Statement of Principles concerning depressive disorder (Balance of Probabilities) (No. 12 of 2024)

This instrument is a Statement of Principles (SoP) made under subsection 196B(3) of the Veterans' Entitlements Act 1986 (VEA). It sets the medical and factual criteria that the Repatriation Medical Authority has determined, on the available medical‑scientific evidence, are more likely than not to establish a nexus between depressive disorder (including death from depressive disorder) and relevant service for the purposes of claims under specified provisions of the VEA and the Military Rehabilitation and Compensation Act 2004 (MRCA). The instrument commences 22 January 2024 (s 2) and expressly repeals the prior depressive disorder Statement of Principles No. 84 of 2015 (s 4).

Mechanically the SoP does three principal things. First, it defines the clinical entities that count as "depressive disorder" for the purpose of connection with service (s 7(2)-(10)). That definition adopts DSM-5-TR criteria for major depressive disorder, major depressive episode, persistent depressive disorder (dysthymia), depressive disorder due to another medical condition, substance/medication-induced depressive disorder, premenstrual dysphoric disorder, and other/unspecified depressive disorders (s 7(2)-(10); Schedule, DSM-5-TR). Second, it lists the specific factors that "must exist" before, on the balance of probabilities, depressive disorder or death from depressive disorder can be said to be connected with the circumstances of a person’s relevant service (s 9). Those factors include time‑limited windows for stressors and exposures (for example category 1A/1B stressors within two years before onset; category 2 stressors within six months; substance exposures within 30 days), clinical comorbidities (sleep-wake disorder, persistent pain, epilepsy), medication exposures (mefloquine, corticosteroids, other drugs), pregnancy and childbirth windows, and other specified events (s 9(1)-(43)). Third, it records the relationship-to-service rules: a listed factor must be related to the person’s relevant service (s 10(1)), and a subset of the factors (subsections 9(22)-(43)) apply only to material contribution or aggravation where the depressive disorder was suffered or contracted before or during, but did not arise out of, the person’s relevant service (s 10(2)). The SoP also directs that where a factor refers to an injury or disease covered by another SoP, the terms of that other SoP prevail (s 11).

Commonwealth Coat of Arms

made under subsection 196B(3) of the

Veterans' Entitlements Act 1986

Compilation No. 1

Compilation date: 26 March 2024

Includes amendments: Amendment Statement of Principles concerning depressive disorder (Balance of Probabilities) (No. 28 of 2024) (F2024L00225)

The day of commencement of this Amendment Statement of Principles concerning depressive disorder is 26 March 2024.

About this compilation

This compilation

This is a compilation of the Statement of Principles concerning depressive disorder (Balance of Probabilities) (No. 12 of 2024) that shows the text of the law as amended and in force on 26 March 2024.

The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.

Uncommenced amendments

The effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Register (www.legislation.gov.au). The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the Register for the compiled law.

Application, saving and transitional provisions for provisions and amendments

If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.

Modifications

If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the Register for the compiled law.

Self‑repealing provisions

If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.

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

Endnotes

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

1 Name

This is the Statement of Principles concerning depressive disorder (Balance of Probabilities) (No. 12 of 2024).

2 Commencement

This instrument commences on 22 January 2024.

3 Authority

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

4 Repeal

The Statement of Principles concerning depressive disorder No. 84 of 2015 (Federal Register of Legislation No. F2015L00916) made under subsections 196B(3) and (8) 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 depressive disorder and death from depressive disorder.

Meaning of depressive disorder

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

(a) major depressive disorder; or

(b) major depressive episode; or

(d) depressive disorder due to another medical condition; or

(e) substance/medication-induced depressive disorder; or

(f) premenstrual dysphoric disorder; or

(g) other specified depressive disorder or unspecified depressive disorder; where:

(3) major depressive disorder meets the following criteria (derived from DSM-5-TR):

(a) Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either depressed mood or loss of interest or pleasure.

(i) Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., 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 (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.

(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).

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

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

(d) At least one major depressive episode is not better explained by schizoaffective disorder and is not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.

(e) There has never been a manic episode or a hypomanic episode.

Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance-induced or are attributable to the physiological effects of another medical condition.

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

(i) Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., 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 (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.

(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).

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

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

(5) persistent depressive disorder (dysthymia) meets the following criteria (derived from DSM-5-TR):

(a) Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years.

Note: In children and adolescents, mood can be irritable and duration must be at least 1 year.

(b) Presence, while depressed, of two (or more) of the following:

(i) Poor appetite or overeating.

(ii) Insomnia or hypersomnia.

(iii) Low energy or fatigue.

(iv) Low self-esteem.

(v) Poor concentration or difficulty making decisions.

(vi) Feelings of hopelessness.

(c) During the 2-year period (1 year for children or adolescents) of the disturbance, the individual has never been without the symptoms in Criteria (a) and (b) for more than 2 months at a time.

(d) Criteria for a major depressive disorder may be continuously present for 2 years.

(e) There has never been a manic episode or a hypomanic episode.

(f) The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

(g) The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hypothyroidism).

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

(6) depressive disorder due to another medical condition meets the following criteria (derived from DSM-5-TR):

(a) A prominent and persistent disturbance in mood that predominates in the clinical picture and is characterized by depressed mood or markedly diminished interest or pleasure in all, or almost all, activities.

(b) There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.

(c) The disturbance is not better explained by another mental disorder (e.g., adjustment disorder, with depressed mood, in which the stressor is a serious medical condition).

(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.

(7) substance/medication-induced depressive disorder meets the following criteria (derived from DSM-5-TR):

(a) A prominent and persistent disturbance in mood that predominates in the clinical picture and is characterised by depressed mood or markedly diminished interest or pleasure in all, or almost all, activities.

(b) 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 or withdrawal from a medication.

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

(c) The disturbance is not better explained by a depressive disorder that is not substance/medication-induced. Such evidence of an independent depressive disorder could include the following:

(i) the symptoms preceded the onset of the substance/medication use;

(ii) the symptoms persist for a substantial period of time (e.g., about 1 month) after the cessation of acute withdrawal or severe intoxication; or

(iii) there is other evidence suggesting the existence of an independent non-substance/medication-induced depressive disorder (e.g., 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.

(8) premenstrual dysphoric disorder meets the following criteria (derived from DSM-5-TR):

(a) In the majority of menstrual cycles, at least 5 symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses.

(b) One (or more) of the following symptoms must be present:

(i) Marked affective lability (e.g., mood swings; feeling suddenly sad or tearful, or increased sensitivity to rejection).

(ii) Marked irritability or anger or increased interpersonal conflicts.

(iii) Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts.

(iv) Marked anxiety, tension, and/or feelings of being keyed up or on edge.

(c) One (or more) of the following symptoms must additionally be present, to reach a total of 5 symptoms when combined with symptoms from Criterion (b) above.

(i) Decreased interest in usual activities (e.g., work, school, friends, hobbies).

(ii) Subjective difficulty in concentration.

(iii) Lethargy, easy fatigability, or marked lack of energy.

(iv) Marked change in appetite; overeating; or specific food cravings.

(v) Hypersomnia or insomnia.

(vi) A sense of being overwhelmed or out of control.

(vii) Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain.

Note: The symptoms in Criteria a–c must have been met for most menstrual cycles that occurred in the preceding year.

(d) The symptoms cause clinically significant distress or interference with work, school, usual social activities, or relationships with others (e.g., avoidance of social activities; decreased productivity and efficiency at work, school, or home).

(e) The disturbance is not merely an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, persistent depressive disorder, or a personality disorder (although it may co-occur with any of these disorders).

(f) Criterion (a) should be confirmed by prospective daily ratings during at least two symptomatic cycles.

(g) The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or another medical condition (e.g., hyperthyroidism).

(9) other specified depressive disorder and unspecified depressive disorder have prominent symptoms of depression that cause clinically significant distress or impairment in social, occupational or other important areas of functioning, however, these depressive symptoms do not meet the full criteria for any of the other depressive disorders (derived from DSM-5-TR).

(10) Depressive disorder excludes disruptive mood dysregulation disorder and unspecified mood disorder.

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

Death from depressive disorder

(11) For the purposes of this Statement of Principles, depressive disorder, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's depressive 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 depressive disorder and death from depressive 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, depressive disorder or death from depressive disorder is connected with the circumstances of a person's relevant service:

(1) experiencing a category 1A stressor within the 2 years before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;

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

(2) experiencing a category 1B stressor within the 2 years before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;

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

(3) experiencing severe childhood abuse before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;

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

(4) having a family member or close friend who experiences a category 1A stressor within the one year before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;

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

(5) experiencing the death of a family member or close friend within the 2 years before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;

(6) experiencing miscarriage, fetal death in utero or stillbirth as a parent, within the 6 months before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;

(7) experiencing a category 2 stressor within the 6 months before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;

Note 1: A category 2 stressor can arise in a variety of circumstances connected with service. Such circumstances can arise during the course of service, as a result of separation from service and the conditions associated with that separation, and in the transition to civilian life in the years following separation.

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

(8) having a clinically significant disorder of mental health within the 2 years before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;

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

(9) having a sleep-wake disorder for at least the one year before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;

Note: Examples of sleep-wake disorders include chronic insomnia disorder, hypersomnolence disorder, narcolepsy, restless legs syndrome and untreated obstructive sleep apnoea.

(10) having an injury which is life-threatening or which results in serious physical or cognitive disability, within the 3 years before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;

(11) having a severe, chronic medical condition for at least the 5 years before the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;

Note: severe, chronic medical condition is defined in the Schedule 1 - Dictionary.

(12) having epilepsy at the time of the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;

(13) having persistent pain of at least 6 months duration at the time of the clinical onset of major depressive disorder, major depressive episode, persistent depressive disorder or premenstrual dysphoric disorder;

Note: persistent pain is defined in the Schedule 1 - Dictionary.

(14) experiencing pregnancy or the first 12 months after childbirth as a parent, at the time of the clinical onset of major depressive disorder, major depressive episode or persistent depressive disorder;

(15) having another medical condition, including an endocrine, cardiovascular, respiratory, metabolic, infectious or neurological disorder, where the signs or symptoms of depression are directly related to the pathological process of the medical condition and not solely due to its psychosocial stress effects, at the time of the clinical onset of “depressive disorder due to another medical condition”;

(16) taking mefloquine or corticosteroids, excluding topical or inhaled corticosteroids, within the 30 days before the clinical onset of substance/medication-induced depressive disorder, where substance/medication-induced depressive disorder persists after the discontinuation or tapering of mefloquine or corticosteroid therapy;

(17) using a psychoactive substance from the specified list of psychoactive substances at an intoxicant dose within the 30 days before the clinical onset of substance/medication-induced depressive disorder;

Note: intoxicant dose and specified list of psychoactive substances are defined in the Schedule 1 – Dictionary.

(18) taking a drug that cannot be ceased or substituted in the long term and which is associated in the individual with the development of depressive symptoms during drug therapy and either:

(a) the improvement of depressive symptoms within days or weeks of discontinuing or tapering drug therapy; or

(b) the redevelopment of depressive symptoms on rechallenge with the same drug;

where the drug was being taken within the 30 days before the clinical onset of substance/medication-induced depressive disorder;

(19) using a psychoactive chemical or substance at an intoxicant dose, which is associated in the individual with the development of depressive symptoms, and where the psychoactive chemical or substance was being taken within the 30 days before the clinical onset of substance/medication-induced depressive disorder;

Note: intoxicant dose is defined in the Schedule 1 – Dictionary.

(20) having ceased or reduced therapeutic or illicit drug use or other substance use within the 30 days before the clinical onset of substance/medication-induced depressive disorder;

(21) having an alcohol use disorder or a substance use disorder at the time of the clinical onset of substance/medication-induced depressive disorder;

(22) experiencing a category 1A stressor within the 2 years before the clinical worsening of depressive disorder;

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

(23) experiencing a category 1B stressor within the 2 years before the clinical worsening of depressive disorder;

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

(24) experiencing severe childhood abuse before the clinical worsening of depressive disorder;

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

(25) having a family member or close friend who experiences a category 1A stressor within the 1 year before the clinical worsening of depressive disorder;

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

(26) experiencing the death of a family member or close friend within the 2 years before the clinical worsening of depressive disorder;

(27) experiencing miscarriage, fetal death in utero or stillbirth as a parent, within the 6 months before the clinical worsening of depressive disorder;

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

Note 1: A category 2 stressor can arise in a variety of circumstances connected with service. Such circumstances can arise during the course of service, as a result of separation from service and the conditions associated with that separation, and in the transition to civilian life in the years following separation.

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

(29) having a clinically significant disorder of mental health within the 2 years before the clinical worsening of depressive disorder;

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

(30) having a sleep-wake disorder for the 1 year before the clinical worsening of depressive disorder;

Note: Examples of sleep-wake disorders include chronic insomnia disorder, hypersomnolence disorder, narcolepsy, restless legs syndrome and untreated obstructive sleep apnoea.

(31) having an injury which is life-threatening or which results in serious physical or cognitive disability, within the 3 years before the clinical worsening of depressive disorder;

(32) having a severe, chronic medical condition for at least the 5 years before the clinical worsening of depressive disorder;

Note: severe, chronic medical condition is defined in the Schedule 1 - Dictionary.

(33) having epilepsy at the time of the clinical worsening of depressive disorder;

(34) having persistent pain of at least 6 months duration at the time of the clinical worsening of depressive disorder;

Note: persistent pain is defined in the Schedule 1 - Dictionary.

(35) experiencing pregnancy or the first 12 months after childbirth as a parent, at the time of the clinical worsening of depressive disorder;

(36) having another medical condition, including an endocrine, cardiovascular, respiratory, metabolic, infectious or neurological disorder, where the signs or symptoms of depression are directly related to the pathological process of the medical condition and not solely due to its psychosocial stress effects, at the time of the clinical worsening of depressive disorder;

(37) taking mefloquine or corticosteroids, excluding topical or inhaled corticosteroids, within the 30 days before the clinical worsening of depressive disorder, where depressive disorder persists after the discontinuation or tapering of mefloquine or corticosteroid therapy;

(38) using a psychoactive substance from the specified list of psychoactive substances at an intoxicant dose within the 30 days before the clinical worsening of depressive disorder;

Note: intoxicant dose and specified list of psychoactive substances are defined in the Schedule 1 – Dictionary.

(39) taking a drug that cannot be ceased or substituted in the long term and which is associated in the individual with the worsening of depressive symptoms during drug therapy and either:

(a) the improvement of depressive symptoms within days or weeks of discontinuing or tapering drug therapy; or

(b) the worsening of depressive symptoms on rechallenge with the same drug;

where the drug was being taken within the 30 days before the clinical worsening of depressive disorder;

(40) using a psychoactive chemical or substance at an intoxicant dose, which is associated in the individual with the worsening of depressive symptoms, and where the psychoactive chemical or substance was being taken within the 30 days before the clinical worsening of depressive disorder;

Note: intoxicant dose is defined in the Schedule 1 – Dictionary.

(41) having ceased or reduced therapeutic or illicit drug use or other substance use within the 30 days before the clinical worsening of depressive disorder;

(42) having an alcohol use disorder or a substance use disorder at the time of the clinical worsening of depressive disorder;

(43) inability to obtain appropriate clinical management for depressive disorder before the clinical worsening of depressive 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(22) to 9(43) apply only to material contribution to, or aggravation of, depressive disorder where the person's depressive 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:

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 a witness 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 a witness.

Note: corpse and witness are 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 on-going distress, concern or worry:

(a) being socially isolated and unable to maintain friendships or family relationships, due to physical location, ethnicity, sexuality, 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 on-going 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, on-going 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; or

(f) having a family member or close friend experience a major deterioration in their health.

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

(a) alcohol use disorder;

(b) another depressive disorder;

(d) disruptive, impulse-control or conduct disorder;

(e) dissociative disorder;

(f) elimination disorder;

(g) feeding or eating disorder;

(h) gambling disorder;

(i) gender dysphoria;

(j) neurocognitive disorder (including vascular neurocognitive disorder and Alzheimer disease);

(k) neurodevelopmental disorder;

(l) obsessive compulsive or related disorder;

(m) paraphilic disorder;

(n) personality disorder;

(o) schizophrenia spectrum or other psychotic disorder (including schizophrenia);

(p) sexual dysfunction;

(q) somatic symptom disorder or related disorder;

(r) substance use disorder; or

(s) trauma- and stressor-related disorder (including acute stress disorder, adjustment disorder and posttraumatic stress 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.

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.

depressive disorder—see subsection 7(2).

DSM-5-TR means the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Text Revision Washington, DC, American Psychiatric Association, 2022.

inhalants means breathable chemicals that produce psychoactive vapours or fumes and include organic solvents, aerosols and anaesthetics.

intoxicant dose means a dose sufficient to cause disturbances in level of consciousness, cognition, perception, affect or behaviour, or other psychophysiological functions and responses.

MRCA means the Military Rehabilitation and Compensation Act 2004.

persistent pain means:

(a) continuous; or

(b) severe, frequent and intermittent pain;

which may or may not be ameliorated by analgesic medication and is of a level to cause interference with usual work or activities of daily living.

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 18 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 18 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.

severe, chronic medical condition means an illness that:

(a) substantially impacts on social, occupational or other important areas of functioning; and

(b) requires on-going daily or almost daily management of symptoms under the supervision of a registered health practitioner, including assistance with activities of daily living, bed rest, dietary modification, drug therapy, nursing care, oxygen therapy and physiotherapy; and

(c) is of a type that does not usually resolve spontaneously, is rarely cured completely and may progress to a life-threatening illness.

Note: Examples of severe, chronic medical conditions include chronic kidney disease requiring dialysis, severe psoriasis, poorly controlled asthma and poorly controlled diabetes mellitus.

specified list of psychoactive substances means:

(a) amphetamine or amphetamine-type substances, including methamphetamine and 3,4-methylenedioxymethamphetamine (ecstasy);

(b) cannabis;

(d) hallucinogens (including phencyclidine);

(e) inhalants; or

(f) opioids.

Note: inhalants 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.

witness means a person who experiences an incident at the time it occurs and can give direct evidence of it. This excludes persons exposed only to public broadcasting or mass media coverage of the incident.

Note: Endnotes

Note: Endnote 1—About the endnotes

The endnotes provide information about this compilation and the compiled law.

The following endnotes are included in every compilation:

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

Abbreviation key—Endnote 2

The abbreviation key sets out abbreviations that may be used in the endnotes.

Legislation history and amendment history—Endnotes 3 and 4

Amending laws are annotated in the legislation history and amendment history.

The legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.

The amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.

Misdescribed amendments

A misdescribed amendment is an amendment that does not accurately describe how an amendment is to be made. If, despite the misdescription, the amendment can be given effect as intended, then the misdescribed amendment can be incorporated through an editorial change made under section 15V of the Legislation Act 2003.

If a misdescribed amendment cannot be given effect as intended, the amendment is not incorporated and “(md not incorp)” is added to the amendment history.

Note: Endnote 2—Abbreviation key

ad = added or inserted	orig = original
am = amended	par = paragraph(s)/subparagraph(s)
amdt = amendment	/sub‑subparagraph(s)
c = clause(s)	pres = present
C[x] = Compilation No. x	prev = previous
Ch = Chapter(s)	(prev…) = previously
def = definition(s)	Pt = Part(s)
Dict = Dictionary	r = regulation(s)/rule(s)
disallowed = disallowed by Parliament	reloc = relocated
Div = Division(s)	renum = renumbered
exp = expires/expired or ceases/ceased to have	rep = repealed
effect	rs = repealed and substituted
F = Federal Register of Legislation	s = section(s)/subsection(s)
gaz = gazette	Sch = Schedule(s)
LA = Legislation Act 2003	Sdiv = Subdivision(s)
LIA = Legislative Instruments Act 2003	SLI = Select Legislative Instrument
(md not incorp) = misdescribed amendment	SR = Statutory Rules
cannot be given effect	Sub‑Ch = Sub‑Chapter(s)
mod = modified/modification	SubPt = Subpart(s)
No. = Number(s)	underlining = whole or part not
o = order(s)	commenced or to be commenced
Ord = Ordinance

Note: Endnote 3—Legislation history

Name	Registration	Commencement	Application, saving and transitional provisions
Statement of Principles concerning depressive disorder (Balance of Probabilities) (No. 12 of 2024)	8 January 2024F2024L00046	22 January 2024
Amendment Statement of Principles concerning depressive disorder (Balance of Probabilities) (No. 28 of 2024)	28 February 2024F2024L00225	26 March 2024

Note: Endnote 4—Amendment history

Provision affected	How affected
Section 2……………….	rep LA s 48D
Section 4……………….	rep LA s 48C
Subsection 9(7)………..	am No. 28 of 2024

1 Statement of Principles concerning depressive disorder (Balance of Probabilities) (No. 12 of 2024)

Statement of Principles concerning depressive disorder (Balance of Probabilities) (No. 12 of 2024)

made under subsection 196B(3) of the

Veterans' Entitlements Act 1986

Compilation No. 1

Compilation date: 26 March 2024

Includes amendments: Amendment Statement of Principles concerning depressive disorder (Balance of Probabilities) (No. 28 of 2024) (F2024L00225)

The day of commencement of this Amendment Statement of Principles concerning depressive disorder is 26 March 2024.

About this compilation

This compilation

The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.

Uncommenced amendments

Application, saving and transitional provisions for provisions and amendments

Modifications

Self‑repealing provisions

If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.

Contents

1 Name

2 Commencement

3 Authority

4 Repeal

The SoP operates as an evidentiary framework linking a defined set of clinical diagnoses to specified service‑related or temporally proximate factors. Two principal concept clusters structure the instrument: (1) clinical definition and diagnostic thresholds, and (2) qualifying causal factors and temporal windows.

Clinical definition and thresholds (s 7). Depressive disorder is not a single undefined concept in the instrument. It is a catalogue of DSM-5-TR diagnostic entities (s 7(2)-(10); Schedule). The SoP imports DSM-5-TR criteria for major depressive disorder and major depressive episode (s 7(3)-(4)), which require five or more specified symptoms within the same two‑week period and clinically significant distress or impairment. Persistent depressive disorder (dysthymia) follows DSM-5-TR criteria with a minimum duration requirement (two years for adults; one year for children/adolescents) and symptom persistence rules (s 7(5)). Substance/medication-induced, due-to-other-medical-condition, and premenstrual dysphoric disorder are separately specified, with the instrument requiring evidence that the mood disturbance is temporally and causally linked to the substance or medical condition and is not better explained by another disorder (s 7(6)-(8)). The Schedule expressly defines DSM-5-TR as the 2022 text revision.
Qualifying causal factors and temporal windows (s 9). Section 9 lists discrete factors that "must exist" before a causal connection can be said to exist on the balance of probabilities. The factors are expressed as temporal relationships (for example, a category 1A or 1B stressor within two years before clinical onset, s 9(1)-(2); a category 2 stressor within six months before onset, s 9(7)) or as comorbid clinical states present at the time of onset (for example epilepsy, persistent pain, sleep-wake disorder, severe chronic medical condition, s 9(12), 9(13), 9(9), 9(11)). A separate group of factors addresses substance/medication-induced depressive disorder and sets short time windows and testable features: exposure to mefloquine or systemic corticosteroids within 30 days where symptoms persist after discontinuation (s 9(16)), use of a specified psychoactive substance at an intoxicant dose within 30 days (s 9(17)), drug-associated depressive symptoms with improvement on discontinuation or redevelopment on rechallenge (s 9(18)), and cessation or reduction of drug use within 30 days prior to onset (s 9(20)). The Schedule defines "intoxicant dose" and the "specified list of psychoactive substances" (Schedule).
Relationship to service and limitation of application (s 10). The instrument requires that any s 9 factor relied on be related to the person’s relevant service (s 10(1)). Importantly, subsections 9(22)-9(43) apply only to material contribution to, or aggravation of, depressive disorder where the person’s depressive disorder was suffered or contracted before or during, but did not arise out of, relevant service (s 10(2)). That means the same enumerated factor will have a different application depending on whether the depressive disorder first arose out of service, or pre-dated service.
Interaction with other SoPs (s 11). Where a s 9 factor refers to an injury or disease covered by another SoP, the provisions of that other SoP apply "in accordance with the terms of that Statement of Principles as in force from time to time" (s 11). The instrument therefore functions within a broader catalogue of SoPs; cross-references will often be operative.
Death from depressive disorder (s 7(11)). The SoP treats death from depressive disorder as including death from a terminal event or condition contributed to by the person’s depressive disorder, with "terminal event" defined in the Schedule (s 7(11), Schedule). This captures scenarios where depressive disorder has contributed to a proximate cause of death.
Definitions as operational rules (Schedule). Many potentially ambiguous concepts are defined in the Schedule so as to operate as legal thresholds: "category 1A stressor" (life‑threat, sexual assault or similar, Schedule), "category 1B stressor" (killing or witnessing killing, viewing corpses under specified conditions, Schedule), "category 2 stressor" (chronic negative life events such as social isolation, relationship breakdown, work issues, serious legal matters, financial hardship, Schedule), "clinically significant disorder of mental health" (a list of discrete diagnoses that would warrant ongoing management, Schedule), "persistent pain", "severe childhood abuse", "severe, chronic medical condition", "specified list of psychoactive substances", "intoxicant dose", and "witness" (which excludes exposure via broadcasting or mass media). Each definition alters how an item in s 9 will be proven and applied.

The SoP therefore operates as a rulebook that maps diagnostic categories to a closed list of qualifying external factors and timeframes. It does not set benefits, administrative procedures or appeal routes. It prescribes the factual and medical evidence that will, according to the Repatriation Medical Authority’s view of the evidence, satisfy causation on a balance of probabilities for specified VEA/MRCA claim types.

The instrument directly affects applicants who lodge claims under the specified provisions of veterans' compensation law, that is claims to which section 120B of the VEA or section 339 of the MRCA apply (s 5). Those claimants will typically be veterans, members of the Forces, or their dependants seeking to establish that depressive disorder, or death from depressive disorder, is connected to relevant service as defined in the Schedule (Schedule, relevant service). The instrument applies to a wide range of depressive diagnoses and therefore potentially affects claimants with acute major depressive episodes, persistent depressive disorder, premenstrual dysphoric disorder, substance/medication-related depression, and depressive disorders arising as part of other medical conditions (s 7(2)-(10)).

Public decision‑makers also are affected. The instrument is a medical‑evidentiary tool manufactured by the Repatriation Medical Authority and intended for use by the decision makers who determine entitlement under the VEA and the MRCA. The SoP will be a determinative piece of medical‑evidentiary guidance when those decision makers assess causation in claims under the specified sections (s 3; s 5). The instrument does not name the Department or decision-making delegates, but its statutory source and application clauses map it into the administrative decision framework of veteran entitlements.

Health practitioners who provide medical reports for claims are affected practically because the SoP adopts DSM-5-TR diagnostic criteria (s 7; Schedule). Clinicians preparing reports for a claims process must align diagnostic statements and documented symptom counts, durations and functional impairments to the DSM-5-TR text incorporated in the SoP to be persuasive on causation. The Schedule also sets clinical thresholds (for example, sleep-wake disorder for at least one year before onset, s 9(9); persistent pain of at least six months duration at the time of onset or worsening, s 9(13) and s 9(34)), so treating practitioners will be asked to provide records evidencing duration and temporality.

Families of claimants can be affected because the SoP recognises family events as qualifying factors. For example, having a family member or close friend experience a category 1A stressor within one year before clinical onset is a listed factor (s 9(4)), and the death of a family member or close friend within two years before onset is another (s 9(5)). Those events and their timing may have evidentiary importance in claims and will require documentary or testimonial evidence.

The Commonwealth’s fiscal position is indirectly affected because the SoP sets a medical gate for entitlements. If the SoP increases successful connections between depressive disorders and relevant service relative to the prior SoP, the Commonwealth will likely pay more entitlements; the instrument itself does not estimate fiscal impact. Conversely, where the SoP narrows qualifying pathways, claim volumes or success rates could reduce fiscal exposure. The instrument itself contains no financial provisions and does not allocate costs, but its adoption and repeal of the 2015 SoP (s 4) will tend to change the evidentiary thresholds applied to claims and so affect payment profiles.

Organisations providing veterans’ assistance and legal advisers will be affected operationally. They must identify which factors in s 9 are relevant, obtain supporting medical and non‑medical evidence within the time windows specified, and map diagnoses to DSM-5-TR criteria. The SoP’s interaction rule (s 11) also requires practitioners to cross-check other SoPs when a factor refers to an injury or disease covered elsewhere, creating additional evidentiary work.

The instrument imposes no criminal sanctions or administrative fines. It is not a statute of obligations in the sense of creating duties enforceable by penalties. Rather, it operates as a prescriptive evidentiary instrument that defines the conditions under which a decision maker may conclude, on the balance of probabilities, that depressive disorder or death from depressive disorder is connected with relevant service. The operative duties and rights are therefore administrative and evidentiary: claimants have the right to rely on the listed factors in s 9 when asserting connection; decision-makers have the duty to apply the SoP in assessing connection in claims within its stated application (s 5). The Repatriation Medical Authority has the statutory authority to make such statements under subsection 196B(3) of the VEA and has exercised that power (s 3).

Practical duties follow for medical practitioners whose evidence is relied upon. The SoP requires DSM-5-TR diagnostic alignment (s 7 and Schedule). A duty thus arises in practice: reports should set out the DSM-5-TR criteria observed, document symptom counts, duration and functional impact, and establish temporality between onset/worsening and qualifying factors in s 9. The Schedule’s definitions will impose evidentiary duties: for example, establishing "severe childhood abuse" requires showing the abuse was perpetrated by a parent, care provider or adult in contact with the child (Schedule, severe childhood abuse). Establishing a "category 1A stressor" requires evidence of life-threatening events or sexual assault as defined (Schedule, category 1A).

Administrative decision-makers have duties to recognise the limits the SoP imposes. Section 10(1) states the factor(s) must be related to the relevant service rendered by the person. That requires decision-makers to make factual findings linking a listed factor to the person’s relevant service type as defined in the Schedule (relevant service includes eligible war service, defence service or peacetime service under MRCA). Section 10(2) narrows application of subsections 9(22)-9(43) to material contribution or aggravation scenarios where the disorder pre-existed or was suffered or contracted before or during service but did not arise out of service. The duty on decision-makers is to apply that structural caveat correctly.

Claimants retain procedural rights under the VEA and MRCA frameworks (not spelled out in the SoP). The instrument does not alter substantive entitlement law; it supplies the medical causation narrative that must be matched to the legal tests in the VEA and MRCA. If a factor in s 9 refers to an injury or disease that is the subject of another SoP, s 11 requires the application of that other SoP in accordance with its terms, so rights to rely on those other instruments attach.

The Repatriation Medical Authority has the right and duty to revise or replace SoPs as it considers appropriate. The instrument’s front matter and endnotes record that it repealed the 2015 SoP (s 4) and was subsequently amended (Endnotes 3 and 4). That institutional power means the evidentiary rules in place can change and practitioners must track amendments in the Federal Register.

This Statement of Principles does not create criminal offences, civil penalties, or administrative fines. The instrument is not framed as an enforcement statute and contains no provisions imposing monetary penalties or criminal liability. Instead, its enforcement is indirect and administrative: the SoP is a determinative medical‑evidentiary tool that decision-makers apply when resolving claims under the VEA and the MRCA. The "enforcement" mechanism is therefore the administrative decision to accept or reject a claim, and any downstream payment or denial of entitlements under those Acts.

Because the instrument references its statutory authority in subsection 196B(3) of the VEA (s 3), it operates within the decision-making architecture established by veteran entitlements legislation. The SoP prescribes the conditions on which a causal connection will be taken to exist "on the balance of probabilities". Decision-makers applying the VEA and MRCA will use the SoP as the medical basis for deciding whether the legal test for service connection is met. Where a decision-maker finds the listed diagnostic criteria and one or more of the s 9 factors satisfied and related to relevant service (s 10(1)), the practical consequence will be that an entitlement may be granted under the relevant Acts; conversely, absence of the required factors will lead to refusals.

Remedies against administrative decisions that rely upon this SoP will be those already available under the VEA and MRCA and the general administrative law framework. The instrument itself does not create a distinct right of appeal or procedural pathway, nor does it describe sanctions for non-compliance by third parties. Any challenge to a decision that applies the SoP would proceed as a challenge to an administrative decision under the VEA or MRCA; the SoP may be considered persuasive medical evidence in tribunal or court review, but the instrument provides no internal enforcement regime.

Because the SoP prescribes diagnostic and temporal criteria, enforcement risks in practice include inconsistent interpretation or application by decision-makers and the evidentiary burden placed on claimants to obtain medical and non‑medical documentation within specified time windows. The instrument does not set standards for how decision-makers should weigh competing medical opinions or how to treat gaps in records. Those procedural rules and enforcement mechanisms remain the domain of the parent statutes, administrative practice directions and tribunals, none of which the instrument alters directly.

Finally, the instrument’s repeal of the prior SoP (s 4) and its own amendment history (Endnotes 3 and 4) indicate that the Repatriation Medical Authority may revise the medical thresholds. The instrument itself does not prescribe transitional or saving rules for claims in progress; any such rules would be in the VEA/MRCA or in the amending instruments, not contained in this document.

The SoP is an instrument made under subsection 196B(3) of the VEA (s 3). It is designed to be applied within the entitlement frameworks of the VEA and the MRCA by decision-makers deciding claims under the sections cited in the application clause (s 5). The instrument therefore functions as a medical‑evidentiary adjunct to the substantive entitlement provisions contained in those Acts. It does not alter entitlement law; it identifies the medical/scientific factors that, where established and related to relevant service as defined in the Schedule, meet the causation standard on the balance of probabilities.

Section 5 explicitly limits the instrument’s application to claims to which section 120B of the VEA or section 339 of the MRCA apply. Those references tie the SoP to particular points in the statutory entitlement scheme; the instrument does not state or alter the legal criteria in those sections. Practitioners must therefore take the SoP as a medical map which must be combined with the legal tests in the parent statutes to reach an entitlement decision.

Section 11 creates a specific rule for interaction with other SoPs: if a factor in s 9 refers to an injury or disease that is the subject of another SoP 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" (s 11). In practice this means cross-referencing will be required: for example, if a s 9 factor refers to a condition like persistent pain or a neurological disorder that is separately the subject of another SoP, decision-makers must read and apply that other SoP’s factors and definitions to resolve causation questions.

The Schedule definitions also interact with other legal regimes by specifying clinical nomenclature (DSM-5-TR) and by setting precise meanings for terms such as "witness" and "corpse" that exclude certain exposures (for example, exposure via public broadcasting or mass media is excluded from "witness", Schedule). That exclusion will interact with evidentiary assessment in claims where a claimant alleges PTSD‑type exposures or traumatic witnessing; the SoP narrows the type of witnessing that qualifies.

The instrument repeals the previous SoP for depressive disorder No. 84 of 2015 (s 4). That repeal means that claims must now be assessed against the new 2024 SoP. Endnotes show an amendment (No. 28 of 2024) that altered subsection 9(7) (Endnote 4). The SoP therefore interacts with the broader statutory and administrative environment through being the current medical standard for causation; it may alter decisions made under the VEA and MRCA when compared with decisions under the repealed 2015 instrument.

The SoP does not amend the VEA or MRCA themselves. It also does not displace or interpret other statutory provisions directly. Any judicial or tribunal review of a decision that applies the SoP will require combining the SoP’s medical criteria with the legal duties and standards in the parent Acts and administrative law; the SoP will be evidence of medical causation but the ultimate legal question remains one for the decision-maker under the VEA or MRCA.

The instrument provides a short amendment history in its front matter and endnotes. The 2024 instrument is Compilation No. 1, compilation date 26 March 2024, and it incorporates Amendment Statement of Principles concerning depressive disorder (Balance of Probabilities) (No. 28 of 2024) (F2024L00225). The main instrument is registered 8 January 2024 and commenced 22 January 2024 (Endnote 3). The Amendment instrument No. 28 of 2024 registered on 28 February 2024 and has a commencement date of 26 March 2024 (Endnote 3). The compilation notes that the day of commencement of that Amendment Statement of Principles is 26 March 2024.

Section 4 of this instrument expressly repeals the earlier Statement of Principles concerning depressive disorder No. 84 of 2015 (F2015L00916). The repeal is thus recorded in the operative text. The endnotes provide an amendment history table (Endnote 4) that records at least one specific amendment: subsection 9(7) was amended by No. 28 of 2024 (Endnote 4). The compilation also notes that the effect of any uncommenced amendments is not shown in the compiled text and that such amendments can be inspected on the Federal Register of Legislation.

The endnotes explain that misdescribed amendments that can be given effect may be corrected editorially under section 15V of the Legislation Act 2003, and that the compilation does not show the effect of modifications made by other laws (front matter). The instrument therefore is the current version as at compilation date 26 March 2024 and includes the stated amendment.

For practitioners this history matters because the SoP that applies to a given claim is the SoP in force at the time the causation decision is made under the VEA/MRCA framework. The repeal of the 2015 instrument and the substitution by the 2024 instrument means comparative outcomes may change; the No. 28 amendment in March 2024 altered at least subsection 9(7) (which concerns a category 2 stressor within six months before clinical onset), so practitioners reviewing claims spanning the amendment dates must check which version of the SoP was operative when the decision was made.

The compilation includes standard notes about uncommenced amendments and modifications. It also sets out that the Repatriation Medical Authority may further amend SoPs in future. The instrument itself does not contain transitional provisions; any application, saving or transitional provisions relevant to amending laws would appear in those amending instruments or in the parent Acts, not in this SoP.

The instrument contains no recorded litigation history. The text, schedule and endnotes do not cite any judicial or tribunal decisions, nor does the compilation record precedents that have interpreted this instrument. The endnotes focus exclusively on the administrative legislation history and amendment history (Endnotes 3 and 4), showing registration and commencement dates, repeal of the 2015 SoP and the No. 28/2024 amendment to subsection 9(7).

Because the instrument is an evidentiary Statement of Principles used in administrative decision-making under the VEA and MRCA, litigation challenging a decision that applies this SoP would proceed as a challenge to an entitlement decision under those Acts in the usual administrative law and tribunal routes. The instrument itself does not create separate judicial processes and does not record outcomes of any such litigation.

Practitioners requiring precedent on how SoPs have been interpreted in decisions (for example, by the Veterans’ Review Board, Administrative Appeals Tribunal, Federal Court or Federal Circuit Court) must look beyond this instrument to reported administrative and judicial decisions that treat SoPs as medical evidence in entitlement cases. The SoP compilation does not provide those authorities and does not summarise how tribunals or courts have treated prior SoPs, including the repealed 2015 instrument.

In short, there is no litigation history contained in this instrument. Any challenge or appeal in practice will be to decisions under the VEA and MRCA that apply the SoP; the outcomes of such challenges are a matter of case law external to the instrument and not referenced here.

The instrument contains a number of concrete drafting features and definitional choices that create practical traps and evidentiary challenges. The following are points that, insofar as they are apparent from the text, commonly lead to disputes or misunderstanding in claims management and clinical reporting.

DSM-5-TR is specified (Schedule). The SoP imports DSM-5-TR criteria for the major categories (s 7; Schedule). This means diagnosis must be demonstrably aligned to the 2022 DSM-5-TR text. Practitioners who rely on ICD coding alone, or older DSM editions, must ensure medical reports explicitly map observed signs and symptoms to DSM-5-TR criteria. Failure to do so may lead a decision-maker to find the diagnostic criteria unproven even where a clinician has recorded depressive features.
Temporal windows are rigid and varied (s 9). The SoP contains multiple distinct time windows: category 1A/1B stressors within two years before onset or worsening (s 9(1), 9(2), 9(22), 9(23)); category 2 stressor within six months (s 9(7), 9(28)); family member experiencing category 1A stressor within one year (s 9(4), 9(25)); death of family member or close friend within two years (s 9(5), 9(26)); miscarriage, fetal death or stillbirth within six months (s 9(6), 9(27)); substance/medication exposures generally within 30 days (s 9(16)-(21), 9(37)-(41)). These distinct windows require specific dating evidence. Vague or approximate timing in medical notes can be inadequate.
Narrow definitions of witnessing and corpse (Schedule). "Witness" excludes persons exposed only to public broadcasting or mass media coverage. "Corpse" excludes seeing a closed body bag or viewing a body in an open-casket coffin. That narrows what counts as category 1B witnessing events (Schedule). Claims based on media exposure or restricted visual contact may fail because the Schedule excludes them.
Substance and medication criteria require particular features (s 7(7); s 9(16)-(21), 9(37)-(41); Schedule). For substance/medication-induced depressive disorder, the SoP requires evidence the symptoms developed during or soon after intoxication/withdrawal or exposure to a medication and that the substance/medication is capable of producing the symptoms (s 7(7)). For drug-associated depressive symptoms, improvement on discontinuation or redevelopment on rechallenge is a listed factor (s 9(18), 9(39)). Proving these pharmacological relationships requires detailed prescribing records, dates of cessation and rechallenge, and clinician observations. The SoP also excludes topical or inhaled corticosteroids in the s 9(16) references.
"Clinically significant disorder of mental health" is a broad list but with an evidentiary nuance (Schedule). The definition includes many disorders but Note 2 clarifies that to "warrant ongoing management" does not require that actual management was received. That is a double-edged point: absence of treatment does not per se disqualify the condition, but evidence must still establish the condition reached the required severity.
Application limitation for post‑service aggravation/material contribution (s 10(2)). Subsections 9(22)-9(43) apply only where the depressive disorder was suffered or contracted before or during but did not arise out of relevant service. Practitioners can err by applying those factors to cases where the depressive disorder first arose out of service; the SoP separates onset causation (s 9(1)-(21)) from material contribution/aggravation in pre-existing cases (s 9(22)-(43)).
Death linkage requires contribution to a terminal event (s 7(11); Schedule). Death from depressive disorder is defined to include death from a terminal event or condition that was "contributed to" by the depressive disorder. That requires medical evidence tying the depressive disorder to the terminal event (for example, depression contributing to self-harm or failing self-care leading to fatal infection). Proving contribution is context-dependent and may be difficult where terminal events have multiple causal strands.
Severity thresholds for definitions such as "severe childhood abuse", "severe, chronic medical condition" and "persistent pain" are high and fact-specific (Schedule). Severe childhood abuse requires perpetration by specified categories of adults. Severe, chronic medical condition requires ongoing daily or almost daily management under a registered health practitioner and examples in the Schedule are illustrative only. Persistent pain requires a level that interferes with usual work or daily activities. Documentary proof needs to show these levels of severity, not merely asserted hardship.
Repeal of the 2015 SoP and amendment timing (s 4; Endnotes). Claims that bridge the repeal and commencement dates may need careful treatment to determine which SoP applies. The compilation notes that amendment No. 28 of 2024 altered subsection 9(7). Practitioners should check which version applied to the claim decision date.
No penalties or enforcement mechanics in the SoP. The SoP will be applied in VEA/MRCA decisions but the instrument does not specify procedural rules on how to handle incomplete records, expert disagreement, or retrospective diagnosis. Those procedural issues are governed by the parent Acts and administrative practice.

Each of these "gotchas" is grounded in the instrument’s text and definitions and presents practical evidentiary, diagnostic and timing risks for claimants, clinicians and decision-makers. The concrete mechanism for many of them is the strict temporal or definitional threshold in the Schedule and s 9 which converts clinical and experiential facts into legal gatekeeping criteria.

Compliance in the context of this SoP is about producing and organising evidence that maps the claimant’s diagnosis and history against the SoP’s diagnostic criteria, factors and temporal windows so a decision-maker can find, on the balance of probabilities, that depressive disorder or death from depressive disorder is connected to relevant service. The following practical checklist is grounded in the instrument’s operative provisions.

Confirm the SoP and timing. Verify which Statement of Principles applies to the claim decision date. The 2024 SoP commenced 22 January 2024 (s 2) and Amendment No. 28 commenced 26 March 2024 (Endnotes). If a claim decision or event falls near these dates, document which SoP was in force.
Establish the DSM-5-TR diagnosis. Under s 7 and the Schedule, the SoP imports DSM-5-TR criteria. Ensure medical reports explicitly state the DSM-5-TR diagnosis and map the patient’s signs and symptoms to each required DSM-5-TR criterion (for example, enumerate the five or more symptoms for a major depressive episode, note the two‑week period, and confirm functional impairment as required by s 7(3)(a)-(b)). Where the disorder is persistent depressive disorder, provide evidence of duration (two years adults; one year children) and the continuous symptom requirements (s 7(5)).
Time the clinical onset and worsening. Section 9 repeatedly links qualifying factors to the clinical onset or clinical worsening of depressive disorder. Prepare a timeline that identifies the clinical onset date (first meeting DSM-5-TR criteria) and any clinically significant worsening dates. Use medical records, GP notes, psychiatry reports, hospital admissions, and workplace absence records to fix dates.
Match factors to s 9 and their windows. For each factor relied upon, gather evidence that meets the SoP’s timing and content requirements. Examples:
- Category 1A/1B stressor: obtain incident reports, military operational records, police reports, witness statements and contemporaneous clinical notes. Remember category 1A/1B must be within two years before onset/worsening (s 9(1)-(2), 9(22)-(23)); the Schedule defines those categories.
- Category 2 stressor: gather evidence of chronicity and ongoing distress (employment records, counselling notes, financial records, relationship separation documentation) to satisfy the six‑month window (s 9(7), 9(28)).
- Family member events: documentary evidence (death certificates, medical records of family member, dated correspondence) to show timing relative to onset (s 9(4)-(5), 9(25)-(26)).
- Substance or medication exposure: compile prescribing records, pharmacy dispensing history, treatment notes documenting cessation, tapering, rechallenge, and temporal proximity within 30 days (s 9(16)-(21), s 7(7)).
Document comorbid conditions and severity thresholds per Schedule definitions. For factors requiring comorbid states:
- Sleep-wake disorder: provide sleep clinic reports, polysomnography where available, or documented diagnoses showing one-year duration (s 9(9), s 9(30)).
- Persistent pain: pain clinic notes, analgesic prescriptions and activity limitation evidence to establish six-month duration and interference (s 9(13), s 9(34); Schedule).
- Severe, chronic medical condition: evidence of ongoing daily management under a registered health practitioner (prescriptions, dialysis records, nursing care documentation) (s 9(11), s 9(32); Schedule).
- Epilepsy: neurologist reports, EEG findings and dated diagnosis (s 9(12), s 9(33)).
Make the service link under s 10. The SoP requires that any listed factor be related to the person’s relevant service (s 10(1)). Assemble evidence showing the factor arose in the context of eligible war service, defence service, or peacetime service as defined in the Schedule (relevant service). That may include service records, deployment orders, character statements, supervisory reports, or other military documentation.
For pre-existing disorders, apply s 10(2). If the depressive disorder was suffered or contracted before or during, but did not arise out of, relevant service, then the material contribution or aggravation factors in subsections 9(22)-9(43) apply. Document the pre-existing diagnosis and show how the listed factors materially contributed to or aggravated the condition.
Use cross-referenced SoPs under s 11. Where a s 9 factor refers to an injury/disease for which another SoP exists, obtain and apply the other SoP to prove that factor, because s 11 requires the other SoP’s factors to be applied as in force. Identify which other SoPs may be relevant early in case additional documentary evidence is needed.
Address "death from depressive disorder" linkage. For claims involving death, prepare evidence that depressive disorder contributed to the terminal event identified in the Schedule (for example, documentation linking depression to self-harm, deliberate non-compliance with medical treatment, or other pathways to death) (s 7(11); Schedule, terminal event). Medical examiner and coronial reports may be necessary.
Anticipate evidentiary gaps and corroboration. Because the SoP often requires contemporaneous or dated evidence within short windows, plan to source corroborative material such as workplace records, police reports, family statements, or contemporaneous counselling notes. Where direct medical documentation is scarce, contemporaneous third-party records can be persuasive.
Prepare clear medico-legal reports. Given the SoP’s technical thresholds, medico-legal reports should:
- State the DSM-5-TR diagnosis and map criteria.
- State the clinical onset/worsening dates and explain how they were determined.
- Identify the specific s 9 factor(s) relied upon and explain how the evidence meets the SoP’s timing and definitional requirements.
- If substance/medication induced, explicitly address whether symptoms persisted after cessation and whether discontinuation or rechallenge produced the outcomes required by s 9(18), s 9(39).
- Where necessary, explain why other diagnoses do or do not better account for the presentation (s 7 exclusions).
Monitor amendments and versions. Because the Repatriation Medical Authority can amend SoPs (as demonstrated by No. 28 of 2024), ensure the version used for preparing evidence is the one applicable to the decision date (s 2; Endnotes).
Procedural follow-up. Lodge any additional records promptly when new information becomes available. The SoP itself does not prescribe how to manage late evidence; follow the procedural rules of the VEA or MRCA decision-making process.

These measures translate the instrument’s diagnostic and temporal rules into concrete evidentiary steps. The key operational task is to align clinical findings, dates and supporting documents precisely to the SoP’s listed criteria so that the decision-maker can determine connection on the balance of probabilities.

Statement of Principles concerning depressive disorder (Balance of Probabilities) (No. 12 of 2024)

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Statement of Principles concerning depressive disorder (Balance of Probabilities) (No. 12 of 2024)

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1 Statement of Principles concerning depressive disorder (Balance of Probabilities) (No. 12 of 2024)

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