{"id":"F2022L00661","name":"Statement of Principles concerning malignant neoplasm of the larynx (Balance of Probabilities) (No. 42 of 2022)","slug":"statement-of-principles-concerning-malignant-neoplasm-of-the-larynx-balance-of-probabilities-no-42-o","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441372,"registerId":"F2022L00661-fast-fetch-1775956684160","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 larynx (Balance of Probabilities) (No. 42 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 LARYNX (Balance of Probabilities)\n\n(No. 42 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 29 April 2022\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 larynx (Balance of Probabilities) (No. 42 of 2022).\n\n2 Commencement\n\n This instrument commences on 30 May 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the larynx No. 62 of 2013 (Federal Register of Legislation No. F2013L01650) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 larynx and death from malignant neoplasm of the larynx.\n\nMeaning of malignant neoplasm of the larynx\n\n(2) For the purposes of this Statement of Principles, malignant neoplasm of the larynx:\n\n(a) means a primary malignancy of the mucosa of the larynx, which extends from the lower border of the hypopharynx to the upper border of the trachea; and\n\n(b) excludes:\n\n(i) carcinoid tumour;\n\n(ii) Hodgkin's lymphoma;\n\n(iii) non-Hodgkin lymphoma; and\n\n(iv) soft tissue sarcoma.\n\nNote: The larynx is divided anatomically into three sections: the supraglottis, glottis and subglottis (infraglottis).\n\n(3) While malignant neoplasm of the larynx attracts ICD‑10‑AM code C32, in applying this Statement of Principles the meaning of malignant neoplasm of the larynx 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 larynx\n\n(5) For the purposes of this Statement of Principles, malignant neoplasm of the larynx, 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 larynx.\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 larynx and death from malignant neoplasm of the larynx 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 larynx or death from malignant neoplasm of the larynx is connected with the circumstances of a person's relevant service:\n\n(1) having smoked tobacco products:\n\n(a) in an amount of at least 3 pack-years before the clinical onset of malignant neoplasm of the larynx; and\n\n(b) commencing at least 10 years before the clinical onset of malignant neoplasm of the larynx; and\n\nif smoking has ceased before the clinical onset of malignant neoplasm of the larynx, then that onset occurred within 15 years of cessation;\n\nNote: one pack-year is defined in the Schedule 1 - Dictionary.\n\n(2) having been exposed to second-hand smoke:\n\n(a) for at least 10,000 hours before the clinical onset of malignant neoplasm of the larynx; and\n\n(b) commencing at least 10 years before the clinical onset of malignant neoplasm of the larynx; and\n\nif exposure to second-hand smoke has ceased before the clinical onset of malignant neoplasm of the larynx, then that onset occurred within 15 years of cessation;\n\nNote: having been exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.\n\n(3) 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 larynx; 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 larynx;\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(4) 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 larynx; 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 larynx;\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(5) inhaling smoke from the combustion of coal or other fossil fuel in an enclosed space:\n\n(a) for a cumulative period of at least 15,000 hours before the clinical onset of malignant neoplasm of the larynx; and\n\n(b) commencing at least 10 years before the clinical onset of malignant neoplasm of the larynx;\n\n(6) consuming alcohol:\n\n(a) in an amount of at least 150 kilograms within any 10 year period; and\n\n(b) at least 5 years before the clinical onset of malignant neoplasm of the larynx; and\n\nif consumption of alcohol has ceased before the clinical onset of malignant neoplasm of the larynx, then that onset occurred within 40 years of cessation;\n\nNote: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.\n\n(7) inhaling mist from sulphuric, nitric or hydrochloric acid:\n\n(a) for a cumulative period of at least 10,000 hours before the clinical onset of malignant neoplasm of the larynx; and\n\n(b) where inhalation of the mist commenced at least 10 years before the clinical onset of malignant neoplasm of the larynx;\n\nNote: mist is defined in the Schedule 1 - Dictionary.\n\n(8) undergoing solid organ transplantation, excluding corneal transplant, before the clinical onset of malignant neoplasm of the larynx;\n\n(9) having infection with human immunodeficiency virus before the clinical onset of malignant neoplasm of the larynx;\n\n(10) acquiring persistent infection of the laryngeal epithelium with human papillomavirus type 16 or 18 before the clinical onset of malignant neoplasm of the larynx;\n\n(11) consuming maté:\n\n(a) on more days than not; and\n\n(b) for at least 10 years before the clinical onset of malignant neoplasm of the larynx; and\n\nif consumption of maté has ceased before the clinical onset of malignant neoplasm of the larynx, then that onset occurred within 10 years of cessation;\n\n(12) having gastro-oesophageal reflux disease for at least the 10 years before the clinical onset of malignant neoplasm of the larynx;\n\n(13) inhaling opium on average at least weekly for at least 10 years before the clinical onset of malignant neoplasm of the larynx;\n\nNote: opium is defined in the Schedule 1 - Dictionary.\n\n(14) inability to obtain appropriate clinical management for malignant neoplasm of the larynx.\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(14) applies only to material contribution to, or aggravation of, malignant neoplasm of the larynx where the person's malignant neoplasm of the larynx 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 having been exposed to second-hand smoke means having been in an enclosed space and inhaling smoke from burning tobacco products or smoke that has been exhaled by another person who is smoking.\n\n malignant neoplasm of the larynx—see subsection 7(2).\n\n mist means a liquid aerosol formed by condensation of a vapour or by atomisation of a liquid.\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 opium means the dried or boiled juice (latex) obtained from the seedpod of the poppy plant (Papaver somniferum).\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":{"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 2013 predecessor—determining service connection for laryngeal cancer claims. The update reflects new medical evidence (adding factors like HPV infection and maté consumption) but does not expand beyond the original purpose of establishing compensation criteria for this specific condition."},"complexity_factors":["Multiple cumulative thresholds requiring precise calculations (pack-years, hours of exposure, kilograms of alcohol over time periods)","Conditional timing requirements nested within factors (e.g., 'if smoking has ceased... then that onset occurred within 15 years of cessation')","Cross-references to external classification systems (ICD-10-AM Tenth Edition)","Defined terms in Schedule 1 that modify the meaning of factors (e.g., 'one pack-year' includes detailed conversion rules for pipe tobacco and cigars)","Interaction clause in section 11 requiring reference to other Statements of Principles for related conditions","Specific exclusions from the definition (carcinoid tumour, Hodgkin's lymphoma, non-Hodgkin lymphoma, soft tissue sarcoma)"],"plain_english_summary":"This instrument updates the medical rules for deciding whether laryngeal cancer (or death from it) is service-related for claims under the Veterans' Entitlements Act and the Military Rehabilitation and Compensation Act. It replaces the 2013 guidance and lists 14 risk factors (e.g. smoking, occupational exposures, alcohol and certain medical/infectious conditions); if at least one factor is linked to service the cancer can be deemed service-related.\n\nIt affects current and former ADF members and their families and determines entitlement to compensation and treatment on the balance of probabilities."},"flash_summary":{"complexity_score":7,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the earlier Statement of Principles (No. 62 of 2013) and replaces it with a new Statement that: (a) narrowly defines 'malignant neoplasm of the larynx' and lists explicit exclusions (section 7(2)); and (b) specifies an enumerated set of qualifying factors with precise quantitative thresholds, latency and cessation rules (section 9 and Schedule 1). As such, the operative scope has been changed by repeal-and-replacement to the definitions and the set of qualifying risk factors now governing connection to relevant service."},"complexity_factors":["Quantitative exposure thresholds and metrics that must be proved (pack‑years for smoking — section 9(1) and Schedule 1 definition; alcohol weight 150 kg over 10 years — section 9(6) and Schedule 1 note).","Multiple cumulative exposure hour thresholds with different workplace contexts (second‑hand smoke 10,000 hours — section 9(2); asbestos enclosed 2,000 hours — 9(3); asbestos open 6,000 hours — 9(4); coal/fossil fuel combustion 15,000 hours — 9(5); acid mists 10,000 hours — 9(7)).","Uniform latency requirements and cessation windows (many factors require exposures to have commenced at least 10 years before clinical onset; cessation limits vary by factor — section 9 and subsection notes).","Specific infectious and medical-state factors requiring clinical evidence (HPV 16/18 persistent infection — 9(10); HIV infection — 9(9); solid organ transplant excluding corneal — 9(8)).","Disease definition and exclusions that narrow scope to primary mucosal laryngeal malignancy and exclude carcinoid, Hodgkin’s and non‑Hodgkin lymphomas, and soft tissue sarcoma — section 7(2).","Interplay with other Statements of Principles where factors overlap with other certified injuries/diseases — section 11 (requires cross‑reference to other statements).","Legal and evidentiary standard: connection assessed 'on the balance of probabilities' based on 'sound medical‑scientific evidence' (section 8), concentrating proof burdens on claimants to document exposures and timings.","Application and transitional mechanics: repeal of prior Statement and commencement date impose administrative change and potential reinterpretation of past claims — sections 2 and 4; applicability limited to claims under specified VEA/MRCA provisions — section 5.","One factor (inability to obtain appropriate clinical management) applies only as material contribution/aggravation when the disease was suffered or contracted before or during service, adding a conditional rule to causation assessment — section 10(2)."],"plain_english_summary":"This Statement sets the medical criteria the Repatriation Medical Authority uses to decide whether laryngeal cancer (and death from it) can be connected to a person’s relevant military service for claims under the Veterans’ Entitlements Act or the Military Rehabilitation and Compensation Act. It defines the disease, excludes certain tumour types, and lists specific risk factors with numeric exposure and timing thresholds.\n\nClaimants must establish the listed exposures or conditions (for example smoking, asbestos, alcohol, HPV, HIV, organ transplant, maté, reflux, or inability to obtain care) within the stated latency and cessation windows; meeting those thresholds determines connection on the balance of probabilities."},"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-larynx-balance-of-probabilities-no-42-o","history":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-larynx-balance-of-probabilities-no-42-o/history","analysis":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-larynx-balance-of-probabilities-no-42-o/analysis","conflicts":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-larynx-balance-of-probabilities-no-42-o/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-larynx-balance-of-probabilities-no-42-o/important-cases","documents":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-larynx-balance-of-probabilities-no-42-o/documents"}}