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Statement of Principles concerning fibromyalgia No. 13 of 2014

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Statement of Principles
No. 13 of 2014
for the purposes of the
Veterans’ Entitlements Act 1986
Military Rehabilitation and Compensation Act 2004
1.         This Instrument may be cited as Statement of Principles concerning fibromyalgia No. 13 of 2014.
2.         This Statement of Principles is determined by the Repatriation Medical Authority under subsection 196B(2) of the Veterans’ Entitlements Act 1986 (the VEA).
Kind of injury, disease or death
3.         (a)        This Statement of Principles is about fibromyalgia and death from fibromyalgia.
(b)        For the purposes of this Statement of Principles, "fibromyalgia" means a syndrome of chronic widespread pain with associated somatic symptoms that lasts for at least three months, and which meets the following diagnostic criteria (as outlined in the 2010 American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity) as assessed by a medical practitioner:
(i)                  a widespread pain index of at least 7 and a symptom severity scale score of at least 5; or
(ii)                a widespread pain index from 3 to 6 and a symptom severity scale score of at least 9; and
(iii)              the pain and symptoms are not better accounted for by another medical or psychiatric condition.
(c)        Fibromyalgia attracts ICD-10-AM code M79.7.
(d)       In the application of this Statement of Principles, the definition of "fibromyalgia" 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 fibromyalgia and death from fibromyalgia 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.
6.         The factor that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting fibromyalgia or death from fibromyalgia with the circumstances of a person’s relevant service is:
(a)                being the victim of severe childhood abuse before the clinical onset of fibromyalgia; or
(b)               being obese at the time of the clinical onset of fibromyalgia; or
(c)                having inflammatory arthritis at the time of the clinical onset of fibromyalgia; or
(d)               inability to obtain appropriate clinical management for fibromyalgia.
Factors that apply only to material contribution or aggravation
7.         Paragraph 6(d) applies only to material contribution to, or aggravation of, fibromyalgia where the person’s fibromyalgia 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:
"being obese" means an increase in body weight by way of fat accumulation which results in a Body Mass Index (BMI) of 30 or greater.
The BMI = W/H2 and where:
W is the person’s weight in kilograms; and
H is the person’s height in metres;
"death from fibromyalgia" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s fibromyalgia;
"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), Eighth Edition, effective date of 1 July 2013, copyrighted by the Independent Hospital Pricing Authority, and having ISBN 978-1-74128-213-9;
"inflammatory arthritis" means an autoimmune inflammatory condition which is associated with the development of arthritis;
"relevant service" means:
(a)                operational service under the VEA;
(b)                peacekeeping service under the VEA;
(c)                hazardous service under the VEA;
(d)               British nuclear test defence service under the VEA;
(e)                warlike service under the MRCA; or
(f)                 non-warlike service under the MRCA;
"severe childhood abuse" means:
(a)                serious physical, emotional, psychological or sexual harm whilst a child aged under 16 years; or
(b)               neglect involving a serious failure to provide the necessities for health, physical and emotional development, or wellbeing whilst a child aged under 16 years;
where such serious harm or neglect has been perpetrated by a parent, a care provider, an adult who works with or around that child, or any other adult in contact with that child;
"specified areas" means the following anatomic sites: left shoulder girdle, right shoulder girdle, left upper arm, right upper arm, left lower arm, right lower arm, left hip, right hip, left upper leg, right upper leg, left lower leg, right lower leg, left jaw, right jaw, chest, abdomen, upper back, lower back and neck;
"symptom severity scale score" means the sum of the severity of three symptoms (fatigue, waking unrefreshed and cognitive symptoms) plus the extent of somatic symptoms in general, scored from 0 to 12, where:
(a)                the level of severity is defined as:
0 = no problem;
1 = slight or mild problems, generally mild or intermittent;
2 = moderate, considerable problems, often present or at a moderate level; or
3 = severe, pervasive, continuous, life-disturbing problems; and
(b)               the extent of somatic symptoms is defined as:
0 = no symptoms;
1 = few symptoms;
2 = a moderate number of symptoms; or
3 = a great deal of symptoms;
"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;
"widespread pain index" means the count of the number of specified areas where the person has had pain in the last week, scored from 0 to19.
Date of effect
10.       This Instrument takes effect from 15 January 2014.
Dated this   nineteenth   day of   December   2013
The Common Seal of the                    )
Repatriation Medical Authority          )
was affixed at the direction of:          )