{"id":"F2024L01049","name":"Statement of Principles concerning neoplasm of the pituitary gland (Reasonable Hypothesis) (No. 70 of 2024)","slug":"statement-of-principles-concerning-neoplasm-of-the-pituitary-gland-reasonable-hypothesis-no-70-of-20","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442545,"registerId":"F2024L01049-fast-fetch-1775957522990","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 (Reasonable Hypothesis) (No. 70 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 (Reasonable Hypothesis)\n\n(No. 70 of 2024)\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 20 August 2024.\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 (Reasonable Hypothesis) (No. 70 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning neoplasm of the pituitary gland No. 53 of 2015 (Federal Register of Legislation No. F2015L00259) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 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\nThe Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that neoplasm of the pituitary gland and death from neoplasm of the pituitary gland 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 neoplasm of the pituitary gland or death from neoplasm of the pituitary gland 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) being obese for at least five years, at least 5 years before the clinical onset of pituitary adenoma;\n\nNote 1: being obese in defined in the Schedule 1 dictionary.\n\n(5) 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(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 kg/m2 or greater.\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 MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n neoplasm of the pituitary gland—see subsection 7(2).\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":{"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the 2015 Statement of Principles (s4) and restates the scope by specifying included and excluded pituitary tumours, by treating death from a related terminal event as part of the condition (s7(2)–(5)), and by enumerating discrete qualifying factors (s9) and definitions (Sch1). The text itself shows a clarified set of factors and definitions, but without the 2015 text here it is not possible to quantify whether the net scope is broader or narrower."},"complexity_factors":["Medical specificity and terminology: clinical events (pituitary apoplexy, Nelson syndrome), procedures (bilateral adrenalectomy) and drugs/tests listed (s9(1)–(3)).","Temporal and causal linking: factors must be related to 'relevant service' and timing/clinical worsening constraints apply (s10(1)–(2)).","Defined epidemiological thresholds: obesity defined by BMI ≥30 and minimum durations (Sch1; s9(4)).","Cross-references to other legal instruments and claim pathways (VEA, MRCA) and to ICD‑10‑AM codes (s3, s5, s7(3)–(4)).","Interaction with other Statements of Principles where a factor refers to another covered injury/disease (s11).","Narrow list of qualifying factors creates binary evidentiary gate for claims (s9), increasing interpretation importance for medical assessors.","Repeal and replacement of a prior instrument may introduce differences requiring comparison to past practice (s4)."],"plain_english_summary":"Replaces the 2015 Statement and sets when a \"reasonable hypothesis\" links neoplasm of the pituitary gland (specified inclusions and exclusions) to a person’s relevant service for VEA/MRCA claims (s4, s7, s5). It lists discrete medical and clinical factors — for example prior bilateral adrenalectomy, certain GnRH agonists or hormone tests around pituitary apoplexy, long‑term obesity, or inability to obtain appropriate management — that, if related to service, can meet the entitlement test (s9, s10)."},"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"},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard RMA Statement of Principles replacement. It maintains the same scope as its 2015 predecessor and other SOPs — establishing medical criteria for a specific condition within the veterans' compensation scheme. The update reflects current medical evidence but does not expand beyond the original purpose of determining service connection for pituitary neoplasms."},"complexity_factors":["Multiple nested definitions: 'neoplasm of the pituitary gland' defined in s 7(2) with 3 inclusions and 7 exclusions, then referenced in Schedule 1","Technical medical terminology throughout (corticotroph, adenohypophysis, infundibulum, apoplexy) requiring explanatory notes","Temporal conditions with specific windows: 'within 4 days' (s 9(3)), 'at least 5 years before' (s 9(4)), 'at the time of' (s 9(2))","Cross-referencing structure: s 11 incorporates other Statements of Principles by reference, creating interdependence with the broader veterans' compensation scheme","Dual statutory framework application: operates under both VEA and MRCA with different service definitions (operational, peacekeeping, hazardous, warlike, non-warlike)","Mathematical definition in dictionary: BMI formula with variables W and H"],"plain_english_summary":"This instrument updates the Repatriation Medical Authority’s Statement of Principles for pituitary gland tumours, setting the medical criteria the Department of Veterans’ Affairs uses to decide service‑connection for veterans, peacekeepers and current/former Defence members. It identifies five specific pathways by which a pituitary neoplasm can be linked to service (including certain surgical, medication, diagnostic, obesity and access‑to‑care scenarios) and tightens the evidentiary requirements—notably stricter timing for the obesity pathway—replacing the 2015 version."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-neoplasm-of-the-pituitary-gland-reasonable-hypothesis-no-70-of-20","history":"/api/acts/statement-of-principles-concerning-neoplasm-of-the-pituitary-gland-reasonable-hypothesis-no-70-of-20/history","analysis":"/api/acts/statement-of-principles-concerning-neoplasm-of-the-pituitary-gland-reasonable-hypothesis-no-70-of-20/analysis","conflicts":"/api/acts/statement-of-principles-concerning-neoplasm-of-the-pituitary-gland-reasonable-hypothesis-no-70-of-20/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-neoplasm-of-the-pituitary-gland-reasonable-hypothesis-no-70-of-20/important-cases","documents":"/api/acts/statement-of-principles-concerning-neoplasm-of-the-pituitary-gland-reasonable-hypothesis-no-70-of-20/documents"}}