Malignant neoplasm of the lung — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 86 of 2023

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 lung or death from malignant neoplasm of the lung with the circumstances of a person's relevant service:

1. (1)
   having smoked tobacco products: (a) in an amount of at least 0.5 pack-year before the clinical onset of malignant neoplasm of the lung; and (b) commencing at least 5 years before the clinical onset of malignant neoplasm of the lung;

   Note: one pack-year is defined in the Schedule 1 - Dictionary.

2. (2)
   having been exposed to second-hand smoke: (a) for at least 5,000 hours before the clinical onset of malignant neoplasm of the lung; and (b) commencing at least 5 years before the clinical onset of malignant neoplasm of the lung;

   Note: having been exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.

3. (3)
   inhaling respirable asbestos fibres in an enclosed space, at the time material containing asbestos was being applied, removed, cut, drilled, dislodged or disturbed, where the first inhalation of asbestos fibres commenced at least 5 years before the clinical onset of malignant neoplasm of the lung;

   Note: Disturbance of debris or dust contaminated with asbestos fibres already present in an enclosed space may result in exposure to respirable asbestos fibres.

4. (4)
   inhaling respirable asbestos fibres in an open environment, at the time material containing asbestos was being applied, removed, cut, drilled, dislodged or disturbed: (a) for a cumulative period of at least 1,000 hours before the clinical onset of malignant neoplasm of the lung; and (b) where the first inhalation of asbestos fibres commenced at least 5 years before the clinical onset of malignant neoplasm of the lung;

   Note: Disturbance of debris or dust contaminated with asbestos fibres already present in an open environment may result in exposure to respirable asbestos fibres.

5. (5)
   being: (a) on land in Vietnam; or (b) at sea in Vietnamese waters; or (c) on board a vessel and consuming potable water supplied on that vessel, when the water supply had been produced by evaporative distillation of estuarine Vietnamese waters; for a cumulative period of at least 30 days, at least 5 years before the clinical onset of malignant neoplasm of the lung;

   Note: being: (a) on land in Vietnam; or (b) at sea in Vietnamese waters and estuarine Vietnamese waters and potable water are defined in the Schedule 1 - Dictionary.

6. (6)
   inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD): (a) for a cumulative period of at least 1,000 hours, within a consecutive period of 10 years before the clinical onset of malignant neoplasm of the lung; and (b) where the first exposure occurred at least 5 years before the clinical onset of malignant neoplasm of the lung;

   Note: inhaling, ingesting or having cutaneous contact with a chemical agent contaminated by 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD) is defined in the Schedule 1 - Dictionary.

7. (7)
   inhaling high concentrations of polycyclic aromatic hydrocarbons, through work involving a specified industry, manufacturing process or substance: (a) for a cumulative period of at least 1,500 hours before the clinical onset of malignant neoplasm of the lung; and (b) where the first inhalation of polycyclic aromatic hydrocarbons occurred at least 5 years before the clinical onset of malignant neoplasm of the lung;

   Note: polycyclic aromatic hydrocarbons and specified industry, manufacturing process or substance are defined in the Schedule 1 - Dictionary.

8. (8)
   being heavily exposed to diesel engine exhaust for a cumulative period of at least 10,000 hours, at least 5 years before the clinical onset of malignant neoplasm of the lung;

   Note: being heavily exposed to diesel engine exhaust is defined in the Schedule 1 dictionary.

9. (9)
   being exposed to mustard gas at least 5 years before the clinical onset of malignant neoplasm of the lung;
10. (10)
    consuming at least 350 kilograms of alcohol at least 5 years before the clinical onset of malignant neoplasm of the lung;

    Note: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.

11. (11)
    having received a cumulative equivalent dose of at least 0.1 sievert of ionising radiation to the lung at least 5 years before the clinical onset of malignant neoplasm of the lung;

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

12. (12)
    inhaling radon gas in an enclosed space for at least 20 Working Level Months, before the clinical onset of malignant neoplasm of the lung, where the first exposure to radon occurred at least 5 years before the clinical onset of malignant neoplasm of the lung;

    Note: Working Level Month is defined in the Schedule 1 - Dictionary.

13. (13)
    having a pulmonary disease at least 5 years before the clinical onset of malignant neoplasm of the lung;

    Note: pulmonary disease is defined in the Schedule 1 - Dictionary.

14. (14)
    working as a painter for a cumulative period of at least 5,000 hours before the clinical onset of malignant neoplasm of the lung, where that work began at least 5 years before the clinical onset of malignant neoplasm of the lung;

    Note: working as a painter is defined in the Schedule 1 - Dictionary.

15. (15)
    inhaling respirable crystalline silica dust at the time material containing respirable crystalline silica dust was being produced, excavated, drilled, cut, ground or polished, or used in construction, manufacturing, cleaning or blasting: (a) for a cumulative period of at least 1,500 hours before the clinical onset of malignant neoplasm of the lung; and (b) where the first inhalation of respirable crystalline silica dust commenced at least 5 years before the clinical onset of malignant neoplasm of the lung;
16. (16)
    having acute silicosis before the clinical onset of malignant neoplasm of the lung;

    Note: acute silicosis is defined in the Schedule 1 - Dictionary.

17. (17)
    inhaling fumes, vapours or dusts of a metal or metalloid from the specified list: (a) for a cumulative period of at least 1,500 hours before the clinical onset of malignant neoplasm of the lung; and (b) where the first inhalation of fumes, vapours or dusts occurred at least 5 years before the clinical onset of malignant neoplasm of the lung;

    Note: metal or metalloid from the specified list is defined in the Schedule 1 - Dictionary.

18. (18)
    inhaling fumes of bis(chloromethyl)ether or chloromethyl methyl ether: (a) for a cumulative period of at least 1,500 hours before the clinical onset of malignant neoplasm of the lung; and (b) where the first inhalation of fumes occurred at least 5 years before the clinical onset of malignant neoplasm of the lung;
19. (19)
    having berylliosis before the clinical onset of malignant neoplasm of the lung;

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

20. (20)
    having smoked cannabis products: (a) in an amount of at least 10 joint-years before the clinical onset of malignant neoplasm of the lung and (b) commencing at least 5 years before the clinical onset of malignant neoplasm of the lung;

    Note: one joint-year is defined in the Schedule 1 - Dictionary.

21. (21)
    being exposed to arsenic as specified before the clinical onset of malignant neoplasm of the lung, where the first exposure to arsenic occurred at least 10 years before the clinical onset of malignant neoplasm of the lung;

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

22. (22)
    inhaling smoke from the combustion of coal, wood, charcoal, or another solid biomass fuel, in an enclosed space: (a) for a cumulative period of at least 7,500 hours before the clinical onset of malignant neoplasm of the lung; and (b) commencing at least 5 years before the clinical onset of malignant neoplasm of the lung;
23. (23)
    inhaling ambient, chronically polluted air as specified: (a) for a cumulative period of at least 35,000 hours before the clinical onset of malignant neoplasm of the lung; and (b) where the first inhalation of ambient chronically polluted air occurred at least 5 years before the clinical onset of malignant neoplasm of the lung;

    Note: ambient, chronically polluted air as specified is defined in the Schedule 1 - Dictionary.

24. (24)
    inhaling mist from sulphuric, nitric or hydrochloric acid: (a) for a cumulative period of at least 1,500 hours before the clinical onset of malignant neoplasm of the lung; and (b) where inhalation of the mist commenced at least 5 years before the clinical onset of malignant neoplasm of the lung;

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

25. (25)
    inhaling, ingesting or having cutaneous contact with diazinon for a cumulative period of at least 1,000 hours before the clinical onset of malignant neoplasm of the lung, where the first exposure to diazinon occurred at least 5 years before the clinical onset of malignant neoplasm of the lung;
26. (26)
    inhaling fumes generated in rubber production, while in an enclosed space in immediate proximity to production facilities: (a) for a cumulative period of at least 1,500 hours before the clinical onset of malignant neoplasm of the lung; and (b) where the first inhalation of fumes occurred at least 5 years before the clinical onset of malignant neoplasm of the lung;
27. (27)
    taking a chemotherapy regimen with procarbazine or mechlorethamine (nitrogen mustard) at least 5 years before the clinical onset of malignant neoplasm of the lung;

    Note: a chemotherapy regimen with procarbazine or mechlorethamine includes MOPP (a combination of mechlorethamine, oncovin (vincristine), procarbazine and prednisone).

28. (28)
    having infection with human immunodeficiency virus before the clinical onset of malignant neoplasm of the lung;
29. (29)
    having systemic sclerosis at least 3 years before the clinical onset of malignant neoplasm of the lung;
30. (30)
    the oral use of smokeless tobacco: (a) on more days than not; and (b) for at least 5 years before the clinical onset of malignant neoplasm of the lung;

    Note: smokeless tobacco is defined in the Schedule 1 - Dictionary.

31. (31)
    inhaling opium smoke or ingesting opium on average at least weekly for at least 10 years before the clinical onset of malignant neoplasm of the lung;

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

32. (32)
    using manual welding equipment for welding metal: (a) for a cumulative period of at least 1,500 hours before the clinical onset of malignant neoplasm of the lung; and (b) where that use began at least 5 years before the clinical onset of malignant neoplasm of the lung;
33. (33)
    being exposed to benzene as specified: (a) for a cumulative total of at least 2,500 hours within a continuous period of 5 years before the clinical onset of malignant neoplasm of the lung; and (b) where the first exposure in that period occurred at least 5 years before the clinical onset of malignant neoplasm of the lung;

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

34. (34)
    being exposed to benzene: (a) in an amount greater than 10 ppm-years of cumulative exposure before the clinical onset of malignant neoplasm of the lung; and (b) where the first exposure occurred at least 5 years before the clinical onset of malignant neoplasm of the lung;

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

35. (35)
    taking a Janus kinase inhibitor on more days than not for at least 6 months before the clinical onset of malignant neoplasm of the lung;

    Note: Janus kinase inhibitors include abrocitinib, filgotinib, baricitinib, upadacitinib and tofacitinib and are used in the treatment of chronic inflammatory disorders (rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis, axial spondyloarthritis, ulcerative colitis, atopic dermatitis and alopecia areata).

36. (36)
    for lymphoepithelial carcinoma of the lung, having infection with the Epstein-Barr virus before the clinical onset of malignant neoplasm of the lung;

    Note: Lymphoepithelial carcinoma of the lung is a rare poorly differentiated squamous cell carcinoma admixed with variable amounts of lymphoplasmacytic infiltrate.

37. (37)
    inability to obtain appropriate clinical management for malignant neoplasm of the lung before the clinical worsening of malignant neoplasm of the lung;

Aggravation-only factors: the factors in subsection 9(37) 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.