Instrument No.23 of 2000

Revocation and Determination

of

Statement of Principles

concerning

MALIGNANT NEOPLASM OF THE BLADDER

ICD-10-AM CODE: C67

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.231 of 1995, Instrument No.362 of 1995 and Instrument No.94 of 1997; 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 neoplasm of the bladder and death from malignant neoplasm of the bladder.

(b) For the purposes of this Statement of Principles, “malignant neoplasm of the bladder” means a primary malignant neoplasm arising from the cells lining the bladder, attracting ICD-10-AM code C67, but excluding soft tissue sarcoma, non-Hodgkin's lymphoma and Hodgkin's disease. 

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 neoplasm of the bladder and death from malignant neoplasm of the bladder 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 neoplasm of the bladder or death from malignant neoplasm of the bladder with the circumstances of a person’s relevant service are:

(a) for squamous cell carcinoma of the bladder only, suffering from Schistosoma haematobium infestation of the bladder before the clinical onset of malignant neoplasm of the bladder; or

(b) undergoing a course of therapeutic radiation to the region of the pelvis, where the first exposure to therapeutic radiation occurred at least five years before the clinical onset of malignant neoplasm of the bladder; or

(c) being exposed to one of the chemicals from the specified list for a cumulative equivalent of at least three days per week for one year before the clinical onset of malignant neoplasm of the bladder; or

(d) receiving systemic cyclophosphamide before the clinical onset of malignant neoplasm of the bladder; or

(e) smoking at least 2.5 pack years of cigarettes or the equivalent thereof in other tobacco products before the clinical onset of malignant neoplasm of the bladder; or

(f)               being exposed to polycyclic aromatic hydrocarbons (PAH) on more days than not at a concentration of at least 0.2mg/m3 benzene soluble matter (BSM) for at least ten years before the clinical onset of malignant neoplasm of the bladder; or

(g) having received a cumulative equivalent dose of at least 0.05 Sievert of atomic radiation to the bladder where this dose was accumulated at least five years before the clinical onset of malignant neoplasm of the bladder; or

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

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 bladder where the person’s malignant neoplasm of the bladder 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;

“atomic radiation” means ionising radiation excluding;

(i)                natural background radiation;

(ii)              therapeutic radiation; and

(iii)           radiation from diagnostic procedures;

“being exposed to one of the chemicals from the specified list” means having cutaneous contact or inhaling one of the following substances: benzidine, benzidine-derived azo dyes, 2-naphthylamine, 4-aminobiphenyl, 4-nitrobiphenyl, 4,4’-methylene dianiline, 3,3’-dichlorobenzene, 2-chloroaniline, 4-chloro-o-toluidine, o-toluidine, chlornaphazine;

“being exposed to polycyclic aromatic hydrocarbons (PAH)” means:

(i)                inhaling PAH vapour; or

(ii)              having skin contact with air containing PAH vapour;

“benzene soluble matter (BSM)” means a measure of the presence of PAH;

“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 malignant neoplasm of the bladder” 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 bladder;

“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;

“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 (being the “standard” cigarette pack contents) 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;

“polycyclic aromatic hydrocarbons (PAH)” means those chemical substances formed during the combustion of organic material or during high temperature processing of crude oil, coal, coke, or other industrial carbon compounds;

“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 applies.

Dated this Twenty-seventh  day of    September    2000

The Common Seal of the    )

Repatriation Medical Authority   )

was affixed to this instrument  )

in the presence of:    )

KEN DONALD

CHAIRMAN