Statement of Principles concerning malignant neoplasm of the anal canal No. 35 of 2002

Administered by Department of Veterans' Affairs

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Instrument No.35 of 2002

 

Determination

of

Statement of Principles

concerning

MALIGNANT NEOPLASM OF THE ANAL CANAL

ICD-10-AM codeS: C21.0, C21.1, C21.2, D01.3

 

Veterans’ Entitlements Act 1986

 

 

1. This Statement of Principles is determined by the Repatriation Medical Authority under subsection 196B(3) of the Veterans’ Entitlements Act 1986 (the Act).

 

Kind of injury, disease or death

2. (a) This Statement of Principles is about malignant neoplasm of the anal canal and death from malignant neoplasm of the anal canal.

 

(b)              For the purposes of this Statement of Principles “malignant neoplasm of the anal canal” means a primary malignant invasive carcinoma or carcinoma in situ arising in the epithelial lining of the anal canal, but excludes soft tissue sarcoma, non-Hodgkin’s lymphoma, Hodgkin’s disease and adenocarcinoma of the anal canal.  The anal canal extends from the junction between the rectum and anal canal to the anus, and does not include the anal margin or perianal skin.  Malignant neoplasm of the anal canal attracts ICD-10-AM code C21.0, C21.1, C21.2 or D01.3.

 

Basis for determining the factors

3. On the sound medical-scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that malignant neoplasm of the anal canal and death from malignant neoplasm of the anal canal can be related to relevant service rendered by veterans 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 exist before it can be said that, on the balance of probabilities, malignant neoplasm of the anal canal or death from malignant neoplasm of the anal canal are connected with the circumstances of a person’s relevant service are:

 

(a)              smoking at least 20 pack-years of cigarettes or the equivalent thereof in other tobacco products, before the clinical onset of malignant neoplasm of the anal canal, and, where smoking has ceased, the clinical onset has occurred within 15 years of cessation; or

 

(b)              suffering from anogenital human papilloma virus infection before the clinical onset of malignant neoplasm of the anal canal; or

 

(c)              being infected with human immunodeficiency virus at the time of the clinical onset of malignant neoplasm of the anal canal; or

 

(d)              being treated with immunosuppressive drugs for organ transplantation before the clinical onset of malignant neoplasm of the anal canal; or

 

(e)              inability to obtain appropriate clinical management for malignant neoplasm of the anal canal.

 

Factors that apply only to material contribution or aggravation

6. Paragraph 5(e) applies only to material contribution to, or aggravation of, malignant neoplasm of the anal canal where the person’s malignant neoplasm of the anal canal was suffered or contracted before or during (but not arising out of) the person’s relevant service; paragraph 8(1)(e), 9(1)(e) or 70(5)(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:

 

“anogenital human papilloma virus infection” means human papilloma virus infection of external genitalia, perianal skin, anal canal, cervix or vagina;

 

“death from malignant neoplasm of the anal canal” 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 anal canal;

 

“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.  Where in this Statement of Principles an ICD code is referenced, such reference is not to constrain or limit the proper meaning of the definition or words preceding the alphanumeric code reference;

 

“pack years of cigarettes or the equivalent thereof in other tobacco products” means a calculation of consumption where one pack year of cigarettes equals twenty tailor made cigarettes per day for a period of one calendar year, or 7 300 cigarettes.  One tailor made cigarette approximates one gram of tobacco or one gram of cigar or pipe tobacco by weight.  One pack year of tailor made cigarettes equates to 7 300 cigarettes, or 7.3kg of smoking tobacco by weight.  Tobacco products means either cigarettes, pipe tobacco or cigars smoked, alone or in any combination;

 

“relevant service” means:

 

(a) eligible war service (other than operational service); or

(b)              defence service (other than 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.

 

Dated this Sixteenth day of  April 2002

 

 

The Common Seal of the    )

Repatriation Medical Authority   )

was affixed to this instrument  )

in the presence of:    )

 

KEN DONALD

CHAIRMAN

 

Overview

The Statement of Principles concerning Malignant Neoplasm of the Anal Canal (ICDO-AM codes: C21.0, C21.1, C21.2, D01.3) was determined by the Repatriation Medical Authority under subsection 196B(3) of the Veterans' Entitlements Act 1986. This Statement of Principles was enacted in 2002 to address the issue of malignant neoplasm of the anal canal and death from this condition in veterans. The policy objective is to establish the connection between the disease and relevant service, thus ensuring that veterans can access appropriate entitlements and support. The Repatriation Medical Authority determined that, based on available medical-scientific evidence, it is more probable than not that malignant neoplasm of the anal canal and death from this condition can be related to service rendered by veterans. The Statement of Principles specifies certain factors that must be related to the veteran's service for the condition to be considered connected to service. These factors include smoking at least 20 pack-years of cigarettes or equivalent tobacco products before the onset of the disease, anogenital human papilloma virus infection, infection with human immunodeficiency virus at the time of onset, treatment with immunosuppressive drugs for organ transplantation, and inability to obtain appropriate clinical management. These factors are crucial for establishing a link between the disease and service, thereby enabling affected veterans to claim relevant benefits and compensation.

Scope and Application

The Statement of Principles concerning malignant neoplasm of the anal canal under the Veterans’ Entitlements Act 1986 applies to veterans and members of the Australian Defence Force who have been diagnosed with malignant neoplasm of the anal canal or have died from it. The legislation establishes the criteria and factors that need to be met for a connection between the disease and the individual's relevant service to be recognised. The Act specifies that certain conditions, such as smoking, anogenital human papilloma virus infection, human immunodeficiency virus infection at the time of clinical onset, treatment with immunosuppressive drugs for organ transplantation, and inability to obtain appropriate clinical management, must be related to the service unless they apply to the aggravation or material contribution to the disease. The scope of the Act is geographically confined to Australia, and it applies to both Commonwealth and state jurisdictions. The Statement of Principles is inclusive of other related injuries or diseases if they have their own Statement of Principles, which are incorporated according to their terms. There are no exclusions or exemptions specified in the Statement of Principles, and its application may be further extended or restricted through subordinate instruments issued under the authority of the Act.

Key Provisions

This legislative instrument, specifically Instrument No. 35 of 2002, is a Statement of Principles determined under subsection 196B(3) of the Veterans' Entitlements Act 1986 (section 1). It pertains to malignant neoplasm of the anal canal, including death from this condition, and outlines the criteria for determining a connection between the disease and relevant military service (section 2). The Statement specifies that "malignant neoplasm of the anal canal" refers to a primary malignant invasive carcinoma or carcinoma in situ in the epithelial lining of the anal canal, excluding certain other types of cancer (section 2(b)). The instrument also sets out the basis for determining the factors that establish a link between the disease and service, indicating that such a link is more probable than not based on available medical-scientific evidence (section 3). The Statement imposes specific obligations on parties, such as veterans and their representatives, to provide evidence of the factors that must be related to relevant service in order to establish a connection between malignant neoplasm of the anal canal or death from this condition and the circumstances of the person's military service (section 4). These factors include smoking a certain amount of cigarettes or equivalent tobacco products before the onset of the disease, having anogenital human papilloma virus infection, being infected with human immunodeficiency virus at the onset of the disease, being treated with immunosuppressive drugs for organ transplantation before the onset, or being unable to obtain appropriate clinical management for the disease (section 5). It is noted that the inability to obtain appropriate clinical management only applies to material contribution to, or aggravation of, the disease if it was suffered or contracted before or during service (section 6). Breach of the requirements set out in this Statement of Principles could result in legal consequences, although the specific offences, penalties, or civil/criminal consequences are not detailed in this legislative instrument. However, under the Veterans' Entitlements Act 1986, there are provisions for penalties for providing false or misleading information, which could include fines or imprisonment (section 196H). The maximum penalties for such offences are not specified in this Statement of Principles but would be found in the primary Act. It is important for parties to adhere to the requirements set out in this instrument to avoid any potential legal repercussions.

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