Anxiety disorder — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 100 of 2023

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 anxiety disorder or death from anxiety disorder with the circumstances of a person's relevant service:

1. (1)
   being a prisoner of war before the clinical onset of generalised anxiety disorder;
2. (2)
   experiencing a category 1A stressor within the 5 years before the clinical onset of generalised anxiety disorder;

   Note: category 1A stressor is defined in the Schedule 1 - Dictionary.

3. (3)
   experiencing a category 1B stressor within the 5 years before the clinical onset of generalised anxiety disorder;

   Note: category 1B stressor is defined in the Schedule 1 - Dictionary.

4. (4)
   experiencing severe childhood abuse before the clinical onset of generalised anxiety disorder;

   Note: severe childhood abuse is defined in the Schedule 1 - Dictionary.

5. (5)
   experiencing a potentially morally injurious event within the 5 years before the clinical onset of generalised anxiety disorder;

   Note: potentially morally injurious event is defined in the Schedule 1 - Dictionary.

6. (6)
   having a family member or close friend who experiences a category 1A stressor within the 2 years before the clinical onset of generalised anxiety disorder;

   Note: category 1A stressor is defined in the Schedule 1 - Dictionary.

7. (7)
   experiencing the death of a family member or close friend within the 5 years before the clinical onset of generalised anxiety disorder;
8. (8)
   experiencing miscarriage, fetal death in utero or stillbirth as a parent, within the 2.5 years before the clinical onset of generalised anxiety disorder;
9. (9)
   living or working in a hostile or life-threatening environment for a cumulative period of at least 4 weeks within the 5 years before the clinical onset of generalised anxiety disorder;

   Note: hostile or life-threatening environment is defined in the Schedule 1 - Dictionary.

10. (10)
    experiencing a category 2 stressor within the 1 year before the clinical onset of generalised anxiety disorder;

    Note: A category 2 stressor can arise in a variety of circumstances connected with service. Such circumstances can arise during the course of service, as a result of separation from service and the conditions associated with that separation, and in the transition to civilian life in the years following separation.

    Note: category 2 stressor is defined in the Schedule 1 - Dictionary.

11. (11)
    having a clinically significant disorder of mental health within the 10 years before the clinical onset of generalised anxiety disorder;

    Note: clinically significant disorder of mental health is defined in the Schedule 1 - Dictionary.

12. (12)
    having a medical illness which is life-threatening or which results in serious physical or cognitive disability within the 5 years before the clinical onset of generalised anxiety disorder;
13. (13)
    having an injury which is life-threatening or which results in serious physical or cognitive disability within the 5 years before the clinical onset of generalised anxiety disorder;
14. (14)
    having epilepsy at the time of the clinical onset of generalised anxiety disorder;
15. (15)
    having severe and permanent tinnitus at the time of the clinical onset of generalised anxiety disorder;

    Note: severe and permanent tinnitus is defined in the Schedule 1 - Dictionary.

16. (16)
    having persistent pain of at least 3 months duration at the time of the clinical onset of generalised anxiety disorder;

    Note: persistent pain is defined in the Schedule 1 - Dictionary.

17. (17)
    being obese at the time of the clinical onset of generalised anxiety disorder;

    Note: being obese is defined in the Schedule 1 - Dictionary.

18. (18)
    inability to undertake physical activity greater than 3 METs for a continuous period of at least the 3 months before the clinical onset of generalised anxiety disorder;

    Note: MET is defined in the Schedule 1 - Dictionary.

19. (19)
    having another medical condition, including an endocrine, cardiovascular, respiratory, metabolic, infectious or neurological disorder, where the signs or symptoms of anxiety are directly related to the pathological process of the medical condition and not solely due to its psychosocial stress effects, at the time of the clinical onset of “anxiety disorder due to another medical condition”;
20. (20)
    taking mefloquine within the 2 days before the clinical onset of substance/medication-induced anxiety disorder, where substance/medication-induced anxiety disorder persists after the discontinuation or tapering of mefloquine therapy;
21. (21)
    using a psychoactive substance from the specified list of psychoactive substances at an intoxicant dose within the 2 days before the clinical onset of substance/medication-induced anxiety disorder;

    Note: intoxicant dose and specified list of psychoactive substances are defined in the Schedule 1 - Dictionary.

22. (22)
    taking a drug that cannot be ceased or substituted in the long term and which is associated in the individual with the development of anxiety symptoms during drug therapy and either: (a) the improvement of anxiety symptoms within days or weeks of discontinuing or tapering drug therapy; or (b) the redevelopment of anxiety symptoms on rechallenge with the same drug; where the drug was being taken within the 2 days before the clinical onset of substance/medication-induced anxiety disorder;
23. (23)
    using a psychoactive chemical or substance at an intoxicant dose, which is associated in the individual with the development of anxiety symptoms, and where the psychoactive chemical or substance was being taken within the 2 days before the clinical onset of substance/medication-induced anxiety disorder;

    Note: intoxicant dose is defined in the Schedule 1 - Dictionary.

24. (24)
    having ceased or reduced therapeutic or illicit drug use or other substance use within the 10 days before the clinical onset of substance/medication-induced anxiety disorder;
25. (25)
    having periodic, heavy alcohol consumption for the 3 months before the clinical onset of substance/medication-induced anxiety disorder;

    Note: periodic, heavy alcohol consumption is defined in the Schedule 1 - Dictionary.

26. (26)
    having an alcohol use disorder or a substance use disorder at the time of the clinical onset of substance/medication-induced anxiety disorder;
27. (27)
    having smoked tobacco products in an amount of at least 0.5 pack- years before the clinical onset of substance/medication-induced anxiety disorder, and if smoking has ceased before the clinical onset of substance/medication-induced anxiety disorder, then that onset occurred within 3 months of cessation;

    Note: one pack-year is defined in the Schedule 1 - Dictionary.

28. (28)
    having an episode of acute cholinergic poisoning from exposure to an organophosphorus ester within the 30 days before the clinical onset of substance/medication-induced anxiety disorder;

    Note: acute cholinergic poisoning and organophosphorus ester are defined in the Schedule 1 - Dictionary.

29. (29)
    for persons without a regular caffeine habit, taking at least 200 milligrams of caffeine from beverages, drugs or foods within the 1 hour before the clinical onset of substance/medication-induced anxiety disorder;

    Note: regular caffeine habit is defined in the Schedule 1 - Dictionary.

30. (30)
    for persons with a regular caffeine habit, taking at least 400 milligrams of caffeine from beverages, drugs or foods within the 1 hour before the clinical onset of substance/medication-induced anxiety disorder;

    Note: regular caffeine habit is defined in the Schedule 1 - Dictionary.

31. (31)
    being a prisoner of war before the clinical worsening of anxiety disorder;
32. (32)
    experiencing a category 1A stressor within the 5 years before the clinical worsening of anxiety disorder;

    Note: category 1A stressor is defined in the Schedule 1 - Dictionary.

33. (33)
    experiencing a category 1B stressor within the 5 years before the clinical worsening of anxiety disorder;

    Note: category 1B stressor is defined in the Schedule 1 - Dictionary.

34. (34)
    experiencing severe childhood abuse before the clinical worsening of anxiety disorder;

    Note: severe childhood abuse is defined in the Schedule 1 - Dictionary.

35. (35)
    experiencing a potentially morally injurious event within the 5 years before the clinical worsening of anxiety disorder;

    Note: potentially morally injurious event is defined in the Schedule 1 - Dictionary.

36. (36)
    having a family member or close friend who experiences a category 1A stressor within the 2 years before the clinical worsening of anxiety disorder;

    Note: category 1A stressor is defined in the Schedule 1 - Dictionary.

37. (37)
    experiencing the death of a family member or close friend within the 5 years before the clinical worsening of anxiety disorder;
38. (38)
    experiencing miscarriage, fetal death in utero or stillbirth as a parent, within the 2.5 years before the clinical worsening of anxiety disorder;
39. (39)
    living or working in a hostile or life-threatening environment for a cumulative period of at least 4 weeks within the 5 years before the clinical worsening of anxiety disorder;

    Note: hostile or life-threatening environment is defined in the Schedule 1 - Dictionary.

40. (40)
    experiencing a category 2 stressor within the 1 year before the clinical worsening of anxiety disorder;

    Note: A category 2 stressor can arise in a variety of circumstances connected with service. Such circumstances can arise during the course of service, as a result of separation from service and the conditions associated with that separation, and in the transition to civilian life in the years following separation.

    Note: category 2 stressor is defined in the Schedule 1 - Dictionary.

41. (41)
    having a clinically significant disorder of mental health within the 10 years before the clinical worsening of anxiety disorder;

    Note: clinically significant disorder of mental health is defined in the Schedule 1 - Dictionary.

42. (42)
    having a medical illness which is life-threatening or which results in serious physical or cognitive disability within the 5 years before the clinical worsening of anxiety disorder;
43. (43)
    having an injury which is life-threatening or which results in serious physical or cognitive disability within the 5 years before the clinical worsening of anxiety disorder;
44. (44)
    having epilepsy at the time of the clinical worsening of anxiety disorder;
45. (45)
    having severe and permanent tinnitus at the time of the clinical worsening of anxiety disorder;

    Note: severe and permanent tinnitus is defined in the Schedule 1 - Dictionary.

46. (46)
    having persistent pain of at least 3 months duration at the time of the clinical worsening of anxiety disorder;

    Note: persistent pain is defined in the Schedule 1 - Dictionary.

47. (47)
    being obese at the time of the clinical worsening of anxiety disorder;

    Note: being obese is defined in the Schedule 1 - Dictionary.

48. (48)
    inability to undertake physical activity greater than 3 METs for a continuous period of at least the 3 months before the clinical worsening of anxiety disorder;

    Note: MET is defined in the Schedule 1 - Dictionary.

49. (49)
    having another medical condition, including an endocrine, cardiovascular, respiratory, metabolic, infectious or neurological disorder, where the signs or symptoms of anxiety are directly related to the pathological process of the medical condition and not solely due to its psychosocial stress effects, at the time of the clinical worsening of anxiety disorder;
50. (50)
    taking mefloquine within the 2 days before the clinical worsening of anxiety disorder, where anxiety disorder persists after the discontinuation or tapering of mefloquine therapy;
51. (51)
    using a psychoactive substance from the specified list of psychoactive substances at an intoxicant dose within the 2 days before the clinical worsening of anxiety disorder;

    Note: intoxicant dose and specified list of psychoactive substances are defined in the Schedule 1 - Dictionary.

52. (52)
    taking a drug that cannot be ceased or substituted in the long term and which is associated in the individual with the worsening of anxiety symptoms during drug therapy and either: (a) the improvement of anxiety symptoms within days or weeks of discontinuing or tapering drug therapy; or (b) the worsening of anxiety symptoms on rechallenge with the same drug; where the drug was being taken within the 2 days before the clinical worsening of anxiety disorder;
53. (53)
    using a psychoactive chemical or substance at an intoxicant dose, which is associated in the individual with the worsening of anxiety symptoms, and where the psychoactive chemical or substance was being taken within the 2 days before the clinical worsening of anxiety disorder;

    Note: intoxicant dose is defined in the Schedule 1 - Dictionary.

54. (54)
    having ceased or reduced therapeutic or illicit drug use or other substance use within the 10 days before the clinical worsening of anxiety disorder;
55. (55)
    having periodic, heavy alcohol consumption for the 3 months before the clinical worsening of anxiety disorder;

    Note: periodic, heavy alcohol consumption is defined in the Schedule 1 - Dictionary.

56. (56)
    having an alcohol use disorder or a substance use disorder at the time of the clinical worsening of anxiety disorder;
57. (57)
    having smoked tobacco products in an amount of at least 0.5 pack- years before the clinical worsening of anxiety disorder, and if smoking has ceased before the clinical worsening of anxiety disorder, then that worsening occurred within 3 months of cessation;

    Note: one pack-year is defined in the Schedule 1 - Dictionary.

58. (58)
    having an episode of acute cholinergic poisoning from exposure to an organophosphorus ester within the 30 days before the clinical worsening of anxiety disorder;

    Note: acute cholinergic poisoning and organophosphorus ester are defined in the Schedule 1 - Dictionary.

59. (59)
    taking at least 400 milligrams of caffeine from beverages, drugs or foods within the 1 hour before the clinical worsening of anxiety disorder;
60. (60)
    inability to obtain appropriate clinical management for anxiety disorder before the clinical worsening of anxiety disorder;

Aggravation-only factors: the factors in subsections 9(31) to 9(60) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.