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Chronic Multisymptom Illness S025

Last amended 
30 June 2015

Current RMA Instruments:

Reasonable Hypothesis SOP55 of 2014
Balance of Probabilities SOP56 of 2014
Chronic multisymptom illness is not a disease in a conventional sense.  

SOP Bulletin 175

This SOP has been created by the RMA to cover: particular groupings of symptoms; that result in distress and severe disruption of functioning; and that are not better explained by another medical or psychiatric condition.  The symptom sets potentially covered by this condition come from the following list:- fatigue, feeling depressed, difficulty remembering or concentrating, feeling moody, feeling anxious, trouble finding words, difficulty sleeping, joint pain, joint stiffness and muscle pain.  See the SOP definition for further details.  The presence of another condition that would account for the symptoms precludes a diagnosis of chronic multisymptom illness.  Similar symptom sets may occur in psychiatric disorders, brain pathology, terminal cancers, immunodeficiency disorders, cardiac disease, respiratory disease, blood disease, rheumatological disorders and chronic fatigue syndrome.

Is specific diagnostic evidence required to apply the SOP? – Yes.  

This diagnosis is complex and is a diagnosis of exclusion.  A business line is available that details the steps that should be taken to investigate claims. 

Are there sub-factors that require specific information? – No.
Additional diagnoses that may be covered by SOP

Gulf war syndrome – gulf war syndrome is not a disease or injury for the purposes of the VEA (or MRCA).  A claim for gulf war syndrome should be rejected on that basis, but such a claim should also be investigated to see if there is any other diagnosis that may be made.  In that situation a diagnosis of chronic multisymptom illness may warrant investigation. 

Conditions excluded from SOP and that generally preclude a diagnosis of chronic multisymptom illness
  • Blood or haematological disorder
  • Cardiac pathology
  • Chronic fatigue syndrome
  • Chronic liver failure
  • Chronic renal failure
  • Conversion disorder (functional neurological symptom disorder) 
  • Dementia
  • Dysthymic disorder
  • Factitious disorder 
  • Fibromyalgia
  • Generalised anxiety disorder
  • Hypochondriasis
  • Illness anxiety disorder
  • Organic brain pathology
  • Other psychiatric disorders such as major depressive disorder which manifest with somatic symptoms. 
  • Other specified somatic symptom and related disorder 
  • Pain disorder with psychological factors
  • Pain disorder with psychological factors and a general medical condition
  • Psychological factors affecting other medical conditions 
  • Respiratory pathology
  • Rheumatoid arthritis; Systemic lupus erythematosus; Ankylosing spondylitis; Psoriatic arthropathy
  • Sleep disorder including obstructive sleep apnoea, narcolepsy.
  • Somatic symptom disorder
  • Somatisation disorder
  • Systemic malignancy
  • Undifferentiated somatoform disorder
  • Unspecified somatic symptoms and related disorder
  • Malingering or conscious simulation
Unconfirmed diagnosis

If, after applying the above information, you are unable to confirm the diagnosis, you should then: 

  • seek medical officer advice about further investigation, or; 
  • re-encode the condition, if appropriate.

The following investigations may be useful in establishing the diagnosis.

  • See the relevant business line