{"id":"F2021L01166","name":"Statement of Principles concerning primary myelofibrosis (Balance of Probabilities) (No. 90 of 2021)","slug":"statement-of-principles-concerning-primary-myelofibrosis-balance-of-probabilities-no-90-of-2021","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440966,"registerId":"F2021L01166-fast-fetch-1775956406494","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning primary myelofibrosis (Balance of Probabilities) (No. 90 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\nPRIMARY MYELOFIBROSIS (Balance of Probabilities)\n\n(No. 90 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 primary myelofibrosis (Balance of Probabilities) (No. 90 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 primary myelofibrosis No. 18 of 2013 (Federal Register of Legislation No. F 2013L00412) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 primary myelofibrosis and death from primary myelofibrosis.\n\nMeaning of primary myelofibrosis\n\n(2) For the purposes of this Statement of Principles, primary myelofibrosis:\n\n(a) means a chronic, Philadelphia-chromosome negative myeloproliferative neoplasm characterised by bone marrow megakaryocytic proliferation, resulting in the replacement of bone marrow with fibrous tissue, extramedullary haematopoiesis, splenomegaly and leukoerythroblastosis in the blood; and\n\n(b) excludes:\n\n(i) myelofibrosis secondary to essential thrombocythaemia, polycythaemia vera or another myeloid neoplasm; and\n\n(ii) secondary myelofibrosis resulting from other causes of bone marrow fibrosis including infections, autoimmune disorders or other chronic inflammatory conditions, hairy cell leukaemia or other lymphoid neoplasms, metastatic malignancies and toxic (chronic) myelopathies.\n\nNote: Typical clinical manifestations of primary myelofibrosis include fatigue, anaemia, bone pain and night sweats. Patients can be asymptomatic.\n\nDeath from primary myelofibrosis\n\n(3) For the purposes of this Statement of Principles, primary myelofibrosis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's primary myelofibrosis.\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 primary myelofibrosis and death from primary myelofibrosis 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, primary myelofibrosis or death from primary myelofibrosis 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 primary myelofibrosis; and\n\n(b) commencing at least 5 years before the clinical onset of primary myelofibrosis; and\n\nif smoking has ceased before the clinical onset of primary myelofibrosis, 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 primary myelofibrosis.\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, primary myelofibrosis where the person's primary myelofibrosis 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 primary myelofibrosis—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":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument maintains the same narrow scope as its 2013 predecessor. It addresses only primary myelofibrosis (explicitly excluding secondary forms) and applies solely to determining liability under veterans' compensation legislation. The 2021 revision appears to be a standard reissue with updated medical evidence rather than an expansion of scope."},"complexity_factors":["Medical terminology requiring specialist knowledge (e.g., 'Philadelphia-chromosome negative myeloproliferative neoplasm', 'extramedullary haematopoiesis', 'leukoerythroblastosis')","Mathematical calculation required for 'pack-years' with conversion rules for different tobacco products (cigarettes, pipe, cigars)","Multiple temporal conditions (5-year commencement window, 15-year post-cessation window, 'before clinical onset' requirements)","Nested exclusions in the disease definition (excluding secondary causes including infections, autoimmune disorders, metastatic malignancies)","Cross-referencing between two separate compensation schemes (VEA and MRCA) with different service categories","Conditional logic in section 9(2) limiting its application to aggravation cases where disease pre-existed service","Incorporation by reference to other Statements of Principles for related conditions"],"plain_english_summary":"This rulebook sets the medical test for linking primary myelofibrosis — a rare bone-marrow cancer — to Australian defence service, determining entitlement under the Veterans' Entitlements Act and the Military Rehabilitation and Compensation Act. It affects veterans and current/former defence members claiming compensation or treatment.\n\nIt requires proof on the balance of probabilities, with a tightened smoking-based test (high pack‑year threshold and timing) or evidence service prevented appropriate care, and excludes secondary myelofibrosis."},"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the 2013 Statement of Principles (s4) and replaces it with criteria that specify particular qualifying factors and temporal thresholds for tobacco exposure and a distinct factor for inability to obtain appropriate clinical management (s9; Schedule 1). That repeal-plus-replacement indicates the operative scope for linking primary myelofibrosis to service has been revised and claim outcomes must be determined under the new wording."},"complexity_factors":["Statutory cross‑links to two different benefits Acts (VEA and MRCA) and the RMA’s authority (ss3, 5) creating administrative interaction.","Medical definition and exclusions for primary myelofibrosis involve specialist clinical terms that claims staff must apply (s7(2)).","Temporal and dosage thresholds for tobacco exposure (minimum 10 pack‑years; start ≥5 years before onset; cessation within 15 years) require precise historical evidence and calculation (s9(1); Schedule 1).","A non‑quantitative factor—'inability to obtain appropriate clinical management'—requires assessment of health‑care access and timing, which is fact‑sensitive and open to interpretation (s9(2); s10(2)).","Causation standard is balance of probabilities; determinations hinge on linking qualifying factors to 'relevant service', creating evidentiary burdens for claimants (s8, s10).","Interaction with other Statements of Principles can import additional factors or obligations, adding cross‑instrument complexity (s11).","Repeal and replacement of the 2013 Statement means administrators must apply the new wording and transitional considerations (s4).","Defined technical terms (pack‑year, terminal event, relevant service) are critical for application and may require corroborating evidence (Schedule 1)."],"plain_english_summary":"This instrument (a Repatriation Medical Authority Statement of Principles) sets the medical criteria used to decide whether primary myelofibrosis — or death from it — is connected to a veteran’s or service member’s time in service, affecting entitlement claims under the VEA and MRCA (see s3, s5). It identifies qualifying factors (notably a defined history of tobacco smoking and inability to obtain appropriate clinical management) and requires those factors be related to the person’s relevant service (see s9–10)."},"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-primary-myelofibrosis-balance-of-probabilities-no-90-of-2021","history":"/api/acts/statement-of-principles-concerning-primary-myelofibrosis-balance-of-probabilities-no-90-of-2021/history","analysis":"/api/acts/statement-of-principles-concerning-primary-myelofibrosis-balance-of-probabilities-no-90-of-2021/analysis","conflicts":"/api/acts/statement-of-principles-concerning-primary-myelofibrosis-balance-of-probabilities-no-90-of-2021/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-primary-myelofibrosis-balance-of-probabilities-no-90-of-2021/important-cases","documents":"/api/acts/statement-of-principles-concerning-primary-myelofibrosis-balance-of-probabilities-no-90-of-2021/documents"}}