Statement of Principles concerning posttraumatic stress disorder No. 5 of 2008

Statement of Principles

concerning

POSTTRAUMATIC STRESS DISORDER

Instrument No. 5 of 2008 as amended

made under section 196B(2) of the

Veterans’ Entitlements Act 1986

This compilation was prepared on 2 April 2014 taking into account Amendment of Statement of Principles concerning POSTTRAUMATIC STRESS DISORDER (Instrument No. 19 of 2014)

Prepared by the Repatriation Medical Authority Secretariat, Brisbane

Statement of Principles

concerning

POSTTRAUMATIC STRESS DISORDER

No. 5 of 2008

for the purposes of the

Veterans’ Entitlements Act 1986

and

Military Rehabilitation and Compensation Act 2004

Title

1. This Instrument may be cited as Statement of Principles concerning posttraumatic stress disorder No. 5 of 2008.

Determination

2.                  The Repatriation Medical Authority under subsection 196B(2) and (8) of the Veterans’ Entitlements Act 1986 (the VEA):

(a) revokes Instrument No. 3 of 1999, as amended by Instrument No. 54 of 1999, concerning post traumatic stress disorder; and

(b) determines in their place this Statement of Principles.

Kind of injury, disease or death

3. (a) This Statement of Principles is about posttraumatic stress disorder and death from posttraumatic stress disorder.

(b)              For the purposes of this Statement of Principles, "posttraumatic stress disorder" means a psychiatric condition meeting the following diagnostic criteria (derived from DSM-IV-TR):

(A) the person has been exposed to a traumatic event in which:

(i) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others; and

(ii) the person’s response involved intense fear, helplessness, or horror; and

(B) the traumatic event is persistently re-experienced in one or more of the following ways:

(i) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions;

(ii) recurrent distressing dreams of the event;

(iii) acting or feeling as if the traumatic event were recurring (including a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated);

(iv) intense psychological distress at exposure to internal or external cues that symbolise or resemble an aspect of the traumatic event;

(v) physiological reactivity on exposure to internal or external cues that symbolise or resemble an aspect of the traumatic event; and

(C) persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three or more of the following:

(i) efforts to avoid thoughts, feelings, or conversations associated with the trauma;

(ii) efforts to avoid activities, places, or people that arouse recollections of the trauma;

(iii) inability to recall an important aspect of the trauma;

(iv) markedly diminished interest or participation in significant activities;

(v) feeling of detachment or estrangement from others;

(vi) restricted range of affect (e.g., unable to have loving feelings);

(vii) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span); and

(D) persistent symptoms of increased arousal (not present before the trauma), as indicated by two or more of the following:

(i) difficulty falling or staying asleep;

(ii) irritability or outbursts of anger;

(iii) difficulty concentrating;

(iv) hypervigilance;

(v) exaggerated startle response; and

(E) duration of the disturbance (indicated by the relevant symptoms set out in paragraphs (b), (c) and (d)) is more than one month; and

(F) the disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning.

(c)               Posttraumatic stress disorder attracts ICD-10-AM code F43.1.

(d)              In the application of this Statement of Principles, the definition of "posttraumatic stress disorder" is that given at paragraph 3(b) above.

Basis for determining the factors

4. The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that posttraumatic stress disorder and death from posttraumatic stress disorder can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces under the VEA, or members under the Military Rehabilitation and Compensation Act 2004 (the MRCA).

Factors that must be related to service

5. Subject to clause 7, at least one of the factors set out in clause 6 must be related to the relevant service rendered by the person.

Factors

6. The factor that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting posttraumatic stress disorder or death from posttraumatic stress disorder with the circumstances of a person’s relevant service is:

(a)               experiencing a category 1A stressor before the clinical onset of posttraumatic stress disorder; or

(b)              experiencing a category 1B stressor before the clinical onset of posttraumatic stress disorder; or

(ba) 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 before the clinical onset of posttraumatic stress disorder; or

(c)               having a significant other who experiences a category 1A stressor within the one year before the clinical onset of posttraumatic stress disorder; or

(d)              experiencing the traumatic death of a significant other within the two years before the clinical onset of posttraumatic stress disorder; or

(da) 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) before the clinical onset of posttraumatic stress disorder; or

(e)               experiencing a category 1A stressor before the clinical worsening of posttraumatic stress disorder; or

(f)                experiencing a category 1B stressor before the clinical worsening of posttraumatic stress disorder; or

(fa) 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 before the clinical worsening of posttraumatic stress disorder; or

(g)              having a significant other who experiences a category 1A stressor within the one year before the clinical worsening of posttraumatic stress disorder; or

(h)              experiencing the traumatic death of a significant other within the two years before the clinical worsening of posttraumatic stress disorder; or

(ha) 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) before the clinical worsening of posttraumatic stress disorder; or

(i)                inability to obtain appropriate clinical management for posttraumatic stress disorder.

Factors that apply only to material contribution or aggravation

7. Paragraphs 6(e) to 6(i) apply only to material contribution to, or aggravation of, posttraumatic stress disorder where the person’s posttraumatic stress disorder was suffered or contracted before or during (but not arising out of) the person’s relevant service.

Inclusion of Statements of Principles

8. In this Statement of Principles if a relevant factor applies and that factor includes an injury or disease in respect of which there is a Statement of Principles then the factors in that last mentioned Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.

Other definitions

9.                  For the purposes of this Statement of Principles:

"a category 1A stressor" means one or more of the following severe traumatic events:

(a)              experiencing a life-threatening event;

(b)              being subject to a serious physical attack or assault including rape and sexual molestation; or

(c)              being threatened with a weapon, being held captive, being kidnapped, or being tortured;

"a category 1B stressor" means one of the following severe traumatic events:

(a)               being an eyewitness to a person being killed or critically injured;

(b)              viewing corpses or critically injured casualties as an eyewitness;

(c)               being an eyewitness to atrocities inflicted on another person or persons;

(d)              killing or maiming a person; or

(e)               being an eyewitness to or participating in, the clearance of critically injured casualties;

"a significant other" means a person who has a close family bond or a close personal relationship and is important or influential in one’s life;

"an eyewitness" means a person who observes an incident first hand and can give direct evidence of it.  This excludes a person exposed only to media coverage of the incident;

"death from posttraumatic stress disorder" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s posttraumatic stress disorder;

"DSM-IV-TR" means the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision.  Washington, DC, American Psychiatric Association, 2000;

"ICD-10-AM code" means a number assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, 10th revision, Australian Modification (ICD-10-AM), Fifth Edition, effective date of 1 July 2006, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 1 86487 772 3;

"relevant service" means:

(a) operational service under the VEA;

(b) peacekeeping service under the VEA;

(c)          hazardous service under the VEA;

(d)          warlike service under the MRCA; or

(e)          non-warlike service under the MRCA;

"terminal event" means the proximate or ultimate cause of death and includes:

(a) pneumonia;

(b) respiratory failure;

(c) cardiac arrest;

(d) circulatory failure; or

(e)          cessation of brain function;

"traumatic death" means death due to homicide, suicide, an accident, or other violent or traumatic circumstances.

Application

10. This Instrument applies to all matters to which section 120A of the VEA or section 338 of the MRCA applies.

Date of effect

11. This Instrument takes effect from 9 January 2008.

Notes to Statement of Principles concerning posttraumatic stress disorder (Instrument No. 5 of 2008)

The Statement of Principles concerning posttraumatic stress disorder (Instrument No. 5 of 2008) in force under section 196B(2) of the Veterans’ Entitlements Act 1986, as shown in this compilation is amended as indicated in the Tables below.

Table of Instruments

Table of Amendments