{"id":"F2018L00001","name":"Statement of Principles concerning malignant neoplasm of the cerebral meninges (Reasonable Hypothesis) (No. 3 of 2018)","slug":"statement-of-principles-concerning-malignant-neoplasm-of-the-cerebral-meninges-reasonable-hypothesis","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439442,"registerId":"F2018L00001-fast-fetch-1775955467638","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 (Reasonable Hypothesis) (No. 3 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 (Reasonable Hypothesis)\n\n(No. 3 of 2018)\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 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 (Reasonable Hypothesis) (No. 3 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Revocation\n\nThe Statement of Principles concerning malignant neoplasm of the cerebral meninges No. 21 of 2009, as amended, made under subsections 196B(2) and (8) of the VEA is revoked.\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 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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates 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, 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 the cerebral meninges or death from malignant neoplasm of the cerebral meninges 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 brain at least five 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 overweight or obese for at least five years within the 20 years before the clinical onset of malignant neoplasm of the cerebral meninges;\n\nNote: being overweight or 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 with a drug as specified within the ten years before the clinical onset of malignant neoplasm of the cerebral meninges;\n\nNote: being treated with a drug as specified is defined in the Schedule 1 - Dictionary. \n\n(5) using hormone replacement therapy for a continuous period of at least six months before the clinical onset of malignant neoplasm of the cerebral meninges, and where the use of hormone replacement therapy has ceased, the clinical onset of malignant neoplasm of the cerebral meninges has occurred within ten years of cessation;\n\nNote: hormone replacement therapy is defined in the Schedule 1 - Dictionary. \n\n(6) 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(7) being treated with a drug as specified within the ten years before the clinical worsening of malignant neoplasm of the cerebral meninges;\n\nNote: being treated with a drug as specified is defined in the Schedule 1 - Dictionary. \n\n(8) 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(6) to 9(8) 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(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 being overweight or obese means having a Body Mass Index (BMI) of 25 or greater.\n\nNote: BMI is also defined in the Schedule 1 - Dictionary.\n\n being treated with a drug as specified means:\n\n(a) receiving medroxyprogesterone acetate at a dose rate of at least 15 milligrams per day for a continuous period of at least one year; or\n\n(b) taking daily cyproterone acetate at a dose rate of at least 15 milligrams per day for a continuous period of at least one year; or\n\n(c) taking daily chlormadinone acetate at a dose rate of at least 50 milligrams per day for a continuous period of at least one year; or\n\n(d) taking daily megestrol acetate at a dose rate of at least 50 milligrams per day for a continuous period of at least one year.\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 hormone replacement therapy means administration of estrogen preparations often in combination with progesterone to offset a hormone deficiency following surgically induced or naturally occurring menopause.\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) 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":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument revokes the earlier Statement of Principles No. 21 of 2009 and replaces it with an updated list of qualifying factors and detailed definitions (section 4). Compared to a general, older statement, this version explicitly: (a) sets a specific low-dose radiation threshold (0.1 sievert) and links dose reconstruction to an ARPANSA methodology (section 9(1) and Schedule 1); (b) adds or clarifies non‑radiation factors such as a BMI threshold for overweight/obesity with timing requirements (section 9(2) and Schedule 1); (c) specifies a list of particular drugs with exact dose and continuous-duration thresholds and a 10‑year timing window (section 9(4) and Schedule 1); (d) includes pregnancy timing and postpartum windows both for onset and for clinical worsening (sections 9(3) and 9(6)); and (e) adds inability to obtain appropriate clinical management as a factor for clinical worsening (section 9(8)). Those additions and the detailed definitional approach broaden and make more specific the routes by which a claimant can establish a reasonable hypothesis, so the scope and practical operation of the SoP have materially changed from the prior instrument."},"complexity_factors":["Single-issue instrument focused on one disease (malignant neoplasm of the cerebral meninges) — limited overall length","About 10 defined terms in Schedule 1 (BMI, cumulative equivalent dose, specified drugs, HRT, relevant service, terminal event, etc.)","Several timing conditions and windows: multiple different time-to-onset and duration requirements (e.g. ≥5 years, within 20 years, ≥1 year continuous drug use, within 10 years after cessation)","Cross-reference to external technical methodology for dose reconstruction (ARPANSA guide) — introduces technical complexity and expert evidence requirements","Conditional logic linking factors to service (section 10) and different application of subsections 9(6)–9(8) depending on whether condition arose before/during service","Cross-reference mechanism to other Statements of Principles where factors reference other diseases (section 11)","Specific drug/dose/duration specifications in Schedule 1 create tightly defined thresholds rather than broad categories"],"plain_english_summary":"**What this instrument does (mechanics)**\n\n- This is a Statement of Principles (SoP) issued by the Repatriation Medical Authority (RMA) that sets out the factual conditions under which it is reasonable to link a diagnosis of malignant neoplasm of the cerebral meninges (a primary cancer of the brain’s protective membranes) — or death from that cancer — to a person’s military service (referred to as \"relevant service\"). (See sections 7, 8, 9 and Schedule 1.)\n\n- The SoP lists the specific medical, exposure and timing factors that, if established, are sufficient to raise a \"reasonable hypothesis\" that the disease is connected with service. A claimant must show at least one of the listed factors and that the factor is related to their relevant service. (See sections 9 and 10.)\n\n- The instrument replaces the earlier SoP on the same condition (No. 21 of 2009) and applies to claims assessed under the Veterans’ Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA). (See sections 2–5 and revocation at section 4.)\n\n**Who is affected**\n\n- Primary subjects are current or former Australian Defence Force members and certain other covered people making claims under the VEA or MRCA (the SoP’s definition of \"relevant service\" lists operational, peacekeeping, hazardous, British nuclear test defence service and MRCA classifications). (Schedule 1: \"relevant service\".)\n\n- Decision-makers in the Department of Veterans’ Affairs use this SoP as the RMA’s medical guidance when deciding whether a reasonable hypothesis exists linking the cancer to service. Medical practitioners may be asked to provide evidence that establishes the listed factors (for example, radiation dose estimates, BMI history, prescription history, pregnancy timing, or evidence of treatment access). (See sections 8–11 and Schedule 1.)\n\n**The concrete factors that can establish a reasonable hypothesis (summary of section 9 and Schedule 1)**\n\nAt least one of the following must be shown, and it must be related to the person’s relevant service (section references in brackets):\n\n- A cumulative equivalent ionising radiation dose of at least 0.1 sievert to the brain, received at least five years before clinical onset (section 9(1); Schedule 1 defines \"cumulative equivalent dose\" and points to an ARPANSA methodology).\n\n- Being overweight or obese (Body Mass Index, BMI ≥ 25) for at least five years within the 20 years before clinical onset (section 9(2); Schedule 1 defines BMI and the BMI threshold).\n\n- Being in the second or third trimester of pregnancy, or within 30 days after giving birth, at the time the cancer first appears (clinical onset) (section 9(3)).\n\n- Treatment with one of a specified list of drugs (particular progestins/anti-androgens) at specified minimum daily doses and for at least one continuous year within the ten years before clinical onset (section 9(4); Schedule 1 lists medications, doses and durations).\n\n- Use of hormone replacement therapy (HRT) continuously for at least six months before clinical onset, and if HRT has ceased the onset occurred within ten years of stopping (section 9(5); Schedule 1 defines HRT).\n\n- For clinical worsening (aggravation), pregnancy in late pregnancy or within 30 days postpartum, or treatment with the specified drugs within ten years before clinical worsening, or inability to obtain appropriate clinical management (sections 9(6)–(8)).\n\n- If a listed factor overlaps with another SoP (i.e., the factor refers to a different disease covered by another SoP), the RMA-directed SoP for that other disease applies as written (section 11).\n\n**Key definitional or technical points that matter for implementation**\n\n- \"Malignant neoplasm of the cerebral meninges\" is limited to primary cancers arising from the cerebral meninges and specifically excludes several cancers (soft tissue sarcoma, carcinoid, non‑Hodgkin’s lymphoma, Hodgkin’s lymphoma and melanoma). Although ICD‑10‑AM codes are noted (C70.0/C70.9), the statutory meaning is the one in section 7(2). (See section 7.)\n\n- Radiation dose reconstruction follows an external ARPANSA guide (Schedule 1), which means decision-makers will rely on dose-estimation methods rather than direct measurement in many cases.\n\n- \"Death from\" the condition includes death from a terminal event (for example, pneumonia or respiratory failure) when that event was contributed to by the cancer (section 7(5) and Schedule 1: \"terminal event\").\n\n**What the RMA claims as its evidence base**\n\n- The RMA states it is of the view that there is sound medical‑scientific evidence that the disease (and death from it) can be related to relevant service; the SoP is the practical expression of that view and the list of factors it identifies (section 8).\n\n**Costs, incentives, trade-offs and implementation risks (testing the instrument against practical effects)**\n\n- Who pays: If a claimant establishes a reasonable hypothesis and other statutory criteria are met, entitlements paid under the VEA/MRCA will be funded from government programs. The SoP therefore constrains when the Department of Veterans’ Affairs will accept a service connection for this condition (sections 5, 9, 10).\n\n- Who decides: The RMA sets these medical thresholds and definitions; individual claims are then assessed by decision-makers applying the SoP. Some factual questions (radiation dose, BMI history, prescription history, pregnancy dates, evidence of access to treatment) require collection and assessment of medical and service records (sections 9, 10; Schedule 1).\n\n- Administrative and compliance burden: Claimants may need reconstructed radiation dose estimates (using ARPANSA methods), longitudinal weight/height records to establish BMI history, prescription records for specified drugs (dose and continuity), and clinical records showing treatment or lack of access to appropriate management. These evidentiary requirements create record-search and expert-evidence costs. (See Schedule 1 definition of \"cumulative equivalent dose\" and the Schedule’s drug/dose/time specifications.)\n\n- Implementation risk and discretion: Dose reconstruction involves technical judgements and assumptions; the ARPANSA methodology is an external guide but leaves room for expert interpretation. Establishing long-term BMI or continuous drug dosing for specified periods may be subject to gaps in historical clinical records, producing disputes. The phrase \"related to the relevant service\" (section 10) requires an evidential link between the factor and the person’s service exposures, creating room for case-by-case adjudication.\n\n- Concentrated benefits and diffuse costs: The eligible group for benefits under this SoP is relatively small and concentrated (people with particular exposures, treatment histories, pregnancy timing, or BMI histories). Fiscal costs of successful claims are spread across the veteran compensation system (diffuse). The design concentrates benefit eligibility on identifiable exposures or medical histories (section 9 and Schedule 1).\n\n- Effects on private actors and behaviour: The SoP does not directly regulate private firms, but it may change behaviour indirectly: for example, demand for accurate occupational/service exposure records, medical record retention and specialist expert reports may increase. Pharmaceutical prescribing practices are not directly constrained by this SoP, but listed drug exposure becomes a potential route to compensation for claimants (Schedule 1: specified drugs).\n\n- Substitution and attribution effects: When a listed factor is proved, a claimant is more likely to have the disease attributed to service rather than to non-service causes; that shifts liability from ordinary health funding arrangements to veteran compensation schemes (sections 9–11).\n\n**Practical indicators for claimants and advisors**\n\n- Establish the relevant factor with documentary evidence (service records for exposure; medical records for BMI, drugs, pregnancies; expert dose reconstructions for ionising radiation). (See sections 9, 10 and Schedule 1.)\n\n- Note timing windows: many factors have explicit timing requirements (e.g., radiation at least five years before clinical onset; overweight/obese for 5 of the 20 years before onset; specified drugs within 10 years before onset; HRT cessation within 10 years). Failure to meet timing windows will usually prevent the factor from qualifying. (See section 9 and Schedule 1.)\n\n**Key sections to consult for evidence and definitions**\n\n- The list of qualifying factors: section 9 (and subsections 9(1)–9(8)).\n- Relationship-to-service rule and limits: section 10.\n- Definitions (BMI, cumulative equivalent dose, specified drugs, HRT, relevant service, terminal event): Schedule 1.\n\n(References: sections 1–11 and Schedule 1 of the Statement of Principles concerning malignant neoplasm of the cerebral meninges (No. 3 of 2018).)"},"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 revokes and replaces the 2009 version (No. 21 of 2009) but maintains the same core purpose: establishing service connection criteria for this specific cancer. The scope remains tightly focused on malignant neoplasm of the cerebral meninges and has not expanded beyond its original intent of providing medical-scientific criteria for veterans' compensation claims."},"complexity_factors":["Multiple defined terms requiring cross-reference to Schedule 1 (approximately 10 defined terms)","Nested temporal conditions (e.g., 'at least five years within the 20 years before', 'within ten years of cessation')","Technical medical definitions requiring external reference (ICD-10-AM codes C70.0/C70.9)","Complex radiation dose calculation methodology referencing external ARPANSA guide","Distinction between 'clinical onset' and 'clinical worsening' with different factor sets applying to each","Conditional limitation in section 10(2) restricting factors 6-8 to aggravation cases only","Cross-reference mechanism in section 11 allowing incorporation of other Statements of Principles by reference","Specific pharmaceutical dosing thresholds (exact milligram amounts and duration requirements)"],"plain_english_summary":"This instrument sets the criteria for when malignant neoplasm of the cerebral meninges is treated as reasonably caused or aggravated by Australian Defence service, creating a presumption that favors the veteran. It applies to current and former ADF members and claimants under the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004.\n\nIt specifies eight qualifying risk factors — e.g., relevant radiation exposure, prolonged overweight, pregnancy/post‑partum timing, certain high‑dose hormone treatments, HRT, and lack of clinical care — some limited to aggravation of pre‑existing disease."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-cerebral-meninges-reasonable-hypothesis","history":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-cerebral-meninges-reasonable-hypothesis/history","analysis":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-cerebral-meninges-reasonable-hypothesis/analysis","conflicts":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-cerebral-meninges-reasonable-hypothesis/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-cerebral-meninges-reasonable-hypothesis/important-cases","documents":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-cerebral-meninges-reasonable-hypothesis/documents"}}