{"id":"F2023L01168","name":"Statement of Principles concerning malignant neoplasm of the small intestine (Reasonable Hypothesis) (No. 80 of 2023)","slug":"statement-of-principles-concerning-malignant-neoplasm-of-the-small-intestine-reasonable-hypothesis-n","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442060,"registerId":"F2023L01168-fast-fetch-1775957178433","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 (Reasonable Hypothesis) (No. 80 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 (Reasonable Hypothesis)\n\n(No. 80 of 2023)\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 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:
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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 (Reasonable Hypothesis) (No. 80 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning malignant neoplasm of the small intestine No. 1 of 2015 (Federal Register of Legislation No. F2014L01807) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 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\nThe Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates 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, 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 small intestine or death from malignant neoplasm of the small intestine 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) being obese for at least 10 years before the clinical onset of malignant neoplasm of the small intestine;\n\nNote: being obese is defined in the Schedule 1 – Dictionary.\n\n(6) having a cholecystectomy at least 5 years before the clinical onset of malignant neoplasm of the small intestine;\n\nNote: Cholecystectomy is the surgical removal of the gallbladder.\n\n(7) having diabetes mellitus for at least 5 years before the clinical onset of malignant neoplasm of the small intestine;\n\n(8) 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(8) 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(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 obese means having a Body Mass Index (BMI) of 30 or greater.\n\nNote: BMI is defined in the Schedule 1 - Dictionary.\n\n BMI 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\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) 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 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 maintaining the same scope as its 2015 predecessor. It updates the medical-scientific evidence base for connecting small intestine cancer to military service without expanding beyond the original purpose of determining liability for veterans' compensation claims."},"complexity_factors":["Moderate cross-referencing between the main instrument and Schedule 1 dictionary (7 defined terms)","Nested definitions requiring calculation (BMI formula with mathematical notation W/H²)","Conditional logic with specific time thresholds (5 years, 10 years, 2 years depending on factor)","Specific anatomical and medical exclusions requiring specialist knowledge (distinguishing adenocarcinoma from carcinoid, lymphoma, sarcoma)","Dual legislative framework application (VEA and MRCA with different service categories)","Exception to the general rule in section 10(2) restricting factor 8 to pre-existing conditions only","Reference to external medical classification system (ICD-10-AM Tenth Edition with specific ISBN)"],"plain_english_summary":"This instrument updates the medical rules for claiming compensation for small intestine malignant neoplasms, replacing the 2015 version. It lists eight medical factors which, if present, create a \"reasonable hypothesis\" that the cancer is connected to military service — triggering the veterans' law presumption that favors the claimant.\n\nIt applies to veterans and current/former defence members under the VEA and MRCA, and excludes small‑intestine sarcomas, lymphomas and carcinoids. The treatment‑deprivation factor only applies when cancer existed before or during service."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"Section 4 expressly repeals the 2015 Statement and replaces it with this instrument. The new instrument continues to apply to claims under section 120A of the VEA and section 338 of the MRCA (s5) but defines the disease, exclusions (s7), and a specified list of factors with timing thresholds (s9) that govern when a 'reasonable hypothesis' exists — thereby changing the specific medical criteria while maintaining the same statutory application to relevant service claims."},"complexity_factors":["Legal cross‑references to two Acts: Veterans' Entitlements Act 1986 (s3 authority, s5 application) and Military Rehabilitation and Compensation Act 2004 (defined in Schedule) increase procedural complexity.","Technical medical definitions and exclusions (s7(2) and s7(3)) require clinicians and decision‑makers to apply diagnostic categories rather than ICD code alone.","Multiple duration/timing thresholds for factors (s9(2), s9(4)–(7)) create evidentiary burdens to prove onset and length of conditions.","Limited discretionary phraseology: 'reasonable hypothesis' standard plus RMA view (s8) requires evaluative medical judgement.","Interaction with other Statements of Principles (s11) creates dependency on other instruments and potential layering of criteria.","Special treatment of inability to obtain appropriate clinical management (s9(8) and s10(2)) introduces conditional application and causation nuance.","Repeal of prior Statement (s4) means claimants and decision makers must track the updated instrument rather than rely on former guidance."],"plain_english_summary":"This instrument replaces the 2015 Statement and sets the medical criteria the Repatriation Medical Authority uses to decide whether malignant neoplasm of the small intestine (and death from it) can be reasonably linked to a person’s relevant service under the VEA or MRCA.\n\nIt lists specified clinical factors with timing thresholds (for example inflammatory bowel disease, coeliac disease, adenoma, long‑term obesity, prior ileostomy, cholecystectomy, diabetes, or lack of appropriate management) that must be present to raise the ‘reasonable hypothesis’. Claimants must supply medical records."},"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-small-intestine-reasonable-hypothesis-n","history":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-small-intestine-reasonable-hypothesis-n/history","analysis":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-small-intestine-reasonable-hypothesis-n/analysis","conflicts":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-small-intestine-reasonable-hypothesis-n/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-small-intestine-reasonable-hypothesis-n/important-cases","documents":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-small-intestine-reasonable-hypothesis-n/documents"}}