{"id":"F2021L00027","name":"Statement of Principles concerning otitis externa (Balance of Probabilities) (No. 26 of 2021)","slug":"statement-of-principles-concerning-otitis-externa-balance-of-probabilities-no-26-of-2021","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440741,"registerId":"F2021L00027-fast-fetch-1775956273044","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning otitis externa (Balance of Probabilities) (No. 26 of 2021)","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\nOTITIS EXTERNA (Balance of Probabilities)\n\n(No. 26 of 2021)\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 24 December 2020\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:
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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 otitis externa (Balance of Probabilities) (No. 26 of 2021).\n\n2 Commencement\n\n This instrument commences on 25 January 2021.\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 otitis externa No. 59 of 2012 (Federal Register of Legislation No. F2012L01803) made under subsections 196B(3) and (8) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 otitis externa and death from otitis externa.\n\nMeaning of otitis externa\n\n(2) For the purposes of this Statement of Principles, otitis externa:\n\n(a) means an infectious or non-infectious inflammation of the external auditory canal; and\n\n(b) includes:\n\n(i) acute diffuse otitis externa;\n\n(ii) acute localised otitis externa (furunculosis);\n\n(iii) eczematous otitis externa;\n\n(iv) malignant otitis externa;\n\n(v) acquired cholesteatoma of the external auditory canal; and\n\n(vi) otomycosis.\n\nNote 1: Otitis externa may be acute or chronic.\n\nNote 2: Typical symptoms of otitis externa include ear pain, pruritus, discharge and hearing loss.\n\nNote 3: Otitis externa may be accompanied by inflammation of the auricle.\n\nNote 4: otomycosis is defined in the Schedule 1 - Dictionary.\n\n(3) While otitis externa attracts ICD‑10‑AM code H60, H62.0, H62.1, H62.2, H62.3 or H62.4, in applying this Statement of Principles the meaning of otitis externa 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), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4.\n\nDeath from otitis externa\n\n(5) For the purposes of this Statement of Principles, otitis externa, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's otitis externa.\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 otitis externa and death from otitis externa 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, otitis externa or death from otitis externa is connected with the circumstances of a person's relevant service:\n\n(1) participating in aquatic activities within the ten days before the clinical onset of otitis externa;\n\nNote: aquatic activities is defined in the Schedule 1 - Dictionary.\n\n(2) being exposed to hot and humid weather conditions or heavy rains, on at least ten days within the 30 days before the clinical onset of otitis externa;\n\nNote: hot and humid weather conditions is defined in the Schedule 1 - Dictionary.\n\n(3) undergoing a course of therapeutic radiation for cancer, where the affected ear was in the field of radiation, before the clinical onset of otitis externa;\n\n(4) having trauma to the external auditory canal of the affected ear within the ten days before the clinical onset of otitis externa;\n\nNote: Examples of trauma include a blunt or penetrating injury, a surgical procedure and blast force.\n\n(5) having a foreign object or implement inserted into, or removed from, the external ear canal of the affected ear within the ten days before the clinical onset of otitis externa;\n\nNote: An example of a foreign body or implement is an ear lavage instrument used for aural irrigation.\n\n(6) blocking the external auditory canal of the affected ear with an extrinsic aural device for a cumulative period of at least 16 hours within the seven days before the clinical onset of otitis externa;\n\nNote: extrinsic aural device is defined in the Schedule 1 - Dictionary.\n\n(7) having an acquired, persistent narrowing or obstruction of the external auditory canal of the affected ear at the time of the clinical onset of otitis externa;\n\nNote 1: Examples of causes of narrowing or obstruction of the external auditory canal include:\n\n(a) benign or malignant neoplasm;\n\n(b) cerumen accumulation;\n\n(c) exostosis of the external auditory canal; and\n\n(d) granuloma.\n\nNote 2: exostosis of the external auditory canal is defined in the Schedule 1 - Dictionary.\n\n(8) having an inflammatory skin disease at the time of the clinical onset of otitis externa, where the skin disease involves the external auditory canal of the affected ear;\n\nNote 1: Examples of an inflammatory skin disease include allergic or irritant contact dermatitis, seborrhoeic dermatitis, lichen planus, psoriasis and eczema.\n\nNote 2: Irritant or allergic contact dermatitis of the external auditory canal may be caused by shampoos, ototopical medications or accidental chemical splashes to the ear.\n\n(9) having an infectious, autoimmune or granulomatous disease at the time of the clinical onset of otitis externa, where the disease involves the external auditory canal of the affected ear;\n\nNote: Examples of an infectious, autoimmune or granulomatous disease include herpes zoster, relapsing polychondritis and sarcoidosis.\n\n(10) having chronic suppurative otitis media, involving the middle ear of the affected side, within the 30 days before the clinical onset of otitis externa;\n\nNote: chronic suppurative otitis media is defined in the Schedule 1 - Dictionary.\n\n(11) having diabetes mellitus at the time of the clinical onset of otitis externa;\n\n(12) being in an immunocompromised state as specified at the time of the clinical onset of otitis externa;\n\nNote: immunocompromised state as specified is defined in the Schedule 1 - Dictionary.\n\n(13) for otomycosis only, taking a course of oral antibiotic therapy or having ototopical therapy for the treatment of otitis externa of the affected ear within the two weeks before the clinical onset of otitis externa;\n\nNote: otomycosis is defined in the Schedule 1 - Dictionary.\n\n(14) participating in aquatic activities within the ten days before the clinical worsening of otitis externa;\n\nNote: aquatic activities is defined in the Schedule 1 - Dictionary.\n\n(15) being exposed to hot and humid weather conditions or heavy rains, on at least ten days within the 30 days before the clinical worsening of otitis externa;\n\nNote: hot and humid weather conditions is defined in the Schedule 1 - Dictionary.\n\n(16) undergoing a course of therapeutic radiation for cancer, where the affected ear was in the field of radiation, before the clinical worsening of otitis externa;\n\n(17) having trauma to the external auditory canal of the affected ear within the ten days before the clinical worsening of otitis externa;\n\nNote: Examples of trauma include a blunt or penetrating injury, a surgical procedure and blast force.\n\n(18) having a foreign object or implement inserted into, or removed from, the external ear canal of the affected ear within the ten days before the clinical worsening of otitis externa;\n\nNote: An example of a foreign body or implement is an ear lavage instrument used for aural irrigation.\n\n(19) blocking the external auditory canal of the affected ear with an extrinsic aural device for a cumulative period of at least 16 hours within the seven days before the clinical worsening of otitis externa;\n\nNote: extrinsic aural device is defined in the Schedule 1 - Dictionary.\n\n(20) having an acquired, persistent narrowing or obstruction of the external auditory canal of the affected ear at the time of the clinical worsening of otitis externa;\n\nNote 1: Examples of causes of narrowing or obstruction of the external auditory canal include:\n\n(a) benign or malignant neoplasm;\n\n(b) cerumen accumulation;\n\n(c) exostosis of the external auditory canal; and\n\n(d) granuloma.\n\nNote 2: exostosis of the external auditory canal is defined in the Schedule 1 - Dictionary.\n\n(21) having an inflammatory skin disease at the time of the clinical worsening of otitis externa, where the skin disease involves the external auditory canal of the affected ear;\n\nNote 1: Examples of an inflammatory skin disease include allergic or irritant contact dermatitis, seborrhoeic dermatitis, lichen planus, psoriasis and eczema.\n\nNote 2: Irritant or allergic contact dermatitis of the external auditory canal may be caused by shampoos, ototopical medications or accidental chemical splashes to the ear.\n\n(22) having an infectious, autoimmune or granulomatous disease at the time of the clinical worsening of otitis externa, where the disease involves the external auditory canal of the affected ear;\n\nNote: Examples of an infectious, autoimmune or granulomatous disease include herpes zoster, relapsing polychondritis and sarcoidosis.\n\n(23) having chronic suppurative otitis media, involving the middle ear of the affected side, within the 30 days before the clinical worsening of otitis externa;\n\nNote: chronic suppurative otitis media is defined in the Schedule 1 - Dictionary.\n\n(24) having diabetes mellitus at the time of the clinical worsening of otitis externa;\n\n(25) being in an immunocompromised state as specified at the time of the clinical worsening of otitis externa;\n\nNote: immunocompromised state as specified is defined in the Schedule 1 - Dictionary.\n\n(26) for otomycosis only, taking a course of oral antibiotic therapy or having ototopical therapy for the treatment of otitis externa of the affected ear within the two weeks before the clinical worsening of otitis externa;\n\nNote: otomycosis is defined in the Schedule 1 - Dictionary.\n\n(27) inability to obtain appropriate clinical management for otitis externa.\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(14) to 9(27) apply only to material contribution to, or aggravation of, otitis externa where the person's otitis externa 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\n aquatic activities means an activity in which the external ear opening is submerged in water, or which causes retention of water in the ear canal.\n\nNote: Examples of aquatic activities include swimming, underwater diving, water sports and trekking through watercourses.\n\n chronic renal failure means:\n\n(a) having a glomerular filtration rate of less than 15 mL/min/1.73 m2 for a period of at least three months; or\n\n(b) a need for renal replacement therapy (dialysis or transplantation) for treatment of complications of decreased glomerular filtration rate which would otherwise increase the risk of morbidity and mortality; or\n\n(c) undergoing chronic dialysis.\n\n chronic suppurative otitis media means a recurrent or continuous infective disorder of the middle ear characterised by perforation of the tympanic membrane and aural discharge.\n\n exostosis 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\n extrinsic aural device means an instrument which occludes the external auditory canal or creates a seal over the ear.\n\nNote: Examples of extrinsic aural devices include:\n\n(a) ear buds or plugs;\n\n(b) hearing aids;\n\n(c) headphones; and\n\n(d) stethoscopes.\n\n hot and humid weather conditions means:\n\n(a) ambient humidity exceeding 40 percent; and\n\n(b) maximum temperature exceeding 30 degrees Celsius.\n\n immunocompromised state as specified means a condition of substantially lowered immune function, such as would occur in the following conditions or circumstances:\n\n(a) being treated with an immunosuppressive drug;\n\n(b) having a haematological or solid organ malignancy;\n\n(c) having chronic renal failure;\n\n(d) having infection with human immunodeficiency virus;\n\n(e) having severe malnutrition; or\n\n(f) undergoing solid organ, stem cell or bone marrow transplantation.\n\nNote: chronic renal failure and immunosuppressive drug are also defined in the Schedule 1 - Dictionary.\n\n immunosuppressive drug means a drug or an agent which results in substantial suppression of immune responses.\n\nNote: Examples of an immunosuppressive drug include:\n\n(a) chemotherapeutic agents used for the treatment of cancer;\n\n(b) corticosteroids, other than inhaled or topical corticosteroids;\n\n(c) drugs used to prevent transplant rejection; and\n\n(d) tumour necrosis factor-α inhibitors.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n otitis externa—see subsection 7(2).\n\n otomycosis means a fungal infection of the external auditory canal.\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":{"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":6,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the earlier Statement of Principles No. 59 of 2012 (s4) and replaces it with updated, enumerated criteria. Notable scope changes in the current text include separate factors for clinical worsening (s9(14)–(26)), an explicit factor for inability to obtain appropriate clinical management (s9(27)), and expanded/quantified definitions in Schedule 1 (for example hot and humid weather, extrinsic aural device, and immunocompromised state). It applies to claims under section 120B of the VEA or section 339 of the MRCA (s5) and commenced on 25 January 2021 (s2)."},"complexity_factors":["Large, detailed list of causation factors including duplicated sets for 'clinical onset' and 'clinical worsening' (27 discrete factors overall) increases mapping and proof complexity (see section 9).","Tight temporal windows and quantitative thresholds (e.g. 10 days, 7 days, 30 days, cumulative 16 hours) create precise evidentiary requirements for claimants (see section 9).","Multiple technical definitions with numeric criteria (hot and humid: humidity >40% and max temp >30°C; chronic renal failure GFR threshold; definitions of immunocompromised state, extrinsic aural device, exostosis) require fact-finding and medical interpretation (see Schedule 1).","Cross-references to other Statements of Principles and to VEA/MRCA create legal interdependence and require decision-makers to reconcile instruments (see sections 5 and 11).","Requirement that any factor be related to the person's relevant service adds a legal nexus test beyond medical causation and gives decision-makers scope to assess service-connection (see section 10(1)).","Specific limitation that factors 14–27 apply only to material contribution/aggravation where otitis externa pre-existed or was contracted before/during service introduces context-sensitive application (see section 10(2)).","Inclusion of death from otitis externa via contribution to a terminal event extends causation to proximate/ultimate causes of death and requires causal chain analysis (see section 7(5) and Schedule 1 'terminal event').","Instrument relies on RMA's view of the medical‑scientific evidence and the balance‑of‑probabilities standard, so application depends on expert medical evidence and interpretation (see section 8 and title).","Repeal of the prior 2012 Statement (section 4) means prior decisions or claimant expectations may need reassessment against the updated criteria (see section 4).","Practical compliance burden on claimants to assemble temporal, clinical and environmental evidence, and on decision-makers to apply detailed definitions and nexus rules (implicit across sections 5, 6, 9 and Schedule 1)."],"plain_english_summary":"This Statement of Principles sets out the medical criteria the Repatriation Medical Authority uses to decide whether otitis externa (and death from it) is connected to a veteran’s or service member’s relevant service for VEA and MRCA claims. It lists specific risk factors, time windows and medical states (for example aquatic exposure, trauma, radiation, diabetes, immunocompromise, obstructed ear canal, and hot/humid exposure) which, if present on the balance of probabilities, establish a service connection."},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a straightforward reissue and update of a 2012 Statement of Principles. It maintains the same narrow, specific purpose: establishing causal factors for a single medical condition (otitis externa) in the veterans' compensation scheme. The scope remains tightly confined to this specific ear condition and its relationship to military service, with no expansion into broader policy areas."},"complexity_factors":["27 distinct factors with specific temporal requirements (e.g., 'within 10 days', 'at least 16 hours within 7 days', 'at least 10 days within 30 days')","14 defined terms in Schedule 1, including nested definitions (e.g., 'immunocompromised state as specified' refers to 'chronic renal failure' and 'immunosuppressive drug', which are also defined)","Parallel structure for onset vs. worsening: factors 1-13 cover initial onset, factors 14-26 mirror these for worsening, plus factor 27 for inadequate treatment","Specific exclusion for otomycosis (fungal infection) in factors 13 and 26, requiring different causal pathways","Cross-reference mechanism in section 11 allowing incorporation of other Statements of Principles by reference","Dual statutory framework application (VEA and MRCA) with different service definitions","Technical medical terminology requiring clinical interpretation (ICD-10-AM codes, specific disease classifications)"],"plain_english_summary":"This instrument sets the medical rules for deciding when Australian veterans and defence personnel can get compensation or treatment for otitis externa. It replaces the 2012 rules, applies the \"balance of probabilities\" test, and requires evidence that at least one of 27 specified service‑related risk factors and timing criteria link the ear infection to military service. It standardises assessments so eligible claims are consistently identified."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-otitis-externa-balance-of-probabilities-no-26-of-2021","history":"/api/acts/statement-of-principles-concerning-otitis-externa-balance-of-probabilities-no-26-of-2021/history","analysis":"/api/acts/statement-of-principles-concerning-otitis-externa-balance-of-probabilities-no-26-of-2021/analysis","conflicts":"/api/acts/statement-of-principles-concerning-otitis-externa-balance-of-probabilities-no-26-of-2021/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-otitis-externa-balance-of-probabilities-no-26-of-2021/important-cases","documents":"/api/acts/statement-of-principles-concerning-otitis-externa-balance-of-probabilities-no-26-of-2021/documents"}}