{"id":"F2022L00015","name":"Statement of Principles concerning malignant neoplasm of the colon and rectum (Balance of Probabilities) (No. 20 of 2022)","slug":"statement-of-principles-concerning-malignant-neoplasm-of-the-colon-and-rectum-balance-of-probabiliti","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441163,"registerId":"F2022L00015-fast-fetch-1775956533573","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 colon and rectum (Balance of Probabilities) (No. 20 of 2022)","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 COLON AND RECTUM (Balance of Probabilities)\n\n(No. 20 of 2022)\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 24 December 2021\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 Terence Campbell AM
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 the colon and rectum (Balance of Probabilities) (No. 20 of 2022).\n\n2 Commencement\n\n This instrument commences on 31 January 2022.\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 the colorectum No. 38 of 2013 (Federal Register of Legislation No. F2013L01130) 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 the colon and rectum and death from malignant neoplasm of the colon and rectum.\n\nMeaning of malignant neoplasm of the colon and rectum\n\n(2) For the purposes of this Statement of Principles, malignant neoplasm of the colon and rectum:\n\n(a) means a primary malignant neoplasm arising from the epithelial cells of the colon or rectum; and\n\n(b) excludes soft tissue sarcoma, carcinoid tumour, non-Hodgkin lymphoma and Hodgkin's lymphoma.\n\nNote 1: The colon extends from the colonic caecum (including the ileocaecal junction and vermiform appendix) to the sigmoid colon (not including the rectosigmoid junction).\n\nNote 2: The rectum extends from the rectosigmoid junction to the junction of the rectum with the anal canal.\n\n(3) While malignant neoplasm of the colon and rectum attracts ICD‑10‑AM code C18, C19 or C20, in applying this Statement of Principles the meaning of malignant neoplasm of the colon and rectum 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 colon or rectum\n\n(5) For the purposes of this Statement of Principles, malignant neoplasm of the colon or rectum, 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 colon or rectum.\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 colon or rectum and death from malignant neoplasm of the colon or rectum 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 colon or rectum or death from malignant neoplasm of the colon or rectum is connected with the circumstances of a person's relevant service:\n\n(1) having familial adenomatous polyposis before the clinical onset of malignant neoplasm of the colon or rectum;\n\n(2) having a colorectal adenoma involving the affected part of the colon or rectum before the clinical onset of malignant neoplasm of the colon or rectum;\n\n(3) being prevented from accessing clinical screening for colorectal precancerous lesions or colorectal cancer in accordance with contemporary medical standards of the time, within the 5 years before the clinical onset of malignant neoplasm of the colon or rectum, and:\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\nNote: colorectal precancerous lesions is defined in the Schedule 1 - Dictionary.\n\n(4) being prevented from accessing appropriate treatment for colorectal precancerous lesions in accordance with contemporary medical standards of the time, within the 5 years before the clinical onset of malignant neoplasm of the colon or rectum;\n\nNote: colorectal precancerous lesions is defined in the Schedule 1 - Dictionary.\n\n(5) having inflammatory bowel disease involving the colon or rectum for at least 3 years before the clinical onset of malignant neoplasm of the colon or rectum;\n\n(6) undergoing a course of therapeutic radiation for cancer, where the affected part of the colon or rectum was in the field of radiation, before the clinical onset of malignant neoplasm of the colon or rectum;\n\n(7) having received a cumulative equivalent dose of at least 0.5 sievert of ionising radiation to the colon or rectum at least 10 years before the clinical onset of malignant neoplasm of the colon or rectum;\n\nNote: cumulative equivalent dose is defined in the Schedule 1 - Dictionary.\n\n(8) inhaling respirable asbestos fibres in an enclosed space, at the time material containing asbestos was being applied, removed, cut, drilled, dislodged or disturbed:\n\n(a) for a cumulative period of at least 2,000 hours before the clinical onset of malignant neoplasm of the colon or rectum; and\n\n(b) where the first inhalation of asbestos fibres commenced at least 10 years before the clinical onset of malignant neoplasm of the colon or rectum;\n\nNote: Disturbance of debris or dust contaminated with asbestos fibres already present in an enclosed space may result in exposure to respirable asbestos fibres.\n\n(9) inhaling respirable asbestos fibres in an open environment, at the time material containing asbestos was being applied, removed, cut, drilled, dislodged or disturbed:\n\n(a) for a cumulative period of at least 6,000 hours before the clinical onset of malignant neoplasm of the colon or rectum; and\n\n(b) where the first inhalation of asbestos fibres commenced at least 10 years before the clinical onset of malignant neoplasm of the colon or rectum;\n\nNote: Disturbance of debris or dust contaminated with asbestos fibres already present in an open environment may result in exposure to respirable asbestos fibres.\n\n(10) having smoked tobacco products:\n\n(a) in an amount of at least 30 pack-years before the clinical onset of malignant neoplasm of the colon or rectum; and\n\n(b) commencing at least 5 years before the clinical onset of malignant neoplasm of the colon or rectum; and\n\nif smoking has ceased before the clinical onset of malignant neoplasm of the colon or rectum, then that onset occurred within 30 years of cessation;\n\nNote: one pack-year is defined in the Schedule 1 - Dictionary.\n\n(11) consuming at least 500 kilograms of alcohol before the clinical onset of malignant neoplasm of the colon or rectum;\n\nNote: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.\n\n(12) being obese for at least 10 years within the 30 years before the clinical onset of malignant neoplasm of the colon or rectum;\n\nNote: being obese is defined in the Schedule 1 - Dictionary.\n\n(13) having diabetes mellitus for at least 5 years before the clinical onset of malignant neoplasm of the colon or rectum;\n\n(14) having chronic schistosomiasis involving the affected part of the colon or rectum for at least 5 years before the clinical onset of malignant neoplasm of the colon or rectum;\n\n(15) inability to consume an average of at least 20 grams per day of fibre in food for at least 5 consecutive years within the 25 years before the clinical onset of malignant neoplasm of the colon or rectum;\n\nNote: fibre in food is defined in the Schedule 1 - Dictionary.\n\n(16) for malignant neoplasm of the colon only:\n\n(a) inability to undertake any physical activity greater than 3 METs for at least 10 consecutive years within the 30 years before the clinical onset of malignant neoplasm of the colon;\n\nNote: MET is defined in the Schedule 1 - Dictionary.\n\n(b) having acromegaly before the clinical onset of malignant neoplasm of the colon;\n\nNote: acromegaly is defined in the Schedule 1 - Dictionary.\n\n(c) consuming an average of at least 100 grams per day of red meat, for at least 10 years within the 25 years before the clinical onset of malignant neoplasm of the colon; or\n\nNote: red meat is defined in the Schedule 1 - Dictionary.\n\n(d) consuming an average of at least 50 grams per day of processed meat product, for at least 10 years within the 25 years before the clinical onset of malignant neoplasm of the colon;\n\nNote: processed meat product is defined in the Schedule 1 - Dictionary.\n\n(17) inability to obtain appropriate clinical management for malignant neoplasm of the colon or rectum.\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(17) applies only to material contribution to, or aggravation of, malignant neoplasm of the colon or rectum where the person's malignant neoplasm of the colon or rectum 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 acromegaly means a chronic disease of adults resulting from excess production of growth hormone after closure of the epiphyses.\n\n being obese means:\n\n(a) having a Body Mass Index (BMI) of 30 or greater; or\n\n(b) for males, having a waist circumference exceeding 120 centimetres; or\n\n(c) for females, having a waist circumference exceeding 88 centimetres.\n\nNote: BMI is also defined in the Schedule 1 - Dictionary.\n\n BMI means W/H2 where:\n\n(a) W is the person's weight in kilograms; and\n\n(b) H is the person's height in metres.\n\n colorectal precancerous lesions means changes to colorectal cells that make them more likely to develop into cancer, and includes colorectal adenomas and non-adenomatous epithelial dysplasia.\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 fibre in food means complex carbohydrates of plant origin consumed as vegetables, fruits or cereals which resist digestion by gastrointestinal enzymes in the gastrointestinal tract, and include plant cell walls and non-starch polysaccharides from sources other than cell walls, including cellulose and pectins.\n\n malignant neoplasm of the colon and rectum—see subsection 7(2).\n\n MET means a unit of measurement of the level of physical exertion. 1 MET = 3.5 ml of oxygen/kg of body weight per minute, or 1.0 kcal/kg of body weight per hour, or resting metabolic rate.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n one 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\nNote 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\nNote 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\n processed meat product means preserved or cured meats, including ham, frankfurters, salami and bacon.\n\n red meat means all types of mammalian meat, including beef, veal, pork, lamb, mutton, horse and goat.\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":"Unauthenticated. Configure AI_GATEWAY_API_KEY or use a provider module. Learn more: https://ai-sdk.dev/unauthenticated-ai-gateway","source":"analysis-cron"},"flash_summary":{"complexity_score":7,"scope_assessment":{"changed":false,"description":"This instrument replaces the earlier 2013 Statement (s4) but, on its face, applies to claims under the same statutory schemes (VEA s120B and MRCA s339) and sets substantive criteria for connection to relevant service (s5, s8–s10). The text does not explicitly state that it narrows or expands the covered kinds of injury beyond the defined meaning of malignant neoplasm of the colon and rectum (s7); therefore no clear change of scope from the prior instrument is apparent within this document alone."},"complexity_factors":["Technical exposure thresholds and time windows are numerous and specific (e.g. 0.5 sievert ≥10 years before onset; asbestos 2,000 or 6,000 cumulative hours; smoking ≥30 pack‑years; alcohol ≥500 kg) — see s9(7)–(11).","Multiple quantified lifestyle and clinical metrics require retroactive measurement and verification (pack‑years, kilograms alcohol, BMI, METs, fibre intake) — Schedule 1 and s9(10)–(16).","Causal standard and decision authority: findings rest on 'more probable than not' medical‑scientific view and the Repatriation Medical Authority's determination — s8 and s3.","Requirement that any listed factor be related to the person's relevant service adds an evidentiary link between exposure/condition and service — s10(1).","Cross-references to other Statements of Principles mean overlapping conditions are resolved by the other instrument’s terms — s11.","Complex definitions and dose‑reconstruction methodology (cumulative equivalent dose) require specialist technical evidence and agency guidance — Schedule 1 (cumulative equivalent dose) and related notes.","Conditional, procedural factors increase factual complexity (e.g. screening prevented within 5 years, subsequent test results, declination of screening) — s9(3).","Clinical-management factor (inability to obtain appropriate management) and special rule for aggravation only where disease pre‑existed service create distinct legal pathways — s9(17) and s10(2).","Repeal of the 2013 Statement and replacement by this instrument may require claimants or administrators to reconcile prior findings with the new criteria — s4.","Long latency periods and overlapping risk contributors create attribution challenges and higher evidence‑gathering burdens for claimants and decision makers — s9 generally."],"plain_english_summary":"**This Statement of Principles sets the medical rules used to decide whether colon or rectal cancer (or death from it) is connected to Australian defence or veteran service.** It lists specific medical conditions, exposures and quantified lifestyle thresholds (for example radiation dose, asbestos‑exposure hours, pack‑years of smoking, alcohol kilograms, obesity duration) and requires those factors be tied to the person’s relevant service. Determinations under these rules affect entitlement decisions under the VEA and MRCA."},"kimi_summary":{"content_quality":"ok","complexity_score":6,"scope_assessment":{"changed":false,"description":"This instrument maintains the established scope of Repatriation Medical Authority Statements of Principles. It replaces the 2013 version (No. 38 of 2013) concerning the same condition (malignant neoplasm of the colorectum), updating medical criteria and definitions but remaining within the original legislative purpose of determining service-relatedness for veterans' compensation claims under Part XIA of the VEA and the MRCA."},"complexity_factors":["17 distinct causal factors with varying temporal requirements (latency periods ranging from 5 to 30 years, cumulative exposure thresholds)","Nested conditional logic in multiple factors (e.g., factor 9(3) has sub-conditions (a) and (b); factor 9(10) has commencement, amount, and cessation conditions)","14 defined terms in Schedule 1, including complex scientific calculations (BMI formula, cumulative equivalent dose methodology referencing external ARPANSA guide, pack-year calculations)","Cross-references to other Statements of Principles (section 11) and external documents (ICD-10-AM Tenth Edition, ARPANSA Guide)","Specific anatomical boundaries requiring precise medical knowledge (colon extends from caecum to sigmoid, excluding rectosigmoid junction; rectum extends from rectosigmoid junction to anal canal)","Exclusion clauses (subsection 7(2)(b) excludes soft tissue sarcoma, carcinoid tumour, and lymphomas)","Dual statutory framework application (VEA and MRCA with different service definitions)","Factor-specific limitations (factor 9(17) restricted by section 10(2) to pre-existing conditions only)"],"plain_english_summary":"The legislation sets medical rules for deciding when colon or rectal cancer in veterans and current/former defence members (and their families for death claims) is accepted as service-related for compensation. The Repatriation Medical Authority lists 17 risk factors—ranging from genetic conditions, prior growths, service-related barriers to care, exposures (radiation, asbestos), to lifestyle and medical risks—any one linking cancer to service can suffice. It matters because it determines access to pensions, treatment and benefits under a lower “balance of probabilities” standard and updates the 2013 criteria."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-colon-and-rectum-balance-of-probabiliti","history":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-colon-and-rectum-balance-of-probabiliti/history","analysis":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-colon-and-rectum-balance-of-probabiliti/analysis","conflicts":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-colon-and-rectum-balance-of-probabiliti/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-colon-and-rectum-balance-of-probabiliti/important-cases","documents":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-colon-and-rectum-balance-of-probabiliti/documents"}}