{"id":"F2021L01460","name":"Statement of Principles concerning fibromyalgia (Balance of Probabilities) (No. 108 of 2021)","slug":"statement-of-principles-concerning-fibromyalgia-balance-of-probabilities-no-108-of-2021","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441051,"registerId":"F2021L01460-fast-fetch-1775956472747","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning fibromyalgia (Balance of Probabilities) (No. 108 of 2021)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 20.2\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n\n\n \n\nStatement of Principles\n\nconcerning\n\nFIBROMYALGIA (Balance of Probabilities)\n\n(No. 108 of 2021)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n \n\nDated 22 October 2021\n\n \n\n \n\n \n\n \n\n \n\n| The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:
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Professor Terence Campbell AM
Chairperson
|\n\n\n \n\n \n\n\nContents\n\n1 Name\n\n2 Commencement\n\n3 Authority\n\n4 Repeal\n\n5 Application\n\n6 Definitions\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n8 Basis for determining the factors\n\n9 Factors that must exist\n\n10 Relationship to service\n\n11 Factors referring to an injury or disease covered by another Statement of Principles\n\nSchedule 1 - Dictionary\n\n1 Definitions\n\n \n\n\n\n\n1 Name\n\nThis is the Statement of Principles concerning fibromyalgia (Balance of Probabilities) (No. 108 of 2021).\n\n2 Commencement\n\n This instrument commences on 22 November 2021.\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning fibromyalgia No. 14 of 2014 (Federal Register of Legislation No. F2014L00018) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 fibromyalgia and death from fibromyalgia.\n\nMeaning of fibromyalgia\n\n(2) For the purposes of this Statement of Principles, fibromyalgia means a syndrome of chronic widespread pain, with associated somatic symptoms, that has persisted for at least 3 months, and which meets the following diagnostic criteria, as assessed by a medical practitioner:\n\n(a) a widespread pain index:\n\n(i) of at least 7, with an associated symptom severity scale score of at least 5; or\n\n(ii) from 4 to 6, with an associated symptom severity scale score of at least 9; and\n\n(b) pain is present in at least 4 of 5 regions from the specified list of regions; and\n\n(c) the pain and symptoms are not better accounted for by another medical or psychiatric condition.\n\nNote 1: Pain in the jaw, chest and abdomen does not count towards the number of regions, but does count towards the widespread pain index score of 0 to 19.\n\nNote 2: specified list of regions, symptom severity scale score and widespread pain index are defined in the Schedule 1 - Dictionary.\n\n(3) While fibromyalgia attracts ICD‑10‑AM code M79.7, in applying this Statement of Principles the meaning of fibromyalgia is that given in subsection (2).\n\n(4) 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\nDeath from fibromyalgia\n\n(5) For the purposes of this Statement of Principles, fibromyalgia, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's fibromyalgia.\n\nNote: terminal event is defined in the Schedule 1 - Dictionary.\n\n8 Basis for determining the factors\n\nOn the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that fibromyalgia and death from fibromyalgia can be related to relevant service rendered by veterans 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 exist before it can be said that, on the balance of probabilities, fibromyalgia or death from fibromyalgia is connected with the circumstances of a person's relevant service:\n\n(1) experiencing severe childhood abuse before the clinical onset of fibromyalgia;\n\nNote: severe childhood abuse is defined in the Schedule 1 - Dictionary.\n\n(2) being overweight or obese at the time of the clinical onset of fibromyalgia;\n\nNote: being overweight or obese is defined in the Schedule 1 - Dictionary.\n\n(3) having an autoimmune inflammatory condition which is associated with the development of arthritis at the time of the clinical onset of fibromyalgia;\n\n(4) inability to obtain appropriate clinical management for fibromyalgia.\n\n10 Relationship to service\n\n(1) The existence in a person of any factor referred to in section 9, must be related to the relevant service rendered by the person.\n\n(2) The factor set out in subsection 9(4) applies only to material contribution to, or aggravation of, fibromyalgia where the person's fibromyalgia 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(3) 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 being overweight or obese means having a Body Mass Index (BMI) of 25 or greater.\n\nNote: BMI is also 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 fibromyalgia—see subsection 7(2).\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n relevant service means:\n\n(a) eligible war service (other than operational service) under the VEA;\n\n(b) defence service (other than hazardous service and British nuclear test defence service) under the VEA; or\n\n(c) peacetime service under the MRCA.\n\nNote: MRCA and VEA are also defined in the Schedule 1 - Dictionary.\n\n severe childhood abuse means:\n\n(a) serious physical, emotional, psychological or sexual harm whilst a child aged under 16 years; or\n\n(b) neglect involving a serious failure to provide the necessities for health, physical and emotional development, or wellbeing whilst a child aged under 16 years;\n\n where such serious harm or neglect has been perpetrated by a parent, a care provider, an adult who works with or around that child, or any other adult in contact with that child.\n\n specified list of regions means:\n\n(a) left upper region, defined as left jaw, left shoulder girdle, left upper arm and left lower arm;\n\n(b) right upper region, defined as right jaw, right shoulder girdle, right upper arm and right lower arm;\n\n(c) left lower region, defined as left hip (including buttock and trochanter), left upper leg and left lower leg;\n\n(d) right lower region, defined as right hip (including buttock and trochanter), right upper leg and right lower leg; or\n\n(e) axial region, defined as neck, upper back, lower back, chest and abdomen.\n\n symptom severity scale score means the combined total of:\n\n(a) the sum (scored from 0 to 9) of the severity of 3 symptoms (fatigue, waking unrefreshed and cognitive symptoms), where the level of severity of these symptoms is defined as:\n\n(i) 0 = no problem;\n\n(ii) 1 = slight or mild problems, generally mild or intermittent;\n\n(iii) 2 = moderate, considerable problems, often present or present at a moderate level; or\n\n(iv) 3 = severe, pervasive, continuous or life-disturbing problems; plus\n\n(b) the sum (scored from 0 to 3) of the number of a further 3 symptoms (headaches, pain or cramps in the lower abdomen, and depression) that the patient has been bothered by during the previous 6 months.\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 widespread pain index means the number of parts of the body within the specified list of regions in which the person has had pain in the last week (scored from 0 to 19).\n\nNote: specified list of regions is also defined in the Schedule 1 - Dictionary.\n\n \n\n \n","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard replacement Statement of Principles that maintains the established scope of determining service connection for fibromyalgia claims. It updates the medical diagnostic criteria to align with current clinical standards (specific 2016 ACR criteria with WPI/SSS scoring) but does not expand beyond the original purpose of defining compensable connections between fibromyalgia and military service."},"complexity_factors":["Multiple nested definitions requiring cross-referencing (e.g., 'fibromyalgia' definition refers to 'widespread pain index' and 'symptom severity scale score', which are themselves defined with mathematical formulas)","Mathematical scoring systems for diagnosis (widespread pain index 0-19, symptom severity scale 0-12 with weighted sub-components)","Conditional logic in diagnostic criteria (subsection 7(2)(a) presents two alternative threshold combinations: WPI ≥7 with SSS ≥5, OR WPI 4-6 with SSS ≥9)","Geographic body region definitions with specific anatomical inclusions/exclusions (Note 1 clarifies jaw/chest/abdomen don't count toward regional requirements but do count toward index scores)","Cross-referencing mechanism in section 11 that incorporates other Statements of Principles by reference","Dual statutory framework application (VEA and MRCA with different service definitions)","Specific edition referencing for ICD-10-AM (Tenth Edition, 1 July 2017 effective date with ISBN)"],"plain_english_summary":"This instrument tells the Repatriation Medical Authority how to decide if fibromyalgia is compensable for Australian veterans and defence members. It narrows diagnosis to specific medical scores and regional pain, requires identifiable service‑related contributors and lack of treatment where relevant, and applies the balance‑of‑probabilities standard; it also covers death from fibromyalgia or related terminal conditions.\n\nIt matters because it determines eligibility for pensions and benefits, replacing a broader 2014 approach with tighter diagnostic rules."},"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"},"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"Replaces the 2014 Statement of Principles (section 4) and sets a new diagnostic definition and a closed set of four qualifying factors for connection to service; it explicitly includes death from fibromyalgia and ties application to claims under s120B VEA and s339 MRCA (sections 4,5,7–10)."},"complexity_factors":["Detailed numerical diagnostic criteria (widespread pain index and symptom severity scale) requiring clinician assessment (section 7(2) and Schedule definitions).","Multiple defined terms and thresholds (BMI ≥25; specified body regions; definition of severe childhood abuse and terminal event) that convert clinical facts into legal criteria (Schedule 1).","Limited, closed list of qualifying factors (section 9) with cross‑linking to other Statements of Principles where factors overlap (section 11).","Nuanced service‑link requirement, including a special rule for pre‑existing fibromyalgia where inability to obtain management only applies to material contribution or aggravation (section 10(2)).","Repeal of prior Statement and explicit statutory placement under VEA/MRCA claims, affecting administrative application and precedent (sections 3–5, 4).","Reference to an external coding standard (ICD‑10‑AM) for disease classification (section 7(3)–(4)).","Evidentiary and administrative burdens on claimants and clinicians to document scores, BMI, service linkage and historical abuse, raising factual complexity in adjudication (sections 7–10, Schedule)."],"plain_english_summary":"Defines a medical test and the evidence required to decide whether fibromyalgia (including death from it) is connected, on the balance of probabilities, to a person’s relevant service. It applies to claims under section 120B of the VEA and section 339 of the MRCA (section 5).\n\nRequires clinician-assessed diagnostic scores and at least one service‑linked factor—severe childhood abuse, BMI ≥25, an autoimmune inflammatory condition associated with arthritis, or inability to obtain appropriate clinical management. The Repatriation Medical Authority issues the Statement; claimants must produce medical and service evidence (ss3,7–10)."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-fibromyalgia-balance-of-probabilities-no-108-of-2021","history":"/api/acts/statement-of-principles-concerning-fibromyalgia-balance-of-probabilities-no-108-of-2021/history","analysis":"/api/acts/statement-of-principles-concerning-fibromyalgia-balance-of-probabilities-no-108-of-2021/analysis","conflicts":"/api/acts/statement-of-principles-concerning-fibromyalgia-balance-of-probabilities-no-108-of-2021/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-fibromyalgia-balance-of-probabilities-no-108-of-2021/important-cases","documents":"/api/acts/statement-of-principles-concerning-fibromyalgia-balance-of-probabilities-no-108-of-2021/documents"}}