Statement of Principles

concerning

MALIGNANT NEOPLASM OF THE OESOPHAGUS
(Balance of Probabilities)

(No. 12 of 2026)

The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.

Dated 19 December 2025

Professor Terence Campbell AM

Chairperson

by and on behalf of

The Repatriation Medical Authority

Contents

1 Name

2 Commencement

3 Authority

4 Repeal

5 Application

6 Definitions

7 Kind of injury, disease or death to which this Statement of Principles relates

8 Basis for determining the factors

9 Factors that must exist

10 Relationship to service

11 Factors referring to an injury or disease covered by another Statement of Principles

Schedule 1 - Dictionary

1 Definitions

1.                Name

This is the Statement of Principles concerning malignant neoplasm of the oesophagus (Balance of Probabilities) (No. 12 of 2026).

1.                Commencement

              This instrument commences on 19 January 2026.

1.                Authority

This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.

1.                Repeal

The Statement of Principles concerning malignant neoplasm of the oesophagus (Balance of Probabilities) (No. 121 of 2015) (Federal Register of Legislation No. F2015L01686) made under subsections 196B(3) and (8) of the VEA is repealed.

1.                Application

This instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004 applies.

1.                Definitions

The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.

1.                Kind of injury, disease or death to which this Statement of Principles relates
   1.           This Statement of Principles is about malignant neoplasm of the oesophagus and death from malignant neoplasm of the oesophagus.

Meaning of malignant neoplasm of the oesophagus

1.           For the purposes of this Statement of Principles, malignant neoplasm of the oesophagus:
   1.           means a primary malignant neoplasm arising from the cells of the oesophagus. The oesophagus is defined as the structure which begins proximally with the lower border of the hypopharynx and extends distally to the lower border of the oesophageal sphincter and can include the gastro-oesophageal junction; and
   2.           excludes soft tissue sarcoma, carcinoid tumour, non-Hodgkin lymphoma and Hodgkin lymphoma.
2.           While malignant neoplasm of the oesophagus attracts ICD‑10‑AM code C15, in applying this Statement of Principles the meaning of malignant neoplasm of the oesophagus is that given in subsection (2).
3.           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.

Death from malignant neoplasm of the oesophagus

1.           For the purposes of this Statement of Principles, malignant neoplasm of the oesophagus, 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 oesophagus.

Note: terminal event is defined in the Schedule 1 – Dictionary.

1.                Basis for determining the factors

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 oesophagus and death from malignant neoplasm of the oesophagus can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA.

Note: MRCA, relevant service and VEA are defined in the Schedule 1 – Dictionary.

1.                Factors that must exist

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

1.           having smoked at least 5 pack-years before clinical onset, and where smoking has ceased, clinical onset occurred within 15 years of cessation;

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

1.           having orally consumed smokeless tobacco on more days than not for at least 10 years before clinical onset, and where consumption has ceased, clinical onset occurred within 10 years of cessation;

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

1.           having received a cumulative equivalent dose of at least 0.5 sievert of ionising radiation to the oesophagus at least 10 years before clinical onset;

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

1.           inhaling respirable asbestos fibres in an enclosed space:
   1.           for a cumulative period of at least 2,000 hours before clinical onset; and
   2.           at the time material containing respirable asbestos fibres was being applied, removed, dislodged, cut or drilled; and
   3.           the first inhalation of respirable asbestos fibres commenced at least 10 years before clinical onset;
2.           inhaling respirable asbestos fibres in an open environment:
   1.           for a cumulative period of at least 6,000 hours before clinical onset; and
   2.           at the time material containing respirable asbestos fibres was being applied, removed, dislodged, cut or drilled; and
   3.           the first inhalation of respirable asbestos fibres commenced at least 10 years before clinical onset;
3.           having a caustic burn of the oesophagus at least 10 years before clinical onset;
4.           for squamous cell or undifferentiated carcinoma of the oesophagus only, consuming alcohol in an amount of at least 250 kilograms before clinical onset;

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

1.           for squamous cell or undifferentiated carcinoma of the oesophagus only, having Plummer-Vinson syndrome at the time of clinical onset;

Note: Plummer-Vinson syndrome is defined in the Schedule 1 – Dictionary.

1.           for squamous cell or undifferentiated carcinoma of the oesophagus only, drinking maté on more days than not for at least 10 years before clinical onset, and where drinking maté has ceased, clinical onset occurred within 10 years of cessation;

Note:  Maté is a tea made from the dried leaves of the plant Ilex paraguariensis, which grows in South America. Synonyms for maté include yerba maté, erva maté, Brazilian tea, Paraguay tea, and Jesuit’s tea.

1.       for adenocarcinoma or undifferentiated carcinoma of the oesophagus only, having gastro-oesophageal reflux disease for at least the 10 years before clinical onset;
2.       for adenocarcinoma or undifferentiated carcinoma of the oesophagus only, having a Body Mass Index (BMI) of 30 or greater for at least 10 years in the 20 years immediately preceding clinical onset;

Note: Body mass index (BMI) is calculated as W/H2 where:

1.         W is the person's weight in kilograms; and
2.        H is the person's height in metres.
   1.       for adenocarcinoma or undifferentiated carcinoma of the oesophagus only, having Barrett oesophagus before clinical onset;

Note: Barrett oesophagus is defined in the Schedule 1 – Dictionary.

1.       having chewed betel quid or areca nut on more days than not for at least the 10 years before clinical onset, and where chewing has ceased, clinical onset occurred within 10 years of cessation;
2.       consuming an average daily intake of at least 25 grams per day of processed meat product for at least 10 years within the 25 years before clinical onset;

Note:  processed meat product is defined in the Schedule 1 - Dictionary.

1.       having an abnormally large or dilated oesophagus due to Chagas’ disease at the time of clinical onset;

Note 1: Chagas’ disease is caused by infection with the protozoan organism Trypanosoma cruzii. Approximately 3% of patients with Chagas’ disease develop an abnormally large or dilated oesophagus.

Note 2: An abnormally large or dilated oesophagus due to Chagas’ disease is also called chagasic megaesophagus.

1.       inability to obtain appropriate clinical management for malignant neoplasm of the oesophagus before clinical worsening.

1.            Relationship to service
   1.           The existence in a person of any factor referred to in section 9, must be related to the relevant service rendered by the person.
   2.           The factor set out in subsection 9(16) applies only to material contribution to, or aggravation of, malignant neoplasm of the oesophagus where the person's malignant neoplasm of the oesophagus was suffered or contracted before or during (but did not arise out of) the person's relevant service.
2.            Factors referring to an injury or disease covered by another Statement of Principles

In this Statement of Principles:

1.           if a factor referred to in section 9 applies in relation to a person; and
2.           that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(3) of the VEA;

then the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.

Schedule 1 - Dictionary  

Note:               See Section 6

1               Definitions

In this instrument:

                                cumulative equivalent dose means the total dose of ionising radiation received by the particular organ or tissue from external exposure, internal exposure or both, apart from normal background radiation exposure in Australia, calculated in accordance with the methodology set out in Guide to calculation of 'cumulative equivalent dose' for the purpose of applying ionising radiation factors contained in Statements of Principles determined under Part XIA of the Veterans' Entitlements Act 1986 (Cth), Australian Radiation Protection and Nuclear Safety Agency, as in force on 2 August 2017.

Note 1: Examples of circumstances that might lead to exposure to ionising radiation include being present during or subsequent to the testing or use of nuclear weapons, undergoing diagnostic or therapeutic medical procedures involving ionising radiation, and being a member of an aircrew, leading to increased levels of exposure to cosmic radiation.

Note 2: For the purpose of dose reconstruction, dose is calculated as an average over the mass of a specific tissue or organ. If a tissue is exposed to multiple sources of ionising radiation, the various dose estimates for each type of radiation must be combined.

                               malignant neoplasm of the oesophagus—see subsection 7(2).

                             MRCA means the Military Rehabilitation and Compensation Act 2004.

                             one pack-year means the amount of tobacco consumed in smoking 20 cigarettes per day for a period of 1 year, or an equivalent amount of tobacco products.

Note 1: An equivalent amount of tobacco products is 7,300 grams of smoking tobacco by weight, either in cigarettes, pipe tobacco or cigars, or a combination of same. For pipe tobacco, cigars or combinations of multiple tobacco types, 1 gram of tobacco is considered to be equal to one cigarette.

Note 2: Pack-years are calculated by dividing the number of cigarettes smoked per day by 20 and multiplying this number by the number of years the person has smoked. For example, smoking 10 cigarettes per day for 10 years is equal to 5 pack-years, and smoking 40 cigarettes per day for 10 years is equal to 20 pack-years.

                               Plummer-Vinson syndrome means the triad of dysphagia, iron deficient anaemia, and oesophageal webs.  It is also known as Paterson-Kelly syndrome, Paterson-Brown-Kelly syndrome, or sideropenic dysphagia.

                               processed meat product means preserved or cured meats, including ham, frankfurters, salami and bacon.

                             relevant service means:

(a)          eligible war service (other than operational service) under the VEA;

(b)          defence service (other than hazardous service and British nuclear test defence service) under the VEA; or

(c)          peacetime service under the MRCA.

Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary.

                             smokeless tobacco means tobacco products without combustion or pyrolysis at the time of use, including chewing tobacco and tobacco snuff.

                             terminal event means the proximate or ultimate cause of death and includes the following:

(a)           pneumonia;

(b)           respiratory failure;

(c)           cardiac arrest;

(d)           circulatory failure; or

(e)           cessation of brain function.

                             VEA means the Veterans' Entitlements Act 1986.