{"id":"F2019L00237","name":"Statement of Principles concerning sinus barotrauma (Balance of Probabilities) (No. 24 of 2019)","slug":"statement-of-principles-concerning-sinus-barotrauma-balance-of-probabilities-no-24-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439952,"registerId":"F2019L00237-fast-fetch-1775955774521","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning sinus barotrauma (Balance of Probabilities) (No. 24 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\nSINUS BAROTRAUMA (Balance of Probabilities)\n\n(No. 24 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 1 March 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 sinus barotrauma (Balance of Probabilities) (No. 24 of 2019).\n\n2 Commencement\n\n This instrument commences on 25 March 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 sinus barotrauma No. 50 of 2010 (Federal Register of Legislation No. F2017C00075) made under subsections 196B(3) and (8) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act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 sinus barotrauma and death from sinus barotrauma.\n\nMeaning of sinus barotrauma\n\n(2) For the purposes of this Statement of Principles, sinus barotrauma means an injury to a paranasal sinus arising from inequalities in the barometric pressure between the surrounding atmosphere and the air within the sinus cavity.\n\nNote: Clinical manifestations typically include inflammation, oedema, or haemorrhage of the mucosa of a paranasal sinus and less commonly fracture of a sinus wall, subcutaneous emphysema of the orbit or pneumocephalus.\n\n(3) While sinus barotrauma attracts ICD‑10‑AM code T70.1, in applying this Statement of Principles the meaning of sinus barotrauma 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 sinus barotrauma\n\n(5) For the purposes of this Statement of Principles, sinus barotrauma, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's sinus barotrauma.\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 sinus barotrauma and death from sinus barotrauma 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, sinus barotrauma or death from sinus barotrauma is connected with the circumstances of a person's relevant service:\n\n(1) experiencing a change in the ambient barometric pressure as specified, within the 24 hours before the clinical onset of sinus barotrauma;\n\nNote: change in the ambient barometric pressure as specified is defined in the Schedule 1 - Dictionary.\n\n(2) receiving mechanical ventilation involving a face mask within the 24 hours before the clinical onset of sinus barotrauma;\n\nNote: mechanical ventilation is defined in the Schedule 1 - Dictionary.\n\n(3) being exposed to an explosive blast within the 24 hours before the clinical onset of sinus barotrauma;\n\n(4) having impaired drainage of the sinus within the 24 hours before the clinical onset of sinus barotrauma;\n\nNote: impaired drainage of the sinus is defined in the Schedule 1 - Dictionary.\n\n(5) having allergic rhinitis or sinusitis within the 24 hours before the clinical onset of sinus barotrauma;\n\n(6) experiencing a change in the ambient barometric pressure as specified, within the 24 hours before the clinical worsening of sinus barotrauma;\n\nNote: change in the ambient barometric pressure as specified is defined in the Schedule 1 - Dictionary.\n\n(7) receiving mechanical ventilation involving a face mask within the 24 hours before the clinical worsening of sinus barotrauma;\n\nNote: mechanical ventilation is defined in the Schedule 1 - Dictionary.\n\n(8) being exposed to an explosive blast within the 24 hours before the clinical worsening of sinus barotrauma;\n\n(9) having impaired drainage of the sinus within the 24 hours before the clinical worsening of sinus barotrauma;\n\nNote: impaired drainage of the sinus is defined in the Schedule 1 - Dictionary.\n\n(10) having allergic rhinitis or sinusitis within the 24 hours before the clinical worsening of sinus barotrauma;\n\n(11) inability to obtain appropriate clinical management for sinus barotrauma.\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(6) to 9(11) apply only to material contribution to, or aggravation of, sinus barotrauma where the person's sinus barotrauma 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 change in the ambient barometric pressure as specified means a significant and rapid reduction or increase in the pressure surrounding the person, including in such circumstances as:\n\n(a) ascending from a submerged craft or device or a submarine escape training facility;\n\n(b) decompression or compression in a hypobaric or hyperbaric chamber;\n\n(c) flying;\n\n(d) sky diving;\n\n(e) underwater diving;\n\n(f) working in a submarine; or\n\n(g) working in a pressurised chamber or tunnel.\n\n impaired drainage of the sinus means one of the following which leads to a narrowing or obstruction of the affected sinus or sinus opening:\n\n(a) an anatomical deformity including, but not limited to, deviated septum, enlarged turbinates, adenoidal hypertrophy, fracture of the facial bones and any other bony structural abnormalities;\n\n(b) a soft tissue abnormality or mucosal swelling affecting the sinus including, but not limited to, polyps, tumours, inflammation, sarcoidosis, granulomas and scarring; or\n\n(c) a foreign body including, but not limited to, fungal balls, nasal packing, nasogastric or nasotracheal tubes, and dental detritus.\n\n mechanical ventilation means an artificial method of ventilation in which air is forced into the lungs of a person via mechanical means, and includes anaesthetic and continuous positive airway pressure (CPAP) use.\n\n MRCA means the Military Rehabilitation and Compensation Act 2004.\n\n relevant service means:\n\n(a) eligible war service (other than operational service) under the VEA;\n\n(b) defence service (other than hazardous service and British nuclear test defence service) under the VEA; or\n\n(c) peacetime service under the MRCA.\n\nNote: MRCA and VEA are also defined in the Schedule 1 - Dictionary.\n\n sinus barotrauma—see subsection 7(2).\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\n \n","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument repeals the earlier Statement of Principles concerning sinus barotrauma (No. 50 of 2010) (s4) and replaces it with a statement that (a) defines sinus barotrauma and death from it (s7), (b) specifies the set of causative or aggravating factors and a 24‑hour timing rule for onset/worsening (s9; Schedule 1), and (c) requires those factors to be related to relevant service for VEA or MRCA claims (s5; s10). The practical scope of qualifying service‑connected claims is therefore reset by the new definitions, factor list and temporal requirements."},"complexity_factors":["Medical-technical definitions and diagnostic references (definition of sinus barotrauma; ICD-10-AM cited but definition in s7(2)-(4)).","Strict 24-hour temporal windows for onset and clinical worsening that apply to most listed factors (s9(1)–(10)).","Multiple distinct causation/aggravation pathways (ambient pressure changes, mechanical ventilation, blast, impaired drainage, allergic rhinitis, inability to obtain care) requiring different kinds of evidence (s9; Schedule 1 definitions).","Requirement that any listed factor be related to 'relevant service' as defined, importing VEA/MRCA entitlement tests and creating a legal-service causation link (s5; s10(1); Schedule 1 relevant service).","Cross‑instrument interaction where a factor refers to an injury/disease governed by another Statement of Principles, requiring look‑through to other instruments (s11).","Discretion and evidentiary assessment by the Repatriation Medical Authority applying the balance of probabilities standard (s3; s8).","Open‑ended factor 'inability to obtain appropriate clinical management' may produce evidentiary uncertainty and administrative assessment of access to care (s9(11)).","Repeal of the 2010 Statement and replacement by this instrument means comparison with prior criteria may be necessary for ongoing or historical claims (s4)."],"plain_english_summary":"This Statement of Principles (No. 24 of 2019) sets the medical rules the Repatriation Medical Authority uses to decide whether sinus barotrauma (including death from it) is connected to a veteran's or service member's relevant service for claims under the VEA or MRCA. It defines the condition, lists specific causative or aggravating factors (pressure changes, mechanical ventilation, blast exposure, impaired sinus drainage, allergic rhinitis, or lack of appropriate treatment) and requires those factors be related to service, usually within 24 hours of onset or worsening. The Authority decides on the balance of probabilities and claimants must supply evidence linking listed factors to service."},"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 established scope of Repatriation Medical Authority Statements of Principles. It replaces the 2010 version (No. 50 of 2010) with updated medical definitions and refined factors, but does not expand beyond the original purpose of determining service connection for sinus barotrauma claims. The structure — covering both onset and aggravation pathways — is consistent with standard RMA practice for physical injury conditions."},"complexity_factors":["Multiple defined terms (9 definitions in Schedule 1) requiring cross-reference to understand operational scope","Dual application framework — distinguishes between 'clinical onset' (factors 1-5) and 'clinical worsening' (factors 6-11) with different legal consequences","Nested conditional logic in section 10(2) restricting factors 6-11 to aggravation cases only where condition pre-existed service","Incorporation by reference to external classification system (ICD-10-AM Tenth Edition) for disease coding","Cross-referencing mechanism in section 11 linking to other Statements of Principles for comorbid conditions","Temporal limitation requiring all triggering events to occur within strict 24-hour window before onset/worsening"],"plain_english_summary":"This instrument sets when veterans and current/former defence members can claim compensation for sinus barotrauma — pressure-induced injury to the sinuses — by requiring a “balance of probabilities” link to military service. It covers injuries from rapid pressure changes, ventilation, blast, blocked drainage or allergic flare-ups that occur or worsen within 24 hours of service exposure.\n\nIt narrows the 2010 approach by tightening medical-evidence rules and limits causal findings where the condition pre-existed service, allowing only worsening to be attributed to service."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-sinus-barotrauma-balance-of-probabilities-no-24-of-2019","history":"/api/acts/statement-of-principles-concerning-sinus-barotrauma-balance-of-probabilities-no-24-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-sinus-barotrauma-balance-of-probabilities-no-24-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-sinus-barotrauma-balance-of-probabilities-no-24-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-sinus-barotrauma-balance-of-probabilities-no-24-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-sinus-barotrauma-balance-of-probabilities-no-24-of-2019/documents"}}