Statement of Principles concerning somatic symptom disorder (Reasonable Hypothesis) (No. 64 of 2022) (Cth)

Statement of Principles

concerning

SOMATIC SYMPTOM DISORDER
(Reasonable Hypothesis)

(No. 64 of 2022)

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

Dated      24 June 2022

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 somatic symptom disorder (Reasonable Hypothesis) (No. 64 of 2022).

1. Commencement

This instrument commences on 25 July 2022.

1. Authority

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

1. Repeal

The Statement of Principles concerning somatic symptom disorder No. 24 of 2014 (Federal Register of Legislation No. F2014L00304) 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 somatic symptom disorder and death from somatic symptom disorder.

Meaning of somatic symptom disorder

(2)For the purposes of this Statement of Principles, somatic symptom disorder means a disorder of mental health characterised by one or more somatic symptoms which has been diagnosed by a psychiatrist and which meets the following criteria (derived from DSM-5-TR):

A.The symptom or symptoms are distressing or result in significant disruption of daily life; and

B.Excessive thoughts, feelings, or behaviours related to the somatic symptoms or associated health concerns as manifested by at least 1 of the following:

(i)Disproportionate and persistent thoughts about the seriousness of one's symptoms;

(ii)Persistently high level of anxiety about health or symptoms; or

(iii)Excessive time and energy devoted to these symptoms or health concerns; and

C.Although any one somatic symptom may not be continuously present, the state of being symptomatic has persisted for at least 6 months.

Note: DSM-5-TR is defined in the Schedule 1 – Dictionary.

Death from somatic symptom disorder

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

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 somatic symptom disorder and death from somatic symptom disorder 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 somatic symptom disorder or death from somatic symptom disorder with the circumstances of a person's relevant service:

(1)experiencing severe childhood abuse before the clinical onset of somatic symptom disorder;

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

(2)experiencing a category 1A stressor within the 1 year before the clinical onset of somatic symptom disorder;

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

(3)experiencing a category 1B stressor within the 1 year before the clinical onset of somatic symptom disorder;

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

(4)experiencing a category 1A stressor within the 1 year before the clinical worsening of somatic symptom disorder;

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

(5)experiencing a category 1B stressor within the 1 year before the clinical worsening of somatic symptom disorder;

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

(6)inability to obtain appropriate clinical management for somatic symptom disorder.

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 factors set out in subsections 9(4) to 9(6) apply only to material contribution to, or aggravation of, somatic symptom disorder where the person's somatic symptom disorder 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.

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.

DSM-5-TR means the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2022.

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.

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.

somatic symptom disorder—see subsection 7(2).

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.