Reasonable Hypothesis SOP [1] | 23 of 2016 |
Balance of Probabilities SOP [2] | 24 of 2016 |
SOP Bulletin 188 [3]
An adjustment disorder is a mental disorder that is a form of stress reaction to a one-off, recurrent, or ongoing stressor. Key features are onset of the condition within 3 months of the onset of the stressor and resolution of the condition within 6 months after the stressor or its consequences have ceased.
A report from a specialist psychiatrist that conforms with the Repatriation Commission’s Guidelines for Psychiatric Compensation Claims [4] is required for diagnosis.
Depressive disorder due to another medical condition*
* another SOP applies
Clinical onset must be within 3 months after the onset of the relevant stressor.
The only SOP worsening factor is for inability to obtain appropriate clinical anagement. Given the nature of the condition, permanent worseing beyond the normal course is unlikely. Specialist opinion would be required to establish that such worsening had occurred.
The RMA has defined this to mean "one or more of the following severe traumatic events:
"Experiencing a severe stressor" has been the subject of Federal Court determinations and an Advisory Note. Whilst a category 1A stressor is not exactly the same there are enough similarities for the following advice to be considered:
In assessing whether a particular event is a "severe stressor" as defined, it is necessary to consider both the objective nature of the event and the veteran's subjective knowledge about the event. The authority for this approach is the Federal Court decision in Stoddart, and you should read AN02/2003 Federal Court Decision Stoddart [7].
35945 the veteran has experienced a category 1A stressor at some time.
18137 the veteran has established the causal connection between the category 1A stressor and VEA service for the clinical onset of adjustment disorder.
18139 the veteran has established the causal connection between the category 1A stressor and operational service for the clinical onset of adjustment disorder.
or
18140 the veteran has established the causal connection between the category 1A stressor and eligible service for the clinical onset of adjustment disorder.
37340 on operational service, the veteran experienced a category 1A stressor.
40211 on operational service, the veteran experienced a category 1A stressor within the three months before the clinical onset of the condition under consideration.
40214 the category 1A stressor that the veteran experienced within the three months before the clinical onset of the condition under consideration, on operational service, was due to the veteran's serious default, wilful act or serious breach of discipline.
or
37352 the veteran experienced the category 1A stressor because of an illness or injury which is identifiable.
40216 as a consequence of the identified illness or injury, the veteran experienced a category 1A stressor within the three months before the clinical onset of the condition under consideration.
37357 the identified illness or injury, as a consequence of which the veteran experienced a category 1A stressor, is causally related to operational service.
37342 on eligible service, the veteran experienced a category 1A stressor.
37343 as a causal result of eligible service, the veteran experienced a category 1A stressor.
40213 as a causal result of eligible service, the veteran experienced a category 1A stressor within the three months before the clinical onset of the condition under consideration.
40215 the category 1A stressor that the veteran experienced within the three months before the clinical onset of the condition under consideration, on eligible service, was due to the veteran's serious default, wilful act or serious breach of discipline.
or
37352 the veteran experienced the category 1A stressor because of an illness or injury which is identifiable.
40216 as a consequence of the identified illness or injury, the veteran experienced a category 1A stressor within the three months before the clinical onset of the condition under consideration.
37358 the identified illness or injury, as a consequence of which the veteran experienced a category 1A stressor, is causally related to eligible service.
The RMA has defined this to mean "one of the following severe traumatic events:
The RMA has also defined "an eyewitness" to mean "a person who observes an incident first hand and can give direct evidence of it. This excludes a person exposed only to media coverage of the incident".
"Experiencing a severe stressor" has been the subject of Federal Court determinations and an Advisory Note. Whilst a category 1B stressor is not exactly the same there are enough similarities for the following advice to be considered:
In assessing whether a particular event is a "severe stressor" as defined, it is necessary to consider both the objective nature of the event and the veteran's subjective knowledge about the event. The authority for this approach is the Federal Court decision in Stoddart, and you should read AN02/2003 Federal Court Decision Stoddart [7].
35935 the veteran has experienced a category 1B stressor at some time.
40217 the veteran has established the causal connection between the category 1B stressor and VEA service for the clinical onset of adjustment disorder.
40218 the veteran has established the causal connection between the category 1B stressor and operational service for the clinical onset of adjustment disorder.
or
40219 the veteran has established the causal connection between the category 1B stressor and eligible service for the clinical onset of adjustment disorder.
37372 on operational service, the veteran experienced a category 1B stressor.
40221 on operational service, the veteran experienced a category 1B stressor within the three months before the clinical onset of the condition under consideration.
40223 the category 1B stressor that the veteran experienced within the three months before the clinical onset of the condition under consideration, on operational service, was due to the veteran's serious default, wilful act or serious breach of discipline.
or
37386 the veteran experienced the category 1B stressor because of an illness or injury which is identifiable.
40225 as a consequence of the identified illness or injury, the veteran experienced a category 1B stressor within the three months before the clinical onset of the condition under consideration.
37391 the identified illness or injury, as a consequence of which the veteran experienced a category 1B stressor, is causally related to operational service.
37374 on eligible service, the veteran experienced a category 1B stressor.
37375 as a causal result of eligible service, the veteran experienced a category 1B stressor.
40222 as a causal result of eligible service, the veteran experienced a category 1B stressor within the three months before the clinical onset of the condition under consideration.
40224 the category 1B stressor that the veteran experienced within the three months before the clinical onset of the condition under consideration, on eligible service, was due to the veteran's serious default, wilful act or serious breach of discipline.
or
37386 the veteran experienced the category 1B stressor because of an illness or injury which is identifiable.
40225 as a consequence of the identified illness or injury, the veteran experienced a category 1B stressor within the three months before the clinical onset of the condition under consideration.
37392 the identified illness or injury, as a consequence of which the veteran experienced a category 1B stressor, is causally related to eligible service.
"A category 2 stressor" means one or more of the following negative life events, the effects of which are chronic in nature and cause the person to feel ongoing distress, concern or worry [emphasis added]:
40226 there is some evidence that a category 2 stressor may be a factor in the development of the condition under consideration.
37395 the veteran has experienced a category 2 stressor at some time.
40227 the veteran has established the causal connection between the category 2 stressor and VEA service for the clinical onset of adjustment disorder.
40228 the veteran has established the causal connection between the category 2 stressor and operational service for the clinical onset of adjustment disorder.
or
40229 the veteran has established the causal connection between the category 2 stressor and eligible service for the clinical onset of adjustment disorder.
37406 on operational service, the veteran experienced a category 2 stressor.
37408 as a causal result of operational service, the veteran experienced a category 2 stressor.
40231 as a causal result of operational service, the veteran experienced a category 2 stressor within the three months before the clinical onset of the condition under consideration.
40233 the category 2 stressor that the veteran experienced within the three months before the clinical onset of the condition under consideration, on operational service, was due to the veteran's serious default, wilful act or serious breach of discipline.
or
37420 the veteran experienced the category 2 stressor because of an illness or injury which is identifiable.
40235 as a consequence of the identified illness or injury, the veteran experienced a category 2 stressor within the three months before the clinical onset of the condition under consideration.
37425 the identified illness or injury, as a consequence of which the veteran experienced a category 2 stressor, is causally related to operational service.
37407 on eligible service, the veteran experienced a category 2 stressor.
37409 as a causal result of eligible service, the veteran experienced a category 2 stressor.
40232 as a causal result of eligible service, the veteran experienced a category 2 stressor within the three months before the clinical onset of the condition under consideration.
40234 the category 2 stressor that the veteran experienced within the three months before the clinical onset of the condition under consideration, on eligible service, was due to the veteran's serious default, wilful act or serious breach of discipline.
or
37420 the veteran experienced the category 2 stressor because of an illness or injury which is identifiable.
40235 as a consequence of the identified illness or injury, the veteran experienced a category 2 stressor within the three months before the clinical onset of the condition under consideration.
37426 the identified illness or injury, as a consequence of which the veteran experienced a category 2 stressor, is causally related to eligible service.
In the SOPs for anxiety disorder, among others, the RMA has defined "a clinically significant psychiatric condition" to mean "any Axis 1 disorder of mental health that attracts a diagnosis under DSM-IV-TR which is sufficient to warrant ongoing management, which may involve regular visits (for example, at least monthly), to a psychiatrist, clinical psychologist or general practitioner".
Axis 1 covers clinical disorders, for example, substance-related disorders, mood disorders, anxiety disorders (including PTSD), depressive disorders, bipolar disorder, and schizophrenia.
Generally, it would be expected that if a psychiatric disorder warranted treatment then treatment would be sought. However, where treatment was not sought, a person's psychiatric disorder might still meet the RMA definition if there was persuasive and professional evidence, based on a comprehensive clinical history, that ongoing management had been warranted.
1709 the veteran has had a psychiatric condition at some time.
6058 psychiatric condition means any Axis 1 disorder of mental health that attracts a diagnosis under DSM-IV-TR. [Default true]
26043 the identified illness or injury, a psychiatric condition, has been clinically significant at some time.
40266 the identified illness or injury, a psychiatric condition, was clinically significant within the three months before the clinical onset of the condition under consideration.
40263 the veteran has established the causal connection between the clinically significant psychiatric condition and VEA service for the clinical onset of adjustment disorder.
40264 the veteran has established the causal connection between the clinically significant psychiatric condition and operational service for the clinical onset of adjustment disorder.
or
40265 the veteran has established the causal connection between the clinically significant psychiatric condition and eligible service for the clinical onset of adjustment disorder.
26044 the identified illness or injury, a clinically significant psychiatric condition, is causally related to operational service.
26045 the identified illness or injury, a clinically significant psychiatric condition, is causally related to eligible service.
The SOP factor is 'having a medical illness or injury which is life-threatening or which results in serious physical or cognitive disability'. The RMA has not defined this factor.
Whether a condition is life-threatening can be a difficult assessment, particularly where cancer has been diagnosed in the past but is currently causing little, if any, incapacity – for example a man with cancer of the prostate that attracts only 10 points under GARP for urinary problems. It can be argued that cancer of any type (except perhaps skin) is always a serious disease, but in this case it is clearly not a serious physical or cognitive disability. But is it "life-threatening"? An assessment in terms of the Life-Expectancy table in GARP can help. The phrase "normal, or near normal, five year survival" used in table 14.2 of GARP means that statistically there is little chance of dying from the disease in the next five years. It doesn't mean the person will remain disease free, but if the person is disease free at five years after diagnosis or staging then there is little prospect of disease recurrence. To a certain extent "life-threatening" is also a matter of perspective. An 80 year old with low grade prostate cancer does not have a life threatening disease. A 50 year old with aggressive prostate cancer does.
40267 there is some evidence that a serious medical illness or injury may be a factor in the development of the condition under consideration.
37310 the veteran has had a serious medical illness or injury at some time.
37311 a serious medical illness or injury means a medical illness or injury which is life-threatening or which results in serious physical or cognitive disability.
40268 the identified illness or injury, a serious medical illness or injury, was life-threatening or resulting in serious physical or cognitive disability within the three months before the clinical onset of the condition under consideration.
40269 the veteran has established the causal connection between the serious medical illness or injury and VEA service for the clinical onset of adjustment disorder.
40270 the veteran has established the causal connection between the serious medical illness or injury and operational service for the clinical onset of adjustment disorder.
or
40271 the veteran has established the causal connection between the serious medical illness or injury and eligible service for the clinical onset of adjustment disorder.
37316 the identified illness or injury, a serious medical illness or injury, is causally related to operational service.
37317 the identified illness or injury, a serious medical illness or injury, is causally related to eligible service.
Note: It is the "significant other" who has to experience the category 1A stressor.
"A significant other" means a person who has a close family bond or a close personal relationship and is important or influential in one's life.
The RMA has defined a "a category 1A stressor" to mean "one or more of the following severe traumatic events:
35924 there is some evidence that having a significant other who experiences a category 1A stressor may be a factor in the development of the condition under consideration.
35925 the veteran has a significant other who experienced a category 1A stressor at some time.
40246 the veteran's significant other experienced the category 1A stressor within the three months before the clinical onset of the condition under consideration.
40247 the veteran has established the causal connection between the veteran's significant other experiencing a category 1A stressor and VEA service for the clinical onset of adjustment disorder.
40248 the veteran has established the causal connection between the veteran's significant other experiencing a category 1A stressor and operational service for the clinical onset of adjustment disorder.
or
40249 the veteran has established the causal connection between the veteran's significant other experiencing a category 1A stressor and eligible service for the clinical onset of adjustment disorder.
40250 the category 1A stressor experienced by the veteran's significant other within the three months before the clinical onset of the condition under consideration is related to the veteran's operational service.
40252 the category 1A stressor experienced by the veteran's significant other within the three months before the clinical onset of the condition under consideration, which was related to the veteran's operational service, was due to the veteran's serious default, wilful act or serious breach of discipline.
40251 the category 1A stressor experienced by the veteran's significant other within the three months before the clinical onset of the condition under consideration is related to the veteran's eligible service.
40253 the category 1A stressor experienced by the veteran's significant other within the three months before the clinical onset of the condition under consideration, which was related to the veteran's eligible service, was due to the veteran's serious default, wilful act or serious breach of discipline.
The RMA has defined chronic pain as meaning "continuous or almost continuous pain, which may or may not be ameliorated by analgesic medication and which is of a level to cause interference with usual work or leisure activities or activities of daily living."
There are several factors that can cause chronic pain:
A pain management plan may include medications, physiotherapy, chiropractic therapy, counselling and psychotherapy, hypnosis, acupuncture, exercise, electrical stimulation and surgery.
26047 the veteran has had chronic pain of at least three months duration at some time.
26048 the veteran's chronic pain of at least three months duration was materially contributed by an illness or injury which is identifiable.
26050 the identified illness or injury made a material contribution to the chronic pain of at least three months duration at the time of the clinical onset of the condition under consideration.
40273 the veteran has established the causal connection between the chronic pain and VEA service for the clinical onset of adjustment disorder.
40274 the veteran has established the causal connection between the chronic pain and operational service for the clinical onset of adjustment disorder.
or
40275 the veteran has established the causal connection between the chronic pain and eligible service for the clinical onset of adjustment disorder.
26058 the identified illness or injury that contributed to the veteran's chronic pain of at least three months duration is causally related to operational service.
40272 the identified illness or injury that contributed to the veteran's chronic pain of at least three months duration is causally related to eligible service.
Most mental health professionals recommend a form of psychosocial treatment for this disorder. Treatments include individual psychotherapy, family therapy, behaviour therapy, and self-help groups. The primary goal of treatment is to relieve symptoms and help the person return to pre-event level of functioning.
When medications are used, they are usually in addition to other forms of treatment.
Inability to obtain appropriate clinical management
11109 the condition under consideration has been accepted on the basis of inability to obtain appropriate clinical management for the condition under consideration.
7066 there is some evidence that an inability to obtain appropriate clinical management for the condition under consideration may be a factor in the worsening of the condition under consideration.
7334 the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.
7335 the condition under consideration permanently worsened.
7378 the veteran was unable to obtain appropriate clinical management for the condition under consideration at some time.
7379 the inability to obtain appropriate clinical management for the condition under consideration contributed to the clinical worsening of the condition under consideration.
11234 the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and VEA service for the clinical worsening of the condition under consideration.
11235 the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and operational service for the clinical worsening of the condition under consideration.
or
11236 the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and eligible service for the clinical worsening of the condition under consideration.
7384 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during operational service.
21084 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during operational service, as a causal result of operational service.
7387 the veteran's inability to obtain appropriate clinical management for the condition under consideration during operational service was due to the veteran's serious default, wilful act or serious breach of discipline.
or
7389 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, because of an illness or injury which is identifiable.
7390 the identified illness or injury which prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related to operational service.
7392 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury that prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related.
7385 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during eligible service.
7386 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during eligible service, as a causal result of eligible service.
7388 the veteran's inability to obtain appropriate clinical management for the condition under consideration during eligible service was due to the veteran's serious default, wilful act or serious breach of discipline.
or
7389 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, because of an illness or injury which is identifiable.
7391 the identified illness or injury which prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related to eligible service.
7393 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury that prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related.
Foetal death in-utero is death prior to the complete expulsion or extraction from its mother of a product of conception, irrespective of gestation, by either miscarriage, induced abortion or stillbirth.
Miscarriage is defined by the Repatriation Medical Authority (RMA) as "spontaneous or induced expulsion of the products of conception from the uterus before the foetus is viable". This is generally considered to be up to 20 weeks. Miscarriage is also called a spontaneous abortion. An incomplete miscarriage occurs when some pregnancy tissue remains inside the uterus and a dilatation and curettage (D & C) or vacuum aspiration operation may be required.
The cause of a miscarriage cannot always be determined. The most common known causes of miscarriage in the first third of pregnancy (1st trimester) are chromosomal abnormalities, collagen vascular disease, diabetes, other hormonal problems infection, and congenital (present at birth) abnormalities of the uterus. Chromosomal abnormalities of the foetus are the most common cause of early miscarriages, including blighted ovum.
Stillbirth is the death of a foetus after the 20th week of pregnancy but before delivery. Identifiable causes of stillbirth generally fall into one of three different categories: birth defects in the baby, problems with the placenta or umbilical cord, or maternal illnesses or conditions which may sometimes affect pregnancy.
40236 there is some evidence that a miscarriage, foetal death in-utero or stillbirth may be a factor in the development of the condition under consideration.
1169 the veteran is a woman.
37511 the veteran has had a miscarriage, foetal death in-utero or stillbirth at some time.
40237 the veteran has established the causal connection between a miscarriage, foetal death in-utero or stillbirth and VEA service for the clinical onset of adjustment disorder.
40238 the veteran has established the causal connection between a miscarriage, foetal death in-utero or stillbirth and operational service for the clinical onset of adjustment disorder.
or
40239 the veteran has established the causal connection between a miscarriage, foetal death in-utero or stillbirth and eligible service for the clinical onset of adjustment disorder.
37521 the veteran had a miscarriage, foetal death in-utero or stillbirth on operational service.
37522 the veteran had a miscarriage, foetal death in-utero or stillbirth as a causal result of operational service.
40241 the veteran had a miscarriage, foetal death in-utero or stillbirth as a causal result of operational service within the three months before the clinical onset of the condition under consideration.
40243 the miscarriage, foetal death in-utero or stillbirth on operational service within the three months before the clinical onset of the condition under consideration was due to the veteran's serious default, wilful act or serious breach of discipline.
or
37535 the veteran had a miscarriage, foetal death in-utero or stillbirth because of an illness or injury which is identifiable.
40245 as a consequence of the identified illness or injury, the veteran had a miscarriage, foetal death in-utero or stillbirth within the three months before the clinical onset of the condition under consideration.
37538 the identified illness or injury, as a consequence of which the veteran had a miscarriage, foetal death in-utero or stillbirth, is causally related to operational service.
37523 the veteran had a miscarriage, foetal death in-utero or stillbirth on eligible service.
37524 the veteran had a miscarriage, foetal death in-utero or stillbirth as a causal result of eligible service.
40242 the veteran had a miscarriage, foetal death in-utero or stillbirth as a causal result of eligible service within the three months before the clinical onset of the condition under consideration.
40244 the miscarriage, foetal death in-utero or stillbirth on eligible service within the three months before the clinical onset of the condition under consideration was due to the veteran's serious default, wilful act or serious breach of discipline.
or
37535 the veteran had a miscarriage, foetal death in-utero or stillbirth because of an illness or injury which is identifiable.
40245 as a consequence of the identified illness or injury, the veteran had a miscarriage, foetal death in-utero or stillbirth within the three months before the clinical onset of the condition under consideration.
37539 the identified illness or injury, as a consequence of which the veteran had a miscarriage, foetal death in-utero or stillbirth, is causally related to eligible service.
"A significant other" means "a person who has a close family bond or a close personal relationship and is important or influential in one's life".
The nature of the death of the significant other can be traumatic or not.
40254 there is some evidence that the death of a significant other may be a factor in the development of the condition under consideration.
37448 the veteran has experienced the death of a significant other at some time.
40255 the veteran experienced the death of a significant other within the three months before the clinical onset of the condition under consideration.
40256 the veteran has established the causal connection between the death of a significant other and VEA service for the clinical onset of adjustment disorder.
40257 the veteran has established the causal connection between the death of a significant other and operational service for the clinical onset of adjustment disorder.
or
40258 the veteran has established the causal connection between the death of a significant other and eligible service for the clinical onset of adjustment disorder.
40259 the death of the veteran's significant other within the three months before the clinical onset of the condition under consideration was related to the veteran's operational service.
40261 the death of the veteran's significant other within the three months before the clinical onset of the condition under consideration, which was related to the veteran's operational service, was due to the veteran's serious default, wilful act or serious breach of discipline.
40260 the death of the veteran's significant other within the three months before the clinical onset of the condition under consideration was related to the veteran's eligible service.
40262 the death of the veteran's significant other within the three months before the clinical onset of the condition under consideration, which was related to the veteran's eligible service, was due to the veteran's serious default, wilful act or serious breach of discipline.
Links
[1] http://www.rma.gov.au/assets/SOP/2016/023.pdf
[2] http://www.rma.gov.au/assets/SOP/2016/024.pdf
[3] https://clik.dva.gov.au/system/files/media/SOP%20Bulletin%20188.pdf
[4] https://clik.dva.gov.au/compensation-and-support-reference-library/commission-guidelines/cm7014-mrcc181-guidelines-psychiatric-compensation-claims
[5] https://clik.dva.gov.au/user/login?destination=comment/reply/63222%23comment-form
[6] http://www.rma.gov.au/SOP/alpha_ind/a.htm
[7] https://clik.dva.gov.au/compensation-and-support-reference-library/advisory-notes/2003/an02-federal-court-decision-stoddart