Statement of Principles

concerning

MALIGNANT NEOPLASM OF THE STOMACH

Instrument No. 8 of 2003 as amended

made under section 196B(3) of the

This compilation was prepared on 28 July 2011 taking into account Amendment of Statement of Principles concerning MALIGNANT NEOPLASM OF THE STOMACH (Instrument No. 66 of 2011)

Prepared by the Repatriation Medical Authority Secretariat, Brisbane

Statement of Principles

concerning

MALIGNANT NEOPLASM OF THE STOMACH

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.68 of 1997 and Instrument No.10 of 1998; 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 stomach and death from malignant neoplasm of the stomach.

(b)       For the purposes of this Statement of Principles, "malignant neoplasm of the stomach" means a primary malignant neoplasm arising from the cells of the stomach.  The stomach is defined as the structure which extends from the lower border of the oesophageal sphincter, to, and including, the pyloric sphincter.  This definition excludes soft tissue sarcoma, non-Hodgkin’s lymphoma and Hodgkin’s disease.

(c)              Malignant neoplasm of the stomach attracts ICD-10-AM code C16.

(d)              In the application of this Statement of Principles, the definition of "malignant neoplasm of the stomach" is that given at para 2(b) above.

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

(a)       for carcinoma of the stomach only,

(i)        smoking at least 25 pack years of cigarettes, or the equivalent thereof in other tobacco products, where smoking commenced at least 20 years before the clinical onset of malignant neoplasm of the stomach, and where smoking has ceased, the clinical onset has occurred within 15 years of cessation; or

(ii)       having received a cumulative equivalent dose of at least 0.5 sievert of ionising radiation to the stomach at least ten years before the clinical onset of malignant neoplasm of the stomach; or

 (b)      for carcinoma of the fundus, body, antrum or pylorus of the stomach only,

(i)        being infected with Helicobacter pylori at least 10 years before the clinical onset of malignant neoplasm of the stomach; or

(ii)       suffering from chronic atrophic gastritis, where the chronic atrophic gastritis commenced at least 15 years before the clinical onset of malignant neoplasm of the stomach; or

(c)              inability to obtain appropriate clinical management for malignant neoplasm of the stomach.

Factors that apply only to material contribution or aggravation

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

"carcinoma of the fundus, body, antrum or pylorus of the stomach" means a carcinoma that has arisen in the mucosa of any part of the stomach, excluding that part of the stomach immediately adjacent to and surrounding the opening of the oesophagus (the cardia of the stomach) that is distinguished histologically by the presence of cardiac glands and the absence of parietal (acid secreting) and chief (pepsin secreting) cells;

"chronic atrophic gastritis" means inflammation of the gastric mucosa characterised by variable gland loss and inflammatory infiltrate extending below the lamina propria with distortion and destruction of the gastric glands;

"cumulative equivalent dose" means the total dose of ionising radiation received by the particular organ or tissue. The formula used to calculate the cumulative equivalent dose allows doses from multiple types of ionising radiation to be combined, by accounting for their differing biological effect. The unit of equivalent dose is the sievert. For the purposes of this Statement of Principles, the calculation of cumulative equivalent dose excludes doses received from normal background radiation, but includes therapeutic radiation, diagnostic radiation, cosmic radiation at high altitude, radiation from occupation-related sources and radiation from nuclear explosions or accidents;

"death from malignant neoplasm of the stomach" 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 stomach;

"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), Third Edition, effective date of 1 July 2002, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 1 86487 413 9;

"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

(c)              cessation of brain function.

Application

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

Notes to Statement of Principles concerning malignant neoplasm of the stomach (Instrument No. 8 of 2003)

The Statement of Principles concerning malignant neoplasm of the stomach (Instrument No. 8 of 2003) in force under section 196B(3) of the Veterans’ Entitlements Act 1986, as shown in this compilation is amended as indicated in the Tables below.

Table of Instruments

Table of Amendments