{"id":"F2020L01110","name":"Statement of Principles concerning malignant neoplasm of bone and articular cartilage (Reasonable Hypothesis) (No. 66 of 2020)","slug":"statement-of-principles-concerning-malignant-neoplasm-of-bone-and-articular-cartilage-reasonable-hyp","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440595,"registerId":"F2020L01110-fast-fetch-1775956164556","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 (Reasonable Hypothesis) (No. 66 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 (Reasonable Hypothesis)\n\n(No. 66 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 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 (Reasonable Hypothesis) (No. 66 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning malignant neoplasm of bone and articular cartilage No. 106 of 2011 (Federal Register of Legislation No. F2011L01742) made under subsections 196B(2) and (8) 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 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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates 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, 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 malignant neoplasm of bone and articular cartilage or death from malignant neoplasm of bone and articular cartilage with the circumstances of a person's relevant service:\n\n(1) having received a cumulative equivalent dose of at least 0.1 sievert of ionising radiation to the affected region at least two 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 osteonecrosis at the affected site before the clinical onset of malignant neoplasm of bone or articular cartilage;\n\nNote: Osteonecrosis is also known as a bone infarct.\n\n(4) having chronic osteomyelitis at the affected site before the clinical onset of malignant neoplasm of bone or articular cartilage;\n\n(5) having giant cell tumour of bone at the affected site before the clinical onset of malignant neoplasm of bone or articular cartilage;\n\n(6) undergoing stem cell or bone marrow transplantation before the clinical onset of malignant neoplasm of bone or articular cartilage;\n\n(7) taking growth hormone for at least three months before the clinical onset of malignant neoplasm of bone or articular cartilage;\n\n(8) taking an anthracycline chemotherapeutic agent at least five years before the clinical onset of malignant neoplasm of bone or articular cartilage;\n\n(9) taking denosumab for at least three months before the clinical onset of malignant neoplasm of bone or articular cartilage, and where taking denosumab has permanently ceased, the clinical onset of malignant neoplasm of bone or articular cartilage has occurred within two years of cessation;\n\n(10) 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(10) 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(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 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) 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":{"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"},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard replacement instrument updating the 2011 version. The scope remains consistent with the original intent: establishing medical criteria for veterans' compensation claims for specific bone cancers. The update appears to add denosumab as a new factor (reflecting medical developments) and updates the ICD-10-AM reference to the 2017 edition, but does not expand beyond the original purpose of determining service connection for bone malignancies."},"complexity_factors":["Moderate cross-referencing between the main instrument and Schedule 1 dictionary (6 defined terms)","Nested definitions requiring external document reference (cumulative equivalent dose calculation methodology refers to ARPANSA guide from 2017)","Conditional temporal requirements (e.g., 'at least two years before', 'at least five years before', 'within two years of cessation')","Exclusion clauses in the disease definition (3 specific exclusions in section 7(2))","Dual legislative framework application (VEA and MRCA with 6 sub-categories of 'relevant service')","Incorporation of external medical classification system (ICD-10-AM Tenth Edition with specific ISBN and effective date)"],"plain_english_summary":"This instrument sets the medical criteria for veterans to claim compensation for malignant bone and articular cartilage cancers (eg, chondrosarcoma, Ewing sarcoma, osteosarcoma) under Australia’s veterans’ laws, replacing the 2011 rules. It applies to current and former defence members and excludes blood cancers in bone, metastases to bone, and soft-tissue sarcomas.\n\nA claim succeeds if at least one specified medical factor links the cancer to service (examples: significant radiation exposure, certain pre‑existing bone conditions, or particular treatments). It operates on a “reasonable hypothesis” standard, making service connection easier to establish."},"flash_summary":{"complexity_score":7,"scope_assessment":{"changed":true,"description":"This instrument repeals and replaces the earlier Statement of Principles No. 106 of 2011 (section 4), so the legal instrument in force has changed. The current instrument continues to target service‑connection for malignant neoplasm of bone and articular cartilage for claims under the VEA and MRCA (section 5), but the source text does not supply a comparison of substantive differences between the old and new criteria."},"complexity_factors":["Technical radiation threshold and dose reconstruction: requires cumulative equivalent dose ≥0.1 sievert and refers to an external methodology for dose calculation (section 9(1); Schedule: cumulative equivalent dose).","Multiple medical risk/treatment factors with distinct temporal rules: e.g. prior Paget's disease, osteonecrosis, chronic osteomyelitis, giant cell tumour, stem cell/bone‑marrow transplant, growth hormone (≥3 months), anthracycline chemotherapy (≥5 years), denosumab (≥3 months with 2‑year cessation window) (section 9(2)–(9)).","Timing windows and latency: different minimum intervals and cessation-to-onset windows increase evidentiary complexity (sections 9(1), 9(8)–(9)).","Interaction with other Statements of Principles: factors may refer to injuries/diseases governed by other SOPs, requiring cross-referencing and application of those instruments (section 11).","Definitions and applied coding: legal definitions (Schedule 1) and an ICD‑10‑AM code reference for identification add technical classification tasks (section 7(3)–(4); Schedule 1).","Scope of application and linkage test: every listed factor must be related to the person’s relevant service; material contribution/aggravation rule varies where disease pre‑existed service (section 10).","Administrative/legal replacement: this instrument repeals an earlier Statement, so practitioners must ensure they apply the current criteria (section 4).","Medical‑legal evidentiary requirements: proving factors (e.g. radiation dose, prior conditions, treatment duration) will often require specialist reports, historical dose reconstruction or clinical records, raising evidentiary and administrative burden (sections 9; Schedule)."],"plain_english_summary":"This instrument tells decision-makers which medical facts the Repatriation Medical Authority treats as enough to reasonably link malignant tumours of bone and articular cartilage to a person’s military or peacekeeping service for claims under the VEA or MRCA. It names included/excluded tumour types and lists specific exposures, pre‑existing bone conditions, treatments and timing rules (for example a ≥0.1 sievert radiation threshold, prior Paget’s disease, certain chemotherapies) that, if shown to be related to the person’s relevant service, support a service‑connection hypothesis."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-bone-and-articular-cartilage-reasonable-hyp","history":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-bone-and-articular-cartilage-reasonable-hyp/history","analysis":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-bone-and-articular-cartilage-reasonable-hyp/analysis","conflicts":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-bone-and-articular-cartilage-reasonable-hyp/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-bone-and-articular-cartilage-reasonable-hyp/important-cases","documents":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-bone-and-articular-cartilage-reasonable-hyp/documents"}}