Document ID: chunk:federal_register_of_legislation:F2020L00213:reg:9:p1
Version: federal_register_of_legislation:F2020L00213
Segment Type: reg
Provision Reference: reg 9 (pt 1/3)
Character Range: 4065–7086

9               Factors that must exist
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 multiple sclerosis or death from multiple sclerosis with the circumstances of a person's relevant service:
(1)          having acute infectious mononucleosis before the clinical onset of multiple sclerosis;
(2)          smoking at least five pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of multiple sclerosis, and where smoking has ceased, the clinical onset of multiple sclerosis has occurred within five years of cessation;
            Note: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary.
(3)          being exposed to second-hand smoke for at least 10 000 hours before the clinical onset of multiple sclerosis;
            Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.
(4)          inhaling an organic solvent or having cutaneous contact with an organic solvent on more days than not for a continuous period of at least one year before the clinical onset of multiple sclerosis;
            Note: organic solvent is defined in the Schedule 1 - Dictionary.
(5)          undergoing a course of treatment with a tumour necrosis factor alpha antagonist within the two years before the clinical onset of multiple sclerosis;
(6)          in the absence of supplemental ultraviolet light exposure, having an inability to meet the specified sunlight exposure levels for at least one year before the clinical onset of multiple sclerosis, and where this inability to meet the specified sunlight exposure levels occurred more than two years before the clinical onset of multiple sclerosis;
            Note: specified sunlight exposure levels is defined in the Schedule 1 - Dictionary.
(7)          having vitamin D deficiency, with a serum 25-hydroxyvitamin D level of less than 50 nanomoles per litre for a continuous period of at least one year before the clinical onset of multiple sclerosis, and where this vitamin D deficiency occurred more than two years before the clinical onset of multiple sclerosis;
(8)          undergoing a course of treatment with an immune checkpoint inhibitor within the four months before the clinical onset of multiple sclerosis;
            Note: Immune checkpoint inhibitors include, but are not limited to, ipilimumab, nivolumab, atezolizumab and pembrolizumab.
(9)          being overweight for at least five years when aged less than 30 years before the clinical onset of multiple sclerosis, and where this five year period occurred within the 15 years before the clinical onset of multiple sclerosis;
            Note: being overweight is defined in the Schedule 1 - Dictionary.
(10)      having type 1 diabetes mellitus before the clinical onset of multiple sclerosis;
(11)      having onset of a viral or bacterial infection within the