Statement of Principles concerning tinnitus (Balance of Probabilities) (No. 85 of 2020)

The instrument revolves around a small set of legal‑medical concepts expressed in statutory form. These are: (1) the definition of tinnitus and death from tinnitus; (2) the “factors that must exist” which operate as the RMA’s causal ladder; (3) the required relationship of any such factor to “relevant service”; and (4) the interaction with other Statements of Principles. Each concept is tightly defined in text and in Schedule 1.

Definition of tinnitus and death from tinnitus. The SoP defines tinnitus as “intermittent or constant perception of sound … in one or both ears; or in or around the head, occurring without an external source of sound” and requires persistence for at least three consecutive months (s 7(2)). The instrument clarifies that although tinnitus normally attracts ICD‑10‑AM code H93.1, the SoP’s operative definition is the statutory text (s 7(3)-(4)). Death from tinnitus is included where tinnitus “contributed to” the person’s terminal event or condition (s 7(5)); “terminal event” is defined in Schedule 1, with enumerated proximate causes (for example pneumonia, respiratory failure, cardiac arrest) (Schedule 1).

Causation and the “factors that must exist.” Section 9 is the core of the instrument. It expresses the RMA’s view in presumptive form: “At least one of the following factors must exist before it can be said that, on the balance of probabilities, tinnitus or death from tinnitus is connected with the circumstances of a person's relevant service.” The list is extensive and grouped so that factors 1-32 relate to clinical onset and 33-64 to clinical worsening (compare the text of s 9). The factors use measurable thresholds where possible (for example peak sound pressure level at tympanic membrane ≥140 dB(C) (s 9(1) and s 9(33)); sound pressure level at tympanic membrane ≥85 dB(A) as an 8‑hour TWA with a 3 dB exchange rate cumulative for at least six months (s 9(2) and s 9(34))); specified time windows for many items (e.g. within 30 days before clinical onset/worsening for several infections, drug exposures, blast or lightning (s 9(5), (16)-(18), (23)-(24), etc)); and diagnostic thresholds (for example serum cobalt concentration ≥200 micrograms per litre sustained for at least four weeks (s 9(30) and s 9(61))). The instrument also includes non‑noise causes such as vascular, anatomical, metabolic, infectious and autoimmune conditions (s 9(8), (11), (14), (24), etc).

Relationship to service. Section 10(1) requires that any factor in s 9 must be related to the person’s relevant service. “Relevant service” is defined in Schedule 1 to mean certain categories under the VEA or peacetime service under the MRCA, and the definition excludes particular categories of VEA service (for example operational service is excluded from the enumerated examples in Schedule 1,see the text). Section 10(2) places an important limitation on factors 9(33)-9(64): they 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. That textual structure separates initial causation questions from aggravation/material contribution questions and imposes a temporal constraint on the latter.

Interaction with other SoPs. Section 11 provides a mechanism for cross‑reference: if a factor in s 9 refers to an injury or disease that itself has an SoP, the other SoP governs that injury/disease “as in force from time to time.” This means the instrument is not closed to technical cross‑reference; decision‑makers must check for other SoPs where factors rely on other recognised disease/injury entities.

Defined technical machinery. The Schedule provides operational definitions for terms used to measure or identify factors: dB(A) and dB(C) are defined as measurement standards (Schedule 1); time‑weighted average (TWA) with a 3‑dB exchange rate is given an explicit formula and table for exposure/duration calculation (Schedule 1); “auditory structure” is defined; a number of specified lists (drugs, bacterial infections, viral infections, bone diseases, haematological diseases, chemical agents) are set out as closed lists in the Schedule. These definitions convert otherwise vague clinical language into items that can be applied consistently (subject to evidentiary proof).

Standard of proof. The instrument repeatedly frames conclusions under the balance‑of‑probabilities standard: the text and the title make clear the causal test is “on the balance of probabilities” (s 8 title and text; s 9). The RMA’s stated view that the link is “more probable than not” sets the evidentiary benchmark that governs how decision‑makers are to use the listed factors.

This SoP affects four distinct groups identified by its text and operation.

Veterans and members of the Forces who bring claims under the VEA or MRCA. The instrument applies specifically to claims “to which section 120B of the VEA or section 339 of the MRCA applies” (s 5). Those statutory references define the administrative claim routes in the underlying schemes; the SoP therefore operates as a determinative evidentiary tool for veterans or members seeking recognition that tinnitus (or death from tinnitus) is connected with relevant service. The Schedule’s definition of “relevant service” narrows the classes of service to which the instrument will apply: eligible war service (other than operational service), defence service (other than hazardous service and British nuclear test defence service) under the VEA, or peacetime service under the MRCA (Schedule 1). That definitional choice places categorical limits on which sets of personnel can rely on the SoP.

Medical practitioners and expert witnesses who provide clinical evidence. The SoP is operationalised through clinical and technical evidence that decision‑makers must evaluate. Medical records documenting clinical onset, audiological test results showing sensorineural or conductive hearing loss, documentation of tympanic membrane perforation where chemical inner ear exposure is alleged, records of surgery or trauma to auditory structures, medication histories with dosing and timing, laboratory results (e.g. serum cobalt levels), and imaging or clinical diagnoses of vascular/neoplastic/autoimmune conditions all become critical. The instrument’s defined time windows (for example 30 days, five years, 48 hours, one year) and measurement thresholds (for example 140 dB(C) peak, 85 dB(A) 8‑hour TWA) direct what practitioners must document if they want their evidence to fall within the SoP’s listed factors (s 9; Schedule 1).

Adjudicators and administrative decision‑makers within the veterans’ compensation framework. The SoP is a statutory instrument that the Repatriation Medical Authority has produced for use by those making decisions about service connection. Decision‑makers must apply the SoP’s list and definitions when determining whether tinnitus or death from tinnitus is connected with a person’s relevant service, and must assess both the existence of a listed factor and its connection to relevant service (s 9; s 10). Section 11 requires decision‑makers to consult other SoPs where a listed factor invokes another injury/disease.

Parties or systems outside the veterans’ compensation regime with overlapping interests. The instrument refers to ICD‑10‑AM codes (s 7(3)-(4)) and to a specific occupational noise exposure guidance source (Schedule 1 source: NIOSH 1998 guidelines). Practitioners handling workplace compensation or workers’ rehabilitation claims, insurers, and occupational health services may find the definitions, thresholds and TWA tables informative or persuasive in their own contexts. However, the instrument does not by itself create obligations for those outside the VEA/MRCA claims processes; it is an authoritative source within those regimes.

Concentrated and diffuse effects. The immediate beneficiaries of the SoP are the claimants whose factual records match one or more of the listed factors and who can demonstrate the required relationship to relevant service. Those individuals have a tailored evidentiary route to a finding of connection. The SoP’s technical thresholds and closed lists also affect clinicians who must document precise facts; they impose practical evidentiary work on claimants and their advisors. At a system level, the instrument affects administrative workload because decision‑makers must verify the presence, timing and service relation of listed factors and sometimes cross‑reference other SoPs (s 11).

Who does not benefit. People with transient tinnitus lasting less than three consecutive months are excluded by the statutory definition (s 7(2)(b)). Likewise, a person whose service does not fall within the Schedule 1 definition of “relevant service” cannot use this SoP in the relevant claim routes (Schedule 1). Also, factors 9(33)-9(64) are limited to aggravation/material contribution for pre‑existing tinnitus that did not arise out of the person’s service (s 10(2)). That wording means that if tinnitus arose out of service, those particular factors are not the route to establish the causal connection for material contribution or aggravation.

This instrument primarily sets standards of proof and definitional content rather than direct duties or sanctions. Nevertheless, it creates de facto procedural obligations and rights within the VEA/MRCA claim processes by prescribing what must exist for a connection to be established.

Right to rely on the SoP for claim connection. A claimant whose facts satisfy at least one factor in s 9, and who can establish the factor’s relationship to relevant service, obtains the evidentiary right to have the condition treated as connected with service on the balance of probabilities. Section 9 is explicit: “At least one of the following factors must exist before it can be said that, on the balance of probabilities, tinnitus or death from tinnitus is connected with the circumstances of a person's relevant service.” The RMA’s formulation grants claimants a pathway to a finding of connection where the listed factor(s) and relationship to service are present.

Duty to show relationship to relevant service. The SoP requires that the existence of any factor must be related to the person’s relevant service (s 10(1)). That is a distinct inquiry: an applicant must not only demonstrate a listed factor (for example exposure to noise at a specified level) but must also show that the factor is tied to relevant service. The instrument does not supply the procedural steps to prove such a relationship, but the text makes the relationship a textual requirement.

Duty to apply time windows and thresholds. The Schedule prescribes numeric and temporal thresholds (for example 85 dB(A) 8‑hour TWA cumulative across six months for onset; 30 day windows for many drug and infection exposures; five‑year window for trauma or surgery (s 9(2), (5), (3))). Decision‑makers and clinicians must account for these thresholds when preparing and assessing evidence. The TWA formula and table in Schedule 1 supply the method for computing cumulative exposures subject to a 3‑dB exchange rate; they function as definitional law for the measurement of occupational noise exposure claims (Schedule 1: time‑weighted average (TWA) with a 3‑dB exchange rate).

Right to cross‑reference other SoPs. Section 11 provides a right (or procedural expectation) that where a factor refers to an injury or disease with its own SoP, the terms of that SoP apply. That means parties may rely on the substantive content of other SoPs when a listed factor invokes a separate medical condition. This cross‑reference creates a duty on decision‑makers to identify and apply relevant SoPs in force.

No penalties or criminal sanctions in the instrument. The SoP contains no express penalties, fines, or enforcement mechanisms beyond its operation as evidentiary guidance in claims. It does not, for example, penalise non‑compliance by clinicians or impose reporting duties on employers. Its force arises from its status under subsection 196B(3) of the VEA as the RMA’s declared Statement of Principles to be used in claims under the relevant statutory regimes (s 3; s 5).

Administrative discretion and interpretation. The instrument leaves room for professional assessment: whether a listed factor is present in a particular factual matrix often requires clinical judgement (for example whether a vascular condition “can be transmitted to the affected ear” (s 9(8)); whether a drug has the requisite temporal association in s 9(6)). The Schedule’s closed lists limit some questions, but many factors require interpretation of clinical records, timing and linkage to service. Decision‑makers retain discretion in adjudication, but must do so in the light of the SoP’s prescriptive items.

The Statement of Principles itself does not create criminal penalties, administrative fines, or enforcement powers. Its statutory function is to govern the evidentiary assessment of claims under the VEA and MRCA; enforcement therefore occurs through the administrative decision process rather than through fines or prosecution.

No sanctioning provisions in the text. A careful reading shows no provisions imposing penalties for non‑compliance by claimants, medical practitioners, employers, or other third parties. The instrument’s operative mechanism is to prescribe circumstances in which tinnitus may be accepted as connected with relevant service; it does not create independent enforcement instruments or compliance regimes (see the overall absence of any penalty clause).

Operational enforcement through claims decisions. The institutional “enforcement” role is exercised by the decision‑maker in the veterans’ compensation system when determining entitlement. The SoP sets criteria that decision‑makers must use when assessing whether, on the balance of probabilities, tinnitus is connected with service (s 9; s 8). A negative administrative finding (that no listed factor exists, or that a factor is not related to relevant service) will result in refusal of the claim or denial of connection under the VEA/MRCA processes; such refusals are the practical means by which the SoP constrains outcomes.

Repercussions in subsequent entitlements. While the SoP does not itself award benefits, its application in claim determinations affects access to pension, compensation or other entitlements available under the VEA/MRCA framework. An administrative acceptance of connection can trigger liability by the Department/authority to provide entitlements, while a rejection will foreclose those benefits. Those downstream financial and rehabilitation consequences are outside the SoP text but arise from its role within the statutory compensation scheme.

No investigative or audit powers. The instrument does not create powers to inspect workplaces, to compel production of occupational noise logs, or to audit employers. Where evidence is needed (for example on historical noise exposure), claimants and their advisors will need to source records, clinical notes, audiology reports, personnel files, unit logs or other documentary evidence. The SoP does not stipulate procedures for obtaining such records.

Dispute resolution and appeal pathways are not detailed. The SoP does not set out appeal mechanisms or review processes; it is silent on procedural steps after an administrative decision that uses the SoP. Those processes will exist in the underlying statutory frameworks (VEA/MRCA) and in the administrative law and review regimes applicable to determinations under those Acts, but the SoP text itself contains no enforcement route or penalty regime.

Direct statutory basis and application. The instrument is expressly made under subsection 196B(3) of the VEA (s 3), and it applies to claims to which s 120B of the VEA or s 339 of the MRCA applies (s 5). Those textual anchors place the SoP within the statutory architecture of the veterans’ entitlements and military compensation schemes, so the instrument functions as a statutory evidentiary standard within those regimes.

Cross‑reference to other Statements of Principles. Section 11 mandates interaction where s 9 refers to an injury or disease that itself has an SoP made under subsection 196B(3) of the VEA. In such cases, “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.” Practically, this creates an obligation to consult and apply other SoPs where relevant. That may generate multi‑instrument analyses where tinnitus factors invoke other recognised conditions (for example suppurative labyrinthitis, otic barotrauma, or neoplasms involving auditory structures).

Use of external clinical and classification standards. The SoP recognises ICD‑10‑AM: it notes that tinnitus attracts ICD‑10‑AM code H93.1 but specifies that, for this instrument, tinnitus means the statutory definition in s 7(2) (s 7(3)). It also specifies the relevant edition of ICD‑10‑AM (Tenth Edition, effective date 1 July 2017) and cites the source (s 7(4)). The Schedule cites an external NIOSH guideline (National Institute of Occupational Safety and Health 1998 Guidelines Publication No. 98‑126) as the source for the TWA table and calculation. These cross‑references mean that adjudicators, clinicians and experts will commonly invoke internationally or nationally accepted clinical classification and occupational measurement standards when giving evidence; the SoP therefore imports those standards into the administrative assessment process.

Relationship with occupational health and safety instruments. Although the SoP is not an occupational health and safety instrument, it incorporates occupational noise exposure measurement concepts (dB(A), dB(C), 8‑hour TWA with a 3‑dB exchange rate, and the NIOSH table). That makes occupational records and standards relevant in establishing whether a particular noise exposure factor is present. Employers’ WHS records, audiometric surveillance programmes, and workplace risk assessments can be probative evidence even though the SoP does not alter employers’ legal duties under WHS legislation.

Interaction with medical practice and standards. The SoP requires clinical and diagnostic facts (for example confirming sensorineural or conductive hearing loss, tympanic membrane defects, serology for infections, serum cobalt levels, diagnosis of Meniere’s disease or multiple sclerosis). Medical practitioners therefore must apply clinical standards and documentation practices consistent with these definitions for their evidence to map neatly onto the SoP’s factors.

No express displacement of statutory provisions outside the VEA/MRCA contexts. The SoP applies only to claims under the referenced sections. It does not purport to bind courts or tribunals in other proceedings, nor does it purport to alter non‑VEA/MRCA statutory schemes (for example workers’ compensation statutes). However, the SoP may be persuasive or relevant in other contexts because it is an official technical evaluation by the Repatriation Medical Authority.

Temporal interaction with prior instruments. The instrument repeals the earlier tinnitus SoP No. 34 of 2012 (s 4). For decisions made after commencement, the new SoP governs. Any temporal transition questions about claims spanning both instruments are outside the text, but the repeal provision makes clear the 2012 instrument is replaced from the commencement date.

The instrument discloses a minimal in‑text amendment history. It is a single, standalone Statement of Principles titled “Statement of Principles concerning tinnitus (Balance of Probabilities) (No. 85 of 2020)” (s 1). It was made on 30 October 2020 and commences on 30 November 2020 (ss 1-2). The only explicit amendment action recorded in the instrument is the repeal of the earlier Statement of Principles concerning tinnitus No. 34 of 2012 , the earlier instrument (Federal Register of Legislation No. F2012L00944) made under subsections 196B(3) and (8) of the VEA is expressly repealed (s 4). No other amendments, schedules, transitional provisions, or savings clauses appear in the text.

What is present about versions and naming. The SoP identifies itself by number and date and includes the Repatriation Medical Authority’s common seal and the Chairperson’s signature page; the instrument thereby establishes an auditable bookend to the earlier 2012 SoP. The instrument also provides that Schedule 1 contains the dictionary and definitions applicable to the SoP (s 6 and Schedule 1).

No amendment timeline beyond repeal. The document does not recite earlier amendment proposals, consultation steps, or legislative history. It states the RMA’s view on the medical‑scientific evidence (s 8) as the basis for the instrument. Because the SoP is to be applied “as in force from time to time” where other SoPs are invoked (s 11), future amendments to other SoPs will affect interaction; but this document itself contains no mechanism for amendment other than the usual statutory processes under the VEA for making new SoPs.

Practical consequence for prior determinations. The repeal of the 2012 SoP means that adjudicators should apply No. 85 of 2020 to claims to which sections 120B VEA or 339 MRCA apply from the instrument’s commencement date. If any claims were decided under the 2012 SoP, those decisions stood at their time; the instrument does not contain retrospective substitution or transitional clauses in its text. Absent any express transitional wording, the new SoP governs claims made after commencement according to standard administrative practice; the instrument itself is silent about transition.

The text of the Statement of Principles contains no litigation history, and it does not name or cite any judicial or tribunal decisions. It does not record any judicial challenge to prior or current SoPs. The instrument is an administrative instrument made under subsection 196B(3) of the VEA, and its text is limited to definitions, factors, and cross‑references.

What the instrument records. The only legal reference points given inside the instrument are the statutory sections authorising its making (subsection 196B(3) of the VEA) and the claim provisions to which it applies (section 120B VEA and section 339 MRCA) (ss 3, 5). It also references ICD‑10‑AM and a NIOSH guideline in Schedule 1 for classification and measurement standards (s 7(3)-(4); Schedule 1). There are no case names nor any recited litigation outcomes.

Implication for counsel and litigators. Because the instrument does not provide litigation examples or precedents, practitioners must treat it as an authoritative administrative standard rather than an adjudicative history. If a claim is denied, parties will typically rely on the statutory review and appeal avenues in the underlying VEA/MRCA frameworks and administrative law channels; any tribunal or court will need to consider the SoP’s terms as part of the record. The SoP’s cross‑references to other SoPs (s 11) and its reliance on technical measurement definitions (Schedule 1) imply that litigated disputes will often hinge on clinical interpretation, measurement evidence, the timing of clinical onset/worsening and the linkage to relevant service.

Absence of named judgments. Because the SoP does not cite cases, any legal argument that relies on precedent must be sourced outside the instrument. Practitioners preparing for litigation should treat the SoP as evidentiary law within the VEA/MRCA regimes, while turning to case law and tribunal decisions for dispute resolution and statutory interpretation questions not resolved by the SoP text.

The SoP is highly prescriptive in places but leaves several practical issues and evidential traps that advisers should note; the following points arise directly from the instrument’s text and definitions.

Three‑month persistence requirement. The statutory definition of tinnitus requires that the perception of sound “must have persisted for at least three consecutive months” (s 7(2)(b)). That is a hard‑edged exclusion for transient tinnitus episodes under three months. Advisers should not treat a single acute episode or short‑term tinnitus as qualifying evidence under this SoP.

Distinction between onset and worsening, and the pre‑existing tinnitus rule. Factors 1-32 in s 9 concern clinical onset. Factors 33-64 concern clinical worsening. Section 10(2) places an important constraint: subsections 9(33)-9(64) 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.” The language is technical: to use the worsening factors as a route to establish material contribution or aggravation, the claimant’s tinnitus must have been present before or during service and must not have arisen out of service. This means that if tinnitus first arose out of service, those worsening factors are not the route; counsel must carefully identify whether a matter is an initial causation or an aggravation matter. The SoP separates initial causation and material contribution paths, and mischaracterisation can lead to misapplication of factors.

Measurement at the tympanic membrane and historical proof. Several factors require exposure levels measured “at the tympanic membrane” (for example s 9(1), s 9(2), s 9(33), s 9(34)). In practice, historical measurements at the tympanic membrane are unlikely to exist for most service exposures. The instrument does not say what proof suffices to establish that a historic exposure equated to the stated tympanic membrane levels. That evidentiary gap creates practical difficulty: claimants will frequently need to use surrogate evidence (unit logs, witness statements, occupational records, reconstructed exposure estimates, expert opinion) to satisfy the factual requirement. The SoP itself does not instruct decision‑makers on acceptable proxies.

Time windows vary and are specific. The SoP imposes differing temporal windows for distinct factors: 30 days for many drug and infection exposures (s 9(5), (23)-(24)), five years for trauma or surgery to auditory structures (s 9(3)), 48 hours for carbon monoxide poisoning (s 9(32)), and one year for meningitis or encephalitis (s 9(25), (56)). Analysts must match the claimant’s clinical onset or worsening date to these windows exactly; failure to document dates accurately can be decisive.

Closed lists and open formulations. Some risk items are contained in specified lists in Schedule 1 (for example specified drugs; specified bacterial and viral infections; specified chemical agents; bone diseases). If a claimant’s drug or infection is not on a specified list, that absence does not automatically preclude causation where s 9(6) applies: s 9(6) is an open formulation allowing a drug to support causation if the individual shows development of tinnitus within 30 days of starting the drug and a decrease soon after discontinuation, with at least three days’ treatment before onset. Practitioners must therefore check both the closed lists and the open provisions.

No explicit maximum latency for some items. Several factors require exposure “before the clinical onset” or “before the clinical worsening” but provide no maximum latency (for example the peak 140 dB(C) exposure factors s 9(1) and s 9(33) do not give an outer time limit). That means, on a literal reading, an historically remote peak exposure could be relied upon if linked to clinical onset, although practicality and medical plausibility will be relevant. The absence of explicit maximum latency in some provisions should alert advisers to potential argument points about remoteness and medical plausibility, but the SoP text itself imposes no explicit outer limit in those items.

Requirement of tympanic membrane defect for “inner ear exposure to a chemical agent.” The Schedule says inner ear exposure to a chemical agent will only occur in the presence of a defect in the tympanic membrane (s 9(7) note; Schedule 1). If a claimant alleges chemical inner ear exposure, evidence of tympanic membrane perforation or defect is therefore essential. Absence of such evidence undermines an argument based on inner ear chemical exposure.

Quantitative threshold for serum cobalt. The instrument sets a numeric threshold for serum cobalt concentration , at least 200 micrograms per litre sustained for at least four weeks (s 9(30) and s 9(61)). That is a precise lab value and a duration requirement; claimants should ensure laboratory records are contemporaneous and meet the duration test. Variation in laboratory reporting units or reference ranges can produce evidentiary problems; the SoP’s numerical criterion is the operative text.

Tinnitus death linkage and the “terminal event” definition. The SoP treats death from tinnitus as where tinnitus “contributed to” a terminal event or condition (s 7(5)). The Schedule gives examples of “terminal event” including pneumonia and cardiac arrest. Advisers pursuing a death‑from‑tinnitus claim will need to show that tinnitus materially contributed to a proximate terminal event , that is a potentially complex medical causation issue requiring robust clinical evidence.

COVID‑19 included among specified viral infections. The Schedule expressly lists “coronavirus disease 2019 (COVID‑19)” among specified viral infections (Schedule 1). That inclusion is textual and immediate; practitioners should note its presence in relation to the 30‑day window for viral infection factors in s 9(24) and s 9(55).

TWA computation formalised. The Schedule prescribes the formula and table for computing time‑weighted average exposures using a 3‑dB exchange rate. This formalisation has two consequences: first, it standardises calculations for adjudicators; second, it requires practitioners to be able to translate historical exposure data into the exact formula and table if claiming an 85 dB(A) 8‑hour TWA cumulative six‑month pathway (s 9(2) and s 9(34)). Failure to compute the TWA per the table risks rejection.

No procedural instructions about evidence. The SoP sets the substantive thresholds but does not direct how evidence is to be collected or how parties should prove those thresholds. In practice, claimants must assemble medical records, audiograms, occupational noise records, unit logs and other documents, but the SoP remains silent about admissibility standards, evidentiary presumptions, or acceptable proxies.

For claimants, clinicians and advisers preparing a claim that seeks recognition of tinnitus (or death from tinnitus) as connected with relevant service under the VEA or MRCA, the text of the SoP gives a discrete checklist of items that should be compiled and matched to the statutory factors. The following steps and documents map directly to the instrument’s text.

1. Establish and document clinical onset and/or clinical worsening dates.

   • Identify the date on which tinnitus first met the statutory definition (persistent for at least three consecutive months) and document course notes showing persistence (s 7(2)(b); s 9 introductory words).
   • Where asserting clinical worsening of pre‑existing tinnitus, identify the date and clinical evidence showing worsening (s 9(33)-(64); s 10(2)).

2. Match the factual record to at least one factor in section 9.

   • For acoustic exposure claims:
     • Gather unit/service logs, duty rosters, after‑action reports, maintenance records or witness statements that document exposure to peak sound events (e.g. explosions, gunshots) and assess whether a peak sound pressure level at the tympanic membrane could have been at least 140 dB(C) (s 9(1) and s 9(33)).
     • For cumulative occupational noise claims, assemble workplace noise monitoring reports, audiometric surveillance data, rostered exposure records and expert reconstructions sufficient to compute an 8‑hour TWA with a 3‑dB exchange rate per the Schedule formula and table, showing a cumulative six months at ≥85 dB(A) (s 9(2); Schedule 1).
   • For trauma/surgery claims:
     • Obtain surgical records, admission notes, imaging and discharge summaries showing blunt or penetrating trauma or surgery to auditory structures within five years before clinical onset/worsening (s 9(3) and s 9(35)).
   • For hearing loss:
     • Produce audiology reports demonstrating sensorineural or conductive hearing loss contemporaneous with clinical onset/worsening (s 9(4), s 9(36)).
   • For drug‑related claims:
     • Provide a medication history with dates and dosing, and clinical notes showing development of tinnitus within 30 days of commencing a listed drug (or meet the s 9(6) temporal criteria), and evidence of improvement on discontinuation if relevant (s 9(5)-(6); Schedule 1: specified list of drugs).
   • For chemical agent exposure:
     • Demonstrate tympanic membrane defect/perforation and records of exposure to specified chemical agents within 30 days before clinical onset/worsening (s 9(7) and Schedule 1: specified list of chemical agents).
   • For infection/systemic disease/other medical causes:
     • Supply diagnostic records and laboratory confirmations for the appropriate specified bacterial or viral infections, meningitis/encephalitis, cerebrovascular accident or other listed conditions, within the timeframes specified (s 9(15), (23)-(26), (56)).
   • For cobalt toxicity:
     • Provide lab reports showing serum cobalt concentration ≥200 micrograms per litre for at least four weeks, or documentation of a cobalt‑containing metal‑on‑metal hip prosthesis in situ for at least four weeks prior to onset/worsening (s 9(30), (61)).
   • For other listed factors (e.g. temporomandibular disorder, acoustic shock, decompression sickness, lightning strike):
     • Assemble appropriate specialist notes, emergency department records, or aeromedical records as needed to establish timing and diagnosis (s 9(16)-(18), (21), (22), (52)-(53)).

3. Show the relationship to relevant service.

   • Demonstrate that the identified factor occurred in circumstances linked to the person’s “relevant service” as that term is defined in Schedule 1 (eligible war service (other than operational), defence service (other than hazardous and British nuclear test defence service) under the VEA, or peacetime service under the MRCA).
   • Provide service records, deployment histories, unit logs, and contemporaneous medical records that connect the factor to the person’s period or conditions of service (s 10(1); Schedule 1).

4. Where a factor invokes another injury/disease, apply the relevant SoP.

   • If a factor refers to an injury or disease with its own SoP (for example suppurative labyrinthitis), identify and compile the materials required under that SoP because s 11 directs decision‑makers to apply those other SoPs “as in force from time to time.”

5. Use the instrument’s definitions and computation method for noise exposure.

   • Apply the Schedule’s TWA formula and table when calculating cumulative 8‑hour exposures with a 3‑dB exchange rate (Schedule 1). Ensure exposure durations are computed in the same units and according to the specified formula.

6. Document the three‑month persistence requirement.

   • Ensure the clinical record supports persistence of tinnitus for at least three consecutive months (s 7(2)(b)). Shorter disorders will not meet the statutory definition.

7. If asserting inner ear chemical exposure, document tympanic membrane defect.

   • Where chemical exposure is alleged to have reached the inner ear, include otoscopic findings or tympanometry showing tympanic membrane perforation or defect, because the Schedule says inner ear exposure occurs only with tympanic membrane defect (Schedule 1; s 9(7) note).

8. For death claims, document causal contribution.

   • Where death from tinnitus is alleged (s 7(5)), obtain the death certificate, terminal event diagnoses and clinical opinion linking tinnitus to the terminal event (Schedule 1: terminal event examples). Expert opinion will often be necessary.

9. Anticipate evidentiary gaps and prepare expert reconstruction.

   • Where direct measurement data (for example tympanic membrane dB readings) are unavailable, gather contemporaneous unit/occupational records, eye‑witness statements, equipment logs, and expert reports reconstructing likely exposure levels. The SoP does not specify acceptable proxies but decision‑makers will rely on clinical and technical experts to bridge measurement gaps.

10. Check closed lists and open criteria.

    • Confirm whether relevant drugs, infections, haematological conditions, and bone diseases are on the Schedule’s specified lists. If an item is not listed, consider whether the open formulation in s 9(6) or other clinical evidence can still establish causation.

11. Prepare for aggravation claims by proving pre‑existing tinnitus and non‑service origin if relying on s 9(33)-(64).

    • For clinical worsening claims, show that tinnitus was present before or during service and that it did not arise out of service (s 10(2)). Then document the aggravating factor(s) and their relationship to service.

12. Maintain contemporaneous, consistent records.

    • The SoP’s various temporal cut‑offs and numerical thresholds make contemporaneous, dated clinical and service records the most reliable evidence. Advisers should obtain audiology reports, clinical notes, occupational records, and lab results with dates and signatures.

13. Prepare to cross‑check ICD and guideline sources.

    • Where diagnostic coding or noise measurement standards are relevant, ensure alignment with ICD‑10‑AM Tenth Edition (effective 1 July 2017) and with the NIOSH 1998 guidance cited in the Schedule (s 7(4); Schedule 1).

14. When in doubt, obtain specialist/occupational expert reports.

    • Many factual questions , for example whether a vascular lesion can transmit sound to an ear, whether a historic blast likely produced a 140 dB(C) tympanic membrane peak, or whether tinnitus improved on drug cessation , require specialist clinical or acoustic expert evidence.

Following these steps aligns evidence and documentation with the instrument’s specified factors, definitions and temporal requirements. The SoP is an evidentiary instrument; successful claims will be those where the factual matrix maps coherently to the listed factors and the relationship to relevant service is demonstrable in records and professional opinion.