{"id":"F2021L00940","name":"Statement of Principles concerning solar keratosis (Balance of Probabilities) (No. 80 of 2021)","slug":"statement-of-principles-concerning-solar-keratosis-balance-of-probabilities-no-80-of-2021","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440912,"registerId":"F2021L00940-fast-fetch-1775956368483","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning solar keratosis (Balance of Probabilities) (No. 80 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\nSOLAR KERATOSIS (Balance of Probabilities)\n\n(No. 80 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 25 June 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 Nicholas Saunders AO
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 solar keratosis (Balance of Probabilities) (No. 80 of 2021).\n\n2 Commencement\n\n This instrument commences on 26 July 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 solar keratosis No. 74 of 2012 (Federal Register of Legislation No. F2012L02085) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 solar keratosis and death from solar keratosis.\n\nMeaning of solar keratosis\n\n(2) For the purposes of this Statement of Principles, solar keratosis:\n\n(a) means a cutaneous lesion characterised by the local proliferation of atypical (dysplastic) epidermal keratinocytes; and\n\n(b) includes sun-damaged skin adjacent to a localised skin lesion (field cancerisation); and\n\n(c) excludes Bowen disease, arsenical keratoses and other keratoses that are not related to ultraviolet light exposure.\n\nNote 1: Solar keratosis is also known as actinic keratosis.\n\nNote 2: Solar keratoses typically present as single or multiple rough erythematous plaques that occur on sun-damaged skin, but the clinical appearance is highly variable, and lesions can be difficult to visualise.\n\nNote 3: Solar keratoses may regress spontaneously, remain stable or undergo malignant transformation into invasive squamous cell carcinoma.\n\n(3) While solar keratosis attracts ICD‑10‑AM code L57.0, in applying this Statement of Principles the meaning of solar keratosis 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 solar keratosis\n\n(5) For the purposes of this Statement of Principles, solar keratosis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's solar keratosis.\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 solar keratosis and death from solar keratosis 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, solar keratosis or death from solar keratosis is connected with the circumstances of a person's relevant service:\n\n(1) having sunlight exposure to unprotected skin at the affected site for a cumulative period of at least 4,500 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of solar keratosis;\n\nNote: equivalent sunlight exposure in other latitude zones, tropical area and unprotected skin are defined in the Schedule 1 - Dictionary.\n\n(2) undergoing organ or tissue transplantation, excluding corneal transplant, before the clinical onset of solar keratosis;\n\nNote: organ or tissue transplantation is defined in the Schedule 1 - Dictionary.\n\n(3) having PUVA therapy involving the affected site where:\n\n(a) the first PUVA treatment commenced at least 5 years before the clinical onset of solar keratosis; and\n\n(b) at least 50 PUVA treatments were administered before the clinical onset of solar keratosis;\n\nNote: PUVA is defined in the Schedule 1 - Dictionary.\n\n(4) taking hydroxyurea or voriconazole for at least the 3 months before the clinical onset of solar keratosis;\n\n(5) inability to obtain appropriate clinical management for solar keratosis.\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(5) applies only to material contribution to, or aggravation of, solar keratosis where the person's solar keratosis 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\nSchedule 1 - Dictionary \n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\n equivalent sunlight exposure in other latitude zones means the cumulative hours of sunlight exposure equivalent to that specified for a tropical area, calculated by multiplying the hours of exposure in each latitude zone by the latitude weighting factor for the zone as per the latitude weighting factor schedule and adding together the result for each zone:\n\nLatitude weighting factor schedule\n\nLatitude zone Latitude weighting factor\n\na latitude between 23° 27' S and 23° 27' N 1.0\n\na latitude from > 23° 27' to 35° 0.75\n\na latitude from > 35° to 45° 0.5\n\na latitude from > 45° to 65° 0.25.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n organ or tissue transplantation means the transplantation of:\n\n(a) all or part of an organ or tissue; or\n\n(b) a substance obtained from an organ or tissue.\n\n PUVA means photochemotherapy with oral methoxsalen (psoralen) and ultraviolet A radiation.\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 solar keratosis—see subsection 7(2).\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 tropical area means any area between the Tropic of Capricorn (23º 27' South) and the Tropic of Cancer (23º 27' North).\n\n unprotected skin means skin that is directly exposed to the sun and is not protected by sunscreen, clothing or any other physical barrier.\n\n VEA means the Veterans' Entitlements Act 1986.\n\n \n","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the earlier Statement of Principles No. 74 of 2012 (section 4) and replaces it with a new Statement that applies to claims under VEA s120B and MRCA s339 (section 5). The new instrument sets specific qualifying factors and measurement rules (section 9; Schedule 1 latitude weighting), so the operative scope (the tests used to connect solar keratosis to relevant service) is changed by replacement. The instrument itself does not record a clause-by-clause comparison to the repealed instrument, so the precise nature of changes must be determined by comparing the two instruments."},"complexity_factors":["Technical medical definitions and ICD code cross-reference (section 7(2)–(4))","Numeric exposure threshold with geographic weighting and calculation method (section 9(1); Schedule 1 latitude weighting factor schedule)","Multiple alternative causal factors with discrete temporal and numerical tests (section 9(1)–(4))","Requirement that identified factors be related to 'relevant service' and interaction with VEA/MRCA definitions (section 10(1); Schedule 1 definitions of relevant service, VEA, MRCA)","Cross‑reference to other Statements of Principles where factors overlap, creating interdependence (section 11)","Legal standard of proof and administrative application (balance of probabilities; section heading and section 8), affecting evidentiary burdens","Definitions that determine scope (e.g. 'unprotected skin', 'tropical area', 'terminal event') and exclusions (section 7(2), Schedule 1)","Repeal and replacement of an earlier instrument, which may require comparison of instruments when applying claims (section 4)"],"plain_english_summary":"This instrument sets the medical criteria for linking solar keratosis (actinic keratosis) and death from it to a veteran's or service member's relevant service for claims under the VEA and MRCA. It defines the condition, excludes non‑UV keratoses, and lists specific, measurable factors (for example, cumulative unprotected sun exposure using a latitude weighting, prior transplants, PUVA treatment, certain drugs, or lack of appropriate clinical management) that must be present and related to service."},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard replacement Statement of Principles updating medical evidence from 2012 to 2021. The scope remains tightly focused on establishing causation criteria for solar keratosis in the veterans' compensation context. The latitude weighting formula and specific medication/treatment factors reflect refined medical understanding rather than scope creep."},"complexity_factors":["Mathematical calculation required for latitude-based sun exposure (latitude weighting factor schedule with 4 zones and multipliers)","Multiple defined terms in Schedule 1 (11 explicit definitions including nested cross-references)","Temporal conditions attached to factors (e.g., 'at least 5 years before', 'at least 3 months before', 'at least 50 treatments')","Conditional logic in section 9(3) with dual requirements for PUVA therapy (time gap AND treatment count)","Specific exclusion of certain conditions from the definition (Bowen disease, arsenical keratoses)","Cross-reference mechanism in section 11 allowing incorporation of other Statements of Principles by reference","Dual legislative framework application (VEA and MRCA with different service definitions)"],"plain_english_summary":"This instrument updates rules for when Australian veterans and defence members can claim compensation for solar (actinic) keratosis, replacing the 2012 guidance and applying a \"balance of probabilities\" test. It matters to anyone claiming under the Veterans' Entitlements Act or the Military Rehabilitation and Compensation Act because it specifies the service‑related circumstances (including heavy sun exposure adjusted by a latitude formula, certain treatments, transplants, medications, and lack of care) that will establish a compensable connection, and excludes non‑UV keratoses like Bowen disease."},"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"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-solar-keratosis-balance-of-probabilities-no-80-of-2021","history":"/api/acts/statement-of-principles-concerning-solar-keratosis-balance-of-probabilities-no-80-of-2021/history","analysis":"/api/acts/statement-of-principles-concerning-solar-keratosis-balance-of-probabilities-no-80-of-2021/analysis","conflicts":"/api/acts/statement-of-principles-concerning-solar-keratosis-balance-of-probabilities-no-80-of-2021/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-solar-keratosis-balance-of-probabilities-no-80-of-2021/important-cases","documents":"/api/acts/statement-of-principles-concerning-solar-keratosis-balance-of-probabilities-no-80-of-2021/documents"}}