{"id":"F2021L00216","name":"Statement of Principles concerning acute lymphoblastic leukaemia/lymphoblastic lymphoma (Balance of Probabilities) (No. 34 of 2021)","slug":"statement-of-principles-concerning-acute-lymphoblastic-leukaemia-lymphoblastic-lymphoma-balance-of-p","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440772,"registerId":"F2021L00216-fast-fetch-1775956290289","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning acute lymphoblastic leukaemia/lymphoblastic lymphoma (Balance of Probabilities) (No. 34 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\nACUTE LYMPHOBLASTIC LEUKAEMIA/LYMPHOBLASTIC LYMPHOMA (Balance of Probabilities)\n\n(No. 34 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 5 March 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:
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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 acute lymphoblastic leukaemia/lymphoblastic lymphoma (Balance of Probabilities) (No. 34 of 2021).\n\n2 Commencement\n\n This instrument commences on 5 April 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 acute lymphoblastic leukaemia No. 76 of 2012 (Federal Register of Legislation No. F2012L02086) made under subsections 196B(3) and (8) 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 acute lymphoblastic leukaemia/lymphoblastic lymphoma and death from acute lymphoblastic leukaemia/lymphoblastic lymphoma.\n\nMeaning of acute lymphoblastic leukaemia/lymphoblastic lymphoma\n\n(2) For the purposes of this Statement of Principles, acute lymphoblastic leukaemia/lymphoblastic lymphoma:\n\n(a) means a malignant neoplasm characterised by the clonal proliferation of morphologically immature, non-functioning lymphoid cells of B- or T-cell origin, which can present clinically as either a leukaemia or a lymphoma; and\n\n(b) excludes:\n\n(i) Burkitt leukaemia/lymphoma;\n\n(ii) adult T-cell leukaemia/lymphoma;\n\n(iii) acute undifferentiated leukaemia; and\n\n(iv) indolent T‑lymphoblastic proliferation.\n\nNote: Acute lymphoblastic lymphoma and lymphoblastic leukaemia are considered to be tumours of the same lymphoid cell type, and are considered to be a single disease entity with two clinical presentations.\n\nDeath from acute lymphoblastic leukaemia/lymphoblastic lymphoma\n\n(3) For the purposes of this Statement of Principles, acute lymphoblastic leukaemia/lymphoblastic lymphoma, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's acute lymphoblastic leukaemia/lymphoblastic lymphoma.\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 acute lymphoblastic leukaemia/lymphoblastic lymphoma and death from acute lymphoblastic leukaemia/lymphoblastic lymphoma 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, acute lymphoblastic leukaemia/lymphoblastic lymphoma or death from acute lymphoblastic leukaemia/lymphoblastic lymphoma is connected with the circumstances of a person's relevant service:\n\n(1) having received a cumulative equivalent dose of at least 0.05 sievert of ionising radiation to the bone marrow at least two years before the clinical onset of acute lymphoblastic leukaemia/lymphoblastic lymphoma;\n\nNote: cumulative equivalent dose is defined in the Schedule 1 - Dictionary. \n\n(2) taking an alkylating agent or a DNA topoisomerase II inhibitor for the treatment of a malignant neoplasm before the clinical onset of acute lymphoblastic leukaemia/lymphoblastic lymphoma, and:\n\n(a) the first exposure occurred at least one year before the clinical onset of acute lymphoblastic leukaemia/lymphoblastic lymphoma; and\n\n(b) if exposure ceased before the clinical onset of acute lymphoblastic leukaemia/lymphoblastic lymphoma, then that onset occurred within 20 years of cessation;\n\n(3) undergoing organ or tissue transplantation, excluding corneal transplant, before the clinical onset of acute lymphoblastic leukaemia/lymphoblastic lymphoma;\n\nNote: organ or tissue transplantation is defined in the Schedule 1 - Dictionary.\n\n(4) inability to obtain appropriate clinical management for acute lymphoblastic leukaemia/lymphoblastic lymphoma.\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(4) applies only to material contribution to, or aggravation of, acute lymphoblastic leukaemia/lymphoblastic lymphoma where the person's acute lymphoblastic leukaemia/lymphoblastic lymphoma 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 acute lymphoblastic leukaemia/lymphoblastic lymphoma—see subsection 7(2).\n\n cumulative equivalent dose means the total dose of ionising radiation received by the particular organ or tissue from external exposure, internal exposure or both, apart from normal background radiation exposure in Australia, calculated in accordance with the methodology set out in Guide to calculation of 'cumulative equivalent dose' for the purpose of applying ionising radiation factors contained in Statements of Principles determined under Part XIA of the Veterans' Entitlements Act 1986 (Cth), Australian Radiation Protection and Nuclear Safety Agency, as in force on 2 August 2017.\n\nNote 1: Examples of circumstances that might lead to exposure to ionising radiation include being present during or subsequent to the testing or use of nuclear weapons, undergoing diagnostic or therapeutic medical procedures involving ionising radiation, and being a member of an aircrew, leading to increased levels of exposure to cosmic radiation.\n\nNote 2: For the purpose of dose reconstruction, dose is calculated as an average over the mass of a specific tissue or organ. If a tissue is exposed to multiple sources of ionising radiation, the various dose estimates for each type of radiation must be combined.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n organ or tissue transplantation means:\n\n(a) the transplantation of all or part of an organ or tissue; or\n\n(b) the transplantation of 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 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":4,"scope_assessment":{"changed":false,"description":"This instrument maintains the established scope of Repatriation Medical Authority Statements of Principles. It updates the 2012 version with current medical evidence but does not expand beyond the traditional purpose of establishing causal factors for service-related disease determination. The four-factor structure (radiation, chemotherapy, transplant, and clinical management) remains consistent with standard RMA practice for haematological malignancies."},"complexity_factors":["Moderate medical terminology requiring definitions (e.g., 'alkylating agent', 'DNA topoisomerase II inhibitor', 'sievert')","Cross-referencing to external methodology documents (ARPANSA Guide to calculation of 'cumulative equivalent dose' as at 2 August 2017)","Conditional logic with multiple temporal requirements (e.g., 'at least two years before', 'at least one year before', 'within 20 years of cessation')","Nested definitions in Schedule 1 (8 defined terms) with some terms referring back to section definitions","Exclusion clauses in the disease definition (subsection 7(2)(b)) listing four specific excluded conditions","Interaction with other Statements of Principles via section 11 (incorporation by reference of other instruments)","Dual statutory framework application (Veterans' Entitlements Act 1986 AND Military Rehabilitation and Compensation Act 2004)"],"plain_english_summary":"This instrument updates the 2012 medical rules for deciding whether acute lymphoblastic leukaemia/lymphoblastic lymphoma (ALL/LBL) in Australian veterans or defence members is service-related and eligible for DVA compensation. It applies to current and former ADF members and their survivors.\n\nA successful claim must show, on the balance of probabilities, that service likely caused or contributed to ALL/LBL by meeting at least one specified medical link (e.g. significant ionising radiation, prior certain chemotherapy, non-corneal transplant, or pre‑existing cancer with lack of care)."},"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"This instrument repeals the 2012 Statement (s4) and replaces it with updated criteria (see s7–9). The new Statement specifies a numeric radiation threshold and dose‑calculation method (s9(1); Schedule 1), clarifies disease definition and exclusions (s7(2)), and sets particular therapeutic and timing conditions for chemotherapy and transplant exposures (s9(2)–(3)). It also adds an inability‑to‑obtain‑care factor with limited application (s9(4); s10(2))."},"complexity_factors":["Technical medical definitions and exclusions (disease definition and listed exclusions) requiring specialist interpretation (s7(2)).","Legal causation standard stated as balance of probabilities and linkage to service (s8; s10(1)).","Numeric radiation threshold and organ‑specific dose calculation methodology referencing an external ARPANSA guide, adding technical dose‑reconstruction work (s9(1); Schedule 1 definition of cumulative equivalent dose).","Specific therapeutic exposures with temporal limits (alkylating agents/DNA topoisomerase II inhibitors, first exposure ≥1 year before onset; cessation within 20 years) requiring detailed treatment histories (s9(2)).","Inclusion of organ/tissue transplantation (excluding corneal) and an evidence requirement for transplantation history (s9(3); Schedule 1).","A non‑medical factor—\"inability to obtain appropriate clinical management\"—which raises evidentiary and administrative discretion issues and has a limited application when disease pre‑existed service (s9(4); s10(2)).","Interplay with other Statements of Principles where factors overlap, requiring cross‑reference to other instruments (s11).","Replaces a prior statutory instrument (repeal), so practitioners must track the new text rather than rely on precedent (s4).","Application limited to claims under specified statutes (VEA/MRCA) meaning procedural and entitlement rules outside this instrument still apply (s5; Schedule 1 definitions).","Administrative workload and compliance burden: claimants/administrators must assemble radiation dose reconstructions, chemotherapy/transplant records, and evidence about access to care—tasks involving medical specialists and record searches (s9; Schedule 1)."],"plain_english_summary":"This instrument sets the medical criteria the Repatriation Medical Authority uses to decide whether acute lymphoblastic leukaemia/lymphoblastic lymphoma (or death from it) is connected to a veteran's or member's service for claims under the VEA or MRCA. It replaces an earlier 2012 Statement.\n\nIt adopts the balance‑of‑probabilities test and prescribes particular exposure and timing conditions (and how radiation dose is calculated) that, if met, make a service connection more probable — thereby defining the evidence and medical findings decision‑makers require."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-acute-lymphoblastic-leukaemia-lymphoblastic-lymphoma-balance-of-p","history":"/api/acts/statement-of-principles-concerning-acute-lymphoblastic-leukaemia-lymphoblastic-lymphoma-balance-of-p/history","analysis":"/api/acts/statement-of-principles-concerning-acute-lymphoblastic-leukaemia-lymphoblastic-lymphoma-balance-of-p/analysis","conflicts":"/api/acts/statement-of-principles-concerning-acute-lymphoblastic-leukaemia-lymphoblastic-lymphoma-balance-of-p/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-acute-lymphoblastic-leukaemia-lymphoblastic-lymphoma-balance-of-p/important-cases","documents":"/api/acts/statement-of-principles-concerning-acute-lymphoblastic-leukaemia-lymphoblastic-lymphoma-balance-of-p/documents"}}