Statement of Principles concerning pulmonary barotrauma (Balance of Probabilities) (No. 65 of 2023) (Cth)

Statement of Principles concerning PULMONARY BAROTRAUMA (Balance of Probabilities) (No. 65 of 2023) The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.

Dated 23 June 2023.

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

Professor Terence Campbell AM 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 pulmonary barotrauma (Balance of Probabilities) (No. 65 of 2023). 2 Commencement This instrument commences on 25 July 2023. 3 Authority This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986. 4 Repeal The Statement of Principles concerning pulmonary barotrauma No. 16 of 2015 (Federal Register of Legislation No. F2014L01839) made under subsection 196B(3) of the VEA is repealed. 5 Application This instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004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 pulmonary barotrauma and death from pulmonary barotrauma. Meaning of pulmonary barotrauma (2) For the purposes of this Statement of Principles, pulmonary barotrauma: (a) means an acute lung injury arising from an abnormal pressure gradient across pulmonary tissues resulting in pulmonary haemorrhage from pulmonary compression, or air leakage into the pleural space (pneumothorax), the pericardial space (pneumopericardium), the peritoneal space (pneumoperitoneum), under the skin (subcutaneous emphysema) or into the blood (arterial gas embolism); and (b) includes: (i) iatrogenic pulmonary barotrauma; (ii) explosive blast injury; (iii) pulmonary barotrauma due to forceful coughing, vomiting, forceful Valsalva or Muller manoeuvres; (iv) pulmonary barotrauma of ascent; (v) pulmonary barotrauma of descent also known as lung or thoracic squeeze; and (vi) pulmonary barotrauma to abnormal pulmonary conditions such as bulla, blebs and cysts; and (c) excludes: (i) decompression sickness; (ii) arterial gas embolism due to decompression sickness; and (iii) pneumothorax, pneumopericardium, pneumoperitoneum, and arterial gas embolism due to non-pressure causes such as lung disease, and penetrating trauma including surgery. Note: The Valsalva manoeuvre is exhaling against a closed glottis and the Muller manoeuvre is inhaling against a closed glottis. Examples of uses of the Valsalva manoeuvre include anti g straining manoeuvres, and straining during childbirth. Death from pulmonary barotrauma (3) For the purposes of this Statement of Principles, pulmonary barotrauma, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's pulmonary 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 pulmonary barotrauma and death from pulmonary 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, pulmonary barotrauma or death from pulmonary barotrauma is connected with the circumstances of a person's relevant service: (1) experiencing an episode of rapid change in the ambient pressure exerted by an envelope of gas or water surrounding the person whilst: (a) descending in an underwater dive; (b) surfacing from an underwater dive; (c) increasing in altitude whilst flying in an aircraft; (d) suffering loss of cabin pressure in an aircraft at altitude; (e) decompressing in a hypobaric chamber; (f) returning to surface air pressure after being in a hyperbaric chamber including hyperbaric oxygen therapy chambers; within 24 hours before the clinical onset of pulmonary barotrauma; (2) receiving artificial ventilation at the time of the clinical onset of pulmonary barotrauma; Note: artificial ventilation is defined in the Schedule 1 - Dictionary. (3) sustaining a blast injury involving the chest at the time of the clinical onset of pulmonary barotrauma; (4) undertaking a Valsalva manoeuvre whilst: (a) forcefully vomiting; (b) forcefully coughing; (c) giving birth; (d) performing positive anti-g straining manoeuvre; (e) suffering intractable hiccups; or (f) weight lifting at a gym; within 24 hours of the clinical onset of pulmonary barotrauma; Note: The Valsalva manoeuvre is exhaling air against a closed glottis (airway). (5) inability to obtain appropriate clinical management for pulmonary barotrauma before the clinical worsening of pulmonary 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 factor set out in subsection 9(5) applies only to material contribution to, or aggravation of, pulmonary barotrauma where the person's pulmonary 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.