{"id":"F2020L01396","name":"Statement of Principles concerning toxic vestibulopathy (Balance of Probabilities) (No. 89 of 2020)","slug":"statement-of-principles-concerning-toxic-vestibulopathy-balance-of-probabilities-no-89-of-2020","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440652,"registerId":"F2020L01396-fast-fetch-1775956214807","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning toxic vestibulopathy (Balance of Probabilities) (No. 89 of 2020)","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\nTOXIC VESTIBULOPATHY (Balance of Probabilities)\n\n(No. 89 of 2020)\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 30 October 2020\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 Application\n\n5 Definitions\n\n6 Kind of injury, disease or death to which this Statement of Principles relates\n\n7 Basis for determining the factors\n\n8 Factors that must exist\n\n9 Relationship to service\n\n10 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 toxic vestibulopathy (Balance of Probabilities) (No. 89 of 2020).\n\n2 Commencement\n\n This instrument commences on 30 November 2020.\n\n3 Authority\n\nThis instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.\n\n4 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\n5 Definitions\n\nThe terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.\n\n6 Kind of injury, disease or death to which this Statement of Principles relates\n\n(1) This Statement of Principles is about toxic vestibulopathy and death from toxic vestibulopathy.\n\nMeaning of toxic vestibulopathy\n\n(2) For the purposes of this Statement of Principles, toxic vestibulopathy:\n\n(a) means damage to the vestibular organs of the inner ear or the vestibular nerve as a result of exposure to a chemical agent, resulting in symptoms or signs of vestibular loss; and\n\n(b) excludes impairment of balance due to damage to the brain or brainstem.\n\nNote: Typical symptoms and signs of damage to the vestibular nerve or vestibular organs include nausea, vomiting, vertigo, dizziness, disequilibrium, nystagmus (eye jerking) and oscillopsia (blurred vision with head movement).\n\nDeath from toxic vestibulopathy\n\n(3) For the purposes of this Statement of Principles, toxic vestibulopathy, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's toxic vestibulopathy.\n\nNote: terminal event is defined in the Schedule 1 - Dictionary.\n\n7 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 toxic vestibulopathy and death from toxic vestibulopathy 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\n8 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, toxic vestibulopathy or death from toxic vestibulopathy is connected with the circumstances of a person's relevant service:\n\n(1) taking a drug from the specified list of drugs within the 30 days before the clinical onset of toxic vestibulopathy;\n\nNote: specified list of drugs is defined in the Schedule 1 - Dictionary.\n\n(2) taking a drug which is associated in the individual with:\n\n(a) the development of toxic vestibulopathy within 30 days of commencing drug therapy; and\n\n(b) a decrease in the symptoms and signs of toxic vestibulopathy within three months 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 toxic vestibulopathy;\n\n(3) having inner ear exposure to a chemical agent from the specified list of chemical agents within the 30 days before the clinical onset of toxic vestibulopathy;\n\nNote 1: Inner ear exposure to a chemical agent will only occur in the presence of a defect in the tympanic membrane.\n\nNote 2: specified list of chemical agents is defined in the Schedule 1 - Dictionary.\n\n(4) taking a drug from the specified list of drugs within the 30 days before the clinical worsening of toxic vestibulopathy;\n\nNote: specified list of drugs is defined in the Schedule 1 - Dictionary.\n\n(5) taking a drug which is associated in the individual with:\n\n(a) an increase in the symptoms or signs of toxic vestibulopathy during drug therapy; and\n\n(b) a decrease in the symptoms or signs of toxic vestibulopathy within three months of discontinuing or tapering drug therapy; and\n\nwhere treatment with the drug continued for at least the three days before the clinical worsening of toxic vestibulopathy;\n\n(6) having inner ear exposure to a chemical agent from the specified list of chemical agents within the 30 days before the clinical worsening of toxic vestibulopathy;\n\nNote 1: Inner ear exposure to a chemical agent will only occur in the presence of a defect in the tympanic membrane.\n\nNote 2: specified list of chemical agents is defined in the Schedule 1 - Dictionary.\n\n(7) inability to obtain appropriate clinical management for toxic vestibulopathy.\n\n9 Relationship to service\n\n(1) The existence in a person of any factor referred to in section 8, must be related to the relevant service rendered by the person.\n\n(2) The factors set out in subsections 8(4) to 8(7) apply only to material contribution to, or aggravation of, toxic vestibulopathy where the person's toxic vestibulopathy was suffered or contracted before or during (but did not arise out of) the person's relevant service.\n\n10 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 8 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 5\n\n1 Definitions\n\nIn this instrument:\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 specified list of chemical agents means:\n\n(a) aminoglycoside-containing ear drops;\n\n(b) Burow's solution (5% aluminium subacetate); or\n\n(c) surgical antiseptics.\n\n specified list of drugs means:\n\n(a) amiodarone;\n\n(b) aminoglycosides;\n\n(c) chloroquine;\n\n(d) hydroxychloroquine;\n\n(e) immune checkpoint inhibitors;\n\n(f) loop diuretics;\n\n(g) mefloquine;\n\n(h) non-steroidal anti-inflammatory drugs;\n\n(i) platinum-based chemotherapy (cisplatin, carboplatin and oxaliplatin); or\n\n(j) sotalol.\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 toxic vestibulopathy—see subsection 6(2).\n\n VEA means the Veterans' Entitlements Act 1986.\n\n \n\n \n","sortOrder":0}],"analysis":{"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 Statement of Principles appears tightly focused on its original purpose: establishing the medical criteria for linking toxic vestibulopathy to military service. The scope remains limited to the specific condition, defined chemical agents and drugs, and the standard compensation framework. No evidence of scope creep beyond the original intent."},"complexity_factors":["Moderate cross-referencing between sections (e.g., definitions in Schedule 1 referenced throughout)","Conditional logic requiring multiple elements to be satisfied simultaneously (e.g., factor 8(2) requires three separate conditions: symptom development within 30 days, symptom decrease within 3 months of stopping, AND minimum 3 days of treatment before onset)","Distinction between 'clinical onset' and 'clinical worsening' with partially overlapping but distinct factor sets","Specific temporal requirements (30-day windows, 3-month windows, 3-day minimums)","10 defined terms in the Dictionary, including two 'specified lists' containing multiple items","Nested conditions in section 9(2) limiting application of certain factors to aggravation cases only","Reference to external legislation (VEA and MRCA) for service definitions"],"plain_english_summary":"This instrument sets the medical test for awarding compensation to veterans and defence personnel for toxic vestibulopathy — inner‑ear balance damage from chemical or medication exposure. It defines the condition, requires medical connection to service on the balance‑of‑probabilities standard (including recent relevant medication or inner‑ear chemical exposure and lack of timely treatment), and covers both new onset and worsening. It matters because it determines entitlement to benefits under the veterans’ compensation schemes."},"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":false,"description":"The instrument confines itself to criteria for linking toxic vestibulopathy (and death from it) to relevant service for claims under the VEA and MRCA. It defines evidentiary factors, specified drugs/agents and timing rules; it does not expand or alter the statutory categories of service or claim types beyond those Acts."},"complexity_factors":["Defined lists of implicated agents and drugs in Schedule 1 (specified list of chemical agents; specified list of drugs).","Temporal and clinical-response conditions for causation (onset within 30 days, treatment at least 3 days prior, symptom decrease within 3 months) (section 8(1)–(6)).","Different tests for first clinical onset versus clinical worsening and a separate factor for inability to obtain appropriate clinical management (sections 8(1)–(7)).","Requirement that any listed factor be related to the person's relevant service (section 9(1)) and limited application of some factors to material contribution/aggravation where condition pre‑existed (section 9(2)).","Cross-reference rule applying other Statements of Principles where a factor refers to another covered injury/disease (section 10).","Medical standard specified as balance of probabilities and reliance on 'sound medical‑scientific evidence' (section 7).","Narrow technical qualification that inner ear chemical exposure requires a tympanic membrane defect (notes to sections 8(3) and 8(6)).","Statutory footing and application to claims under specific Acts (authority under subsection 196B(3); application under section 4 referencing VEA/MRCA)."],"plain_english_summary":"This Statement of Principles tells decision-makers how to decide, on the balance of probabilities, whether toxic vestibulopathy (damage to the inner‑ear vestibular organs or nerve) or death from it is connected to a person’s relevant military service. It lists specific drugs and chemical agents, timing windows and clinical-response tests that, if met, support a service connection. It applies to claims under the Veterans’ Entitlements Act and the Military Rehabilitation and Compensation Act and requires the causal factor to be related to the person’s relevant service."}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-toxic-vestibulopathy-balance-of-probabilities-no-89-of-2020","history":"/api/acts/statement-of-principles-concerning-toxic-vestibulopathy-balance-of-probabilities-no-89-of-2020/history","analysis":"/api/acts/statement-of-principles-concerning-toxic-vestibulopathy-balance-of-probabilities-no-89-of-2020/analysis","conflicts":"/api/acts/statement-of-principles-concerning-toxic-vestibulopathy-balance-of-probabilities-no-89-of-2020/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-toxic-vestibulopathy-balance-of-probabilities-no-89-of-2020/important-cases","documents":"/api/acts/statement-of-principles-concerning-toxic-vestibulopathy-balance-of-probabilities-no-89-of-2020/documents"}}