{"id":"F2018L00931","name":"Statement of Principles concerning panic disorder (Balance of Probabilities) (No. 56 of 2018)","slug":"statement-of-principles-concerning-panic-disorder-balance-of-probabilities-no-56-of-2018","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439687,"registerId":"F2018L00931-fast-fetch-1775955616930","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning panic disorder (Balance of Probabilities) (No. 56 of 2018)","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\nPANIC DISORDER (Balance of Probabilities)\n\n(No. 56 of 2018)\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 June 2018\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 Nicholas Saunders AO
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 panic disorder (Balance of Probabilities) (No. 56 of 2018).\n\n2 Commencement\n\n This instrument commences on 23 July 2018.\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 panic disorder No. 69 of 2009 (Federal Register of Legislation No. F2016C00976) made under subsections 196B(3) and (8) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 panic disorder and death from panic disorder.\n\nMeaning of panic disorder\n\n(2) For the purposes of this Statement of Principles, panic disorder means a disorder of mental health meeting the following diagnostic criteria (derived from DSM-5):\n\n1. Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur:\n\n\nNote: The abrupt surge can occur from a calm state or an anxious state.\n\n(i) palpitations, pounding heart, or accelerated heart rate;\n\n(ii) sweating;\n\n(iii) trembling or shaking;\n\n(iv) sensations of shortness of breath or smothering;\n\n(v) feelings of choking;\n\n(vi) chest pain or discomfort;\n\n(vii) nausea or abdominal distress;\n\n(viii) feeling dizzy, unsteady, light-headed or faint;\n\n(ix) chills or heat sensations;\n\n(x) paraesthesias (numbness or tingling sensations);\n\n(xi) derealisation (feelings of unreality) or depersonalisation (being detached from oneself);\n\n(xii) fear of losing control or \"going crazy\"; or\n\n(xiii) fear of dying.\n\nNote: Culture-specific symptoms (for example, tinnitus, neck soreness, headache, uncontrollable screaming or crying) may be seen. Such symptoms should not count as one of the four required symptoms.\n\nB. At least one of the attacks has been followed by one month (or more) of one or both of the following:\n\n(i) persistent concern or worry about additional panic attacks or their consequences (for example, losing control, having a heart attack, \"going crazy\"); or\n\n(ii) a significant maladaptive change in behaviour related to the attacks (for example, behaviours designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations).\n\nC. The disturbance is not attributable to the physiological effects of a substance (for example, a drug of abuse, a medication) or another medical condition (for example, hyperthyroidism, cardiopulmonary disorders).\n\nD. The disturbance is not better explained by another mental disorder (for example, the panic attacks do not occur only in response to feared social situations, as in social anxiety disorder; in response to circumscribed phobic objects or situations, as in specific phobia; in response to obsessions, as in obsessive-compulsive disorder; in response to reminders of traumatic events, as in posttraumatic stress disorder; or in response to separation from attachment figures, as in separation anxiety disorder).\n\nNote: DSM-5 is defined in the Schedule 1 – Dictionary.\n\n(3) While panic disorder attracts ICD‑10‑AM code F40.01 or F41.0, in applying this Statement of Principles the meaning of panic disorder 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 panic disorder\n\n(5) For the purposes of this Statement of Principles, panic disorder, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's panic disorder.\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 panic disorder and death from panic disorder 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, panic disorder or death from panic disorder is connected with the circumstances of a person's relevant service:\n\n(1) experiencing a category 1A stressor within the two years before the clinical onset of panic disorder; \n\nNote: category 1A stressor is defined in the Schedule 1 – Dictionary.\n\n(2) experiencing a category 1B stressor within the two years before the clinical onset of panic disorder;\n\nNote: category 1B stressor is defined in the Schedule 1 – Dictionary.\n\n(3) experiencing severe childhood abuse before the clinical onset of panic disorder;\n\nNote: severe childhood abuse is defined in the Schedule 1 – Dictionary.\n\n(4) experiencing the death of a significant other within the five years before the clinical onset of panic disorder;\n\nNote: significant other is defined in the Schedule 1 – Dictionary.\n\n(5) having a clinically significant disorder of mental health from Specified List 1 within the five years before the clinical onset of panic disorder; \n\nNote: clinically significant disorder of mental health from Specified List 1 is defined in the Schedule 1 – Dictionary\n\n(6) having sleep apnoea within the five years before the clinical onset of panic disorder;\n\n(7) having a medical illness or injury, which is life-threatening or which results in serious physical or cognitive disability, within the two years before the clinical onset of panic disorder;\n\n(8) having a severe, chronic medical condition within the two years before the clinical onset of panic disorder;\n\nNote: severe, chronic medical condition is defined in the Schedule 1 – Dictionary.\n\n(9) having concussion or moderate to severe traumatic brain injury within the five years before the clinical onset of panic disorder;\n\n(10) having epilepsy at the time of the clinical onset of panic disorder;\n\n(11) experiencing a category 2 stressor within the two years before the clinical onset of panic disorder;\n\nNote: category 2 stressor is defined in the Schedule 1 - Dictionary.\n\n(12) experiencing a category 1A stressor within the two years before the clinical worsening of panic disorder; \n\nNote: category 1A stressor is defined in the Schedule 1 – Dictionary.\n\n(13) experiencing a category 1B stressor within the two years before the clinical worsening of panic disorder;\n\nNote: category 1B stressor is defined in the Schedule 1 – Dictionary.\n\n(14) experiencing severe childhood abuse before the clinical worsening of panic disorder;\n\nNote: severe childhood abuse is defined in the Schedule 1 – Dictionary.\n\n(15) experiencing the death of a significant other within the five years before the clinical worsening of panic disorder;\n\nNote: significant other is defined in the Schedule 1 – Dictionary.\n\n(16) having a clinically significant disorder of mental health from Specified List 2 within the five years before the clinical worsening of panic disorder; \n\nNote: clinically significant disorder of mental health from Specified List 2 is defined in the Schedule 1 – Dictionary\n\n(17) having sleep apnoea within the five years before the clinical worsening of panic disorder;\n\n(18) having a medical illness or injury, which is life-threatening or which results in serious physical or cognitive disability, within the two years before the clinical worsening of panic disorder;\n\n(19) having a severe, chronic medical condition within the two years before the clinical worsening of panic disorder;\n\nNote: severe, chronic medical condition is defined in the Schedule 1 – Dictionary.\n\n(20) having concussion or moderate to severe traumatic brain injury within the five years before the clinical worsening of panic disorder;\n\n(21) having epilepsy at the time of the clinical worsening of panic disorder;\n\n(22) experiencing a category 2 stressor within the two years before the clinical worsening of panic disorder;\n\nNote: category 2 stressor is defined in the Schedule 1 - Dictionary.\n\n(23) inability to obtain appropriate clinical management for panic 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(12) to 9(23) apply only to material contribution to, or aggravation of, panic disorder where the person's panic 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(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 category 1A stressor means one of the following severe traumatic events:\n\n(a) experiencing a life-threatening event;\n\n(b) being subject to a serious physical attack or assault including rape and sexual molestation; or\n\n(c) being threatened with a weapon, being held captive, being kidnapped or being tortured. \n\n category 1B stressor means one of the following severe traumatic events:\n\n(a) killing or maiming a person;\n\n(b) being an eyewitness to a person being killed or critically injured;\n\n(c) being an eyewitness to atrocities inflicted on another person;\n\n(d) participating in the clearance of a corpse or a critically injured casualty; or\n\n(e) viewing a corpse or a critically injured casualty as an eyewitness.\n\nNote: corpse and eyewitness are also defined in the Schedule 1 - Dictionary.\n\n 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 ongoing 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 or school environment including ongoing 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, ongoing 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) having a family member or significant other experience a major deterioration in their health; or\n\n(g) being a full-time caregiver to a family member or significant other with a severe physical, mental or developmental disability.\n\nNote: significant other is also defined in the Schedule 1 - Dictionary.\n\n clinically significant disorder of mental health from Specified List 1 means one of the following conditions, which is of sufficient severity to warrant ongoing management:\n\n(a) acute stress disorder;\n\n(b) agoraphobia;\n\n(c) alcohol use disorder;\n\n(d) anxiety disorder;\n\n(e) attention-deficit/hyperactivity disorder;\n\n(f) bipolar disorder;\n\n(g) conduct disorder;\n\n(h) conversion disorder;\n\n(i) depressive disorder;\n\n(j) dissociative disorder;\n\n(k) eating disorder;\n\n(l) illness anxiety disorder;\n\n(m) insomnia disorder;\n\n(n) obsessive-compulsive disorder;\n\n(o) oppositional defiant disorder;\n\n(p) personality disorder;\n\n(q) posttraumatic stress disorder;\n\n(r) schizophrenia;\n\n(s) separation anxiety disorder;\n\n(t) social anxiety disorder;\n\n(u) somatic symptom disorder;\n\n(v) specific phobia; or\n\n(w) substance use 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 clinically significant disorder of mental health from Specified List 2 means one of the following conditions, which is of sufficient severity to warrant ongoing management:\n\n(a) acute stress disorder;\n\n(b) agoraphobia;\n\n(c) alcohol use disorder;\n\n(d) anxiety disorder;\n\n(e) attention-deficit/hyperactivity disorder;\n\n(f) bipolar disorder;\n\n(g) conduct disorder;\n\n(h) conversion disorder;\n\n(i) depressive disorder;\n\n(j) dissociative disorder;\n\n(k) eating disorder;\n\n(l) illness anxiety disorder;\n\n(m) insomnia disorder;\n\n(n) obsessive-compulsive disorder;\n\n(o) oppositional defiant disorder;\n\n(p) posttraumatic stress disorder;\n\n(q) schizophrenia;\n\n(r) separation anxiety disorder;\n\n(s) social anxiety disorder;\n\n(t) somatic symptom disorder;\n\n(u) specific phobia; or\n\n(v) substance use 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 DSM-5 means the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013.\n\n eyewitness means a person who observes an incident first hand and can give direct evidence of it. This excludes persons exposed only to public broadcasting or mass media coverage of the incident.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\npanic disorder—see subsection 7(2).\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 severe, chronic medical condition means an illness which substantially impacts on social, occupational or other important areas of functioning; and requires on-going daily or almost daily management of symptoms. This management may include, but is not limited to, assistance with activities of daily living, bed rest, dietary modification, drug therapy, nursing care, oxygen therapy or physiotherapy. This management must be supervised by a registered health practitioner. Severe, chronic medical conditions do not usually resolve spontaneously, are rarely cured completely and may progress to life-threatening illnesses. \n\nNote: Examples of these conditions include poorly controlled asthma, chronic obstructive pulmonary disease, poorly controlled diabetes mellitus, inflammatory bowel disease, pemphigus, psoriasis and rheumatoid arthritis.\n\n significant other means a person who has a close family bond or a close personal relationship and is important or influential in one's life.\n\n terminal event means the proximate or ultimate cause of death and includes the following:\n\n(a) pneumonia;\n\n(b) respiratory failure;\n\n(c) cardiac arrest;\n\n(d) circulatory failure; or\n\n(e) cessation of brain function.\n\n VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":6,"scope_assessment":{"changed":false,"description":"The legislation maintains its original purpose as a medical-determination instrument for a specific psychiatric condition. While it updates diagnostic criteria from DSM-IV to DSM-5 and refines stressor categories, it has not expanded beyond its core function of establishing service connection for panic disorder compensation claims."},"complexity_factors":["23 distinct causal factors with varying time windows (2-year vs 5-year lookback periods)","Parallel structure for 'clinical onset' vs 'clinical worsening' creating near-duplicate factor sets (factors 1-11 vs 12-22)","Extensive defined terms in Schedule 1 (15+ definitions) including nested definitions (e.g., 'category 1A stressor' has 3 sub-types, 'category 1B stressor' has 5 sub-types)","Cross-references to external classification systems (DSM-5, ICD-10-AM) and other Statements of Principles","Conditional logic in section 10(2) restricting certain factors to aggravation cases only","Detailed diagnostic criteria in section 7(2) with 13 enumerated symptoms and exclusion clauses"],"plain_english_summary":"This Statement of Principles sets the medical test for linking panic disorder (defined by DSM‑5 criteria: recurrent unexpected attacks plus persistent worry/behaviour change) to military service for compensation. It specifies 23 service‑related factors that, on the balance of probabilities, support a service connection.\n\nIt governs claims by veterans and current/former ADF members and guides DVA decision‑makers; it’s the legal gateway to benefits and replaces the 2009 version with updated medical evidence."},"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"},"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":true,"description":"Compared with earlier, simpler templates for linking panic disorder to service, this Statement expands and clarifies the factual pathways by: (a) adopting explicit DSM‑5 diagnostic criteria as the operative definition (section 7(2)); (b) listing a wide range of medical comorbidities and life events (including concussion/TBI, epilepsy, sleep apnoea, severe chronic medical conditions and two long 'specified' psychiatric lists) as qualifying factors with detailed time windows (section 9 and Schedule 1); (c) expressly including death where panic disorder contributed to a terminal event (section 7(5)); and (d) adding a non‑clinical pathway — \"inability to obtain appropriate clinical management\" — as a qualifying factor for causation or aggravation (section 9(23)). These additions broaden the factual circumstances under which a claimant can establish a service connection, and increase reliance on cross‑referenced Statements and medical interpretation (sections 9, 11 and Schedule 1)."},"complexity_factors":["Detailed DSM‑5 diagnostic criteria are incorporated (section 7(2)), requiring clinical interpretation","Twenty‑three enumerated factors in section 9 with multiple time windows (two years, five years, 'at time of') and separate lists for onset vs worsening","Multiple defined terms in Schedule 1 that materially affect application (category 1A, 1B, 2 stressors; severe childhood abuse; severe chronic medical condition; specified lists 1 and 2; significant other; terminal event; relevant service)","Two long, overlapping ‘Specified Lists’ of clinically significant mental disorders (Schedule 1) used with different timeframes","Cross‑references to external taxonomies and documents (DSM‑5, ICD‑10‑AM) and to other Statements of Principles (section 11)","Conditional logic restricting subsections 9(12)–9(23) to aggravation/material contribution where disorder pre‑existed service (section 10(2))","Inclusion of non‑medical social/administrative factors (e.g. inability to obtain appropriate clinical management) as a listed factor (section 9(23))","Repeal and replacement of an earlier Statement imply comparisons and transitional reading may be required for cases spanning versions (section 4)"],"plain_english_summary":"**What this instrument is and who it affects**\n\n- This is a Statement of Principles made by the Repatriation Medical Authority that sets out the medical and factual criteria used to decide whether a veteran or serving member (covered by the Veterans' Entitlements Act 1986 or the Military Rehabilitation and Compensation Act 2004) can link panic disorder (or death contributed to by panic disorder) to their military or defence service for compensation/entitlement purposes (see sections 3, 5 and 7).\n\n**What the Statement does, mechanically**\n\n- Defines exactly what is meant by \"panic disorder\" for these claims by importing DSM‑5 diagnostic criteria (see section 7(2)). It also maps the condition to the ICD‑10‑AM codes but makes clear that the DSM‑5 definition controls for the instrument's purposes (see sections 7(3)–(4)).\n\n- Lists the specific factors that must exist before a decision‑maker can say, \"on the balance of probabilities\" (i.e. more likely than not), that the panic disorder (or death from it) is connected with relevant service (see section 9). At least one of the listed factors must be present.\n\n- Establishes time windows within which those factors must have occurred relative to the clinical onset or clinical worsening of panic disorder (for example, category 1A or 1B stressors within two years before clinical onset; some events within five years; others at the time of onset—see section 9). Subsections 9(12)–9(23) are confined to cases where panic disorder pre‑existed service and service materially contributed to or aggravated it (see section 10(2)).\n\n- Includes death where a terminal event was contributed to by panic disorder (see section 7(5)).\n\n- Cross‑refers to other Statements of Principles where a listed factor points to a different disease or injury that already has its own Statement (see section 11).\n\n**Key definitions that determine how the factors operate**\n\n- \"Category 1A\" and \"Category 1B\" stressors: lists of severe traumatic events (e.g. life‑threatening events, assault, killing/maiming, witnessing corpses) with different subcategories and examples (Schedule 1).\n\n- \"Category 2\" stressors: chronic negative life events causing ongoing distress (e.g. social isolation, relationship breakdown, workplace bullying, serious legal issues, severe financial hardship, caring for a severely disabled family member) (Schedule 1).\n\n- Lists of \"clinically significant\" mental disorders (Specified Lists 1 and 2) that, if present within set timeframes, qualify as factors (Schedule 1). The lists are long and largely overlap.\n\n- Other defined terms important for operation: \"severe childhood abuse\", \"severe, chronic medical condition\", \"significant other\", \"terminal event\", \"relevant service\" (Schedule 1).\n\n**Who pays, who decides, and how behaviour changes**\n\n- Who decides: claims are assessed by the decision‑maker using this Statement as the evidentiary template (the Repatriation Medical Authority sets the Statement, but claims decisions are made under the VEA or MRCA by the responsible agency). The Statement prescribes the medical/factual connections the decision‑maker must look for (see sections 3, 5, 7–11).\n\n- Who pays/benefits: veterans or members eligible under the VEA or MRCA who can show the required link to service may be entitled to compensation/entitlements under those Acts. The instrument itself does not set payments; it sets the causal rules.\n\n- Behavioural and practical effects: claimants will need medical records and factual evidence that match the diagnostic criteria and the listed factors within the specified time windows (for example, evidence of a qualifying stressor, contemporaneous clinical notes, or records showing inability to obtain appropriate clinical management). This shapes how claimants and their clinicians document history and how decisions weigh comorbidity and timing (see sections 7, 9 and Schedule 1).\n\n**Why the Statement matters (stated purpose and practical trade‑offs)**\n\n- Purpose stated by the instrument: to provide an evidence‑based rule set so that it is \"more probable than not\" that panic disorder (or death from it) can be related to relevant service (see section 8).\n\n- Trade‑offs and incentives to note:\n - Concentrated benefit: the rules concentrate benefits on claimants who can demonstrate one or more specified factors within the prescribed windows (section 9). That creates an incentive for precise clinical documentation of timing, stressor exposure and comorbid conditions.\n - Administrative burden and compliance cost: the requirement for particular types of evidence (DSM‑5 diagnosis, timing relative to onset, records of comorbid conditions, evidence of inability to obtain management) raises the evidentiary burden on claimants and the evidentiary workload for decision‑makers (sections 7, 9, Schedule 1).\n - Medical interpretation risk: many listed factors overlap with other psychiatric diagnoses and medical conditions; decision‑makers must assess clinical causation and distinguish panic disorder from other disorders based on the DSM‑5 criteria and cross‑referenced Statements (sections 7(2), 7(3), 11). This creates implementation risk from variable clinical interpretation.\n - Substitution and overlap effects: because the Statement cross‑refers to other Statements (section 11) and includes many comorbid conditions (Schedule 1 lists), claimants may pursue alternate causal routes or claims (e.g. PTSD, depressive disorder) depending on which path is easier to establish.\n - Expanded eligibility pathways: the inclusion of factors such as severe chronic medical conditions, concussion/TBI, epilepsy, sleep apnoea and \"inability to obtain appropriate clinical management\" potentially broadens factual routes to establish service connection beyond single traumatic events (section 9, Schedule 1). That increases the universe of circumstances in which a claimant might show a service link.\n\n**Practical highlights for clinicians, claimants and decision‑makers**\n\n- Clinicians: use DSM‑5 criteria, record the precise timing of panic attacks, onset and any worsening, document comorbid conditions and any barriers to receiving care (section 7; section 9(23)).\n\n- Claimants: assemble contemporaneous evidence for qualifying stressors/events, medical records for comorbid diagnoses within the specified windows (two years, five years, or \"at time of\" as required), and evidence of service connection (section 9; section 10).\n\n- Decision‑makers: must check that at least one factor in section 9 is present, that it is related to relevant service (section 10(1)), and apply any linked Statements of Principles where a factor points to another injury or disease (section 11).\n\n**Key sections to read for specifics**\n\n- Definition of panic disorder: section 7(2).\n- Required factors and timeframes: section 9.\n- Relationship of factors to relevant service and limits on aggravation claims: section 10.\n- Definitions of stressor categories, comorbid lists and other key terms: Schedule 1.\n\n(End of summary.)"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-panic-disorder-balance-of-probabilities-no-56-of-2018","history":"/api/acts/statement-of-principles-concerning-panic-disorder-balance-of-probabilities-no-56-of-2018/history","analysis":"/api/acts/statement-of-principles-concerning-panic-disorder-balance-of-probabilities-no-56-of-2018/analysis","conflicts":"/api/acts/statement-of-principles-concerning-panic-disorder-balance-of-probabilities-no-56-of-2018/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-panic-disorder-balance-of-probabilities-no-56-of-2018/important-cases","documents":"/api/acts/statement-of-principles-concerning-panic-disorder-balance-of-probabilities-no-56-of-2018/documents"}}