{"id":"F2018L00002","name":"Statement of Principles concerning malignant neoplasm of the cerebral meninges (Balance of Probabilities) (No. 4 of 2018)","slug":"statement-of-principles-concerning-malignant-neoplasm-of-the-cerebral-meninges-balance-of-probabilit","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439443,"registerId":"F2018L00002-fast-fetch-1775955467649","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 the cerebral meninges (Balance of Probabilities) (No. 4 of 2018)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 22.10.0\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 THE CEREBRAL MENINGES (Balance of Probabilities)\n\n(No. 4 of 2018)\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 22 December 2017\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 Revocation\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 the cerebral meninges (Balance of Probabilities) (No. 4 of 2018).\n\n2 Commencement\n\n This instrument commences on 29 January 2018.\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n4 Revocation\n\nThe Statement of Principles concerning malignant neoplasm of the cerebral meninges No. 22 of 2009, as amended, made under subsections 196B(3) and (8) of the VEA is revoked.\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 the cerebral meninges and death from malignant neoplasm of the cerebral meninges.\n\nMeaning of malignant neoplasm of the cerebral meninges\n\n(2) For the purposes of this Statement of Principles, malignant neoplasm of the cerebral meninges:\n\n(a) means a primary malignant neoplasm arising from the cells of the cerebral meninges; and\n\n(b) excludes soft tissue sarcoma, carcinoid tumour, non-Hodgkin's lymphoma, Hodgkin's lymphoma and melanoma.\n\n(3) While malignant neoplasm of the cerebral meninges attracts ICD‑10‑AM code C70.0 or C70.9, in applying this Statement of Principles the meaning of malignant neoplasm of the cerebral meninges 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 the cerebral meninges\n\n(5) For the purposes of this Statement of Principles, malignant neoplasm of the cerebral meninges, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's malignant neoplasm of the cerebral meninges.\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 the cerebral meninges and death from malignant neoplasm of the cerebral meninges 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 the cerebral meninges or death from malignant neoplasm of the cerebral meninges 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 brain at least ten years before the clinical onset of malignant neoplasm of the cerebral meninges;\n\nNote: cumulative equivalent dose is defined in the Schedule 1 - Dictionary. \n\n(2) being obese for at least ten years within the 20 years before the clinical onset of malignant neoplasm of the cerebral meninges;\n\nNote: being obese is defined in the Schedule 1 - Dictionary. \n\n(3) being in the second or third trimester of pregnancy, or within the 30 days postpartum, at the time of the clinical onset of malignant neoplasm of the cerebral meninges;\n\n(4) being treated daily with cyproterone acetate at a dose rate of at least 15 milligrams per day for a continuous period of at least one year, within the ten years before the clinical onset of malignant neoplasm of the cerebral meninges;\n\n(5) being in the second or third trimester of pregnancy, or within the 30 days postpartum, at the time of the clinical worsening of malignant neoplasm of the cerebral meninges;\n\n(6) being treated daily with cyproterone acetate at a dose rate of at least 15 milligrams per day for a continuous period of at least one year, within the ten years before the clinical worsening of malignant neoplasm of the cerebral meninges;\n\n(7) inability to obtain appropriate clinical management for malignant neoplasm of the cerebral meninges.\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 factors set out in subsections 9(5) to 9(7) apply only to material contribution to, or aggravation of, malignant neoplasm of the cerebral meninges where the person's malignant neoplasm of the cerebral meninges 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 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\nW is the person's weight in kilograms; and\n\nH is the person's height in metres.\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 the cerebral meninges—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","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument expressly revokes the earlier Statement of Principles No. 22 of 2009 (section 4) and replaces it with updated factors, definitions and measurement rules (notably the 0.5 sievert radiation threshold, specified obesity/BMI timing, pregnancy windows, cyproterone acetate dose/duration, and the clinical‑management factor) and states its application to claims under VEA s120B and MRCA s339 (section 5). The revocation and the new, explicit factor list indicate a change in the operative Statement of Principles and the criteria used to link this disease to relevant service (sections 4, 9, Schedule)."},"complexity_factors":["Technical radiation threshold and latency: requires a cumulative equivalent dose to the brain of at least 0.5 sievert, with clinical onset at least 10 years later; dose calculated by ARPANSA methodology (section 9(1); Schedule - cumulative equivalent dose).","Anthropometric and temporal rules for obesity: 'being obese' defined as BMI ≥ 30, and must have been obese for at least 10 years within the 20 years before clinical onset (section 9(2); Schedule - BMI definition).","Pregnancy timing windows: factors triggered by being in the 2nd or 3rd trimester or within 30 days postpartum at clinical onset or clinical worsening (sections 9(3) and 9(5)).","Drug‑exposure requirement: daily cyproterone acetate ≥15 mg for a continuous period of at least one year within the ten years before clinical onset or worsening (sections 9(4) and 9(6)).","Clinical management factor: inability to obtain appropriate clinical management may qualify as a factor for material contribution or aggravation (section 9(7)).","Service linkage requirement: any listed factor must be related to the person's relevant service; some factors (9(5)–9(7)) apply only as material contribution or aggravation where the disease existed before or during service (section 10(1)–(2)).","Interplay with other Statements of Principles: where a factor refers to another injury/disease covered by a different Statement, that other Statement applies (section 11).","Exclusions and coding nuance: the definition excludes specific tumour types (soft tissue sarcoma, carcinoid, lymphomas, melanoma) and notes ICD‑10‑AM codes but uses its own definitional language (section 7(2)–(3)).","Administrative framing and replacement: revokes an earlier Statement (No. 22 of 2009) and takes effect on a specified commencement date; applies to claims under particular statutory sections (sections 2–5).","Evidence and burden implications: requirements such as dose reconstruction, long‑term BMI history, drug dosing records, pregnancy timing and proof of inadequate clinical management create evidentiary and administrative burdens on claimants and decision makers (sections 9, Schedule)."],"plain_english_summary":"This Statement of Principles sets the medical criteria used to decide whether malignant neoplasm of the cerebral meninges (and death from it) can be linked to a person’s military service for claims under the Veterans' Entitlements Act or the Military Rehabilitation and Compensation Act. It lists specific, time‑bounded causation factors (radiation dose, long‑term obesity, pregnancy timing, a defined drug exposure, or inability to obtain appropriate clinical management) and defines how those factors are measured."},"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 Statement of Principles under the Veterans' Entitlements Act framework. It maintains the same scope as its predecessor (No. 22 of 2009) - establishing causation factors for a specific medical condition in veterans' compensation claims. The update appears to be a routine republication with updated references (ICD-10-AM Tenth Edition, current ARPANSA guide) rather than an expansion of scope."},"complexity_factors":["Moderate cross-referencing between main sections and Schedule 1 Dictionary (7 defined terms)","Nested conditional logic in section 9 with specific temporal requirements (e.g., 'at least ten years before', 'within the 20 years before', 'within the ten years before')","Dual application structure - distinguishes between 'clinical onset' and 'clinical worsening' with different factor applicability","Technical medical terminology requiring definition (ICD-10-AM codes, sievert measurements, cyproterone acetate dosing)","Section 10 creates a two-tier application system where factors 9(5)-9(7) only apply to pre-existing conditions aggravated by service","Incorporation of external documents by reference (ARPANSA Guide to calculation of cumulative equivalent dose, ICD-10-AM Tenth Edition)","Exclusion clauses in the definition that require knowledge of other cancer types"],"plain_english_summary":"This Statement of Principles sets the medical-scientific tests used to decide, on the balance of probabilities, whether malignant neoplasm of the cerebral meninges is connected to a person’s Australian defence service. It affects veterans and current/former ADF members claiming under the VEA or MRCA.\n\nIt identifies service‑related exposures and conditions — notably significant brain ionising radiation, long‑term obesity, late pregnancy, prolonged cyproterone acetate use, or lack of appropriate treatment — that can establish causation."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-cerebral-meninges-balance-of-probabilit","history":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-cerebral-meninges-balance-of-probabilit/history","analysis":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-cerebral-meninges-balance-of-probabilit/analysis","conflicts":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-cerebral-meninges-balance-of-probabilit/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-cerebral-meninges-balance-of-probabilit/important-cases","documents":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-cerebral-meninges-balance-of-probabilit/documents"}}