EXPLANATORY STATEMENT
STATEMENT OF PRINCIPLES CONCERNING
MALIGNANT NEOPLASM OF THE COLON AND RECTUM
(REASONABLE HYPOTHESIS) (NO. 19 OF 2022)
VETERANS' ENTITLEMENTS ACT 1986
MILITARY REHABILITATION AND COMPENSATION ACT 2004
- This is the Explanatory Statement to the Statement of Principles concerning malignant neoplasm of the colon and rectum (Reasonable Hypothesis) (No. 19 of 2022).
Background
2. The Repatriation Medical Authority (the Authority), under subsection 196B(8) of the Veterans' Entitlements Act 1986 (the VEA), repeals Instrument No. 37 of 2013 (Federal Register of Legislation No. F2013L01134) determined under subsections 196B(2) and (8) of the VEA concerning malignant neoplasm of the colorectum.
3. The Authority is of the view that there is sound medical-scientific evidence that indicates that malignant neoplasm of the colon or rectum and death from malignant neoplasm of the colon or rectum can be related to particular kinds of service. The Authority has therefore determined pursuant to subsection 196B(2) of the VEA a Statement of Principles concerning malignant neoplasm of the colon and rectum (Reasonable Hypothesis) (No. 19 of 2022). This Instrument will in effect replace the repealed Statement of Principles.
Purpose and Operation
4. The Statement of Principles will be applied in determining claims under the VEA and the Military Rehabilitation and Compensation Act 2004 (the MRCA).
5. The Statement of Principles sets out the factors that must as a minimum exist, and which of those factors must be related to the following kinds of service rendered by a person:
operational service under the VEA;
peacekeeping service under the VEA;
hazardous service under the VEA;
British nuclear test defence service under the VEA;
warlike service under the MRCA;
non-warlike service under the MRCA,
before it can be said that a reasonable hypothesis has been raised connecting malignant neoplasm of the colon or rectum or death from malignant neoplasm of the colon or rectum, with the circumstances of that service. The Statement of Principles has been determined for the purposes of both the VEA and the MRCA.
6. This Instrument results from an investigation notified by the Authority in the Government Notices Gazette of 5 January 2021 concerning malignant neoplasm of the colorectum in accordance with section 196G of the VEA. The investigation involved an examination of the sound medical-scientific evidence now available to the Authority, including the sound medical-scientific evidence it has previously considered.
7. The contents of this Instrument are in similar terms as the repealed Instrument. Comparing this Instrument and the repealed Instrument, the differences include:
- adopting the latest revised Instrument format, which commenced in 2015;
- specifying a day of commencement for the Instrument in section 2;
- revising the name of the condition from 'malignant neoplasm of the colorectum' to 'malignant neoplasm of the colon and rectum';
- revising the definition of 'malignant neoplasm of the colon and rectum' in subsection 7(2);
- revising the reference to 'ICD-10-AM code' in subsection 7(4);
- revising the factor in subsection 9(2) concerning having a colorectal adenoma, for clinical onset only;
- new factor in subsection 9(3) concerning being prevented from accessing clinical screening for colorectal precancerous lesions or colorectal cancer in accordance with contemporary medical standards of the time, for clinical onset only;
- new factor in subsection 9(4) concerning being prevented from accessing appropriate treatment for colorectal precancerous lesions in accordance with contemporary medical standards of the time, for clinical onset only;
- new factor in subsection 9(5) concerning having inflammatory bowel disease, for clinical onset only;
- new factor in subsection 9(6) concerning undergoing a course of therapeutic radiation for cancer, for clinical onset only;
- revising the factor in subsection 9(7) concerning having received a cumulative equivalent dose of ionising radiation, by the inclusion of a note, for clinical onset only;
- revising the factor in subsection 9(8) concerning inhaling respirable asbestos fibres in an enclosed space, for clinical onset only;
- revising the factor in subsection 9(9) concerning inhaling respirable asbestos fibres in an open environment, for clinical onset only;
- revising the factor in subsection 9(10) concerning having smoked tobacco products, for clinical onset only;
- revising the factor in subsection 9(11) concerning consuming alcohol, for clinical onset only;
- revising the factor in subsection 9(12) concerning being overweight or obese, for clinical onset only;
- new factor in subsection 9(14) concerning having a solid organ transplant, for clinical onset only;
- revising the factor in subsection 9(15) concerning having chronic schistosomiasis, for clinical onset only;
- new factor in subsection 9(16) concerning having a ureterosigmoidostomy, for clinical onset only;
- new factor in subsection 9(17) concerning having psoriasis, for clinical onset only;
- new factor in subsection 9(18) concerning having sarcoidosis, for clinical onset only;
- new factor in subsection 9(19) concerning having bilateral oophorectomy, for clinical onset only;
- new factor in subsection 9(20) concerning having bilateral orchiectomy, for clinical onset only;
- new factor in subsection 9(21) concerning having androgen deprivation therapy, for clinical onset only;
- revising the factor in subsection 9(22) concerning an inability to consume fibre, for clinical onset only;
- revising the factor in subsection 9(23) concerning an inability to consume dairy milk, for clinical onset only;
- revising the factor in paragraph 9(24)(a) concerning an inability to undertake physical activity, for malignant neoplasm of the colon only, for clinical onset only;
- revising the factor in paragraph 9(24)(b) concerning having acromegaly, for malignant neoplasm of the colon only, for clinical onset only;
- revising the factor in paragraph 9(24)(c) concerning consuming red meat, for malignant neoplasm of the colon only, for clinical onset only;
- revising the factor in paragraph 9(24)(d) concerning consuming processed meat product, for malignant neoplasm of the colon only, for clinical onset only;
- new factor in paragraph 9(24)(e) concerning an inability to consume fruit and vegetables, for malignant neoplasm of the colon only, for clinical onset only;
- new factor in paragraph 9(24)(f) concerning having a cholecystectomy, for malignant neoplasm of the colon only, for clinical onset only;
- deleting the factor concerning having ulcerative colitis as this is now covered by factor 9(5) concerning having inflammatory bowel disease;
- deleting the factor concerning having Crohn's disease as this is now covered by factor 9(5) concerning having inflammatory bowel disease;
- deleting the factor concerning an inability to consume folate in food;
- new definitions of 'being overweight or obese', 'BMI', 'colorectal precancerous lesions', 'cumulative equivalent dose', 'MRCA', 'one pack-year' and 'VEA' in Schedule 1 - Dictionary;
- revising the definitions of 'red meat' and 'relevant service' in Schedule 1 - Dictionary; and
- deleting the definitions of 'alcohol', 'being obese', 'folate in food', 'pack-years of cigarettes, or the equivalent thereof in other tobacco products'.
Incorporation
8. The definition of "cumulative equivalent dose" contained in the Schedule 1 – Dictionary incorporates the Guide to calculation of 'cumulative equivalent dose' for the purpose of applying ionising radiation factors contained in Statements of Principles determined under Part XIA of the Veterans' Entitlements Act 1986 (Cth), Australian Radiation Protection and Nuclear Safety Agency, as in force on 2 August 2017. This writing is incorporated pursuant to subsection 14(b) of the Legislation Act 2003.
9. A copy of this document is available to any person on the website of the Repatriation Medical Authority at www.rma.gov.au or from the Repatriation Medical Authority, Level 8, 480 Queen St, Brisbane, Queensland 4000, by contacting the Registrar on telephone (07) 3815 9404.
Consultation
10. Prior to determining this Instrument, the Authority advertised its intention to undertake an investigation in relation to malignant neoplasm of the colorectum in the Government Notices Gazette of 5 January 2021, and circulated a copy of the notice of intention to investigate to a wide range of organisations representing veterans, service personnel and their dependants. The Authority invited submissions from the Repatriation Commission, the Military Rehabilitation and Compensation Commission, organisations and persons referred to in section 196E of the VEA, and any person having expertise in the field. No submissions were received for consideration by the Authority in relation to the investigation.
11. On 10 September 2021, the Authority wrote to organisations representing veterans, service personnel and their dependants regarding the proposed Instrument and the medical-scientific material considered by the Authority. This letter emphasised the deletion of factors relating to an inability to consume an average daily intake of 150 micrograms of folate in food for a period of at least five consecutive years, where this period commenced at least ten years before the clinical onset of malignant neoplasm of the colorectum. The Authority provided an opportunity to the organisations to make representations in relation to the proposed Instrument prior to its determination. No submissions were received for consideration by the Authority. Minor changes were made to the proposed Instrument following this consultation process.
Human Rights
12. This instrument is compatible with the Human Rights and Freedoms recognised or declared in the International Instruments listed in Section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011. A Statement of Compatibility with Human Rights follows.
Finalisation of Investigation
13. The determining of this Instrument finalises the investigation in relation to malignant neoplasm of the colorectum as advertised in the Government Notices Gazette of 5 January 2021.
References
14. A list of references relating to the above condition is available on the Authority’s website at: www.rma.gov.au. Any other document referred to in this Statement of Principles is available on request to the Repatriation Medical Authority at the following address:
Email: info@rma.gov.au
Post: The Registrar
Repatriation Medical Authority
GPO Box 1014
BRISBANE QLD 4001
Statement of Compatibility with Human Rights
(Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011)
Instrument No.: Statement of Principles No. 19 of 2022
Kind of Injury, Disease or Death: Malignant neoplasm of the colon and rectum
This Legislative Instrument is compatible with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.
Overview of the Legislative Instrument
1. This Legislative Instrument is determined pursuant to subsection 196B(2) of the Veterans' Entitlements Act 1986 (the VEA) for the purposes of the VEA and the Military Rehabilitation and Compensation Act 2004 (the MRCA). Part XIA of the VEA requires the determination of these instruments outlining the factors connecting particular kinds of injury, disease or death with service such being determined solely on the available sound medical-scientific evidence.
2. This Legislative Instrument:-
- facilitates claimants in making, and the Repatriation Commission and the Military Rehabilitation and Compensation Commission in assessing, claims under the VEA and the MRCA respectively, by specifying the circumstances in which medical treatment and compensation can be extended to eligible persons who have malignant neoplasm of the colon or rectum;
- facilitates the review of such decisions by the Veterans' Review Board and the Administrative Appeals Tribunal;
- outlines the factors which the current sound medical-scientific evidence indicates must as a minimum exist, before it can be said that a reasonable hypothesis has been raised, connecting malignant neoplasm of the colon or rectum with the circumstances of eligible service rendered by a person, as set out in clause 5 of the Explanatory Statement;
- replaces Instrument No. 37 of 2013; and
- reflects developments in the available sound medical-scientific evidence concerning malignant neoplasm of the colon and rectum which have occurred since that earlier instrument was determined.
3. The Instrument is assessed as being a technical instrument which improves the medico-scientific quality of outcomes under the VEA and the MRCA.
Human Rights Implications
4. This Legislative Instrument does not derogate from any human rights. It promotes the human rights of veterans, current and former Defence Force members as well as other persons such as their dependents, including:
- the right to social security (Art 9, International Covenant on Economic, Social and Cultural Rights; Art 26, Convention on the Rights of the Child and Art 28, Convention on the Rights of Persons with Disabilities) by helping to ensure that the qualifying conditions for the benefit are 'reasonable, proportionate and transparent'[1];
- the right to an adequate standard of living (Art 11, ICESCR; Art 27, CRC and Art 28, CRPD) by facilitating the assessment and determination of social security benefits;
- the right to the enjoyment of the highest attainable standard of physical and mental health (Art 12, ICESCR and Art 25, CRPD), by facilitating the assessment and determination of compensation and benefits in relation to the treatment and rehabilitation of veterans and Defence Force members;
- the rights of persons with disabilities by facilitating the determination of claims relating to treatment and rehabilitation (Art 26, CRPD); and
- ensuring that those rights "will be exercised without discrimination of any kind as to race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status" (Art 2, ICESCR).
Conclusion
This Legislative Instrument is compatible with human rights as it does not derogate from and promotes a number of human rights.
Repatriation Medical Authority
[1] In General Comment No. 19 (The right to social security), the Committee on Economic, Social and Cultural Rights said (at paragraph 24) this to be one of the elements of ensuring accessibility to social security.