Bowen and Military Rehabilitation and Compensation Commission
[2006] AATA 289
•30 March 2006
Administrative
Appeals
Tribunal
DECISION AND REASONS FOR DECISION [2006] AATA 289ADMINISTRATIVE APPEALS TRIBUNAL Nº V2003/1120
GENERAL ADMINISTRATIVE DIVISION
Re: MARY MARGARET BOWEN
Applicant
And:MILITARY REHABILITATION AND COMPENSATION COMMISSION
Respondent
DECISION
Tribunal: Regina Perton, Member
Date:30 March 2006
Place:Melbourne
Decision:The Tribunal sets aside the decision under review and substitutes a decision that the late John Bowen’s psychiatric condition arose out of his employment.
The Tribunal remits the matter to the respondent for calculation of compensation entitlements.
(sgd) Regina Perton
Member
COMPENSATION ‑ whether illness caused or aggravated by employment – depression – decision set aside
Safety, Rehabilitation and Compensation Act 1988 ss 4, 14, 55
REASONS FOR DECISION
30 March 2006 Regina Perton, Member
1. Mary Bowen is the widow of the late Dr John Russell Bowen, who died on 23 June 2000, at the age of 44. Dr Bowen, a medical practitioner, enlisted in the Australian Army (the Army) as a medical student on 1 January 1978. Having attained the rank of Major, he completed army service on 6 February 2000.
2. While still a serving officer, Dr Bowen lodged a claim for compensation on 3 May 1996 for stress, depression and anxiety. He cited his three years of service, from 1987 to 1989, as an army doctor in Papua New Guinea as contributing to his condition. The respondent refused the application on 21 January 1997 on the basis that Dr Bowen was not suffering from a diagnosable psychiatric condition. On 1 May 2003, Mrs Bowen, who married Dr Bowen in 1994, sought reconsideration of the determination to refuse her late husband’s claim. On 8 September 2003, the respondent affirmed the original decision on the basis that even if Dr Bowen was suffering from a psychiatric condition, his employment did not contribute to his condition in a material degree. Mrs Bowen lodged an application for review with the Tribunal on 9 October 2003.
3. The Tribunal is also considering an application for review by Mrs Bowen for compensation in relation to the death of Dr Bowen. Dr Bowen died of a haemorrhage following gastric surgery. Mrs Bowen claims that Dr Bowen would not have undergone the operation for his gastric condition had it not been for his psychiatric condition. The medication required to treat the psychiatric condition is claimed to have caused and/or aggravated his gastric condition. It is therefore claimed that his work-related psychiatric condition led to his death. That application for review (V2003/1121) is the subject of a separate decision.
4. In this matter, the issues for the Tribunal to consider are whether the late Dr Bowen suffered from a psychiatric condition; and if so, did it arise out of, and/or was it aggravated by his employment and therefore compensable under the Safety, Rehabilitation and Compensation Act 1988 (the Act).
5. The Tribunal is satisfied that Dr Bowen’s employment contributed to his condition for the reasons set out below.
RELEVANT LEGISLATION
6. Section 14(1) of the Safety, Rehabilitation and Compensation Act 1988 (the Act) provides:
14(1) Subject to this Part, Comcare is liable to pay compensation in accordance with this Act in respect of an injury suffered by an employee if the injury results in death, incapacity for work, or impairment.
7.Injury is defined in s 4(1) of the Act:
injury means:
(a)a disease suffered by an employee; or
(b)an injury (other than a disease) suffered by an employee, being a physical or mental injury arising out of, or in the course of, the employee’s employment; or
(c)an aggravation of a physical or mental injury (other than a disease) suffered by an employee (whether or not that injury arose out of, or in the course of, the employee’s employment), being an aggravation that arose out of, or in the course of, that employment;
but does not include any such disease, injury or aggravation suffered by an employee as a result of reasonable disciplinary action taken against the employee or failure by the employee to obtain a promotion, transfer or benefit in connection with his or her employment.
8. Section 55 of the Act allows the claim to continue after Dr Bowen’s death.
EVIDENCE
Dr Mendelson
9. In refusing the claim, the respondent relied on a report it commissioned from Dr George Mendelson, who examined Dr Bowen on 29 November 1996 and prepared a report on the same day (T12). Under the heading History of Symptom Onset, Dr Mendelson stated:
At the commencement of the consultation, when I asked Dr Bowen to tell me what had happened to him, he told me that “basically I’m here for my compo thing”.
He then told me that he had served in Papua New Guinea for three years as a doctor with the Army and returned to Australia in October 1989. He said that he took an overdose of chloroquine tablets about three days after he returned to Australia from his posting in Papua New Guinea, and told me “I haven’t been the same since”.
Dr Bowen then said that he has “always been a little inclined towards anxiety and depression”. He then said that he continues to serve with the Army at the present time, as a doctor, but that he is not seeing patients
….
Dr Bowen told me “I don’t want the responsibility any more, I don’t know the reason”. He said “I find it rather dreadful to do so”.
…
Dr Bowen then told me that in 1989 prior to returning to Australia from Papua New Guinea “I’d been talking about suicide increasingly frequently throughout 1989”.
10.Dr Mendelson then gives the following opinion of Dr Bowen’s condition:
…
The history which I obtained from Dr Bowen indicates that on his return to Australia from Papua New Guinea in 1989 he took an overdose of chloroquine, following an argument with his wife.
There is also a history of anxiety symptoms related to travel on public transport and going to shops, but Dr Bowen said that these symptoms are now “a lot better”.
The history which I obtained from Dr Bowen does not indicate that the anxiety symptoms which he has experienced under the circumstances described above can be attributed to any specific aspect of his Army service. There is also no indication at the present time the anxiety symptoms are associated with any restriction in terms of his occupational or social functioning.
On the basis of the history which I obtained from Dr Bowen, and mental state examination during today’s consultation, it is my opinion that at the present time there is no indication that he suffers from any specific diagnosable mental disorder such as a depressive illness, a Generalized Anxiety Disorder, or a psychotic condition. It is also my opinion that there is no indication that Dr Bowen has any loss of work capacity due to a mental disorder of the type listed above, or due to any specific psychiatric impairment.
…
It would appear that Dr Bowen has made a decision to confine his medical activities at the present time to administrative duties, rather than continue in clinical practice, and he has also made the decision that after completing his current term of Army service he will no longer practice medicine….It is not uncommon for medical practitioners to seek an alternative career outside medicine, as seems to be the case in relation to Dr Bowen, and in my view this decision on his part is not attributable to any mental disorder.
11. In oral evidence, Dr Mendelson stated that he did not have an impression that Dr Bowen’s early life had impacted on his psychiatric condition in any specific adverse way. He stated that the comment in his report that Dr Bowen had been a little inclined towards anxiety and depression was in the context of Dr Bowen being a person who was more sensitive than others to the stresses of life. Dr Mendelson stated that on the day on which he examined Dr Bowen, it was his view that Dr Bowen was not suffering from any specific diagnosable disorder.
12. Under cross-examination, Dr Mendelson indicated that he had no recollection of what material he had been provided from army records concerning Dr Bowen’s treatment apart from that recorded in his report. He also confirmed that he had only seen Dr Bowen for the one consultation.
Dr Bowen’s evidence
13. In his Claim for Rehabilitation and Compensation, which he completed on 3 May 1996, Dr Bowen described the condition for which he was claiming was stress/depression/anxiety leading to suicide attempt at 10:45 hours on 17-10-89. He stated that he first became aware of his illness in early 1989. The first medical treatment occurred on 17 October 1989. In response to a prompt question as to what aspects of his employment contributed to the illness, Dr Bowen stated it was working as a doctor 24 hr 7 days/wk on call in a foreign country under trying circumstances.
14. In an attachment to a claim for a disability pension for multiple medical conditions including his psychiatric condition (T7), Dr Bowen explained why he believed that his condition of stress/anxiety/depression was caused by conditions of service.
a. I hd [sic] what I regard as a “normal” amount of stress due to army life until my final year of my 3 years in PNG. I began to feel anxious, depressed, and then to feel suicidal through that year of 1989. This occured [sic] as a result of working as a military doctor for 3 years providing a 24 hours a day 7 days a week on call medical service, in a foreign country with limited specialist support, no Aust Army medical colleages [sic] to offer support, and having to offer medical cover to members and their dependants in 3 areas spread though out PNG…
b. The personal cost to me of providing this service was recognised by the CGS in his commendation of me….
c. Although I requested a quiet posting on my return (preferably an academic one at RAAF School of Languages), the army posted me to LWC at Canungra – a posting where I would again have a heavy load of after hours work (including on call for Christmas Day while ostensibly on leave). I could not face another such posting and that precipitated my suicidal episode…
d. After a degree of recovery, I resigned from the army. I subsequently rescinded my resignation, and shortly thereafter, my then wife left me. She took the children to Tasmania where there is no posting for an ARA Medical Offr.
e. Currently the 11Med Coy BASB is understaffed. I have no RMO’s (I am entitled to 3), and the SMO 6 Bde is on Civil Schooling.
f. Given my medical history, I believe the army should not post me to high stress positions such as OC Pucka Med Cen, and OC Med Coy BASB, as they have done. I believe this has contributed to my continued stress levels.
g. As there is no posting in Tas for an MO, the army is keeping me away from my children, despite a CSA investigation recommending a posting to Tas on compassionate grounds as a first option.
h. I needed to take a years LWOP 16 Dec 93 – 6 Jan 96, which delayed my career for 12 months….
15. The Veterans' Review Board (VRB) determined on 21 February 1997 that Dr Bowen was entitled to a disability pension at 60 per cent of the general rate on the basis of his depressive disorder. The VRB, in its decision (Exhibit A4), related oral evidence given by Dr Bowen concerning his time in Port Moresby (at p9):
….
At the hearing the applicant gave very detailed evidence concerning the difficulties associated with his appointment as a medical officer in the Australian High Commission in Port Moresby. He stated that he was on duty 24 hours per day and would receive two or three telephone calls per night and, about five times every week, would have to go out in answer to one of these calls. Travelling around Port Moresby at night caused him stress because of perceived threats to his own personal security and to his family, in his absence. The applicant described several episodes in which his wife was accosted or followed by local residents and indicted that living in Port Moresby presented ongoing potential danger to their personal safety and was a factor which contributed to the deterioration of his relationship with his wife.
The applicant said that his task was made more difficult by the complete absence of medical staff and the fact that he had an inadequate supply of medical equipment or stores in the Australian High Commission. Despite these problems, he said, he was expected to provide a medical service, not only for Australian military personnel, but also for embassy staff and other Australian nationals living in Papua New Guinea.…The applicant told the Board that he had complained about the conditions of post to his “boss” (an officer of the rank of Lieutenant Colonel) but little was done to improve the situation. The applicant also informed the Board that the difficulty associated with his posting has now been recognised by the army who have made it policy for the Posting to Papua New Guinea to be for a maximum of twelve months.
….
16. On 15 May 2000, Dr Bowen filled in a form requesting review by the VRB of a decision made on 28 January 2000 that he was not eligible for an increase in his pension to a special rate. Dr Bowen gave the following grounds for seeking review:
The Determining Officer stated that he was unable to consider me for special rate “because you have retired from remunerative work”. I have been treated for a Depressive disorder since October 1989 by various specialists because of interstate postings in the Regular Army. For the last six months I have been treated by Dr J D BUCHANAN…on a fortnightly basis. I believe that in his opinion that I am unable to continue work because of my accepted disabilities alone…
In regard to my retirement from the ARA I had been assessed prior to discharge as “unfit for Military Service, Unfit for duty”.
I am not able to work as a doctor nor am I able to be employed in any capacity.
…
17. There were a number of other documents tendered in which Dr Bowen had described his symptoms in similar terms to those above. These include a Lifestyle Questionnaire completed on 21 September 1999 (Exhibit A5) and a Brief Life History Questionnaire dated 19 August 1999 (Exhibit A10).
Mrs Bowen
18. Mrs Bowen provided a written statement dated 29 April 2005 in which she described in detail her recollections of her late husband’s condition emphasizing the last two years of their life together (Exhibit A12). She stated that the period from middle to end of 1999 was particularly bad while the last three months of his life were particularly good.
19. In oral evidence, Mrs Bowen stated that she had met Dr Bowen on 15 July 1991 in Brisbane. He was posted to Puckapunyal in January 1992. Mrs Bowen described Dr Bowen’s role there and the difficulties he had with accommodation. On arriving there, he found that he could not obtain married quarters because he was divorced. Instead of being able to live in the doctor’s house opposite the hospital, where he could have had his children stay with him, he was housed in the barracks with 40 or 50 other officers. He did not have his own toilet, bathroom or cooking facilities and did not believe it appropriate for his young daughter, then 8 years old, to share those facilities with other adult males, unsupervised. The doctor’s house was given to the nurse who was Dr Bowen’s subordinate. Mrs Bowen described his next posting to Victoria Barracks in February 1993 and his decision to take a year’s leave without pay from December 1993. She stated that he was exhausted and felt that he needed rest if he were to continue with his work. She and Dr Bowen were married in December 1994 after which he was posted to Brisbane.
20. Mrs Bowen described his work over the next few years and his worsening ability to cope. Dr Bowen was posted back to Melbourne in April 1996 to an administrative and policy role as he could no longer cope with clinical work. She said that his moods were not as dark and the mood swings less pronounced at that time. Mrs Bowen described his health and behaviour over the next few years, citing his deterioration. He withdrew socially from the family and others, was aggressive, no longer took pride in his appearance and reacted badly in physical terms to his prescribed antidepressants.
21. Under cross-examination, Mrs Bowen described her late husband’s conflicts with his second ex-wife over their children. She described his medication and reaction to it. She also recounted aspects of her shared life with Dr Bowen, the support he needed and her perceptions of his illness.
P M Dennis
22. Lieutenant Colonel P M Dennis MBE (Rtd) provided a written statement dated 17 May 2004 (Exhibit A13). He was Dr Bowen’s Commanding Officer in Papua New Guinea. He was based at the Australian High Commission in Port Moresby. He provided information about Dr Bowen’s role in Papua New Guinea. He stated, among other things:
…
Capt Bowen’s workload was significant and unfortunately he did not benefit from his and my efforts to get some assistance in the form of a locally employed nursing sister, which occurred at the end of his posting.
Capt Bowen’s [sic]was posted to PNG for 3 years, which under the circumstances was far too long for the workload pressures he was under. Most postings were for 2 years although quite a few were extended for 1 year.
….
PNG was and is a very dangerous posting environment…
Australian government and Defence houses were built like fortresses with armoured safe havens, security guards, razor wire fences and safety radio networks. One did not go out side your safe environment at night, as it was too dangerous.
Capt Bowen was on call 24 hours a day and on many occasions he reacted to emergencies in this environment. He also flew at short notice to the outstations in emergencies. Because he was reliable and the PNGDF Medical Officers were not, on many occasions he would be called out to the PNGDF Hospital to cover for the on-call PNGDF doctor who was uncontactable or drunk.
….
Capt Bowen and I had a very good professional relationship. He was a very competent doctor and had a genuine concern for his patients and their welfare. I was impressed by his work ethic but could see the detrimental effects it was having on him and others under my command….
I am not surprised Capt Bowen suffered a stress related illness following a extremely demanding 3 year posting in PNG.
Army Medical Records
23. Army records provide a history of Dr Bowen’s illnesses, symptoms and perceptions. In a Medical History Questionnaire signed by Dr Bowen and an Examining Medical Officer on 3 December 1990 prepared in relation to a discharge (T4), it was indicated at Question 4 that reactive depression had kept Dr Bowen off work for more than one week. He also indicated that he had suffered from nervous trouble, severe depression, mental illness and attempted suicide at Question 37.
24. A number of reports prepared by medical officers during Dr Bowen’s service were available to the Tribunal. An Inpatient Summary prepared on 14 December 1989 by Dr P Singh, Medical Officer, (T4) states:
Major Bowen was admitted for the management of stress and anxiety related to his prolonged post for 3 years to PNG.
This lead [sic] to personal stress + stress in his marriage.
…
25. On 10 February 1993, a medical officer at Puckapunyal referred Dr Bowen to a specialist (T4), with a provisional diagnosis of depression. The referring doctor stated:
This young medical officer is considering resigning both from Army and from Medicine. Pressure of work and difficult personal circumstances have combined to create a crisis which he is having difficulty coping with. Can you see and advise.
26. Dr T B Stephens prepared a specialist report on 16 February 1993 (T4), finding that Dr Bowen had no gross psychiatric disability. Dr Stephens stated:
He describes a life which has had a number of ups and downs and more than average number of emotional crises. These include two marriages and an engagement, two threatened resignations from the army, withdrawn at the eleventh hour and on the second occasion immediately followed by an application for a permanent commission. There is also a history of a suicide attempt which had the characteristics of a defiant gesture against a wife who was not listening to him. Now he presents with a number of complaints about his particular job which are presumably well founded but not unusual in nature of severity. These have again led to threatened resignation and to a query whether he should give up medicine altogether. In my view he is showing characteristics of the histrionic personality and he has no psychiatric illness. In my opinion it is not constructive to label this a disorder as that is merely a pejorative rehash of the information he has given himself. I do mean that he is unlikely to change his character dramatically in the short term, that the defects will remain but that this should be put against the merits and it be remembered that he is an unusual man but not a grossly abnormal one. In this connection you have reminded me that he is a good doctor, well qualified and in receipt of two commendations for particularly good military service. For the future he has been advised, pretentiously, to conduct his life as much as possible taking advantage of the good things about him an [sic] minimising the less good.
27. Dr Smart, in a Medical Attendance and Treatment Report dated 26 July 1993 (T4), stated, amongst other things,
…
Feeling generally tired and lethargic…(returned PNG 1989).
Suffered from depressive episodes during this period – seeing psychologist…
28. Dr Dekker, in a Specialist Referral and Report dated 24 July 1995 (T4 [p65]) to his Commanding Officer, seeking army funding for Dr Bowen’s treatment, which was subsequently approved, stated:
Thank you for considering Maj Bowen (a Medical Officer) to be referred to Dr Frank Walsh (a Clinical Psychologist, specializing in Stress Management. He has seen a Clinical Psychologist previously (payed(sic) by the Army) for similar problems, and now presents an ongoing problem. Considering Maj Bowen’s position, I think it is appropriate that he be referred outside the Army.
29. Outpatient Clinical Records during the first six months of 1996 indicate that Dr Bowen was suffering from depression. He had taken a large amount of valium which had not been effective and was prescribed Aurorix. He had repeat dosages. He was then referred to a psychiatrist by Colonel R A McNeil, in a Specialist Referral and Report dated 10 July 1996 addressed to Dr Cronin (T4). The referral stated:
John is referred for continuing management of stress related problems. He has previously benefited from psychological counselling as well as Aurorix (around late Jun).
30.Dr Cronin, in a response to Colonel McNeil dated 16 July 1996 stated:
…..He presents with long standing dysthymia with intermittent episodes of major depression.
He has had cognitive behaviour therapy in the past 12/12 with good effect and should be encouraged to continue with this in Melbourne – he has …[indecipherable] to follow up.
I have prescribed Zoloft 50 mg as an antidepressant and will review him in 3/52…
31. Outpatient Clinical Records raised during August 1997 indicate that Dr Bowen’s depression had worsened and that he received regular monitoring and advice. Dr Cronin, in a note written in early August 1997 (T4), confirmed the worsening of Dr Bowen’s depressive symptoms. In a note written on 8 August 1997, Dr Cronin stated:
Has not been too good in recent weeks, largely because of anger he is experiencing in sorting out administrative hassles, as well as other family issues. He is still functioning better than when I first saw him.
I have suggested he increase his Zoloft to 200 mg in the short term, and am hopeful this will improve his functioning….
32. Army medical records in March and July 1999 confirm that Dr Bowen was suffering from anxiety/depression and taking medication. An entry made on 2 August 1999 by Dr Wride indicates a worsening of Dr Bowen’s psychiatric condition.
33. In a Discharge Health Statement dated 8 October 1999, Dr Bowen listed his depression/anxiety as one of many conditions from which he suffered at that time. The Medical Officer’s comments on the form indicate that Dr Bowen’s major concern was depression/anxiety. In a Minute dated 9 December 1999, Major V.R. Ross stated:
…As you are aware, MAJ Bowen has an extensive and long history of psychological and psychiatric problems variously diagnosed as major depressive disorder, anxiety, and histrionic personality. It would seem his problems are unlikely to resolve in the foreseeable future…
Dr Walsh
34. In a report dated 18 January 1996 (T8), Dr Frank J Walsh, Clinical Psychologist, reported that Major Bowen presented with high levels of stress at work, which has been an ongoing problem for him for a considerable number of years. Dr Walsh made the following assessment:
Major Bowen suffers from extremely high levels of both social and performance anxiety. He is highly anxious in all social interactions, from simple commercial transactions to formal social events. He is also constantly and highly anxious about his performance and proficiency in all aspects of his work as a medical practitioner and as an officer in the army. The origins of his anxiety are in his family background, and particularly the relationship he had with his parents. His condition is treatable.
He requires quite intensive and extensive psychological treatment….The longer-term prognosis, provided he remains in treatment, is reasonably good.
35. In a report dated 6 March 1996 (T8), Dr Walsh, who is based in Brisbane, recommended that Dr Bowen receive ongoing psychological assistance following his posting to Melbourne. He expressed the view that Dr Bowen’s condition had improved but still remains within the clinical range at times.
Dr Cronin
36. In a report dated 31 July 1997 (T14), Dr John Cronin, Consultant Psychiatrist, indicated that he had first seen Dr Bowen on 16 July 1996. Dr Cronin stated, amongst other things, that:
He had joined the army as a medical student and whilst he had had some difficulties with interpersonal relationships included a short and turbulent marriage, he had basically been getting by. In 1986 he was posted to Papua New Guinea where he remained for three years. He enjoyed the first year and felt adequately supported. He found the local doctors to be competent and trusted their judgement. The second year was more difficult. The people he knew and trusted were promoted away and their replacements he found to be less competent and had difficulty with. Major Bowen was the only Australian doctor and was in charge of four major areas of the country. Additionally his wife was finding the situation difficult and was becoming less supportive, refusing to take messages which added to his work load. When his posting was extended to the third year he was upset and found the going very difficult. He became more and more tired, anergic and disinterested which was not relieved by a holiday. The work became harder and harder. His friends were also his patients and he felt he could not speak to them about his difficulties. He tired to talk to his bosses but did not find them very receptive. He knew it was difficult to get doctors to go to Paua New Guinea, felt it was his responsibility to stay there and did not think he could realistically plead a case to be returned to Australia. The social situation in Papua New Guinea was also very difficult and he felt in physical danger whilst there….
Following Papua New Guinea he tied to achieve a posting which would enable him a less stressful job but his concerns were not listened to and he was posted to Canungra where he was the only doctor and on call 24 hours a day. He became very angry at the army for giving him such a difficult posting.
His feelings of depression and anxiety were much worse following Papua New Guinea and he has received psychiatric and psychological assistance since then including in-patient hospitalisation.
….
37.In a report dated 2 December 1999 (T16), Dr Cronin stated:
…
Since the time of the previous report I have continued to review him periodically at roughly monthly intervals, depending on his clinical condition. For the earlier part of the time he coped fairly well although he has continued to need antidepressant medication and on no occasion could he had been considered to be in remission from his depression. However during 1999 his condition has deteriorated and he has become more depressed, lethargic, lacking confidence and with increasing difficulty concentrating. He has become more dependant upon his wife and more socially withdrawn. He is anxious and because of this has difficulty using public transport. His libido has decreased. He has become unable to work because of his symptoms and is on long term sick leave until he is discharged from the army.
…
Dr Bowen continues to present with anxious and depressive features. The diagnosis remains recurrent major depression and dysthymia.
With respect to work capacity he has already demonstrated that he is currently unfit for any work…..
38. In a report dated 10 November 2003 (Exhibit A2), Dr Cronin indicated that Dr Bowen had been his patient from 16 July 1996 until his death. Dr Cronin stated that Dr Bowen suffered from chronic dysthymia and recurrent major depression and was not free of psychiatric symptoms throughout the time that he saw him.
39. Dr Cronin, in a report dated 3 March 2005 (Exhibit A1), stated that:
In my opinion, Dr. Bowen's employment with the ADF, in particular whilst in PNG, contributed to his psychiatric condition at that time. I consider that he was at least suffering an exacerbation of dysthymic disorder and may possibly have been suffering from a major depressive episode.
40. Dr Cronin considered that the breakdown of Dr Bowen’s marital relationship shortly after his return from Papua New Guinea was an additional factor exacerbating the dysthymic disorder. He also commented as follows in relation to Dr Bowen’s condition over the following years:
Dr Bowen continued to suffer from dysthymic disorder. At times he suffered persistent depressive symptoms in blocks greater than 2 weeks, which I consider to be periods of major depression. Whilst there was some diminution in the role that PNG played in his dysthymia and depression, Dr. Bowen expressed the belief that he had not recovered from his experiences in PNG. In my opinion he suffered ongoing psychiatric disorder, which can be thought of as burn out, as a result of his experiences in PNG.
41. Dr Cronin stated that he disagreed with Dr Mendelson’s assessment in the report of November 1996. Dr Cronin stated:
I had first seen Dr Bowen on the 16th July 1996 when he was referred for continuing management of stress related problems. I made a diagnosis of long standing dysthymia with intermittent episodes of major depression. I noted he had previously been treated with cognitive behaviour therapy with good effect and that he was encouraged to continue with this. I prescribed the anti-depressant Zoloft 50mg daily and reviewed him periodically including before and after November 1996. At no stage whilst I was seeing him was he free of psychiatric symptoms. I do not agree with Dr Mendelson that Dr Bowen was not suffering from a psychiatric condition at November 1996.
42. Dr Cronin considered that Dr Bowen suffered a 20% permanent impairment using Table 5 of the Guide to the Assessment of the Degree of Permanent Impairment.
43. In oral evidence, Dr Cronin confirmed the diagnoses and opinions he had given in his reports. He stated that whilst there may have been possible predisposing factors in Dr Bowen’s family history, it was his view that Papua New Guinea was the major effect in the development of his depression.
Dr Wride
44. In a Medical Impairment Assessment Form prescribed by the Department of Veterans' Affairs, Dr S Wride, Dr Bowen’s general practitioner, provided responses to questions concerning Dr Bowen’s depressive disorder on 15 November 1999 (T28). Dr Wride stated that Dr Bowen made three visits per fortnight to him and also saw psychiatrists Dr Cronin and Dr Buchanan weekly. He described symptoms including General social withdrawal and Marked interference with function in many everyday situations.
M D Miller
45. In July 2001, Mrs Bowen sought reconsideration of the circumstances of her late husband’s discharge. She submitted that Dr Bowen’s resignation should have been treated as a discharge on medical grounds due to his state of health and lack of decision-making ability at that time. On 18 September 2001, M D Miller, on behalf of the Joint Health Services Agency, prepared a Minute to the Director of Entitlements via Major R J Tattersall (Exhibit A11). M D Miller’s opinion was as follows (at paragraph 49):
It is my opinion that, at the time of Dr Bowen’s discharge from the Army grounds existed whereby he could have been discharged on the grounds of invalidity. The condition, which could have led to this discharge, was depression/anxiety….
Dr Walton
46. Dr Lester A Walton provided a psychiatric report dated 28 April 2005 (Exhibit R3). Dr Walton’s opinion on Dr Bowen’s condition, which was based on an examination of available medical and army records, is as follows :
1.You will appreciate that my opinion is necessarily limited because I have not had the opportunity to assess Dr. Bowen personally. However, as best I can judge, Dr. Bowen does seem to have been afflicted by a chronic depressive disorder (dysthymia) and, in my opinion, it is probable that that condition continued until the time of his death.
2.As is not at all uncommon, it would appear highly likely that there have been multiple relevant factors contributing to Dr. Bowen’s depression. These reach right back into his seemingly rather affectionless childhood, his troubled relationship history, perhaps some histrionic tendencies in his personality and a degree of substance abuse. As best I can judge from the materials supplied, it does appear that D . Bowen was working in meaningfully stressful circumstances during his placement to Papua New Guinea and, at a minimum, that particular factor did aggravate his depression both directly and indirectly, for example, by contributing to further marital disharmony. I believe that the work-related component would be properly described as an aggravating factor.
3.….
4.`…Precisely when the continuing effects of the stressful circumstances in Papua New Guinea may have ended is very difficult to answer indeed. I am afraid that I could be no more precise than stating that it is not possible to exclude the proposition that there may have been some continuing component of the ongoing depressive disorder which can be meaningfully linked to the work stress experienced in Papua New Guinea. As best I can judge, that probably was of quite modest proportions at the time of Dr. Bowen’s death, but arguably remained significant.
5.…..
6.….
If it is established that Dr. Bowen had a continuing psychiatric condition which was in existence from at least 1989 until the time of his demise, simply on the basis of the established chronicity, it would be a reasonable conclusion that the condition was permanent.
….
47. Dr Walton’s view expressed in the report of 28 April 2005 was that Dr Bowen was suffering from a 10% permanent impairment rating. In a later report dated 31 May 2005 (Exhibit R4), Dr Walton altered his view of the level of impairment after he read Mrs Bowen’s statement dated 29 April 2005. His fresh view was that a rating of 20% permanent impairment under Table 5.1 was appropriate.
CONSIDERATION OF THE ISSUES
48. In reaching its decision the Tribunal takes into account the written and oral evidence and the submissions made at the hearing.
49. In determining whether Dr Bowen was suffering from a psychiatric condition, the Tribunal gives significant weight to the evidence of Dr Cronin. Dr Cronin treated Dr Bowen from mid-1996 until his death. Dr Cronin’s opinion is supported by the written evidence of the late Dr Bowen; the oral and written evidence of his widow whom he met in 1991; extracts from army medical records from Dr Singh, Dr Smart, Dr Dekker, Major Ross and others; Dr Wride who was Dr Bowen’s general practitioner in his later years; Ms or Mr Miller for the Joint Health Services Agency in a report after Dr Bowen’s death; and by Dr Walton who provided a report to the respondent based on the available documentation. The respondent relied primarily on the November 1996 report of Dr Mendelson in forming its view of Dr Bowen’s condition. Dr Mendelson’s report was based on one visit in November 1996 at a time when Dr Cronin was already treating Dr Bowen for his psychiatric condition. Furthermore, there is evidence from Mrs Bowen and others that Dr Bowen’s condition varied in intensity at different times over the years, but that it deteriorated significantly around 1999. The Tribunal prefers Dr Cronin’s view to that of Dr Mendelson. The Tribunal finds that Dr Bowen suffered from dysthymia and major depression before and after he lodged his claim for compensation.
50. The Tribunal then needs to consider whether Dr Bowen’s condition arose as the result of his service in Papua New Guinea and other subsequent work-related stressors. Mr Gourlay, on behalf of the respondent, submitted that if the Tribunal were to find that Dr Bowen suffered from a psychiatric illness, it should not find that it arose out of his army service. He put forward a number of possible alternative causes of Dr Bowen’s condition. These include his upbringing, his personality, his two unsuccessful marriages and conflict with his second ex-wife over child-related issues in the Family Court. Mr White, representing Mrs Bowen, highlighted evidence supporting Dr Bowen’s service in Papua New Guinea including the reports of Dr Cronin and Dr Walton, army medical records, the statement of Lt-Col Dennis and those of Dr Bowen himself.
51. Dr Cronin, an experienced psychiatrist, who treated Dr Bowen regularly over four years, is strongly of the opinion that the posting to Papua New Guinea and its aftermath was a causal factor in Dr Bowen’s psychiatric condition. Dr Walton, who undertook his review at the request of the respondent, concurred with Dr Cronin. Both of them assess a permanent impairment of 20% due to Dr Cronin’s psychiatric condition. Lt-Col Dennis’s statement highlights the difficulties faced by Dr Bowen in Papua New Guinea due to the nature of the work. The information provided by Dr Bowen in his claim forms and in his evidence before the VRB is also illustrative. The Tribunal notes that the VRB was persuaded that Dr Bowen was entitled to a disability pension of 60% due to his psychiatric impairment. The Tribunal accepts the opinions of Dr Cronin and Dr Walton as to the factors impacting on Dr Bowen’s psychiatric condition. The Tribunal notes the timing of the onset and the exacerbating additional stress such as the accommodation difficulties in Puckapunyal and other postings soon after the return from Papua New Guinea.
52. Taking into account all the evidence before it, the Tribunal is satisfied that Dr Bowen’s posting in Papua New Guinea, along with aspects of his subsequent postings, was the cause of and/or aggravated his psychiatric condition. Hence, Mrs Bowen is entitled to compensation under s 14 of the Act. The Tribunal will remit the application so that the respondent can calculate the appropriate entitlement.
DECISION
53. The Tribunal sets aside the decision under review and substitutes a decision that the late John Bowen’s psychiatric condition arose out of his employment.
The Tribunal remits the matter to the respondent for calculation of compensation entitlements.
I certify that the fifty‑three [53] preceding paragraphs are a true copy of the reasons for the decision of:
Regina Perton, Member
(sgd) Catherine Thomas
Clerk
Dates of hearing: 30 August 2005, 31 August 2005 and 10 October 2005
Date of decision: 30 March 2006
Counsel for applicant: Mr E White
Solicitor for applicant: KCI Lawyers
Counsel for respondent: Mr I Gourlay
Solicitor for respondent: Australian Government Solicitor
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