{"id":"F2025L01641","name":"Statement of Principles concerning malignant neoplasm of the oesophagus (Reasonable Hypothesis) (No. 11 of 2026)","slug":"statement-of-principles-concerning-malignant-neoplasm-of-the-oesophagus-reasonable-hypothesis-no-11-","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":443114,"registerId":"F2025L01641-fast-fetch-1775958032238","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 oesophagus (Reasonable Hypothesis) (No. 11 of 2026)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n![RMA Australian Government Coat of Arms](image.001.jpeg)\n\n \n\nStatement of Principles\n\nconcerning\n\nMALIGNANT NEOPLASM OF THE OESOPHAGUS  (Reasonable Hypothesis)\n\n(No. 11 of 2026)\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    19 December 2025\n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\nProfessor Terence Campbell AM\n\nChairperson\n\nby and on behalf of\n\nThe Repatriation Medical Authority\n\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\n\n\n1.                Name\n\n\nThis is the Statement of Principles concerning malignant neoplasm of the oesophagus (Reasonable Hypothesis) (No. 11 of 2026).\n\n1.                Commencement\n\n\n              This instrument commences on 19 January 2026.\n\n1.                Authority\n\n\nThis instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n1.                Repeal\n\n\nThe Statement of Principles concerning malignant neoplasm of the oesophagus (Reasonable Hypothesis) (No. 120 of 2015) (Federal Register of Legislation No. F2015L01685) made under subsections 196B(2) and (8) of the VEA is repealed.\n\n1.                Application\n\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\n1.                Definitions\n\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n1.                Kind of injury, disease or death to which this Statement of Principles relates\n  1.           This Statement of Principles is about malignant neoplasm of the oesophagus and death from malignant neoplasm of the oesophagus.\n\n\nMeaning of malignant neoplasm of the oesophagus\n\n1.           For the purposes of this Statement of Principles, malignant neoplasm of the oesophagus:\n  1.           means a primary malignant neoplasm arising from the cells of the oesophagus. The oesophagus is defined as the structure which begins proximally with the lower border of the hypopharynx and extends distally to the lower border of the oesophageal sphincter and can include the gastro-oesophageal junction; and\n  2.            excludes soft tissue sarcoma, carcinoid tumour, non-Hodgkin lymphoma and Hodgkin lymphoma.\n2.           While malignant neoplasm of the oesophagus attracts ICD‑10‑AM code C15, in applying this Statement of Principles the meaning of malignant neoplasm of the oesophagus is that given in subsection (2).\n3.           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\n\nDeath from malignant neoplasm of the oesophagus\n\n1.           For the purposes of this Statement of Principles, malignant neoplasm of the oesophagus, 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 oesophagus.\n\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n1.                Basis for determining the factors\n\n\nThe Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that malignant neoplasm of the oesophagus and death from malignant neoplasm of the oesophagus 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\n1.                Factors that must exist\n\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 oesophagus or death from malignant neoplasm of the oesophagus with the circumstances of a person's relevant service:\n\n1.           having smoked at least 2.5 pack-years before clinical onset, and where smoking has ceased, clinical onset occurred within 20 years of cessation;\n\n\nNote: one pack-year is defined in the Schedule 1 – Dictionary.\n\n1.           having orally consumed smokeless tobacco on more days than not for at least 5 years before clinical onset, and where consumption has ceased, clinical onset occurred within 15 years of cessation;\n\n\nNote:  smokeless tobacco is defined in the Schedule 1 - Dictionary.\n\n1.           having received a cumulative equivalent dose of at least 0.1 sievert of ionising radiation to the oesophagus at least 5 years before clinical onset;\n\n\nNote:  cumulative equivalent dose is defined in the Schedule 1 - Dictionary.\n\n1.           inhaling respirable asbestos fibres in an enclosed space:\n  1.           for a cumulative period of at least 1,000 hours before clinical onset; and\n  2.            at the time material containing respirable asbestos fibres was being applied, removed, dislodged, cut or drilled; and\n  3.            the first inhalation of respirable asbestos fibres commenced at least 5 years before clinical onset;\n2.           inhaling respirable asbestos fibres in an open environment:\n  1.           for a cumulative period of at least 3,000 hours before clinical onset; and\n  2.            at the time material containing respirable asbestos fibres was being applied, removed, dislodged, cut or drilled; and\n  3.            the first inhalation of respirable asbestos fibres commenced at least 5 years before clinical onset;\n3.           having a caustic burn of the oesophagus at least 10 years before clinical onset;\n4.           for squamous cell or undifferentiated carcinoma of the oesophagus only, consuming alcohol in an amount of at least 180 kilograms before clinical onset;\n\n\nNote: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.\n\n1.           for squamous cell or undifferentiated carcinoma of the oesophagus only, having Plummer-Vinson syndrome at the time of clinical onset;\n\n\nNote: Plummer-Vinson syndrome is defined in the Schedule 1 – Dictionary.\n\n1.           for squamous cell or undifferentiated carcinoma of the oesophagus only, drinking maté on more days than not for at least 5 years before clinical onset, and where drinking maté has ceased, clinical onset occurred within 15 years of cessation;\n\n\nNote:  Maté is a tea made from the dried leaves of the plant Ilex paraguariensis, which grows in South America. Synonyms for maté include yerba maté, erva maté, Brazilian tea, Paraguay tea, and Jesuit’s tea.\n\n1.       for squamous cell or undifferentiated carcinoma of the oesophagus only, acquiring persistent infection of the epithelium of the oesophagus with a strain from the specified list of human papilloma virus (HPV) strains before clinical onset;\n\n\nNote: specified list of human papilloma virus (HPV) strains is defined in the Schedule 1 – Dictionary.\n\n1.       for squamous cell carcinoma or undifferentiated carcinoma of the oesophagus only, having lichen planus of the oesophagus at the time of clinical onset;\n2.       for squamous cell carcinoma or undifferentiated carcinoma of the oesophagus only, having gastro-oesophageal reflux disease for at least the 5 years before clinical onset;\n3.       for adenocarcinoma or undifferentiated carcinoma of the oesophagus only, having gastro-oesophageal reflux disease for at least the 5 years before clinical onset;\n4.       for adenocarcinoma or undifferentiated carcinoma of the oesophagus only, having a Body Mass Index (BMI) of 30 or greater for at least 5 years in the 20 years immediately preceding clinical onset;\n\n\nNote: Body Mass Index (BMI) is calculated as W/H2 where:\n\n1.      W is the person's weight in kilograms; and\n2.      H is the person's height in metres.\n  1.       for adenocarcinoma or undifferentiated carcinoma of the oesophagus only, having Barrett oesophagus before clinical onset;\n\n\nNote: Barrett oesophagus is defined in the Schedule 1 – Dictionary.\n\n1.       having chewed betel quid or areca nut on more days than not for at least the 5 years before clinical onset, and where chewing has ceased, clinical onset occurred within 15 years of cessation;\n2.       consuming an average daily intake of at least 25 grams per day of processed meat product for at least 10 years within the 25 years before clinical onset;\n\n\nNote:  processed meat product is defined in the Schedule 1 - Dictionary.\n\n1.       having at least daily consumption of pickled vegetables for at least 5 years within the 25 years before clinical onset;\n2.       inhaling, ingesting or having cutaneous contact with tetrachloroethylene for a cumulative period of at least 1,000 hours before clinical onset, where the first exposure to tetrachloroethylene occurred at least 10 years before clinical onset;\n3.       having an abnormally large or dilated oesophagus due to Chagas’ disease at the time of clinical onset;\n\n\nNote 1: Chagas’ disease is caused by infection with the protozoan organism Trypanosoma cruzii. Approximately 3% of patients with Chagas’ disease develop an abnormally large or dilated oesophagus.\n\nNote 2: An abnormally large or dilated oesophagus due to Chagas’ disease is also called chagasic megaesophagus.\n\n1.       inability to consume an average of at least 200 grams per day of any combination of fruit and vegetables, for at least 5 consecutive years within the 25 years before clinical onset;\n2.       inability to obtain appropriate clinical management for malignant neoplasm of the oesophagus before clinical worsening.\n\n\n1.            Relationship to service\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  2.           The factor set out in subsection 9(22) applies only to material contribution to, or aggravation of, malignant neoplasm of the oesophagus where the person's malignant neoplasm of the oesophagus was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n2.            Factors referring to an injury or disease covered by another Statement of Principles\n\n\nIn this Statement of Principles:\n\n1.           if a factor referred to in section 9 applies in relation to a person; and\n2.           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\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                                 cumulative equivalent dose means the total dose of ionising radiation received by the particular organ or tissue from external exposure, internal exposure or both, apart from normal background radiation exposure in Australia, calculated in accordance with the methodology set out in Guide to calculation of 'cumulative equivalent dose' for the purpose of applying ionising radiation factors contained in Statements of Principles determined under Part XIA of the Veterans' Entitlements Act 1986 (Cth), Australian Radiation Protection and Nuclear Safety Agency, as in force on 2 August 2017.\n\nNote 1: Examples of circumstances that might lead to exposure to ionising radiation include being present during or subsequent to the testing or use of nuclear weapons, undergoing diagnostic or therapeutic medical procedures involving ionising radiation, and being a member of an aircrew, leading to increased levels of exposure to cosmic radiation.\n\nNote 2: For the purpose of dose reconstruction, dose is calculated as an average over the mass of a specific tissue or organ. If a tissue is exposed to multiple sources of ionising radiation, the various dose estimates for each type of radiation must be combined.\n\n                                malignant neoplasm of the oesophagus—see subsection 7(2).\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                               Plummer-Vinson syndrome means the triad of dysphagia, iron deficient anaemia, and oesophageal webs.  It is also known as Paterson-Kelly syndrome, Paterson-Brown-Kelly syndrome, or sideropenic dysphagia.\n\n                                processed meat product means preserved or cured meats, including ham, frankfurters, salami and bacon.\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 defined in the Schedule 1 - Dictionary.\n\n                                smokeless tobacco means tobacco products without combustion or pyrolysis at the time of use, including chewing tobacco and tobacco snuff.\n\n                                specified list of human papilloma virus (HPV) strains means HPV type 6, 11, 16, 18, 30, 31 or 33.\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":6,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals and replaces the 2015 Statement (see Repeal). The text reissues a Statement with updated factors, definitions and cross‑references and applies to VEA s120A and MRCA s338 claims. The instrument itself does not set out a line‑by‑line comparison to the 2015 version, so the precise substantive differences require a side‑by‑side comparison of the two instruments."},"complexity_factors":["Multiple discrete, condition‑ and histology‑specific factors (smoking, smokeless tobacco, alcohol, HPV, GERD, Barrett’s, BMI, caustic injury, asbestos, radiation, chemical exposures, diet, infectious and parasitic causes) spread across section 9, increasing rule complexity.","Quantitative thresholds and timing requirements (e.g. pack‑years, 0.1 sievert dose, cumulative hours of asbestos exposure, multi‑year exposure/cessation windows) require numeric assessment and historical reconstruction (see s9 and Schedule 1 definitions).","Different causal rules for cancer subtypes (squamous cell, adenocarcinoma, undifferentiated) mean outcome depends on histopathology rather than a single test (s9 subtype‑specific factors).","Cross‑references to other Statements of Principles (s11) create dependence on separate instruments and evolving versions of those instruments.","Reliance on defined technical methodologies outside the instrument (dose reconstruction methodology referenced in Schedule 1 'cumulative equivalent dose') imposes administrative and expert evidence requirements.","Requirement that any identified factor be related to relevant service (s10(1)) introduces an additional causation/legal link beyond medical criteria, and s10(2) limits one factor (s9(22)) to material contribution/aggravation when disease pre‑existed.","Extensive defined terms in Schedule 1 (e.g. pack‑year, smokeless tobacco, specified HPV strains, terminal event) means legal effect depends on precise definitions."],"plain_english_summary":"This Statement of Principles sets the medical and exposure conditions that must exist to raise a reasonable hypothesis linking malignant neoplasm of the oesophagus (and death from it) to a person’s relevant military service. Determined by the Repatriation Medical Authority, it applies to claims under the VEA (s120A) and MRCA (s338) and replaces the earlier 2015 Statement."},"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"},"kimi_summary":{"content_quality":"ok","complexity_score":6,"scope_assessment":{"changed":false,"description":"This is a standard replacement Statement of Principles maintaining the established scope of the Repatriation Medical Authority's function under Part XIA of the Veterans' Entitlements Act 1986. It updates the 2015 version but does not expand beyond the original purpose of establishing medical criteria for compensation claims. The structure and approach mirror other RMA Statements of Principles."},"complexity_factors":["22 distinct causal factors with varying specificity (some apply only to specific cancer subtypes like squamous cell vs adenocarcinoma)","Multiple temporal requirements (time lags of 5, 10, 15, 20, or 25 years between exposure and clinical onset)","Subtype-specific restrictions: 7 factors apply only to 'squamous cell or undifferentiated carcinoma', 4 factors apply only to 'adenocarcinoma or undifferentiated carcinoma'","Technical measurement requirements: pack-years of smoking, sieverts of radiation, kilograms of alcohol, grams of processed meat, Body Mass Index calculations","Cumulative exposure calculations required for asbestos (1,000/3,000 hours), tetrachloroethylene (1,000 hours), and radiation (0.1 sievert)","12 defined terms in Schedule 1 Dictionary, including complex definitions like 'cumulative equivalent dose' which references external ARPANSA methodology documents","Cross-referencing to other Statements of Principles for factors that refer to injuries/diseases covered elsewhere","Dual legislative framework application (VEA and MRCA) with different service definitions"],"plain_english_summary":"This instrument sets the medical rules used to decide whether Australian Defence Force members and veterans can get compensation for oesophageal cancer or death from it. It replaces the 2015 version and lists 22 risk factors (smoking, asbestos, radiation, certain diets, medical conditions, some chemical exposures, caustic injury, infections, etc.) that, if met, create a “reasonable hypothesis” the cancer was service-related.\n\nIt matters because meeting one listed factor and linking it to service is sufficient to support a valid compensation claim."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-oesophagus-reasonable-hypothesis-no-11-","history":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-oesophagus-reasonable-hypothesis-no-11-/history","analysis":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-oesophagus-reasonable-hypothesis-no-11-/analysis","conflicts":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-oesophagus-reasonable-hypothesis-no-11-/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-oesophagus-reasonable-hypothesis-no-11-/important-cases","documents":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-oesophagus-reasonable-hypothesis-no-11-/documents"}}