Instrument No.83 of 2001
Revocation and Determination
of
Statement of Principles
concerning
ACUTE LYMPHOID LEUKAEMIA
ICD-10-AM CODES: C91.0, C91.5
Veterans’ Entitlements Act 1986
1. The Repatriation Medical Authority under subsection 196B(2) of the Veterans’ Entitlements Act 1986 (the Act):
(a) revokes Instrument No.77 of 1995; and
(b) determines in its place the following Statement of Principles.
Kind of injury, disease or death
2. (a) This Statement of Principles is about acute lymphoid leukaemia and death from acute lymphoid leukaemia.
(b) For the purposes of this Statement of Principles, “acute lymphoid leukaemia” means a malignant disease of the early precursor cells of the B cell and T cell lymphocytic lineages, attracting ICD-10-AM code C91.0 or C91.5.
Basis for determining the factors
3. The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that acute lymphoid leukaemia and death from acute lymphoid leukaemia can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces.
Factors that must be related to service
4. Subject to clause 6, at least one of the factors set out in clause 5 must be related to any relevant service rendered by the person.
Factors
5. The factors that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting acute lymphoid leukaemia or death from acute lymphoid leukaemia with the circumstances of a person’s relevant service are:
(a) having received a cumulative equivalent dose of 0.01 Sievert of atomic radiation to the bone marrow where this dose was accumulated at least two years before the clinical onset of acute lymphoid leukaemia; or
(b) undergoing a course of therapeutic radiation before the clinical onset of acute lymphoid leukaemia, where the first exposure occurred more than one year before the clinical onset of acute lymphoid leukaemia; or
(c) for acute lymphoid leukaemia L3 subtype only, being infected with Epstein-Barr virus, at least one year before the clinical onset of acute lymphoid leukaemia; or
(d) for Adult T-cell lymphoma-leukaemia only, being infected with HTLV-1 virus before the clinical onset of acute lymphoid leukaemia; or
(e) inability to obtain appropriate clinical management for acute lymphoid leukaemia.
Factors that apply only to material contribution or aggravation
6. Paragraph 5(e) applies only to material contribution to, or aggravation of, acute lymphoid leukaemia where the person’s acute lymphoid leukaemia was suffered or contracted before or during (but not arising out of) the person’s relevant service; paragraph 8(1)(e), 9(1)(e), 70(5)(d) or 70(5A)(d) of the Act refers.
Inclusion of Statements of Principles
7. 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.
Other definitions
8. For the purposes of this Statement of Principles:
“a course of therapeutic radiation” means one or more fractions (treatment portions) of ionising radiation administered with the aim of achieving palliation or cure with gamma rays, x-rays, alpha particles or beta particles;
“acute lymphoid leukaemia L3 subtype” is a subtype of acute lymphatic leukaemia under the French-American-British (FAB) classification, being characterised by large, uniform cells having moderately abundant cytoplasm with deep basophilia and prominent vacuoles, and a regular shaped nucleus with prominent nuclei;
“atomic radiation” means ionising radiation excluding:
(i) natural background radiation;
(ii) therapeutic radiation; and
(iii) radiation from diagnostic procedures;
“being infected with Epstein-Barr virus” means serological evidence of infection with Epstein-Barr virus;
“being infected with HTLV-1” means serological evidence of infection within the retro virus human T-cell lymphotrophic virus Type 1;
“cumulative equivalent dose” means the total equivalent dose of atomic radiation from all types of radiation (eg alpha, gamma). It accounts for the differences in biological effectiveness of various types of radiation and allows doses from different radiations to be combined. Each component is calculated by multiplying the absorbed dose in a particular tissue or organ for a given type of radiation by the radiation weighting factor for that radiation. The unit of equivalent dose is the Sievert (Sv);
“death from acute lymphoid leukaemia” in relation to a person includes death from a terminal event or condition that was contributed to by the person’s acute lymphoid leukaemia;
“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), Second Edition, effective date of 1 July 2000, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 1 86487 271 3;
“relevant service” means:
(a) operational service; or
(b) peacekeeping service; or
(c) hazardous service;
“terminal event” means the proximate or ultimate cause of death and includes:
(a) pneumonia;
(b) respiratory failure;
(c) cardiac arrest;
(d) circulatory failure; or
(e) cessation of brain function.
Application
9. This Instrument applies to all matters to which section 120A of the Act applied.
Dated this Ninth day of October 2001
The Common Seal of the )
Repatriation Medical Authority )
was affixed to this instrument )
in the presence of: )
KEN DONALD
CHAIRMAN