{"id":"F2024L00045","name":"Statement of Principles concerning depressive disorder (Reasonable Hypothesis) (No. 11 of 2024)","slug":"statement-of-principles-concerning-depressive-disorder-reasonable-hypothesis-no-11-of-2024","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442249,"registerId":"F2024L00045-fast-fetch-1775957295158","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning depressive disorder (Reasonable Hypothesis) (No. 11 of 2024)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n\n\n \n\nStatement of Principles\n\nconcerning\n\nDEPRESSIVE DISORDER (Reasonable Hypothesis)\n\n(No. 11 of 2024)\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 December 2023.\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 depressive disorder (Reasonable Hypothesis) (No. 11 of 2024).\n\n2 Commencement\n\n This instrument commences on 22 January 2024.\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 depressive disorder No. 83 of 2015 (Federal Register of Legislation No. F2015L00915) made under subsections 196B(2) and (8) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 depressive disorder and death from depressive disorder.\n\nMeaning of depressive disorder\n\n(2) For the purposes of this Statement of Principles, depressive disorder means:\n\n(a) major depressive disorder; or\n\n(b) major depressive episode; or\n\n(c) persistent depressive disorder (including dysthymia); or\n\n(d) depressive disorder due to another medical condition; or\n\n(e) substance/medication-induced depressive disorder; or\n\n(f) premenstrual dysphoric disorder; or\n\n(g) other specified depressive disorder or unspecified depressive disorder; where:\n\n(3) major depressive disorder meets the following criteria (derived from DSM-5-TR):\n\n(a) Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either depressed mood or loss of interest or pleasure.\n\n(i) Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful).\n\n Note: In children and adolescents, can be irritable mood.\n\n(ii) Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).\n\n(iii) Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.\n\n(iv) Insomnia or hypersomnia nearly every day.\n\n(v) Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).\n\n(vi) Fatigue or loss of energy nearly every day.\n\n(vii) Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).\n\n(viii) Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).\n\n(ix) Recurrent thoughts of death (not just fear of dying); recurrent suicidal ideation without a specific plan; a specific suicide plan; or a suicide attempt.\n\n(b) The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.\n\n(c) The episode is not attributable to the physiological effects of a substance or another medical condition.\n\n(d) At least one major depressive episode is not better explained by schizoaffective disorder and is not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.\n\n(e) There has never been a manic episode or a hypomanic episode.\n\nNote: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance-induced or are attributable to the physiological effects of another medical condition.\n\n(4) major depressive episode meets the following criteria (derived from DSM-5-TR):\n\n(a) Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either depressed mood or loss of interest or pleasure.\n\n(i) Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful).\n\n Note: In children and adolescents, can be irritable mood.\n\n(ii) Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).\n\n(iii) Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.\n\n(iv) Insomnia or hypersomnia nearly every day.\n\n(v) Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).\n\n(vi) Fatigue or loss of energy nearly every day.\n\n(vii) Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).\n\n(viii) Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).\n\n(ix) Recurrent thoughts of death (not just fear of dying); recurrent suicidal ideation without a specific plan; a specific suicide plan; or a suicide attempt.\n\n(b) The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.\n\n(c) The episode is not attributable to the physiological effects of a substance or another medical condition.\n\n(5) persistent depressive disorder (dysthymia) meets the following criteria (derived from DSM-5-TR):\n\n(a) Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years.\n\n Note: In children and adolescents, mood can be irritable and duration must be at least 1 year.\n\n(b) Presence, while depressed, of two (or more) of the following:\n\n(i) Poor appetite or overeating.\n\n(ii) Insomnia or hypersomnia.\n\n(iii) Low energy or fatigue.\n\n(iv) Low self-esteem.\n\n(v) Poor concentration or difficulty making decisions.\n\n(vi) Feelings of hopelessness.\n\n(c) During the 2-year period (1 year for children or adolescents) of the disturbance, the individual has never been without the symptoms in Criteria (a) and (b) for more than 2 months at a time.\n\n(d) Criteria for a major depressive disorder may be continuously present for 2 years.\n\n(e) There has never been a manic episode or a hypomanic episode.\n\n(f) The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.\n\n(g) The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hypothyroidism).\n\n(h) The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.\n\n(6) depressive disorder due to another medical condition meets the following criteria (derived from DSM-5-TR):\n\n(a) A prominent and persistent disturbance in mood that predominates in the clinical picture and is characterized by depressed mood or markedly diminished interest or pleasure in all, or almost all, activities.\n\n(b) There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.\n\n(c) The disturbance is not better explained by another mental disorder (e.g., adjustment disorder, with depressed mood, in which the stressor is a serious medical condition).\n\n(d) The disturbance does not occur exclusively during the course of a delirium.\n\n(e) The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning.\n\n(7) substance/medication-induced depressive disorder meets the following criteria (derived from DSM-5-TR):\n\n(a) A prominent and persistent disturbance in mood that predominates in the clinical picture and is characterised by depressed mood or markedly diminished interest or pleasure in all, or almost all, activities.\n\n(b) There is evidence from the history, physical examination, or laboratory findings of both (i) and (ii):\n\n(i) The symptoms in Criterion (a) developed during or soon after substance intoxication or withdrawal or after exposure to or withdrawal from a medication.\n\n(ii) The involved substance/medication is capable of producing the symptoms in Criterion (a).\n\n(c) The disturbance is not better explained by a depressive disorder that is not substance/medication-induced. Such evidence of an independent depressive disorder could include the following:\n\n(i) the symptoms preceded the onset of the substance/medication use;\n\n(ii) the symptoms persist for a substantial period of time (e.g., about 1 month) after the cessation of acute withdrawal or severe intoxication; or\n\n(iii) there is other evidence suggesting the existence of an independent non-substance/medication-induced depressive disorder (e.g., a history of recurrent non-substance/medication-related episodes).\n\n(d) The disturbance does not occur exclusively during the course of a delirium.\n\n(e) The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.\n\n(8) premenstrual dysphoric disorder meets the following criteria (derived from DSM-5-TR):\n\n(a) In the majority of menstrual cycles, at least 5 symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses.\n\n(b) One (or more) of the following symptoms must be present:\n\n(i) Marked affective lability (e.g., mood swings; feeling suddenly sad or tearful, or increased sensitivity to rejection).\n\n(ii) Marked irritability or anger or increased interpersonal conflicts.\n\n(iii) Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts.\n\n(iv) Marked anxiety, tension, and/or feelings of being keyed up or on edge.\n\n(c) One (or more) of the following symptoms must additionally be present, to reach a total of 5 symptoms when combined with symptoms from Criterion (b) above.\n\n(i) Decreased interest in usual activities (e.g., work, school, friends, hobbies).\n\n(ii) Subjective difficulty in concentration.\n\n(iii) Lethargy, easy fatigability, or marked lack of energy.\n\n(iv) Marked change in appetite; overeating; or specific food cravings.\n\n(v) Hypersomnia or insomnia.\n\n(vi) A sense of being overwhelmed or out of control.\n\n(vii) Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain.\n\nNote: The symptoms in Criteria a–c must have been met for most menstrual cycles that occurred in the preceding year.\n\n(d) The symptoms cause clinically significant distress or interference with work, school, usual social activities, or relationships with others (e.g., avoidance of social activities; decreased productivity and efficiency at work, school, or home).\n\n(e) The disturbance is not merely an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, persistent depressive disorder, or a personality disorder (although it may co-occur with any of these disorders).\n\n(f) Criterion (a) should be confirmed by prospective daily ratings during at least two symptomatic cycles.\n\n(g) The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or another medical condition (e.g., hyperthyroidism).\n\n(9) other specified depressive disorder and unspecified depressive disorder have prominent symptoms of depression that cause clinically significant distress or impairment in social, occupational or other important areas of functioning, however, these depressive symptoms do not meet the full criteria for any of the other depressive disorders (derived from DSM-5-TR).\n\n(10) Depressive disorder excludes disruptive mood dysregulation disorder and unspecified mood disorder.\n\nNote: DSM-5-TR is defined in the Schedule 1 – Dictionary.\n\nDeath from depressive disorder\n\n(11) For the purposes of this Statement of Principles, depressive disorder, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's depressive disorder.\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 depressive disorder and death from depressive 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 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 depressive disorder or death from depressive disorder with the circumstances of a person's relevant service:\n\n(1) being a prisoner of war before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;\n\n(2) experiencing a category 1A stressor within the 5 years before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;\n\nNote: category 1A stressor is defined in the Schedule 1 – Dictionary.\n\n(3) experiencing a category 1B stressor within the 5 years before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;\n\nNote: category 1B stressor is defined in the Schedule 1 – Dictionary.\n\n(4) experiencing severe childhood abuse before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;\n\nNote: severe childhood abuse is defined in the Schedule 1 – Dictionary.\n\n(5) experiencing a potentially morally injurious event within the 5 years before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;\n\nNote: potentially morally injurious event is defined in the Schedule 1 – Dictionary.\n\n(6) having a family member or close friend who experiences a category 1A stressor within the 2 years before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;\n\nNote: category 1A stressor is defined in the Schedule 1 - Dictionary.\n\n(7) experiencing the death of a family member or close friend within the 5 years before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;\n\n(8) experiencing miscarriage, fetal death in utero or stillbirth as a parent, within the 6 months before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;\n\n(9) experiencing a category 2 stressor within the one year before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;\n\nNote 1: A category 2 stressor can arise in a variety of circumstances connected with service. Such circumstances can arise during the course of service, as a result of separation from service and the conditions associated with that separation, and in the transition to civilian life in the years following separation.\n\nNote 2: category 2 stressor is defined in the Schedule 1 - Dictionary.\n\n(10) having a clinically significant disorder of mental health within the 5 years before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;\n\nNote: clinically significant disorder of mental health is defined in the Schedule 1 - Dictionary.\n\n(11) having a sleep-wake disorder for at least the 6 months before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;\n\nNote: Examples of sleep-wake disorders include chronic insomnia disorder, hypersomnolence disorder, narcolepsy, restless legs syndrome and untreated obstructive sleep apnoea.\n\n(12) having an injury which is life-threatening or which results in serious physical or cognitive disability, within the 5 years before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;\n\n(13) having a severe, chronic medical condition for at least the 2 years before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;\n\nNote: severe, chronic medical condition is defined in the Schedule 1 - Dictionary.\n\n(14) having epilepsy at the time of the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;\n\n(15) having severe and permanent tinnitus at the time of the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;\n\nNote: severe and permanent tinnitus is defined in the Schedule 1 - Dictionary.\n\n(16) having persistent pain of at least 3 months duration at the time of the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;\n\nNote: persistent pain is defined in the Schedule 1 - Dictionary.\n\n(17) having untreated or unsuccessfully treated vitamin D deficiency, with a serum 25-hydroxyvitamin D level of less than 25 nanomoles per litre, at the time of the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;\n\n(18) being obese at the time of the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;\n\nNote: being obese is defined in the Schedule 1 - Dictionary.\n\n(19) experiencing pregnancy or the first 12 months after childbirth as a parent, at the time of the clinical onset of major depressive disorder, major depressive episode or persistent depressive disorder;\n\n(20) being in the menopausal transition or within the 2 years after the final menstrual period at the time of the clinical onset of major depressive disorder, major depressive episode or persistent depressive disorder;\n\nNote: menopausal transition is defined in the Schedule 1 - Dictionary.\n\n(21) having another medical condition, including an endocrine, cardiovascular, respiratory, metabolic, infectious or neurological disorder, where the signs or symptoms of depression are directly related to the pathological process of the medical condition and not solely due to its psychosocial stress effects, at the time of the clinical onset of “depressive disorder due to another medical condition”;\n\n(22) taking mefloquine or corticosteroids, excluding topical or inhaled corticosteroids, within the 30 days before the clinical onset of substance/medication-induced depressive disorder, where substance/medication-induced depressive disorder persists after the discontinuation or tapering of mefloquine or corticosteroid therapy;\n\n(23) using a psychoactive substance from the specified list of psychoactive substances at an intoxicant dose within the 30 days before the clinical onset of substance/medication-induced depressive disorder;\n\nNote: intoxicant dose and specified list of psychoactive substances are defined in the Schedule 1 – Dictionary.\n\n(24) taking a drug that cannot be ceased or substituted in the long term and which is associated in the individual with the development of depressive symptoms during drug therapy and either:\n\n(a) the improvement of depressive symptoms within days or weeks of discontinuing or tapering drug therapy; or\n\n(b) the redevelopment of depressive symptoms on rechallenge with the same drug;\n\nwhere the drug was being taken within the 30 days before the clinical onset of substance/medication-induced depressive disorder;\n\n(25) using a psychoactive chemical or substance at an intoxicant dose, which is associated in the individual with the development of depressive symptoms, and where the psychoactive chemical or substance was being taken within the 30 days before the clinical onset of substance/medication-induced depressive disorder;\n\nNote: intoxicant dose is defined in the Schedule 1 – Dictionary.\n\n(26) having ceased or reduced therapeutic or illicit drug use or other substance use within the 30 days before the clinical onset of substance/medication-induced depressive disorder;\n\n(27) having an alcohol use disorder or a substance use disorder at the time of the clinical onset of substance/medication-induced depressive disorder;\n\n(28) having smoked tobacco products:\n\n(a) on an average of at least 20 cigarettes per day or the equivalent thereof in other tobacco products; and\n\n(b) for at least the 2 years before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder, premenstrual dysphoric disorder or substance/medication-induced depressive disorder; and\n\nif smoking has ceased before the clinical onset then that onset occurred within 6 months of cessation;\n\nNote: cigarettes per day or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary.\n\n(29) inhaling, ingesting or having cutaneous contact with organic solvents, in an unventilated and confined space, on more days than not for a continuous period of at least 5 years before the clinical onset of substance/medication-induced depressive disorder, and where the clinical onset occurs within 2 years of that period;\n\n(30) having an episode of acute cholinergic poisoning from exposure to an organophosphorus ester or paraquat poisoning within the 30 days before the clinical onset of substance/medication-induced depressive disorder;\n\nNote: acute cholinergic poisoning, organophosphorus ester and paraquat are defined in the Schedule 1 – Dictionary.\n\n(31) being a prisoner of war before the clinical worsening of depressive disorder;\n\n(32) experiencing a category 1A stressor within the 5 years before the clinical worsening of depressive disorder;\n\nNote: category 1A stressor is defined in the Schedule 1 – Dictionary.\n\n(33) experiencing a category 1B stressor within the 5 years before the clinical worsening of depressive disorder;\n\nNote: category 1B stressor is defined in the Schedule 1 – Dictionary.\n\n(34) experiencing severe childhood abuse before the clinical worsening of depressive disorder;\n\nNote: severe childhood abuse is defined in the Schedule 1 – Dictionary.\n\n(35) experiencing a potentially morally injurious event within the 5 years before the clinical worsening of depressive disorder;\n\nNote: potentially morally injurious event is defined in the Schedule 1 – Dictionary.\n\n(36) having a family member or close friend who experiences a category 1A stressor within the 2 years before the clinical worsening of depressive disorder;\n\nNote: category 1A stressor is defined in the Schedule 1 - Dictionary.\n\n(37) experiencing the death of a family member or close friend within the 5 years before the clinical worsening of depressive disorder;\n\n(38) experiencing miscarriage, fetal death in utero or stillbirth as a parent, within the 6 months before the clinical worsening of depressive disorder;\n\n(39) experiencing a category 2 stressor within the 1 year before the clinical worsening of depressive disorder;\n\nNote 1: A category 2 stressor can arise in a variety of circumstances connected with service. Such circumstances can arise during the course of service, as a result of separation from service and the conditions associated with that separation, and in the transition to civilian life in the years following separation.\n\nNote 2: category 2 stressor is defined in the Schedule 1 - Dictionary.\n\n(40) having a clinically significant disorder of mental health within the 5 years before the clinical worsening of depressive disorder;\n\nNote: clinically significant disorder of mental health is defined in the Schedule 1 - Dictionary.\n\n(41) having a sleep-wake disorder for the 6 months before the clinical worsening of depressive disorder;\n\nNote: Examples of sleep-wake disorders include chronic insomnia disorder, hypersomnolence disorder, narcolepsy, restless legs syndrome and untreated obstructive sleep apnoea.\n\n(42) having an injury which is life-threatening or which results in serious physical or cognitive disability, within the 5 years before the clinical worsening of depressive disorder;\n\n(43) having a severe, chronic medical condition for at least the 2 years before the clinical worsening of depressive disorder;\n\nNote: severe, chronic medical condition is defined in the Schedule 1 - Dictionary.\n\n(44) having epilepsy at the time of the clinical worsening of depressive disorder;\n\n(45) having severe and permanent tinnitus at the time of the clinical worsening of depressive disorder;\n\nNote: severe and permanent tinnitus is defined in the Schedule 1 - Dictionary.\n\n(46) having persistent pain of at least 3 months duration at the time of the clinical worsening of depressive disorder;\n\nNote: persistent pain is defined in the Schedule 1 - Dictionary.\n\n(47) having untreated or unsuccessfully treated vitamin D deficiency, with a serum 25-hydroxyvitamin D level of less than 25 nanomoles per litre, at the time of the clinical worsening of depressive disorder;\n\n(48) being obese at the time of the clinical worsening of depressive disorder;\n\nNote: being obese is defined in the Schedule 1 - Dictionary.\n\n(49) experiencing pregnancy or the first 12 months after childbirth as a parent, at the time of the clinical worsening of depressive disorder;\n\n(50) being in the menopausal transition or within the 2 years after the final menstrual period at the time of the clinical worsening of depressive disorder;\n\nNote: menopausal transition is defined in the Schedule 1 - Dictionary.\n\n(51) having another medical condition, including an endocrine, cardiovascular, respiratory, metabolic, infectious or neurological disorder, where the signs or symptoms of depression are directly related to the pathological process of the medical condition and not solely due to its psychosocial stress effects, at the time of the clinical worsening of depressive disorder;\n\n(52) taking mefloquine or corticosteroids, excluding topical or inhaled corticosteroids, within the 30 days before the clinical worsening of depressive disorder, where depressive disorder persists after the discontinuation or tapering of mefloquine or corticosteroid therapy;\n\n(53) using a psychoactive substance from the specified list of psychoactive substances at an intoxicant dose within the 30 days before the clinical worsening of depressive disorder;\n\nNote: intoxicant dose and specified list of psychoactive substances are defined in the Schedule 1 – Dictionary.\n\n(54) taking a drug that cannot be ceased or substituted in the long term and which is associated in the individual with the worsening of depressive symptoms during drug therapy and either:\n\n(a) the improvement of depressive symptoms within days or weeks of discontinuing or tapering drug therapy; or\n\n(b) the worsening of depressive symptoms on rechallenge with the same drug;\n\nwhere the drug was being taken within the 30 days before the clinical worsening of depressive disorder;\n\n(55) using a psychoactive chemical or substance at an intoxicant dose, which is associated in the individual with the worsening of depressive symptoms, and where the psychoactive chemical or substance was being taken within the 30 days before the clinical worsening of depressive disorder;\n\nNote: intoxicant dose is defined in the Schedule 1 – Dictionary.\n\n(56) having ceased or reduced therapeutic or illicit drug use or other substance use within the 30 days before the clinical worsening of depressive disorder;\n\n(57) having an alcohol use disorder or a substance use disorder at the time of the clinical worsening of depressive disorder;\n\n(58) inhaling, ingesting or having cutaneous contact with organic solvents, in an unventilated and confined space, on more days than not for a continuous period of at least 5 years before the clinical worsening of depressive disorder, and where the clinical worsening occurs within 2 years of that period;\n\n(59) having an episode of acute cholinergic poisoning from exposure to an organophosphorus ester or paraquat poisoning within the 30 days before the clinical worsening of depressive disorder;\n\nNote: acute cholinergic poisoning, organophosphorus ester and paraquat are defined in the Schedule 1 – Dictionary.\n\n(60) inability to obtain appropriate clinical management for depressive disorder before the clinical worsening of depressive disorder.\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 factors set out in subsections 9(31) to 9(60) apply only to material contribution to, or aggravation of, depressive disorder where the person's depressive disorder 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 acute cholinergic poisoning means symptoms and signs due to the inhibition of acetylcholinesterase enzyme activity which occur within 24 hours following exposure. These symptoms and signs are acute paralysis, overwhelming bronchial secretions, bradycardia, gastrointestinal distress, miosis, lacrimation and diarrhoea.\n\n being obese means having a Body Mass Index (BMI) of 30 or greater.\n\nNote: BMI is defined in the Schedule 1 - Dictionary.\n\n BMI means W/H2 where:\n\n(a) W is the person's weight in kilograms; and\n\n(b) H is the person's height in metres.\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 a witness to a person being killed or critically injured;\n\n(c) being a witness 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 a witness.\n\nNote: corpse and witness are defined in the Schedule 1 – Dictionary.\n\n category 2 stressor means one of the following negative life events, the effects of which are chronic in nature and cause the person to feel on-going distress, concern or worry:\n\n(a) being socially isolated and unable to maintain friendships or family relationships, due to physical location, ethnicity, sexuality, disability, or medical or psychiatric illness;\n\n(b) experiencing a problem with a long-term relationship including the break-up of a close personal relationship, the need for marital or relationship counselling, marital separation, or divorce;\n\n(c) having concerns in the work or school environment including on-going disharmony with fellow work or school colleagues, perceived lack of social support within the work or school environment, perceived lack of control over tasks performed and stressful workloads, or experiencing bullying in the workplace or school environment;\n\n(d) experiencing serious legal issues including being detained or held in custody, on-going involvement with the police concerning violations of the law, or court appearances associated with personal legal problems;\n\n(e) having severe financial hardship including loss of employment, long periods of unemployment, foreclosure on a property, or bankruptcy; or\n\n(f) having a family member or close friend experience a major deterioration in their health.\n\n cigarettes per day or the equivalent thereof in other tobacco products means:\n\n(a) cigarettes, pipe tobacco or cigars, alone or in any combination; and\n\n(b) one gram of cigar, pipe or other smoking tobacco (including roll your own smoking tobacco) is equivalent to one tailor made cigarette.\n\n clinically significant disorder of mental health means one of the following conditions, which is of sufficient severity to warrant ongoing management:\n\n(a) alcohol use disorder;\n\n(b) another depressive disorder;\n\n(c) anxiety disorder;\n\n(d) disruptive, impulse-control or conduct disorder;\n\n(e) dissociative disorder;\n\n(f) elimination disorder;\n\n(g) feeding or eating disorder;\n\n(h) gambling disorder;\n\n(i) gender dysphoria;\n\n(j) neurocognitive disorder (including vascular neurocognitive disorder and Alzheimer disease);\n\n(k) neurodevelopmental disorder;\n\n(l) obsessive compulsive or related disorder;\n\n(m) paraphilic disorder;\n\n(n) personality disorder;\n\n(o) schizophrenia spectrum or other psychotic disorder (including schizophrenia);\n\n(p) sexual dysfunction;\n\n(q) somatic symptom disorder or related disorder;\n\n(r) substance use disorder; or\n\n(s) trauma- and stressor-related disorder (including acute stress disorder, adjustment disorder and posttraumatic stress disorder).\n\nNote 1: Management of the condition may involve regular visits (for example, at least monthly) to a psychiatrist, counsellor or general practitioner.\n\nNote 2: To warrant ongoing management does not require that any actual management was received or given for the condition.\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 depressive disorder—see Section 7.\n\n DSM-5-TR means the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2022.\n\n inhalants means breathable chemicals that produce psychoactive vapours or fumes and include organic solvents, aerosols and anaesthetics.\n\n intoxicant dose means a dose sufficient to cause disturbances in level of consciousness, cognition, perception, affect or behaviour, or other psychophysiological functions and responses.\n\n menopausal transition means the time from when the first menopausal symptoms appear until there has been no menstrual period for 12 consecutive months.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n organophosphorus ester means an agent used to inhibit acetylcholinesterase, and includes the organophosphate pesticides chlorpyrifos, dichlorvos, EPN, leptophos, methamidophos, mipafox (diisopropyl phosphorofluoridate), omethoate, parathion, TOCP (tri-ortho-cresyl phosphate), trichlorfon and trichlornat.\n\n paraquat means a dipyridilium compound whose dichloride and\n\n dimethylsulphate salts are used as contact herbicides.\n\n persistent pain means:\n\n(a) continuous; or\n\n(b) severe, frequent and intermittent pain;\n\n which may or may not be ameliorated by analgesic medication and is of a level to cause interference with usual work or activities of daily living.\n\n potentially morally injurious event means an event that transgresses a person’s deeply held moral beliefs and expectations.\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 and permanent tinnitus means tinnitus that is present every day and requires use of a tinnitus masking device or causes loss of concentration, extreme discomfort and interferes with sleep.\n\n \n\n severe childhood abuse means:\n\n(a) serious physical, emotional, psychological or sexual harm whilst a child aged under 18 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 18 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 severe, chronic medical condition means an illness that:\n\n(a) substantially impacts on social, occupational or other important areas of functioning; and\n\n(b) requires on-going daily or almost daily management of symptoms under the supervision of a registered health practitioner, including assistance with activities of daily living, bed rest, dietary modification, drug therapy, nursing care, oxygen therapy and physiotherapy; and\n\n(c) is of a type that does not usually resolve spontaneously, is rarely cured completely and may progress to a life-threatening illness.\n\nNote: Examples of severe, chronic medical conditions include chronic kidney disease requiring dialysis, severe psoriasis, poorly controlled asthma and poorly controlled diabetes mellitus.\n\n specified list of psychoactive substances means:\n\n(a) amphetamine or amphetamine-type substances, including methamphetamine and 3,4-methylenedioxymethamphetamine (ecstasy);\n\n(b) cannabis;\n\n(c) cocaine;\n\n(d) hallucinogens (including phencyclidine);\n\n(e) inhalants; or\n\n(f) opioids.\n\nNote: inhalants is defined in the Schedule 1 – Dictionary.\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 witness means a person who experiences an incident at the time it occurs and can give direct evidence of it. This excludes persons exposed only to public broadcasting or mass media coverage of the incident.\n\n \n\n \n","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":7,"scope_assessment":{"changed":false,"description":"This instrument appears consistent with the original purpose of Statements of Principles under the Veterans' Entitlements Act 1986. It updates and replaces the 2015 version (No. 83 of 2015), incorporating newer medical understanding (DSM-5-TR rather than earlier editions) and expanding recognised risk factors to include contemporary military health concerns like moral injury, mefloquine exposure, and specific deployment-related stressors. While the list of factors has grown substantially (60 factors vs fewer in earlier versions), this reflects evolving medical-scientific evidence rather than mission creep beyond the original legislative purpose of determining service-related compensation for veterans' health conditions."},"complexity_factors":["Extensive cross-referencing to external medical standards (DSM-5-TR) with detailed diagnostic criteria spanning multiple subsections","60 separate factors with varying timeframes (30 days, 6 months, 1 year, 2 years, 5 years) and different applicability to onset vs worsening","27 defined terms in Schedule 1, many with nested definitions (e.g., 'category 1A stressor' defined by listing specific traumatic events)","Complex conditional logic: factors apply differently depending on whether depression is new (clinical onset) or worsening, and whether it arose before/during/after service","Multiple exclusion clauses and caveats (e.g., substance-induced depression exclusions, notes about closed body bags not counting as 'corpse' exposure)","Dual legislative framework application (VEA and MRCA) with different service types defined","Medical terminology requiring specialist knowledge (psychomotor agitation, hypomanic episodes, schizoaffective disorder, organophosphorus esters)","Circular and interdependent definitions (e.g., 'depressive disorder' refers to section 7, which refers to DSM-5-TR, which is defined in Schedule 1)"],"plain_english_summary":"The instrument is a Repatriation Medical Authority Statement of Principles that sets the medical test for when depression is compensable for veterans and current/former defence members (and their families in fatal cases). It defines multiple depressive disorders using DSM‑5‑TR criteria and lists 60 service‑related factors—ranging from severe trauma and moral injury to chronic pain, sleep disorders, medications and workplace stress—that can link depression to military service. It determines access to pensions, treatment and rehabilitation."},"flash_summary":{"complexity_score":7,"scope_assessment":{"changed":false,"description":"This instrument repeals and replaces the earlier 2015 Statement of Principles for depressive disorder but remains squarely within the original purpose: setting medical criteria for linking depressive disorder to relevant service for VEA/MRCA claims (sections 3–5, 7–11). The 2024 version refines and updates diagnostic detail, adds or clarifies a number of specific risk factors and temporal windows (for example explicit vitamin D thresholds, named drug exposures like mefloquine and corticosteroids, organic solvent and organophosphate/paraquat exposures, and definitions for morally injurious events), but it does not broaden the SOP into a new policy domain. It is therefore an update and technical elaboration rather than a substantive enlargement of scope beyond the SOP function it has always performed."},"complexity_factors":["Long, detailed DSM‑5‑TR diagnostic criteria for multiple depressive subtypes (section 7, subsections (2)–(10))","Large list of discrete factors in section 9 — approximately 60 separate numbered factors covering onset and worsening scenarios","Many temporal windows and differing look‑back periods (30 days, 6 months, 1 year, 2 years, 5 years) embedded across factors in section 9","Extensive Schedule 1 dictionary with roughly 25–30 defined terms (e.g. category 1A/1B/2 stressors, clinically significant disorder of mental health, intoxicant dose, organophosphorus ester, persistent pain)","Nested conditional rules (for example substance/medication‑induced disorder requires timing, drug‑specific rules, improvement on cessation or rechallenge — section 9(22)–(26))","Cross‑references to other SOPs where a factor refers to another injury or disease (section 11), adding dependency and further reading","Distinct rules for new onset versus worsening of pre‑existing depressive disorder (section 10(2) and section 9 subsections 31–60)","Several qualitative or clinically interpretive terms (e.g. \"potentially morally injurious event\", \"intoxicant dose\", \"severe and permanent tinnitus\") that require discretionary clinical judgment (Schedule 1)","Laboratory and measurement requirements (e.g. serum 25‑hydroxyvitamin D <25 nmol/L, BMI ≥30) introduce objective thresholds within a largely clinical matrix (section 9; Schedule 1)"],"plain_english_summary":"**What this instrument does (mechanically)\n\n- This is a Statement of Principles (SOP) issued by the Repatriation Medical Authority (RMA) that sets the medical rules used when deciding whether a depressive disorder (or death from one) can be linked to a person’s military service for the purposes of veteran entitlements. (See sections 3, 5 and 7.)\n\n- It defines what counts as \"depressive disorder\" by adopting detailed diagnostic criteria from DSM‑5‑TR for multiple subtypes (major depressive disorder, major depressive episode, persistent depressive disorder/dysthymia, substance/medication‑induced depressive disorder, depressive disorder due to another medical condition, premenstrual dysphoric disorder, and other/unspecified depressive disorders). (Section 7(2)–(10); Schedule 1.)\n\n- It lists the specific factors (risk exposures, diagnoses, events and medical states) that must be present for a \"reasonable hypothesis\" to be raised that the depressive disorder is related to relevant service. At least one of the listed factors in section 9 must be established. The list covers traumatic exposures (e.g. being a prisoner of war, category 1A/1B stressors), life events (e.g. bereavement, miscarriage), medical and biological contributors (e.g. persistent pain, epilepsy, severe chronic medical conditions, vitamin D deficiency, obesity), substance and drug associations (specific psychoactive drugs, mefloquine, corticosteroids, organic solvent exposure, organophosphate/paraquat poisoning), sleep disorders and other mental‑health conditions, pregnancy, menopausal transition, and inability to obtain appropriate clinical management. (Section 9; Schedule 1 definitions.)\n\n- The SOP sets time windows for many of those factors (for example, some stressors or exposures must have occurred within specified months or years before clinical onset or worsening). (See multiple subsections of section 9.)\n\n- It requires that any factor relied on be related to the person's \"relevant service\" (so the exposure must be connected to the service types listed in the Dictionary — operational, peacekeeping, hazardous, warlike, etc.). It also distinguishes factors that can support *material contribution* or *aggravation* where depressive disorder existed before service. (Section 10.)\n\n- It says other SOPs apply where a listed factor refers to an injury or disease already covered by a different SOP — i.e. cross‑application of existing medical rules. (Section 11.)\n\nWho this affects\n\n- Primary: veterans and former members of the ADF (and members covered under the Military Rehabilitation and Compensation Act) who claim DVA/MRCA benefits for depressive disorder or for death contributed to by depressive disorder. (Section 5.)\n- Secondary: clinicians, medico‑legal report writers, rehabilitation providers and decision makers in DVA who must gather and assess evidence against the specified criteria and time windows.\n\nWhy it matters (official purpose and practical effect)\n\n- Officially, the RMA states it has medical‑scientific evidence that depressive disorder and death from it can be related to relevant service, and this SOP sets the medical thresholds for raising a \"reasonable hypothesis\" linking the condition to service. (Section 8.)\n- Practically, the SOP tells decision makers which clinical findings, exposures and time relationships are sufficient (as a matter of RMA policy) to proceed on a reasonable hypothesis. It therefore materially affects which claims are progressed, what medical evidence is required and what tests or history clinicians will be asked to provide (for example, BMI, serum 25‑hydroxyvitamin D, documentation of exposures, DSM‑based diagnostic detail, and timelines of events). (Sections 7, 9; Schedule 1.)\n\nPurpose claims tested against costs, incentives and risks\n\n- Claimed purpose: to provide an evidence‑based list of medical and exposure factors that can connect depressive disorder to service (Section 8). This clarifies adjudication endpoints and reduces ad hoc decision‑making.\n\n- Compliance and administrative costs: the SOP increases documentary and clinical evidence needs (DSM criteria, lab values such as vitamin D <25 nmol/L in some cases, BMI calculations, specific exposure histories). That imposes time and cost on claimants and on DVA for evidence collection and verification (see sections 7 and 9, and Schedule 1 definitions of BMI and vitamin D).\n\n- Incentives and behaviour changes: claimants and their clinicians are likely to tailor medical reports to the SOP factors and time windows (for example, emphasising a category 1A/1B stressor, documenting sleep‑wake disorder durations, or providing records of drug exposures like mefloquine or prolonged organic solvent use). Decision makers will prioritise those items of evidence in adjudication. (Section 9; Schedule 1.)\n\n- Trade‑offs and implementation risk: the SOP is detailed and medically specific, which improves predictability but creates borderline cases where decision makers must interpret qualitative concepts (e.g. \"potentially morally injurious event\", \"intoxicant dose\", or \"severe and permanent tinnitus\"). Those interpretive judgments create discretion and potential inconsistency across cases. (Schedule 1: definitions.)\n\n- Concentrated benefits and diffuse costs: benefits concentrate on claimants who can document the enumerated factors; administrative costs and potential benefit outlays are borne by the veteran entitlements system (i.e. public budget). The SOP may increase successful claims where common and chronic contributors (sleep disorders, obesity, pregnancy/postpartum, menopause) are included, but each such factor still must be shown to relate to relevant service per section 10.\n\nWho pays, who decides, and what behaviour changes\n\n- Who pays: benefits that flow from claims accepted under these rules are paid from the veterans' entitlements/rehabilitation compensation schemes administered by government. (See application to VEA/MRCA at section 5 and Schedule 1 definitions of VEA/MRCA.)\n- Who decides: the RMA issues the SOP (sections 3 and 8); DVA (or MRCA decision makers) apply it when deciding claims. Medical assessors and clinicians provide evidence against the SOP’s criteria. (Sections 3, 5, 9–11.)\n- Likely behaviour changes: claimants and clinicians will focus on documenting the SOP’s enumerated factors and time windows (e.g. records of exposure, DSM diagnostic detail, lab tests), and DVA may request evidence targeted to those factors.\n\nKey implementation details to watch (operational risks)\n\n- Many factors require temporal precision (different look‑back windows in months or years) which can be hard to demonstrate from records alone. (Section 9.)\n- Several definitions use qualitative terms (\"potentially morally injurious event\", \"intoxicant dose\") that require clinical judgment and may lead to variable decisions. (Schedule 1.)\n- The SOP cross‑references other SOPs where factors refer to other injuries or diseases, introducing dependency on the content and status of those other SOPs. (Section 11.)\n\nPrimary legal citations (examples)\n\n- Application to claims: section 5. \n- Diagnostic criteria and depressive disorder definitions: section 7 and Schedule 1. \n- List of factors that raise a reasonable hypothesis: section 9. \n- Requirement that factors be related to relevant service and the material contribution rule for pre‑existing conditions: section 10. \n- RMA’s evidentiary basis statement: section 8.\n\nOverall mechanical effect\n\n- The SOP does not itself grant benefits. It provides the medical thresholds and definitions that decision makers must apply when considering whether depressive disorder (or death from it) can reasonably be linked to a person’s relevant service. That directly affects evidentiary requirements, the likelihood that a claim reaches the compensation stage, and what clinical documentation claimants and clinicians will prioritise. (Sections 7–11.)"},"flash_summary_failed":{"failed":true,"reason":"Unauthenticated. Configure AI_GATEWAY_API_KEY or use a provider module. Learn more: https://ai-sdk.dev/unauthenticated-ai-gateway","source":"analysis-cron"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-depressive-disorder-reasonable-hypothesis-no-11-of-2024","history":"/api/acts/statement-of-principles-concerning-depressive-disorder-reasonable-hypothesis-no-11-of-2024/history","analysis":"/api/acts/statement-of-principles-concerning-depressive-disorder-reasonable-hypothesis-no-11-of-2024/analysis","conflicts":"/api/acts/statement-of-principles-concerning-depressive-disorder-reasonable-hypothesis-no-11-of-2024/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-depressive-disorder-reasonable-hypothesis-no-11-of-2024/important-cases","documents":"/api/acts/statement-of-principles-concerning-depressive-disorder-reasonable-hypothesis-no-11-of-2024/documents"}}