Document ID: chunk:federal_register_of_legislation:F2020L00214:reg:9:p1
Version: federal_register_of_legislation:F2020L00214
Segment Type: reg
Provision Reference: reg 9 (pt 1/2)
Character Range: 4063–7098

9               Factors that must exist
At least one of the following factors must exist before it can be said that, on the balance of probabilities, multiple sclerosis or death from multiple sclerosis is connected 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 ten 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)          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;
(5)          being obese 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 obese is defined in the Schedule 1 - Dictionary.
(6)          having onset of a viral or bacterial infection within the five weeks before, or the two weeks after, the clinical worsening of multiple sclerosis;
(7)          smoking at least ten pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of multiple sclerosis, and where smoking has ceased, the clinical worsening 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.
(8)          being exposed to second-hand smoke for at least 10 000 hours before the clinical worsening of multiple sclerosis;
            Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.
(9)          undergoing a course of treatment with a tumour necrosis factor alpha antagonist within the one year before the clinical worsening of multiple sclerosis;
(10)      undergoing a course of treatment with granulocyte colony-stimulating factor or interferon within the six months before the clinical worsening of multiple sclerosis;
(11)      undergoing a course of treatment with an immune checkpoint inhibitor within the four months before the clinical worsening of multiple sclerosis;
            Note: Immune checkpoint inhibitors include, but are not limited to, ipilimumab, nivolumab,