Statement of Principles concerning SOMATIC SYMPTOM DISORDER (Balance of Probabilities) (No. 65 of 2022) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986. Dated 24 June 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 somatic symptom disorder (Balance of Probabilities) (No. 65 of 2022). 2 Commencement This instrument commences on 25 July 2022. 3 Authority This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning somatic symptom disorder No. 25 of 2014 (Federal Register of Legislation No. F2014L00299) made under subsection 196B(3) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004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 somatic symptom disorder and death from somatic symptom disorder. Meaning of somatic symptom disorder (2) For the purposes of this Statement of Principles, somatic symptom disorder means a disorder of mental health characterised by one or more somatic symptoms which has been diagnosed by a psychiatrist and which meets the following criteria (derived from DSM-5-TR): 1. The symptom or symptoms are distressing or result in significant disruption of daily life; and 2. Excessive thoughts, feelings, or behaviours related to the somatic symptoms or associated health concerns as manifested by at least 1 of the following: (i) Disproportionate and persistent thoughts about the seriousness of one's symptoms; (ii) Persistently high level of anxiety about health or symptoms; or (iii) Excessive time and energy devoted to these symptoms or health concerns; and C. Although any one somatic symptom may not be continuously present, the state of being symptomatic has persisted for at least 6 months. Note: DSM-5-TR is defined in the Schedule 1 – Dictionary. Death from somatic symptom disorder (3) For the purposes of this Statement of Principles, somatic symptom disorder, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's somatic symptom 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 somatic symptom disorder and death from somatic symptom 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, somatic symptom disorder or death from somatic symptom disorder is connected with the circumstances of a person's relevant service: (1) experiencing severe childhood abuse before the clinical onset of somatic symptom disorder; Note: severe childhood abuse is defined in the Schedule 1 – Dictionary. (2) inability to obtain appropriate clinical management for somatic symptom 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 factor set out in subsection 9(2) 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 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. Schedule 1 - Dictionary Note: See Section 6 1 Definitions In this instrument: DSM-5-TR means the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2022. MRCA means the Military Rehabilitation and Compensation Act 2004. relevant service means: (a) eligible war service (other than operational service) under the VEA; (b) defence service (other than hazardous service and British nuclear test defence service) under the VEA; or (c) peacetime service under the MRCA. Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary. severe childhood abuse means: (a) serious physical, emotional, psychological or sexual harm whilst a child aged under 16 years; or (b) neglect involving a serious failure to provide the necessities for health, physical and emotional development, or wellbeing whilst a child aged under 16 years; where such serious harm or neglect has been perpetrated by a parent, a care provider, an adult who works with or around that child, or any other adult in contact with that child. somatic symptom disorder—see subsection 7(2). terminal event means the proximate or ultimate cause of death and includes the following: (a) pneumonia; (b) respiratory failure; (c) cardiac arrest; (d) circulatory failure; or (e) cessation of brain function. VEA means the Veterans' Entitlements Act 1986.