{"id":"F2021L01164","name":"Statement of Principles concerning polycythaemia vera (Reasonable Hypothesis) (No. 87 of 2021)","slug":"statement-of-principles-concerning-polycythaemia-vera-reasonable-hypothesis-no-87-of-2021","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440965,"registerId":"F2021L01164-fast-fetch-1775956406493","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning polycythaemia vera (Reasonable Hypothesis) (No. 87 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 (Reasonable Hypothesis)\n\n(No. 87 of 2021)\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 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:
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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 (Reasonable Hypothesis) (No. 87 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning polycythaemia vera No. 11 of 2013 (Federal Register of Legislation No. F2013L00404) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that polycythaemia vera and death from polycythaemia vera 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 polycythaemia vera or death from polycythaemia vera 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(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 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) 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 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":"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":3,"scope_assessment":{"changed":false,"description":"This instrument maintains the standard scope of Repatriation Medical Authority Statements of Principles. It follows the established template for determining service-related connections to specific diseases under the 'reasonable hypothesis' standard. The scope remains tightly focused on establishing eligibility criteria for a single medical condition (polycythaemia vera) under the veterans' compensation schemes, consistent with the original legislative intent of subsection 196B(2) of the Veterans' Entitlements Act 1986."},"complexity_factors":["Short, focused instrument (approximately 1,500 words) dealing with a single medical condition","Only 7 defined terms in the Dictionary (MRCA, one pack-year, polycythaemia vera, relevant service, terminal event, VEA)","Simple binary structure: two alternative factors in section 9, with straightforward temporal conditions (5-year commencement window, 15-year post-cessation window)","Minimal cross-referencing — primarily internal references to the Dictionary and the two parent Acts (VEA and MRCA)","Single level of exceptions (section 7(2)(c) excludes three specific types of polycythaemia)","No nested conditional logic or exceptions to exceptions","Clear, formulaic legislative template typical of Repatriation Medical Authority instruments"],"plain_english_summary":"This instrument updates the medical rules for claiming compensation for polycythaemia vera, introducing a \"reasonable hypothesis\" test so veterans need not prove causation definitively. It applies to current and former Australian Defence Force members under the Veterans' Entitlements Act and the Military Rehabilitation and Compensation Act.\n\nEligibility can be met mainly via a qualifying smoking history (10+ pack‑years, onset timing limits) or where lack of access to medical care worsened pre‑existing disease. It matters because it affects access to pensions, treatment and other veteran supports."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument repeals the prior Statement (No. 11 of 2013) and replaces it with a new Statement that: introduces a specific, quantitative smoking criterion (section 9(1); Schedule); adds inability to obtain appropriate clinical management as a factor but limits that factor to material contribution/aggravation of pre‑existing PV (section 9(2); section 10(2)); and clarifies disease inclusions and exclusions (section 7(2)). It applies to claims under the VEA/MRCA (section 5)."},"complexity_factors":["Quantitative smoking threshold and timing requirements create evidentiary specificity: ≥10 pack‑years, start ≥5 years before clinical onset, and defined cessation timing (section 9(1); Schedule - one pack‑year).","Inability to obtain appropriate clinical management is a factor but is limited to material contribution or aggravation where PV pre‑existed service (section 9(2); section 10(2)), adding conditional application.","Detailed disease definition with listed inclusions and exclusions (masked/bled down included; relative, familial/congenital and secondary polycythaemia excluded) requires medical interpretation (section 7(2)).","Death linkage includes deaths from terminal events contributed to by PV, requiring causal assessment of proximate causes (section 7(5); Schedule - terminal event).","Reference to but independence from ICD‑10‑AM coding: instrument uses its own substantive definition while noting the code (section 7(3)–(4)), producing potential mapping issues for claims files.","Cross‑instrument interaction: repeal of the 2013 Statement (section 4) and incorporation of other Statements where factors overlap (section 11) create transition and cross‑reference complexity for decision makers.","Calculation rules for pack‑years and tobacco equivalence (Schedule) require retrospective quantification of tobacco use, often from incomplete records.","Legal standard and administrative decision‑making: application of the \"reasonable hypothesis\" test by the RMA under statutory authority requires legal and medical judgement (sections 3 and 8)."],"plain_english_summary":"This instrument tells the Repatriation Medical Authority (RMA) how to test whether polycythaemia vera (PV) or death from PV can be linked to a person’s military service for VEA/MRCA claims. It replaces the earlier Statement, defines PV and exclusions, and lists the minimum factors that must exist to raise a reasonable hypothesis. Claimants must show either a quantified smoking history (≥10 pack‑years, started ≥5 years before clinical onset, with defined cessation timing) or inability to obtain appropriate clinical management. RMA decides; outcomes affect entitlement to government veterans’ benefits."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-polycythaemia-vera-reasonable-hypothesis-no-87-of-2021","history":"/api/acts/statement-of-principles-concerning-polycythaemia-vera-reasonable-hypothesis-no-87-of-2021/history","analysis":"/api/acts/statement-of-principles-concerning-polycythaemia-vera-reasonable-hypothesis-no-87-of-2021/analysis","conflicts":"/api/acts/statement-of-principles-concerning-polycythaemia-vera-reasonable-hypothesis-no-87-of-2021/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-polycythaemia-vera-reasonable-hypothesis-no-87-of-2021/important-cases","documents":"/api/acts/statement-of-principles-concerning-polycythaemia-vera-reasonable-hypothesis-no-87-of-2021/documents"}}