Statement of Principles concerning sensorineural hearing loss No. 29 of 2001

Administered by Department of Veterans' Affairs

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Instrument No.29 of 2001

 

Revocation and Determination

of

Statement of Principles

concerning

 

SENSORINEURAL HEARING LOSS

 

ICD-10-AM CODES: H90.3, H90.4, H90.5

 

Veterans’ Entitlements Act 1986

 

 

1. The Repatriation Medical Authority under subsection 196B(2) of the Veterans’ Entitlements Act 1986 (the Act):

 

(a) revokes Instrument No.13 of 2001; and

 

(b) determines in its place the following Statement of Principles.

 

Kind of injury, disease or death

2. (a) This Statement of Principles is about sensorineural hearing loss and death from sensorineural hearing loss.

 

(b) For the purposes of this Statement of Principles, “sensorineural hearing loss” means a permanent hearing threshold shift of 25 decibels (dB) or more, at 500, 1000, 1500, 2000, 3000 or 4000 hertz (Hz) due to a defect in the cochlea or the auditory nerve, attracting ICD-10-AM code H90.3, H90.4 or H90.5, but excluding congenital deafness.

 

Basis for determining the factors

3. The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that sensorineural hearing loss and death from sensorineural hearing loss can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces.

 

Factors that must be related to service

4. Subject to clause 6, at least one of the factors set out in clause 5 must be related to any relevant service rendered by the person.

 

Factors

5.                  The factors that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting sensorineural hearing loss or death from sensorineural hearing loss with the circumstances of a person’s relevant service are:

 

(a) being exposed to an impulsive noise of at least 130 dBA without adequate ear protection before the clinical onset of sensorineural hearing loss; or

 

(b)              being exposed to noise of at least 85 dBA as an 8-hour time-weighted average (TWA) with a 3‑dB exchange rate without adequate ear protection for a cumulative period of at least 180 days before the clinical onset of sensorineural hearing loss; or

 

(c)               undergoing a course of treatment with an ototoxic drug from the specified list within the year immediately before the clinical onset of sensorineural hearing loss; or

 

(d)              undergoing a course of salicylate or quinine derivatives, for a condition for which the drug cannot be ceased or substituted, at the time of the clinical onset of sensorineural hearing loss; or

 

(e)               suffering from suppurative labyrinthitis of the affected ear within the 30 days immediately before the clinical onset of sensorineural hearing loss; or

 

(f)                suffering from chronic suppurative otitis media on the affected side before the clinical onset of sensorineural hearing loss; or

 

(g)              suffering from Meniere’s disease at the time of the clinical onset of sensorineural hearing loss; or

 

(h)              suffering from a systemic immune mediated disorder at the time of the clinical onset of sensorineural hearing loss; or

 

(j) suffering from leprosy with audiovestibular involvement of the affected ear before the clinical onset of sensorineural hearing loss; or

 

(k)           suffering from an acute vascular lesion involving the arteries supplying the cochlea of the affected ear at the time of the clinical onset of sensorineural hearing loss; or

 

(m)           suffering from a hyperviscosity syndrome within the 30 days immediately before the clinical onset of sensorineural hearing loss; or

 

(n)              suffering from an acute viral infection from the specified list of viruses within the 30 days immediately before the clinical onset of sensorineural hearing loss; or

 

(o)              suffering from bacterial meningitis before the clinical onset of sensorineural hearing loss; or

 

(p)              suffering from neurosyphilis before the clinical onset of sensorineural hearing loss; or

 

(q)              suffering from tuberculosis involving the temporal bone on the affected side before the clinical onset of sensorineural hearing loss; or

 

(r)               suffering from Paget’s disease of the skull at the time of the clinical onset of sensorineural hearing loss; or

 

(s)               suffering a head trauma causing:

 

(i)                ruptured ear drum of the affected ear,

(ii)              a perilymph fistula of the affected ear,

(iii)            fracture of the temporal bone of the affected side, or

(iv)            concussion

 

within the five years immediately before the clinical onset of sensorineural hearing loss; or

 

(t)                 suffering at least one episode of otitic barotrauma within the 30 days immediately before the clinical onset of sensorineural hearing loss; or

 

(u)              suffering from a neoplasm affecting the auditory apparatus on the affected side at the time of the clinical onset of sensorineural hearing loss; or

 

(v)              undergoing a course of therapeutic radiation to the head or neck region within the 18 months immediately before the clinical onset of sensorineural hearing loss; or

 

(w)            undergoing surgery to the middle ear, inner ear or posterior cranial fossa on the affected side before the clinical onset of sensorineural hearing loss; or

 

(x)              being exposed to an impulsive noise of at least 130 dBA without adequate ear protection before the clinical worsening of sensorineural hearing loss; or

 

(y)              being exposed to noise of at least 85 dBA as an 8-hr time-weighted average (TWA) with a 3‑dB exchange rate without adequate ear protection for a cumulative period of at least 180 days before the clinical worsening of sensorineural hearing loss; or

 

(z)              undergoing a course of treatment with an ototoxic drug from the specified list within the year immediately before the clinical worsening of sensorineural hearing loss; or

 

(za) undergoing a course of salicylate or quinine derivatives, for a condition for which the drug cannot be ceased or substituted, at the time of the clinical worsening of sensorineural hearing loss; or

 

(zb) suffering from suppurative labyrinthitis of the affected ear within the 30 days immediately before the clinical worsening of sensorineural hearing loss; or

 

(zc) suffering from chronic suppurative otitis media on the affected side before the clinical worsening of sensorineural hearing loss; or

 

(zd) suffering from Meniere’s disease at the time of the clinical worsening of sensorineural hearing loss; or

 

(ze) suffering from a systemic immune mediated disorder at the time of the clinical worsening of sensorineural hearing loss; or

 

(zf) suffering from leprosy with audiovestibular involvement of the affected ear before the clinical worsening of sensorineural hearing loss; or

 

(zg) suffering from an acute vascular lesion involving the arteries supplying the cochlea of the affected ear at the time of the clinical worsening of sensorineural hearing loss; or

 

(zh) suffering from a hyperviscosity syndrome within the 30 days immediately before the clinical worsening of sensorineural hearing loss; or

 

(zj) suffering from an acute viral infection from the specified list of viruses within the 30 days immediately before the clinical worsening of sensorineural hearing loss; or

 

(zk) suffering from bacterial meningitis before the clinical worsening of sensorineural hearing loss; or

 

(zm) suffering from neurosyphilis before the clinical worsening of sensorineural hearing loss; or

 

(zn) suffering from tuberculosis involving the temporal bone on the affected side before the clinical worsening of sensorineural hearing loss; or

 

(zo) suffering from Paget’s disease of the skull at the time of the clinical worsening of sensorineural hearing loss; or

 

(zp) suffering a head trauma causing:

 

(i)               ruptured ear drum of the affected ear,

(ii) a perilymph fistula of the affected ear,

(iii)           fracture of the temporal bone of the affected side, or

(iv)            concussion

 

within the five years immediately before the clinical worsening

of sensorineural hearing loss; or

 

(zq) suffering at least one episode of otitic barotrauma within the 30 days immediately before the clinical worsening of sensorineural hearing loss; or

 

(zr) suffering from a neoplasm affecting the auditory apparatus on the affected side at the time of the clinical worsening of sensorineural hearing loss; or

 

(zs) undergoing a course of therapeutic radiation to the head or neck region within the 18 months immediately before the clinical worsening of sensorineural hearing loss; or

 

(zt) undergoing surgery to the middle ear, inner ear or posterior cranial fossa on the affected side before the clinical worsening of sensorineural hearing loss; or

 

(zu) inability to obtain appropriate clinical management for sensorineural hearing loss.

 

Factors that apply only to material contribution or aggravation

6. Paragraphs 5(x) to 5(zu) apply only to material contribution to, or aggravation of, sensorineural hearing loss where the person’s sensorineural hearing loss was suffered or contracted before or during (but not arising out of) the person’s relevant service; paragraph 8(1)(e), 9(1)(e), 70(5)(d) or 70(5A)(d) of the Act refers.

 

Inclusion of Statements of Principles

7. In this Statement of Principles if a relevant factor applies and that factor includes an injury or disease in respect of which there is a Statement of Principles then the factors in that last mentioned Statement of Principles apply in accordance with the terms of that Statement of Principles.

 

Other definitions

8. For the purposes of this Statement of Principles:

 

“a course of therapeutic radiation” means one or more fractions (treatment portions) of ionising radiation administered with the aim of achieving palliation or cure with gamma rays, x-rays, alpha particles or beta particles;

 

“adequate ear protection” means a device which plugs the outer ear canal or which covers the outside of the ear so as to protect the wearer from harmful noise;

 

“an ototoxic drug from the specified list” means one of the following:

 

(a)               -difluromethylornithine;

(b)              6-amino nicotinamide;

(c)               Amikacin;

(d)              Bumetanide;

(e)               Cisplatin;

(f)                Erythromycin;

(g)              Ethacrynic acid;

(h)              Frusemide;

(i)                Gentamicin;

(j)                Kanamycin;

(k)              Misonidazole;

(l)                Neomycin;

(m)            Netilmicin;

(n)              Nitrogen Mustard;

(o)              Streptomycin;

(p)              Tobramycin;

(q)              Vancomycin;

(r)                Vinblastine;

(s)               Vincristine; or

(t)                Viomycin;

 

“bacterial meningitis” means inflammation of the lining of the brain and spinal cord caused by bacteria;

 

“chronic suppurative otitis media” means a recurrent or continuous infective disorder of the middle ear characterised by perforation of the tympanic membrane, aural discharge and hearing loss;

 

“death from sensorineural hearing loss” in relation to a person includes death from a terminal event or condition that was contributed to by the person’s sensorineural hearing loss;

 

“hyperviscosity syndrome” means a disorder causing an increased viscosity of the blood;

 

“ICD-10-AM code” means a number assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, 10th revision, Australian Modification (ICD-10-AM), Second Edition, effective date of 1 July 2000, copyrighted by the National Centre for Classification in Health, Sydney, NSW, and having ISBN 1 86487 271 3;

 

“impulsive noise” means noise which is characterised by a sharp rise and a rapid decay in sound levels and is less than one second in duration;

 

“Meniere’s disease” means a clinical condition characterised by fluctuating hearing loss, tinnitus, a sense of fullness in the involved ear associated with recurring attacks of rotational vertigo of sudden onset, often associated with nausea and vomiting;

 

“neoplasm affecting the auditory apparatus” means a primary or secondary neoplasm of the auditory nerve, inner ear, temporal bone, cerebellopontine angle or posterior cranial fossa;

 

“Paget’s disease of the skull” (otherwise known as osteitis deformans) means a disease of bone marked by repeated episodes of bone resorption and new bone formation resulting in weakened deformed bones of increased mass of the skull;

 

“perilymph fistula” means a leakage of perilymph fluid into the middle ear space from the inner ear due to the rupture of the membrane between the middle and inner ear at the oval or round window;

 

“relevant service” means:

 

(a) operational service; or

(b) peacekeeping service; or

(c) hazardous service;

 

“specified list of viruses” means:

 

(a)               mumps virus;

(b)               measles virus;

(c)               rubella virus;

(d)               pertussis virus; or

(e)               varicella-zoster virus;

 

“suppurative labyrinthitis” means inflammation of the labyrinth characterised by the presence of pus;

 

“systemic immune mediated disorder” means one of the following:

 

(a)               Behçet’s syndrome;

(b)               Cogan’s syndrome;

(c)               periarteritis nodosa;

(d)               systemic lupus erythematosus; or

(e)               Wegener’s granulomatosis;

 

“terminal event” means the proximate or ultimate cause of death and includes:

 

(a) pneumonia;

(b) respiratory failure;

(c) cardiac arrest;

(d)              circulatory failure; or

(e)               cessation of brain function;

 

“tuberculosis involving the temporal bone” means infection of the temporal bone with Mycobacterium tuberculosis;


“time-weighted average (TWA) with 3‑dB exchange rate” means the time-weighted average noise exposure level calculated according to the following formulae and shown in the table:

 

TWA = 10.0 x Log(D/100) + 85

where D = daily dose; and

 

 D = [ C1/T1 + C2/T2 + …..+ Cn/Tn] x 100

where  Cn = total time of exposure at a specified noise level,

Tn = exposure duration for which noise at this level becomes hazardous

 

Table of noise exposure levels and

durations based on 3-dBA exchange rate

 

Duration, T

 

Duration, T

Exposure

Level, L

(dBA)

Hours

Minutes

Seconds

Exposure

Level, L

(dBA)

Hours

Minutes

Seconds

 

 

 

 

 

 

 

 

80

25

24

106

3

45

81

20

10

107

2

59

82

16

108

2

22

83

12

42

109

1

53

84

10

5

110

1

29

85

8

111

1

11

86

6

21

112

56

87

5

2

113

45

88

4

114

35

89

3

10

115

28

90

2

31

116

22

91

2

117

18

92

1

35

118

14

93

1

16

119

11

94

1

120

9

95

47

37

121

7

96

37

48

122

6

97

30

123

4

98

23

49

124

3

99

18

59

125

3

100

15

126

2

101

11

54

127

1

102

9

27

128

1

103

7

30

129

1

104

5

57

130-140

<1

105

4

43

Source: National Institute of Occupational Safety and Health 1998 Guidelines

Publication No. 98-126

 

 


Application

9. This Instrument applies to all matters to which section 120A of the Act applies.

 

 

Dated this Twenty-fourth     day of May 2001

 

 

The Common Seal of the    )

Repatriation Medical Authority   )

was affixed to this instrument  )

in the presence of:    )

KEN DONALD

CHAIRMAN

Overview

The Veterans' Entitlements Act 1986 was enacted to address the needs of veterans who suffer from various injuries, diseases, or death related to their service. This legislation provides a comprehensive framework for the assessment and compensation of veterans’ claims. The Repatriation Medical Authority, under subsection 196B(2) of the Act, has the authority to issue Statements of Principles concerning specific conditions, including sensorineural hearing loss and death from such loss. This legislative instrument, No. 29 of 2001, revokes a previous statement and establishes a new one, defining sensorineural hearing loss as a permanent hearing threshold shift of 25 decibels or more due to cochlea or auditory nerve defects, excluding congenital deafness. The policy objective is to ensure that veterans who have developed sensorineural hearing loss or have died from such loss due to their service receive appropriate recognition and compensation. This is achieved by linking specific factors, such as exposure to high noise levels or ototoxic drugs, to the circumstances of the veteran’s service.

Scope and Application

The legislative instrument, Instrument No. 29 of 2001, concerns the revocation and determination of a Statement of Principles relating to sensorineural hearing loss and death from sensorineural hearing loss, as outlined under the Veterans' Entitlements Act 1986. This instrument applies to all matters governed by section 120A of the Act. The Act primarily concerns veterans, members of Peacekeeping Forces, and members of the Australian Defence Force, focusing on their eligibility for veterans' benefits. The instrument identifies sensorineural hearing loss as a permanent hearing threshold shift of 25 decibels or more at specified frequencies, attributable to defects in the cochlea or auditory nerve, and excludes congenital deafness. It stipulates that at least one specified factor must be related to the relevant service rendered by the individual to establish a connection between the hearing loss and their service. The factors include exposure to certain levels of noise, treatment with specific drugs, and various medical conditions. The instrument also outlines the criteria for determining when these factors apply to the material contribution or aggravation of sensorineural hearing loss. The instrument further clarifies terms such as "adequate ear protection," "ototoxic drug," and "relevant service," and provides definitions for various medical conditions and treatments mentioned. The instrument’s application extends to all matters governed by section 120A of the Veterans’ Entitlements Act 1986, which encompasses the assessment of entitlements for veterans and related personnel.

Key Provisions

The Veterans’ Entitlements Act 1986 (the Act) contains provisions that govern the recognition of certain injuries, diseases, or deaths suffered by veterans, members of Peacekeeping Forces, or members of the Forces. The Act mandates that the Repatriation Medical Authority (RMA) establish Statements of Principles to determine the circumstances under which particular conditions are considered related to service. In this context, Instrument No. 29 of 2001 revokes the previous Instrument No. 13 of 2001 and establishes a new Statement of Principles concerning sensorineural hearing loss and death from sensorineural hearing loss. This Statement of Principles specifies the types of service-related conditions that must be present to establish a connection between the service and the medical condition in question. Under the new Statement of Principles, sensorineural hearing loss is defined as a permanent hearing threshold shift of 25 decibels (dB) or more, at specific frequencies, due to a defect in the cochlea or the auditory nerve, excluding congenital deafness. The Statement of Principles identifies various factors that must be related to the person's relevant service to establish a connection with the condition. These factors include exposure to impulsive or continuous noise without adequate ear protection, treatment with ototoxic drugs, certain infections, diseases, and trauma. For example, exposure to impulsive noise of at least 130 dBA without adequate ear protection before the onset of sensorineural hearing loss, or undergoing a course of treatment with an ototoxic drug from a specified list within the year immediately before the onset, are among the factors that must be related to the service. The Statement of Principles imposes obligations on the parties involved in determining the connection between the service and the condition. Specifically, it requires that at least one of the identified factors must be related to the person’s relevant service. For instance, if a veteran claims that their sensorineural hearing loss is related to their service, they must provide evidence that at least one of the specified factors occurred during their service and was connected to it. Additionally, if a factor listed in paragraphs 5(x) to 5(zu) applies, it must relate to a material contribution to, or aggravation of, sensorineural hearing loss where the condition was suffered or contracted before or during service. Failure to comply with the requirements of the Act and the Statement of Principles can lead to civil or criminal consequences. However, the specific penalties are not detailed in this legislative instrument. Generally, under Australian law, breaches of legislative instruments can result in penalties such as fines or imprisonment, depending on the severity of the breach. The maximum penalties would be determined by the specific provisions of the Act and any related legislation. It is important for practitioners to refer to the full text of the Act and relevant case law to understand the full scope of potential penalties.

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