Statement of Principles concerning morbid obesity (Reasonable Hypothesis) (No. 43 of 2022) (Cth)

Statement of Principles concerning MORBID OBESITY (Reasonable Hypothesis) (No. 43 of 2022) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 29 April 2022

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

Professor Terence Campbell AM 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 morbid obesity (Reasonable Hypothesis) (No. 43 of 2022). 2 Commencement This instrument commences on 30 May 2022. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning morbid obesity No. 5 of 2014 (Federal Register of Legislation No. F2014L00010) made under subsections 196B(2) and (8) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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 morbid obesity and death from morbid obesity. Meaning of morbid obesity (2) For the purposes of this Statement of Principles, morbid obesity means an excessive accumulation of fat in the body resulting in: (a) a Body Mass Index (BMI) of at least 40; or (b) in those aged 18 years or younger, a BMI of at least 120 percent of the 97th percentile in the 2007 World Health Organisation Body Mass Index Charts, for Age and Gender. Note: BMI is defined in the Schedule 1 - Dictionary. Death from morbid obesity (3) For the purposes of this Statement of Principles, morbid obesity, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's morbid obesity. Note: terminal event is defined in the Schedule 1 - Dictionary. 8 Basis for determining the factors The Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that morbid obesity and death from morbid obesity can be related to relevant service rendered by veterans, members of Peacekeeping Forces, 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 as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting morbid obesity or death from morbid obesity with the circumstances of a person's relevant service: (1) having a caloric intake that is excessive for energy needs for at least the 5 years before the clinical onset of morbid obesity; (2) taking a drug from the specified list of drugs for at least the 6 months before the clinical onset of morbid obesity; Note: specified list of drugs is defined in the Schedule 1 - Dictionary. (3) taking an antipsychotic drug for at least the 3 months before the clinical onset of morbid obesity; (4) taking at least 5 milligrams of prednisone per day, or equivalent glucocorticoid therapy, for at least the 3 months before the clinical onset of morbid obesity; Note: equivalent glucocorticoid therapy is defined in the Schedule 1 - Dictionary. (5) having binge eating disorder or night eating syndrome for at least the 1 year before the clinical onset of morbid obesity; Note: binge eating disorder and night eating syndrome are defined in the Schedule 1 - Dictionary. (6) having a clinically significant disorder of mental health as specified for at least the 2 years before the clinical onset of morbid obesity; Note: clinically significant disorder of mental health as specified is defined in the Schedule 1 – Dictionary. (7) having Cushing syndrome for at least the 3 months before the clinical onset of morbid obesity; (8) having hypothyroidism, including Hashimoto thyroiditis that has resulted in hypothyroidism, for at least the 3 months before the clinical onset of morbid obesity; (9) having a hypothalamic disorder causing excessive eating for at least the 3 months before the clinical onset of morbid obesity; Note: hypothalamic disorder is defined in the Schedule 1 - Dictionary. (10) inability to sleep for an average of more than 5 hours per night for at least the 5 years before the clinical onset of morbid obesity; (11) undertaking night shift work on at least 500 occasions within a continuous period of at least the 5 years before the clinical onset of morbid obesity; Note: night shift work is defined in the Schedule 1 - Dictionary. (12) in a person with a prior history of a regular smoking habit as specified, permanently ceasing to smoke within the 2 years before the clinical onset of morbid obesity; Note: regular smoking habit as specified is defined in the Schedule 1 - Dictionary. (13) having consumed a cumulative total of at least 50 kilograms of alcohol from drinking beer within the 5 years before the clinical onset of morbid obesity; Note: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink. (14) experiencing severe childhood abuse before the clinical onset of morbid obesity; Note: severe childhood abuse is defined in the Schedule 1 - Dictionary. (15) having a caloric intake that is excessive for energy needs for at least the 5 years before the clinical worsening of morbid obesity; (16) taking a drug from the specified list of drugs for at least the 6 months before the clinical worsening of morbid obesity; Note: specified list of drugs is defined in the Schedule 1 - Dictionary. (17) taking an antipsychotic drug for at least the 3 months before the clinical worsening of morbid obesity; (18) taking at least 5 milligrams of prednisone per day, or equivalent glucocorticoid therapy, for at least the 3 months before the clinical worsening of morbid obesity; Note: equivalent glucocorticoid therapy is defined in the Schedule 1 - Dictionary. (19) having binge eating disorder or night eating syndrome for at least the 1 year before the clinical worsening of morbid obesity; Note: binge eating disorder and night eating syndrome are defined in the Schedule 1 - Dictionary. (20) having a clinically significant disorder of mental health as specified for at least the 2 years before the clinical worsening of morbid obesity; Note: clinically significant disorder of mental health as specified is defined in the Schedule 1 – Dictionary. (21) having Cushing syndrome for at least the 3 months before the clinical worsening of morbid obesity; (22) having hypothyroidism, including Hashimoto thyroiditis that has resulted in hypothyroidism, for at least the 3 months before the clinical worsening of morbid obesity; (23) having a hypothalamic disorder causing excessive eating for at least the 3 months before the clinical worsening of morbid obesity; Note: hypothalamic disorder is defined in the Schedule 1 - Dictionary. (24) inability to sleep for an average of more than 5 hours per night for at least the 5 years before the clinical worsening of morbid obesity; (25) undertaking night shift work on at least 500 occasions within a continuous period of at least the 5 years before the clinical worsening of morbid obesity; Note: night shift work is defined in the Schedule 1 - Dictionary. (26) in a person with a prior history of a regular smoking habit as specified, permanently ceasing to smoke within the 2 years before the clinical worsening of morbid obesity Note: regular smoking habit as specified is defined in the Schedule 1 - Dictionary. (27) having consumed a cumulative total of at least 50 kilograms of alcohol from drinking beer within the 5 years before the clinical worsening of morbid obesity; Note: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink. (28) inability to obtain appropriate clinical management for morbid obesity. 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(15) to 9(28) apply only to material contribution to, or aggravation of, morbid obesity where the person's morbid obesity 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(2) 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.