DECLARATION UNDER SUBSECTION 196B(9)
OF THE VETERANS’ ENTITLEMENTS ACT 1986
The Repatriation Medical Authority (the Authority), under subsection 196B(9) of the Veterans' Entitlements Act 1986 (the Act), makes the following declaration in respect of an investigation to review the contents of the Statements of Principles in force under the Act concerning non-Hodgkin's lymphoma. The investigation related to "exposure to ionising radiation" and "benzene exposure" and the Notice of Investigation was published in the Government Notices Gazette of 16 October 2013.
The Authority declares that while it proposes to amend Statement of Principles, Instrument No. 28 of 2010, concerning non-Hodgkin's lymphoma, it does not propose to amend Statement of Principles, Instrument No. 29 of 2010, for the reason that the new sound medical-scientific evidence available is not sufficient to justify an amendment to this Statement of Principles already determined in respect of non-Hodgkin's lymphoma.
With regard to benzene, the International Agency for Research on Cancer in 2009 concluded that there is limited evidence for a causal association between benzene and non-Hodgkin's lymphoma. Three of four recent meta-analyses found no association between benzene exposure and non-Hodgkin's lymphoma, and (apart from one cohort study), no evidence for a dose-response effect. The study with possibly the highest and purest exposure to benzene found no association with non-Hodgkin's lymphoma. Assessment of the association of benzene and lymphoma is also complicated by problems with exposure misclassification, outcome misclassification, heterogeneity of lymphoma subtypes and low statistical power. The available sound medical-scientific evidence does not establish that such a relationship is more probable than not and does not enable the Authority to determine a benzene factor for inclusion in the Statement of Principles, Instrument No. 29 of 2010, determined pursuant to subsection 196B(3) of the Act.
In relation to ionising radiation, the sound medical-scientific evidence is too limited to conclude that exposure to ionising radiation is causally related to non-Hodgkin's lymphoma at the reasonable hypothesis or balance of probabilities standards of proof. A previous major review concluded that there is little evidence of an association of non-Hodgkin's lymphoma with exposure to external radiation, and insufficient evidence in relation to other types or sources of radiation. No significant association was identified in a multinational study of nuclear industry workers, though an association with mortality from non-Hodgkin's lymphoma was found in US nuclear weapons workers. Elevations in risk of cancers after radiotherapy for benign or malignant conditions are inconsistent. Overall, the evidence concerning the association between ionising radiation and non-Hodgkin's lymphoma is limited in amount and consistency.
The Common Seal of the )
Repatriation Medical Authority )
was affixed in the presence of: )
PROFESSOR NICHOLAS SAUNDERS AO
CHAIRPERSON 24 / 4 / 2014
Overview
The Veterans' Entitlements Act 1986 was enacted to provide a legislative framework for the provision of benefits and services to Australian veterans and their dependants. It aimed to address the gap in adequate recognition and support for the health and welfare needs of veterans, ensuring they receive appropriate medical care, financial assistance, and other benefits. The Act was passed by the Australian Parliament with the policy objective of acknowledging and compensating the sacrifices made by veterans and their families. The Repatriation Medical Authority, under the Act, has the responsibility to review and amend Statements of Principles concerning various health conditions, including non-Hodgkin's lymphoma, based on the most recent and reliable medical-scientific evidence. This ensures that the benefits and entitlements provided to veterans are grounded in contemporary understanding and research of their health issues.
Scope and Application
The Veterans' Entitlements Act 1986 (VEA) applies to eligible veterans and their families, providing them with a range of benefits and services. The Act covers a broad spectrum of veterans who have served in the Australian Defence Force, including those who have served in warlike operations or under certain peacetime conditions. It encompasses various types of conduct and transactions related to service, disability, and the provision of benefits. The jurisdictional reach of the VEA is national, applying across Australia as a Commonwealth Act. The Act's provisions are implemented through subordinate instruments, such as the Statements of Principles, which detail the conditions that are recognised as service-related for the purpose of entitlement to benefits. These Statements of Principles are subject to review and amendment based on new medical-scientific evidence. The Repatriation Medical Authority has the authority to declare changes to these Statements, as seen in the case of the review concerning non-Hodgkin's lymphoma, where specific exclusions and limitations on amendments were noted due to the available evidence.
Key Provisions
The declaration under subsection 196B(9) of the Veterans' Entitlements Act 1986 (the Act) outlines the Repatriation Medical Authority's (the Authority) intentions regarding proposed amendments to the Statements of Principles concerning non-Hodgkin's lymphoma. Specifically, the Authority declares its intention to amend Statement of Principles, Instrument No. 28 of 2010, which relates to exposure to ionising radiation, but not Statement of Principles, Instrument No. 29 of 2010, which pertains to benzene exposure (subsection 196B(9)). This decision is based on the assessment that the new medical-scientific evidence does not sufficiently justify an amendment to the latter Statement of Principles.
The Authority has determined that the available evidence concerning benzene exposure and non-Hodgkin's lymphoma does not support a causal association. The International Agency for Research on Cancer concluded in 2009 that there is limited evidence for such a relationship. Recent meta-analyses and studies, including one with high and pure benzene exposure, found no association or dose-response effect. Consequently, the Authority cannot determine a benzene factor for inclusion in Statement of Principles, Instrument No. 29 of 2010. The evidence is further complicated by factors such as exposure misclassification and low statistical power (subsection 196B(9)).
Regarding ionising radiation, the medical-scientific evidence is deemed too limited to establish a causal relationship with non-Hodgkin's lymphoma at the reasonable hypothesis or balance of probabilities standards. Previous reviews found little evidence of an association with external radiation and insufficient evidence for other types or sources of radiation. A multinational study of nuclear industry workers found no significant association, although an association with mortality was found in US nuclear weapons workers. The Authority's conclusion is that the evidence is limited in both amount and consistency (subsection 196B(9)).
The obligations imposed by this declaration on the Authority include the responsibility to review and assess new medical-scientific evidence concerning the relationship between non-Hodgkin's lymphoma and exposure to ionising radiation and benzene. The Authority must determine whether this evidence is sufficient to warrant amendments to the relevant Statements of Principles. The declaration also entails the duty to publish notices of investigation and to provide a transparent rationale for any proposed amendments. The Authority is further obligated to ensure that its decisions are based on sound medical-scientific evidence and adhere to the standards of proof as outlined in the Act (subsection 196B(9)).
There are no explicit offences, penalties, or consequences stated in the declaration itself. However, the Authority’s decision-making process and the outcomes of the investigation could have significant implications for veterans and their families, potentially affecting their entitlements and benefits. The Act and related legislation may impose other legal obligations and consequences for any breaches or non-compliance with the Authority’s decisions.