Merkel cell carcinoma

Merkel cell carcinoma — DVA SoP factors

Every factor in the Repatriation Medical Authority Statements of Principles for Merkel cell carcinoma. DVA can only accept a claim for Merkel cell carcinoma if at least one of these factors is met and connected to your service. Reasonable Hypothesis (RH) applies to operational service; Balance of Probabilities (BoP) applies to peacetime service.

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. 80 of 2024 · BoP No. 81 of 202415 factors

Meaning of merkel cell carcinoma: For the purposes of this Statement of Principles, Merkel cell carcinoma means a primary cutaneous neuroendocrine carcinoma; (3) While Merkel cell carcinoma attracts ICD-10-AM codes C00.0, C00.1, C00.2, C00.6, C00.8, C00.9, C44, C51.0, C51.1, C51.2, C51.8, C51.9, C60.0, C60.1, C60.2, C60.8, C60.9, C63.2, D04, D07.1, D07.4., in applying this Statement of Principles the meaning of Merkel cell carcinoma 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. 80 of 2024

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 Merkel cell carcinoma or death from Merkel cell carcinoma with the circumstances of a person's relevant service:

(1)
having sunlight exposure to unprotected skin for a cumulative period of at least 2,250 latitude equivalent hours before clinical onset;
Note: latitude equivalent hours and unprotected skin are defined in the Schedule 1 dictionary.
(2)
having PUVA therapy, where: (a) the first PUVA treatment commenced at least 5 years before clinical onset; and (b) at least 50 PUVA treatments were administered before clinical onset;
Note: PUVA therapy is defined in the Schedule 1 - Dictionary.
(3)
being infected with Merkel cell polyomavirus before clinical onset;
(4)
being infected with human immunodeficiency virus before clinical onset;
(5)
undergoing solid organ (excluding corneal transplant) or bone marrow transplantation at least 5 years before clinical onset;
(6)
having non-Hodgkin lymphoma before clinical onset;
(7)
having mature B-cell lymphoid leukaemia and small lymphocytic lymphoma before clinical onset;
Note: Mature B-cell lymphoid leukaemia and small lymphocytic lymphoma is also known as chronic lymphocytic leukaemia/small cell lymphoma.
(8)
inability to obtain appropriate clinical management for Merkel cell carcinoma before clinical worsening;

Aggravation-only factors: the factors in subsection 9(8) 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. 81 of 2024

7 factors

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

(1)
having sunlight exposure to unprotected skin for a cumulative period of at least 4,500 latitude equivalent hours before clinical onset;
Note: latitude equivalent hours and unprotected skin are defined in the Schedule 1- Dictionary.
(2)
being infected with Merkel cell polyomavirus before clinical onset;
(3)
being infected with human immunodeficiency virus before clinical onset;
(4)
undergoing solid organ (excluding corneal transplant) or bone marrow transplantation at least 10 years before clinical onset;
(5)
having non-Hodgkin lymphoma before clinical onset;
(6)
having mature B-cell lymphoid leukaemia and small lymphocytic lymphoma before clinical onset;
Note: Mature B-cell lymphoid leukaemia and small lymphocytic lymphoma is also known as chronic lymphocytic leukaemia/small cell lymphoma.
(7)
inability to obtain appropriate clinical management for Merkel cell carcinoma before clinical worsening;

Aggravation-only factors: the factors in subsection 9(7) 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.

Accepted — what is it worth?

A Statement of Principles decides one thing only: whether DVA accepts liability for merkel cell carcinoma. It says nothing about how much you are paid. Compensation is worked out separately, from impairment points under the GARP — so a condition can be accepted and still rate few points, or rate more than you expect once it is combined with everything else on your file.

Merkel cell carcinoma may be accepted without proving the link to service

Merkel cell carcinoma is listed in Part 2 of the determination as attributable to defence service, provided the criteria below are met.

Qualifying service: peacetime service for at least 56 weeks; or warlike service or non-warlike service for at least 29 weeks.

A diagnosis is still required, and the presumption may not apply where there is clear evidence of a cause other than service. "Onset" means when an injury was sustained, or when all the signs and symptoms of a disease were first present — not the date of diagnosis. Applies to claims made on or after 1 July 2026.