Statement of Principles concerning hyperacusis (Reasonable Hypothesis) (No. 27 of 2021) (Cth)

Statement of Principles concerning HYPERACUSIS (Reasonable Hypothesis) (No. 27 of 2021) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.

Dated 24 December 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 Application 5 Definitions 6 Kind of injury, disease or death to which this Statement of Principles relates 7 Basis for determining the factors 8 Factors that must exist 9 Relationship to service 10 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 hyperacusis (Reasonable Hypothesis) (No. 27 of 2021). 2 Commencement This instrument commences on 25 January 2021. 3 Authority This instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986. 4 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. 5 Definitions The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument. 6 Kind of injury, disease or death to which this Statement of Principles relates (1) This Statement of Principles is about hyperacusis and death from hyperacusis. Meaning of hyperacusis (2) For the purposes of this Statement of Principles, hyperacusis: (a) means a disorder of sound tolerance or perception in which there is increased sensitivity or decreased tolerance to certain everyday sounds at levels that would not disturb most individuals; and (b) causes significant distress and impairment in social, occupational, recreational, and other day-to-day activities; and (c) must have persisted for at least three months. Note 1: The sounds may be perceived as uncomfortably loud, unpleasant, frightening or painful. Note 2: Sounds generated within the body may also cause hyperacusis. Death from hyperacusis (3) For the purposes of this Statement of Principles, hyperacusis, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's hyperacusis. Note: terminal event is defined in the Schedule 1 - Dictionary. 7 Basis for determining the factors The Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that hyperacusis and death from hyperacusis 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. 8 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 hyperacusis or death from hyperacusis with the circumstances of a person's relevant service: (1) being exposed to a peak sound pressure level at the tympanic membrane of at least 140 dB(C) before the clinical onset of hyperacusis; Note: dB(C) is defined in the Schedule 1 - Dictionary. (2) being exposed to a sound pressure level at the tympanic membrane of at least 85 dB(A) as an 8-hour time-weighted average (TWA) with a 3‑dB exchange rate for a cumulative period of at least six months before the clinical onset of hyperacusis; Note: dB(A) and time-weighted average (TWA) with a 3-dB exchange rate are defined in the Schedule 1 - Dictionary. (3) having sensorineural hearing loss at the time of the clinical onset of hyperacusis; (4) having acoustic shock at the time of the clinical onset of hyperacusis; Note: acoustic shock is defined in the Schedule 1 - Dictionary. (5) having an episode of otitic barotrauma within the 30 days before the clinical onset of hyperacusis; Note: Otitic barotrauma is also known as otic barotrauma. (6) being exposed to an explosive blast within the 30 days before the clinical onset of hyperacusis; (7) having concussion or moderate to severe traumatic brain injury within the 30 days before the clinical onset of hyperacusis; (8) having blunt trauma to the head causing a fracture of the temporal bone within the 30 days before the clinical onset of hyperacusis; (9) having stapedectomy or surgery involving the insular cortex or another part of the brain involved in central auditory processing within the 30 days before the clinical onset of hyperacusis; (10) having an inner ear disorder of the affected ear from the specified list of inner ear disorders at the time of the clinical onset of hyperacusis; Note: specified list of inner ear disorders is defined in the Schedule 1 - Dictionary. (11) having Meniere's disease at the time of the clinical onset of hyperacusis; (12) having paralysis of the facial nerve on the affected side at the time of the clinical onset of hyperacusis; Note 1: The facial nerve is also known as the seventh cranial nerve. Note 2: Facial nerve paralysis is also known as Bell's palsy. Note 3: Conditions that can cause paralysis of the facial nerve include autoimmune disease, multiple sclerosis and viral infection. (13) having a viral or bacterial infection from the specified list of viral or bacterial infections within the 30 days before the clinical onset of hyperacusis; Note: specified list of viral or bacterial infections is defined in the Schedule 1 - Dictionary. (14) having dysfunction of the stapedius muscle or the tensor tympani muscle on the affected side at the time of the clinical onset of hyperacusis; (15) having a middle cerebral artery aneurysm at the time of the clinical onset of hyperacusis; (16) having a cerebrovascular accident within the 30 days before the clinical onset of hyperacusis; (17) having multiple sclerosis at the time of the clinical onset of hyperacusis; (18) undergoing withdrawal following long-term benzodiazepine use within the seven days before the clinical onset of hyperacusis; Note: long-term benzodiazepine use is defined in the Schedule 1 - Dictionary. (19) being exposed to a peak sound pressure level at the tympanic membrane of at least 140 dB(C) before the clinical worsening of hyperacusis; Note: dB(C) is defined in the Schedule 1 - Dictionary. (20) being exposed to a sound pressure level at the tympanic membrane of at least 85 dB(A) as an 8-hour time-weighted average (TWA) with a 3‑dB exchange rate for a cumulative period of at least six months before the clinical worsening of hyperacusis; Note: dB(A) and time-weighted average (TWA) with a 3-dB exchange rate are defined in the Schedule 1 - Dictionary. (21) having sensorineural hearing loss at the time of the clinical worsening of hyperacusis; (22) having acoustic shock at the time of the clinical worsening of hyperacusis; Note: acoustic shock is defined in the Schedule 1 - Dictionary. (23) having an episode of otitic barotrauma within the 30 days before the clinical worsening of hyperacusis; Note: Otitic barotrauma is also known as otic barotrauma. (24) being exposed to an explosive blast within the 30 days before the clinical worsening of hyperacusis; (25) having concussion or moderate to severe traumatic brain injury within the 30 days before the clinical worsening of hyperacusis; (26) having blunt trauma to the head causing a fracture of the temporal bone within the 30 days before the clinical worsening of hyperacusis; (27) having stapedectomy or surgery involving the insular cortex or another part of the brain involved in central auditory processing within the 30 days before the clinical worsening of hyperacusis; (28) having an inner ear disorder of the affected ear from the specified list of inner ear disorders at the time of the clinical worsening of hyperacusis; Note: specified list of inner ear disorders is defined in the Schedule 1 - Dictionary. (29) having Meniere's disease at the time of the clinical worsening of hyperacusis; (30) having paralysis of the facial nerve on the affected side at the time of the clinical worsening of hyperacusis; Note 1: The facial nerve is also known as the seventh cranial nerve. Note 2: Facial nerve paralysis is also known as Bell's palsy. Note 3: Conditions that can cause paralysis of the facial nerve include autoimmune disease, multiple sclerosis and viral infection. (31) having a viral or bacterial infection from the specified list of viral or bacterial infections within the 30 days before the clinical worsening of hyperacusis; Note: specified list of viral or bacterial infections is defined in the Schedule 1 - Dictionary. (32) having dysfunction of the stapedius muscle or the tensor tympani muscle on the affected side at the time of the clinical worsening of hyperacusis; (33) having a middle cerebral artery aneurysm at the time of the clinical worsening of hyperacusis; (34) having a cerebrovascular accident within the 30 days before the clinical worsening of hyperacusis; (35) having multiple sclerosis at the time of the clinical worsening of hyperacusis; (36) undergoing withdrawal following long-term benzodiazepine use within the seven days before the clinical worsening of hyperacusis; Note: long-term benzodiazepine use is defined in the Schedule 1 - Dictionary. (37) inability to obtain appropriate clinical management for hyperacusis. 9 Relationship to service (1) The existence in a person of any factor referred to in section 8, must be related to the relevant service rendered by the person. (2) The factors set out in subsections 8(19) to 8(37) apply only to material contribution to, or aggravation of, hyperacusis where the person's hyperacusis was suffered or contracted before or during (but did not arise out of) the person's relevant service. 10 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 8 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.