Coleman and Repatriation Commission (Veterans’ entitlements)

[2015] AATA 757

Coleman and Repatriation Commission (Veterans’ entitlements) [2015] AATA 757 (28 September 2015)

Division	VETERANS' APPEALS DIVISION
File Number(s)	2014/0609
Re	Valma Coleman
APPLICANT
And	Repatriation Commission
RESPONDENT

DECISION

Tribunal	Ms G Ettinger, Senior Member
Date	28 September 2015
Place	Sydney

The Tribunal sets aside the decision under review and in substitution finds that Mr Coleman’s death was war-caused. Accordingly Mrs Coleman is eligible to receive a war widow’s pension.

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Ms G Ettinger, Senior Member

CATCHWORDS

Veterans’ entitlements – claim for widow’s pension – operational service – kind of death – hypertension – salt intake – reasonable hypothesis – decision under review set aside – death of Veteran was war-caused

LEGISLATION

Veterans’ Entitlements Act 1986 ss 8, 13, 120, 120A

CASES

Bull v Repatriation Commission (2001) 66 ALD 271

Deledio v Repatriation Commission (1997) 47 ALD 261
East v Repatriation Commission (1987) 16 FCR 517
Repatriation Commission v Bey (1997) 79 FCR 364
Repatriation Commission v Deledio (1998) 83 FCR 82
Collins v Repatriation Commission (2009) 177 FCR 280

SECONDARY MATERIALS

Statements of Principles:

No.89 of 2007, Ischaemic Heart Disease

No.63 of 2013, Hypertension

REASONS FOR DECISION

Ms G Ettinger, Senior Member

28 September 2015

SUMMARY

1. Mrs Valma Coleman, who is 88 years old is the Applicant before the Tribunal claiming a widow’s pension to which she says she is entitled because her late husband, the Veteran, Mr Harry Coleman, served on operational service and his death was war-caused. He served in the Royal Australian Navy, (the Navy), from 30 November 1942 to 1 April 1946. Mr Coleman died on 25 December 2012 aged 88, and Mrs Coleman subsequently made a claim for a widow’s pension on 1 March 2013.

2. The Repatriation Commission determined that the death of the Veteran was not war-caused. Mrs Coleman applied to the Veterans’ Review Board (the VRB), for a review of that decision, and on 26 November 2013 the VRB affirmed the decision of the delegate of the Commission.

3. Mrs Coleman has exercised her rights to appeal to this Tribunal. She gave evidence by telephone, and remained on the line for the full hearing which was conducted over two days. She is a credible witness, and I am satisfied that when she gave evidence she told it as it was. I note without making any adverse findings about it, that she made an error in nominating 1968 as the onset of her husband’s hypertension citing the occasion when he was admitted to Royal Prince Alfred Hospital (RPAH) with a blood pressure reading of 240/140, when it was in fact indicated in the documents before the Tribunal that the hospital admission was in 1976.

4. Other family members also gave evidence by telephone. They were, Pamela Godden, Ronald Coleman, and Kathleen Coleman. Their statements are before the Tribunal. There was also the statement of Major Ian Hawke RAInf Retd of Writeway Research Service Pty Ltd, as Exhibit A6, William Barlow, a colleague of Mr Coleman as Exhibit A2, salt samples as Exhibit A8, the report of Dr Dianne Volker, a nutrition scientist as Exhibit A7, the report of Professor Michael O’Rourke, a cardiologist as Exhibit R2, and a file note documenting a conversation with Mr Coleman’s 99 year old aunt, Margery McKenzie, Exhibit A9.

5. Mr T Saunders of counsel represented Mrs Coleman and Mr T O’Reilly appeared for the Repatriation Commission.

6. I have considered the evidence and submissions, and the application of sections 120 and 120A of the Veterans’ Entitlements Act 1986, (the Act), and am satisfied that the death of Mr Coleman was war-caused. I have accordingly set aside the decision under review, and find that Mrs Coleman is eligible for the widow’s pension. My reasons follow.

   ISSUE BEFORE THE TRIBUNAL

7. The Tribunal has to decide whether Mr Coleman’s death was war-caused pursuant to section 8(1) of the Veterans’ Entitlements Act 1986 (the Act).

8. This involves a decision regarding the kind of death pursuant to the standard of proof in section 120(4) of the Act, and a consideration of whether there is a reasonable hypothesis connecting the death of Veteran with his war service (section 120 of the Act).

   LEGISLATION

9. The relevant legislation in this matter is the Veterans’ Entitlements Act 1986, in particular sections 8, 13(1), and 120.

10. Section 8 of the Act sets out the circumstances under which an injury or disease is taken to be war-caused. It can be found to be war-caused if, amongst other things, the veteran’s death resulted from an occurrence that happened while the veteran was rendering operational service; the death arose out of, or was attributable to his eligible war service; or the veteran’s death was due to a disease that he would not have contracted, but for his having rendered eligible war service.

11. Where a veteran’s death is war-caused, a pension is payable by way of compensation to the widow or other relevant dependent (section 13(1) of the Act).

12. The Repatriation Medical Authority (RMA) provides that if there is sound medical-scientific evidence indicating that a condition can be related to a veteran’s service, the RMA must determine a Statement of Principles (SoP) (section 196B of the Act) in respect of that condition. The SoP sets out the factors, one of which as a minimum must exist, (and which must be related to the Veteran’s service), before it can be said that a reasonable hypothesis has been raised connecting the condition with that service.

13. The relevant SoPs in this matter are Instrument No. 63 of 2013 concerning Hypertension, and Instrument No. 89 of 2007 concerning Ischaemic Heart Disease. None of the amendments to the Instruments are material to the claim before us.

14. The date of effect in this matter, should the Applicant be successful, is 26 December 2012.

15. The Veteran served in the Royal Australian Navy (the Navy), from 30 November 1942 to 1 April 1946. This service is recognised as operational service, and thus eligible war service (section 7 of the Act).

16. As Mr Coleman served on operational service, the determination of whether his death was war-caused must include the application of sections 120(1) and 120(3) of the Act. The kind of death is dealt with pursuant to section 120(4) of the Act, the standard of proof being to the reasonable satisfaction of the Tribunal, or on the balance of probabilities.

    EVIDENCE AND CONSIDERATION

    Mrs Valma Coleman, the Applicant & widow of Mr Harry Coleman

17. Mrs Coleman provided a statement dated 16 April 2014, and gave oral evidence by telephone. She told me that she first met her husband in August 1950, a couple of years following his return from service. Over the next two years they would see each other approximately once a week or fortnight when he was on leave from his ship. In that time, she said that he was always using salt. She said that his body craved it. They married in 1952, and there always had to be salt on the table. Mrs Coleman said that her husband did not speak much about the diet on the ship on which he served. She said that she did all the cooking at their home. There was a salt canister on the side of the stove for cooking purposes, but in addition, her husband sprinkled salt on everything, to the extent it even went on the tablecloth. 

18. Mrs Coleman described the eight inch silver salt shaker with the base the size of a 50 cent piece, which was always on the table, and was refilled approximately once a week. Notwithstanding extensive cross-examination by Mr O’Reilly, she maintained her position regarding the silver salt shaker, and walked away from the telephone in order to get it and make her point. She described a matching pepper shaker which was not used much she said. Mrs Coleman said that both she and her children confronted Mr Coleman many times with regard to his salt consumption, but that he told her he had to have it.

19. Mrs Coleman said that from 1968 (which factually has been shown to be 1976), when Mr Coleman was admitted to RPAH, and found to have kidney problems, her husband always had very high blood pressure.

20. She also said that he had check-ups every 12 months in connection with his job at the railways. Mrs Coleman said that her husband was very unhappy because there was no salt available while he was at RPAH, and he accordingly, would not eat anything.  She said that he told her he did not like the taste of food without salt.

21. She said that he was very dedicated to the Veterans Association and followed meetings round Australia. She said that: The Navy was everything to him.

    Mr William Barlow, a wartime colleague

22. Mr Barlow served on HMAS Lithgow with Mr Coleman, and indicated that with a crew of 90, everyone knew each other. He provided a statement and oral evidence. He said that following discharge from the Navy he lived in Melbourne and saw the Veteran at reunions once or twice a year.

23. Mr Barlow described the salt consumption on the Lithgow, noting that the sick bay attendant handed out salt tablets at meal times. He detailed that each seaman was given one salt tablet a day with Attebrin, an antimalarial medication. Engine room personnel and cooks who worked in areas of great heat, neither of which described Mr

    
    

    Coleman’s work, were given a second salt tablet. Extra salt tablets were available on request. Mr Barlow was not able to say how much salt was in a salt tablet. He said that he no longer uses salt, and attributed his heart by-pass surgery to the excessive consumption of salt which commenced during his time at the Navy.

    Mrs Pamela Godden, the Colemans’ daughter

24. Mrs Godden who is the Colemans’ daughter, provided a statement and oral evidence. She told me that she left home aged 17 to join the Navy, but lived at home at various times. Otherwise she visited her parents’ home when on holidays.

25. Mrs Godden’s recollection of her father’s salt consumption was that there was always salt at his end of the table, and that he would use it heavily. She said that there was a number of salt shakers in use in her parents’ home, and she remembered in particular one which was orange plastic, and had large holes.

26. Mrs Godden said that the family was always trying to get Mr Coleman to reduce his salt intake. She said that he would put salt on everything, and liked heavily processed salty food such as sardines, and white bread. She described him putting salt on a boiled egg between mouthfuls, even though it was at 4:00 am before he left for work. She said that he put salt on tomato sandwiches, and even added salt to porridge. Dinner was always a standard Australian dinner of the time, being meat and three vegetables, to which her father always added salt, she said.

    Mr Ronald Coleman, the Veteran’s son

27. Mr Coleman who is now 60 years old, said that he left home some 39 years ago, and was only at home on holidays now and then. He provided a statement and oral evidence. His earliest recollection of his father’s salt consumption was eggs for breakfast with salt, salad with pepper and salt, salty pickles, fish and chips, and Sao biscuits with tomato, cheese and salt. Mr Coleman said that he recalled a variety of different tupperware salt shakers which were in the cupboard, and used on the table.

28. Mr Coleman said that he did not try to stop his father from having salt. He recalled his father being hospitalised for hypertension at a time when his parents were about to go on holidays to the USA about forty years ago.

    Kathleen Coleman, daughter-in-law of the Coleman’s

29. Mrs Coleman said that she first met her father-in-law in 1975, and had been in close contact ever since, as she and her husband, Ronald Coleman, first lived with his parents, and then moved only 20 houses away. She corroborated the evidence previously given by other witnesses of Mr Coleman senior putting large quantities of salt on his eggs. She said that at meals he would not even taste the food first, but added salt to everything.

30. Mrs Coleman explained that later she and her husband moved further away, but that when her father-in-law came to her place, she observed him continue to add salt to everything. She stated that towards the end of his life he was putting even more salt on his food than before because he could not see how much he was using.

    Margery McKenzie, Mr Coleman’s aunt

31. Mrs McKenzie who is 99 years old provided a statement to a paralegal which was provided to the Tribunal in the form of a file note. She stated therein that before the War, the Colemans had a salt shaker on the table, but did not use salt much except for a little bit on vegetables. She provided information that Mr Coleman was a gunner during the War, but did not discuss it much afterwards. She said that he would sprinkle some salt on his food, but that she did not notice a change in that habit from before, to after the War. I noted that she had never lived in the same house as Mr Coleman.

    Major Ian Hawke RAInf Retd

32. Major Hawke provided a report dated 12 May 2014 with regard to Mr Coleman’s service in the Navy, and specifically with regard to the 22 months he spent in hot tropical environments aboard HMAS Lithgow during World War II. Major Hawke stated that during that time the daily entitlement to salt was 14 grams per person which was used in the cooking of meals and in garnishing food. He cited the official history of Australia in World War II, and described the salt consumption by sailors. Those in the engine room were called upon to consume salt tablets twice a day, he said. Others like Mr Coleman took one salt tablet (1.5 grams) a day, translating into a normal minimum salt intake of 15.5 grams per day over a period of 22 months.

    APPLICATION OF THE LAW

    Kind of death

33. Mr Coleman died on 25 December 2012.

34. The cause of death indicated on the death certificate was:

    (1)       (a) Congestive cardiac failure, weeks

    (b) Ischaemic heart disease, years

    (c) Atrial fibrillation, years

    (d) Chronic renal failure, years

    (2)       Acute on chronic renal failure.

35. The Applicant relies on the opinion of Dr Volker who opined in her report (Exhibit A7), that the Veteran died as a result of congestive cardiac failure and acute on chronic renal failure, as well as chronic ischaemic heart disease. Dr Volker’s opinion was that the common risk factor for these conditions is hypertension.

36. The Respondent on the other hand, relied upon the Death Certificate, and the clinical notes of Dr Park, as well as the report of Professor O’Rourke (Exhibit R2). The Respondent contends that the kind of death suffered by the Veteran was death from ischaemic heart disease, congestive heart failure and acute on chronic renal failure.

37. I am mindful that Professor O’Rourke AM, MD DSc FRACP FACC FESC FRCPI (Hon) has been a cardiologist for over forty years, and is Professor of Medicine at the University of NSW.  Professor O’Rourke opined that Mr Coleman died from chronic congestive cardiac failure, ischaemic heart disease, and acute on chronic renal failure at the age of 88. Professor O’Rourke opined also that Mr Coleman had chronic renal insufficiency which contributed to hypertension, and which remained reasonably well controlled until the last days of his life. Professor O’Rourke commented that age was a major factor in Mr Coleman’s death, adding that had he been in relatively good health, active, and not in hospital, his expectation of life would have been approximately another five years.

38. I noted Dr Volker’s opinion that the common risk factor for Mr Coleman’s conditions is hypertension. In commenting on that statement, Professor O’Rourke noted that Dr Volker is not trained or qualified in medicine. As to her reliance on the one reading of blood pressure being 120/90 for Mr Coleman in 1946; Professor O’Rourke opined that could not be construed by a medical practitioner as evidence of hypertension at that time. Professor O’Rourke stated that when blood pressure is taken on a number of occasions, far more often than not, the second, third and subsequent readings are lower than the initial recording. He added that multiple readings of blood pressure are only taken where there is concern about an original reading. He concluded that given there was no follow-up, there was no further concern following the initial measurement of 120/90 for Mr Coleman in 1946.

39. In coming to a decision regarding the kind of death in relation to Mr Coleman, I am mindful that the kind of death is the medical cause of death (Collins v Repatriation Commission [2009] FCAFC 90).  

40. I prefer the opinion of Professor O’Rourke to that of Dr Volker in regard to the kind of death Mr Coleman suffered. I note she is a prominent nutrition scientist with a PhD from Newcastle University who also holds an Honours Degree in Nutrition and Dietetics, and has held an appointment at the Human Nutrition Unit at Sydney University.  I base my decision however, on Professor O’Rourke’s experience as a cardiologist with many years of experience, and his evidence with regard to hypertension, as well as the earliest measurement we have of Mr Coleman’s blood pressure in 1946 which Professor O’Rourke considered not to have indicated that Mr Coleman suffered hypertension.

41. I am satisfied to conclude that the kind of death Mr Coleman suffered was death from ischaemic heart disease, congestive heart failure and acute on chronic renal failure.

    Repatriation Commission v Deledio (1998) 83 FCR 82

42. Because Mr Coleman served on operational service, in order to decide the matter, I must apply the tests as explained in Repatriation Commission v Deledio (1998) 83 FCR 82 [97] as follows:

    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). …

    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.

    The hypothesis

43. The hypothesis raised in this matter by the Applicant is that Mr Coleman consumed excessive amounts of salt during his service for a period of more than six months, which caused or contributed to the development of hypertension in approximately 1946, and that the hypertension caused or contributed to the development of ischaemic heart disease that caused the Veteran’s death.

44. The hypothesis raised by the Applicant, in the alternative, is that during his time on service, he developed a habit of consuming excessive amounts of salt that continued throughout his life. That was hypothesised to have caused the hypertension which caused or contributed to the development of ischaemic heart disease which caused the Veteran’s death.

1. I am satisfied there is material pointing in particular to the Applicant’s alternative hypothesis, as noted below.

2. Mrs Coleman told me she met the Veteran in August 1950, a couple of years following his return from service. Over the next two years, until they married in 1952, they would see each other approximately once a week or fortnight when he was on leave from his ship. She said that he was always using salt, and his body craved it (because he had been used to having it on the ship). She said that in their home there always had to be salt on the table. There was a salt canister on the side of the stove for cooking purposes, but in addition, her husband sprinkled salt on everything to the extent it even went on the tablecloth.  Mrs Coleman said that both she and her children confronted Mr Coleman many times with regard to his salt consumption, but that he told her he had to have it.

3. Mrs Coleman said that from 1968 (which factually has been shown to have been 1976), when the Veteran was admitted to RPAH, and found to have kidney problems, her husband always had very high blood pressure. Mrs Coleman told me that her husband was very unhappy because there was no salt available in hospital, and he accordingly, would not eat anything.  He told her that he did not like the taste of food without salt.

4. Major Ian Hawke stated that the food provided to Navy personnel such as Mr Coleman serving on HMAS Lithgow in hot tropical environments during WWII, included excessive amounts of salt, and salt supplements. He indicated that the daily entitlement to salt was 14 grams per person which was used in the cooking of meals and in garnishing food. Sailors in the engine room were called upon to consume salt tablets twice a day, he said. Others like Mr Coleman took one salt tablet (1.5 grams) a day, translating into a normal minimum salt intake of 15.5 grams per day over a period of 22 months.

5. Mr Barlow served on HMAS Lithgow with Mr Coleman, and described the salt consumption on the Lithgow which was that the sick bay attendant handed out salt tablets at meal times. He detailed that each seaman was given one salt tablet a day with Attebrin, an antimalarial medication. Engine room personnel and cooks who worked in areas of great heat, were given a second salt tablet. Extra salt tablets were available on request. Mr Barlow believes that his salt consumption led to him suffering hypertension and bypass surgery. He said that he no longer uses salt.

6. Mrs Godden who is the Colemans’ daughter, told me that her recollection of her father’s salt consumption was that there was always salt at his end of the table, and that he would use it heavily. She described him putting it on a boiled egg between mouthfuls even it was at 4:00 am before he left for work, putting salt on tomato sandwiches, and even adding salt to porridge. Dinner was always a standard Australian dinner of the time, being meat and three vegetables to which her father always added salt, she said. Mrs Godden said that the family was always trying to get Mr Coleman to reduce his salt intake.

7. Mr Ronald Coleman, the Veteran’s son who is now 60 years old, said that he left home some 39 years ago, and was only at home on holidays now and then. His earliest recollections of his father’s salt consumption were eggs for breakfast with salt, salad with pepper and salt, salty pickles, and Sao biscuits with tomato, cheese and salt. Mr Coleman said that he did not try to stop his father from having salt. He recalled his father being hospitalised for hypertension at a time when his parents were about to go on holidays to the USA.

8. Mrs Kathleen Coleman, wife of Ronald Coleman said that she first met her father-in-law in 1975, and had been in close contact ever since as she and her husband, Ronald Coleman, first lived with his parents, and then moved only 20 houses away. She corroborated the evidence that Mr Coleman senior put large quantities of salt on his eggs. She said that at meals he would not even taste the food first, but added salt to everything.

9. Margery McKenzie, Mr Coleman’s aunt, who is 99 years old, stated in the file note taken of a conversation with her, that Mr Coleman would sprinkle salt on his food both before and after the war.

10. Dr Volker raised the hypothesis that excessive salt, amongst other factors such as smoking, alcohol, obesity and others, are risk factors for hypertension. She commented on the humid conditions on ships such as the one on which Mr Coleman served, on which salt rations were recommended, and provided at the relevant time. She considered that the Veteran continued to ingest excessive amounts of salt after service because he had developed a taste for it.

11. Professor O’Rourke noted that there was no suggestion in Dr Harris’ letters to Dr Park that he or Dr Horvath considered that heavy salt intake or war service was a factor in Mr Coleman’s episodes of elevated blood pressure.

    Clinical Onset

12. The earliest blood pressure reading for Mr Coleman which is before me, was in 1946 on discharge from the Navy, and was 120/90.

13. Professor O’Rourke opined that hypertension was not apparent in Mr Coleman until 1976, and that the single recording of blood pressure of 120/90 available in 1946 could not be construed by a medical practitioner as evidence of hypertension at that time. He stated that when blood pressure is taken on a number of occasions, far more often than not, the second, third and subsequent blood pressure recordings are lower than the initial recording. Multiple recordings of blood pressure are only taken when there is concern about the original level, and no concern was apparent with respect to the recording taken in 1946.

14. Professor O’Rourke also stated that he was guided by the report of Dr Park dated 30 September 2013 that the onset of ischaemic heart disease was 4 October 2012. Onset of hypertension was in 1976 when the Veteran was investigated thoroughly at RPAH under the supervision of Dr John Horvath, when no cause for hypertension was established. He noted that the condition then came under control with medical therapy.

15. Dr Volker confirmed in her report the demobilisation blood pressure reading of 120/90 which Mr Coleman had in 1946. She stated that suggested an early indication of the left diastolic ventricular dysfunction that became apparent at the end of his life. She concurred that the available clinical notes suggest Dr Horvath at RPAH made the initial diagnosis of severe hypertension being 240/140 mmHg in 1976.

    Application of the SoPs

16. I am satisfied there is material pointing to the alternative hypothesis raised by the Applicant, that during service Mr Coleman developed a habit of consuming excessive amounts of salt that continued throughout his life, causing the hypertension which caused or contributed to the development of ischaemic heart disease leading to the Veteran’s death.

17. There are SoPs in force, relevantly No.63 of 2013 for Hypertension, and No. 89 of 2007 for Ischaemic Heart Disease. I must form an opinion whether the hypotheses raised are reasonable. They will be reasonable if the hypothesis fits, that is to say, is consistent with the template to be found in the SoP. The hypotheses raised 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 hypotheses do contain these factors, they could neither be said to be contrary to proved or known scientific facts, nor otherwise fanciful. If the hypotheses fail to fit within the template, they will be deemed not to be reasonable, and the claim will fail. (Deledio v Repatriation Commission (1997) 47 ALD 261 and East v Repatriation Commission (1987) 16 FCR 517).

18. In regard to SoP No.63 of 2013, hypertension is defined to mean persistently elevated blood pressure diagnosed by a medical practitioner and evidenced by:

    (i) a usual clinic blood pressure reading of greater than or equal to 140 mmHg systolic or greater than or equal to 90 mmHg diastolic, or equivalent levels using ambulatory blood pressure measurement; …

19. The factor that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting hypertension or death from hypertension with the circumstances of a person’s relevant service is: Factor 6.(c) – consuming at least 12 grams (200 millimoles) of salt per day on average for at least the six months before the clinical onset  of hypertension to support the hypothesis connecting hypertension or death from hypertension with the circumstances of the Veteran’s relevant service.

20. Major Hawke commented on Mr Coleman’s service in the Navy, and specifically with regard to the 22 months he spent in hot tropical environments aboard HMAS Lithgow during World War II. Major Hawke stated that the daily entitlement to salt was 14 grams per person which was used in the cooking of meals and in garnishing food during that period. He described the salt consumption of sailors. Those in the engine room were called upon to consume salt tablets twice a day, he stated. Others like Mr Coleman, took one salt tablet (1.5 grams) a day, translating into a normal minimum salt intake of 15.5 grams per day over a period of 22 months.

21. Dr Volker opined that Australian service personnel had an intake of salt during World War II of a minimum of 14 grams per day as well as salt supplements to a maximum of 45.5 grams a day. She opined that this suggested Australian service personnel, accustomed to a high level of salt intake during service would continue the habit in civilian life, leading to twice the level of hypertension evident in the general population. Dr Volker referred to the single blood pressure reading of 120/90 taken of Mr Coleman in 1946 on demobilisation. She opined that suggested an early indication of the left diastolic ventricular dysfunction that became apparent at the end of his life. She concurred that the available clinical notes suggest Dr Horvath at RPAH made the initial diagnosis of severe hypertension being 240/140 mmHg in 1976.

22. Professor O’Rourke opined that there was no suggestion in Dr Harris’ letter to Dr Park that he or Dr Horvath considered that heavy salt intake or war service was a factor in Mr Coleman’s episodes of elevated blood pressure. He also referred to the diagnosis of hypertension by Dr Horvath in 1976, and that Mr Coleman was treated for severe hypertension from that time. He can be considered to have had persistently elevated blood pressure from that time.

23. The evidence of Mr Coleman’s family as noted in the paragraphs above, was unequivocally that he consumed excessive amounts of salt with every food he ate, and at all meals following World War II.

24. The alternative hypothesis in this case is reasonable in that it is consistent with the template in SoP No.63 of 2013, and Factor 6.(c) – Mr Coleman consuming at least 12 grams (200 millimoles) of salt per day on average for at least the six months before the clinical onset of hypertension in 1976. Thus, the hypothesis could neither be said to be contrary to proven or known scientific facts, nor otherwise fanciful.

25. In regard to No. 89 of 2007, the factor that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting ischaemic heart disease or death from ischaemic heart disease with the circumstances of a person’s relevant service is: Factor 6.(a) – having hypertension before the clinical onset of ischaemic heart disease.

26. Dr Volker stated that the Veteran’s clinical notes chronicle a developing problem with hypertension, commencing with the 1946 reading. She noted that hypertension develops over many years, and that Mr Coleman had regular health assessments in connection with his employment, but that his hypertension was not detected until 30 years after demobilisation.

27. Professor O’Rourke considered the onset of hypertension was in 1976 when the Veteran was investigated thoroughly at RPAH under the supervision of Dr John Horvath. He noted that no cause for the hypertension was established, but that Mr Coleman was treated for the condition from that time on.  Professor O’Rourke, in reliance on the report of Dr Park dated 30 September 2013 noted that the onset of ischaemic heart disease was 4 October 2012.

28. The hypothesis will be reasonable if the hypothesis fits, that is to say, it is consistent with the template to be found in the SoP.  The hypothesis raised 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. The hypothesis in this case is that during his time on service, Mr Coleman developed a habit of consuming excessive amounts of salt that continued throughout his life. That was hypothesised to have caused the hypertension which caused or contributed to the development of ischaemic heart disease which caused the Veteran’s death. The hypothesis is reasonable in that it is consistent with the template in SoP N.89 of 2007, and Factor 6.(a), Mr Coleman having hypertension before the clinical onset of ischaemic heart disease on 4 October 2012. Accordingly the hypothesis could neither be said to be contrary to proven or known scientific facts, nor otherwise fanciful.

    Can the Tribunal be satisfied beyond reasonable doubt that Mr Coleman’s death was not war-caused

29. On all the material before it, the Tribunal was not made aware of any evidence which would satisfy it beyond reasonable doubt that Mr Coleman’s death was not war-caused. Mrs Coleman’s application must accordingly succeed.

    DECISION

30. The Tribunal sets aside the decision under review and in substitution finds that Mr Coleman’s death was war-caused. Accordingly Mrs Coleman is eligible to receive a war widow’s pension.

I certify that the preceding 74 (seventy -four) paragraphs are a true copy of the reasons for the decision herein of Ms G Ettinger, Senior Member

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

Associate

Dated 28 September 2015

Date(s) of hearing	2 - 3 June 2015
Counsel for the Applicant	Mr T Saunders
Solicitors for the Applicant	Kemp & Co Lawyers
Solicitors for the Respondent	Mr T O'Reilly, Department of Veteran's Affairs