{"id":"F2021L01165","name":"Statement of Principles concerning primary myelofibrosis (Reasonable Hypothesis) (No. 89 of 2021)","slug":"statement-of-principles-concerning-primary-myelofibrosis-reasonable-hypothesis-no-89-of-2021","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440964,"registerId":"F2021L01165-fast-fetch-1775956406495","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning primary myelofibrosis (Reasonable Hypothesis) (No. 89 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 (Reasonable Hypothesis)\n\n(No. 89 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 primary myelofibrosis (Reasonable Hypothesis) (No. 89 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 primary myelofibrosis No. 17 of 2013 (Federal Register of Legislation No. F2013L00416) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that primary myelofibrosis and death from primary myelofibrosis 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 primary myelofibrosis or death from primary myelofibrosis 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(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 primary myelofibrosis—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":{"complexity_score":3,"scope_assessment":{"changed":true,"description":"This instrument repeals the previous Statement of Principles concerning primary myelofibrosis No. 17 of 2013 (section 4) and replaces it (section 1). It updates and specifies qualifying factors — including a 10 pack‑year smoking threshold, timing rules and a factor for inability to obtain appropriate clinical management (section 9; Schedule 1) — and confirms application to claims under VEA s120A and MRCA s338 (section 5)."},"complexity_factors":["Technical medical definition of primary myelofibrosis with exclusion list (subsection 7(2)) increases the need for specialist interpretation.","Quantified tobacco exposure rule requires pack‑year calculation and timing analysis (section 9(1); Schedule 1 definitions and notes).","Temporal thresholds for smoking onset and cessation (section 9(1)(b) and cessation within 15 years) create discrete evidentiary cutoffs.","Broad, potentially open‑ended factor — 'inability to obtain appropriate clinical management' — requires factual assessment and may invite case‑by‑case adjudication (section 9(2); see also section 10(2) limiting its application).","Interaction with other Statements of Principles where factors overlap requires cross‑reference and coordination (section 11).","Application to specific claim types under the VEA and MRCA requires procedural alignment with those statutes (section 5).","Use of the 'reasonable hypothesis' causation standard (authority in section 3; basis stated in section 8) is a lower evidentiary test than proof on balance of probabilities but requires interpretation by decision‑makers."],"plain_english_summary":"This Statement of Principles sets the medical criteria the Repatriation Medical Authority will use to decide whether primary myelofibrosis (PMF) or death from PMF can be reasonably linked to military or peacekeeping service for claims under the VEA and MRCA. It replaces the 2013 statement and identifies key qualifying factors (notably a quantified smoking history and inability to obtain appropriate clinical management), plus timing and definition rules that determine when a reasonable hypothesis of service connection exists."},"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 a Repatriation Medical Authority Statement of Principles. It replaces the 2013 version (No. 17 of 2013) with updated medical criteria but does not expand beyond the established purpose of determining service connection for a specific disease under the veterans' compensation scheme. The structure, definitions, and factor-based approach remain consistent with the template used for all such instruments."},"complexity_factors":["Short, self-contained instrument (approximately 1,500 words)","Only 7 defined terms in the Dictionary (Schedule 1)","Simple binary structure: two alternative factors in section 9, with one containing three cumulative conditions","Minimal cross-referencing — only refers to parent Acts (VEA and MRCA) for service definitions","Single level of exceptions (section 7(2)(b) excludes secondary causes)","No nested conditional logic or 'exceptions to exceptions'","Clear, standardised format typical of Repatriation Medical Authority Statements of Principles"],"plain_english_summary":"This instrument updates medical criteria for linking primary myelofibrosis to service, replacing the 2013 version. It governs compensation eligibility for current and former Australian Defence Force members under the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004. To qualify, a claimant must show either a qualifying heavy smoking history (≥10 pack‑years with timing rules) or that inadequate medical care during service worsened pre‑existing disease. Without one of these factors, claims are likely to be denied."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-primary-myelofibrosis-reasonable-hypothesis-no-89-of-2021","history":"/api/acts/statement-of-principles-concerning-primary-myelofibrosis-reasonable-hypothesis-no-89-of-2021/history","analysis":"/api/acts/statement-of-principles-concerning-primary-myelofibrosis-reasonable-hypothesis-no-89-of-2021/analysis","conflicts":"/api/acts/statement-of-principles-concerning-primary-myelofibrosis-reasonable-hypothesis-no-89-of-2021/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-primary-myelofibrosis-reasonable-hypothesis-no-89-of-2021/important-cases","documents":"/api/acts/statement-of-principles-concerning-primary-myelofibrosis-reasonable-hypothesis-no-89-of-2021/documents"}}