{"id":"F2021L01173","name":"Statement of Principles concerning essential thrombocythaemia (Balance of Probabilities) (No. 92 of 2021)","slug":"statement-of-principles-concerning-essential-thrombocythaemia-balance-of-probabilities-no-92-of-2021","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440973,"registerId":"F2021L01173-fast-fetch-1775956410922","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning essential thrombocythaemia (Balance of Probabilities) (No. 92 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\nESSENTIAL THROMBOCYTHAEMIA (Balance of Probabilities)\n\n(No. 92 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 20 August 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 Terence Campbell AM
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 essential thrombocythaemia (Balance of Probabilities) (No. 92 of 2021).\n\n2 Commencement\n\n This instrument commences on 20 September 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 essential thrombocythaemia No. 16 of 2013 (Federal Register of Legislation No. F2013L00411) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 essential thrombocythaemia and death from essential thrombocythaemia.\n\nMeaning of essential thrombocythaemia\n\n(2) For the purposes of this Statement of Principles, essential thrombocythaemia:\n\n(a) means a chronic, Philadelphia-chromosome negative myeloproliferative neoplasm characterised by bone marrow megakaryocytic proliferation, resulting in excessive, clonal platelet production and marked thrombocytosis in peripheral blood; and\n\n(b) excludes secondary or reactive thrombocytosis.\n\nNote 1: Typical clinical manifestations of essential thrombocythaemia include formation of blood clots, bleeding, fatigue, night sweats, visual disturbances, headache, nausea and abdominal pain.\n\nNote 2: The clinical course is usually indolent, but transformation to bone marrow failure, myelofibrosis and acute leukaemia may occur.\n\nNote 3: Causes of secondary or reactive thrombocytosis include infection, trauma and haemorrhage.\n\n(3) While essential thrombocythaemia attracts ICD‑10‑AM code D47.3, in applying this Statement of Principles the meaning of essential thrombocythaemia 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 essential thrombocythaemia\n\n(5) For the purposes of this Statement of Principles, essential thrombocythaemia, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's essential thrombocythaemia.\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 essential thrombocythaemia and death from essential thrombocythaemia 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, essential thrombocythaemia or death from essential thrombocythaemia 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 10 pack-years before the clinical onset of essential thrombocythaemia; and\n\n(b) commencing at least 5 years before the clinical onset of essential thrombocythaemia; and\n\nif smoking has ceased before the clinical onset of essential thrombocythaemia, then that onset occurred within 15 years of cessation;\n\nNote: one pack-year is defined in the Schedule 1 - Dictionary.\n\n(2) inability to obtain appropriate clinical management for essential thrombocythaemia.\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(2) applies only to material contribution to, or aggravation of, essential thrombocythaemia where the person's essential thrombocythaemia 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 essential thrombocythaemia—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 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":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument maintains the original narrow scope of Repatriation Medical Authority Statements of Principles. It addresses a single specific disease (essential thrombocythaemia) for a defined population (veterans and defence members) under established statutory frameworks. The 2021 version is a straightforward replacement of the 2013 version with updated medical definitions and references, not an expansion into new policy areas."},"complexity_factors":["Medical terminology requiring clinical knowledge (e.g., 'Philadelphia-chromosome negative myeloproliferative neoplasm', 'megakaryocytic proliferation')","Mathematical calculation required for pack-years with conversion rules for non-cigarette tobacco (7,300 grams = 1 pack-year; 1 gram pipe tobacco = 1 cigarette)","Temporal conditions with multiple thresholds (10 pack-years minimum, 5-year commencement window, 15-year post-cessation window)","Cross-referencing between two separate compensation schemes (VEA and MRCA) with different service definitions","Nested conditional logic in section 9(1) with three cumulative requirements plus a conditional fourth","Specific exclusion clause distinguishing primary disease from secondary/reactive thrombocytosis","Reference to external classification system (ICD-10-AM Tenth Edition) with specific ISBN and effective date"],"plain_english_summary":"This instrument sets the medical test for when essential thrombocythaemia (a chronic blood cancer) is treated as service-related for Australian Defence Force members claiming under the VEA or MRCA. To satisfy the balance‑of‑probabilities test, claimants must show either a long-term heavy smoking history or that service prevented proper treatment. Its outcome decides veterans’ access to treatment, pensions and other DVA support, replacing a 2013 version."},"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":true,"description":"The instrument repeals the earlier Statement of Principles No. 16 of 2013 (s.4) and replaces it with a Statement that (a) defines essential thrombocythaemia and excludes secondary/reactive thrombocytosis (s.7(2)–(4)); (b) explicitly includes death from essential thrombocythaemia (s.7(5)); and (c) narrows connection-to-service to two discrete factors: specified smoking history thresholds and inability to obtain appropriate clinical management (s.9–10). These express criteria alter the operational scope used to decide claims under the VEA/MRCA (s.5)."},"complexity_factors":["Medical definition with exclusion of secondary/reactive thrombocytosis (s.7(2)–(4)) increases technical medical interpretation.","Numeric exposure thresholds and timing for smoking (pack‑years, commencement and cessation windows) require precise factual proof (s.9(1); Schedule 1).","Causation link: each factor must be related to the person's relevant service, creating a legal connection question (s.10(1)).","Alternative factor based on access to clinical management raises evidentiary issues about healthcare availability and its timing (s.9(2); s.10(2)).","Interplay with other Statements of Principles where factors overlap requires cross‑reference to other instruments (s.11).","Statutory definitions collected in the Schedule affect interpretation (Schedule 1).","Repeal of a prior Statement indicates change-management and transitional evidentiary questions (s.4)."],"plain_english_summary":"This instrument replaces an earlier Statement and sets the medical definition of essential thrombocythaemia and the factual criteria that must be met for a veteran or member to link the condition (or related death) to relevant service for claims under the VEA or MRCA (see s.5–7, s.8). Connection requires either specified smoking history (thresholds for pack‑years, start and cessation timing) or inability to obtain appropriate clinical management; evidence must show the factor was related to the person's relevant service (see s.9–10)."},"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-essential-thrombocythaemia-balance-of-probabilities-no-92-of-2021","history":"/api/acts/statement-of-principles-concerning-essential-thrombocythaemia-balance-of-probabilities-no-92-of-2021/history","analysis":"/api/acts/statement-of-principles-concerning-essential-thrombocythaemia-balance-of-probabilities-no-92-of-2021/analysis","conflicts":"/api/acts/statement-of-principles-concerning-essential-thrombocythaemia-balance-of-probabilities-no-92-of-2021/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-essential-thrombocythaemia-balance-of-probabilities-no-92-of-2021/important-cases","documents":"/api/acts/statement-of-principles-concerning-essential-thrombocythaemia-balance-of-probabilities-no-92-of-2021/documents"}}