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220.127.116.11 Limited streamlining approach for Barotrauma claims
The following policy advice relates to sinus barotrauma and otitic barotrauma (barotrauma) liability claims, and sequela conditions which are considered by medical advice to have arisen from a barotrauma incident.
This policy applies to members/former members who contend that they experienced a barotrauma from a specific Australian Defence Force (ADF) employment role or a training activity, but lack service records/evidence that the barotrauma incident took place. This can be common as barotrauma usually resolves within a short time period, meaning that members may not report incidents. Additionally, barotrauma incidents can take place in ADF settings where there may be a lack of access to medical treatment or limited medical reporting, such as on board submarines.
This policy assists in identifying ADF employment roles and training activities which involve a high risk of barotrauma incidents, and applies a streamlined approach to Barotrauma claims from members of these cohorts. Certain ADF cohorts are considered to have met barotrauma SOP factors and can therefore potentially have barotrauma claims accepted in the absence of evidence on the ADF medical files.
This policy applies to the Statement of Principles (SOPs) for sinus barotrauma and otitic barotrauma under the Veterans’ Entitlements Act 1986 (VEA) and the Military Rehabilitation and Compensation Act 2004 (MRCA).
This policy may also provide guidance for claims under the Safety, Rehabilitation and Compensation (Defence-related Claims) Act 1988 (DRCA). For DRCA claims, the Balance of Probabilities SOP can be used as a guide by delegates.
Pulmonary barotrauma is specifically excluded as it is a severe and potentially life-threatening injury for which there will be evidence on file.
SOPs for Otitic and Sinus Barotrauma
Both otitic (ear) and sinus (nasal passageway) barotrauma include a SOP factor which includes “experiencing a change in the ambient barometric pressure as specified”. This means a significant and rapid reduction or increase in the pressure surrounding the person.
Under the definitions of these SOPs, the following circumstances involve a “change in the ambient barometric pressure as specified”:
· ascending from a submerged craft or device or a submarine escape training facility;
· decompression or compression in a hypobaric or hyperbaric chamber;
· sky diving;
· underwater diving;
· working in a submarine;
· working in a pressurised chamber or tunnel;
· exposure to explosive blasts.
Prescribed ADF roles and training activities
According to Defence advice, certain ADF activities may give rise to ‘a change in ambient barometric pressure’ and blast exposure. Accordingly, the following ADF employment roles and training activities are covered under the policy and are considered to have met the factor for experiencing a change in ambient barometric pressure:
· Special forces; including SASR, Commandos, Special Operations Engineer Regiment (whose roles may include diving or parachute training as well as roles involving being in close proximity to explosions such as breaching)
· Engineers with roles including the disposal/use of explosive ordinance
· Clearance/Ships’ divers
· Pilots and aircrew
· Aeromedical evacuation personnel
· Underwater medicine medical personnel (officers and medics)
Training and other activities
If an ADF member has not been involved in an above employment role, the following training activities could be taken into consideration by delegates:
· Training in submerged environments (e.g. Helicopter Underwater Escape Training (HUET) or submarine escape training)
· Scuba training
· Other diving roles (non scuba)
· Parachute training
· Documented exposure in close proximity to an explosion
· Personnel whose role includes being inside an operational hyperbaric chamber
The above list does not preclude a delegate from assessing the relevance of other ADF roles or training activities in barotrauma liability claims. However, for barotrauma claims that do not involve the specified ADF roles or training activities contained in this policy, the normal liability assessment process would take place, and the assumption of relevant exposure does not apply.
To apply this policy in circumstances where there is a lack of service records or evidence of a barotrauma incident, the following process should be followed.
1. Client contention
The client would need to contend that the barotrauma incident arose from at least one of the ‘Prescribed ADF roles and training activities’.
2. ENT Specialist
In the absence of records in the veterans’ service medical documents an Ear, Nose and Throat (ENT) specialist would need to
I. Provide a diagnosis and conduct an assessment concerning the causation of the barotrauma.
II. Attribute the cause of the barotrauma to at least one of the ‘Prescribed ADF roles and training activities’, as opposed to any non-service related activity.
III. Provide the date of clinical onset of the barotrauma.
(please note that if the service medical documents contain a relevant barotrauma incident, a specialist opinion is not required.)
3. Service documentation
Service records/evidence must demonstrate that the member was engaged in the attributed ‘Prescribed ADF roles and training activities’, at the time of the onset that has been advised by the ENT specialist. Specific training activities may not show up on the service medical/personnel records, but if the delegate is unable to confirm the client’s contention a SAM request could be lodged.
4. SOP timeframe
The delegate would need to review the relevant SOPs and establish whether the date of onset of barotrauma (as noted by the ENT specialist) meets the specified onset timeframes outlined by the SOPs.
Given the required onset timeframes for barotrauma under the SOP factors are typically limited to a 24 hour period following relevant exposure, an ENT specialist will need to provide evidence of onset having occurred at the relevant time, and a delegate will need to be satisfied that the onset timeframe has been met.
While barotrauma typically resolves within a short time period, a barotrauma incident may lead to sequela conditions.
According to the SOP factors, otitic barotrauma may lead to sensorineural hearing loss, conductive hearing loss, otitis media and tinnitus. Sinus barotrauma may lead to sinusitis and trigeminal neuropathy. Most of these sequela conditions are required by the SOPs to have emerged within a short timeframe (usually weeks) after the barotrauma incident.
Should a member submit a claim for a sequela condition contending that it arose from a service-related barotrauma, and barotrauma has not previously been accepted or has been determined as ‘No Incapacity Found’, a report from an Ear, Nose and Throat specialist will be required.
If the sequela is contended to have arisen from a previously accepted barotrauma, it will be necessary to see whether medical evidence attributes causation of the sequela to the barotrauma and confirms onset within the relevant SOP factor timeframe.
If liability for sinus or otitic barotrauma has not been accepted, assessment of liability for barotrauma and the contended sequela should take place at the same time.
If liability for sinus or otitic barotrauma is to be accepted prior to accepting the sequela, the following would need to take place to accept liability for the barotrauma and contended sequela:
1. Client contention
The client would need to contend that the barotrauma incident arose from at least one of the ‘Prescribed ADF roles and training activities’, and a sequela condition arose from that same incident.
2. ENT Specialist
An Ear, Nose and Throat (ENT) specialist would need to:
- Provide a diagnosis and conduct an assessment concerning the causation of the barotrauma and sequela condition.
- Attribute the cause of the barotrauma to the ‘Prescribed ADF roles and training activities’, as opposed to any non-service related activity.
- Attribute the cause of the sequela to the same incident of barotrauma, as opposed to any non-service related activity.
- Provide the dates of clinical onset of the barotrauma and sequela condition.
*If an ENT specialist is not suitable for providing advice for the contended sequela, the relevant medical specialist for that sequela should be utilised.
3. Service documentation
Service records/evidence must demonstrate that the member was engaged in the attributed ‘Prescribed ADF roles and training activities’, at the time of onset for the barotrauma that has been advised by the ENT specialist. Specific training activities may not show up on the service medical/personnel records, but if the delegate is unable to confirm the client’s contention a SAM request could be lodged.
The delegate would need to review the relevant SOP of the barotrauma and sequela. The delegate must be satisfied that the date of onset of the barotrauma and sequela, provided by the relevant specialist, has met the specified onset timeframes in relation to the factor as outlined by the respective SOP.
For further information or advice about this policy, please contact Liability and Service Eligibility Section at L.and.SE.Policy@dva.gov.au