{"id":"F2018L00006","name":"Statement of Principles concerning cerebral meningioma (Reasonable Hypothesis) (No. 1 of 2018)","slug":"statement-of-principles-concerning-cerebral-meningioma-reasonable-hypothesis-no-1-of-2018","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439447,"registerId":"F2018L00006-fast-fetch-1775955469768","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning cerebral meningioma (Reasonable Hypothesis) (No. 1 of 2018)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 22.10.0\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n\n\n \n\nStatement of Principles\n\nconcerning\n\nCEREBRAL MENINGIOMA (Reasonable Hypothesis)\n\n(No. 1 of 2018)\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 22 December 2017\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 Revocation\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 cerebral meningioma (Reasonable Hypothesis) (No. 1 of 2018).\n\n2 Commencement\n\n This instrument commences on 29 January 2018.\n\n3 Authority\n\nThis instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n4 Revocation\n\nThe Statement of Principles concerning cerebral meningioma No. 19 of 2009, as amended, made under subsections 196B(2) and (8) of the VEA is revoked.\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 cerebral meningioma and death from cerebral meningioma.\n\nMeaning of cerebral meningioma\n\n(2) For the purposes of this Statement of Principles, cerebral meningioma means a primary benign or intermediate grade tumour of the cerebral meninges.\n\n(3) While cerebral meningioma attracts ICD‑10‑AM code D32.0 or D32.9, in applying this Statement of Principles the meaning of cerebral meningioma is that given in subsection (2).\n\n(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.\n\nDeath from cerebral meningioma\n\n(5) For the purposes of this Statement of Principles, cerebral meningioma, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's cerebral meningioma.\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 cerebral meningioma and death from cerebral meningioma 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 cerebral meningioma or death from cerebral meningioma with the circumstances of a person's relevant service:\n\n(1) having received a cumulative equivalent dose of at least 0.1 sievert of ionising radiation to the brain at least five years before the clinical onset of cerebral meningioma;\n\nNote: cumulative equivalent dose is defined in the Schedule 1 - Dictionary. \n\n(2) being overweight or obese for at least five years within the 20 years before the clinical onset of cerebral meningioma;\n\nNote: being overweight or obese is defined in the Schedule 1 - Dictionary. \n\n(3) being in the second or third trimester of pregnancy, or within the 30 days postpartum, at the time of the clinical onset of cerebral meningioma;\n\n(4) being treated with a drug as specified within the ten years before the clinical onset of cerebral meningioma;\n\nNote: being treated with a drug as specified is defined in the Schedule 1 - Dictionary. \n\n(5) using hormone replacement therapy for a continuous period of at least six months before the clinical onset of cerebral meningioma, and where the use of hormone replacement therapy has ceased, the clinical onset of cerebral meningioma has occurred within ten years of cessation;\n\nNote: hormone replacement therapy is defined in the Schedule 1 - Dictionary.\n\n(6) being in the second or third trimester of pregnancy, or within the 30 days postpartum, at the time of the clinical worsening of cerebral meningioma;\n\n(7) being treated with a drug as specified within the ten years before the clinical worsening of cerebral meningioma;\n\nNote: being treated with a drug as specified is defined in the Schedule 1 - Dictionary. \n\n(8) inability to obtain appropriate clinical management for cerebral meningioma.\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 factors set out in subsections 9(6) to 9(8) apply only to material contribution to, or aggravation of, cerebral meningioma where the person's cerebral meningioma 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 overweight or obese means having a Body Mass Index (BMI) of 25 or greater.\n\nNote: BMI is also defined in the Schedule 1 - Dictionary.\n\n being treated with a drug as specified means:\n\n(a) receiving medroxyprogesterone acetate at a dose rate of at least 15 milligrams per day for a continuous period of at least one year; or\n\n(b) taking daily cyproterone acetate at a dose rate of at least 15 milligrams per day for a continuous period of at least one year; or\n\n(c) taking daily chlormadinone acetate at a dose rate of at least 50 milligrams per day for a continuous period of at least one year; or\n\n(d) taking daily megestrol acetate at a dose rate of at least 50 milligrams per day for a continuous period of at least one year.\n\n BMI means W/H2 where:\n\nW is the person's weight in kilograms; and\n\nH is the person's height in metres.\n\n cerebral meningioma—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 hormone replacement therapy means administration of estrogen preparations often in combination with progesterone to offset a hormone deficiency following surgically induced or naturally occurring menopause.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\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 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":{"complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument replaces the earlier 2009 Statement (s4) and updates the medical factors and definitions that raise a reasonable hypothesis linking cerebral meningioma to relevant service (see ss7\u0002s11). It remains within the original statutory purpose of Statements of Principles: to identify medical evidence that may link a condition to service. While it updates and refines specific factors (dose thresholds, drug lists, timing windows, and an explicit reference to inability to obtain appropriate clinical management), it does not expand the instrument beyond that core purpose."},"complexity_factors":["Relatively short instrument (11 substantive sections plus a Schedule) but with precise medical thresholds.","Approximately 10 defined terms in Schedule 1 (e.g. \"being overweight or obese\", \"cumulative equivalent dose\", \"BMI\", \"relevant service\", \"terminal event\").","Multiple conditional rules: different factors apply to clinical onset versus clinical worsening (see s9(1)-(8) and s10(2)).","Dose- and timing-specific thresholds: 0.1 sievert with 5-year latency for radiation (s9(1)); BMI >=25 for 5 years within 20 years (s9(2)); drug dose/duration and 10-year windows (s9(4), Schedule).","Cross-reference to external technical guidance for dose calculation (ARPANSA guide referenced in Schedule).","Cross-application rule to other Statements of Principles (s11) requiring readers to check other instruments for overlapping exposures.","Some nested limitation: subsections 9(6)-9(8) apply only where disease existed before or during service but did not arise out of service (s10(2)).","Specific, discrete exposure definitions for drugs with dose and continuous-duration requirements (Schedule).","Clear interaction between medical facts (timing, dose) and legal threshold (\"reasonable hypothesis\") but no complex arithmetic or many cross-amendments."],"plain_english_summary":"**What this instrument does (mechanics)\n\n- This is a Repatriation Medical Authority (RMA) \"Statement of Principles\" that sets out the medical factors which, if present and related to a person's military/relevant service, are sufficient to raise a \"reasonable hypothesis\" that the person\u0002s cerebral meningioma (or death from it) is connected to that service (see sections 7, 8 and 9). The Statement replaces the earlier 2009 Statement (s4).\n\n- It defines the disease at issue: \"cerebral meningioma\" means a primary benign or intermediate grade tumour of the cerebral meninges (s7(2)). Death from cerebral meningioma is included where death was contributed to by the tumour (s7(5)).\n\n- The Statement lists specific qualifying factors. If at least one of those factors existed in the person, and that factor is related to their relevant service, then a reasonable hypothesis of service connection is raised (s9 and s10(1)). The Statement applies to claims under the Veterans' Entitlements Act and the Military Rehabilitation and Compensation Act (s5).\n\n\nWho this affects\n\n- Primary affected persons are veterans, former or current members of the Australian Defence Force, and eligible members of Peacekeeping Forces who lodge claims for compensation or entitlements for cerebral meningioma or death caused by it (see s5 and the definition of \"relevant service\" in the Schedule).\n\n- Decision-makers (the Department that administers claims and medical assessors) use this Statement as the medical basis for determining whether a claim can be linked to service.\n\n\nKey qualifying factors (what will raise a reasonable hypothesis) (s9)\n\nAt least one of the following must be shown and also must be related to the person's relevant service (s10(1)):\n\n- Ionising radiation: The person received a cumulative equivalent dose to the brain of at least 0.1 sievert (100 millisievert) at least five years before clinical onset (s9(1); Schedule definition of \"cumulative equivalent dose\"). The Schedule cross-references ARPANSA guidance on how to calculate that dose.\n\n- Body mass index (BMI): The person was overweight or obese (BMI of 25 or more) for at least five years within the 20 years before clinical onset (s9(2); Schedule defines \"being overweight or obese\" and BMI calculation).\n\n- Pregnancy timing: The person was in the second or third trimester of pregnancy, or within 30 days after giving birth, at the time of clinical onset (s9(3)). The same timing is listed for clinical worsening in s9(6).\n\n- Certain drug exposures: The person was treated with specified progestogen-type drugs at or above stated dose thresholds for continuous periods of at least one year within ten years before clinical onset (s9(4); Schedule lists specific drugs and dose/duration thresholds). Similar drug-exposure wording applies to clinical worsening (s9(7)).\n\n- Hormone replacement therapy (HRT): The person used HRT continuously for at least six months before clinical onset, and if HRT ceased, onset occurred within ten years of stopping (s9(5)).\n\n- Clinical management access: \"Inability to obtain appropriate clinical management for cerebral meningioma\" is listed as a factor (s9(8)). Note: subsections 9(6) to 9(8) apply only when they materially contribute to or aggravate an existing meningioma that was suffered or contracted before or during (but did not arise out of) the person's relevant service (s10(2)).\n\n\nHow the Statement is intended to be used (purpose claim and practical testing)\n\n- The RMA states there is \"sound medical-scientific evidence\" that these factors can link cerebral meningioma to relevant service (s8). Practically, if a claimant can establish one of the listed factors and show the factor is connected to their relevant service, the claim meets the threshold of a \"reasonable hypothesis\" of service connection, which affects how entitlement decisions proceed.\n\n- Implementation requires factual proof: medical records for diagnosis and timing, evidence of radiation dose (which may need dose reconstruction per the ARPANSA-guided methodology in the Schedule), records of medication type, dose and duration, and documented BMI history or pregnancy records (Schedule, s9 and defined terms).\n\n\nCosts, incentives, and trade-offs (mechanisms, not judgments)\n\n- Who pays: any successful service-connection finding can lead to government-administered entitlements or compensation under the VEA or MRCA; the Treasury/entitlement system bears the fiscal cost when claims succeed.\n\n- Who decides and how: the RMA sets the medical criteria (this instrument). Claim-assessing bodies and medical assessors decide on individual claims by applying the Statement to each applicant\u0002s medical and service records.\n\n- Evidence and administrative burden: some factors (notably radiation exposure) require technical dose reconstruction; medication and BMI factors require sufficiently detailed medical records. These requirements increase investigative and evidentiary costs for both claimants and administrators (see Schedule definition of \"cumulative equivalent dose\" and the drug dose/duration specifications).\n\n- Behavioural effects: the Statement gives an objective list of pathways by which claimants can satisfy the medical threshold. That concentrates benefits in people with one or more of the specified exposures (for example, recorded radiation exposure, long-term use of specific drugs, long-term elevated BMI, or specific pregnancy timing). The cost of successful claims is borne by the compensation system; the Statement does not itself change private clinical practice, but it may shape the records and evidence collected by clinicians and claimants.\n\n- Interaction with other Statements: if a listed factor also relates to another Statement of Principles, that other Statement applies according to its terms (s11). This creates cross-application where exposures overlap across different disease Statements.\n\n\nNotable implementation risks and trade-offs\n\n- Dose reconstruction for ionising radiation requires technical expertise and may be uncertain for historical exposures (Schedule definition of \"cumulative equivalent dose\").\n\n- The BMI criterion uses a single numerical cutoff (BMI >= 25) and fixed retrospective windows (5 years within a 20-year period), which makes the rule predictable but depends on reliable weight/height records.\n\n- The Statement places timing and dose/duration thresholds on drug and HRT exposure; absent clear records, claimants may struggle to meet those thresholds.\n\n- Subsection 10(2) narrows some factors (9(6) to 9(8)) to material contribution/aggravation of pre-existing disease, so those particular factors do not support causation where meningioma first arose because of service.\n\n\nBottom line (plain declarative):\n\n- This instrument tells claim decision-makers which medical exposures or circumstances are, on the RMA's view, sufficient to raise a reasonable hypothesis that a cerebral meningioma (or death from it) is connected to a person's military/relevant service (see s7\u0002s11). It lists concrete exposure, timing and dosage thresholds, defines terms used to measure those thresholds, and requires the factor(s) to be related to the person's relevant service before a service link can be inferred (s9 and s10)."},"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 replaces the 2009 version (No. 19 of 2009) with updated medical evidence but does not expand beyond the traditional function of determining service connection for specific conditions. The inclusion of obesity as a factor reflects evolving medical consensus rather than scope creep, and the structure remains consistent with other RMA instruments under Part XIA of the VEA."},"complexity_factors":["Moderate cross-referencing: 9 defined terms in Schedule 1, with some terms (BMI, cumulative equivalent dose) requiring mathematical or technical calculations","Nested conditional logic in factor 5 (HRT): requires both minimum duration (6 months) AND temporal relationship to cessation (within 10 years)","Dual-purpose factors: factors 3/4/6/7 have parallel structures for 'clinical onset' versus 'clinical worsening' with different legal consequences per section 10(2)","Technical medical definitions: incorporates external medical classification system (ICD-10-AM 10th Edition) by specific ISBN and effective date","External methodology incorporation: cumulative equivalent dose requires calculation per ARPANSA guide dated 2 August 2017","Specific pharmaceutical dosing requirements: four named drugs with precise milligram thresholds and minimum duration periods","Interaction clause (section 11): creates dynamic relationship with other Statements of Principles that may modify application"],"plain_english_summary":"This Statement of Principles tells the Repatriation Medical Authority when a cerebral meningioma can reasonably be linked to military service for VEA or MRCA claims. It applies the lower \"reasonable hypothesis\" standard, favoring claimants.\n\nIt identifies key qualifying risk factors — notably ionising radiation, sustained overweight/obesity, pregnancy/postpartum, certain high‑dose progestogens or HRT, and lack of appropriate clinical care — and covers worsening of pre‑existing tumours. These rules determine veterans' eligibility for pensions and treatment."},"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/statement-of-principles-concerning-cerebral-meningioma-reasonable-hypothesis-no-1-of-2018","history":"/api/acts/statement-of-principles-concerning-cerebral-meningioma-reasonable-hypothesis-no-1-of-2018/history","analysis":"/api/acts/statement-of-principles-concerning-cerebral-meningioma-reasonable-hypothesis-no-1-of-2018/analysis","conflicts":"/api/acts/statement-of-principles-concerning-cerebral-meningioma-reasonable-hypothesis-no-1-of-2018/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-cerebral-meningioma-reasonable-hypothesis-no-1-of-2018/important-cases","documents":"/api/acts/statement-of-principles-concerning-cerebral-meningioma-reasonable-hypothesis-no-1-of-2018/documents"}}