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

Statement of Principles concerning BIPOLAR DISORDER (Balance of Probabilities) (No. 54 of 2018) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.

Dated 22 June 2018

The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:

Professor Nicholas Saunders AO Chairperson

Contents 1 Name 2 Commencement 3 Authority 4 Repeal 5 Application 6 Definitions 7 Kind of injury, disease or death to which this Statement of Principles relates 8 Basis for determining the factors 9 Factors that must exist 10 Relationship to service 11 Factors referring to an injury or disease covered by another Statement of Principles Schedule 1 - Dictionary 1 Definitions

1 Name This is the Statement of Principles concerning bipolar disorder (Balance of Probabilities) (No. 54 of 2018). 2 Commencement This instrument commences on 23 July 2018. 3 Authority This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning bipolar disorder No. 28 of 2009 (Federal Register of Legislation No. F2009L01595) made under subsection 196B(3) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004 applies. 6 Definitions The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument. 7 Kind of injury, disease or death to which this Statement of Principles relates (1) This Statement of Principles is about bipolar disorder and death from bipolar disorder. Meaning of bipolar disorder (2) For the purposes of this Statement of Principles, bipolar disorder: (a) means a group of disorders of mental health which are manifested by one or more periods of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased activity or energy; and (b) includes: (i) bipolar and related disorder due to another medical condition; (ii) bipolar I disorder; (iii) bipolar II disorder; (iv) cyclothymic disorder; (v) major depressive episode with mixed features; (vi) other specified bipolar and related disorder and unspecified bipolar and related disorder; and (vii) substance/medication-induced bipolar and related disorder. Note 1: bipolar and related disorder due to another medical condition, bipolar I disorder, bipolar II disorder, cyclothymic disorder, major depressive episode with mixed features, other specified bipolar and related disorder and unspecified bipolar and related disorder and substance/medication-induced bipolar and related disorder are defined in the Schedule 1 – Dictionary. Note 2: The definition for each of the conditions included herein are derived from DSM-5. Note 3: DSM-5 is defined in the Schedule 1 – Dictionary. Death from bipolar disorder (3) For the purposes of this Statement of Principles, bipolar disorder, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's bipolar disorder. Note: terminal event is defined in the Schedule 1 – Dictionary. 8 Basis for determining the factors On the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that bipolar disorder and death from bipolar disorder can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA. Note: MRCA, relevant service and VEA are defined in the Schedule 1 – Dictionary. 9 Factors that must exist At least one of the following factors must exist before it can be said that, on the balance of probabilities, bipolar disorder or death from bipolar disorder is connected with the circumstances of a person's relevant service: (1) for bipolar I disorder, bipolar II disorder, cyclothymic disorder, major depressive episode with mixed features, other specified bipolar and related disorder and unspecified bipolar and related disorder only: Note: bipolar I disorder, bipolar II disorder, cyclothymic disorder, major depressive episode with mixed features and other specified bipolar and related disorder and unspecified bipolar and related disorder are defined in the Schedule 1 – Dictionary. (a) experiencing a category 1A stressor within the six months before the clinical onset of bipolar disorder; Note: category 1A stressor is defined in the Schedule 1 - Dictionary. (b) experiencing a category 1B stressor within the six months before the clinical onset of bipolar disorder; Note: category 1B stressor is defined in the Schedule 1 - Dictionary. (c) experiencing a category 2 stressor within the six months before the clinical onset of bipolar disorder; Note: category 2 stressor is defined in the Schedule 1 - Dictionary. (d) experiencing the death of a significant other within the six months before the clinical onset of bipolar disorder; Note: significant other is defined in the Schedule 1 - Dictionary. (e) being within 90 days postpartum at the time of the clinical onset of bipolar disorder; (f) having alcohol use disorder or substance use disorder at the time of the clinical onset of bipolar disorder; or (g) having a disorder of mental health from Specified List 1 of clinically significant disorders of mental health within the five years before the clinical onset of bipolar disorder; Note: Specified List 1 of clinically significant disorders of mental health is defined in the Schedule 1 - Dictionary. (2) for substance/medication-induced bipolar and related disorder only: Note: substance/medication-induced bipolar and related disorder is defined in the Schedule 1 – Dictionary. (a) taking a drug, or a drug from a class of drugs, from the specified list of drugs, within the 14 days before the clinical onset of bipolar disorder; Note: specified list of drugs is defined in the Schedule 1 - Dictionary. (b) taking a drug which is associated in the individual with the development of symptoms of bipolar disorder while taking the drug, and the cessation or significant reduction of the symptoms of bipolar disorder within days or weeks of discontinuing the drug, where taking the drug continued for at least the two days before the clinical onset of bipolar disorder; (c) having ceased or reduced antidepressant drug therapy or antiepileptic drug therapy within the 30 days before the clinical onset of bipolar disorder; or (d) having alcohol use disorder or substance use disorder at the time of the clinical onset of bipolar disorder; (3) for bipolar and related disorder due to another medical condition only, having an endocrine, cardiovascular, respiratory, metabolic, infectious or neurological disorder, where the medical condition is a direct physiological cause of the mood symptoms at the time of the clinical onset of bipolar disorder; Note: bipolar and related disorder due to another medical condition and medical condition is a direct physiological cause of the mood symptoms are defined in the Schedule 1 - Dictionary. (4) experiencing a category 1A stressor within the six months before the clinical worsening of bipolar disorder; Note: category 1A stressor is defined in the Schedule 1 - Dictionary. (5) experiencing a category 1B stressor within the six months before the clinical worsening of bipolar disorder; Note: category 1B stressor is defined in the Schedule 1 - Dictionary. (6) experiencing a category 2 stressor within the six months before the clinical worsening of bipolar disorder; Note: category 2 stressor is defined in the Schedule 1 - Dictionary. (7) experiencing the death of a significant other within the six months before the clinical worsening of bipolar disorder; Note: significant other is defined in the Schedule 1 - Dictionary. (8) being within 90 days postpartum at the time of the clinical worsening of bipolar disorder; (9) having a disorder of mental health from Specified List 2 of clinically significant disorders of mental health at the time of the clinical worsening of bipolar disorder; Note: Specified List 2 of clinically significant disorders of mental health is defined in the Schedule 1 - Dictionary. (10) taking a drug, or a drug from a class of drugs, from the specified list of drugs, within the 14 days before the clinical worsening of bipolar disorder; Note: specified list of drugs is defined in the Schedule 1 - Dictionary. (11) taking a drug which is associated in the individual with the worsening of symptoms of bipolar disorder while taking the drug, and the cessation or significant reduction of the symptoms of bipolar disorder within days or weeks of discontinuing the drug, where taking the drug continued for at least the two days before the clinical worsening of bipolar disorder; (12) having ceased or reduced antidepressant drug therapy or antiepileptic drug therapy within the 30 days before the clinical worsening of bipolar disorder; (13) having a medical condition as specified at the time of the clinical worsening of bipolar disorder; Note: medical condition as specified is defined in the Schedule 1 - Dictionary. (14) experiencing severe childhood abuse before the clinical worsening of bipolar disorder; Note: severe childhood abuse is defined in the Schedule 1 - Dictionary. (15) being deprived of at least one whole night's sleep within the two days before the clinical worsening of bipolar disorder; (16) having electroconvulsive therapy within the 14 days before the clinical worsening of bipolar disorder; (17) having a course of bright light therapy within the 14 days before the clinical worsening of bipolar disorder; (18) having deep brain stimulation for Parkinson's disease within the 48 hours before the clinical worsening of bipolar disorder; (19) having vagus nerve stimulation within the 48 hours before the clinical worsening of bipolar disorder; (20) inability to obtain appropriate clinical management for bipolar disorder. 10 Relationship to service (1) The existence in a person of any factor referred to in section 9, must be related to the relevant service rendered by the person. (2) The factors set out in subsections 9(4) to 9(20) apply only to material contribution to, or aggravation of, bipolar disorder where the person's bipolar disorder was suffered or contracted before or during (but did not arise out of) the person's relevant service. 11 Factors referring to an injury or disease covered by another Statement of Principles In this Statement of Principles: (1) if a factor referred to in section 9 applies in relation to a person; and (2) that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(3) of the VEA; then the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.