Brook and Repatriation Commission
[2003] AATA 615
•30 June 2003
Administrative
Appeals
Tribunal
DECISION AND REASONS FOR DECISION [2003] AATA 615
ADMINISTRATIVE APPEALS TRIBUNAL )
) No N2001/1533
VETERANS' AFFAIRS DIVISION ) Re PETER BROOK Applicant
And
REPATRIATION COMMISSION
Respondent
DECISION
Tribunal Dr M.E.C. Thorpe, Member Date30 June 2003
PlaceSydney
Decision The decision under review is set aside and in substitution therefor the Tribunal decides that the Applicant suffers from Post Traumatic Stress Disorder and Alcohol Abuse. The earliest date of effect is 13 January 2000. The matter is remitted to the Department of Veterans’ Affairs for assessment. [Sgd] Dr M. E. C. Thorpe
Member
CATCHWORDS
VETERANS’ AFFAIRS – defence service – whether the Applicant suffered from post traumatic stress disorder, alcohol dependence or alcohol abuse – depressive disorder – whether the relevant statements of principles were satisfied – decision set aside
Veterans’ Entitlements Act 1986 – ss 70(1), 70(5), 120(4), 120B, 196B(14)
Repatriation Commission v Smith (1987) 15 FCR 327
Re Budworth and Repatriation Commission [2000] AATA 127
Stoddart v Repatriation Commission [2003] FCA 334
Repatriation Commission v Cooke (1998) 160 ALR 17
Lees v Repatriation Commission [2002] FCAFC 398
Re Robertson and Repatriation Commission (1998) 50 ALD 668
Re Cranage v Repatriation Commission (2000) 63 ALD 312
Repatriation Medical Authority Statement of Principles Instrument No. 4 of 1999 as amended by No. 54 of 1999 concerning Post Traumatic Stress Disorder
Repatriation Medical Authority Revocation of Statement of Principles Instrument No. 77 of 1998 concerning Psychoactive Substance Abuse or Dependence and Determination of Statement of Principles concerning Alcohol Dependence or Alcohol Abuse
Repatriation Medical Authority Nos. 58 and 59 of 1998 concerning Depressive Disorder
REASONS FOR DECISION
30 June 2003 Dr M.E.C. Thorpe, Member 1. By application lodged with the Tribunal on 28 September 2001 the Applicant sought review of that part of a decision by the Veterans’ Review Board (“the VRB”) on 21 August 2001 that refused his claim for Post Traumatic Stress Disorder and Alcohol Dependence.
2. The task for the Tribunal was to determine if Mr Brook (“the Applicant”) suffers from a psychiatric disorder consequent to an incident on the HMAS Melbourne in 1977. The possible diagnosis(es) open to the Tribunal included Post Traumatic Stress Disorder (“PTSD”), Alcohol Dependence or Abuse and Depressive Disorder. The other task is to determine if the Applicant experienced a severe stressor within the meaning of that term in the applicable Statement of Principles (“SoP”) for PTSD, or Alcohol Dependence or Abuse or Depressive Disorder.
3. The Applicant rendered full-time service in the Royal Australian Navy from 7 July 1975 to 6 July 1987, all of which constitutes eligible defence service under the Veterans’ Entitlements Act 1986 (“the Act”). The standard of proof governing the relationship between the claimed diseases and eligible defence service, as well as the question of diagnosis and all other preliminary issues, is the ordinary civil standard as laid down in sub-section 120(4) of the Act: Repatriation v Smith (1987) 15 FCR 327.
4. In this matter three SoPs are applicable, namely Instrument No. 4 of 1999 as amended by No. 54 of 1999 concerning PTSD, Instrument No.77 of 1998 concerning Psychoactive Substance Abuse or Dependence, and Instrument Nos. 58 and 59 of 1998 concerning Depressive Disorder.
5. The earliest date of effect if the claim should succeed is 13 January 2000.
6. The Applicant gave evidence before the Tribunal. Drs Dinnen and Haik gave concurrent evidence before the Tribunal. The Tribunal had the reports of both doctors; Dr Dinnen dated 11 November 2002 (Exhibit A1) and Dr Haik dated 27 August 2002 (Exhibit R5) with a supplementary report dated 21 April 2003 (Exhibit R6). Other medical documents included Additional Service Medical Records (Exhibit R1); Clinical notes from Dr Antonio (Exhibit R3); and a medical report from Dr Peter Jenkings, Consultant Psychiatrist dated 2 May 2000 (T6/66-67).
Background
7. The applicant joined the Navy in July 1975 for nine years. He did a two-year apprenticeship at HMAS Nirimba at Quakers Hill, as a fitter and turner. His first job on board a ship was during the refit of HMAS Melbourne at Garden Island. He was put onto a tank cleaning party. The task was to paint the interior of a fresh water tank on the Melbourne with “Coraline black”, to stop rusting. There was a fire in the tank and the circumstances of the fire as the genesis of a psychiatric disorder are the basis of this application.
8. In 1984 he re-signed for another three years because he was drinking a bit and he was concerned who might employ him. He had divorced his first wife in 1984. He was discharged from the Navy in 1987 by which time he had remarried. He had cut down his drinking at that time because he had an obligation to his wife. He joined the Federal Police for one year but he found the work boring. He then worked for one year as a school bus driver and in 1990 joined the NSW Police on General Duties and then with the Highway Patrol. He left the NSW Police when he got sick of it. He was exposed to no particular stress in the police force. Then he worked as a truck driver for two years and in 1997 began work as a general service attendant of the boiler at a paper mill. His job is to supervise the movement of hot ash and on occasions he has to break up red hot coals which have fused. There was an episode in 1999 when breaking up the hot coals, the ash exploded when it hit the water and this brought back to him memories of the Navy.
9. He remains happily married and intends to remain in his current job because there is no other work available.
Applicant’s Evidence
10. After Narimba he was posted to HMAS Melbourne in about October 1977. His duties were cleaning, painting and minor repairs. These duties included painting the fresh water tanks to stop rust.
11. This particular day he was painting a tank with Mr Glen Green. The tank was at least 16 feet deep and about 30 feet long and 15 feet wide. At the bow was a recessed area, as large as a small room, which he was involved in painting. There was a stream of festoon lighting on the floor consisting of naked light bulbs. They used large rollers to paint. He wore a mask to cover his face and an air hose was attached to the mask.
12. The Applicant’s evidence was that he put his paint roller, which had a long handle down on the floor to rest when his colleague Mr Green started yelling at him. Mr Green had seen the Applicant’s roller catch on fire and was moving towards him and hit the Applicant’s roller with his own roller and when the Applicant looked down he saw both rollers on fire.
13. The Applicant picked up both rollers and his legs started shaking. He froze. He was paralysed with fear. He stated:
“I couldn't move and I thought I was going to die. I was waiting for the fire to the tank to erupt into flames.”
When asked about what happened when he froze, he stated:
“Yes my leg – my leg was shaking and I just could not physically move.”
When asked how long this lasted, he replied:
“It could be a minute or two --- I don't know.”
14. Mr Green returned with a fire extinguisher and put out the roller fires. The Applicant then exited the tank. Another man Mr Alan Cottrell was outside the tank waiting for his turn in the tank. After exiting the tank an officer asked the Applicant some questions and took details, but that was the only investigation that was made in relation to the incident.
15. The Applicant was in a relationship at this time which eventuated into marriage. The marriage ended when:
“I started drinking quite heavily and used not to come home at times and I think she was fed up with it.”
Besides alcohol the Applicant had problems with bouts of fright and nerviness. The Applicant felt nervousness and depression at times.
“If I drank I felt quite good. For no apparent reason I would feel aggressive.”
16. When asked about the quantity of his drinking the Applicant said he could not drink at sea:
“you are only issued with two cans at sea. I used to drink heavily when I came ashore. I'd have binge drinks when we came back and I've always done the same since --- I still binge drink and I think about three to four drinks a day.”
His drinking has caused problems with his marriage.
17. The Applicant does not suffer from nightmares but from “daymares” at times and refers to them as “flashbacks” of the situation. Previously he had told the Tribunal that the effects of the incident in the water tank seemed to get less and less that is, until another incident evokes the same memories. A recent incident in the last couple of years he had at work brought the flashbacks and memories back again.
18. The particular incident was at work when hot ashes making contact with water exploded. The Applicant is not currently receiving medical treatment.
19. Under cross examination the Respondent drew the Applicant to the attention of his statement in the box marked number 2 on the form supporting his claim for Disability Pension entitled “Disability and/or Symptom” (T4, p23). In that box the Applicant wrote “nervous condition with alcohol dependence”, and stated that being “[T]rapped inside the compartment” was the way in which the Applicant’s service caused, contributed to or aggravated this disability.
20. In relation to the above statement, the Respondent asked:
“When you say “trapped” do you mean the circumstances you have just described where you felt you froze and weren't able to move: is that what you mean?”
The Applicant replied:
“There was only one exit out of the tank was that manhole”
The Respondent then asked:
“Yes. But when you say “trapped”, you weren't locked in or anything like that, were you?”
In response, the Applicant stated:
“No one was … I was trapped with fear because I was trapped with fear. I couldn't move.”
The Respondent also referred to Dr Jenkins report, stating:
“you were further upset by an officer who described a successful refit and outlined how the problem was the fault of the people in the tank''.
Later in cross-examination the Applicant agreed, with reference to the VRB decision, that later in his service he cleaned and painted tanks with some apprehension but he did as he was ordered. He also agreed that the Navy considered him fit to continue to clean tanks and that he was fit for a diving course for which he required a medical. The Applicant had also had medical examinations before he joined the Commonwealth and State police forces but no information was before the Tribunal if this included psychological testing. The Respondent put to the applicant that the Writeway Research found no official documentation of the incident and that, whilst not disputing that the incident occurred, it was not recorded because the incident was regarded as minor. To this the Applicant replied:
“I certainly didn't feel like it was minor.”
21. The Respondent put to the Applicant that the reason for his depression in the mid 80's was in relation to his family problems. The Applicant stated that he did not agree that it was due to his marital breakup and domestic problems. He had told Dr Jenkins that he went a Navy doctor feeling depressed and upset in 1984/1985. Later in cross-examination (Transcript p.28 para 3) the Applicant said he did not know whether it was his marital situation that was the source of his depression when he saw Dr Parry, but that was what Dr Parry seemed to think it would be.
22. The Applicant said in reply to the cross-examination of the Respondent that he had not drunk at all before he joined the Navy and that he started having a few drinks at Narimba. He agreed with the Respondent's reference to Dr Dinnen's report dated 11 November 2002 which states that the Applicant drinks around four beers a day, with occasional binge drinking (Exhibit A1). This was either at the Club or in a room at home by himself. The Applicant also agreed that his drinking reduced after his remarriage.
writeway research
23. A report was available to the Tribunal from Writeway Research by Captain RAN Rtd H.A. Josephs dated 20 May 2002 (Exhibit R4). “Coraline Black” was manufactured by International Paints (Taubmans) and their responsible executive was Mr John Matthews. At paragraph 8 of the report Mr Matthews advised that although “Coraline Black” was bitumen based it was not easily ignited in its liquid form and he did not think an exploding electric light bulb would be enough to cause a fire. Used in closed confines of a water tank, however, fumes from the tars and solvents in the paint would accumulate, and if there were fumes in the vicinity when the bulb shattered those fumes might well explode. The severity of the explosion would depend upon the density of fumes in the tank but Mr Matthews did not think any unused paint would catch fire.
24. Statutory Declarations were available from Glenn Donald Green dated 23 May 2000 (T7), Alan Jeffrey Cottrell dated 30 April 2001 (T14) and Brian William Bailey dated 6 April 2001 (T15). All three were sailors who served on HMAS Melbourne and were employed in tank cleaning parties at the time of the incident involving the Applicant. Mr Green was in the tank with the Applicant on the particular occasion of the incident. In paragraph two of his statutory declaration Mr Green stated that “although his roller was in flames, Peter appeared to be unaware of this. Whilst I was yelling, he then realised what had happened. In the ensuing panic, my roller caught on fire. Peter gathered up the two flaming rollers and I exited the tank to return with a fire extinguisher.” Mr Bailey's declaration generally confirmed the conditions and nature of the tank cleaning. Mr Cottrell actually remembered the occasion, stating that “while Peter and Glenn were working in the tank and we waited our turn just outside the access manhole, Glenn stuck his head out of the manhole and shouted there was a fire in the tank below. Within seconds the Petty Officer in charge had grabbed a fire extinguisher and re-entered the tank with Glenn. A few minutes later all three exited the tank.”
Medical Evidence
25. Dr Jenkings, psychiatrist, assessed the Applicant on 1 May and 2 May 2000 (T6, p 66), following referral by his general practitioner Dr Francis Antonio. The referral was made in the context of a twenty year history of intermittent alcohol abuse and opinion regarding possible post traumatic stress disorder and treatment. Concerning the incident in the tank Dr Jenkings reported:
“He described painting a tank with lots of fumes and then his mate began screaming with his roller on fire. This spread and the patient became fearful with shaking and stated ‘ I couldn’t get on the plank to get out of the place- there were flames everywhere and blobs of paint falling down. I was petrified and I couldn’t move”.
26. The Applicant was further upset by an officer who described a successful refit and he outlined how the problem was “the fault of the people in the tank.” He said he couldn’t go to anyone in those days. Later he went to a Navy doctor feeling depressed and upset in 1984 or 1985 and at Albatross was told he was “normal.” The Applicant said:
“I thought I was going to die that day. The event was clearly life threatening.
He went on to say
“it is easy to have a few drinks to forget about it”.
27. Dr Jenkins reported that the applicant had recurring thoughts about the episode and after it he began to drink much more to try to forget about it (T6, p 66). He joined the Navy aged seventeen and a half and did not drink much at all until the incident. He cannot remember having nightmares. However when the Applicant is threatened in some situations he reports feeling “sick in the guts, petrified, nervous and depressed like something has happened”. The Applicant said that this lasts a day or so like the original event in 1978. After the incident the Applicant increased his alcohol intake and had “quite a bit each time he went out”. There was loss of control and he described blackouts. The Applicant developed quite a tolerance and “couldn’t get drunk on beer” and so he switched to vodka. His wife left him and they were subsequently divorced. The Applicant stated that the drinking excesses have continued and although they have lessened to once per week or fortnight, it has still a habit. The Applicant said he was anxious, agitated and tense and that alcohol eases these feelings.
28. Dr Jenkings did not consider the Applicant to have a sustained major depressive illness (T6, p 67). In his opinion the Applicant suffered from a service related chronic post traumatic disorder which has settled but he coped, especially in earlier times, by quite marked service related alcohol dependence. The Tribunal noted Dr Jenkings gave a GARP rating of 19.
29. A report from Anthony Weaver Clinical Psychologist dated 13 February 2003 Exhibit A2 confirmed that Mr Brook was treated by him over the period December 2000 to December 2001 for symptoms including flashbacks (of the incidents aboard ship), hyperarousal, intense free floating fear and panic sensations lasting up to 24 hours, anger outbursts disrupting employment, intrusive recall causing sleep disturbances and self medication with alcohol. “He consistently reported from the first session that he felt during the incident that he was going to die.”
30. The clinical notes Dr F.E. Antonio, the Applicant’s local doctor, (Exhibit R3) cover the period 13 May 1994 to 2 March 2002. An entry at 20 November 2000 refers to Dr Jenkings’ report and states that the Applicant presented “still with problems at home and work and ongoing EtOH abuse”.
31. Dr Dinnen in his report of 11 November 2002 felt there was no doubt that the Applicant has chronic post traumatic stress disorder (Exhibit A1). Dr Dinnen reported that it is associated with alcohol abuse and not alcohol dependence. He believed that SoP no. 4 of 1999 and 77 of 1998 applied. It was also clear to Dr Dinnen that the condition did not cause major incapacity.
32. Dr Dinnen was critical of both Dr Haik's and the Veterans Review Board's proposition that only a threat which is realised and directly affecting the individual can cause post traumatic stress disorder. Such a proposition, according to Dr Dinnen, flies in the face of world expert opinion and current world experience about traumatic events. He opined that the real threat of ignition and explosion in the tank cannot be discounted simply because it did not occur. An individual's incapacity through fear is a fact of life that has been known for many years. It accounts for why one man in the front line in the First World War will suffer from “shell shock” while others around him are able to keep going.
33. Dr Haik in his report of 22 August 2002 considered the Applicant might be considered to suffer an anxiety state where he is made vulnerable to stressors and requires excessive self-medication such as alcohol (Exhibit R5). However Dr Haik opined that this anxiety was insufficient to satisfy the DSM IV definition. He did not consider the Applicant to suffer from a psychiatric disorder and stated that he satisfied neither the SoP criteria for Alcohol Dependence or Abuse nor the SoP criteria for Post traumatic Stress Disorder.
34. In his report 21 April 2003 Dr Haik wrote:
“ It is a self evident truth that objective criteria should be present when making a diagnosis in medicine, be it internal medicine, surgical medicine or psychiatric medicine. In other words, there needs to be 'physical' support to compliment the subjective account of the symptoms offered by the patient. In psychiatry, unbiased evidence of disablement is required before a clear diagnosis is made” (Exhibit R6)
35. Dr Haik continued:
“Posttraumatic Stress Disorder is a disabling condition as noted in SoP 54 of 1999 and 3 of 1999. So that objectivity can be established, Criterion (F) must be met: that the disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning. Unless Mr Brook can demonstrate that such distress or impairment as defined exist, he cannot be regarded to have and thus be disabled by Posttraumatic Stress. Disorder. Unfortunately Dr Dinnen chooses to disregard this objective measure and appears to rely on his own subjective experiences when he makes a diagnosis of PTSD.” (Exhibit R6)
36. For these reasons, Dr Haik opined that an objective factor must be evident during a person's assessment before a sensible conclusion can be drawn (Exhibit R6). He considered that “[B]ending the rules is unacceptable.” Because the Applicant could not demonstrate that he has these objective criteria in Dr Haik’s opinion, he was unable to make a diagnosis of Post Traumatic Disorder.
37. The Tribunal had the advantage of concurrent evidence from Dr Dinnen and Dr Haik affording the doctors the opportunity to test each other’s opinion and diagnosis. This also gave the Tribunal access to the best medical information and a chance test the veracity of that medical information upon which the Tribunal would base their conclusion and decision.
38. By way of introduction, the Presiding Member informed the doctors that the Tribunal was satisfied that all relevant information was already available and that nil new of significance had arisen out of the evidence of the Applicant. Both Representatives for both the Applicant and the Respondent agreed. The relevant SoP for PTSD was 4 of 99 and 154 of 1999 (the latter of which clarifies “severe stressor”) and 77 of 1998 for alcohol dependence or abuse.
39. As with the procedure of concurrent evidence the Applicant’s doctor, Dr Dinnen, gave a summary to the Tribunal and then in turn the Respondents doctor, Dr Haik, did similarly.
Evidence of Dr Dinnen
40. Dr Dinnen confirmed the opinion stated in his report (Exhibit A1), that the Applicant felt embarrassed and ashamed of his emotional response to the incident in the tank when he froze with fear. Dr Dinnen also reiterated his belief that the incident affected the Applicant’s emotional state from that time and that his reaction was to drink more and that his drinking became a problem.
41. Dr Dinnen stated that there was a particular problem in recent years in the Applicant’s work place where he is exposed to coal fire burners and hot coal and ashes and at times has to get close to a fire. Dr Dinnen stated the Applicant has indicated to him that being in these situations makes the Applicant’s emotional reactions even stronger.
42. Dr Dinnen said the above reaction is really in some senses an unusually clear example of the stereotypical response that is supposed to occur after a traumatic event. He considered the ongoing events were in accord with a diagnosis of PTSD. In particular Dr Dinnen opined that the use of alcohol as a way of alleviating symptoms of anxiety was typical of that condition. He did not believe that the condition had been of a major disabling extent over the years. That was quite obvious. Dr Jenkings had given a GARP rating of 19 which equated to slight to moderate disability and Dr Dinnen did not consider the Applicant’s disability greater than that, even considering the alcohol excessive use as part of the PTSD. Dr Dinnen considered the episode in 1995 when Mr Brook was treated for depression as part of his PTSD.
Evidence of Dr Haik
43. Dr Haik considered the event in the water tank was of short duration and that as the fire was put out within seconds, the chance of it being a severe stressor was doubtful. He stated that neither the Applicant nor his partner was burned and that the Applicant immediately resumed his job refitting the ship. Dr Haik pointed out that the Applicant married within a year and that he did not mention the fire incident to the doctor in 1985 when he was treated for depression. That is what it was called but Dr Haik labelled it a substantial reaction to marital conflict with his first wife, pointing out there was no mention of it over a number of sessions with a therapist in 1985. Dr Haik also drew attention to the fact that the Applicant has had no subsequent periods of unemployment, he has sustained a good marriage for the last 15 years and has not sought psychiatric help between 1985 and 2000.
44. Dr Haik opined that there was no real or objective evidence that the Applicant was exposed to a threat or serious injury or death. He stated that the Applicant exhibited no objective evidence of disablement as a result of that 1978 water tank experience. Dr Haik was unable to find a case for PTSD based upon the lack of those objective criteria.
45. Dr Haik was unable to find a case based upon the SoP for alcohol dependence or abuse as the Applicant was able to fulfil his work and family obligations, he had not placed himself in hazardous situations while drinking, he had no legal problems and no social or interpersonal problems as a result of his alcohol use.
46. The two summaries of Drs Dinnen and Haik indicated two issues to be considered by the Tribunal:
(a) The Diagnosis
· Dr Dinnen concluded that PTSD that is associated with an Alcohol Abuse. He held that the depression in 1984/85 was part of his PTSD.
· Dr Haik opined that no psychiatric diagnosis other than anxiety state that requires alcohol for self-medication, and that that did not satisfy DSMIV for anxiety state.
(b) Whether the Applicant experienced a severe stressor within the meaning of that term in the applicable SoP for the particular psychiatric condition
· Dr Dinnen concluded that the PTSD satisfied the relevant SoP and Alcohol Abuse satisfied the relevant SoP.
· Dr Haik opined that whether using DSMIV or SoP criteria there was absence of vital criteria for PTSD, for Alcohol Abuse or for Alcohol Dependence.
47. The procedure with concurrent evidence was to first invite Dr Dinnen to question Dr Haik and then Dr Haik to question Dr Dinnen. This produced the following dialogue:
“Dr Dinnen: If you were to consider, as DSM IV does, and as my textbook does, that PTSD is one of a group of anxiety disorders, then surely you would agree that there are other anxiety disorders which might be present of slight, mild, moderate or severe degree --- of PTSD?
…
Dr Haik: If we get out DSMIV and for example, look up generalised anxiety disorder, that is a disabling condition ... If you look up the diagnosis of schizophrenia that is a very disabling condition … When they get better, they have had a schizophrenic disorder or they have had an anxiety disorder but … they now don't have the criteria defined in the book. If you believe Mr Brook had a PTSD … I don't believe he has it now.
…
Dr Dinnen: If you say schizophrenia and generalised anxiety disorder are all or nothing conditions and PTSD is an all or nothing condition, then I am afraid that doesn't fit with the facts. You treat people as I do with mild degrees of anxiety … you treat people who have schizophrenia who hold down jobs ...
Dr Haik: I don't.
…
Dr Dinnen: … the GARP scale alone attests to the reality that there are varying degrees of severity.
…
Dr Haik: But PTSD is a disabling condition according to the SoP.
Dr Dinnen: Well, it is not. … all that does is tell you the criteria for the diagnosis. There is nothing in the SoP or in the DSMIV that will tell you the degree of disability caused by the condition.
Dr Haik: Sure. … If you don't have those [objective social and occupational] disablements, you can't say the person has the condition. … This man has no disablement whatsoever as evidenced by his story of his life since 1978.
…
Dr Dinnen: You are saying he is normal?
Dr Haik: Like it's been for you and me.
Dr Dinnen: So Dr Jenkings who treated him and he psychologist who treated him in Nowra for a year were treating someone who was normal, no different to you and I?
Dr Haik: Well presumably they had not assessed his condition objectively … They have formed the criteria, the subjective criteria and said “Look, he's got it. He has just told us all the criteria”.
Dr Dinnen: … we disagree on that … Where we might agree is that anxiety disorders as a group may be like other psychiatric disorders in general in that there can be fluctuation, all right? So we get someone who has a depressive illness, for example. They can get worse and they can get better … we see patients with anxiety who seem to be getting better … and then seem to get worse, they have a relapse, they have a problem. …
Dr Haik: Yes, stresses
…
Dr Dinnen: … what I am saying in this gentleman … is that this event has affected him through the years in a way that caused him to be aware of irritability, of tension, of drinking, of difficulty in relationships, of a degree of what we might call dysphoria, of episodic feelings of depression. And he says that came about after this accident which was the “most frightening incident of my life”. …
Dr Haik: Well that's what he said but it doesn't necessarily mean that that’s the absolute truth because all of us can contribute reasons for things that happen to us on a variety of causations but that doesn't mean because we believe it, it is necessarily the truth.
Dr Dinnen: All right, so we might have a different view of his veracity. ... If we come back to where we started from, you and I are still at odds as to whether or not PTSD can be present without causing major disability. …
…
Dr Haik: I don't have any evidence that any part of this man's … life has been impaired in any way.
…
Dr Dinnen: … you're saying regardless of what the diagnosis is, there's no evidence that he ever had any impairment, therefore it can’t be PTSD?
Dr Haik: Yes
…
Dr Thorpe: Can I just clarify the situation… Dr Haik you are saying because there's no impairment, it's unlikely he has PTSD?
Dr Haik: Correct
…
Dr Thorpe: … let us move onto … the criteria for diagnosis of PTSD
Dr Dinnen: … Dr Haik does not believe that this was a frightening experience – because it lasted a few seconds.
Dr Haik: Not true. Not true. … It was a frightening experience … but it was like a car accident where you feel shocked but this doesn't last longer than hours or a day or two and maximum a week.
…
Dr Dinnen: And your argument is: it would have only lasted a few seconds, so it could not have been significant?
Dr Haik: Correct
Dr Dinnen: Well we have to disagree on that as well.
Dr Haik: All right.
Dr Dinnen: The other point Dr Haik raised quite appropriately following on remarks I made about the first marriage … I wasn't saying that the PTSD caused the marriage to break down … What I was saying is whatever problems … that he had from the PTSD would have made it more difficult for him to deal with the marriage situation. And the other point about that marriage, Dr Haik suggests that because he married a year after he incident, he must have been okay, I don't think that really can be a serious comment.”
48. Both experts agreed that ongoing emotional baggage would not interfere with the Applicant’s love and his desire to marry. They then continued:
“Dr Haik: … why … didn't [the Applicant] mention [the enormously traumatic event] … to the doctor in 1985?
…
Dr Dinnen: … Isn't it common [in therapy] that matters will surface which are of great significance in explaining their psychiatric problem which weren't evident initially?
Dr Thorpe: Dr Dinnen you said that the … PTSD was present in 1985
Dr Dinnen: Yes, I think so … now whether it's a clinical severity, whether it's mild or moderate at that time, we don't know, but I don't think it was blatant. He was drinking at that time and I believe that there's a continuum from 1977 till today, so that 1985 episode where he was having treatment for depression, I think Dr Haik is quite right that you would have liked him to have explored the relevance of that event on the Melbourne to his emotional state at the time … I say he has a mild ongoing post traumatic stress disorder which causes a mild degree of disability which is reflected in excessive use of alcohol through these years.
…
Dr Haik: … why he was only drinking in 1984 after this problem with his marriage only three or four beers a day which isn't much?
…
Dr Dinnen: I'm not arguing about what alcohol abuse he did or didn't have. What I said was that he used alcohol excessively through the years according to his account.” (Emphasis added)
49. Under cross-examination, Mr Dawson confirmed with Dr Dinnen that in providing a diagnosis of PTSD the Applicant meets the criteria set out in DSMIV and that he similarly meets the criteria set out in the SoP relating to PTSD.
50. Mr Dawson drew Dr Haik's attention to the highlighted section on the page numbered (x111) in the introduction to DSMIV which says ”[T]he specific diagnostic criteria in DSMIV are meant to serve as guidelines to be informed by clinical judgement and are not meant to be used in a cook book fashion” and that the exercise of clinical judgement in the application in the application of DSMIV may justify the giving of a certain diagnosis to an individual even though a clinical presentation may fall just short of meeting the full criteria. Dr Haik agreed with this contention.
51. Mr Dawson stated the first essential criteria for PTSD is that the two sub-clauses of clause A of the criteria to do with the stressor are satisfied, namely:
“Kind of injury, disease or death
…
2(b)(A) the person has been exposed to a traumatic event in which:
(i)the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others; and
(ii) the person’s response involved intense fear,
helplessness, or horror;”
52. Dr Haik considered this to be an objective test and that Criteria F of the SoP concerning PTSD was the objective test:
“(F)the disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning,”
However Dr Haik was corrected by Mr Dawson who stated that there was no objective test to assess whether or not an event was a stressful event. Dr Haik agreed with this contention.
53. Dr Haik under cross-examination expressed the view that it was the duration of the “stressful” event that was important, as were the severe consequences of the event. He gave the example of an automobile accident. Dr Haik’s reference to the length of time in the excerpt of transcript above was in reference to the seriousness of the consequences – that is the drama and events after the motor vehicle accident. In summary, Dr Haik argued that the event experienced by the Applicant and its’ consequences were of very short duration and therefore incompatible with the criteria for stressor in the DSMIV and the SoP. He further submitted that although the Applicant may have imagined he was exposed to a threat or injury there was no real objective evidence.
54. Dr Haik opined that a condition must be disabling in that to have a condition a person cannot function perfectly normally and then ten years later start to become disabled. Dr Haik agreed to Mr Dawson’s reference to a publication by the National Centre for war-related PTSD that symptoms could vary in intensity and fluctuate. Dr Haik also stated that the incident would need to have had “ruined his [the Applicant’s] life” and that the Applicant be “pretty disabled” in order to satisfy the SoP for PTSD. Dr Haik concluded that the Applicant was not very disabled and that he therefore did not have PTSD.
GARP Assessment
55. It was agreed that as Dr Haik had made no psychiatric diagnosis he should not have performed a GARP assessment. Dr Haik agreed that the GARP assessment allows for a range of disablement in relation to psychiatric disorders. Mr Dawson argued that this was at odds with Dr Haik’s view that psychiatric disorders have to be significantly disabling. Dr Haik upheld his view that the criteria set out in DSMIV and also in the SoP provide for a fairly disabled person.
56. In summary Dr Haik's opinion was that PTSD and a low GARP rating are not compatible. He likened it to either having appendicitis or not having appendicitis:
“Or you can't have – I guess you can have mild heart disease , but you still have heart disease and you're disabled by it. When the heart – when the heart inefficiency improves so that you don't have swollen ankles and breathlessness, you don't have heart disease anymore, or sorry, you don't have the symptoms of congestive cardiac failure.”
In his report of 21 April 2003 in support of the need for objective criteria as necessary in making a diagnosis, Dr Haik wrote:
“In psychiatry unbiased evidence of disablement is required before a clear diagnosis is made.”
57. Dr Haik did not consider the Applicant to have an alcohol dependent or abuse problem. He also opined that the Applicant did not have a psychiatric disorder and that for purposes 5(a) of the SoP (which provides for the onset of alcohol dependence or abuse at anytime), this was not relevant. He did not consider the Applicant to have any psychiatric disorder.
58. Mr Marsh questioned Dr Dinnen on the duration of the incident in question and Dr Dinnen said it did not matter whether the fire lasted 30 seconds or 30 minutes, there was no difference in diagnosis. Dr Dinnen opined that the most important aspect of the whole description was the fact that he froze in terror and was, in effect, immobilised and at great risk because he was unable to move.
59. Dr Dinnen also speculated about the disappointment or embarrassment of the Applicant over the fact that he froze during the incident, which generated feelings of shame and humiliation. This was not survivor guilt and Dr Dinnen thought this embarrassment could not be overlooked, in particular in relation to his depressive symptoms associated with PTSD particularly where there was shame and guilt about the individual's response..
Criteria F
60. Mr Marsh asked Dr Dinnen for evidence of criteria F of the SoP relating to PTSD being satisfied.
61. Dr Dinnen stated in support of the Applicant meeting criteria F that he had difficulty coping with his first marriage. Dr Dinnen pointed out that the Applicant felt that his excessive drinking contributed to the breakdown of his first marriage, in that it increased his levels of irritability and made him easily upset, getting him cranky about the slightest things. The excessive drinking reputedly also made contributed to the Applicant’s feeling of restlessness and to his difficulty associating with people who are not servicemen. According to Dr Dinnen, every time the Applicant thinks of the incident he gets a feeling of fright and a sickness in the stomach. The Applicant also has extreme difficulty maintaining his current job working on a boiler which involves having to expose himself to hot coal and ash.
62. Dr Dinnen’s subjective response to the DSMIV was that what are not reflected in DSMIV are the various clinical features of the condition and that DSMIV is a categorisation of clinical features to provide a diagnosis. Dr Dinnen also maintained that DSMIV does not specify that the event has to be experienced in a way that is objectively validated; DSMIV does not differentiate the subjective and the objective.
63. In response to Mr Marsh's inquiry in regards to the Applicant undertaking further painting and cleaning of tanks later in service, Dr Dinnen said it was a common occurrence for the person traumatised to go back to the situation where they were traumatised. Dr Dinnen also opined that if PTSD had been looked for by a psychiatrist in 1997 it would have been found and that when he saw the Naval doctor, Dr Parry for depression (T3, pp 4-14) he actually suffered from PTSD. Dr Dinnen also held that the Applicant had PTSD when he was in the Commonwealth and NSW Police Force.
64. Dr Dinnen’s diagnosis was alcohol abuse rather than alcohol dependence.
Submissions - Applicant
65. The Applicant’s submitted that the test relating to PTSD was a subjective one. Dr Dinnen (Exhibit A1), Dr Jenkings (T6, pp 66-69) and the psychologist Anthony Weaver (Exhibit A2) diagnosed PTSD. Dr Haik rejected a diagnosis of PTSD because he submitted that it required a higher level of symptomatology than exhibited by the Applicant. A finding of PTSD would satisfy the criteria for depression. The Applicant further submitted that he suffered from Alcohol Abuse rather than Alcohol Dependence.
Submissions - Respondent
66. The Respondent considered that the proposition for PTSD and Alcohol Abuse did not support the objective material. It was the Respondent’s position that there must be a severe stressor that requires objective and subjective analysis. Concerning the severity of the stressor Mr Marsh referred to Re Repatriation Commission v Budworth [2000] AATA 127 (a decision of DP McMahon upheld in the Full Federal Court) which stated that the nature of the traumatic stressor envisaged by the authors (of DSMIV) was that of a grave or serious experience. The authors of DSMIV used the term “extreme”. The second requirement envisaged by the authors of DSMIV was that the stressor have an objective existence.
67. Mr Marsh also referred to Stoddart v Repatriation Commission [2003] FCA 334, a recent decision by Mansfield J on 17 April 2003 which is currently on appeal.
68. Mr Marsh looked at criterion B of the SoP relating to PTSD which pertains to the re-experiencing of the event:
“(B)the traumatic event is persistently re-experienced in one or more of the following ways:
(i)recurrent and intrusive thoughts distressing recollections of the event, including images, thoughts, or perceptions;
(ii)recurrent distressing dreams of the event;
(iii)acting or feeling as if the traumatic event were recurring (including a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated);
(iv)intense psychological distress at exposure to internal or external cues that symbolise or resemble an aspect of the traumatic event; and”
Mr Marsh did not consider that any of the above specified criteria were met. In terms of avoidance, as per criteria C of the SoP relating to PTSD, it was the Respondent’s position that the necessary number of three of those criteria were absent:
“(C)persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three or more of the following:
(i)efforts to avoid thoughts, feelings, or conversations associated with trauma;
(ii)efforts to avoid activities, places, or people that arouse recollections of the trauma;
(iii)inability to recall an important aspect of the trauma;
(iv)markedly diminished interest or participation in significant activities;
(v)feeling of detachment or estrangement from others;
(vi)restricted range of affect (eg, does not expect to have a career, marriage, children, or a normal life span); and”
Criterion F (extracted earlier in this decision) specifies that the disturbance causes “clinically significant distress or impairment in social, occupational or other important areas of functioning”. The respondent relied on the opinions of Dr Haik in relation to this criterion.
69. Mr. Marsh's submission was that if criterion A was met (extracted earlier in this decision), it follows that criteria B to F also have to be satisfied:
Findings and Consideration
70. The main issue raised was whether the Applicant actually suffered PTSD. Dr Jenkins who saw him in 2000 thought so and sent him to a psychologist for ongoing therapy. Dr Dinnen is also of the belief that the Applicant suffered from PTSD. Dr Haik who consulted the Applicant on behalf of the Respondent opined that the Applicant did not have PTSD. It was submitted on the part of the Applicant that the diagnosis could be made on the evidence of Drs Jenkins Dinnen. Mr Marsh opined that to make the diagnosis it must satisfy the SoPs. A difficulty for the Tribunal was that on the evidence of Dr Dinnen the applicant was suffering PTSD in a mild or moderate form only. Dr Haik had difficulty accepting that the PTSD could be present in a mild form and still satisfy the SoP.
71. In Repatriation Commission v Cooke (1998) 160 ALR 17 it was held that the standard of proof to be applied in determining whether a disease was war caused is set out in section 120 of the Act. Before applying the appropriate subsection, it was held necessary to determine whether or not the disease, which is the subject of the claim, actually exists. Such a determination is to be made on the balance of probabilities.
72. The Tribunal has identified to its reasonable satisfaction the collection of relevant symptoms from which the Applicant suffers to constitute the PTSD, which the Tribunal finds the Applicant contracted. The Tribunal is also satisfied that the PTSD is present in the Applicant in a mild to moderate form. The Tribunal had difficulty with Dr Haik's opinion that in order to make diagnoses of PTSD or anxiety disorder or schizophrenia they must be disabling disorders. The Tribunal had difficulty accepting Dr Haik's evidence in cross-examination wherein he stated:
“You can't have mild appendicitis. You've got appendicitis. Or you can't have – I guess you can have mild heart disease, but you still have heart disease and you're disabled by it. … When the heart inefficiency improves so that you don't have swollen ankles … you don't have heart disease or sorry, you don't have symptoms of congestive cardiac failure.”
73.The Tribunal interprets the evidence of Dr Haik to mean that in order to satisfy the SoP for PTSD the condition must be disabling. In fact the Tribunal interprets Dr Haik’s statements to mean that in order to satisfy a SoP for any disease or other medical condition it must be disabling. It would be a novel medical argument to say that you cannot have a medical condition just because you have no disablement. The Tribunal has difficulty with Dr Haik's requirement that objective criteria should be present when making a diagnosis in medicine.. The Tribunal refers to Lees v Repatriation Commission [2002] FCAFC 398 where the Full Court quoted ReRobertson and Repatriation Commission (1998) 50 ALD 668 which held that “clinical onset” occurs:
“either when a person becomes aware of some features or symptoms which enables a doctor to say the disease was present at that time, or when a finding is made on investigation which is indicative to a doctor of the disease being present.”
74. The Tribunal does however accept that in order to satisfy the SoP for PTSD, the requirements of the SoP must be met. It was assumed that the medical experts reached their respective conclusions based on their observations of the Applicant, his history and their expertise. It was also assumed they had regard to DSMIV. But the existence of PTSD, whether as diagnosed or found as a fact by reference to the SoPs, will not alone be sufficient for a finding of PTSD. The Applicant must, by reason of Factor 5(a) of the SoP for PTSD establish that he experienced “a stressor prior to the clinical onset of PTSD.” ”Experiencing a stressor” is therefore a precondition for a finding of PTSD, which must have occurred before the clinical onset of PTSD. The diagnostic criteria of DSMIV does not mandate this: Re Cranage v Repatriation Commission (2000) 63 ALD 312.
Whether an Applicant has PTSD must eventually be a question of fact. It will be determined by reference to the evidence of the treating doctors and whether the criteria found within the SoPs has been satisfied. There are two aspects to the relevant SoP: first, an assessment of the subjective test, and second an objective test as to whether a stressful event occurred.
75. For the purposes of the SoPs “post traumatic stress disorder” means a psychiatric condition meeting the following description (derived from the DSMIV):
“(A) the person has been exposed to a traumatic event in which:
(i)the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others; and
(ii) the person’s response involved intense fear, helplessness, or horror;”
76. The evidence was that there was an incident, which involved a fire. The Applicant's reaction to this was that he froze and he was in fear of his life. The Tribunal accepted the evidence of Dr Dinnen that the Applicant’s response to the traumatic event of intense fear and helplessness satisfies the requirements of 2(b)A(ii) of the SoP for PTSD.
77. There is no requirement in the SoP for PTSD concerning the duration of the event and the Tribunal was not persuaded by Dr Haik's opinion that an event of such short duration was insufficient to meet the criteria for PTSD.
78. It was open to the Tribunal to find that if held that the subjective test was satisfied, the “objective test” found in 2(b)A(i) of the SoP concerning PTSD followed: Stoddart (supra). The alternative, as submitted by the Respondent, was that Budworth (supra) applied with a requirement that both the objective and subjective requirements of the test are satisfied.
79. There was evidence before the Tribunal that Mr Brook experienced an event that involved threatened death or injury or a threat of physical integrity to himself. There was unrefuted evidence that there was a fire in the tank. It is undisputed that the paint rollers were on fire in the tank. At the time of the fire, the Applicant froze in fear inside the tank. The fear was that the tank would catch fire and explode.
80. The fact the tank did not explode or catch fire does not negate the Applicant’s fear. The evidence obtained by Writeway Research from Mr Matthews concerning “Coraline Black” was that the fumes from the paint might well explode and the severity of the explosion would depend upon the density of the fumes in the tank (Exhibit R4). The Tribunal was satisfied that there was a real and objective event where the Applicant was in danger of death and/or physical injury. The Tribunal agreed with the evidence of Dr Dinnen that the real threat of ignition and explosion in the tank cannot be discounted simply because it did not occur. As stated by Dr Dinner by way of illustration, if a pistol is held to a person’s head, does it matter if is loaded or if it is not loaded; that person would not know at the time.
81. It was then for the Tribunal to examine whether the Applicant satisfied the Does Mr Brook satisfy factors 2(b)(B),(C),(D), (E) and (F) of the SoP relating to PTSD.
2(b)(B) of the SoP relating to PTSD
82. The Respondent did not consider that any of the criteria of factor 2(b)(B)(I)-(v) were met by the Applicant. Dr Jenkings reported that the Applicant had recurring thoughts about the episode and that after it he began to drink much more to try to forget it (Exhibit T6). Dr Dinnen reported that the Applicant reported when the incident happened that he experienced a feeling of “fright” that “always comes back” and “makes you feel sick in the stomach”.. Dr Dinnen gave evidence that the Applicant has this feeling every time he thinks of the incident. Dr Dinnen also reported that every time hot coals explode at the Applicant’s current place of work, the original incident comes back to him. And apart from these recurrent experiences, memories also come back at times for no apparent reason. Mr Weaver reported intense free-floating fear and panic sensations lasting up to 24 hours (Exhibit A2).
83. The Respondent submitted that the Applicant continued to serve in the Navy for a further ten years after the incident without apparent difficulties. The Respondent also stated that when the Applicant sought medical attention in 1985, his primary concerns were with his domestic situation and not with any previous fire. The Respondent also pointed out that the Applicant did further tank cleaning in the Navy after the incident.
Factor 2(b)(C) of the SoP relating to PTSD
84. There was ample evidence that the Applicant used alcohol to avoid thoughts associated with the trauma. Dr Haik reported that the Applicant and his wife have little social life together. They are not invited to other people's houses nor do they invite others over to their house. Dr Haik also reported that the Applicant drinks heavily on Friday evenings at the Nowra Bowling Club and that this forms his only social outlet. The Applicant has no hobbies and simply potters around the house. His only friends are his ex-Navy mates, some three or four in number, who he meets on Friday nights at the Nowra Bowling Club when he is not rostered to work. On other occasions he binge drinks alone.
Factor 2(b)(D) of the SoP relating to PTSD
85. The Applicant described himself as prone to irritability and outbursts of anger. Dr Jenkings considered prescribing one of the SSRI group of drugs for his angry outbursts (T6). Dr Jenkings also describes hyperarousal with emotional dysregulation and agitation. Mr Weaver reported that the Applicant experienced intrusive recall of the incident causing sleep disturbance (Exhibit A2).
Factor 2(b)(F) of the SoP relating to PTSD
86. In his report of 21 April 2003 (Exhibit R6), Dr Haik reported:
“Posttraumatic Stress Disorder is a disabling condition as noted in SoP 54 of 1999 and 3 of 1999. So that objectivity can be established, Criterion (F) must be met. …
Because Mr Brook was unable to demonstrate that he has these objective criteria, one was unable to make a diagnosis of PTSD.”
On factor 2(b)(F) of the SoP relating to PTSD, Dr Haik opined that this factor requires:
“… that the disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning.”
87. The Tribunal noted that the Applicant uses alcohol to self medicate and although he has moderated his alcohol in recent times he still has a “bender” each two weeks or so and this has led to some secondary family problems. The Applicant’s only friends are ex-Navy friends and he and his wife do not socialise. Dr Jenkings noted that he is still having problems at home with hyperarousal and argumentativeness with his wife and there was also quite an episode at work (T6). Mr Weaver also noted anger outbursts disrupting employment (Exhibit A2). The Applicant’s representatives debated the Respondent’s submission that the Applicant had had a consistent work history. The Applicant stated that he was in current employment and had been in employment since he left the Navy, conceding that he had had six different jobs in the past ten years. The Applicant stated that remained in his current employment because there was no other job available in the area.
88. The Tribunal noted that Dr Haik was of the opinion that the PTSD was to be a “disabling condition” in order to be established. Both Dr Jenkings and Dr Dinnen gave the Applicant a moderate GARP impairment rating of 19. Mr McCombe (a representative of the Applicant) pointed to “a stack of decisions made by the Department where they provided low impairment points for accepted conditions of PTSD.” He also stated that there can be impairment on the part of an applicant and yet the person remains in the workforce.
89. The Tribunal is satisfied that factors 2(b)(B) through (F) are met. Therefore the Applicant meets all the requirements to satisfy the SoP No.4 of 1999 for Post Traumatic Stress Disorder. The Tribunal accepts that the PTSD is only of mild to moderate severity in the Applicant. The Tribunal holds that there was no requirement to find the PTSD to be a disabling condition.
Alcohol
90. The question for the Tribunal was whether the Applicant could be diagnosed with Alcohol Abuse or Alcohol Dependence as per the diagnostic criteria specified in SoP 77 of 1998 (DSMIV). Dr Jenkings was alone in his diagnosis of Alcohol Dependence (T6). Dr Dinnen said the Applicant satisfied the requirements for Alcohol Abuse and Dr Haik opined that he did not.
91. The diagnostic criteria for alcohol abuse is found in factor 2(b)(A) of the SoP 77 of 1998 is as follows:
“A maladaptive pattern of alcohol use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period …”
92. The evidence before the Tribunal was that recurrent alcohol use on the part of the Applicant resulted in a failure to fulfil major role obligations at home, thus satisfying criteria A(1) of factor 2(b) of the SoP 77 of 1998. The Applicant continued alcohol use despite persistent social or interpersonal problems caused or exacerbated by the effects of alcohol (satisfying the criteria in A(4) within the 12-month period). The Tribunal also noted that there has been a significant improvement in the Applicant’s alcohol abuse during recent times.
93. The “stressor” relevant on the balance of probabilities connecting alcohol abuse to the Applicant’s relevant service is factor 5(b) of the SoP 77 of 1998, which namely entails experiencing a severe stressor within the one year immediately before the clinical onset of alcohol dependence or alcohol abuse. This was essentially the same stressor as for PTSD that was satisfied by the Applicant. It followed that the Applicant satisfied the criteria for Alcohol Abuse, provided the one year requirement was satisfied. Alternatively or in addition, factor 5.(a) would apply if it were found that the Applicant was suffering a psychiatric disorder at the time of the clinical onset of alcohol abuse. As the Tribunal has accepted that a psychiatric condition PTSD was present at the time of the clinical onset of the alcohol abuse, factor 5(a) does apply.
94. The Tribunal was satisfied that the Applicant suffered from alcohol abuse and that he met the requirement of the relevant SoP including the 12 month requirement. It was open to the Tribunal to decide that the Applicant’s alcohol abuse was part of his PTSD, but ultimately held that he did satisfy the SoP 77 of 1998 for Alcohol Abuse. In terms of an impairment assessment under Chapter 4 of the GARP, taken with the impairment for PTSD it is unlikely to make a significant difference to such an outcome. The Tribunal on balance was not satisfied the Applicant fulfilled the requirements for Alcohol Dependence.
Depression
95. Dr Dinnen considered depression to be part of the Applicant’s PTSD. Dr Haik considered the Applicant’s depression to be a reactive depression as a result of relationship problems. Dr Parry had treated Mr Brook, apparently successfully, for a bout of depression in 1985 (T3). Neither party addressed the relevant SoPs for depressive disorders, instruments 58 and 59 of 1998, and the Tribunal did not make a finding for depressive disorder.
Decision
96. The decision under review is set aside and the Tribunal substitutes its own decision that the Applicant, Mr Brook, suffers Post Traumatic Stress Disorder and Alcohol Abuse. Both conditions were acquired during his period of eligible defence service. The earliest date of effect is 13 January 2000. The matter is remitted to the Department of Veterans Affairs for assessment.
I certify that the 96 preceding paragraphs are a true copy of the reasons for the decision herein of Dr M.E.C. Thorpe, Member
Signed: L Bonouvrie
AssociateDate/s of Hearing 29 April 2003
Date of Decision 30 June 2003
Counsel for the Applicant Mr Neil Dawson
Solicitor for the Applicant Mr Tim McCombe
Solicitor for the Respondent Mr Jim Marsh
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