Statement of Principles concerning tinnitus No. 26 of 2001

Administered by Department of Veterans' Affairs

Legislation au F2005B01746 Not in force Legislative Instrument

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Instrument No.26 of 2001

 

Revocation and Determination

of

Statement of Principles

concerning

 

TINNITUS

 

ICD-10-AM CODE: H93.1

 

Veterans’ Entitlements Act 1986

 

 

1. The Repatriation Medical Authority under subsection 196B(3) of the Veterans’ Entitlements Act 1986 (the Act):

 

(a) revokes Instrument No.8 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 tinnitus and death from tinnitus.

 

(b) For the purposes of this Statement of Principles, “tinnitus” means a persistent perception of endogenous noise heard in the ear, attracting ICD-10-AM code H93.1

 

Basis for determining the factors

3. On the sound medical-scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that tinnitus and death from tinnitus can be related to relevant service rendered by veterans 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 exist before it can be said that, on the balance of probabilities, tinnitus or death from tinnitus are connected with the circumstances of a person’s relevant service are:

 

(a) being exposed to an impulsive noise of at least 140 dBA without adequate ear protection within the 48 hours immediately before the clinical onset of tinnitus; 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 one year immediately before the clinical onset of tinnitus; or

 

(c)               suffering trauma to the auditory apparatus at the time of the clinical onset of tinnitus; or

 

(d)              suffering from sensorineural hearing loss at the time of the clinical onset of tinnitus; or

 

(e)               undergoing a course of treatment with an ototoxic drug from the specified list within the year immediately before the clinical onset of tinnitus; or

 

(f)                undergoing a course of treatment with salicylate or quinine derivatives, for a condition for which the drug cannot be ceased or substituted, at the time of the clinical onset of tinnitus; or

 

(g)              suffering from a source of vascular sound proximal to the affected ear at the time of the clinical onset of tinnitus; or

 

(h)              suffering from an intracranial neoplasm at the time of the clinical onset of tinnitus; or

 

(j)                suffering from otosclerosis at the time of the clinical onset of tinnitus; or

 

(k)              suffering from Meniere’s disease at the time of the clinical onset of tinnitus; or

 

(m)           suffering at least one episode of otitic barotrauma within the 30 days immediately before the clinical onset of tinnitus; or

 

(n)              being exposed to an impulsive noise of at least 140 dBA without adequate ear protection within the 48 hours immediately before the clinical worsening of tinnitus; or

 

(o)              being exposed to noise greater than 85 dBA as an 8-hour time-weighted average (TWA) with a 3‑dB exchange rate without adequate ear protection for one year immediately before the clinical worsening of tinnitus; or

 

(p)              suffering trauma to the auditory apparatus at the time of the clinical worsening of tinnitus; or

 

(q)              suffering from sensorineural hearing loss at the time of the clinical worsening of tinnitus; or

 

(r)               undergoing a course of treatment with an ototoxic drug from the specified list within the year immediately before the clinical worsening of tinnitus; or

 

(s)               undergoing a course of treatment with salicylate or quinine derivatives, for a condition for which the drug cannot be ceased or substituted, at the time of the clinical worsening of tinnitus; or

 

(t)                suffering from a source of vascular sound proximal to the affected ear at the time of the clinical worsening of tinnitus; or

 

(u)              suffering from an intracranial neoplasm at the time of the clinical worsening of tinnitus; or

 

(v)              suffering from otosclerosis at the time of the clinical worsening of tinnitus; or

 

(w)            suffering from Meniere’s disease at the time of the clinical worsening of tinnitus; or

 

(x)              suffering at least one episode of otitic barotrauma within the 30 days immediately before the clinical worsening of tinnitus; or

 

(y)              inability to obtain appropriate clinical management for the tinnitus.

 

Factors that apply only to material contribution or aggravation

6. Paragraphs 5(n) to 5(y) apply only to material contribution to, or aggravation of tinnitus where the person’s tinnitus was suffered or contracted before or during (but not arising out of) the person’s relevant service; paragraph 8(1)(e), 9(1)(e) or 70(5)(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:

 

“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;


“a source of vascular sound” means one of the following:

 

(a) acquired arteriovenous fistulae;

(b)               benign intracranial hypertension;

(c)               carotid occlusion;

(d)               carotid stenosis;

(e)               cerebral atherosclerosis;

(f)               glomus jugulare tumour;

(g)              intracranial aneurysm; or

(h)              Paget’s disease of the skull;

 

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

 

“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;

 

“intracranial neoplasm” means a neoplasm affecting the brain, meninges, skull or cranial nerves;

 

“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;

 

“otosclerosis” means a primary disorder of the labyrinthine capsule, characterised by new bone formation commonly involving the footplate of the stapes;

 

“relevant service” means:

 

(a) eligible war service (other than operational service); or

(b) defence service (other than hazardous service);

 

“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, but excluding congenital deafness;

 

“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;

 

“trauma to the auditory apparatus” means injury to the tympanic membrane, ear ossicles, cochlea or acoustic nerve caused by trauma to the head;

 

“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 Log(D/100) + 85

where D = daily dose; and

 

 D = [ C1/T1 + C2/T2 + …..+ Cn/Tn] 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 120B of the Act applies.

Dated this  First 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 Repatriation Medical Authority, under the Veterans’ Entitlements Act 1986, has introduced a legislative instrument to address the problem of tinnitus and death from tinnitus among veterans. This instrument revokes an earlier determination and replaces it with a new Statement of Principles concerning tinnitus and death from tinnitus. The Repatriation Medical Authority has determined that it is more probable than not that tinnitus and death from tinnitus can be related to relevant service rendered by veterans or members of the Forces, based on available medical-scientific evidence. The Statement of Principles outlines specific factors that must be related to service for a claim to be considered, including exposure to certain levels of noise, trauma to the auditory apparatus, and treatment with ototoxic drugs, among others. This legislative instrument aims to provide clear guidelines for the assessment and recognition of tinnitus and related conditions in the veteran community. The instrument applies to all matters to which section 120B of the Act applies, ensuring that the new Statement of Principles is incorporated into the existing framework of veterans' entitlements. By establishing these criteria, the Repatriation Medical Authority seeks to facilitate the recognition and support of veterans who have suffered from tinnitus and related conditions as a result of their service.

Scope and Application

The Repatriation Medical Authority, under the authority granted by subsection 196B(3) of the Veterans’ Entitlements Act 1986, has issued a legislative instrument that revokes an earlier determination and establishes a new Statement of Principles concerning tinnitus, including death from tinnitus, for the purposes of the Act. This Statement of Principles applies to all matters that fall under section 120B of the Act, thereby affecting the eligibility of veterans and members of the Australian Defence Force for medical and related benefits concerning tinnitus. The instrument addresses the causal link between tinnitus and relevant military service, considering specific factors such as exposure to loud noises, ototoxic drug treatments, and other auditory conditions. The determination applies to individuals who have experienced tinnitus during or as a result of their military service, and it outlines the medical-scientific evidence supporting a probable connection between certain exposures and the onset or aggravation of tinnitus. The instrument also includes detailed definitions for various terms used in the context of tinnitus and its related conditions, ensuring clarity and consistency in application.

Key Provisions

The main operative sections of this legislative instrument include the revocation of Instrument No. 8 of 2001 (section 1) and the determination of a new Statement of Principles concerning tinnitus and death from tinnitus (section 2). This new Statement of Principles outlines the conditions under which tinnitus or death from tinnitus can be considered related to relevant service rendered by veterans or members of the Australian Defence Force. The specific factors that must exist for such a connection to be made are detailed in section 5, which includes exposure to certain levels of noise, trauma to the auditory apparatus, and treatment with ototoxic drugs, among others. Additionally, section 6 clarifies that certain factors apply only to the material contribution or aggravation of tinnitus in cases where the condition was present before or during service. Section 7 addresses the inclusion of other Statements of Principles where relevant, and section 8 provides definitions for terms used within the document. The obligations and requirements imposed by this Act on the parties it governs are primarily centred around the provision of evidence to substantiate claims of tinnitus or death from tinnitus being related to relevant service. Claimants must provide documentation or testimony that demonstrates exposure to the specified factors at the time of the clinical onset or worsening of tinnitus. Additionally, claimants must show that at least one of these factors is related to their service, as outlined in section 4. The Repatriation Medical Authority, in turn, is responsible for assessing the validity of these claims based on the sound medical-scientific evidence available, as indicated in section 3. The legislative instrument does not explicitly state offences, penalties, or consequences for breach within its text. However, the Veterans' Entitlements Act 1986 under which this instrument operates may have provisions that address non-compliance or fraudulent claims. Typically, such consequences could include fines, imprisonment, or the denial of benefits or entitlements. For precise details on penalties, reference to the primary Act or relevant legal guidance would be necessary.

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