{"id":"F2020L01385","name":"Statement of Principles concerning tinnitus (Reasonable Hypothesis) (No. 84 of 2020)","slug":"statement-of-principles-concerning-tinnitus-reasonable-hypothesis-no-84-of-2020","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":130605,"registerId":"commonwealth-F2020L01385-current","compilationNumber":null,"startDate":"2026-04-03","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning tinnitus (Reasonable Hypothesis) (No. 84 of 2020)","content":"![Commonwealth Coat of Arms](image.001.png)\n\nStatement of Principles concerning tinnitus (Reasonable Hypothesis) (No. 84 of 2020)\n\nmade under subsection 196B(2) of the\n\nVeterans' Entitlements Act 1986\n\nCompilation No. 1\n\nCompilation date: 19 September 2022\n\nIncludes amendments up to: Veterans' Entitlements (Statements of Principles—definition of \"one pack-year\") Amendment Determination 2022 (No. 94 of 2022) (F2022L01128)\n\nThe day of commencement of this Amendment Determination is 19 September 2022.\n\nAbout this compilation\n\nThis compilation\n\nThis is a compilation of the Statement of Principles concerning tinnitus (Reasonable Hypothesis) (No. 84 of 2020) that shows the text of the law as amended and in force on 19 September 2022.\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 tinnitus (Reasonable Hypothesis) (No. 84 of 2020).\n\n3 Authority\n\nThis instrument is made under subsection 196B(2) of the Veterans' Entitlements Act 1986.\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 tinnitus and death from tinnitus.\n\nMeaning of tinnitus\n\n(2) For the purposes of this Statement of Principles, tinnitus:\n\n(a) means intermittent or constant perception of sound:\n\n(i) in one or both ears; or\n\n(ii) in or around the head;\n\noccurring without an external source of sound; and\n\n(b) must have persisted for at least three consecutive months.\n\n> Note: The sounds of tinnitus include buzzing, hissing, ringing, whistling and clicking.\n\n(3) While tinnitus attracts ICD‑10‑AM code H93.1, in applying this Statement of Principles the meaning of tinnitus 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 tinnitus\n\n(5) For the purposes of this Statement of Principles, tinnitus, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's tinnitus.\n\n> Note: 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 tinnitus and death from tinnitus 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\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 tinnitus or death from tinnitus with the circumstances of a person's relevant service:\n\n(1) being exposed to a peak sound pressure level at the tympanic membrane of at least 140 dB(C) before the clinical onset of tinnitus;\n\n> Note: dB(C) is defined in the Schedule 1 - Dictionary.\n\n(2) 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 tinnitus;\n\n> Note: dB(A) and time-weighted average (TWA) with a 3-dB exchange rate are defined in the Schedule 1 - Dictionary.\n\n(3) having blunt trauma, penetrating trauma or surgery to an auditory structure or central auditory neural pathway, within the five years before the clinical onset of tinnitus;\n\n> Note 1: Examples of trauma include temporal bone fracture and basilar skull fracture.\n\n> Note 2: auditory structure is defined in the Schedule 1 - Dictionary.\n\n(4) having sensorineural hearing loss or conductive hearing loss at the time of the clinical onset of tinnitus;\n\n(5) taking a drug from the specified list of drugs within the 30 days before the clinical onset of tinnitus;\n\n> Note: specified list of drugs is defined in the Schedule 1 - Dictionary.\n\n(6) taking a drug which is associated in the individual with:\n\n(a) the development of tinnitus within 30 days of commencing drug therapy; and\n\n(b) a decrease in tinnitus within days or weeks of discontinuing or tapering drug therapy; and\n\nwhere treatment with the drug continued for at least the three days before the clinical onset of tinnitus;\n\n(7) having smoked at least ten pack-years of tobacco products before the clinical onset of tinnitus, and where smoking has ceased, the clinical onset of tinnitus has occurred within five years of cessation;\n\n> Note: one pack-year is defined in the Schedule 1 - Dictionary.\n\n(8) being exposed to second-hand smoke:\n\n(a) for at least 2,500 hours before the clinical onset of tinnitus; and\n\n(b) where the first exposure to second-hand smoke commenced at least five years before the clinical onset of tinnitus; and\n\n(c) where the last exposure to second-hand smoke occurred within the two years before the clinical onset of tinnitus;\n\n> Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.\n\n(9) having inner ear exposure to a chemical agent from the specified list of chemical agents within the 30 days before the clinical onset of tinnitus;\n\n> Note 1: Inner ear exposure to a chemical agent will only occur in the presence of a defect in the tympanic membrane.\n\n> Note 2: specified list of chemical agents is defined in the Schedule 1 - Dictionary.\n\n(10) having a vascular, muscular or other anatomical source of sound that can be transmitted to the affected ear at the time of the clinical onset of tinnitus;\n\n> Note: vascular, muscular or other anatomical source of sound is defined in the Schedule 1 \\- Dictionary.\n\n(11) having a reduced supply of blood to an auditory structure of the affected ear at the time of the clinical onset of tinnitus;\n\n> Note 1: Examples of causes of a reduced supply of blood to an auditory structure include coagulation disorders, embolism, thrombosis, haemorrhage or vasospasm of the vertebro-basilar circulation, hyperviscosity, vasculitis, and intralabyrinthine haemorrhage or infarction.\n\n> Note 2: auditory structure is defined in the Schedule 1 - Dictionary.\n\n(12) having a bone 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 tinnitus;\n\n> Note: specified list of bone diseases is defined in the Schedule 1 - Dictionary.\n\n(13) having osteoporosis at the time of the clinical onset of tinnitus;\n\n(14) having an autoimmune disease at the time of the clinical onset of tinnitus;\n\n(15) having multiple sclerosis at the time of the clinical onset of tinnitus;\n\n(16) having a benign or malignant neoplasm involving the petrous temporal bone, an auditory structure or central auditory neural pathway of the affected ear at the time of the clinical onset of tinnitus;\n\n> Note: auditory structure is defined in the Schedule 1 - Dictionary.\n\n(17) having a haematological disease from the specified list of haematological diseases at the time of the clinical onset of tinnitus;\n\n> Note: specified list of haematological diseases is defined in the Schedule 1 - Dictionary.\n\n(18) having a cerebrovascular accident within the 30 days before the clinical onset of tinnitus;\n\n(19) having concussion or moderate to severe traumatic brain injury within the three months before the clinical onset of tinnitus;\n\n(20) being exposed to an explosive blast within the 30 days before the clinical onset of tinnitus;\n\n(21) being struck by lightning within the 30 days before the clinical onset of tinnitus;\n\n(22) having temporomandibular disorder at the time of the clinical onset of tinnitus;\n\n(23) having trigeminal neuralgia at the time of the clinical onset of tinnitus;\n\n(24) having migraine or tension-type headache before the clinical onset of tinnitus;\n\n(25) having Meniere's disease or delayed endolymphatic hydrops at the time of the clinical onset of tinnitus;\n\n(26) having:\n\n(a) an episode of otitic barotrauma involving the affected ear; or\n\n(b) cerebral arterial gas embolism; or\n\n(c) decompression sickness;\n\nwithin the 30 days before the clinical onset of tinnitus;\n\n> Note: Otitic barotrauma is also known as otic barotrauma.\n\n(27) having acoustic shock at the time of the clinical onset of tinnitus;\n\n> Note: acoustic shock is defined in the Schedule 1 - Dictionary.\n\n(28) having a bacterial infection from the specified list of bacterial infections within the 30 days before the clinical onset of tinnitus;\n\n> Note: specified list of bacterial infections is defined in the Schedule 1 - Dictionary.\n\n(29) having a viral infection from the specified list of viral infections within the 30 days before the clinical onset of tinnitus;\n\n> Note: specified list of viral infections is defined in the Schedule 1 - Dictionary.\n\n(30) having meningitis or encephalitis within the one year before the clinical onset of tinnitus;\n\n(31) having neurosyphilis before the clinical onset of tinnitus;\n\n(32) having tuberculosis involving the nasopharynx, meninges, temporal bone, middle ear or inner ear of the affected side before the clinical onset of tinnitus;\n\n(33) having typhoid fever within the 30 days before the clinical onset of tinnitus;\n\n(34) undergoing a course of therapeutic radiation for cancer, where the auditory apparatus was in the field of radiation, before the clinical onset of tinnitus;\n\n(35) having:\n\n(a) a cobalt-containing metal-on-metal hip prosthesis; or\n\n(b) a serum cobalt concentration of at least 200 micrograms per litre;\n\nfor at least the four weeks before the clinical onset of tinnitus;\n\n(36) having vitamin B1 (thiamine) or vitamin B12 (cobalamin) deficiency at the time of the clinical onset of tinnitus;\n\n(37) having carbon monoxide poisoning within the 48 hours before the clinical onset of tinnitus;\n\n(38) having hypothyroidism for at least the three months before the clinical onset of tinnitus;\n\n(39) having a clinically significant depressive disorder or a clinically significant anxiety disorder at the time of the clinical onset of tinnitus;\n\n> Note: clinically significant is defined in the Schedule 1 - Dictionary.\n\n(40) being exposed to a peak sound pressure level at the tympanic membrane of at least 140 dB(C) before the clinical worsening of tinnitus;\n\n> Note: dB(C) is defined in the Schedule 1 - Dictionary.\n\n(41) 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 tinnitus;\n\n> Note: dB(A) and time-weighted average (TWA) with a 3-dB exchange rate are defined in the Schedule 1 - Dictionary.\n\n(42) having blunt trauma, penetrating trauma or surgery to an auditory structure or central auditory neural pathway, within the five years before the clinical worsening of tinnitus;\n\n> Note 1: Examples of trauma include temporal bone fracture and basilar skull fracture.\n\n> Note 2: auditory structure is defined in the Schedule 1 - Dictionary.\n\n(43) having sensorineural hearing loss or conductive hearing loss at the time of the clinical worsening of tinnitus;\n\n(44) taking a drug from the specified list of drugs within the 30 days before the clinical worsening of tinnitus;\n\n> Note: specified list of drugs is defined in the Schedule 1 - Dictionary.\n\n(45) having smoked at least ten pack-years of tobacco products before the clinical worsening of tinnitus, and where smoking has ceased, the clinical worsening of tinnitus has occurred within five years of cessation;\n\n> Note: one pack-year is defined in the Schedule 1 - Dictionary.\n\n(46) being exposed to second-hand smoke:\n\n(a) for at least 2,500 hours before the clinical worsening of tinnitus; and\n\n(b) where the first exposure to second-hand smoke commenced at least five years before the clinical worsening of tinnitus; and\n\n(c) where the last exposure to second-hand smoke occurred within the two years before the clinical worsening of tinnitus;\n\n> Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.\n\n(47) having inner ear exposure to a chemical agent from the specified list of chemical agents within the 30 days before the clinical worsening of tinnitus;\n\n> Note 1: Inner ear exposure to a chemical agent will only occur in the presence of a defect in the tympanic membrane.\n\n> Note 2: specified list of chemical agents is defined in the Schedule 1 - Dictionary.\n\n(48) having a vascular, muscular or other anatomical source of sound that can be transmitted to the affected ear at the time of the clinical worsening of tinnitus;\n\n> Note: vascular, muscular or other anatomical source of sound is defined in the Schedule 1 \\- Dictionary.\n\n(49) having a reduced supply of blood to an auditory structure of the affected ear at the time of the clinical worsening of tinnitus;\n\n> Note 1: Examples of causes of a reduced supply of blood to an auditory structure include coagulation disorders, embolism, thrombosis, haemorrhage or vasospasm of the vertebro-basilar circulation, hyperviscosity, vasculitis, and intralabyrinthine haemorrhage or infarction.\n\n> Note 2: auditory structure is defined in the Schedule 1 - Dictionary.\n\n(50) having a bone 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 tinnitus;\n\n> Note: specified list of bone diseases is defined in the Schedule 1 - Dictionary.\n\n(51) having osteoporosis at the time of the clinical worsening of tinnitus;\n\n(52) having an autoimmune disease at the time of the clinical worsening of tinnitus;\n\n(53) having multiple sclerosis at the time of the clinical worsening of tinnitus;\n\n(54) having a benign or malignant neoplasm involving the petrous temporal bone, an auditory structure or central auditory neural pathway of the affected ear at the time of the clinical worsening of tinnitus;\n\n> Note: auditory structure is defined in the Schedule 1 - Dictionary.\n\n(55) having a haematological disease from the specified list of haematological diseases at the time of the clinical worsening of tinnitus;\n\n> Note: specified list of haematological diseases is defined in the Schedule 1 - Dictionary.\n\n(56) having a cerebrovascular accident within the 30 days before the clinical worsening of tinnitus;\n\n(57) having concussion or moderate to severe traumatic brain injury within the three months before the clinical worsening of tinnitus;\n\n(58) being exposed to an explosive blast within the 30 days before the clinical worsening of tinnitus;\n\n(59) being struck by lightning within the 30 days before the clinical worsening of tinnitus;\n\n(60) having temporomandibular disorder at the time of the clinical worsening of tinnitus;\n\n(61) having trigeminal neuralgia at the time of the clinical worsening of tinnitus;\n\n(62) having migraine or tension-type headache before the clinical worsening of tinnitus;\n\n(63) having Meniere's disease or delayed endolymphatic hydrops at the time of the clinical worsening of tinnitus;\n\n(64) having:\n\n(a) an episode of otitic barotrauma involving the affected ear; or\n\n(b) cerebral arterial gas embolism; or\n\n(c) decompression sickness;\n\nwithin the 30 days before the clinical worsening of tinnitus;\n\n> Note: Otitic barotrauma is also known as otic barotrauma.\n\n(65) having acoustic shock at the time of the clinical worsening of tinnitus;\n\n> Note: acoustic shock is defined in the Schedule 1 - Dictionary.\n\n(66) having a bacterial infection from the specified list of bacterial infections within the 30 days before the clinical worsening of tinnitus;\n\n> Note: specified list of bacterial infections is defined in the Schedule 1 - Dictionary.\n\n(67) having a viral infection from the specified list of viral infections within the 30 days before the clinical worsening of tinnitus;\n\n> Note: specified list of viral infections is defined in the Schedule 1 - Dictionary.\n\n(68) having meningitis or encephalitis within the one year before the clinical worsening of tinnitus;\n\n(69) having neurosyphilis before the clinical worsening of tinnitus;\n\n(70) having tuberculosis involving the nasopharynx, meninges, temporal bone, middle ear or inner ear of the affected side before the clinical worsening of tinnitus;\n\n(71) having typhoid fever within the 30 days before the clinical worsening of tinnitus;\n\n(72) undergoing a course of therapeutic radiation for cancer, where the auditory apparatus was in the field of radiation, before the clinical worsening of tinnitus;\n\n(73) having:\n\n(a) a cobalt-containing metal-on-metal hip prosthesis; or\n\n(b) a serum cobalt concentration of at least 200 micrograms per litre;\n\nfor at least the four weeks before the clinical worsening of tinnitus;\n\n(74) having vitamin B1 (thiamine) or vitamin B12 (cobalamin) deficiency at the time of the clinical worsening of tinnitus;\n\n(75) having carbon monoxide poisoning within the 48 hours before the clinical worsening of tinnitus;\n\n(76) having hypothyroidism for at least the three months before the clinical worsening of tinnitus;\n\n(77) having a clinically significant depressive disorder or a clinically significant anxiety disorder at the time of the clinical worsening of tinnitus;\n\n> Note: clinically significant is defined in the Schedule 1 - Dictionary.\n\n(78) inability to obtain appropriate clinical management for tinnitus.\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(40) to 9(78) apply only to material contribution to, or aggravation of, tinnitus where the person's tinnitus 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\nSchedule 1 \\- Dictionary\n\nNote: See Section 6\n\n1 Definitions\n\nIn this instrument:\n\nacoustic shock means the development of acoustic shock symptoms within 30 days of being exposed to a brief, sudden, unexpected, loud sound.\n\n> Note: acoustic shock symptoms is also defined in the Schedule 1 - Dictionary.\n\nacoustic shock symptoms means the acoustic shock symptoms identified in Work Health and Safety (Managing Noise and Preventing Hearing Loss at Work) Code of Practice 2015, as in force on 17 December 2015, including:\n\n(a) a feeling of fullness in the ear;\n\n(b) burning sensations or sharp pain around or in the ear;\n\n(c) dizziness;\n\n(d) hypersensitivity (sensitivity to previously tolerated sounds such as loud voices, television and radio);\n\n(e) hypervigilance; and\n\n(f) numbness, tingling or soreness down the side of face, neck or shoulder.\n\n> Note: The sounds associated with the development of acoustic shock symptoms include crackles, hisses, whistles, shrieks and high-pitched noises.\n\nauditory structure means the inner ear, middle ear, cochlear nerve or vestibulocochlear nerve.\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 another person who is smoking.\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\nclinically significant means sufficient to warrant ongoing management, which may involve regular visits (for example, at least monthly), to a psychiatrist, counsellor or general practitioner.\n\n> Note: To warrant ongoing management does not require that any actual management was received or given for the condition.\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 polycythaemia and Waldenstrom macroglobulinaemia.\n\nMRCA means the Military Rehabilitation and Compensation Act 2004.\n\none pack-year means the amount of tobacco consumed in smoking 20 cigarettes per day for a period of 1 year, or an equivalent amount of tobacco products.\n\n> Note 1: An equivalent amount of tobacco products is 7,300 grams of smoking tobacco by weight, either in cigarettes, pipe tobacco or cigars, or a combination of same. For pipe tobacco, cigars or combinations of multiple tobacco types, 1 gram of tobacco is considered to be equal to one cigarette.\n\n> Note 2: Pack-years are calculated by dividing the number of cigarettes smoked per day by 20 and multiplying this number by the number of years the person has smoked. For example, smoking 10 cigarettes per day for 10 years is equal to 5 pack-years, and smoking 40 cigarettes per day for 10 years is equal to 20 pack-years.\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\nspecified list of bacterial infections means:\n\n(a) acute otitis media of the affected side;\n\n(b) chronic suppurative otitis media of the affected side;\n\n(c) Lyme disease; or\n\n(d) suppurative labyrinthitis of the affected side.\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) aminoglycoside-containing ear drops;\n\n(b) Burow's solution (5% aluminium subacetate);\n\n(c) chloramphenicol-containing ear drops; or\n\n(d) surgical antiseptics.\n\nspecified list of drugs means:\n\n(a) α-difluoromethylornithine (eflornithine);\n\n(b) 2-hydroxypropyl- b-cyclodextrin (HPbCD);\n\n(c) aminoglycoside antibiotics;\n\n(d) carbimazole;\n\n(e) carboplatin;\n\n(f) cisplatin;\n\n(g) loop diuretics;\n\n(h) macrolide antibiotics;\n\n(i) opioids;\n\n(j) oxaliplatin;\n\n(k) phosphodiesterase 5 inhibitors;\n\n(l) propylthiouracil;\n\n(m) quinidine;\n\n(n) quinine and quinine derivatives, including mefloquine;\n\n(o) vancomycin; or\n\n(p) 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 viral infections means:\n\n(a) coronavirus disease 2019 (COVID-19);\n\n(b) cytomegalovirus infection of the vestibulocochlear nerve of the affected side;\n\n(c) hepatitis B;\n\n(d) hepatitis C;\n\n(e) herpes simplex;\n\n(f) human immunodeficiency virus infection;\n\n(g) Lassa fever;\n\n(h) measles;\n\n(i) mumps;\n\n(j) herpes zoster of the geniculate ganglion on the affected side; or\n\n(k) viral labyrinthitis of the affected ear.\n\n> Note: Herpes zoster 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  Log(D/100) + 85\n\nwhere D = daily dose; and\n\nD = \\[C1/T1 + C2/T2 + …..+ Cn/Tn\\]  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\ntinnitus—see subsection 7(2).\n\nvascular, muscular or other anatomical source of sound means:\n\n(a) acquired arteriovenous fistula;\n\n(b) benign intracranial hypertension;\n\n(c) brachiocephalic artery stenosis;\n\n(d) carotid artery stenosis or dissection;\n\n(e) dural venous sinus stenosis;\n\n(f) jugular bulb abnormalities;\n\n(g) neoplastic and non-neoplastic space-occupying lesions involving or arising near the middle or inner ear;\n\n(h) vascular conditions causing turbulent blood flow in structures close to the middle or inner ear;\n\n(i) palatal myoclonus;\n\n(j) patulous eustachian tube;\n\n(k) spasm of the stapedius or tensor tympani muscles; or\n\n(l) valvular heart disease.\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 tinnitus (Reasonable Hypothesis) (No. 84 of 2020) | 2 November 2020F2020L01385 | 30 November 2020 | |\n| Veterans' Entitlements (Statements of Principles—definition of \"one pack-year\") Amendment Determination 2022 (No. 94 of 2022) | 26 August 2022F2022L01128 | 19 September 2022 | |\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| Subsection 9(7) note..... | rs No. 94 of 2022 |\n| Subsection 9(45) note... | rs No. 94 of 2022 |\n| Schedule 1 – Dictionary – one pack-year...…….. | rs No. 94 of 2022 |","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":6,"scope_assessment":{"changed":false,"description":"The 2022 amendment noted in the compilation alters definitions and clarifying notes (for example the definition of ‘one pack‑year’ and related notes to subsections 9(7) and 9(45)). Those are definitional/clarifying changes rather than substantive expansions of the classes of factors that can raise a reasonable hypothesis. In other words, the instrument’s practical scope — the categories of exposures, injuries and medical conditions that can link tinnitus to relevant service — remains the same; the amendment refines how one specific measures a smoking history and clarifies related notes rather than broadening coverage."},"complexity_factors":["Large list of qualifying factors (sections 9(1)–9(78)) covering onset and clinical worsening, with many near-duplicate entries","Multiple technical definitions in Schedule 1 (dB(A), dB(C), time-weighted average (TWA) with 3‑dB exchange rate, pack‑year, auditory structure, clinically significant, terminal event, etc.) — approx. 20+ named definitions","Nested temporal conditions and multiple time windows (30 days, 48 hours, 3 months, 1 year, 5 years, etc.) across different factors","Detailed technical noise exposure calculation and lookup table (TWA formula plus long table) requiring numerical computation and interpretation","Several \"specified lists\" (drugs, chemical agents, bacterial and viral infections, bone and haematological diseases) that require cross-referencing within the instrument","Conditional application rules (section 10) that distinguish factors for onset vs for material contribution/aggravation — subtle legal effect differences","Cross-reference mechanism to other Statements of Principles (section 11) so some factors defer to separate SOPs, increasing cross-document complexity","Repetition of largely similar factor sets for onset and for worsening increases the document length and makes locating the relevant provision error-prone","Technical medical terminology (e.g. intralabyrinthine haemorrhage, petrous temporal bone neoplasm, acoustic shock) requiring clinical expertise to apply correctly"],"plain_english_summary":"**What this instrument does (mechanically)**\n\n- This is a Statement of Principles used for veterans' and defence-member compensation claims. Mechanically it sets out what counts as \"tinnitus\" and then lists the specific medical, exposure and behavioural factors which — if they existed and were related to a person’s relevant service — are sufficient to raise a \"reasonable hypothesis\" that the tinnitus (or death from tinnitus) is connected to that service (see sections 7, 8 and 9).\n\n- The instrument distinguishes two types of connection: factors that can support the claim that tinnitus was suffered or contracted because of service (onset) and factors that can support the claim that service materially contributed to or aggravated pre-existing tinnitus (worsening). Many of the same items are repeated for both onset and worsening, but the legal effect differs (see sections 9 and 10).\n\n- It defines technical measurement thresholds and time windows (for example, single peak exposures of at least 140 dB(C) at the eardrum, or 8-hour time-weighted average exposures of at least 85 dB(A) over six months), and it supplies the definitions and calculation method for those measurements (see Schedule 1 — definitions, and the TWA formula and table).\n\n- The Repatriation Medical Authority states that there is sound medical‑scientific evidence supporting links between tinnitus and relevant service; this Statement of Principles is the instrument that implements that evidentiary judgment for claims (see section 8).\n\n**Who is affected**\n\n- Primarily claimants to veterans’/military compensation schemes: veterans and former members of the Australian Defence Force (and related peacekeeping or nuclear-test categories) claiming under the Veterans' Entitlements Act 1986 (VEA) or the Military Rehabilitation and Compensation Act 2004 (MRCA) (see section 5 and Schedule 1 — relevant service definitions).\n\n- Medical practitioners, occupational health experts and claims examiners who must document, measure or assess the listed factors (for example noise exposure histories, audiology reports, records of trauma, drug history, infections and other medical diagnoses).\n\n- Indirectly, taxpayers and the compensation system because benefits paid on accepted claims draw on public funds.\n\n**Why it matters (practical effects)**\n\n- It sets a clear, administrable threshold for causation in tinnitus claims: if one of the listed factors existed and is shown to be related to relevant service, a decision‑maker may be satisfied that a reasonable hypothesis of service connection has been raised (this affects the claimant’s burden of proof and how claims are triaged and decided) (see section 9 and 10).\n\n- It standardises the medical and exposure evidence the Department of Veterans' Affairs will look for, so claimants and clinicians know what types of evidence matter (noise levels, timing windows, specific diagnoses, drug exposures, smoking history, infections, blast/ball lightning exposure, etc.) (see section 9 and Schedule 1).\n\n**Official purpose-claim and an analytical test of trade-offs and implementation risks**\n\n- Official claim: the Repatriation Medical Authority considers there is sound medical-scientific evidence for the links listed (section 8). In practice, the Statement of Principles translates that view into a checklist of qualifying factors that raise a reasonable hypothesis of service connection.\n\n- Costs and who pays: benefits accepted under these SOPs are paid from public funds. The concentrated benefit is to successful claimants; the cost is dispersed across government expenditure.\n\n- Incentives and behaviour changes: the instrument encourages claimants and their clinicians to document specific exposures and diagnoses (for example detailed noise histories, audiometry, records of drug use, smoking history and timing). Decision-makers are incentivised to apply the standardised list rather than re-evaluating general medical causation from first principles in each case (see section 9 and Schedule 1).\n\n- Compliance burden: claimants must supply medical records, exposure histories and sometimes technical noise measures; clinicians may be required to provide more specific reports to meet the thresholds (e.g. establishing dB(A)/dB(C) exposure or pack-year smoking history) (see sections 6–9 and Schedule 1).\n\n- Implementation risk and evidentiary difficulties: several qualifying factors require historical exposure quantification (past peak dB(C) events, cumulative dB(A) TWA), or timing evidence (exposures within 30 days, 3 months, 1 year, etc.), which can be hard to verify decades after service. That raises administrative risk that genuine cases might be under‑ or over‑accepted depending on record availability and the quality of retrospective assessment (see section 9 and Schedule 1).\n\n- Bureaucratic discretion and legal effect: the Repatriation Medical Authority sets the Statement; claim decision-makers apply it when deciding whether a reasonable hypothesis is raised. The Statement narrows medical discretion by listing qualifying factors, but the ultimate assessment of whether a factor is actually related to the person’s relevant service (and whether the reasonable hypothesis threshold is met) rests with decision-makers (see sections 8, 9 and 10).\n\n**Effects on private enterprise and other economic considerations**\n\n- Direct economic effects on private businesses are minimal. The measure is administrative and applies to benefit decisions; it does not regulate private companies’ behaviour directly.\n\n- Indirect effects: employers, industrial medical providers, and lawyers advising veteran claimants may see increased demand for noise exposure assessments, audiometry and historical exposure reconstruction. That is a small, concentrated demand effect rather than a broad market change.\n\n**Concentrated benefits, diffuse costs, and substitution effects**\n\n- Concentrated benefit to veterans and eligible members whose tinnitus matches the listed factors; diffuse fiscal cost to the general public through the compensation scheme. The instrument does not create private‑sector subsidies or alter market competition.\n\n**Key sections to read for decision-making**\n\n- Definition of tinnitus and inclusion of death from tinnitus: section 7.\n- Evidence base and authority: section 8.\n- The qualifying factors that raise a reasonable hypothesis (onset and worsening): section 9.\n- Service-relationship rules and the limitation on which factors apply to aggravation vs causation: section 10.\n- Technical and definitional material (noise metrics, pack-year, lists of drugs, infections and other specified conditions): Schedule 1 (Definitions and tables).\n\n(References in parentheses are to sections and Schedule 1 of the Statement of Principles.)"},"kimi_summary":{"_metrics":{"completionTokens":716},"content_quality":"ok","complexity_score":7,"scope_assessment":{"changed":false,"description":"The instrument remains focused on its original purpose of establishing medical-scientific factors linking tinnitus to veterans' service. The 2022 amendment refined the definition of 'one pack-year' for smoking calculations but did not expand the scope beyond tinnitus and its relationship to service."},"complexity_factors":["78 distinct factors across two categories (onset and worsening), each with specific temporal requirements","Multiple nested definitions requiring cross-referencing to Schedule 1 dictionary","Technical medical and acoustic terminology requiring specialist knowledge (decibel measurements, time-weighted averages, anatomical structures)","Extensive lists of specified drugs, chemical agents, bacterial infections, viral infections, bone diseases, and haematological diseases","Complex calculation methodology for noise exposure with mathematical formula and reference table","Multiple cross-references to other Statements of Principles and external documents (ICD-10-AM, Work Health and Safety Code of Practice)","Conditional logic with multiple elements required for some factors (e.g., second-hand smoke requires 2,500 hours AND 5-year first exposure AND 2-year last exposure)","Amendment history showing evolving definitions (notably 'one pack-year' was substituted in 2022)"],"plain_english_summary":"This Statement of Principles sets the medical/scientific test for whether tinnitus in Australian veterans and defence members is linked to service and thus compensable. It applies a “reasonable hypothesis” standard: if at least one listed factor plausibly relates the claimant’s tinnitus (lasting ≥3 consecutive months) to relevant service, entitlement may follow. The 78 factors cover noise and blast exposure, head/ear trauma, medical conditions, drugs/chemicals, smoking, psychological issues and other causes, and distinguish new onset from clinical worsening."},"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"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-tinnitus-reasonable-hypothesis-no-84-of-2020","history":"/api/acts/statement-of-principles-concerning-tinnitus-reasonable-hypothesis-no-84-of-2020/history","analysis":"/api/acts/statement-of-principles-concerning-tinnitus-reasonable-hypothesis-no-84-of-2020/analysis","conflicts":"/api/acts/statement-of-principles-concerning-tinnitus-reasonable-hypothesis-no-84-of-2020/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-tinnitus-reasonable-hypothesis-no-84-of-2020/important-cases","documents":"/api/acts/statement-of-principles-concerning-tinnitus-reasonable-hypothesis-no-84-of-2020/documents"}}