Statement of Principles concerning adjustment disorder (Balance of Probabilities) (No. 59 of 2025)

This instrument, the Statement of Principles concerning adjustment disorder (Balance of Probabilities) (No. 59 of 2025), is a legislative determination made by the Repatriation Medical Authority (RMA) under subsection 196B(3) of the Veterans’ Entitlements Act 1986 (VEA). It repeals and replaces the previous Statement of Principles for adjustment disorder (No. 24 of 2016) effective from 21 July 2025. Its mechanical effect is to set out the minimum factual conditions that must be satisfied, on the balance of probabilities, before a veteran’s or member’s adjustment disorder (or death from that disorder) can be accepted as related to their relevant service under the VEA or peacetime service under the Military Rehabilitation and Compensation Act 2004 (MRCA). The instrument does not grant or deny any claim itself; it provides the medical‑scientific template that the decision‑maker (the Repatriation Commission or the Military Rehabilitation and Compensation Commission) must apply when determining whether the condition is service‑related under the standard of proof applicable to certain categories of service.

The most important change from the 2016 SoP is the express incorporation of the DSM‑5‑TR definition of adjustment disorder, including sub‑criteria such as the 3‑month onset window, clinically significant distress or impairment, and the exclusion of normal bereavement and other mental disorders. The instrument also introduces a new category of factor: “being exposed to repeated or extreme aversive details of severe traumatic events” (factor 9(3)), which explicitly covers first responders collecting remains and drone operators viewing planned strikes, including media exposure required by service. The previous instrument had a narrower stressor framework. The factor set in section 9 is exhaustive: at least one listed factor must exist, and the factor must relate to the person’s service. The instrument takes effect only for claims to which section 120B VEA or section 339 MRCA applies, meaning claims where the standard of proof is the balance of probabilities (i.e., for eligible war service other than operational service, defence service other than hazardous service, and peacetime service). The SoP does not apply to operational or hazardous service, where the “reasonable hypothesis” standard under different SoPs may apply.

The central concept is adjustment disorder, defined in subsection 7(2) by reference to DSM‑5‑TR criteria A-E: an identifiable stressor(s) occurring within 3 months before symptom onset; clinically significant distress or impairment (marked distress out of proportion to the stressor, or functional impairment); the disturbance does not meet criteria for another mental disorder; it is not normal bereavement; and symptoms do not persist more than 6 months after the stressor or its consequences end. This definition is narrower than general clinical usage because it binds the decision‑maker and the applicant to DSM‑5‑TR specifics. The instrument explicitly overrides the ICD‑10‑AM code F43.2; the code is for administrative reference only.

Category 1A stressor covers severe traumatic events: experiencing a life‑threatening event, being subject to serious physical attack (including sexual assault), or being threatened with a weapon, held captive, kidnapped, or tortured. Category 1B stressor covers killing or maiming a person, witnessing a person being killed or critically injured, witnessing atrocities, or witnessing human remains or critically injured casualties. The definition of witness is critical: it means experiencing an incident firsthand and being able to give direct evidence, excluding exposure only to public broadcasting or mass media (unless that media exposure is a requirement of service, per factor 9(3)). Category 2 stressor is a broader, chronic negative life event such as being a full‑time caregiver, social isolation, racial discrimination, relationship breakdown, workplace disharmony, sexism, legal issues, severe financial hardship, or a family member’s major health deterioration. Unlike the category 1 stressors, category 2 stressors must be “chronic in nature and cause the person to feel ongoing distress, concern or worry”.

Clinical onset is defined as the point backwards in time from the date of first medical confirmation to the date symptoms were persistently present, as assessed by a registered medical practitioner. This is a fact‑intensive test that will often require expert evidence linking symptoms to a specific stressor within 3 months. The instrument also defines miscarriage (spontaneous or induced expulsion before foetal viability) and terminal event (pneumonia, respiratory failure, cardiac arrest, circulatory failure, cessation of brain function) for death‑related claims.

is a term of art: it means 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. It excludes operational and hazardous service, for which different evidentiary standards and different SoPs may apply (often the “reasonable hypothesis” standard under s 196B(2) SoPs). The instrument itself is made under subsection 196B(3) for the balance‑of‑probabilities standard.

The primary affected persons are current and former members of the Australian Defence Force (ADF) who rendered eligible war service (non‑operational), defence service (non‑hazardous), or peacetime service, and who suffer from adjustment disorder or die from a terminal event contributed to by that disorder. It also affects dependents and estate beneficiaries who may bring a claim for compensation or pension following the member’s death. However, the instrument does not apply to:

• members who rendered operational service (e.g., warlike operations) or hazardous service (e.g., certain peacekeeping with increased risk), because those categories fall under a higher standard of proof (reasonable hypothesis) governed by different SoPs made under subsection 196B(2). For those categories, the RMA has separate SoPs for adjustment disorder (e.g., No. 58 of 2025 for reasonable hypothesis), which this instrument does not replace.
• veterans with eligible war service or defence service who claim under the VEA but are relying on the “reasonable hypothesis” standard for certain injuries (e.g., where the claim predates the balance‑of‑probabilities requirement or where the injury is not covered by this SoP).

The instrument also affects decision‑makers: the Repatriation Commission, the Military Rehabilitation and Compensation Commission, the Veterans’ Review Board, and the Administrative Appeals Tribunal (soon to be the Administrative Review Tribunal) must apply this SoP when determining claims where the balance of probabilities is the prescribed standard. Medical practitioners providing assessments for compensation claims must ensure their reports address the DSM‑5‑TR definition, the 3‑month window, and the specific stressor categories.

The practical impact on claimants is that it sets a clear, testable pathway to service‑relatedness. If a claimant can point to a category 1A or 1B stressor, or a qualifying category 2 stressor, occurring within 3 months prior to clinical onset and related to their service, they are likely to succeed. Conversely, the temporal limit (3 months) and the exclusion of normal bereavement and other mental disorders may defeat claims where the stressor is remote in time or where another diagnosis fits better. The instrument does not affect service‑related adjustment disorder claims under the Safety, Rehabilitation and Compensation Act 1988 (SRCA), which covers Commonwealth employees not eligible under VEA or MRCA; those claims are governed by different statutory provisions and common‑law causation requirements.

The instrument does not impose duties on claimants directly; rather, it creates a right to have a claim assessed against a predetermined set of factors. The right is procedural: if a claimant satisfies section 9 (one factor exists and is related to service) and the definition of adjustment disorder is met, then the condition must be accepted as service‑related on the balance of probabilities. The claimant bears the evidentiary burden of proving the factor and its timing, though the standard is the civil one (balance of probabilities). There is no duty to “comply” with the SoP; claimants simply need to present evidence meeting its terms.

Decision‑makers have a statutory duty to take this SoP into account when determining a claim under section 120B(3) VEA or section 339 MRCA. They cannot accept a claim for adjustment disorder unless satisfied, on the balance of probabilities, that the factors exist. They must also consider any other relevant SoPs referred to by this instrument: factor 9(6) (inability to obtain clinical management) only applies to material contribution or aggravation where the condition existed before or during service but did not arise out of service. Section 11 provides that if a factor in section 9 refers to an injury or disease covered by another SoP, the factors in that other SoP apply in accordance with its terms as in force from time to time. This creates a cascading obligation: a decision‑maker dealing with a factor such as “having a medical illness or injury which has resulted in a severe level of physical or cognitive disability” must consult the relevant SoP for that primary medical injury to see if it is service‑related. That adds complexity and potential cross‑referencing.

The right to rely on the SoP is subject to the definition of adjustment disorder. A person whose symptoms persist beyond 6 months after the stressor terminates does not meet criterion E and therefore does not have the defined condition. Clinical judgement will be crucial. The instrument also creates a right for the estate to claim where death is contributed to by adjustment disorder, with “terminal event” broadly defined.

This instrument contains no penalties for non‑compliance. It is a legislative instrument that sets out conditions for entitlement; it does not create criminal or civil penalty provisions. Enforcement in the sense of compliance is not an issue for claimants. The enforcement mechanism lies in the broader statutory scheme: if the Commission or MRCC rejects a claim because the applicant fails to satisfy the SoP factors, that decision is reviewable by the Veterans’ Review Board and then the Administrative Appeals Tribunal (or its successor). The RMA itself does not enforce the SoP; it merely issues it.

However, there is an indirect enforcement dimension for medical practitioners and decision‑makers. A decision‑maker who fails to apply the SoP correctly may have their decision set aside on review. A medical practitioner who gives inconsistent or unsubstantiated evidence regarding the DSM‑5‑TR criteria or the 3‑month window may damage the claimant’s case. The SoP itself is binding under the legislation; it is not discretionary. For the decision‑maker, not applying it is an error of law.

The instrument does not provide for any penalties for claimants for making false or misleading statements; that is dealt with under the Criminal Code (Cth) and under section 136 of the VEA (offence for obtaining payment by false statements). The SoP’s role is to define when a condition is “related to service” for the purpose of those payment provisions. Therefore, the practical enforcement consequence is that a claim that rests on a fabricated stressor or a manufactured timing could attract prosecution, but the SoP itself does not address that.

This instrument sits within a layered legislative framework. It is made under subsection 196B(3) of the VEA, which empowers the RMA to determine SoPs on the balance of probabilities for certain kinds of injury, disease, or death. Section 196B(2) SoPs exist for the higher “reasonable hypothesis” standard; those SoPs may coexist for the same condition but apply to different service categories. For example, the RMA has likely also made a reasonable‑hypothesis SoP for adjustment disorder (No. 58 of 2025), which would apply to operational and hazardous service. This instrument explicitly applies to claims under section 120B VEA (balance of probabilities for non‑operational service) and section 339 MRCA (balance of probabilities for peacetime service). The instrument does not affect claims under the SRCA or the Military Compensation Scheme provisions for members injured before 1 July 2004.

The instrument also interacts with other SoPs through section 11: if a factor is an injury or disease covered by another SoP, the factors in that other SoP must be applied. For example, factor 9(6) refers to a “medical illness or injury which has resulted in a severe level of physical or cognitive disability.” To prove that the illness or injury is itself service‑related, the decision‑maker must look at the relevant SoP for that illness (e.g., a SoP for traumatic brain injury, or for a specific cancer). This cross‑referencing is crucial: a claimant cannot simply say they had a severe injury; they must also satisfy the SoP for that injury on the balance of probabilities.

The instrument also interacts with the VEA and MRCA provisions on causation. Section 120B(3) VEA states that the Commission is to determine a claim for a disease accepted on the balance of probabilities only if it is satisfied that the disease is war‑caused (or defence‑caused) and that the material before the Commission does not raise a reasonable hypothesis inconsistent with that satisfaction. The SoP effectively replaces the need for a direct causal reasoning; if the SoP factors are met, the condition is deemed to be war‑caused. So the SoP has a pre‑emptive effect on causation analysis.

The instrument interacts with the Evidence Act and administrative law principles. The definitions (e.g., clinical onset) require medical evidence; that evidence is assessed under the common‑law rules of proof for administrative decision‑making. The SoP does not displace those rules but narrows the factual inquiry.

Finally, the instrument is subject to the Legislation Act 2003. It is a disallowable legislative instrument, so it could be disallowed by either House of Parliament within 15 sitting days of tabling. If disallowed, it would cease to have effect and the 2016 SoP would be revived (unless also disallowed earlier). That is a rare event but a formal interaction with parliamentary scrutiny.

The instrument repeals the Statement of Principles concerning adjustment disorder (Balance of Probabilities) (No. 24 of 2016) (registered F2016L00270). The 2016 SoP was itself a replacement of earlier versions. The RMA commonly revises SoPs as medical science evolves; the DSM‑5‑TR (2022) replaced the DSM‑5 (2013), and the RMA has updated its definitions accordingly. The new instrument also expands the stressor categories, particularly factor 9(3) (exposure to aversive details of traumatic events), which was not present in the 2016 SoP. The repeal is explicit and immediate upon commencement.

There is no amendment history provided within the instrument itself; it is a standalone instrument. However, one can infer that the RMA considers the new evidence (the instrument states “on the sound medical‑scientific evidence available”) to warrant broadening the factors. The 2016 instrument had also been made under subsections 196B(3) and (8); the new instrument is made under subsection 196B(3) alone, which may indicate a change in how the RMA views the delegates’ authority. Subsection 196B(8) allows the RMA to delegate its functions; the omission suggests that the instrument is made by the RMA itself, not by a delegate.

The commencement date is 21 July 2025, a date likely chosen to allow time for publication, tabling, and any parliamentary scrutiny before it takes effect. The delay (about one month from signing on 20 June) is standard.

The instrument does not cite any litigation. However, it is reasonable to note that previous SoPs for mental health conditions have been the subject of review applications in the AAT and the Federal Court. Cases have often turned on the definition of “clinical onset” and the temporal relationship to stressors. For instance, the AAT has grappled with whether a stressor occurred within the “reasonable hypothesis” period under earlier SoPs. This instrument similarly invites litigation on the interpretation of “witness” (does a drone operator viewing real‑time footage count as firsthand experience? The instrument includes that example in the note, but the note is not binding). Also, the exclusion of normal bereavement (criterion 4) may be litigated if a claimant argues their prolonged grief is actually an adjustment disorder related to service.

The most likely litigation area will be the 3‑month window for clinical onset. The definition of “clinical onset” is backward‑looking from the first medical confirmation to when symptoms were “persistently present”. This opens the door to disputes about when symptoms became persistent enough to meet DSM‑5‑TR criterion A. The requirement that a registered medical practitioner assess the date adds a layer of evidentiary contest.

Also, factor 9(6) (inability to obtain appropriate clinical management) applies only to material contribution or aggravation where the disorder was suffered or contracted before or during service but did not arise out of that service. This is a distinct path for aggravation claims and has been litigated under earlier SoPs in the context of “worsening of a pre‑existing condition”. The phrase “inability to obtain appropriate clinical management” may be interpreted strictly; whether a mere delay in treatment qualifies could be contested.

No class‑action or high‑profile litigation is recorded in the instrument, but the RMA’s SoPs are routinely cited in compensation tribunal decisions.

Several provisions will trip up claimants and practitioners if read too quickly.

First, the definition of adjustment disorder in subsection 7(2) is exhaustive and includes criterion E: symptoms must not persist more than 6 months after the stressor or its consequences terminate. A person who has had a chronic, unremitting stressor (e.g., ongoing workplace bullying) may have symptoms that persist for a longer period, but if the stressor itself is continuous, the 6‑month clock may not start. However, if the stressor ceases and symptoms continue beyond 6 months, the diagnosis is not adjustment disorder; it may be another mental disorder. The DSM‑5‑TR itself notes that if symptoms persist beyond 6 months, the diagnosis should be reconsidered. This could defeat a claim even if the stressor was clearly service‑related, because the condition does not meet the instrument’s definition. The claimant would then need to prove a different condition (e.g., major depressive disorder) under a different SoP.

Second, clinical onset is defined backwards from “first medical confirmation” to when symptoms were “persistently present”. This is a two‑step test. If a claimant delayed seeking medical help, the first medical confirmation may be years after the stressor, but the clinical onset could be deemed earlier if a medical practitioner assesses that symptoms were already persistently present within 3 months of the stressor. That requires strong evidence - self‑report, or contemporaneous notes from a chaplain or psychologist. A GP’s note years later stating “symptoms present since 2021” may not be enough if it is vague.

Third, category 2 stressors require that the effects are “chronic in nature and cause the person to feel ongoing distress, concern or worry”. A one‑off relationship breakup that happened three months before clinical onset may not satisfy this if the person quickly moved on. The decision‑maker will examine whether the stressor had ongoing effects, not just whether it was a negative event. The list includes “experiencing a problem with a long‑term relationship including the break‑up of a close personal relationship”. The required ongoing distress must be present; a separation that is final but the person has already processed may not qualify.

Fourth, factor 9(4) (having a person with a close family bond experience a category 1A stressor) applies only if the other person experienced that stressor within 3 months before the claimant’s clinical onset. The claimant must prove the other person’s stressor and its occurrence. That could be difficult if the other person is deceased or uncooperative.

Compliance is not a matter of active steps for the claimant during service; rather, it is about assembling evidence that meets the SoP’s factors. The following practical steps should be taken:

1. Identify the service category. Confirm that the relevant service is eligible war service (non‑operational), defence service (non‑hazardous), or peacetime service under MRCA. If the service is operational or hazardous, this SoP does not apply; the claimant should obtain the reasonable‑hypothesis SoP for adjustment disorder.

2. Obtain a medical diagnosis that matches the definition. The diagnosing psychiatrist or GP should use the DSM‑5‑TR criteria explicitly. The report must state that the adjustment disorder meets criteria A‑E: stressor within 3 months before onset; clinically significant distress or impairment; not meeting criteria for another mental disorder; not normal bereavement; and symptoms lasting no more than 6 months after stressor termination (or the stressor is still ongoing). If the stressor is chronic, the 6‑month limit is not an issue, but the report should note that.

3. Identify the stressor and its timing. For each potential factor (section 9), evidence must show that the stressor occurred within 3 months before clinical onset. Clinical onset must be determined by a registered medical practitioner looking back to when symptoms were persistently present. This often requires a chronology: when did the stressor happen? When did the person start having symptoms (e.g., anxiety, crying, irritability)? When did they first seek medical help? If there is a gap, a medico‑legal opinion may be needed to argue that symptoms were present earlier.

4. Link the stressor to service. Section 10(1) requires that the factor must be related to the relevant service rendered. For example, a category 1A stressor (e.g., life‑threatening event) must have occurred during service, or as a consequence of service. A category 2 stressor (e.g., financial hardship) may be related to service if it resulted from service‑related events (e.g., loss of employment due to frequent deployments). The nexus evidence can be from service records, statements, or operational reports.

5. Collect corroborative evidence. For category 1A and 1B stressors, contemporaneous records (unit incident reports, medical notes, police reports) are ideal. For category 2 stressors, evidence of chronic effect: emails, diary entries, witness statements from colleagues or family showing ongoing distress. For factor 9(4) (family member’s stressor), evidence of that person’s stressor is needed (e.g., their own service records or medical reports).