Specialist Medical Review Council
Declarations
Section 196W
Veterans’ Entitlements Act 1986
____________________________
Re: Statements of Principles Nos. 5 and 6 of 2008
In Respect of Posttraumatic Stress Disorder
Requests for Review Declaration No. 23
- In relation to the Repatriation Medical Authority (the RMA) Statement of Principles No. 5 of 2008 concerning posttraumatic stress disorder and death from posttraumatic stress disorder, made under subsection 196B(2) of the Veterans' Entitlements Act 1986 (the VEA), the Specialist Medical Review Council (the Council) under subsection 196W of the VEA:
DECLARES that there is sound medical-scientific evidence on which the RMA could have relied to amend the Statement of Principles to include the factors set out below;
DIRECTS the RMA to amend Statement of Principles No. 5 of 2008 by including the following factors for each of clinical onset and clinical worsening:
(a) Having a perception of threat and/or harm to the integrity of the self as a consequence of being in what:
(i) the individual concerned; and
(ii) a reasonable person in the circumstances of that individual would have;
considered to be any or all of a threatening, hostile, hazardous and/or menacing situation and/or environment.
(b) Having a perception of threat and/or harm to the integrity of:
(i) a significant other; and/or
(ii) other persons known to the individual or with whom the individual concerned has had contact in the discharge of that individual's duties and/or responsibilities;
as a consequence of the individual concerned and the persons in (i) and/or (ii) being in the same or similar circumstances as the individual concerned which:
(iii) the individual concerned; and
(iv) a reasonable person in the circumstances of that individual would have;
considered to be any or all of a threatening, hostile, hazardous and/or menacing situation and/or environment but excluding a perception engendered from viewing or listening to mass media (unless such viewing or listening is part of that individual's duties and/or responsibilities).
and
2. In relation to the RMA Statement of Principles No. 6 of 2008 concerning posttraumatic stress disorder and death from posttraumatic stress disorder, made under subsection 196B(3) of the VEA the Council under subsection 196W of the VEA:
DECLARES that the sound medical-scientific evidence available to the
RMA is insufficient to justify any amendment to the Statement of
Principles to include as factors exposure to malevolent environment
and/or perceived threat or any other factor.
3. In addition, the Council:
REMITS both Statements of Principles Nos. 5 and 6 of 2008 concerning posttraumatic stress disorder and death from posttraumatic stress disorder to the RMA, and
DIRECTS the RMA to conduct a new investigation as soon as reasonably practicable, taking into account whatever new information has become available since both Statements of Principles were determined in 2008, including but not limited to the DSM-5[1] in addition to the information that was available to the RMA when Statements of Principles Nos. 5 and 6 were determined.
Jonathan Phillips |
Presiding Councillor |
Richard Bryant | Helen Herrman | Alexander McFarlane | Derek Silove |
Councillor | Councillor | Councillor | Councillor |
The Common Seal of the )
Specialist Medical Review )
Council was affixed by ) authority of the Council in ) the presence of: ) | |
Jan Bowman
Registrar
Dated this Seventeenth day of December 2013
The Council’s Reasons for Decision in relation to this Declaration can be obtained from its website at www.smrc.gov.au, or on request by writing to the Specialist Medical Review Council Secretariat, PO Box 895, Woden ACT 2606 or by telephoning (07) 3223 8840.
[1] Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5™) American Psychiatric Association 2013.
Overview
The Veterans’ Entitlements Act 1986 (VEA), enacted by the Parliament of Australia, was introduced to provide support and benefits to veterans and their families, addressing the need for comprehensive and fair entitlements for those who have served in the defence forces. The Specialist Medical Review Council, as part of its role under the VEA, was tasked with reviewing and providing advice on medical and scientific matters concerning veterans’ health. In this context, the Council was called upon to review and amend Statements of Principles No. 5 and No. 6 of 2008 concerning posttraumatic stress disorder (PTSD). The policy objective of these declarations was to ensure that the Statements of Principles accurately reflected the current medical-scientific evidence, thereby enhancing the fairness and accuracy of the entitlements awarded to veterans affected by PTSD.
Scope and Application
The Specialist Medical Review Council Declaration No. 23 under Section 196W of the Veterans' Entitlements Act 1986 addresses the Statements of Principles Nos. 5 and 6 of 2008 concerning posttraumatic stress disorder (PTSD) and death from PTSD. The declaration applies to the Repatriation Medical Authority (RMA) and outlines specific amendments to Statement of Principles No. 5, including factors for clinical onset and clinical worsening of PTSD, such as the perception of threat and/or harm to the individual or others in a threatening situation. The declaration also directs the RMA to conduct a new investigation considering the latest medical evidence, such as the DSM-5. The Council found insufficient evidence to amend Statement of Principles No. 6. This declaration extends the scope of the VEA by clarifying and updating the criteria for PTSD in veterans, and it affects the process by which the RMA assesses claims related to PTSD. The declaration is binding on the RMA and applies nationally, ensuring consistency in the assessment of PTSD claims across Australia.
Key Provisions
The Specialist Medical Review Council (SMRC) under section 196W of the Veterans' Entitlements Act 1986 (VEA) declares that there is sufficient sound medical-scientific evidence to amend the Repatriation Medical Authority's (RMA) Statement of Principles No. 5 of 2008 concerning posttraumatic stress disorder (PTSD). Specifically, the SMRC directs the RMA to include new factors for both clinical onset and clinical worsening of PTSD. These factors pertain to the individual's perception of threat and harm to themselves or others in threatening situations, excluding media-induced perceptions unless part of their duties. Conversely, the SMRC finds the available evidence insufficient to justify any amendments to Statement of Principles No. 6 of 2008 regarding death from PTSD.
Under these declarations, the RMA is obligated to amend Statement of Principles No. 5 to incorporate the newly identified factors, ensuring that these are considered in future assessments and claims related to PTSD. The RMA must also undertake a new investigation into both Statements of Principles Nos. 5 and 6, taking into account updated information and the DSM-5, which is the latest edition of the Diagnostic and Statistical Manual of Mental Disorders. This directive ensures that the principles are based on the most current medical-scientific evidence.
Failure to comply with these directives can lead to legal consequences. While the Act does not explicitly outline specific penalties for non-compliance, breaches of statutory duties by the RMA could potentially result in administrative or judicial review, with possible repercussions including the quashing of decisions, directions for corrective action, or other remedies deemed appropriate by a court. The SMRC’s decisions, while authoritative, are subject to judicial review, which can further enforce adherence to the legislative mandates.