Statement of Principles concerning somatic symptom disorder (Balance of Probabilities) (No. 65 of 2022)

The instrument’s controlling medical concept is somatic symptom disorder as defined in subsection 7(2). The definition requires three elements: (A) one or more somatic symptoms that are distressing or that significantly disrupt daily life; (B) excessive thoughts, feelings or behaviours relating to those symptoms manifested by at least one of (i) disproportionate and persistent thoughts about seriousness of symptoms, (ii) persistently high anxiety about health or symptoms, or (iii) excessive time and energy devoted to symptoms or health concerns; and (C) that a symptomatic state has persisted for at least six months, even if any single somatic symptom is not continuously present (s 7(2)). The instrument requires that somatic symptom disorder be diagnosed by a psychiatrist (s 7(2)) and explicitly anchors the diagnostic criteria to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) as published in 2022 (Schedule 1).

Death from somatic symptom disorder is included where the disorder contributed to a terminal event, with “terminal event” defined in the Schedule to include proximate or ultimate causes such as pneumonia, respiratory failure, cardiac arrest, circulatory failure and cessation of brain function (s 7(3); Schedule 1). The RMA states its causal position on the balance of probabilities, situating its view on “sound medical‑scientific evidence” that somatic symptom disorder and death from it can be related to relevant service (s 8).

Causation is framed by two discrete factors listed in s 9. A claimant must establish at least one of the two: (1) experiencing severe childhood abuse before clinical onset of the disorder, or (2) inability to obtain appropriate clinical management for the disorder (s 9). The instrument requires that any factor relied upon “must be related to the relevant service rendered by the person” (s 10(1)). It also limits the applicability of the clinical-management factor: that factor applies only to material contribution to, or aggravation of, somatic symptom disorder where the person’s somatic symptom disorder was suffered or contracted before or during (but did not arise out of) the relevant service (s 10(2)).

The Schedule supplies the operative meanings of several terms central to application: relevant service is defined by reference to categories of service under the VEA and MRCA; severe childhood abuse is defined by age threshold, types of harm or neglect, and the class of perpetrators (Schedule 1). The instrument also contains an interaction rule (s 11) that, where a factor refers to an injury or disease that is itself the subject of a different Statement of Principles, the factors in that other Statement apply in accordance with its terms.

Directly affected individuals are people making claims under the VEA or MRCA provisions specified: claims to which section 120B of the VEA or section 339 of the MRCA apply (s 5). That description identifies veterans and members of the Forces whose claims fall within those statutory claim pathways. The instrument applies to both living claimants with somatic symptom disorder and to claims involving death where the disorder contributed to a terminal event (s 7(3)).

Claimants must meet the diagnostic requirement set by the instrument: somatic symptom disorder “diagnosed by a psychiatrist” in accordance with the DSM-5-TR derived criteria (s 7(2)). Claimants therefore need psychiatric assessment and documentation showing the DSM-5-TR elements, including evidence of the symptomatic state persisting for at least six months (s 7(2)(C)). Those who suffered or contracted somatic symptom disorder before or during relevant service but whose disorder did not arise out of service are the only claimants for whom the second factor (inability to obtain appropriate clinical management) is potentially applicable (s 10(2)).

The defined category “relevant service” restricts the instrument’s reach to certain service types: eligible war service (other than operational service) under the VEA; defence service (other than hazardous service and British nuclear test defence service) under the VEA; and peacetime service under the MRCA (Schedule 1). Consequently, claimants must show both that they fall within one of those categories and that a factor under s 9 exists and is related to that service (s 10(1)).

Other affected parties include diagnosticians and evidence providers. The instrument places diagnostic centrality on psychiatrists and the DSM-5-TR framework (s 7(2); Schedule 1). Administrative decision-makers implementing the VEA and MRCA provisions will apply the RMA’s stated view that, on the sound medical‑scientific evidence available, the relationship to service is “more probable than not” (s 8). The instrument also affects cases where a claimed factor overlaps with another Statement of Principles: the alternative Statement’s factors will apply as set out in s 11.

Finally, families and estates are affected for death claims, because death from somatic symptom disorder is captured if the disorder contributed to a terminal event (s 7(3); Schedule 1 definitions of terminal events). The instrument therefore governs the medical-causal threshold for entitlement decisions in living and fatal presentations where the claimant falls within the specified service definitions.

The instrument does not create new statutory penalties or criminal offences. Its operative effect is to place obligations and evidential requirements on parties participating in administrative entitlement processes under the VEA and MRCA. The key duties are evidentiary and procedural rather than prescriptive duties of conduct.

Claimants’ primary obligations, as set by the instrument, are to establish: (a) that somatic symptom disorder exists and is diagnosed by a psychiatrist in accordance with the DSM-5-TR derived criteria (s 7(2)); (b) that at least one of the factors in s 9 exists; and (c) that the factor relied upon is related to the person’s relevant service (s 10(1)). For a claim that depends on the clinical‑management factor in s 9(2), a claimant must also show that the disorder was suffered or contracted before or during relevant service and did not arise out of service, because that factor applies only to material contribution or aggravation in that factual context (s 10(2)).

The RMA declares its view on causation: that on “sound medical‑scientific evidence available” it is more probable than not that somatic symptom disorder and death from it can be related to relevant service (s 8). That statement establishes the RMA’s evidential posture and the standard it applies: balance of probabilities. Administratively, decision-makers applying the VEA or MRCA provisions will use this Statement as the basis for linking somatic symptom disorder to service where the prescribed factors and relationships are proven.

Rights under the instrument flow from the statutory claim mechanisms it governs. If a claimant can demonstrate the diagnostic criteria, the relevant factor(s), and the requisite relationship to relevant service, then their claim falls within the RMA’s framework for establishing a service connection under the VEA/MRCA pathways cited in s 5. The instrument also provides a cross‑reference protection: where a factor in s 9 refers to an injury or disease addressed by another Statement of Principles, that other Statement’s factors govern in accordance with its terms (s 11). That means claimants and decision-makers must consult the other Statement where overlap occurs.

There are no explicit procedural duties on health providers or service agencies in the instrument beyond the diagnostic specification that the disorder be “diagnosed by a psychiatrist” (s 7(2)). The instrument’s operational effect is therefore to define what evidence is necessary for administrative decision-making rather than to create direct regulatory obligations on third parties.

The Statement of Principles is an administrative instrument made under subsection 196B(3) of the VEA (s 3). It does not itself prescribe criminal sanctions, civil penalties, or enforcement mechanisms. The instrument functions as the RMA’s determinative statement of medical causation and as such is intended to be applied in the administrative adjudication of claims under section 120B of the VEA and section 339 of the MRCA (s 5).

Enforcement, to the extent that term applies here, is the application of the Statement in decision-making on entitlement claims. The RMA’s declared evidential stance , that it is of the view, on the sound medical‑scientific evidence available, that it is more probable than not that somatic symptom disorder and related deaths can be linked to relevant service , supplies the medical framework for case assessment (s 8). The instrument therefore directs administrative decision-makers to apply the defined diagnostic criteria, the listed factors, and the relationship-to-service requirement when determining service connection. The Schedule’s definitions (for example, of terminal event, relevant service and severe childhood abuse) are part of the instrument’s enforceable content (Schedule 1).

There is no provision in the instrument that creates inspection, compliance, or penalty powers against claimants, clinicians or agencies. The instrument’s operation sits within the VEA and MRCA claim regimes, and any enforcement mechanisms, sanctions or review processes will be those established by those Acts rather than by the Statement itself (s 5; s 3). The Statement does, however, repeal the earlier RMA Statement No. 25 of 2014 (s 4), so decisions or assessments must proceed under the current instrument as of its commencement date (s 2).

Because the instrument relies on medical diagnosis and evidence, practical enforcement of the Statement’s criteria will be through administrative fact-finding: consideration of psychiatric diagnoses, medical records, evidence of childhood abuse or clinical-management access, and evidence of the relationship between those factors and the claimant’s relevant service. The instrument sets the standards but not the enforcement apparatus.

The instrument is expressly made under subsection 196B(3) of the Veterans’ Entitlements Act 1986 (s 3) and applies to claims to which section 120B of the VEA or section 339 of the MRCA applies (s 5). Its operative role is therefore to define the medical and causal framework for administrative application within those Acts’ claims processes. The instrument does not purport to change the substantive entitlement rules in the VEA or MRCA; rather, it supplies the RMA’s medical determination for how somatic symptom disorder may be linked to relevant service when those statutory claim provisions are invoked (s 5, s 8).

Section 11 creates a statutory interaction with other RMA Statements of Principles. If a factor in s 9 “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 other Statement apply “in accordance with the terms of that Statement of Principles as in force from time to time” (s 11). In practice, this means that where a claimant’s asserted causal factor overlaps with another recognised injury or disease, the other Statement’s factors and any temporal or factual qualifications must be consulted and applied as directed. The instrument therefore does not operate in isolation; it directs decision-makers to defer to other Statements where the factual issue is governed by them.

The instrument integrates an external diagnostic standard by reference. The DSM-5-TR is cited and defined in Schedule 1 (Schedule 1 defines DSM-5-TR as the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision, Washington, DC, American Psychiatric Association, 2022). That external standard informs the diagnostic content the RMA requires. The instrument’s reliance on an external edition of a diagnostic manual introduces an interaction where changes to that external standard could affect diagnostic practice, subject to the terms of the instrument itself.

The repeal provision (s 4) interacts with the prior legal framework: the instrument repeals Statement No. 25 of 2014, so any decisions made after commencement should be made under the current instrument. The instrument does not specify transitional arrangements, but the repeal is explicit.

Beyond these specific interactions, the instrument’s practical effect is incorporated into the VEA and MRCA administrative systems. The Statement sets the RMA’s medical position, and tribunals or administrative decision-makers operating under the VEA and MRCA will apply the criteria, factors and definitions contained in the instrument when assessing the service connection of somatic symptom disorder and related deaths (s 5, s 8, s 11).

The instrument identifies itself as Statement of Principles concerning somatic symptom disorder (Balance of Probabilities) (No. 65 of 2022) and is dated 24 June 2022. It states a commencement date of 25 July 2022 (s 1; s 2). The instrument expressly repeals the prior Statement of Principles concerning somatic symptom disorder No. 25 of 2014, which was published in the Federal Register of Legislation as F2014L00299 (s 4). Those are the only temporal or amendment events recorded within the instrument’s text.

There is no further amendment history within the text supplied: no amendments, variations, or subsequent determinations are recorded in this document. The Schedule identifies DSM-5-TR as the 2022 text revision, which is the diagnostic standard adopted by the instrument as at its date; the instrument therefore anchors its diagnostic definition to that edition. The instrument also notes that factors in other Statements of Principles apply “as in force from time to time” where s 11 is engaged, which indicates that other Statements may be amended and those amendments will be relevant to s 11 interplays. However, the instrument itself contains no subsequent amendment entries, transitional provisions, or saving clauses in the supplied text.

Practitioners should therefore treat this instrument as the RMA’s current Statement from its commencement date and should monitor for any later RMA determinations or legislative changes that would alter definitions, factors, or interactions referenced here. The instrument’s repeal of the 2014 Statement is definitive in this document (s 4), and the current definitions and factors replace those in the repealed instrument from the commencement date (s 2).

The instrument as supplied contains no litigation history, no references to judicial decisions, and no citations of cases. It does not record any judicial consideration of this Statement of Principles, nor does it identify legal challenges or precedent related to the content herein. The only legal authorities expressly cited in the instrument are statutory: subsection 196B(3) of the Veterans’ Entitlements Act 1986 is the enabling provision under which the RMA made the Statement (s 3), and the instrument applies to claims under section 120B of the VEA and section 339 of the MRCA (s 5).

Because no cases or litigation events are named in the instrument, there is no litigation history to summarise from this source. The instrument does, however, set standards and definitions that will be relied upon in administrative decision-making and that may be the subject of future administrative or judicial review in the context of VEA or MRCA claims. Any such litigation after the instrument’s commencement date is outside the scope of the instrument itself and is not recorded in the text provided.

If practitioners need to know whether courts or tribunals have considered or applied this Statement, they will need to consult external legal databases or decision repositories for post‑commencement decisions. That material is not present in the instrument and therefore is not summarised here.

There are several points in the instrument that commonly produce implementation risk, evidential difficulty, or interpretative uncertainty. These are matters that decision-makers, claimants and advisers should be attentive to because the instrument sets specific but sometimes narrowly framed rules.

Diagnosis by a psychiatrist is required. The instrument requires somatic symptom disorder to be “diagnosed by a psychiatrist” (s 7(2)). A diagnosis documented by another clinician, such as a general practitioner, psychologist or non‑psychiatric specialist, is not the diagnosis the instrument mandates. That procedural requirement can be a practical hurdle where access to psychiatric assessment is limited, and it places evidentiary weight on obtaining a psychiatrist’s diagnostic statement that maps to the DSM-5-TR criteria reproduced in the instrument.

DSM-5-TR anchoring and the six‑month persistence requirement. The instrument explicitly derives its criteria from DSM-5-TR and insists that the symptomatic state has persisted for at least six months even where any one symptom is not continuously present (s 7(2)(C); Schedule 1). Claimants and clinicians must therefore document the temporal pattern of symptoms to meet that persistence threshold.

Narrowly defined “relevant service.” The Schedule defines relevant service in specific categories under the VEA and MRCA (Schedule 1). A claimant whose service falls outside those categories will not fall within the instrument’s scope, and the instrument does not purport to cover other service types.

The “related to relevant service” requirement. Section 10(1) requires that the existence of any s 9 factor “must be related to the relevant service rendered by the person.” The instrument does not define the precise legal test of how the factor must be related to service beyond this statement and the RMA’s balance‑of‑probabilities view (s 8). That leaves factual and legal assessment to the claim process, with potential for dispute about the nature and degree of relationship required.

Limitations on the clinical-management factor. The second factor in s 9 (inability to obtain appropriate clinical management) applies only in a narrow factual window: where the disorder was suffered or contracted before or during (but did not arise out of) the person’s relevant service, and where the factor materially contributed to, or aggravated, the disorder (s 10(2)). The instrument lacks a definition of “inability to obtain appropriate clinical management” and does not specify what evidence will satisfy that concept. That opens room for interpretive contention about what constitutes “appropriate” care and about acceptable proof that care was unavailable.

Overlap with other Statements of Principles. Section 11 requires applying factors from another Statement where a s 9 factor refers to an injury or disease covered by that other Statement. Practically, this requires cross-referencing other RMA Statements and may complicate case preparation when multiple Statements bear on a claim.

Death claims hinge on terminal events as defined. The instrument’s definition of terminal event is explicit and limited to the listed proximate or ultimate causes (Schedule 1). For a death claim to be captured, the death must involve one of those terminal events and the claimant must show the disorder contributed to it (s 7(3); Schedule 1).

No definition of causation beyond balance of probabilities and “sound medical‑scientific evidence.” Section 8 frames the RMA’s view on the balance of probabilities and references “sound medical‑scientific evidence,” but the instrument does not provide a detailed causation test or thresholds of medical proof. The combination of a medical diagnosis requirement and these general evidential statements places emphasis on the quality and specificity of medical evidence provided in each case.

Timing and repeal. The instrument repeals the 2014 Statement as of its commencement date; practitioners must ensure reliance on the current instrument (ss 2, 4). There are no transitional provisions included in the text supplied.

For claimants and advisers preparing somatic symptom disorder claims under the VEA or MRCA pathways specified (s 5), compliance means assembling evidence that maps precisely to the instrument’s diagnostic, factor and relationship requirements.

1. Obtain a psychiatrist’s diagnosis. The instrument requires somatic symptom disorder to be “diagnosed by a psychiatrist” in accordance with the DSM-5-TR‑derived criteria (s 7(2); Schedule 1). Compliance therefore starts with a psychiatric assessment that explicitly applies the DSM-5-TR criteria reproduced in the instrument: distressing somatic symptoms, at least one of the three excessive thoughts/feelings/behaviours, and a symptomatic state persisting for at least six months (s 7(2)(A)-(C)). The psychiatric report should record how the DSM-5-TR elements are met.

2. Demonstrate persistence and symptom pattern. The psychiatric and medical records should document the six‑month symptomatic state requirement (s 7(2)(C)). Even if individual somatic symptoms have been intermittent, evidence should show an ongoing state of being symptomatic over the six‑month period.

3. Prove at least one factor in s 9 and its relation to relevant service. Claimants must establish at least one of the listed factors (s 9). If relying on severe childhood abuse, gather records, contemporaneous accounts, medical or counselling notes, or other evidence to show that severe abuse occurred before clinical onset and that the existence of that factor is related to the claimant’s relevant service (s 9(1); s 10(1); Schedule 1 defines severe childhood abuse). If relying on inability to obtain appropriate clinical management, assemble evidence showing attempts to access care, barriers encountered, timelines and how the lack of care materially contributed to or aggravated the disorder; remember that s 10(2) limits this factor’s applicability to disorders suffered or contracted before or during but not arising out of service.

4. Establish relevant service. Provide service records and documentary proof that the claimant’s service falls within the instrument’s definition of relevant service (Schedule 1). Relevant service categories are narrowly specified and are a prerequisite for applying the Statement (Schedule 1; s 5).

5. Link factor to service. For whichever factor is relied upon, ensure the evidence shows the required relationship to relevant service. Section 10(1) is unqualified in the instrument: any s 9 factor “must be related to the relevant service rendered by the person.” Medical evidence should include opinion on how the factor bears on the disorder in the context of service.

6. For death claims, document terminal events and contribution. Where a claim involves death, produce cause‑of‑death documentation showing a terminal event as defined in the Schedule (for example, pneumonia or cardiac arrest) and medical opinion that somatic symptom disorder contributed to that terminal event (s 7(3); Schedule 1).

7. Consider overlap with other Statements. If a relied factor refers to an injury or disease covered by another Statement of Principles, obtain the evidence required by that other Statement because s 11 directs application of those factors “as in force from time to time” (s 11).

8. Prepare for evidentiary gaps. The instrument does not define “inability to obtain appropriate clinical management” or specify the standard of proof for relating factors to service beyond the RMA’s balance‑of‑probabilities stance (s 8; s 10(2)). Anticipate that decision-makers will scrutinise documentary evidence, and where possible obtain contemporaneous records, treatment histories, and qualified medical opinion linking the facts to the DSM-5-TR diagnosis.

9. Mind the commencement and repeal dates. The instrument commenced on 25 July 2022 and repealed the 2014 Statement (ss 2, 4). Ensure the relevant Statement in force at the time of claim lodging or decision is the 2022 Statement.

10. Present cross-cutting medical evidence. Because the instrument anchors its definition to DSM-5-TR and requires a psychiatrist’s diagnosis, produce psychiatric reports that quote or reference DSM-5-TR criteria, include timeline information, and address the relationship between any established s 9 factor and the claimant’s service. Where there is potential overlap with other diseases or injuries, obtain specialist reports that address those interactions per s 11.

Following these steps aligns documentary evidence and medical opinion to the specific contents of the instrument, which is the RMA’s operative framework for linking somatic symptom disorder and related deaths to specified categories of relevant service.