Statement of Principles
concerning
 
SOMATIC SYMPTOM DISORDER
No. 24 of 2014
 
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 somatic symptom disorder No. 24 of 2014.
Determination
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 somatic symptom disorder and death from somatic symptom disorder.
(b)        For the purposes of this Statement of Principles, "somatic symptom disorder" means a mental disorder characterised by one or more somatic symptoms which has been diagnosed by a psychiatrist and which meets the following criteria (derived from DSM-5):
A.                The symptom or symptoms are distressing and result in significant disruption of daily life; and
B.                Excessive thoughts, feelings, or behaviours related to the somatic symptoms or associated health concerns as manifested by at least two of the following:
(i)                 Disproportionate and persistent thoughts about the seriousness of one's symptoms;
(ii)               Persistently high level of anxiety about health or symptoms; or
(iii)             Excessive time and energy devoted to these symptoms or health concerns; and
C.                Although any one somatic symptom may not be continuously present, the state of being symptomatic has persisted for at least six months.
(c)        Somatic symptom disorder attracts ICD-10-AM code F45.1.
(d)       In the application of this Statement of Principles, the definition of "somatic symptom 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 somatic symptom disorder and death from somatic symptom 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 somatic symptom disorder or death from somatic symptom disorder with the circumstances of a person’s relevant service is:
(a)                being the victim of severe childhood abuse before the clinical onset of somatic symptom disorder; or
(b)               inability to obtain appropriate clinical management for somatic symptom disorder.
Factors that apply only to material contribution or aggravation
7.         Paragraph 6(b) applies only to material contribution to, or aggravation of, somatic symptom disorder where the person’s somatic symptom 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:
"death from somatic symptom disorder" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s somatic symptom disorder;
"DSM-5" means the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.  Arlington, VA, American Psychiatric Association, 2013;
"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;
"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;
"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.
Date of effect
10.       This Instrument takes effect from 26 March 2014.
Dated this   fourteenth   day of   March   2014
The Common Seal of the                    )
Repatriation Medical Authority          )
was affixed to this instrument                        )
in the presence of:                               )
PROFESSOR NICHOLAS SAUNDERS AO
CHAIRPERSON