{"id":"F2024L01332","name":"Statement of Principles concerning Merkel cell carcinoma (Balance of Probabilities) (No. 81 of 2024)","slug":"statement-of-principles-concerning-merkel-cell-carcinoma-balance-of-probabilities-no-81-of-2024","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442614,"registerId":"F2024L01332-fast-fetch-1775957585651","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning Merkel cell carcinoma (Balance of Probabilities) (No. 81 of 2024)","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![RMA Australian Government Coat of Arms](image.001.jpeg)\n\n \n\nStatement of Principles\n\nconcerning\n\nMERKEL CELL CARCINOMA  (Balance of Probabilities)\n\n(No. 81 of 2024)\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 18 October 2024.\n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\nProfessor Terence Campbell AM\n\nChairperson\n\nby and on behalf of\n\nThe Repatriation Medical Authority\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\n\n\n1.                Name\n\n\nThis is the Statement of Principles concerning Merkel cell carcinoma (Balance of Probabilities) (No. 81 of 2024).\n\n1.                Commencement\n\n\n              This instrument commences on 19 November 2024.\n\n1.                Authority\n\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n1.                Repeal\n\n\nThe Statement of Principles concerning non-melanotic malignant neoplasm of the skin (Balance of Probabilities) (No. 8 of 2016) (Federal Register of Legislation No. F2016L00241) made under subsection 196B(3) and (8) of the VEA is repealed.\n\n1.                Application\n\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\n1.                Definitions\n\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n1.                Kind of injury, disease or death to which this Statement of Principles relates\n  1.           This Statement of Principles is about Merkel cell carcinoma and death from Merkel cell carcinoma.\n\n\nMeaning of Merkel cell carcinoma\n\n1.           For the purposes of this Statement of Principles, Merkel cell carcinoma means a primary cutaneous neuroendocrine carcinoma;\n2.           While Merkel cell carcinoma attracts ICD‑10‑AM codes: C00.0, C00.1, C00.2, C00.6, C00.8, C00.9, C44, C51.0, C51.1, C51.2, C51.8, C51.9, C60.0, C60.1, C60.2, C60.8, C60.9, C63.2, D04, D07.1, D07.4, in applying this Statement of Principles the meaning of Merkel cell carcinoma is that given in subsection (2).\n3.           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\n\nDeath from Merkel cell carcinoma\n\n1.           For the purposes of this Statement of Principles, Merkel cell carcinoma, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's Merkel cell carcinoma.\n\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n1.                Basis for determining the factors\n\n\nOn the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that Merkel cell carcinoma and death from Merkel cell carcinoma 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\n1.                Factors that must exist\n\n\nAt least one of the following factors must exist before it can be said that, on the balance of probabilities, Merkel cell carcinoma or death from Merkel cell carcinoma is connected with the circumstances of a person's relevant service:\n\n1.           having sunlight exposure to unprotected skin for a cumulative period of at least 4,500 latitude equivalent hours before clinical onset;\n\n\nNote: latitude equivalent hours and unprotected skin are defined in the Schedule 1- Dictionary.\n\n1.           being infected with Merkel cell polyomavirus before clinical onset;\n\n\n1.           being infected with human immunodeficiency virus before clinical onset;\n2.           undergoing solid organ (excluding corneal transplant) or bone marrow transplantation at least 10 years before clinical onset;\n3.           having non-Hodgkin lymphoma before clinical onset;\n4.           having mature B-cell lymphoid leukaemia and small lymphocytic lymphoma before clinical onset;\n\n\nNote: Mature B-cell lymphoid leukaemia and small lymphocytic lymphoma is also known as chronic lymphocytic leukaemia/small cell lymphoma.\n\n1.           inability to obtain appropriate clinical management for Merkel cell carcinoma before clinical worsening.\n\n\n1.            Relationship to service\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  2.           The factor set out in subsection 9(7) applies only to material contribution to, or aggravation of, Merkel cell carcinoma where the person's Merkel cell carcinoma was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n2.            Factors referring to an injury or disease covered by another Statement of Principles\n\n\nIn this Statement of Principles:\n\n1.           if a factor referred to in section 9 applies in relation to a person; and\n2.           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\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                               latitude equivalent hours means hours of exposure multiplied by the appropriate latitude weighting factor as follows:\n\n(a)          for tropical latitudes (23.5° South to 23.5° North) multiply by 1.0;\n\n(b)           for subtropical latitudes (23.6° - 35°) multiply by 0.75;\n\n(c)           for warm temperate latitudes (35.1° - 45°) multiply by 0.5;\n\n(d)           for cool temperate latitudes (45.1° - 65°) multiply by 0.25.\n\nNote: sunlight exposure is calculated as the sum of sunlight exposure in each separate latitude, accounting for the different sunlight intensity in each latitude (weighting factor).\n\nSum of sunlight exposure = (hours spent in tropical latitude x tropical latitude weighting factor) + (hours spent in subtropical latitude x subtropical latitude weighting factor) + (hours spent in warm temperate latitude x warm temperate latitude weighting factor) + (hours spent in cool temperate latitude x cool temperate latitude weighting factor).\n\n                               Merkel cell carcinoma—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 also 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                               unprotected skin means skin that is directly exposed to the sun and is not protected by sunscreen, clothing or other physical barrier.\n\n                             VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"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"},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":true,"description":"The original 2016 instrument covered 'non-melanotic malignant neoplasm of the skin' broadly. This 2024 instrument narrows scope dramatically to focus solely on Merkel cell carcinoma, recognising it as a distinct disease with unique aetiological factors (Merkel cell polyomavirus, specific immune suppressive conditions). This represents a 'splitting' of the original instrument rather than expansion — moving from a broad category to a specific, medically distinct condition with its own causal pathways."},"complexity_factors":["Mathematical calculation required for sun exposure with four-tier latitude weighting system (tropical 1.0, subtropical 0.75, warm temperate 0.5, cool temperate 0.25)","Cross-references to two separate Acts (Veterans' Entitlements Act 1986 and Military Rehabilitation and Compensation Act 2004)","Conditional logic in section 10(2) restricting the 'inability to obtain appropriate clinical management' factor to pre-existing conditions only","Nested definitions: 'terminal event' includes five specific conditions, and 'relevant service' has three distinct categories","ICD-10-AM coding references with specific edition requirements (Tenth Edition, 1 July 2017)","Section 11 creates dynamic incorporation of other Statements of Principles by reference ('as in force from time to time')"],"plain_english_summary":"This instrument creates a new Statement of Principles for Merkel cell carcinoma (MCC), replacing a broader skin-cancer rule and setting the medical criteria to link MCC to military service. It affects veterans and current/former defence members claiming under the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004. To qualify, claimants must show service-connected heavy sun exposure (4,500 latitude-equivalent hours), prior Merkel cell polyomavirus infection, specific immune-suppressing conditions, or service-related denial of proper care that worsened the cancer."},"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":true,"description":"Yes. This instrument replaces the earlier Statement of Principles for 'non‑melanotic malignant neoplasm of the skin' with a disease‑specific Statement focused on Merkel cell carcinoma and death from it (see section 4). It narrows the named condition to a primary cutaneous neuroendocrine carcinoma (section 7(2)), introduces a precise sunlight‑exposure threshold and defined latitude weightings (Schedule 1), and sets discrete qualifying medical and service‑relation rules that alter the scope of conditions and evidentiary factors relevant to claims (sections 7–11)."},"complexity_factors":["Technical sunlight‑exposure threshold using 'latitude equivalent hours' with multiple latitude weighting factors (Schedule 1 - Dictionary).","Disease definition anchored to a specific pathological description plus cross‑references to multiple ICD‑10‑AM codes (subsection 7(2) and 7(3)).","Multiple medical qualifying factors with differing evidentiary windows and latency implications (section 9: infections, HIV, transplants, lymphoid malignancies, etc.).","Requirement that any qualifying factor be 'related to the relevant service' (section 10(1)), creating causation linkage and proof burden.","Interplay with other Statements of Principles when a factor refers to a condition covered elsewhere (section 11), adding regulatory cross‑referencing.","Inclusion of a non‑medical eligibility factor — 'inability to obtain appropriate clinical management' — which raises administrative and factual assessment questions (section 9(7)).","Formal repeal of a prior, broader instrument and narrow refocusing on Merkel cell carcinoma (section 4), affecting existing claim frameworks.","Specific commencement and application to particular statutory claim processes (sections 2 and 5) which determine when and to whom the SoP applies."],"plain_english_summary":"This Statement of Principles (Repatriation Medical Authority) sets the medical and exposure factors that, if proved on the balance of probabilities and linked to a person’s relevant service, establish that Merkel cell carcinoma (a primary cutaneous neuroendocrine carcinoma) or death from it is connected with service. It applies to claims under the Veterans’ Entitlements Act and the Military Rehabilitation and Compensation Act, lists specific qualifying factors (eg. a 4,500 latitude‑equivalent hour sunlight threshold, certain infections, transplant and lymphoid malignancy histories), and replaces the prior broader skin‑cancer statement."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-merkel-cell-carcinoma-balance-of-probabilities-no-81-of-2024","history":"/api/acts/statement-of-principles-concerning-merkel-cell-carcinoma-balance-of-probabilities-no-81-of-2024/history","analysis":"/api/acts/statement-of-principles-concerning-merkel-cell-carcinoma-balance-of-probabilities-no-81-of-2024/analysis","conflicts":"/api/acts/statement-of-principles-concerning-merkel-cell-carcinoma-balance-of-probabilities-no-81-of-2024/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-merkel-cell-carcinoma-balance-of-probabilities-no-81-of-2024/important-cases","documents":"/api/acts/statement-of-principles-concerning-merkel-cell-carcinoma-balance-of-probabilities-no-81-of-2024/documents"}}