{"id":"F2019L01338","name":"Statement of Principles concerning malignant neoplasm of the renal pelvis and ureter (Reasonable Hypothesis) (No. 92 of 2019)","slug":"statement-of-principles-concerning-malignant-neoplasm-of-the-renal-pelvis-and-ureter-reasonable-hypo","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440271,"registerId":"F2019L01338-fast-fetch-1775955960474","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 renal pelvis and ureter (Reasonable Hypothesis) (No. 92 of 2019)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 20.2\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 RENAL PELVIS AND URETER (Reasonable Hypothesis)\n\n(No. 92 of 2019)\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 18 October 2019\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 Nicholas Saunders AO
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 renal pelvis and ureter (Reasonable Hypothesis) (No. 92 of 2019).\n\n2 Commencement\n\n This instrument commences on 18 November 2019.\n\n3 Authority\n\nThis instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning malignant neoplasm of the renal pelvis and ureter No. 98 of 2011 (Federal Register of Legislation No. F2011L01733) made under subsections 196B(2) and (8) of the VEA is repealed.\n\n5 Application\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\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 renal pelvis and ureter and death from malignant neoplasm of the renal pelvis and ureter.\n\nMeaning of malignant neoplasm of the renal pelvis and ureter\n\n(2) For the purposes of this Statement of Principles, malignant neoplasm of the renal pelvis and ureter:\n\n(a) means a primary malignant neoplasm arising from the epithelial cells of the upper urinary tract, including the renal calyces, renal pelvis, pelviureteric junction and ureter, but excluding the ureteric orifice of the bladder; and\n\n(b) includes urothelial carcinoma (also known as transitional cell carcinoma), squamous cell carcinoma, adenocarcinoma, small cell carcinoma and carcinoma in situ; and\n\n(c) excludes soft tissue sarcoma, carcinoid tumour, non-Hodgkin lymphoma and Hodgkin’s lymphoma.\n\n(3) While malignant neoplasm of the renal pelvis and ureter attracts ICD‑10‑AM code C65 or C66, in applying this Statement of Principles the meaning of malignant neoplasm of the renal pelvis and ureter 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 renal pelvis and ureter\n\n(5) For the purposes of this Statement of Principles, malignant neoplasm of the renal pelvis and ureter, 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 renal pelvis and ureter.\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n8 Basis for determining the factors\n\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that malignant neoplasm of the renal pelvis and ureter and death from malignant neoplasm of the renal pelvis and ureter 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\n9 Factors that must exist\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 renal pelvis and ureter or death from malignant neoplasm of the renal pelvis and ureter with the circumstances of a person's relevant service:\n\n(1) smoking at least 2.5 pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of malignant neoplasm of the renal pelvis or ureter, where smoking commenced at least five years before the clinical onset of malignant neoplasm of the renal pelvis or ureter;\n\nNote: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary. \n\n(2) having received a cumulative equivalent dose of at least 0.1 sievert of ionising radiation to the affected site at least five years before the clinical onset of malignant neoplasm of the renal pelvis or ureter;\n\nNote: cumulative equivalent dose is defined in the Schedule 1 - Dictionary. \n\n(3) inhaling, ingesting or having cutaneous contact with high concentrations of polycyclic aromatic hydrocarbons, through work involving a specified industrial or manufacturing process 1:\n\n(a) for a cumulative period of at least 1 500 hours, before the clinical onset of malignant neoplasm of the renal pelvis or ureter; and\n\n(b) where the first exposure occurred at least five years before the clinical onset of malignant neoplasm of renal pelvis or ureter;\n\nNote: polycyclic aromatic hydrocarbons and specified industrial or manufacturing process 1 are defined in the Schedule 1 – Dictionary.\n\n(4) inhaling, ingesting or having cutaneous contact with an agent from the specified list of agents containing high concentrations of polycyclic aromatic hydrocarbons:\n\n(a) for a cumulative period of at least 1 500 hours, before the clinical onset of malignant neoplasm of the renal pelvis or ureter; and\n\n(b) where the first exposure occurred at least five years before the clinical onset of malignant neoplasm of the renal pelvis or ureter;\n\nNote: specified list of agents containing high concentrations of polycyclic aromatic hydrocarbons is defined in the Schedule 1 – Dictionary.\n\n(5) inhaling, ingesting or having cutaneous contact with an aromatic amine from the specified list of aromatic amines:\n\n(a) for a cumulative period of at least 1 000 hours, before the clinical onset of malignant neoplasm of the renal pelvis or ureter; and\n\n(b) where the first exposure occurred at least five years before the clinical onset of malignant neoplasm of the renal pelvis or ureter;\n\nNote 1: Inhaling, ingesting or having cutaneous contact with an aromatic amine does not include exposure due to cigarette smoke or hair dyes.\n\nNote 2: specified list of aromatic amines is defined in the Schedule 1 – Dictionary.\n\n(6) inhaling, ingesting or having cutaneous contact with a high concentration of an aromatic amine, through work involving the specified industrial or manufacturing process 2:\n\n(a) for a cumulative period of at least 1 500 hours, before the clinical onset of malignant neoplasm of the renal pelvis or ureter; and\n\n(b) where the first exposure occurred at least five years before the clinical onset of malignant neoplasm of the renal pelvis or ureter;\n\nNote 1: Inhaling, ingesting or having cutaneous contact with a high concentration of an aromatic amine does not include exposure due to cigarette smoke or hair dyes.\n\nNote 2: specified industrial or manufacturing process 2 is defined in the Schedule 1 – Dictionary.\n\n(7) inhaling, ingesting or having cutaneous contact with tetrachloroethylene for a cumulative period of at least 5 000 hours, before the clinical onset of malignant neoplasm of the renal pelvis or ureter, where the first exposure occurred at least five years before the clinical onset of malignant neoplasm of the renal pelvis or ureter;\n\n(8) being heavily exposed to diesel engine exhaust for a cumulative period of at least 15 000 hours, before the clinical onset of malignant neoplasm of the renal pelvis or ureter;\n\nNote: being heavily exposed to diesel engine exhaust is defined in the Schedule 1 – Dictionary.\n\n(9) being exposed to lead as specified before the clinical onset of malignant neoplasm of the renal pelvis or ureter, where the first exposure to lead occurred at least five years before the clinical onset of malignant neoplasm of the renal pelvis or ureter;\n\nNote: being exposed to lead as specified is defined in the Schedule 1 – Dictionary.\n\n(10) being exposed to arsenic as specified before the clinical onset of malignant neoplasm of the renal pelvis or ureter, where the first exposure to arsenic occurred at least ten years before the clinical onset of malignant neoplasm of the renal pelvis or ureter;\n\nNote: being exposed to arsenic as specified is defined in the Schedule 1 – Dictionary.\n\n(11) working as a painter for a cumulative period of at least 5 000 hours, before the clinical onset of malignant neoplasm of the renal pelvis or ureter, where that work began at least five years before the clinical onset of malignant neoplasm of the renal pelvis or ureter;\n\nNote: working as a painter is defined in the Schedule 1 – Dictionary.\n\n(12) working as a hairdresser or barber for a cumulative period of at least 5 000 hours, before the clinical onset of malignant neoplasm of the renal pelvis or ureter, where that work began at least five years before the clinical onset of malignant neoplasm of the renal pelvis or ureter;\n\nNote: working as a hairdresser or barber is defined in the Schedule 1 – Dictionary.\n\n(13) having renal stone disease of the affected urinary tract at least five years before the clinical onset of malignant neoplasm of the renal pelvis or ureter;\n\n(14) having hydronephrosis or hydroureter of the affected urinary tract at least five years before the clinical onset of malignant neoplasm of the renal pelvis or ureter;\n\n(15) having chronic renal failure at least one year before the clinical onset of malignant neoplasm of the renal pelvis or ureter;\n\nNote: chronic renal failure is defined in the Schedule 1 – Dictionary.\n\n(16) ingesting aristolochic acid as specified at least two years before the clinical onset of malignant neoplasm of the renal pelvis or ureter;\n\nNote: ingesting aristolochic acid as specified is defined in the Schedule 1 – Dictionary.\n\n(17) consuming a total of at least 50 grams of phenacetin at least five years before the clinical onset of malignant neoplasm of the renal pelvis or ureter;\n\nNote: phenacetin is defined in the Schedule 1 – Dictionary.\n\n(18) being treated with systemic cyclophosphamide or systemic ifosfamide, at least five years before the clinical onset of malignant neoplasm of the renal pelvis or ureter;\n\n(19) being treated with chlornaphazine at least five years before the clinical onset of malignant neoplasm of the renal pelvis or ureter;\n\n(20) being treated with pioglitazone, or a medication containing pioglitazone, for a continuous period of at least one year, within the ten years before the clinical onset of malignant neoplasm of the renal pelvis or ureter;\n\n(21) having diabetes mellitus for at least five years before the clinical onset of malignant neoplasm of the renal pelvis or ureter;\n\n(22) having an infection of the renal pelvis or ureter with Schistosoma haematobium at least five years before the clinical onset of malignant neoplasm of the renal pelvis or ureter;\n\n(23) having an indwelling ureteric stent or other foreign body in the ureter for a continuous period (excepting routine stent changes) of at least five years, before the clinical onset of malignant neoplasm of the renal pelvis or ureter;\n\n(24) having neurogenic bladder at least five years before the clinical onset of malignant neoplasm of the renal pelvis or ureter;\n\nNote: neurogenic bladder is defined in the Schedule 1 – Dictionary.\n\n(25) having chronic urinary tract infection at least five years before the clinical onset of malignant neoplasm of the renal pelvis or ureter;\n\nNote: chronic urinary tract infection is defined in the Schedule 1 – Dictionary.\n\n(26) inability to obtain appropriate clinical management for malignant neoplasm of the renal pelvis and ureter.\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(26) applies only to material contribution to, or aggravation of, malignant neoplasm of the renal pelvis and ureter where the person's malignant neoplasm of the renal pelvis and ureter 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(2) 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 being 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 ten 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 ten years; or\n\n(c) having clinical evidence of chronic arsenic toxicity.\n\n being exposed to lead as specified means:\n\n(a) engaging in lead risk work as specified for at least two years; or\n\n(b) having a blood lead level of at least 40 micrograms per decilitre; or\n\n(c) having lead nephropathy.\n\nNote: lead risk work as specified is also defined in the Schedule 1 – Dictionary.\n\n being heavily exposed to diesel engine exhaust means:\n\n(a) being an occupant in an enclosed diesel-powered vehicle cabin contaminated with diesel fumes; or\n\n(b) working in an enclosed space where diesel-powered engines or motors are being operated; or\n\n(c) repairing and/or servicing diesel engines.\n\n chronic renal failure means:\n\n(a) having a glomerular filtration rate of less than 15 mL/min/1.73 m2 for a period of at least three months; or\n\n(b) a need for renal replacement therapy (dialysis or transplantation) for treatment of complications of decreased glomerular filtration rate which would otherwise increase the risk of morbidity and mortality; or\n\n(c) undergoing chronic dialysis.\n\n chronic urinary tract infection means bacterial infection of the urinary tract that either does not respond to treatment, keeps recurring over a period of at least one year or at least ten episodes of urinary tract infection.\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 the 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 ingesting aristolochic acid as specified means:\n\n(a) consuming a total of at least 60 grams of plant material of the genus Aristolochia as a constituent of herbal medication; or\n\n(b) consuming plant material of the genus Aristolochia or foods containing plant material of the genus Aristolochia, as part of the regular diet for a period of at least 15 months.\n\n lead risk work as specified means work that exposes a worker to:\n\n(a) lead particulates, lead dust or lead fumes; or\n\n(b) molten alloys containing lead; or\n\n(c) lead included in batteries or parts of batteries; or\n\n(d) lead based spray paint.\n\nNote: Examples of work that may expose a worker to lead include, but are not limited to, soldering; abrasive blasting or water jet treatment of surfaces coated in lead based paint; removing paint from old houses, ships or bridges; plumbing work; cleaning up or sifting through the remains of a fire; radiator repair work; machining metals or alloys containing lead; and welding leaded steel.\n\n malignant neoplasm of the renal pelvis and ureter—see subsection 7(2).\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n neurogenic bladder means flaccid, spastic or mixed bladder dysfunction caused by neurological damage affecting the bladder.\n\nNote: Examples of a cause of neurogenic bladder include, but are not limited to, spinal cord injury, cerebrovascular accident, Parkinson's disease and diabetic autonomic neuropathy. \n\n pack-years of cigarettes, or the equivalent thereof in other tobacco products means a calculation of consumption where one pack-year of cigarettes equals twenty tailor-made cigarettes per day for a period of one calendar year, or 7 300 cigarettes. One tailor-made cigarette approximates one gram of tobacco or one gram of cigar or pipe tobacco by weight. One pack-year of tailor-made cigarettes equates to 7.3 kilograms of smoking tobacco by weight. Tobacco products mean cigarettes, pipe tobacco or cigars, smoked alone or in any combination.\n\n phenacetin means an aniline derivative that has analgesic and antipyretic properties, that was formerly used as a constituent of several over-the-counter compound analgesic medications, including Bex or Vincent's powder, Empirin Compound and Bromo seltzer.\n\n polycyclic aromatic hydrocarbons means hydrocarbons with three or more condensed aromatic rings in which certain carbon atoms are common to two or three rings. Polycyclic aromatic hydrocarbons occur in crude oil, shale oil and coal tars, and can be formed during the combustion of organic material or during high temperature processing of crude oil, coal, coke or other industrial carbon compounds.\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 also defined in the Schedule 1 - Dictionary.\n\n soot means a carbonaceous by-product material produced from the incomplete combustion of fossil fuel or other carbon-containing material, including airborne, residual, pyrolysed fuel particles such as coal, cenospheres, charred wood and petroleum coke.\n\n specified industrial or manufacturing process 1 means:\n\n(a) aluminium production; or\n\n(b) carbon electrode manufacturing; or\n\n(c) coal gasification; or\n\n(d) coal tar distillation; or\n\n(e) coke production; or\n\n(f) iron or steel foundries or smelters.\n\n specified industrial or manufacturing process 2 means:\n\n(a) auramine production; or\n\n(b) magenta production; or\n\n(c) rubber manufacturing.\n\n specified list of agents containing high concentrations of polycyclic aromatic hydrocarbons means:\n\n(a) coal tar pitch during paving and roofing;\n\n(b) concentrated coal tar distillates during coal tar distillation;\n\n(c) creosote;\n\n(d) soot during the cleaning of chimneys or flues; or\n\n(e) untreated or mildly treated mineral oils.\n\n \n\nNote: soot and untreated or mildly treated mineral oils are also defined in the Schedule 1 – Dictionary.\n\n specified list of aromatic amines means:\n\n(a) 2-naphthylamine;\n\n(b) 4-aminobiphenyl;\n\n(c) 4-chloro-ortho-toluidine;\n\n(d) benzidine;\n\n(e) benzidine-based dyes; or\n\n(f) ortho-toluidine.\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 untreated or mildly treated mineral oils:\n\n(a) means mineral oils which have not been highly refined to remove polycyclic aromatic hydrocarbons; and\n\n(b) includes lubricant products, including, but not limited to, engine oils, transmission fluids, gear oils, hydraulic fluids and metalworking fluids; and\n\n(c) excludes:\n\n(i) mineral oils used in cosmetic, pharmaceutical and food products; and\n\n(ii) other petroleum distillates used as fuels such as petrol, kerosene, jet fuel, diesel fuel and fuel oils.\n\nNote: These mineral oils may also be found in certain agricultural sprays, printing inks, and concrete mould release agents.\n\n VEA means the Veterans' Entitlements Act 1986.\n\n working as a hairdresser or barber means the cutting and styling of hair, including the application of hair colourants and other chemicals.\n\n working as a painter:\n\n(a) means applying paint, including solvent- or water-based conventional paint, spray paint, varnish, enamel, lacquer, water-emulsion and solution finish, nonaqueous dispersion or organosol, plastisol, and powder coating, during the course of activities such as building, maintenance and construction, interior and exterior decoration, artistic painting, and wood and metal painting; and\n\n(b) includes mixed activities in which application of paint occurs with other tasks, such as wallpapering and plastering, and activities that are preparatory to painting, such as mixing paints, maintaining painting equipment, and background preparation of surfaces for application of paint.\n\n \n\n \n","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":7,"scope_assessment":{"changed":true,"description":"This 2019 Statement replaces the 2011 instrument and broadens and updates the explicit list of qualifying factors and definitions. The 2019 version adds and/or clarifies a number of specific chemical and occupational risk items (for example, explicit inclusion of pioglitazone use (9(20)), tetrachloroethylene (9(7)), diesel exhaust thresholds (9(8)), and precise definitions for lead and arsenic exposure in Schedule 1). It also sets detailed quantitative thresholds and latency requirements and cross-references modern technical guidance for dose calculation (Schedule 1). Those additions and the more prescriptive thresholds expand the practical scope of cases that can meet the \"reasonable hypothesis\" test and increase the technical detail required to evidence a claim, compared with a prior instrument that used different or fewer listed factors. (See sections 4, 7–9 and Schedule 1.)"},"complexity_factors":["Relatively long list of specific causal factors in section 9 (26 discrete factors/subclauses).","Extensive Schedule 1 dictionary with many defined terms (approx. 28 distinct definitions and sub-definitions, including multi-part technical definitions).","Multiple numerical thresholds and units to be applied (e.g. 2.5 pack‑years, 0.1 sievert, 1 500/5 000/15 000 cumulative hours, 50 µg/L arsenic for 10 years, blood lead ≥40 µg/dL).","Multiple latency periods attached to different factors (1, 2, 5 and 10 year minima).","Cross-references to other instruments and technical guides (ICD‑10‑AM coding, ARPANSA Guide to calculation of cumulative equivalent dose, other Statements of Principles per section 11).","Nested conditions and exclusions (e.g. exposures excluded from certain factors such as cigarette smoke or hair dyes; cumulative exposure plus first-exposure timing requirements).","Technical assessment requirements that may need expert evidence (dose reconstruction, occupational exposure quantification, laboratory confirmation of toxicities).","Repeal and replacement of an earlier instrument (2011) — creates need to compare versions for changed content and transitional issues."],"plain_english_summary":"**What this instrument does (mechanics)**\n\n- This is a \"Statement of Principles\" (an authoritative medical/causation guide) about malignant tumours of the renal pelvis and ureter, and death from those tumours. It is used when deciding veterans’ and members’ compensation claims under the Veterans' Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA) (see sections 3 and 5).\n\n- The Statement lists the medical definition of the disease (what counts as malignant neoplasm of the renal pelvis and ureter) and then sets out a fixed list of exposures, medical conditions and treatments that, if present and connected to a person's relevant military service, are sufficient to raise a \"reasonable hypothesis\" that the disease is related to service (see sections 7, 9 and 10). If at least one listed factor applies, decision-makers can treat service as a credible cause for the condition for the purposes of a claim.\n\n- The instrument also repeals the prior (2011) Statement on the same condition and replaces it with the 2019 version (section 4).\n\n**Who this affects**\n\n- Veterans, current or former members of the Australian Defence Force, and members of peacekeeping forces who lodge claims under the VEA or MRCA for malignant neoplasm of the renal pelvis and ureter (section 5).\n\n- Decision-makers in the Department of Veterans’ Affairs (DVA) and the agencies that assess entitlement: they rely on this Statement to determine whether a reasonable hypothesis connects the disease to service (sections 3, 8–11).\n\n- Medical and occupational evidence providers: clinicians, occupational hygienists and others must document exposures, medical history and latency in ways that meet the Statement’s thresholds and definitions (sections 6, 9 and Schedule 1).\n\n**Key substantive rules and thresholds (what must be proved)**\n\n- The Statement treats the disease as including several histological subtypes (e.g. urothelial carcinoma, squamous cell carcinoma) but excludes certain tumours like soft tissue sarcoma and lymphomas (subsection 7(2)).\n\n- At least one of the listed factors in section 9 must be present and linked to the person’s relevant service for a reasonable hypothesis of service connection. Examples include:\n - Smoking: at least 2.5 pack‑years, with smoking starting at least five years before clinical onset (9(1) and Schedule definition of \"pack‑years\").\n - Ionising radiation: cumulative equivalent dose to the affected site of at least 0.1 sievert, with first exposure at least five years prior (9(2) and Schedule definition of \"cumulative equivalent dose\").\n - Occupational chemical exposures: specified hours of exposure to polycyclic aromatic hydrocarbons, aromatic amines, tetrachloroethylene, diesel exhaust, lead or arsenic, with defined minimum cumulative hours/doses and latency periods (various subclauses of section 9 and Schedule 1).\n - Specific medical conditions and treatments: renal stone disease, hydronephrosis, chronic renal failure, chronic urinary tract infection, neurogenic bladder, infection with Schistosoma haematobium, ingestion of aristolochic acid, prior certain chemotherapies (e.g. cyclophosphamide), pioglitazone use for at least one continuous year in the previous ten years, and prior consumption of phenacetin (section 9 and Schedule 1).\n - Work categories: e.g. working as a painter or as a hairdresser/barber for specified cumulative periods (9(11), 9(12) and Schedule 1 definitions).\n - A residual factor: inability to obtain appropriate clinical management for the condition (9(26)), which applies only in material contribution/aggravation cases where the disease existed before or during service (section 10(2)).\n\n- Many factors require specified minimum cumulative exposure or dose and specified minimum latency (time gap) between first exposure and clinical onset; those thresholds are set in section 9 and in Schedule 1.\n\n- Some exposures are expressly excluded from particular items (for example, exposure to aromatic amines does not include exposure from cigarette smoke or hair dyes; see notes to 9(5) and 9(6)).\n\n- If a factor listed here refers to another disease or injury that is covered by a different Statement of Principles, that other Statement applies as written (section 11).\n\n**Why this matters (official purpose and practical implications)**\n\n- Officially, the Repatriation Medical Authority states the Statement is based on sound medical-scientific evidence that these factors can link the disease to military or related service (section 8).\n\n- Practically, the Statement operationalises causation for entitlement decisions: it sets the specific exposures/conditions and numerical thresholds that claimants must meet (or their evidence must support) for decision-makers to accept a service link as a \"reasonable hypothesis.\" That affects which claims advance to compensation and which do not.\n\n**Costs, incentives, trade-offs and implementation issues**\n\n- Who pays: Approved benefits following a successful claim are met under the relevant veterans’ compensation schemes; the Statement itself determines causal thresholds but does not set benefit amounts (sections 3 and 5). The fiscal cost of any additional accepted claims falls to the administering agencies and ultimately the Commonwealth.\n\n- Who decides and what evidence is required: Decision-makers apply the Statement; claimants must provide medical and exposure evidence that meets the Statement’s quantitative thresholds (e.g. hours of exposure, laboratory results, medication history). This shifts the evidentiary burden onto claimants to document occupational histories, dose reconstructions, medication timelines and medical diagnoses (sections 9, Schedule 1).\n\n- Compliance, administrative burden and implementation risk: several factors require technical measures (cumulative equivalent radiation dose, cumulative exposure hours, blood lead levels, arsenic concentrations in drinking water). Reconstructing these accurately—especially decades after service—can be difficult and may increase dispute rates and demand for expert reports (section 9 and Schedule 1).\n\n- Trade-offs and opportunity costs: the Statement sets specific thresholds (for example, 0.1 sievert, 1 500 or 5 000 hours of exposure, 2.5 pack‑years). These cut-offs make determinations clearer for some cases but will exclude claimants who fall just below thresholds even where some risk existed. The instrument also requires a service-connection link, so non-service exposures remain relevant only insofar as they intersect with service (section 10).\n\n- Concentrated vs diffuse effects: benefits concentrate on claimants whose service records or medical histories match the defined exposures and thresholds (e.g. those with prolonged occupational exposures or certain medical histories). Costs to the system are diffuse (borne by the compensation scheme) but administrative costs (evidence collection, expert assessment) are concentrated on claimants and the assessing agency.\n\n- Interaction with other Statements of Principles: if a factor overlaps with another Statement, that other Statement controls the application, which creates cross-referencing and potential complexity for claim assessors (section 11).\n\n**Practical points claimants and advisers should note**\n\n- Produce exposure evidence linked to service records (dates, duties, locations) and clinical records showing timing of diagnosis and relevant medical history (sections 9, 10 and Schedule 1).\n\n- Pay attention to the defined latency requirements and numerical thresholds; meet the measurement definitions (e.g. pack‑years, cumulative equivalent dose) used in the Schedule (section 9 and Schedule 1).\n\n- Some items exclude non-occupational sources (see notes in 9(5) and 9(6)), so identify the source of exposure carefully in evidence.\n\n**Bottom line**\n\nThis Statement of Principles sets an explicit, evidence-based checklist (with numerical thresholds and latency requirements) that decision-makers use to form a reasonable hypothesis that malignant neoplasm of the renal pelvis and ureter is connected with a person’s service. It affects veterans and other eligible members who must document exposure or medical histories that meet those criteria; it also imposes technical evidence and administrative expectations on assessors and claimants (sections 7–11 and Schedule 1)."},"kimi_summary":{"content_quality":"ok","complexity_score":6,"scope_assessment":{"changed":false,"description":"This instrument maintains its original scope as a specific medical-determination tool for a single disease under the veterans' compensation scheme. It replaces an earlier 2011 Statement of Principles (No. 98 of 2011) but does not expand beyond the established framework of determining service-related causation for malignant neoplasm of the renal pelvis and ureter. The structure and purpose remain consistent with the statutory scheme under section 196B of the Veterans' Entitlements Act 1986."},"complexity_factors":["26 distinct causal factors with varying temporal requirements (ranging from 1 year to 10 years pre-onset)","Extensive defined terms in Schedule 1 (approximately 20+ specialised definitions including nested definitions)","Multiple cross-references between sections and the Dictionary (e.g., 'see subsection 7(2)', 'defined in Schedule 1')","Technical medical and scientific terminology requiring precise measurement (sieverts, pack-years, micrograms per litre, glomerular filtration rates)","Conditional logic with multiple conjunctive requirements (e.g., factors requiring both cumulative hours AND minimum time since first exposure)","Specific exclusions within definitions (e.g., aromatic amine exposure excludes cigarette smoke and hair dyes)","Incorporation of external documents by reference (ICD-10-AM Tenth Edition, ARPANSA Guide to calculation of cumulative equivalent dose)","Dual statutory framework application (VEA and MRCA with different service definitions)","Nested definitions (e.g., 'being exposed to lead as specified' contains three sub-definitions, one of which refers to another defined term 'lead risk work as specified')"],"plain_english_summary":"This Statement of Principles by the Repatriation Medical Authority sets the medical test for linking service to malignant neoplasm of the renal pelvis and ureter, determining eligibility for veterans’ compensation. It affects veterans, current/former defence members, and claim decision-makers. To succeed a claim, a veteran must show at least one of 26 specified service‑related risk factors (eg. smoking, radiation, certain chemical/occupational exposures, or specific medical conditions). The instrument is decisive for whether rare upper‑urinary‑tract cancer claims are accepted."},"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"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-renal-pelvis-and-ureter-reasonable-hypo","history":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-renal-pelvis-and-ureter-reasonable-hypo/history","analysis":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-renal-pelvis-and-ureter-reasonable-hypo/analysis","conflicts":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-renal-pelvis-and-ureter-reasonable-hypo/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-renal-pelvis-and-ureter-reasonable-hypo/important-cases","documents":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-renal-pelvis-and-ureter-reasonable-hypo/documents"}}