Malignant neoplasm of the liver — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 31 of 2020

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting malignant neoplasm of the liver or death from malignant neoplasm of the liver with the circumstances of a person's relevant service:

1. (1)
   having cirrhosis of the liver before the clinical onset of malignant neoplasm of the liver;
2. (2)
   having chronic infection with hepatitis B virus before the clinical onset of malignant neoplasm of the liver;

   Note: chronic infection with hepatitis B virus is defined in the Schedule 1 - Dictionary.

3. (3)
   having chronic infection with hepatitis C virus before the clinical onset of malignant neoplasm of the liver;

   Note: In the past, hepatitis C viral infection may have been classified as non-A, non-B hepatitis.

   Note: chronic infection with hepatitis C virus is defined in the Schedule 1 - Dictionary.

4. (4)
   having chronic infection with hepatitis D virus before the clinical onset of malignant neoplasm of the liver;

   Note: chronic infection with hepatitis D virus is defined in the Schedule 1 - Dictionary.

5. (5)
   having infection with human immunodeficiency virus before the clinical onset of malignant neoplasm of the liver;
6. (6)
   having chronic hepatitis before the clinical onset of malignant neoplasm of the liver;

   Note: chronic hepatitis is defined in the Schedule 1 - Dictionary.

7. (7)
   having diabetes mellitus for at least five years before the clinical onset of malignant neoplasm of the liver;
8. (8)
   being overweight or obese for at least five years within the 20 years before the clinical onset of malignant neoplasm of the liver;

   Note: being overweight or obese is defined in the Schedule 1 - Dictionary.

9. (9)
   for males, consuming at least 110 kilograms of alcohol within any ten year period at least five years before the clinical onset of malignant neoplasm of the liver;

   Note: Alcohol is measured by the alcohol consumption calculations utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink.

10. (10)
    for females, consuming at least 55 kilograms of alcohol within any ten year period at least five years before the clinical onset of malignant neoplasm of the liver;

    Note: Alcohol is measured by the alcohol consumption calculations utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink.

11. (11)
    smoking at least ten pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of malignant neoplasm of the liver, and: (a) smoking commenced at least five years before the clinical onset of malignant neoplasm of the liver; and (b) where smoking has ceased, the clinical onset of malignant neoplasm of the liver has occurred within 20 years of cessation;

    Note: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary.

12. (12)
    having received a cumulative equivalent dose of at least 0.1 sievert of ionising radiation to the liver at least five years before the clinical onset of malignant neoplasm of the liver;

    Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary.

13. (13)
    being treated with systemic immunosuppressive therapy for solid organ, stem cell or bone marrow transplantation before the clinical onset of malignant neoplasm of the liver;
14. (14)
    being exposed to high levels of dietary aflatoxins, on more days than not, for a period of at least five years within the 30 years before the clinical onset of malignant neoplasm of the liver;

    Note: being exposed to high levels of dietary aflatoxins is defined in the Schedule 1 - Dictionary.

15. (15)
    inhaling a cumulative dose of at least 1 250 ppm-years of gaseous vinyl chloride at least five years before the clinical onset of malignant neoplasm of the liver;

    Note: ppm-years is defined in the Schedule 1 - Dictionary.

16. (16)
    inhaling gaseous vinyl chloride for a cumulative period of at least 5 000 hours while working in the production or processing of vinyl chloride monomer or polyvinyl chloride, at least five years before the clinical onset of malignant neoplasm of the liver;
17. (17)
    inhaling respirable asbestos fibres in an enclosed space: (a) for a cumulative period of at least 1 000 hours before the clinical onset of malignant neoplasm of the liver; and (b) at the time material containing respirable asbestos fibres was being applied, removed, dislodged, cut or drilled; and (c) where the first inhalation of respirable asbestos fibres commenced at least five years before the clinical onset of malignant neoplasm of the liver;
18. (18)
    inhaling respirable asbestos fibres in an open environment: (a) for a cumulative period of at least 3 000 hours before the clinical onset of malignant neoplasm of the liver; and (b) at the time material containing respirable asbestos fibres was being applied, removed, dislodged, cut or drilled; and (c) where the first inhalation of respirable asbestos fibres commenced at least five years before the clinical onset of malignant neoplasm of the liver;
19. (19)
    an inability to undertake any physical activity greater than three METs for at least ten years within the 15 years before the clinical onset of malignant neoplasm of the liver;

    Note: MET is defined in the Schedule 1 - Dictionary.

20. (20)
    using the combined oral contraceptive pill for a continuous period of at least three years before the clinical onset of malignant neoplasm of the liver, and where the use of the combined oral contraceptive pill has ceased, the clinical onset of malignant neoplasm of the liver has occurred within 30 years of cessation;

    Note: combined oral contraceptive pill is defined in the Schedule 1 - Dictionary.

21. (21)
    taking or being treated with an anabolic-androgenic steroid: (a) for a continuous period of at least three years; and (b) to a cumulative total of at least 14 grams; and (c) where the cumulative total dose of anabolic-androgenic steroid was taken at least five years before the clinical onset of malignant neoplasm of the liver; and (d) where taking or being treated with the steroid has ceased, the clinical onset of malignant neoplasm of the liver has occurred within 20 years of cessation;
22. (22)
    chewing betel quid or areca nut on more days than not, for at least five years before the clinical onset of malignant neoplasm of the liver, and where chewing of betel quid or areca nut has ceased, the clinical onset has occurred within 20 years of cessation;
23. (23)
    being exposed to arsenic as specified before the clinical onset of malignant neoplasm of the liver, where the first exposure to arsenic occurred at least ten years before the clinical onset of malignant neoplasm of the liver;

    Note: being exposed to arsenic as specified is defined in the Schedule 1 - Dictionary.

24. (24)
    having steatohepatitis for at least five years before the clinical onset of malignant neoplasm of the liver;
25. (25)
    having autoimmune chronic active hepatitis or primary biliary cholangitis before the clinical onset of malignant neoplasm of the liver;

    Note: autoimmune chronic active hepatitis is defined in the Schedule 1 - Dictionary.

26. (26)
    having a disorder from the specified list of disorders before the clinical onset of malignant neoplasm of the liver;

    Note: specified list of disorders is defined in the Schedule 1 - Dictionary.

27. (27)
    inability to obtain appropriate clinical management for malignant neoplasm of the liver;

Aggravation-only factors: the factors in subsection 9(27) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.