Statement of Principles concerning posttraumatic stress disorder (Balance of Probabilities) (No. 98 of 2022)
1Statement of Principles concerning posttraumatic stress disorder (Balance of Probabilities) (No. 98 of 2022)
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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 posttraumatic stress disorder (Balance of Probabilities) (No. 98 of 2022).
2 Commencement
This instrument commences on 21 November 2022.
3 Authority
This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.
4 Repeal
The Statement of Principles concerning posttraumatic stress disorder No. 83 of 2014 (Federal Register of Legislation No. F2014L01145) made under subsections 196B(3) and (8) of the VEA is repealed.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 posttraumatic stress disorder and death from posttraumatic stress disorder.
Meaning of posttraumatic stress disorder
(2) For the purposes of this Statement of Principles, posttraumatic stress disorder means a disorder of mental health which meets the following criteria (derived from DSM-5-TR):
Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
(i) directly experiencing the traumatic event(s);
(ii) witnessing, in person, the event(s) as it occurred to others;
(iii) learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental; or
(iv) experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (for example, first responders collecting human remains; police officers repeatedly exposed to details of child abuse). This criterion does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related; and
B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:
(i) recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). In children older than six years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed;
(ii) recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). In children, there may be frightening dreams without recognisable content;
(iii) dissociative reactions (for example, flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) In children, trauma-specific reenactment may occur in play;
(iv) intense or prolonged psychological distress at exposure to internal or external cues that symbolise or resemble an aspect of the traumatic event(s); or
(v) marked physiological reactions to internal or external cues that symbolise or resemble an aspect of the traumatic event(s); and
C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:
(i) avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s); or
(ii) avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s); and
D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
(i) inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs);
(ii) persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (for example, "I am bad", "None can be trusted", "The world is completely dangerous", "My whole nervous system is permanently ruined");
(iii) persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others;
(iv) persistent negative emotional state (for example, fear, horror, anger, guilt, or shame);
(v) markedly diminished interest or participation in significant activities;
(vi) feelings of detachment or estrangement from others; or
(vii) persistent inability to experience positive emotions (for example, inability to experience happiness, satisfaction, or loving feelings); and
E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
(i) irritable behaviour and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects;
(ii) reckless or self-destructive behaviour;
(iii) hypervigilance;
(iv) exaggerated startle response;
(v) problems with concentration; or
(vi) sleep disturbance (for example, difficulty falling or staying asleep or restless sleep); and
F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month; and
G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning; and
H. The disturbance is not attributable to the physiological effects of a substance (for example, medication, alcohol) or another medical condition.
Note: DSM-5-TR is defined in the Schedule 1 – Dictionary.
(3) While posttraumatic stress disorder attracts ICD‑10‑AM code F43.1, in applying this Statement of Principles the meaning of posttraumatic stress disorder is that given in subsection (2).
(4) For subsection (3), a reference to an ICD-10-AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4.
Death from posttraumatic stress disorder
(5) For the purposes of this Statement of Principles, posttraumatic stress disorder, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's posttraumatic stress 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 posttraumatic stress disorder and death from posttraumatic stress 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, posttraumatic stress disorder or death from posttraumatic stress disorder is connected with the circumstances of a person's relevant service:
(1) experiencing a category 1A stressor before the clinical onset of posttraumatic stress disorder;
Note: category 1A stressor is defined in the Schedule 1 – Dictionary.
(2) experiencing a category 1B stressor before the clinical onset of posttraumatic stress disorder;
Note: category 1B stressor is defined in the Schedule 1 – Dictionary.
(3) having a significant other who experiences a category 1A stressor within the 1 year before the clinical onset of posttraumatic stress disorder;
Note: category 1A stressor and significant other are defined in the Schedule 1 – Dictionary.
(4) experiencing the traumatic death of a significant other within the 2 years before the clinical onset of posttraumatic stress disorder;
Note: significant other and traumatic death are defined in the Schedule 1 – Dictionary.
(5) being exposed to repeated or extreme aversive details of severe traumatic events before the clinical onset of posttraumatic stress disorder;
Note: being exposed to repeated or extreme aversive details of severe traumatic events is defined in the Schedule 1 – Dictionary.
(6) experiencing severe childhood abuse before the clinical onset of posttraumatic stress disorder;
Note: severe childhood abuse is defined in the Schedule 1 – Dictionary.
(7) experiencing a category 1A stressor before the clinical worsening of posttraumatic stress disorder;
Note: category 1A stressor is defined in the Schedule 1 – Dictionary.
(8) experiencing a category 1B stressor before the clinical worsening of posttraumatic stress disorder;
Note: category 1B stressor is defined in the Schedule 1 – Dictionary.
(9) having a significant other who experiences a category 1A stressor within the 1 year before the clinical worsening of posttraumatic stress disorder;
Note: category 1A stressor and significant other are defined in the Schedule 1 – Dictionary.
(10) experiencing the traumatic death of a significant other within the 2 years before the clinical worsening of posttraumatic stress disorder;
Note: significant other and traumatic death are defined in the Schedule 1 – Dictionary.
(11) being exposed to repeated or extreme aversive details of severe traumatic events before the clinical worsening of posttraumatic stress disorder;
Note: being exposed to repeated or extreme aversive details of severe traumatic events is defined in the Schedule 1 – Dictionary.
(12) experiencing severe childhood abuse before the clinical worsening of posttraumatic stress disorder;
Note: severe childhood abuse is defined in the Schedule 1 – Dictionary.
(13) inability to obtain appropriate clinical management for posttraumatic stress 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(7) to 9(13) apply only to material contribution to, or aggravation of, posttraumatic stress disorder where the person's posttraumatic stress 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:
being exposed to repeated or extreme aversive details of severe traumatic events means witnessing a person suffering real, severe, traumatic events (for example, first responders collecting human remains, police officers repeatedly exposed to details of child abuse or drone operators viewing planned strikes) or repeatedly listening to a person's account of their exposure to severe traumatic events. This definition includes media exposure of the traumatic event (for example, electronic media, television images or photographs) where viewing these images is a work requirement.
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
(c) being threatened with a weapon, being held captive, being kidnapped or being tortured.
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;
(c) being an eyewitness to atrocities inflicted on another person;
(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.
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.
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.
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.
MRCA means the Military Rehabilitation and Compensation Act 2004.
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
(c) peacetime service under the MRCA.
Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary.
(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.
terminal event means the proximate or ultimate cause of death and includes the following:
(a) pneumonia;
(b) respiratory failure;
(c) cardiac arrest;
(d) circulatory failure; or
(e) cessation of brain function.
traumatic death means death which occurs in sudden, violent or traumatic circumstances such as homicide, suicide or an accidental death.