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 panic disorder, Instrument Nos. 68 and 69 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. 68 and 69 of 2009, concerning panic 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 panic disorder.
A cross-sectional Vietnam veteran study reported some significant associations between panic disorder and malevolent environment and perceived threat. A cross-sectional Australian Gulf War Veterans' Health Study found that when compared with the control group, Australian Gulf War Veterans had an increased risk of presenting with a panic disorder/agoraphobia diagnosis after the Gulf War, however, these results were not significant. A significant increased risk for panic disorder/agoraphobia 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 anxiety disorders, but no findings for panic disorder specifically were reported.
Overall, the evidence was limited in quality and quantity and one study did not report specifically on panic disorder as an outcome. An association was demonstrated in some of the analyses, 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 diagnoses are required to confirm if 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 panic 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 (VEA) was enacted to provide benefits and support to Australian veterans and their families, ensuring they receive the care and recognition they deserve for their service. This legislation established a framework for veterans' entitlements, including health care, pensions, and rehabilitation services. One of the critical aspects of the VEA is the management of Statements of Principles (SoPs), which outline the circumstances under which specific conditions may be recognised as related to military service. The 2014 declaration by the Repatriation Medical Authority (the Authority) under subsection 196B(9) of the VEA addressed the review of SoPs concerning panic disorder. The Authority determined not to amend the existing Statements of Principles, Instrument Nos. 68 and 69 of 2009, due to insufficient new medical-scientific evidence supporting a causal link between exposure to threatening, hostile, hazardous, and/or menacing situations and panic disorder. This decision was based on an evaluation of available studies, which, while indicating some associations, were limited in scope and quality, thus not providing a strong basis for amending the current SoPs.
Scope and Application
The declaration made under subsection 196B(9) of the Veterans’ Entitlements Act 1986 by the Repatriation Medical Authority concerns the review of the Statements of Principles in force under the Act regarding panic disorder, specifically Instrument Nos. 68 and 69 of 2009. This Act applies to veterans and their dependants who are eligible for benefits and services under the Act, encompassing conduct and transactions related to the review of entitlements concerning specific medical conditions. The authority of the Act extends across the Commonwealth of Australia, as it is a federal statute. The Act does not propose to amend the existing Statements of Principles on panic disorder due to insufficient new medical-scientific evidence to justify such amendments. While some studies indicate associations between panic disorder and exposure to threatening environments, the evidence is limited in quality and quantity, and further research is required to confirm any causal relationships. The declaration thus leaves the current Statements of Principles unaffected by the recent investigation.
Key Provisions
The main operative sections of this declaration (subsection 196B(9) of the Veterans’ Entitlements Act 1986) relate to the review of the Statements of Principles concerning panic disorder, specifically Instrument Nos. 68 and 69 of 2009. The Repatriation Medical Authority (the Authority) has declared its intention not to amend these Statements of Principles based on the current evidence available. The Authority examined several studies to determine whether there was sufficient evidence to link panic disorder with exposure to threatening, hostile, hazardous, and/or menacing situations and/or environments. Despite some findings indicating an association, the Authority concluded that the available evidence is inadequate to establish a causal relationship.
The obligations and requirements imposed by this Act on the parties it governs include the necessity for the Authority to thoroughly review and evaluate the latest medical-scientific evidence before making any amendments to the Statements of Principles. The Authority must ensure that any changes to these statements are supported by robust and reliable evidence, demonstrating a clear and reasonable hypothesis of a causal relationship between the specified exposures and the condition in question. This involves assessing the quality, quantity, and design of the studies, as well as considering the potential for confounding factors and the need for further research to confirm any associations identified.
In terms of offences, penalties, or consequences for breach, the Act does not explicitly outline specific criminal or civil penalties for failing to comply with the requirements of the Authority’s declaration. However, the failure to adhere to the established procedures and guidelines for reviewing and amending the Statements of Principles could potentially result in legal challenges or administrative actions. Such non-compliance might lead to the need for judicial review or other corrective measures to ensure that the Authority’s decisions are in line with the legislative intent and based on sound medical-scientific evidence. The consequences of such non-compliance could include the requirement to revisit the evidence or the process used to arrive at the Authority’s conclusions, potentially leading to further investigations or reviews.