Collins and Repatriation Commission - [2006] AATA 833

Administrative

Appeals

Tribunal

DECISION AND REASONS FOR DECISION [2006] AATA 833
ADMINISTRATIVE APPEALS TRIBUNAL )
) N2005/618

VETERANS’ APPEAL DIVISION

Re EILEEN COLLINS

Applicant

And

REPATRIATION COMMISSION

Respondent

DECISION

Tribunal
Justice Tamberlin, Presidential Member

Dr M Thorpe, Member

Date29 September 2006
PlaceSydney

Decision The decision under review is affirmed.

[Sgd] Justice Tamberlin

CATCHWORDS
VETERANS’ AFFAIRS – compensation to dependant of veteran – whether veteran’s death caused by operational service during the war – veteran served on Dutch ship that sank in 1941 – applicant contended that event caused veteran to develop Post Traumatic Stress Disorder leading to hypertension and eventually myocardial infarction, resulting in death – Statement of Principles Concerning PTSD (No. 54 of 2003) – whether veteran suffered PTSD during the six months prior to the onset of hypertension – expert evidence – psychiatrist for applicant relied on written statements alone, psychiatrist for respondent ascertained additional oral evidence – four from six factors (A,B,E,F) satisfied – Factor C “avoidance of stimuli associated with trauma and numbing of general responsiveness” not satisfied – Factor D “persistent symptoms of increased arousal” not satisfied – appeal dismissed.
Veterans Entitlement Act 1986 (Cth) ss 8, 13, 120, 120A, 196B
Byrnes v Repatriation Commission (1993) 177 CLR 564
Smith v Repatriation Commission (2004) FMCA 368
Cameron v Repatriation Commission (2003) 77 ALD 81
Repatriation Commission v Bey (1997) 79 FCR 364
Hardman v Repatriation Commission (2004) 82 ALD 381
Streatfeild v Repatriation Commission [2006] FCA 984
REASONS FOR DECISION

Justice Tamberlin, Presidential Member

Dr M Thorpe, Member

This is an appeal from a decision of the Repatriation Commission dated 12 May 2004 as affirmed by the Veterans Review Board on 20 April 2005, which decided that the veteran’s death was not war-caused within the meaning of s 8 of the Veterans Entitlement Act 1986 (Cth) (“the Act”).
The applicant is the widow of the veteran Mr John Collins who died on 3 August 1985 at the age of 64. The cause of death as stated in the Registrar of Deaths is sudden myocardial infarction with previous myocardial infarction. It is also stated that the veteran was a diabetic and suffered hypertension over 13 years. The cause of death was certified by Dr Tiwari, the veteran’s treating doctor.
The central issue on the appeal is whether the veteran was suffering from a clinically significant anxiety disorder for the six months immediately before the clinical onset of hypertension in 1972.
In determining this question, the Tribunal must consider the Statements of Principles related to the compensation scheme as established in the framework of the Act. Three Statements are of particular relevance to the circumstances of this case:
·   Statement of Principles Concerning Ischaemic Heart Disease (Instrument No 53 of 2003)
·   Statement of Principles Concerning Hypertension (Instrument No 35 of 2003 as amended by No 3 of 2004)
·   Statement of Principles Concerning Post Traumatic Stress Disorder (Instrument No 54 of 2003)
The parties are in agreement that the veteran suffered from ischaemic heart disease. It is conceded that the applicant has satisfied Factor A under cl 5 of the Statement of Principles Concerning Ischaemic Heart disease, which means it can be said on the balance of probabilities that the heart disease was connected with the circumstances of a person’s relevant service. Clause 5(a) is satisfied because the applicant demonstrated the presence of hypertension before the clinical onset of ischaemic heart disease.
It is not in dispute that the veteran’s hypertension had arisen by 1972, three years before the hypertension was diagnosed. The major issue is whether Mr Collins was suffering from a clinically significant anxiety disorder for six months immediately before the onset of the hypertension. A “clinically significant anxiety disorder” is defined in the Statement of Principles Concerning Hypertension as any anxiety disorder attracting a diagnosis sufficient to warrant ongoing management by a psychiatrist, counsellor or General Practitioner.
The anxiety disorder contended for on behalf of the applicant is Post Traumatic Stress Disorder (“PTSD”). PTSD is classified as a subcategory of anxiety disorder and is sufficient to satisfy the requirement of an anxiety disorder on this application. In order to succeed on a claim based on the existence of PTSD, the application must satisfy the factors listed under cl 2(b) of the Statement of Principles Concerning PTSD.
LEGISLATIVE PROVISIONS
Section 13 of the Act provides that where the death of a veteran is war-caused, the Commonwealth may be liable to pay a pension by way of compensation to the dependants of the veteran. Section 8 provides that the death of the veteran shall be taken to have been war-caused if it resulted from an occurrence that happened while the veteran was rendering operational service. It is common ground that Mr Collins was engaged in operational service.
Where this is the case, s 120(1) of the Act requires the Commission to determine that the death of the veteran was war-caused unless it is satisfied beyond reasonable doubt that there is no sufficient ground for making that determination. Sub-section (3) provides that in respect of the death of a person related to service, the Commission must be satisfied beyond reasonable doubt that there is no sufficient ground for determining that the death was war-caused if the Commission, after considering all the material before it, is of the opinion that the material does not raise a reasonable hypothesis connecting the death with the circumstances of the service rendered by the person.
Prior to amendments of the Act in June 1994, the approach was set out by the High Court in Byrnes v Repatriation Commission (1993) 177 CLR 564 at 571 as follows:
“The position may be summarised as follows: (1) First, sub-section (3) of s 120 is applied: do all or some of the facts raised by the material before the Commission give rise to a reasonable hypothesis connecting the veteran’s injury with war service? The hypothesis will not be reasonable if it is contrary to known scientific facts or is obviously fanciful or untenable. If the hypothesis is not reasonable, the claim fails. Proof of facts is not in issue at this point. (2) If a reasonable hypothesis is established, sub-section(1) of s 120 is applied. The claim will succeed unless: (a) one or more of the facts necessary to support the hypothesis are disproved beyond reasonable doubt; or (b) the truth of another fact in the material, which is inconsistent with the hypothesis, is proved beyond reasonable doubt, thus disproving, beyond reasonable doubt, the hypothesis.”
In June 1994, the Act was amended to insert s 120A, which provides that a hypothesis connecting the death of a person with the circumstance of any service rendered by that person is reasonable only if there is in force a Statement of Principles determined under the Act that upholds the hypothesis. Statements of Principle have been determined under s 196B of the Act.
THE HYPOTHESIS
The hypothesis as formulated by the applicant in the Amended Statement of Facts and Contentions is that the veteran suffered severe stress during his war service and that this stressful war service caused him to develop PTSD in accordance with factors which apply under the Statement of Principles Concerning PTSD. It is submitted that as a result of the PTSD, the veteran developed hypertension around 1972 and the hypertension led him to develop ischaemic heart disease. The applicant contends that in light of this sequence of events, the veteran’s death was a result of his war service. Thus the critical question is whether the veteran was suffering PTSD during the six months period before the onset of the hypertension.
As noted above, in the present case there are three instruments which bear on the hypothesis. The most important Statement for the purposes of this application is the Statement of Principles Concerning PTSD. The relevant question is whether the following requirements as listed under cl 2(b) of that Statement are satisfied:
“(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; and
(B) the traumatic event is persistently re-experienced in one or more of the following ways:
(i) recurrent and intrusive 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 symbolize or resemble an aspect of the traumatic event;
(v) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event; and
(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 the 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 insignificant activities;
(v) feeling of detachment or estrangement from others;
(vi) restricted range of affect (eg, unable to have loving feelings);
(vii) sense of a foreshortened future (eg, does not expect to have a career, marriage, children, or a normal lifespan); and
(D) persistent symptoms of increased arousal (not present before the trauma), as indicated by two or more of the following:
(i) difficulty falling or staying asleep;
(ii) irritability or outbursts of anger;
(iii) difficulty concentrating;
(iv) hyper vigilance;(v)exaggerated startle response; and
(E) duration of the disturbance (indicated by the relevant symptoms set out in paragraphs (b), (c) and (d)) is more than one month; and
(F) the disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning.”
It is common ground that (A), (B), (E) and (F) are satisfied. Thus the question turns on Factors (C) and (D).
OVERVIEW
The issue arises in this way. During World War II, the veteran was engaged in operational service between March 1941 and June 1945 in the course of which he was exposed to a relevant traumatic event. He was serving as a fireman’s boy during the period of March to July 1941 when the Dutch ship on which he was serving, the Montferland, was lost through enemy action. The veteran was 20 years of age when the ship was sunk. Following this event, he enlisted in the Australian Military Forces in April 1942 but was reclassified in May 1942 as unfit for service. He signed up with the United States Army Services of Supply in September 1942 and continued to serve with the unit until discharged in September 1944. He then served with the Merchant Marines until June 1945.
THE FACTUAL MATERIAL
A friend of the veteran, Mr Jim Liprini, made a statement on 20 September 1987 but has since died. Mr Liprini stated that he became friendly with the veteran early in 1936 when both were involved in numerous sporting, business and social activities, including football and cricket. Mr Liprini said that most of these activities were arranged by Mr Collins, who was an excellent organiser with a large number of friends to call on for this type of entertainment. Mr Liprini described the veteran as someone who was “always the life of the party”. Their friendship was continuous until the outbreak of World War II. The friends met again in 1950 and did some business together. In 1951, Mr Liprini tried to get the veteran to start up a business but he said that Mr Collins did not seem interested. Mr Liprini commented that the veteran seemed a changed man and did not have the same drive and ambition that he had possessed before the war. Mr Liprini considered that Mr Collins had become despondent over the years. When Mr Liprini tried to question the veteran about this, he came to the conclusion that something had happened to the veteran during his time in the Merchant Navy. Mr Liprini said that the veteran would sometimes speak of his war service but would then become bitter and say that the war had been the cause of all his troubles. In conversation, the veteran would only get up to the point when his ship was lost and seemed to blame himself for the disaster, saying it was all his fault. When questioned, Mr Liprini said that Mr Collins would become aggressive and then remorseful to the state of almost being in tears. Mr Liprini said he would try and change the subject when the veteran started to mention the war.
In later years, Mr Collins seemed to keep to himself and their meetings became less frequent. Often their conversations would end with talk of the loss of the ship and “death of” many men at sea. The veteran’s manner of saying this worried Mr Liprini. In his statement, Mr Liprini ventured the opinion that the veteran had developed a serious sickness that was caused by his war service.
There was evidence from Dr Tiwari, who had Mr Collins under his care from June 1975 until August 1985. He considered that the veteran had suffered hypertension for three years before Dr Tiwari was consulted in June 1975. In 1978, Mr Collins was diagnosed as a diabetic, and in 1982 he had an attack of myocardial infarction. The veteran had another attack in August 1985, which led to his death.
In her application for the pension dated 3 November 1987, Mrs Collins stated that she first met the veteran in May 1960. In this statement, Mrs Collins said:
“He had nightmares, always about ships and sinking. He had indigestion. He had falls and blackouts and forgetfulness. He was most easily upset and seemed to be over highly-strung and too easily agitated.”
In another part of this application, Mrs Collins wrote:
“He became very nervous and easily upset, had frequent indigestion, took Mylanta and Quickease tablets. He smoked cigarettes during sea service but ceased when he left the sea.”
In a statement of 10 April 2000, Mrs Collins said that the veteran would experience nightmares with sweating several times a week. She said that Mr Collins would get up during the night carrying a pillow, presumably as a life belt, and later had no recollection of being out of bed. One morning in bed, he had grass and blood on him after falling on the lawn during one of these episodes. Mrs Collins said that the veteran ceased driving taxis when his application for life insurance with the Government Insurance Office was refused due to his hypertension. She referred to the veteran’s weight having increased considerably, so that he was 16 stone by 1976. In November 1982, the veteran was 17 stone. Following a heart attack in this year, Mr Collins lost some weight but was still big. Mrs Collins said her husband had been a substantial eater.
In a statement of 2 August 2005, Mrs Collins stated that her husband used to sleep a lot during the day. She described him as always tired and feeling fatigued because his sleep was disturbed during the night. Mrs Collins said that her husband was a very quiet man who mainly kept to himself. He worked as a taxi driver but did not have any hobbies, apart from being a keen gambler on horses. He was not interested in sports. He was not a sulky man but if he became depressed, he would become quieter than usual. He had a large appetite. He was first diagnosed with heart trouble in 1982, when he was planning to take out a life insurance policy and the insurance company required him to have his blood pressure checked. As also noted in the statement of 10 August 2005, this application was knocked back because the veteran’s blood pressure was too high. He suffered a heart attack later that year. When admitted to hospital, the veteran weighed about 17 stone.
Expert medical evidence in this case was given by two psychiatrists. Dr Dinnen provided his medical report from the file notes and had not interviewed Mrs Collins, whereas Dr Delaforce provided a report from the same notes and interviewed Mrs Collins by phone on two occasions for a total period of over one hour.
Dr Dinnen, a consultant, gave evidence for Mrs Collins. In compiling his report of 30 September 2005, Dr Dinnen did not interview Mrs Collins but relied on her statements of April 2000, together with some letters and a Veteran’s Service History form completed by Mrs Collins in 1997. On the form completed in 1997, Mrs Collins described the veteran as being very nervous, easily upset and a sufferer of nightmares.
In his report of 5 May 2006, Dr Dinnen refers to new information obtained by Dr Delaforce. Dr Delaforce was called for the respondent and participated in two interviews with the applicant. Dr Dinnen considered there was no further relevant new information in the report of Dr Delaforce, and expressed the view that the widow did not contradict her previous statements in any material respect. Dr Dinnen did not think the information obtained by Dr Delaforce during the interviews added much to the discussion of the issues. He expressed satisfaction with his previous report in which he articulated the view that the events that took place during the veteran’s service changed the veteran’s behaviour and character in an ongoing fashion. Dr Dinnen concluded that the veteran’s symptoms more likely than not reflected the existence of PTSD.
Dr Delaforce also considered the statements of Mrs Collins in evidence. In addition, he elicited further information from Mrs Collins on two occasions for a total period of over one hour and made contemporaneous notes of these interviews. During this time, Mrs Collins said that her husband did not tell her of any deaths on the sunken vessel. Dr Delaforce asked Mrs Collins for details in relation to the nightmares experienced by her husband. She said the veteran would not say why he could not sleep or what troubled him. She described her husband as a peaceful sleeper although he experienced a lot of twitches. Even though her husband’s sleep was sometimes disturbed, Mrs Collins offered no details of his behaviour to Dr Delaforce that indicated an actual nightmare. Mrs Collins said the nightmares ceased in 1982 which she associated with his being prescribed medication following a heart attack.
Dr Delaforce also recorded that Mrs Collins stated to him that her husband was not upset easily. She did say that the veteran was highly strung, in the sense of being agitated and a bit annoyed. She stated that he did not show anger or irritability with her. She said that he was very placid and you would not describe him as a bad tempered man, although he was fidgety. He did not have any panic episodes or particular fears or matters that he would avoid, and his concentration was good at all times. He was a good reader and had a considerable library of books. He maintained his interest in horse racing. She said that he loved ships and continued to keep up his interest in ships. It was mentioned that whenever a US Defence Force vessel came to Sydney, the veteran would go and visit the ship and sometimes bring US servicemen back to his home. After his war service, the veteran became a taxi driver and worked full-time, mostly at night. Mrs Collins said that he enjoyed this work and meeting people. However, she noted that when driving a taxi at Blacktown on one occasion, the veteran had a bad experience when he saw a woman with blood on her. It was also mentioned that on a separate occasion, a passenger had pulled a gun out in Mr Collins’ taxi. In addition, the veteran had been in his taxi near Sydney Town Hall when the Hilton Hotel was bombed in the 1970s only a few hundred metres away.

Mrs Collins said that when the veteran’s application for life insurance was rejected due to his high blood pressure, his behaviour changed. Following his heart attack in 1982, Mr Collins was forced to give up taxi driving and this made him unhappy and depressed. He lost his licence but obtained more work at Sydney race meetings. This resulted in an increase in his gambling. Mrs Collins described the veteran when she first met him in 1960 as being overweight and a happy-go-lucky person who was positive about the future. She said that he loved to talk to anybody and this made him a good taxi driver, and that he was a loving and friendly person up to his death. Mrs Collins stated that since 1960, the veteran had consumed alcohol only very rarely.
Dr Delaforce also noted that it appears from other material that there was no loss of life when the Montferland sunk. The only mention of “death of many men at sea” is by Mr Liprini in his statement, and this appears to be surmise in relation to that vessel.
MEDICAL EVIDENCE
The critical medical issue is whether Mr Collins suffered from a war-related anxiety disorder as a factor in the genesis of his hypertension. The clinical onset of the hypertension was some 31 years after the sinking of the Montferland.
The Statement of Principles for Generalised Anxiety Disorder requires the experiencing of a stressor within two years immediately before the clinical onset of anxiety disorder. There is no dispute that Mr Collins experienced a severe stressor at the time of the sinking of the Montferland in 1941. However, the time interval from the stressor until the clinical onset of the Generalised Anxiety Disorder would mean the anxiety state would not be considered reasonable and so any claim so far as this hypothesis is concerned would fail.
By contrast, the Statement of Principles concerning PTSD makes no reference to the time interval between the traumatic event and the clinical onset of the PTSD. For the purposes of this application, it is relevant that cl 5(n) in the Statement of Principles Concerning Hypertension specifies that hypertension may be considered to be connected to the circumstances of a person’s service if that person was "suffering from a clinically significant anxiety disorder for the 6 months immediately before the clinical onset of hypertension."
Dr Tiwari’s medical records did not mention any stress, anxiety or depression that Mr Collins might have suffered. There was no mention of any psychiatric history in the Bankstown Hospital clinical notes either at the time of his infarction in 1982 or hernia repair in 1985. However, it should be noted that in that period, PTSD was only beginning to be recognised as a clinical diagnosis.
On 30 September 2005, Dr Dinnen reported he was able to make a psychiatric diagnosis on the available evidence, namely, long-standing PTSD. In his further report of 5 May 2006, Dr Dinnen said that he was satisfied that the events of service had changed the behaviour of Mr Collins and his character in an ongoing fashion, and that the veteran’s nervousness and sleep disturbance were more likely than not to reflect the presence of PTSD. On the meagre evidence available, Dr Dinnen argued that signs of hypervigilance and avoidance were also evident. Dr Dinnen considered that one of the most important indicators of PTSD concerned the fact of disturbed sleep, rather than the content of the nightmares that may have occurred in the disturbed sleep. He considered that Mr Collins had experienced recurrent dreams with distress that were frequent and continued throughout the years. Dr Dinnen did not obtain the history of Mr Collins working night shifts as a taxi driver, but agreed that taxi driving at night could result in sleep disturbance.
Dr Dinnen's view was that Mr Collins was agitated, nervous, had sleep disturbance and did not like talking about the war. Putting all of these factors together, Dr Dinnen considered that it was reasonable to consider that Mr Collins had suffered from PTSD. Dr Dinnen opined that the veteran’s illness had been more than an anxiety condition because there was evidence of a traumatic stressor, a history of some attempted avoidance of memories of the event, and a history of influence of those traumatic memories. He contended that these were matters pointing to the diagnosis of PTSD, namely, exposure to a traumatic experience, attempts to avoid being reminded of that traumatic experience and an excessive awareness of that experience.
In cross-examination, Dr Dinnen agreed that he made assumptions to connect all the bits of information together – or “connected the dots” - to come to a firm diagnosis based on his knowledge and expertise, as opposed to Dr Delaforce, who came to a different view. Dr Dinnen believed that Dr Delaforce arrived at his view because he was not prepared to connect all the pieces of information. Dr Dinnen said that having treated these problems for over 40 years, he had significant experience in understanding the impact of traumatic events, especially on veterans who prefer not to discuss their experiences in the war.
Dr Delaforce, who relied on his interviews with Mrs Collins, came to a different view. He considered that due to the interviews, he had a better history and could make a more accurate diagnosis. This is because he believed the interviews gave him an opportunity not only to ask a question and get a response, but to follow up with other questions to ensure the answers were clear and that the questions were understood. Otherwise, he said, one was relying on information from other people, not necessarily medical practitioners, and without knowing how the information was obtained. Therefore, he stated, the interview provided a better history and more accurate diagnosis.
Mrs Collins told him:
“Jack was very placid. You wouldn't say he was a bad tempered man”.
This additional material from Mrs Collins was contrary to her statements given in 1987 on the Veteran’s Service History form, where she said that Mr Collins was easily upset, highly-strung and easily agitated. Dr Delaforce, in evidence, said he had specifically asked Mrs Collins if the veteran had been an irritable person, and she had emphatically indicated that he had not. Mrs Collins’ oral evidence was that her husband was a person who could converse with anyone and loved television and the movies. She said he loved cartoons and was a good reader. In her statement of 2 August 2005, Mrs Collins said her husband had been a very quiet man, kept mainly to himself, and was not sulky. She said that if ever he got depressed, he would become very quiet. Mrs Collins noted that the veteran was always tired and feeling fatigued, probably because of disturbed sleep.
As to Mr Liprini's letter of 20 September 1987, which stated that Mr Collins kept to himself and seemed to be a changed man after the war, Dr Delaforce responded that this was in contrast to Mr Collins being a likeable person, a good husband and someone who loved his work, loved people and loved mariners and ships, as recounted by Mrs Collins. Dr Delaforce considered Mr Liprini's information involved an assumption by Mr Liprini, because it was contrary to the other material.
In contrast to Dr Dinnen, Dr Delaforce's opinion concerning the significance of sleep disturbance was that Mr Collins’ insomnia was caused by taxi driving at night, and was not a consequence of anxiety related to war service. Dr Delaforce thought it was significant that Mrs Collins did not know the content of her husband’s dreams, or if in fact they were nightmares.
Dr Delaforce considered that his assessment highlighted the inadequacy, inaccuracy and inconsistencies regarding some of the information available before his interviews. When challenged as to the meaning of "inadequacy, inaccuracy and inconsistency," he replied that the information available was inadequate to support a diagnosis of PTSD. In his view, there was not enough evidence to point to that diagnosis, even allowing for the generous diagnosis according to Smith v Repatriation Commission (2004) FMCA 368. Dr Delaforce said such a diagnosis was inconsistent with information provided by Mrs Collins at times. He considered that the final information given in 2005 was the most accurate information obtained from Mrs Collins. It was contended that the earlier information was inaccurate in the sense that it seemed to suggest some people were killed during the sinking of the ship in 1941. Dr Dinnen, however, considered that Dr Delaforce had provided no new evidence as a result of interviewing Mrs Collins.
The parties agree that the critical Statement of Principles is that Concerning PTSD. To determine whether the Statement “upholds” the hypothesis, it is necessary to see whether the requirements of that Statement are satisfied on the material before the Tribunal: see Cameron v Repatriation Commission (2003) 77 ALD 81; Repatriation Commission v Bey (1997) 79 FCR 364; Hardman v Repatriation Commission (2004) 82 ALD 381; and Streatfeild v Repatriation Commission [2006] FCA 984. The word “uphold” is defined by the Oxford English Dictionary to denote support against objection. Where the hypothesis, on the material, is inconsistent and fails to meet necessary elements required by the Statement of Principles, it cannot be said to be upheld by the Statement.
Dr Dinnen and Dr Delaforce gave differing interpretations in relation to the requirements under cl 2(b) of the Statement of Principles Concerning PTSD (as listed in entirety above) as follows:
Factor A:      Exposure to a traumatic event
Both psychiatrists were satisfied that this was made out.
Factor B:      The traumatic event is persistently re-experienced
Dr Dinnen considered that Factor B(ii) was satisfied if one assumed that Mr Collins had experienced distressing dreams of the event. Dr Dinnen accepted that Factor B(i) was also satisfied in light of Mr Liprini’s statement that the veteran experienced recurrent distressing recollections and would not talk about his experiences on the vessel. Dr Delaforce would accept B(i) if Mr Liprini’s statement was accepted. Dr Delaforce did not accept that the veteran’s insomnia necessarily meant that he experienced recurrent distressing dreams. We consider that this factor has been satisfied.
Factor 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 [factors]
Relying on the evidence of Mrs Collins and Mr Liprini, Dr Dinnen accepted that Factors (C)(iv), (v), and (vi) were satisfied. Dr Dinnen considered Factor (C)(i) – “efforts to avoid activities, places or people that arouse recollections of the trauma" – was satisfied, although his evidence concerning Mr Collins’ willingness to visit ships was unclear. His statements were based on Mrs Collins’ earlier evidence that the when the veteran was alive, he was always tired, fatigued, kept to himself, had no hobbies, was not interested in sport and lost interest in activities.
Dr Delaforce did not accept that the material indicated any avoidance behaviour or numbing of general responsiveness, and considered the interview evidence of Mrs Collins negated factors (C)(iv), (v), and (vi), in particular her description that the veteran had loved to talk to people and was able to talk to anyone, and that this quality made him a good taxi driver. Dr Delaforce contended that what usually happens in PTSD is that the sufferer drops out of life, and they are not interested in life and people or participating in activities. Dr Delaforce considered that Mr Collins’ love of ships and entertainment of US servicemen was directly contrary to the required avoidance behaviour as specified in (C)(i).
Factor D:      Persistent symptoms of increased arousal (not present before the trauma), as indicated by two or more of the following [factors]
Both psychiatrists considered that the application satisfied Factor D(i), which specifies one symptom as being “difficulty falling or staying asleep.”
Dr Dinnen assumed that the reference to Mr Collins being highly strung and easily agitated could demonstrate irritability, as required by Factor D(ii). He relied on the statement of the applicant in 1987 that "[The veteran] was most easily upset and seemed to be overly-highly strung and too easily agitated" to translate into perhaps an exaggerated startle response, or certainly hypervigilance if common language was translated into scientific terminology.
Dr Delaforce did not consider that there was any evidence of anger, hypervigilance or startle response based on what Mrs Collins had told him. Therefore, he found that only one factor in (D) was satisfied where two are required.
Factor E: Duration of the disturbance is more than one month
Both psychiatrists agreed this factor was satisfied.
Factor F: The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning
Both psychiatrists agreed this factor was satisfied.
REASONING ON APPEAL
The determination in this matter turns on the weight which the Tribunal thinks should be given to the material before it and the evidence of Dr Dinnen and Dr Delaforce. It is a question solely for the Tribunal, and not for the medical experts, to decide whether a relevant Statement of Principles supports the hypothesis advanced for the applicant. Where the Tribunal examines the material as a whole, if there is a failure to satisfy an essential requirement in the relevant Statement of Principles, there can be no reasonable hypothesis.
To determine whether the factors in the Statement of Principles uphold the hypothesis in this case, it is necessary to consider the behaviour and characteristics of the veteran in the six month period preceding the onset of hypertension in 1972.
To some extent there is an overlap in the material considered by both doctors, but a significantly different picture emerges from the information given by Mrs Collins in the interviews with Dr Delaforce compared to that which appears in the documentary material.
As indicated above, Dr Dinnen relied on documentary material recording statements by Mrs Collins. However, he did not have the opportunity of interviewing the applicant and enquiring into matters which may have invited further questioning or required further elaboration.
In our view, having regard to the terms of the hypothesis and all the material before the Tribunal, including that recorded by Dr Delaforce, the picture which emerges of the veteran is that he was able to cope with work over many years as a taxi driver and was able to relate to Mrs Collins and people generally. He did not avoid the memories of the incident or seamen or the sea. He was able to concentrate well. Dr Dinnen did not have the advantage of the additional oral evidence and his opinion as to conformity with the Statement of Principles is not based on a fully informed examination of the veteran’s behaviour. On the other hand, the opinion of Dr Delaforce does take into account the relevant additional facts, and his opinion is that the Statement of Principles is not satisfied by the hypothesis. The Tribunal accepts this opinion as representing an accurate description of the characteristics of the veteran.
In this case, the opinion of Dr Dinnen was founded on an incomplete and unsatisfactory limited matrix of facts. As a consequence, essential aspects of the behaviour of the veteran were not before Dr Dinnen when he committed to his opinion. The view of Dr Delaforce is more fully informed and based on a more complex and expansive picture of the behaviour of the veteran as evident from material provided by the applicant. Some of this material illustrated other aspects of the veteran’s personality that suggested better adjustment and were inconsistent with some important factors in the Statement of Principles Concerning PTSD.
The Tribunal does not consider that the comments of Dr Dinnen in relation to the additional material recorded by Dr Delaforce during the interviews negate the importance of that additional information in forming an accurate view as to the relevant characteristics of the veteran during the specified period. The factual and observational evidence by Dr Delaforce is of critical importance in this case in characterising the behaviour of the veteran and determining whether the requirements set out in the Statement of Principles Concerning PTSD are satisfied.
In the view of the Tribunal, the position in relation to the Statement of Principles Concerning PTSD on all the material is as follows: Mr Collins was exposed to a traumatic event, namely the sinking of the vessel, and this satisfies the requirements of Factor A of the requirements for PTSD. We are also satisfied that Factor B is satisfied in that the traumatic event was persistently re-experienced by way of recurrent and intrusive and distressing recollections.
In relation to Factor C, the Tribunal is not satisfied that there was persistent avoidance of stimuli associated with the trauma and a numbing of general responsiveness. There is some evidence from Mr Liprini’s statement that the veteran made efforts to avoid conversations associated with the trauma. However, the evidence as to the veteran maintaining an interest in US navy vessels is inconsistent with avoiding activities, places or people that arouse recollections of the trauma. In addition, Mr Collins remained in maritime engagement after the sinking of the vessel in 1941. There is no evidence that he had an inability to recall an important aspect of the trauma. It is doubtful whether he had a markedly diminished interest or participation in significant activities. He was able to engage in taxi driving for many years and on the evidence of Mrs Collins, he got along well with almost anybody over that period. The veteran was a good reader, took an interest in horses and gambling, and enjoyed television. Nor is the Tribunal satisfied that he had a feeling of detachment or estrangement from others. The evidence does not indicate that Mr Collins had a restricted range of affect, for example, being unable to have loving feelings. The veteran did maintain a warm and loving relationship with the applicant for a very substantial period of time. There is no evidence that he had a sense of a foreshortened future, in the sense of not expecting to have a normal life span. Accordingly, Factor C is not made out, and therefore the application must fail.
In relation to Factor D, there is evidence that the veteran experienced difficulty sleeping. This satisfies one of the criteria under Factor D. However, it is doubtful that the veteran exhibited signs of irritability or anger in the context of this provision, as opposed to being merely agitated. The fact that he was a good reader and was able to drive a taxi for a substantial period of time indicates that the veteran did not have undue difficulty concentrating. There was evidence that Mr Collins was highly strung, but there is no evidence that he had an exaggerated startle response. In relation to this last factor, the evidence is to the contrary, as the veteran was described as “placid.” Therefore, Factor D has not been made out on the evidence as only one symptom under this section has been established where two are required.
For these reasons, having regard to all the material before us, including that of the psychiatrists, the Tribunal is not satisfied that there is a reasonable hypothesis raised. The decision under review is affirmed.
I certify that the fifty-five preceding paragraphs are a true copy of the reasons for the decision herein of
Signed:         .....................................................................................
  Associate (Claire Palmer)
Date/s of Hearing  21 August 2006
Date of Decision  29 September 2006
Counsel for the Applicant          Mr M Vincent
Solicitor for the Applicant           Dibbs Barker Gosling
Solicitor for the Respondent      Department of Veterans’ Affairs