{"id":"F2020L01383","name":"Statement of Principles concerning malignant neoplasm of the cervix (Balance of Probabilities) (No. 81 of 2020)","slug":"statement-of-principles-concerning-malignant-neoplasm-of-the-cervix-balance-of-probabilities-no-81-o","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":130601,"registerId":"commonwealth-F2020L01383-current","compilationNumber":null,"startDate":"2026-04-03","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning malignant neoplasm of the cervix (Balance of Probabilities) (No. 81 of 2020)","content":"![Commonwealth Coat of Arms](image.001.png)\n\nStatement of Principles concerning malignant neoplasm of the cervix (Balance of Probabilities) (No. 81 of 2020)\n\nmade under subsection 196B(3) of the\n\nVeterans' Entitlements Act 1986\n\nCompilation No. 1\n\nCompilation date: 19 September 2022\n\nIncludes amendments up to: Veterans' Entitlements (Statements of Principles—definition of \"one pack-year\") Amendment Determination 2022 (No. 94 of 2022) (F2022L01128)\n\nThe day of commencement of this Amendment Determination is 19 September 2022.\n\nAbout this compilation\n\nThis compilation\n\nThis is a compilation of the Statement of Principles concerning malignant neoplasm of the cervix (Balance of Probabilities) (No. 81 of 2020) that shows the text of the law as amended and in force on 19 September 2022.\n\nThe notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.\n\nUncommenced amendments\n\nThe effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register (www.legislation.gov.au). The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.\n\nApplication, saving and transitional provisions for provisions and amendments\n\nIf the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.\n\nModifications\n\nIf the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.\n\nSelf‑repealing provisions\n\nIf a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.\n\nContents\n\n1 Name\n\n3 Authority\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\nEndnotes\n\nEndnote 1—About the endnotes\n\nEndnote 2—Abbreviation key\n\nEndnote 3—Legislation history\n\nEndnote 4—Amendment history\n\n  \n\n1 Name\n\nThis is the Statement of Principles concerning malignant neoplasm of the cervix (Balance of Probabilities) (No. 81 of 2020).\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\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 cervix and death from malignant neoplasm of the cervix.\n\nMeaning of malignant neoplasm of the cervix\n\n(2) For the purposes of this Statement of Principles, malignant neoplasm of the cervix:\n\n(a) means a primary invasive carcinoma, carcinoma in situ, adenocarcinoma in situ or cervical intraepithelial neoplasia grade 3, arising from the cells of the cervix uteri; and\n\n(b) includes squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma; and\n\n(c) excludes:\n\n(i) cervical intraepithelial neoplasia grades 1 or 2;\n\n(ii) malignant melanoma and melanoma in situ;\n\n(iii) neuroendocrine tumours; and\n\n(iv) soft tissue sarcoma, adenosarcoma, carcinosarcoma,  \nnon-Hodgkin lymphoma and Hodgkin’s lymphoma.\n\n(3) While malignant neoplasm of the cervix attracts ICD‑10‑AM code C53 or D06, in applying this Statement of Principles the meaning of malignant neoplasm of the cervix 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 cervix\n\n(5) For the purposes of this Statement of Principles, malignant neoplasm of the cervix, 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 cervix.\n\n> Note: 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 cervix and death from malignant neoplasm of the cervix can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA.\n\n> Note: 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 cervix or death from malignant neoplasm of the cervix is connected with the circumstances of a person's relevant service:\n\n(1) having a persistent infection of the cervical epithelium with a specified human papillomavirus before the clinical onset of malignant neoplasm of the cervix;\n\n> Note: persistent infection and specified human papillomavirus are defined in the Schedule 1 \\- Dictionary.\n\n(2) having infection with human immunodeficiency virus before the clinical onset of malignant neoplasm of the cervix;\n\n(3) for squamous cell carcinoma of the cervix only, having smoked at least 20 pack-years of tobacco products, at least two years before the clinical onset of squamous cell carcinoma of the cervix, and where smoking has ceased, the clinical onset of squamous cell carcinoma of the cervix has occurred within 15 years of cessation;\n\n> Note: one pack-year is defined in the Schedule 1 - Dictionary.\n\n(4) taking a combined oral contraceptive pill for a continuous period of at least five years, commencing at least five years before the clinical onset of malignant neoplasm of the cervix, and where taking the combined oral contraceptive pill has ceased, the clinical onset of malignant neoplasm of the cervix has occurred within 15 years of cessation;\n\n> Note: combined oral contraceptive pill is defined in the Schedule 1 - Dictionary.\n\n(5) taking an immunosuppressive drug for organ or tissue transplantation at least two years before the clinical onset of malignant neoplasm of the cervix;\n\n> Note: organ or tissue transplantation is defined in the Schedule 1 - Dictionary.\n\n(6) being prevented from accessing clinical screening for cervical precancerous lesions or cervical cancer in accordance with contemporary medical standards of the time, within the seven years before the clinical onset of malignant neoplasm of the cervix, and where:\n\n(a) if clinical screening has subsequently resumed, there has been no normal test result; and\n\n(b) the opportunity for subsequent clinical screening has not been declined;\n\n> Note: cervical precancerous lesions and clinical screening for cervical precancerous lesions or cervical cancer are defined in the Schedule 1 - Dictionary.\n\n(7) being prevented from accessing appropriate treatment for cervical precancerous lesions in accordance with contemporary medical standards of the time, between two and seven years before the clinical onset of malignant neoplasm of the cervix;\n\n> Note: cervical precancerous lesions is defined in the Schedule 1 - Dictionary.\n\n(8) inability to obtain appropriate clinical management for malignant neoplasm of the cervix.\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(8) applies only to material contribution to, or aggravation of, malignant neoplasm of the cervix where the person's malignant neoplasm of the cervix 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\nSchedule 1 \\- Dictionary\n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\ncervical precancerous lesions means changes to cervical cells that make them more likely to develop into cancer, and includes cervical intraepithelial neoplasia grades 1 or 2, low grade squamous intraepithelial lesion, mild to moderate dysplasia of the cells of the cervix and atypical glandular cells in the cervix.\n\nclinical screening for precancerous lesions or cervical cancer means human papillomavirus testing or Papanicolaou cytology examinations.\n\ncombined oral contraceptive pill means an oral contraceptive compound containing both estrogen and progestogen.\n\nmalignant neoplasm of the cervix—see subsection 7(2).\n\nMRCA means the Military Rehabilitation and Compensation Act 2004.\n\none pack-year means the amount of tobacco consumed in smoking 20 cigarettes per day for a period of 1 year, or an equivalent amount of tobacco products.\n\n> Note 1: An equivalent amount of tobacco products is 7,300 grams of smoking tobacco by weight, either in cigarettes, pipe tobacco or cigars, or a combination of same. For pipe tobacco, cigars or combinations of multiple tobacco types, 1 gram of tobacco is considered to be equal to one cigarette.\n\n> Note 2: Pack-years are calculated by dividing the number of cigarettes smoked per day by 20 and multiplying this number by the number of years the person has smoked. For example, smoking 10 cigarettes per day for 10 years is equal to 5 pack-years, and smoking 40 cigarettes per day for 10 years is equal to 20 pack-years.\n\norgan or tissue transplantation means the transplantation of:\n\n(a) all or part of an organ or tissue; or\n\n(b) a substance obtained from an organ or tissue.\n\npersistent infection means an infection by the same human papillomavirus type for at least two consecutive years.\n\nrelevant 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\n> Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary.\n\nspecified human papillomavirus means human papillomavirus type 16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 67, 68, 70, 73 or 82.\n\nterminal 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\nVEA means the Veterans' Entitlements Act 1986.\n\n> Note: Endnotes\n\n> Note: Endnote 1—About the endnotes\n\nThe endnotes provide information about this compilation and the compiled law.\n\nThe following endnotes are included in every compilation:\n\nEndnote 1—About the endnotes\n\nEndnote 2—Abbreviation key\n\nEndnote 3—Legislation history\n\nEndnote 4—Amendment history\n\nAbbreviation key—Endnote 2\n\nThe abbreviation key sets out abbreviations that may be used in the endnotes.\n\nLegislation history and amendment history—Endnotes 3 and 4\n\nAmending laws are annotated in the legislation history and amendment history.\n\nThe legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.\n\nThe amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.\n\nMisdescribed amendments\n\nA misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.\n\nIf a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history.\n\n> Note: Endnote 2—Abbreviation key\n\n|                                                | o = order(s)                        |\n| ---------------------------------------------- | ----------------------------------- |\n| ad = added or inserted                         | Ord = Ordinance                     |\n| am = amended                                   | orig = original                     |\n| amdt = amendment                               | par = paragraph(s)/subparagraph(s)  |\n| c = clause(s)                                  | /sub‑subparagraph(s)                |\n| C[x] = Compilation No. x                       | pres = present                      |\n| Ch = Chapter(s)                                | prev = previous                     |\n| def = definition(s)                            | (prev…) = previously                |\n| Dict = Dictionary                              | Pt = Part(s)                        |\n| disallowed = disallowed by Parliament          | r = regulation(s)/rule(s)           |\n| Div = Division(s)                              |                                     |\n| exp = expires/expired or ceases/ceased to have | reloc = relocated                   |\n| effect                                         | renum = renumbered                  |\n| F = Federal Register of Legislation            | rep = repealed                      |\n| gaz = gazette                                  | rs = repealed and substituted       |\n| LA = Legislation Act 2003                      | s = section(s)/subsection(s)        |\n| LIA = Legislative Instruments Act 2003         | Sch = Schedule(s)                   |\n| (md) = misdescribed amendment can be given     | Sdiv = Subdivision(s)               |\n| effect                                         | SLI = Select Legislative Instrument |\n| (md not incorp) = misdescribed amendment       | SR = Statutory Rules                |\n| cannot be given effect                         | Sub‑Ch = Sub‑Chapter(s)             |\n| mod = modified/modification                    | SubPt = Subpart(s)                  |\n| No. = Number(s)                                | underlining = whole or part not     |\n|                                                | commenced or to be commenced        |\n\n> Note: Endnote 3—Legislation history\n\n| Name                                                                                                                          | Registration               | Commencement      | Application, saving and transitional provisions |\n| ----------------------------------------------------------------------------------------------------------------------------- | -------------------------- | ----------------- | ----------------------------------------------- |\n| Statement of Principles concerning malignant neoplasm of the cervix (Balance of Probabilities) (No. 81 of 2020)               | 2 November 2020F2020L01383 | 30 November 2020  |                                                 |\n| Veterans' Entitlements (Statements of Principles—definition of \"one pack-year\") Amendment Determination 2022 (No. 94 of 2022) | 26 August 2022F2022L01128  | 19 September 2022 |                                                 |\n\n> Note: Endnote 4—Amendment history\n\n| Provision affected                             | How affected      |\n| ---------------------------------------------- | ----------------- |\n| Section 2……………….                               | rep LA s 48D      |\n| Section 4……………….                               | rep LA s 48C      |\n| Subsection 9(3) note.....                      | rs No. 94 of 2022 |\n| Schedule 1 – Dictionary – one pack-year...…….. | rs No. 94 of 2022 |","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This legislation maintains its original scope as a specific medical-determination instrument for cervical cancer under the Veterans' Entitlements Act 1986. The 2022 amendment (No. 94 of 2022) was a technical amendment that updated only the definition of 'one pack-year' in the Dictionary and the related note in section 9(3). This did not expand the scope beyond the original purpose of establishing causation factors for cervical cancer claims. The instrument remains narrowly focused on its original intent: providing the medical-scientific basis for linking cervical cancer to military service."},"complexity_factors":["Multiple defined terms in Schedule 1 Dictionary (approximately 15 defined terms including technical medical concepts like 'persistent infection', 'specified human papillomavirus', and 'cervical precancerous lesions')","Nested timing conditions in factor 9(3) requiring calculation of pack-years, cessation dates, and 15-year windows","Nested timing conditions in factor 9(4) requiring continuous periods, commencement dates, and 15-year post-cessation windows","Complex conditional structure in factor 9(6) with two sub-conditions (a) and (b) regarding screening access and test results","Specific exclusion list in section 7(2)(c) with four distinct categories of excluded conditions","Cross-reference to other Statements of Principles in section 11 for factors referring to other injuries/diseases","Dual statutory framework application (VEA and MRCA) requiring understanding of two different compensation schemes","Medical-technical definitions requiring specialised knowledge (ICD-10-AM codes, specific HPV types 16/18/26/31 etc., histological classifications)"],"plain_english_summary":"This instrument sets the medical test (a Statement of Principles) for deciding if cervical cancer in veterans or current/former Defence members is more likely than not caused by their service, determining entitlement under veterans’ and military compensation laws.  \n\nIt covers invasive and in‑situ cervical cancer and certain precancers, and links causation to factors such as persistent high‑risk HPV, HIV, significant smoking, long‑term combined oral contraceptive use, immunosuppression, or being prevented from accessing screening, treatment or appropriate care."},"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"The instrument was amended by Veterans' Entitlements (Statements of Principles—definition of \"one pack‑year\") Amendment Determination 2022 (No. 94 of 2022) (see Endnote 3 and Endnote 4). The amendment revised the Schedule 1 definition of 'one pack‑year' and the note to subsection 9(3), which changes how the smoking‑related threshold in s9(3) is calculated and therefore affects who satisfies that specific factor (commenced 19 September 2022)."},"complexity_factors":["Technical medical definitions and inclusions/exclusions for the condition (see s7(2)–(4)), requiring medical interpretation.","Multiple distinct causal factors with precise timing, duration and threshold requirements (see s9(1)–(4), (5)–(8)).","A specific quantitative smoking threshold (20 pack‑years) with calculation rules located in Schedule 1 (see s9(3) and Schedule 1).","Cross‑references to other instruments and codes (ICD‑10‑AM reference in s7(3)–(4); other Statements of Principles in s11), creating interoperability and evidentiary linkage.","Service‑connection requirement that factors be related to ‘relevant service’ (see s10(1)), imposing a legal causation layer beyond medical causation.","Evidentiary and temporal tests for access to screening or treatment (s9(6)–(7)) that can be fact‑specific and proof‑intensive.","A residual material‑contribution/aggravation rule with a timing limit for pre‑existing conditions (s10(2)), adding nuance to causation assessments.","Numerous defined terms in Schedule 1 (e.g. persistent infection, specified HPV, combined oral contraceptive pill), increasing interpretive burden.","Recent amendment history that altered a core definition ('one pack‑year') (Endnote 4), meaning prior decisions may need re‑interpretation.","Application limited to claims under specified statutory provisions (s5), so legal effect depends on interaction with VEA/MRCA claim rules."],"plain_english_summary":"This Statement of Principles sets the medical criteria the Repatriation Medical Authority uses to decide, on the balance of probabilities, whether malignant neoplasm of the cervix (and death from it) is connected with a person’s relevant service. It defines the cancer types covered, specific causal factors, timing windows and exclusions. \n\nIt applies to veterans and service members lodging claims under the Veterans' Entitlements Act 1986 or the Military Rehabilitation and Compensation Act 2004 and therefore governs what medical and exposure evidence is required for entitlement decisions."},"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"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-cervix-balance-of-probabilities-no-81-o","history":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-cervix-balance-of-probabilities-no-81-o/history","analysis":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-cervix-balance-of-probabilities-no-81-o/analysis","conflicts":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-cervix-balance-of-probabilities-no-81-o/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-cervix-balance-of-probabilities-no-81-o/important-cases","documents":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-cervix-balance-of-probabilities-no-81-o/documents"}}