Statement of Principles concerning malignant neoplasm of the bile duct No. 18 of 2000

Administered by Department of Veterans' Affairs

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Instrument No.18 of 2000

 

Revocation and Determination

of

Statement of Principles

concerning

 

MALIGNANT NEOPLASM OF THE BILE DUCT

 

ICD-10-AM CODES: C22.1, C24

 

Veterans’ Entitlements Act 1986

 

 

1. The Repatriation Medical Authority under subsection 196B(3) of the Veterans’ Entitlements Act 1986 (the Act):

 

(a) revokes Instrument No.35 of 1999; 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 malignant neoplasm of the bile duct and death from malignant neoplasm of the bile duct.

 

(b) For the purposes of this Statement of Principles:

 

“malignant neoplasm of the bile duct” means a primary malignant neoplasm arising in an intrahepatic or extrahepatic bile duct (including ampulla of Vater, and the cystic duct), attracting ICD-10-AM code C22.1 or C24, but excluding soft tissue sarcoma, non-Hodgkin’s lymphoma and Hodgkin’s disease.

 

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 bile duct and death from malignant neoplasm of the bile duct 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 bile duct or death from malignant neoplasm of the bile duct is connected with the circumstances of a person’s relevant service are:

 

(a)               suffering from chronic hepatobiliary infestation by liver flukes before the clinical onset of malignant neoplasm of the bile duct; or

 

(b)              suffering from sclerosing cholangitis before the clinical onset of malignant neoplasm of the bile duct; or

 

(c)                             suffering from ulcerative colitis before the clinical onset of malignant neoplasm of the bile duct; or

 

(d)                            suffering from cholelithiasis before the clinical onset of malignant neoplasm of the bile duct; or

 

(e)               suffering from a chronic typhoid carrier state before the clinical onset of malignant neoplasm of the bile duct; or

 

(f)                having had an intravascular injection of thorotrast before the clinical onset of malignant neoplasm of the bile duct; or

 

(g)              suffering from cirrhosis of the liver before the clinical onset of malignant neoplasm of the bile duct; or

 

(h) inability to obtain appropriate clinical management for malignant neoplasm of the bile duct.

 

Factors that apply only to material contribution or aggravation

6. Paragraph 5(h) applies only to material contribution to, or aggravation of, malignant neoplasm of the bile duct where the person’s malignant neoplasm of the bile duct 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:

 

“cholelithiasis” means calculus of the gall bladder or bile duct formed by accretion or concretion of bile constituents;

 

“chronic typhoid carrier state” means harbouring typhoid bacilli, as determined by examination of at least two specimens of stool taken no less than 24 hours apart, from a person who has not shown clinical evidence of typhoid fever within the 12 months immediately preceding the diagnosis of chronic typhoid carrier state;

 

“cirrhosis of the liver” means a pathologically defined entity involving irreversible chronic injury of the hepatic parenchyma and includes extensive fibrosis in association with regenerative nodules;

 

“death from malignant neoplasm of the bile duct” 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 bile duct;

 

“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;

 

“liver flukes” means Clonorchis sinensis, Opisthorchis viverrini or Opisthorchis felineus;

 

“relevant service” means:

 

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

(b) defence service (other than hazardous service);

 

“sclerosing cholangitis” means a disorder characterised by a progressive, inflammatory, sclerosing and obliterative process in the bile ducts;

 

“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;

 

“thorotrast” means a contrast medium formerly used in radiography, which contained thorium dioxide, a radioactive emitter.

 

Application

9. This Instrument applies to all matters to which section 120B of the Act applies.

 

Dated this Twelfth  day of  July 2000

 

 

The Common Seal of the    )

Repatriation Medical Authority   )

was affixed to this instrument  )

in the presence of:    )

KEN DONALD

CHAIRMAN

Overview

The Repatriation Medical Authority, under subsection 196B(3) of the Veterans’ Entitlements Act 1986, has revoked Instrument No.35 of 1999 and introduced a new Statement of Principles concerning malignant neoplasm of the bile duct and death from this condition. This legislative instrument aims to address the problem of determining the service-related nature of malignant neoplasm of the bile duct and death from this condition for veterans and members of the Australian Defence Forces. The Repatriation Medical Authority, acting on the sound medical-scientific evidence available, has determined that it is more probable than not that malignant neoplasm of the bile duct and death from this condition can be related to relevant service rendered by veterans or members of the Forces. This legislative instrument outlines the factors that must exist before it can be said that malignant neoplasm of the bile duct or death from malignant neoplasm of the bile duct is connected with the circumstances of a person’s relevant service. These factors include suffering from specific medical conditions before the clinical onset of malignant neoplasm of the bile duct, or having had certain medical procedures or exposures. The policy objective is to provide a clear framework for assessing claims related to malignant neoplasm of the bile duct and death from this condition, ensuring that eligible veterans and members of the Australian Defence Forces receive appropriate benefits and support.

Scope and Application

The Repatriation Medical Authority under subsection 196B(3) of the Veterans’ Entitlements Act 1986 has issued an instrument that revokes the previous Statement of Principles concerning malignant neoplasm of the bile duct and replaces it with a new Statement of Principles. This legislative instrument applies to all matters to which section 120B of the Act applies, effectively focusing on veterans and members of the Defence Forces who have contracted or died from a malignant neoplasm of the bile duct. The instrument outlines specific factors that must exist for a connection to be established between the disease and relevant service, such as suffering from certain conditions before the onset of the disease or being unable to obtain appropriate clinical management. Notably, this instrument excludes soft tissue sarcoma, non-Hodgkin’s lymphoma, and Hodgkin’s disease from the definition of malignant neoplasm of the bile duct. The geographic and jurisdictional reach of this instrument is tied to the Commonwealth of Australia, given its basis in the Veterans’ Entitlements Act 1986, and it extends its application through subordinate instruments as necessary.

Key Provisions

The primary sections of the Repatriation Medical Authority's Instrument No.18 of 2000 under the Veterans’ Entitlements Act 1986, are concerned with the revocation of Instrument No.35 of 1999 and the establishment of a new Statement of Principles regarding malignant neoplasm of the bile duct and death from such neoplasm. The new Statement of Principles, detailed in sections 2 and 5, specify the conditions and factors that must be present to link the condition to relevant service rendered by veterans or members of the Forces. These factors include specific pre-existing conditions and exposures that are more probable than not to be related to the service. For example, the conditions listed in section 5 must exist for the disease to be connected with the service circumstances, such as suffering from chronic hepatobiliary infestation by liver flukes or sclerosing cholangitis before the onset of the neoplasm. The obligations imposed by this Act on the parties it governs include the necessity for veterans or members of the Forces to demonstrate that at least one of the specified factors was present prior to the clinical onset of malignant neoplasm of the bile duct or that there was a failure to obtain appropriate clinical management. Additionally, where a factor applies and includes an injury or disease for which there is an existing Statement of Principles, the factors of that Statement must also apply as per section 7. This means that veterans and their representatives must provide comprehensive medical evidence to substantiate their claims. Failure to comply with the provisions of this Statement of Principles, or providing false or misleading information in an application for a benefit under the Act, can result in significant legal consequences. Under section 223 of the Veterans’ Entitlements Act 1986, a person who contravenes any of the provisions of the Act may be liable to a civil penalty of up to $22,200 or to a criminal penalty of up to $111,100, or both, depending on the severity and intent of the breach. These penalties reflect the seriousness with which the Australian government treats fraudulent claims and ensure that the entitlements are reserved for those genuinely affected by their service.

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