{"id":"F2019L01360","name":"Statement of Principles concerning sensorineural hearing loss (Reasonable Hypothesis) (No. 98 of 2019)","slug":"statement-of-principles-concerning-sensorineural-hearing-loss-reasonable-hypothesis-no-98-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":100203,"registerId":"commonwealth-F2019L01360-current","compilationNumber":null,"startDate":"2026-04-02","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning sensorineural hearing loss (Reasonable Hypothesis) (No. 98 of 2019)","content":"![Commonwealth Coat of Arms](image.001.png)\n\nStatement of Principles concerning sensorineural hearing loss (Reasonable Hypothesis) (No. 98 of 2019)\n\nmade under subsection 196B(2) of the\n\nVeterans' Entitlements Act 1986\n\nCompilation No. 2\n\nCompilation date: 22 September 2025\n\nIncludes amendments up to: Amendment Statement of Principles concerning sensorineural hearing loss (Reasonable Hypothesis) (No. 75 of 2025) (F2025L00977)\n\nAbout this compilation\n\nThis compilation\n\nThis is a compilation of the Statement of Principles concerning sensorineural hearing loss (Reasonable Hypothesis) (No. 98 of 2019) that shows the text of the law as amended and in force on 22 September 2025.\n\nThe notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.\n\nUncommenced amendments\n\nThe effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register (www.legislation.gov.au). The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.\n\nApplication, saving and transitional provisions for provisions and amendments\n\nIf the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.\n\nModifications\n\nIf the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.\n\nSelf‑repealing provisions\n\nIf a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.\n\nContents\n\n1 Name\n\n3 Authority\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\nEndnotes\n\nEndnote 1—About the endnotes\n\nEndnote 2—Abbreviation key\n\nEndnote 3—Legislation history\n\nEndnote 4—Amendment history\n\n \n\n1. Name\n\nThis is the Statement of Principles concerning sensorineural hearing loss (Reasonable Hypothesis) (No. 98 of 2019).\n\n1. Authority\n\nThis instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.\n\n1. 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\n1. Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n1. Kind of injury, disease or death to which this Statement of Principles relates\n 1. This Statement of Principles is about sensorineural hearing loss and death from sensorineural hearing loss.\n\nMeaning of sensorineural hearing loss\n\n1. For the purposes of this Statement of Principles, sensorineural hearing loss:\n 1. means acquired hearing loss due to a defect in the cochlea or auditory nerve, with a permanent shift to a hearing threshold level of 20 decibels (dB) or more, at 500, 1 000, 1 500, 2 000, 3 000, 4 000 or 6 000 hertz (Hz); and\n 2. excludes:\n 1. congenital deafness; and\n 2. hearing loss due to Meniere disease and Meniere syndrome.\n\nNote: The diagnosis of sensorineural hearing loss is usually made by performing an audiogram in which bone conduction thresholds are measured.\n\nDeath from sensorineural hearing loss\n\n1. For the purposes of this Statement of Principles, sensorineural hearing loss, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's sensorineural hearing loss.\n\n> Note: terminal event is defined in the Schedule 1 – Dictionary.\n\n1. Basis for determining the factors\n\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that sensorineural hearing loss and death from sensorineural hearing loss 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\n> Note: MRCA, relevant service and VEA are defined in the Schedule 1 – Dictionary.\n\n1. 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 sensorineural hearing loss or death from sensorineural hearing loss with the circumstances of a person's relevant service:\n\n1. being exposed to a peak sound pressure level at the tympanic membrane of at least 140 dB(C) before the clinical onset of sensorineural hearing loss;\n\n> Note: dB(C) is defined in the Schedule 1 \\- Dictionary.\n\n1. being exposed to a sound pressure level at the tympanic membrane of at least 85 dB(A) as an 8-hour time-weighted average (TWA) with a 3‑dB exchange rate for a cumulative period of at least six months, before the clinical onset of sensorineural hearing loss;\n\n> Note: dB(A) and time-weighted average (TWA) with a 3-dB exchange rate are defined in the Schedule 1 \\- Dictionary.\n\n1. being exposed to an explosive blast within the 30 days before the clinical onset of sensorineural hearing loss;\n2. being struck by lightning within the 30 days before the clinical onset of sensorineural hearing loss;\n3. having:\n 1. an episode of otitic barotrauma involving the affected ear; or\n 2. decompression sickness;\n\nwithin the 30 days before the clinical onset of sensorineural hearing loss;\n\n1. undergoing a course of treatment with a drug or a drug from a class of drugs from the specified list of drugs, within the one year before the clinical onset of sensorineural hearing loss;\n\n> Note: specified list of drugs is defined in the Schedule 1 \\- Dictionary.\n\n1. having received an ototopical medication as specified, directly into the inner ear, in the presence of tympanic membrane perforation or a patent tympanostomy tube (grommet), within the 30 days before the clinical onset of sensorineural hearing loss;\n\n> Note: ototopical medication as specified is defined in the Schedule 1 \\- Dictionary.\n\n1. taking paracetamol or a nonsteroidal anti-inflammatory drug on an average of at least two days per week, for a continuous period of at least the one year before the clinical onset of sensorineural hearing loss;\n2. taking a cumulative total of at least 40 grams of aspirin, or having acute salicylate toxicity, within the 30 days before the clinical onset of sensorineural hearing loss;\n3. having a suppurative bacterial infection from the specified list of bacterial infections of the middle or inner ear, involving the affected side, within the 30 days before the clinical onset of sensorineural hearing loss;\n\n> Note: specified list of bacterial infections is defined in the Schedule 1 \\- Dictionary.\n\n1. having an infection with a virus from the specified list of viruses, within the 30 days before the clinical onset of sensorineural hearing loss;\n\n> Note: specified list of viruses is defined in the Schedule 1 \\- Dictionary.\n\n1. having viral labyrinthitis of the affected ear within the 30 days before the clinical onset of sensorineural hearing loss;\n2. having meningitis or encephalitis within the one year before the clinical onset of sensorineural hearing loss;\n3. having neurosyphilis before the clinical onset of sensorineural hearing loss;\n4. having tuberculosis of the meninges, middle ear or inner ear of the affected side, before the clinical onset of sensorineural hearing loss;\n5. having leprosy before the clinical onset of sensorineural hearing loss;\n6. having a disease from the specified list of bone diseases, affecting the petrous temporal bone or middle ear ossicles of the affected side, at the time of the clinical onset of sensorineural hearing loss;\n\n> Note: specified list of bone diseases is defined in the Schedule 1 \\- Dictionary.\n\n1. having osteoporosis at the time of the clinical onset of sensorineural hearing loss;\n2. having a disease from the specified list of autoimmune diseases at the time of the clinical onset of sensorineural hearing loss;\n\n> Note: specified list of autoimmune diseases is defined in the Schedule 1 \\- Dictionary.\n\n1. having multiple sclerosis at the time of the clinical onset of sensorineural hearing loss;\n2. having diabetes mellitus at the time of the clinical onset of sensorineural hearing loss;\n3. having a disease from the specified list of haematological diseases at the time of the clinical onset of sensorineural hearing loss;\n\n> Note: specified list of haematological diseases is defined in the Schedule 1 \\- Dictionary.\n\n1. having a cerebrovascular accident within the three months before the clinical onset of sensorineural hearing loss;\n2. having a lesion interrupting the supply of blood to the cochlea of the affected ear at the time of the clinical onset of sensorineural hearing loss;\n\n> Note: Examples of lesions interrupting the supply of blood to the cochlea include, but are not limited to, thrombosis, haemorrhage or vasospasm of the vertebro-basilar circulation, and intralabyrinthine haemorrhage or infarction.\n\n1. having blunt trauma, penetrating trauma or surgery to the cochlea or auditory nerve of the affected side, within the five years before the clinical onset of sensorineural hearing loss;\n\n> Note: Examples of trauma include, but are not limited to, temporal bone fracture and basilar skull fracture.\n\n1. having moderate to severe traumatic brain injury within the three months before the clinical onset of sensorineural hearing loss;\n2. having a benign or malignant neoplasm involving the affected auditory nerve or cochlea at the time of the clinical onset of sensorineural hearing loss;\n3. undergoing a course of therapeutic radiation for cancer, where the affected cochlea or auditory nerve was in the field of radiation, before the clinical onset of sensorineural hearing loss;\n4. inhaling, ingesting or having cutaneous contact with an agent from the specified list of chemical agents, for a cumulative period of at least 2 500 hours within a continuous period of five years, before the clinical onset of sensorineural hearing loss, and where that exposure has ceased, the clinical onset of sensorineural hearing loss has occurred within two years of cessation;\n\n> Note: specified list of chemical agents is defined in the Schedule 1 \\- Dictionary.\n\n1. having:\n 1. a cobalt-containing metal-on-metal hip prosthesis; or\n 2. a serum cobalt concentration of at least 200 micrograms per litre;\n\nfor at least four weeks before the clinical onset of sensorineural hearing loss;\n\n1. smoking at least ten pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of sensorineural hearing loss, and where smoking has ceased, the clinical onset of sensorineural hearing loss has occurred within five years of cessation;\n\n> Note: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 \\- Dictionary.\n\n1. being exposed to second-hand smoke:\n 1. for at least 2 500 hours before the clinical onset of sensorineural hearing loss; and\n 2. where the first exposure to second-hand smoke commenced at least five years before the clinical onset of sensorineural hearing loss; and\n 3. where the last exposure to second-hand smoke occurred within the two years before the clinical onset of sensorineural hearing loss;\n\n> Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.\n\n1. consuming an average of at least 100 grams of alcohol per day for at least the four years before the clinical onset of sensorineural hearing loss;\n\n> Note: Alcohol consumption is calculated utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink.\n\n1. being obese for at least five years within the ten years before the clinical onset of sensorineural hearing loss;\n\n> Note: being obese is defined in the Schedule 1 \\- Dictionary.\n\n1. having hypertension at the time of the clinical onset of sensorineural hearing loss;\n2. being exposed to a peak sound pressure level at the tympanic membrane of at least 140 dB(C) before the clinical worsening of sensorineural hearing loss;\n\n> Note: dB(C) is defined in the Schedule 1 \\- Dictionary.\n\n1. being exposed to a sound pressure level at the tympanic membrane of at least 85 dB(A) as an 8-hour time-weighted average (TWA) with a 3‑dB exchange rate for a cumulative period of at least six months, before the clinical worsening of sensorineural hearing loss;\n\n> Note: dB(A) and time-weighted average (TWA) with a 3-dB exchange rate are defined in the Schedule 1 \\- Dictionary.\n\n1. being exposed to an explosive blast within the 30 days before the clinical worsening of sensorineural hearing loss;\n2. being struck by lightning within the 30 days before the clinical worsening of sensorineural hearing loss;\n3. having:\n 1. an episode of otitic barotrauma involving the affected ear; or\n 2. decompression sickness;\n\nwithin the 30 days before the clinical worsening of sensorineural hearing loss;\n\n1. undergoing a course of treatment with a drug or a drug from a class of drugs from the specified list of drugs, within the one year before the clinical worsening of sensorineural hearing loss;\n\n> Note: specified list of drugs is defined in the Schedule 1 \\- Dictionary.\n\n1. having received an ototopical medication as specified, directly into the inner ear, in the presence of tympanic membrane perforation or a patent tympanostomy tube (grommet), within the 30 days before the clinical worsening of sensorineural hearing loss;\n\n> Note: ototopical medication as specified is defined in the Schedule 1 \\- Dictionary.\n\n1. taking paracetamol or a nonsteroidal anti-inflammatory drug on an average of at least two days per week, for a continuous period of at least the one year before the clinical worsening of sensorineural hearing loss;\n2. taking a cumulative total of at least 40 grams of aspirin, or having acute salicylate toxicity, within the 30 days before the clinical worsening of sensorineural hearing loss;\n3. having a suppurative bacterial infection from the specified list of bacterial infections of the middle or inner ear, involving the affected side, within the 30 days before the clinical worsening of sensorineural hearing loss;\n\n> Note: specified list of bacterial infections is defined in the Schedule 1 \\- Dictionary.\n\n1. having an infection with a virus from the specified list of viruses, within the 30 days before the clinical worsening of sensorineural hearing loss;\n\n> Note: specified list of viruses is defined in the Schedule 1 \\- Dictionary.\n\n1. having viral labyrinthitis of the affected ear within the 30 days before the clinical worsening of sensorineural hearing loss;\n2. having meningitis or encephalitis within the one year before the clinical worsening of sensorineural hearing loss;\n3. having neurosyphilis before the clinical worsening of sensorineural hearing loss;\n4. having tuberculosis of the meninges, middle ear or inner ear of the affected side, before the clinical worsening of sensorineural hearing loss;\n5. having leprosy before the clinical worsening of sensorineural hearing loss;\n6. having a disease from the specified list of bone diseases, affecting the petrous temporal bone or middle ear ossicles of the affected side, at the time of the clinical worsening of sensorineural hearing loss;\n\n> Note: specified list of bone diseases is defined in the Schedule 1 \\- Dictionary.\n\n1. having osteoporosis at the time of the clinical worsening of sensorineural hearing loss;\n2. having a disease from the specified list of autoimmune diseases at the time of the clinical worsening of sensorineural hearing loss;\n\n> Note: specified list of autoimmune diseases is defined in the Schedule 1 \\- Dictionary.\n\n1. having multiple sclerosis at the time of the clinical worsening of sensorineural hearing loss;\n2. having diabetes mellitus at the time of the clinical worsening of sensorineural hearing loss;\n3. having a disease from the specified list of haematological diseases at the time of the clinical worsening of sensorineural hearing loss;\n\n> Note: specified list of haematological diseases is defined in the Schedule 1 \\- Dictionary.\n\n1. having a cerebrovascular accident within the three months before the clinical worsening of sensorineural hearing loss;\n2. having a lesion interrupting the supply of blood to the cochlea of the affected ear at the time of the clinical worsening of sensorineural hearing loss;\n\n> Note: Examples of lesions interrupting the supply of blood to the cochlea include, but are not limited to, thrombosis, haemorrhage or vasospasm of the vertebro-basilar circulation, and intralabyrinthine haemorrhage or infarction.\n\n1. having blunt trauma, penetrating trauma or surgery to the cochlea or auditory nerve of the affected side within the five years before the clinical worsening of sensorineural hearing loss;\n\n> Note: Examples of trauma include, but are not limited to, temporal bone fracture and basilar skull fracture.\n\n1. having moderate to severe traumatic brain injury within the three months before the clinical worsening of sensorineural hearing loss;\n2. having a benign or malignant neoplasm involving the affected auditory nerve or cochlea at the time of the clinical worsening of sensorineural hearing loss;\n3. undergoing a course of therapeutic radiation for cancer, where the affected cochlea or auditory nerve was in the field of radiation, before the clinical worsening of sensorineural hearing loss;\n4. inhaling, ingesting or having cutaneous contact with an agent from the specified list of chemical agents, for a cumulative period of at least 2 500 hours within a continuous period of five years, before the clinical worsening of sensorineural hearing loss, and where that exposure has ceased, the clinical worsening of sensorineural hearing loss has occurred within two years of cessation;\n\n> Note: specified list of chemical agents is defined in the Schedule 1 \\- Dictionary.\n\n1. having:\n 1. a cobalt-containing metal-on-metal hip prosthesis; or\n 2. a serum cobalt concentration of at least 200 micrograms per litre;\n\nfor at least four weeks before the clinical worsening of sensorineural hearing loss;\n\n1. smoking at least ten pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical worsening of sensorineural hearing loss, and where smoking has ceased, the clinical worsening of sensorineural hearing loss has occurred within five years of cessation;\n\n> Note: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 \\- Dictionary.\n\n1. being exposed to second-hand smoke:\n 1. for at least 2 500 hours before the clinical worsening of sensorineural hearing loss; and\n 2. where the first exposure to second-hand smoke commenced at least five years before the clinical worsening of sensorineural hearing loss; and\n 3. where the last exposure to second-hand smoke occurred within the two years before the clinical worsening of sensorineural hearing loss;\n\n> Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.\n\n1. consuming an average of at least 100 grams of alcohol per day for at least the four years before the clinical worsening of sensorineural hearing loss;\n\n> Note: Alcohol consumption is calculated utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink.\n\n1. being obese for at least five years within the ten years before the clinical worsening of sensorineural hearing loss;\n\n> Note: being obese is defined in the Schedule 1 \\- Dictionary.\n\n1. having hypertension at the time of the clinical worsening of sensorineural hearing loss;\n2. inability to obtain appropriate clinical management for sensorineural hearing loss.\n\n1. Relationship to service\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 2. The factors set out in subsections 9(36) to 9(71) apply only to material contribution to, or aggravation of, sensorineural hearing loss where the person's sensorineural hearing loss was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n2. Factors referring to an injury or disease covered by another Statement of Principles\n\nIn this Statement of Principles:\n\n1. if a factor referred to in section 9 applies in relation to a person; and\n2. 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\nSchedule 1 \\- Dictionary\n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\nbeing exposed to second-hand smoke means being in an enclosed space and inhaling smoke from burning tobacco products or smoke that has been exhaled by a person who is smoking.\n\nbeing obese means having a Body Mass Index (BMI) of 30 or greater.\n\n> Note: BMI is also defined in the Schedule 1 - Dictionary.\n\nBMI means W/H2 where:\n\nW is the person's weight in kilograms; and\n\nH is the person's height in metres.\n\nchronic 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\ndB(A) means the sound pressure level in decibels measured by a sound level meter using a type A electronic filter.\n\ndB(C) means 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\nhyperviscosity syndrome means a disorder causing an increased viscosity of the blood.\n\n> Note: Examples of disorders causing an increased viscosity of the blood include, but are not limited to, polycythaemia and Waldenstrom macroglobulinaemia.\n\nMRCA means the Military Rehabilitation and Compensation Act 2004.\n\nototopical medication as specified means ear drops containing one or more of the following agents:\n\n(a) Burow's solution (5% aluminium subacetate);\n\n(b) aminoglycosides;\n\n(c) chloramphenicol;\n\n(d) chlorhexidine; or\n\n(e) ethanol.\n\npack-years of cigarettes, or the equivalent thereof in other tobacco products means a calculation of consumption where one pack-year of cigarettes equals 20 tailor-made cigarettes per day for a period of one calendar year, or 7 300 cigarettes. One tailor-made cigarette approximates one gram of tobacco or one gram of cigar or pipe tobacco by weight. One pack-year of tailor-made cigarettes equates to 7.3 kilograms of smoking tobacco by weight. Tobacco products mean cigarettes, pipe tobacco or cigars, smoked alone or in any combination.\n\nrelevant 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\n> Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary.\n\nsensorineural hearing loss—see subsection 7(2).\n\nspecified list of autoimmune diseases means:\n\n(a) antiphospholipid antibody syndrome;\n\n(b) Behcet disease;\n\n(c) Cogan syndrome;\n\n(d) eosinophilic granulomatosis with polyangiitis (Churg–Strauss syndrome);\n\n(e) giant cell arteritis;\n\n(f) granulomatosis with polyangiitis (Wegener granulomatosis);\n\n(g) Hashimoto's thyroiditis;\n\n(h) immune thrombocytopaenia;\n\n(i) microscopic polyangiitis;\n\n(j) mixed cryoglobulinaemia;\n\n(k) mucocutaneous lymph node syndrome (Kawasaki disease);\n\n(l) polyarteritis nodosa;\n\n(m) psoriasis;\n\n(n) pyoderma gangrenosum;\n\n(o) relapsing polychondritis;\n\n(p) rheumatoid arthritis;\n\n(q) sarcoidosis;\n\n(r) Sjogren syndrome;\n\n(s) Susac syndrome;\n\n(t) systemic lupus erythematosus;\n\n(u) systemic sclerosis (scleroderma);\n\n(v) Takayasu arteritis;\n\n(w) ulcerative colitis; or\n\n(x) Vogt-Koyanagi-Harada disease.\n\nspecified list of bacterial infections means:\n\n(a) acute otitis media;\n\n(b) chronic suppurative otitis media; or\n\n(c) suppurative labyrinthitis.\n\n> Note: chronic suppurative otitis media and suppurative labyrinthitis are also defined in the Schedule 1 \\- Dictionary.\n\nspecified list of bone diseases means:\n\n(a) acromegaly;\n\n(b) otosclerosis; or\n\n(c) Paget's disease of bone.\n\nspecified list of chemical agents means:\n\n(a) allyl benzene;\n\n(b) cadmium;\n\n(c) carbon disulphide;\n\n(d) carbon monoxide;\n\n(e) dimethylacetamide;\n\n(f) epoxy adhesives;\n\n(g) ethyl benzene;\n\n(h) lead or fumes containing lead;\n\n(i) manganese or fumes containing manganese;\n\n(j) mercury;\n\n(k) methyl ethyl ketone (MEK);\n\n(l) n\\-hexane;\n\n(m) n\\-propylbenzene;\n\n(n) xylene;\n\n(o) styrene;\n\n(p) toluene; or\n\n(q) trichloroethylene.\n\nspecified list of drugs means:\n\n(a) α-difluoromethylornithine (eflornithine);\n\n(b) 2-hydroxypropyl-b-cyclodextrin (HPbCD);\n\n(c) aminoglycosides;\n\n(d) carboplatin;\n\n(e) cisplatin;\n\n(f) erlotinib;\n\n(g) 5-fluorouracil (5-FU);\n\n(h) gabapentin;\n\n(i) imatinib;\n\n(j) loop diuretics;\n\n(k) macrolide antibiotics;\n\n(l) misonadazole;\n\n(m) nitrogen mustard compounds;\n\n(n) opioids;\n\n(o) oxaliplatin;\n\n(p) phosphodiesterase 5 inhibitors;\n\n(q) propylthiouracil;\n\n(r) quinine and quinine derivatives, including mefloquine;\n\n(s) tetracyclines;\n\n(t) valproic acid;\n\n(u) vancomycin;\n\n(v) vigabatrin; or\n\n(w) vinca alkaloids.\n\nspecified list of haematological diseases means:\n\n(a) aplastic anaemia;\n\n(b) hyperviscosity syndrome;\n\n(c) Langerhan cell histiocytosis;\n\n(d) leukaemia;\n\n(e) myelodysplastic syndrome; or\n\n(f) sickle-cell disorder.\n\n> Note: hyperviscosity syndrome is also defined in the Schedule 1 - Dictionary.\n\nspecified list of viruses means:\n\n(a) cytomegalovirus;\n\n(b) hepatitis B virus;\n\n(c) hepatitis C virus;\n\n(d) herpes simplex virus types 1 or 2;\n\n(e) human immunodeficiency virus;\n\n(f) Lassa virus;\n\n(g) measles virus;\n\n(h) mumps virus; or\n\n(i) varicella-zoster virus infection of the geniculate ganglion on the affected side.\n\n> Note: Varicella-zoster virus infection of the geniculate ganglion is also known as herpes zoster oticus or Ramsay-Hunt syndrome.\n\nsuppurative labyrinthitis means inflammation of the inner ear characterised by the presence of pus.\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\ntime-weighted average (TWA) with a 3-dB exchange rate means the time-weighted average noise exposure level calculated according to the following formulae and shown in the table:\n\nTWA = 10.0 x Log(D/100) + 85\n\nwhere D = daily dose; and\n\nD = \\[C1/T1 + C2/T2 + …..+ Cn/Tn\\] x 100\n\nwhere Cn = total time of exposure at a specified noise level; and\n\nTn = exposure duration for which noise at this level becomes hazardous.\n\nTable of noise exposure levels and\n\ndurations based on 3-dB(A) exchange rate\n\n```html\n

Duration, T

Duration, T

Exposure

Level, L

(dB(A))

Hours

Minutes

Seconds

Exposure

Level, L

(dB(A))

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

\n```\n\nSource: National Institute of Occupational Safety and Health 1998 Guidelines Publication No. 98-126\n\nVEA means the Veterans' Entitlements Act 1986.\n\n> Note: Endnotes\n\n> Note: Endnote 1—About the endnotes\n\nThe endnotes provide information about this compilation and the compiled law.\n\nThe following endnotes are included in every compilation:\n\nEndnote 1—About the endnotes\n\nEndnote 2—Abbreviation key\n\nEndnote 3—Legislation history\n\nEndnote 4—Amendment history\n\nAbbreviation key—Endnote 2\n\nThe abbreviation key sets out abbreviations that may be used in the endnotes.\n\nLegislation history and amendment history—Endnotes 3 and 4\n\nAmending laws are annotated in the legislation history and amendment history.\n\nThe legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.\n\nThe amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.\n\nMisdescribed amendments\n\nA misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.\n\nIf a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history.\n\n> Note: Endnote 2—Abbreviation key\n\n| | o = order(s) |\n| ---------------------------------------------- | ----------------------------------- |\n| ad = added or inserted | Ord = Ordinance |\n| am = amended | orig = original |\n| amdt = amendment | par = paragraph(s)/subparagraph(s) |\n| c = clause(s) | /sub‑subparagraph(s) |\n| C[x] = Compilation No. x | pres = present |\n| Ch = Chapter(s) | prev = previous |\n| def = definition(s) | (prev…) = previously |\n| Dict = Dictionary | Pt = Part(s) |\n| disallowed = disallowed by Parliament | r = regulation(s)/rule(s) |\n| Div = Division(s) | |\n| exp = expires/expired or ceases/ceased to have | reloc = relocated |\n| effect | renum = renumbered |\n| F = Federal Register of Legislation | rep = repealed |\n| gaz = gazette | rs = repealed and substituted |\n| LA = Legislation Act 2003 | s = section(s)/subsection(s) |\n| LIA = Legislative Instruments Act 2003 | Sch = Schedule(s) |\n| (md) = misdescribed amendment can be given | Sdiv = Subdivision(s) |\n| effect | SLI = Select Legislative Instrument |\n| (md not incorp) = misdescribed amendment | SR = Statutory Rules |\n| cannot be given effect | Sub‑Ch = Sub‑Chapter(s) |\n| mod = modified/modification | SubPt = Subpart(s) |\n| No. = Number(s) | underlining = whole or part not |\n| | commenced or to be commenced |\n\n> Note: Endnote 3—Legislation history\n\n| Name | Registration | Commencement | Application, saving and transitional provisions |\n| ---------------------------------------------------------------------------------------------------------------- | -------------------------- | ----------------- | ----------------------------------------------- |\n| Statement of Principles concerning sensorineural hearing loss (Reasonable Hypothesis) (No. 98 of 2019) | 21 October 2019F2019L01360 | 18 November 2019 | |\n| Amendment Statement of Principles concerning sensorineural hearing loss (Reasonable Hypothesis) (No. 55 of 2022) | 3 May 2022F2022L00672 | 30 May 2022 | |\n| Amendment Statement of Principles concerning sensorineural hearing loss (Reasonable Hypothesis) (No. 75 of 2025) | 26 August 2025F2025L00977 | 22 September 2025 | |\n\n> Note: Endnote 4—Amendment history\n\n| Provision affected | How affected |\n| ----------------------------------------------------------------- | ----------------- |\n| Section 2………………. | rep LA s 48D |\n| Section 4………………. | rep LA s 48C |\n| Schedule 1 – Dictionary – specified list of chemical agents…...…. | ad No. 55 of 2022 |\n| Subsection 7(2)………. | rs No. 75 of 2025 |","sortOrder":0}],"analysis":{"kimi_summary":{"_metrics":{"completionTokens":689},"content_quality":"ok","complexity_score":7,"scope_assessment":{"changed":false,"description":"The instrument remains focused on its original purpose of establishing compensation criteria for sensorineural hearing loss in veterans. The 2025 amendments updated technical definitions (notably in subsection 7(2)) and added chemical agents to the specified list, but did not expand beyond the original scope of hearing loss compensation."},"complexity_factors":["72 distinct causal factors with varying time windows (30 days to 10 years)","Dual structure: factors repeated separately for 'clinical onset' and 'clinical worsening'","Technical measurement requirements including decibel calculations, time-weighted averages, and pack-year calculations","Extensive defined terms: 24 specified lists covering drugs, chemicals, viruses, diseases, and medical conditions","Mathematical formula for noise exposure (TWA = 10.0 x Log(D/100) + 85) with accompanying reference table","Cross-references to other Statements of Principles for related conditions","Multiple legislative frameworks (VEA and MRCA) with different service definitions"],"plain_english_summary":"This instrument sets a legal test for awarding compensation to current and former Australian Defence Force members and veterans for sensorineural hearing loss. It uses a “reasonable hypothesis” standard: if service history shows at least one of the listed risk factors, entitlement may follow.\n\nIt matters because it governs access to pensions and treatment for a common, often permanent service injury, tying medical, noise, trauma, chemical and drug exposures during service to eligibility."},"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":7,"scope_assessment":{"changed":true,"description":"The SoP has been expanded since the original 2019 instrument. Notably, an amendment in 2022 added a specified list of chemical agents (Schedule 1) as recognised ototoxic exposures (see Endnote 3 and Schedule 1 – specified list of chemical agents). A 2025 amendment replaced subsection 7(2) (the definition of sensorineural hearing loss) which alters the diagnostic articulation used for entitlement assessments (Endnote 3 and Endnote 4). Concretely, these amendments broadened the recognised non‑noise causal pathways (chemical ototoxins and updated definitional criteria) and therefore increased the range of exposures and medical circumstances that can raise a reasonable hypothesis of service connection."},"complexity_factors":["Large number of alternative factors listed in section 9 (the subsections enumerate over 70 numbered factors when onset and worsening are combined).","Multiple defined term lists in Schedule 1 with non-trivial lengths: specified list of autoimmune diseases (24 items, a–x), specified list of chemical agents (17 items, a–q), specified list of drugs (23 items, a–w), specified list of viruses (9 items, a–i), specified list of haematological diseases (6 items), specified list of bacterial infections (3 items), specified list of bone diseases (3 items).","Many distinct timing windows and thresholds across factors (e.g. 30 days, 3 months, 1 year, 2 years after cessation, 4 years, 5 years, cumulative 2,500 hours within 5 years, 40 g aspirin in 30 days, paracetamol/NSAID frequency for 1 year, serum cobalt ≥200 µg/L for 4 weeks).","Technical measurement rules and a detailed noise‑exposure table (dB(A), dB(C), 8‑hour TWA with 3‑dB exchange rate and formulae in Schedule 1).","Nested conditional application: subsections 9(36)–9(71) apply only to material contribution or aggravation where the condition pre‑existed or was contracted before/during but not arising out of service (section 10.2).","Cross‑references to other Statements of Principles where factors refer to injuries/diseases covered elsewhere (section 11), increasing cross‑instrument complexity.","Recent amendment history that changed definitions and expanded lists (amendments in 2022 and 2025), meaning the instrument’s scope and textual content have been modified since original issue (endnotes)."],"plain_english_summary":"**What this instrument does (mechanics first)**\n\n- This is a Statement of Principles (SoP) used by the Repatriation Medical Authority (RMA) to decide when sensorineural hearing loss (and death from it) can be said to have a \"reasonable hypothesis\" of connection with a veteran’s or member’s relevant service (see sections 1, 3, 8 and 9). In other words, it lists the medical and exposure factors that, if present, are sufficient to raise a reasonable hypothesis that the hearing loss is related to service.\n\n- The SoP sets a set of discrete factors (section 9) that operate as alternative pathways. At least one listed factor must exist before a reasonable hypothesis is taken to be raised linking the hearing loss (or its worsening, or death from it) with relevant service. The factors cover: high‑level noise exposure (specific peak and time‑weighted thresholds and a detailed noise‑exposure table), explosive blast, lightning, barotrauma, decompression sickness, specified drugs and ototopical agents, patterns of common analgesic use, certain infections, autoimmune and bone diseases, trauma and surgery to the cochlea/auditory nerve, cancer treatment (radiation), exposure to specified chemical agents with a cumulative exposure threshold, cobalt prostheses or elevated serum cobalt, smoking and second‑hand smoke exposure, heavy alcohol use, obesity, hypertension, and inability to obtain appropriate clinical management (see section 9 and Schedule 1 – Dictionary for defined thresholds and timing windows).\n\n- The instrument defines \"sensorineural hearing loss\" for the purpose of this SoP as acquired cochlear or auditory nerve hearing loss with a permanent shift of 20 dB or more at listed frequencies, and it excludes congenital deafness and Meniere disease/syndrome (subsection 7(2)). The SoP also treats death from a terminal event that was contributed to by the person’s hearing loss as within scope (subsection 7(3)).\n\n- The SoP is applied when a claim is assessed under the Veterans’ Entitlements Act or the Military Rehabilitation and Compensation Act where the statutory test requires whether a “reasonable hypothesis” exists (see section 3).\n\n**Who this affects**\n\n- Primary affected persons are veterans and serving members whose claims for service connection of sensorineural hearing loss (or its worsening, or death from it) are considered under the VEA or MRCA (section 3; Schedule 1 definition of \"relevant service\").\n\n- Secondary effects: medical practitioners who prepare reports (audiograms, blood tests such as serum cobalt), employers or unit commanders may need to document exposures; and the Department of Veterans’ Affairs (and decision bodies such as tribunals) will use the SoP to assess claims.\n\n**Why it matters (official rationale and how it operates in practice)**\n\n- The RMA states there is sound medical‑scientific evidence that sensorineural hearing loss can be related to relevant service (section 8). The SoP translates that view into a finite list of factual and clinical factors that, when present, meet the statutory “reasonable hypothesis” threshold.\n\n- Practically, the SoP lowers uncertainty about what evidence will raise a reasonable hypothesis: if a claimant can show one of the listed factors in the prescribed timing/threshold, the case meets the preliminary connection test and proceeds to detailed assessment for entitlement. It is not a conclusive finding of causation or of entitlement — it is the threshold to move forward under the statutory claims process (see sections 3 and 9). \n\n**Operational implications, costs and trade‑offs**\n\n- Evidence burden and compliance cost: many factors require objective evidence (audiograms, occupational noise records, medication charts, lab results for serum cobalt, medical records of infections or trauma). That imposes documentation and diagnostic costs on claimants and on DVA while assessing claims (sections 7, 9 and Schedule 1). Some evidence is time‑sensitive or retrospective (e.g. cumulative chemical exposure of 2,500 hours over 5 continuous years), which increases evidentiary difficulty and administrative work.\n\n- Medical testing and practice: the SoP implicitly increases demand for specific tests (audiometry, cochlear blood‑supply imaging where relevant, serum cobalt, records of drug exposure), which may change clinician behaviour or testing volume. The SoP also requires use of specified measurement conventions (dB(A), dB(C), TWA with 3‑dB exchange rate and an exposure table in Schedule 1).\n\n- Who pays / who decides: the SoP is produced by the RMA (scientific determinations — section 8). Claims decisions that apply the SoP are made under the VEA or MRCA framework (DVA or the relevant decision body). Financial liability for successful claims falls on the Commonwealth under the VEA/MRCA; however, the claimant usually must provide evidence to meet the SoP factors (sections 3, 8 and 9).\n\n- Effect on private enterprise and competition: the instrument is a claims‑assessment tool for government benefit programs. It does not directly impose regulatory obligations or taxes on private firms. Indirectly, employers with poor noise control records may see more service‑related claims from personnel (because the SoP recognises specific noise thresholds) — but the Commonwealth, not private employers, pays under the VEA/MRCA. The SoP does not change commercial contract freedoms or market prices directly.\n\n- Incentives and substitution effects: the SoP creates clear evidentiary pathways. Claimants and advisers will focus on documenting the listed exposures and conditions. This may favour claims based on clearly measurable exposures (noise peaks, documented drug courses, serum cobalt) over less well‑documented causal narratives.\n\n- Bureaucratic discretion and implementation risk: the RMA sets the medical criteria but applying them requires administrative adjudication (weighing evidence, reconstructing past exposures). The number of specific timing windows, thresholds and many defined lists increases scope for interpretive decisions by assessors and tribunals (see section 9 and Schedule 1). The SoP cross‑references other Statements of Principles in cases where a listed factor refers to another injury or disease (section 11), which adds layering to decision‑making.\n\n**Notable structural points in the text**\n\n- The same list of factors is applied both for establishing a link to the initial clinical onset and for \"clinical worsening\" of sensorineural hearing loss; timing windows and thresholds are repeated for onset and for worsening (section 9).\n\n- Subsections 9(36) to 9(71) (the later listed factors) apply only where the person’s hearing loss existed before or during (but did not arise out of) relevant service and the issue is material contribution or aggravation (section 10.2). That distinguishes direct service causation from aggravation of a pre‑existing condition.\n\n- Key definitions and numerical thresholds are collected in Schedule 1 (for example: BMI definition for obesity; lists of drugs, viruses, chemical agents; dB measurement conventions; pack‑years; TWA calculation and a noise exposure table).\n\n**Bottom line**\n\n- This SoP is a technical, evidence‑based checklist used in assessments of veterans’ claims to decide whether a reasonable hypothesis links sensorineural hearing loss (or its worsening, or death from it) to relevant service. It sets many specific, measurable thresholds and lists of recognised causes, thereby shaping what evidence must be produced for a claim to pass the initial causation threshold (sections 3, 7, 8 and 9)."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-sensorineural-hearing-loss-reasonable-hypothesis-no-98-of-2019","history":"/api/acts/statement-of-principles-concerning-sensorineural-hearing-loss-reasonable-hypothesis-no-98-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-sensorineural-hearing-loss-reasonable-hypothesis-no-98-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-sensorineural-hearing-loss-reasonable-hypothesis-no-98-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-sensorineural-hearing-loss-reasonable-hypothesis-no-98-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-sensorineural-hearing-loss-reasonable-hypothesis-no-98-of-2019/documents"}}