Statement of Principles
CHRONIC MULTISYMPTOM ILLNESS
No. 55 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 chronic multisymptom illness No. 55 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 chronic multisymptom illness and death from chronic multisymptom illness.
(b) For the purposes of this Statement of Principles, "chronic multisymptom illness" means a condition characterised by multiple somatic symptoms which has been diagnosed by a specialist physician or a psychiatrist and which meets the following criteria:
A. There are one or more current symptoms from two of the following three categories and at least one symptom in each of the categories must be rated as severe:
(ii) mood-cognition: feeling depressed, difficulty remembering or concentrating, feeling moody, feeling anxious, trouble finding words or difficulty sleeping; or
(iii) musculoskeletal: joint pain, joint stiffness or muscle pain; and
B. The collection of symptoms relied upon to make the diagnosis is distressing and results in severe disruption of social and occupational functioning; and
C. The collection of symptoms relied upon to make the diagnosis must have persisted for at least six consecutive months; and
D. Any or all of the symptoms are not better explained by another medical or psychiatric condition.
Basis for determining the factors
4. The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that chronic multisymptom illness and death from chronic multisymptom illness 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 chronic multisymptom illness or death from chronic multisymptom illness with the circumstances of a person’s relevant service is:
(a) living or working in a hostile or life-threatening environment for a period of at least one month in the six months before the clinical onset of chronic multisymptom illness; or
(b) experiencing a category 1A stressor in the six months before the clinical onset of chronic multisymptom illness; or
(c) experiencing a category 1B stressor in the six months before the clinical onset of chronic multisymptom illness; or
(d) inability to obtain appropriate clinical management for chronic multisymptom illness.
Factors that apply only to material contribution or aggravation
7. Paragraph 6(d) applies only to material contribution to, or aggravation of, chronic multisymptom illness where the person’s chronic multisymptom illness 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.
9. For the purposes of this Statement of Principles:
"a category 1A stressor" means one 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 hostile or life-threatening environment" means a situation or setting which is characterised by a pervasive threat to life or bodily integrity, such as would be experienced in the following circumstances:
(a) experiencing or being under threat of artillery, missile, rocket, mine or bomb attack; or
(b) experiencing or being under threat of nuclear, biological or chemical agent attack; or
(c) being involved in combat or going on combat patrols;
"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 chronic multisymptom illness" in relation to a person includes death from a terminal event or condition that was contributed to by the person’s chronic multisymptom illness;
"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;
"terminal event" means the proximate or ultimate cause of death and includes:
(b) respiratory failure;
(c) cardiac arrest;
(d) circulatory failure; or
(e) cessation of brain function.
Date of effect
10. This Instrument takes effect from 14 May 2014.
Dated this eighth day of May 2014
The Common Seal of the )
Repatriation Medical Authority )
was affixed at the direction of: )
PROFESSOR NICHOLAS SAUNDERS AO