{"id":"F2023L00003","name":"Statement of Principles concerning malignant neoplasm of the prostate (Balance of Probabilities) (No. 4 of 2023)","slug":"statement-of-principles-concerning-malignant-neoplasm-of-the-prostate-balance-of-probabilities-no-4-","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":103675,"registerId":"commonwealth-F2023L00003-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 prostate (Balance of Probabilities) (No. 4 of 2023)","content":"![RMA Australian Government Coat of Arms](image.001.jpeg)\n\nStatement of Principles\n\nconcerning\n\nMALIGNANT NEOPLASM OF THE PROSTATE  \n(Balance of Probabilities)\n\n(No. 4 of 2023)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\nDated 23 December 2022.\n\n| The Common Seal of theRepatriation Medical Authoritywas affixed to this instrumentat the direction of: |\n| ------------------------------------------------------------------------------------------------------ |\n| Professor Terence Campbell AMChairperson                                                               |\n\n  \n\nContents\n\n1 Name....................................................3\n\n2 Commencement.............................................3\n\n3 Authority..................................................3\n\n4 Repeal...................................................3\n\n5 Application................................................3\n\n6 Definitions................................................3\n\n7 Kind of injury, disease or death to which this Statement of Principles relates.....3\n\n8 Basis for determining the factors..................................4\n\n9 Factors that must exist.........................................4\n\n10 Relationship to service.........................................5\n\n11 Factors referring to an injury or disease covered by another Statement of Principles.5\n\nSchedule 1 - Dictionary...............................................6\n\n1 Definitions................................................6\n\n  \n\n1.  Name\n\nThis is the Statement of Principles concerning malignant neoplasm of the prostate (Balance of Probabilities) (No. 4 of 2023).\n\n1.  Commencement\n\nThis instrument commences on 23 January 2023.\n\n1.  Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n1.  Repeal\n\nThe Statement of Principles concerning malignant neoplasm of the prostate No. 54 of 2014 (Federal Register of Legislation No. F2014L00523) made under subsections 196B(3) and (8) of the VEA is repealed.\n\n1.  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\n1.  Definitions\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 prostate and death from malignant neoplasm of the prostate.\n\nMeaning of malignant neoplasm of the prostate\n\n1.  For the purposes of this Statement of Principles, malignant neoplasm of the prostate:\n    1.  means a primary malignant neoplasm arising from the epithelial cells of the prostate gland; and\n    2.  includes high grade prostatic intraepithelial neoplasia; and\n    3.  excludes:\n        1.  haematolymphoid tumours (including non-Hodgkin lymphoma and Hodgkin lymphoma);\n        2.  low grade prostatic intraepithelial neoplasia;\n        3.  malignant melanoma;\n        4.  mesenchymal tumours (including soft tissue sarcoma); and\n        5.  primary neuroendocrine tumours.\n2.  While malignant neoplasm of the prostate attracts ICD‑10‑AM code C61, in applying this Statement of Principles the meaning of malignant neoplasm of the prostate 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\nDeath from malignant neoplasm of the prostate\n\n1.  For the purposes of this Statement of Principles, malignant neoplasm of the prostate, 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 prostate.\n\n> Note: terminal event is defined in the Schedule 1 – Dictionary.\n\n1.  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 prostate and death from malignant neoplasm of the prostate 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\n1.  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 prostate or death from malignant neoplasm of the prostate is connected with the circumstances of a person's relevant service:\n\n1.  being exposed to arsenic as specified before the clinical onset of malignant neoplasm of the prostate, where the first exposure to arsenic occurred at least 10 years before the clinical onset of malignant neoplasm of the prostate;\n\n> Note: being exposed to arsenic as specified is defined in the Schedule 1 - Dictionary.\n\n1.  having smoked tobacco products:\n    1.  in an amount of at least 15 pack-years before the clinical worsening of malignant neoplasm of the prostate; and\n    2.  commencing at least 5 years before the clinical worsening of malignant neoplasm of the prostate; and\n\nif smoking has ceased before the clinical worsening of malignant neoplasm of the prostate, then that worsening occurred within 10 years of cessation;\n\n> Note: one pack-year is defined in the Schedule 1 – Dictionary.\n\n1.  being obese for at least 10 years within the 20 years before the clinical worsening of malignant neoplasm of the prostate;\n\nNote: being obese is defined in the Schedule 1 – Dictionary.\n\n1.  inability to obtain appropriate clinical management for malignant neoplasm of the prostate.\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 factors set out in subsections 9(2) to 9(4) apply only to material contribution to, or aggravation of, malignant neoplasm of the prostate where the person's malignant neoplasm of the prostate 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\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(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\nbeing exposed to arsenic as specified means:\n\n(a) consuming drinking water with an average arsenic concentration of at least 50 micrograms per litre for a cumulative period of at least 10 years; or\n\n(b) consuming drinking water resulting in a cumulative total arsenic exposure equivalent to having consumed drinking water containing at least 50 micrograms per litre for at least 10 years; or\n\n(c) having clinical evidence of chronic arsenic toxicity.\n\nbeing 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 102 centimetres; or\n\n(c) for females, having waist circumference exceeding 88 centimetres.\n\nNote: BMI is also defined in the Schedule 1 - Dictionary.\n\nBMI 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\nmalignant neoplasm of the prostate \\- see subsection 7(2).\n\nMRCA means the Military Rehabilitation and Compensation Act 2004.\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\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\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.","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument maintains the standard scope of Repatriation Medical Authority Statements of Principles. It follows the established template for determining service connection for specific diseases under the VEA and MRCA. The scope remains tightly focused on establishing evidentiary factors for prostate cancer claims, consistent with the original legislative intent of subsection 196B(3) of the Veterans' Entitlements Act 1986."},"complexity_factors":["Multiple defined terms in Schedule 1 (approximately 8 key definitions including 'being exposed to arsenic as specified', 'being obese', 'one pack-year', 'terminal event')","Nested conditions within each factor (e.g., smoking requires pack-years threshold, 5-year commencement window, and potential 10-year post-cessation window)","Specific quantitative thresholds throughout (50 micrograms/litre arsenic, 10/15/20 year timeframes, BMI 30, 102cm/88cm waist measurements)","Exclusion clauses in the disease definition (5 specific exclusions from the cancer definition)","Conditional application limitation in section 10(2) restricting factors 9(2)-9(4) to aggravation cases only, not initial causation","Cross-referencing mechanism in section 11 allowing incorporation of other Statements of Principles by reference","Mathematical formula for BMI calculation included in definitions"],"plain_english_summary":"This instrument sets the medical test for linking malignant prostate cancer (and death) to Australian military service for claims under the VEA and MRCA, replacing the 2014 guidance with updated evidence. It names key service-related contributors—notably significant arsenic-contaminated water, heavy long-term smoking, prolonged obesity, or inadequate medical care—as bases for establishing causation on the balance of probabilities.\n\nA crucial limit: those factors only help where prostate cancer pre‑existed or was present during service and was worsened by it; they do not cover new-onset disease caused wholly by service."},"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":3,"scope_assessment":{"changed":true,"description":"Replaces the earlier Statement (No. 54 of 2014) (s 4) and restates the covered condition with explicit inclusions/exclusions, specific qualifying exposures and timing rules, and application to death from terminal events (s 7, s 9; Schedule). The instrument therefore modifies the governing criteria for service connection determinations by setting defined numeric thresholds and new or clarified factors."},"complexity_factors":["Targeted legal application to VEA and MRCA claims and repeal of prior Statement (s 4, s 5 application).","Precise exposure thresholds and latency/timing rules (arsenic ≥50 μg/L for ≥10 years; smoking ≥15 pack‑years with specific commencement/cessation windows; obesity duration) (s 9; Schedule).","Technical clinical definitions and ICD‑10‑AM coding references that require medical records and coding (s 7(2)‑(3)).","Inclusion of death via terminal events ties proximate causes of death to the underlying condition (s 7(4); Schedule terminal event).","Subjective/administrative element — 'inability to obtain appropriate clinical management' creates potential evidentiary and decision‑maker discretion (s 9(4)).","Cross‑references to other Statements of Principles may require coordination of multiple instruments and their current terms (s 11).","Mathematical definitions (BMI, pack‑year) clarify measurement but demand reliable anthropometric and smoking history data (Schedule)."],"plain_english_summary":"**Statement of Principles** sets the medical rules used to decide whether prostate cancer (and death from it) is connected to Australian military service for veteran compensation claims. It identifies qualifying exposures and timing thresholds — arsenic in drinking water, a specified smoking history, long‑term obesity, and inability to obtain appropriate clinical management — and applies these rules to claims under the VEA and MRCA."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-prostate-balance-of-probabilities-no-4-","history":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-prostate-balance-of-probabilities-no-4-/history","analysis":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-prostate-balance-of-probabilities-no-4-/analysis","conflicts":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-prostate-balance-of-probabilities-no-4-/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-prostate-balance-of-probabilities-no-4-/important-cases","documents":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-prostate-balance-of-probabilities-no-4-/documents"}}