{"id":"F2020L01394","name":"Statement of Principles concerning toxic vestibulopathy (Reasonable Hypothesis) (No. 88 of 2020)","slug":"statement-of-principles-concerning-toxic-vestibulopathy-reasonable-hypothesis-no-88-of-2020","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":440646,"registerId":"F2020L01394-fast-fetch-1775956212572","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Statement of Principles concerning toxic vestibulopathy (Reasonable Hypothesis) (No. 88 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 (Reasonable Hypothesis)\n\n(No. 88 of 2020)\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 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 (Reasonable Hypothesis) (No. 88 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(2) of the Veterans' Entitlements Act 1986.\n\n4 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\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\nThe Repatriation Medical Authority is of the view that there is sound medical‑scientific evidence that indicates that toxic vestibulopathy and death from toxic vestibulopathy 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\n8 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 toxic vestibulopathy or death from toxic vestibulopathy 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) inhaling fumes from jet fuel or having cutaneous contact with jet fuel:\n\n(a) for a cumulative period of at least 2,000 hours before the clinical onset of toxic vestibulopathy; and\n\n(b) where that exposure has ceased, the clinical onset of toxic vestibulopathy has occurred within one year of cessation;\n\nNote: fumes is defined in the Schedule 1 - Dictionary.\n\n(5) 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(6) 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(7) 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(8) inhaling fumes from jet fuel or having cutaneous contact with jet fuel: \n\n(a) for a cumulative period of at least 2,000 hours before the clinical worsening of toxic vestibulopathy;\n\n(b) and where that exposure has ceased, the clinical worsening of toxic vestibulopathy has occurred within one year of cessation;\n\nNote: fumes is defined in the Schedule 1 - Dictionary.\n\n(9) 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(5) to 8(9) 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(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\nSchedule 1 - Dictionary \n\nNote: See Section 5\n\n1 Definitions\n\nIn this instrument:\n\n fumes means combustion products, aerosols, vapours or dust arising through industrial processes or from workplace practices that involve the refining, manufacture or use of the stated material.\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 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) bleomycin;\n\n(d) chloroquine;\n\n(e) hydroxychloroquine;\n\n(f) immune checkpoint inhibitors;\n\n(g) loop diuretics;\n\n(h) mefloquine;\n\n(i) non-steroidal anti-inflammatory drugs;\n\n(j) opiates and opioids;\n\n(k) platinum-based chemotherapy (cisplatin, carboplatin and oxaliplatin);\n\n(l) phosphodiesterase-5 inhibitors;\n\n(m) quinidine;\n\n(n) quinine;\n\n(o) sotalol; or\n\n(p) vincristine.\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":{"complexity_score":5,"scope_assessment":{"changed":false,"description":"The instrument expressly defines its scope as toxic vestibulopathy and death from toxic vestibulopathy for claims under section 120A of the VEA or section 338 of the MRCA. It contains no statement that it widens or narrows coverage compared with a prior instrument; it sets definitional and evidentiary thresholds for linking the condition to relevant service."},"complexity_factors":["Specialised medical definitions and exclusions (vestibular organ or nerve damage vs brain/brainstem causes).","Long, explicit lists of implicated drugs and chemical agents that must be checked in each claim.","Multiple and differing temporal thresholds (eg. 30 days for onset, 3 months for symptom decrease after stopping drug, cumulative 2,000 hours for jet fuel exposure, 1 year post‑cessation limits).","Conditional, individualised clinical-response criteria (association in the individual; symptom decrease after discontinuing/tapering therapy).","Route‑specific exposure rules (oral/systemic drug, inner‑ear exposure requiring tympanic membrane defect, inhalation or cutaneous contact with jet fuel).","Cross‑reference to other Statements of Principles (factors may invoke other SOPs) and to statute (applies to claims under VEA/MRCA).","Legal causation standard set as a 'reasonable hypothesis' rather than a higher civil standard, affecting evidentiary assessment by decisionmakers."],"plain_english_summary":"This Statement of Principles sets the medical criteria the Repatriation Medical Authority uses to decide when toxic vestibulopathy (inner‑ear vestibular damage from chemicals or drugs) can be connected to a person’s relevant service for VEA/MRCA claims. It lists specific drugs and chemical agents, exposure routes and timings, and clinical-response patterns that, if met, raise a reasonable hypothesis linking the condition to service. The instrument affects veterans and service members claiming entitlements and the clinicians and decision‑makers who assess those claims."},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"This is a standard Repatriation Medical Authority Statement of Principles instrument, consistent with the established template and purpose under section 196B(2) of the Veterans' Entitlements Act 1986. The scope remains tightly focused on establishing the reasonable hypothesis test for a specific medical condition (toxic vestibulopathy) and does not appear to have expanded beyond its original statutory purpose of determining service-related compensation eligibility."},"complexity_factors":["Moderate cross-referencing between main text and Schedule 1 dictionary (7 defined terms)","Dual application framework — distinguishes between new onset (factors 1-4) and clinical worsening (factors 5-9) with different rules for each","Nested conditional logic in factors 2 and 6 requiring three cumulative elements: temporal relationship to drug commencement, improvement after cessation, and minimum 3-day treatment duration","Specific quantitative thresholds: 30-day windows for drug/chemical exposure, 3-month improvement windows, 2,000-hour cumulative exposure requirement for jet fuel, 3-day minimum treatment duration","Anatomical precondition for chemical exposure factors — requires defect in tympanic membrane (eardrum) for inner ear exposure to count","Interplay with other Statements of Principles through section 10, creating potential recursive application of other instruments"],"plain_english_summary":"This instrument sets when Australian defence members and veterans can claim compensation for toxic vestibulopathy — inner-ear balance damage from certain chemicals or drugs. It applies to current and former ADF personnel under veterans’ compensation schemes.\n\nRather than proving direct causation, it uses a “reasonable hypothesis” test: meeting at least one of several service‑linked factors (e.g., specific drugs, ear chemical exposure with a damaged eardrum, prolonged jet‑fuel exposure) makes a claim plausible."},"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"}},"importantCases":[],"_links":{"self":"/api/acts/statement-of-principles-concerning-toxic-vestibulopathy-reasonable-hypothesis-no-88-of-2020","history":"/api/acts/statement-of-principles-concerning-toxic-vestibulopathy-reasonable-hypothesis-no-88-of-2020/history","analysis":"/api/acts/statement-of-principles-concerning-toxic-vestibulopathy-reasonable-hypothesis-no-88-of-2020/analysis","conflicts":"/api/acts/statement-of-principles-concerning-toxic-vestibulopathy-reasonable-hypothesis-no-88-of-2020/conflicts","importantCases":"/api/acts/statement-of-principles-concerning-toxic-vestibulopathy-reasonable-hypothesis-no-88-of-2020/important-cases","documents":"/api/acts/statement-of-principles-concerning-toxic-vestibulopathy-reasonable-hypothesis-no-88-of-2020/documents"}}