{"id":"F2024L00486","name":"Statement of Principles concerning malignant melanoma of the skin (Balance of Probabilities) (No. 35 of 2024)","slug":"statement-of-principles-concerning-malignant-melanoma-of-the-skin-balance-of-probabilities-no-35-of-","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442373,"registerId":"F2024L00486-fast-fetch-1775957393915","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning malignant melanoma of the skin (Balance of Probabilities) (No. 35 of 2024)","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\nMALIGNANT MELANOMA OF THE SKIN (Balance of Probabilities)\n\n(No. 35 of 2024)\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 26 April 2024.\n\n \n\n \n\n \n\n \n\n \n\n|
|\n| --- |\n| Professor Terence Campbell AM
Chairperson
by and on behalf of
The Repatriation Medical Authority |\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 malignant melanoma of the skin (Balance of Probabilities) (No. 35 of 2024).\n\n2 Commencement\n\n This instrument commences on 28 May 2024.\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 malignant melanoma of the skin (Balance of Probabilities) (No. 103 of 2015) (Federal Register of Legislation No. F2015L01318) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 malignant melanoma of the skin and death from malignant melanoma of the skin.\n\nMeaning of malignant melanoma of the skin\n\n(2) For the purposes of this Statement of Principles, malignant melanoma of the skin:\n\n(a) means a primary malignant neoplasm arising from the melanocytes; and\n\n(b) includes:\n\n(i) melanoma in situ including Hutchinson melanotic freckle/lentigo maligna;\n\n(ii) superficial spreading melanoma;\n\n(iii) lentigo maligna melanoma;\n\n(iv) nodular melanoma;\n\n(v) desmoplastic melanoma;\n\n(vi) amelanotic melanoma; and\n\n(vii) malignant melanoma of the skin of the lip, anogenital region, and acral regions (palms of the hands, soles of the feet, and skin underlying the nails); and\n\n(c) excludes:\n\n(i) malignant melanoma of the eye;\n\n(ii) malignant melanoma of the mucosa; and\n\n(iii) melanocytic naevi.\n\n(3) While malignant melanoma of the skin attracts ICD‑10‑AM codes C43 and D03, in applying this Statement of Principles the meaning of malignant melanoma of the skin 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 malignant melanoma of the skin\n\n(5) For the purposes of this Statement of Principles, malignant melanoma of the skin, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's malignant melanoma of the skin.\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 malignant melanoma of the skin and death from malignant melanoma of the skin 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, malignant melanoma of the skin or death from malignant melanoma of the skin is connected with the circumstances of a person's relevant service:\n\n(1) having at least 5 sunburns at the affected site at least 5 years before clinical onset;\n\nNote: sunburn is defined in the Schedule 1 - Dictionary.\n\n(2) having sunlight exposure to unprotected skin for a cumulative period of at least 4,500 latitude equivalent hours before clinical onset;\n\nNote: latitude equivalent hours and unprotected skin are defined in the Schedule 1 - Dictionary.\n\n(3) having ultraviolet radiation exposure from an ultraviolet-emitting tanning device on at least 10 occasions before the clinical onset of malignant melanoma of the skin, where the first exposure occurred more than 5 years before clinical onset;\n\n(4) having PUVA therapy, where:\n\n(a) the first PUVA treatment commenced at least 15 years before clinical onset; and\n\n(b) at least 250 PUVA treatments were administered, before clinical onset;\n\nNote: PUVA therapy is defined in the Schedule 1 - Dictionary.\n\n(5) undergoing solid organ (excluding corneal transplant) or bone marrow transplantation before clinical onset;\n\n(6) being treated with methotrexate or azathioprine within the 2 years before clinical onset;\n\n(7) having non-Hodgkin lymphoma at least one year before clinical onset;\n\n(8) having chronic lymphocytic leukaemia/small cell lymphoma at least one year before clinical onset;\n\nNote: Chronic lymphocytic leukaemia/small cell lymphoma is also known as mature B-cell lymphoid leukaemia and small lymphocytic lymphoma.\n\n(9) having Parkinson’s disease for at least 2 years before clinical onset;\n\n(10) inability to obtain appropriate clinical management for malignant melanoma of the skin before clinical worsening.\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(10) applies only to material contribution to, or aggravation of, malignant melanoma of the skin where the person's malignant melanoma of the skin 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 latitude equivalent hours means hours of sunlight exposure multiplied by the appropriate latitude weighting factor as follows:\n\n(a) For tropical latitudes (23.5° South to 23.5° North) multiply by 1.0;\n\n(b) For subtropical latitudes (23.6° to 35°) multiply by 0.75;\n\n(c) For warm temperate latitudes (35.1° to 45°) multiply by 0.5;\n\n(d) For cool temperate latitudes (45.1° to 65°) multiply by 0.25.\n\nNote: sunlight exposure is calculated as the sum of sunlight exposure in each separate latitude, accounting for the different sunlight intensity in each latitude (weighting factor).\n\nSum of sunlight exposure = (hours spent in tropical latitude x tropical latitude weighting factor) + (hours spent in subtropical latitude x subtropical latitude weighting factor) + (hours spent in warm temperate latitude x warm temperate latitude weighting factor) + (hours spent in cool temperate latitude x cool temperate latitude weighting factor)\n\n malignant melanoma of the skin—see subsection 7(2).\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n PUVA therapy means a combination treatment consisting of taking oral psoralen (P) (also known as Methoxsalen) and exposing the skin to long-wave ultra-violet light (UVA).\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 sunburn means painful erythema of the skin of at least 48 hours duration, resulting from exposure to solar ultraviolet radiation.\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 unprotected skin means skin that is directly exposed to the sun and is not protected by sunscreen, clothing or other physical barrier.\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 is a straightforward reissue/update of an existing Statement of Principles. It replaces the 2015 version (No. 103 of 2015) with the same basic structure and purpose. The scope remains tightly focused on establishing medical criteria for linking malignant melanoma of the skin to military service. No expansion beyond the original intent is evident."},"complexity_factors":["Specialised medical terminology throughout (neoplasm, melanocytes, PUVA therapy, amelanotic melanoma)","Mathematical calculation required for latitude equivalent hours with four different weighting factors (1.0, 0.75, 0.5, 0.25) based on geographic zones","Multiple temporal conditions ('at least 5 years before', 'within 2 years before', 'at least one year before')","Cross-references to other legislation (VEA, MRCA) and other Statements of Principles","Specific exclusion clauses (eye melanoma, mucosal melanoma, naevi excluded from definition)","Nested definitions (sunburn requires 'painful erythema of at least 48 hours duration')","Dual application framework (applies to two different Acts with different service definitions)"],"plain_english_summary":"This instrument replaces the 2015 medical rules and sets updated criteria for deciding, on the balance of probabilities, whether malignant melanoma in veterans and defence members is related to their service (claims under the Veterans’ Entitlements Act 1986 and MRCA 2004). It lists ten specified risk factors — including repeated sunburn, quantified heavy sun exposure (latitude-equivalent hours), tanning beds, certain therapies/conditions and immunosuppression — and clarifies the evidence needed to establish service connection."},"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"This instrument repeals the 2015 Statement (s4) and replaces it with updated, specified qualifying factors and definitions (notably latitude equivalent hours and numeric thresholds for sun/tanning/PUVA exposure; s9, Schedule 1). It also clarifies included and excluded melanoma sites (s7(2)–(3)) and confirms interaction with other Statements (s11). The repeal plus these new numeric and definitional criteria indicate a change in scope and application compared with the earlier instrument."},"complexity_factors":["Technical medical definitions and exclusions (definition of malignant melanoma of the skin, s7(2)–(4))","Quantitative exposure thresholds requiring calculation (latitude equivalent hours; Schedule 1; s9(2))","Multiple distinct qualifying pathways with temporal thresholds (sunburn counts, tanning device occasions, PUVA number and timing, s9(1)–(4))","Cross‑reference to other Statements of Principles and need to apply those instruments where relevant (s11)","Proof and causation requirement that each factor be related to the person's relevant service (s10(1)), increasing evidentiary and administrative burden","Presence of medical, treatment and disease history factors (transplantation, immunosuppressant drugs, lymphoid malignancies, Parkinson’s) that require clinical records (s9(5)–(9))","Definitional and calculation complexity for exposure assessment (sunburn definition; unprotected skin; Schedule 1)"],"plain_english_summary":"This Statement of Principles, made by the Repatriation Medical Authority, sets the medical criteria used to decide whether malignant melanoma of the skin (and death from it) is connected to a person’s veteran or defence service for claims under the VEA or MRCA (ss 3, 5, 7). It lists specific qualifying factors—such as multiple sunburns, cumulative sunlight measured in latitude‑equivalent hours, tanning‑device exposure, PUVA treatment thresholds, certain transplants, drugs or cancers, Parkinson’s disease, and lack of appropriate clinical management—that must be linked to service (ss 9–10)."},"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-malignant-melanoma-of-the-skin-balance-of-probabilities-no-35-of-","history":"/api/acts/statement-of-principles-concerning-malignant-melanoma-of-the-skin-balance-of-probabilities-no-35-of-/history","analysis":"/api/acts/statement-of-principles-concerning-malignant-melanoma-of-the-skin-balance-of-probabilities-no-35-of-/analysis","conflicts":"/api/acts/statement-of-principles-concerning-malignant-melanoma-of-the-skin-balance-of-probabilities-no-35-of-/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-malignant-melanoma-of-the-skin-balance-of-probabilities-no-35-of-/important-cases","documents":"/api/acts/statement-of-principles-concerning-malignant-melanoma-of-the-skin-balance-of-probabilities-no-35-of-/documents"}}