Bridge and Repatriation Commission (Veterans' entitlements)

Bridge and Repatriation Commission (Veterans' entitlements) [2020] AATA 1417 (21 May 2020)
Division:VETERANS’ APPEALS DIVISION
File Number: 2016/2169
Re:Garry Bridge
APPLICANT

Repatriation CommissionAnd
RESPONDENT

DECISION
Tribunal:Deputy President Dr P McDermott RFD
Date:21 May 2020
Place:Brisbane

I affirm the decision under review.
........................................................................
Deputy President Dr P McDermott RFD
CATCHWORDS
VETERANS’ AFFAIRS – Veterans’ Entitlements Act 1986(Cth) – claim in respect of incapacity from disease of a veteran – whether veteran has a disease – identification of disease to precede consideration of reasonable hypothesis or reasonable satisfaction – insufficient and conflicting evidence as to diagnosis and symptoms – decision under review affirmed
LEGISLATION
Veterans’ Entitlements Act 1986 (Cth)
Veterans' Entitlements (Statements of Principles—Category 1B Stressor) Amendment Determination 2018 (No. 87 of 2018) (Cth)
CASES
Collins v Administrative Appeals Tribunal (2007) 163 FCR 35; [2007] FCAFC 111
Forrester v Repatriation Commission [2013] FCA 898
Repatriation Commission v Bawden (2012) 206 FCR 296; [2012] FCAFC 176
Repatriation Commission v Deledio (1998) 83 FCR 82; [1998] FCA 391
Repatriation Commission v Money (2009) 173 FCR 410; [2009] FCAFC 11
Repatriation Commission v Warren (2008) 167 FCR 511; [2008] FCAFC 64
REASONS FOR DECISION
Deputy President Dr P McDermott RFD
21 May 2020
BACKGROUND

Mr Garry Bridge (‘the veteran’) served in the Royal Australian Air Force (‘RAAF’) from 14 March 1978 to 2 July 2010.
There is no issue that the veteran rendered eligible ‘defence service’[1] from 14 March 1978 to 26 November 1999, eligible ‘operational service’[2] in East Timor from 27 November 1999 to 31 December 1999, and eligible ‘defence service’ again from 1 January 2000 to 30 June 2004.[3] The veteran also rendered ‘warlike service’[4] from 28 March 2007 to 4 July 2007 and 1 September 2009 to 10 December 2009, and peacetime service from 5 July 2004 to 31 August 2009 and 11 December 2009 to 2 July 2010.
[1] Veterans’ Entitlements Act 1986 (Cth) ss 5Q(1), ss 68(1).
[2] Veterans’ Entitlements Act 1986 (Cth) ss 5Q(1), s 6 and 6F.
[3] Exhibit A, T Documents; Respondent’s Facts and Contentions filed 4 August 2017.
[4] Veterans’ Entitlements Act 1986 (Cth) ss 5C(1).
On 28 November 2013 the veteran lodged a claim with the Repatriation Commission (‘the respondent’) for clinical depression diagnosed as major depressive disorder (‘MDD’) and panic disorder.
On 14 April 2014 the respondent refused the veteran’s claim for depressive disorder (MDD), panic disorder with agoraphobia, and alcohol dependence.
On 15 December 2015 the Veterans’ Review Board (‘VRB’) affirmed the decision of the respondent.
On 22 April 2016 the veteran applied to this Tribunal for further review of the respondent’s decision which refused his claim for a pension under the Veterans’ Entitlements Act 1986 (Cth) (‘the Act’) for MDD, post-traumatic stress disorder (‘PTSD’) and panic disorder with agoraphobia as being caused by his eligible service.
The veteran has a number of accepted claims listed by the Department of Veterans’ Affairs (‘DVA’) as accepted variously under:
·the Act;
·the Military Rehabilitation Compensation Act 2004 (Cth) (‘MRCA’); and
·the Safety, Rehabilitation and Compensation (Defence-related Claims) Act 1988 (Cth) (‘SRCA’).
MDD is listed as a condition which was accepted under the SRCA on 21 October 2013.[5]
[5] Exhibit A, T-Documents.
LEGISLATIVE FRAMEWORK
Section 7(1)(a) of the Act provides that a person who has rendered operational service shall be taken to have rendered eligible war service.
The veteran has performed operational and defence service. The determination of whether the veteran’s injury or disease was war-caused in relation to his operational service is to be made by applying the ‘reasonable hypothesis’ standard of proof outlined in sections 120 and 120A of the Act. The determination of whether the veteran’s injury or disease is defence-caused in relation to his defence service is to be made by applying the standard of proof outlined in ss 120(4) of the Act. Subsection 120(4) requires this Tribunal to decide the matter to its ‘reasonable satisfaction’.
Subsections 120(1), 120(3) and 120(4) of the Act provide that where a claim for a pension:
(1)… in respect of the incapacity from injury or disease of a veteran, or of the death of a veteran, relates to the operational service rendered by the veteran, the Commission shall determine that the injury was a war-caused injury, that the disease was a war-caused disease or that the death of the veteran was war-caused, as the case may be, unless it is satisfied, beyond reasonable doubt, that there is no sufficient ground for making that determination.
…
(3)In applying subsection (1) or (2) in respect of the incapacity of a person from injury or disease, or in respect of the death of a person, related to service rendered by the person, the Commission shall be satisfied, beyond reasonable doubt, that there is no sufficient ground for determining:
(a)that the injury was a war-caused injury or a defence-caused injury;
(b)that the disease was a war-caused disease or a defence-caused disease; or
(c)that the death was war-caused or defence-caused;
as the case may be, if the Commission, after consideration of the whole of the material before it, is of the opinion that the material before it does not raise a reasonable hypothesis connecting the injury, disease or death with the circumstances of the particular service rendered by the person.
…
(4)Except in making a determination to which subsection (1) or (2) applies, the Commission shall, in making any determination or decision in respect of a matter arising under this Act or the regulations, including the assessment or re-assessment of the rate of a pension granted under Part II or Part IV, decide the matter to its reasonable satisfaction…
Section 120A of the Act provides how a hypothesis must be assessed:
(1)This section applies to any of the following claims made on or after 1 June 1994:
(a)a claim under Part II that relates to the operational service rendered by a veteran;
…
(3)For the purposes of subsection 120(3), a hypothesis connecting an injury suffered by a person, a disease contracted by a person or 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)a Statement of Principles determined under subsection 196B(2) or (11); …
that upholds the hypothesis…
(4)Subsection (3) does not apply in relation to a claim in respect of the incapacity from injury or disease, or the death, of a person if the Authority has neither determined a Statement of Principles under subsection 196B(2), nor declared that it does not propose to make such a Statement of Principles, in respect of:
(a)the kind of injury suffered by the person; or
(b)the kind of disease contracted by the person; or
(c)the kind of death met by the person;
as the case may be.
Subsection 120B(3) of the Act provides how ‘reasonable satisfaction’ is to be assessed:
(3)In applying subsection 120(4) to determine a claim, the Commission is to be reasonably satisfied that an injury suffered by a person, a disease contracted by a person or the death of a person was war-caused or defence-caused only if:
(a)the material before the Commission raises a connection between the injury, disease or death of the person and some particular service rendered by the person; and
(b)there is in force:
(i)a Statement of Principles determined under subsection 196B(3) or (12); or
(ii)a determination of the Commission under subsection 180A(3);
that upholds the contention that the injury, disease or death of the person is, on the balance of probabilities, connected with that service.
In Repatriation Commission v Money Dowsett J remarked:[6]
[86] Section 120B(3) imposes a significant limitation upon the circumstances in which the Commission may find that a disease is defence-caused. It prescribes a two-step process. Firstly, the Commission must, on the material before it, identify any connection between the disease and a veteran’s service. Secondly, it must consider whether the relevant statement of principles "upholds the contention" that the disease is, on the balance of probabilities, connected with such service…
[6] (2009) 173 FCR 410 At [86].
STATEMENT OF PRINCIPLES
Section 196A of the Act provides for the establishment of the Repatriation Medical Authority (‘RMA’), which is an independent medical body that issues Statements of Principles (‘SoPs’) based on sound medical-scientific evidence. The SoP sets out factors relating to service which must exist in order to establish a causal connection between service and particular diseases, injuries or death.
Subsections 196B(2) and 196B(3) of the Act provides that if the RMA:
(2)… is of the view that there is sound medical-scientific evidence that indicates that a particular kind of injury, disease or death can be related to:
(a)operational service rendered by veterans; …
the [RMA] must determine a Statement of Principles in respect of that kind of injury, disease or death setting out:
(d)the factors that must as a minimum exist; and
(e)which of those factors must be related to service rendered by a person;
before it can be said that a reasonable hypothesis has been raised connecting an injury, disease or death of that kind with the circumstances of that service …
(3)If the Authority is of the view that on the sound medical-scientific evidence available it is more probable than not that a particular kind of injury, disease or death can be related to:
(a)eligible war service (other than operational service) rendered by veterans; …
the Authority must determine a Statement of Principles in respect of that kind of injury, disease or death setting out:
(c)the factors that must exist; and
(d)which of those factors must be related to service rendered by a person;
before it can be said that, on the balance of probabilities, an injury, disease or death of that kind is connected with the circumstances of that service ...
A SoP is binding on the respondent and various review bodies, including this Tribunal.
There are a number of SoPs which may be applicable in this application:
·SoP No. 82 of 2014 (PTSD – operational service: reasonable hypothesis)
·SoP No. 83 of 2014 (PTSD – defence service: balance of probabilities)
·SoP No. 83 of 2015 (depressive disorder – operational service: reasonable hypothesis)
·SoP No. 84 of 2015 (depressive disorder – defence service: balance of probabilities)
·SoP No. 55 of 2018 (Panic Disorder – operational service: reasonable hypothesis)
·SoP No. 56 of 2018 (Panic Disorder – defence service: balance of probabilities)
·SoP No. 37 of 2019 (Insomnia Disorder – operational service: reasonable hypothesis)
·SoP No. 38 of 2019 (Insomnia Disorder – defence service: balance of probabilities)
On 24 September 2018, the PTSD SoPs, No. 82 and 83 of 2014 and depressive disorder SoPs, No. 83 and 84 of 2015, were amended by a determination which made amendments to clause 9 in each of the PTSD SoPs, and clause 1 schedule 1 in each of the depressive disorder SoPs, in particular in relation to the definition of ‘a category 1B stressor’.[7] On 25 March 2019, the RMA determined SoPs No. 37 and 28 of 2019 in relation to chronic insomnia disorder. The Tribunal sought submissions from the parties as to the effect, if any, of these SoPs on this application.
[7] Veterans' Entitlements (Statements of Principles—Category 1B Stressor) Amendment Determination 2018 (No. 87 of 2018) (Cth).
THE HEARING
A hearing was held over two days on 29 and 30 January 2018. On 29 January 2018, the veteran gave evidence in person under oath, followed by Dr Bradley Ng, Consultant Psychiatrist, and Dr David Storor, Consultant Psychiatrist, both of whom were called by the respondent and gave evidence under affirmation by telephone. Dr Andrew Nielsen, Psychiatrist, was called by the veteran and gave evidence under affirmation by telephone on 30 January 2018.
EVIDENCE
Oral evidence of the veteran
On 29 January 2018, the veteran gave evidence in-person under oath. The veteran was taken to his statement dated 24 November 2016[8] and he confirmed the contents were true and correct to the best of his knowledge and belief.
The F-111 Deseal/Reseal program
[8] Exhibit B.
The veteran confirmed his participation in the F-111 Deseal/Reseal program at Amberley from 1979 to 1980 when he was 19 to 20 years of age. The veteran described the experience as follows:
it was a case of people having to get - physically get into the fuel tanks of the aircraft… occasionally some of the spaces we had to get into - and obviously I was lot smaller then, but you’d have to climb in, worm your way around all the aircraft structure to clean the stuff out. And it was very claustrophobic, you know, because you’re in there, and there’s no windows, and the only air was being pumped from back at the beginning of the aircraft. And occasionally we had guys that panicked in there, and they were - they became trapped. And, you know, you couldn’t get them out so you had to - the medical guys would come and literally sedate them. Not knock them out but sedate them enough so that they wouldn’t panic any more, and then you could help them out of the aircraft.
When asked to describe how he felt about undertaking the task, the veteran explained:
… it was my job but at the time it wasn’t too bad, but eventually I was always feeling claustrophobic in there because, you know, some of the small places you had to get into, you know, that thing about being caught in there was always in the back of your mind, and I’m thinking, “God, I hope I’m not the fellow that panics and has to, you know, get the needle.” Yes, so it was always on your mind you’re going to get trapped in there.
The veteran was asked to confirm he wasn’t aware of symptoms of claustrophobia at the time; the veteran confirmed this was the case. The veteran was asked to explain further; he added:
At first there wasn’t anything, you know, like, it’s a big adventure, I’m working on F-111s and climbing - you know, doing this sort of work. But after a while, you know, it played on your mind that, well, you know, like I was saying before, the chances of getting trapped in some of these tanks are fairly real and I suppose it just came on slowly. You know, that, hang on, things can go wrong in here. It’s no longer an adventure. It could go horribly wrong at any stage.
Woomera
The veteran was invited to elaborate on his duties at the Woomera test range base from June to August 1982. He described working on Canberra bombers, and later, walking through the testing range at Karinga flagging unexploded ordnance. The veteran described the instructions received at the safety briefings as: ““Keep your eyes down and don’t kick or touch anything, and you’ll be okay.” And that was it.”
When asked to describe the level of focus or concentration the veteran applied to the task of flagging the unexploded ordnance, he said it was: “like walking through a minefield… That’s the way it was playing in your head… it was absolute stress… you didn’t know if these weapons were armed or not…”
The veteran went on to describe the terrain as “Semi-arid Australia” and that he supposed the temperature would have been in the mid-30s in around June to July of 1982. He confirmed it was an “unsophisticated operation” and that there were “no formal safety briefs, no training”.
When asked whether those aspects of his service at Woomera concerned him, the veteran stated: “Of course because, you know, we’d never been trained in any of this stuff. You know, like, I’m a spanner turner, not a weapons fellow or a trained armourer, yes.”
The Tribunal and the veteran were shown photographs of the impact of explosions said to be caused by the type of ordnance which the veteran was tasked to identify, both in exploded and unexploded form.[9] The veteran described the ordnance as follows:
A Karinga bomb is a large cannister that’s dropped from any altitude from a few hundred feet to several thousand feet. And when it departs the aircraft it splits open and 240-odd bomblets come out of it. They’re actually a banned weapon now because of their indiscriminate nature. And these photos show when happens when a Karinga - it starts hitting the ground behind the aircraft and exploding, so any personnel or ground support equipment that was near the aircraft would also be written off.
[9] Exhibit D.
The veteran stated that he had also found unexploded bombs inside the aircraft and that this was one of his duties as an aircraft technician. He explained that, as the “Karinga” was a new weapon, “not everything was going right”. The Tribunal and the veteran were also taken to photographs of the impacts of exploded ordnance which had been recovered by personnel at Woomera which had been detonated by “armourers” who were trained to pick the weapon up and dispose of it.[10]
[10] Exhibit C.
The veteran confirmed that he was 22 year of age while he was at Woomera.
Papua New Guinea
The veteran’s statement describes his recollection of his service in Papua New Guinea as follows:
Papua New Guinea (PNG) – Late 1980’s to Early 1990’s
21.      PNG had gangs of armed "Rascals" roaming the streets day and night robbing and murdering indiscriminately. Foreigners were highly targeted as they were easy targets and had valuables and money.
22.      While on Deployment to PNG we were forced to land at a remote airstrip where local missionaries asked us to stay the night. We tried to help a little boy who had been bitten by a snake only to have a vehicle accident in a tropical storm while trying to rescue him, he consequently died.
23.      PNG was notorious for emergencies arising. There was very rugged terrain and limited landing facilities available ii an emergency arose. A commonly told joke told during safety briefings concerned an engine falling (as the aircraft had no capacity to fly on the remaining engine).
24.      It was necessary to hire guards at night to look after the aircraft to stop them from being vandalised.
The veteran was asked, further to the reference in his statement to “rascals”, whether there was any incident in particular he wished to refer to; he replied:
I don’t know if you’d call it an incident… but we were out one night sort of we - because we were living in a motel, not a protected compound. And we just finished the day’s flying. Went back to the motel, and we’ve decided we’ll go down the road to the bar and have a few drinks and that. And then while we were out and about there’s young youths and that in utes driving around. And, you know, they just heckle you and things like that. And when we’ve come back to the hotel or the motel we were staying at, the travel lodge, the guard that’s on duty at the gate, by this stage they’ve closed the gates and he’s standing there with a shotgun. Anyway we though, “Oh, okay, that’s obviously for our protection.” And he goes, “What are you doing wandering the streets at this [hour]?” “We went to the bar.” He goes, “Don’t you know those rascals there have been watching you boys and that?” And then all of a sudden it dawned on us that, shit, we could’ve been robbed or, you know, worse at any second, only through our own - and then it hit us again, bloody hell, how wrong could this have gone. You know, it was sheer - I don’t know - luck or whatever, that later on you hear the news stories.
This incident is later referred to as ‘the rascals incident’.

The veteran was asked about an incident where he had described being forced to land in a remote air strip. He described staying with missionaries after being forced to land due to weather conditions. He described that during the night while staying with the missionaries they responded a phone call which the veteran described as being:
about a young boy that’s been bitten by a snake. And normally up in New Guinea because everything is so remote, that there is no first aid, no medical attention and that. And by this stage the weather had cleared enough for us to be able to fly, so we’ve offered to - the captain has offered to run the boy down to Port Moresby to see if we can help him. Anyway, we’ve jumped in a four wheel drive with the local driver, and we’re heading to the camp - the village to retrieve the boy to fly him to Port Moresby, but en route we’ve had an accident, and the driver’s left the road, we’ve hit a ditch and we could never get to the young boy. And he has subsequently died, and we all felt pretty bad about that because here we are, we were the only guys who were in the area that could help this kid and, you know, we blew it by having an accident. Yes, so that wasn’t very nice.
East Timor
The veteran was asked about his service in East Timor. The veteran expanded on his statement where he indicated he was tasked with helping Medivac flights; he stated:
Yes. We had four Caribous in country and apart from the army’s helicopters we were the main air transport unit in country for doing the little strips and that. So whenever a helicopter wasn’t available or it was too big a job for the helicopter, we were tasked to do Medivacs or treat movements or food resupplies or ammunition resupplies.
The veteran’s description of the environment in which he was serving was as follows:
The country was just decimated. You know, like, everywhere you looked, villages were burnt. We were shown a headquarters for a political group that had literally been machine-gunned. You know, and you could just tell the building was destroyed. Every village we saw was burnt to the ground. People living under blue tarps, you know, anything they could find. The odd sheet - you know, galvanised bit of tin, that was somebody’s roof. The country was just horrible. There was, you know - I looked at it, I thought, how can people live like this or even survive.
When asked about an incident the veteran had described where assisted with transporting two people injured by a grenade, the veteran elaborated:
And we’ve met the ambulance at the air field and we’ve helped stretcher the people onto the aircraft, and it wasn’t a very pretty sight. Like, I couldn’t see gaping wounds but there’s blood all coming through their bandages and the blankets and they had IV drips and it just wasn’t a very pretty sight… it was … helpless. I just - there’s nothing I could do to make these two guys’ lives better. You know, like, I couldn’t take any of their pain away. And the aeroplane just smelt of - I don’t know, it just smelt of, you know, people and medicines and it was just not a very nice smell. But it sort of gets into your head, that sort of a smell… and, you know, like, are we going to get bogged, are we going to lose an engine on take-off, or - all this stuff’s going through your head…
The Middle East
The veteran described the following incident in his statement:
… an urgent requirement arose which involved looking for a crane to do an engine change on our aircraft in the UAE. Myself and my flight sergeant, together with a local driver made various contacts throughout the day which resulted in our driving in a remote location. I was in the first vehicle with the local driver and my flight sergeant in the vehicle behind me. The local driver started driving extremely fast and erratically and turned the radio up to a volume where I could not hear anything else or make efficient telephone contact with my flight sergeant in the following vehicle… When we eventually stopped at a remote location I was taken into a room where there were a variety of members of foreign military forces with whom we were not supposed to be having contact. I felt like I was being set up to be abducted.
The veteran described his experience with the members of the foreign military force as follows:
Anyway, and they’re asking us all these questions and that, and I’m just starting to not - well, I was panicking inside. I was screaming inside, but I’m trying to say, “Oh, no, no, no, you don’t have what we’re after. We’ll send back to Australia for what we want,” and that. Anyway, and then once we left there… we’re thinking, excuse the French but, “What the fuck did we just avoid?” You know, like, that could have gone very nasty very quickly for us, yes.
Symptoms
The questioning then moved away from the veteran’s service and centred on his medical history. The veteran was asked about his symptoms and how he had compiled the list of symptoms included in his statement; he explained:
Well, from early on, like, when I went to see the first doctor, like, not even before I saw the first doctor, it was - people are always saying to me, “Bridgey, what’s wrong with you?” You know, “What’s going on?” I said, “What do you mean?” He goes, “Well, normally you’re the centre of attention and you’re the party boy and all that but now you’re just, you know, Mr Mope-Around and don’t want to do anything.” And even my parents were starting to, you know, get a bit worried about it. And then I’m noticing that I’m getting angrier and angrier every time - like, if I ask someone to do something and it’s not there, I’m cracking up at them. Like, I’m just getting wilder and wilder all the time, and not being able to control my emotions. So I thought, all right, there must be something wrong. I’ve talked to a couple of RAAF doctors, and they’ve gone, “Well, we can go down this path but it’d be the end of your career sort of thing,” you know, like, if we - and I’m thinking, well, I’m not going to have that because I love this job. I want to stay in the air force. So I’ve approached DVA and they’ve sent me to see their doctors, and it’s just gone on from there. You know, like, I go in to talk to them, and they - they’d say, “Oh, how are you feeling today?” And on the day I was fine, you know. And they were just too generic. You know, like, they go, “Well, tell me about something.” And I’d tell them about a road rage incident or something. And then they’d just harp on that one thing, not asking me - you know, they did ask, “So what service have you done?” I’ve said, “Timor, you know, Iraq, Afghanistan,” all those joints. But never about what ever happened in the country; just that you’d been there sort of thing…
The veteran was asked whether he had found it difficult to explain his situation; he answered:
… today you’re asking me a direct question - you’re asking me, sorry, direct questions. I’ll answer them. It’s in my training, my nature, whatever, to only answer a direct question. You know, I don’t give you anything that you don’t ask for because quite frankly you don’t need to know it, or it doesn’t concern you. And these doctors would - well, one of them, he just wanted to talk about my family and F-111s all the period. You know, not once asked me about any horrific - and, quite frankly, he didn’t even understand what Deseal/Reseal was. And I tried to explain it to him and he just gave me blank looks.
The veteran was asked about his experience of treatment with Dr Nielsen and his ability to relate to him; he explained:
… In the early days very hard because, you know, the same as these other doctors. You know, he would just ask general stuff, and then we would just sit down and shoot the breeze. And he would go, “Well, tell me about what happened there?” And all of a sudden I’m relating to him, you know, that - what’s gone on. Where these other guys never even asked half these questions. Well, never asked any of them. And after probably about 12 months of seeing Dr Nielsen, I’m talking about stuff that I didn’t even remember had happened. You know, like, you know - or how things had affected me, like, the two hand grenade victims. You know, I didn’t think that had affected me. I - he was saying this thing in the Middle East, “Shit, that must have been very stressful on you,” you know, like, a normal person would have been, you know - I’m going, but it - you know, at the I’m doing a job. It’s only now that we’re talking about it, I’m reflecting on it going, well, yes, that could have gone pear-shaped really well. And in the early says, Deseal/Reseal, you know, people throwing out, “These chemicals will eventually kill you. You’ll be right,” and it’s a big joke. But one of my good mates actually did die as a direct cause of the chemicals…
When asked whether the veteran had tried to outline as comprehensively as possible the sort of feelings that he’d had, the veteran stated:
Yes. The thing is too, like, I’m very private so it takes a lot to get things out of me, and having talked to Dr Nielsen, you know, it’s all out there now, you know. And nowadays I still get a bit emotional talking about some of it, but I can talk to him about it because he actually sits there, listens and understands.
Cross-examination
The veteran was asked to confirm that he spoke with medical professionals about his feelings prior to his discharge from the RAAF; he replied: “Yes. Just, see, I don’t know what depression is or what it was, you know. To me, I only know if I’ve broken a leg or got a hang-nail or something like that. I’m not really up with mental issues, you know.” The veteran described being referred to a Neurologist in 2008 who he states said to a RAAF doctor: “Look, this is more than likely depression. Not a physical problem””. While the transcript records the veteran referring to a Neurologist, the only relevant evidence is the report of the urologist in which he recommended that the veteran be ‘checked for depression’.[11]
[11] Exhibit E.
The veteran was asked whether he had had any earlier conversations about his feelings with medical professionals; he recounted:
Yes. I quite often went in and saw my doctor. Like, it sounds funny but I’d be going in there and saying, “Look, am I going through menopause or something? I’ve got hot flushes. I’m just feeling down in the dumps.” And, yes, but he just couldn’t give me an answer… During my period at Edinburgh. So from early 2000s onward, I think. About 2002 onward… and feeling a bit, you know, down in the dumps, but I couldn’t explain it. And the doctor, being a GP, didn’t have the answers for me either. But I was just too worried about my career… I wanted to stay in the air force…
When asked whether the veteran had mentioned any of those conditions or feelings when being discharged in 2010, he stated:
Well, I was getting out of the air force, so they were pretty irrelevant at the time because I wasn’t getting out because I was, you know, feeling depressed or anything. I was getting out because of physical injuries that I just couldn’t do my job any more. And you can’t lead from the front if you can’t do your fitness test.
The veteran confirmed he was not medically discharged and added:
the discharge was very quick. It was like you put your application in, there’s a cursory you see the doctor, he fills in the form saying, yes, you’re fit to discharge, see you later. It’s a very non-event. You know, because they’re getting rid of you. They’re not interested in you anymore.
As to treatment or medication, the veteran advised he was taking “Panadiene Forte and lots of it”. He denied having any specific treatment, medication or counselling for emotions, feelings or psychological symptoms until he commenced treatment with Dr Nielsen. He stated that it wasn’t until his feelings were coming out during treatment with Dr Nielsen that he realised that medication was required.
As to claustrophobia, the veteran stated that he started experiencing symptoms of claustrophobia throughout his whole career and that “the claustrophobia thing has always been there after [the F-111 Deseal/Reseal program]”. He confirmed it stopped him from performing some tasks and he would sometimes make excuses as to why somebody else should complete certain tasks and added that, in any event, necessity would require him to put himself in those situations.
When asked whether the veteran had explored the prospects of a medical discharge, the veteran explained:
No, no, no, I wanted to leave on my own terms, you know, because - I don’t know - there seems to be a bit of a stigma about medical discharges and stuff like that and, yes, and I wanted to go on my own terms.
The veteran was taken through a number of accepted claims listed in the DVA records dating back to 1979 and the veteran confirmed that he was familiar with the claims process. It was put to the veteran that he had a history of making claims; he stated:
Yes. So quite frankly, as at when I joined the Air Force we were told in no uncertain terms if you hurt yourself you’re to report it and to, you know, to put the claims in. In fact some of them - one of them I had a motorbike accident. I knew it was nothing to do with the Air Force but my orderly room said “No, you’ve got to put the paperwork in” so I was just doing as I was told.
When asked whether he had worked after being discharged, he stated that he had:
tried a couple of jobs but my back and my knees were just killing me but I was living on the fact I was abusing painkillers just to get through the day so I thought “I’m not going to live like this” so no, I haven’t worked. I tried but I couldn’t do it.
The veteran then confirmed he receives an incapacity pension from DVA and a Defence Force Retirement and Death Benefits Scheme (‘DFRDB’) pension.
The veteran was asked whether he could recall his examination with Dr Ng in 2011 following his discharge; he stated
… I do recall parts of interviews but I couldn’t tell you the exact doctor or the time because only certain things were sticking in my head and - yeah. I don’t remember everything.
The veteran was asked whether he recalled being asked about his military service and whether he volunteered any information; he answered:
No. The only things I remember clearly about those sort of interviews are a lot of questions about family, aeroplanes and where I served, you know, like “Where did you serve?” I’d tell them but I don’t ever recall them asking any direct questions about what happened on any of those trips. I just don’t remember… I don’t volunteer any information to anybody unless you ask me a direct question. That’s the military in me. That’s how I kept my security clearance.The veteran confirmed that at the time of his interview with Dr Ng in 2011 and the interview was part of the process he was following to make a claim for medical conditions arising from the F-111 Deseal/Reseal program.
The veteran described the relevant symptoms as “anger issues and memory loss” and reiterated he didn’t know he had depression until he commenced treatment with Dr Nielsen. The veteran stated he had raised these issues with “every single DVA doctor” he had spoken to. He went on to state that the doctors had asked where he had served but did not ask whether he had had any stressful experiences.
It was put to the veteran that he did not raise any stressors relating to unexploded ordnance at Woomera, East Timor, and the Middle East with Dr Nielsen until mid-2015; the veteran agreed. When asked to explain why those issues had not been raised with Dr Nielsen until 2015 when he had commenced treatment with Dr Nielsen in 2015, the veteran answered:
… you’ve got to get to know someone before you start telling them your life story and, you know, a lot of things to me are not relevant at the time and then he says, “Oh, you know, what about this? Did anything happen here?” And then he would say something that would prompt a reaction, you go “Oh, yeah, you’re right, you know, this happened and then” - it’s like us talking now, you know, I’m only going to answer what you ask me directly where I got to know him, you know, I trusted him, so I could talk to him properly.
The veteran was asked whether those stressors were not relevant at the time; he answered:
Yes, well I mean not relevant is probably not the right term but he - we’re talking, we’re getting to know each other and then I’m getting more relaxed and then in that two years how many times had I seen him? I can’t remember. If it was in a one hour session it’s like seeing the DVA doctors. I’m not going to splurge out my entire life’s history to a total stranger in a one hour period, you know. It’s - yeah. I’m a very private person and you’ve got to have my confidence before I’ll start talking to you. And, to give an example, even just on my last visit to Dr Nielsen things were still coming up that we were sitting there just chewing the fat, chatting and “Oh, that’s right, that happened” - even though it’s got nothing to do with my depression but memories are coming back, you know, like of experiences, you know.
The veteran was asked whether Dr Ng and Dr Storor asked where he had served; he replied:
Yes. And that was it. Never ever dabbled into - well, that I can remember - whatever happened in those places… I might’ve mentioned mediocre things but nothing as - you know, that we’re talking about now because frankly, in half their meetings there wasn’t enough time to go into something I’ve spent years talking to another doctor about.
The veteran was asked whether Dr Ng and Dr Storor had the same questioning as Dr Nielsen; the veteran replied: “I don’t believe… Well, the two previous doctors I don’t believe actually asked me direct questions”. The veteran was asked whether he believed that this was the reason that the stressors don’t appear in the reports of Dr Ng and Dr Storor; he answered:
Well, I don’t know. I mean if they did ask me and I didn’t know at the time that it was affecting me I couldn’t have answered that question. It’s only after talking to someone I trust that these things are actually coming out and actually relevant to what I was explaining to him, you know, why I am feeling like I am. I didn’t now at the time why I was feeling angry and, you know, have outbursts of rage. That’s why I was talking to the doctors.
The veteran was shown a copy of a report dated 27 November 2008 by Dr Graham Sinclair, Urologist, in which he states: “I am confident that his problem is more likely to be psychological”. The veteran was asked whether the matter referred to in that report, which Dr Sinclair thought to be psychological, was taken or explored any further; the veteran replied: “No. It’s - again I’ve told you, that would be the end of my career - and I wasn’t going to have that. I’m a career Air Force officer. I will do nothing to jeopardise that”.
I asked the veteran about whether he had difficulty sleeping; he stated that he continues to the present day to have difficulty sleeping. I asked him whether he had ever undergone a sleep study from a physician; he stated: “Yes. Dr Nielsen sent me to one… Yes, and there was no problems, no, they put me on the machine and all the things, “You’re fine, Mr Bridge so it’s something else””.
Claim for Disability Pension for disabilities that have not yet been accepted as service related dated 10 November 2004
The veteran outlined in a DVA claim document dated 10 November 2004[12] that he experiences mood swings and memory loss. The veteran believed this to be caused by exposure to chemicals without proper protective equipment during the F-111 Deseal/Reseal program (1979 to 1980) and exposure to chemicals from 1978 to current.[13]
[12] T-Documents, at pp. 56-63 (received by DVA NSW on 17 April 2013).
[13] T-Documents, at p. 58.
Separation Health Statement dated 15 June 2010
On discharge in 2010, the veteran completed a Separation Health Statement which contains a detailed outline of the veteran’s then current treatment and significant injuries or illnesses during his service.[14] A number of physiological conditions are listed dating back through to, and including, exposure during his involvement with the F-111 Deseal/Reseal program in 1978 to 1979. There is, however, no reference to any psychological or psychiatric symptoms, in particular, the veteran made no claim for depression.
[14] T-Documents, at pp. 53-55.
Report of Dr Marty Ewer, Psychiatrist, dated 8 February 2005

Dr Marty Ewer, Psychiatrist, provided a report dated 8 February 2005 at the request of the respondent.[15]
[15] T-Documents, T6, at p.64.
Dr Ewer recorded that the veteran joined the RAAF in 1978 and for most of his time he has been an Aircraft Technician. Dr Ewer recorded that the veteran was involved in de-sealing and re-sealing aircraft fuel tanks in 1978 and that he may have been exposed to chemicals at that time and at other times. The veteran reported his job being very stressful between 1995 and 1997. The veteran also reported serving in a number of overseas countries including a one month tour in East Timor in 1999.
Dr Ewer recorded that the veteran had noted irritability and problems with short term memory and concentration over the last few years. The veteran reported that his short term memory has deteriorated significantly in recent years and he is forgetting names and details. The veteran reported difficulty sustaining concentration and thinking clearly, and that if he had to remember information or work problems out he would have significant difficulty.
The veteran reported experiencing significant mood swings over the past few years, and being quick to anger. The veteran reported generally overreacting to minor stresses and having “bad road rage”. The veteran reported physically threatening another motorist on one occasion by grabbing him by the collar and threatening him.
The veteran reported minor difficulties with sleep but did not report nightmares. The veteran reported satisfactory confidence but diminished motivation. The veteran did not report any suicidal thoughts or avoidant symptoms.
The veteran reported being a non-smoker but intermittently drinks alcohol now. The veteran reported sometimes not having a drink of alcohol for a month but then having twelve beers in a day. The veteran reported driving alcohol excessively on a regular basis in the 1980s attributing this to peer pressure.
The veteran reported no history of psychiatric illness or alcohol abuse, and when asked about memory loss he reported that his grandmother developed Alzheimer’s disease late in life. He reported marrying his wife at the age of 30.
Dr Ewer considered that the veteran was not clinically depressed or anxious, but that his short term memory and concentration was mildly impaired. Dr Ewer also performed the Davidson’s ‘Structured Interview for Post-Traumatic Stress Disorder’ with test results indicating that the veteran did not suffer from PTSD.
Dr Ewer considered that the veteran did not suffer from any psychiatric disorder but the memory problems were greater than expected for someone of his age. Dr Ewer recommended that this be investigated further.
Report of Dr Jules Begg, Consultant Psychiatrist, dated 24 March 2005
Dr Jules Begg, Consultant Psychiatrist, assessed the veteran on 16 March 2005 and provided his report at the request of the respondent on 24 March 2005.[16]
[16] T-Documents, T7, pp.68-72.
The veteran reported that over the past few years he had become intolerant of the mistakes of others and more forceful in his enforcement of rules. The veteran also reported the ability to quickly develop an irritable and bad mood, with the veteran’s wife reporting that he over-reacts. The veteran reported incidents of road rage where on one occasion he got out of his car (after an accident) and his wife had to urge him not to become violent.
The veteran reported being exposed to chemicals in the F-111 Deseal/Reseal program and is aware that memory loss and mood swings were identified as symptoms of toxic chemical exposure.
The veteran reported that his mood was very good ten years ago as he had to coordinate many people who were working on multiple aircrafts which required a “bear trap” memory. The veteran reported his memory as “less sharp” but he is still able to maintain his work. He reported enjoying the stressful nature of his work as it stimulates him to achieve highly.
The veteran reported sleeping well with the occasional restless night, and his interest in life is maintained. The veteran reported not ruminating on past mistakes and remembering positive things from the past. He reported difficulty remembering people’s names and telephone numbers.
The veteran reported being a non-smoker and drinking beers with friends on the weekend. He also reported no history of psychiatric disorder.
Dr Begg considered that the veteran’s ability to concentrate throughout the interview appeared unimpaired. He also considered that the veteran did not suffer sufficient symptoms to diagnose a psychiatric disorder.
Dr Begg considered that there is a remote possibility of sleep apnoea syndrome which contributes towards the veteran’s tiredness and irritability but believed that the sudden onset of anger with an equally sudden offset is more typical of a reaction to an event rather than persisting neurological damage due to toxic exposure. However, Dr Begg reported that he could not exclude prior toxic exposure as a cause for the veteran’s current symptoms in the context of the report regarding the study of health outcomes in aircraft maintenance personnel which found that psychological symptoms can be subtle and early. However, Dr Begg considered that on balance, he would favour another cause for the veteran’s current symptoms such as undiagnosed sleep apnoea or psychological reactions due to the stressful nature of his current position.
Supplementary report of Dr Jules Begg, Consultant Psychiatrist, dated 16 August 2005
Dr Begg provided a supplementary report on 16 August 2005 which outlined that his opinion remains unchanged.[17]
[17] T-Documents, T10, at p. 86.
Report of Dr Bradley Ng, Consultant Psychiatrist, dated 11 April 2011
Dr Ng assessed the veteran on 6 April 2011 and provided his report on 11 April 2011.[18]
[18] T-Documents, T16, at p. 118-124.
The veteran reported spending 18 months on the F-111 Deseal/Reseal program between 1979 and 1980 where he was involved in tasks such as chemical spraying and picking and cleaning the fuel tanks. The veteran reported spending several days at a time in the fuel tanks with minimal protection. He reported no acute effects at the time apart from headaches and smelling bad. The veteran also reported overseas service in Malaysia, East Timor (1990-2000) and Afghanistan (2007). He did not report any traumas related to his overseas service or deployments.
The veteran reported being discharged in 2010 because he had ongoing physical injuries which made the work increasingly hard to do, and that the RAAF was not what it was when he joined.
The veteran reported having a bad temper, suffering from mood swings for several years, being easily irritable, frustrated and suffering from road rage. The veteran also reported sleep disturbance with a particular deterioration after returning from Afghanistan in 2007. He reported his marriage also broke down at this time.
The veteran reported himself as “generally very happy” denying any suicidal ideas. The veteran reported being most annoyed by his ongoing pains, poor mobility, irritability and bad-temperedness. He reported significant sleep disturbance noting that this pattern of sleep resulted from him doing shift work and being on call every four weeks for one week, 24 hours a day. The veteran also reported that his sleep had worsened since returning from his last overseas deployment. The veteran also reported the urological condition referred to by Dr Sinclair in 2008.
The veteran reported being a non-smoker and consuming anywhere from one to twelve beers at social occasions which were infrequent.
Dr Ng considered that he could not diagnose the veteran with having a severe affective disorder such as bipolar disorder or major depression. Dr Ng considered that the veteran did not appear to be suffering from an adjustment disorder and did not describe enough symptoms for a severe anxiety disorder. Dr Ng considered that there was no psychiatric disorder to explain the veteran’s urological condition.
Dr Ng, however, did consider that the veteran’s sleep disturbance was quite significant and has obviously had difficulty falling asleep long-term. Dr Ng considered that this leads to difficulties including increased tiredness and that this has been happening on a long-term basis most likely exacerbated by the shift work and demands in the RAAF. Dr Ng did not consider that the F-111 Deseal/Reseal program had anything to do with the veteran’s sleep disturbance.
Dr Ng considered that the veteran suffered from a primary insomnia disorder with the date of onset in 2007. Dr Ng considered that the veteran’s insomnia disorder was due to his long-term disrupted sleep patterns with the RAAF which continued despite his discharge. Dr Ng classified the insomnia disorder as mild to moderate in severity recommending that the veteran see a sleep physician or sleep psychiatrist. Dr Ng did not consider the condition to be permanent but did note that the fatigue would be contributing to the veteran’s irritability.
Progress note of Dr Anup Kumar, General Practitioner, dated 15 April 2011
A progress note by Dr Anup Kumar, General Practitioner, dated 15 April 2011 contains the following notation: “insomnia mgmt explained”.[19]
[19] T-Documents, T33, p. 244.
Report of Dr Andrew Nielsen, Psychiatrist, dated 4 November 2013
Dr Nielsen provided a report on 4 November 2013 diagnosing the veteran with ‘panic disorder and major depressive disorder. Alcohol and anger might be a focus of treatment. There is no PTSD’.[20]
[20] T-Documents, T33, p. 246.
Dr Nielsen considered that the veteran’s depression and anxiety occurred in the context of the F-111 Deseal/Reseal program and so, from an administrative point of view, the F-111 Deseal/Reseal program caused the conditions. Dr Nielsen considered that the back pain and depression will exacerbate one another and the alcohol consumption might not be high in absolute amounts, but it will exacerbate the anxiety and depression.
It was not long after this report that the veteran was recommended to commence anti-depressants.[21]
[21] T-Documents, T33, p. 247-248.
Report of Dr Andrew Nielsen, Psychiatrist, dated 6 January 2014
Dr Nielsen provided a further report dated 6 January 2014.[22]
[22] T-Documents, T30, p. 226-229.
Dr Nielsen considered that the veteran’s psychiatric conditions were panic disorder, specific phobia, MDD, alcohol dependence and the urological condition referred to by Dr Sinclair; all of which he considered satisfied the DSM-IV criteria.
Dr Nielsen justified his diagnosis of panic disorder and agoraphobia by noting that the veteran avoids crowds and lifts, and when in those situations he gets stressed. Dr Nielsen noted that the veteran’s heart races with his chest tight. The veteran also sweats even in cool conditions and worries about losing control with anger. Dr Nielsen considered that the date of onset for the veteran’s panic disorder and agoraphobia was in 2002 which is when he became conscious of his difficulties.
Dr Nielsen justified his diagnosis of MDD by noting that the veteran no longer did the enjoyable things he used to do, and felt down in the dumps most days for most of the day. The veteran reported not being happy with his personal appearance and being fatigued and irritable. The veteran would also find himself crying for no reason, doubting himself and having difficulty making decisions. He described his memory as “crap” but did not report any suicidal ideation. Dr Nielsen considered that the date of onset for the veteran’s MDD was the late 1990s. Dr Nielsen considered that the veteran first sought treatment for anxiety and depression in 2013, when he first saw him. The veteran reported being concerned about speaking to a RAAF doctor as he would not be sent out on any deployments.
Dr Nielsen justified his diagnosis of alcohol dependence by noting that the veteran drinks and does not stop for about a week every month. His drinking takes up most of the relevant week and he drinks more than he intends to when he drinks. Despite persistent efforts to stop or decrease his drinking, the veteran has not been successful and is tolerant to alcohol. Dr Nielsen considered that the veteran had to stop drinking when he went to the Middle East as he was not able to drink while being there, but when he returned from deployment he was drinking more and has had the most difficulty reducing his alcohol consumption since 2009. Dr Nielsen considered that the date of onset for alcohol dependence was in 2009.
Dr Nielsen considered the conditions to be “probably no [sic] permanent” and should become stable and stationary within 12 months. Dr Nielsen considered that the conditions exacerbated each other and for the urological condition to be a psychiatric diagnosis then physical causes would need to be ruled out.
Dr Nielsen considered that there was no exacerbation or aggravation of a pre-existing condition and that there is a direct link between the veteran’s employment and his condition. Dr Nielsen considered that the depression decreased the veteran’s social and occupational functioning, and the panic disorder decreased instrumental activities of daily living such as shopping and banking.
Supplementary Report of Dr Andrew Nielsen, Psychiatrist, dated 14 February 2014
Dr Nielsen also provided a supplementary report on 14 February 2014.[23]
[23] T-Documents, T32, p. 233-242.
Dr Nielsen reiterated his diagnosis of MDD, panic disorder and agoraphobia, and alcohol dependence in line with his previous report dated 6 January 2014.
Dr Nielsen reported that the veteran’s MDD was caused by service as the F-111 Deseal/Reseal program doubled the rate of depression and anxiety, with there being an administrative determination of causation.
Dr Nielsen also reported that the veteran’s panic disorder was caused by service as the veteran was petrified of confined fuel tanks because he was worried that he would not be able to get out. Further, he reported that the Caribou wings were worse because one would be in an area that was too small to get an air line in. Dr Nielsen reported that the veteran had been anxious of small spaces since then.
Dr Nielsen also reported that the veteran drank during his service because of the culture, to be sociable and because it was enjoyable.
Dr Nielsen considered that the relationship between the conditions were that they exacerbated one another. There were no pre-existing conditions. Dr Nielsen considered that each of the conditions attributed the following percentages to the veteran’s psychiatric condition:
·panic disorder with agoraphobia – 30 per cent;
·MDD – 60 per cent;
·alcohol dependence – 10 per cent; and
·urological condition – 0 per cent.
Medical Opinion – F-111 Deseal/Reseal program – of Dr E Nicoll dated 17 February 2014
Dr E Nicoll, Compensation Medical Adviser, provided a report on 17 February 2014.[24]
[24] T-Documents, T31, p.230-232.
Dr Nicoll considered that there is a possible diagnosis of MDD (diagnosed by Dr Nielsen with a clinical onset in the late 1990s) but this was not confirmed, and not consistent with the reports of Dr Ewer, Dr Begg and Dr Ng.
Dr Nicoll considered that there was also a possible diagnosis of panic disorder with agoraphobia (diagnosed by Dr Nielsen with a clinical onset in 2002) but this was not confirmed, and not consistent with the reports of Dr Ewer, Dr Begg and Dr Ng.
Dr Nicoll considered that there was a possible diagnosis of alcohol dependence (diagnosed by Dr Nielsen with a clinical onset in 2009) but this was not confirmed, and not consistent with the report of Dr Ng. However, Dr Nicoll did diagnose the veteran with ‘hazardous or harmful drinking’.
Dr Nicoll considered that there was a possible diagnosis of “specific phobia (example claustrophobia) mild formerly known as ‘simple phobia’” (diagnosed by Dr Nielsen with a clinical onset in 2002) but this was not confirmed, and not consistent with the reports of Dr Ewer, Dr Begg and Dr Ng.
Medical Examination Form – Capacity to Work dated 18 March 2014
On 18 March 2014 a medical examination form was completed which noted that the veteran’s “depression” is “stable at present”.[25] It was also reported that the veteran had knee pain, back pain and ankle pain which prevented or restricted his capacity to work, and it was recommended that he undertake light semi-skilled work for less than 8 hours per week.[26] At this point the veteran’s suitability for rehabilitation and retraining was listed as “uncertain”.
[25] T-Documents, T34, p. 249.
[26] T-Documents, T34, p. 253.
Supplementary report of Dr Andrew Nielsen, Psychiatrist, dated 28 July 2015
Dr Nielsen provided a further supplementary report on 28 July 2015 at the request of the respondent.[27]
[27] T-Documents, T38, pp. 287-295.
Dr Nielsen reiterated his previous views regarding the justification for the MDD, panic disorder and agoraphobia diagnoses. Dr Nielsen also reported that the veteran began having a recurrent, unpleasant dream where he was being chased and was hiding behind a log. The person who was chasing him caught up, and lunged at him to stab him. The veteran was armed with a pistol, was pointing it at the assailant but was unable to pull the trigger. After the veteran returned from East Timor he would become upset when he heard how the UN was supposed to be helping people. The veteran reported that the UN came to town and commandeered the best building in town and did not seem to do anything.
Dr Nielsen reported that the veteran avoided reminders of East Timor such as, he would never attend return-home parades and he was angry that they had been there and nothing was achieved. When asked about his experiences, the veteran denied any trouble and did not talk about the events. He reported that he lost contact with quite a few people and his relationship with his wife deteriorated.
Dr Nielsen also reported that the veteran had insomnia and was irritable.
Dr Nielsen reported that there were a number of stressors that he was not aware of at the time of his first report which have been outlined below.
Mid 1980’s – Woomera – Unexploded Bombs
In the mid 1980’s the veteran, as an aircraft tradesman, was involved in the Karinga Trials (cluster bombs) but had not been trained in working with bombs. The veteran was initially there to put old aircraft on the range but was ordered to walk the range to look for unexploded bombs. The veteran reported that the safety briefing was very brief, amounting only to being told not to kick anything and how to tell whether a bomb’s tail was armed. The veteran reported that if there was an unexploded bomb, he would place a red flag in the location and if the bomb had exploded, he would place a green flag instead.
The veteran reported being scared during this period, not daring to look anywhere but down on the ground as if he stood on a bomb then it might have exploded and killed him. However, the veteran did not report having nightmares about bombs.
1999 – East Timor – Wounded People
In 1999 the veteran was in charge of a detachment of 48 people that looked after four airplanes. He went on a retrieval as the crew chief picking up two civilians who were wounded by grenades by a militia. The wounded men were aged in about their 30’s, lying with their heads exposed in a lot of pain. There was a lot of blood on the blankets that covered them. The wounded men were taken on two flights. The veteran reported that he felt helpless during this experience.
The veteran reported that the airfield perimeter was protected by the Thai army and he was told to expect people carrying machetes, but to worry if there was a crowd. Soon after he arrived, a loud crowd gathered with machetes. The veteran reported being worried until he was told that it was a bus stop.
The veteran also reported being very angry about an incident where a siren went off and he had been told that if there was a problem he would have to get all of his people on an airplane and leave however there was only one serviceable aeroplane. He had told some people to repair the plane while others guarded the plane. Army people yelled at him because he was not in a gun pit. He told them to leave, lest he do them bodily harm. The veteran reported being stressed out by this incident.
1999 to 2010 – Warrant Officer

The veteran reported being a warrant officer and he was 100 per cent stressed all of the time. The biggest stressors were when he was doing Operation Resolute where he was obliged to always have one of two airplanes ready at all times however the planes were old and needed a lot of maintenance. The veteran reported that the hierarchy would not take ‘no’ for an answer.
2007 – Middle East – Abducted
The veteran was based in the United Arab Emirates. He was the detachment commander for one of two shifts and had two P3s with one having to be available at all times. The veteran worked a couple of 36 hour days doing over-watch protection for people in Iraq and Afghanistan.
On one occasion they had to go into the city to get a crane that they needed to remove an engine from the airplane. They went to numerous places with people asking them questions that they were not allowed to answer. During this trip the veteran went into someone’s Range Rover. That person was driving at 150km/hour and when the veteran asked the driver to slow down, he refused. Then when the veteran went to call the others who were in another vehicle that was falling behind, the driver turned the music up very loud. In the end the veteran was taken to a place far out of town where there was a gathering of people from the United Arab Emirates military, the Indian military and high-ranking civilians. The veteran left empty-handed however described the experience as “unnerving” as he “did not know how it would end”. The veteran reported having no nightmares.
The veteran reported being psychiatrically assessed before leaving the RAAF, however, he denied any symptoms because he was still serving as a warrant officer and knew that if he mentioned having psychiatric symptoms the RAAF would have medically discharged him.
Dr Nielsen updated his diagnoses to include a diagnosis of PTSD, MDD, panic disorder with agoraphobia, alcohol dependence and the urological condition. Dr Nielsen updated his breakdown of percentages as follows:
·PTSD – 20 per cent;
·Panic disorder with agoraphobia – 20 per cent;
·MDD – 50 per cent;
·Alcohol dependence – 10 per cent; and
·Urological condition – 0 per cent.
Report of Dr David Storor, Consultant Psychiatrist dated 9 August 2016
Dr Storor, Consultant Psychiatrist, assessed the veteran on 5 August 2016 and provided his 18 page report, at the request of the respondent, on 9 August 2016.[28]
[28] Exhibit F.
In his report, Dr Storor concluded:
In my opinion Mr Bridge does not demonstrate symptoms sufficient to meet the criteria for any psychiatric disorder. Specifically in my opinion he does not suffer from major depression, panic disorder with agoraphobia or posttraumatic stress disorder.
Specifically with respect to posttraumatic stress disorder, the experiences Mr Bridge relates do not seem in themselves sufficient to cause a posttraumatic stress disorder and he certainly does not describe sufficient symptoms to meet criteria for posttraumatic stress disorder.
Mr Bridge does not have nightmares, flashbacks or intrusive recollections. Essentially he describes irritability, insomnia and experiences anxiety.
I note that Mr Bridge reports excessive alcohol intake on occasions. At this point he does not in my opinion meet criteria for alcohol abuse. However, if his drinking persists then he may ultimately reach criteria for an alcohol use disorder. Currently, he does not describe sufficient complications of his drinking to meet criteria for alcohol abuse.
In my opinion, Mr Bridge is a man who has not transitioned well from military service to civilian life. He appears under occupied and has not been able to fill his life sufficiently with interests and activities.
As a result he spends much of his time at home and on occasions drinks to excess. In itself I do not believe these circumstances constitute a psychiatric disorder.
Mr Bridge has been under the care of Psychiatrist, Dr Andrew Nielsen. I note that he makes diagnoses of posttraumatic stress disorder, major depression and panic disorder with agoraphobia. Mr Bridge advised me that Dr Nielsen has spoken with him about his excessive alcohol intake. In my opinion Mr Bridge should see Dr Nielsen and have counselling to address his alcohol intake before it causes significant problems for him.
Supplementary report of Dr David Storor, Consultant Psychiatrist, dated 11 April 2018
Following the Hearing of this matter on 29-30 January 2018, the respondent filed a four-page supplementary report of Dr Storor, who reported as follows:[29]
[29] Exhibit F.
1. The significance of not being shown photographs of stressful events
I note that during his interview with me on the 05.08.2016, Mr Bridge showed me photographs of bombs on a military range. During the course of the interview with me, he described a number of other events which he reported to have been stressful to him; including an incident in the Middle East in which he mistakenly believed that he was being kidnapped; and another incident in Papua New Guinea in the late 1980's when he believed that he was being threatened by locals, though this turned out not to be the case and he was not harmed.
I am unable to comment why Mr Bridge did not show me photographs of the latter two events or other events he reported as being stressful. The only comment I can make is that the photographs of the bombs on the range were presented to me by Mr Bridge as being evidence of a stressful event.
2. Is there a contradiction between the historv given and the Mental State Examination as opined by Dr Nielsen?
No. My opinion of Mr Bridge at the time of my assessment of him, was that he was not suffering from any diagnosable psychiatric disorder, and my findings on Mental State Examinations were consistent with that opinion.
My Mental State Examination of Mr Bridge revealed a man exhibiting a normal mood and normal reactive affect. He was in no distress, and did not display any distress when he recounted the experiences during his military service, which he believed caused him emotional problems.
My description of his affect or emotional state at the time of the interview as "reactive", means that at the time of the interview with me, he was displaying a normal range of emotional response as would be expected from a person who was not suffering from any major psychiatric disorder.
The salient point with regard to the history provided by Mr Bridge, is that the potentially traumatic experiences which he describes, did not eventuate in him suffering any actual trauma. He did not report being injured or witnessing anyone injured on the bomb range where he was placing flags for personnel to pick up unexploded ordnances. When he was taken into the desert to locate a crane, he mistakenly believed that he was being kidnapped, whereas this was not the case. In Papua New Guinea, he initially believed that he was being threatened by locals. However, this threat did not eventuate.
In summary, Mr Bridge recounted to me a number of incidents which he believed could have been traumatic, but did not result in any actual threat to his wellbeing or safety. Given these circumstances, I do not believe there is any contradiction between the history given to me by Mr Bridge, the Mental State Examination described in my report, and my finding that he was not suffering from any psychiatric disorder.
3. Is the affect more properly described as incongruent as opined by Dr Nielsen?
No. Incongruent is a term used to refer to an affect displayed in a patient suffering from a major psychiatric condition such as Schizophrenia.
I prefer my description of Mr Bridges' affect as a reactive, given that he was exhibiting a normal range of emotional response and demonstrated no evidence of a psychiatric disorder. If Mr Bridge had sustained a Post Traumatic Stress Disorder as a result of the experiences that he described to me, then it would have been expected that he would have exhibited distress, agitation, and possibly tearfulness when describing the reported stressful events. It would be expected that photographs of his experiences, such as the bomb range, would have been overtly distressing for him. Instead, he displayed a lively interest in the photographs and exhibited no sign of distress whatsoever. Mr Bridge's normal, reactive affect during the course of his interview is consistent with my opinion that Mr Bridge is not suffering from any major psychiatric disorder.
4. Does the reference to reactive imply there was evidence of distress during the interview as opined by Dr Nielsen?
No. As stated in answer to previous questions, the term reactive when used in Mental State Examination, implies the person is demonstrating a normal range of emotional response and implies the absence of any major psychiatric condition. The term reactive is not meant to imply evidence of distress during the interview.
5. If so, should it have been differently documented as opined by Dr Nielsen?
No. In my opinion, the term reactive was appropriately used by me to describe Mr Bridges' mental state. In my opinion, Mr Bridge does not suffer any diagnosable psychiatric disorder and the presence of reactive affect and euthymic mood during his interview with me was entirely consistent with my opinion.
6. Does it follow that the Mental State Examination is necessarily inaccurate because the history included description of painful things as opined by Dr Nielsen?
No.
As discussed in answer to the previous questions, it is important to note that the events that Mr Bridge described were perceived as threats but did not eventuate in him sustaining any actual harm: he was not kidnapped; he was not attacked by rascals; he was not injured on the bomb range.
It should be noted that if an individual has not sustained a traumatic event then he does not meet Criteria A for Post Traumatic Stress Disorder, and thus cannot suffer from this condition. It would not be unusual that if a person did not demonstrate abnormal affect, low mood, hypervigilance or agitation if they had not actually been traumatized. As noted previously, Mr Bridge did not demonstrate any of the latter signs during the course of his interview with me.
7. Are your findings on Mental State Examination consistent or inconsistent with the opinion of Dr Nielsen at pages 4-5 of his report dated 25 August 2015.
I agree with most of Dr Nielsen's Mental State Examination described in his report of the 25^th August 2015. I agree that Mr Bridge was well groomed. I agree that his speech was normal. I agree that his affect or facial expression was normal, which is to say reactive. I do not agree, however, that his mood was depressed. I agree that there was no evidence of abnormal thought content, form stream possession nor perceptual disturbance. I agree that he demonstrated a normal level of consciousness.
In summary, I reiterate my opinion expressed to the Tribunal at the hearing, namely that Mr Bridge does not suffer from any recognisable psychiatric disorder. He is a man who has not transitioned well from military to civilian life and his time is under-occupied and at times he drinks alcohol to excess, which is most likely the cause of the symptoms he reports experiencing occasionally.
Furthermore, I suggest to the Tribunal that debate over correct usage of psychiatric terminology is really missing the point. The main point is whether or not Mr Bridge is suffering from a recognizable psychiatric disorder. I have provided my opinion and reasoning as to this question, namely that Mr Bridge does not suffer from any recognisable psychiatric disorder.
Supplementary Report of Dr Bradley Ng, Consultant Psychiatrist, dated 8 March 2018
Dr Ng, who assessed the veteran on 6 April 2011 and whose report on 11 April 2011 is discussed above, prepared a four-page supplementary report dated 8 March 2018.[30]
[30] Exhibit I.
Dr Ng reported as follows:
In your letter you provided relevant evidence from Dr Andrew Nielsen, Consultant Psychiatrist who made some comments about the Mental State Examination section in my report dated 11 April 2011. I must admit the line of thinking is hard to follow at times but in essence Dr Nielsen raised possible issues about the Mental State Examination being inaccurate with regards to the history.
It was also noted that Dr Nielsen accused my Mental State Examination as being some "sort of quick shorthand, but it's certainly not a nuanced Mental State Examination". I will address this issue first, by comparing Mental State Examinations of various psychiatrists as it relates to Mr Bridge.
I refer to the report by Dr Jules Begg, Consultant Psychiatrist, dated 24 March 2005. On page 4, in the Mental State Examination, the mood and affect was described by the psychiatrist as "normal affective response was present".
I refer to the report by Dr Marty Ewer, Consultant Psychiatrist, dated 8 February 2005. On page 4, in the Mental State Examination, Mr Bridge's mood and affect was described as "He was not clinically depressed nor anxious".
I refer to my report, dated 11 April 2011, and on page 4, in the Mental State Examination, the mood and affect was described as "His mood was euthymic and his affect appeared reactive and congruent with his mood".
I refer to the report by Dr David Storor, Consultant Psychiatrist, dated 9 August 2016. On page 14 in the Mental State Examination, Mr Bridge's mood and affect was described as "Mr Bridge's mood was euthymic. His affect was reactive".
I refer to the report by Dr Andrew Nielsen, Consultant Psychiatrist, dated 28 July 2015. On page 6 in the section of the Mental State Examination it was noted "The affect (facial expression) was normal". It then stated "The mood was depressed".
Considering all of the above Mental State Examinations it is my opinion that my Mental State Examination does not differ in quality from standard medicolegal practice or indeed clinical practice. It is genuinely hard to argue that Dr Andrew Nielsen's description of Mr Bridge's mood and affect is more nuanced or sophisticated than any other psychiatrist's description or examination, when comparing reports side by side. The evidence would bear out a remarkable congruency in Mr Bridge's mood and affect between psychiatrists.
When I describe someone as euthymic they are not elevated, euphoric or depressed. Euthymic mood can be seen as a mood that is neither very positive nor very negative. There is a subjective and an objective component. In the Mental State Examination the mood usually focuses on the objective component though a subjective component can be acknowledged. It is quite clear in the symptomatology section that Mr Bridge described himself as happy. That would cover the subjective component of the mood. Hence my Mental State Examination covered the objective component of the mood. He did not look depressed, elevated or euphoric. When I discuss mood reactivity one is allowed to have a shift in emotional state from topic to topic but that does not deviate from the general atmosphere of the person's emotional state. For example one could be euthymic or happy and when one broaches on a difficult topic, one may appear sad for a brief period of time. In other words a brief shower on a summer's day does not mean it is going to be raining. Therefore reactivity is commonly seen in both people with and without psychiatric disorders.
When mood congruency is discussed we again focus on the overall picture rather than a second by second or minute by minute account. Mr Bridge reported himself as happy and the overall outward emotional state appeared to match that general description. Indeed even when talking about relatively pained topics there was an ability to put some distance between him and the events. The events themselves did not draw a major emotional reaction. If it had done that, I would have noted it. For example in clinical practice one could be talking about one's current life in very positive terms and would appear to be euthymic or happy and when they broach on a particular topic they would become very teary and then return back to a positive mood state. For Mr Bridge's situation he described problems in a distant way that did not have the immediate saliency that would render a distressed or distraught affect.
In my opinion, it is commonly clinically accepted practice that when one describes the mood as euthymic and affect as reactive there is no great disturbance in emotional state either subjectively or objectively.
Supplementary Report of Dr Andrew Nielsen, Psychiatrist, dated 26 May 2018
The veteran filed a further supplementary report of Dr Nielsen dated 26 May 2018 in respect of the supplementary reports by Dr Ng on 8 March 2018 and by Dr Storor on 11 April 2018. I address this report later when discussing Dr Nielsen’s oral evidence.
CONSIDERATION
I have to determine whether the veteran has a disease from which incapacity can arise, and, if so, whether such disease is related to service.
The Full Court of the Federal Court of Australia in Repatriation Commission v Deledio (‘Deledio’) formulated this four-step process when assessing the hypothesis:[31]
(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. No question of fact finding arises at this stage. If no such hypothesis arises, the application must fail.
(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). If no such SoP is in force, the hypothesis will be taken not to be reasonable and, in consequence, the application must fail.
(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. The hypothesis raised before it must thus contain one or more of the factors which the Authority has determined to be the minimum which must exist, and be related to the person’s service (as required by ss 196B(2)(d) and (e)). If the hypothesis does contain these factors, it could neither be said to be contrary to proved or known scientific facts, nor otherwise fanciful. If the hypothesis fails to fit within the template, it will be deemed not to be “reasonable” and the claim will fail.
(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, or in the case of a claim for incapacity, that the incapacity did not arise from a war-caused injury. If not so satisfied, the claim must succeed. If the Tribunal is so satisfied, the claim must fail. It is only at this stage of the process that the Tribunal will be required to find facts from the material before it. In so doing, no question of onus of proof or the application of any presumption will be involved.
[31] (1998) 83 FCR 82; [1998] FCA 391 at [82] to [83].
In Forrester v Repatriation Commission,[32] Mortimer J observed that in Collins v Administrative Appeals Tribunal,[33] Allsop J (as he then was) pointed out that the second sentence in the second paragraph is not correct and that otherwise these four steps have been consistently endorsed and applied to the operation of sections 120 and 120A of the Act.
[32] [2013] FCA 898 at [26].
[33] (2007) 163 FCR 35 at [31].
Diagnosis
There first needs to be the diagnosis of a disease. This was explained by the Full Court in Repatriation Commission v Warren where Lindgren and Bennett JJ remarked:[34]
The operation of ss 120 and 120A of the VE Act and of SoPs made under s 196B of that Act has been discussed in Repatriation Commission v Deledio (1998) 83 FCR 82 (‘Deledio’) and subsequent cases. In Deledio, the Full Court laid down a course comprising four steps that should be followed in an assessment of whether the incapacity of a veteran from, relevantly, a disease is related to service rendered by that person. It was common ground on the hearing that the Deledio four steps are preceded by an inquiry as to whether a veteran is incapacitated from a "disease". Thus, it was common ground that this pre-Deledio step of whether there is a diagnosis of a disease as a matter of clinical assessment, must be resolved before Deledio requires the four steps … to be taken to determine the question of connection with service.
Justice Logan emphasised that a SoP made under the Act had no role to play in the making of this diagnosis.[35]
[34] (2008) 167 FCR 511; [2008] FCAFC 64 at [22].
[35] Repatriation Commission v Warren (2008) 167 FCR 511; [2008] FCAFC 64 at [105].

Dr Storor was informed that when he saw the veteran that he had taken that medication and when he presented to him he was affected to an extent by that medication; he answered: “Well, he reported taking the medication”. Dr Storor said that the medication is used for depression, and or anxiety which was prescribed by Dr Nielsen. It was put to Dr Storor that the purpose of the medication is to stabilise the mood and to alleviate the feelings of distress, or to improve the mood so that it is euthymic, he answered: “Well, you would have to ask Dr Nielsen why he prescribed it”. .Dr Storor remarked that that the medication may possibly achieve an euthymic mood.
I asked Dr Storor whether he would reach a conclusion about the reference in Dr Nielsen’s report to an excessive alcohol intake, he answered:
That sort of excessive, sporadic binge drinking could certainly result in a temporary change in a person’s mental state, leading them to have a period of low mood following the binge, and possibly feeling anxious following the binge on alcohol. That could certainly do that.
Oral evidence of Dr Andrew Nielsen, Psychiatrist
The last witness who was called to give evidence before the Tribunal was Dr Nielsen. Dr Nielsen stated that he is a psychiatrist in private practice and he has routinely treated people with PTSD. He stated that he has completed about 400 independent medical examinations but is not a forensic psychiatrist.
Dr Nielsen stated that he commenced treating the veteran on 4 November 2013. He sees him about once a month although he has seen the veteran more often or less often at times.
Dr Nielsen was directed to his reports of 6 January 2014, 14 February 2014 and 28 July 2015. Dr Nielsen was also directed to his final report of 28 July 2015 in which he provided an additional diagnosis of PTSD. He gave a number of reasons for a change in his opinion:
Well, there are a number of reasons. The first time I met Mr Bridge, he mentioned symptoms of PTSD which I didn’t pick up on. He mentioned that he was sensitive to noise and that he avoided crowds. Mr Bridge also underestimates or downplays the severity of the trauma that he has experienced. I made a note, for example, when I saw him on 18 November 2013, that he tends to underplay things. I had asked him about some of those symptoms, but he was downplaying them. He still downplays his symptoms. For example, he, in my opinion, was kidnapped when he was in the Middle East, but he doesn’t view it as a kidnapping. I think that’s partially as a way of dealing with the stress of it.
Dr Nielsen stated that later it was requested that he examine the veteran for the diagnosis of PTSD and the veteran mentioned some more causes of PTSD and other psychological injuries which Dr Nielsen wasn’t aware of before. Dr Nielsen explained that the veteran had gradually been describing more traumatic events.
Dr Nielsen was asked about the veteran having seen a number of psychiatrists. Dr Nielsen stated that the psychiatrists who did the independent examinations only spent a short amount of time with the veteran and would not have had time to elicit that history. Dr Nielsen considered that if the psychiatrists had examined the veteran at an earlier date, then he would have been “less aware” and less able to describe those events and those psychiatrists “would have got less of the story without any discredit to them”. Dr Nielsen stated that a core feature of PTSD is fearful memories, so people tend to avoid thinking about them.
Dr Nielsen confirmed his diagnoses of Depression, Panic Disorder with Agoraphobia, and PTSD and stated that DSM-IV was applied in respect of each of those diagnoses.
Dr Nielsen was referred to the report of Dr Storor of 9 August 2016. Dr Nielsen stated that it appeared to him that Dr Storor had not asked about the symptoms that would lead him to make a diagnosis and the report was imperfect in other ways. Dr Nielsen stated that:
if someone is obliged to work out if someone has PTSD then they are obliged, in my view, to ask the question of causes and symptoms of PTSD and then if the symptoms are not present, to make a note of it as what’s called a significant negative, but that didn’t happen in this report although the applicant had mentioned to Dr Storor some symptoms of post-traumatic stress disorder.
Dr Nielsen stated that: “some of the elements that Dr Storor did not think met criterion A for PTSD, did in fact meet criterion A for PTSD”.
Dr Nielsen stated that the veteran was treated with the antipsychotic medication “Abilify” and also takes some Selective Serotonin Reuptake Inhibitors (‘SSRI’). Dr Nielsen then stated that he was going to give the veteran Abilify but he has been treated with the SSRI antidepressant “Sertraline”, which is intended to decrease the symptoms of anxiety and depression and added that this medication is similar to Citalopram. Dr Nielsen stated that the veteran has been treated with Warfarin and, rather than prescribe the antidepressant himself, he asked the GP to prescribe it, so as to not interfere with the Warfarin treatment. Dr Nielsen stated that Sertraline decreases symptoms but it would be very unlikely that someone’s symptoms would go away completely. Dr Nielsen stated that:
the best treatment of post-traumatic stress disorder is to have talking treatment, which Mr Bridge has been reluctant to have as much as I might have wanted which is understandable because of the memories are painful and frightening.
Dr Nielsen remarked that the veteran is not yet ready for speaking or talking treatment in respect of PTSD.
Under cross-examination Dr Nielsen stated that he first saw the veteran in 2013 and referred to a report dated 8 November 2013[39] to Dr Kumar. Dr Nielsen was directed to his report dated 4 November 2013[40] in which he stated: “Gary has panic disorder and major depressive disorder. Alcohol and anger might be a focus of treatment. There is no PTSD.” Dr Nielsen was asked how he ruled out a diagnosis of PTSD in November 2013; Dr Nielsen answered:
Well, the short answer is that I was wrong. With my notes here in front of me, Garry Bridge mentioned that he was sensitive to noise and crowds - as I mentioned - but he denied some of the symptoms, and what I (indistinct) to find out about that criteria to rule out PTSD is they asked him about events that might have caused PTSD, so he mentioned that he would do guard duty and he’d fly around and drop stuff off in fields that weren’t secure places, and he said the base used to belong to a particular bunch of people and they were all killed by special forces out of spite, and he mentioned the (indistinct) told people to leave, so he’s mentioning, when I asked him about stressful things, he said he didn’t know if he was ever under a direct threat and he mentioned some more about airplanes. So, when I first met Mr Bridge, he denied really any specific stressful events and spoke about things in general terms, and as I mentioned he at that time was avoiding or unable to mention those events because the memories were too frightening. Or, he chose not to.
Dr Nielsen confirmed that he explored symptoms and any stressful events.
[39] Exhibit A, T Documents, p 247.
[40] Exhibit A, T Documents, p 246.
Dr Nielsen was asked about the other interviewing doctors not being able to elicit a diagnosis; he stated he was informed that the veteran was concerned that one doctor simply wanted to talk about the F-111 Deseal/Reseal program. Dr Nielsen was asked whether the veteran did not disclose stressful events because of the Secrets Act or their not being relevant; Dr Nielsen remarked that he did not think that people usually have that understanding of the Secrets Act, that they are not allowed to tell people about traumatic events. Dr Nielsen added that the other doctors who examined the veteran were unable to make a diagnosis of PTSD; his reading of the reports was that they didn’t ask the questions that would have led to a diagnosis of PTSD, or other conditions for that matter.
Dr Nielsen was directed to his report of 14 February 2014[41] in which he reported under the “Anxiety” heading that the veteran avoids crowds; he confirmed that this is the same symptom or description for avoidance. Dr Nielsen remarked:
Well, with the DSM 5 or DSM 4 criteria for things, the criteria are chosen because they are characteristic of conditions and also because they distinguish between them. So, avoiding crowds is definitely something that happens with panic disorder because people have trouble escaping, but it’s characteristic of PTSD. People with PTSD just avoid crowded places, so that one is not specific. The being sensitive to noise is more specific to PTSD. The other thing is that one of the main things that he presented with - and this is one of the other challenges that face people who do independent examinations and treaters - one of the things that Mr Bridge presented with is anger, and anger is very characteristic of PTSD; it causes people with PTSD major problems. On the other hand, men with depression and anxiety who don’t have PTSD can get angry. So, he did have symptoms of PTSD that I didn’t twig to.
[41] Exhibit A, T Documents, pp 233-242.
Dr Nielsen was directed to Dr Ng’s report of 11 April 2011 in which Dr Ng records:
… he initially started looking for work but attempts to perform it were restricted by pain. He was not looking for work at this point in time. He had returned to his family home in … Queensland, and was tidying up the house. This was keeping him busy most of the time. He enjoyed motorbikes and was able to catch up with old friends and his folks. He was reconnecting with his family. Most of his friends were ex-military, but he had a few civilian friends. He enjoyed time with them at barbecues or at the pub. He recounted one episode where he drove down to Adelaide on a 5,000 kilometre road trip on his motorbike to meet up with his friends for a barbecue.
Dr Nielsen was asked whether the history taken by Dr Ng was consistent with what he took in 2013; he answered:
“So he was telling me that he used to go out and then he had stopped. … I’m reading from my actual handwritten notes. Is this what you wanted me to compare? I mean it will take a little while for me to go through my handwritten notes and compare it to - and look for symptoms that he mentioned. … Yes. Well, I - without going through it … Well, I think I said that - yes, that’s consistent with depression. When people are depressed they’re supposed to do enjoyable things.
Dr Nielsen was asked whether the report of Dr Ng was simply a proper history of the veteran’s activities; he answered:
Well, that’s a proper history of his activities. It would have been good to know if he had been advised to do that to cheer himself up. Perhaps he had been advised to do that by friends or his GP. And you mentioned taking a proper history, I - my own view is that the history for that report skipped out asking the DSM-IV elements. So I - I, on a whole, am not impressed with that report. But it’s a good point you make, if he didn’t have a psychologist or a psychiatrist hassling him to do enjoyable things, then - then - then it is more likely that he was doing them spontaneously rather than having his arm twisted. Having said that, if the report skipped out asking for DSM-IV symptoms, then I, myself, would question how - in what way the report would present someone’s recreational activities. So I’m not - so I think, in my view, not asking about the DSM-IV symptoms casts a bit of a shadow over those elements that are in the report.
Dr Nielsen was directed to the Mental State Examination in the report of Dr Ng; Dr Nielsen remarked:
… what it says, for example, is that his mood is euthymic and his affect appeared reactive and congruent with his mood, and he didn’t make any reference to any distress. Now, Mr Bridge did mention distressing things, like … being bad tempered, mood swings, chronic pains in multiple joints, sleep disturbance, and his marriage breakdown. Now, what that means is that he would have appeared distressed when he was describing those things, or sad, or his affect or emotional state would have actually been incongruent with what he was describing. So in my view the Mental State Examination was contradicted [by] the history that he has given. So his - or he was distressed when he mentioned those things and the Mental State Examination glossed over them. I mean if - so I will say - so I will just clarify that. If someone is describing distressing things and their affect is reactive, then they’re going to become at least a little bit distressed when they’re describing that in the - during the interview. If they don’t become a little bit distressed then that’s a positive finding, you would say that their affect or their facial expression was incongruent. Instead what we’ve got here is a Mental State Examination that just says that Mr Bridge has a normal - has a euthymic moods, which implies happy, and that his affect is reactive, which is also normal. So what we’ve got is a Mental State Examination that just mentions positive things, in the sense of being good, rather than reflecting what should have actually happened in the interview based, not on anything I think, but what is actually in the history there.
Dr Nielsen was asked if he was saying that there is an inconsistency there between what the veteran has complained and how he has presented; he answered:
Well, there might - well, there’s an inconsistency in the report because you can’t be - if someone discussed distressing things and their affect is reactive, as the report says, then they will be distressed, and then if someone is distressed when they mention something, that should go in the Mental State Examination, but it’s not there. So if he didn’t become distressed that means his affect is incongruent, and that should have gone in the Mental State Examination. So instead what happens is Mr Bridge has described bad things happening in his marriage, but the Mental State Examination in Dr Ng’s report is bland and positive, but it can’t - it - that Mental State Examination can’t be accurate if the history is accurate because the history included description of painful things. So what you won’t have in - now, it may be that Dr Ng - in fairness to Dr Ng - well, setting aside the issue that he didn’t ask about symptoms of depression, he may - if he decided that Mr Bridge wasn’t depressed then he may have just written that out as short of a quick shorthand, but it’s certainly not a nuanced Mental State Examination.
Dr Nielsen was asked to confirm if he was doubtful about the conclusions in the Mental State Examination of Dr Ng; he answered: “That’s - yes, of Dr Ng’s report, yes”.
Dr Nielsen was directed to the Mental State Examination of Dr Storor who reported:
He was relaxed and chatty throughout the course of the interview with me, he did not display any distress when he recounted the experiences during his military service, that he believed had caused him emotional problems. On the contrary, he was particularly interested in these events and went to the length of showing me photographs of some of the events which he had described as being stressful experiences for him.
Dr Nielsen remarked:
Well, I contend that that’s a little bit of a misrepresentation because what [the veteran] didn’t show was photographs of him being kidnapped or being threatened by rascals or dead children and wounded people. He didn’t show him photographs of those things, I don’t think.
Dr Nielsen was asked how he knew that Dr Storor was not shown photographs of wounded people or being kidnapped; he answered:
Well, Mr Bridge told me that he didn’t show photographs of those things … I mean he - what he said was that he showed him photographs of bombs from the range. So as you know, people in the air force pick up unexploded ordnance, so Garry said that he showed him a photograph of stacked up, unexploded bombs, standing beside it, which is normal. Now, if he - if he showed - Garry Bridge was - my understanding was, he told me, he was riding in a car trying to take a child to hospital who had been bitten by [a snake] and the car went off the road and the child died. … Mr Bridge didn’t take any photographs of the dead child, to the best of my knowledge…
It was put to Dr Nielsen that the evidence of the veteran was that he was driving towards the village where the child was, but didn’t make it because of the traffic accident; he answered:
my history was that the child was in the car and also that it wasn’t Mr Bridge driving, that it was one of the locals who was driving. So I suppose I could stand - well, stand corrected, but I was quite certain that the child was - was in the car. But well, if he didn’t make it to the - so he didn’t take photographs of the stressful events, that’s what he told me, and I didn’t check directly with him: “Did you take a photograph of the kidnapping? Did you take a photograph where the vehicle ran off the road?”
Dr Nielsen went on to add:
So - now, the other thing was “mood was [euthymic], reactive, and happy.” So - so Dr Storor’s Mental State said that the mood was [euthymic], his affect was reactive, and he has also said he was relaxed and chatty. So Dr Storor’s Mental State has the same problem as Dr Ng’s, only it’s worse because Mr Bridge was describing kidnapping, attacked by rascals, children dying, wounded people, which would have been distressing or he would have had an incongruent affect, as if he was just - as if they were inventions or he was putting it on. That would have been an important positive finding. So just suppose all of these stories are inventions then - and Mr Bridge remained relaxed and happy when he was describing these events, that’s - that would be an important suggestion that Mr Bridge was either disassociating or that the events were inventions. But none of that is reflected on the Mental State Examination, we’ve - actually, it has got the same phrases in Dr Ng’s report. The mood was euthymic, the affect was reactive. So this bit of the Mental State Examination ignores the - ignores the content in the history. So the Mental State Examination is incongruent with the history. So in fairness to Dr Storor, he may have just concluded that Mr Bridge didn’t have any physiological injuries and just sort of written that as a shorthand, sort of lazy, and not commented on the incongruence. The problem I have with that interpretation of the Mental State Examination is that - is that he didn’t ask him about the symptoms of the disorder, and also he said that being kidnapped wasn’t - didn’t meet the diagnostic criteria for criterion A. So - or having a child die either in the next village - well, maybe that doesn’t meet the criterion - but being threatened by rascals or seeing the wounded people, it’s all - his idea was that if someone is kidnapped then that doesn’t meet - can’t possibly meet the diagnostic criteria for criterion A, which in my view casts a shadow over the quality of the Mental State Examination.
Dr Nielsen was asked how the rascals incident was explained to him; he answered: “I don’t think I wrote about that in my report, so it’s possible that I can’t enlarge on that at all. It may be that he mentioned it in … Dr Storor’s history”.
Dr Nielsen was referred to Dr Storor’s report where it states:
He also related an event that occurred in Papua New Guinea in the late 1980s when he had a run in with the rascals with machetes… There was another incident when a little boy was bitten by a snake and in attempting to take him for medical treatment their four-wheel drive ran off the road.
Dr Nielsen remarked that he did not think that he found out about the rascals incident when he was talking to the veteran. It was put to Dr Nielsen that the rascals incident played out as follows:
·the veteran spoke with colleagues;
·they were located in a motel;
·they went out for drinks after work;
·he saw rascals and there may have been some verbal interaction;
·they had their drinks at the hotel;
·they came back and there was a guard at the gate that said: “You shouldn’t have gone out because you could have been - drew the attention of the rascals”.
Dr Nielsen said that whether there’s a criterion A stressor “depends on the nature of the run-ins”. Dr Nielsen remarked that the veteran didn’t raise the rascal incident during his interviews with the veteran.

In re-examination Dr Nielsen was asked about his report of 28 July 2015. Dr Nielsen confirmed that the “Precipitants” listed in his report were the particular events or stressors which he considered met criterion A for PTSD. Dr Nielsen added:
when they were - when they were writing DSM-IV they came up with a document called the DSM-IV Source Book and in that it explains the origin of the - of the criteria. So what they did was they were working out whether or not to put in a criterion A at all, and what they found was if you leave criterion A out then people can still develop the full-blown symptoms of PTSD. So when they did the field trials they - they looked - examined 400 people with PTSD symptoms, the other criteria, and they found that with less-severe trauma people could develop PTSD, even when they suddenly lost their job or if they were suddenly divorced. Now, I’m not suggesting that people develop PTSD - I don’t give people a diagnosis of PTSD if they get divorced, but people can develop symptoms of it. So from a medical point of view, if someone has a - has a traumatic event, then they can develop the symptoms of PTSD and it’s a red herring when you’re trying to work out if someone has got PTSD if the criterion A meets certain levels of severity. Now, that’s not to say that - but with - when doing reports for DVA, obviously I don’t try and rewrite the rules, I just play by the rules. So the short answer is yes, I think those events met the criterion A for PTSD. I suppose the longer answer is that medically it’s a little bit less important, but no, definitely they met criterion A for PTSD.
Dr Nielsen reiterated that he outlined the discrete events which were relevant in that regard.
I asked Dr Nielsen what effect the veteran’s alcohol consumption had on the depression condition; he answered: “Well, alcohol consumption worsens depression, and it - probably it worsened Mr Bridge’s depression if he was drinking heavily”.
I referred Dr Nielsen to his note:
Mr Bridge drinks and does not stop for about a week every month
Dr Nielsen confirmed that this “would have definitely made his… depression worse and depression makes people drink more and PTSD makes people drink more.” He added: “I’m not saying that happened in Mr Bridge’s case, but alcohol and psychological injuries exacerbate one another”.
Dr Nielsen’s supplementary report dated 26 May 2018
In his report dated 26 May 2018 Dr Nielsen comments about the rascals incident. Dr Nielsen asserts that the veteran “was actually threatened by locals”. This conclusion was not in accordance with the evidence of the veteran who stated that he was “watched” and he did not state that at any time he was threatened.
In his report Dr Nielsen asserted that “Dr Storor was aware that [the veteran] was with the boy who died from snake bite…”. However, in his evidence-in-chief, the veteran remarked that “we could never get to the young boy”.
CONCLUSION
At the conclusion of the evidence I remarked that the evidence of Dr Nielsen was not given before the respondent’s specialists’ evidence was given. I observed that Dr Nielsen made criticisms of the respondent’s specialists. I raised whether the respondent’s specialists would need to be recalled or not, because of the strong criticisms that Dr Nielsen made about the reports of Dr Ng and Dr Storor. No application was made for them to be recalled, however, all three psychiatrists provided supplementary reports which I have examined.
Dr Nielsen, in giving evidence, referred to the Mental State Examination of Dr Ng in which Dr Ng stated that the mood of the veteran was euthymic and his affect appeared reactive and congruent with his mood. Dr Nielsen was critical of Dr Ng because he didn’t make any reference to any distress of the veteran. When Dr Ng was cross-examined it was certainly not put to him that the veteran was distressed when he saw him. I do not consider that there is any basis for the assumption of Dr Nielsen that the veteran was distressed at the time of the Mental State Examination. Certainly, when the veteran gave evidence, he did not claim that he was distressed when he saw Dr Ng. Dr Nielsen, in giving evidence, had stated that Dr Storor had “just concluded that Mr Bridge didn’t have any physiological injuries and just sort of written that as a shorthand, sort of lazy, and not commented on the incongruence”. Dr Nielsen had assumed that the veteran was distressed when he saw Dr Storor, however, the veteran made no such assertion when he gave evidence. I do not accept that the veteran was distressed when he saw Dr Ng and Dr Storor.
I do not give any weight on the opinion of Dr Nielsen that the veteran has PTSD. In his report of 28 July 2015 he gave a different opinion to what he had earlier said in his report of 4 November 2013 in which he reported that there was no PTSD and no pain. Dr Nielsen remarked that when he met the veteran, he explored symptoms and the veteran informed him that he didn’t know if he was ever under a direct threat. However, in later appointments the veteran has evidently changed his account that was originally given to Dr Nielsen. In his report of 28 July 2015, Dr Nielsen refers to various stressors mentioned by the veteran that were evidently not mentioned earlier, however, it is apparent from Dr Nielsen’s supplementary report on 26 May 2018 that his opinion that the veteran experienced certain stressors is based on a history which is inconsistent with what the veteran has reported to other psychiatrists and in his evidence in chief. I note in particular Dr Nielsen’s assertions that the veteran was actually kidnapped in the Middle East, that the veteran was actually threatened during the rascals incident, and that the veteran was with the boy who died from the snake bite.
I place great weight upon the report of Dr Storor who saw the veteran on 5 August 2016 and who gave evidence before the Tribunal. His report dated 9 August 2016 is a comprehensive report which fairly addresses the claims of the veteran. Dr Storor maintained his opinion despite being subject to extensive cross-examination. Dr Ng’s opinion is consistent with the opinions of Dr Ewer, Dr Begg, Dr Storor.
In his subsequent report of 11 April 2018, Dr Storor has put forward his opinion that the fact that the veteran drinks alcohol to excess is most likely the cause of the symptoms he reports experiencing occasionally. Dr Nielsen has had the opportunity to comment upon this opinion of Dr Storor. In his report of 26 May 2018, Dr Nielsen disputes that the symptoms are experienced “occasionally” but does not dispute the effect of alcohol on the symptoms of the veteran. . I have earlier made reference to my referring Dr Nielsen to his note: “Mr Bridge drinks and does not stop for about a week every month.” Dr Nielsen confirmed that the drinking would have an adverse effect on the veteran. I rely upon the opinion of Dr Storor who states that excessive, sporadic binge drinking could certainly result in a temporary change in a person’s mental state, leading them to have a period of low mood following the binge, and possibly feeling anxious following the binge. I accept Dr Storor’s opinion that the binge drinking would cause symptoms of depression such as anxiety and depressed mood. It is my opinion, in accepting Dr Storor’s view, that the veteran’s drinking habit may explain the symptoms of depression experienced by the veteran.
I have relied upon the opinions of Dr Ewer, Dr Begg, Dr Ng, and Dr Storor who have concluded that the veteran does not have MDD, panic disorder with agoraphobia and PTSD. The opinions of these specialists reflect a longitudinal view of the condition of the veteran. I appreciate that a depression condition of the veteran has been accepted under a different legislative scheme, however, I have reached my conclusion after an examination of the evidence before me.
There is no evidence that the veteran meets the diagnostic criteria for panic disorder or of when there was the onset of the condition. I am of the view that there is no cogent evidence that the veteran has an agoraphobia condition, having regard to the fact that the veteran recounted, to Dr Ng in 2011, one episode where he drove down to Adelaide on a 5,000 kilometre road trip on his motorbike to meet up with his friends for a barbecue.
I also note the Separation Health Statement completed by the veteran on discharge in 2010 which is a comprehensive document in which the veteran listed a number of medical complaints. In that document he did not list any psychological or psychiatric symptoms or concerns. I have also concluded that in 2008, Dr Sinclair had not made any diagnosis of depression, but had wanted such a condition to be excluded as contributing to the urological condition.[42]
[42] Exhibit E.
Insomnia Disorder
Dr Ng has made a diagnosis of primary insomnia disorder. In forming that opinion, he had regard to the shift work that the veteran experienced for a significant period. Dr Ng stated that the condition appeared to have emerged out of his time in the military. The condition of chronic insomnia disorder is the subject of SoP No 37 of 2019 and SoP No 38 of 2019. The veteran advised the Tribunal that he has not made a claim for the condition. The Tribunal accordingly, in the circumstances, concludes that it does not have jurisdiction in relation to that condition.
Alcohol Dependence
As a matter of completeness I have given some thought to whether the veteran has an alcohol dependence condition. Dr Ng in his report dated 11 April 2011 remarked that the veteran had reported that the consumption of alcohol was “infrequent”. Dr Storor in his report dated 9 August 2016 remarked that there was no sign of substance intoxication or withdrawal. Dr Storor also remarked that while the veteran reports alcohol abuse on occasions, he does not meet the criteria for alcohol abuse: his opinion was not challenged in this respect. In his supplementary report dated 11 April 2018 Dr Storor confirmed his previous opinion. Dr Nielsen in his report dated 28 July 2015 remarked: “The justification for the alcohol dependence is as follows. Mr Bridge drinks and does not stop for about a week every month. He has made persistent efforts to stop or decrease his drinking but has not been successful. The drinking takes up most of the relevant week. When he is drinking he does not do things that need to be done, like fixing up things around the house or mowing the lawn. He drank more than he intended when he drank. He was tolerant to alcohol.” That report does not address whether the veteran meets the diagnostic criteria for an alcohol dependence condition. There is no evidence of any treatment for an alcohol dependence condition. There, is in my opinion, no cogent evidence before me that the veteran meets any diagnostic criteria for an alcohol dependence condition. In final submissions the veteran did not make any submission that the Tribunal should make a finding that the veteran has an alcohol dependence condition.
For the reasons given above, I am not reasonably satisfied that the veteran has the psychiatric conditions of MDD, Panic Disorder with agoraphobia, PTSD, and alcohol dependence. I acknowledge the extensive service the veteran has rendered in defence of his country for over three decades. However, under the scheme of the Act, I am unable to grant this application. It would be reasonable in the circumstances for the respondent to investigate the insomnia disorder having regard to the opinion of Dr Ng that this condition arose from the veteran’s service.
DECISION
I affirm the decision under review.

I certify that the preceding 214 (two hundred and fourteen) paragraphs are a true copy of the reasons for the decision herein of Deputy President Dr P McDermott RFD

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Associate
Dated: 21 May 2020

Dates of Hearing: 29-30 January 2018

Date final submissions received: 14 October 2018

Counsel for the Applicant: Mr Anthony Harding

Solicitor for the Applicant: Mr Matthew Woods, Woods Prince Lawyers

Solicitor for the Respondent: Mr Bruce Williams, Repatriation Commission

[2020] AATA 1417

21 May 2020

Key Legal Topics

Areas of Law

Administrative Law

Statutory Interpretation

Legal Concepts

Judicial Review

Natural Justice

Procedural Fairness

Expert Evidence

Standing

Dates of Hearing:	29-30 January 2018
Date final submissions received:	14 October 2018
Counsel for the Applicant:	Mr Anthony Harding
Solicitor for the Applicant:	Mr Matthew Woods, Woods Prince Lawyers
Solicitor for the Respondent:	Mr Bruce Williams, Repatriation Commission