{"id":"F2019L01689","name":"Statement of Principles concerning Kaposi sarcoma (Reasonable Hypothesis) (No. 1 of 2020)","slug":"statement-of-principles-concerning-kaposi-sarcoma-reasonable-hypothesis-no-1-of-2020","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440351,"registerId":"F2019L01689-fast-fetch-1775956013959","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning Kaposi sarcoma (Reasonable Hypothesis) (No. 1 of 2020)","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\nKAPOSI SARCOMA (Reasonable Hypothesis)\n\n(No. 1 of 2020)\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 December 2019\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 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 Kaposi sarcoma (Reasonable Hypothesis) (No. 1 of 2020).\n\n2 Commencement\n\n This instrument commences on 27 January 2020.\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 Kaposi's sarcoma No. 9 of 2011 (Federal Register of Legislation No. F2010L03266) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 Kaposi sarcoma and death from Kaposi sarcoma.\n\nMeaning of Kaposi sarcoma\n\n(2) For the purposes of this Statement of Principles, Kaposi sarcoma:\n\n(a) means a multicentric vascular neoplasm arising from endothelial cells and characterised by the proliferation of spindle cells, formation of new blood vessels and inflammation; and\n\n(b) excludes soft tissue sarcoma.\n\nNote: Typical clinical manifestations are coloured patches, plaques or nodules on the skin, although lesions may also involve the mucous membranes, lymph nodes and viscera.\n\n(3) While Kaposi sarcoma attracts ICD‑10‑AM code C46, in applying this Statement of Principles the meaning of Kaposi sarcoma 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 Kaposi sarcoma\n\n(5) For the purposes of this Statement of Principles, Kaposi sarcoma, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's Kaposi sarcoma.\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 Kaposi sarcoma and death from Kaposi sarcoma 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 Kaposi sarcoma or death from Kaposi sarcoma with the circumstances of a person's relevant service:\n\n(1) having infection with human herpesvirus type 8 before the clinical onset of Kaposi sarcoma;\n\n(2) having infection with human immunodeficiency virus before the clinical onset of Kaposi sarcoma;\n\n(3) having non-Hodgkin lymphoma or chronic lymphocytic leukaemia/small lymphocytic lymphoma before the clinical onset of Kaposi sarcoma;\n\n(4) having chronic renal failure at least six months before the clinical onset of Kaposi sarcoma;\n\nNote: chronic renal failure is defined in the Schedule 1 - Dictionary. \n\n(5) having an autoimmune disease from the specified list of autoimmune diseases at least six months before the clinical onset of Kaposi sarcoma;\n\nNote: specified list of autoimmune diseases is defined in the Schedule 1 - Dictionary. \n\n(6) having diabetes mellitus for at least six months before the clinical onset of Kaposi sarcoma;\n\n(7) having lymphoedema involving the affected site at least five years before the clinical onset of Kaposi sarcoma;\n\n(8) undergoing solid organ, stem cell or bone marrow transplantation before the clinical onset of Kaposi sarcoma;\n\n(9) being treated with an immunosuppressive drug:\n\n(a) for a continuous period of at least three months before the clinical onset of Kaposi sarcoma; and\n\n(b) where that exposure has ceased, the clinical onset of Kaposi sarcoma has occurred within ten years of cessation;\n\nNote: immunosuppressive drug is defined in the Schedule 1 - Dictionary. \n\n(10) being treated with an angiotensin converting enzyme inhibitor:\n\n(a) for at least three months before the clinical onset of Kaposi sarcoma; and\n\n(b) where that exposure has ceased, the clinical onset of Kaposi sarcoma has occurred within ten years of cessation;\n\n(11) inability to obtain appropriate clinical management for Kaposi sarcoma.\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(11) applies only to material contribution to, or aggravation of, Kaposi sarcoma where the person's Kaposi sarcoma 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 chronic renal failure means:\n\n(a) having a glomerular filtration rate of less than 15 mL/min/1.73 m2 for a period of at least three months; or\n\n(b) a need for renal replacement therapy (dialysis or transplantation) for treatment of complications of decreased glomerular filtration rate which would otherwise increase the risk of morbidity and mortality; or\n\n(c) undergoing chronic dialysis.\n\n immunosuppressive drug means a drug or an agent which results in substantial suppression of immune responses.\n\n Note: Examples of an immunosuppressive drug include, but are not limited to:\n\n(a) chemotherapeutic agents used for the treatment of cancer;\n\n(b) corticosteroids, other than inhaled or topical corticosteroids;\n\n(c) drugs used to prevent transplant rejection; and\n\n(d) tumour necrosis factor-α inhibitors.\n\n Kaposi sarcoma—see subsection 7(2).\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 specified list of autoimmune diseases means:\n\n(a) Addison disease;\n\n(b) autoimmune haemolytic anaemia;\n\n(c) Behcet disease;\n\n(d) granulomatosis with polyangiitis (Wegener granulomatosis);\n\n(e) myasthenia gravis;\n\n(f) pemphigoid;\n\n(g) pemphigus;\n\n(h) polyarteritis nodosa;\n\n(i) polymyalgia rheumatica;\n\n(j) psoriasis;\n\n(k) rheumatoid arthritis;\n\n(l) systemic lupus erythematosus;\n\n(m) systemic or localised scleroderma; or \n\n(n) ulcerative colitis.\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 established scope of Repatriation Medical Authority Statements of Principles. It replaces the 2011 version concerning the same disease (Kaposi sarcoma) without expanding into new policy areas. The structure follows the standard template: definition, factors, relationship to service, and dictionary. The update appears to reflect contemporary medical understanding (ICD-10-AM 10th Edition, updated autoimmune disease list) rather than scope creep."},"complexity_factors":["Moderate cross-referencing: 8 defined terms in Schedule 1, with some terms (MRCA, VEA) circularly defined","Temporal conditions: Multiple factors require specific timeframes (6 months, 5 years, 3 months continuous, 10-year post-cessation windows)","Nested definitions: 'Chronic renal failure' has 3 alternative technical criteria involving medical measurements (glomerular filtration rate)","Exclusion clause: Explicitly excludes soft tissue sarcoma from the definition, requiring careful diagnostic distinction","Conditional logic in factor 9(11): Special limitation applying only to aggravation cases where disease pre-existed service","Incorporation by reference: ICD-10-AM coding system (external document) incorporated for classification purposes","Interlocking instruments: Section 11 creates dynamic references to other Statements of Principles that apply 'as in force from time to time'"],"plain_english_summary":"This Statement of Principles sets the medical test for whether Kaposi sarcoma (or death from it) in veterans and defence members can be attributed to service. Using a \"reasonable hypothesis\" standard, it identifies 11 medical/exposure factors — such as HHV‑8 infection, HIV, immunosuppression and gaps in treatment — that can support a service link.\n\nIt applies to veterans, peacekeepers and current/former defence personnel claiming under the VEA or MRCA, updates the 2011 guidance, and helps determine eligibility for pensions or compensation."},"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":5,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the prior Statement of Principles concerning Kaposi's sarcoma No. 9 of 2011 (s4) and replaces it with a new Statement that defines the disease, lists qualifying medical factors, sets temporal exposure windows, and adds or clarifies specific risk factors (for example ACE‑inhibitor exposure, diabetes, specified autoimmune diseases, transplant/immunosuppression, chronic renal failure, lymphoedema) and definitions in Schedule 1. It applies to claims under section 120A of the VEA or section 338 of the MRCA (s5)."},"complexity_factors":["Medical and technical terminology (Kaposi sarcoma, HHV‑8, ICD‑10‑AM code) requiring clinical interpretation (s7(2),(3))","Temporal thresholds and exposure windows for causation (e.g. 3 months, 6 months, 5 years, 10 years) that affect eligibility (s9(4)–(10))","Legal standard of a \"reasonable hypothesis\" and requirement that factors be \"related to\" relevant service, which requires factual and causal assessment (s8, s9, s10)","Cross-references to other legislation and Statements of Principles (VEA, MRCA, other SOPs) creating dependency on external instruments (s3, s5, s11)","Defined terms and exclusions that constrain meaning (chronic renal failure, immunosuppressive drug, specified autoimmune diseases, terminal event) in the Schedule (Schedule 1)","An open-ended, partially discretionary factor (\"inability to obtain appropriate clinical management\") that may require evaluative decision-making (s9(11), s10(2))","Interplay between factors that are themselves other compensable conditions (application of other SOPs via s11)"],"plain_english_summary":"This Statement sets the medical criteria for treating Kaposi sarcoma (and death from it) as plausibly connected to military service. It was made by the Repatriation Medical Authority under subsection 196B(2) of the VEA and applies to claims under the VEA and the MRCA (s3–s5; s4 repeals the 2011 instrument).\n\nA claim requires at least one listed medical factor (for example HHV‑8 or HIV infection, transplant/immunosuppression, chronic renal failure, diabetes, prolonged lymphoedema, ACE‑inhibitor exposure, or inability to obtain appropriate clinical management) that is related to the person’s relevant service (s9–s11)."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-kaposi-sarcoma-reasonable-hypothesis-no-1-of-2020","history":"/api/acts/statement-of-principles-concerning-kaposi-sarcoma-reasonable-hypothesis-no-1-of-2020/history","analysis":"/api/acts/statement-of-principles-concerning-kaposi-sarcoma-reasonable-hypothesis-no-1-of-2020/analysis","conflicts":"/api/acts/statement-of-principles-concerning-kaposi-sarcoma-reasonable-hypothesis-no-1-of-2020/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-kaposi-sarcoma-reasonable-hypothesis-no-1-of-2020/important-cases","documents":"/api/acts/statement-of-principles-concerning-kaposi-sarcoma-reasonable-hypothesis-no-1-of-2020/documents"}}