{"id":"F2020L01112","name":"Statement of Principles concerning malignant neoplasm of bone and articular cartilage (Balance of Probabilities) (No. 67 of 2020)","slug":"statement-of-principles-concerning-malignant-neoplasm-of-bone-and-articular-cartilage-balance-of-pro","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440596,"registerId":"F2020L01112-fast-fetch-1775956164557","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning malignant neoplasm of bone and articular cartilage (Balance of Probabilities) (No. 67 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\nMALIGNANT NEOPLASM OF BONE AND ARTICULAR CARTILAGE (Balance of Probabilities)\n\n(No. 67 of 2020)\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 28 August 2020\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 malignant neoplasm of bone and articular cartilage (Balance of Probabilities) (No. 67 of 2020).\n\n2 Commencement\n\n This instrument commences on 28 September 2020.\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 neoplasm of bone and articular cartilage No. 107 of 2011 (Federal Register of Legislation No. F2011L01740) made under subsections 196B(3) and (8) 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 neoplasm of bone and articular cartilage and death from malignant neoplasm of bone and articular cartilage.\n\nMeaning of malignant neoplasm of bone and articular cartilage\n\n(2) For the purposes of this Statement of Principles, malignant neoplasm of bone and articular cartilage:\n\n(a) means a primary malignant neoplasm arising in bone or articular cartilage; and\n\n(b) includes:\n\n(i) chondrosarcoma of bone or articular cartilage;\n\n(ii) Ewing sarcoma; and\n\n(iii) osteosarcoma; and\n\n(c) excludes:\n\n(i) malignant neoplasms of haematopoietic tissue within bones;\n\n(ii) metastatic lesions within bone or articular cartilage arising from other primary malignant neoplasms; and\n\n(iii) soft tissue sarcoma.\n\n(3) While malignant neoplasm of bone and articular cartilage attracts ICD‑10‑AM code C40 or C41, in applying this Statement of Principles the meaning of malignant neoplasm of bone and articular cartilage 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 neoplasm of bone and articular cartilage\n\n(5) For the purposes of this Statement of Principles, malignant neoplasm of bone and articular cartilage, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's malignant neoplasm of bone and articular cartilage.\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 neoplasm of bone and articular cartilage and death from malignant neoplasm of bone and articular cartilage 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 neoplasm of bone and articular cartilage or death from malignant neoplasm of bone and articular cartilage is connected with the circumstances of a person's relevant service:\n\n(1) having received a cumulative equivalent dose of at least 0.5 sievert of ionising radiation to the affected region at least five years before the clinical onset of malignant neoplasm of bone or articular cartilage;\n\nNote: cumulative equivalent dose is defined in the Schedule 1 - Dictionary.\n\n(2) having Paget's disease of bone at the affected site before the clinical onset of malignant neoplasm of bone or articular cartilage;\n\n(3) having chronic osteomyelitis at the affected site before the clinical onset of malignant neoplasm of bone or articular cartilage;\n\n(4) having giant cell tumour of bone at the affected site before the clinical onset of malignant neoplasm of bone or articular cartilage;\n\n(5) taking an anthracycline chemotherapeutic agent at least five years before the clinical onset of malignant neoplasm of bone or articular cartilage;\n\n(6) inability to obtain appropriate clinical management for malignant neoplasm of bone or articular cartilage.\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(6) applies only to material contribution to, or aggravation of, malignant neoplasm of bone and articular cartilage where the person's malignant neoplasm of bone and articular cartilage 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 cumulative equivalent dose means the total dose of ionising radiation received by the particular organ or tissue from external exposure, internal exposure or both, apart from normal background radiation exposure in Australia, calculated in accordance with the methodology set out in Guide to calculation of 'cumulative equivalent dose' for the purpose of applying ionising radiation factors contained in Statements of Principles determined under Part XIA of the Veterans' Entitlements Act 1986 (Cth), Australian Radiation Protection and Nuclear Safety Agency, as in force on 2 August 2017.\n\nNote 1: Examples of circumstances that might lead to exposure to ionising radiation include being present during or subsequent to the testing or use of nuclear weapons, undergoing diagnostic or therapeutic medical procedures involving ionising radiation, and being a member of an aircrew, leading to increased levels of exposure to cosmic radiation.\n\nNote 2: For the purpose of dose reconstruction, dose is calculated as an average over the mass of a specific tissue or organ. If a tissue is exposed to multiple sources of ionising radiation, the various dose estimates for each type of radiation must be combined.\n\n malignant neoplasm of bone and articular cartilage—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 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"},"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 updates the 2011 version with current medical evidence and ICD-10-AM coding (Tenth Edition, 2017) but does not expand beyond the traditional purpose of establishing service connection criteria for specific conditions under veterans' compensation legislation."},"complexity_factors":["Moderate cross-referencing: Requires understanding of the Veterans' Entitlements Act 1986 and Military Rehabilitation and Compensation Act 2004","Technical medical terminology: Uses specific ICD-10-AM coding references and defined radiation measurement units (sieverts)","Nested definitions: Key terms like 'cumulative equivalent dose' rely on external ARPANSA methodology documents","Conditional logic in factor 9(6): Special limitation applying only to pre-existing conditions aggravated by service","Exclusion clauses in section 7(2)(c): Three specific exclusions that narrow the scope beyond the general definition","Temporal requirements: Two factors require 5-year latency periods between exposure and clinical onset"],"plain_english_summary":"This Statement of Principles sets the medical criteria for treating primary bone cancers (e.g. chondrosarcoma, Ewing, osteosarcoma) as service‑related for veterans and defence members. Claims are decided on the balance of probabilities and are accepted only if at least one specified factor applies—notably significant ionising radiation exposure, pre‑existing Paget’s disease, chronic osteomyelitis, giant cell tumour, prior anthracycline chemotherapy, or lack of timely treatment. The RMA uses it to ensure consistent compensation decisions."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":false,"description":"The instrument repeals the earlier Statement (s4) and restates the operative scope in its own terms (see s7(1)–(5)). The text does not itself state that the substantive scope has been broadened or narrowed relative to the prior instrument; therefore, based only on this instrument, the scope should be read as defined here without an express change from the original."},"complexity_factors":["Technical medical definitions and inclusions/exclusions for the disease (see s7(2)–(3)).","Numeric radiation threshold and multi‑step dose reconstruction methodology referring to an external guide (s9(1); Schedule: cumulative equivalent dose definition).","Temporal qualifications (eg. 5‑year latency for radiation and anthracycline exposure) and site‑specificity of factors (s9(1), s9(5)).","Requirement that any qualifying factor be related to the person’s relevant service under the VEA/MRCA (s10(1); Schedule: relevant service).","Interaction with other Statements of Principles — factors may import another Statement’s terms (s11).","Definitions affecting scope of death causation via 'terminal event' and exclusions (Schedule: terminal event; s7(2)(c)).","Statutory cross‑references and administrative effect (application to claims under specified sections of VEA and MRCA) (s5)."],"plain_english_summary":"This instrument sets out the medical conditions and factual links that must exist for malignant tumours of bone and articular cartilage (and death from them) to be treated as connected with a person’s military service for veterans’ compensation claims. It applies to claims under the Veterans’ Entitlements Act and the Military Rehabilitation and Compensation Act. Key mechanics: it lists included/excluded tumour types, specific causal factors (for example, prior radiation dose, certain pre‑existing bone diseases, specified chemotherapy, or failure to obtain appropriate clinical management) and requires those factors to be related to the person’s relevant service."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-bone-and-articular-cartilage-balance-of-pro","history":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-bone-and-articular-cartilage-balance-of-pro/history","analysis":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-bone-and-articular-cartilage-balance-of-pro/analysis","conflicts":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-bone-and-articular-cartilage-balance-of-pro/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-bone-and-articular-cartilage-balance-of-pro/important-cases","documents":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-bone-and-articular-cartilage-balance-of-pro/documents"}}