Statement of Principles concerning periodic limb movement disorder (Reasonable Hypothesis) (No. 19 of 2023) (Cth)

Statement of Principles concerning PERIODIC LIMB MOVEMENT DISORDER (Reasonable Hypothesis) (No. 19 of 2023) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 27 February 2023

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 periodic limb movement disorder (Reasonable Hypothesis) (No. 19 of 2023). 2 Commencement This instrument commences on 27 March 2023. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning periodic limb movement disorder No. 26 of 2014 (Federal Register of Legislation No. F2014L00313) made under subsection 196B(2) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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 periodic limb movement disorder and death from periodic limb movement disorder. Meaning of periodic limb movement disorder (2) For the purposes of this Statement of Principles, periodic limb movement disorder: (a) means a sleep disorder in which excessive periodic limb movements of sleep are accompanied by a clinical sleep disturbance and impaired daytime behavioural, social, physical or occupational functioning; and (b) the clinical features are not better explained by another primary sleep disorder; and (c) excludes periodic limb movements of sleep which are not accompanied by a clinical sleep disturbance or impaired daytime functioning. Note 1: Clinical sleep disturbance is characterised by difficulty with sleep initiation or sleep maintenance, or unrefreshing sleep. Note 2: The diagnosis is confirmed by overnight polysomnography (PSG) showing periodic limb movements occurring at a frequency of at least 15 per hour during sleep in adults. Note 3: Examples of other primary sleep disorders include restless legs syndrome, obstructive sleep apnoea, rapid eye movement sleep behaviour disorder and narcolepsy. Note 4: periodic limb movements of sleep is defined in the Schedule 1 – Dictionary. (3) While periodic limb movement disorder attracts ICD‑10‑AM code G47.61, in applying this Statement of Principles the meaning of periodic limb movement disorder 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 periodic limb movement disorder (5) For the purposes of this Statement of Principles, periodic limb movement disorder, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's periodic limb movement disorder. 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 periodic limb movement disorder and death from periodic limb movement disorder 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 periodic limb movement disorder or death from periodic limb movement disorder with the circumstances of a person's relevant service: (1) having chronic renal failure at the time of the clinical onset of periodic limb movement disorder; Note: chronic renal failure is defined in the Schedule 1 - Dictionary. (2) having a spinal cord lesion at the time of the clinical onset of periodic limb movement disorder; Note: Examples of spinal cord lesions include transverse myelitis, trauma or compression of the spine and spondylotic myelopathy. (3) 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 periodic limb movement disorder; Note: specified list of drugs is defined in the Schedule 1 – Dictionary. (4) having iron deficiency at the time of the clinical onset of periodic limb movement disorder; Note: iron deficiency is defined in the Schedule 1 – Dictionary. (5) having a cerebrovascular accident within the 3 months before the clinical onset of periodic limb movement disorder; (6) having moderate to severe traumatic brain injury within the 3 months before the clinical onset of periodic limb movement disorder, and in the case of sustained unconsciousness following injury to the head, the clinical onset of periodic limb movement disorder occurred within 3 months of regaining consciousness; (7) having Parkinson's disease at the time of the clinical onset of periodic limb movement disorder; (8) having multiple sclerosis at the time of the clinical onset of periodic limb movement disorder; (9) having a clinically significant depressive disorder or posttraumatic stress disorder at the time of the clinical onset of periodic limb movement disorder; Note: clinically significant is defined in the Schedule 1 – Dictionary. (10) having chronic renal failure at the time of the clinical worsening of periodic limb movement disorder; Note: chronic renal failure is defined in the Schedule 1 - Dictionary. (11) having a spinal cord lesion at the time of the clinical worsening of periodic limb movement disorder; Note: Examples of spinal cord lesions include transverse myelitis, trauma or compression of the spine and spondylotic myelopathy. (12) 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 periodic limb movement disorder; Note: specified list of drugs is defined in the Schedule 1 – Dictionary. (13) having iron deficiency at the time of the clinical worsening of periodic limb movement disorder; Note: iron deficiency is defined in the Schedule 1 – Dictionary. (14) having a cerebrovascular accident within the 3 months before the clinical worsening of periodic limb movement disorder; (15) having moderate to severe traumatic brain injury within the 3 months before the clinical worsening of periodic limb movement disorder, and in the case of sustained unconsciousness following injury to the head, the clinical worsening of periodic limb movement disorder occurred within 3 months of regaining consciousness; (16) having Parkinson's disease at the time of the clinical worsening of periodic limb movement disorder; (17) having multiple sclerosis at the time of the clinical worsening of periodic limb movement disorder; (18) having a clinically significant depressive disorder or posttraumatic stress disorder at the time of the clinical worsening of periodic limb movement disorder; Note: clinically significant is defined in the Schedule 1 – Dictionary. (19) inability to obtain appropriate clinical management for periodic limb movement 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(10) to 9(19) apply only to material contribution to, or aggravation of, periodic limb movement disorder where the person's periodic limb movement 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(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.