Betty May Lloyd and Repatriation Commission

Case

[2012] AATA 657

28 September 2012


[2012] AATA 657 

Division VETERANS' APPEALS DIVISION

File Number

2011/2931

Re

Betty May Lloyd

APPLICANT

And

Repatriation Commission

RESPONDENT

DECISION

Tribunal

G. D. Friedman, Senior Member

Date 28 September 2012
Place Melbourne

The Tribunal affirms the decision under review.

..............................[sgd]..........................................

G. D. Friedman, Senior Member

VETERANS' AFFAIRS – veterans' entitlements – widow's claim – diabetes mellitus – hypertension – ischaemic heart disease – whether conditions war-caused

Veterans' Entitlements Act 1986 ss 8(1), 119(1)(h), 120(1), 120(3), 120A

Bull v Repatriation Commission (2001) 188 ALR 756

Bushell v Repatriation Commission [1992] HCA 47
Collins v Repatriation Commission (2009) 177 FCR 280
East v Repatriation Commission (1987) 16 FCR 517
Holthouse v Repatriation Commission [1982] FCA 113
Knight v Repatriation Commission [2010] FCA 1134
Mason v Repatriation Commission [2000] FCA 1409
Repatriation Commission v Deledio (1998) 83 FCR 82
Repatriation Commission v Hancock (2003) 37 AAR 383

Repatriation Commission v Law (1980) 31 ALR 140

REASONS FOR DECISION

G. D. Friedman, Senior Member

28 September 2012

  1. Betty Lloyd is the widow of Keith Thomas Lloyd (the veteran), who died on 7 November 2008 primarily from acute kidney failure arising from an infection in his leg, which led to a deterioration in his cardiac problems and then multi-organ failure.  On 14 July 2010 the Veterans’ Review Board (VRB) affirmed a decision of the respondent to refuse Mrs Lloyd’s application for a widow's pension on the basis that the death was not war-caused.  Mrs Lloyd seeks review of that decision.

LEGISLATIVE FRAMEWORK

  1. The veteran served in the Australian Army from 2 April 1951 to 1 April 1957.  His service in Japan and Korea from 11 December 1951 to 6 April 1953 was operational service under the Veterans' Entitlements Act 1986 (the Act).

  1. Section 8(1) of the Act provides:

8(1)     Subject to this section …, for the purposes of this Act, the death of a veteran shall be taken to have been war-caused if:

(a)       the death of the veteran resulted from an occurrence that happened while the veteran was rendering operational service;

  1. The standard of proof in claims made in respect of the death of a veteran relating to operational service is specified in s 120(1) of the Act, which provides that the death of a veteran was war-caused unless the Tribunal is satisfied, beyond reasonable doubt, that there is no sufficient ground for making that determination. 

  1. Section 120A of the Act provides that, for the purposes of s 120(3) of the Act:

…a hypothesis connecting the… death of a person with the circumstances of any particular service rendered by the person is reasonable only if there is in force… a Statement of Principles (SoP)… that upholds the hypothesis.

  1. In cases where s 120A of the Act applies, the Full Court of the Federal Court in Repatriation Commission v Deledio (1998) 83 FCR 82 at 97 set out a four-step process:

1.        The Tribunal must consider all the material which is before it and determine whether that material points to a hypothesis connecting the injury, disease or death with the circumstances of the particular service rendered by the person…  

2.        If the material does raise such a hypothesis, the Tribunal must then ascertain whether there is in force an SoP determined by the Authority under s 196B(2) or (11)….

3.        If an SoP is in force, the Tribunal must then form the opinion whether the hypothesis raised is a reasonable one.  It will do so if the hypothesis fits, that is to say, is consistent with the "template" to be found in the SoP…  

4.        The Tribunal must then proceed to consider under s 120(1) whether it is satisfied beyond reasonable doubt that the death was not war-caused… If the Tribunal is so satisfied, the claim must fail.  

  1. In Repatriation Commission v Hancock (2003) 37 AAR 383 at 386 Selway J set out the approach to be followed by the Tribunal:

(a)       First, the AAT was required to determine, on balance of probabilities, whether the pre-conditions other than causation, had been made out…

(b)       Next, the AAT was required to determine on balance of probabilities what 'kind of death' Mr Hancock had suffered.  This involved the identification, on balance of probabilities, of any and all SoPs and/or determinations under s 180A(2) of the Act and any other 'kinds of death' which were applicable to that death.

(c)       If one or more SoPs were applicable, then the methodology in Deledio is applicable in relation to those 'kinds of death'.

  1. In Collins v Repatriation Commission (2009) 177 FCR 280 the Federal Court stated at [20]:

Certainly, in order to ascertain whether a statement of principles applies, it is necessary to identify the kind of death met by the Veteran. The identification of the kind of death is the critical step in the analysis, but in determining the kind of death, the proof is on the balance of probabilities (see Hancock [2003] FCA 711 at [9]). Clearly enough, the phrase "kind of death met by a person" is concerned with causation. It is not a question about whether the death was slow, fast or otherwise, it asks questions of medical causation about the cause of death in the context of the Act.

ISSUE

  1. The issue before the Tribunal is whether there is a causal relationship between the veteran's death and his operational service.  This requires an assessment of the kind of death and consideration of whether the medical conditions contributing to the death were war-caused.

WHAT IS THE KIND OF DEATH?

  1. In following the approach laid down in Hancock, the Tribunal finds that the pre- conditions, other than causation (step (a)), have been made out because Mrs Lloyd's husband was a veteran, the veteran has died and Mrs Lloyd is his widow.  In relation to a determination of the kind of death suffered by the veteran (step (b)), the Tribunal notes that the death certificate and medical evidence confirm that the main cause of death was acute renal failure, plus peripheral vascular disease, congestive heart failure, coronary artery bypass graft, stroke, type 2 diabetes and pulmonary hypertension. 

  1. In a report dated 23 May 2012 Professor J Cade, Principal Specialist in Intensive Care, The Royal Melbourne Hospital, stated after reviewing relevant documentation that the cause of the veteran’s death appears to have been acute on chronic renal failure which was caused by sepsis or infection, which arose in his foot and would have been related to his diabetes and peripheral vascular disease.  Significant comorbidities also included ischaemic heart disease.  Professor Cade stated that the underlying nature of the veteran's long-standing illnesses was the metabolic syndrome, comprising obesity, diabetes, hypertension and dyslipidaemia (high level of cholesterol). 

  1. The Tribunal finds that the conditions relevant to the kind or cause of death of the veteran were diabetes mellitus, hypertension and ischaemic heart disease.     

WAS DIABETES MELLITUS WAR-CAUSED?

  1. Mrs Lloyd told the Tribunal that she met the veteran in 1947.  She stated that he joined the Army in 1951 and was posted to Japan and then Korea.  She said that during the veteran’s service in Korea his father told her that the veteran had been wounded in a bomb attack and had suffered injuries to his legs and arms.  She explained that after their marriage in 1954 the veteran was hospitalised for about six weeks for treatment to his arms and legs, and afterwards he walked with a limp which remained with him throughout his life.

  1. Mrs Lloyd said that after discharge from the Army the veteran was employed as a barman for about three years, and he began to gain weight gradually.  He then commenced work as a milkman, which involved securing a horse to a milk cart and loading crates of bottled milk, which he then delivered to households during the night.  The work was strenuous because of the lifting and carrying of crates and bottles, together with walking and running, as well as climbing on and off the milk cart.  Mrs Lloyd said that, in addition to his work as a milkman, the veteran was working as a cleaner and delivery driver.  She explained that his legs were becoming weaker and he was having increasing difficulty performing the duties as a milkman, particularly jumping on and off the cart.  She said that eventually he was unable to continue and ceased this employment in the early 1970s.  Under cross-examination Mrs Lloyd agreed that the veteran continued to work as a cleaner and established a business as a contractor until suffering heart problems in 1991, forcing him to cease work.  Mrs Lloyd stated that she believed the veteran’s heart attack was the result of his diabetes and war injuries which resulted from the bombing incident in Korea in which the veteran was burnt by shrapnel.  She said that soon after their marriage she noticed sores or ulcers on his lower legs, although she said he never discussed his war service with her.

  1. Mrs Lloyd agreed that the medical records show that in Korea on 5 September 1952 the veteran suffered minor multiple superficial wounds to his face and upper left arm/shoulder as a result of an enemy shell, with minor abrasions to the nose and left arm, but no mention is made of any injury to his legs.  The records also show that in Korea on 28 September 1952 the veteran suffered burns to both hands while cooking with petrol.  He was admitted to a field ambulance facility for treatment and returned to his unit on 3 October 1952.    

  1. Mr G Lloyd, the veteran's son, stated that he recalled that the veteran always walked with a limp, which was the effect of a war injury.  He said he remembered his father working as a milkman and having difficulty breathing and getting on and off the cart, and eventually having to cease this employment.  Mr Lloyd said that he and his older brother used to help the veteran with the milk run when they were boys.  He confirmed that the veteran then commenced employment as a self-employed cleaner but at the age of about 63 years was forced to cease this business because of his physical limitations.  Mr Lloyd said that in the last five or six years of his father’s life the veteran’s mobility was severely restricted.

  1. In a statement dated 25 October 2011 Dr S Carbone, general practitioner, said that he was the veteran’s treating doctor from 2 April 2008 until the veteran's death on 7 November 2008.  He said that the veteran suffered from multiple medical conditions including type 2 diabetes.  Dr Carbone confirmed that the veteran was obese at the time of his death but was not sure when the obesity commenced.  The first mention of the veteran’s weight in previous clinical notes refers to an entry on 25 November 1991 which states: lost seven lb, now 15 stone, however the veteran's actual weight was not recorded.  The first recorded weight was 2 December 2002 when his weight was 95 kg.  Dr Carbone concluded that there was insufficient information in the clinical notes to draw any conclusion between the veteran’s service and his health problems, because the first entry was made when the veteran was aged 59 years and was already suffering from diabetes.

  1. Professor Cade stated in his report that diabetes was first diagnosed in 1984.  The veteran’s Body Mass Index (BMI) was 24.5 on enlistment, and given a finding of abdominal obesity on discharge it would be inconceivable that the BMI at that time would not have been greater than 25.  For all recorded times in the 1980s the veteran’s BMI was greater than 30 and in 1985 his BMI was 37.8.  Professor Cade acknowledged that there would be difficulty in relating the obesity to the veteran’s service.  However he noted that the latter part of the veteran’s service was sedentary and that the transition from active physical service to one of physical idleness inevitably led to the veteran’s obesity.  Professor Cade stated that the veteran’s situation might be likened to a previously fit and well person (such as an athlete) becoming rapidly overweight after retirement, because a previously large appetite required to fuel the physical activity some takes some time to switch off and requires considerable discipline to adjust the person's new dietary requirements to the changed circumstances. 

  1. Service medical records indicate that the veteran had abdominal obesity at the time of discharge.  Records held by the Department of Veterans Affairs, which appear to be taken from notes of an interview with the veteran, indicate that at the time the veteran contracted diabetes mellitus in 1984 his weight was 17 stone (107.8 kg).  The notes also record a reduction in weight to approximately 14 stone in 1985 (88.9 kg) and that his weight was controlled by diet.  In 1989 his weight appears to have been 90 kg, with a BMI of 31.91.

  1. In relation to the first step from Deledio, after considering all the material about the veteran’s diabetes mellitus, the Tribunal determines that the material points to a hypothesis connecting the condition suffered by him with the circumstances of his particular service.  Therefore Mrs Lloyd satisfies the first step.

  1. In relation to the second step from Deledio the relevant SoP is SoP No. 89 of 2011 concerning diabetes mellitus.  Paragraph 5 states:

5. Subject to clause 7, at least one of the factors set out in clause 6 must be related to the relevant service rendered by the person.

  1. Factor 6 states:

(b) for type 2 diabetes mellitus only,

(i) being overweight for a period of at least five years before the clinical onset of diabetes mellitus; or

(ii) an inability to undertake any physical activity greater than three METs for at least the five years before the clinical onset of diabetes mellitus;

Paragraph 9 states:

"being overweight" means an increase in body weight by way of fat accumulation which results in at least one of the following: (i) a Body Mass Index (BMI) of 25 or greater; or (ii) a waist circumference of greater than 80 centimetres in women or greater than 94 centimetres in men; The BMI = W/H2 and where: W is the person’s weight in kilograms and H is the person’s height in metres;

"MET" means a unit of measurement of the level of physical exertion. 1 MET = 3.5 ml of oxygen/kg of body weight per minute or, 1.0 kcal/kg of body weight per hour, or resting metabolic rate;

  1. The relevant SoP at the time of the application was SoP No. 11 of 2004.  Paragraph 4 states:

4. Subject to clause 6, at least one of the factors set out in clause 5 must be related to any relevant service rendered by the person.

  1. Factor 5 states:

(b) in relation to type 2 diabetes mellitus, being obese for a period of at least five years before the clinical onset of diabetes mellitus;

(u) in relation to type 2 diabetes mellitus, an inability to undertake any physical activity greater than 3 METs for at least the five years immediately before the clinical onset of diabetes mellitus;

Paragraph 9 states:

“being obese” means an increase in body weight by way of fat accumulation which results in a Body Mass Index (BMI) of 30 or greater.

The BMI = W/H2 and where:

W is the person’s weight in kilograms and

H is the person’s height in metres;

“MET” means a unit of measurement of the level of physical exertion.

1 MET = 3.5 ml of oxygen/kg of body weight per minute or, 1.0 kcal/kg of body weight per hour, or resting metabolic rate;

Therefore Mrs Lloyd satisfies the second step.

  1. In relation to the third step from Deledio it is necessary for the hypothesis to be reasonable. For a hypothesis to be reasonable it must be more than a mere possibility, not fanciful, and consistent with the known facts (East v Repatriation Commission (1987) 16 FCR 517). In Bull v Repatriation Commission (2001) 188 ALR 756 Emmett and Allsop JJ said (when referring to East) at 761:

The court said that an hypothesis is not reasonable if it is obviously fanciful or impossible or incredible or not tenable or too remote or too tenuous. However, the Full Court did not say that if an hypothesis was not obviously fanciful or not impossible, or not incredible or tenable or not too remote or not too tenuous, it was therefore necessarily reasonable.

  1. Taking into account the evidence from Mrs Lloyd, Mr Lloyd and the medical evidence, the Tribunal forms the opinion that the material is consistent with the template found in the relevant SoP and therefore the hypothesis is reasonable and Mrs Lloyd satisfies the third step.

  1. In relation to the fourth step from Deledio the Tribunal must decide whether it is satisfied beyond reasonable doubt that there is no sufficient ground for determining that diabetes mellitus was connected with his operational service within the meaning of the Act.  The claim will succeed unless one or more of the facts necessary to support the hypothesis is disproved or the truth of a fact inconsistent with the hypothesis is proved.

  1. As stated in Repatriation Commission v Law (1980) 31 ALR 140, there may be more than one medical cause for the veteran's incapacity or death, which must be a contributing cause, but not necessarily the sole or dominant cause.

  1. However in Holthouse v Repatriation Commission [1982] FCA 113 Davies J stated:

…The words '...has arisen out of, or is attributable to, ...' require there to be a causal connection between the defence service and the incapacity or death. The words require that the defence service contribute in a material way to the incapacity or death. The connection need not be the sole, dominant, direct or proximate cause and effect. It is sufficient if there be a contributory cause or connection (see McNicol v Commonwealth of Australia, [1969] HCA 18; (1969) 119 CLR 126 at 129; Nunan v Cockatoo Docks & Engineering Co. Ltd., (1941) 41 SR NSW 119 at 124; W. v Minister of Pensions, (1946) 2 All ER 501 at 502; Minister of Pensions v Chennell, (1946) 2 All ER 719 at 720-1; Marshall v Minister of Pensions, (1947) 2 All ER 706 at 708; Repatriation Commission v Law [1981] HCA 57; (1981) 36 ALR 411.

  1. In Knight v Repatriation Commission [2010] FCA 1134 Katzmann J noted at [95] that the relevant causal connection is between the factor and service, and not the disease and service.

  1. There is no dispute that clinical onset of diabetes mellitus occurred in 1984.  In respect of factor 6(b)(i) of SoP No. 89 of 2011 the Tribunal accepts the conclusion by Professor Cade that the veteran was diagnosed with abdominal obesity on discharge from the Army and his BMI readings in the 1980s were greater than 30, so the veteran was overweight for a period of five years before the clinical onset of diabetes mellitus. The veteran’s service documents indicate that after his return from Korea he was posted to the Royal Australian Army Ordnance Corps where he performed administrative and general duties for four years before his discharge, and the Tribunal takes into account Mrs Lloyd’s evidence that the veteran slowly gained weight after discharge from the Army.  The Tribunal also takes into account Professor Cade’s analogy of an athlete gaining weight after retirement. However Professor Cade also acknowledged the difficulty of linking the veteran’s obesity in the 1980s to his service.  The Tribunal concludes that, despite a temporal relationship between his weight and his service, there is no material that connects the veteran’s situation of being overweight for the period of at least five years before the clinical onset of diabetes mellitus with his operational service.     

  1. In respect of factor 6(b)(ii) of SoP No. 89 of 2011 the Guide to the Assessment of Rates of Veterans’ Pensions (fifth edition) published by the Department of Veterans’ Affairs Scale 1.1 shows that 3-4 METS  refers to energy expended in walking at an average pace of 5 km/h in activities that include: cleaning car; tidying house; cleaning windows; vacuuming; shifting chairs; light gardening; hanging out washing; and making bed.  4-5 METS refers to moderate activity encompassing more strenuous daily activities with the exclusion of manual labour and vigorous exercise that include: mopping floors; light carpentry; scrubbing floors; beating carpets; shopping and carrying groceries (10 kg); and stacking firewood.    

  1. Section 119(1)(h) of the Act requires the Tribunal to consider the difficulties attributable to the passage of time and the absence or deficiency of relevant records resulting from the fact that an occurrence was not reported to appropriate authorities.  In Mason v Repatriation Commission [2000] FCA 1409 Weinberg J stated at [76]:

… The role of s 119 is not to invent evidence which may serve to establish that connection. Inevitably cases of this type will involve problems of remembering details of events, and s 119(1)(h) is designed to ensure that those matters are taken into account. Those matters are not, however, to prevail over the structure and text of the remaining provisions of the VE Act.  

  1. The Tribunal takes into account that at the time of the hearing Mrs Lloyd was aged 80 years and that an accurate recollection of conversations with the veteran and observation of events that occurred in the 1950s and the years following his operational service was difficult because of the passage of time.  Nevertheless medical records for the relevant period of the veteran’s service are available.  These demonstrate that there is no record of any injury or illness concerning his legs during his service in the Army, including the two incidents in which he suffered injuries.  At his medical examination for the purposes of discharge in 1957 the veteran did not mention any leg condition, and the medical officer wrote NAD (or no abnormality detected) regarding limbs.

  1. The Tribunal takes into account Mrs Lloyd’s evidence about ulcers she noticed on the veteran’s legs and the evidence from Mr Lloyd about his father walking with a limp.  However in her evidence Mrs Lloyd confirmed that although the veteran had ceased his employment as a milkman in the early 1970s he was working as a contract cleaner until he ceased his cleaning work after his heart problems which commenced in 1991.  She also confirmed that the cleaning duties involved cleaning of offices and toilets for commercial premises and that he performed the duties himself.  The Tribunal is satisfied that these duties included moderate activity such as mopping and scrubbing floors, which would be equivalent to 4-5 METS.  Therefore the Tribunal finds that the veteran did not have an inability to undertake any physical activity greater than three METS for at least the five years before the clinical onset of diabetes mellitus.

  1. For these reasons the Tribunal is satisfied beyond reasonable doubt that Mrs Lloyd does not satisfy the fourth step and the veteran’s death from diabetes mellitus was not war-caused.

WAS HYPERTENSION WAR-CAUSED?

  1. In relation to the first step from Deledio, after considering all the material about the veteran’s hypertension, the Tribunal determines that the material points to a hypothesis connecting the condition suffered by him with the circumstances of his particular service.  Therefore Mrs Lloyd satisfies the first step.

  1. In relation to the second step from Deledio the relevant SoP is SoP No. 35 of 2003 concerning hypertension.  Factor 5 states:

(a) being obese at the time of the clinical onset of hypertension;

(m) an inability to undertake more than a mildly strenuous level of physical activity for at least the five years immediately before the clinical onset of hypertension;

Paragraph 8 states:

“being obese” means an increase in body weight by way of fat accumulation which results in a Body Mass Index (BMI) of 30 or greater.

The BMI = W/H2 and where:

W is the person’s weight in kilograms and

H is the person’s height in metres;

“a mildly strenuous level of physical activity” means any physical activity greater than 3 METS, where a “MET” is a unit of measurement of the level of physical exertion. 1 MET = 3.5 ml of oxygen/kg of body weight per minute or, 1.0 kcal/kg of body weight per hour, or resting metabolic rate;

Therefore Mrs Lloyd satisfies the second step.

  1. In relation to the third step from Deledio, taking into account the evidence from Mrs Lloyd, Mr Lloyd and the medical evidence, the Tribunal forms the opinion that the material is consistent with the template found in the relevant SoP and therefore the hypothesis is reasonable and Mrs Lloyd satisfies the third step.

  1. In relation to the fourth step from Deledio the Tribunal finds that clinical onset of hypertension occurred in 1975 and that the veteran was obese at the time of clinical onset.   However, in respect of factor 5(a) of SoP No. 35 of 2004, for the reasons set out in relation to diabetes mellitus, the Tribunal finds that, despite a temporal relationship between his obesity and the date of the clinical onset, there is no material that connects the veteran’s obesity at the time of the clinical onset of hypertension with his operational service.

  1. In respect of factor 5(m) of SoP No. 35 of 2004, the Tribunal takes into account that the definition of a mildly strenuous level of physical activity means any physical activity greater than 3 METS.  In the five years before 1975 the veteran was working as a milkman, involving demanding physical activity, or had during the period ceased this work but had but had continued to work as a cleaner, either as an employee or as a contractor.  For the reasons set out in relation to diabetes mellitus, the Tribunal finds that that the veteran did not have an inability to undertake more than a mildly strenuous level of physical activity for at least the five years immediately before the clinical onset of hypertension.

  1. For these reasons the Tribunal is satisfied beyond reasonable doubt that Mrs Lloyd does not satisfy the fourth step and the veteran’s death from hypertension was not war-caused.

WAS ISCHAEMIC HEART DISEASE WAR-CAUSED?

  1. In relation to the first step from Deledio, after considering all the material about the veteran’s ischaemic heart disease, the Tribunal determines that the material points to a hypothesis connecting the condition suffered by him with the circumstances of his particular service.  Therefore Mrs Lloyd satisfies the first step.

  1. In relation to the second step from Deledio the relevant SoP is SoP No. 89 of 2007 concerning ischaemic heart disease.  Factor 6 states:

(a) having hypertension before the clinical onset of ischaemic heart disease; or

(b) having diabetes mellitus before the clinical onset of ischaemic heart disease; or

(c) being obese for at least five years before the clinical onset of ischaemic heart disease;

(d) for males, having a waist to hip circumference ratio exceeding 1.0 for at least five years, before the clinical onset of ischaemic heart disease;

Paragraph 9 states:

"being obese" means an increase in body weight by way of fat accumulation which results in a Body Mass Index (BMI) of thirty or greater.

The BMI = W/H2 and where:

W is the person’s weight in kilograms and

H is the person’s height in metres;

Therefore Mrs Lloyd satisfies the second step.

  1. In relation to the third step from Deledio, taking into account the evidence from Mrs Lloyd, Mr Lloyd and the medical evidence, the Tribunal forms the opinion that the material is consistent with the template found in the relevant SoP and therefore the hypothesis is reasonable and Mrs Lloyd satisfies the third step.

  1. In relation to the fourth step from Deledio the veteran first complained of chest pains in 1991 and the Tribunal finds that clinical onset of ischaemic heart disease occurred in 1991.  In respect of factors 6(a) and 6(b) of SoP No. 89 of 2007, the Tribunal takes into account that the veteran had hypertension and diabetes mellitus respectively before the clinical onset of ischaemic heart disease.  However, in view of the Tribunal’s findings that diabetes mellitus and hypertension were not war-caused, the Tribunal finds that despite a temporal relationship there is no causal relationship between these factors and the veteran’s operational service.

  1. In respect of factor 6(c) of SoP No. 89 of 2007 the Tribunal finds that the veteran was obese for at least five years before 1991.  However, for the reasons set out in relation to diabetes mellitus and hypertension, the Tribunal finds that, despite a temporal relationship between his obesity and the date of the clinical onset, there is no material that connects the veteran’s obesity for at least five years before the clinical onset of ischaemic heart disease with his operational service.

  1. In respect of factor 6(d) of SoP No. 89 of 2007 there was no material provided to the Tribunal specifically referring to a waist to hip circumference ratio exceeding 1.0 in the five-year period before 1991.  Even if such material was available, the Tribunal is satisfied that there is no causal relationship between this factor and the veteran’s operational service.

  1. For these reasons the Tribunal is satisfied beyond reasonable doubt that Mrs Lloyd does not satisfy the fourth step and the veteran’s death from ischaemic heart disease was not war-caused.

DECISION

  1. The Tribunal affirms the decision under review.

I certify that the preceding 50 (fifty) paragraphs are a true copy of the reasons for the decision of G. D. Friedman, Senior Member.

..........................[sgd]..............................

Associate

Dated 28 September 2012

Date of hearing 24 September 2012
Advocate for the Applicant Mr D De Marchi
Solicitor for the Applicant De Marchi & Associates
Advocate for the Respondent Mr K Rudge, Department of Veterans' Affairs
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