{"id":"F2021L01172","name":"Statement of Principles concerning essential thrombocythaemia (Reasonable Hypothesis) (No. 91 of 2021)","slug":"statement-of-principles-concerning-essential-thrombocythaemia-reasonable-hypothesis-no-91-of-2021","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440970,"registerId":"F2021L01172-fast-fetch-1775956408723","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning essential thrombocythaemia (Reasonable Hypothesis) (No. 91 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 (Reasonable Hypothesis)\n\n(No. 91 of 2021)\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 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 (Reasonable Hypothesis) (No. 91 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning essential thrombocythaemia No. 15 of 2013 (Federal Register of Legislation No. F2013L00409) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that essential thrombocythaemia and death from essential thrombocythaemia 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 essential thrombocythaemia or death from essential thrombocythaemia 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(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 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) 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":{"kimi_summary":{"content_quality":"ok","complexity_score":3,"scope_assessment":{"changed":false,"description":"This instrument maintains the standard scope of Repatriation Medical Authority Statements of Principles. It provides the specific medical nexus test for essential thrombocythaemia claims under the veterans' compensation scheme, consistent with the original legislative framework established by the Veterans' Entitlements Act 1986. The 2021 version updates the 2013 predecessor without expanding beyond the established purpose of determining service-related causation for this specific condition."},"complexity_factors":["Short, single-purpose instrument (approximately 1,500 words)","Only 7 defined terms in the Dictionary (Schedule 1)","Simple binary structure: two alternative factors in section 9 with clear thresholds (10 pack-years, 5-year commencement, 15-year cessation window)","Minimal cross-referencing—primarily internal references to the Dictionary and the two principal Acts (VEA and MRCA)","No nested exceptions or conditional logic beyond the basic temporal requirements in the smoking factor","Straightforward application provision (section 5) linking to specific claim types under the VEA and MRCA","Medical definition in section 7(2) uses technical terminology but is explicitly defined and excludes reactive thrombocytosis clearly"],"plain_english_summary":"This instrument sets the medical test for whether Australian veterans and current/former defence personnel with essential thrombocythaemia can get benefits under veterans' compensation laws. It replaces the 2013 version.\n\nTo qualify, a claimant must show either a qualifying smoking history (≥10 pack‑years, beginning ≥5 years before diagnosis, with timing rules if they quit) or that they lacked access to proper medical care for the condition; meeting the test can lead to pensions, treatment, or rehabilitation."},"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":true,"description":"This instrument repeals the 2013 Statement (s.4) and replaces it with updated criteria (ss.7–11 and Schedule 1). It narrows the determinative factors to a defined clinical meaning of essential thrombocythaemia, a specific smoking‑history threshold and timing rules, and inability to obtain appropriate clinical management; it applies to VEA and MRCA claims (s.5)."},"complexity_factors":["Medical specificity: the instrument defines a clinical diagnosis (Philadelphia‑chromosome negative myeloproliferative neoplasm) and excludes reactive causes (s.7(2)), requiring medical evidence to apply.","Evidentiary thresholds: quantitative smoking threshold (≥10 pack‑years), timing requirements (commencement ≥5 years before onset; onset within 15 years of cessation) and pack‑year calculation rules (Schedule 1).","Timing and causal framing: connection requires a 'reasonable hypothesis' standard and linking of factor(s) to relevant service (ss.8, 9, 10), introducing forensic timing questions (clinical onset, service dates).","Interaction with other Statements: factors may cross‑refer to other Statements of Principles and their terms (s.11), requiring cross‑instrument interpretation.","Discretion and medical judgement: the Repatriation Medical Authority applies medical‑scientific evidence to form the reasonable hypothesis (s.8), leaving room for expert assessment and administrative discretion.","Scope of application and repeal: replaces prior 2013 Statement (s.4) and applies to claims under VEA and MRCA (s.5), so claim processing must follow the new criteria.","Death causation: includes death from a terminal event contributed to by the condition and defines 'terminal event' narrowly (Schedule 1), which affects proximate cause analysis.","Potential compliance burden: claimants must produce medical records, smoking history and evidence about access to clinical management, which can be evidentially challenging."],"plain_english_summary":"Replaces the 2013 Statement and sets the tests the Repatriation Medical Authority will use to decide whether essential thrombocythaemia is connected to service for VEA/MRCA claims. It defines the medical condition, and requires at least one qualifying factor — a specified smoking history (pack‑years and timing) or inability to obtain appropriate clinical management — and sets timing and death‑causation rules."},"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"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-essential-thrombocythaemia-reasonable-hypothesis-no-91-of-2021","history":"/api/acts/statement-of-principles-concerning-essential-thrombocythaemia-reasonable-hypothesis-no-91-of-2021/history","analysis":"/api/acts/statement-of-principles-concerning-essential-thrombocythaemia-reasonable-hypothesis-no-91-of-2021/analysis","conflicts":"/api/acts/statement-of-principles-concerning-essential-thrombocythaemia-reasonable-hypothesis-no-91-of-2021/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-essential-thrombocythaemia-reasonable-hypothesis-no-91-of-2021/important-cases","documents":"/api/acts/statement-of-principles-concerning-essential-thrombocythaemia-reasonable-hypothesis-no-91-of-2021/documents"}}