Statement of Principles concerning chronic insomnia disorder (Balance of Probabilities) (No. 38 of 2019) (Cth)

Statement of Principles concerning CHRONIC INSOMNIA DISORDER (Balance of Probabilities) (No. 38 of 2019) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.

Dated 1 March 2019

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 Application 5 Definitions 6 Kind of injury, disease or death to which this Statement of Principles relates 7 Basis for determining the factors 8 Factors that must exist 9 Relationship to service 10 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 chronic insomnia disorder (Balance of Probabilities) (No. 38 of 2019). 2 Commencement This instrument commences on 25 March 2019. 3 Authority This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986. 4 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. 5 Definitions The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument. 6 Kind of injury, disease or death to which this Statement of Principles relates (1) This Statement of Principles is about chronic insomnia disorder and death from chronic insomnia disorder. Meaning of chronic insomnia disorder (2) For the purposes of this Statement of Principles, chronic insomnia disorder means a persistent disorder of sleep that meets the following diagnostic criteria (derived from DSM-5): 1. A predominant complaint of dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms: (i) difficulty initiating sleep; (ii) difficulty maintaining sleep, characterised by frequent awakenings or problems returning to sleep after awakenings; or (iii) early-morning awakening with inability to return to sleep. B. The sleep difficulty causes clinically significant distress or impairment in social, occupational, educational, academic, behavioural or other important areas of functioning. C. The sleep difficulty occurs at least three nights per week. D. The sleep difficulty is present for at least three months. E. The sleep difficulty occurs despite adequate opportunity for sleep and cannot be explained by inadequate circumstances for sleep. F. The sleep difficulty is not better explained by and does not occur exclusively during the course of another sleep-wake disorder (for example, narcolepsy, a breathing-related sleep disorder, a circadian rhythm sleep-wake disorder, a parasomnia). Note 1: This definition includes chronic insomnia disorder that is attributable to the effects of a substance (including a drug of abuse or a medication). Note 2: DSM-5 is defined in the Schedule 1 – Dictionary. Death from chronic insomnia disorder (3) For the purposes of this Statement of Principles, chronic insomnia disorder, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's chronic insomnia disorder. Note: terminal event is defined in the Schedule 1 – Dictionary. 7 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 chronic insomnia disorder and death from chronic insomnia 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. 8 Factors that must exist At least one of the following factors must exist before it can be said that, on the balance of probabilities, chronic insomnia disorder or death from chronic insomnia disorder is connected with the circumstances of a person's relevant service: (1) having a clinically significant disorder of mental health as specified within the one year before the clinical onset of chronic insomnia disorder; Note: clinically significant disorder of mental health as specified is defined in the Schedule 1 - Dictionary. (2) experiencing a category 1A stressor within the one year before the clinical onset of chronic insomnia disorder; Note: category 1A stressor is defined in the Schedule 1 - Dictionary. (3) experiencing a category 1B stressor within the one year before the clinical onset of chronic insomnia disorder; Note: category 1B stressor is defined in the Schedule 1 - Dictionary. (4) experiencing a category 2 stressor within the one year before the clinical onset of chronic insomnia disorder; Note: category 2 stressor is defined in the Schedule 1 - Dictionary. (5) experiencing severe childhood abuse before the clinical onset of chronic insomnia disorder; Note: severe childhood abuse is defined in the Schedule 1 - Dictionary. (6) having a medical illness or injury, which is life-threatening or which results in serious physical or cognitive disability, within the one year before the clinical onset of chronic insomnia disorder; (7) having a severe, chronic medical condition within the one year before the clinical onset of chronic insomnia disorder; Note: severe, chronic medical condition is defined in the Schedule 1 - Dictionary. (8) having persistent pain for at least the three months before the clinical onset of chronic insomnia disorder; Note: persistent pain is defined in the Schedule 1 - Dictionary. (9) having tinnitus for at least the three months before the clinical onset of chronic insomnia disorder; (10) being pregnant at the time of the clinical onset of chronic insomnia disorder; (11) being treated with a drug or a drug from a class of drugs from the specified list of drugs, for a continuous period of at least seven days before the clinical onset of chronic insomnia disorder, where the last dose of the drug was received within the 30 days before the clinical onset of chronic insomnia disorder; Note: specified list of drugs is defined in the Schedule 1 - Dictionary. (12) being treated with a drug for a continuous period of at least seven days before the clinical onset of chronic insomnia disorder, where: (a) the involved drug is capable of producing a prominent and severe disturbance in sleep; and (b) the drug is associated in the individual with the development of insomnia symptoms during drug therapy; and (c) the last dose was received within the 30 days before the clinical onset of chronic insomnia disorder; (13) being treated with mefloquine within the two months before the clinical onset of chronic insomnia disorder; (14) having a clinically significant disorder of mental health as specified within the one year before the clinical worsening of chronic insomnia disorder; Note: clinically significant disorder of mental health as specified is defined in the Schedule 1 - Dictionary. (15) experiencing a category 1A stressor within the one year before the clinical worsening of chronic insomnia disorder; Note: category 1A stressor is defined in the Schedule 1 - Dictionary. (16) experiencing a category 1B stressor within the one year before the clinical worsening of chronic insomnia disorder; Note: category 1B stressor is defined in the Schedule 1 - Dictionary. (17) experiencing a category 2 stressor within the one year before the clinical worsening of chronic insomnia disorder; Note: category 2 stressor is defined in the Schedule 1 - Dictionary. (18) having a medical illness or injury, which is life-threatening or which results in serious physical or cognitive disability, within the one year before the clinical worsening of chronic insomnia disorder; (19) having a severe, chronic medical condition within the one year before the clinical worsening of chronic insomnia disorder; Note: severe, chronic medical condition is defined in the Schedule 1 - Dictionary. (20) having persistent pain for at least the three months before the clinical worsening of chronic insomnia disorder; Note: persistent pain is defined in the Schedule 1 - Dictionary. (21) having tinnitus for at least the three months before the clinical worsening of chronic insomnia disorder; (22) being pregnant at the time of the clinical worsening of chronic insomnia disorder; (23) being treated with a drug or a drug from a class of drugs from the specified list of drugs, for a continuous period of at least seven days before the clinical worsening of chronic insomnia disorder, where the last dose of the drug was received within the 30 days before the clinical worsening of chronic insomnia disorder; Note: specified list of drugs is defined in the Schedule 1 - Dictionary. (24) being treated with a drug for a continuous period of at least seven days before the clinical worsening of chronic insomnia disorder, where: (a) the involved drug is capable of producing a prominent and severe disturbance in sleep; and (b) the drug is associated in the individual with the worsening of insomnia symptoms during drug therapy; and (c) the last dose was received within the 30 days before the clinical worsening of chronic insomnia disorder; (25) being treated with mefloquine within the two months before the clinical worsening of chronic insomnia disorder; (26) inability to obtain appropriate clinical management for chronic insomnia disorder. 9 Relationship to service (1) The existence in a person of any factor referred to in section 8, must be related to the relevant service rendered by the person. (2) The factors set out in subsections 8(14) to 8(26) apply only to material contribution to, or aggravation of, chronic insomnia disorder where the person's chronic insomnia disorder was suffered or contracted before or during (but did not arise out of) the person's relevant service. 10 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 8 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.