{"id":"F2019L01095","name":"Statement of Principles concerning conductive hearing loss (Balance of Probabilities) (No. 82 of 2019)","slug":"statement-of-principles-concerning-conductive-hearing-loss-balance-of-probabilities-no-82-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440203,"registerId":"F2019L01095-fast-fetch-1775955921843","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning conductive hearing loss (Balance of Probabilities) (No. 82 of 2019)","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\nCONDUCTIVE HEARING LOSS (Balance of Probabilities)\n\n(No. 82 of 2019)\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 23 August 2019\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 Repeal\n\n5 Application\n\n6 Definitions\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n8 Basis for determining the factors\n\n9 Factors that must exist\n\n10 Relationship to service\n\n11 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 conductive hearing loss (Balance of Probabilities) (No. 82 of 2019).\n\n2 Commencement\n\n This instrument commences on 23 September 2019.\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning conductive hearing loss No. 8 of 2011 (Federal Register of Legislation No. F2010L03256) made under subsection 196B(3) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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\n6 Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n7 Kind of injury, disease or death to which this Statement of Principles relates\n\n(1) This Statement of Principles is about conductive hearing loss and death from conductive hearing loss\n\nMeaning of conductive hearing loss\n\n(2) For the purposes of this Statement of Principles, conductive hearing loss:\n\n(a) means acquired hearing loss due to defective conduction of sound from the external environment to the inner ear, with a permanent shift to a hearing threshold level of 25 decibels (dB) or more in the frequency of 500, 1 000, 2 000, 3 000, 4 000 or 6 000 hertz (Hz), and an air-bone gap in the affected ear of:\n\n(i) at least 10 dB at three or more of these frequencies; or\n\n(ii) at least 15 dB at any one of these frequencies.\n\nNote 1: The hearing loss is related to defective conduction of sound through the external auditory canal, the tympanic membrane (ear drum), middle ear ossicles or the middle ear space.\n\nNote 2: air-bone gap is defined in the Schedule 1 – Dictionary.\n\nDeath from conductive hearing loss\n\n(3) For the purposes of this Statement of Principles, conductive hearing loss, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's conductive hearing loss.\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n8 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 conductive hearing loss and death from conductive hearing loss can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA.\n\nNote: MRCA, relevant service and VEA are defined in the Schedule 1 – Dictionary.\n\n9 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, conductive hearing loss or death from conductive hearing loss is connected with the circumstances of a person's relevant service:\n\n(1) having otosclerosis on the affected side at the time of the clinical onset of conductive hearing loss;\n\n(2) having a disease from the specified list of bone diseases, involving the conductive hearing apparatus of the affected side, at the time of the clinical onset of conductive hearing loss;\n\nNote: conductive hearing apparatus and specified list of bone diseases are defined in the Schedule 1 - Dictionary. \n\n(3) having an episode of otitic barotrauma involving the affected ear, within the seven days before the clinical onset of conductive hearing loss;\n\n(4) being exposed to a peak sound pressure level at the tympanic membrane of at least 140 dB(C), within the seven days before the clinical onset of conductive hearing loss;\n\nNote: dB(C) is defined in the Schedule 1 - Dictionary. \n\n(5) being exposed to an explosive blast within the seven days before the clinical onset of conductive hearing loss;\n\n(6) being struck by lightning within the seven days before the clinical onset of conductive hearing loss;\n\n(7) having blunt trauma, penetrating trauma or surgery, involving the conductive hearing apparatus of the affected ear, within the seven days before the clinical onset of conductive hearing loss;\n\nNote: conductive hearing apparatus is defined in the Schedule 1 - Dictionary. \n\n(8) having acquired, permanent narrowing or obstruction of the external auditory canal of the affected ear, at the time of the clinical onset of conductive hearing loss;\n\nNote 1: Examples of causes of narrowing or obstruction of the external auditory canal include, but are not limited to:\n\n(a) benign fibro-osseous lesion;\n\n(b) benign or malignant neoplasm;\n\n(c) chronic otitis externa;\n\n(d) exostosis of the external auditory canal;\n\n(e) granuloma; and\n\n(f) necrotising otitis externa.\n\nNote 2: exostosis of the external auditory canal is defined in the Schedule 1 – Dictionary.\n\n(9) having chronic otitis media, involving the middle ear of the affected side, at the time of the clinical onset of conductive hearing loss;\n\nNote: chronic otitis media is defined in the Schedule 1 - Dictionary. \n\n(10) having:\n\n(a) a benign or malignant neoplasm; or\n\n(b) other mass lesion;\n\ninvolving the middle ear of the affected side, at the time of the clinical onset of conductive hearing loss;\n\nNote: Examples of neoplasms or mass lesions involving the middle ear include, but are not limited to:\n\n(a) cholesteatoma;\n\n(b) granuloma; and\n\n(c) neuroendocrine adenoma.\n\n(11) having a disease from the specified list of autoimmune diseases, at the time of the clinical onset of conductive hearing loss;\n\nNote: specified list of autoimmune diseases is defined in the Schedule 1 – Dictionary.\n\n(12) undergoing a course of therapeutic radiation for cancer, where the conductive hearing apparatus of the affected side was in the field of radiation, before the clinical onset of conductive hearing loss;\n\nNote: conductive hearing apparatus is defined in the Schedule 1 – Dictionary.\n\n(13) having otosclerosis on the affected side at the time of the clinical worsening of conductive hearing loss;\n\n(14) having a disease from the specified list of bone diseases, involving the conductive hearing apparatus of the affected side, at the time of the clinical worsening of conductive hearing loss;\n\nNote: conductive hearing apparatus and specified list of bone diseases are defined in the Schedule 1 - Dictionary. \n\n(15) having an episode of otitic barotrauma involving the affected ear, within the seven days before the clinical worsening of conductive hearing loss;\n\n(16) being exposed to a peak sound pressure level at the tympanic membrane of at least 140 dB(C), within the seven days before the clinical worsening of conductive hearing loss;\n\nNote: dB(C) is defined in the Schedule 1 - Dictionary. \n\n(17) being exposed to an explosive blast within the seven days before the clinical worsening of conductive hearing loss;\n\n(18) being struck by lightning within the seven days before the clinical worsening of conductive hearing loss;\n\n(19) having blunt trauma, penetrating trauma or surgery, involving the conductive hearing apparatus of the affected ear, within the seven days before the clinical worsening of conductive hearing loss;\n\nNote: conductive hearing apparatus is defined in the Schedule 1 - Dictionary. \n\n(20) having acquired, permanent narrowing or obstruction of the external auditory canal of the affected ear, at the time of the clinical worsening of conductive hearing loss;\n\nNote 1: Examples of causes of narrowing or obstruction of the external auditory canal include, but are not limited to:\n\n(a) benign fibro-osseous lesion;\n\n(b) benign or malignant neoplasm;\n\n(c) chronic otitis externa;\n\n(d) exostosis of the external auditory canal;\n\n(e) granuloma; and\n\n(f) necrotising otitis externa.\n\nNote 2: exostosis of the external auditory canal is defined in the Schedule 1 – Dictionary.\n\n(21) having chronic otitis media, involving the middle ear of the affected side, at the time of the clinical worsening of conductive hearing loss;\n\nNote: chronic otitis media is defined in the Schedule 1 - Dictionary. \n\n(22) having:\n\n(a) a benign or malignant neoplasm; or\n\n(b) other mass lesion;\n\ninvolving the middle ear of the affected side, at the time of the clinical worsening of conductive hearing loss;\n\nNote: Examples of neoplasms or mass lesions involving the middle ear include, but are not limited to:\n\n(a) cholesteatoma;\n\n(b) granuloma; and\n\n(c) neuroendocrine adenoma.\n\n(23) having a disease from the specified list of autoimmune diseases, at the time of the clinical worsening of conductive hearing loss;\n\nNote: specified list of autoimmune diseases is defined in the Schedule 1 – Dictionary.\n\n(24) undergoing a course of therapeutic radiation for cancer, where the conductive hearing apparatus of the affected side was in the field of radiation, before the clinical worsening of conductive hearing loss;\n\nNote: conductive hearing apparatus is defined in the Schedule 1 – Dictionary.\n\n(25) inability to obtain appropriate clinical management for conductive hearing loss.\n\n10 Relationship to service\n\n(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.\n\n(2) The factors set out in subsections 9(13) to 9(25) apply only to material contribution to, or aggravation of, conductive hearing loss where the person's conductive hearing loss was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n\n11 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 9 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 6\n\n1 Definitions\n\nIn this instrument:\n\nair-bone gap means a difference between the air conduction and bone conduction thresholds, as measured by pure-tone audiometry.\n\nchronic otitis media means a chronic inflammation of the middle ear that is characterised by discharge from the middle ear through a perforated tympanic membrane that persists for at least six weeks.\n\nconductive hearing apparatus means the external auditory canal or middle ear, including the tympanic membrane (ear drum) and middle ear ossicles.\n\nconductive hearing loss—see subsection 7(2).\n\ndB(C) is the sound pressure level in decibels measured by a sound level meter using a type C electronic filter. The type C filter is used to measure peak or impact sound pressure levels.\n\nexostosis of the external auditory canal means abnormal bone growth within the external auditory ear canal caused by irritation from prolonged or repeated exposure to cold wind and water. It is also known as surfer's ear.\n\nfibrous dysplasia is a benign disorder that causes marrow fibrosis, abnormal matrix production, and stimulation of osteoclastic reabsorption.\n\nMRCA means the Military Rehabilitation and Compensation Act 2004.\n\nosteoma means a benign neoplasm in which a new piece of bone usually grows on another piece of bone.\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\nspecified list of autoimmune diseases means:\n\n(a) granulomatosis with polyangiitis (Wegener granulomatosis);\n\n(b) relapsing polychondritis;\n\n(c) rheumatoid arthritis; \n\n(d) systemic lupus erythematosus; or\n\n(e) systemic sclerosis.\n\nspecified list of bone diseases means:\n\n(a) fibrous dysplasia;\n\n(b) osteoma;\n\n(c) osteonecrosis; or\n\n(d) Paget's disease of bone.\n\nNote: fibrous dysplasia and osteoma are also defined in the Schedule 1 – Dictionary.\n\nterminal 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\nVEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n\n \n","sortOrder":0}],"analysis":{"flash_summary_failed":{"failed":true,"reason":"Unauthenticated. Configure AI_GATEWAY_API_KEY or use a provider module. Learn more: https://ai-sdk.dev/unauthenticated-ai-gateway","source":"analysis-cron"},"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":false,"description":"This Statement continues the original purpose: to set the medical criteria linking conductive hearing loss (and death contributed to by it) to relevant service for entitlement decisions. It does not grow significantly beyond that purpose. Relative to prior instruments it chiefly clarifies diagnostic thresholds, lists specific causal factors (including timing windows), and adds an explicit factor concerning inability to obtain appropriate clinical management (section 9(25)). Those are refinements and some modest broadening in evidentiary pathways, but not a significant change in overall scope or objective."},"complexity_factors":["25 enumerated causal factors in section 9 (many duplicated for onset and for clinical worsening).","About 14 defined terms in Schedule 1 (e.g. air-bone gap, chronic otitis media, conductive hearing apparatus, dB(C), exostosis, fibrous dysplasia, MRCA, osteoma, relevant service, specified lists, terminal event, VEA).","Multiple quantitative thresholds to interpret (25 dB hearing loss threshold; air–bone gap criteria: ≥10 dB at three frequencies or ≥15 dB at one frequency; peak sound pressure level ≥140 dB(C)).","Temporal windows: several factors require occurrence within seven days before clinical onset or worsening (adds strict timing conditions).","Cross-references to other Statements of Principles (section 11) which may require consulting other instruments and create conditional application.","Conditional application rule limiting worsening factors to cases where hearing loss existed before or during service (section 10(2)) — a non-intuitive exception.","Repeal and replacement of an earlier Statement (section 4) — requires comparison with previous instrument for full interpretation.","Multiple lists embedded in the Schedule (specified autoimmune diseases: 5 items; specified bone diseases: 4 items) that must be matched to clinical records."],"plain_english_summary":"**What this instrument does (mechanically)**\n\n- Replaces the previous Repatriation Medical Authority (RMA) Statement of Principles for conductive hearing loss and sets the medical criteria the Department of Veterans’ Affairs (and decision-makers under the Military Rehabilitation and Compensation Act) must use when deciding whether conductive hearing loss (or death contributed to by it) is connected to a person’s relevant service (see sections 3–5 and 7).\n- Defines the medical diagnosis thresholds for “conductive hearing loss” used for decisions: an acquired conductive hearing loss with a permanent hearing threshold shift of 25 dB or more at specified frequencies and with a specified air–bone gap (see section 7(2)).\n- Lists 25 specific factual/medical factors (and timed windows for some) any one of which, if shown and related to the person’s relevant service, is sufficient to satisfy the RMA’s “balance of probabilities” causal test that the condition is connected to service (see section 9).\n- Clarifies how factors that refer to clinical worsening apply (they only address material contribution or aggravation where the hearing loss existed before or during service) (see section 10(2)).\n- Includes a dictionary of defined terms used throughout the instrument (Schedule 1).\n\n**Who this affects**\n\n- Current and former members of the Australian Defence Force (and veterans) claiming entitlements under the Veterans’ Entitlements Act 1986 (VEA) or the Military Rehabilitation and Compensation Act 2004 (MRCA) for conductive hearing loss, or for death where conductive hearing loss contributed to the terminal event (see section 5 and 7(3)).\n- Medical practitioners and audiologists providing evidence for entitlement claims: the Statement prescribes the audiometric thresholds and medical events that decision-makers will treat as causative if proved (see sections 7 and 9).\n- The Department of Veterans’ Affairs (and ultimately, taxpayers), who pay accepted claims once the legal and medical tests are satisfied.\n\n**Why it matters (stated purpose and practical effect)**\n\n- The RMA states its view that, on the available medical-scientific evidence, it is more probable than not that conductive hearing loss can be related to relevant service (section 8). That is a statement of medical causation used by decision-makers when applying the statutory standard of proof.\n- Practically, if a claimant can demonstrate one of the listed factors (section 9) and show it is related to their relevant service (section 10(1)), decision-makers will treat the RMA’s Statement as meeting the medical causation requirement on the balance of probabilities. This reduces the need for separate medical causal expert evidence on those particular factors.\n\n**Key medical thresholds and examples to watch for**\n\n- Diagnostic threshold: permanent shift to a hearing threshold level of 25 dB or more at 500, 1000, 2000, 3000, 4000 or 6000 Hz plus an air–bone gap of at least 10 dB at three or more of these frequencies, or at least 15 dB at any one frequency (section 7(2)).\n- Many acute external insults are included if they occur within seven days before clinical onset or clinical worsening — e.g. otitic barotrauma, exposure to peak sound pressure of at least 140 dB(C), explosive blast, lightning strike, blunt or penetrating trauma, or surgery involving the conductive hearing apparatus (section 9(3)–(7), (15)–(19)).\n- Chronic disease states and structural causes are also included at the time of onset or worsening — e.g. otosclerosis, chronic otitis media, neoplasms/mass lesions of the middle ear, autoimmune diseases, specified bone diseases, acquired permanent narrowing/obstruction of the external auditory canal, and therapeutic radiation to the ear (section 9(1)–(2), (8)–(14), (20)–(24)).\n- A non-medical factor: “inability to obtain appropriate clinical management for conductive hearing loss” is listed as a factor (section 9(25)).\n\n**How the Statement changes incentives, costs and behaviour (practical tests and trade-offs)**\n\n- Who pays: the Commonwealth (via the Department) pays accepted claims; taxpayers bear the aggregate cost of any increased acceptance of claims that meet the RMA’s criteria.\n- Who decides: the RMA sets the medical criteria; claims officers and tribunals apply them to individual claims. The RMA’s Statement operates as authoritative medical guidance for decision-makers (sections 3 and 8).\n- Claimant behaviour: claimants and their clinicians will seek to document one or more of the listed factors and meet the audiometric thresholds to improve the chance of acceptance. The inclusion of a clear audiometric threshold reduces uncertainty about diagnostic evidence required (section 7(2)).\n- Clinical/administrative burden: medical practitioners must supply audiometry and clinical records showing timing (onset or worsening), presence of listed diseases/trauma, or evidence that appropriate management could not be obtained (section 9 and Schedule 1 definitions). This can increase administrative work for clinicians and the Department.\n- Bureaucratic discretion and cross-application: section 11 makes factors that refer to conditions covered by other Statements of Principles apply according to those other Statements. That creates cross-references and some administrative complexity where multiple SOPs overlap.\n- Trade-offs and risks:\n - The Statement reduces the need for novel causation expert evidence on the listed factors (lower claimant transaction costs), but it transfers discretion to decision-makers to assess whether the factor is shown and related to service (implementation risk in evidentiary assessment) (sections 9–10).\n - The seven‑day temporal windows for acute events set tight evidentiary timing requirements: failure to show timing within that window could lead to claim rejection even where an event plausibly harmed hearing (sections 9(3), (4), (15), (16)).\n - The factor “inability to obtain appropriate clinical management” (section 9(25)) introduces an evidentiary and policy judgment about access to care; assessing this may require facts about health‑system access, not only biomedical causation, creating potential administrative difficulty and variance in outcomes.\n\n**Concentrated benefits and diffuse costs**\n\n- Benefits are concentrated: individual claimants who meet the Statement’s factors can obtain entitlements. Costs are diffuse: the Commonwealth budget funds accepted claims.\n\n**Implementation considerations**\n\n- Decision-makers will need reliable audiometry records and contemporaneous medical notes to confirm timing and presence of listed conditions. Establishing the “air–bone gap” and the 25 dB threshold requires properly performed pure‑tone audiometry (Schedule 1 definition).\n- Where a listed factor is itself an injury or disease already governed by another RMA Statement, the rules in that other Statement apply (section 11), which means claim preparation must account for those cross-references.\n\n**Source-claimed rationale vs practical costs**\n\n- The RMA’s stated rationale is that the current medical-scientific evidence supports treating these factors as sufficient for causation on the balance of probabilities (section 8). Practically, that lowers evidentiary burdens for claimants who can demonstrate one of the listed factors, but it requires precise clinical documentation and may shift some decision-making complexity into administrative assessment, especially where timing, access to care, or overlap with other Statements arise (sections 9–11)."},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"The legislation maintains its original purpose as a medical determination instrument for a specific condition (conductive hearing loss). It updates the 2011 version with revised medical factors but does not expand beyond its intended function of establishing service connection criteria for veterans' compensation claims."},"complexity_factors":["25 distinct factual factors with specific temporal requirements (e.g., 'within seven days' for 8 factors)","Dual structure covering both clinical onset (factors 1-12) and clinical worsening (factors 13-24) with near-mirror provisions","14 defined terms in Schedule 1, including nested definitions (e.g., 'specified list of bone diseases' contains 4 items, two of which have separate definitions)","Cross-references to other Statements of Principles via section 11 for conditions mentioned in the factors","Technical medical terminology requiring audiometric measurements (air-bone gap, decibel thresholds at specific frequencies, dB(C) weighting)","Conditional application in section 10(2) limiting factors 13-25 to aggravation cases where hearing loss pre-existed service"],"plain_english_summary":"This instrument updates the medical rules for claiming compensation for conductive hearing loss, replacing the 2011 guidance. It defines the clinical thresholds (permanent hearing shift plus air–bone gap), sets 25 medical factors used to link the condition to service, and applies the “balance of probabilities” test. It affects veterans and current/former defence members under the Veterans’ Entitlements Act and MRCA. Practically, it creates a medical‑legal checklist that determines entitlement."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-conductive-hearing-loss-balance-of-probabilities-no-82-of-2019","history":"/api/acts/statement-of-principles-concerning-conductive-hearing-loss-balance-of-probabilities-no-82-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-conductive-hearing-loss-balance-of-probabilities-no-82-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-conductive-hearing-loss-balance-of-probabilities-no-82-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-conductive-hearing-loss-balance-of-probabilities-no-82-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-conductive-hearing-loss-balance-of-probabilities-no-82-of-2019/documents"}}