{"id":"F2021L00938","name":"Statement of Principles concerning solar keratosis (Reasonable Hypothesis) (No. 79 of 2021)","slug":"statement-of-principles-concerning-solar-keratosis-reasonable-hypothesis-no-79-of-2021","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440913,"registerId":"F2021L00938-fast-fetch-1775956368488","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning solar keratosis (Reasonable Hypothesis) (No. 79 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 (Reasonable Hypothesis)\n\n(No. 79 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 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 (Reasonable Hypothesis) (No. 79 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning solar keratosis No. 73 of 2012 (Federal Register of Legislation No. F2012L02084) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that solar keratosis and death from solar keratosis 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 solar keratosis or death from solar keratosis 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 2,250 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) having sunburn as specified:\n\n(a) on at least 5 occasions:\n\n(i) before the age of 20 years; and\n\n(ii) at least 5 years before the clinical onset of solar keratosis; and\n\n(b) where the clinical onset of solar keratosis has occurred before the age of 50 years;\n\nNote: sunburn as specified is defined in the Schedule 1 - Dictionary.\n\n(3) being a prisoner of war of Japan before the clinical onset of solar keratosis;\n\n(4) having exposure of the affected region to welding light, while arc-welding metal without skin protection, for a cumulative period of at least 12,000 hours before the clinical onset of solar keratosis;\n\nNote: Examples of skin protection include leather gloves, long sleeve jackets, and a welding helmet with a face plate.\n\n(5) 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(6) 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 25 PUVA treatments were administered before the clinical onset of solar keratosis;\n\nNote: PUVA is defined in the Schedule 1 - Dictionary.\n\n(7) taking hydroxyurea or voriconazole for at least the 3 months before the clinical onset of solar keratosis;\n\n(8) 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(8) 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(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 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) 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 solar keratosis—see subsection 7(2).\n\n sunburn as specified means painful erythema of the skin of at least 48 hours duration, or blistering of the skin, resulting from exposure to solar ultraviolet radiation.\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\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 same scope as its 2012 predecessor and the broader Repatriation Medical Authority framework. It remains tightly focused on establishing specific medical causation criteria for one discrete condition (solar keratosis) within the veterans' compensation system. The updates reflect evolving medical understanding (e.g., expanded drug triggers, refined latitude calculations) rather than scope creep."},"complexity_factors":["Specialised medical terminology requiring definitions (e.g., 'PUVA therapy', 'erythema', 'dysplastic epidermal keratinocytes')","Mathematical calculation required for latitude-based sun exposure (latitude weighting factor schedule with four zones and multipliers)","Multiple temporal conditions (time delays between exposure and onset, age thresholds, cumulative hour requirements)","Cross-referencing between this instrument and other Statements of Principles for related conditions","Dual legislative framework application (VEA and MRCA with different service definitions)","8 distinct causal factors with varying evidentiary requirements"],"plain_english_summary":"This instrument sets updated medical criteria for linking solar (actinic) keratosis to Australian Defence Force service so affected members can claim compensation and care. It replaces the 2012 guidance with current medical evidence.\n\nIt affects current and former ADF members and veterans claiming under the VEA or MRCA, clarifying when sun- and service-related exposures (including tropical, shipboard and outdoor duties) justify entitlement; it also recognises geographic sun intensity via a latitude weighting system."},"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals Statement of Principles No. 73 of 2012 (section 4) and replaces it with the current Statement of Principles No. 79 of 2021, restating the definition of solar keratosis and prescribing specific qualifying factors and thresholds (sections 7–9 and Schedule 1). The text shows the instrument updates the criteria used to link solar keratosis to relevant service but does not, within the instrument itself, state whether those criteria are broader or narrower than the repealed 2012 instrument."},"complexity_factors":["Technical medical definition and diagnostic scope of solar keratosis, including exclusions (subsection 7(2)–(4)).","Multiple quantitative exposure thresholds to prove service connection (e.g. 2,250 cumulative sunlight hours in tropics; 12,000 welding hours; 25 PUVA treatments; 5 sunburn episodes) (section 9).","Temporal and age-related conditions attached to some factors (e.g. sunburn before age 20 and clinical onset before age 50) (subsection 9(2)).","Latitude weighting system that converts hours in different zones into ‘equivalent’ exposure (Schedule 1 latitude weighting factor schedule).","Interplay with other Statements of Principles and statutory claim frameworks (application to VEA/MRCA claims in section 5 and cross-reference rule in section 11).","Evidentiary and administrative burdens implicit in proving cumulative hours, historical sunburn episodes, POW status, clinical management access, or prior treatments/medications (sections 9, 10).","Repeal and replacement of a prior instrument (section 4) which requires administrators and claimants to apply the new criteria."],"plain_english_summary":"This Statement of Principles, issued by the Repatriation Medical Authority, replaces the earlier 2012 instrument and sets the medical criteria required to raise a “reasonable hypothesis” that solar keratosis (actinic keratosis) or death from it is related to a person’s relevant military service. It applies to claims under the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004 and therefore affects veterans and former or current members whose entitlement claims rely on a service connection.\n\nThe instrument defines what is meant by solar keratosis and lists the types of evidence and quantitative exposure thresholds (sunlight hours, sunburn history, welding exposure, PUVA, transplants, certain drugs, POW status, or inability to obtain care) and a latitude-weighting method used to assess whether service exposure satisfies the criteria."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-solar-keratosis-reasonable-hypothesis-no-79-of-2021","history":"/api/acts/statement-of-principles-concerning-solar-keratosis-reasonable-hypothesis-no-79-of-2021/history","analysis":"/api/acts/statement-of-principles-concerning-solar-keratosis-reasonable-hypothesis-no-79-of-2021/analysis","conflicts":"/api/acts/statement-of-principles-concerning-solar-keratosis-reasonable-hypothesis-no-79-of-2021/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-solar-keratosis-reasonable-hypothesis-no-79-of-2021/important-cases","documents":"/api/acts/statement-of-principles-concerning-solar-keratosis-reasonable-hypothesis-no-79-of-2021/documents"}}