{"id":"F2023L00179","name":"Statement of Principles concerning periodic limb movement disorder (Reasonable Hypothesis) (No. 19 of 2023)","slug":"statement-of-principles-concerning-periodic-limb-movement-disorder-reasonable-hypothesis-no-19-of-20","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441739,"registerId":"F2023L00179-fast-fetch-1775956966276","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning periodic limb movement disorder (Reasonable Hypothesis) (No. 19 of 2023)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 22.10.0\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n\n\n \n\nStatement of Principles\n\nconcerning\n\nPERIODIC LIMB MOVEMENT DISORDER (Reasonable Hypothesis)\n\n(No. 19 of 2023)\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 27 February 2023\n\n \n\n \n\n \n\n \n\n \n\n| The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:
|\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 periodic limb movement disorder (Reasonable Hypothesis) (No. 19 of 2023).\n\n2 Commencement\n\n This instrument commences on 27 March 2023.\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 periodic limb movement disorder No. 26 of 2014 (Federal Register of Legislation No. F2014L00313) made under subsection 196B(2) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 periodic limb movement disorder and death from periodic limb movement disorder.\n\nMeaning of periodic limb movement disorder\n\n(2) For the purposes of this Statement of Principles, periodic limb movement disorder:\n\n(a) means a sleep disorder in which excessive periodic limb movements of sleep are accompanied by a clinical sleep disturbance and impaired daytime behavioural, social, physical or occupational functioning; and\n\n(b) the clinical features are not better explained by another primary sleep disorder; and\n\n(c) excludes periodic limb movements of sleep which are not accompanied by a clinical sleep disturbance or impaired daytime functioning.\n\nNote 1: Clinical sleep disturbance is characterised by difficulty with sleep initiation or sleep maintenance, or unrefreshing sleep.\n\nNote 2: The diagnosis is confirmed by overnight polysomnography (PSG) showing periodic limb movements occurring at a frequency of at least 15 per hour during sleep in adults.\n\nNote 3: Examples of other primary sleep disorders include restless legs syndrome, obstructive sleep apnoea, rapid eye movement sleep behaviour disorder and narcolepsy.\n\nNote 4: periodic limb movements of sleep is defined in the Schedule 1 – Dictionary.\n\n(3) While periodic limb movement disorder attracts ICD‑10‑AM code G47.61, in applying this Statement of Principles the meaning of periodic limb movement 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 periodic limb movement disorder\n\n(5) For the purposes of this Statement of Principles, periodic limb movement disorder, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's periodic limb movement disorder.\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n8 Basis for determining the factors\n\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that periodic limb movement disorder and death from periodic limb movement disorder can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces under the VEA, or members under the MRCA.\n\nNote: MRCA, relevant service and VEA are defined in the Schedule 1 – Dictionary.\n\n9 Factors that must exist\n\nAt least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting periodic limb movement disorder or death from periodic limb movement disorder with the circumstances of a person's relevant service:\n\n(1) having chronic renal failure at the time of the clinical onset of periodic limb movement disorder;\n\nNote: chronic renal failure is defined in the Schedule 1 - Dictionary.\n\n(2) having a spinal cord lesion at the time of the clinical onset of periodic limb movement disorder;\n\nNote: Examples of spinal cord lesions include transverse myelitis, trauma or compression of the spine and spondylotic myelopathy.\n\n(3) taking a drug from the specified list of drugs:\n\n(a) as prescribed for ongoing use; and\n\n(b) within the 30 days before the clinical onset of periodic limb movement disorder;\n\nNote: specified list of drugs is defined in the Schedule 1 – Dictionary.\n\n(4) having iron deficiency at the time of the clinical onset of periodic limb movement disorder;\n\nNote: iron deficiency is defined in the Schedule 1 – Dictionary.\n\n(5) having a cerebrovascular accident within the 3 months before the clinical onset of periodic limb movement disorder;\n\n(6) having moderate to severe traumatic brain injury within the 3 months before the clinical onset of periodic limb movement disorder, and in the case of sustained unconsciousness following injury to the head, the clinical onset of periodic limb movement disorder occurred within 3 months of regaining consciousness;\n\n(7) having Parkinson's disease at the time of the clinical onset of periodic limb movement disorder;\n\n(8) having multiple sclerosis at the time of the clinical onset of periodic limb movement disorder;\n\n(9) having a clinically significant depressive disorder or posttraumatic stress disorder at the time of the clinical onset of periodic limb movement disorder;\n\nNote: clinically significant is defined in the Schedule 1 – Dictionary.\n\n(10) having chronic renal failure at the time of the clinical worsening of periodic limb movement disorder;\n\nNote: chronic renal failure is defined in the Schedule 1 - Dictionary.\n\n(11) having a spinal cord lesion at the time of the clinical worsening of periodic limb movement disorder;\n\nNote: Examples of spinal cord lesions include transverse myelitis, trauma or compression of the spine and spondylotic myelopathy.\n\n(12) taking a drug from the specified list of drugs:\n\n(a) as prescribed for ongoing use; and\n\n(b) within the 30 days before the clinical worsening of periodic limb movement disorder;\n\nNote: specified list of drugs is defined in the Schedule 1 – Dictionary.\n\n(13) having iron deficiency at the time of the clinical worsening of periodic limb movement disorder;\n\nNote: iron deficiency is defined in the Schedule 1 – Dictionary.\n\n(14) having a cerebrovascular accident within the 3 months before the clinical worsening of periodic limb movement disorder;\n\n(15) having moderate to severe traumatic brain injury within the 3 months before the clinical worsening of periodic limb movement disorder, and in the case of sustained unconsciousness following injury to the head, the clinical worsening of periodic limb movement disorder occurred within 3 months of regaining consciousness;\n\n(16) having Parkinson's disease at the time of the clinical worsening of periodic limb movement disorder;\n\n(17) having multiple sclerosis at the time of the clinical worsening of periodic limb movement disorder;\n\n(18) having a clinically significant depressive disorder or posttraumatic stress disorder at the time of the clinical worsening of periodic limb movement disorder;\n\nNote: clinically significant is defined in the Schedule 1 – Dictionary.\n\n(19) inability to obtain appropriate clinical management for periodic limb movement 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(10) to 9(19) apply only to material contribution to, or aggravation of, periodic limb movement disorder where the person's periodic limb movement disorder was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n\n11 Factors referring to an injury or disease covered by another Statement of Principles\n\nIn this Statement of Principles:\n\n(1) if a factor referred to in section 9 applies in relation to a person; and\n\n(2) that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(2) of the VEA;\n\nthen the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.\n\n \n\n \n\nSchedule 1 - Dictionary \n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\n chronic renal failure means:\n\n(a) having a glomerular filtration rate of less than 15 mL/min/1.73 m2 for a period of at least 3 months; or\n\n(b) a need for renal replacement therapy (dialysis or transplantation) for treatment of complications of decreased glomerular filtration rate which would otherwise increase the risk of morbidity and mortality; or\n\n(c) undergoing chronic dialysis.\n\n clinically significant means sufficient to warrant ongoing management which may involve regular visits (for example, at least monthly) to a psychiatrist, counsellor or general practitioner.\n\nNote: To warrant ongoing management does not require that any actual management was received or given for the condition.\n\n iron deficiency means having a serum ferritin level of less than 30 micrograms per litre. \n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n periodic limb movement disorder—see subsection 7(2).\n\n periodic limb movements of sleep are repetitive, stereotyped, involuntary movements of the extremities that occur during sleep. They typically consist of extension of the first toe and dorsiflexion of the ankle, which can also be accompanied by flexion of the knee and hip. The upper extremities may rarely be involved.\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 specified list of drugs means:\n\n(a) mirtazapine;\n\n(b) olanzapine;\n\n(c) selective serotonin re-uptake inhibitors including citalopram, escitalopram, fluoxetine and sertraline;\n\n(d) tricyclic antidepressants including amitriptyline; and\n\n(e) venlafaxine.\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\n \n","sortOrder":0}],"analysis":{"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"},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard replacement Statement of Principles under the Veterans' Entitlements Act framework. It repeals the 2014 version (No. 26 of 2014) and maintains the same narrow, specific purpose: establishing medical criteria for linking periodic limb movement disorder to military service. The scope remains tightly confined to this discrete medical condition and its relationship to defined service types."},"complexity_factors":["19 distinct factors with specific temporal requirements (e.g., 'within 30 days', 'within 3 months', 'at the time of')","Bifurcated structure: separate factor lists for clinical onset (factors 1-9) versus clinical worsening (factors 10-19)","Cross-referencing mechanism in section 11: factors referring to other diseases trigger separate Statements of Principles","8 defined terms in Schedule 1, including technical medical definitions (e.g., glomerular filtration rate <15 mL/min/1.73 m² for chronic renal failure, serum ferritin <30 µg/L for iron deficiency)","Conditional logic in section 10(2) restricting worsening factors to pre-existing conditions not arising from service","Specific drug list with 5 categories of psychotropic medications in the definition of 'specified list of drugs'","Diagnostic criteria incorporating external medical classification (ICD-10-AM) while overriding it with statutory definition in section 7(2)"],"plain_english_summary":"This instrument sets medical rules for awarding compensation for periodic limb movement disorder (PLMD): diagnosis requires a sleep study showing frequent limb movements plus sleep or daytime impairment. It identifies 19 service‑related \"connection factors\" (e.g., renal failure, certain medications, iron deficiency, neurological or psychiatric conditions) that can link PLMD to military service.\n\nIt affects veterans and defence personnel claiming under the VEA or MRCA and creates the legal pathway to establish service connection for benefits."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"Replaces the 2014 Statement (s4). Updates and clarifies the definition and diagnostic requirement for periodic limb movement disorder (s7(2), Note 2), adds or restates specific qualifying factors including a defined drug list and lab thresholds (Schedule 1; s9), introduces factors for clinical worsening and inability to obtain management (s9(10)–(19)), and limits certain factors to material contribution/aggravation where the disorder pre‑existed service (s10(2))."},"complexity_factors":["Medical-technical thresholds and diagnostic criteria (overnight polysomnography requirement; subsection 7(2) Note 2).","Objective laboratory cut-offs requiring specific evidence (iron deficiency: ferritin <30 µg/L; chronic renal failure: GFR <15 or dialysis/transplant definitions) (Schedule 1).","Time-bound causal windows and temporal conditions (30 days for drug exposure in s9(3)/(12); 3-month windows for cerebrovascular accident and moderate–severe TBI in s9(5)/(6)/(14)/(15)).","Multiple clinical antecedents and comorbidities listed as standalone qualifying factors (spinal cord lesion, Parkinson’s, MS, depressive disorder/PTSD) (s9(2),(7),(8),(9)).","Separate sets of factors for clinical onset and clinical worsening, and an explicit material contribution/aggravation rule when disorder pre-existed service (s9(1)–(19); s10(2)).","Interaction with other Statements of Principles where a factor refers to another disease (s11) — requires cross-referencing and possible application of different SOPs.","Specified drug list that requires prescription evidence and timing (Schedule 1: mirtazapine, olanzapine, SSRIs, TCAs, venlafaxine) (s9(3)/(12); Schedule 1).","Administrative scope and application to claims under two statutes (VEA and MRCA) and repeal of prior instrument (ss5,3,4) — affects claim processing and precedent.","Inclusion of non-clinical evidentiary factor (inability to obtain appropriate clinical management) which raises evidentiary and causation questions (s9(19)).","Standard of causation is 'reasonable hypothesis' via RMA determination under subsection 196B(2) (Authority: s3 and header) — lower threshold than balance of probabilities but requires documented linkage."],"plain_english_summary":"This Statement of Principles defines periodic limb movement disorder and sets the medical criteria that, if present and linked to a veteran’s relevant service, raise a reasonable hypothesis that the condition or death is service‑related. It applies to VEA and MRCA claims and repeals the 2014 Statement. The Repatriation Medical Authority cites medical evidence; the instrument prescribes diagnostic thresholds (PSG), lab cut‑offs (ferritin, GFR), specified drugs, recent neurological events and lack of clinical management as qualifying factors."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-periodic-limb-movement-disorder-reasonable-hypothesis-no-19-of-20","history":"/api/acts/statement-of-principles-concerning-periodic-limb-movement-disorder-reasonable-hypothesis-no-19-of-20/history","analysis":"/api/acts/statement-of-principles-concerning-periodic-limb-movement-disorder-reasonable-hypothesis-no-19-of-20/analysis","conflicts":"/api/acts/statement-of-principles-concerning-periodic-limb-movement-disorder-reasonable-hypothesis-no-19-of-20/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-periodic-limb-movement-disorder-reasonable-hypothesis-no-19-of-20/important-cases","documents":"/api/acts/statement-of-principles-concerning-periodic-limb-movement-disorder-reasonable-hypothesis-no-19-of-20/documents"}}