DECLARATION UNDER SUBSECTION 196B(9)
OF THE VETERANS’ ENTITLEMENTS ACT 1986
The Repatriation Medical Authority (the Authority), under subsection 196B(9) of the Veterans’ Entitlements Act 1986 (the Act), makes the following declaration in respect of the review of the contents of the Statements of Principles in force under the Act concerning bipolar disorder, Instrument Nos. 27 and 28 of 2009.
The investigation related to "a threatening, hostile, hazardous and/or menacing situation and/or environment". The Notice of Investigation was published in the Government Notices Gazette of 26 March 2014.
The Authority declares that it does not propose to amend Statements of Principles, Instrument Nos. 27 and 28 of 2009, concerning bipolar disorder for the reason that the new sound medical-scientific evidence available is not sufficient to justify an amendment to the Statements of Principles already determined in respect of bipolar disorder.
A cross-sectional Vietnam veteran study reported some significant associations between manic episode and malevolent environment and perceived threat. A cross-sectional Australian Gulf War Veterans' Health Study reported on bipolar depressed and bipolar manic diagnoses combined and found that when compared with the control group, Australian Gulf War Veterans were significantly more likely to present with a bipolar disorder diagnosis. However, a non-significant increased risk for bipolar disorder in the previous 12-months was reported. A retrospective database study of veterans of the recent Afghanistan and Iraq conflicts reported that greater perceived threat during deployment was significantly associated with mood disorders, but no findings for bipolar disorder specifically were reported.
Overall, the evidence was limited in quality and quantity and all studies did not report specifically on bipolar disorder as an outcome. An association was demonstrated in some of the studies, but the findings are limited by the cross-sectional design, retrospective data collection, lack of independent validation of some measures and possible confounding by other lifestyle factors and pre-deployment factors. Studies with prospective design and clinical measurement of psychiatric diagnosis are required to confirm these associations are causal.
The Authority concluded that the sound medical-scientific evidence available is inadequate to raise a reasonable hypothesis concerning a causal relationship between exposure to a threatening, hostile, hazardous and/or menacing situation and/or environment and bipolar disorder.
The Common Seal of the )
Repatriation Medical Authority )
was affixed at the direction of: )
PROFESSOR NICHOLAS SAUNDERS AO
CHAIRPERSON 17 / 10 /2014
Overview
The Veterans’ Entitlements Act 1986 was enacted to provide a framework for the administration of veterans' entitlements, ensuring that those who have served in the Australian Defence Force are appropriately compensated for any injuries or illnesses incurred during their service. This Act addresses the need to fairly and efficiently manage claims made by veterans for health conditions related to their military service. The Parliament of Australia enacted this legislation to establish a system that recognises and supports the health and welfare of veterans, aligning with the policy objective of providing comprehensive care and compensation for service-related disabilities. The Repatriation Medical Authority, under subsection 196B(9) of the Act, has the responsibility to review and determine the Statements of Principles concerning various health conditions, including bipolar disorder, to ensure that veterans receive the appropriate benefits based on sound medical-scientific evidence.
Scope and Application
The Veterans' Entitlements Act 1986 applies to persons who are or were members of the Australian Defence Force, including current and former service personnel, and their dependants, with respect to the entitlements and benefits available to them. The Act provides for various benefits, including health care, pensions, and other forms of assistance. The scope of the Act encompasses the review and amendment of Statements of Principles, which are formal statements regarding the health conditions that are presumed to be caused by service in the Defence Force. This includes the review of Statements of Principles concerning bipolar disorder, as evidenced by the declaration made by the Repatriation Medical Authority under subsection 196B(9). The declaration pertains to the review of Instruments Nos. 27 and 28 of 2009, which outline the presumptions related to bipolar disorder. The Authority's decision not to amend these Statements of Principles is based on the evaluation of available medical-scientific evidence, which did not sufficiently establish a causal relationship between exposure to threatening, hostile, hazardous, or menacing environments and bipolar disorder. The declaration is made under the authority of the Commonwealth of Australia, extending its application across the national jurisdiction. No specific exclusions, exemptions, or thresholds are noted in the declaration, though the Authority may consider such factors in its broader assessments under the Act. Subordinate instruments may further refine the application of the Act's provisions, although the specific declaration focuses on the evidence available at the time of review.
Key Provisions
The main operative sections of this declaration, made by the Repatriation Medical Authority under subsection 196B(9) of the Veterans’ Entitlements Act 1986, pertain to the review of Statements of Principles concerning bipolar disorder (Instrument Nos. 27 and 28 of 2009). The Authority has decided against amending these Statements of Principles, as the available new sound medical-scientific evidence is not deemed sufficient to warrant such amendments. This decision follows an investigation into the potential causal relationship between exposure to a threatening, hostile, hazardous and/or menacing situation and/or environment and bipolar disorder in veterans. The Authority's conclusion is based on the findings of various studies, which, while indicating some associations between certain environmental factors and mood disorders, do not provide conclusive evidence specifically linking these factors to bipolar disorder.
The declaration imposes certain obligations on the Repatriation Medical Authority, primarily to review and assess the available medical-scientific evidence in relation to the Statements of Principles. This involves evaluating studies that explore the potential link between veterans’ exposure to hazardous environments and the development of bipolar disorder. The Authority must ensure that its findings are based on sound evidence and that any conclusions drawn are reasonable and justifiable. Additionally, the Authority is required to communicate its decision to the relevant stakeholders, including the public, through the publication of the Notice of Investigation and the subsequent declaration.
There are no explicit offences, penalties, or civil/criminal consequences outlined in this particular declaration for non-compliance with the obligations or for breaches of the Act. However, the failure to adhere to the requirements and obligations set forth by the Veterans’ Entitlements Act 1986 could potentially lead to legal challenges or disputes, particularly if veterans or their representatives believe that the Authority has not properly assessed the evidence or made a fair decision. Such disputes would likely be addressed in the appropriate legal forums, with outcomes depending on the specific circumstances and the interpretation of the relevant provisions of the Act.