{"id":"F2023L00942","name":"Statement of Principles concerning malignant neoplasm of the stomach (Reasonable Hypothesis) (No. 74 of 2023)","slug":"statement-of-principles-concerning-malignant-neoplasm-of-the-stomach-reasonable-hypothesis-no-74-of-","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441993,"registerId":"F2023L00942-fast-fetch-1775957135394","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 (Reasonable Hypothesis) (No. 74 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 (Reasonable Hypothesis)\n\n(No. 74 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 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 (Reasonable Hypothesis) (No. 74 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning malignant neoplasm of the stomach No. 58 of 2014 (Federal Register of Legislation No. F2014L00939) made under subsections 196B(2) and (8) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 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\nThe Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that malignant neoplasm of the stomach and death from malignant neoplasm of the stomach 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 stomach or death from malignant neoplasm of the stomach 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 15 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 25 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 0.1 sievert of ionising radiation to the stomach at least 5 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 2 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 5 years before the clinical onset of malignant neoplasm of the stomach;\n\n(6) consuming alcohol in an amount of at least 400 kilograms before the clinical onset of malignant neoplasm of the stomach;\n\nNote: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.\n\n(7) inability to consume an average of at least 200 grams per day of any combination of fresh fruits and allium vegetables, for at least 5 consecutive years within the 20 years before the clinical onset of malignant neoplasm of the stomach;\n\nNote: allium vegetables are defined in the Schedule 1 – Dictionary.\n\n(8) consuming an average intake of at least 20 grams per day of preserved vegetables, for at least 5 consecutive years within the 20 years before the clinical onset of malignant neoplasm of the stomach;\n\nNote: preserved vegetables are defined in the Schedule 1 – Dictionary.\n\n(9) having at least daily consumption of fermented soy products for at least 5 consecutive years within the 20 years before the clinical onset of malignant neoplasm of the stomach;\n\nNote: fermented soy products are defined in the Schedule 1 – Dictionary.\n\n(10) having at least weekly consumption of Chinese-style salted fish for at least 5 consecutive years within the 20 years before the clinical onset of malignant neoplasm of the stomach;\n\nNote: Chinese-style salted fish is defined in the Schedule 1 – Dictionary.\n\n(11) for non-cardia stomach carcinoma only, consuming an average intake of at least 25 grams per day of processed meat product, for at least 5 consecutive years within the 20 years before the clinical onset of malignant neoplasm of the stomach;\n\nNote: non-cardia stomach carcinoma and processed meat product are defined in the Schedule 1 – Dictionary.\n\n(12) for cardia stomach carcinoma only, being overweight or obese for at least the 5 years before the clinical onset of malignant neoplasm of the stomach;\n\nNote: cardia stomach carcinoma and being overweight and being obese are defined in the Schedule 1 – Dictionary.\n\n(13) inhaling respirable asbestos fibres in an enclosed space, at the time material containing asbestos was being applied, removed, cut, drilled, dislodged or disturbed:\n\n(a) for a cumulative period of at least 1,000 hours before the clinical onset of malignant neoplasm of the stomach; and\n\n(b) where the first inhalation of asbestos fibres commenced at least 5 years before the clinical onset of malignant neoplasm of the stomach;\n\nNote: Disturbance of debris or dust contaminated with asbestos fibres may result in exposure to respirable asbestos fibres.\n\n(14) inhaling respirable asbestos fibres in an open environment, at the time material containing asbestos was being applied, removed, cut, drilled, dislodged or disturbed:\n\n(a) for a cumulative period of at least 3,000 hours before the clinical onset of malignant neoplasm of the stomach; and\n\n(b) where the first inhalation of asbestos fibres commenced at least 5 years before the clinical onset of malignant neoplasm of the stomach;\n\nNote: Disturbance of debris or dust contaminated with asbestos fibres may result in exposure to respirable asbestos fibres.\n\n(15) having infection with Epstein-Barr virus at least 10 years before the clinical onset of malignant neoplasm of the stomach;\n\n(16) having diabetes mellitus for at least 5 years before the clinical onset of malignant neoplasm of the stomach;\n\n(17) having a gastric ulcer at least 5 years before the clinical onset of malignant neoplasm of the stomach;\n\n(18) 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(19) for non-cardia stomach carcinoma only, taking a proton pump inhibitor drug for at least a continuous period of 1 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(20) inhaling respirable crystalline silica in an enclosed space, at the time material containing crystalline silica dust was being produced, excavated, drilled, cut, ground or polished, or used in construction, manufacturing, cleaning or blasting:\n\n(a) for a cumulative period of at least 1,500 hours before the clinical onset of malignant neoplasm of the stomach; and\n\n(b) where the first inhalation of respirable crystalline silica dust commenced at least 1 year before the clinical onset of malignant neoplasm of the stomach;\n\nNote: Disturbance of debris or dust contaminated with crystalline silica may result in exposure to respirable crystalline silica.\n\n(21) inhaling respirable crystalline silica in an open space, at the time material containing crystalline silica dust was being produced, excavated, drilled, cut, ground or polished, or used in construction, manufacturing, cleaning or blasting:\n\n(a) for a cumulative period of at least 3,000 hours before the clinical onset of malignant neoplasm of the stomach; and\n\n(b) where the first inhalation of crystalline silica dust commenced at least 1 year before the clinical onset of malignant neoplasm of the stomach;\n\nNote: Disturbance of debris or dust contaminated with crystalline silica may result in exposure to respirable crystalline silica.\n\n(22) inhaling or ingesting opium on average at least weekly for at least 10 years before the clinical onset of malignant neoplasm of the stomach;\n\nNote: opium is defined in the Schedule 1 – Dictionary.\n\n(23) 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(23) 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(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 allium vegetables means raw or cooked, but not preserved, bulbous plants belonging to the genus Allium and includes garlic, leek, onion, chives and shallots.\n\n being overweight means having a Body Mass Index (BMI) of 25 to 29.9.\n\nNote: BMI is also defined in the Schedule 1 - Dictionary.\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 Chinese-style salted fish means fish preserved by salting and is characterised by using less salt and a higher degree of fermentation during the drying process than other methods because of the relatively high outdoor temperature and moisture levels. Chinese-style salted fish is a traditional part of the diet in southern China, Hong Kong, Taiwan, Malaysia, Singapore and other areas of South-East Asia.\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 fermented soy products means food and food additives made from fermented soybeans, examples include naturally brewed soy sauce, tamari, pickled tofu, miso, fermented bean paste, yellow soybean paste and tempeh.\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 opium means the dried or boiled juice (latex) obtained from the seedpod of the poppy plant (Papaver somniferum).\n\n preserved vegetables means vegetables that have been preserved by salting, fermenting or pickling.\n\n processed meat product means meat, offal or meat by-products that have been transformed through salting, curing, fermentation, smoking, or other processes to improve preservation, including ham, frankfurters, salami and bacon.\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 specified list of autoimmune diseases means:\n\n(a) Addison disease;\n\n(b) dermatitis herpetiformis;\n\n(c) dermatomyositis;\n\n(d) Graves disease;\n\n(e) pernicious anaemia; or\n\n(f) systemic lupus erythematosus.\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"},"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the prior Statement of Principles No. 58 of 2014 (s.4) and substitutes a new set of criteria. The instrument therefore replaces the operative legal basis for connecting malignant neoplasm of the stomach to relevant service. From this text alone, the exact degree of substantive change compared to the 2014 instrument cannot be determined, but the new instrument updates and specifies factors, numerical thresholds, temporal rules and definitions (see ss.7–9 and Schedule 1), and applies to claims under the VEA and MRCA (s.5)."},"complexity_factors":["Large number of discrete causal factors (23 listed) each with its own quantitative and temporal conditions (s.9).","Multiple exposure metrics with precise thresholds (pack‑years, sieverts, hours, grams) requiring numeric calculation and record evidence (s.9; Schedule 1).","Different rules for disease subtypes (cardia vs non‑cardia carcinoma) altering applicability of certain factors (s.9(11), s.9(12), Schedule 1).","Temporal linking requirements (e.g. exposures must have commenced or occurred a minimum number of years before clinical onset; many factors specify 1–25 year windows) (s.9).","Cross‑references to other Statements of Principles so overlapping conditions must be coordinated with other instruments (s.11).","Technical dose reconstruction requirement for ionising radiation referencing an external ARPANSA guide (Schedule 1: cumulative equivalent dose).","Detailed medical and pathological definitions and exclusions that narrow scope (definition of malignant neoplasm of the stomach, Schedule 1; s.7(2)–(4)).","Applicability limited to statutory claim frameworks (VEA/MRCA) so legal classification matters for who may claim (s.5; Schedule 1 definitions of relevant service).","Compliance burden on claimants and assessors to supply occupational histories, clinical records, dietary/alcohol histories and specialist reports for proof of thresholds (implied by s.9 and Schedule 1).","Repeal and replacement of an earlier 2014 Statement requires assessors to switch to the new criteria and may need reinterpretation of existing decisions (s.4)."],"plain_english_summary":"This Statement of Principles prescribes the medical criteria for accepting a reasonable hypothesis that a veteran’s stomach cancer (or death from it) is connected to their service. It lists specific risk factors, numerical thresholds and timing rules (for example for smoking, radiation dose, infections, occupational dust or asbestos exposure, diet, surgery and drugs), defines key terms, and applies to claims under the VEA and MRCA, guiding decisions by medical assessors and claims officers."},"kimi_summary":{"content_quality":"ok","complexity_score":6,"scope_assessment":{"changed":false,"description":"This is a standard replacement Statement of Principles (SOP) issued under the Veterans' Entitlements Act 1986. It repeals and replaces the 2014 version (No. 58 of 2014) with updated medical-scientific evidence. The scope remains consistent with the original legislative intent: establishing medical criteria for service connection of specific diseases. The 2023 update appears to reflect expanded medical knowledge (adding factors like proton pump inhibitors, Epstein-Barr virus, and refined dietary exposures) rather than mission creep beyond the original purpose."},"complexity_factors":["23 distinct causal factors with multiple sub-conditions (e.g., factor 1 has 3 separate temporal and quantitative requirements)","Extensive cross-referencing to Schedule 1 Dictionary for 15+ defined terms including technical medical and scientific concepts","Type-specific application: 2 factors apply only to 'non-cardia stomach carcinoma' and 2 factors apply only to 'cardia stomach carcinoma', requiring histological classification","Complex temporal requirements: most factors require specific time intervals between exposure and clinical onset (ranging from 1 year to 25 years)","Quantitative thresholds requiring calculation: pack-years of smoking, kilograms of alcohol, hours of asbestos/silica exposure, grams per day of food items, sieverts of radiation","Nested definitions: terms like 'being overweight' and 'being obese' depend on BMI calculations, which themselves are defined by formula","External document incorporation by reference: ICD-10-AM Tenth Edition and ARPANSA radiation dose calculation guide (as at 2 August 2017)","Conditional logic in factor 1 regarding smoking cessation timing (25-year window post-cessation)","Interaction clause in section 11 creating dynamic referencing to other Statements of Principles that may change over time"],"plain_english_summary":"The RMA sets medical rules creating a legal presumption that stomach cancer is connected to service if a veteran can show one of 23 specified service‑related risk factors. Affecting veterans and current/former defence members claiming under the VEA or MRCA, it makes claims easier by shifting the burden of proof — notably covering factors like smoking, radiation, infections, occupational exposures and certain medical or dietary histories — and distinguishing cardia vs non‑cardia cancers."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-stomach-reasonable-hypothesis-no-74-of-","history":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-stomach-reasonable-hypothesis-no-74-of-/history","analysis":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-stomach-reasonable-hypothesis-no-74-of-/analysis","conflicts":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-stomach-reasonable-hypothesis-no-74-of-/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-stomach-reasonable-hypothesis-no-74-of-/important-cases","documents":"/api/acts/statement-of-principles-concerning-malignant-neoplasm-of-the-stomach-reasonable-hypothesis-no-74-of-/documents"}}