REPATRIATION MEDICAL AUTHORITY
INSTRUMENT NO. 27 of 2009
VETERANS’ ENTITLEMENTS ACT 1986
MILITARY REHABILITATION AND COMPENSATION ACT 2004
EXPLANATORY NOTES FOR TABLING
- The Repatriation Medical Authority (the Authority), under subsection 196B(8) of the Veterans' Entitlements Act 1986 (the VEA), revokes Instrument No. 25 of 2008 determined under subsection 196B(2) of the VEA concerning 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. 27 of 2009 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 5 November 2008 concerning bipolar disorder in accordance with section 196G of the VEA. The investigation 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:
- revising factor 6(t) concerning 'antidepressant drug therapy';
- new factor 6(e) concerning 'severe childhood abuse';
- new definition of 'severe childhood abuse' in clause 9;
- revising definition of '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' and 'a drug in specified list 4' in clause 9.
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 5 November 2008, and circulated a copy of the notice 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. No submissions were received for consideration by the Authority during the investigation.
10. The determining of this new instrument finalises the investigation in relation to bipolar disorder as advertised in the Government Notices Gazette of 5 November 2008.
11. A list of references relating to the above condition is available to any person or organisation referred to in subsection 196E(1)(a) to (c) of the VEA. Any such request must be made in writing to the Repatriation Medical Authority at the following address:
The Registrar
Repatriation Medical Authority Secretariat
GPO Box 1014
BRISBANE QLD 4001
Overview
The Veterans' Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA) were enacted by the Parliament of Australia to provide entitlements, rehabilitation, and compensation to veterans and their families. The Repatriation Medical Authority Instrument No. 27 of 2009 addresses the gap in the recognition of bipolar disorder as a service-related condition. This instrument, under subsection 196B(2) of the VEA, aims to establish a Statement of Principles concerning bipolar disorder, replacing the previously revoked Instrument No. 25 of 2008. The Authority, having considered sound medical-scientific evidence, has determined that bipolar disorder and death from bipolar disorder can be related to specific kinds of service, including operational, peacekeeping, hazardous, warlike, and non-warlike service. This new instrument incorporates revisions and new factors, such as severe childhood abuse, and references the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). The policy objective is to ensure that veterans and their families receive appropriate recognition and compensation for service-related conditions, including bipolar disorder.
Scope and Application
The Repatriation Medical Authority Instrument No. 27 of 2009 pertains to the Veterans' Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA). This instrument is concerned with the acknowledgment of bipolar disorder as a service-related condition, applicable to veterans and service personnel who have served in various capacities including operational, peacekeeping, hazardous, warlike, and non-warlike services. The instrument serves to replace a previous statement of principles concerning bipolar disorder, and it is applicable to claims for compensation initiated on or after 1 July 2004. The instrument delineates the medical-scientific evidence required to establish a connection between bipolar disorder or death from bipolar disorder and the specified types of service, and it incorporates definitions and references from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). The instrument's scope is national, as it applies across Australia, and it is determined by the Repatriation Medical Authority under the VEA, with relevance to the MRCA for claims postdating 1 July 2004. The instrument does not explicitly mention any exclusions, exemptions, or thresholds, nor does it indicate extensions or restrictions through subordinate instruments, but it does clarify its dual applicability under both the VEA and the MRCA.
Key Provisions
The main operative sections of the Repatriation Medical Authority Instrument No. 27 of 2009, as detailed in the explanatory notes, primarily focus on revising the Statement of Principles concerning bipolar disorder (section 4). This revision follows the revocation of Instrument No. 25 of 2008, which had previously addressed bipolar disorder under the Veterans' Entitlements Act 1986 (VEA) (section 2). The new Instrument No. 27 of 2009 provides updated criteria and definitions for determining whether there is a connection between bipolar disorder and particular kinds of military service, including operational, peacekeeping, and hazardous service under the VEA, and warlike and non-warlike service under the Military Rehabilitation and Compensation Act 2004 (MRCA). The new instrument incorporates these criteria by referencing the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) (section 7).
The obligations imposed by this Act on the parties or entities it governs primarily relate to the assessment and determination of compensation claims for veterans and service personnel who have been diagnosed with bipolar disorder. The Repatriation Medical Authority (the Authority) is responsible for determining whether a reasonable hypothesis exists that connects a person's bipolar disorder or death from bipolar disorder to their service under the VEA or MRCA (section 4). This determination is made by reference to the Statement of Principles set out in Instrument No. 27 of 2009. The Authority must ensure that claims for compensation are evaluated based on the sound medical-scientific evidence available, including evidence of the relationship between the service rendered and the onset of bipolar disorder. Additionally, the Authority must incorporate the DSM-IV-TR in its assessment process and provide this document to relevant parties upon request (section 7).
There are no specific offences, penalties, or civil/criminal consequences outlined in the explanatory notes for breaching the provisions of this Act. However, the implications of non-compliance or failure to adhere to the determined Statement of Principles could result in disputes over compensation claims. The Military Rehabilitation and Compensation Commission, which determines claims for acceptance of liability under section 319 of the MRCA, would rely on the Authority's Statement of Principles to assess the validity of claims. Therefore, any perceived failure by the Authority to accurately determine the connection between service and bipolar disorder could lead to challenges in the processing and acceptance of claims. While the Act does not specify penalties for such breaches, the legal and administrative consequences for the Authority and claimants could be significant.
The Authority's process for determining the Statement of Principles also includes an investigative phase, during which it seeks input from various stakeholders, including veterans' organisations, service personnel, and experts in the field (section 9). This comprehensive approach ensures that the Authority considers a wide range of perspectives and evidence before finalising the Statement of Principles. The Authority's decision-making process is transparent, with public notice of its intention to investigate and opportunities for relevant parties to submit their views. The absence of submissions during the investigation indicates that the Authority proceeded with its determination based on the available evidence and expert consultation. Ultimately, the Act facilitates a structured and evidence-based approach to addressing the complex relationship between military service and bipolar disorder, aiming to support affected veterans and service personnel in their pursuit of compensation.