REPATRIATION MEDICAL AUTHORITY

INSTRUMENT NO. 25 of 2008

VETERANS’ ENTITLEMENTS ACT 1986

MILITARY REHABILITATION AND COMPENSATION ACT 2004

EXPLANATORY NOTES FOR TABLING

1. The Repatriation Medical Authority (the Authority), under subsection 196B(8) of the Veterans' Entitlements Act 1986 (the VEA) revokes Instrument No. 128 of 1996 determined under subsection 196B(2) of the VEA concerning bipolar disorder and death from bipolar disorder.

2.             The Authority is of the view that there is sound medical-scientific evidence that indicates that bipolar disorder and death from bipolar disorder can be related to particular kinds of service.  The Authority has therefore determined pursuant to subsection 196B(2) of the VEA a Statement of Principles, Instrument No. 25 of 2008 concerning bipolar disorder.  This Instrument will in effect replace the revoked Statement of Principles.

3.             The provisions of the Military Rehabilitation and Compensation Act 2004 (the MRCA) relating to claims for compensation commenced on 1 July 2004.  Claims under section 319 of the MRCA for acceptance of liability for a service injury sustained, a service disease contracted or service death on or after 1 July 2004 are determined by the Military Rehabilitation and Compensation Commission by reference to Statements of Principles issued by the Authority pursuant to the VEA.

4.             The Statement of Principles sets out the factors that must as a minimum exist, and which of those factors must be related to the following kinds of service rendered by a person:

 operational service under the VEA;

 peacekeeping service under the VEA;

 hazardous service under the VEA;

 warlike service under the MRCA;

 non-warlike service under the MRCA,

before it can be said that a reasonable hypothesis has been raised connecting bipolar disorder or death from bipolar disorder, with the circumstances of that service.

5.             This new instrument results from an investigation notified by the Authority in the Government Notices Gazette of 24 March 2004 concerning bipolar disorder and from an investigation notified by the Authority in the Government Notices Gazette of 28 February 2007 concerning substance induced mood disorder, in accordance with section 196G of the VEA.  The investigations involved an examination of the sound medical-scientific evidence now available to the Authority, including the sound medical-scientific evidence it has previously considered.

6.             The contents of the new Instrument are in similar terms as the revoked Instrument.  Comparing the new and the revoked Instruments, the differences include:

• adopting the latest revised Instrument format, which commenced in 2005;
• deleting the ICD code from the Instrument header;
• revising the definition of 'bipolar disorder' in clause 3;
• revising factors 6(a)(i) & 6(e) concerning 'category 1A stressor';
• revising factor 6(k) concerning 'drug dependence or drug abuse';
• revising factor 6(l) concerning 'alcohol dependence or alcohol abuse';
• revising factor 6(n) concerning 'a drug from a class of drugs in specified list 1';
• new factors 6(a)(ii) & 6(f) concerning 'category 1B stressor';
• new factors 6(a)(iii) & 6(g) concerning 'category 2 stressor';
• new factors 6(a)(iv) & 6(h) concerning 'a significant other';
• new factors 6(a)(v) & 6(i) concerning 'suicide';
• new factor 6(a)(vii) concerning 'drug dependence or drug abuse';
• new factor 6(a)(viii) concerning 'alcohol dependence or alcohol abuse';
• new factors 6(a)(ix) & 6(m) concerning 'anxiety spectrum disorder';
• new factor 6(b) concerning 'substance-induced mood disorder with manic features';
• new factor 6(c) concerning 'substance-induced mood disorder with mixed features';
• new factor 6(d) concerning 'mood disorder due to a general medical condition with manic or mixed features';
• new factor 6(o) concerning 'drug in specified list 2';
• new factor 6(p) concerning 'a drug from a class of drugs in specified list 3';
• new factor 6(q) concerning 'drug in specified list 4';
• new factor 6(r) concerning 'being treated with a drug';
• new factor 6(s) concerning 'therapeutic or illicit drugs';
• new factor 6(t) concerning 'a medical condition as specified';
• new factor 6(u) concerning 'sleep';
• new factor 6(v) concerning 'electroconvulsive therapy';
• new factor 6(w) concerning 'bright light therapy';
• new definitions of 'mood disorder due to a general medical condition with manic or mixed features', 'substance-induced mood disorder with manic or mixed features' in clause 3(b);
• new definitions of 'a category 1A stressor', 'a category 1B stressor', 'a category 2 stressor', 'a clinically significant anxiety spectrum disorder', 'a close family member', 'a drug from the class of drugs in specified list 1', 'a drug from the class of drugs in specified list 3', 'a drug in specified list 2', 'a drug in specified list 4', 'a medical condition as specified', 'a significant other', 'an eyewitness', 'death from bipolar disorder', 'DSM-IV-TR', 'inhalants', 'terminal event' and 'the general medical condition is a direct physiological cause of the mood symptoms' in clause 9;
• revising definitions of 'bipolar 1 disorder', 'bipolar II disorder', 'bipolar disorder not otherwise specified', 'cyclothymia' and 'relevant service' in clause 9;
• deleting definition of 'DSM-IV', 'ICD code', 'severe psychological stressor', 'substance abuse involving alcohol or cocaine', 'substance induced mood disorder' and 'using a specified drug'; and
• specifying a date of effect for the Instrument in clause 11.

7.             This new instrument incorporates by reference the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), American Psychiatric Association, Washington DC 2000.  A copy of this document is available from the offices of the Repatriation Medical Authority, Level 8, Bank of Queensland Building, 259 Queen St, Brisbane Queensland 4000, by contacting the Registrar on telephone (07) 3815 9404.

8.             Further changes to the format of the Instrument reflect the commencement of the MRCA and clarify that pursuant to subsection 196B(3A) of the VEA, the Statement of Principles has been determined for the purposes of both the VEA and the MRCA.

9.             Prior to determining this instrument, the Authority advertised its intention to undertake an investigation in relation to bipolar disorder in the Government Notices Gazette of 24 March 2004 and an investigation in relation to substance induced mood disorder in the Government Notices Gazette of 28 February 2007, and circulated a copy of the notices of intention to investigate to a wide range of organisations representing veterans, service personnel and their dependants.  The Authority invited submissions from the Repatriation Commission, organisations and persons referred to in section 196E of the VEA, and any person having expertise in the field.  Two submissions were received with respect to bipolar disorder and one submission was received with respect to substance induced mood disorder, for consideration by the Authority during the investigations.

10.         The determining of this new instrument finalises the investigation in relation to bipolar disorder, as advertised in the Government Notices Gazette of 24 March 2004 and the investigation in relation to substance induced mood disorder, as advertised in the Government Notices Gazette of 28 February 2007.

11.         A list of references relating to the above condition is available, on written request, from the Repatriation Medical Authority Secretariat.