Statement of Principles

concerning

OTITIC BAROTRAUMA
(Reasonable Hypothesis)

(No. 86 of 2020)

The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated                                           30 October 2020

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 otitic barotrauma (Reasonable Hypothesis) (No. 86 of 2020).

2               Commencement

              This instrument commences on 30 November 2020.

3               Authority

This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.

4               Repeal

The Statement of Principles concerning otitic barotrauma No. 35 of 2012 (Federal Register of Legislation No. F2012L00945) made under subsections 196B(2) and (8) of the VEA is repealed.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 otitic barotrauma and death from otitic barotrauma.

Meaning of otitic barotrauma

(2)          For the purposes of this Statement of Principles, otitic barotrauma means an injury to the middle or inner ear arising from inequalities in the barometric pressure between the surrounding atmosphere and the air within the middle ear space.

Note 1: Clinical manifestations of otitic barotrauma typically include:

(a) disruption of the ossicle chain;

(b) hearing loss;

(c) otalgia;

(d) perforation of the               tympanic membrane;

(e) rupture of the round or oval               window membranes with vertigo or perilymphatic fistula; and

(f) tinnitus.

Note 2: Otitic barotrauma is also known as otic barotrauma.

(3)          While otitic barotrauma attracts ICD‑10‑AM code T70.0, in applying this Statement of Principles the meaning of otitic 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 otitic barotrauma

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

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 otitic barotrauma and death from otitic barotrauma 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 otitic barotrauma or death from otitic barotrauma with the circumstances of a person's relevant service:

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

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

(2)          being exposed to blast pressure from an explosion or lightning strike within the 24 hours before the clinical onset of otitic barotrauma;

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

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

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

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

(5)          being exposed to blast pressure from an explosion or lightning strike within the 24 hours before the clinical worsening of otitic barotrauma;

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

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

(7)          inability to obtain appropriate clinical management for otitic 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(4) to 9(7) apply only to material contribution to, or aggravation of, otitic barotrauma where the person's otitic 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(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.

Schedule 1 - Dictionary  

Note:               See Section 6

1               Definitions

In this instrument:

                               change in 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 pressurised chamber or tunnel; and

(g)          working in a submarine.

                               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.

                               otitic barotrauma—see subsection 7(2).

                               relevant service means:

(a)          operational service under the VEA;

(b)          peacekeeping service under the VEA;

(c)          hazardous service under the VEA;

(d)          British nuclear test defence service under the VEA;

(e)          warlike service under the MRCA; or

(f)           non-warlike service under the MRCA.

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

                               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.