{"id":"F2024L01050","name":"Statement of Principles concerning neoplasm of the pituitary gland (Balance of Probabilities) (No. 71 of 2024)","slug":"statement-of-principles-concerning-neoplasm-of-the-pituitary-gland-balance-of-probabilities-no-71-of","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442542,"registerId":"F2024L01050-fast-fetch-1775957517930","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning neoplasm of the pituitary gland (Balance of Probabilities) (No. 71 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\n\n \n\nStatement of Principles\n\nconcerning\n\nNEOPLASM OF THE PITUITARY GLAND (Balance of Probabilities)\n\n(No. 71 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 20 August 2024.\n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n|
Professor Terence Campbell AM
Chairperson
by and on behalf of
The Repatriation Medical Authority |\n| --- |\n| |\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 neoplasm of the pituitary gland (Balance of Probabilities) (No. 71 of 2024).\n\n2 Commencement\n\n This instrument commences on 24 September 2024.\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 neoplasm of the pituitary gland No. 54 of 2015 (Federal Register of Legislation No. F2015L00260) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 neoplasm of the pituitary gland and death from neoplasm of the pituitary gland.\n\nMeaning of neoplasm of the pituitary gland\n\n(2) For the purposes of this Statement of Principles, neoplasm of the pituitary gland:\n\n(a) means a primary neoplasm, either benign or malignant, arising from the cells of the pituitary gland; and\n\n(b) includes:\n\n(i) tumours of the anterior pituitary (adenohypophysis);\n\n(ii) tumours of the posterior pituitary (neurohypophysis); and\n\n(iii) tumours of the pituitary stalk (infundibulum); and\n\n(c) excludes:\n\n(i) soft tissue sarcoma;\n\n(ii) carcinoid tumour;\n\n(iii) non-Hodgkin lymphoma;\n\n(iv) Hodgkin lymphoma;\n\n(v) tumours of the hypothalamus;\n\n(vi) tumours of the sella turcica of the sphenoid bone; and\n\n(vii) tumours of the diaphragma sellae.\n\n(3) While neoplasm of the pituitary gland attracts ICD‑10‑AM codes C75.1, D35.2, or D44.3, in applying this Statement of Principles the meaning of neoplasm of the pituitary gland 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 neoplasm of the pituitary gland\n\n(5) For the purposes of this Statement of Principles, neoplasm of the pituitary gland, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's neoplasm of the pituitary gland.\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 neoplasm of the pituitary gland and death from neoplasm of the pituitary gland 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, neoplasm of the pituitary gland or death from neoplasm of the pituitary gland is connected with the circumstances of a person's relevant service:\n\n(1) having undergone bilateral adrenalectomy for the treatment of Cushing syndrome due to a corticotroph pituitary adenoma before the clinical worsening of corticotroph pituitary adenoma;\n\nNote 1: Bilateral adrenalectomy is the excision of both adrenal glands.\n\nNote 2: Cushing disease is Cushing syndrome due to a corticotroph pituitary adenoma.\n\nNote 3: A corticotroph is a cell of the anterior pituitary that secretes corticotropin (adrenocorticotrophic hormone (ACTH)), a hormone that stimulates secretion of corticosteroids from the adrenal cortex.\n\nNote 4: An example of clinical worsening is Nelson syndrome.\n\n(2) taking one of the following gonadotropin-releasing hormone (GnRH) agonists at the time of pituitary apoplexy of a pre-existing pituitary adenoma:\n\n(a) goserelin;\n\n(b) leuprorelin/leuprolide;\n\n(c) nafarelin; or\n\n(d) triptorelin;\n\nNote 1: Pituitary apoplexy is a clinical worsening of a pre-existing pituitary adenoma.\n\nNote 2: Pituitary apoplexy is the sudden loss of blood supply to the pituitary gland, leading to tissue necrosis and loss of function.\n\n(3) taking one of the following hormones as part of a dynamic endocrine test, within the 4 days before pituitary apoplexy of a pre-existing pituitary adenoma:\n\n(a) gonadotropin-releasing hormone (GnRH)\n\n(b) growth hormone-releasing hormone (GHRH);\n\n(c) thyrotropin-releasing hormone (TRH); or\n\n(d) corticotropin-releasing hormone (CRH);\n\nNote 1: Pituitary apoplexy is a clinical worsening of a pre-existing pituitary adenoma.\n\nNote 2: Pituitary apoplexy is the sudden loss of blood supply to the pituitary gland, leading to tissue necrosis and loss of function.\n\nNote 3: Dynamic endocrine tests assess the dynamic response of hormonal axes to aid diagnosis of endocrine disorders.\n\n(4) inability to obtain appropriate clinical management for neoplasm of the pituitary gland before clinical worsening.\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 clinical worsening aspects of factors set out in section 9 apply only to material contribution to, or aggravation of, neoplasm of the pituitary gland where the person's neoplasm of the pituitary gland 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 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 neoplasm of the pituitary gland—see subsection 7(2).\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":6,"scope_assessment":{"changed":false,"description":"This is a standard replacement Statement of Principles maintaining the established scope of the Repatriation Medical Authority's determinations. It updates the 2015 version with current medical evidence but does not expand beyond the original purpose of establishing causal factors for pituitary neoplasms in the veterans' compensation scheme."},"complexity_factors":["Dense medical terminology requiring specialist knowledge (corticotroph adenomas, pituitary apoplexy, dynamic endocrine tests, GnRH agonists)","Precise temporal requirements ('at the time of', 'within the 4 days before', 'before the clinical worsening')","Nested definitions with cross-references between sections and the Schedule 1 Dictionary","Exclusion clauses in the definition that require knowledge of other tumour types to understand scope","Dual legislative framework application (VEA and MRCA with different service definitions)","Specific pharmaceutical naming requirements (four specific drugs listed for factor 2, four specific hormones for factor 3)","Interaction clause in section 11 creating potential overlap with other Statements of Principles"],"plain_english_summary":"This instrument sets medical criteria for when a pituitary gland neoplasm (benign or malignant pituitary tumour, with some exclusions) can be accepted as service-related for veterans. It replaces the 2015 rules.\n\nIt only applies to non-operational/non-hazardous/peacetime service under the VEA and MRCA and requires one of four narrowly defined medical scenarios (surgical adrenalectomy timing for Cushing, GnRH agonist use at pituitary apoplexy, diagnostic hormone testing within four days, or lack of timely treatment) — otherwise claims will likely fail."},"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":true,"description":"This instrument repeals the 2015 Statement of Principles (s4) and replaces it with updated criteria. It narrows and clarifies the medical events that establish a service connection (explicitly listing surgical procedures, specific drugs, timing for hormone tests, and failure to obtain appropriate clinical management) and reaffirms application to VEA s120B and MRCA s339 claims (s5). The instrument also restates included ICD‑10‑AM codes while using the statutory definition in s7(2)-(4)."},"complexity_factors":["Technical medical definitions and exclusions for the condition (s7(2)-(3))","Specific clinical triggers and timing constraints (e.g. 4‑day window for dynamic endocrine tests) (s9(2)-(3))","Requirement to connect identified factors to 'relevant service' and to show temporal/causal relationships (s10(1)-(2))","Interaction with other Statements of Principles where factors refer to other diseases (s11)","Administrative scope limited to claims under VEA s120B and MRCA s339 (s5)","Repeal and replacement of a prior Statement, requiring attention to changes from the 2015 instrument (s4)","Reference to ICD‑10‑AM codes while adopting a bespoke statutory definition (s7(3)-(4))"],"plain_english_summary":"This Statement of Principles sets the medical criteria that decision‑makers must use to link pituitary gland tumours (certain primary pituitary tumours, with listed exclusions) to a veteran’s relevant service for VEA or MRCA claims. It identifies specific medical events or treatments — for example bilateral adrenalectomy for Cushing disease, certain GnRH agonists at the time of pituitary apoplexy, recent dynamic endocrine tests, or inability to obtain appropriate clinical management — which, if evidenced, establish a service connection on the balance of probabilities. Claimants and clinicians must provide supporting clinical evidence."},"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"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-neoplasm-of-the-pituitary-gland-balance-of-probabilities-no-71-of","history":"/api/acts/statement-of-principles-concerning-neoplasm-of-the-pituitary-gland-balance-of-probabilities-no-71-of/history","analysis":"/api/acts/statement-of-principles-concerning-neoplasm-of-the-pituitary-gland-balance-of-probabilities-no-71-of/analysis","conflicts":"/api/acts/statement-of-principles-concerning-neoplasm-of-the-pituitary-gland-balance-of-probabilities-no-71-of/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-neoplasm-of-the-pituitary-gland-balance-of-probabilities-no-71-of/important-cases","documents":"/api/acts/statement-of-principles-concerning-neoplasm-of-the-pituitary-gland-balance-of-probabilities-no-71-of/documents"}}