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Statement of Principles

concerning

MALIGNANT NEOPLASM OF THE THYROID GLAND

No. 39 of 2014

for the purposes of the

Veterans’ Entitlements Act 1986

and

Military Rehabilitation and Compensation Act 2004

Title

1. This Instrument may be cited as Statement of Principles concerning malignant neoplasm of the thyroid gland No. 39 of 2014.

Determination

2. The Repatriation Medical Authority under subsection 196B(2) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):

(a) revokes Instrument No. 9 of 2006, as amended by Instrument No. 67 of 2011, concerning malignant neoplasm of the thyroid gland; and

(b) determines in their place this Statement of Principles.

Kind of injury, disease or death

3. (a) This Statement of Principles is about malignant neoplasm of the thyroid gland and death from malignant neoplasm of the thyroid gland.

(b) For the purposes of this Statement of Principles, "malignant neoplasm of the thyroid gland" means a primary malignancy arising from the cells of the thyroid gland. This definition includes papillary, follicular and anaplastic thyroid carcinomas, but excludes soft tissue sarcoma, medullary carcinoma, non-Hodgkin’s lymphoma and Hodgkin’s lymphoma.

(d) In the application of this Statement of Principles, the definition of "malignant neoplasm of the thyroid gland" is that given at paragraph 3(b) above.

Basis for determining the factors

4. The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that malignant neoplasm of the thyroid gland and death from malignant neoplasm of the thyroid gland 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 Military Rehabilitation and Compensation Act 2004 (the MRCA).

Factors that must be related to service

5. Subject to clause 7, at least one of the factors set out in clause 6 must be related to the relevant service rendered by the person.

Factors

6. The factor that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting malignant neoplasm of the thyroid gland or death from malignant neoplasm of the thyroid gland with the circumstances of a person’s relevant service is:

(a) having received a cumulative equivalent dose of at least 0.1 sievert of ionising radiation to the thyroid gland at least five years before the clinical onset of malignant neoplasm of the thyroid gland; or

(b) having a specified disorder of the thyroid gland at least one year before the clinical onset of malignant neoplasm of the thyroid gland; or

(c) being overweight or obese for a period of at least five years before the clinical onset of malignant neoplasm of the thyroid gland; or

(d) undergoing stem cell, bone marrow or solid organ transplantation before the clinical onset of malignant neoplasm of the thyroid gland; or

(e) inability to obtain appropriate clinical management for malignant neoplasm of the thyroid gland.

Factors that apply only to material contribution or aggravation

7. Paragraph 6(e) applies only to material contribution to, or aggravation of, malignant neoplasm of the thyroid gland where the person’s malignant neoplasm of the thyroid gland was suffered or contracted before or during (but not arising out of) the person’s relevant service.

Inclusion of Statements of Principles

8. In this Statement of Principles if a relevant factor applies and that factor includes an injury or disease in respect of which there is a Statement of Principles then the factors in that last mentioned Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.

Other definitions

9. For the purposes of this Statement of Principles:

"a specified disorder of the thyroid gland" means:

(a) goitre (includes thyroid adenoma);

(b) Graves' disease; or

"being overweight or obese" means an increase in body weight by way of fat accumulation which results in a Body Mass Index (BMI) of 25 or greater.

The BMI = W/H2 and where:

W is the person’s weight in kilograms; and

H is the person’s height in metres;

"cumulative equivalent dose" means the total dose of ionising radiation received by the particular organ or tissue. The formula used to calculate the cumulative equivalent dose allows doses from multiple types of ionising radiation to be combined, by accounting for their differing biological effect. The unit of equivalent dose is the sievert. For the purposes of this Statement of Principles, the calculation of cumulative equivalent dose excludes doses received from normal background radiation, but includes therapeutic radiation, diagnostic radiation, cosmic radiation at high altitude, radiation from occupation-related sources and radiation from nuclear explosions or accidents;

"death from malignant neoplasm of the thyroid gland" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s malignant neoplasm of the thyroid gland;

"ICD-10-AM code" means a number assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM), Eighth Edition, effective date of 1 July 2013, copyrighted by the Independent Hospital Pricing Authority, and having ISBN 978-1-74128-213-9;

"relevant service" means:

(a) operational service under the VEA;

(b) peacekeeping service under the VEA;

(d) British nuclear test defence service under the VEA;

(e) warlike service under the MRCA; or

(f) non-warlike service under the MRCA;

"terminal event" means the proximate or ultimate cause of death and includes:

(a) pneumonia;

(b) respiratory failure;

(d) circulatory failure; or

(e) cessation of brain function.

Application

10. This Instrument applies to all matters to which section 120A of the VEA or section 338 of the MRCA applies.

Date of effect

11. This Instrument takes effect from 7 May 2014.

Dated this twenty-fourth day of April 2014

The Common Seal of the )

Repatriation Medical Authority )

was affixed to this instrument )

in the presence of: )

PROFESSOR NICHOLAS SAUNDERS AO

CHAIRPERSON