Statement of Principles concerning sinus barotrauma (Reasonable Hypothesis) (No. 23 of 2019) (Cth)

Statement of Principles concerning SINUS BAROTRAUMA (Reasonable Hypothesis) (No. 23 of 2019) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 1 March 2019

The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:

Professor Nicholas Saunders AO Chairperson

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 (Reasonable Hypothesis) (No. 23 of 2019). 2 Commencement This instrument commences on 25 March 2019. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning sinus barotrauma No. 49 of 2010 (Federal Register of Legislation No. 2017C00074) made under subsections 196B(2) and (8) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act 2004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 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 The Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that sinus barotrauma and death from sinus 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 sinus barotrauma or death from sinus barotrauma 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(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.