Statement of Principles concerning OTITIC BAROTRAUMA (Balance of Probabilities) (No. 87 of 2020) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986. Dated 30 October 2020 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 otitic barotrauma (Balance of Probabilities) (No. 87 of 2020). 2 Commencement This instrument commences on 30 November 2020. 3 Authority This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning otitic barotrauma No. 36 of 2012 (Federal Register of Legislation No. F2012L00947) made under subsections 196B(3) and (8) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004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 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 On the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that otitic barotrauma and death from otitic 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, otitic barotrauma or death from otitic barotrauma is connected 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(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 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) 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. 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.