{"id":"F2021L01455","name":"Statement of Principles concerning chronic fatigue syndrome (Reasonable Hypothesis) (No. 105 of 2021)","slug":"statement-of-principles-concerning-chronic-fatigue-syndrome-reasonable-hypothesis-no-105-of-2021","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441044,"registerId":"F2021L01455-fast-fetch-1775956470556","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning chronic fatigue syndrome (Reasonable Hypothesis) (No. 105 of 2021)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 20.2\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n\n\n \n\nStatement of Principles\n\nconcerning\n\nCHRONIC FATIGUE SYNDROME (Reasonable Hypothesis)\n\n(No. 105 of 2021)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n \n\nDated 22 October 2021\n\n \n\n \n\n \n\n \n\n \n\n| The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:
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Professor Terence Campbell AM
Chairperson
|\n\n\n \n\n \n\n\nContents\n\n1 Name\n\n2 Commencement\n\n3 Authority\n\n4 Repeal\n\n5 Application\n\n6 Definitions\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n8 Basis for determining the factors\n\n9 Factors that must exist\n\n10 Relationship to service\n\n11 Factors referring to an injury or disease covered by another Statement of Principles\n\nSchedule 1 - Dictionary\n\n1 Definitions\n\n \n\n\n\n\n1 Name\n\nThis is the Statement of Principles concerning chronic fatigue syndrome (Reasonable Hypothesis) (No. 105 of 2021).\n\n2 Commencement\n\n This instrument commences on 22 November 2021.\n\n3 Authority\n\nThis instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning chronic fatigue syndrome No. 11 of 2014 (Federal Register of Legislation No. F2014L00013) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004 applies.\n\n6 Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n(1) This Statement of Principles is about chronic fatigue syndrome and death from chronic fatigue syndrome.\n\nMeaning of chronic fatigue syndrome\n\n(2) For the purposes of this Statement of Principles, chronic fatigue syndrome means a syndrome of intense, prolonged fatigue that meets the following diagnostic criteria:\n\n(a) new or definitive onset of severe fatigue that is not improved by bed rest and that may be worsened by physical activity or mental exertion;\n\n(b) the fatigue has persisted for at least 6 consecutive months and is not due to ongoing exertion;\n\n(c) other mental or physical conditions associated with fatigue have been ruled out by a doctor and by any relevant diagnostic testing;\n\n(d) the fatigue significantly interferes with daily activities and work; and\n\n(e) the individual concurrently has 4 or more of the following 8 symptoms:\n\n(i) post-exertion malaise lasting more than 24 hours;\n\n(ii) unrefreshing sleep;\n\n(iii) significant impairment of short-term memory or concentration;\n\n(iv) muscle pain;\n\n(v) pain in the joints without swelling or redness;\n\n(vi) headaches of a new type, pattern, or severity;\n\n(vii) tender lymph nodes in the neck or armpit; or\n\n(viii) a sore throat that is frequent or recurring.\n\nNote 1: Any of these additional symptoms should have persisted or recurred during 6 or more consecutive months of illness and they cannot have first appeared before the fatigue.\n\nNote 2: Other mental and physical conditions that can be associated with severe, chronic fatigue include depressive disorder, bipolar disorder, alcohol use disorder, substance use disorder, schizophrenia, eating disorders, dementia of any type and morbid obesity.\n\nDeath from chronic fatigue syndrome\n\n(3) For the purposes of this Statement of Principles, chronic fatigue syndrome, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's chronic fatigue syndrome.\n\nNote: terminal event is defined in the Schedule 1 - Dictionary.\n\n8 Basis for determining the factors\n\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that chronic fatigue syndrome and death from chronic fatigue syndrome 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 MRCA.\n\nNote: MRCA, relevant service and VEA are defined in the Schedule 1 - Dictionary.\n\n9 Factors that must exist\n\nAt least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting chronic fatigue syndrome or death from chronic fatigue syndrome with the circumstances of a person's relevant service:\n\n(1) having an acute infection from the specified list of infections at the time of the clinical onset of chronic fatigue syndrome;\n\nNote: specified list of infections is defined in the Schedule 1 - Dictionary.\n\n(2) living or working in a hostile or life-threatening environment for a period of at least 4 weeks within the 6 months before the clinical onset of chronic fatigue syndrome;\n\nNote: hostile or life-threatening environment is defined in the Schedule 1 - Dictionary.\n\n(3) experiencing severe childhood abuse before the clinical onset of chronic fatigue syndrome;\n\nNote: severe childhood abuse is defined in the Schedule 1 - Dictionary.\n\n(4) experiencing a category 1A stressor within the 1 year before the clinical onset of chronic fatigue syndrome;\n\nNote: category 1A stressor is defined in the Schedule 1 - Dictionary.\n\n(5) experiencing a category 1B stressor within the 1 year before the clinical onset of chronic fatigue syndrome;\n\nNote: category 1B stressor is defined in the Schedule 1 - Dictionary.\n\n(6) inability to obtain appropriate clinical management for chronic fatigue syndrome.\n\n10 Relationship to service\n\n(1) The existence in a person of any factor referred to in section 9, must be related to the relevant service rendered by the person.\n\n(2) The factor set out in subsection 9(6) applies only to material contribution to, or aggravation of, chronic fatigue syndrome where the person's chronic fatigue syndrome was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n\n11 Factors referring to an injury or disease covered by another Statement of Principles\n\nIn this Statement of Principles:\n\n(1) if a factor referred to in section 9 applies in relation to a person; and\n\n(2) that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(2) of the VEA;\n\nthen the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.\n\n \n\n \n\nSchedule 1 - Dictionary \n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\n category 1A stressor means one of the following severe traumatic events:\n\n(a) experiencing a life-threatening event;\n\n(b) being subject to a serious physical attack or assault including rape and sexual molestation; or\n\n(c) being threatened with a weapon, being held captive, being kidnapped, or being tortured.\n\n category 1B stressor means one of the following severe traumatic events:\n\n(a) killing or maiming a person;\n\n(b) being an eyewitness to a person being killed or critically injured;\n\n(c) being an eyewitness to atrocities inflicted on another person;\n\n(d) participating in the clearance of a corpse or a critically injured casualty; or\n\n(e) viewing a corpse or a critically injured casualty as an eyewitness.\n\nNote: corpse and eyewitness are also defined in the Schedule 1 - Dictionary.\n\n chronic fatigue syndrome—see subsection 7(2).\n\n corpse means the human remains or body parts of one or more persons who have met a violent or horrific death.\n\nNote: Examples of a violent or horrific death may include death due to suicide, gunshot, improvised explosive devices, natural and technological disasters, terrorist attacks or motor vehicle accidents. Seeing a closed body bag or viewing a body in an open-casket coffin are excluded from this definition.\n\n eyewitness means a person who experiences an incident first hand and can give direct evidence of it. This excludes persons exposed only to public broadcasting or mass media coverage of the incident.\n\n 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:\n\n(a) experiencing or being under threat of artillery, missile, rocket, mine or bomb attack;\n\n(b) experiencing or being under threat of nuclear, biological or chemical agent attack; or\n\n(c) being involved in combat or going on combat patrols.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n relevant service means:\n\n(a) operational service under the VEA;\n\n(b) peacekeeping service under the VEA;\n\n(c) hazardous service under the VEA;\n\n(d) British nuclear test defence service under the VEA;\n\n(e) warlike service under the MRCA; or\n\n(f) non-warlike service under the MRCA.\n\nNote: MRCA and VEA are also defined in the Schedule 1 - Dictionary.\n\n severe childhood abuse means:\n\n(a) serious physical, emotional, psychological or sexual harm whilst a child aged under 16 years; or\n\n(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;\n\n 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.\n\n specified list of infections means:\n\n(a) Coxiella burnetii (Q fever);\n\n(b) Epstein-Barr virus (infectious mononucleosis);\n\n(c) Giardia lamblia;\n\n(d) parvovirus B19; or\n\n(e) Ross River virus.\n\n terminal event means the proximate or ultimate cause of death and includes the following:\n\n(a) pneumonia;\n\n(b) respiratory failure;\n\n(c) cardiac arrest;\n\n(d) circulatory failure; or\n\n(e) cessation of brain function.\n\n VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard replacement instrument (repealing No. 11 of 2014) that maintains the established scope of Repatriation Medical Authority determinations. It continues the long-standing practice of creating medical evidentiary gateways for specific conditions under the veterans' compensation framework. The 2021 version appears to be a routine update rather than an expansion beyond the original purpose of establishing service-connection criteria for chronic fatigue syndrome."},"complexity_factors":["Moderate definitional density: 11 defined terms in Schedule 1, including nested definitions (e.g., 'corpse' and 'eyewitness' are defined separately and referenced within 'category 1B stressor')","Cross-referencing structure: Section 11 creates a dynamic incorporation of other Statements of Principles by reference, meaning the full legal framework isn't self-contained","Temporal and conditional requirements: Multiple factors include specific time windows (e.g., 'within 1 year before', 'at least 4 weeks within the 6 months before') that must be precisely calculated","Diagnostic criteria in section 7(2) contain 5 separate elements with 8 sub-elements, creating a checklist-style complexity for medical assessors","Dual statutory framework: The instrument operates across two different Acts (VEA and MRCA) with different service categories, requiring understanding of both compensation schemes"],"plain_english_summary":"This instrument sets the medical rules for when veterans and defence members can claim compensation for chronic fatigue syndrome (CFS) related to service. It defines CFS for claims (persistent fatigue plus specific symptoms) and specifies six distinct factors—e.g. certain infections, prolonged exposure to hostile environments, severe childhood abuse, recent severe trauma, or lack of treatment—that can establish a reasonable hypothesis of service connection. It’s the gateway test for service-related CFS claims."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument repeals the 2014 Statement of Principles and re‑establishes the rules for assessing chronic fatigue syndrome in claims under the VEA and MRCA (section 4, section 5). On its face it continues to apply to the same claim classes and sets explicit diagnostic criteria and an enumerated list of causal factors, but the text does not state whether these provisions broaden or narrow coverage compared to the repealed instrument."},"complexity_factors":["Medical diagnostic criteria require new or definitive onset, ≥6 months duration, exclusion of other causes by a doctor and testing, and concurrent presence of 4 of 8 listed symptoms (section 7(2)(a)–(e), (e)(i)–(viii); Note 2).","A claimant must show at least one enumerated causal factor to raise a reasonable hypothesis: specified infections, hostile/life‑threatening environment exposure, severe childhood abuse, category 1A or 1B stressors, or inability to obtain appropriate clinical management (section 9(1)–(6); Schedule 1 definitions).","Temporal and linkage rules constrain causal claims: specific time windows (e.g. infections at clinical onset; 4+ weeks in a hostile environment within 6 months before onset; stressors within 1 year) and requirement that factors be related to the person's relevant service (sections 9, 10; Schedule 1).","Several technical terms and thresholds are defined in Schedule 1 (e.g. 'hostile or life‑threatening environment', 'severe childhood abuse', 'specified list of infections', 'corpse', 'eyewitness'), creating interpretive tasks for decision‑makers and medical assessors (Schedule 1).","Interaction with other Statements of Principles: where a listed factor refers to an injury/disease covered by another Statement, that other Statement’s factors apply (section 11), adding cross‑instrument dependency.","Administrative and evidentiary burden on claimants: requirement for medical diagnosis, rule‑out of alternative causes, and proof that a listed factor both existed and was related to relevant service (sections 7(2)(c), 9, 10).","Regulatory framing and discretion: the Repatriation Medical Authority relies on its view of 'sound medical‑scientific evidence' as the basis for linking CFS to service (section 8).","Instrument replaces the 2014 Statement (repeal in section 4) and is explicitly limited to claims under specified VEA and MRCA provisions (section 5), which concentrates application on statutory entitlement processes."],"plain_english_summary":"It replaces the prior Statement of Principles and establishes diagnostic criteria plus an enumerated list of causal factors that can raise a 'reasonable hypothesis' linking chronic fatigue syndrome (CFS) or death from CFS to relevant service. It applies to veterans and service members making claims under the Veterans' Entitlements Act or the Military Rehabilitation and Compensation Act and matters because it defines what medical findings and service-related exposures are needed to support entitlement claims."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-chronic-fatigue-syndrome-reasonable-hypothesis-no-105-of-2021","history":"/api/acts/statement-of-principles-concerning-chronic-fatigue-syndrome-reasonable-hypothesis-no-105-of-2021/history","analysis":"/api/acts/statement-of-principles-concerning-chronic-fatigue-syndrome-reasonable-hypothesis-no-105-of-2021/analysis","conflicts":"/api/acts/statement-of-principles-concerning-chronic-fatigue-syndrome-reasonable-hypothesis-no-105-of-2021/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-chronic-fatigue-syndrome-reasonable-hypothesis-no-105-of-2021/important-cases","documents":"/api/acts/statement-of-principles-concerning-chronic-fatigue-syndrome-reasonable-hypothesis-no-105-of-2021/documents"}}