{"id":"F2023L01170","name":"Statement of Principles concerning malignant neoplasm of the small intestine (Balance of Probabilities) (No. 81 of 2023)","slug":"statement-of-principles-concerning-malignant-neoplasm-of-the-small-intestine-balance-of-probabilitie","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442059,"registerId":"F2023L01170-fast-fetch-1775957178431","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 small intestine (Balance of Probabilities) (No. 81 of 2023)","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\n\n \n\nStatement of Principles\n\nconcerning\n\nMALIGNANT NEOPLASM OF THE SMALL INTESTINE (Balance of Probabilities)\n\n(No. 81 of 2023)\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 25 August 2023.\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 small intestine (Balance of Probabilities) (No. 81 of 2023).\n\n2 Commencement\n\n This instrument commences on 26 September 2023.\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 small intestine No. 2 of 2015 (Federal Register of Legislation No. F2014L01810) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 small intestine and death from malignant neoplasm of the small intestine.\n\nMeaning of malignant neoplasm of the small intestine\n\n(2) For the purposes of this Statement of Principles, malignant neoplasm of the small intestine:\n\n(a) means a primary malignant neoplasm arising from the epithelial cells of the small intestine; and\n\n(b) excludes:\n\n(i) soft tissue sarcoma;\n\n(ii) non-Hodgkin lymphoma and Hodgkin lymphoma; and\n\n(iii) carcinoid tumour.\n\nNote: The small intestine extends from the lower border of the pyloric sphincter up to the ileocaecal junction, including the duodenum, jejunum and ileum.\n\n(3) While malignant neoplasm of the small intestine attracts ICD‑10‑AM code C17, in applying this Statement of Principles the meaning of malignant neoplasm of the small intestine 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 small intestine\n\n(5) For the purposes of this Statement of Principles, malignant neoplasm of the small intestine, 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 small intestine.\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 small intestine and death from malignant neoplasm of the small intestine 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 small intestine or death from malignant neoplasm of the small intestine is connected with the circumstances of a person's relevant service:\n\n(1) having Crohn disease (a type of inflammatory bowel disease) of the small intestine before the clinical onset of malignant neoplasm of the small intestine;\n\n(2) having coeliac disease for at least 5 years before the clinical onset of malignant neoplasm of the small intestine;\n\n(3) having an adenoma of the small intestine before the clinical onset of malignant neoplasm of the small intestine;\n\n(4) for adenocarcinoma of an ileostomy or ileal pouch only, having an ileostomy or ileal pouch for at least 2 years before the clinical onset of malignant neoplasm of the small intestine;\n\n(5) inability to obtain appropriate clinical management for malignant neoplasm of the small intestine before the clinical worsening of malignant neoplasm of the small intestine.\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(5) applies only to material contribution to, or aggravation of, malignant neoplasm of the small intestine where the person's malignant neoplasm of the small intestine 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 malignant neoplasm of the small intestine—see subsection 7(2).\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\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 defined in the Schedule 1 - Dictionary.\n\n terminal event means the proximate or ultimate cause of death and includes the following:\n\n(a) pneumonia;\n\n(b) respiratory failure;\n\n(c) cardiac arrest;\n\n(d) circulatory failure; or\n\n(e) cessation of brain function.\n\n VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"flash_summary_failed":{"failed":true,"reason":"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":3,"scope_assessment":{"changed":false,"description":"The instrument maintains its original narrow purpose: establishing specific medical causation factors for one particular cancer type in veterans' compensation law. It replaces a 2015 version without expanding into new policy areas."},"complexity_factors":["Short, focused instrument (approximately 1,500 words)","Only 5 defined terms in the Dictionary (Schedule 1)","Straightforward structure: definition, factors, relationship to service","Limited cross-referencing—only refers to other Statements of Principles in section 11 and standard definitions","Clear, enumerated list of 5 factors in section 9 with minimal conditional logic","Single nested condition in section 9(4) limiting a factor to specific cancer subtypes (adenocarcinoma of ileostomy/ileal pouch only)","One temporal limitation (section 9(5)) restricting application to pre-existing conditions"],"plain_english_summary":"This instrument sets the medical test for when Australian veterans and defence members can get compensation for small‑intestine cancer: it defines the cancer (with some tumour types excluded) and requires a \"more likely than not\" service link. It ties entitlement to specific clinical circumstances (pre‑existing intestinal disease, prior benign lesions, certain pouch/ileostomy histories, or inadequate treatment) and guides decision‑makers under the VEA and MRCA—serving as the legal gateway for compensation."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the 2015 Statement of Principles (section 4) and restates the definition, exclusions and the specific factors that must exist to connect malignant neoplasm of the small intestine to relevant service (sections 7–9). The instrument itself does not enumerate differences from the repealed instrument, so while the prior instrument is formally replaced, the text does not identify which, if any, substantive scope changes have been made."},"complexity_factors":["Legal-technical framing and cross-references to two Acts (VEA and MRCA) and the balance-of-probabilities standard (sections 3, 5, 8).","Medical definition with explicit exclusions (soft tissue sarcoma, lymphomas, carcinoid) and ICD‑10‑AM code reference (subsection 7(2)–(4)).","Requirement to prove existence and timing of specific pre-existing conditions or exposures (Crohn disease, coeliac disease ≥5 years, adenoma, ileostomy/ileal pouch ≥2 years) to meet causation (section 9(1)).","A factor based on ‘inability to obtain appropriate clinical management’ introduces evidentiary and factual uncertainty about health‑system access and timing (section 9(1)(5); section 10(2)).","Interplay with other Statements of Principles where a listed factor refers to another covered injury/disease—requires cross-application of different instruments (section 11).","Repeal of a prior Statement creates administrative transition needs and possible divergence from previous wording though no explicit differences are stated here (section 4)."],"plain_english_summary":"This instrument replaces the earlier Statement of Principles and sets the medical definition, exclusions and the specific medical factors needed to establish that malignant neoplasm of the small intestine (or death from it) is connected to a veteran’s or member’s relevant service under the VEA or MRCA. It requires at least one listed medical factor (for example Crohn disease, long‑standing coeliac disease, adenoma, prolonged ileostomy/ileal pouch, or evidence of inadequate clinical management) to link the condition to service, and cites an evidentiary standard (balance of probabilities)."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-small-intestine-balance-of-probabilitie","history":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-small-intestine-balance-of-probabilitie/history","analysis":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-small-intestine-balance-of-probabilitie/analysis","conflicts":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-small-intestine-balance-of-probabilitie/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-small-intestine-balance-of-probabilitie/important-cases","documents":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-small-intestine-balance-of-probabilitie/documents"}}