Dunn and Repatriation Commission - [2002] AATA 801

DECISION AND REASONS FOR DECISION [2002] AATA 801

ADMINISTRATIVE APPEALS TRIBUNAL )

) No A2000/458

VETERANS' APPEALS DIVISION          )
           Re      Philip Dunn
  Applicant
           And    Repatriation Commission
  Respondent

DECISION

Tribunal Mr G A Mowbray

Date12 September 2002
PlaceCanberra

Decision The Tribunal sets aside the decision under review and in substitution therefor decides:

1.Mr Dunn's condition of post traumatic stress disorder is war-caused for the purposes of the Veterans' Entitlements Act 1986 (the Act).
2.Mr Dunn's condition of hypertension is war-caused for the purposes of the Act.
3.Mr Dunn's condition of depressive disorder is defence-caused for the purposes of the Act.
4.The date of effect is 18 April 1996.
..............................................
Member
CATCHWORDS
VETERANS' AFFAIRS – whether suffering from post traumatic stress disorder - whether post traumatic stress disorder war-caused – whether veteran experienced a severe stressor during operational service
VETERANS' AFFAIRS – whether hypertension war-caused – whether severe stressor caused alcohol abuse – whether suffering alcohol abuse at clinical onset of hypertension
VETERANS' AFFAIRS - whether depressive disorder defence-caused – whether suffered a psychosocial stressor – whether during defence service – date of onset

Veterans' Entitlement Act 1986 ss 9, 70, 120, 120A, 120B
Statement of Principles No.3 and 54 of 1999 – Post Traumatic Stress Disorder
Statement of Principles No.31 of 2001 – Hypertension
Statement of Principles No.76 of 1998 – Alcohol Dependence or Alcohol Abuse
Statement of Principles No.59 of 1998 – Depressive Disorder

Repatriation Commission v Gorton (2001) 110 FCR 321; 33 AAR 370
Repatriation Commission v Budworth (2001) 33 AAR 476; 66 ALD 285
Repatriation Commission v Deledio (1998) 83 FCR 82; 49 ALD 193; 27 AAR 144
Repatriation Commission v Bey (1997) 79 FCR 364; 149 ALR 721; 47 ALD 481; 26 AAR 298
Bull v Repatriation Commission (2001) 188 ALR 756; 66 ALD 271; 34 AAR 326
Connors v Repatriation Commission (2000) 59 ALD 61
McKenna v Repatriation Commission (1999) 86 FCR 144; 29 AAR 70
Repatriation Commission v Smith (1987) 15 FCR 327; 74 ALR 537; 12 ALD 798; 7 AAR 17

REASONS FOR DECISION

12 September 2002 Mr G A Mowbray

This is an application by Mr Philip Dunn for review of a decision by the Repatriation Commission on 28 January 1997, as varied by the Veterans' Review Board on 27 September 2000. The Commission's decision refused Mr Dunn's claim to have hypertension, chronic anxiety with alcohol abuse (which was the Commission's categorisation of what Mr Dunn had described as "anxiety state") and Parkinson's disease accepted as war or defence caused. The Board varied the decision by adding a further diagnosis of depressive disorder, then affirmed the decision as varied.
At the hearing on 28 November 2001, Mr Dunn was represented by his solicitor, Mr Paul Crabb, and the Commission was represented by Mr Stephen Modder, a Department of Veterans' Affairs advocate.
Background
Mr Dunn was born on 12 November 1934. He joined the Royal Australian Air Force in 1951 as an apprentice engine fitter, but later trained as a fighter pilot. He undertook operational service as defined in the Veterans' Entitlements Act 1986 (the Act) in Malaya from 9 July 1959 to 29 July 1961. He also performed defence service from 7 December 1972 until leaving the RAAF on 11 August 1977.
Mr Dunn's current claim was formally lodged on 18 July 1996. Prior to this he already had an accepted condition of sensori-neural deafness, for which he receives a disability pension at 10% of the General Rate. An application for an increase in this rate was refused in August 2000, but this is not a matter before the current Tribunal. A previous claim for Parkinson's' disease was rejected by the Commission in 1985.
The precise list of conditions under consideration has varied throughout the history of Mr Dunn's claim. The original claim was for hypertension, Parkinson's disease and anxiety state. The Commission substituted "chronic anxiety with alcohol abuse" for "anxiety state". In August 1999 the Board adjourned its hearing of the claim and indicated to Mr Dunn's advocate that "anxiety disorder due to a general medical condition" ought to be considered. When the Board came to a decision on 27 September 2000 it chose to add a diagnosis of depressive disorder alongside the existing diagnosis of chronic anxiety with alcohol abuse.
Mr Dunn lodged an application for review with the Tribunal on 1 December 2000. The claim for Parkinson's disease was withdrawn on 13 March 2001. On 9 July 2001 the claim for "generalised anxiety state" was withdrawn, but it had by that time effectively been replaced by a claim for post traumatic stress disorder. Alcohol abuse or dependence was also "claimed", but Mr Crabb made it clear in the course of the hearing that this was not claimed as a current condition, rather as a past condition that was a factor in the onset of hypertension.
Yet another diagnosis of Mr Dunn's psychological condition(s), this time of adjustment disorder, was put forward on behalf of the Commission rather than Mr Dunn.
Issues
The issues before the Tribunal may be simply stated

whether Mr Dunn in fact suffers from any of the conditions put forward (see paragraphs 5 to 7 above)
the date of onset of each condition from which he suffers
the dates of any precipitating stressors
whether each condition he suffers from is either war or defence-caused.

Legislation

The relevant sections of the Act are as follows
"9 War-caused injuries or diseases
(1) Subject to this section, for the purposes of this Act, an injury suffered by a veteran shall be taken to be a war-caused injury, or a disease contracted by a veteran shall be taken to be a war-caused disease, if:
(a) the injury suffered, or disease contracted, by the veteran resulted from an occurrence that happened while the veteran was rendering operational service;
(b) the injury suffered, or disease contracted, by the veteran arose out of, or was attributable to, any eligible war service rendered by the veteran;
(c) the injury suffered, or disease contracted, by the veteran resulted from an accident that occurred while the veteran was travelling, while rendering eligible war service but otherwise than in the course of duty, on a journey to a place for the purpose of performing duty or away from a place of duty upon having ceased to perform duty;
(d) the injury suffered, or disease contracted, by the veteran is to be deemed by subsection (2) to be a war-caused injury or a war-caused disease;
(e) the injury suffered, or disease contracted, by the veteran:
(i) was suffered or contracted while the veteran was rendering eligible war service, but did not arise out of that service; or
(ii)was suffered or contracted before the commencement of the period, or last period, of eligible war service rendered by the veteran, but not while the veteran was rendering eligible war service;
and, in the opinion of the Commission, the injury or disease was contributed to in a material degree by, or was aggravated by, any eligible war service rendered by the veteran, being service rendered after the veteran suffered that injury or contracted that disease;
but not otherwise.
(2) For the purposes of this Act, where any incapacity of a veteran was, in the opinion of the Commission, due to an accident that would not have occurred, or due to a disease that would not have been contracted, but for his or her having rendered eligible war service or but for changes in the veteran's environment consequent upon his or her having rendered eligible war service:
(a) if that incapacity was due to an accident—that incapacity shall be deemed to have arisen out of the injury suffered by the veteran as a result of the accident and the injury so suffered shall be deemed to be a war-caused injury suffered by the veteran; or
(b) if the incapacity was due to a disease—the incapacity shall be deemed to have arisen out of that disease and that disease shall be deemed to be a war-caused disease contracted by the veteran.
…"
"70 Eligibility for pension under this Part
…
(5) For the purposes of this Act, the death of a member of the Forces (other than a member to whom this Part applies solely because of section 69A) or member of a Peacekeeping Force shall be taken to have been defence-caused, an injury suffered by such a member shall be taken to be a defence-caused injury or a disease contracted by such a member shall be taken to be a defence-caused disease if:
(a) the death, injury or disease, as the case may be, arose out of, or was attributable to, any defence service, or peacekeeping service, as the case may be, of the member;
(b) subject to subsection (8), the death, injury or disease, as the case may be, resulted from an accident that occurred while the member was travelling, during any defence service or peacekeeping service of the member but otherwise than in the course of duty, on a journey to a place for the purpose of performing duty or away from a place upon having ceased to perform duty; or
(c) the death is to be deemed by subsection (6) to be defence-caused, the injury is to be deemed by subsection (7) to be a defence-caused injury or the disease is to be deemed by subsection (7) to be a defence-caused disease, as the case may be; or
(d) the injury or disease from which the member died, or has become incapacitated:
(i) was suffered or contracted during any defence service or peacekeeping service of the member, but did not arise out of that service; or
(ii) was suffered or contracted before the commencement of the period, or the last period, of defence service or peacekeeping service of the member, but not during such a period of service;
and, in the opinion of the Commission, the injury or disease was contributed to in a material degree by, or was aggravated by, any defence service or peacekeeping service rendered by the member, being service rendered after the member suffered that injury or contracted that disease; or
(e) the injury or disease from which the member died is an injury or disease that has been determined in accordance with this section other than this paragraph to have been a defence-caused injury or defence-caused disease, as the case may be;
but not otherwise."
"120 Standard of proof
(1) Where a claim under Part II for a pension in respect of the incapacity from injury or disease of a veteran, or of the death of a veteran, relates to the operational service rendered by the veteran, the Commission shall determine that the injury was a war-caused injury, that the disease was a war-caused disease or that the death of the veteran was war-caused, as the case may be, unless it is satisfied, beyond reasonable doubt, that there is no sufficient ground for making that determination.
…
(3) In applying subsection (1) or (2) in respect of the incapacity of a person from injury or disease, or in respect of the death of a person, related to service rendered by the person, the Commission shall be satisfied, beyond reasonable doubt, that there is no sufficient ground for determining:
(a) that the injury was a war-caused injury or a defence-caused injury;
(b) that the disease was a war-caused disease or a defence-caused disease; or
(c) that the death was war-caused or defence-caused;
as the case may be, if the Commission, after consideration of the whole of the material before it, is of the opinion that the material before it does not raise a reasonable hypothesis connecting the injury, disease or death with the circumstances of the particular service rendered by the person.
(4) Except in making a determination to which subsection (1) or (2) applies, the Commission shall, in making any determination or decision in respect of a matter arising under this Act or the regulations, including the assessment or re-assessment of the rate of a pension granted under Part II or Part IV, decide the matter to its reasonable satisfaction.
…"
"120A Reasonableness of hypothesis to be assessed by reference to Statement of Principles
(1) This section applies to any of the following claims made on or after 1 June 1994:
(a) a claim under Part II that relates to the operational service rendered by a veteran;
….
(3) For the purposes of subsection 120(3), a hypothesis connecting an injury suffered by a person, a disease contracted by a person or the death of a person with the circumstances of any particular service rendered by the person is reasonable only if there is in force:
(a) a Statement of Principles determined under subsection 196B(2) or (11); or
(b) a determination of the Commission under subsection 180A(2);
that upholds the hypothesis.
(4) Subsection (3) does not apply in relation to a claim in respect of the incapacity from injury or disease, or the death, of a person if the Authority has neither determined a Statement of Principles under subsection 196B(2), nor declared that it does not propose to make such a Statement of Principles, in respect of:
(a) the kind of injury suffered by the person; or
(b) the kind of disease contracted by the person; or
(c) the kind of death met by the person;
as the case may be."
"120B Reasonable satisfaction to be assessed in certain cases by reference to Statement of Principles
(1) This section applies to any of the following claims made on or after 1 June 1994:
(a) a claim under Part II that relates to the eligible war service (other than operational service) rendered by a veteran;
(b) a claim under Part IV that relates to the defence service (other than hazardous service) rendered by a member of the Forces.
…
(3) In applying subsection 120(4) to determine a claim, the Commission is to be reasonably satisfied that an injury suffered by a person, a disease contracted by a person or the death of a person was war-caused or defence-caused only if:
(a) the material before the Commission raises a connection between the injury, disease or death of the person and some particular service rendered by the person; and
(b) there is in force:
(i) a Statement of Principles determined under subsection 196B(3) or (12); or
(ii) a determination of the Commission under subsection 180A(3);
that upholds the contention that the injury, disease or death of the person is, on the balance of probabilities, connected with that service.
(4) Subsection (3) does not apply in relation to a claim in respect of the incapacity from injury or disease, or the death, of a person if the Authority has neither determined a Statement of Principles under subsection 196B(3), nor declared that it does not propose to make such a Statement of Principles, in respect of:
(a) the kind of injury suffered by the person; or
(b) the kind of disease contracted by the person; or
(c) the kind of death met by the person;
as the case may be."
It became evident early in the hearing that much of the preparation by both parties had been conducted using the Statements of Principles applying at the time of the reviewable decision, in apparent ignorance of the Full Federal Court's decision in Repatriation Commission v Gorton (2001) 110 FCR 321; 33 AAR 370 almost three months earlier. That case decided that the Tribunal should look first at the current Statement of Principles. Only if a favourable decision could not be made for the Applicant should it then look at a Statement of Principles operative at the time of the reviewable decision.
In light of Gorton the parties agreed that the following Statements of Principles were relevant to the current matter

Instrument No.3 of 1999 as amended by No.54 of 1999 for post traumatic stress disorder (relating to operational service)
Instrument No.76 for alcohol dependence or alcohol abuse (operational service)
Instrument No.31 of 2001 for hypertension (operational service)
Instrument No.59 of 1998 for depressive disorder (defence service).

Evidence

At the hearing the Tribunal took into evidence the following documents

Documents filed under section 37 of the Administrative Appeals Tribunal 1975 (T1 to T55)
Applicant's Statement of Facts and Contentions, dated 3 July 2001 (A1)
"Statement on Habits" by Philip Dunn, 23 April 2001 (A2)
Report of Ms Barrelle, clinical psychologist, 12 June 2001 (A3)
Facsimile from Mr Crabb to the Respondent, 9 July 2001 (A4)
Facsimile from Mr Crabb to the Respondent, 27 November 2001 (A5)
Respondent's Statement of Facts and Contentions, 26 November 2001 (R1)
Historical Research Report by Mr Brennan, 26 November 2001 (R2)
Report of Dr Shand, 18 May 2001 (R3)
Report of Dr Shand, 19 October 2001 (R4)

At the close of the hearing a direction was made allowing the parties to provide further evidence on the single issue of postings within the RAAF to flight duties, which had been raised during closing submissions. Mr Dunn provided three statements from current and former members of the RAAF

Statement of Lee Colin Roberts, 10 December 2001 (A6)
Statement of J.S. Back, 9 December 2001 (A7)
Statement of R.S. Cooper, 10 December 2001 (A8)

The Commission provided a supplementary report from Mr Brennan dated 12 December 2001 (R5).

Oral evidence was provided by Mr Dunn and Ms Barrelle.
Evidence of Mr Dunn
Mr Dunn gave oral evidence in addition to his written statements (Exhibit T28 p.171 and Exhibit A2). His oral evidence was given with a measure of interpretation by his wife, and at times others present at the hearing, because of difficulties in understanding his speech which has been severely affected by Parkinson's disease. For this reason Mr Dunn generally found it necessary to keep his answers brief.
Mr Dunn could not accurately date an accident that occurred in Malaya, other than to say it was after a number of his colleagues had been killed flying the same type of aircraft. It may have been about 1960. His engine compressor stalled, causing decompression and a loud explosion. His ears and sinuses were affected. He could not recall whether he lost control of the aircraft, or whether he purposely dived to get a better oxygen pressure. The engine came back on at a lower altitude.
He did not record the accident in his log book or report it, because he was "young and stupid", a "knucklehead" and a fighter pilot. In cross-examination he acknowledged that the accident could have raised safety issues but said that recording an incident did not necessarily mean there would be an investigation. When asked if he considered the incident to be significant, Mr Dunn answered "yes and no" and described it as "an operational hazard".
Mr Dunn first began to have bad dreams after the decompression accident. His alcohol intake also increased after the accident and he would drink to fall asleep in order to avoid bad dreams.
Mr Dunn joined the Red Arrows in England in 1967. This was a role reserved for elite pilots, and he was the only pilot from Australia who went at the time. During this time he observed the accidental death of a member of the Red Arrows. Mr Dunn also established the Roulettes here in Australia in 1971.
Mr Dunn was transferred to his first ground posting at Adelaide University in he thought about 1972 or 1973. This came as a surprise to him even though he was aware he would have a ground posting at some stage. The inevitably of a transfer to ground staff did not make it any easier. He contacted a lot of friends to try and ensure he would get another flying job, but in the next round of postings in he thought about 1974 or 1975 he was instead posted to Canberra. He subsequently received a further two ground postings in Canberra.
Mr Dunn said that on hearing the news in Adelaide that he had been assigned another ground posting he punched a hole in a wall. The realisation he was not getting back into the air affected him more than the original ground posting. His alcohol intake increased both with the original posting in Adelaide and his assignment to Canberra.

He began to have dreams about losing face in front of colleagues in 1972-3. At the time of the hearing he still had dreams that were a combination of reliving the decompression accident and losing face in front of colleagues because of ground postings. The dreams produced fear (in the case of the decompression) and a feeling of being put down.
Mr Dunn did not specifically recall an interview with Dr Bern in 1984, but rejected Dr Bern's recording of his drinking habits (Exhibit T4 p.21) as inaccurate. The record of consuming "3 beers and 2 glasses of wine daily" was true for 1959 when he first started drinking rather than 1984. The record "Has always drunk about the same amount since he started (5-6) drinks per day" was not true. The correct consumption figures at various times (showing several increases in consumption over the years) were in his statement (Exhibit A2). By 1961 he was probably consuming eight to ten alcoholic drinks a day, later to reach twenty or more a day.
In two different documents Mr Dunn had indicated he first started drinking when he was married (Exhibit A2) and when he joined the officer's mess (Exhibit T12). These were not contradictory statements because both events occurred at about the same time in 1959. He was only a light drinker before the decompression accident. His drinking became a serious problem in Adelaide and Canberra. He also developed a gambling habit in Canberra, although he had always gambled a little.
He was not proud of his alcohol habit and had at times downplayed its extent. It was "not something you broadcast". He had not ever been unable to perform his duties because of it, but had come close. It was not unusual for him to fly with a hangover for example.
Mr Dunn was told he had hypertension about the time of his second ground posting, which was to Canberra in he thought 1974 or 1975. More recently he has been told that his medication for Parkinson's disease helps control his hypertension. He acknowledged his earlier statement regarding hypertension (Exhibit T11 p.60) that the last years of his service (ie the ground postings) were particularly stressful, but added that this type of stress was entirely different to the stress involved in flying.
Evidence of Ms Barrelle
Ms Barrelle, a clinical psychologist, gave oral evidence to supplement her written report (Exhibit A3). She diagnosed Mr Dunn as having mild post-traumatic stress disorder (PTSD) "arising from accumulation of a number of traumatic events that he experienced, both directly and indirectly, during his service" (oral evidence). This disorder was present at a sub-clinical level prior to Mr Dunn's ground postings, which was when his symptoms were exacerbated and sufficient to make a formal diagnosis of PTSD, albeit mild. In the early sub-clinical stages Mr Dunn had been "self-medicating" with alcohol use.
Mr Dunn also met the criteria for major depressive disorder, which came into being as a reaction to his ground postings. Historically he had also met the criteria for alcohol abuse and pathological gambling, but he did not presently meet those criteria as he was not exhibiting the behaviour required for a diagnosis.
In her consultation with Mr Dunn he had discussed experiencing an explosive decompression in an aircraft where the cabin pressure changed dramatically and the plane stalled, falling about 23,000 feet before he could regain control. During the incident he felt that he might die and recalled other fatal accidents involving his colleagues.
Ms Barrelle was referred to the definition of "experiencing a severe stressor" in Statement of Principles No.54 of 1999. In her opinion the decompression incident was an example of a threat of serious injury or death. Mr Dunn's belief that he was going to die would have been exacerbated by reports he had heard of colleagues and friends dying, and by having witnessed crashes himself and being involved in retrieving body parts.
Mr Dunn had recurrent and intrusive recollections of these events. He had visions of crashes, including an image of picking up body pieces at Woomera. He also experienced recollections of smells of rubber, petrol and kerosene. He had recurrent distressing dreams, and would become very distressed when exposed to memories of the events, such as footage of plane crashes on television.
Mr Dunn had reported efforts to avoid thoughts, feeling and conversations relating to these incidents. He also reported persistent symptoms of increased arousal, including

great difficulty sleeping and using alcohol to induce sleep
irritability and outbursts of anger, along with a short temper
hypervigilance or paranoia
to a lesser degree, an exaggerated startle response.

Mr Dunn also showed evidence of difficulty concentrating, but Ms Barrelle was not confident this could be attributed to PTSD rather than Parkinson's disease or perhaps depression.
These symptoms did not interfere significantly with Mr Dunn's occupational, social or family life until he was posted to ground jobs. Prior to that Mr Dunn was managing his symptoms with alcohol. But they came to the fore with the change in his work and then interfered considerably with his functioning. The ground posting could not be described as a physically threatening stressor, but it was a large threat to Mr Dunn's psychological integrity and would represent a large psychosocial stressor sufficient to trigger an exacerbation of the previously existing symptoms of PTSD to the point where they caused dysfunction. The criteria for PTSD did not require immediate onset of the condition.
In cross-examination Ms Barrelle agreed that Mr Dunn had not shown any avoidance of flying following the decompression incident and other traumas. Instead he "self-medicated" with alcohol. She also agreed that it was possible he had simply taken that event in his stride, but she considered it improbable given the later dreams, flashbacks and intrusive recollections. Once his environmental situation changed, he did engage in avoidant behaviour and other symptoms typical of a post-traumatic reaction.
She did not agree that the decompression accident could be equated with "a near miss on the roads". It was parallel to being in a car crash where a person thought they were going to die but in fact did not. This was precisely the sort of experience that led to PTSD in civilians.
Ms Barrelle believed that the onset of Mr Dunn's depressive disorder was linked to his second and subsequent ground postings rather than the first. His reaction to the first posting was one of disbelief, but it was "the realisation that he wasn't ever going to fly again" that prompted a depressed reaction. Mr Dunn had reported being so frustrated at being posted to Canberra that he punched a hole through a wall.
Ms Barrelle was referred to the definition of "severe psychosocial stressor" in Statement of Principles No.59 of 1998. She gave evidence that loss of the opportunity to fly would satisfy the definition in Mr Dunn's case. He had indicated that he felt useless and worthless in a ground posting and that he found the news of his second ground posting extremely distressing. His reaction was similar to how a person would react to loss of employment or a divorce.
The onset of Mr Dunn's depressive disorder was within one year of this event. The condition was now in partial remission, meaning that Mr Dunn suffered episodes of symptoms. It was not as severe as in the past but was still present.
In Ms Barrelle's opinion Mr Dunn had met the criteria for a diagnosis of alcohol abuse from 1960 to the late 1980s. The onset was linked with a series of events clearly associated with death and danger – the decapitation of some pilots, the death of another pilot when his parachute failed to open, witnessing plane crashes and recovering body parts. His increase in alcohol consumption was also associated with the decompression accident as he used alcohol to cope with his feelings and deal with the symptom of disturbed sleep. Cumulatively and progressively these events led to increments in his drinking. He gave a history of not participating a lot in drinking alcohol prior to these incidents, despite peer pressure. He did not speak about enjoying the social aspect of drinking, although Ms Barrelle acknowledged she had not asked him that question directly.
Ms Barrelle was referred to the definition of "experiencing a severe stressor" in Statement of Principles No.76 of 1998 and said that the above events would satisfy this definition. She understood that Mr Dunn had stopped consuming alcohol because it conflicted with his medication for Parkinson's disease.
Ms Barrelle was asked to comment on Dr Shand's views. She noted that he did not consider a diagnosis of PTSD appropriate, but she considered that symptoms he described in his report were consistent with PTSD. There was nothing else in his report she would take issue with. What he referred to as adjustment disorder covered the same symptoms that she was referring to as PTSD, namely anxiety and depressive symptoms. PTSD was itself an anxiety disorder.
She was also asked to apportion the significance of the different stressful incidents, that is the traumatic stressors. She considered the decompression incident in Malaya to be the most important, accounting for about 75 per cent. The other incidents where he heard of or witnessed accidents, or collected body parts, made up the remaining 25 per cent.
Consideration of issues and Findings
Post Traumatic Stress Disorder (PTSD)
Mr Dunn contends that he experienced a severe stressor during his operational service as a consequence of which he now suffers from PTSD. He claims that the severe stressor was "an explosive decompression of my aircraft" in about 1960 in Malaya (paragraph 16 above and Exhibit A2). However, the PTSD remained subclinical, with its clinical onset being triggered by the second ground posting in about 1972-73.
Does Mr Dunn have PTSD?
Section 120(4) of the Act provides that in certain matters the Tribunal must "decide the matter to its reasonable satisfaction". Repatriation Commission v Budworth (2001) 33 AAR 476; 66 ALD 285 includes in this class of matters whether the veteran is suffering from the claimed injury or disease
"15. Counsel for Mr Budworth argued that Cooke [Repatriation Commission v Cooke (1998) 90 FCR 307; 160 ALR 17; 52 ALD 1; 28 AAR 400] was incorrectly decided or clearly wrong and invited us not to follow it. We decline to take that course because we find the reasoning in Cooke persuasive. In our view, s 120(1) of the Act assumes the existence of a relevant injury or disease and provides a standard of proof for the determination of whether that injury or disease was war-caused. When the Commission, or the AAT on review, is required to determine whether a veteran is suffering from the claimed injury or disease, that issue must be decided to the "reasonable satisfaction" of the decision maker in accordance with s 120(4) of the Act."
Mr Modder for the Commission submitted that Mr Dunn does not have PTSD. In particular, he did not satisfy criteria (A)(ii) and (C) of the definition in the Statement of Principles. Mr Modder referred to the reports of Drs Cullen and Shand, both psychiatrists. In September 1996 Dr Cullen reported that Mr Dunn had serious psychological problems of multiple aetiology dating back to his service (Exhibit T13). He did not make a finding of PTSD. Dr Shand saw Mr Dunn on 23 April 2001 (Exhibit R3). While noting that he satisfied paragraph A of the definition of PTSD, he did not satisfy the remaining criteria. This is confirmed in Exhibit R4.
Another psychiatrist, Dr White, saw Mr Dunn on 5 July 1999 (Exhibit T24). In his view Mr Dunn was exposed to a number of incidents producing a chronic PTSD. Ms Barrelle, a clinical psychologist, also diagnosed PTSD arising from a number of stressful events as a pilot (Exhibit A3).
Both the current Statement of Principles No.3 of 1999 and the earlier No.15 of 1994 in operation at the time of the Commission's decision (see Repatriation Commission v Gorton (supra)) contain the same definition of PTSD. This provides
"For the purposes of this Statement of Principles, "post traumatic stress disorder" means a psychiatric condition meeting the following description (derived from DSM-IV):
(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 in significant 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 life span); 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) hypervigilance;
(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,
attracting ICD-9-CM code 309.81."
Turning to the criteria in this definition, I am satisfied that criteria (A)(i) and (ii) are met despite Mr Modder's contention that Mr Dunn's response to the decompression incident did not involve intense fear, helplessness or horror. Mr Dunn gave clear evidence of this. Dr Shand also said Mr Dunn satisfied this criterion. I also note that these responses are expressed in the alternative.
The other criterion that Mr Modder contests is criterion (C) on avoidance of stimuli associated with the trauma. It requires at least three of seven sub-criteria be met. Mr Modder argued that far from avoiding activities, places or people that could arouse recollections of the decompression incident trauma, Mr Dunn went on to serve with two elite flying squadrons, the Red Arrows and the Roulettes.
Ms Barrelle carefully assessed Mr Dunn's condition against each of these sub-criteria (Exhibit A3). She found that five of the seven were met. She supported these findings under cross-examination noting

Mr Dunn did not avoid flying
he self-medicated with alcohol to deal "with the post-traumatic symptoms so that he could continue flying and working in that capacity"
PTSD can remain subclinical for a time if there are other ways of coping
in Mr Dunn's case the onset of clinical PTSD was triggered by his ground postings, especially the second one in about 1973
he then engaged in avoidance behaviour.

Dr Shand does not specifically address the criteria but suggests that PTSD is "clearly disqualified by his long and successful Air Force career" (Exhibit R3). Dr White, who found that Mr Dunn does suffer PTSD, also did not report on each criterion.
Having regard particularly to the specific evidence of Ms Barrelle and that of Mr Dunn, I am satisfied that the requirements of criterion (C) have been met.
Mr Modder did not raise any difficulties with the remaining criteria. Instead he relied on Dr Shand's opinion that Mr Dunn does not currently satisfy the diagnostic criteria for PTSD.
The detailed written evidence of Ms Barrelle which was tested on cross-examination, supported by that of Dr White, persuades me that Mr Dunn does suffer from PTSD and I find accordingly.
Is Mr Dunn's PTSD war-caused?
Mr Dunn undertook operational service from 9 July 1959 to 29 July 1961 at Butterworth in Malaya. It was during this period of service that the decompression incident took place.
It is common ground that in assessing the question of entitlement relating to operational service the standard of proof or satisfaction is that set out in subsections 120(1) and (3) as modified by section 120A of the act. The relationship between the standard of proof, Statements of Principles and how they must be applied by a decision maker has been considered by the Full Federal Court Repatriation Commission v Deledio (1998) 83 FCR 82 at 97-8; 49 ALD 193 at 206; 27 AAR 144 at 159-160
"[T]he course which the Tribunal is to take in a case, such as the present, (that is, one involving a claim to be decided after the 1994 Amendments) in respect of the incapacity of a person from injury or disease, or in respect of the death of a person related to service rendered by that person is as follows:
1.        The Tribunal must consider all the material which is before it and determine whether that material points to a hypothesis connecting the injury, disease or death with the circumstances of the particular service rendered by the person. No question of fact finding arises at this stage. If no such hypothesis arises, the application must fail.
2.        If the material does raise such a hypothesis, the Tribunal must then ascertain whether there is in force an SoP [Statement of Principles] determined by the Authority under s 196B(2) or (11)…
3.        If an SoP is in force, the Tribunal must then form the opinion whether the hypothesis raised is a reasonable one. It will do so if the hypothesis fits, that is to say, is consistent with the "template" to be found in the SoP. The hypothesis raised before it must thus contain one or more of the factors which the Authority has determined to be the minimum which must exist, and be related to the person's service (as required by ss 196B(2)(d) and (e)). If the hypothesis does contain these factors, it could neither be said to be contrary to proved or known scientific facts, nor otherwise fanciful. If the hypothesis fails to fit within the template, it will be deemed not to be "reasonable" and the claim will fail.
4.        The Tribunal must then proceed to consider under s 120(1) whether it is satisfied beyond reasonable doubt that the death was not war-caused, or in the case of a claim for incapacity, that the incapacity did not arise from a war-caused injury. If not so satisfied, the claim must succeed. If the Tribunal is so satisfied, the claim must fail. It is only at this stage of the process that the Tribunal will be required to find facts from the material before it. In so doing, no question of onus of proof or the application of any presumption will be involved."
The reasonable hypothesis test has been considered in numerous cases. In Repatriation Commission v Bey (1997) 79 FCR 364 at 372-3; 149 ALR 721 at 730-1; 47 ALD 481 at 489-91; 26 AAR 298 at 306-7 the Full Federal Court stated
"While a hypothesis may be no more than a possibility or supposition, in order for a hypothesis to be reasonable, it must, as East states, be pointed to or supported, and not merely left open as a possibility, by the material before the decision maker…
…
…The respondent's contention appears to be that in requiring a causative link between the arthritis and war service the Tribunal was acting contrary to s 119. For the reasons we have given, in order for the hypothesis advanced by the respondent to be reasonable there must be material pointing to a connection between his disease and his war service. The material either points to a connection or it does not. If it does not, the deficiency cannot be remedied by resort to a procedural provision such as s 119(1)(g). The requirement to act towards substantial justice does not displace the Tribunal's obligation to act in accordance with the law."

In Bull v Repatriation Commission (2001) 188 ALR 756; 66 ALD 271; 34 AAR 326 the Full Federal Court said
"17.     In East, after an examination of the early legislation and other legislative history, of the background to the amendments to the Repatriation Act in 1985, in particular the decision of the High Court in Repatriation Commission v O'Brien (1985) 155 CLR 422, of the surrounding Parliamentary material to those 1985 amendments, of the drafting of the Act in 1986 and of the relationship between s 120 and that background, the Court said the following:
… The adoption of Brennan J's notion of a reasonable hypothesis meant that Parliament was requiring something by way of a causal link, but which fell short of proof of the link – even prima facie – as a fact.   The meaning of the phrase "reasonable hypothesis" was felicitously explained by a Veterans' Review Board in Stacey (unreported Nos V83/0396, V84/0821 and V28/072, 26 June 1985); words quoted by the Administrative Appeals Tribunal in Re Dell and Repatriation Commission (1986) 5 AAR 253 at 254-255:
"A hypothesis may be conveniently defined as: 'proposition made as basis for reasoning, without assumption of its truth; supposition made as starting point for further investigation from known facts; groundless assumption': The Concise Oxford Dictionary.…
The addition of the word 'reasonable' would however seem to imply that what is required is more than a mere hypothesis. In the opinion of the Board, to be reasonable, a hypothesis must possess some degree of acceptability or credibility – it must not be obviously fanciful, impossible, incredible or not tenable or too remote or too tenuous. For a reasonable hypothesis to be 'raised' by material before the Board, we think it must find some support in that material – that is, the material must point to, and not merely leave open, a hypothesis as a reasonable hypothesis. At the same time, however, a hypothesis may be reasonable without having been proved (either on the balance of probability or beyond reasonable doubt) to be correct as a matter of fact. Were it otherwise, it would no longer be a hypothesis but it would have been elevated to some higher status. Accordingly a connection asserted by a hypothesis to exist between death or incapacity and service may still be reasonable even though theoretical, and it may be theoretical in either or both of a [sic] least two senses: by postulating a known medical fact but in circumstances not known to have definitely existed in the instant case; or by postulating a medical principle which science is not yet able to definitely prove but is unable to describe as unreasonable."
We agree with this analysis. A reasonable hypothesis requires more than a possibility, not fanciful or unreal, consistent with the known facts. It is an hypothesis pointed to by the facts, even though not proved upon the balance of probabilities. [Emphasis added in Bull.]
18.      It is important to understand the following about East. The Court said that an hypothesis is not reasonable if it is obviously fanciful or impossible or incredible or not tenable or too remote or too tenuous. However, the Full Court did not say that if an hypothesis was not obviously fanciful or not impossible, or not incredible or tenable or not too remote or not too tenuous, it was therefore necessarily reasonable. The material must point to the connecting hypothesis: see the emphasised paragraph in [17] above.
19.      Before proceeding any further two comments are appropriate. First, it should be borne in mind that the hypothesis to be raised by the material must be one connecting the disease or injury or death with the circumstances of service. Secondly, the phrases used by the Court such as 'not obviously fanciful', 'not impossible', 'not incredible', 'tenable', 'not too remote' and 'not too tenuous' are useful elucidators of the meaning of 'reasonable'. This is especially so given the subtle range of meaning of the words and phrase 'reasonable', 'unreasonable' and 'not unreasonable'. Much depends on context and purpose. However, the words of elucidation should not be substituted for the words of the statute: see generally the comments of the Full Court in National Mutual v Campbell (2000) 99 FCR 562 at 571, [36]. What is required of the decision-maker by subs 120(3) is the formation of an opinion that the material before it does or does not raise a reasonable hypothesis connecting the injury, disease or death with the circumstances of the particular service.
…
21.      There is no doubt that the Tribunal is obliged to look at all the material, not just some of it. It is not entitled at this point to find facts or reject matters. See generally Gleeson v Repatriation Commission (1994) 34 ALD 505, 509."
Connors v Repatriation Commission (2000) 59 ALD 61 stands for the proposition that each individual element of a factor must be pointed to by the material before the decision maker.
Steps 1 and 2 of Deledio
These are satisfied

the material before points to the hypothesis set out at paragraph 44 above which connects Mr Dunn's PTSD with the decompression incident during his operational service in Malaya
the relevant Statement of Principles is No.3 of 1999 as amended by No.54 of 1999.
Step 3 of Deledio

At this stage the Tribunal must examine all the material before it to see whether it points to the hypothesis raised as being a reasonable one. It must be supported by the material but must not be obviously fanciful, impossible, incredible or too remote. The Tribunal must not make findings of fact at this point.
Factor 5(a) from Statement of Principles No.3 of 1999 relevantly provides
"The factors that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting post traumatic stress disorder… with the circumstances of a person's relevant service are:
(a) experiencing a severe stressor prior to the clinical onset of post traumatic stress disorder;…"

The related definition from Statement of Principles No.54 of 1999 is

"For the purposes of this Statement of Principles:
…
"experiencing a severe stressor" means the person experienced, witnessed, or was confronted with an event or events that involved actual or threat of death or serious injury, or a threat to the person's, or another person's, physical integrity.
In the setting of service in the Defence Forces, or other service where the Veterans' Entitlements Act applies, events that qualify as severe stressors include:
(i) threat of serious injury or death; or
(ii) engagement with the enemy; or
(iii) witnessing casualties or participation in or observation of casualty clearance, atrocities or abusive violence;"

Mr Dunn's and Ms Barrelle's evidence included

Mr Dunn's experience of the decompression incident in 1960 which involved a threat of death or serious injury
this resulted in PTSD at a subclinical level prior to Mr Dunn's ground postings
the ground postings, especially the second one in about 1973, triggered the clinical onset of PTSD.

The severe stressor identified for the purposes of factor 5(a) was the decompression incident during operational service.

Mr Modder's submissions were not directed to these issues but rather to whether Mr Dunn suffered PTSD at all.
Taking into account all the evidence I find that the material points to and supports the hypothesis raised, which is not fanciful, impossible, remote or untenable. The hypothesis fits the template of the Statement of Principles and is reasonable for the purposes of sections 120(3) and 120A(3) of the Act. Step 3 of Deledio is satisfied.
Step 4 of Deledio
Here the Tribunal must consider whether it is satisfied beyond reasonable doubt that the PTSD was not war-caused. Is there then evidence to establish beyond reasonable doubt that there is no sufficient ground for determining that Mr Dunn's PTSD was war-caused?
Having accepted that Mr Dunn has PTSD there is no sufficient evidence before me to suggest that it is not war-caused, although a number of other stressful experiences were referred to. These included incidents both during operational and other service. However, I cannot be satisfied beyond reasonable doubt that Mr Dunn's PTSD was not war-caused. In accordance with section 120(1) I therefore find that it was war-caused for the purposes of section 9 of the Act.

Hypertension

The hypothesis contended for by Mr Crabb for Mr Dunn essentially involved two sub-hypotheses (see McKenna v Repatriation Commission (1999) 86 FCR 144; 29 AAR 70)

Mr Dunn commenced heavy drinking of alcohol as a consequence of the decompression incident in 1960 resulting in a condition of alcohol abuse
this condition in turn led to hypertension.

Thus Mr Dunn is said to suffer from hypertension which is war-caused.

Does Mr Dunn have hypertension?

The Statement of Principles No.31 of 2001 defines hypertension as
"[P]ermanently elevated blood pressure, evidenced by:
(i) a usual blood pressure reading where the systolic reading is greater than or equal to 140 mmHg and/or where the diastolic reading is greater than or equal to 90 mmHg; or
(ii) the regular administration of antihypertensive therapy to reduce blood pressure,
attracting ICD codes I10, I11, I12, I13 or I15. This definition excludes temporary elevations in blood pressure from conditions such as acute renal failure, neurogenic hypertension, eclampsia, pre-eclampsia or medications."
It is not in dispute that Mr Dunn has hypertension, satisfying the above criteria. His service medical records (T-documents pages 12, 14, 16, and 56) and post-service records (T-documents pages 22, 28 and 43) evidence this. Dr Coffey is of the view that its onset was about 1977 (T-documents page 27). Mr Modder agreed to a date of onset in 1976-77. It also appears that in recent times Mr Dunn's other medication "may be masking raised blood pressure" (T-documents pages 105 and 136).
I accept that Mr Dunn suffers from hypertension and that its clinical onset was about 1976-77.
Did Mr Dunn suffer from alcohol abuse?
The Statement of Principles No.76 of 1998 defines alcohol abuse as
"[T]he presence of cognitive, behavioural or physiological symptoms indicating the use of alcohol despite significant alcohol-related problems, however these symptoms have never met the criteria for alcohol dependence. Additionally, signs of tolerance or withdrawal are absent.
The diagnostic criteria for alcohol abuse are those specified in DSM-IV, and are as follows
A. A maladaptive pattern of alcohol use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:
(1) recurrent alcohol use resulting in a failure to fulfil major role obligations at work, school, or home
(2) recurrent alcohol use in situations in which it is physically hazardous
(3) recurrent alcohol-related legal problems
(4) continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol
B. The symptoms have never met the criteria for alcohol dependence.
…
Alcohol… abuse attracts ICD-9-CM code… 305.0"
Mr Dunn started drinking in about 1959. His evidence is

he consumed about three to four glasses of beer per day in 1959
he increased his drinking as a result of a number of incidents, but principally the decompression incident, to eight to ten drinks a day by 1961
by 1971 when Mr Dunn was with the Roulettes this had increased to 15 or more drinks a day
during his ground postings from 1972 to 1977 his drinking reached about 20 beers a day, increasing significantly after the second in posting in 1972-73
he continued to drink heavily until 1983 when he found his medication for Parkinson's disease reacted adversely with alcohol (Exhibit A2).

In oral evidence Mr Dunn disputed contradictory material in the T-documents.

Dr Cullen found that Mr Dunn reacted to his loss of status as pilot with symptoms of "alcohol abuse (DSM IV 305.00)" (Exhibit T13). This is supported by Dr Shand (Exhibit R3). In her report Ms Barrelle concluded
"Mr Dunn recorded a score of 23 on the AUDIT, which he completed retrospectively for the period 1972-1991. This very high score is indicative of (at least) alcohol abuse.
Diagnosis: I have attached the DSM-IV criteria for Substance Abuse (see Appendix B1) for your information. There is sufficient evidence, based on Mr Dunn's report, that he met the criteria for this disorder from at least 1960 to the late 1980s. There was insufficient evidence for a diagnosis of Substance Dependence."
This written evidence was confirmed in her oral testimony. Under cross-examination Ms Barrelle disputed that peer pressure and social drinking were significant in precipitating Mr Dunn's habit.
Mr Modder for the Commission contested that Mr Dunn met the diagnostic criteria for alcohol abuse, asserting that none of the sub-criteria (1) to (4) applied.
However, on the evidence before me I am satisfied that from about 1960 until about 1983 Mr Dunn suffered from alcohol abuse. In my view at least sub-criteria (2) and (4) have been met. I refer in particular to Ms Barrelle's evidence and that of Mr Dunn, supported by other material in the T-documents and to some extent by Dr Shand.
Was Mr Dunn's alcohol abuse war-caused?
I have found that the onset of alcohol abuse was about 1960 during a period of operational service.
Steps 1 and 2 of Deledio
These are satisfied

the material before me points to the sub-hypothesis set out at paragraph 69 above connecting Mr Dunn's alcohol abuse with the decompression incident during his operational service
the relevant Statement of Principles is No.76 of 1998.
Step 3 of Deledio

Factor 5(b) from this Statement of Principles relevantly provides
"The factors that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting…alcohol abuse…with the circumstances of a person's relevant service are:
…
(b) experiencing a severe stressor within the two years immediately before the clinical onset of alcohol dependence or alcohol abuse;…"

The Statement of Principles defines "experiencing a severe stressor" as

"[T]he person experienced, witnessed or was confronted with, an event or events that involved actual or threat of death or serious injury, or a threat to the person's or other people's physical integrity, which event or events might evoke intense fear, helplessness or horror.
In the setting of service in the Defence Forces, or other service where the Veterans' Entitlements Act applies, events that qualify as severe stressors include:
(i) threat of serious injury or death; or
(ii) engagement with the enemy; or
(iii) witnessing casualties or participation in or observation of casualty clearance, atrocities or abusive violence;"

The evidence of Mr Dunn and Ms Barrelle covered

the decompression incident in 1960 which clearly was a severe stressor with the possibility of death or serious injury
Mr Dunn's experience of fear and horror during this incident
the clinical onset of alcohol abuse within two years of this incident. By 1961 Mr Dunn was drinking eight to ten drinks a day
the severe stressor, the decompression incident, being attributable to operational service.

Therefore it is clear that the material points to or supports the hypothesis in the sense referred to in the authorities. The hypothesis can not be said to be fanciful, remote or impossible. It fits the template and is reasonable for the purposes of sections 120(3) and 120A(3). Step 3 of Deledio is satisfied.
Step 4 of Deledio
Having found that Mr Dunn suffered from alcohol abuse from about 1960 to 1983, there is no sufficient evidence before me to satisfy me beyond reasonable doubt that it is not war-caused. Mr Modder pointed to suggestions of peer pressure and social drinking. However, this evidence does not even come close to satisfying the reverse criminal standard of proof. Indeed, Ms Barrelle was of the view that the decompression incident was the factor 75 per cent responsible.
In accordance with section 120(1) I therefore find that Mr Dunn's alcohol abuse was war-caused for the purposes of section 9 of the Act.
Is Mr Dunn's hypertension war-caused?
I have already found that Mr Dunn suffers from hypertension with its clinical onset in about 1976-77.
Steps 1 and 2 of Deledio
These are satisfied

the material before me points to a hypothesis connecting Mr Dunn's hypertension to his operational service in 1960. See paragraph 69 above where two sub-hypotheses are set out suggesting this causal link
the relevant Statement of Principles is No.31 of 2001.
Step 3 of Deledio

Factor 5(b) from the Statement of Principles relevantly provides
"The factors that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting hypertension…with the circumstances of a person's relevant service are:
…
(b) suffering from alcohol dependence or alcohol abuse, involving consumption of an average of at least 200 grams per week of alcohol (contained within alcoholic drinks) at the time of the clinical onset of hypertension;…"
The definition of "alcohol abuse" is the same as in Statement of Principles No.76 of 1998 and is set out at paragraph 73 above. A further relevant definition is
"For the purposes of this Statement of Principles:
…
"alcohol (contained within alcoholic drinks)" is measured by the alcohol consumption calculations utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink;"
Mr Dunn and Ms Barrelle's evidence included

Mr Dunn was suffering from alcohol abuse at the time of clinical onset of hypertension in 1976-77
at that time he was consuming about 20 beers a day
the alcohol abuse was as a result of operational service in 1960.

On the definition of "alcohol (contained within alcoholic drinks)", 20 beers a day would far exceed 200 grams of alcohol per week.
Again it is clear that the material points to or supports the hypothesis in the sense referred to in the authorities. In my view the hypothesis can not be said to be fanciful, remote or impossible. I find that it fits the template of the Statement of Principles and is reasonable for the purposes of sections 120(3) and 120A(3). Step 3 of Deledio is satisfied.
Step 4 of Deledio
Mr Modder did not point to any additional evidence, other than that to which I have already referred, which might lead to a rejection of the hypothesis relying on a reverse criminal standard of proof.
Therefore in accordance with section 120(1) of the Act I find that Mr Dunn's hypertension is war-caused for the purposes of section 9. On all the evidence I can not be satisfied beyond reasonable doubt that there is no sufficient ground for making this determination.
Depressive Disorder
Mr Dunn claims that he has a depressive disorder which is defence-caused. He contends that it resulted from a severe psychosocial stressor during his defence service, which commenced on 7 December 1972. That psychosocial stressor was the loss of his employment as a pilot when he was given a second ground posting at the end of 1972 which he took up early in 1973.
As this issue concerns a period of defence service rather than operational service, the applicable standard of satisfaction or proof for both the diagnosis of the condition and assessment of entitlement is that of reasonable satisfaction (section 120(4) of the Act). This has been equated with satisfaction on the balance of probabilities (Repatriation Commission v Smith (1987) 15 FCR 327; 74 ALR 537; 12 ALD 798; 7 AAR 17).
Does Mr Dunn have a depressive disorder?
The applicable Statement of Principles No.59 of 1998 defines depressive disorder as
"(A) the presence of major depressive disorder, dysthymic disorder or depression not otherwise specified where:
(i) major depressive disorder is either a single episode or recurrent episode as defined in DSM-IV; and
(ii) 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; and
(iii) depression not otherwise specified, such as minor depressive disorder and recurrent brief depressive disorder, as defined in DSM-IV, includes disorders with depressive features that do not meet the DSM-IV diagnostic criteria for other specific mood disorders,
attracting ICD-9-CM code 296.2, 296.3, 300.4 or 311."

Ms Barrelle diagnosed Mr Dunn as "currently suffering from major depressive disorder, recurrent, with mild symptoms, in partial remission" (Exhibit A3). The depression has been a chronic condition since 1972 when it was more severe in intensity and pre-dated the onset of Parkinson's disease.
Dr Shand provides a series of diagnoses in his two reports. In his first report he states that "the history indicates some symptoms of Chronic Adjustment Disorder with Depression of Dysthymic type" (Exhibit R3). He then goes on to refer to "depression" and "the veteran's depressive disorder". In his second report he says "I favour the diagnoses of Adjustment Disorder and Depressive Disorder" (Exhibit R4).
Support for a diagnosis of depressive disorder is also found in the reports of Dr Cullen (Exhibit T13), Dr White (T-documents page 129) and Dr Ryan (T-documents page 62).
Mr Modder referred in his final submissions to diagnosis of an adjustment disorder fitting the history. Notwithstanding this he appeared to accept that Mr Dunn suffered from a depressive disorder and addressed his submissions on causation on that basis.
On the evidence I am satisfied that Mr Dunn suffers from a depressive disorder as defined in the Statement of Principles.
Is Mr Dunn's depressive disorder defence-caused?
The applicable Statement of Principles relevantly provides
"The factors that must exist before it can be said that, on the balance of probabilities, depressive disorder… is connected with the circumstances of a person's relevant service are:
(a) experiencing a severe psychosocial stressor or stressors within the one year immediately before the clinical onset of depressive disorder; …"
When was the clinical onset of the depressive disorder?
Ms Barrelle says that the depressive disorder commenced in 1972-73 following Mr Dunn's posting to a second non-flying position in Canberra (Exhibit A3). In her oral evidence she said that the disorder was linked to his second and subsequent ground postings rather than the first. His reaction to the first was of disbelief. However, it was ""he realisation that he wasn't ever going to fly again" that prompted a depressed reaction. Mr Dunn had punched a hole in the wall through frustration. Mr Dunn's evidence also supported this.
Some support for this can be found in Dr Shand's reports
"The history obtained from the veteran satisfies the Statement of Principles concerning Depressive Disorder with onset after transfer from active flying to an administrative position in Adelaide in 1971, therefore during the period of eligible defence service from 7 December 1972 to 11 August 1977. The history qualifies Factor (b) [sic] "Experiencing (what was to him) a severe psychosocial stressor or stressors within the two [sic] years immediately before the clinical onset of Depressive Disorder." (Exhibit R3)
"I favour the diagnoses of Adjustment Disorder and Depressive Disorder. These diagnoses are retrospective to the time period following his transfer to administrative duties with the University Squadron in Adelaide in about 1971/1972,…" (Exhibit R4)
There is some ambiguity in these passages. It is unclear whether Dr Shand places clinical onset at the time of the first or second posting. However, the first quote suggests it was during the defence service after 7 December 1972.
Having regard to the evidence, I find that it is more probable than not that the onset of Mr Dunn's depressive disorder occurred after notification of his second ground posting, that is within the period of defence service.
Did Mr Dunn experience a severe psychosocial stressor?
A "severe psychosocial stressor" is defined in the Statement of Principles as
"[A]n identifiable occurrence that evokes feelings of substantial distress in an individual, for example, being shot at, death or serious injury of a close friend or relative, assault (including sexual assault), severe illness or injury, experiencing a loss such as divorce or separation, loss of employment, major financial problems or legal problems;"
In his statement Mr Dunn said
"11. In December 1972 the end-of-year posting came out, but I was not one of those posted. It was apparent that my requests to return to flying had not been successful. The stress and anxiety I was feeling at this time so affected me that I suffered psychosomatic diarrhoea for approximately eight months starting in early 1973. At this stage I was prescribed valium and lomotil. It was during this and subsequent "ground" postings prior to my resignation from the RAAF in 1977 that my symptoms of anxiety developed further and I also became depressed." (Exhibit A2)
Ms Barrelle reported
"Mr Dunn stated that he first felt depressed after his posting to his second non-flying job in Canberra. He reported feeling "worthless" and "useless". He "dreaded" going into work, and felt his duties were "demeaning". Asked to rate his depressed mood on a scale from 0 to 10, where 10/10 is the most depressed one could feel, Mr Dunn considered that his mood at that point was 10/10. He reported losing interest in life, and having frequent suicidal thoughts. He lost weight, had difficulty sleeping, and reported feelings of guilt about his perceived treatment of his family. Mr Dunn considered that this degree of depression lasted for about five years, gradually reducing after he left the RAAF in 1977. Asked whether he had attempted to kill or harm himself, Mr Dunn stated that he was trying to "drink myself to death"" (Exhibit A3)
In her oral evidence Ms Barrelle stated that the loss of the opportunity to fly would be a severe psychosocial stressor in the circumstances described by Mr Dunn. He had been made to fell useless and worthless and the news of his second ground posting was extremely distressing. It was akin to the loss of employment or a divorce. Certainly it evoked feelings of substantial distress in Mr Dunn.
Dr Shand agrees
"However, if the history is an accurate one, the transfer from active flying to administrative work could be seen as a severe psychosocial stressor to his veteran at that time." (Exhibit R4)

See also the quote at paragraph 105 above from Dr Shand's earlier report.

Mr Modder for the Commission contended that

it is artificial to separate as the trigger the second ground appointment from the first
the first ground posting was before defence service began
as a ground posting was inevitable as a normal part of a career path, it could not amount to a severe psychosocial stressor
the onset of Parkinson's disease, although not the cause of the depression, exacerbated it.

I accept the evidence of Mr Dunn and Ms Barrelle, supported somewhat ambiguously by Dr Shand, that the trigger for the depressive disorder was the second ground posting, that is from Adelaide to Canberra. Although the evidence on the precise date of notification and commencement of that posting is unclear, I think it more probable than not that this stressor occurred and/or continued after 7 December 1972.
I also accept Ms Barrelle's and Dr Shand's evidence that the notification and/or commencement of the second ground posting was a severe psychosocial stressor for the purposes of the Statement of Principles

it constituted an identifiable occurrence
it evoked substantial distress in Mr Dunn in that it detracted from his feelings of self worth
he has suicidal thoughts and feelings of guilt and of losing interest in life.

On the evidence this stressor was clearly experienced within one year immediately before the onset of the depressive disorder. In fact the onset followed soon after the second ground posting.
Furthermore, this stressor having been triggered by the second ground posting is related to defence service rendered by Mr Dunn. For the purposes of section 120B(3) the material raises a connection between the condition and defence service and the relevant Statement of Principles upholds the contention that it was connected with that service.
Having considered all the evidence I am reasonably satisfied and find that Mr Dunn's depressive disorder is defence-caused for the purposes of section 70 of the Act.
Other Conditions
Mr Crabb for Mr Dunn asked the Tribunal to note that the claims for Parkinson's disease and a generalised anxiety disorder had been withdrawn.
The Commission argued in its written contentions (Exhibit R1) that the appropriate diagnosis was an adjustment disorder not a depressive disorder. However, this was not pursued in any substantive way during the hearing.
Date of Effect
It was agreed between the parties that the date of effect for any decision favourable to Mr Dunn would be 18 April 1996, that is three months prior to the lodgement of his application with the Commission.
Conclusions
In summary I conclude

Mr Dunn experienced severe stress from an explosive decompression in about 1960 in Malaya, as a consequence of which he now suffers from PTSD
the PTSD is war-caused
Mr Dunn commenced heavy drinking as a consequence of the decompression incident in 1960, resulting in a condition of alcohol abuse which in turn has led to his current hypertension
the alcohol abuse was war-caused
the hypertension is war-caused
Mr Dunn suffered severe psychosocial stress from his second ground posting during his defence service from 7 December 1972, as a consequence of which he now suffers a depressive disorder
the depressive disorder is defence-caused.

Decision

The decision under review is set aside. In substitution therefor the Tribunal decides that Mr Dunn's conditions of post traumatic stress disorder and hypertension are war-caused, and that his condition of depressive disorder is defence-caused. The date of effect of this decision is 18 April 1996.
I certify that the 123 preceding paragraphs are a true copy of the reasons for the decision herein of Mr G A Mowbray
Signed:         .....................................................................................
  Associate
Date/s of Hearing  28 November 2001
Date of Decision  12 September 2002
Solicitor for the Applicant         Mr Paul Crabb, Snedden Hall & Gallop
Solicitor for the Respondent    Mr Stephen Modder, departmental advocate