{"id":"F2024L01329","name":"Statement of Principles concerning non-melanoma malignant neoplasm of the skin (Balance of Probabilities) (No. 79 of 2024)","slug":"statement-of-principles-concerning-non-melanoma-malignant-neoplasm-of-the-skin-balance-of-probabilit","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442615,"registerId":"F2024L01329-fast-fetch-1775957585652","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning non-melanoma malignant neoplasm of the skin (Balance of Probabilities) (No. 79 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\nNON-MELANOMA MALIGNANT NEOPLASM OF THE SKIN (Balance of Probabilities)\n\n(No. 79 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|
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Professor Terence Campbell AM
Chairperson
by and on behalf of
The Repatriation Medical Authority |\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\n\n\n1. Name\n\n\nThis is the Statement of Principles concerning non-melanoma malignant neoplasm of the skin (Balance of Probabilities) (No. 79 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 non-melanoma malignant neoplasm of the skin and death from non-melanoma malignant neoplasm of the skin.\n\n\nMeaning of non-melanoma malignant neoplasm of the skin\n\n1. For the purposes of this Statement of Principles, non-melanoma malignant neoplasm of the skin:\n 1. means a primary malignant neoplasm arising from the non-melanotic cells of the epidermis of the skin; and\n 2. includes:\n 1. basal cell carcinoma;\n 2. squamous cell carcinoma;\n 3. squamous cell carcinoma in situ (Bowen disease) or basal cell carcinoma in situ; and\n 4. non-melanoma malignant neoplasm of the external aspect of the lip, subungual skin, external auditory canal skin, and anogenital skin; and\n 3. excludes:\n 1. non-melanoma malignant neoplasm mucosa lining the oral (inner) aspects of the lips, conjunctiva, and anogential mucosa;\n 2. malignant melanoma of the skin;\n 3. keratoacanthoma;\n 4. Merkel cell carcinoma;\n 5. mammary and extramammary Paget disease;\n 6. Kaposi sarcoma;\n 7. soft tissue sarcoma;\n 8. carcinoid tumour;\n 9. non-Hodgkin lymphoma; and\n 10. Hodgkin lymphoma.\n2. While non-melanoma malignant neoplasm of the skin 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 non-melanoma malignant neoplasm of the skin 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 non-melanoma malignant neoplasm of the skin\n\n1. For the purposes of this Statement of Principles, non-melanoma malignant neoplasm of the skin, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's non-melanoma malignant neoplasm of the skin.\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 non-melanoma malignant neoplasm of the skin and death from non-melanoma malignant neoplasm of the skin 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, non-melanoma malignant neoplasm of the skin or death from non-melanoma malignant neoplasm of the skin 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. having at least 10 sunburns at the affected site at least 5 years before clinical onset;\n\n\nNote: sunburn is defined in the Schedule 1 - Dictionary. \n\n1. having ultraviolet radiation exposure from an ultraviolet-emitting tanning device (excluding sunlamps) on at least 20 occasions at the affected site before clinical onset, at least 5 years before clinical onset;\n2. having PUVA therapy, where:\n 1. the first PUVA treatment commenced at least 5 years before clinical onset; and\n 2. at least 100 PUVA treatments were administered before clinical onset;\n\n\nNote: PUVA therapy is defined in the Schedule 1 - Dictionary.\n\n1. having received a cumulative equivalent dose of at least 0.5 sievert of ionising radiation to the affected site at least 10 years before clinical onset of basal cell carcinoma;\n\n\nNote: cumulative equivalent dose is defined in the Schedule 1 - Dictionary.\n\n1. undergoing a course of radiotherapy for cancer at the affected site, at least 10 years before clinical onset;\n2. being infected by the same human papillomavirus type 16, 18 or 33 for at least 2 consecutive years before clinical onset of squamous cell carcinoma of the penis, vulva or perianal skin;\n3. being infected with human immunodeficiency virus before clinical onset;\n4. undergoing solid organ (excluding corneal transplant) or bone marrow transplantation at least 10 years before clinical onset;\n5. taking one of the following medications within the 5 years before clinical onset:\n 1. acalabrutinib;\n 2. azathioprine;\n 3. ciclosporin;\n 4. elotuzumab;\n 5. fingolimod\n 6. hydroxycarbimide (hydroxyurea);\n 7. ibrutinib;\n 8. methotrexate;\n 9. mycophenolate;\n 10. ruxolitinib;\n 11. siponimod\n 12. sirolimus;\n 13. tacrolimus;\n 14. tofacitinib;\n 15. upadacitinib;\n 16. ustekinumab;\n 17. zanubrutinib;\n 18. tumour necrosis factor-α inhibitors adalimumab, certolizumab, etanercept, golimumab, or infliximab; or\n 19. BRAF kinase inhibitors dabrafenib, encorafenib, vemurafenib.\n6. taking ripretinib within the 5 years before clinical onset of squamous cell carcinoma of the skin;\n7. taking ozanimod or ponesimod within the 5 years before clinical onset of basal cell carcinoma of the skin;\n8. taking voriconazole continuously for at least 3 months, at least 1 year before clinical onset of squamous cell carcinoma of the skin\n9. taking a cumulative dose of at least 25 g of hydrochlorothiazide, at least 1 year before clinical onset of squamous cell carcinoma of the skin;\n10. having autoimmune hepatitis at the time of clinical onset;\n11. having inflammatory bowel disease at the time of clinical onset;\n12. having chronic osteomyelitis with a sinus tract draining to the affected skin site at least 5 years before clinical onset of squamous cell carcinoma;\n\n\nNote: sinus tract is defined in the Schedule 1 - Dictionary.\n\n1. having non-Hodgkin lymphoma before clinical onset;\n2. 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. having phimosis for a continuous period of at least 2 years before clinical onset of squamous cell carcinoma of the glans penis or prepuce of the penis;\n\n\nNote: phimosis is defined in the Schedule 1 - Dictionary.\n\n1. having a scar at the affected site at least 10 years before clinical onset;\n2. having ulceration at the affected site for a cumulative period of at least 1 year, at least 10 years before clinical onset;\n3. having lichen sclerosus at the affected site, at least 10 years before clinical onset of squamous cell carcinoma of the penis, vulva or perianal skin;\n4. having hidradenitis suppurativa at the affected site, at least 10 years before clinical onset of squamous cell carcinoma of the skin;\n\n\nNote: hidradenitis suppurativa is defined in the Schedule 1 - Dictionary.\n\n1. being exposed to arsenic as detailed below, at least 10 years before clinical onset;\n 1. consuming arsenic containing compounds (for example, Fowler's solution) for a cumulative period of at least 3 months; or\n 2. consuming drinking water with an average arsenic concentration of at least 50 micrograms per litre for a cumulative period of at least 5 years; or\n 3. inhaling, ingesting or having cutaneous contact with a pesticide containing arsenic, or arsenic in copper smelting operations, for a cumulative period of at least 1,000 hours; or\n 4. having clinical evidence of chronic arsenic toxicity.\n2. having cutaneous contact at the affected site with coal-tar distillate, for a cumulative period of at least 3,000 hours, at least 10 years before clinical onset;\n3. inability to obtain appropriate clinical management for non-melanoma malignant neoplasm of the skin 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(27) applies only to material contribution to, or aggravation of, non-melanoma malignant neoplasm of the skin where the person's non-melanoma malignant neoplasm of the skin 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 cumulative equivalent dose means the total dose of ionising radiation received by the particular organ or tissue. The formula used to calculate the cumulative equivalent dose allows doses from multiple types of ionising radiation to be combined, by accounting for their differing biological effect. The unit of equivalent dose is the sievert. For the purposes of this Statement of Principles, the calculation of cumulative equivalent dose excludes doses received from normal background radiation, but includes therapeutic radiation, diagnostic radiation, cosmic radiation at high altitude, radiation from occupation-related sources and radiation from nuclear explosions or accidents;\n\n hidradenitis suppurativa means a chronic skin disease of the terminal follicular epithelium in the apocrine gland-bearing skin (axillae, groin, and under the breasts), characterised by comedo-like follicular occlusion, chronic relapsing inflammation, mucopurulent discharge, and progressive scarring.\n\n latitude equivalent hours means hours of sunlight 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 MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n non-melanoma malignant neoplasm of the skin—see subsection 7(2).\n\n phimosis means an inability to retract the penile foreskin over the glans penis.\n\n PUVA therapy means a combination treatment consisting of taking oral psoralen (P) (also known as Methoxsalen) and exposing the skin to long-wave ultra-violet light (UVA).\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 sinus tract means an infected blind-ending epithelium-lined tract leading from a focus of infection to the surface of the skin.\n\n sunburn means painful erythema of the skin of at least 48 hours duration, resulting from exposure to solar ultraviolet radiation.\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":{"kimi_summary":{"content_quality":"ok","complexity_score":6,"scope_assessment":{"changed":false,"description":"This is a standard periodic update of a Repatriation Medical Authority Statement of Principles. It replaces the 2016 version (No. 8 of 2016) with the same fundamental scope: establishing causal factors for non-melanoma skin cancer in veterans. While it expands the list of medications and refines some exposure thresholds, this represents normal medical-evidence updating rather than scope creep beyond the original purpose."},"complexity_factors":["27 distinct causal factors with varying temporal requirements (ranging from 'at time of clinical onset' to 'at least 10 years before')","Specialised mathematical formula for 'latitude equivalent hours' requiring geographic weighting calculations across four latitude zones","Extensive cross-referencing to other Statements of Principles for comorbid conditions (section 11)","19 specific medications listed across multiple drug classes with varying cancer-type specificity","Dual legislative framework application (VEA and MRCA) with different service definitions","10 defined terms in Schedule 1, several requiring substantial medical/scientific knowledge (e.g., 'cumulative equivalent dose' measured in sieverts with complex exclusion/inclusion rules)","Nested inclusions and exclusions in the disease definition (section 7) — includes 4 sub-categories but excludes 10 specific conditions","Conditional logic for specific cancer subtypes (e.g., factor 9(8) applies only to squamous cell carcinoma of penis/vulva/perianal skin)","Dual-purpose application covering both the disease itself and death resulting from it"],"plain_english_summary":"This instrument updates the medical test for when non‑melanoma skin cancer is presumed service‑related for veterans and current/former defence members, replacing the 2016 guidance with newer evidence. It identifies specific risk factors and applies a \"balance of probabilities\" standard to link cancer to military service. It matters because meeting one of the listed factors can determine entitlement to compensation under the veterans’ and military compensation Acts."},"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"},"flash_summary":{"complexity_score":7,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the earlier Statement of Principles (No. 8 of 2016) (section 4) and substitutes a new Statement defining the conditions, exclusions and qualifying factors that connect non‑melanoma skin cancer to relevant service (sections 7–9, Schedule 1). The instrument itself does not set out a point‑by‑point comparison with the prior text, so whether the scope has expanded or narrowed in specific respects cannot be determined from this document alone."},"complexity_factors":["Multiple discrete qualifying factors with numeric thresholds and time windows (Section 9: e.g. 4,500 latitude equivalent hours; ≥10 sunburns; ≥20 tanning-device exposures; ≥0.5 sievert; 5–10 year latency periods).","Extensive, condition- and site-specific listings (inclusions and exclusions in section 7(2)).","Long prescribed drug and therapy lists with differing links to specific cancer types (Section 9(5)–(9)).","Specialised technical calculations and definitions (Schedule 1: cumulative equivalent dose, latitude equivalent hours, PUVA, unprotected skin).","Cross‑references to other Statements of Principles and statutory schemes (section 11 and section 5 — VEA and MRCA application).","Temporal and causal linkage rules tying factors to ‘relevant service’ and pre-existing conditions (section 10).","Operational evidence standard (balance of probabilities) applied to complex medical/scientific criteria (section 8), increasing adjudication complexity."],"plain_english_summary":"This instrument replaces the earlier Statement of Principles and sets the Repatriation Medical Authority’s medical criteria for linking non‑melanoma skin cancer (and death from it) to a person’s relevant service on the balance of probabilities. It lists specific qualifying exposures, treatments, infections, medical conditions, drugs, latency periods and numeric thresholds that, if met, establish a service connection.\n\nIt affects veterans and members claiming under the VEA or MRCA. The RMA’s listed criteria determine entitlement outcomes; claimants must show the listed factor(s) and timing requirements."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-non-melanoma-malignant-neoplasm-of-the-skin-balance-of-probabilit","history":"/api/acts/statement-of-principles-concerning-non-melanoma-malignant-neoplasm-of-the-skin-balance-of-probabilit/history","analysis":"/api/acts/statement-of-principles-concerning-non-melanoma-malignant-neoplasm-of-the-skin-balance-of-probabilit/analysis","conflicts":"/api/acts/statement-of-principles-concerning-non-melanoma-malignant-neoplasm-of-the-skin-balance-of-probabilit/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-non-melanoma-malignant-neoplasm-of-the-skin-balance-of-probabilit/important-cases","documents":"/api/acts/statement-of-principles-concerning-non-melanoma-malignant-neoplasm-of-the-skin-balance-of-probabilit/documents"}}