Statement of Principles concerning restless legs syndrome (Reasonable Hypothesis) (No. 113 of 2022) (Cth)

Statement of Principles concerning RESTLESS LEGS SYNDROME (Reasonable Hypothesis) (No. 113 of 2022) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 21 October 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 restless legs syndrome (Reasonable Hypothesis) (No. 113 of 2022). 2 Commencement This instrument commences on 21 November 2022. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning restless legs syndrome No. 20 of 2014 (Federal Register of Legislation No. F2014L00307) made under subsections 196B(2) and (8) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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 restless legs syndrome and death from restless legs syndrome. Meaning of restless legs syndrome (2) For the purposes of this Statement of Principles, restless legs syndrome: (a) means a sensorimotor neurological disorder, in which there is: (i) a strong urge to move the legs, usually accompanied or caused by uncomfortable and unpleasant sensations in the legs; and (ii) the urge to move or unpleasant sensations begin or worsen during periods of rest or inactivity such as lying or sitting; and (iii) the urge to move or unpleasant sensations are partially or totally relieved by movement, such as walking or stretching; and (iv) the urge to move or unpleasant sensations are worse in the evening or night than during the day, or only occur in the evening or night; and (b) these clinical features: (i) occur at least 3 times per week, and have persisted for at least 3 consecutive months; and (ii) cause significant distress, or impairment in behavioural, social, physical or occupational functioning; and (iii) are not solely accounted for by another medical or behavioural condition. Note: Examples of other medical or behavioural conditions with clinical features that mimic restless legs syndrome include myalgia, venous stasis, leg oedema, arthritis, leg cramps and habitual foot tapping. (3) While restless legs syndrome attracts ICD‑10‑AM code G25.81, in applying this Statement of Principles the meaning of restless legs syndrome is that given in subsection (2). (4) For subsection (3), a reference to an ICD-10-AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4. Death from restless legs syndrome (5) For the purposes of this Statement of Principles, restless legs syndrome, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's restless legs syndrome. 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 restless legs syndrome and death from restless legs syndrome 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 restless legs syndrome or death from restless legs syndrome with the circumstances of a person's relevant service: (1) having diabetes mellitus at the time of the clinical onset of restless legs syndrome; (2) having iron deficiency at the time of the clinical onset of restless legs syndrome; Note: iron deficiency is defined in the Schedule 1 – Dictionary. (3) having chronic renal failure at the time of the clinical onset of restless legs syndrome; Note: chronic renal failure is defined in the Schedule 1 - Dictionary. (4) having a neurological disorder from the specified list of neurological disorders, involving the lower limbs, at the time of the clinical onset of restless legs syndrome; Note: specified list of neurological disorders is defined in the Schedule 1 – Dictionary. (5) having Parkinson's disease at the time of the clinical onset of restless legs syndrome; (6) taking a drug from the specified list of drugs: (a) as prescribed for ongoing use; and (b) within the 30 days before the clinical onset of restless legs syndrome; Note: specified list of drugs is defined in the Schedule 1 - Dictionary. (7) having multiple sclerosis at the time of the clinical onset of restless legs syndrome; (8) having a clinically significant disorder of mental health as specified at the time of the clinical onset of restless legs syndrome; Note: clinically significant disorder of mental health as specified is defined in the Schedule 1 - Dictionary. (9) receiving spinal anaesthesia within the 30 days before the clinical onset of restless legs syndrome; (10) having smoked tobacco products in an amount of at least 5 pack-years before the clinical onset of restless legs syndrome, and if smoking has ceased before the clinical onset of restless legs syndrome, then that onset occurred within 5 years of cessation; Note: one pack-year is defined in the Schedule 1 - Dictionary. (11) being obese for at least the 5 years before the clinical onset of restless legs syndrome; Note: being obese is defined in the Schedule 1 – Dictionary. (12) having narcolepsy or obstructive sleep apnoea at the time of the clinical onset of restless legs syndrome; (13) being pregnant at the time of the clinical onset of restless legs syndrome; (14) inability to undertake physical activity greater than 3 METs for a continuous period of at least the 1 year before the clinical onset of restless legs syndrome; Note: MET is defined in the Schedule 1 – Dictionary. (15) having dyslipidaemia for at least the 1 year before the clinical onset of restless legs syndrome; Note: dyslipidaemia is defined in the Schedule 1 – Dictionary. (16) having migraine at the time of the clinical onset of restless legs syndrome; (17) having chronic obstructive pulmonary disease or asthma at the time of the clinical onset of restless legs syndrome; (18) having a cerebrovascular accident within 3 months before the clinical onset of restless legs syndrome; (19) having diabetes mellitus at the time of the clinical worsening of restless legs syndrome; (20) having iron deficiency at the time of the clinical worsening of restless legs syndrome; Note: iron deficiency is defined in the Schedule 1 – Dictionary. (21) having chronic renal failure at the time of the clinical worsening of restless legs syndrome; Note: chronic renal failure is defined in the Schedule 1 - Dictionary. (22) having a neurological disorder from the specified list of neurological disorders, involving the lower limbs, at the time of the clinical worsening of restless legs syndrome; Note: specified list of neurological disorders is defined in the Schedule 1 – Dictionary. (23) having Parkinson's disease at the time of the clinical worsening of restless legs syndrome; (24) taking a drug from the specified list of drugs: (a) as prescribed for ongoing use; and (b) within the 30 days before the clinical worsening of restless legs syndrome; Note: specified list of drugs is defined in the Schedule 1 – Dictionary. (25) having multiple sclerosis at the time of the clinical worsening of restless legs syndrome; (26) having a clinically significant disorder of mental health as specified at the time of the clinical worsening of restless legs syndrome; Note: clinically significant disorder of mental health as specified is defined in the Schedule 1 - Dictionary. (27) receiving spinal anaesthesia within the 30 days before the clinical worsening of restless legs syndrome; (28) having smoked tobacco products in an amount of at least 5 pack-years before the clinical worsening of restless legs syndrome, and if smoking has ceased before the clinical worsening of restless legs syndrome, then that worsening occurred within 5 years of cessation; Note: one pack-year is defined in the Schedule 1 - Dictionary. (29) being obese for at least the 5 years before the clinical worsening of restless legs syndrome; Note: being obese is defined in the Schedule 1 – Dictionary. (30) having narcolepsy or obstructive sleep apnoea at the time of the clinical worsening of restless legs syndrome; (31) being pregnant at the time of the clinical worsening of restless legs syndrome; (32) inability to undertake physical activity greater than 3 METs for a continuous period of at least the 1 year before the clinical worsening of restless legs syndrome; Note: MET is defined in the Schedule 1 – Dictionary. (33) having dyslipidaemia for at least the 1 year before the clinical worsening of restless legs syndrome; Note: dyslipidaemia is defined in the Schedule 1 – Dictionary. (34) having migraine at the time of the clinical worsening of restless legs syndrome; (35) having chronic obstructive pulmonary disease or asthma at the time of the clinical worsening of restless legs syndrome; (36) having a cerebrovascular accident within the 3 months before the clinical worsening of restless legs syndrome; (37) for restless legs syndrome augmentation only, taking a dopaminergic agent including levodopa and pramipexole, or tramadol, for a continuous period of at least the 3 months before that clinical worsening of restless legs syndrome; Note: restless legs syndrome augmentation is defined in the Schedule 1 – Dictionary. (38) inability to obtain appropriate clinical management for restless legs syndrome. 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(19) to 9(38) apply only to material contribution to, or aggravation of, restless legs syndrome where the person's restless legs syndrome 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.