Malignant neoplasm of the pancreas

Source: Repatriation Medical Authority Statements of Principles as held by the Veterans Health Centre. SoPs are amended and replaced regularly; always confirm the current instrument at rma.gov.au before relying on it.

RH No. 103 of 2021 · BoP No. 104 of 202119 factors

Meaning of malignant neoplasm of the pancreas: For the purposes of this Statement of Principles, malignant neoplasm of the pancreas: (a) means a primary malignant neoplasm arising from the cells of the exocrine pancreas; and (b) excludes soft tissue sarcoma, carcinoid tumour, endocrine tumours, non-Hodgkin lymphoma and Hodgkin's lymphoma. (3) While malignant neoplasm of the pancreas attracts ICD-10-AM code C25.0, C25.1, C25.2, C25.3, C25.7 or C25.8, in applying this Statement of Principles the meaning of malignant neoplasm of the pancreas is that given in subsection (2). (4) For subsection (3), a reference to an ICD-10-AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4.

Reasonable Hypothesis (RH) — Statement of Principles No. 103 of 2021

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

(1)
having smoked tobacco products: (a) in an amount of at least 10 pack-years before the clinical onset of malignant neoplasm of the pancreas; and (b) commencing at least 5 years before the clinical onset of malignant neoplasm of the pancreas; and if smoking has ceased before the clinical onset of malignant neoplasm of the pancreas, then that onset occurred within 20 years of cessation;
Note: one pack-year is defined in the Schedule 1 - Dictionary.
(2)
the oral use of smokeless tobacco: (a) on more days than not; and (b) for at least 20 years before the clinical onset of malignant neoplasm of the pancreas; and if the oral use of smokeless tobacco has ceased before the clinical onset of malignant neoplasm of the pancreas, then that onset occurred within 20 years of cessation;
Note: smokeless tobacco is defined in the Schedule 1 - Dictionary.
(3)
being overweight or obese for at least 5 years within the 30 years before the clinical onset of malignant neoplasm of the pancreas;
Note: being overweight or obese is defined in the Schedule 1 - Dictionary.
(4)
having diabetes mellitus for at least 5 years before the clinical onset of malignant neoplasm of the pancreas;
(5)
having chronic pancreatitis for at least 2 years before the clinical onset of malignant neoplasm of the pancreas;
(6)
having acute pancreatitis at least 2 years before the clinical onset of malignant neoplasm of the pancreas;
(7)
inhaling, ingesting or having cutaneous contact with DDT: (a) for a cumulative period of at least 1,000 hours before the clinical onset of malignant neoplasm of the pancreas; and (b) where the first exposure occurred at least 5 years before the clinical onset of malignant neoplasm of the pancreas;
Note: DDT and inhaling, ingesting or having cutaneous contact with DDT are defined in the Schedule 1 - Dictionary.
(8)
undergoing a partial gastrectomy at least 20 years before the clinical onset of malignant neoplasm of the pancreas;
(9)
having received ionising radiation to the pancreas, from internal deposition of a therapeutic or diagnostic substance which emits alpha particles, at least 5 years before the clinical onset of malignant neoplasm of the pancreas;
Note: An example of a therapeutic or diagnostic substance which emits alpha particles is thorium dioxide which is the main component of the radiocontrast agent Thorotrast, used during the 1930s - 1950s.
(10)
having cholelithiasis or having undergone a cholecystectomy at least 2 years before the clinical onset of malignant neoplasm of the pancreas;
(11)
having infection with hepatitis B virus before the clinical onset of malignant neoplasm of the pancreas;
(12)
having infection with hepatitis C virus before the clinical onset of malignant neoplasm of the pancreas;
(13)
inability to obtain appropriate clinical management for malignant neoplasm of the pancreas;

Aggravation-only factors: the factors in subsection 9(13) 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.

Balance of Probabilities (BoP) — Statement of Principles No. 104 of 2021

6 factors

At least one of the following factors must exist before it can be said that, on the balance of probabilities, malignant neoplasm of the pancreas or death from malignant neoplasm of the pancreas is connected with the circumstances of a person's relevant service:

(1)
having smoked tobacco products: (a) in an amount of at least 20 pack-years before the clinical onset of malignant neoplasm of the pancreas; and (b) commencing at least 10 years before the clinical onset of malignant neoplasm of the pancreas; and if smoking has ceased before the clinical onset of malignant neoplasm of the pancreas, then that onset occurred within 15 years of cessation;
Note: one pack-year is defined in the Schedule 1 - Dictionary.
(2)
the oral use of smokeless tobacco: (a) on more days than not; and (b) for at least 40 years before the clinical onset of malignant neoplasm of the pancreas; and if the oral use of smokeless tobacco has ceased before the clinical onset of malignant neoplasm of the pancreas, then that onset occurred within 15 years of cessation;
Note: smokeless tobacco is defined in the Schedule 1 - Dictionary.
(3)
being overweight or obese for at least 10 years within the 30 years before the clinical onset of malignant neoplasm of the pancreas;
Note: being overweight or obese is defined in the Schedule 1 - Dictionary.
(4)
having diabetes mellitus for at least 10 years before the clinical onset of malignant neoplasm of the pancreas;
(5)
having chronic pancreatitis for at least 5 years before the clinical onset of malignant neoplasm of the pancreas;
(6)
inability to obtain appropriate clinical management for malignant neoplasm of the pancreas;

Aggravation-only factors: the factors in subsection 9(6) 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.

Malignant neoplasm of the pancreas — DVA SoP factors