Statement of Principles concerning malignant melanoma of the skin No. 39 of 2001

Instrument No.39 of 2001

Revocation and Determination

of

Statement of Principles

concerning

MALIGNANT MELANOMA OF THE SKIN

ICD-10-AM CODE: C43

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.97 of 1995 and Instrument No.189 of 1996; and

(b) determines in their place the following Statement of Principles.

Kind of injury, disease or death

2. (a) This Statement of Principles is about malignant melanoma of the skin and death from malignant melanoma of the skin.

(b)              For the purposes of this Statement of Principles, “malignant melanoma of the skin” means a malignant neoplastic disease arising from the melanocyte cell lines within the skin, attracting ICD-10-AM code C43.

Basis for determining the factors

3. The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that malignant melanoma of the skin and death from malignant melanoma of the skin 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 malignant melanoma of the skin or death from malignant melanoma of the skin with the circumstances of a person’s relevant service are:

(a)               suffering from sunburn before the clinical onset of malignant melanoma of the skin; or

(b)              having a solar UV damage factor ratio of at least 1.1 at the time of the clinical onset of malignant melanoma of the skin; or

(c)               being treated with immunosuppressive drugs for organ transplantation or systemic malignancy before the clinical onset of malignant melanoma of the skin; or

(d)              having PUVA therapy where:

(i)                    the first PUVA treatment commenced at least 15 years before, and

(ii)              at least 250 PUVA treatments were administered before

the clinical onset of malignant melanoma of the skin; or

(e) inability to obtain appropriate clinical management for malignant melanoma of the skin.

Factors that apply only to material contribution or aggravation

6. Paragraph 5(e) applies only to material contribution to, or aggravation of malignant melanoma of the skin where the person’s malignant melanoma of the skin 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:

“death from malignant melanoma of the skin” in relation to a person includes death from a terminal event or condition that was contributed to by the person’s malignant melanoma of the skin;

“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;

“PUVA” means photochemotherapy with oral methoxsalen (psoralen) and ultraviolet A radiation;

“relevant service” means:

(a) operational service; or

(b) peacekeeping service; or

(c) hazardous service;

“sunburn” means painful erythema of the skin of at least 48 hours duration or blistering of the skin, resulting from excessive exposure to sunlight;

“solar UV damage factor ratio” means the value obtained by applying the solar UV damage factor ratio formula. This may be calculated by using the computer program, UV Risk Version 3.3 (created by the Australian Radiation Laboratory using Microsoft Visual Basic Programming System for Windows Professional Edition, Version 3.0) to the data concerning the exposure of the person to ultra violet (UV) radiation;

Note: (this note does not form part of the instrument) The computer program UV Risk Version 3.3 can be run on a personal computer with at least 8 megabytes of Random Access Memory, using the Microsoft Windows version 3.1 graphical user interface. Further information may be obtained from the Department of Veterans’ Affairs, PO Box 21, Woden ACT 2606.

“solar UV damage factor ratio formula” means:

where:

“total lifetime UV damage factor” means the numerical value calculated by the formula:

T

[MED cum (a,T)] -1  .  PAE (n,M,a) at age (T-t)  . t-

t=0

for the person’s lifetime to the time of the clinical onset of malignant melanoma of the skin; and

“non-service UV damage factor” means the numerical value calculated by the formula:

T

[MED cum (a,T)] -1  .  PAE (n,M,a) at age (T-t)  . t-

t=0

for the person’s lifetime to the time of the clinical onset of malignant melanoma of the skin, with the PAE for each month of the person’s period or periods of relevant service being the arithmetic mean of the PAE for each and every month of the person’s life, other than the period or periods of relevant service, where:

“” has the value of five and is a numerical constant associated with the age dependence of the cumulative incidence;

“” has the value of two and is a biological amplification factor;

“a” is an anatomical body site;

“M” is a specified month of the year;

“MED” means minimal erythemal dose, where one MED is equal to 200 Joules of radiation per square metre of skin;

“[MED cum (a,T)]” is the cumulative solar UV dose to the skin for any given anatomical body site for the person’s age at the time of the clinical onset of malignant melanoma of the skin;

“n” has the value specified in column 2 of Table 1 opposite the item in column 1 of that Table for each of the specified life activities set out in column 1:

Table 1—specified life activities

“PAE” means personal ambient exposure in MEDs, calculated for each and every month of a person’s life to the time of the clinical onset of malignant melanoma of the skin based on an estimate of a typical month during each of the five year periods between the ages of 0 and 20 years and each of the ten year periods thereafter;

“PAE (n,M,a)”means the number calculated by the formula:

n8

 MAE (M,Ln) . ABFa . EFn . TRFn . ESFn . CPFn . ERFn . Wn

n1

where:

“ABFa”  is the anatomical body factor, and has the value specified in column 2 of Table 2 opposite the item in column 1 of that Table for each of the various body sites set out in column 1:

Table 2—body sites

“CPFn”  is the clothing protection factor, and has the value assigned to a particular anatomical site proportionately according to the amount of protection provided by clothing and sun screen, ranging from a value of 1.00 for no protection to a value of 0.05 for full cover with heavy clothing for a given specified life activity in column 1 of Table 1;

“EFn” is the exposure factor, and has the value specified in column 2 of Table 3 opposite the item in column 1 of that Table for different exposure situations set out in column 1:

Table 3—exposure situations

“ERFn” is the environment reflectance factor, and has the value specified in column 2 of Table 4 opposite the item in column 1 of that Table for the different environment types set out in column 1:

Table 4—environment types

where:

“Urban” means a location that is either a city or a town;

“Rural” means a location that is bushland, pastoral, or agricultural setting;

“Maritime” means either on the sea, lake, major river, or directly adjacent to such a body of water;

“ESFn”  is the environment shade factor, and has the value specified in column 2 of Table 5 opposite the item in column 1 of that Table for the different environment shade types set out in column 1:

Table 5—environment shade types

where:

“Dense shade” means a location that is predominantly under dense shade, such as jungle or dense forest;

“Moderate shade” means a location that is predominantly under moderate shade, such as open forest or high density housing;

“Light shade” means a location that is predominantly under light shade, such as lightly timbered country or low density housing;

“No shade”  means a location that is predominantly without shade, such as open fields, tundra, beach, or ocean;

“MAE(M,Ln)” is the average daily ambient exposure for month, M, in location, L, assuming a long term average cloud cover, being the value, obtained from the Table set out in Schedule 1, that is contained in the row that corresponds to the particular latitude (rounded to the nearest five degrees) and is contained in the column that corresponds to the month of the year that is the particular month under consideration, for each specified life activity;

“TRFn”  is the terrain reflectance factor, and has the value specified in column 2 of Table 6 opposite the item in column 1 of that Table for the different terrain types set out in column 1:

Table 6—terrain types

where:

“Black”  means a terrain predominantly of black material such as asphalt;

“Brown” means a terrain predominantly of bare soil, clay, or buildings;

“Green” means a terrain predominantly of green vegetation;

“Open Water” means an environment surrounded by water;

“Sand” means a terrain predominantly of light material such as white or yellow sand;

“Snow” means a terrain that is predominantly covered in snow;

“Wn ” is an estimate of the number of days in a month in which a specified life activity in column 1 of Table 1 is performed, and where, for the purposes of this definition, every month is taken to have 30.4375 days;

“t” is the age in months of the person for the particular specified activity;

“T” is the age in months of the person at the time of clinical onset of malignant melanoma of the skin;

“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 applies.

Dated this Twenty-fourth     day of May 2001

The Common Seal of the    )

Repatriation Medical Authority   )

was affixed to this instrument  )

in the presence of:    )

KEN DONALD

CHAIRMAN

Schedule 1

Average daily MED calculated for the given month and latitude

Data assumes long-term average cloud cover