Statement of Principles concerning chronic fatigue syndrome (Reasonable Hypothesis) (No. 105 of 2021) (Cth)

Statement of Principles

concerning

CHRONIC FATIGUE SYNDROME
(Reasonable Hypothesis)

(No. 105 of 2021)

The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated   22 October 2021

The Common Seal of the
Repatriation Medical Authority
was affixed to this instrument
at the direction of:

Professor Terence Campbell AM
Chairperson

Contents

1Name........................................................................................................................................... 3

2Commencement........................................................................................................................ 3

3Authority..................................................................................................................................... 3

4Repeal......................................................................................................................................... 3

5Application................................................................................................................................. 3

6Definitions.................................................................................................................................. 3

7Kind of injury, disease or death to which this Statement of Principles relates............... 3

8Basis for determining the factors........................................................................................... 4

9Factors that must exist............................................................................................................. 4

10Relationship to service............................................................................................................. 5

11Factors referring to an injury or disease covered by another Statement of Principles. 5

Schedule 1 - Dictionary............................................................................................. 6

1Definitions.................................................................................................................................. 6

1. Name

This is the Statement of Principles concerning chronic fatigue syndrome (Reasonable Hypothesis) (No. 105 of 2021).

1. Commencement

This instrument commences on 22 November 2021.

1. Authority

This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.

1. Repeal

The Statement of Principles concerning chronic fatigue syndrome No. 11 of 2014 (Federal Register of Legislation No. F2014L00013) made under subsection 196B(2) of the VEA is repealed.

1. Application

This instrument applies to a claim to which section 120A of the VEA or section 338 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 chronic fatigue syndrome and death from chronic fatigue syndrome.

Meaning of chronic fatigue syndrome

(2)For the purposes of this Statement of Principles, chronic fatigue syndrome means a syndrome of intense, prolonged fatigue that meets the following diagnostic criteria:

(a) new or definitive onset of severe fatigue that is not improved by bed rest and that may be worsened by physical activity or mental exertion;

(b) the fatigue has persisted for at least 6 consecutive months and is not due to ongoing exertion;

(c)other mental or physical conditions associated with fatigue have been ruled out by a doctor and by any relevant diagnostic testing;

(d) the fatigue significantly interferes with daily activities and work; and

(e) the individual concurrently has 4 or more of the following 8 symptoms:

(i)post-exertion malaise lasting more than 24 hours;

(ii)unrefreshing sleep;

(iii)significant impairment of short-term memory or concentration;

(iv)muscle pain;

(v)pain in the joints without swelling or redness;

(vi)headaches of a new type, pattern, or severity;

(vii) tender lymph nodes in the neck or armpit; or

(viii) a sore throat that is frequent or recurring.

Note 1: Any of these additional symptoms should have persisted or recurred during 6 or more consecutive months of illness and they cannot have first appeared before the fatigue.

Note 2: Other mental and physical conditions that can be associated with severe, chronic fatigue include depressive disorder, bipolar disorder, alcohol use disorder, substance use disorder, schizophrenia, eating disorders, dementia of any type and morbid obesity.

Death from chronic fatigue syndrome

(3)For the purposes of this Statement of Principles, chronic fatigue syndrome, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's chronic fatigue syndrome.

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

1. Basis for determining the factors

The Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that chronic fatigue syndrome and death from chronic fatigue syndrome can be related to relevant service rendered by veterans, members of Peacekeeping Forces, 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 as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting chronic fatigue syndrome or death from chronic fatigue syndrome with the circumstances of a person's relevant service:

(1)having an acute infection from the specified list of infections at the time of the clinical onset of chronic fatigue syndrome;

Note: specified list of infections is defined in the Schedule 1 - Dictionary.

(2)living or working in a hostile or life-threatening environment for a period of at least 4 weeks within the 6 months before the clinical onset of chronic fatigue syndrome;

Note: hostile or life-threatening environment is defined in the Schedule 1 - Dictionary.

(3)experiencing severe childhood abuse before the clinical onset of chronic fatigue syndrome;

Note: severe childhood abuse is defined in the Schedule 1 - Dictionary.

(4)experiencing a category 1A stressor within the 1 year before the clinical onset of chronic fatigue syndrome;

Note: category 1A stressor is defined in the Schedule 1 - Dictionary.

(5)experiencing a category 1B stressor within the 1 year before the clinical onset of chronic fatigue syndrome;

Note: category 1B stressor is defined in the Schedule 1 - Dictionary.

(6)inability to obtain appropriate clinical management for chronic fatigue syndrome.

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(6) applies only to material contribution to, or aggravation of, chronic fatigue syndrome where the person's chronic fatigue syndrome was suffered or contracted before or during (but did not arise out of) the person's relevant service.

1. 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(2) 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:

category 1A stressor means one of the following severe traumatic events:

(a)experiencing a life-threatening event;

(b)being subject to a serious physical attack or assault including rape and sexual molestation; or

(c)being threatened with a weapon, being held captive, being kidnapped, or being tortured.

category 1B stressor means one of the following severe traumatic events:

(a)killing or maiming a person;

(b)being an eyewitness to a person being killed or critically injured;

(c)being an eyewitness to atrocities inflicted on another person;

(d)participating in the clearance of a corpse or a critically injured casualty; or

(e)viewing a corpse or a critically injured casualty as an eyewitness.

Note: corpse and eyewitness are also defined in the Schedule 1 - Dictionary.

chronic fatigue syndrome—see subsection 7(2).

corpse means the human remains or body parts of one or more persons who have met a violent or horrific death.

Note: Examples of a violent or horrific death may include death due to suicide, gunshot, improvised explosive devices, natural and technological disasters, terrorist attacks or motor vehicle accidents. Seeing a closed body bag or viewing a body in an open-casket coffin are excluded from this definition.

eyewitness means a person who experiences an incident first hand and can give direct evidence of it. This excludes persons exposed only to public broadcasting or mass media coverage of the incident.

hostile or life-threatening environment means a situation or setting which is characterised by a pervasive threat to life or bodily integrity, such as would be experienced in the following circumstances:

(a)experiencing or being under threat of artillery, missile, rocket, mine or bomb attack;

(b) experiencing or being under threat of nuclear, biological or chemical agent attack; or

(c)being involved in combat or going on combat patrols.

MRCAmeans the Military Rehabilitation and Compensation Act 2004.

relevant service means:

(a)operational service under the VEA;

(b)peacekeeping service under the VEA;

(c)hazardous service under the VEA;

(d)British nuclear test defence service under the VEA;

(e)warlike service under the MRCA; or

(f)non-warlike service under the MRCA.

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

severe childhood abuse means:

(a)serious physical, emotional, psychological or sexual harm whilst a child aged under 16 years; or

(b)neglect involving a serious failure to provide the necessities for health, physical and emotional development, or wellbeing whilst a child aged under 16 years;

where such serious harm or neglect has been perpetrated by a parent, a care provider, an adult who works with or around that child, or any other adult in contact with that child.

specified list of infections means:

(a)Coxiella burnetii (Q fever);

(b)Epstein-Barr virus (infectious mononucleosis);

(c)Giardia lamblia;

(d)parvovirus B19; or

(e)Ross River virus.

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.