{"id":"F2021L01171","name":"Statement of Principles concerning polycythaemia vera (Balance of Probabilities) (No. 88 of 2021)","slug":"statement-of-principles-concerning-polycythaemia-vera-balance-of-probabilities-no-88-of-2021","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440969,"registerId":"F2021L01171-fast-fetch-1775956408722","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning polycythaemia vera (Balance of Probabilities) (No. 88 of 2021)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 20.2\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n\n\n \n\nStatement of Principles\n\nconcerning\n\nPOLYCYTHAEMIA VERA (Balance of Probabilities)\n\n(No. 88 of 2021)\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 2021\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 polycythaemia vera (Balance of Probabilities) (No. 88 of 2021).\n\n2 Commencement\n\n This instrument commences on 20 September 2021.\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 polycythaemia vera No. 12 of 2013 (Federal Register of Legislation No. F2013L00406) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 polycythaemia vera and death from polycythaemia vera.\n\nMeaning of polycythaemia vera\n\n(2) For the purposes of this Statement of Principles, polycythaemia vera:\n\n(a) means a chronic Philadelphia-chromosome negative myeloproliferative neoplasm characterised by proliferation of bone marrow cells of all types, resulting in elevated red cell production and increased haematocrit, haemoglobin or red blood cell mass, and usually an excess of platelets and white blood cells; and\n\n(b) includes masked, or bled down polycythaemia vera; and\n\n(c) excludes:\n\n(i) relative polycythaemia;\n\n(ii) familial and congenital polycythaemia; and\n\n(iii) secondary polycythaemia from hypoxaemia or increased erythropoietin.\n\nNote 1: Polycythaemia vera is also known as polycythaemia rubra vera.\n\nNote 2: Typical clinical manifestations of polycythaemia vera include formation of blood clots, bleeding, fatigue, night sweats, visual disturbances, headache, nausea and abdominal pain. Patients can be asymptomatic.\n\nNote 3: The clinical course is usually indolent, but transformation to bone marrow failure, myelofibrosis and acute leukaemia may occur.\n\n(3) While polycythaemia vera attracts ICD‑10‑AM code D45, in applying this Statement of Principles the meaning of polycythaemia vera 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 polycythaemia vera\n\n(5) For the purposes of this Statement of Principles, polycythaemia vera, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's polycythaemia vera.\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 polycythaemia vera and death from polycythaemia vera 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, polycythaemia vera or death from polycythaemia vera is connected 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 10 pack-years before the clinical onset of polycythaemia vera; and\n\n(b) commencing at least 5 years before the clinical onset of polycythaemia vera; and\n\nif smoking has ceased before the clinical onset of polycythaemia vera, then that onset occurred within 15 years of cessation;\n\nNote: one pack-year is defined in the Schedule 1 - Dictionary. \n\n(2) inability to obtain appropriate clinical management for polycythaemia vera.\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(2) applies only to material contribution to, or aggravation of, polycythaemia vera where the person's polycythaemia vera 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 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 polycythaemia vera—see subsection 7(2).\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 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":false,"description":"This instrument maintains the standard scope of Repatriation Medical Authority Statements of Principles. It provides a focused, disease-specific determination for polycythaemia vera without expanding beyond the traditional function of establishing causal factors for veterans' compensation claims. The 2021 revision appears to be a routine update rather than a scope expansion."},"complexity_factors":["Medical terminology requiring clinical knowledge (e.g., 'Philadelphia-chromosome negative myeloproliferative neoplasm', 'haematocrit', 'erythropoietin')","Mathematical calculation required for pack-years with conversion rules for non-cigarette tobacco","Conditional logic with multiple temporal requirements (5-year commencement window, 15-year post-cessation window)","Cross-referencing between the main instrument and Schedule 1 Dictionary for defined terms","Specific exclusion of related but distinct conditions (relative, familial, congenital, and secondary polycythaemia)","Dual statutory framework application (VEA and MRCA with different service definitions)","Nested application provision in section 11 allowing incorporation of other Statements of Principles by reference"],"plain_english_summary":"This Statement of Principles sets the medical rules for when polycythaemia vera — a rare blood cancer — can be treated as service-related for DVA compensation, replacing the 2013 version. It affects veterans and current/former defence members claiming under the VEA or MRCA.\n\nTo qualify, claimants must show at least one of two things: a heavy smoking history (≥10 pack‑years with specific timing rules), or that they were unable to obtain proper medical treatment during service for a pre‑existing or service‑worsened disease."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument replaces the earlier 2013 Statement (s4) and sets a narrower, specified set of causal factors for acceptance: defined smoking thresholds and an inability to obtain appropriate clinical management (s9). It continues to cover death from polycythaemia vera (s7(5)) and applies to claims under the VEA and MRCA (s5). The new text also limits application of the clinical‑management factor to cases where disease pre‑existed or occurred during service but did not arise out of it (s10(2))."},"complexity_factors":["Technical medical definition of polycythaemia vera, its inclusions and exclusions, and ICD‑10‑AM cross‑reference — s7(2)–(4)","Numeric and temporal smoking thresholds and pack‑year calculations require historical quantification of tobacco use — s9(1), Schedule (one pack‑year)","The alternative factor 'inability to obtain appropriate clinical management' is open to factual dispute and is limited in its application — s9(2), s10(2)","Requirement that any listed factor be causally related to the person's relevant service introduces a legal nexus inquiry — s10(1)","Interaction with other Statements of Principles may import additional factors or tests by reference — s11","Repeal of the prior 2013 Statement changes the controlling text for claims and requires transition to the new terms — s4","Scope confined to claims under specified statutes and defined forms of 'relevant service' (VEA/MRCA) — s5, Schedule","The governing standard is 'balance of probabilities' supported by medical‑scientific evidence, creating reliance on clinical assessment and expert evidence — s8"],"plain_english_summary":"This Repatriation Medical Authority Statement of Principles sets when polycythaemia vera (and death from it) can be accepted as connected to a person's relevant service for claims under the VEA and MRCA. Mechanically it replaces the 2013 statement (s4) and requires at least one causal factor: substantial tobacco smoking (≥10 pack‑years, started ≥5 years before clinical onset; cessation within 15 years) or inability to obtain appropriate clinical management (ss7–9).\n\nThese factors determine which veterans' claims can succeed and shape the medical, evidentiary and administrative assessment."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-polycythaemia-vera-balance-of-probabilities-no-88-of-2021","history":"/api/acts/statement-of-principles-concerning-polycythaemia-vera-balance-of-probabilities-no-88-of-2021/history","analysis":"/api/acts/statement-of-principles-concerning-polycythaemia-vera-balance-of-probabilities-no-88-of-2021/analysis","conflicts":"/api/acts/statement-of-principles-concerning-polycythaemia-vera-balance-of-probabilities-no-88-of-2021/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-polycythaemia-vera-balance-of-probabilities-no-88-of-2021/important-cases","documents":"/api/acts/statement-of-principles-concerning-polycythaemia-vera-balance-of-probabilities-no-88-of-2021/documents"}}