilities) (No. 32 of 2025)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n![RMA Australian Government Coat of Arms](image.001.jpeg)\n\n \n\nStatement of Principles\n\nconcerning\n\nMALIGNANT NEOPLASM OF THE ENDOMETRIUM  (Balance of Probabilities)\n\n(No. 32 of 2025)\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 18 February 2025.\n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\nProfessor Terence Campbell AM\n\nChairperson\n\nby and on behalf of\n\nThe Repatriation Medical Authority\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\n\n\n1.                Name\n\n\nThis is the Statement of Principles concerning malignant neoplasm of the endometrium (Balance of Probabilities) (No. 32 of 2025).\n\n1.                Commencement\n\n\n              This instrument commences on 25 March 2025.\n\n1.                Authority\n\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n1.                Repeal\n\n\nThe Statement of Principles concerning malignant neoplasm of the endometrium No. 12 of 2016 (Federal Register of Legislation No. F2016L00244) made under subsection 196B(3) and (8) of the VEA is repealed.\n\n1.                Application\n\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\n1.                Definitions\n\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n1.                Kind of injury, disease or death to which this Statement of Principles relates\n  1.           This Statement of Principles is about malignant neoplasm of the endometrium and death from malignant neoplasm of the endometrium.\n\n\nMeaning of malignant neoplasm of the endometrium\n\n1.           For the purposes of this Statement of Principles, malignant neoplasm of the endometrium:\n  1.           means a primary malignant neoplasm arising from the cells of the mucous membrane that line the uterine cavity; and\n  2.           includes;\n    1.             carcinoma in situ and\n    2.          carcinosarcoma (also known as malignant mesodermal mixed tumour); and\n  3.           excludes;\n    1.             malignant neoplasm of the cervix;\n    2.          carcinoid tumour;\n    3.        soft tissue sarcoma of the uterus;\n    4.         non-Hodgkin's lymphoma; and\n    5.           Hodgkin's lymphoma.\n2.           While malignant neoplasm of the endometrium attracts ICD‑10‑AM code C54.1, in applying this Statement of Principles the meaning of malignant neoplasm of the endometrium is that given in subsection (2).\n3.           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.\n\n\nDeath from malignant neoplasm of the endometrium\n\n1.           For the purposes of this Statement of Principles, malignant neoplasm of the endometrium, 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 endometrium.\n\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n1.                Basis for determining the factors\n\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 endometrium and death from malignant neoplasm of the endometrium 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\n1.                Factors that must exist\n\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 endometrium or death from malignant neoplasm of the endometrium is connected with the circumstances of a person's relevant service:\n\n1.           for females aged over 35 years only, having never been pregnant for more than 8 weeks, at the time of clinical onset;\n2.           using oestrogen-only hormone replacement therapy for at least 6 months before clinical onset, and where the use of oestrogen-only hormone replacement therapy has ceased, clinical onset has occurred within 20 years of cessation;\n\n\nNote: oestrogen-only hormone replacement therapy is defined in the Schedule 1 - Dictionary.\n\n1.           having cyclical combined hormone replacement therapy where oestrogen is combined with cyclical administration of progesterone for less than 15 days during each treatment cycle, for a continuous period of at least 5 years before clinical onset. Where the use of cyclical combined hormone replacement therapy has ceased, clinical onset has occurred within 5 years of cessation;\n2.           for post-menopausal females only, undergoing treatment with tamoxifen for at least 3 months before clinical onset, and where treatment has ceased, clinical onset has occurred within 20 years of cessation.\n3.           being overweight or obese for a period of at least 10 years within the 20 years before clinical onset;\n\n\nNote: being overweight or obese is defined in the Schedule 1 - Dictionary.\n\n1.           having diabetes mellitus for at least 10 years before clinical onset;\n2.           an inability to undertake any physical activity greater than 3 METs for at least 10 years within the 30 years before clinical onset;\n\n\nNote: MET is defined in the Schedule 1 - Dictionary.\n\n1.           Having undergone treatment with Tibolone for at least 1 year before clinical onset, and where treatment has ceased, clinical onset has occurred within 10 years of cessation.\n2.           inability to obtain appropriate clinical management for malignant neoplasm of the endometrium before clinical worsening.\n\n\n1.            Relationship to service\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  2.           The factor set out in subsection 9(9) applies only to material contribution to, or aggravation of, malignant neoplasm of the endometrium where the person's malignant neoplasm of the endometrium was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n2.            Factors referring to an injury or disease covered by another Statement of Principles\n\n\nIn this Statement of Principles:\n\n1.           if a factor referred to in section 9 applies in relation to a person; and\n2.           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\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 overweight or obese means having a Body Mass Index (BMI) of 25 or\n\n                               greater.\n\nNote; BMI is defined in the Schedule 1 – Dictionary.\n\n                               BMI means W/H2\n\n                               where:\n\n                               W is the person's weight in kilograms; and\n\n                               H is the person's height in metres.\n\n                             malignant neoplasm of the endometrium—see subsection 7(2).\n\n                             MET means a unit of measurement of the level of physical exertion.  1 MET = 3.5 ml of oxygen/kg of body weight per minute, 1.0 kcal/kg of body weight per hour or resting metabolic rate.\n\n                             MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n                             oestrogen-only hormone replacement therapy means the continuous, cyclical or intermittent administration of unopposed oestrogen, including diethylstilbestrol, to combat surgically induced or naturally occurring menopause.\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                             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":"Unauthenticated. Configure AI_GATEWAY_API_KEY or use a provider module. Learn more: https://ai-sdk.dev/unauthenticated-ai-gateway","source":"analysis-cron"},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard replacement of an existing Statement of Principles (repealing No. 12 of 2016). The scope remains consistent with the original intent: establishing medical criteria for linking endometrial cancer to military service. The structure follows the standard template for Repatriation Medical Authority instruments with no significant expansion beyond the original purpose."},"complexity_factors":["Multiple defined terms in Schedule 1 (approximately 8 key definitions including technical medical terms like 'MET', 'BMI', and specific hormone therapies)","Temporal conditions attached to most factors (e.g., 'at least 6 months before clinical onset', 'within 20 years of cessation')","Nested definitions (BMI defined in terms of weight/height formula, then referenced in 'being overweight or obese')","Specific exclusions in the disease definition (5 specific cancer types excluded from scope)","Cross-references to other Statements of Principles in section 11","Dual legislative framework application (VEA and MRCA with different service definitions)","Age and gender restrictions on certain factors (e.g., 'for females aged over 35 years only', 'for post-menopausal females only')"],"plain_english_summary":"This instrument updates the medical rules for deciding when endometrial (uterine) cancer is attributable to Australian military service, replacing the 2016 version with current evidence and applying the “balance of probabilities” test. It identifies specific risk factors that can link cancer to service.\n\nIt affects female veterans and defence members (and their families for death claims) under the Veterans’ Entitlements and Military Rehabilitation and Compensation Acts, determining eligibility for treatment and compensation."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the 2016 Statement (s4) and replaces it with updated, enumerated factors and definitions (s7–s9, Schedule 1). Changes visible in the text include new named treatments (Tibolone), explicit temporal windows for cessation of therapy, the addition of long‑term physical inactivity (measured in METs) and an explicit BMI threshold (Schedule 1). These textual updates alter the checklist adjudicators use to link disease to relevant service, thereby affecting which claims meet the test and the evidence required to prove them (s5, s8, s10)."},"complexity_factors":["Causal standard and evidentiary framing: Uses the civil standard 'balance of probabilities' and asserts a view based on 'sound medical‑scientific evidence' (s8), which places medical assessment at the core of decisions.","Enumerated medical factors with temporal thresholds: Multiple discrete risk factors are listed with minimum exposure/duration and cessation windows (e.g. oestrogen-only HRT ≥6 months with onset within 20 years of cessation; cyclical combined HRT <15 days progesterone per cycle ≥5 years with 5‑year cessation window; tamoxifen ≥3 months with 20‑year window; Tibolone ≥1 year with 10‑year window) (s9).","Sex- and age-limited criteria: Some factors apply only to females or to post‑menopausal females or those aged over 35, which requires administrative checks of sex/age/status (s9(1), s9(4)).","Objective metric definitions: BMI threshold for 'overweight or obese' (BMI ≥25) with the calculation formula (W/H2) and MET unit defined in the Dictionary (Schedule 1), enabling numeric assessment (Schedule 1).","Subjective/clinically variable factors: 'Inability to obtain appropriate clinical management' and prolonged inability to do activities >3 METs (over long lookback periods) introduce evidence-gathering and judgment calls for adjudicators (s9(11), s9(8)).","Disease definition and coding cross-checks: Defines malignant neoplasm of the endometrium (inclusions/exclusions) and notes the ICD‑10‑AM code reference, requiring diagnosis verification against both textual and coding definitions (s7(2)–(3)).","Interdependence with other Statements: If a listed factor refers to another disease with its own Statement, that other Statement’s factors apply, creating cross-references and layered inquiries (s11).","Administrative scope and lifecycle: Repeals the 2016 Statement (s4), applies to VEA/MRCA claims (s5), and has a fixed commencement date (s2), requiring updating of claims processes and training.","Requirement of service‑relation: Even where a factor exists, it must be 'related to the relevant service' as a legal nexus, meaning adjudicators must connect the medical factor to service circumstances (s10)."],"plain_english_summary":"This Statement of Principles sets the medical test used to decide whether malignant endometrial cancer (and death from it) is connected to a veteran's service for VEA/MRCA claims. It lists specific medical and exposure factors (e.g. nulliparity, hormone therapies, obesity, diabetes, long-term low physical capacity, tamoxifen, Tibolone, and lack of appropriate management) and requires at least one such factor, related to the person’s relevant service, to establish connection on the balance of probabilities. It replaces the 2016 Statement and starts 25 March 2025."}},"importantCases":[],"_links":{"self":"/api/acts/f2025l00155","history":"/api/acts/f2025l00155/history","analysis":"/api/acts/f2025l00155/analysis","conflicts":"/api/acts/f2025l00155/conflicts","importantCases":"/api/acts/f2025l00155/important-cases","documents":"/api/acts/f2025l00155/documents"}}