Compston and Repatriation Commission
[2003] AATA 937
•22 September 2003
Administrative
Appeals
Tribunal
DECISION AND REASONS FOR DECISION [2003] AATA 937
ADMINISTRATIVE APPEALS TRIBUNAL N2001/642
VETERANS AFFAIRS DIVISION
Re: Robert John COMPSTON
Applicant
And: Repatriation Commission
Respondent
DECISION
Tribunal: P.J. Lindsay, Senior Member, Dr P.D. Lynch, Member
Date: 22 September 2003
Place: Sydney
Decision:The decision under review is varied by amending the diagnosis to personality disorder but in all other respects the decision under review is affirmed.
(sgd) P.J. Lindsay
© Commonwealth of Australia (2003)
CATCHWORDS
VETERANS ENTITLEMENTS - disability pension – operational service – diagnosis of psychiatric symptoms - whether depressive disorder appropriate diagnosis – whether personality disorder war-caused – diagnosis varied but decision under review otherwise affirmed
Veterans’ Entitlement Act 1986, ss. 9, 120, 120A, 196B
Repatriation Medical Authority Statements of Principles:
- Instrument No. 58 of 1998 concerning Depressive Disorder
- Instrument No. 3 of 1999 concerning Post Traumatic Stress Disorder
- Instrument No. 143 of 1995 concerning Personality Disorder (as varied by Instrument No. 13 of 1997)
Repatriation Commission v Deledio (1998) 49 ALD 193
Repatriation Commission v Hill [2002] FCAFC 192
Benjamin v Repatriation Commission (2001) 34 AAR 270
Repatriation Commission v Budworth (2001) 66 ALD 285
Fogarty v Repatriation Commission [2003] FCAFC 136REASONS FOR DECISION
P.J. Lindsay, Senior Member, Dr P.D. Lynch, Member
1. This is an application by Robert John Compston (the applicant) under the Veterans Entitlements Act 1986 (the Act) for review of a decision by the Repatriation Commission (the Commission) made on 3 June 1999. The Commission refused Mr Compston’s claim for acceptance of stress as a war-caused disease under the Act. The decision was affirmed by the Veterans’ Review Board (the Board).
2. At the hearing Mr M. Vincent of counsel appeared for Mr Compston. The Commission was represented by Mr J. Marsh from the Department of Veterans’ Affairs (the Department). Evidence was given by the applicant, his wife Mavis Compston, Dr A. Dinnen, a consultant psychiatrist and Dr R. Haik, a consultant psychiatrist. The Tribunal had before it the documents lodged under s.37 of the Administrative Appeals Tribunal Act 1975 (the T-documents) and the exhibits tendered at the hearing.
background
3. Mr Compston was born on 11 January 1929 and served in the Australian Army from 17 June 1947 to 1 November 1974. His service record is as follows:
· eligible war service in World War II from 17 June 1947 to 2 January 1949
· operational service in Vietnam from 21 April 1967 to 23 April 1968
· eligible defence service from 7 December 1972 to 1 November 1974
4. Mr Compston’s claim was lodged with the Department on 5 November 1998 (T4). He claimed that his stress was caused, contributed to or aggravated by service, and provided the following explanation:
In Vietnam, many of the personnel fell victim to stress. Reports from home on the demonstrations, the wharf labourers refusing to load our food and ammunition and the separation from home added to the problem, when coupled with the futility of the whole exercise. I received treatment at the field Hospital at Vung Tau as an out patient over a period. On return to Australia I was able to obtain access to my documents and destroyed all medical records pertaining to Vietnam to ensure promotion. On my return to Australia I attended a self-improvement course (at my expense) to regain some confidence, but because of my attitudes my marriage deteriorated rapidly until in 1972 I moved from the family home and was divorced in 1973. While still in the family home in 1972 I was accused of making a suicide attempt. … I am still easily depressed and do not believe I have lost all inclinations in regard to my views on life. I did remarry and the success of this union has helped me to control my feelings.
The Commission refused the claim for disability pension for incapacity due to stress because “ … the condition is not present nor is any other medical condition that would answer the claim for this condition” (T2-F).
5. Mr Compston filed a further, related claim for pension on 19 October 1999 in which he said he was suffering from post traumatic stress disorder that was caused, contributed to or aggravated by service. The claim form contained the following details:
During operational service in SVN 1968 Tet Offensive I was in constant danger and feared for my life because of the heavy action around me. Part of my duties was to supply machinery equipment and other equipment to the fire support bases throughout the operational areas. My life was in constant danger and I experienced severe bouts of depression mainly after when I was at the Horseshoe during heavy fire during the Tet Offensive. This depression continues today.
The Commission refused the claim. That decision was affirmed by the Board because it was of the opinion that Mr Compston’s condition did not satisfy what it considered to be the relevant Statement of Principles being No. 3 of 1999 concerning post traumatic stress disorder.
6. In opening, Mr Vincent said the only issue in the case was that of diagnosis. The applicant’s case is that depressive disorder is the proper diagnosis of his condition and reliance would be placed on the opinion of Dr Dinnen. Mr Marsh’s preliminary remarks were that the respondent rejected Dr Pusic’s diagnosis of post traumatic stress disorder, as the Board had also done, and relied on Dr Haik’s opinion for the diagnosis of personality disorder. Further Mr Marsh said Mr Compston could not satisfy the factors in the relevant Statement of Principles connecting personality disorder with service.
7. Mr Compston’s claim for pension in respect of depressive disorder relates to his operational service in Vietnam and accordingly the standard of proof in respect of causation of a war-caused disease is that prescribed by s.120(1) of the Act. Subject to determining whether Mr Compston is suffering from depressive disorder, pursuant to s.120(1) a decision-maker will determine depressive disorder to be war-caused unless the decision-maker is satisfied beyond reasonable doubt that there is no sufficient grounds for making that determination. The decision-maker will be so satisfied if of the view that the material before it does not raise a reasonable hypothesis connecting that psychiatric condition with the circumstances of Mr Compston’s service: s.120(3). The decision maker is to assess the reasonableness of the hypothesis in accordance with any Statement of Principles (SoP) issued by the Repatriation Medical Authority (RMA).
8. The Tribunal must follow the approach that the Full Federal Court laid down in Repatriation Commission v Deledio (1998) 49 ALD 193 in reviewing the decision in question (at 206):
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.
There is a preliminary issue in this matter as there is a dispute as to whether Mr Compston suffers from depressive disorder. The Tribunal must initially address the question whether Mr Compston suffers from a disease and, if so, what disease: Repatriation Commission v Hill [2002] FCAFC 192 at [61].
evidence
9.
Mr Compston’s career in the Army began in 1947 when he enlisted as a private. He studied carpentry and was steadily promoted. In part he attributed his promotions to being well behaved and very sociable.
He was aged 38 when he was posted to Vietnam on 21 April 1967 as a Lieutenant Quartermaster for the 17th Construction Squadron based in Vung Tau. He explained that he wanted promotion and serving in Vietnam was a means to that end. At the time of his posting to Vietnam he had been married for about 17 years. His evidence was that he was well known and respected in the Army during his career prior to service in Vietnam. Mr Compston said that he and his wife had been happy to this point. They lived quietly and kept to themselves in married quarters. Their entertainment and social life involved only themselves, their children and his wife’s family. He agreed that he was socially awkward but attributed that to not mixing with the general public and living in quarters. He said he was not shy as a child or youth. He told the Tribunal about jobs he had as a school child in Ballarat, running messages for the grocer and helping a butcher with odd jobs.
10. About two thirds of the way through his period of operational service, Mr Compston began to receive treatment as an outpatient of Vung Tau Field Hospital because he was having trouble sleeping, was nervous and easily upset. Elaborating, he said he felt a bit uneasy about sleeping alone in a hut even though the area was patrolled by US soldiers. Mr Compston said the doctor diagnosed depression and he was given Mogadon and another drug to help settle him down. He consulted the doctor every couple of weeks yet was able to continue with his normal duties. At a medical examination not long before leaving Vietnam, it was discovered that his weight had dropped by about 20kg. X-rays were taken and a radiology report of 8 April 1968 (T12-104) found that the applicant’s lungs were clear and his heart as normal. Mr Compston’s evidence was that the loss had been gradual and he had not suffered from any illness at the time. He thought the weight loss was a consequence of his depression. In cross-examination, however, Mr Compston said he did not seek medical treatment for his weight loss and that it had nothing to do with his problems that led to his treatment as an outpatient.
11. Mr Compston’s statement dated 9 October 2001 (Exhibit A1) referred to separate incidents that occurred during his period of operational service that caused him stress, fear and feelings of vulnerability and apprehension. With a driver and a bodyguard, he frequently travelled in a land rover along the road to Nui Dat as a non-combat engineer. On one occasion, contrary to instructions, he stopped along the road so he could take photos of a church. He heard a weapon being fired and sensed a bullet pass over his head. He was intensely fearful and anticipated an attack. He and his party returned to their vehicle and quickly left. He did not hear any more bullets. On another occasion while travelling to Nui Dat shortly after the Tet Offensive, he drove past a stockade and noticed many stacks of coffins. As a carpenter he was interested in the coffins, so they stopped to have a look. On their return trip, they stopped again to investigate why a large crowd had gathered around the coffins. Due to heat and humidity, the corpses had swollen and the applicant could see limbs protruding from the coffins. As a non-combatant, he was not used to seeing corpses and the sight was nauseating and very upsetting.
12. There was an occasion when he was flown by helicopter from Nui Dat to a location where bull dozers were to be used to clear jungle. He wore a bullet-proof vest but said he felt extremely vulnerable in the small helicopter fearing its noise would alert the enemy. In addition to these incidents, Mr Compston stated that simply being in Vietnam made him feel vulnerable because it was a hostile place. He did not trust the local people. He knew of servicemen who were ambushed and killed while travelling from Vung Tau, where he was based, to Nui Dat. He would arrange his trips along the road at different times of the day.
13. At the conclusion of his period of operational service Mr Compston was to be transferred to a different unit in Australia.. He said that, in keeping with normal practice, he was asked to present to the new unit with documents including the medical records of treatment in Vietnam. He was given his medical records. In order not to jeopardise his promotion to major he decided to destroy some of the records, thus ensuring his new unit did not learn about his medical condition. In cross-examination he agreed that this action was a serious offence but he explained that he was in a panic and did not think about the consequences. A letter from a manager of Army records at the Department of Defence to the Commission stated that the reports in the Central Medical Record “are obviously incomplete and in particular the Medical attendances etc. whilst in Vietnam are non existent except for one X ray request …”. (Exhibit R6)
14. When he got back to Australia, he said he had difficulty settling down. He caused trouble at work, losing his temper and being belligerent even with his superior officers. There was also disruption in his family life. Mr Compston said that things were not the same at home. He was argumentative and gave his wife and children no peace. Things were so bad at work that he felt that he had lost the confidence of the men he commanded. As he was still hoping for further promotion, he decided that a transfer from Queensland to Sydney would help him. Mr Compston eventually was promoted to major in February 1974.
15. Mr Compston was taken to hospital in February 1973 after an overdose of valium. The in-patient history (Exhibit R5) referred to his impending marital break-up and an affair, which Mr Compston firmly denied. The medical officer noted “No significant depression. No features to suggest high suicide risk. No evidence of significant psychiatric impairment.” It was around this period that Mr Compston consulted an Army medical officer seeking treatment for sleeping difficulties. A service medical officer noted (T11B) a consultation on 12 February 1973 when Mr Compston reported that he had not been sleeping well recently because of family worries. In April 1973 Mr Compston still had unresolved worries and asked for a referral to a psychiatrist. At a consultation on 13 April 1973 with Dr Collins, consulting psychiatrist, it was noted that his insomnia seemed to be “ …a single symptom in reaction to long standing family problems coming to a head in recent months. There is no evidence of morbid depression. His insomnia and problems do not appear to be affecting him adversely in his work at this stage. He needs some supportive psycho-therapy to help him sort out his future roles in family problems.” (T3-19).
16. Subsequent reports noted that Dr Collins provided the applicant with counselling over a number of months. By August 1973 Dr Collins noted that there had been “considerable improvement in adjustment” and the applicant’s “only problems now are practical” – arranging his remarriage while awaiting his divorce, his wife’s animosity and changing the attitudes of his children. Mr Compston’s divorce was finalised in December 1973 and he remarried in February 1974.
17. If he had destroyed the records of his medical treatment in Vietnam so as not to affect his promotion, Mr Marsh asked the applicant why he was not concerned about his superiors learning of his consultations with Dr Collins. Mr Compston explained that being treated for his problems in Vietnam would affect his prospects for promotion but seeing a psychiatrist for family problems would not.
18. By the time he resigned from the Army Mr Compston was a qualified carpenter and joiner. He received a lump sum, bought a truck and obtained an unrestricted builders licence. Due to problems supervising men, which he said was a problem that had developed while he was in the Army, and not being prepared to put his commuted pension and other assets at risk, Mr Compston decided not to attempt to start his own business. He has not worked since leaving the Army. Mr Compston said he and his wife started role reversal, she working full time as a receptionist while he would attend to most household chores. For relatively short periods, he joined a photography club and a woodturners guild. He decided to leave because of his behaviour – not being able to control his temper, being argumentative and telling other members what he thought of them. He said that he has no friends, preferring his own company. His marriage, however, has been successful and happy. He still does not sleep well, having difficulty falling asleep and usually waking around 3.00 to go to the toilet and then dozing and not really getting back to sleep until he rises around 7.00. He finds that while in church or elsewhere, he may ruminate about his dangerous experiences in Vietnam. He is a member of the RSL and will have a meal at the local RSL club. Of recent years he has increased his participation in various events commemorating the service by Australians in the war in Vietnam.
19. Mr Compston said he has a very good marriage and that he and his wife get along well together. He can get upset at times but they sort things out. If he finds he dwells on things, he often goes into the garden, does some weeding and that helps pass the time. He said he sleeps for about an hour in the early afternoon, which his doctor says could be related to nerve trouble in his back or polymyalgia, and then feels fit and ready to do chores such as mowing the lawn.
20. The applicant’s second wife, Mavis, provided a statement dated 6 December 2001 (Exhibit A4) and gave oral evidence. She first met the applicant in 1960. She was married and had a family. They were neighbours. For a few years thereafter, she said that the two families would have a cup of tea together and occasionally go out as part of a bigger group. Following Mr Compston’s transfer to Brisbane in 1966, the families did not become reacquainted until 1972 when his family moved back into their old house upon the applicant being transferred back to Sydney. Mavis Compston’s evidence about this period was that, although she saw more of his then wife than him, she noticed that he had changed in the interim. He was no longer as cheeky and was quieter. At the time she thought this change in the applicant was because of the breakdown in his marriage. She said that his wife was quieter and also behaved differently to the earlier years and she put it down to problems they had in the marriage.
21. She said Mr Compston is still a reserved man who seldom goes out. She referred to an occasion during their marriage when the applicant began to cry as he watched a television item commemorating the war in Vietnam but he would not talk to her about his service. Describing his moods, she said he will go quiet but then come good after a few hours. Mrs Compston said that earlier on in the marriage she pulled him up when she thought he was being too sensitive to criticism. As for the applicant’s sleeping patterns, she said that in the earlier years of their marriage she did not notice the problems he now has in getting to sleep and staying asleep. She said he worries about everything excessively but is not the sort of person who fights a lot.
22. The clinical notes from the Wentworth Area Health Service, Nepean District Hospital in relation to treatment and admissions of the applicant were accepted in evidence (Exhibit R1). The notes covered various admissions from December 1978 December 1991 for complaints including fractured ribs, severe abdominal pains, and partial amputation of a finger. The notes do not record symptoms of depression or Mr Compston’s advising hospital staff that he suffered or in the past had suffered from depression.
Dr Farbotko
23. The applicant’s general practitioner, Dr Farbotko, completed a medical impairment assessment in relation to the conditions referred to in the claim for pension that Mr Compston lodged on 5 November 1998 (T5). Dr Farbotko noted that he had not observed features of stress, nor had symptoms of stress been reported to him by others, apart from the applicant. Dr Farbotko noted that Mr Compston could cope with the effect of stress in his everyday life, but he was unable to comment on its effect on Mr Compston’s domestic inter-personal relations. Further, Dr Farbotko noted that Mr Compston had not consulted him nor a psychiatrist for treatment for stress.
Dr Ahmed
24. Mr Compston was referred to Dr N Ahmed, consultant psychiatrist, for assessment. There was an interview on 29 January 1999 and Dr Ahmed provided a report dated 15 February 1999 (T6). The history referred to Mr Compston’s twelve month period of operational service in Vietnam when he was involved in construction. Mr Compston described feeling “somewhat anxious and depressed and skeptical” while in Vietnam and attributed these emotions to what he thought was the futility of his service in Vietnam, his concern about demonstrations against the war at home and related industrial action. Dr Ahmed noted that Mr Compston was given treatment as an outpatient in a field hospital in Vung Tau. Dr Ahmed recorded that the applicant worked satisfactorily and diligently on his return to Australia from Vietnam and was promoted to major. There was reference to his attempt at suicide in late 1972 due to the break up of his marriage and to subsequent psychiatric counselling by Dr Collins.
25.
In coming to an opinion about Mr Compston’s emotional state while he was in Vietnam, Dr Ahmed noted that the applicant’s breakdown might have been due to attitude and resentment and inability to adjust to a war time environment.
Dr Ahmed diagnosed Adjustment Disorder by reference to the diagnostic criteria set out in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Noting Mr Compston’s subsequent promotion, Dr Ahmed considered that he completely recovered from the condition. There was a second Adjustment Disorder that was largely precipitated by the marriage break up in 1973. In Dr Ahmed’s opinion, it was not related to service and he thought Dr Collins’ notes supported that conclusion.
Dr Pusic
26. Mr Compston considered that Dr Ahmed did not give a proper assessment of his condition and, at the time of lodging his second claim at the end of November 1999 (T9) sought an opinion from Dr Pusic, consultant psychiatrist. In a report dated 1 March 2000 (Exhibit A6), Dr Pusic diagnosed chronic post traumatic stress disorder which he said was directly related to traumatic experiences in Vietnam. Mr Compston described his emotional state whilst in Vietnam as feeling pervasively dysphoric, shattered and jittery. Dr Pusic also noted the current symptomatology included recurrent intrusive recollections of traumatic experiences from Vietnam, disturbed sleep and waking in an agitated state, irritability with a low frustration tolerance and social isolation.
27. Dr Pusic thought there was evidence that the applicant had suffered a major depressive episode during his operational service period. Further, Dr Pusic considered there had been another episode of major depression in 1973, consequent on the applicant’s marriage breaking up. Dr Pusic thought the divorce was directly related to the applicant’s inability to readjust to life in Australia following service in Vietnam. In Dr Pusic’s opinion, Mr Compston would be vulnerable to experiencing further episodes of depressive illness. He thought the applicant would benefit from continued psycho-therapeutic intervention and possibly pharmocotherapy. In the history that Dr Pusic obtained, he noted there had been no evidence of anxiety disorder or conduct disorder in childhood.
Dr Dinnen28. During their interview on 10 September 2001, Dr Dinnen asked Mr Compston what he felt was wrong with him. Mr Compston’s response was that in his 20 years of service prior to Vietnam, he had been a well known and well respected serviceman in the engineering group. But he had trouble settling back into his role after serving in Vietnam. Even after the transfer from Brisbane to Sydney in 1972, and his promotion to major, Mr Compston said he was still argumentative, both at home and at work. While acknowledging that his second wife is very understanding, Mr Compston told Dr Dinnen that his mood did not improve much on remarriage. He described his present condition as being friendless, argumentative and lacking interest in things. He also said he remains pre-occupied with thinking about his experiences in Vietnam. He informed Dr Dinnen that his experience there, was of being in danger the whole time. He was both frightened and depressed and had sought treatment at the field hospital for depression.
29. Dr Dinnen stated that Dr Collins' reports did not indicate much in the way of a severe depression and he asked the applicant about the treatment he received from Dr Collins. Mr Compston said he did not fully confide in Dr Collins, adding that he was reluctant to have treatment because of the threat to his Army career.
30.
Dr Dinnen agreed clinically with Dr Pusic that the diagnosis of post traumatic stress disorder appears to fit the patient’s symptom complex best, but the classical features and the diagnostic criteria set out in DSM-IV were not apparent. In conclusion, Dr Dinnen’s report of 7 November 2001 (Exhibit A5) stated
However my findings and the reports of other psychiatrists, Collins, Ahmed and Pusic provide ample evidence to sustain the diagnosis of chronic depressive disorder, dating from service in Vietnam.
The relevant statement of principles, Instrument number 58 of 1998, for depressive disorder in my view is satisfied. There is clear evidence of depressive illness during service. He lost weight and received medical attention. Although the further episode in 1972/3 was attributed to family problems, I believe that it was in the context of operational service providing the triggering mechanism and vulnerability for the depressive illness to recur.
The definition of ‘severe psychosocial stressor (Factor 5 (b))’ is satisfied by his twelve months in Vietnam.Dr Dinnen noted that Mr Compston’s depressive disorder is of an ongoing chronic, moderate severity warranting ongoing psychiatric treatment. In his opinion, the condition causes considerable impairment.
31. In his oral evidence Dr Dinnen gave a number of reasons for disagreeing with Dr Haik’s diagnosis of avoidant personality disorder. Dr Dinnen said that there was no evidence of significant personality pathology during Mr Compston’s early years in the Army. Dr Dinnen thought moreover, that a diagnosis of personality disorder means a pervasively dysfunctional adjustment to the environment, which is an unusual condition and one that he has not often encountered. Dr Dinnen disputed the diagnosis on another basis, namely, that he thought it incongruent for an avoidant personality to achieve officer status in the Army. Rather than having an avoidant personality disorder, Dr Dinnen thought Mr Compston’s behaviour since returning from Vietnam has been to avoid stress as a means of coping with his chronic depression. Dr Dinnen also disagreed with Dr Haik’s opinion that the applicant had a pathological dependency on his second wife. Dr Dinnen explained the stutter that Mr Compston developed in Vietnam as reflecting the level of anxiety that he was experiencing.
32. Under cross-examination, Dr Dinnen agreed that Mogodon is not an anti-depressant treatment but a sleeping tablet. In amplification, however, Dr Dinnen pointed out that sleeping difficulties are a common symptom of both depression and anxiety. Dr Dinnen said his diagnosis of depressive illness during service in Vietnam was based on the history he obtained about a general sense of unhappiness and feeling of futility. Mr Marsh asked Dr Dinnen if he was confident in his diagnosis given that it was based on the history and he had reported that it was difficult to get a coherent history from the applicant. Dr Dinnen’s response was that he was confident in his diagnosis.
33. Mr Marsh pointed out that Dr Collins did not refer to depression in his notes of consultations with the applicant. Further, Dr Collins’ notes were of insomnia and associated problems not adversely affecting the applicant’s work. Dr Dinnen’s response was to speculate that the reference merely to insomnia and the absence of a diagnosis was due to Dr Collins not wanting to record a diagnosis that could have been damaging to an officer’s Army career. As for Dr Collins not referring in his notes to service in Vietnam, Dr Dinnen thought that during that period in the 1970s, it was not common for psychiatrists to focus on military service as a cause of a person’s problems. Asked for his explanation of the in patient notes of the Parramatta Hospital psychiatric unit (Exhibit R5) stating that there was no significant depression and no features to suggest risk of suicide, Dr Dinnen said that there were no vegetative signs of major depressive illness with fixed suicidal ideation that would warrant compulsory admission to hospital. However, he did not think that necessarily led to a conclusion that the overdose was not in the context of disturbed or depressed mood.
34. Mr Marsh asked Dr Dinnen whether his diagnosis of depression was inconsistent with the fact that Dr Pusic has been consulting with Mr Compston for approximately three years without prescribing any anti-depressants or other medication. Dr Dinnen’s answer was that a patient may have a chronic depressive illness that limits the person’s lifestyle so that they reduce stressful events and their symptoms are going to be relatively contained, which is the case here. He agreed that Mr Compston suffers from a mild form of depression that limits his ability to get much enjoyment from life. Though it is not dramatic, Dr Dinnen said this form of depression is obvious to those who know the person and to their family doctor. Dr Dinnen elaborated that it has become more common of recent years to use drugs in treatment than it was twenty to thirty years ago. He also pointed out that many patients can be helped effectively with psychotherapy rather than pharmacotherapy.
Dr Haik
35. Dr Haik interviewed Mr Compston on 29 November 2001 and provided a report (Exhibit R4) of the same date. In describing what led up to the applicant’s leaving the Army at the end of 1974, Dr Haik reported that the applicant lamented that it was a premature resignation, provoked by his emotional problems, and caused him financial loss. Dr Haik observed, however, that in the ensuing twenty five years the applicant did not seek psychiatric assistance. When Dr Haik asked him if he was depressed, Mr Compston replied that he was not happy. Further, Dr Haik observed that despite treatment in Vietnam for depression, upon returning to Australia, Mr Compston was promoted to captain and later to major and Mr Compston must have been functioning well for promotion to have been considered. Dr Collins’ clinical notes did not refer either to Vietnam or depression and Dr Haik thought it relevant that the applicant’s long standing family problems and not his work were associated with his insomnia. It was quite unlikely, in Dr Haik’s opinion, that Mr Compston’s experiences in Vietnam were an element in the discomfort he experienced early in 1973.
36. That Dr Pusic was not prescribing medications currently, suggested to Dr Haik that Mr Compston’s present symptoms were not very significant. For him to diagnose chronic depressive disorder dating from and continuing from service in Vietnam, Dr Haik would have expected to see a reference to the applicant’s experiences in Vietnam in Dr Collins’ clinical notes. He particularly thought it surprising that, if the applicant were significantly distressed or disabled by depression or post traumatic stress disorder, he was not being treated with anti depressants by Dr Pusic. In diagnosing avoidant personality disorder, Dr Haik observed that that condition and dependent personality disorder are both characterised by feelings of inadequacy and hypersensitivity to criticism. Dr Haik noted from his interview with Mr Compston that he was talkative, helpful and cooperative and he did not consider that he was depressed in any respect. He did not consider that treatment would have any influence upon Mr Compston.
37. Dr Haik’s report addressed each of the criteria in DSM-IV for a diagnosis of avoidant personality disorder. Dr Haik’s overall analysis was that, as Mr Compston was being promoted in the Army, demands upon him to manage his men became greater. Those demands pushed Mr Compston to the limit of what Dr Haik thought was his interpersonal endurance. This explained Mr Compston’s decision to leave the Army and not to start up a business in building. Further, Dr Haik suggested that Mr Compston’s decline was facilitated by the development of a most dependent relationship with a widow who had been his neighbour and became his wife. His relationship with his first wife declined inversely with the progression of his association with his new wife.
38. Dr Haik thought that Mr Compston had led a relatively isolated social life for most of his Army years and in the years following. Dr Haik did not agree with Dr Dinnen that there was no evidence of personality pathology during the applicant’s Army career. Dr Haik’s explanation was that a person may perform a good job but not necessarily have to mix with and meet people, and therefore there was no inconsistency between the promotions he received and the diagnosis. Dr Haik thought it reasonable to extrapolate from the history he had of Mr Compston’s early years in the Army to conclude that he was socially awkward during earlier periods. When informed that Mr Compston had worked at part time jobs while still at school, Dr Haik thought that the development of the personality disorder would have been in the late teens and early twenties as a result of the slings and arrows of adolescence and childhood. Whether the personality disorder began at age 19 or 25 was not as important to Dr Haik as assessing the bigger picture and in that regard, the history was of decades in the first marriage where he led a very asocial life. In Dr Haik’s opinion, the applicant’s attending the Dale Carnegie course ‘How to win friends and influence people’ shortly after coming home from Vietnam could be motivated by overcoming awkwardness with people. A stutter could develop from such an awkwardness and therefore he would attend the course to address the social awkwardness. Dr Haik allowed that social inhibition may be a personality trait experienced by a large proportion of the population. It is the dysfunction due to the personality trait that leads to a diagnosis of a disorder. Dr Haik said that Mr Compston’s unhappiness is not necessarily related to Vietnam but to his personality which is explained by his social awkwardness over which he has no control but which he could not deal with in the Army once he was promoted to a certain rank. Dr Haik thought that avoidant personality disorder would explain Mr Compston’s unwillingness to have an ongoing association with his children and them with him, although equally an acute episode of depression for possibly six months, not twenty years, could also explain not having anything to do with his children.
39. Dr Haik told the Tribunal that Mr Compston’s evidence that he did not wish to set up a building business because he was fearful of bankruptcy and being unable to pay his employees, could indicate feelings of inadequacy inhibiting new interpersonal relations. Dr Haik thought it could also explain his being uncomfortable in establishing relationships with customers.
40. Dr Haik was asked about Mr Compston’s history of sleep disturbance. Such a symptom does not suggest avoidant personality disorder, in his opinion, in the absence of a discrete stressor. On the other hand, Dr Haik believed that Mr Compston’s joining and then leaving the woodworker’s guild and the photography club suggested an avoidant personality. Rather than such conduct being inconsistent with the diagnosis, Dr Haik believed that leaving after a period could suggest that Mr Compston wanted to try something but it became uncomfortable for him and therefore he left.
41. It was put by Mr Vincent to Dr Haik that there were no adverse reports in Mr Compston’s Army records about his behaviour or inability to cope with work. Dr Haik’s response was that he would not have expected the same given that the applicant was doing his work satisfactorily. Dr Haik did not agree with the view of others, including Dr Dinnen, that a person can suffer from a depressive disorder for ten or twenty years without being prescribed anti depressants to make the depression less disabling. Dr Haik added that in his clinical experience, it is not at all common to see chronic depression extending over ten years, as opposed to enduring and disabling personality disorders, without the depression being treated with pharmacotherapy.
CONSIDERATION OF ISSUES42. Mr Vincent submitted that Mr Compston suffers from a condition that is appropriately diagnosed as depressive disorder. He referred to Mr Compston’s evidence regarding a number of stressful incidents that occurred during his operational service in Vietnam and his seeking treatment at a field hospital because some experiences had made him feel uneasy. Mr Vincent submitted that Mr Compston’s emotional problems were evident in Vietnam, continued on his return to Australia and resulted in poor behaviour at work and a deteriorating marriage. In his submission the applicant relied on Factor 5(b) of SoP 58 of 1998 concerning depressive disorder as being raised by the material before the Tribunal. The respondent’s contention that the appropriate diagnosis is personality disorder should be rejected because all of the required diagnostic criteria relating to personality disorder were not present. On the contrary, Dr Dinnen’s diagnosis of depressive disorder was based on firm evidence of such an illness during operational service and thereafter. Further, Mr Vincent submitted that Dr Haik’s diagnosis should be rejected because Dr Haik’s evidence was that he did not refer to the relevant SoP at the time of making his diagnosis. Dr Dinnen disagreed with the diagnosis because he did not think Mr Compston‘s life demonstrated a pervasively dysfunctional adjustment to the environment, given his achievement of officer rank and a successful second marriage of almost thirty years.
43. For the respondent, Mr Marsh submitted that the appropriate diagnosis was personality disorder and that it was not connected in any relevant way with Mr Compston’s service. Alternatively, the respondent submitted that if depressive disorder were found to be the appropriate diagnosis, that condition cannot be connected with service since the hypothesis does not fit the template of the relevant SoP and thus the hypothesis is not reasonable. Mr Marsh stated that the respondent conceded that the applicant experienced a severe psychosocial stressor, an occurrence that happened during operational service that was covered by the definition in SoP 58 of 1998. However, Mr Marsh submitted that there was no material before the Tribunal that pointed to clinical onset of depressive disorder within two years of the end of the applicant’s period in Vietnam, that is by 23 April 1970. In his submission, therefore, the proposed hypothesis is not supported by material pointing to each element that the SoP makes essential for the hypothesis to be considered reasonable.
44. Where there is a preliminary question about the nature or type of incapacitating disease from which an applicant suffers, the Tribunal’s function has been described by the Full Court of the Federal Court in Benjamin v Repatriation Commission (2001) 34 AAR 270 as follows (at 283):
The first question for the Tribunal will be how to characterise the psychiatric problems exhibited by the Veteran. If the Tribunal is satisfied that the symptoms constitute an injury or illness, the second question will be whether there is an SoP in force in respect of the disease. The diagnosis of that disease, and the determination of whether or not there is an SoP in force in respect of that kind of disease, falls for determination according to the standard of proof laid down in s.120(4). The characterisation of a disease (or injury or death in an appropriate case), for the purpose of determining whether an SoP is in force in respect of that kind of disease (or injury or death), is separate from the question of whether a claim relates to the operational service rendered by a veteran within s.120(1). The standard of proof laid down by s.120(1) has no application to the former question.
45. In characterising the symptoms, the Tribunal is to:
… identify the collection of relevant symptoms which he or she is satisfied constituted the disease which the veteran contracted. It is not a matter of nomenclature or attaching a traditional label to the collection of symptoms. That, as the conflicting expert psychiatric evidence of Dr Knox and Dr Dent on the one hand and Dr Spragg on the other, shows in relation to the label ‘Post-Traumatic Stress Disorder’, may turn on questions of causation or aetiology. Once the decision maker has identified, to his or her reasonable satisfaction, the collection of relevant symptoms from which an applicant suffers, the question of whether those symptoms were war-caused has to be resolved by imposing on the Commission the reverse onus of proof on the criminal standard in accordance with s.120(1) as qualified by s.120(3): Repatriation Commission v Budworth (2001) 66 ALD 285, 292.
Moreover, it is quite clear from Benjamin that “SoPs are not relevant to the question of diagnosis”, the Full Court there noted (at 280):
The primary judge observed that, on all the evidence before the Tribunal, exposure to a traumatic event was the primary criterion required for the diagnosis of post traumatic stress disorder. The Tribunal made its diagnosis by reference to SoP 15 of 1994. His Honour correctly held that to be impermissible, as the scheme of the Act contemplates that SoPs be used to determine the standard of proof. SoPs are not relevant to the question of diagnosis.
46. It is thus established by Benjamin and Budworth that when determining the issue of diagnosis, the Tribunal will apply the standard of proof prescribed by s.120(4) of the Act – reasonable satisfaction. Where the Tribunal determines that the symptoms constitute a disease, the next step is to determine whether a SoP is in force in respect of the disease.
47. In passing we observe that each of the four psychiatrists who has interviewed Mr Compston in relation to his claim has put forward a different diagnosis. We will start by considering the material as to whether or not Mr Compston suffers from depressive disorder, which is the diagnosis made by Dr Dinnen. The parties agree that in relation to this condition, SoP 58 of 1998 concerning Depressive Disorder is the relevant SoP. ‘Depressive disorder’ is defined in the SoP as “the presence of major depressive disorder, dysthymic disorder or depression not otherwise specified …”. The SoP then incorporates the relevant definition of each disorder as found in DSM-IV. The Tribunal’s task is complicated, however, by the fact that Dr Dinnen has not specified which of these disorders he diagnosed.
48. The essential feature given by DSM-IV for major depressive disorder is a clinical course characterised by one or more major depressive episodes. DSM-IV states that the symptoms present during such an episode “represent a change from previous functioning”. The diagnostic criteria for ‘major depressive episode’ in DSM-IV are summarised as follows:
The essential feature of a Major Depressive Episode is a period of at least 2 weeks during which there is either depressed mood or the loss of interest or pleasure in nearly all activities. … The individual must also experience at least four additional symptoms drawn from a list that includes changes in appetite or weight, sleep, and psychomotor activity; decreased energy; feelings of worthlessness or guilt; difficulty thinking, concentrating or making decisions; or recurrent thoughts of death or suicidal ideation, plans, or attempts. To count toward a Major Depressive Episode, a symptom must either be newly present or must have clearly worsened compared with the person’s preepisode status. The symptoms must persist for most of the day, nearly every day, for at least 2 consecutive weeks. The episode must be accompanied by clinically significant distress or impairment in social, occupational, or other important areas of functioning. For some individuals with milder episodes, functioning may appear to be normal, but requires markedly increased effort. (DSM-IV p.320)
49. The applicant’s evidence concerning his severe weight loss, insomnia, agitation about vulnerability to attack while in Vietnam and the incomplete state of his medical records covering that period, as well as with the opinions of Dr Ahmed and Dr Pusic, satisfy us that he suffered an episode of either major depression or adjustment disorder. The material relating to his emotional upheaval at the time his marriage was breaking down, particularly the notes of Dr Collins, suggests two conclusions. First, the acute adjustment disorder or major depression episode that Mr Compston experienced in Vietnam had concluded at some point before February 1973. Secondly, the emotional distress he suffered during the course of separating from his wife and family did not lead to depression. At the time of Mr Compston’s valium overdose in February 1973, he was not admitted to the psychiatric unit at Parramatta Hospital, the registrar noting that there was no significant depression or psychiatric impairment. Any occupational disabling effect of this event was temporary. Indeed Mr Compston’s evidence was that on the next day, he accompanied the chief engineer to a conference at Victoria Barracks. Over the following few months he consulted Dr Collins, but not for depression. Dr Collins’ treatment notes refer to marital difficulties that did not have any adverse effect on the applicant’s work. Accordingly, we find that, if as a consequence of operational service Mr Compston suffered a major episode of mood disorder, such as a major depressive episode, or an episode of acute adjustment disorder, it was a single episode that concluded well before 1973. We accept Dr Ahmed’s opinion that the marital upheaval led the development of symptoms of an adjustment disorder that was acute, less than six months, in duration.
50. In relation to dysthymic disorder, SoP 58 of 1998 states:
dysthymic disorder, as defined in DSM-IV, is a chronic mood disturbance, of at least two years duration, involving depressed mood, or loss of interest or pleasure, with manifestation of the symptoms used to diagnose major depression such as neurovegative signs, social withdrawal, cognitive impairment and suicidal ideation;
Criteria A and B of DSM-IV’s diagnostic criteria for dysthymic disorder state (p.349):
A. Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable and duration must be at least 1 year.
B. Presence, while depressed, of two (or more) of the following:
(1) poor appetite or overeating(2) insomnia or hypersomnia
(3) low energy or fatigue
(4) low self-esteem
(5) poor concentration or difficulty making decisions
(6) feelings of hopelessness
The diagnostic criteria for dysthymic disorder in DSM-IV also include a reference to symptoms causing clinically significant distress or impairment in social, occupational or other important areas of functioning.
51. In contrast to major depression, this disorder is more enduring. However, the evidence does not support such a diagnosis. The evidence of his G.P. Dr Farbotko (T5) is that he has not observed or had reported to him, any symptoms of stress. Mr Compston first saw Dr Pusic in relation to a report in support of the claim to have post traumatic stress disorder accepted as war-caused. Dr Pusic diagnosed post traumatic stress disorder not depression. In relation to depression his report goes no further than saying that “Mr Compston would be vulnerable to experiencing further episodes of depressive illness.” Dr Dinnen, however, diagnosed chronic depressive disorder for which he said there was ample support in the findings and reports of psychiatrists, Collins, Ahmed and Pusic. We do not agree and consider that the findings of Dr Ahmed and Dr Pusic conflict with Dr Dinnen’s diagnosis. Moreover Dr Collins did not find depression at all. The evidence does not establish to our satisfaction that Mr Compston’s symptoms amount to dysthymic disorder.
52. As for depressive disorder not otherwise specified, such as minor depressive disorder and recurrent brief depressive disorder, SoP 58 of 1998 provides that DSM-IV’s definition includes disorders that do not meet the diagnostic criteria for other specific mood disorders. Relevantly DSM-IV reads as follows:
The essential feature is one or more periods of depressive symptoms that are identical to Major Depressive Episodes in duration, but which involve fewer symptoms and less impairment. An episode involves either a sad or ’depressed’ mood or loss of interest or pleasure in nearly all activities. … At the onset of the episode, the symptoms are either newly present or must be clearly worsened compared with the person’s preepisode status. During the episode, these symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. (DSM-IV p.719)
In relation to differential diagnosis the following appears in DSM-IV “This proposed disorder is considered to be a remedial category and is not to be used if there is a history of a Major Depressive Episode, … Symptoms meeting research criteria for minor depressive disorder can be difficult to distinguish from periods of sadness that are an inherent part of everyday life.” (p.719) In addition, DSM-IV includes minor depressive disorders and recurrent brief depressive disorders as examples of depressive disorder not otherwise specified. Given the evidence of Dr Dinnen that the applicant’s condition is chronic, it is considered that recurrent brief depressive disorder is not apt to describe his symptoms.
53. We have already observed that when Mr Compston lodged the claim for disability pension, Dr Farbotko was not giving him treatment for any emotional or behavioural condition. Notwithstanding he is not a specialist, it might be expected that, if Mr Compston had been experiencing symptoms of depression, such would have been noted by Dr Farbotko. Further, the clinical notes of the Nepean Hospital do not record treatment for depression or make any mention of psychiatric illness such as patient ‘appeared depressed’. Dr Haik reported that depression would not appear to be a significant factor in Mr Compston’s life. The applicant’s evidence and that of his wife was of a very good marriage and little to suggest ongoing emotional disturbance other than his insomnia and that he can be irritable and not in need of friends. We note that it was Mrs Compston’s evidence that the symptoms of insomnia appear to have arisen only in more recent years.
54. Against that evidence is the fact that the applicant has regular consultations with Dr Pusic, who believes that he has displayed symptoms of chronic post traumatic stress disorder. There is also Dr Dinnen’s opinion that Mr Compston’s chronic depressive disorder is of moderate severity and causes considerable impairment, although in oral evidence he said the applicant’s was a mild form of depression.
55. In coming to a conclusion about whether Mr Compston suffers from a depressive disorder not otherwise specified, we are mindful of that the Full Federal Court has recently affirmed that the Tribunal, under s.120(4) of the Act, must decide the issue to its reasonable satisfaction on the balance of probabilities (Fogarty v Repatriation Commission [2003] FCAFC 136). We prefer Dr Haik’s analysis that Mr Compston’s withdrawal from the workforce, all social relationships and his hobbies is because he would feel uncomfortable in trying to accommodate the expectations of social interaction. This behaviour is not due to depression, in Dr Haik’s view, because if it were, there would be additional symptoms present that would require treatment with anti-depressants, a conclusion that Dr Farbotko’s evidence would confirm. He prefers his own company and may go quiet for a few hours on some days, but his wife’s evidence was that he then comes good. Further Dr Dinnen’s evidence that Mr Compston’s form of depression, while being mild, would be obvious to the family doctor, which it was not, militates against finding that Mr Compston suffers from depression. Dr Ahmed’s opinion also supports a conclusion that a diagnosis of depressive disorder is not appropriate for the applicant’s symptoms. We are satisfied that Mr Compston experienced two discrete episodes of intense, emotional upset, from which he fully recovered. After considering the material before us, we cannot find to our reasonable satisfaction that Mr Compston suffers from symptoms of any persisting depressive disorder including depressive disorder not otherwise specified.
56. In summary we find, on balance, that Mr Compston’s symptoms are not symptoms that satisfy the diagnostic criteria laid down in DSM-IV for major depressive disorder, dysthymic disorder or depressive disorder not otherwise specified. Our finding, therefore covers each of the disorders referred to in SoP 58 of 1998 under the rubric ‘depressive disorder’.
57. The Tribunal will now move on to decide whether Mr Compston’s collection of symptoms constitute a psychiatric condition. Dr Pusic’s diagnosis of post traumatic stress disorder has been expressly disputed by Dr Dinnen and Dr Haik. There was little in the material about Mr Compston’s symptomatology that would include “persistent reexperiencing of the traumatic event (Criterion B), persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (Criterion C), and persistent symptoms of increased arousal (Criterion D)” (DSM-IV p.424). We are satisfied, therefore, that Mr Compston is not suffering from post traumatic stress disorder.
58. Dr Ahmed’s opinion suggests that, although he considered Mr Compston’s emotional symptoms while on operational service in Vietnam and later during 1973 when treated in relation to marital upheaval were periods of acute adjustment disorder, at other times the applicant has not suffered from a psychiatric condition that warrants a formal diagnosis. Dr Haik, however, was of the view that Mr Compston appears to suffer from a longterm avoidant personality disorder, a psychiatric disability. Dr Haik summed his opinion about the disorder as follows “It was in evidence during his first marriage but he was able to cope with his army service until promoted beyond his level of competence by the late 1960s. He found some comfort from the army routine.” (Exhibit R4). The SoP concerning personality disorder is SoP 143 of 1995, as amended by SoP 13 of 1997. The definition of ‘personality disorder’ in SoP 13 of 1997 states that it is derived from DSM-IV and means a psychiatric condition attracting one of a number of codes assigned to particular kinds of injury or disease in the International Classification of Diseases, 9th revision (ICD). Dr Haik’s diagnosis of avoidant personality disorder, ICD code 301.82 is specifically included in the SoP as one of the disorders covered by the general descriptor ‘personality disorder’.
59. DSM-IV sets out the essential features of avoidant personality disorder in the following terms (p.662):
The essential feature of Avoidant Personality Disorder is a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation that begins by early adulthood and is present in a variety of contexts. …
The major problems associated with this disorder occur in social and occupational functioning. The low self-esteem and hypersensitivity to rejection are associated with restricted interpersonal contacts.
60. DSM-IV’s general diagnostic criteria for a Personality Disorder are (p.633):
A. An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture. This pattern is manifested in two (or more) of the following areas:
(1) cognition (i.e., ways of perceiving and interpreting self, other people, and events
(2) affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response)
(3) interpersonal functioning
(4) impulse control
B. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.
C. The enduring pattern leads to clinically significant distress or impairment in social, occupation, or other important areas of functioning.
D. The pattern is stable and of long duration and its onset can be traced back at least to adolescence or early adulthood.
E. The enduring pattern is not better accounted for as a manifestation or consequence of another mental disorder.
F. The enduring pattern is not due to the direct physiological effects of a substance, (e.g., a drug of abuse, a medication) or a general medical condition (e.g. head trauma).
61. Mr Vincent submitted that a diagnosis of personality disorder was not appropriate because of the absence of a number diagnostic criteria. He referred specifically to the pattern of experience and behaviour not being traced back at least to adolescence or early adulthood. Relying on Dr Dinnen’s evidence, he argued also that Mr Compston’s career in the Army demonstrated that he did not have dysfunctional personal inadequacy. Since leaving the Army, the applicant’s behaviour suggested to Dr Dinnen that he was trying to avoid stressful and challenging situations that could make his depression worse. Further, Mr Vincent put it to Dr Haik that many aspects of Mr Compston’s personality are simply personality traits that are not pathological.
62. There is material that satisfies us that Mr Compston, at least since early adulthood, has demonstrated a pervasive pattern of social inhibition. His evidence was that after marriage, he and his wife did not mix socially with others apart from one set of neighbours, one of whom he was to later to marry. The evidence about Mr Compston’s working odd jobs whilst still a school pupil, suggests an appreciation of his family’s difficult financial circumstances and intentions to give his mother some financial assistance as much as it suggests normal interpersonal functioning. Despite his years of experience as an Army officer, formal joining and carpentry qualifications and being a licensed builder, he chose not to work in the building trade. He said that he did not want to let down employees. We accept Dr Haik’s view that this demonstrates an avoidance of establishing relations with customers and other tradespeople and not wanting to be involved in interpersonal relations through the conduct of his business. It also suggests an unusual reluctance to take risks that may prove embarrassing.
63. Resigning from his hobby groups reflected his outlook that he would tell people what he thought regardless of their reaction. As Mr Compston said in evidence “I tell people just the way it is.” This behaviour, according to Dr Haik, was part of Mr Compston’s enduring pattern of becoming uncomfortable with expectations. We find this material demonstrates some impairment of the applicant’s perceptions and interpretations of self and others.
64. Dr Haik was prepared to allow that Mr Compston‘s personality disorder did not result in occupational impairment while in the Army. However, he explained that few interpersonal demands were made of him as an engineer and his admitted difficulty in supervising his men that developed later on, demonstrated more of an interpersonal rather than a functional impairment.
65. In accepting Dr Haik’s diagnosis, we are also mindful of Dr Ahmed’s diagnosis of acute adjustment disorder covering the episode in Vietnam and the later period of upheaval when his marriage was breaking down. Dr Ahmed’s opinion depended upon the diagnostic criteria for adjustment disorder for periods not exceeding six months and thus not being a disorder that is enduring or chronic in nature. However, the overall picture from the material is of a persisting avoidant personality disorder. It is a permanent pattern of experience and behaviour, which in Mr Compston’s case has been present at least from his early adulthood. The symptoms constitute a mental ailment and thus a ‘disease’ as defined in s.5D of the Act and we find accordingly.
66. In determining whether the disease is war-caused under s.9 of the Act, Mr Compston would have to rely on SoP 143 of 1995 as amended by SoP 13 of 1997.. The SoP sets out two factors, either of which must be related to service, so that it can be said that there is a reasonable hypothesis raised connecting the disease with circumstances of his service. Those factors are as follows:
1(a) suffering a catastrophic experience that immediately preceded an enduring personality change to the level of disorder;
1(b) inability to obtain appropriate clinical management for personality disorder.
67. We are satisfied that Mr Compston did not experience catastrophic stress that has brought about an enduring personality change. On the contrary, the material suggests that Mr Compston’s personality disorder has been constant from early adulthood and prior to his operational service in Vietnam. As for factor 1(b), the material before us suggests that Mr Compston sought out clinical management for his episode of depression, in the case of his experience during operational service, and his adjustment disorder as part of the process of divorce, for which he received adequate treatment. Until recently, there has been little psychiatric treatment and that accords with our view that the effect of the experience in Vietnam was temporary not enduring. We are satisfied that factor 1(b) is not met. We find, therefore, that a hypothesis connecting Mr Compston’s personality disorder with his operational service is not a reasonable hypothesis because there is no factor in SoP 143 of 1995 (as amended by SoP 13 of 1997) that connects that condition with the circumstances of his service. The Tribunal, accordingly, accepts the Commission’s submission that Mr Compston’s personality disorder is not a war-caused disease. Moreover, in this respect the Tribunal refers to the diagnosis of Dr Haik who stated that the applicant’s condition of personality disorder has been with him for most of his life and it is totally unrelated to service.
68.
We therefore decide to affirm the decision under review.
I certify that the preceding 68 paragraphs are a true copy of the decision and reasons for decision herein of P.J. Lindsay, Senior Member and Dr P.D. Lynch, Member:
Signed:
..............................................................................
(Associate)
Hearing 4 September and 16 October 2002
Written submissions received: 13 May and 21 July 2003
Date of Decision 22 September 2003
Applicant’s Counsel Mr M. VincentRespondent’s Representative Mr J. Marsh, Department of Veterans’ Affairs.
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