{"id":"F2022L00945","name":"Statement of Principles concerning otitis media (Reasonable Hypothesis) (No. 62 of 2022)","slug":"statement-of-principles-concerning-otitis-media-reasonable-hypothesis-no-62-of-2022","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":441461,"registerId":"F2022L00945-fast-fetch-1775956744998","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning otitis media (Reasonable Hypothesis) (No. 62 of 2022)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 22.10.0\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n\n\n \n\nStatement of Principles\n\nconcerning\n\nOTITIS MEDIA (Reasonable Hypothesis)\n\n(No. 62 of 2022)\n\nThe Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n \n\nDated 24 June 2022\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 Terence Campbell AM
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 media (Reasonable Hypothesis) (No. 62 of 2022).\n\n2 Commencement\n\n This instrument commences on 25 July 2022.\n\n3 Authority\n\nThis instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning otitis media No. 51 of 2014 (Federal Register of Legislation No. F2014L00483) made under subsections 196B(2) and (8) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 media and death from otitis media.\n\nMeaning of otitis media\n\n(2) For the purposes of this Statement of Principles, otitis media:\n\n(a) means an infective or inflammatory process within the middle ear; and\n\n(b) excludes cholesteatoma and isolated perforation of the tympanic membrane.\n\n(3) While otitis media attracts ICD‑10‑AM code H65, H66 or H67 in applying this Statement of Principles the meaning of otitis media 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 media\n\n(5) For the purposes of this Statement of Principles, otitis media, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's otitis media.\n\nNote: terminal event is defined in the Schedule 1 – Dictionary.\n\n8 Basis for determining the factors\n\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that otitis media and death from otitis media can be related to relevant service rendered by veterans, members of Peacekeeping Forces, 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 as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting otitis media or death from otitis media with the circumstances of a person's relevant service:\n\n(1) having an upper respiratory tract infection within the 28 days before the clinical onset of otitis media;\n\n(2) having partial or complete obstruction of the Eustachian tube of the affected side within the 7 days before the clinical onset of otitis media;\n\nNote: Obstruction of the Eustachian tube usually involves symptoms of Eustachian tube dysfunction and negative pressure in the middle ear. Symptoms of Eustachian tube dysfunction include aural fullness, a feeling of pressure or being clogged, pain, popping and crackling in the ears. Signs include a serous middle ear effusion and retraction of the tympanic membrane. \n\n(3) having allergic rhinitis or sinusitis within the 7 days before the clinical onset of otitis media;\n\n(4) having a space-occupying mass within the nasopharynx at the time of the clinical onset of otitis media;\n\nNote: Examples of a space-occupying mass within the nasopharynx include malignant neoplasm of the nasopharynx, lymphoma, benign neoplasm of the nasopharynx such as pleomorphic adenoma and oncocytoma, and nasopharyngeal cyst such as an oncocytic cyst.\n\n(5) undergoing a course of therapeutic radiation for cancer, where the head or upper neck was in the field of radiation, before the clinical onset of otitis media;\n\nNote: Radiotherapy given to the nasopharynx or adjacent areas for cancer may include either or both Eustachian tubes in the field of radiation. This may result in otitis media in the ear contralateral to the side of the cancer.\n\n(6) having an acute rupture of the tympanic membrane of the affected side within the 3 months before the clinical onset of otitis media;\n\nNote: Circumstances in which an acute rupture of the tympanic membrane can occur include intrusion of a foreign body such as an implement, stick or projectile into the tympanic cavity and surgical procedures involving the tympanic membrane.\n\n(7) having chronic perforation of the tympanic membrane of the affected side before the clinical onset of otitis media;\n\nNote: Chronic perforation may be the result of previous otitis media. Chronic perforation includes tympanostomy tubes (“grommets”), usually inserted for acute recurrent otitis media or chronic otitis media.\n\n(8) having an episode of otitic barotrauma involving the affected ear within the 7 days before the clinical onset of otitis media;\n\nNote: Otitic barotrauma is also known as otic barotrauma.\n\n(9) having tuberculosis or nontuberculous mycobacterial disease at the time of the clinical onset of otitis media;\n\n(10) having gastro-oesophageal reflux disease at the time of the clinical onset of otitis media;\n\n(11) swimming, diving or water-skiing, where such activities allow water to enter the oropharynx, within the 7 days before the clinical onset of otitis media;\n\n(12) having ascariasis or myiasis of the ear, nose or throat at the time of the clinical onset of otitis media;\n\nNote: Myiasis is an infestation of maggots.\n\n(13) having ANCA-associated vasculitis at the time of the clinical onset of otitis media;\n\nNote: ANCA (anti-neutrophil cytoplasmic antibody)-associated vasculitis refers to necrotizing vasculitis that primarily affects small and medium blood vessels and includes granulomatosis with polyangiitis, microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis.\n\n(14) having infection with human immunodeficiency virus before the clinical onset of otitis media;\n\n(15) taking an immunosuppressive drug for organ or tissue transplantation before the clinical onset of otitis media; \n\nNote: organ or tissue transplantation is defined in the Schedule 1 – Dictionary.\n\n(16) having an upper respiratory tract infection within the 28 days before the clinical worsening of otitis media;\n\n(17) having partial or complete obstruction of the Eustachian tube of the affected side within the 7 days before the clinical worsening of otitis media;\n\nNote: Obstruction of the Eustachian tube usually involves symptoms of Eustachian tube dysfunction and negative pressure in the middle ear. Symptoms of Eustachian tube dysfunction include aural fullness, a feeling of pressure or being clogged, pain, popping and crackling in the ears. Signs include a serous middle ear effusion and retraction of the tympanic membrane. \n\n(18) having allergic rhinitis or sinusitis within the 7 days before the clinical worsening of otitis media;\n\n(19) having a space-occupying mass within the nasopharynx at the time of the clinical worsening of otitis media;\n\nNote: Examples of a space-occupying mass within the nasopharynx include malignant neoplasm of the nasopharynx, lymphoma, benign neoplasm of the nasopharynx such as pleomorphic adenoma and oncocytoma, and nasopharyngeal cyst such as an oncocytic cyst.\n\n(20) undergoing a course of therapeutic radiation for cancer, where the head or upper neck was in the field of radiation, before the clinical worsening of otitis media;\n\nNote: Radiotherapy given to the nasopharynx or adjacent areas for cancer may include either or both Eustachian tubes in the field of radiation. This may result in otitis media in the ear contralateral to the side of the cancer.\n\n(21) having an acute rupture of the tympanic membrane of the affected side within the 3 months before the clinical worsening of otitis media;\n\nNote: Circumstances in which an acute rupture of the tympanic membrane can occur include intrusion of a foreign body such as an implement, stick or projectile into the tympanic cavity and surgical procedures involving the tympanic membrane.\n\n(22) having chronic perforation of the tympanic membrane of the affected side before the clinical worsening of otitis media;\n\nNote: Chronic perforation may be the result of previous otitis media. Chronic perforation includes tympanostomy tubes (“grommets”), usually inserted for acute recurrent otitis media or chronic otitis media.\n\n(23) having an episode of otitic barotrauma involving the affected ear within the 7 days before the clinical worsening of otitis media;\n\nNote: Otitic barotrauma is also known as otic barotrauma.\n\n(24) having tuberculosis or nontuberculous mycobacterial disease at the time of the clinical worsening of otitis media;\n\n(25) having gastro-oesophageal reflux disease at the time of the clinical worsening of otitis media;\n\n(26) swimming, diving or water-skiing, where such activities allow water to enter the oropharynx, within the 7 days before the clinical worsening of otitis media;\n\n(27) having ascariasis or myiasis of the ear, nose or throat at the time of the clinical worsening of otitis media;\n\nNote: Myiasis is an infestation of maggots.\n\n(28) having ANCA-associated vasculitis at the time of the clinical worsening of otitis media;\n\nNote: ANCA (anti-neutrophil cytoplasmic antibody)-associated vasculitis refers to necrotizing vasculitis that primarily affects small and medium blood vessels and includes granulomatosis with polyangiitis, microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis.\n\n(29) having infection with human immunodeficiency virus before the clinical worsening of otitis media;\n\n(30) taking an immunosuppressive drug for organ or tissue transplantation before the clinical worsening of otitis media; \n\nNote: organ or tissue transplantation is defined in the Schedule 1 – Dictionary.\n\n(31) inability to obtain appropriate clinical management for otitis media.\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(16) to 9(31) apply only to material contribution to, or aggravation of, otitis media where the person's otitis media 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(2) 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 MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n organ or tissue transplantation means the transplantation of:\n\n(a) all or part of an organ or tissue; or\n\n(b) a substance obtained from an organ or tissue.\n\n otitis media—see subsection 7(2).\n\n relevant service means:\n\n(a) operational service under the VEA;\n\n(b) peacekeeping service under the VEA;\n\n(c) hazardous service under the VEA;\n\n(d) British nuclear test defence service under the VEA;\n\n(e) warlike service under the MRCA; or\n\n(f) non-warlike 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":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument expressly repeals the earlier Statement of Principles concerning otitis media No. 51 of 2014 (s4) and replaces it as the operative Statement. It applies to claims governed by section 120A of the VEA or section 338 of the MRCA (s5), and sets the current list of clinical factors, exclusions and definitions in Schedule 1 (s7, s9, Schedule 1)."},"complexity_factors":["Detailed clinical and diagnostic terminology (e.g. otitis media definition, ICD-10-AM codes) (s7(2)–(4))","Multiple discrete temporal thresholds for different factors (28 days, 7 days, 3 months) that affect causal linking (s9)","Long enumerated list of 31 potential causative or aggravating factors with medical diversity (infection, allergy, trauma, radiation, parasites, systemic disease, immunosuppression) (s9(1)–(31))","Separate treatment of 'clinical onset' versus 'clinical worsening' requiring different evidential linking (s9; s10(2))","Requirement that any listed factor be related to the person's relevant service—an extra legal causal step (s10(1))","Cross-reference to other Statements of Principles where factors overlap, creating dependency on external instruments (s11)","Exclusionary language (e.g. cholesteatoma, isolated tympanic perforation) and specific inclusion of death from a terminal event, which affect scope of claims (s7(2), s7(5))","Definitions and operative terms placed in Schedule 1, requiring cross-read of definitions (Schedule 1)"],"plain_english_summary":"**This Statement of Principles sets the medical criteria that must be met to connect otitis media (middle‑ear infection) to Australian military, peacekeeping or MRCA service for entitlements.** It operates by listing specific clinical factors and time windows that raise a 'reasonable hypothesis' for claims under the VEA or MRCA (see sections 5, 9).\n\nIt excludes cholesteatoma and isolated tympanic membrane perforation and treats death as compensable where otitis media contributed to a terminal event (section 7)."},"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"},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This instrument maintains the standard scope of Repatriation Medical Authority Statements of Principles. It replaces a 2014 version (No. 51 of 2014) with updated medical factors and current ICD-10-AM coding references, but does not expand beyond the established purpose of determining service connection for otitis media claims."},"complexity_factors":["31 enumerated factors with specific temporal windows (ranging from 7 days to 3 months)","Parallel structure requiring near-identical reading of factors 1-15 (clinical onset) and 16-30 (clinical worsening)","Cross-references to other Statements of Principles for conditions mentioned as factors (section 11)","Dual legislative framework application (VEA and MRCA with six distinct service types)","Medical terminology requiring explanatory notes (8 of the 31 factors include substantive definitional notes)","Conditional logic in section 10(2) restricting factors 16-31 to aggravation cases only","Specific ICD-10-AM coding reference with edition and ISBN citation"],"plain_english_summary":"This instrument lists 31 medical factors that, if present and shown to be related to a person’s military service, create a “reasonable hypothesis” that otitis media (or death from it) was caused or aggravated by service. It guides decision-making under the Veterans’ Entitlements Act and the Military Rehabilitation and Compensation Act, shifting the benefit of the doubt to veterans and Defence members when a service link can be established."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-otitis-media-reasonable-hypothesis-no-62-of-2022","history":"/api/acts/statement-of-principles-concerning-otitis-media-reasonable-hypothesis-no-62-of-2022/history","analysis":"/api/acts/statement-of-principles-concerning-otitis-media-reasonable-hypothesis-no-62-of-2022/analysis","conflicts":"/api/acts/statement-of-principles-concerning-otitis-media-reasonable-hypothesis-no-62-of-2022/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-otitis-media-reasonable-hypothesis-no-62-of-2022/important-cases","documents":"/api/acts/statement-of-principles-concerning-otitis-media-reasonable-hypothesis-no-62-of-2022/documents"}}