Statement of Principles concerning schizophrenia (Balance of Probabilities) (No. 28 of 2026)

Schizophrenia: the instrument defines schizophrenia strictly by reference to the DSM-5-TR diagnostic criteria set out in subsection 7(2). These criteria require at least two active-phase symptoms (including delusions, hallucinations, disorganised speech, grossly disorganised or catatonic behaviour, or negative symptoms) with at least one being among the first three; significant functional decline; continuous signs for at least six months; exclusion of schizoaffective disorder and substance-induced causes; and, where there is a history of autism spectrum disorder or communication disorder, the additional requirement of prominent delusions or hallucinations. The ICD-10-AM codes F20.0-F20.3, F20.5 or F20.9 are cross-referenced but the meaning of schizophrenia is the DSM-5-TR definition, which may differ slightly from the classification coding. Death from schizophrenia includes death from a terminal event contributed to by the schizophrenia (such as pneumonia, respiratory failure, cardiac arrest, circulatory failure, or cessation of brain function). Balance of probabilities: the standard of proof applied in this SoP. This means the factors are determined on the basis that it is more probable than not that schizophrenia can be related to relevant service. This is a lower standard than "reasonable hypothesis" but still requires the Authority to be satisfied on sound medical-scientific evidence. Relevant service: defined in the Schedule 1 dictionary as operational service, peacekeeping service, hazardous service, or British nuclear test defence service under the VEA; or warlike service or non-warlike service under the MRCA. This definition excludes peacetime service under the VEA and peacetime service under the MRCA that is not warlike or non-warlike. Category 1A and 1B stressors: these are specific traumatic events that may serve as connecting factors. A category 1A stressor includes experiencing a life-threatening event, being subject to a serious physical attack or assault (including rape or sexual molestation), or being threatened with a weapon, held captive, kidnapped, or tortured. A category 1B stressor includes killing or maiming a person, being a witness to a person being killed or critically injured, being a witness to atrocities, or witnessing human remains or a critically injured casualty (excluding closed body bags or open-casket viewing). The definition of witness requires direct personal experience, not exposure through public broadcasting or mass media. Clinically significant disorder of mental health: defined as a disorder of mental health of sufficient severity to warrant ongoing management. Critically, the note clarifies that actual management need not have been received or given. This means the condition can be severe enough to warrant treatment even if no treatment occurred. Specified List 1 and List 2 of drugs: these are lists of substances relevant to factors involving substance use disorders or drug ingestion. List 1 includes amphetamines/amphetamine-type substances, cocaine, and opioids. List 2 is broader and includes many of those plus aciclovir, aldesleukin, bupropion, cannabis, ephedrine, fenfluramine, hallucinogens, inhalants (themselves defined as breathable chemicals producing psychoactive vapours, including organic solvents, aerosols, and anaesthetics), mefloquine, phencyclidine, phentermine, phenylpropanolamine, pseudoephedrine, and varenicline. The inclusion of cannabis in both lists is notable: it appears in List 2 as a factor for clinical worsening and in the separate factor for cannabis use disorder and heavy adolescent use. Terminal event: defined as the proximate or ultimate cause of death including pneumonia, respiratory failure, cardiac arrest, circulatory failure, or cessation of brain function. Related child: biological, adopted, step-, or foster child.

The instrument directly affects any person who has rendered "relevant service" as defined, and who makes a claim for schizophrenia under the VEA or MRCA. This includes veterans who served in operational, peacekeeping, hazardous, or British nuclear test defence service under the VEA, and members of the Defence Force who served in warlike or non-warlike service under the MRCA. It also affects the dependants of such persons in claims for death from schizophrenia. The instrument is binding on the Repatriation Medical Authority itself (as the maker), and on decision-makers within the Department of Veterans' Affairs and the Military Rehabilitation and Compensation Commission who must apply the SoP when determining claims under sections 120B of the VEA or 339 of the MRCA. The instrument does not directly affect clinicians, but they may be asked to provide evidence in support of claims, particularly regarding the timing of onset and the presence of factors. The instrument also indirectly affects legal practitioners and advocates who assist claimants in preparing submissions, as they must ensure that the evidence matches one or more of the listed factors and that the temporal requirements are satisfied. The instrument may have economic effects on the Commonwealth budget, since if schizophrenia is accepted as service-related, the claimant becomes eligible for compensation, medical treatment, and other benefits under the relevant Acts. The instrument's factors are drawn from "sound medical-scientific evidence" but the selection of which factors to include and their time windows reflects policy choices about causal attribution. For example, the inclusion of SARS-CoV-2 infection within one month before onset may reflect recent research, but it also creates a new pathway for claims that may not have existed under the 2016 SoP. Conversely, the instrument does not include many other potential risk factors for schizophrenia, such as genetic predisposition, urbanicity, or migration, which may be relevant in individual cases but are not considered sufficiently connected to service by the Authority. The instrument also affects decision-makers by requiring them to consider whether a factor is actually related to the person's service, not merely whether the factor exists (section 10). This means a factor such as cannabis use must be shown to have arisen from or been caused by the person's service, not simply that the person used cannabis heavily as a teenager before service began. The instrument's application clause limits it to claims under s 120B VEA and s 339 MRCA, which means it does not apply to claims under other sections of the VEA (such as claims for operational service under s 120 where the reasonable hypothesis standard applies) or to claims under the Safety, Rehabilitation and Compensation Act 1988 (which has its own legislative framework). However, the instrument may be used as evidence in other contexts.

The instrument imposes a duty on the Repatriation Medical Authority to determine Statements of Principles under s 196B of the VEA. This particular instrument fulfils that duty by setting out factors for schizophrenia. The primary right it confers is on claimants: if they can establish a factor exists and that factor is related to their service, they have a right to have schizophrenia accepted as service-related on the balance of probabilities. This acceptance then triggers entitlements under the VEA or MRCA, including pension, medical treatment, and other benefits. The instrument does not create a duty on claimants to prove anything beyond the factors; rather, it creates a rebuttable presumption (technically an evidentiary standard) that if a factor is present and service-related, the disease is connected. Conversely, if a claimant cannot establish any factor, the decision-maker may deny the claim unless other evidence can bridge the gap. The instrument also creates a duty on decision-makers to apply the factors as set out, including the temporal requirements. For example, factor 9(3) requires onset of SARS-CoV-2 infection in the one month before clinical onset. If the infection occurred outside that window, the factor cannot be used. Decision-makers must also consider the rules for clinical worsening: the factors in section 9 can apply to both clinical onset and clinical worsening, but section 10(2) clarifies that the clinical worsening aspect of factors apply only to material contribution to, or aggravation of, schizophrenia where the person's schizophrenia was suffered or contracted before or during (but did not arise out of) the person's relevant service. This means a claimant who already had schizophrenia before service can still claim aggravation if service factors worsened it. The instrument also gives the Authority the power to refer to other Statements of Principles (section 11): if a factor refers to an injury or disease covered by another SoP (for example, alcohol use disorder), then the factors in that other SoP apply as in force from time to time. This creates a duty on practitioners to check the current version of the referenced SoP. The instrument does not confer any right to appeal its contents, but decisions made under it can be reviewed by the Veterans' Review Board and the Administrative Appeals Tribunal.

This instrument does not contain any penalty provisions. It is not a criminal or regulatory instrument that imposes fines, imprisonment, or other sanctions. Enforcement is indirect: if a claimant or their representative submits a claim that relies on a factor that does not exist or is not related to service, the decision-maker will reject the claim, and the claimant may then seek review. The instrument itself does not provide for any penalties for making false statements; those are covered by general provisions in the VEA and MRCA (such as offences for obtaining benefits dishonestly). The Repatriation Medical Authority is not subject to enforcement for the instrument's content; however, the instrument could be challenged on judicial review grounds if it were ultra vires the Act or procedurally flawed. The instrument's legal effect is to create a binding rule of evidence for decision-makers. Failure by a decision-maker to correctly apply the instrument could be grounds for appeal by the claimant. There are no monetary penalties or compliance costs imposed on private individuals or businesses by this instrument. The costs are borne by the Commonwealth in processing claims and paying benefits if claims succeed. The instrument may also impose costs on claimants who must gather evidence (such as medical reports confirming childhood trauma, or proof of cannabis use disorder) but these are opportunity costs of the claims process, not penalties. The instrument's "balance of probabilities" standard is less demanding for claimants than the "reasonable hypothesis" standard (which requires a hypothesis that is not contrary to proved facts or impossible), but more demanding than mere possibility. This may affect the volume of successful claims and thus the fiscal impact.

The instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986, which empowers the Repatriation Medical Authority to determine Statements of Principles for the purposes of claims under the VEA and MRCA. It directly applies to claims under section 120B of the VEA and section 339 of the MRCA. These provisions set the standard of proof for certain claim types: section 120B VEA applies to claims for operational service (among others) and requires that the disease be connected to service on the balance of probabilities, but also requires that the existence of the connection be determined in accordance with the relevant Statement of Principles. Section 339 MRCA does the same for warlike and non-warlike service claims. The instrument supersedes the earlier 2016 SoP and any inconsistent Statements of Principles concerning schizophrenia made under the same subsection. The instrument does not directly interact with the Safety, Rehabilitation and Compensation Act 1988 (SRCA) or the Defence Force Retirement and Death Benefits Act 1973, but evidence from this SoP may be used in those contexts as expert opinion. It also interacts with other SoPs through section 11: if a factor refers to an injury or disease for which a separate SoP exists (for example, alcohol use disorder, posttraumatic stress disorder), then the factors in that other SoP apply as in force from time to time. This means a claimant who relies on factor 9(10) (having a clinically significant disorder of mental health such as PTSD at the time of clinical worsening) must also satisfy the relevant SoP for that disorder if it is itself a disease covered by a SoP. The instrument adopts definitions from external sources: DSM-5-TR (the American Psychiatric Association's manual) and ICD-10-AM (the Australian modification of the WHO classification). These are incorporated by reference as static editions (DSM-5-TR 2022, ICD-10-AM Tenth Edition 2017). Changes to those classifications after those editions do not automatically update the SoP. The instrument also interacts with the general law of evidence and administrative law. The VEA and MRCA contain their own interpretation provisions and rights of review that apply to decisions made using this SoP. The instrument does not override the operation of the Acts themselves; it fills in the evidential gap as to whether a disease is service-related.

This instrument is a standalone instrument. The source text does not provide a history of amendments to this version, but it does state that it repeals the previous Statement of Principles concerning schizophrenia No. 84 of 2016 made under subsection 196B(3) of the VEA. That previous instrument was registered as F2016L01685. The new instrument commences on 23 March 2026. The Authority has replaced the 2016 version with updated factors, definitions, and diagnostic criteria. No other amendments are listed in the source. It is common for the Repatriation Medical Authority to issue revised SoPs periodically as medical evidence evolves. The instrument itself is not subject to amendment like an Act; instead, the Authority will issue a new instrument to replace it. Any future amendments would be reflected in a new numbered instrument. The instrument's legislative history can be traced through the Federal Register of Legislation, but the source does not provide details on what changed between 2016 and 2026. The new instrument introduces factors relating to SARS-CoV-2 infection, updates the definition of schizophrenia from DSM-5 to DSM-5-TR, and revises the lists of specified drugs (for example, adding varenicline to List 2). The 2016 SoP likely contained different stressor definitions and cannabis use thresholds.

The source text does not reference any litigation history. No cases are mentioned in the instrument itself. It is worth noting that Statements of Principles are often the subject of appeals to the Veterans' Review Board, the Administrative Appeals Tribunal, and the Federal Court, particularly on questions of interpretation of factors or whether the Authority had sound medical-scientific evidence to support a factor. However, no such cases are cited in this instrument. The Repatriation Medical Authority's decisions can be challenged on administrative law grounds, but the instrument as a legislative instrument is not itself litigated; rather, the decisions applying it are. The absence of litigation history in the source is expected, as the instrument is a new legislative instrument with no court decisions yet. Future litigation may test the meaning of terms such as "clinically significant disorder of mental health" (specifically the note that actual management is not required) or the definition of "witness" for category 1B stressors. The instrument's specific temporal windows may also be contested. For example, the two-year window for death of a related child and the ten-year window for death of a parent before age 18 may be challenged as arbitrary. But again, no such challenge is recorded in the source.

Several provisions in this instrument could trip up practitioners or claimants if not carefully read. First, the definition of "clinically significant disorder of mental health" in the dictionary explicitly states that "to warrant ongoing management does not require that any actual management was received or given for the condition." This means a claimant can have a disorder that meets the threshold even if they were never treated or diagnosed, but only if the disorder is of sufficient severity to warrant management. This is a high bar for proof: the decision-maker must be satisfied that the severity would justify treatment, not just that symptoms existed. The note means a claimant cannot be penalised for not seeking help, but it also means the absence of treatment does not prove lack of severity. Second, factor 9(2) concerning SARS-CoV-2 infection requires onset in the one month before clinical onset of schizophrenia. This is a narrow window. A claimant who had COVID-19 six months before developing psychotic symptoms cannot use this factor. The note says SARS-CoV-2 is the virus causing COVID-19, but the factor does not require a positive test; it requires having onset of infection. That may be difficult to prove retrospectively. Third, factor 9(8) regarding cannabis use: it requires using cannabis at least twice a week for a continuous period of at least two years before age 18, within the 20 years before clinical onset. The factor explicitly includes prescribed cannabis. This means a veteran who was prescribed medicinal cannabis as a minor (from a state scheme, for example) could be caught by this factor even if the use was lawful and for medical reasons. The term "cannabis use disorder" in factor 9(7) is not defined in the instrument; presumably it would be diagnosed under DSM-5-TR criteria, which requires a problematic pattern of use leading to clinically significant impairment or distress. But the factor does not say that the cannabis use disorder must be diagnosed; it says "having cannabis use disorder" which suggests a clinical diagnosis is needed. Fourth, the definition of "witness" for category 1B stressors excludes exposure through public broadcasting or mass media coverage. This is significant for veterans who may have seen traumatic events on television or online, such as during deployments or after, but cannot claim that as a category 1B stressor unless they were physically present. Fifth, the "death of a parent" factor only applies if the person was under 18 at the time of the parent's death. If the parent died when the person was 18 or older, this factor does not apply, even if the death occurred within 10 years before clinical onset. Sixth, factor 9(15) "inability to obtain appropriate clinical management for schizophrenia before clinical worsening" is broad. "Inability" suggests that the person could not access care for reasons beyond their control (such as lack of services, financial barriers, or deployment). However, the factor does not define "appropriate clinical management" or "inability." This could be a gateway for claims where a veteran's schizophrenia worsened because they could not get treatment on base or in a remote posting. Seventh, the instrument's interaction with other SoPs (section 11) means that if a factor refers to a disorder like alcohol use disorder, the claimant may need to satisfy both this SoP and the SoP for alcohol use disorder. Eighth, for clinical worsening factors, section 10(2) limits them to cases where the schizophrenia was suffered or contracted before or during (but did not arise out of) relevant service. This means a veteran whose schizophrenia was already service-related (arose out of service) cannot use the clinical worsening factors to get additional compensation for aggravation; the disease is already accepted. The clinical worsening factors only help those whose schizophrenia started before service or during service but from a cause unrelated to service.

Compliance with this instrument is primarily relevant to (1) the Repatriation Medical Authority, which must ensure future SoPs are made on sound medical-scientific evidence, (2) decision-makers at DVA and MRCC, who must apply the factors correctly, and (3) claimants and their representatives, who must present evidence that matches the factors. The instrument does not impose "compliance" in the sense of regulatory obligations; rather, it sets the criteria for acceptance of claims. For practitioners advising veterans, the steps are: first, establish whether the claimant has schizophrenia as defined in the instrument, using DSM-5-TR criteria. This requires obtaining a diagnosis from a qualified psychiatrist or psychologist that explicitly references the DSM-5-TR criteria. Note that the instrument also mentions ICD-10-AM codes but the meaning is the DSM-5-TR definition, so ensure the diagnosis conforms to that. Second, identify which factors (from section 9) may apply to the claimant. This requires a thorough history of childhood trauma (factor 9(1)), infections (factor 9(2)), exposure to severe traumatic events (factors 9(3) and 9(4)), bereavements (factors 9(5) and 9(6)), substance use (factors 9(7) to 9(9)), other mental health disorders (factor 9(10)), medication induced worsening (factor 9(11)), drug ingestion (factor 9(12)), antipsychotic therapy changes (factor 9(13)), or inability to obtain management (factor 9(14)). For each factor, the timing must match: the factor must occur before clinical onset or before clinical worsening, as specified. Third, establish that the factor is itself related to the person's relevant service (section 10(1)). This is a separate hurdle: even if the claimant experienced childhood trauma, it must be connected to their service. For example, a veteran who suffered childhood abuse by a civilian parent cannot use that factor unless the abuse occurred while the parent was in the military and the abuse was related to service? The instrument does not define "related to the relevant service" further; it will be interpreted by decision-makers and tribunals. Typically, factors that occurred before service may be difficult to link, unless the trauma was caused by a parent's service (e.g., a veteran who as a child was abused by a father with PTSD from service). Fourth, if the claimant is relying on clinical worsening, ensure the schizophrenia was not already contracted during service from a service-related cause (section 10(2)). If the disease arose out of service, the clinical worsening factors do not apply. Fifth, gather medical evidence to support the existence of the factor and the temporal relationship. This may include medical records, witness statements, military service records, and expert psychiatric reports. Sixth, if a factor refers to another disorder (e.g., alcohol use disorder), consult the current SoP for that disorder to ensure all its factors are also met. Seventh, for death claims, establish that schizophrenia contributed to the terminal event. The instrument defines terminal event narrowly, so ensure the cause of death is one of pneumonia, respiratory failure, cardiac arrest, circulatory failure, or cessation of brain function, and that the schizophrenia was a contributing factor. Finally, practitioners should check the commencement date: this instrument applies from 23 March 2026. Claims determined before that date use the 2016 SoP. Transitional arrangements are not specified in the source, but the repeal of the 2016 SoP likely means that after 23 March 2026, all claims assessed under the balance of probabilities standard must use this new instrument.