{"id":"F2019L00235","name":"Statement of Principles concerning sinus barotrauma (Reasonable Hypothesis) (No. 23 of 2019)","slug":"statement-of-principles-concerning-sinus-barotrauma-reasonable-hypothesis-no-23-of-2019","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439950,"registerId":"F2019L00235-fast-fetch-1775955774476","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning sinus barotrauma (Reasonable Hypothesis) (No. 23 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 (Reasonable Hypothesis)\n\n(No. 23 of 2019)\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 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 (Reasonable Hypothesis) (No. 23 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(2) of the Veterans' Entitlements Act 1986.\n\n4 Repeal\n\nThe Statement of Principles concerning sinus barotrauma No. 49 of 2010 (Federal Register of Legislation No. 2017C00074) made under subsections 196B(2) and (8) of the VEA is repealed.\n\n5 Application\n\nThis instrument applies to a claim to which section 120A of the VEA or section 338 of the Military Rehabilitation and Compensation Act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 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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that sinus barotrauma and death from sinus barotrauma 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 sinus barotrauma or death from sinus barotrauma 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(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 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) 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 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","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"This instrument repeals the 2010 Statement of Principles (s.4) and replaces it with updated, more specific criteria: a defined medical meaning of sinus barotrauma (s.7), a 24‑hour temporal window for listed factors that may raise a reasonable hypothesis (s.9), explicit inclusion of mechanical ventilation, blast exposure, impaired sinus drainage, allergic rhinitis and inability to obtain clinical management (s.9; Schedule 1), and a clarification that subsections relating to worsening apply only as material contribution or aggravation where the condition pre‑existed or did not arise out of service (s.10(2))."},"complexity_factors":["Use of a single, medically specific definition of 'sinus barotrauma' distinct from but linked to an ICD‑10‑AM code (s.7(2)‑(4)).","Strict 24‑hour temporal requirement for listed factors to precede clinical onset or worsening (s.9).","Multiple alternative causal or contributing factors (s.9(1)‑(11)) creating several pathways to satisfy the reasonable‑hypothesis test.","Interplay between causation and contribution/aggravation rules where pre‑existing conditions are involved (s.10(2)).","Cross‑reference to other Statements of Principles when a factor involves a different injury/disease (s.11).","Detailed technical definitions in the Dictionary/Schedule (e.g. ‘change in the ambient barometric pressure as specified’, ‘impaired drainage’, ‘mechanical ventilation’) that affect application (Schedule 1).","Repeal and replacement of the 2010 Statement of Principles, requiring attention to changes in criteria (s.4)."],"plain_english_summary":"This instrument sets out how the Repatriation Medical Authority (RMA) decides whether sinus barotrauma (injury from pressure differences in a paranasal sinus) is connected to a person’s relevant military service for claims under the VEA or MRCA. It defines the condition and lists specific factors that, if present in the required temporal window, raise a “reasonable hypothesis” of service connection (see ss.3,5,7,9). It replaces the earlier 2010 Statement of Principles (s.4)."},"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"},"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 the 2010 version with updated medical definitions and factors, but does not expand beyond the established purpose of determining service-related causation for specific medical conditions in the veterans' compensation scheme."},"complexity_factors":["Multiple defined terms (9 definitions in Schedule 1, plus inline definitions)","Cross-references between sections and to external legislation (VEA, MRCA)","Conditional logic: distinction between 'clinical onset' (factors 1-5) and 'clinical worsening' (factors 6-11)","Nested conditions in section 10(2) limiting application of worsening factors to pre-existing conditions","Incorporation by reference to ICD-10-AM coding system (specific edition with ISBN)","Section 11 creates dynamic incorporation of other Statements of Principles 'as in force from time to time'","Temporal requirements ('within 24 hours') create precise but complex qualifying conditions"],"plain_english_summary":"This Statement of Principles sets the medical rules for deciding veterans’ and defence force members’ entitlement to compensation for sinus barotrauma — pressure-related injury to the facial sinuses from flying, diving, blast or other pressurised-environment activities. \n\nIt identifies the specific, service-related factors that create a “reasonable hypothesis” linking the condition (or its worsening) to service — e.g. rapid pressure changes, face‑mask ventilation, blast exposure, blocked sinus drainage or allergic sinus disease within 24 hours — and replaces the 2010 instrument."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-sinus-barotrauma-reasonable-hypothesis-no-23-of-2019","history":"/api/acts/statement-of-principles-concerning-sinus-barotrauma-reasonable-hypothesis-no-23-of-2019/history","analysis":"/api/acts/statement-of-principles-concerning-sinus-barotrauma-reasonable-hypothesis-no-23-of-2019/analysis","conflicts":"/api/acts/statement-of-principles-concerning-sinus-barotrauma-reasonable-hypothesis-no-23-of-2019/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-sinus-barotrauma-reasonable-hypothesis-no-23-of-2019/important-cases","documents":"/api/acts/statement-of-principles-concerning-sinus-barotrauma-reasonable-hypothesis-no-23-of-2019/documents"}}