Statement of Principles concerning bipolar disorder (Balance of Probabilities) (No. 54 of 2018)

This Statement of Principles sets out the medical and temporal criteria the Repatriation Medical Authority uses to decide whether bipolar disorder (and death from it) can be connected to a veteran's or member's relevant service for claims under the VEA and MRCA. It defines bipolar conditions by DSM‑5 criteria and lists specific stressors, medical causes, drugs and time windows that, if present and related to service, satisfy the authority’s “balance of probabilities” test.

It affects claimants, treating clinicians and decision‑makers by specifying what evidence and timeframes are required to establish service connection.

This instrument is a Statement of Principles (SoP) made by the Repatriation Medical Authority (RMA) under subsection 196B(3) of the Veterans' Entitlements Act 1986 (VEA). It is titled Statement of Principles concerning bipolar disorder (Balance of Probabilities) (No. 54 of 2018). The instrument commenced on 23 July 2018 (sections 1-2) and expressly repeals the earlier Statement of Principles concerning bipolar disorder No. 28 of 2009 (section 4).

Mechanically, the SoP performs the RMA’s statutory task of setting medical‑causation factors that decision‑makers must consider when determining whether bipolar disorder, or death from bipolar disorder, is connected with a person’s relevant service for the purposes of claims under section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004 (MRCA) (section 5). The RMA states that, on the medical‑scientific evidence available, it is more probable than not that bipolar disorder and death from bipolar disorder can be related to relevant service (section 8). The SoP therefore sets out the particular factual and temporal factors that must exist, on the balance of probabilities, before a link to service can be found (section 9).

Substantively, the instrument (a) defines the diagnostic construct of “bipolar disorder” and lists the specific bipolar and related conditions included (section 7(2) and Schedule 1); (b) specifies separate factor sets for different diagnostic subtypes and for onset versus clinical worsening (section 9); (c) provides a large, enumerated “specified list of drugs” and two “Specified Lists” of other clinically significant mental disorders that interact with causation findings (Schedule 1); and (d) clarifies relationship‑to‑service rules, including that certain factors (subsections 9(4)-9(20)) apply only to material contribution or aggravation where the disorder pre‑existed service (section 10).

The Schedule contains the RMA’s clinical definitions, largely derived from DSM‑5, plus precise definitions of stressor categories, time windows, medical conditions that can directly cause mood symptoms, and the defined drug list (Schedule 1). Section 11 instructs that if a factor in this SoP refers to an injury or disease covered by another SoP, the factors from that other SoP apply as in force from time to time.

In sum, the instrument replaces the 2009 SoP with a DSM‑5‑derived, factorised framework,temporal, clinical and exposure‑based,that decision‑makers will apply when adjudicating service connection for bipolar disorder or death from bipolar disorder under the VEA and MRCA (sections 5, 7-11; Schedule 1).

The key legal and clinical concepts are set out in the body and Schedule 1 and operate together to convert clinical phenomena into adjudicative factors. The central concept is “bipolar disorder”, which the SoP defines as a class of mental disorders manifested by periods of abnormally and persistently elevated, expansive or irritable mood and increased activity or energy, and expressly lists the subtypes it covers: bipolar and related disorder due to another medical condition, bipolar I disorder, bipolar II disorder, cyclothymic disorder, major depressive episode with mixed features, other specified/unspecified bipolar and related disorder, and substance/medication‑induced bipolar and related disorder (section 7(2); Schedule 1 definitions). The definitions in the Schedule are explicitly derived from DSM‑5 (Schedule 1, “DSM‑5”).

Causation is captured via discrete, enumerated “factors” in section 9. They are grouped by diagnostic subtype and by whether they refer to clinical onset or clinical worsening. For bipolar I, bipolar II, cyclothymic disorder, major depressive episode with mixed features and other specified/unspecified bipolar disorders, factors for clinical onset include experiencing category 1A, 1B or 2 stressors within six months before onset, death of a significant other within six months, being within 90 days postpartum at onset, comorbid alcohol or substance use disorder at onset, or having a clinically significant mental disorder from Specified List 1 within five years before onset (section 9(1)(a)-(g)). For substance/medication‑induced bipolar disorder, causation is framed around recent exposure to drugs from the “specified list of drugs”, timing of symptom onset relative to exposure, and cessation patterns (section 9(2)). For bipolar and related disorder due to another medical condition, the factor is the presence of an endocrine, cardiovascular, respiratory, metabolic, infectious or neurological disorder that is a direct physiological cause of the mood symptoms at the time of clinical onset (section 9(3)).

The instrument defines three stressor tiers in the Schedule. Category 1A stressors are life‑threatening or severe physical assaults (Schedule 1, “category 1A stressor”). Category 1B stressors relate to exposure to killings, viewing corpses or participation in corpse clearance (Schedule 1, “category 1B stressor” and “corpse”). Category 2 stressors are chronic negative life events with ongoing distress, such as social isolation, relationship breakdown, workplace disharmony, legal problems, severe financial hardship, deterioration in a family member’s health, or being a full‑time carer (Schedule 1, “category 2 stressor”).

Primary affected persons are veterans and members of the Australian Defence Force seeking entitlement determinations under the VEA or MRCA. The SoP applies specifically to claims “to which section 120B of the VEA or section 339 of the MRCA applies” (section 5). The Schedule defines “relevant service” to include eligible war service (other than operational service), defence service (other than hazardous service and British nuclear test defence service) under the VEA, and peacetime service under the MRCA (Schedule 1, “relevant service”). Therefore claimants whose service meets those statutory categories will have this SoP applied when medical causation questions for bipolar disorder arise.

Decision‑makers and administrators are secondarily affected. The SoP supplies the RMA’s medical framework for establishing a causal connection. Policymakers and departmental medical assessors (for example, staff at the Department of Veterans’ Affairs or MRCA decision units) will apply the SoP’s factors to documentary and clinical evidence in adjudicating claims. The Schedule’s DSM‑5‑derived diagnostic criteria will guide clinical assessors, including psychiatrists and general practitioners providing reports.

Medical practitioners who provide evidence for claims will be affected in practice. The SoP requires precise temporal and clinical information (for example, dates of onset or worsening, details of stressor exposure, drug exposure and cessation timelines, records of electroconvulsive therapy, deep brain or vagus nerve stimulation). Practitioners will need to map clinical notes to the SoP’s defined criteria , for instance, showing that a manic or hypomanic episode met the DSM‑5 criterion as set out in the Schedule.

Families and dependants can be affected where death from bipolar disorder is alleged, since the SoP covers “death from bipolar disorder” defined to include terminal events or conditions contributed to by the person's bipolar disorder (section 7(3); Schedule 1, “terminal event”). Entitlement determinations for dependant benefits may pivot on whether the SoP’s factors support a link between the veteran’s disorder and service.

Finally, other SoPs and their stakeholders are implicated by cross‑reference. If a factor in this SoP refers to an injury or disease covered by another SoP, those other SoPs apply as in force (section 11). That means practitioners and decision‑makers must consult multiple SoPs where overlap occurs (for example, where a medical condition specified as causing mood symptoms is itself covered by another SoP).

The instrument thus imposes evidential expectations on claimants and medical witnesses and channels adjudicative attention of decision‑makers to specific, time‑bounded clinical and non‑clinical factors tied to relevant service definitions.

The SoP sets out the facts that must exist, on the balance of probabilities, to establish that bipolar disorder or death from bipolar disorder is connected to relevant service. It does not itself create statutory entitlements; rather, it operates within the VEA/MRCA claim frameworks (section 5). The operative duties and rights flow from that interaction.

Duty to demonstrate a factor: A claimant seeking to establish service connection must show that at least one of the factors listed in section 9 applied at the relevant time (section 9). For many subtypes, the SoP imposes strict temporal windows and exposure thresholds; for example, category 1A, 1B or 2 stressor exposure must be within six months before clinical onset for most listed subtypes (section 9(1)(a)-(c)), and certain drug exposures require evidence of use within 14 days prior to onset or worsening (sections 9(2)(a), 9(10)).

Duty to show relationship to service: Any factor relied upon must be related to the person’s relevant service (section 10(1)). This introduces a further factual step: the factor (for example, exposure to a category 1A stressor) must be causally linked to the person’s service experience. The SoP then sets a narrower rule for subsections 9(4)-9(20): those factors apply only to claims of material contribution to, or aggravation of, bipolar disorder where the disorder pre‑existed service or was suffered or contracted before or during service but did not arise out of service (section 10(2)). Practically, that means if bipolar disorder arose out of service, these aggravation factors are not the route,they are only for exacerbation/material contribution contexts.

Right to have the SoP applied: For claims specified in section 5, the SoP is the RMA’s instrument setting medical causation factors. Where a factor refers to an injury or disease covered by another SoP, the other SoP’s factors apply as in force from time to time (section 11). That creates a right, in procedural terms, for claimants to have the appropriate SoPs consulted and applied by adjudicators when relevant.

Duty to align clinical diagnosis with DSM‑5‑derived criteria: The Schedule contains DSM‑5‑based diagnostic criteria for the bipolar subtypes and for manic, hypomanic and major depressive episodes. When a medical practitioner provides an opinion, the diagnosis should be mapped to those Schedule criteria if causation is to be demonstrated under this SoP. For example, a bipolar I diagnosis must meet the Schedule’s manic episode criteria and the requirement that the manic/major depressive episodes are not better explained by certain psychotic disorders (Schedule 1, “bipolar I disorder”).

The Statement of Principles itself contains no penal sanctions, fines, or criminal offences. It is an administrative instrument setting medical causation criteria; enforcement is achieved through its use in adjudications under the VEA and MRCA rather than by direct sanctionary power within the instrument.

How the SoP is enforced in practice: The SoP functions as the RMA’s technical framework for assessing causation. Decision‑makers adjudicating claims under section 120B of the VEA or section 339 of the MRCA will apply the SoP’s factors to documentary and clinical evidence when determining whether, on the balance of probabilities, bipolar disorder or death from bipolar disorder is connected with relevant service (sections 5 and 9). Adverse administrative consequences follow where a claimant cannot satisfy a required factor or the link to relevant service: entitlement may be denied or limited under the governing statute. Those administrative outcomes, and any statutory appeal or review mechanisms, are set out in the VEA and MRCA, not in this instrument.

No compliance or reporting penalties in this instrument: The SoP does not require particular reporting by clinicians nor impose statutory record‑keeping obligations beyond what is already required by the VEA/MRCA or other legislation. It does not prescribe enforcement mechanisms such as audits, sanctions for non‑compliance by decision‑makers, or penalties for incorrect expert evidence. Issues about misleading claims or false statements by claimants remain within the enforcement provisions of the relevant entitlement statutes and general law, which are not recited in the SoP.

Administrative discretion and evidential standards: The SoP establishes evidentiary gates (the listed factors and timing windows) that create de facto enforcement outcomes: absent evidence satisfying a listed factor and its relationship to service, the threshold for finding service connection on balance of probabilities will not be met (section 9). The RMA’s view that the SoP reflects “sound medical‑scientific evidence” (section 8) supports its use as the standard by which adjudicators measure causation evidence. Administrative enforcement therefore operates through decision‑making, review and appeal processes under the VEA and MRCA statutes, which implement the SoP’s criteria rather than through penalties in the instrument itself.

Cross‑application with other SoPs: Section 11 directs that when a factor refers to an injury or disease covered by another SoP, the other SoP applies “as in force from time to time”. Enforcement of those cross‑referenced criteria likewise occurs through claims adjudication rather than through separate penal mechanisms contained here.

The instrument is expressly made under subsection 196B(3) of the VEA (section 3) and applies to claims to which section 120B of the VEA or section 339 of the MRCA applies (section 5). Its legal operation is therefore as a medical‑causation SoP used within the statutory structures of those Acts. The Schedule’s definitions incorporate and reference DSM‑5 clinical constructs, but DSM‑5 is a clinical manual rather than a statute; the SoP imports DSM‑5 criteria for diagnostic precision (Schedule 1, “DSM‑5”).

Cross‑references to other Statements of Principles: Section 11 provides a direct interaction rule with other SoPs determined under the VEA. If a factor in this SoP refers to an injury or disease that is the subject of another SoP, then the factors in that other SoP apply “in accordance with the terms of that Statement of Principles as in force from time to time” (section 11). That means adjudicators must consult relevant SoPs in parallel where overlap occurs , for example, where a medical condition specified as a direct physiological cause of mood symptoms is itself addressed in a separate SoP.

Relationship to VEA/MRCA decision processes: The SoP is a technical, evidentiary instrument; the entitlement, benefit calculation, administration, review, and appeal mechanisms remain governed by the substantive and procedural provisions of the VEA and MRCA. The instrument does not displace statutory procedural protections or appellate rights. Practitioners must therefore use the SoP as the RMA’s medical input into the broader legal processes established by the VEA and MRCA.

Interaction with medical and clinical law/regulation: The Schedule’s DSM‑5‑derived diagnostic definitions impose clinical expectations on expert medical evidence. Medical practitioners providing opinions in support of claims will need to map their clinical findings to the Schedule criteria to be persuasive. The SoP’s mention of treatments and interventions (for example, electroconvulsive therapy, deep brain stimulation, vagus nerve stimulation, antidepressant and antiepileptic therapy) means that clinical treatment records and prescribing records are relevant evidence. Those records exist under clinical privacy and health records law; obtaining and disclosing them will implicate usual privacy rules and practitioner obligations, but those privacy regimes are external to and not modified by the SoP.

No explicit conflict‑of‑laws clauses: The instrument does not purport to override other legislative or common law rules. It is an instrument used within statutory adjudication frameworks, and it must be read and applied in that context. If a conflict were to arise between the SoP and statutory provisions of the VEA/MRCA, the latter would prevail. The SoP does not create rights or obligations beyond its role as medical guidance for causation determinations under the relevant Acts.

The instrument itself records only a narrow amendment history within its text. It states that it is No. 54 of 2018, was dated 22 June 2018 and commenced on 23 July 2018 (sections 1-2). Section 4 expressly repeals the earlier Statement of Principles concerning bipolar disorder No. 28 of 2009 (Federal Register of Legislation No. F2009L01595). No other amendments, revisions or past instruments are set out in the text.

Implication of “as in force from time to time”: Section 11 directs that, where a factor refers to an injury or disease covered by another SoP, those other SoP factors apply “as in force from time to time”. That phrase signals an intent that the RMA updates or revises SoPs over time and that any cross‑references will be dynamically linked to current versions. The instrument does not itself detail the RMA’s amendment process, but this language anticipates and accommodates future SoP revisions.

Clinical sourcing: The Schedule notes that the diagnostic definitions are derived from the DSM‑5 (Schedule 1). Because the Schedule ties the SoP’s clinical definitions to a specified edition of DSM‑5 (the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, 2013), an update to DSM criteria would not change this SoP unless the RMA amends the SoP. The SoP therefore fixes a clinical standard as at the date of its making, until amended.

No incremental amendment record in instrument: The instrument does not list any subsequent modifications, clarifications, or corrigenda. Practitioners should therefore presume that the text as published (No. 54 of 2018) and the repealed 2009 instrument are the only versions contained in the instrument itself. Any later amendments would appear as separate instruments or updates on the Federal Register or the RMA’s publications; those are outside the present text.

Practical note for users: Because the SoP framework is intended to be evidence‑based and the RMA signals that factors reflect current medical‑scientific evidence (section 8), the SoP is susceptible to revision as new evidence emerges. Section 11’s cross‑SoP wording and the RMA’s institutional role imply an ongoing maintenance function. Consequently, practitioners should check for later SoPs or updates when preparing or litigating claims, but any such updates are not contained in this instrument.

In summary, the explicit amendment history in the instrument is limited to the 2018 replacement of the 2009 SoP. The instrument’s language anticipates future revisions through the “as in force from time to time” mechanism for cross‑references, but does not record any subsequent amendments itself.

The Statement of Principles document as provided contains no litigation history. It does not reference judicial or tribunal decisions, and no cases or determinations are cited in the text or Schedule. There are no examples, footnotes, or explanatory memoranda contained within this instrument that recount adjudicative application or appellate outcomes.

Implications for practitioners: Because the instrument contains no litigation record, its practical legal effect , how courts and tribunals have treated or interpreted these particular SoP provisions , is not evident from the text itself. The SoP is an administrative medical instrument; the way tribunals or courts use SoPs in judicial review, merits review or appeals will depend on the VEA and MRCA decision frameworks and subsequent caselaw that is not included in this instrument.

Need to consult external authorities: Practitioners should not assume that any particular phrase in the SoP has been judicially authoritatively construed. When preparing submissions, arguments or appeals that rely on this SoP, it is necessary to research contemporary tribunal and court decisions that interpret how the SoP’s factors are applied in practice, how strict the temporal windows are treated, and how cross‑referenced SoPs have been applied. The instrument itself provides no guidance on those points.

Value of SoP content in litigation: Although no litigation history is provided, the SoP’s value in adjudication is its specificity. The Schedule’s DSM‑5‑derived criteria and the enumerated factors and timing windows in section 9 create discrete evidentiary thresholds that decision‑makers and reviewers will apply. How strictly those thresholds are applied, how medical opinions are weighed against them, and how “relation to service” under section 10 is established are matters that will be fleshed out in tribunal practice and potentially case law , none of which is recorded here.

Record‑keeping for litigators: Given the absence of litigation history in the instrument, litigators should assemble contemporaneous clinical evidence that maps directly to the SoP’s criteria,dates of onset/worsening, precise drug exposure and cessation timelines, treatment dates for ECT/DBS/VNS, documentation of stressor exposure with dates, and evidence of the relationship of those events to the claimant’s relevant service. Those materials are likely to be central in any merits review or judicial review, but how they have been treated in prior litigation will have to be sourced from tribunal/court databases rather than from this instrument.

In short, the instrument itself contains no litigation history; practitioners must research external adjudicative authorities to understand how the SoP has been interpreted and applied in dispute resolution.

There are multiple practical pitfalls embedded in the SoP’s structure and definitions that can affect claim preparation and decision outcomes. These are concrete, text‑based traps for the unwary.

Time windows are strictly prescribed and vary by factor. For example:

Stressor exposures (category 1A, 1B, 2) must be within six months before clinical onset for the listed subtypes (section 9(1)(a)-(c)), and within six months before clinical worsening for the worsening factors (sections 9(4)-(6)). Failure to document timing precisely can be dispositive.
Certain drug exposures require evidence of taking a listed drug within 14 days before onset or worsening (sections 9(2)(a), 9(10)), and some causation pathways require that the drug was taken for at least the two days before onset/worsening (sections 9(2)(b), 9(11)).
Cessation or reduction of antidepressant or antiepileptic therapy must have occurred within 30 days before onset or worsening to operate as a factor (sections 9(2)(c), 9(12)).
Some interventions carry very short windows: deep brain stimulation or vagus nerve stimulation within 48 hours before worsening (sections 9(18)-(19)); electroconvulsive therapy within 14 days before worsening (section 9(16)); sleep deprivation of at least one whole night within two days before worsening (section 9(15)).

Diagnostic precision is required. The Schedule sets out DSM‑5‑derived criteria for bipolar subtypes and for manic, hypomanic and major depressive episodes (Schedule 1). A psychiatric opinion that lacks mapping to those criteria risks being less persuasive. For example, a bipolar I diagnosis must be supported by criteria for a manic episode per the Schedule (Schedule 1, “bipolar I disorder” and “manic episode”).

Differences between Specified List 1 and Specified List 2. Section 9(1)(g) requires having a Specified List 1 disorder within five years before clinical onset; Specified List 2 disorders are relevant to clinical worsening (section 9(9)). The two lists overlap but differ (Schedule 1). Accurate chronological and diagnostic evidence is necessary to invoke the correct list.

Substance/drug criteria are detailed and expansive. The “specified list of drugs” in the Schedule contains many items, and some classes are broadly stated (for example, “antidepressants”; “antipsychotics” are included as “atypical antipsychotics”). Practitioners must check whether a particular medicine falls within the list, and whether the drug exposure pattern satisfies the particular sub‑clause (e.g. whether symptoms remit following cessation within days or weeks as required by section 9(2)(b)).

Preparation of a claim that relies on this SoP requires methodical assembly of medical, service and documentary evidence to map facts to the enumerated factors in section 9 and the Schedule’s diagnostic criteria. Below are practical, text‑grounded steps to comply with the SoP’s expectations.

Establish the diagnostic category using Schedule criteria.
- Obtain psychiatric reports that state the diagnosis in DSM‑5 terms and explicitly map the patient’s symptoms to the Schedule criteria for the relevant subtype (for example, manic episode criteria for bipolar I, hypomanic and major depressive episode criteria for bipolar II). The Schedule contains specific symptom counts and duration requirements (Schedule 1, “manic episode”, “hypomanic episode”, “major depressive episode”, “bipolar I disorder”, “bipolar II disorder”).
Demonstrate clinical onset or worsening and precise timing.
- The SoP distinguishes clinical onset and clinical worsening. Provide dated clinical notes, hospital admission records, emergency department presentations, or contemporaneous primary care entries that show the date (or narrow window) of symptom emergence or deterioration to satisfy the timing windows in section 9 (for example, six months for stressor exposure, 14 days for certain drug exposures, 30 days for cessation of therapy, 48 hours for DBS/VNS, etc.).
Link the relevant factor to the diagnostic event.
- For stressor‑based factors (category 1A, 1B, 2), supply evidence of the stressor with dates and, where possible, corroboration (service records, witness statements, deployment logs, police records, counselling notes). For category 1B events involving corpses, documentation that the claimant was an eyewitness is needed given the SoP excludes media exposure (Schedule 1, “eyewitness”, “corpse”).
- For substance/medication‑related factors, provide medication charts, prescription records, pharmacy dispensing records, blood/urine toxicology if available, and clinical notes showing symptom development during exposure and remission or reduction following cessation (sections 9(2)(a)-(b), 9(11)). Demonstrate that drug use met the temporal thresholds (e.g. at least two days of use before onset where required).
Demonstrate relationship to relevant service.
- Show how the factor arose from or during the person’s relevant service (section 10(1)). For example, if alleging exposure to a category 1A stressor during deployment, provide service logs or unit incident reports showing the event occurred in the course of relevant service dates. If the stressor arose outside service, articulate how it is related to service (for example, stressor consequences continuing into service).

meta-content-style-type: text/css meta-content-type: application/xhtml+xml; charset=utf-8 meta-generator: Aspose.Words for .NET 20.2

?xml version="1.0" encoding="utf-8" standalone="no"?>

RMA-Red

Statement of Principles

concerning

BIPOLAR DISORDER (Balance of Probabilities)

(No. 54 of 2018)

The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.

Dated 22 June 2018

The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:<br>
<br>View image in the official source<br>Professor Nicholas Saunders AO<br>Chairperson<br>

Contents

1 Name

2 Commencement

3 Authority

4 Repeal

5 Application

6 Definitions

7 Kind of injury, disease or death to which this Statement of Principles relates

8 Basis for determining the factors

9 Factors that must exist

10 Relationship to service

11 Factors referring to an injury or disease covered by another Statement of Principles

Schedule 1 - Dictionary

1 Definitions

1 Name

This is the Statement of Principles concerning bipolar disorder (Balance of Probabilities) (No. 54 of 2018).

2 Commencement

This instrument commences on 23 July 2018.

3 Authority

This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.

4 Repeal

The Statement of Principles concerning bipolar disorder No. 28 of 2009 (Federal Register of Legislation No. F2009L01595) made under subsection 196B(3) of the VEA is repealed.

5 Application

This instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004 applies.

6 Definitions

The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.

7 Kind of injury, disease or death to which this Statement of Principles relates

(1) This Statement of Principles is about bipolar disorder and death from bipolar disorder.

Meaning of bipolar disorder

(2) For the purposes of this Statement of Principles, bipolar disorder:

(a) means a group of disorders of mental health which are manifested by one or more periods of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased activity or energy; and

(b) includes:

(i) bipolar and related disorder due to another medical condition;

(ii) bipolar I disorder;

(iii) bipolar II disorder;

(iv) cyclothymic disorder;

(v) major depressive episode with mixed features;

(vi) other specified bipolar and related disorder and unspecified bipolar and related disorder; and

(vii) substance/medication-induced bipolar and related disorder.

Note 1: bipolar and related disorder due to another medical condition, bipolar I disorder, bipolar II disorder, cyclothymic disorder, major depressive episode with mixed features, other specified bipolar and related disorder and unspecified bipolar and related disorder and substance/medication-induced bipolar and related disorder are defined in the Schedule 1 – Dictionary.

Note 2: The definition for each of the conditions included herein are derived from DSM-5.

Note 3: DSM-5 is defined in the Schedule 1 – Dictionary.

Death from bipolar disorder

(3) For the purposes of this Statement of Principles, bipolar disorder, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's bipolar disorder.

Note: terminal event is defined in the Schedule 1 – Dictionary.

8 Basis for determining the factors

On the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that bipolar disorder and death from bipolar disorder can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA.

Note: MRCA, relevant service and VEA are defined in the Schedule 1 – Dictionary.

9 Factors that must exist

At least one of the following factors must exist before it can be said that, on the balance of probabilities, bipolar disorder or death from bipolar disorder is connected with the circumstances of a person's relevant service:

(1) for bipolar I disorder, bipolar II disorder, cyclothymic disorder, major depressive episode with mixed features, other specified bipolar and related disorder and unspecified bipolar and related disorder only:

Note: bipolar I disorder, bipolar II disorder, cyclothymic disorder, major depressive episode with mixed features and other specified bipolar and related disorder and unspecified bipolar and related disorder are defined in the Schedule 1 – Dictionary.

(a) experiencing a category 1A stressor within the six months before the clinical onset of bipolar disorder;

Note: category 1A stressor is defined in the Schedule 1 - Dictionary.

(b) experiencing a category 1B stressor within the six months before the clinical onset of bipolar disorder;

Note: category 1B stressor is defined in the Schedule 1 - Dictionary.

Note: category 2 stressor is defined in the Schedule 1 - Dictionary.

(d) experiencing the death of a significant other within the six months before the clinical onset of bipolar disorder;

Note: significant other is defined in the Schedule 1 - Dictionary.

(e) being within 90 days postpartum at the time of the clinical onset of bipolar disorder;

(f) having alcohol use disorder or substance use disorder at the time of the clinical onset of bipolar disorder; or

(g) having a disorder of mental health from Specified List 1 of clinically significant disorders of mental health within the five years before the clinical onset of bipolar disorder;

Note: Specified List 1 of clinically significant disorders of mental health is defined in the Schedule 1 - Dictionary.

(2) for substance/medication-induced bipolar and related disorder only:

Note: substance/medication-induced bipolar and related disorder is defined in the Schedule 1 – Dictionary.

(a) taking a drug, or a drug from a class of drugs, from the specified list of drugs, within the 14 days before the clinical onset of bipolar disorder;

Note: specified list of drugs is defined in the Schedule 1 - Dictionary.

(b) taking a drug which is associated in the individual with the development of symptoms of bipolar disorder while taking the drug, and the cessation or significant reduction of the symptoms of bipolar disorder within days or weeks of discontinuing the drug, where taking the drug continued for at least the two days before the clinical onset of bipolar disorder;

(c) having ceased or reduced antidepressant drug therapy or antiepileptic drug therapy within the 30 days before the clinical onset of bipolar disorder; or

(d) having alcohol use disorder or substance use disorder at the time of the clinical onset of bipolar disorder;

(3) for bipolar and related disorder due to another medical condition only, having an endocrine, cardiovascular, respiratory, metabolic, infectious or neurological disorder, where the medical condition is a direct physiological cause of the mood symptoms at the time of the clinical onset of bipolar disorder;

Note: bipolar and related disorder due to another medical condition and medical condition is a direct physiological cause of the mood symptoms are defined in the Schedule 1 - Dictionary.

(4) experiencing a category 1A stressor within the six months before the clinical worsening of bipolar disorder;

Note: category 1A stressor is defined in the Schedule 1 - Dictionary.

(5) experiencing a category 1B stressor within the six months before the clinical worsening of bipolar disorder;

Note: category 1B stressor is defined in the Schedule 1 - Dictionary.

(6) experiencing a category 2 stressor within the six months before the clinical worsening of bipolar disorder;

Note: category 2 stressor is defined in the Schedule 1 - Dictionary.

(7) experiencing the death of a significant other within the six months before the clinical worsening of bipolar disorder;

Note: significant other is defined in the Schedule 1 - Dictionary.

(8) being within 90 days postpartum at the time of the clinical worsening of bipolar disorder;

(9) having a disorder of mental health from Specified List 2 of clinically significant disorders of mental health at the time of the clinical worsening of bipolar disorder;

Note: Specified List 2 of clinically significant disorders of mental health is defined in the Schedule 1 - Dictionary.

(10) taking a drug, or a drug from a class of drugs, from the specified list of drugs, within the 14 days before the clinical worsening of bipolar disorder;

Note: specified list of drugs is defined in the Schedule 1 - Dictionary.

(11) taking a drug which is associated in the individual with the worsening of symptoms of bipolar disorder while taking the drug, and the cessation or significant reduction of the symptoms of bipolar disorder within days or weeks of discontinuing the drug, where taking the drug continued for at least the two days before the clinical worsening of bipolar disorder;

(12) having ceased or reduced antidepressant drug therapy or antiepileptic drug therapy within the 30 days before the clinical worsening of bipolar disorder;

(13) having a medical condition as specified at the time of the clinical worsening of bipolar disorder;

Note: medical condition as specified is defined in the Schedule 1 - Dictionary.

(14) experiencing severe childhood abuse before the clinical worsening of bipolar disorder;

Note: severe childhood abuse is defined in the Schedule 1 - Dictionary.

(15) being deprived of at least one whole night's sleep within the two days before the clinical worsening of bipolar disorder;

(16) having electroconvulsive therapy within the 14 days before the clinical worsening of bipolar disorder;

(17) having a course of bright light therapy within the 14 days before the clinical worsening of bipolar disorder;

(18) having deep brain stimulation for Parkinson's disease within the 48 hours before the clinical worsening of bipolar disorder;

(19) having vagus nerve stimulation within the 48 hours before the clinical worsening of bipolar disorder;

(20) inability to obtain appropriate clinical management for bipolar disorder.

10 Relationship to service

(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.

(2) The factors set out in subsections 9(4) to 9(20) apply only to material contribution to, or aggravation of, bipolar disorder where the person's bipolar disorder was suffered or contracted before or during (but did not arise out of) the person's relevant service.

11 Factors referring to an injury or disease covered by another Statement of Principles

In this Statement of Principles:

(1) if a factor referred to in section 9 applies in relation to a person; and

(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;

then 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.

Schedule 1 - Dictionary

Note: See Section 6

1 Definitions

In this instrument:

bipolar and related disorder due to another medical condition means a disorder of mental health that meets the following diagnostic criteria (derived from DSM-5):

A prominent and persistent period of abnormally elevated, expansive, or irritable mood and abnormally increased activity or energy that predominates in the clinical picture.
There is evidence from the history, physical examination or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.
The disturbance is not better explained by another mental disorder.
The disturbance does not occur exclusively during the course of a delirium.
The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning, or necessitates hospitalisation to prevent harm to self or others or there are psychotic features.

Note: DSM-5 is also defined in the Schedule 1 - Dictionary.

bipolar disorder—see subsection 7(2).

bipolar I disorder means a disorder of mental health that meets the following diagnostic criteria (derived from DSM-5):

Criteria have been met for at least one manic episode (criteria A-D under manic episode).
The occurrence of the manic and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

Note 1: For a diagnosis of bipolar I disorder, it is necessary to meet the criteria for a manic episode. The manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes.

Note 2: DSM-5, hypomanic episode, manic episode and major depressive episode are also defined in the Schedule 1 - Dictionary.

bipolar II disorder means a disorder of mental health that meets the following diagnostic criteria (derived from DSM-5):

Criteria have been met for at least one hypomanic episode (criteria A-F under hypomanic episode) and at least one major depressive episode (criteria A-C under major depressive episode).
There has never been a manic episode.
The occurrence of the hypomanic episode(s) and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomania causes clinically significant distress or impairment in social, occupational or other important areas of functioning.

Note 1: For a diagnosis of bipolar II disorder, it is necessary to meet the criteria for a current or past hypomanic episode and the criteria for a current or past major depressive episode.

Note 2: DSM-5, hypomanic episode and major depressive episode are also defined in the Schedule 1 - Dictionary.

category 1A stressor means one of the following severe traumatic events:

(a) experiencing a life-threatening event;

(b) being subject to a serious physical attack or assault including rape and sexual molestation; or

category 1B stressor means one of the following severe traumatic events:

(a) killing or maiming a person;

(b) being an eyewitness to a person being killed or critically injured;

(d) participating in the clearance of a corpse or a critically injured casualty; or

(e) viewing a corpse or a critically injured casualty as an eyewitness.

Note: corpse and eyewitness are also defined in the Schedule 1 - Dictionary.

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:

(a) being socially isolated and unable to maintain friendships or family relationships, due to physical location, language barriers, disability, or medical or psychiatric illness;

(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;

(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;

(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;

(e) having severe financial hardship including loss of employment, long periods of unemployment, foreclosure on a property or bankruptcy;

(f) having a family member or significant other experience a major deterioration in their health; or

(g) being a full-time caregiver to a family member or significant other with a severe physical, mental or developmental disability.

Note: significant other is also defined in the Schedule 1 - Dictionary.

corpse means the human remains or body parts of one or more persons who have met a violent or horrific death.

Note: 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.

cyclothymic disorder means a disorder of mental health that meets the following diagnostic criteria (derived from DSM-5):

For at least two years (at least one year in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode.
During the above two-year period (one year in children and adolescents), the hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than two months at a time.
Criteria for a major depressive, manic or hypomanic episode have never been met.
The symptoms in Criterion A are not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
The symptoms are not attributable to the physiological effects of a substance (for example, a drug of abuse, a medication) or another medical condition (for example, hyperthyroidism).
The symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning.

Note: DSM-5 is also defined in the Schedule 1 - Dictionary.

DSM-5 means the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013.

eyewitness means a person who experiences 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.

hypomanic episode meets the following diagnostic criteria (derived from DSM-5):

A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least four consecutive days and present most of the day, nearly every day.
During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms (four if the mood is only irritable) have persisted, represent a noticeable change from usual behaviour, and have been present to a significant degree:

(i) inflated self-esteem or grandiosity;

(ii) decreased need for sleep (for example, feels rested after only three hours of sleep);

(iii) more talkative than usual or pressure to keep talking;

(iv) flight of ideas or subjective experience that thoughts are racing;

(v) distractibility (that is, attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed;

(vi) increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation; or

(vii) excessive involvement in activities that have a high potential for painful consequences (for example, engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).

C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic.

D. The disturbance in mood and the change in functioning are observable by others.

E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalisation. If there are psychotic features, the episode is, by definition, manic.

F. The episode is not attributable to the physiological effects of a substance (for example, a drug of abuse, a medication, other treatment) or another medical condition. The episode is not attributable to the physiological effects of a substance (for example, a drug of abuse, a medication, other treatment) or another medical condition.

Note 1: Criteria A–F constitute a hypomanic episode. Hypomanic episodes are common in bipolar I disorder but are not required for the diagnosis of bipolar I disorder.

Note 2: bipolar I disorder and DSM-5 are also defined in the Schedule 1 - Dictionary.

major depressive episode meets the following diagnostic criteria (derived from DSM-5):

Five (or more) of the following symptoms have been present during the same two-week period and represent a change from previous functioning; at least one of the symptoms is either (i) depressed mood or (ii) loss of interest or pleasure:

Note: Do not include symptoms that are clearly attributable to another medical condition.

(i) depressed mood most of the day, nearly every day, as indicated by either subjective report (for example, feels sad, empty, or hopeless) or observation made by others (for example, appears tearful);

Note: In children and adolescents, can be irritable mood.

(ii) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation);

(iii) significant weight loss when not dieting or weight gain (for example, a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day;

Note: In children, consider failure to make expected weight gain.

(iv) insomnia or hypersomnia nearly every day;

(v) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down);

(vi) fatigue or loss of energy nearly every day;

(vii) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick);

(viii) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others); or

(ix) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The episode is not attributable to the physiological effects of a substance or another medical condition.

Note 1: Criteria A–C constitute a major depressive episode. Major depressive episodes are common in bipolar I disorder but are not required for the diagnosis of bipolar I disorder.

Note 2: bipolar I disorder and DSM-5 are also defined in the Schedule 1 - Dictionary.

major depressive episode with mixed features meets the following diagnostic criteria (derived from DSM-5):

At least three of the following manic/hypomanic symptoms are present during the majority of days of a major depressive episode:

(i) elevated, expansive mood;

(ii) inflated self-esteem or grandiosity;

(iii) more talkative than usual or pressure to keep talking;

(iv) flight of ideas or subjective experience that thoughts are racing;

(v) increase in energy or goal-directed activity (either socially, at work or school, or sexually);

(vi) increased or excessive involvement in activities that have a high potential for painful consequences (for example, engaging in unrestrained buying sprees, sexual indiscretions, foolish business investments); or

(vii) decreased need for sleep (feeling rested despite sleeping less than usual, to be contrasted with insomnia).

B. Mixed symptoms are observable by others and represent a change from the person's usual behaviour.

C. For individuals whose symptoms meet full criteria for either mania or hypomania, the diagnosis should be bipolar I or bipolar II disorder.

D. The mixed symptoms are not attributable to the physiological effects of a substance (for example, a drug of abuse, a medication or other treatment).

Note: DSM-5 and major depressive episode are also defined in the Schedule 1 - Dictionary.

manic episode meets the following diagnostic criteria (derived from DSM‑5):

A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least one week and present most of the day, nearly every day (or any duration if hospitalisation is necessary).
During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behaviour:

(i) inflated self-esteem or grandiosity;

(ii) decreased need for sleep (for example, feels rested after only three hours of sleep);

(iii) more talkative than usual or pressure to keep talking;

(iv) flight of ideas or subjective experience that thoughts are racing;

(v) distractibility (that is, attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed;

(vi) increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (that is, purposeless non-goal-directed activity); or

C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalisation to prevent harm to self or others, or there are psychotic features.

D. The episode is not attributable to the physiological effects of a substance (for example, a drug of abuse, a medication, other treatment) or another medical condition.

Note 1: A full manic episode that emerges during antidepressant treatment (for example, medication, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a manic episode and, therefore, a bipolar I diagnosis.

Note 2: Criteria A–D constitute a manic episode. At least one lifetime manic episode is required for the diagnosis of bipolar I disorder.

Note 3: bipolar I disorder and DSM-5 are also defined in the Schedule 1 - Dictionary.

medical condition as specified means an endocrine, cardiovascular, respiratory, metabolic, infectious or neurological condition, that causes symptoms consistent with bipolar disorder, as a direct physiological consequence of the condition.

Note: Examples of these medical conditions include:

(a) adrenal insufficiency;

(b) Alzheimer-type dementia;

(d) cerebrovascular accident;

(e) Cushing syndrome;

(f) epilepsy;

(g) Graves' disease;

(h) human immunodeficiency virus;

(i) hypothyroidism;

(j) multiple sclerosis;

(k) Parkinson's disease; or

(l) toxoplasmosis.

medical condition is a direct physiological cause of the mood symptoms means signs or symptoms of depressed, elevated, expansive or irritable mood are directly related to the pathological process of the medical condition, and:

(a) the bipolar disorder has a close temporal relationship with the onset or exacerbation of the general medical condition, and the bipolar disorder developed at the same time or after the onset of the general medical condition; or

(b) treatment which causes remission of the general medical condition also results in remission of the bipolar disorder symptoms; or

(c) features of the bipolar disorder, such as an unusual age of onset, a qualitative difference in symptoms, or disproportionately severe or unusual symptoms, are inconsistent with a primary diagnosis of any of the bipolar disorders.

Note: Examples of these medical conditions include:

(a) adrenal insufficiency;

(b) Alzheimer-type dementia;

(d) cerebrovascular accident;

(e) Cushing syndrome;

(f) epilepsy;

(g) Graves' disease;

(h) human immunodeficiency virus;

(i) hypothyroidism;

(j) multiple sclerosis;

(k) Parkinson's disease; or

(l) toxoplasmosis.

MRCA means the Military Rehabilitation and Compensation Act 2004.

other specified bipolar and related disorder and unspecified bipolar and related disorder are mental disorders (derived from DSM-5) in which symptoms characteristic of a bipolar and related disorder cause clinically significant distress or impairment in social, occupational or other important areas of functioning. The symptoms do not meet the full criteria for any of the disorders in the bipolar and related disorders diagnostic class.

Note: DSM-5 is also defined in the Schedule 1 - Dictionary.

relevant service means:

(a) eligible war service (other than operational service) under the VEA;

(b) defence service (other than hazardous service and British nuclear test defence service) under the VEA; or

Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary.

severe childhood abuse means:

(a) serious physical, emotional, psychological or sexual harm whilst a child aged under 16 years; or

(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;

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.

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.

specified list of drugs means:

(a) alpha-adrenoceptor agonists;

(b) alprazolam;

(d) amphetamines, including methamphetamine and 3,4-methylenedioxymethamphetamine (ecstasy);

(e) anabolic-androgenic steroids;

(f) angiotensin converting enzyme (ACE) inhibitors;

(g) antidepressants;

(h) antiepileptics, except valproate, lamotrigine and levetiracetam;

(i) armodafinil;

(j) atypical antipsychotics;

(k) baclofen;

(l) benzodiazepines;

(m) cannabis;

(n) centrally acting antihypertensives;

(o) chloroquine;

(p) clarithromycin;

(q) cocaine;

(r) corticosteroids, other than topical steroids;

(s) depot medroxyprogesterone acetate;

(t) dextromethorphan;

(u) digoxin;

(v) disulfiram;

(w) dopaminergic anti-Parkinsonian drugs;

(x) ephedrine;

(y) eszopiclone;

(z) fenfluramine;

(aa) fluoroquinolones;

(bb) fluphenazine;

(cc) fluspirilene;

(dd) gonadotropin releasing agents;

(ee) hallucinogens;

(ff) hydralazine;

(gg) hydroxychloroquine;

(hh) ifosfamide;

(ii) interferons;

(jj) interleukin-2;

(kk) intravenous 5-flurouracil;

(ll) iproniazid;

(mm) isocarboxazid;

(nn) isoetharine;

(oo) isoniazid;

(pp) levothyroxine;

(qq) mefloquine;

(rr) methylphenidate;

(ss) modafinil;

(tt) mycophenolate mofetil;

(uu) opioids;

(vv) oral contraceptive agents;

(ww) phencyclidine;

(xx) phentermine;

(yy) phenylephrine;

(zz) phenylpropanolamine;

(aaa) pseudoephedrine;

(bbb) quinagolide;

(ccc) ramelteon;

(ddd) reserpine;

(eee) rimonabant;

(fff) thiazide;

(ggg) thyroxine;

(hhh) varenicline;

(iii) zaleplon; or

(jjj) zolpidem.

Specified List 1 of clinically significant disorders of mental health means one of the following conditions, which is of sufficient severity to warrant ongoing management:

(a) acute stress disorder;

(b) agoraphobia;

(d) obsessive-compulsive disorder;

(e) panic disorder;

(f) posttraumatic stress disorder;

(g) social anxiety disorder; or

(h) specific phobia.

Note 1: "Management" of the condition may involve regular visits (for example, at least monthly) to a psychiatrist, counsellor or general practitioner.

Note 2: To "warrant ongoing management" does not require that any actual management was received or given for the condition.

Specified List 2 of clinically significant disorders of mental health means one of the following conditions, which is of sufficient severity to warrant ongoing management:

(a) acute stress disorder;

(b) agoraphobia;

(d) anxiety disorder;

(e) attention-deficit/hyperactivity disorder;

(f) depressive disorder due to another medical condition;

(g) disruptive impulse-control and conduct disorder;

(h) eating disorder;

(i) obsessive-compulsive disorder;

(j) panic disorder;

(k) personality disorder;

(l) posttraumatic stress disorder;

(m) premenstrual dysphoric disorder;

(n) social anxiety disorder;

(o) specific phobia;

(p) substance use disorder; or

(q) substance/medication-induced depressive disorder.

Note 1: "Management" of the condition may involve regular visits (for example, at least monthly) to a psychiatrist, counsellor or general practitioner.

Note 2: To "warrant ongoing management" does not require that any actual management was received or given for the condition.

Note 3: Depressive disorder due to another medical condition, premenstrual dysphoric disorder and substance/medication-induced depressive disorder are types of depressive disorders.

substance/medication-induced bipolar and related disorder means a disorder of mental health that meets the following diagnostic criteria (derived from DSM-5):

A prominent and persistent disturbance in mood that predominates in the clinical picture and is characterised by elevated, expansive, or irritable mood, with or without depressed mood or markedly diminished interest or pleasure in all, or almost all, activities.
There is evidence from the history, physical examination, or laboratory findings of both (i) and (ii):

(i) the symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication; and

(ii) the involved substance/medication is capable of producing the symptoms in Criterion A.

C. The disturbance is not better explained by a bipolar or related disorder that is not substance/medication-induced. Such evidence of an independent bipolar or related disorder could include the following:

(i) the symptoms precede the onset of the substance/medication use, the symptoms persist for a substantial period of time (for example, about one month) after the cessation of acute withdrawal or severe intoxication, or there is other evidence suggesting the existence of an independent non-substance/medication-induced bipolar and related disorder (for example, a history of recurrent non-substance/medication-related episodes).

D. The disturbance does not occur exclusively during the course of a delirium.

E. The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning.

Note: DSM-5 is also defined in the Schedule 1 - Dictionary.

terminal event means the proximate or ultimate cause of death and includes the following:

(a) pneumonia;

(b) respiratory failure;

(d) circulatory failure; or

(e) cessation of brain function.

VEA means the Veterans' Entitlements Act 1986.

meta-content-style-type: text/css meta-content-type: application/xhtml+xml; charset=utf-8 meta-generator: Aspose.Words for .NET 20.2

?xml version="1.0" encoding="utf-8" standalone="no"?>

Statement of Principles

concerning

BIPOLAR DISORDER (Balance of Probabilities)

(No. 54 of 2018)

The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.

Dated 22 June 2018

The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:<br>
<br><br>Professor Nicholas Saunders AO<br>Chairperson<br>