{"id":"F2021L01459","name":"Statement of Principles concerning fibromyalgia (Reasonable Hypothesis) (No. 107 of 2021)","slug":"statement-of-principles-concerning-fibromyalgia-reasonable-hypothesis-no-107-of-2021","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441046,"registerId":"F2021L01459-fast-fetch-1775956470559","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning fibromyalgia (Reasonable Hypothesis) (No. 107 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 (Reasonable Hypothesis)\n\n(No. 107 of 2021)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n \n\nDated 22 October 2021\n\n \n\n \n\n \n\n \n\n \n\n| The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:
|\n| --- |\n|
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 (Reasonable Hypothesis) (No. 107 of 2021).\n\n2 Commencement\n\n This instrument commences on 22 November 2021.\n\n3 Authority\n\nThis instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning fibromyalgia No. 13 of 2014 (Federal Register of Legislation No. F2014L00016) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004 applies.\n\n6 Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n(1) This Statement of Principles is about 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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that fibromyalgia and death from fibromyalgia 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 fibromyalgia or death from fibromyalgia 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) experiencing a category 1A stressor within the 1 year before the clinical onset of fibromyalgia;\n\nNote: category 1A stressor is defined in the Schedule 1 - Dictionary.\n\n(5) having a severe, chronic medical condition for at least the 2 years before the clinical onset of fibromyalgia;\n\nNote: severe, chronic medical condition is defined in the Schedule 1 - Dictionary.\n\n(6) 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(6) 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(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 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 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 fibromyalgia—see subsection 7(2).\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n relevant service means:\n\n(a) operational service under the VEA;\n\n(b) peacekeeping service under the VEA;\n\n(c) hazardous service under the VEA;\n\n(d) British nuclear test defence service under the VEA;\n\n(e) warlike service under the MRCA; or\n\n(f) non-warlike service under the MRCA.\n\nNote: MRCA and VEA are also defined in the Schedule 1 - Dictionary.\n\n severe childhood abuse means:\n\n(a) serious physical, emotional, psychological or sexual harm whilst a child aged under 16 years; or\n\n(b) neglect involving a serious failure to provide the necessities for health, physical and emotional development, or wellbeing whilst a child aged under 16 years;\n\n where such serious harm or neglect has been perpetrated by a parent, a care provider, an adult who works with or around that child, or any other adult in contact with that child.\n\n 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:\n\n(i) does not usually resolve spontaneously; or\n\n(ii) is rarely cured completely; or\n\n(iii) may progress to a life-threatening illness.\n\nNote: Examples of severe, chronic medical conditions include:\n\n (a) chronic kidney disease requiring dialysis;\n\n (b) severe psoriasis; and\n\n (c) a poorly controlled form of any of the following conditions:\n\n (i) asthma;\n\n (ii) chronic obstructive pulmonary disease;\n\n (iii) diabetes mellitus; and\n\n (iv) epilepsy.\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 symptom severity 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":5,"scope_assessment":{"changed":false,"description":"This instrument maintains the established scope of Repatriation Medical Authority Statements of Principles. It updates the specific medical criteria for fibromyalgia (replacing the 2014 version) but does not expand beyond the traditional purpose of defining service-connected disease factors for veteran compensation. The structure — diagnostic definition, connecting factors, and dictionary — follows the standard template for such instruments."},"complexity_factors":["Multiple nested definitions requiring cross-referencing (e.g., 'fibromyalgia' definition in s.7(2) refers to 'specified list of regions', 'widespread pain index', and 'symptom severity scale score' — all defined separately in Schedule 1)","Mathematical scoring systems for diagnosis (widespread pain index 0-19, symptom severity scale 0-12 with weighted sub-components)","Conditional diagnostic criteria with alternative pathways (s.7(2)(a)(i) OR (ii) must be satisfied, combined with mandatory s.7(2)(b) and (c))","14 defined terms in Schedule 1, several with their own internal sub-definitions (e.g., 'severe, chronic medical condition' has 3 cumulative criteria plus non-exhaustive examples)","Interaction with other Statements of Principles (s.11 creates dynamic incorporation by reference — factors from other instruments apply 'as in force from time to time')","Dual statutory framework application (VEA and MRCA with different service categories)","Specific temporal requirements ('within 1 year before', 'at least 2 years before', 'at the time of') creating multiple date-critical conditions"],"plain_english_summary":"This instrument updates the Statement of Principles for linking fibromyalgia to Australian defence service, guiding compensation under the Veterans' Entitlements Act and Military Rehabilitation and Compensation Act. It requires a defined medical diagnosis of fibromyalgia plus at least one specified connecting factor (e.g., prior severe trauma, obesity, autoimmune disease, prolonged chronic illness or treatment gaps) that can be shown to relate to service. It brings clearer, measurable thresholds to a frequently contested condition."},"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"This instrument repeals Statement No.13 of 2014 (s4) and replaces it with updated diagnostic criteria and an explicit set of qualifying factors linking fibromyalgia or death from fibromyalgia to relevant service (see s7, s9). It narrows uncertainty by prescribing numerical thresholds (eg. BMI ≥25, specific pain index and symptom scores) and timeframes, and it adds procedural rules about how factors relate to service and to other Statements of Principles (s10, s11)."},"complexity_factors":["Detailed medical diagnostic thresholds and scoring (widespread pain index; symptom severity scale) (s7(2); Schedule definitions)","Multiple temporal and quantitative tests (symptoms ≥3 months; category 1A within 1 year; chronic condition ≥2 years) (s7(2); s9(4); s9(5))","Numerical BMI threshold and formula for overweight/obesity (Schedule definitions)","Nuanced treatment of death from fibromyalgia and terminal events (s7(5); Schedule terminal event)","Interplay with other Statements of Principles when factors reference other injuries/diseases (s11)","Requirement that any listed factor be related to the person's relevant service (s10(1)) and special rule limiting factor 9(6) to material contribution/aggravation where condition pre-existed (s10(2))","Cross-reference to external classification (ICD‑10‑AM) for coding (s7(3)–(4))","Repeal of the prior Statement (s4) — potential administrative transition issues","Application to claims under specific statutory provisions (section 120A VEA and section 338 MRCA) — procedural scope (s5)","Granular definitional schedule with examples and exclusions that affect evidentiary requirements (Schedule)"],"plain_english_summary":"Mechanically, this instrument repeals the 2014 Statement and sets the medical definition, diagnostic thresholds and procedural rules that determine when fibromyalgia (or death from it) can be reasonably connected to a person's relevant service under the VEA and MRCA. It lists specific qualifying factors (for example: overweight/obesity, severe childhood abuse, certain severe stressors, chronic medical conditions, autoimmune arthritis, or lack of appropriate clinical management) that, if related to service, raise a reasonable hypothesis for entitlement."},"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-fibromyalgia-reasonable-hypothesis-no-107-of-2021","history":"/api/acts/statement-of-principles-concerning-fibromyalgia-reasonable-hypothesis-no-107-of-2021/history","analysis":"/api/acts/statement-of-principles-concerning-fibromyalgia-reasonable-hypothesis-no-107-of-2021/analysis","conflicts":"/api/acts/statement-of-principles-concerning-fibromyalgia-reasonable-hypothesis-no-107-of-2021/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-fibromyalgia-reasonable-hypothesis-no-107-of-2021/important-cases","documents":"/api/acts/statement-of-principles-concerning-fibromyalgia-reasonable-hypothesis-no-107-of-2021/documents"}}