{"id":"F2023L00943","name":"Statement of Principles concerning malignant neoplasm of the stomach (Balance of Probabilities) (No. 75 of 2023)","slug":"statement-of-principles-concerning-malignant-neoplasm-of-the-stomach-balance-of-probabilities-no-75-","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441996,"registerId":"F2023L00943-fast-fetch-1775957135422","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 stomach (Balance of Probabilities) (No. 75 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 STOMACH (Balance of Probabilities)\n\n(No. 75 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 23 June 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 stomach (Balance of Probabilities) (No. 75 of 2023).\n\n2 Commencement\n\n This instrument commences on 25 July 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 stomach No. 59 of 2014 (Federal Register of Legislation No. F2014L00938) made under subsections 196B(3) and (8) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 stomach and death from malignant neoplasm of the stomach.\n\nMeaning of malignant neoplasm of the stomach\n\n(2) For the purposes of this Statement of Principles, malignant neoplasm of the stomach:\n\n(a) means a primary malignant neoplasm arising from the epithelial cells of the stomach; and\n\n(b) excludes:\n\n(i) stomach neuroendocrine tumours;\n\n(ii) gastroblastoma;\n\n(iii) haematolymphoid tumours including non-Hodgkin lymphoma, MALT lymphoma and Hodgkin lymphoma;\n\n(iv) malignant melanoma; and\n\n(v) mesenchymal tumours including soft tissue sarcoma.\n\nNote: The stomach extends from the lower border of the oesophageal sphincter, up to and including the pyloric sphincter.\n\n(3) While malignant neoplasm of the stomach attracts ICD‑10‑AM code C16, in applying this Statement of Principles the meaning of malignant neoplasm of the stomach 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 stomach\n\n(5) For the purposes of this Statement of Principles, malignant neoplasm of the stomach, 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 stomach.\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 stomach and death from malignant neoplasm of the stomach 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 stomach or death from malignant neoplasm of the stomach is connected with the circumstances of a person's relevant service:\n\n(1) having smoked tobacco products:\n\n(a) in an amount of at least 25 pack-years before the clinical onset of malignant neoplasm of the stomach; and\n\n(b) commencing at least 10 years before the clinical onset of malignant neoplasm of the stomach; and\n\nif smoking has ceased before the clinical onset of malignant neoplasm of the stomach, then that onset occurred within 15 years of cessation;\n\nNote: one pack-year is defined in the Schedule 1 – Dictionary.\n\n(2) having received a cumulative equivalent dose of at least 0.5 sievert of ionising radiation to the stomach at least 10 years before the clinical onset of malignant neoplasm of the stomach;\n\nNote: cumulative equivalent dose is defined in the Schedule 1 – Dictionary.\n\n(3) having infection with Helicobacter pylori at least 10 years before the clinical onset of malignant neoplasm of the stomach;\n\n(4) having chronic atrophic gastritis, where the chronic atrophic gastritis commenced at least 5 years before the clinical onset of malignant neoplasm of the stomach;\n\nNote: chronic atrophic gastritis is defined in the Schedule 1 – Dictionary.\n\n(5) having undergone a partial gastrectomy at least 10 years before the clinical onset of malignant neoplasm of the stomach;\n\n(6) for cardia stomach carcinoma only, being obese for at least the 5 years before the clinical onset of malignant neoplasm of the stomach;\n\nNote: cardia stomach carcinoma and being obese are defined in the Schedule 1 – Dictionary.\n\n(7) having a gastric ulcer at least 10 years before the clinical onset of malignant neoplasm of the stomach;\n\n(8) having an autoimmune disease from the specified list of autoimmune diseases at the time of the clinical onset of malignant neoplasm of the stomach;\n\nNote: specified list of autoimmune diseases is defined in the Schedule 1 – Dictionary.\n\n(9) for non-cardia stomach carcinoma only, taking a proton pump inhibitor drug for at least a continuous period of 2 year within the 5 years before the clinical onset of malignant neoplasm of the stomach, and where the last dose of the drug was taken at least 1 year before the clinical onset of malignant neoplasm of the stomach;\n\nNote: non-cardia stomach carcinoma is defined in the Schedule 1 – Dictionary.\n\n(10) inability to obtain appropriate clinical management for malignant neoplasm of the stomach before the clinical worsening of malignant neoplasm of the stomach.\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(10) applies only to material contribution to, or aggravation of, malignant neoplasm of the stomach where the person's malignant neoplasm of the stomach 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 being obese means having a Body Mass Index (BMI) of 30 or greater.\n\nNote: BMI is also 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 cardia stomach carcinoma means a carcinoma that has arisen in the part of the stomach immediately adjacent to and surrounding the opening of the oesophagus (the cardia of the stomach) that is distinguished histologically by the presence of cardiac glands and the absence of parietal (acid secreting) and chief (pepsin secreting) cells.\n\n chronic atrophic gastritis means inflammation of the stomach mucosa characterised by variable gland loss and inflammatory infiltrate extending below the lamina propria with distortion and destruction of the stomach glands.\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 stomach—see subsection 7(2).\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n non-cardia stomach carcinoma means a carcinoma that has arisen in the mucosa of any part of the stomach, excluding that part of the stomach immediately adjacent to and surrounding the opening of the oesophagus (the cardia of the stomach) that is distinguished histologically by the presence of cardiac glands and the absence of parietal (acid secreting) and chief (pepsin secreting) cells.\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 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 also defined in the Schedule 1 - Dictionary.\n\n specified list of autoimmune diseases means:\n\n(a) dermatomyositis; or\n\n(b) pernicious anaemia.\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":5,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the earlier Statement of Principles concerning malignant neoplasm of the stomach No. 59 of 2014 (section 4) and replaces it with the 2023 Statement (No. 75). It therefore changes the operative instrument governing claims. Determining whether the substantive eligibility criteria have been widened or narrowed requires comparison with the 2014 text, which is not included here."},"complexity_factors":["Technical medical definitions and exclusions: detailed definition of 'malignant neoplasm of the stomach' and specific exclusions (subsection 7(2), Schedule 1).","Multiple, condition‑specific qualifying factors with differing latency and duration rules (section 9: e.g. smoking pack‑years and cessation windows at s9(1); PPI criteria at s9(9)).","Quantitative exposure and dose reconstruction requirement for ionising radiation (0.5 sievert threshold; s9(2) and cumulative equivalent dose definition in Schedule 1).","Interplay with other Statements of Principles: factors that overlap an injury/disease covered by another SOP defer to that SOP as in force (section 11), requiring cross‑instrument reference checks.","Causation standard and administrative determination: RMA expresses view on medical‑scientific evidence and applies balance of probabilities to link disease to relevant service (section 8 and section 9 precondition), concentrating decision power in an expert administrative body.","Temporal and service‑relationship constraints: requirements that factors be temporally related to clinical onset and to relevant service, plus a special rule for inability to obtain appropriate management applying only where disease pre‑existed or was contracted before/during service (section 10 and s9(10)).","Evidence and compliance burden on claimants: need for medical records, exposure histories (e.g. pack‑years, BMI, radiation dose reconstruction), infection history and surgical records to meet specific thresholds (sections 9 and Schedule 1).","Specialised medical concepts and measurement rules (BMI calculation, pack‑year equivalences, histological distinctions for cardia vs non‑cardia carcinoma) require expert interpretation (Schedule 1)."],"plain_english_summary":"This Statement of Principles sets the medical tests the Repatriation Medical Authority uses to decide, on the balance of probabilities, whether stomach cancer (as defined) and related deaths are connected to a person's service. It lists specific qualifying risk factors (for example: heavy smoking, ionising radiation dose, Helicobacter pylori infection, chronic gastritis, prior partial gastrectomy, obesity for cardia cancer, gastric ulcer, selected autoimmune diseases, prolonged PPI use, and lack of appropriate clinical management) with timing and dose thresholds. It applies to claims under the VEA and the MRCA."},"kimi_summary":{"content_quality":"ok","complexity_score":5,"scope_assessment":{"changed":false,"description":"This is a standard replacement Statement of Principles under the Veterans' Entitlements Act framework. It maintains the established scope of determining service connection for specific diseases through prescribed risk factors. The 2023 version updates medical evidence and definitions but does not expand beyond the original purpose of providing medical criteria for compensation determinations. The structure mirrors previous SOPs with factors, definitions, and application provisions consistent with the legislative scheme established in 1986."},"complexity_factors":["Multiple conditional thresholds with specific timeframes (e.g., 'at least 25 pack-years', 'commencing at least 10 years before', 'within 15 years of cessation')","Bifurcated factors applying to specific cancer subtypes only (cardia vs non-cardia stomach carcinoma)","Cross-references to external medical classification systems (ICD-10-AM Tenth Edition)","Nested definitions requiring calculation (pack-years, BMI, cumulative equivalent dose with reference to ARPANSA methodology guide)","Conditional logic for cessation of smoking and timing of last medication dose","Specific exclusion list of 5 tumour types from the definition","Dual statutory framework application (VEA and MRCA with different service definitions)","Incorporation by reference of external technical documents (ARPANSA dose calculation guide dated 2 August 2017)"],"plain_english_summary":"This instrument sets the medical test for recognising malignant stomach cancer as service-related under the Veterans' Entitlements Act and MRCA. It requires the Repatriation Medical Authority and DVA decision-makers to apply a \"balance of probabilities\" link between service and at least one of ten listed risk factors (e.g., heavy smoking, radiation, H. pylori, certain surgeries, obesity for cardia cancers, long PPI use, lack of care for worsening cancer).\n\nIt excludes non‑epithelial stomach tumours (e.g., neuroendocrine tumours, lymphomas, melanomas, sarcomas)."},"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-stomach-balance-of-probabilities-no-75-","history":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-stomach-balance-of-probabilities-no-75-/history","analysis":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-stomach-balance-of-probabilities-no-75-/analysis","conflicts":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-stomach-balance-of-probabilities-no-75-/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-stomach-balance-of-probabilities-no-75-/important-cases","documents":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-stomach-balance-of-probabilities-no-75-/documents"}}