{"id":"F2024L01709","name":"Statement of Principles concerning eating disorder (Reasonable Hypothesis) (No. 15 of 2025)","slug":"statement-of-principles-concerning-eating-disorder-reasonable-hypothesis-no-15-of-2025","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442689,"registerId":"F2024L01709-fast-fetch-1775957641254","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning eating disorder (Reasonable Hypothesis) (No. 15 of 2025)","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![RMA Australian Government Coat of Arms](image.001.jpeg)\n\n \n\nStatement of Principles\n\nconcerning\n\nEATING DISORDER  (Reasonable Hypothesis)\n\n(No. 15 of 2025)\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    17 December 2024.\n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\n \n\nProfessor Terence Campbell AM\n\nChairperson\n\nby and on behalf of\n\nThe Repatriation Medical Authority\n\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\n\n\n1.                Name\n\n\nThis is the Statement of Principles concerning eating disorder (Reasonable Hypothesis) (No. 15 of 2025).\n\n1.                Commencement\n\n\n              This instrument commences on 28 January 2025.\n\n1.                Authority\n\n\nThis instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n1.                Repeal\n\n\nThe Statement of Principles concerning eating disorder (Reasonable Hypothesis) (No. 13 of 2016) (Federal Register of Legislation No. F2016L00261) made under subsections 196B(2) and (8) of the VEA is repealed.\n\n1.                Application\n\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\n1.                Definitions\n\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n1.                Kind of injury, disease or death to which this Statement of Principles relates\n  1.           This Statement of Principles is about eating disorder and death from eating disorder.\n\n\nMeaning of eating disorder\n\n1.           For the purposes of this Statement of Principles, eating disorder:\n  1.           means a persistent disturbance of eating or eating-related behaviour resulting in the altered consumption or absorption of food, which significantly impairs physical health or psychosocial functioning; and\n  2.           includes:\n    1.                anorexia nervosa;\n    2.             bulimia nervosa;\n    3.           binge-eating disorder;\n    4.            pica;\n    5.              rumination disorder;\n    6.           avoidant/restrictive food intake disorder\n    7.        other specified feeding or eating disorder; and\n    8.      unspecified feeding or eating disorder; and\n  3.           excludes:\n    1.                anorexia;\n    2.             orthorexia nervosa; and\n    3.           polyphagia.\n\n\nanorexia nervosa means a disorder of mental health meeting the following diagnostic criteria (derived from DSM-5-TR):\n\n1.            Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected;\n\n\n1.            Intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain, even though at a significantly low weight;\n2.            Restricting type: During the last 3 months, the individual has not engaged in recurrent episodes of binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise; and\n3.            Binge-eating/purging type: During the last 3 months, the individual has engaged in recurrent episodes of binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).\n\n\nbulimia nervosa means a disorder of mental health meeting the following diagnostic criteria (derived from DSM-5-TR):\n\n1.           Recurrent episodes of binge eating. An episode of binge eating is characterised by both of the following:\n  1.              Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances; and\n  2.          A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating); and\n\n\n1.            Recurrent inappropriate compensatory behaviours in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise;\n2.           The binge eating and inappropriate compensatory behaviours both occur, on average, at least once a week for 3 months;\n3.            Self-evaluation is unduly influenced by body shape and weight; and\n4.           The disturbance does not occur exclusively during episodes of anorexia nervosa.\n\n\nbinge-eating disorder means a disorder of mental health meeting the following diagnostic criteria (derived from DSM-5-TR):\n\n1.           Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:\n  1.             Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances; and\n  2.           A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating); and\n\n\n1.            The binge-eating episodes are associated with three (or more) of the following:\n  1.              Eating much more rapidly than normal;\n  2.          Eating until feeling uncomfortably full;\n  3.        Eating large amounts of food when not feeling physically hungry;\n  4.          Eating alone because of feeling embarrassed by how much one is eating;\n  5.            Feeling disgusted with oneself, depressed, or very guilty afterward;\n2.           Marked distress regarding binge eating is present;\n3.            The binge eating occurs, on average, at least once a week for 3 months; and\n4.            The binge eating is not associated with the recurrent use of inappropriate compensatory behaviour as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.\n\n\npica means a disorder of mental health meeting the following diagnostic criteria (derived from DSM-5-TR):\n\n1.           Persistent eating of non-nutritive, nonfood substances over a period of at least 1 month;\n\n\n1.           The eating of nonnutritive, nonfood substances is inappropriate to the developmental level of the individual;\n2.            The eating behaviour is not part of a culturally supported or socially normative practice; and\n3.            If the eating behaviour occurs in the context of another mental disorder (e.g., intellectual developmental disorder [intellectual disability], autism spectrum disorder, schizophrenia) or medical condition (including pregnancy), it is sufficiently severe to warrant additional clinical attention.\n\n\nrumination disorder means a disorder of mental health meeting the following diagnostic criteria (derived from DSM-5-TR):\n\n1.            Repeated regurgitation of food over a period of at least 1 month. Regurgitated food may be re-chewed, re-swallowed, or spit out;\n\n\n1.            The repeated regurgitation is not attributable to an associated gastrointestinal or other medical condition (e.g., gastroesophageal reflux, pyloric stenosis);\n2.           The eating disturbance does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder; and\n3.            If the symptoms occur in the context of another mental disorder (e.g., intellectual developmental disorder [intellectual disability] or another neurodevelopmental disorder), they are sufficiently severe to warrant additional clinical attention.\n\n\navoidant/restrictive food intake disorder means a disorder of mental health meeting the following diagnostic criteria (derived from DSM-5-TR):\n\n1.            An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) associated with one (or more) of the following:\n  1.             Significant weight loss (or failure to achieve expected weight gain or faltering growth in children);\n  2.          Significant nutritional deficiency;\n  3.        Dependence on enteral feeding or oral nutritional supplements; and\n  4.         Marked interference with psychosocial functioning; and\n\n\n1.            The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice;\n2.            The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced; and\n3.           The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.\n\n\nother specified feeding or eating disorder means a category of disorder of mental health applying to (derived from DSM-5-TR):\n\n1.            Presentations in which symptoms characteristic of a feeding and eating disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate, but do not meet the full criteria for any of the disorders in the feeding and eating disorders diagnostic class; and\n\n\n1.            includes:\n  1.              atypical anorexia nervosa;\n  2.           bulimia nervosa (of low frequency and/or limited duration);\n  3.         binge-eating disorder (of low frequency and/or limited duration);\n  4.          purging disorder; and\n  5.            night eating syndrome.\n\n\natypical anorexia nervosa means a disorder of mental health meeting the following diagnostic criteria (derived from DSM-5-TR):\n\n1.           All of the criteria for anorexia nervosa are met, except that despite significant weight loss, the individual’s weight is within or above the normal range; and\n\n\n1.            Individuals with atypical anorexia nervosa may experience many of the physiological complications associated with anorexia nervosa.\n\n\nbulimia nervosa (of low frequency and/or limited duration) means a disorder of mental health meeting the following diagnostic criteria (derived from DSM-5-TR):\n\n1.           All of the criteria for bulimia nervosa are met, except that the binge eating and inappropriate compensatory behaviours occur, on average, less than once a week and/or for less than 3 months.\n\n\nbinge-eating disorder (of low frequency and/or limited duration) means a disorder of mental health meeting the following diagnostic criteria (derived from DSM-5-TR):\n\n1.           All of the criteria for binge-eating disorder are met, except that the binge eating occurs, on average, less than once a week and/or for less than 3 months.\n\n\npurging disorder means a disorder of mental health meeting the following diagnostic criteria (derived from DSM-5-TR):\n\n1.           Recurrent purging behaviour to influence weight or shape (e.g., self-induced vomiting; misuse of laxatives, diuretics, or other medications) in the absence of binge eating.\n\n\nnight eating syndrome means a disorder of mental health meeting the following diagnostic criteria (derived from DSM-5-TR):\n\n1.           Recurrent episodes of night eating, as manifested by eating after awakening from sleep or by excessive food consumption after the evening meal;\n\n\n1.            There is awareness and recall of the eating;\n2.           The night eating is not better explained by external influences such as changes in the individual’s sleep-wake cycle or by local social norms;\n3.            The night eating causes significant distress and/or impairment in functioning; and\n4.           The disordered pattern of eating is not better explained by binge-eating disorder or another mental disorder, including substance use, and is not attributable to another medical condition or to an effect of medication.\n\n\nunspecified feeding or eating disorder means a disorder of mental health meeting the following diagnostic criteria (derived from DSM-5-TR):\n\n1.           This category applies to presentations in which symptoms characteristic of a feeding and eating disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the feeding and eating disorders diagnostic class; and\n\n\n1.            Is used in situations in which the clinician chooses not to specify the reason that the criteria are not met for a specific feeding and eating disorder and includes presentations in which there is insufficient information to make a more specific diagnosis (e.g., in emergency room settings).\n\n\nNote: DSM-5-TR is defined in the Schedule 1 dictionary.\n\n1.           While eating disorder attracts ICD‑10‑AM codes: F50.0, F50.1, F50.2, F50.3, F50.4, F50.8, F50.9, in applying this Statement of Principles the meaning of eating disorder is that given in subsection (2).\n2.           For subsection (3), a reference to an ICD-10-AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4.\n\n\nDeath from eating disorder\n\n1.           For the purposes of this Statement of Principles, eating disorder, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's eating disorder.\n\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n1.                Basis for determining the factors\n\n\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that eating disorder and death from eating 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\n1.                Factors that must exist\n\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 eating disorder or death from eating disorder with the circumstances of a person's relevant service:\n\n1.           experiencing a category 1A stressor during the 2 years before clinical onset or clinical worsening of anorexia nervosa, bulimia nervosa, binge-eating disorder or avoidant/restrictive food intake disorder;\n\n\nNote: category 1A stressor is defined in the Schedule 1 – Dictionary\n\n1.           experiencing a category 1B stressor during the 2 years before clinical onset or clinical worsening of anorexia nervosa, bulimia nervosa, binge-eating disorder or avoidant/restrictive food intake disorder;\n\n\nNote: category 1B stressor is defined in the Schedule 1 – Dictionary\n\n1.           experiencing a category 2 stressor during the 2 years before clinical onset or clinical worsening of anorexia nervosa, bulimia nervosa, binge-eating disorder or avoidant/restrictive food intake disorder;\n\n\nNote: category 2 stressor is defined in the Schedule 1 - Dictionary.\n\n1.           being the subject of bullying during the 2 years before clinical onset or clinical worsening of anorexia nervosa, bulimia nervosa, binge-eating disorder or avoidant/restrictive food intake disorder;\n\n\nNote: bullying is defined in the Schedule 1 - Dictionary.\n\n1.           experiencing the death of an important or influential person who has a close family bond or personal relationship, during the 2 years before the clinical onset or clinical worsening of binge-eating disorder;\n2.           having one of the following clinically significant disorders of mental health during the 2 years before clinical onset or clinical worsening of anorexia nervosa, bulimia nervosa, binge-eating disorder or avoidant/restrictive food intake disorder:\n  1.           alcohol use disorder;\n  2.           anxiety disorder;\n  3.           attention-deficit/hyperactivity disorder;\n  4.           depressive disorder;\n  5.           gender dysphoria;\n  6.            obsessive compulsive disorder;\n  7.           panic disorder;\n  8.           personality disorder;\n  9.             posttraumatic stress disorder;\n  10.             social anxiety disorder; or\n  11.           substance use disorder.\n\n\nNote: clinically significant disorder of mental health is defined in the Schedule 1 - Dictionary\n\n1.           having experienced as a child (under the age of 18) one of the following;\n  1.           serious physical, emotional, or sexual harm;\n  2.           neglect involving a serious failure to provide the necessities for health, physical and emotional development, or wellbeing by an adult;\n\n\nbefore clinical onset or clinical worsening of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder;\n\n1.           having experienced as a child (under the age of 18) sexual abuse before clinical onset or clinical worsening of other specified feeding or eating disorder;\n2.           experiencing regular food insecurity for a continuous period of 3 months at the time of clinical onset or clinical worsening of binge-eating disorder;\n\n\nNote: food insecurity is defined in the Schedule 1 – Dictionary.\n\n1.       having type 1 diabetes mellitus for at least the 3 months before clinical onset or clinical worsening of anorexia nervosa, bulimia nervosa, or avoidant/restrictive food intake disorder;\n2.       inability to obtain appropriate clinical management for eating disorder before clinical worsening.\n\n\n1.            Relationship to service\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  2.           The clinical worsening aspects of factors set out in section 9 apply only to material contribution to, or aggravation of, eating disorder where the person's eating disorder was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n2.            Factors referring to an injury or disease covered by another Statement of Principles\n\n\nIn this Statement of Principles:\n\n1.           if a factor referred to in section 9 applies in relation to a person; and\n2.           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\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                               bullying means repeated unwanted, aggressive behaviour that involves an observed or perceived imbalance of power.\n\nNote: Bullying may inflict physical, psychological, or social harm. Examples of bullying include physical (e.g. hitting, kicking, spitting, damaging property), verbal (e.g. teasing, insults, slurs), social (e.g. gossiping, spreading rumours, social exclusion), and cyberbullying.\n\n                                category 1A stressor means one of the following severe traumatic events:\n\n(a)          experiencing a life-threatening event including an illness or injury;\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;\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, language barriers, 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 environment including on-going disharmony with fellow work colleagues, perceived lack of social support within the work environment, perceived lack of control over tasks performed and stressful workloads;\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;\n\n(f)           experiencing prejudice or discrimination based on gender, or behaviour or attitudes that foster stereotyped social roles based on gender (sexism);\n\n(g)          experiencing adverse prejudicial differential treatment or unequal access to opportunities based on membership to a particular racial group.\n\n                               clinically significant disorder of mental health means a disorder of mental health which is of sufficient severity to warrant ongoing management.\n\nNote: 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\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                               eating disorder—see subsection 7(2).\n\n                               food insecurity means a lack of regular access to enough safe and nutritious food for normal growth and development and an active and healthy life, and can result from an unavailability of food and/or a lack of resources to obtain food.\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 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\n \n","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"This instrument repeals the 2016 Statement (No.13 of 2016) and updates the Statement of Principles. Compared with the earlier instrument (which is expressly repealed), this version: (a) adopts DSM‑5‑TR phrasing for diagnostic criteria; (b) names and incorporates a broader set of feeding and eating disorder categories (explicitly listing pica, rumination disorder, ARFID, OSFED subtypes and unspecified disorders); (c) sets out a more detailed list of stressor categories (category 1A, 1B, and category 2) and other social/clinical factors (bullying, childhood abuse/neglect, food insecurity, inability to obtain appropriate clinical management, and type 1 diabetes for specified periods) as triggers for a reasonable hypothesis; and (d) clarifies timing windows and the interaction of \"clinical worsening\" with pre‑existing disorders. Those changes widen and more precisely define the factual and diagnostic circumstances that will raise a reasonable hypothesis, so the instrument has expanded and refined the scope of conditions and causal factors covered compared with the earlier Statement it replaces."},"complexity_factors":["Multiple DSM‑5-TR derived diagnostic criteria included verbatim for several disorders (anorexia nervosa, bulimia nervosa, binge‑eating disorder, pica, rumination disorder, ARFID, OSFED subcategories, unspecified) with nested sub-clauses","Approximately 12–15 discrete defined terms in Schedule 1 (e.g. \"bullying\", \"category 1A/1B/2 stressor\", \"clinically significant disorder of mental health\", \"terminal event\", \"relevant service\", \"DSM‑5‑TR\")","Several temporal conditions and windows to track: 2 years for many stressors/comorbidities, 3 months for food insecurity and diabetes, and continuous periods specified (e.g. 3 months food insecurity)","Multiple conditional rules (e.g. \"clinical worsening\" provisions only apply where disorder existed before/during but did not arise out of service)","Cross‑references to other Statements of Principles where factors refer to other injuries/diseases (section 11)","Reference to ICD‑10‑AM codes and an external DSM text (DSM‑5‑TR) increases complexity for medical verification","Replaces an earlier Statement (No.13 of 2016) — requires comparison/transition considerations for ongoing claims","Mixture of factual, clinical and legal standards (evidentiary judgments required for bullying, witness/corpse exposure, relationship to service) increasing adjudicative complexity"],"plain_english_summary":"**What this instrument does (mechanics)\n\n- This is a Statement of Principles made by the Repatriation Medical Authority under the Veterans' Entitlements Act. It sets the medical definitions and the list of factual/medical circumstances that, if present, are sufficient to raise a \"reasonable hypothesis\" that an eating disorder (or death from an eating disorder) is connected to a person's relevant military service. (See sections 3, 5, 7 and 9.)\n\n- It replaces the earlier Statement of Principles on eating disorder (No. 13 of 2016) and commences on 28 January 2025. (See sections 4 and 2.)\n\n- The instrument applies to claims made under the VEA or the Military Rehabilitation and Compensation Act (MRCA). (See section 5 and Schedule 1 definitions of \"relevant service\".)\n\n- It defines \"eating disorder\" by reference to a list of specific diagnostic categories (anorexia nervosa, bulimia nervosa, binge‑eating disorder, pica, rumination disorder, avoidant/restrictive food intake disorder (ARFID), other specified feeding or eating disorder (OSFED), and unspecified feeding or eating disorder) and then sets out DSM-5-TR‑derived diagnostic criteria for the named disorders. (See section 7(2) and the disorder-by-disorder definitions.)\n\n- It also treats \"death from eating disorder\" as covered where a terminal event or condition was contributed to by the person's eating disorder. (See section 7(5) and Schedule 1 definition of \"terminal event\".)\n\n- The core operational rule is in section 9: at least one of the listed factors must exist for a \"reasonable hypothesis\" that the eating disorder (or death from it) is related to relevant service. The listed factors include particular stressors, mental‑health comorbidities, childhood abuse/neglect, food insecurity, some medical conditions, and lack of access to appropriate clinical management. Key features and timing requirements include:\n  - Category 1A, 1B or category 2 stressors (as defined in Schedule 1) experienced within 2 years before clinical onset or clinical worsening of certain disorders (noted at section 9). (See section 9(1)–(3) and Schedule 1.)\n  - Being the subject of bullying within 2 years before onset/worsening for certain disorders. (See section 9(4) and Schedule 1 definition of \"bullying\".)\n  - Death of an important person with a close bond within 2 years before onset/worsening of binge‑eating disorder. (See section 9(5).)\n  - Presence of specified clinically significant mental‑health disorders during the 2 years before onset/worsening (e.g., depressive disorder, PTSD, substance use disorder, ADHD, personality disorder, etc.). (See section 9(6).)\n  - Childhood exposure (under 18) to serious physical, emotional or sexual harm, or neglect, before onset/worsening of several named disorders; and childhood sexual abuse before onset/worsening of \"other specified\" disorders. (See section 9(7)–(8).)\n  - Regular food insecurity for a continuous 3‑month period at the time of onset/worsening of binge‑eating disorder. (See section 9(9).)\n  - Having type 1 diabetes mellitus for at least 3 months before onset/worsening of anorexia nervosa, bulimia nervosa, or ARFID. (See section 9(10).)\n  - Inability to obtain appropriate clinical management for eating disorder before clinical worsening. (See section 9(11).)\n\n- Section 10 requires that any of the listed factors must be related to the person's relevant service. It also explains that the \"clinical worsening\" aspects only operate where the disorder was present before or during service (but did not arise out of service). (See section 10.)\n\n- Section 11 provides that if a listed factor refers to another injury or disease that already has its own Statement of Principles, the factors in that other Statement apply according to its terms. (See section 11.)\n\n\nWho is affected and why it matters\n\n- Primary effect: veterans, ex‑members and serving members whose claims for service‑related incapacity or death under the VEA or MRCA involve an eating disorder. The Statement tells decision‑makers (and claimants) what medical definitions and which factual/medical circumstances are sufficient to raise a reasonable hypothesis linking the condition to service.\n\n- Who decides: the Repatriation Medical Authority sets the medical rules; claims are assessed by the Department of Veterans' Affairs using these rules. If the required factors and the link to service can be established on the balance that a reasonable hypothesis exists, the claimant may proceed to a benefits decision under the VEA or MRCA.\n\n- What claimants need to show: a qualifying eating‑disorder diagnosis (as defined here) and at least one of the listed factors within the stated time‑windows, plus evidence that the factor is related to the person's relevant service. This typically requires medical evidence (diagnosis, timing, clinical history) and evidence of the relevant stressor/event in service records or other contemporaneous material.\n\n\nHow the instrument changes incentives, costs and administrative effects (light economic/legal lens)\n\n- Who pays: If a claimant establishes the required connection, government benefit/entitlement programs under the VEA or MRCA may pay treatment, compensation or death benefits; that cost falls on the DVA (taxpayer funded). (See application in section 5 and legal basis section 3.)\n\n- Administrative and compliance costs: claimants and medical practitioners will need to supply more precise diagnostic material and evidence of timing and of the listed stressors/events. DVA will incur administrative costs in obtaining, verifying and adjudicating service‑related links (medical records, service records, corroboration of stressors such as bullying or witnessing events).\n\n- Evidence standards and subjectivity: several operative concepts (e.g., \"bullying\", \"clinically significant disorder of mental health\", \"related to relevant service\") are partly factual and partly clinical, requiring evaluative judgments. That creates room for disagreement and appeals, and may raise implementation burden and adjudication time.\n\n- Distribution of benefits and costs: the instrument concentrates benefits on claimants who meet the specific diagnostic definitions and listed factors (for example those with documented category 1A/1B trauma, childhood abuse, comorbid mental‑health conditions, or type 1 diabetes). Costs (administration and program outlays) are dispersed across the government budget.\n\n- Effects on private markets: the Statement itself does not directly change private‑sector regulation or markets. It may, however, affect demand for clinical services for veterans (diagnosis, treatment, evidence gathering) and could slightly increase use of specialist assessment services by claimants.\n\n- Risk of substitution or perverse incentives: the Statement lowers uncertainty about which medical facts support a reasonable hypothesis. That can make it easier to lodge claims that rely on the listed factors. It does not itself create payments, but it affects the threshold to get to a benefits decision. The text does not create new financial incentives for private providers beyond normal clinical practice.\n\n\nKey implementation and legal trade‑offs to note\n\n- Time windows matter: many factors must have occurred within 2 years before clinical onset or worsening (some require 3 months). Accurate timing of onset/worsening will therefore be an important evidentiary issue.\n\n- \"Clinical worsening\" carve: the worsening-related factors apply only where the disorder existed before/during service but did not arise out of service. That limits the operation of some factors for people whose disorder first arose because of service.\n\n- Cross‑references: where a factor invokes another injury/disease that has its own Statement of Principles, the other Statement applies — this requires cross‑checking additional medical statements.\n\n- Diagnostic standardisation: the Statement uses DSM-5-TR language for diagnostic criteria, which provides a recognised clinical standard but requires claimants' diagnoses to be demonstrably consistent with DSM-5-TR criteria.\n\n\nWhere to look in the instrument\n\n- Definitions and precise diagnostic criteria: section 7 and the disorder sub‑sections; Schedule 1 for defined terms (\"bullying\", stressor categories, \"clinically significant disorder\", \"relevant service\", \"terminal event\", DSM‑5‑TR). \n- Factors giving rise to a reasonable hypothesis: section 9. \n- Relationship to service and clinical worsening rule: section 10.\n\n\nBottom line (mechanical):\n- This Statement defines eating disorders by DSM‑5‑TR categories and sets a list of specific stressors, comorbidities, childhood experiences, medical conditions and access‑to‑treatment situations which, if present within the stated timeframes and related to a person's relevant military service, are sufficient to raise a reasonable hypothesis that the eating disorder (or death from it) is connected to service. It therefore supplies the medical/legal rule DVA uses when deciding whether claims involving eating disorders proceed for entitlement assessment.\n"},"kimi_summary":{"content_quality":"ok","complexity_score":6,"scope_assessment":{"changed":false,"description":"This instrument maintains the same scope as its predecessor (No. 13 of 2016). It is a standard periodic update of a Statement of Principles under the Veterans' Entitlements Act, replacing the 2016 version with updated medical definitions (DSM-5-TR instead of DSM-5) and refined factors. The core purpose—establishing medical criteria for linking eating disorders to military service—remains unchanged."},"complexity_factors":["Extensive nested definitions: 15+ defined conditions within the primary 'eating disorder' definition, each with multiple diagnostic criteria","Cross-referencing to external medical standards: Heavy reliance on DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders) criteria","Multiple conditional factors: 11 distinct factors in section 9, each with specific temporal requirements (e.g., 'during the 2 years before clinical onset')","Selective application: Different factors apply to different sub-types of eating disorders (e.g., some factors only for anorexia/bulimia/binge-eating/ARFID, others specifically for binge-eating or other specified disorders)","Dual legislative framework: Must operate under both Veterans' Entitlements Act 1986 and Military Rehabilitation and Compensation Act 2004","Defined terms in Schedule 1: 14 defined terms including complex concepts like 'category 1A/1B/2 stressors' with their own sub-definitions","Clinical worsening vs onset distinction: Separate rules for when condition existed before service versus developed during service"],"plain_english_summary":"The Repatriation Medical Authority has updated its medical guideline on eating disorders to DSM‑5‑TR standards, clarifying when eating disorders linked to military service qualify for DVA compensation. It applies to current and former ADF members and veterans claiming under the VEA or MRCA.\n\nThe guideline names recognized disorders (e.g., anorexia, bulimia, binge‑eating, pica) and identifies service‑related contributors—trauma, chronic stress, bullying, comorbid mental illness, childhood abuse, food insecurity, and certain medical conditions—giving veterans clearer grounds to claim."},"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-eating-disorder-reasonable-hypothesis-no-15-of-2025","history":"/api/acts/statement-of-principles-concerning-eating-disorder-reasonable-hypothesis-no-15-of-2025/history","analysis":"/api/acts/statement-of-principles-concerning-eating-disorder-reasonable-hypothesis-no-15-of-2025/analysis","conflicts":"/api/acts/statement-of-principles-concerning-eating-disorder-reasonable-hypothesis-no-15-of-2025/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-eating-disorder-reasonable-hypothesis-no-15-of-2025/important-cases","documents":"/api/acts/statement-of-principles-concerning-eating-disorder-reasonable-hypothesis-no-15-of-2025/documents"}}