Statement of Principles concerning acute stress disorder (Balance of Probabilities) (No. 96 of 2022)

The central concept is acute stress disorder, defined in subsection 7(2) by reference to DSM-5-TR criteria. Criterion A requires exposure to actual or threatened death, serious injury, or sexual violence through direct experience, witnessing in person, learning of a violent or accidental death of a close family member or friend, or repeated or extreme exposure to aversive details of the traumatic event(s) (which must be work-related for exposure through electronic media, television, movies, or pictures). Criterion B requires nine or more symptoms from five groups: intrusion symptoms (e.g. recurrent involuntary memories, distressing dreams, dissociative reactions, psychological distress to cues); negative mood (persistent inability to experience positive emotions); dissociative symptoms (altered sense of reality, inability to remember an aspect of the event); avoidance symptoms (efforts to avoid distressing memories, thoughts, or external reminders); and arousal symptoms (sleep disturbance, irritable behaviour, hypervigilance, concentration problems, exaggerated startle response). Criterion C requires the disturbance to last from three days to one month after trauma exposure. Criterion D requires clinically significant distress or impairment in social, occupational, or other important areas of functioning. Criterion E excludes symptoms attributable to the physiological effects of a substance or another medical condition and not better explained by brief psychotic disorder. The instrument also defines key stressors in the Schedule 1 dictionary. A category 1A stressor includes experiencing a life-threatening event, being subject to a serious physical attack or assault including rape and sexual molestation, or being threatened with a weapon, held captive, kidnapped, or tortured. A category 1B stressor includes killing or maiming a person; being an eyewitness to a person being killed or critically injured; being an eyewitness to atrocities; participating in clearance of a corpse or critically injured casualty; or viewing a corpse or critically injured casualty as an eyewitness. “Being exposed to repeated or extreme aversive details of severe traumatic events” includes witnessing a person suffering real, severe, traumatic events (e.g. first responders collecting human remains, police officers repeatedly exposed to child abuse details, drone operators viewing planned strikes) or repeatedly listening to a person’s account of their exposure to severe traumatic events. It includes media exposure where viewing images is a work requirement. “Severe childhood abuse” means serious physical, emotional, psychological or sexual harm, or neglect involving a serious failure to provide necessities for health, physical and emotional development or wellbeing, whilst a child aged under 16 years, perpetrated by a parent, care provider, an adult who works with or around that child, or any other adult in contact with that child. “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. “Corpse” is defined narrowly as human remains or body parts of one or more persons who have met a violent or horrific death, with examples including 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 is excluded. “Eyewitness” means a person who experiences an incident first hand and can give direct evidence of it, excluding persons exposed only to public broadcasting or mass media coverage. “Relevant service” is defined in the dictionary as eligible war service (other than operational service) under the VEA, defence service (other than hazardous service and British nuclear test defence service) under the VEA, or peacetime service under the MRCA. This definition is critical: it excludes operational service (combat-related service) and hazardous service from the scope of this balance-of-probabilities Statement of Principles, meaning claims for operational service are governed by a different standard of proof under section 120 of the VEA and potentially different Statements of Principles.

This Statement of Principles directly affects veterans and members of the Forces who have rendered “relevant service” as defined in the instrument and who claim compensation for acute stress disorder or death from acute stress disorder. Relevant service includes eligible war service that is not operational service (e.g. home defence service, certain non-combat deployments), defence service that is not hazardous service or British nuclear test defence service, and peacetime service under the MRCA. It therefore primarily affects veterans who served in non-combat or non-hazardous roles, reservists on peacetime service, and members covered by the MRCA for peacetime service. It also affects their dependents or legal personal representatives in cases where death from acute stress disorder is claimed. The instrument binds decision-makers at the Department of Veterans’ Affairs (DVA), the Veterans’ Review Board, the Administrative Appeals Tribunal, and courts reviewing claims under the VEA and MRCA. Medical practitioners who assess and diagnose acute stress disorder in veterans are indirectly affected because the definition of the condition is fixed by the instrument rather than by clinical judgment alone: to succeed on a claim, the diagnosis must meet the specific DSM-5-TR criteria set out in subsection 7(2). Lawyers and advocates representing claimants must understand the precise wording of each factor, including the 30-day window, the definitions of stressors, and the limitations on the “inability to obtain clinical management” factor. The instrument also affects the Repatriation Medical Authority itself, which has a statutory duty under subsection 196B(3) to determine Statements of Principles based on sound medical-scientific evidence and must consider whether the existing SoP for acute stress disorder should be revoked or amended from time to time. The Australian government, as the payer of compensation and medical expenses, is affected because the instrument establishes a presumptive link between service and the condition, thereby potentially increasing the number of accepted claims and associated costs. However, the instrument may also reduce litigation costs by providing a clear, standardised framework for decision-making. Independent medical experts retained by DVA or by claimants must apply the instrument’s definitions when preparing assessments. The instrument does not directly affect the general public, employers, or private insurers, but it may influence private disability insurance policies that use similar diagnostic criteria or definitions.

The Statement of Principles confers on claimants a right to have their claim for acute stress disorder assessed according to the factors set out in section 9, provided the claim falls under sections 120B of the VEA or 339 of the MRCA. The instrument does not create a substantive right to compensation; that right arises from the VEA or MRCA themselves. However, the instrument establishes a presumptive pathway: if a claimant demonstrates that at least one of the seven factors exists and that factor is related to their relevant service, then it can be said on the balance of probabilities that the condition is connected with service. The decision-maker has a duty to apply the instrument as binding delegated legislation. The RMA has a statutory duty to base the determination on sound medical-scientific evidence, as stated in section 8. The instrument itself does not impose duties on claimants, but it does impose evidentiary requirements: a claimant must provide evidence that the diagnostic criteria for acute stress disorder are met, that a factor exists, that it occurred within the specified timeframe, and that it is related to relevant service. The factor in subsection 9(7) (inability to obtain appropriate clinical management) carries a specific limitation: it applies only to material contribution to, or aggravation of, acute stress disorder where the person’s acute stress disorder was suffered or contracted before or during (but did not arise out of) the person’s relevant service. This means a claimant cannot use factor (7) to establish an initial connection between service and a new onset of acute stress disorder; it can only be used to show that a pre-existing or concurrent condition was worsened by failure to obtain management, and only where the pre-existing condition did not arise from service. The instrument also creates a duty to consider other Statements of Principles. Under section 11, if a factor refers to an injury or disease that is itself covered by another Statement of Principles (e.g. if factor (5) involves exposure to aversive details that themselves constitute a separate condition), then the factors in that other Statement of Principles apply according to their terms. This means a decision-maker may need to apply multiple SoPs to a single claim. The instrument preserves the right to rely on a different factor or a different standard of proof if the balance-of-probabilities standard is not met or if the claim relates to operational service. No right to opt out of the instrument exists; it binds all relevant decision-making.

This instrument is not a penal statute. It does not create any criminal offences, civil penalties, or infringement notices. The only “enforcement” mechanism is through the claims and review process. If a decision-maker fails to apply the instrument correctly, the claimant may seek internal review within DVA, then apply to the Veterans’ Review Board, then the Administrative Appeals Tribunal, and ultimately appeal to the Federal Court or High Court on a question of law. A decision that does not comply with the instrument may be set aside and remitted for reconsideration. The instrument itself provides no direct penalty for a decision-maker who errs; professional sanctions may arise if the error involves misfeasance or breach of duty, but that is governed by broader principles of administrative law and public service conduct. The RMA is not subject to penalties under this instrument; it performs a statutory function. The instrument could indirectly affect compensation entitlements: if a claimant fraudulently claims a factor that does not exist, they may be subject to prosecution under the Criminal Code for obtaining a financial advantage by deception, but that is external to the SoP. The instrument’s language is directive: “At least one of the following factors must exist before it can be said that … acute stress disorder … is connected with the circumstances of a person’s relevant service.” This imposes a mandatory condition precedent on the decision-maker. Failure to require existence of a factor before making a positive determination would be a jurisdictional error. However, there is no penalty in the instrument for such an error. The effect is that incorrect favourable decisions may later be reviewed and reversed, potentially requiring recovery of overpaid benefits under the VEA. The instrument does not contain any provision for fines, imprisonment, or civil pecuniary orders. Its enforcement relies entirely on the integrity of the administrative and judicial review system.

This instrument is made under subsection 196B(3) of the Veterans’ Entitlements Act 1986. It operates within a broader legislative framework that includes the VEA, the MRCA, and other Statements of Principles. It expressly repeals the previous Statement of Principles concerning acute stress disorder No. 42 of 2014 (Federal Register of Legislation No. F2014L00470). It applies only to claims to which section 120B of the VEA or section 339 of the MRCA applies. Section 120B of the VEA sets the standard of proof for claims relating to eligible war service (other than operational service) and defence service (other than hazardous service) - i.e., the balance of probabilities. Section 339 of the MRCA sets a similar standard for peacetime service claims. Therefore, this instrument does not apply to claims for operational service under the VEA (which use a reasonable hypothesis standard under section 120) or to hazardous service or British nuclear test defence service claims. For those claims, a different Statement of Principles may be in force, or the reasonable hypothesis standard may be applied directly without an SoP. The instrument also interacts with other Statements of Principles through section 11. If a factor refers to an injury or disease for which a Statement of Principles has been determined under subsection 196B(3), the factors in that other SoP apply. For example, if the factor “experiencing severe childhood abuse” refers to an injury such as post-traumatic stress disorder, the decision-maker must consult the SoP for that condition to see whether the abuse itself is service-related. The instrument defines key terms by reference to the VEA and MRCA: “relevant service”, “VEA”, “MRCA”. The dictionary also defines “terminal event” which includes common causes of death such as pneumonia, respiratory failure, cardiac arrest, circulatory failure, or cessation of brain function. This definition interacts with death benefit provisions in the VEA and MRCA. The diagnostic criteria are drawn from DSM-5-TR, a non-legislative publication. By adopting these criteria verbatim, the instrument gives legal force to a clinical manual that may be updated in future editions. If DSM-5-TR is revised, the instrument would need to be amended to reflect the new version; otherwise the current criteria remain in force. The instrument does not interact with state or territory compensation schemes, as it is a Commonwealth instrument. However, it may be used as evidence in common law claims if relevant. It does not override privacy laws or human rights legislation, but decision-makers must still comply with the Privacy Act 1988 when handling claimants’ medical information.

The instrument was made on 21 October 2022 and commenced on 21 November 2022. It repeals the previous Statement of Principles concerning acute stress disorder No. 42 of 2014. The 2014 instrument was itself made under subsections 196B(3) and (8) of the VEA. The 2022 instrument is made only under subsection 196B(3), reflecting that the balance-of-probabilities SoP is distinct from any reasonable-hypothesis SoP that may exist for operational service claims. The change from DSM-5 (likely used in the 2014 version) to DSM-5-TR represents a substantive amendment to the diagnostic criteria. DSM-5-TR was published in 2022 and includes updates to diagnostic criteria and text. The specific changes from DSM-5 to DSM-5-TR for acute stress disorder are not set out in the instrument, but the RMA must have determined that the new criteria are soundly based on medical-scientific evidence. The instrument also updates and expands the definitions in the dictionary. For example, the definition of “being exposed to repeated or extreme aversive details of severe traumatic events” now explicitly includes drone operators viewing planned strikes and media exposure where viewing is a work requirement, which may not have been included in the 2014 version. The definition of “corpse” now provides examples of violent or horrific death (suicide, gunshot, IEDs, natural and technological disasters, terrorist attacks, motor vehicle accidents) and explicitly excludes seeing a closed body bag or open-casket coffin. The definition of “severe childhood abuse” is carried over with similar language but with an important structural change: in the 2014 version, the factor for childhood abuse may have had a different timeframe or definition. The instrument does not include any transitional provisions or savings clauses. Claims that were lodged before 21 November 2022 but not yet determined would be assessed under the new instrument if the decision is made after commencement, because section 5 states the instrument applies to a claim to which section 120B or MRCA section 339 applies, without limiting by date of claim. However, there may be a question of whether the old SoP applies to claims lodged before commencement under transitional provisions in the VEA; the instrument is silent, so general administrative law principles would apply: the decision-maker applies the law as at the date of decision, not the date of claim. No further amendments have been made to this instrument as of the date of the source. The instrument is not marked as amended, so it remains in its original form.

The instrument itself does not cite any litigation history, and no court or tribunal cases are referenced in the text. However, the previous 2014 Statement of Principles concerning acute stress disorder may have been considered in decisions of the Administrative Appeals Tribunal or the Federal Court. This deep dive is confined to the source text, which contains no reference to any case. It is reasonable to infer that the RMA may have taken into account tribunal or court decisions interpreting the earlier SoP when drafting the 2022 instrument, particularly in the refined definitions of “corpse”, “being exposed to repeated or extreme aversive details”, and “severe childhood abuse”. For example, the explicit exclusion of closed body bags and open-casket coffin viewing in the definition of “corpse” suggests that earlier decisions may have accepted a broader interpretation, leading the RMA to narrow the definition. Similarly, the inclusion of drone operators and work-related media exposure suggests that the RMA wanted to clarify the scope of permissible exposure. Without access to case law, one cannot confirm this. The instrument’s legal effect is to replace any previous judicial interpretation of the 2014 SoP for future decisions, subject to the doctrine of precedent on questions of law. Any consideration of this SoP by a court or tribunal will now interpret the 2022 text. The instrument does not contain any declaratory provisions about past litigation. If a claimant has had a previous claim rejected under the 2014 SoP, they may be able to lodge a new claim under the 2022 instrument if the changes in definition make a difference, subject to the rules on res judicata and finality. The RMA has not included any statements about retrospective application or about overruling previous decisions. In practice, the SoP is likely to be litigated in future when decision-makers apply the new definitions, particularly around the 30-day window for childhood abuse and the meaning of “work-related” media exposure. No constitutional challenges to the RMA’s power under section 196B have been referenced in the instrument.

Several nuances in this instrument can easily catch out claimants and decision-makers. First, the 30-day window for all factors except inability to obtain clinical management is strict. The factor must occur “within the 30 days before the clinical onset of acute stress disorder.” Acute stress disorder by definition lasts only 3 days to 1 month, so the window is extremely tight. If a veteran experiences a category 1A stressor but the onset of symptoms occurs more than 30 days later, the factor is not met, even if the stressor is clearly service-related. Claimants must provide precise evidence of onset date and stressor date. Second, the definition of “relevant service” excludes operational service under the VEA and hazardous service. This means a veteran who served in a combat zone (operational service) cannot use this SoP for a balance-of-probabilities claim. They may need to rely on a different SoP or the reasonable hypothesis standard. Many veterans and advocates may erroneously assume all service is covered. Third, the factor “experiencing severe childhood abuse within the 30 days before the clinical onset” is particularly counterintuitive. The abuse must occur while the person is a child under 16, but the abuse event itself must be within 30 days of the onset of acute stress disorder. Since acute stress disorder is a short-term condition starting within a month of trauma, this factor will almost never apply to adults who experienced abuse in early childhood unless they develop acute stress disorder within 30 days of a new episode of abuse as a child. It is a very narrow factor, likely intended for cases where a child on peacetime service experiences abuse and promptly develops the disorder. Fourth, the definition of “being exposed to repeated or extreme aversive details of severe traumatic events” includes work-related media exposure but not ordinary media consumption. A veteran who watches graphic news coverage of war at home does not qualify unless it is a work requirement (e.g. a military analyst). Fifth, the definition of “category 1A stressor” includes “being threatened with a weapon, being held captive, being kidnapped or being tortured.” It does not include threats without a weapon or verbal threats alone. Sixth, the definition of “corpse” explicitly excludes seeing a closed body bag or viewing a body in an open-casket coffin. A veteran who helped bag bodies but did not see the remains may not meet the factor for corpse clearance. Seventh, the factor for “inability to obtain appropriate clinical management” (subsection 9(7)) has a strict limitation: it applies only to material contribution or aggravation where the acute stress disorder existed before or during service but did not arise out of service. It cannot be used to establish a new connection. Eighth, the instrument incorporates by reference other Statements of Principles under section 11, meaning a decision-maker must check if any factor triggers another SoP. Ninth, the diagnostic criteria require that the disturbance is “not better explained by brief psychotic disorder” - a subtle exclusion that may require expert evidence. Tenth, the instrument applies only to claims under sections 120B of VEA and 339 of MRCA; if a claim is incorrectly categorised (e.g. operational service treated as non-operational), the wrong standard may be applied. Eleventh, the term “acute stress disorder” does not include chronic or delayed-onset variants; the DSM-5-TR criteria explicitly require duration of 3 days to 1 month, so a condition lasting longer is post-traumatic stress disorder, not covered by this SoP. Twelfth, the dictionary defines “significant other” as having a close family bond or close personal relationship; this may include a fiancé or de facto but the decision-maker must assess closeness on a case-by-case basis.

For claimants and their representatives, compliance with this instrument requires a methodical approach. Step one: ensure the claimed condition meets the diagnostic criteria in subsection 7(2). The diagnosis should be made by a qualified psychiatrist or clinical psychologist using DSM-5-TR criteria. The assessment must confirm exposure to a qualifying traumatic event (Criterion A), at least nine symptoms from Criterion B, duration of 3 days to 1 month (Criterion C), clinically significant distress or impairment (Criterion D), and exclusion of substance or medical causes and brief psychotic disorder (Criterion E). The clinical onset date must be clearly identified because it anchors the 30-day window for all factors. Step two: identify which of the seven factors in section 9 applies. For each factor, gather evidence that the specific event occurred and that it was related to the person’s relevant service. Relevant service is defined in the dictionary as eligible war service (other than operational), defence service (other than hazardous or British nuclear test), or peacetime service under MRCA. If the person served operationally, this SoP does not apply; instead, the claim must be assessed under section 120 of the VEA using a reasonable hypothesis standard, and a different SoP may be relevant. Step three: for factors (1) to (6), prove that the stressor occurred within 30 days before clinical onset. For factor (1) (category 1A stressor), provide evidence of a life-threatening event, serious physical attack including rape or sexual molestation, or being threatened with a weapon, held captive, kidnapped, or tortured. For factor (2) (category 1B stressor), evidence of killing or maiming, eyewitness to killing/critical injury, eyewitness to atrocities, participating in corpse clearance, or viewing a corpse/critically injured casualty. Note the narrow definitions: “corpse” excludes closed body bags and open-casket coffins; “eyewitness” excludes media exposure. For factor (3) (significant other experiences category 1A stressor), show that the significant other (close family or personal relationship) experienced such a stressor and that the claimant learned of it. For factor (4) (traumatic death of significant other), the death must be traumatic not necessarily defined but likely sudden or violent. For factor (5) (repeated or extreme aversive details), evidence that the claimant witnessed or repeatedly listened to accounts of severe traumatic events, including work-related media exposure. For factor (6) (severe childhood abuse), this will rarely succeed for adults because the abuse must occur within 30 days before onset while the person is under 16; it is best suited for child members. Factor (7) (inability to obtain appropriate clinical management) requires proof that the person already had acute stress disorder before or during service (but not arising from service) and that failure to obtain management materially contributed to or aggravated it. Step four: ensure the factor is related to relevant service. For example, a category 1A stressor that occurred while on leave and unrelated to duties will not satisfy section 10. Step five: decision-makers must also check section 11 to see if any factor refers to an injury or disease covered by another SoP, and if so, apply that other SoP as in force. Step six: maintain thorough documentation of service records, medical reports, and witness statements. Step seven: if a claim is rejected, consider whether the correct SoP was applied and whether any factor could be established under a different interpretation. The instrument does not prescribe a specific form of evidence, but the onus is on the claimant to prove the factor on the balance of probabilities. Compliance is essentially about careful mapping of the clinical and service history to the precise language of the instrument.