Statement of Principles

concerning

SINUS BAROTRAUMA
(Balance of Probabilities)

(No. 24 of 2019)

The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.

Dated 1 March 2019

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 sinus barotrauma (Balance of Probabilities) (No. 24 of 2019).

2               Commencement

              This instrument commences on 25 March 2019.

3               Authority

This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.

4               Repeal

The Statement of Principles concerning sinus barotrauma No. 50 of 2010 (Federal Register of Legislation No. F2017C00075) made under subsections 196B(3) and (8) of the VEA is repealed.

5               Application

This instrument applies to a claim to which section 120B of the VEA or section 339 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 sinus barotrauma and death from sinus barotrauma.

Meaning of sinus barotrauma

(2)          For the purposes of this Statement of Principles, sinus barotrauma means an injury to a paranasal sinus arising from inequalities in the barometric pressure between the surrounding atmosphere and the air within the sinus cavity.

Note:  Clinical manifestations typically include inflammation, oedema, or haemorrhage of the mucosa of a paranasal sinus and less commonly fracture of a sinus wall, subcutaneous emphysema of the orbit or pneumocephalus.

(3)          While sinus barotrauma attracts ICD‑10‑AM code T70.1, in applying this Statement of Principles the meaning of sinus barotrauma 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 sinus barotrauma

(5)          For the purposes of this Statement of Principles, sinus barotrauma, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's sinus barotrauma.

Note: terminal event is defined in the Schedule 1 – Dictionary.

8               Basis for determining the factors

On the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that sinus barotrauma and death from sinus barotrauma can be related to relevant service rendered by veterans 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 exist before it can be said that, on the balance of probabilities, sinus barotrauma or death from sinus barotrauma is connected with the circumstances of a person's relevant service:

(1)          experiencing a change in the ambient barometric pressure as specified, within the 24 hours before the clinical onset of sinus barotrauma;

Note: change in the ambient barometric pressure as specified is defined in the Schedule 1 - Dictionary.

(2)          receiving mechanical ventilation involving a face mask within the 24 hours before the clinical onset of sinus barotrauma;

Note: mechanical ventilation is defined in the Schedule 1 - Dictionary.

(3)          being exposed to an explosive blast within the 24 hours before the clinical onset of sinus barotrauma;

(4)          having impaired drainage of the sinus within the 24 hours before the clinical onset of sinus barotrauma;

Note: impaired drainage of the sinus is defined in the Schedule 1 - Dictionary.

(5)          having allergic rhinitis or sinusitis within the 24 hours before the clinical onset of sinus barotrauma;

(6)          experiencing a change in the ambient barometric pressure as specified, within the 24 hours before the clinical worsening of sinus barotrauma;

Note: change in the ambient barometric pressure as specified is defined in the Schedule 1 - Dictionary.

(7)          receiving mechanical ventilation involving a face mask within the 24 hours before the clinical worsening of sinus barotrauma;

Note: mechanical ventilation is defined in the Schedule 1 - Dictionary.

(8)          being exposed to an explosive blast within the 24 hours before the clinical worsening of sinus barotrauma;

(9)          having impaired drainage of the sinus within the 24 hours before the clinical worsening of sinus barotrauma;

Note: impaired drainage of the sinus is defined in the Schedule 1 - Dictionary.

(10)      having allergic rhinitis or sinusitis within the 24 hours before the clinical worsening of sinus barotrauma;

(11)      inability to obtain appropriate clinical management for sinus barotrauma.

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(6) to 9(11) apply only to material contribution to, or aggravation of, sinus barotrauma where the person's sinus barotrauma 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(3) 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.

Schedule 1 - Dictionary  

Note:               See Section 6

1               Definitions

In this instrument:

                               change in the ambient barometric pressure as specified means a significant and rapid reduction or increase in the pressure surrounding the person, including in such circumstances as:

(a)          ascending from a submerged craft or device or a submarine escape training facility;

(b)          decompression or compression in a hypobaric or hyperbaric chamber;

(c)          flying;

(d)          sky diving;

(e)          underwater diving;

(f)           working in a submarine; or

(g)          working in a pressurised chamber or tunnel.

                               impaired drainage of the sinus means one of the following which leads to a narrowing or obstruction of the affected sinus or sinus opening:

(a)          an anatomical deformity including, but not limited to, deviated septum, enlarged turbinates, adenoidal hypertrophy, fracture of the facial bones and any other bony structural abnormalities;

(b)          a soft tissue abnormality or mucosal swelling affecting the sinus including, but not limited to, polyps, tumours, inflammation, sarcoidosis, granulomas and scarring; or

(c)          a foreign body including, but not limited to, fungal balls, nasal packing, nasogastric or nasotracheal tubes, and dental detritus.

                               mechanical ventilation means an artificial method of ventilation in which air is forced into the lungs of a person via mechanical means, and includes anaesthetic and continuous positive airway pressure (CPAP) use.

                             MRCA means the Military Rehabilitation and Compensation Act 2004.

                             relevant service means:

(a)          eligible war service (other than operational service) under the VEA;

(b)          defence service (other than hazardous service and British nuclear test defence service) under the VEA; or

(c)          peacetime service under the MRCA.

Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary.

                               sinus barotrauma—see subsection 7(2).

                             terminal event means the proximate or ultimate cause of death and includes the following:

(a)           pneumonia;

(b)           respiratory failure;

(c)           cardiac arrest;

(d)           circulatory failure; or

(e)           cessation of brain function.

                             VEA means the Veterans' Entitlements Act 1986.