{"id":"F2023L00950","name":"Statement of Principles concerning Hodgkin lymphoma (Balance of Probabilities) (No. 71 of 2023)","slug":"statement-of-principles-concerning-hodgkin-lymphoma-balance-of-probabilities-no-71-of-2023","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441998,"registerId":"F2023L00950-fast-fetch-1775957137648","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning Hodgkin lymphoma (Balance of Probabilities) (No. 71 of 2023)","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\n\n \n\nStatement of Principles\n\nconcerning\n\nHODGKIN LYMPHOMA (Balance of Probabilities)\n\n(No. 71 of 2023)\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 23 June 2023.\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 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 Hodgkin lymphoma (Balance of Probabilities) (No. 71 of 2023).\n\n2 Commencement\n\n This instrument commences on 25 July 2023.\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 Hodgkin's lymphoma No. 36 of 2014 (Federal Register of Legislation No. F2014L00468) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 Hodgkin lymphoma and death from Hodgkin lymphoma.\n\nMeaning of Hodgkin lymphoma\n\n(2) For the purposes of this Statement of Principles, Hodgkin lymphoma:\n\n(a) means a specific group of malignant neoplasms of the lymph nodes and lymphoid tissue derived from B lymphocytes; and\n\n(b) includes:\n\n(i) nodular sclerosis classical Hodgkin lymphoma;\n\n(ii) lymphocyte-rich classical Hodgkin lymphoma;\n\n(iii) mixed cellularity classical Hodgkin lymphoma;\n\n(iv) lymphocyte-depleted classical Hodgkin lymphoma; and\n\n(v) nodular lymphocyte predominant Hodgkin lymphoma; and\n\n(c) excludes non-Hodgkin lymphoma.\n\nNote 1: Hodgkin lymphoma is also known as Hodgkin’s lymphoma and Hodgkin’s disease. \n\nNote 2: Symptoms of Hodgkin lymphoma include painless lymphadenopathy, fever, night sweats and loss of body mass. \n\n(3) While Hodgkin lymphoma attracts ICD‑10‑AM code C81, in applying this Statement of Principles the meaning of Hodgkin lymphoma 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 Hodgkin lymphoma\n\n(5) For the purposes of this Statement of Principles, Hodgkin lymphoma, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's Hodgkin 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 Hodgkin lymphoma and death from Hodgkin 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, Hodgkin lymphoma or death from Hodgkin lymphoma 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 15 pack-years before the clinical onset of Hodgkin lymphoma; and\n\n(b) commencing at least 10 years before the clinical onset of Hodgkin lymphoma; and\n\nif smoking has ceased before the clinical onset of Hodgkin lymphoma, then that onset occurred within 5 years of cessation;\n\nNote: one pack-year is defined in the Schedule 1 - Dictionary.\n\n(2) being obese for at least 5 years within the 20 years before the clinical onset of Hodgkin lymphoma;\n\nNote: being obese is defined in the Schedule 1 - Dictionary.\n\n(3) having infection with human immunodeficiency virus before the clinical onset of Hodgkin lymphoma;\n\n(4) having serological evidence of infection with Epstein-Barr virus before the clinical onset of Hodgkin lymphoma;\n\n(5) having an autoimmune disease from the specified list of autoimmune diseases before the clinical onset of Hodgkin lymphoma;\n\nNote: specified list of autoimmune diseases is defined in the Schedule 1 - Dictionary.\n\n(6) having received a stem cell, bone marrow or solid organ transplantation before the clinical onset of Hodgkin lymphoma;\n\n(7) having mature B-cell lymphoid leukaemia/small lymphocytic lymphoma at the time of the clinical onset of Hodgkin lymphoma;\n\nNote: Mature B-cell lymphoid leukaemia/small lymphocytic lymphoma are also known as mature B-cell lymphoid leukaemia and small lymphocytic lymphoma, and chronic lymphocytic leukaemia/small lymphocytic lymphoma.\n\n(8) having an active tuberculosis disease before the clinical onset of Hodgkin lymphoma;\n\nNote: active tuberculosis disease is defined in the Schedule 1 - Dictionary.\n\n(9) inability to obtain appropriate clinical management for Hodgkin lymphoma before the clinical worsening of Hodgkin 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(9) applies only to material contribution to, or aggravation of, Hodgkin lymphoma where the person's Hodgkin 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\nSchedule 1 - Dictionary \n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\n active tuberculosis disease means an illness in which tuberculosis bacteria are multiplying and inducing an inflammatory response.\n\n being obese means having a Body Mass Index (BMI) of 30 or greater.\n\nNote: BMI is also defined in the Schedule 1 - Dictionary.\n\n BMI means W/H2 where:\n\n (a) W is the person's weight in kilograms; and\n\n (b) H is the person's height in metres.\n\n Hodgkin lymphoma—see subsection 7(2).\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\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 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 specified list of autoimmune diseases means:\n\n(a) Behçet disease;\n\n(b) immune thrombocytopaenic purpura;\n\n(c) psoriasis;\n\n(d) rheumatoid arthritis;\n\n(e) sarcoidosis;\n\n(f) Sjögren syndrome; or\n\n(g) systemic lupus erythematosus.\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"},"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the 2014 Statement (section 4) and substitutes updated criteria and definitions. It specifies a new list of qualifying factors, numeric thresholds (eg. 15 pack‑years; BMI ≥30 for 5 years), temporal rules for onset/cessation, and cross‑references to other Statements, thereby modifying the medical criteria used to link Hodgkin lymphoma to relevant service for VEA/MRCA claims (sections 4, 7–11; Schedule)."},"complexity_factors":["Legal replacement and application mechanics: instrument repeals prior Statement (section 4) and applies to claims under VEA s120B and MRCA s339 (section 5).","Medical-technical definitions: detailed clinical definition of Hodgkin lymphoma and exclusion of non-Hodgkin lymphoma (section 7(2)–(4)).","Quantitative exposure thresholds and temporal conditions (smoking 15 pack‑years; start ≥10 years before onset; cessation within 5 years) (section 9(1); Schedule definition of pack‑year).","Duration and timing conditions for obesity (BMI ≥30 for ≥5 years within 20 years before onset) and BMI calculation (section 9(2); Schedule).","List of discrete clinical risk factors (HIV, EBV serology, specified autoimmune diseases, transplants, prior mature B‑cell leukaemia, active tuberculosis) with defined terms (section 9(3)–(8); Schedule).","Causal linkage requirement: each factor must be related to the person's relevant service (section 10(1)) and limits on aggravation material contribution (section 10(2)).","Cross-referencing to other Statements of Principles where factors overlap (section 11).","Evidentiary standard and its operationalisation: 'more probable than not' on sound medical‑scientific evidence (section 8) — requires medical assessment and documentary proof.","Potentially high evidentiary/compliance burden where proof of timing, duration, serology, or inability to obtain appropriate care is needed (sections 9, Schedule)."],"plain_english_summary":"**What this does:** This instrument replaces the 2014 Statement and sets the medical criteria used to decide whether Hodgkin lymphoma (and death from it) can be connected to a veteran's or member's relevant service for claims under the VEA or MRCA. \n\n**Who it affects and why it matters:** It affects veterans and Defence members lodging entitlement claims. It lists specific medical and exposure factors (for example, smoking ≥15 pack‑years with timing limits, obesity for 5 years, HIV/EBV infection, certain autoimmune diseases, prior transplants or B‑cell leukaemia, active tuberculosis, or lack of appropriate clinical management) that must be present and related to service before a causal link is accepted."},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard replacement Statement of Principles under the Veterans' Entitlements Act framework. It maintains the same scope as its 2014 predecessor and other similar instruments — establishing medical connection factors for a specific disease in the veterans' compensation scheme. No scope creep is evident; it performs the same function as the original legislation intended."},"complexity_factors":["Multiple nested conditions within single factors (e.g., factor 9(1) has 3 sub-conditions for smoking: quantity, timing, and cessation window)","Cross-referencing between Acts: requires understanding of VEA and MRCA service types (eligible war service, defence service, peacetime service, operational service, hazardous service)","Mathematical calculation required for pack-years and BMI with specific formulas provided","Defined terms scattered throughout with some terms defined by reference to other subsections (e.g., 'Hodgkin lymphoma—see subsection 7(2)')","Specific list of 7 autoimmune diseases that must be cross-checked","Conditional logic distinguishing between 'clinical onset' and 'clinical worsening' with different rules applying to each","Note 2 under 'one pack-year' contains a mathematical error in the example (10 cigarettes/day × 10 years = 5 pack-years is correct, but the explanation says 'dividing the number of cigarettes smoked per day by 20' — 10/20 × 10 = 5, which is actually correct, though the phrasing is slightly awkward)"],"plain_english_summary":"This instrument issues a Statement of Principles that tests, on the balance of probabilities, whether a veteran’s Hodgkin lymphoma is connected to Australian military service, replacing the 2014 rules. It applies to claims under the Veterans’ Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004. \nIt matters because claimants must link at least one specified medical or exposure-related risk factor to their service under tight timing and definition rules — without that link, compensation is unlikely."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-hodgkin-lymphoma-balance-of-probabilities-no-71-of-2023","history":"/api/acts/statement-of-principles-concerning-hodgkin-lymphoma-balance-of-probabilities-no-71-of-2023/history","analysis":"/api/acts/statement-of-principles-concerning-hodgkin-lymphoma-balance-of-probabilities-no-71-of-2023/analysis","conflicts":"/api/acts/statement-of-principles-concerning-hodgkin-lymphoma-balance-of-probabilities-no-71-of-2023/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-hodgkin-lymphoma-balance-of-probabilities-no-71-of-2023/important-cases","documents":"/api/acts/statement-of-principles-concerning-hodgkin-lymphoma-balance-of-probabilities-no-71-of-2023/documents"}}