{"id":"F2017L01051","name":"Statement of Principles concerning benign paroxysmal positional vertigo (Balance of Probabilities) (No. 57 of 2017)","slug":"statement-of-principles-concerning-benign-paroxysmal-positional-vertigo-balance-of-probabilities-no-","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439299,"registerId":"F2017L01051-fast-fetch-1775955379032","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning benign paroxysmal positional vertigo (Balance of Probabilities) (No. 57 of 2017)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 20.2\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n\n\n \n\nStatement of Principles\n\nconcerning\n\nBENIGN PAROXYSMAL POSITIONAL VERTIGO (Balance of Probabilities)\n\n(No. 57 of 2017)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n \n\nDated 18 August 2017\n\n \n\n \n\n \n\n \n\n \n\n| The Common Seal of the Repatriation Medical Authority was affixed to this instrument at the direction of:
|\n| --- |\n| 
Professor Nicholas Saunders AO
Chairperson
|\n\n\n \n\n \n\n\nContents\n\n1 Name\n\n2 Commencement\n\n3 Authority\n\n4 Application\n\n5 Definitions\n\n6 Kind of injury, disease or death to which this Statement of Principles relates\n\n7 Basis for determining the factors\n\n8 Factors that must exist\n\n9 Relationship to service\n\n10 Factors referring to an injury or disease covered by another Statement of Principles\n\nSchedule 1 - Dictionary\n\n1 Definitions\n\n \n\n\n\n\n1 Name\n\nThis is the Statement of Principles concerning benign paroxysmal positional vertigo (Balance of Probabilities) (No. 57 of 2017).\n\n2 Commencement\n\n This instrument commences on 18 September 2017.\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n4 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004 applies.\n\n5 Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n6 Kind of injury, disease or death to which this Statement of Principles relates\n\n(1) This Statement of Principles is about benign paroxysmal positional vertigo and death from benign paroxysmal positional vertigo.\n\nMeaning of benign paroxysmal positional vertigo\n\n(2) For the purposes of this Statement of Principles, benign paroxysmal positional vertigo means recurrent episodes of vertigo lasting less than one minute that are provoked by specific types of head movements, together with the observation of nystagmus during a provoking manoeuver or evidence of response to treatment with repositioning manoeuvers.\n\n(3) While benign paroxysmal positional vertigo attracts ICD‑10‑AM code H81.1, in applying this Statement of Principles the meaning of benign paroxysmal positional vertigo is that given in subsection (2).\n\n(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), Ninth Edition, effective date of 1 July 2015, copyrighted by the Independent Hospital Pricing Authority, ISBN 978‑1‑76007‑020‑5.\n\nDeath from benign paroxysmal positional vertigo\n\n(5) For the purposes of this Statement of Principles, benign paroxysmal positional vertigo, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's benign paroxysmal positional vertigo.\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n7 Basis for determining the factors\n\nOn the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that benign paroxysmal positional vertigo and death from benign paroxysmal positional vertigo can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA.\n\nNote: relevant service is defined in the Schedule 1 – Dictionary.\n\n8 Factors that must exist\n\nAt least one of the following factors must exist before it can be said that, on the balance of probabilities, benign paroxysmal positional vertigo or death from benign paroxysmal positional vertigo is connected with the circumstances of a person's relevant service:\n\n(1) having trauma involving the head or the head and neck within the 30 days before the clinical onset of benign paroxysmal positional vertigo;\n\nNote: Types of trauma include the head being struck by an object, the head striking an object or the head undergoing jolting movements. \n\n(2) having surgery to the head or neck, including dental surgery, where that surgery involves transmission of vibration or percussive forces to the inner ear, in the three months before the clinical onset of benign paroxysmal positional vertigo;\n\n(3) having cochlear implantation surgery in the three years before the clinical onset of benign paroxysmal positional vertigo;\n\n(4) having Meniere's disease on the affected side before the clinical onset of benign paroxysmal positional vertigo;\n\n(5) having vestibular neuritis or labyrinthitis on the affected side within the three months before the clinical onset of benign paroxysmal positional vertigo;\n\n(6) being infected with herpes simplex virus or varicella zoster virus, where there is evidence of the infection causing a clinical illness involving the vestibular nerve of the affected side, before the clinical onset of benign paroxysmal positional vertigo;\n\n(7) undertaking physical activity at a rate of at least six METs, where the activity involves sudden head turning, jolting or vibration of the body, within the seven days before the clinical onset of benign paroxysmal positional vertigo;\n\nNote: MET is defined in the Schedule 1 - Dictionary.\n\n(8) having trauma involving the head or the head and neck within the 30 days before the clinical worsening of benign paroxysmal positional vertigo;\n\nNote: Types of trauma include the head being struck by an object, the head striking an object or the head undergoing jolting movements. \n\n(9) having surgery to the head or neck, including dental surgery, where that surgery involves transmission of vibration or percussive forces to the inner ear, in the three months before the clinical worsening of benign paroxysmal positional vertigo;\n\n(10) having cochlear implantation surgery in the three years before the clinical worsening of benign paroxysmal positional vertigo;\n\n(11) having Meniere's disease on the affected side before the clinical worsening of benign paroxysmal positional vertigo;\n\n(12) having vestibular neuritis or labyrinthitis on the affected side within the three months before the clinical worsening of benign paroxysmal positional vertigo;\n\n(13) being infected with herpes simplex virus or varicella zoster virus, where there is evidence of the infection causing a clinical illness involving the vestibular nerve of the affected side, before the clinical worsening of benign paroxysmal positional vertigo;\n\n(14) undertaking physical activity at a rate of at least six METs, where the activity involves sudden head turning, jolting or vibration of the body, within the seven days before the clinical worsening of benign paroxysmal positional vertigo;\n\nNote: MET is defined in the Schedule 1 - Dictionary.\n\n(15) inability to obtain appropriate clinical management for benign paroxysmal positional vertigo.\n\n9 Relationship to service\n\n(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.\n\n(2) The factors set out in subsections 8(8) to 8(15) apply only to material contribution to, or aggravation of, benign paroxysmal positional vertigo where the person's benign paroxysmal positional vertigo was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n\n10 Factors referring to an injury or disease covered by another Statement of Principles\n\nIn this Statement of Principles:\n\n(1) if a factor referred to in section 8 applies in relation to a person; and\n\n(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;\n\nthen 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.\n\n \n\n \n\nSchedule 1 - Dictionary \n\nNote: See Section 5\n\n1 Definitions\n\nIn this instrument:\n\n benign paroxysmal positional vertigo—see subsection 6(2).\n\n MET means a unit of measurement of the level of physical exertion. 1 MET = 3.5 ml of oxygen/kg of body weight per minute, 1.0 kcal/kg of body weight per hour or resting metabolic rate.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n relevant service means:\n\n(a) eligible war service (other than operational service) under the VEA;\n\n(b) defence service (other than hazardous service and British nuclear test defence service) under the VEA; or\n\n(c) peacetime service under the MRCA.\n\nNote: MRCA and VEA are also defined in the Schedule 1 - Dictionary. \n\n terminal event means the proximate or ultimate cause of death and includes the following:\n\n(a) pneumonia;\n\n(b) respiratory failure;\n\n(c) cardiac arrest;\n\n(d) circulatory failure; or\n\n(e) cessation of brain function.\n\n VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard Repatriation Medical Authority Statement of Principles, tightly scoped to establish medical causation criteria for a single specific condition (BPPV). It follows the standard template for such instruments and does not appear to have expanded beyond its original purpose of determining service connection for this particular vestibular disorder."},"complexity_factors":["15 distinct factual scenarios with varying timeframes (7 days, 30 days, 3 months, 3 years)","Dual structure covering both clinical onset and clinical worsening with partially overlapping but distinct factor sets","Cross-references to other Statements of Principles for conditions mentioned as factors (Ménière's disease, vestibular neuritis, labyrinthitis)","Technical medical terminology requiring definitions (nystagmus, repositioning manoeuvers, vestibular nerve, METs)","Specific definition of BPPV that overrides the standard ICD-10-AM classification","Conditional application of factors 8-15 restricted to aggravation cases where condition pre-existed service","Nested definitions in Schedule 1 with some terms defined by cross-reference to substantive sections"],"plain_english_summary":"This instrument sets the medical criteria for when benign paroxysmal positional vertigo (BPPV) — or death from it — is presumed more likely than not to be connected to Australian military service, letting veterans and current/former defence members seek compensation under the Veterans' Entitlements Act and MRCA. \n\nIt lists specific service-linked factors that can make new or worsening BPPV compensable (e.g., recent head/neck trauma or surgery, cochlear implants, viral inner‑ear infection, intense head‑movements, prior vestibular disease, or inability to obtain treatment)."},"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"},"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":false,"description":"This SOP stays within the established purpose of Statements of Principles under the VEA/MRCA framework: it defines the medical criteria for connecting a specified condition (BPPV) to relevant service. It does not broaden the statutory scheme or add new categories of entitlement; it simply specifies the clinical definition and a closed list of factors and time windows for causation. There is no material expansion beyond that original purpose in this instrument."},"complexity_factors":["Short instrument: 10 main sections plus a Schedule (relatively concise).","15 listed causal factors in section 8 with repeated parallel structure (onset and worsening).","Several specific temporal windows creating conditional logic (30 days, 3 months, 3 years, 7 days).","Cross-reference to other Statements of Principles (section 10) which can import external complexity.","Limited number of defined terms in Schedule 1 (benign paroxysmal positional vertigo, MET, MRCA, relevant service, terminal event, VEA).","Use of a specific evidentiary standard ('balance of probabilities') but no complex multi‑tiered evidentiary rules."],"plain_english_summary":"**What this instrument does (mechanical effect)\n\n- This is a \"Statement of Principles\" (SOP) made by the Repatriation Medical Authority. It sets the medical criteria used to decide whether benign paroxysmal positional vertigo (BPPV) — or death contributed to by BPPV — can be connected to a veteran's or member's relevant service for the purposes of claims under the Veterans' Entitlements Act 1986 (VEA) or the Military Rehabilitation and Compensation Act 2004 (MRCA). (See sections 3–4 and 6.)\n\n**Who it affects\n\n- Veterans, ex‑members and current members making claims under the VEA or MRCA for BPPV (or death from BPPV). (See section 4.)\n- Medical practitioners and medico‑legal advisers who supply evidence for those claims.\n- The department that administers entitlements under the VEA/MRCA (payments or compensation are decided under those Acts once causation is established using this SOP).\n\n**How it determines causation (plain terms)\n\n- The SOP defines BPPV for claim purposes (recurrent brief vertigo provoked by head movements, nystagmus on testing, or response to repositioning treatment). It also includes death that a BPPV episode contributed to. (See section 6.)\n- The standard of proof is the civil standard \"balance of probabilities\" — the Authority decided that, on available medical evidence, it is more likely than not that BPPV can be related to relevant service. (See section 7.)\n- The SOP lists specific factors; at least one must be present to link BPPV to service. These include recent head/neck trauma, certain head/neck surgeries (including dental) within defined time windows, cochlear implantation in the prior three years, pre‑existing Meniere's disease or vestibular neuritis/labyrinthitis on the affected side, certain viral infections affecting the vestibular nerve, intense physical activity involving sudden head movements within seven days, or inability to obtain appropriate clinical management. (See section 8.)\n- Some factors apply both to initial onset and to clinical worsening; others apply only as material contribution or aggravation where BPPV existed before or during service but did not arise out of service. (See sections 8 and 9.)\n- If a listed factor refers to a condition already covered by another SOP, that other SOP governs how that factor is applied. (See section 10.)\n\n**Official rationale (what the Authority says)\n\n- The Repatriation Medical Authority states that, on the available medical‑scientific evidence, it is more probable than not that BPPV and death from BPPV can be related to relevant service. The SOP translates that medical judgement into concrete temporal and clinical criteria for decision‑makers. (See section 7.)\n\n**Practical consequences, incentives and trade‑offs (testing the rationale)\n\n- Who decides and who pays: This SOP does not itself award money. It provides the causation rule used by decision makers applying the VEA or MRCA. If decision makers accept a claim on that basis, benefits or compensation under those Acts may follow — those are publicly funded. (See sections 3–4 and 6.)\n- Evidence burden and compliance: Claimants must produce clinical evidence showing BPPV as defined (short positional vertigo with nystagmus or response to repositioning) plus evidence that one of the listed factors occurred within the stated time windows (for example, head trauma within 30 days, surgery within three months, cochlear implant within three years). That creates a predictable evidentiary checklist but requires contemporaneous medical records or credible clinical history. (See sections 6 and 8.)\n- Bureaucratic discretion and implementation risk: The Authority sets the medical test, but application rests with the decision‑maker under the VEA/MRCA. Disputes can arise over whether specific events meet the SOP’s wording (e.g. whether a dental procedure transmitted percussive forces to the inner ear) or whether clinical records adequately show vestibular involvement. That produces case‑by‑case judgment calls.\n- Administrative costs and fiscal impact: By defining causal links with clear time windows, the SOP can increase or reduce grant rates of entitlement for BPPV claims; any net change in approvals would affect public expenditure under the VEA/MRCA. The instrument itself does not estimate cost. (See sections 8 and 9.)\n- Effects on private sector providers and behaviour: Private clinicians and surgeons supplying evidence may face greater demand to document perioperative vibrations, head trauma, or vestibular infections explicitly. Private practice is not restricted, but recordkeeping and the content of clinical notes become more consequential for claims. Insurers or private compensation schemes are not directly changed by this SOP; it only governs eligibility under veterans' statutory schemes. (See sections 5 and Schedule 1.)\n- Concentrated benefits and diffuse costs: The direct beneficiaries are claimants whose clinical history meets the listed factors; costs, if any, are borne by the public funds that pay statutory entitlements. The SOP concentrates the medical basis for entitlement on a defined set of circumstances (see section 8).\n- Potential for substitution and unintended consequences: Where the SOP ties causation to specific recent events (trauma, surgery, high‑MET activity), claimants or advisers may emphasise those items in clinical histories or seek retrospective documentation. Conversely, absence of those factors may make service connection harder even where other plausibly related mechanisms exist.\n\n**Key implementation details to watch**\n\n- Time windows: trauma (30 days), head/neck surgery (3 months), cochlear implant (3 years), intense physical activity (7 days), vestibular infections or neuritis/labyrinthitis (3 months). (See section 8.)\n- Definition of BPPV used for claims may differ from the ICD code; the SOP uses its own clinical definition. (See section 6(2)–(3).)\n\n**Where to look in the instrument for specifics**\n\n- Definitions and terms: Schedule 1. (See section 5 and Schedule 1.)\n- Causation factors: section 8. \n- How factors relate to service timing and aggravation: section 9.\n\n"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-benign-paroxysmal-positional-vertigo-balance-of-probabilities-no-","history":"/api/acts/statement-of-principles-concerning-benign-paroxysmal-positional-vertigo-balance-of-probabilities-no-/history","analysis":"/api/acts/statement-of-principles-concerning-benign-paroxysmal-positional-vertigo-balance-of-probabilities-no-/analysis","conflicts":"/api/acts/statement-of-principles-concerning-benign-paroxysmal-positional-vertigo-balance-of-probabilities-no-/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-benign-paroxysmal-positional-vertigo-balance-of-probabilities-no-/important-cases","documents":"/api/acts/statement-of-principles-concerning-benign-paroxysmal-positional-vertigo-balance-of-probabilities-no-/documents"}}