Godbolt and Repatriation Commission - [2001] AATA 225

DECISION AND REASONS FOR DECISION [2001] AATA 225

ADMINISTRATIVE APPEALS TRIBUNAL )

) No. N2000/447

VETERANS' APPEALS DIVISION       )
           Re      Harold Paul GODBOLT
  Applicant
           And    REPATRIATION COMMISSION
  Respondent

DECISION

Tribunal Mrs M T Lewis, Senior Member

Date22 March 2001
PlaceSydney

Decision The Tribunal – 1. Sets aside that part of the decision of the Repatriation Commission ("the Respondent") dated 20 January 1999 that refused the claim of Harold Paul Godbolt ("the Applicant") in respect of chronic eczema; 2. Substitutes for that part of the decision so set aside, its decision that: (i) the diagnosis of the claimed condition is dyshidrotic eczema, and (ii) the Applicant's condition of dyshidrotic eczema is war-caused, with effect on and from 21 June 1998; 3. Affirms that part of the decision of the Respondent that assessed the rate of pension payable to the Applicant at sixty percent of the General Rate.

.............................................
M T Lewis
Senior Member
CATCHWORDS
VETERANS' AFFAIRS – entitlement – whether correct diagnosis of claimed condition is dyshidrotic eczema (endogenous dermatitis) or contact dermatitis (exogenous dermatitis) - whether reasonable hypothesis raised that dyshidrotic eczema was war-caused - assessment of disability pension

Veterans' EntitlementsAct 1986, ss120(1), 120(3)

REASONS FOR DECISION

Mrs M T Lewis, Senior Member

This is a review of those parts of a decision of a delegate of the Repatriation Commission ("the Respondent") dated 20 January 1999 that refused a claim made by Harold Paul Godbolt ("the Applicant") that a condition diagnosed as chronic eczema was war-caused, and that assessed the rate of disability pension payable to the Applicant at 60 percent of the General Rate on and from 21 June 1998. Those parts of the decision of the Respondent were reviewed by the Veterans' Review Board on 25 January 2000 and affirmed. The Applicant lodged an application for review by this Tribunal on 22 March 2000. All applications for review were in time, and therefore the earliest date of effect is 21 June 1998, being a date not earlier than three months before the claim in respect of the Applicant's skin condition was lodged.
At the hearing the Tribunal had before it the documents provided by the Respondent pursuant to s37 of the Administrative Appeals Tribunal Act 1975. The Applicant gave oral evidence at the hearing, and tendered the following documents –

Reports of Dr E Lobel, occupational dermatology consultant, dated 3 August 2000 and 20 September 2000, and letter from Respondent to Dr Lobel dated 15 September 2000 (exhibit A)
Statement of Harold Godbolt dated 3 November 2000 (exhibit B)

The following documents were tendered as evidence on behalf of the Respondent –

Report of Dr M Burns, occupational physician, dated 2 August 2000 (exhibit 1)
Clinical notes of Dr Edwards (exhibit 2)
Reports of Mr D J Tilbrook, researcher, dated 22 June 2000 and 22 February 2001, and letters from the Respondent to Mr Tilbrook dated 26 May 2000 and 8 January 2001 (exhibit 3).

The Applicant was conscripted to the Australian Army on 3 February 1966 for two years compulsory military service. His service included a period in Vietnam from 31 March 1967 to 12 December 1967, which constituted operational service. Hence this matter falls for determination pursuant to s120(1) and (3) of the Veterans' Entitlements Act 1986, which provides –
(1)       Where a claim under Part II for a pension in respect of the incapacity from injury or disease of a veteran, or 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.

The Evidence

The Applicant lodged a claim for conditions including "skin problems", that was diagnosed by Dr King, dermatologist on 27 April 1987 as "chronic eczema" (T5, p30). Dr King noted a recurrent irritable eruption on the Applicant's palms and fingers. He noted that the condition commenced some three years previously, and that from time to time the skin "flares" with the appearance of blisters. The blisters then dry and tend to fissure with marked dryness of the skin. Dr King noted that the Applicant was employed as a machinist and plant operator, and from time to time he handled oils, greases and solvents, although not to any great extent as his job had become largely supervisory. Dr King noted at the time of examination that there was scaling and subsiding redness and vesiculation on the fingers and thumbs, that also involved the palms and particularly the hypothermar eminences. He diagnosed "chronic eczema, largely endogenous in nature but with possible contact aggravation."
In relation to these proceedings the parties jointly requested a medico-legal report from Dr Edmund Lobel, dermatologist, dated 3 August 2000 (exhibit A). In that report Dr Lobel noted a history of gradual onset of an itchy rash on the palms and dorsal surfaces of both hands and fingers a few months after the Applicant's arrival in Vietnam in 1967. The rash consisted of multiple tiny fluid blisters on the palms of the hands and the palmar surface of the fingers, and scaling on the dorsal surface of the hands. During his service he was using fuel to clean oil and grease from machine parts. He was using a particular soap/detergent hand cleaner two or three times a day to wash the oil and grease from his hands.
Dr Lobel recorded a history that the Applicant's condition continued after he returned to Australia and "well into the 1970's". After his return from Vietnam the Applicant has continued to work as a machine operator, but since his discharge he has been less involved in servicing the equipment. Although the rash cleared it continued to be intermittent. In 1987 he developed a severe episode of skin rash which he attributed to a particular hand cleaner.
Dr Lobel noted that at the time of his examination in July 2000 the skin on the Applicant's hands was normal, except for some pre-malignant actinic hyperkeratoses. He noted, however, that the examination was conducted in winter.
In his second report dated 20 September 2000 Dr Lobel explained that dyshidrotic eczema (otherwise called dermatitis) is a condition that is an endogenous or constitutional dermatitis. A person who is genetically predisposed will develop the condition given the presence of certain well-defined environmental trigger factors. The condition presents as multiple bubbles in the skin on the palms and palmar surface of the fingers and/or the soles of the feet and is confined to these areas specifically. Trigger factors include hot humid environmental conditions, chemical contact and stress. Hence, an external irritant chemical may trigger dyshidrotic eczema in a susceptible person. Dr Lobel also noted that contact dermatitis (also known as exogenous dermatitis) can occur whether a person is genetically predetermined or not, and will usually occur at the site of contact with the external irritant chemical. Hence it has a different distribution to an endogenous dermatitis such as dyshidrotic dermatitis. Dr Lobel also noted that the terms dermatitis and eczema were used interchangeably.
Dr Lobel opined that the Applicant had scaly dermatitis on the dorsal (back) of his hands, which was exogenous (or contact) dermatitis. He also had multiple bubbles on the palms of his hands and the palmar surfaces of his fingers that was endogenous dyshidrotic dermatitis, triggered by external irritants. Dr Lobel agreed with Dr King's assessment that the Applicant suffered from endogenous dyshidrotic dermatitis. Dr Lobel also noted that this condition "can be precipitated by stress and nervous tension". He noted that the Applicant suffered from a war-caused post-traumatic stress disorder ("PTSD").
In the primary decision the diagnosis of the claimed condition is "chronic eczema", but the Tribunal is reasonably satisfied that the preferable diagnosis is dyshidrotic eczema; that is, the endogenous condition, which is consistent with the diagnosis of chronic eczema. Therefore, the Tribunal considers it appropriate to change the diagnosis of the claimed condition to "dyshidrotic eczema" to remove any uncertainty.
It was the Applicant's evidence that he had not suffered from any skin disorder or from stress prior to his service in Vietnam. When he went to Vietnam he was assigned to No.17 Construction Squadron in Vung Tau and his work involved the maintenance and operation of large earthmoving machinery. The Applicant said that after a few months' service in Vietnam the backs and palms of both hands became "red and weepy". He applied a barrier cream to them that he had obtained from the RAP, which he said "eased the problem". Although at the time he did not associate the rash with any particular activity, he thought subsequently that it was from the hot humid weather and the use of harsh solvents. He had no time off because of the condition of his hands, but it was irritating especially in the humid climate. The Tribunal notes that there is nothing in the service documents available to the Tribunal to corroborate the Applicant's RAP attendance.
In cross-examination, the Applicant said that he continued to have the problem with his hands until after he returned to Australia. However, he also said he thought he did not raise it at his discharge medical examination because by that time he had been back in Australia for six weeks and it had probably cleared up by then. On the other hand, at the discharge medical examination he raised the vaccination reaction he had experienced because that caused him to be admitted to hospital.
The Applicant said that on arrival in Vietnam he felt anxious about being in a war zone. He settled down after a few weeks in Vung Tau although he continued to feel more anxious there than when he was in Australia. He said he did not feel personally threatened while on the "base". While he was in Vietnam he said that troops from his Squadron were moving "all the time" from Vung Tau to Nui Dat where an advance party was stationed.
The Applicant said that some six to eight weeks after arriving in Vietnam he was instructed that he was to go with another person on a truck to Nui Dat where he was to use a bulldozer to clear bamboo. This was his first experience outside the "base" and he said he was very worried about going to the "front line". The trip took some four hours during which he felt very tense. The Applicant also said he felt tense while he was operating the bulldozer from an exposed seat covered only by an open canopy. He had been warned by Warrant Officer Bancks that there had been reports of firing in the area and he understood that snipers hid in the bamboo. He said that he did not know whether any firing occurred as he was unable to hear over the noise of the machinery he was operating. On that day he spent four or five hours operating the bulldozer.
The Applicant reported the abovementioned incident in a statement dated 3 November 2000 (exhibit B), viz.
I was once sent from Vung Tau to Nui Dat and got there by way of a landing barge with a truck on board leaded (sic) with a bulldozer. We went half way up a river, then unloaded the truck and drove the rest of the way to Nui Dat. I was a passenger and this was the first time I had been to Nui Dat. I was with one other Sapper or Lance Corporal at the time. At Nui Dat I operated the bulldozer "close to the wire" and flattered (sic) a lot of bamboo. Before leaving Vung Tau I had been briefed by WO Banks (sic) to be careful because the bamboo had harboured the enemy and shots had been fired from the bamboo using it as a cover. I worked the bulldozer and flattered (sic) the bamboo. I was fearful because of what WO Banks (sic) had told me and felt helpless sitting in the bulldozer. If the enemy had been in the bamboo at the time, I could have been killed or suffered serious injury. Fortunately, for me the job was done without mishap but my perception at the time was otherwise.
Mr John Tilbrook, CSM, FRD, provided two reports to the Respondent based on his research (exhibit 3), which involved not only accessing documentary evidence from the war records but also interviewing Officers who were in No.17 Construction Squadron at the time of the Applicant's service. In relation to the incident when the Applicant was clearing bamboo, Mr Tilbrook wrote in his report dated 22 February 2001 –
BRIG Florence has advised that in the period after the end of March 67 further work was carried out by 1 FD SQN to upgrade and improve the bypass road. He recalls that this second phase involved the clearing of bamboo growing profusely along the creek lines in order to improve drainage in wet areas. BRIG Florence recalls that the bamboo around NUI DAT was some of the largest and heaviest thickets that he had encountered in his Army career. The noise from the bulldozers engine operating under load, tearing and crashing through bamboo thickets would have made it almost impossible for the operators to have heard enemy small fire in their vicinity. Fortunately in 1967 there were no reported incidents of plant operators being fired upon by enemy forces or by 'snipers' in the vicinity of the 1 ATF base. It is accepted that there was an ever present 'risk' to plant operators from enemy that could well have been secreted in the thickets of bamboo, hence the precautions taken with the use of infantry protection parties with the engineer land clearing parties.
The Applicant said that he was also involved in driving machines from Vung Tau to Nui Dat on five or six other occasions. At those times he travelled at 15 to 20 mph, there was no protection for him as the driver and he felt tense. On one of these trips, on the outskirts of a small village, he saw a group of people standing over a dead body on the ground. There was blood evident at the scene. This was the first time he had seen a dead body and he felt "horrified". He said he was "tense and frightened" as he did not know what had caused the death. He did not stop at the scene and continued travelling in convoy.
The Applicant said that his memory of this is recalled once a month, but sometimes the period is longer. This is mostly when he is asleep. If he sees a car accident now he thinks of this incident.
The Applicant said that in August or September 1967 he was required to travel in convoy to Nui Dat and load a truck and trailer with pipes to take to the 'Horseshoe' - a forward fire base about ten miles from Nui Dat. He said he was "very nervous" about going because that was the first time he had been so far away from Nui Dat. He was at Horseshoe for two to four hours. On the return journey there were about six vehicles in the convoy including "a few APCs" leading. He was travelling in the last truck. During the journey there was a sudden huge blast after the first vehicle had gone through, and he said the rest of the convoy "sped up to get out of there". He said that the machine guns on the APCs opened fire into the jungle some 20 to 30 yards from the side of the road. He said he remembers the noise of the blast and a huge cloud of dust. He said he was worried, shaken and frightened as he did not know what was happening or what had caused the blast. The Applicant said that this incident comes back to him. He wakes in a cold sweat after he recalls it, and at those times he is "tense, worried and frightened".
In the Applicant's written statement dated 3 November 2000 (exhibit B) he said in respect of the abovementioned incident –
I was about 100 metres away from a mine going off. A mine was detonated by remote control and went off between two leading vehicles in a convoy heading from Fire Base "Horseshoe" to Vung Tau and Nui Dat. I was a (sic) in a truck toward the rear with a Corporal. The Convoy sped off with the APCs opening fire onto both sides of the road. At this time I felt threatened. More mines could have gone off or enemy opened fire on the Convoy. I could have been killed or seriously injured. At the time I felt intense fear and helplessness. There was no other incident but the memory of the mine exploding and the shooting still distresses me. I still recollect the event and have recurrent distressing dreams of Vietnam.
Mr Tilbrook (exhibit 3) obtained a record of an incident on 28 August 1967, and reported it in the following terms –
HQ 1 ALSG Duty Officer's Log reports 5 Coy RAASC convoy witnessed explosion in vicinity of road on Route 2 at YS 388619 near XA XOM CAT in northern BARIA. Incident reported at 1835 hrs. Explosion occurred near travelling vehicles. Driver believed that a claymore had been detonated. (On route cited by Mr H. P. Godbolt).
In cross-examination, the Applicant said he did not recall what happened when they returned to Vung Tau, but he assumed that the incident would have been spoken about in the bar.
In cross-examination the Applicant's attention was drawn to the report of Dr Koller (T6) in which it was noted, inter alia –
Ruminations. Often recalls over and over thoughts of Vietnam war service. Was a National Serviceman, went to Vietnam for ten months in 1967. He was an Engineer/Plant operator. "I was all over the place". "Things were lively at times, I was shot at, we cleared mines, there always was the danger of a mine going off, when you cleared bamboo, there was always a good chance that a sniper would take a shot at you". (Tribunal's emphasis)

In his oral evidence the Applicant admitted that he was never involved in clearing mines in Vietnam and to his knowledge he had never been shot at but because of the noise of the machinery when he was clearing the bamboo he does not know whether he was shot at or not. He was not asked, however, whether he had lied to Dr Koller, nor was he asked if he could explain how Dr Koller came to record this history.

The Applicant's evidence was that his experiences away from the "base" were different from his normal experiences at Vung Tau. He said he did not go outside the "base" sufficiently often to get used to it. He returned to Australia on 12 December 1967 and was discharged in February 1968. In the meantime he went on leave for a few weeks to be with his parents. He said that for the first few weeks back in Australia "it was unnerving". He could not sleep at night because it was too quiet and he found that he woke with the slightest noise. He said he was very "nervous" when he came back and only then he realised how "nervous" he was in Vietnam. When he returned to work at his old job at the Commonwealth Railways he was sent to the Northern Territory outside Alice Springs. He said he could not cope with being in a lonely situation with only a few other people so he resigned and returned to Sydney and obtained his present job with the Department of Defence. He said he did not realise at the time that he had changed, but in retrospect he knows he had changed. He said he cannot talk about his experience in Vietnam. He walks away from arguments and is no longer "confrontational". He said that although he liked to be on his own he liked to have people around him. He said that before he went into the Army he was "a fairly wild young boy".

The Applicant said that he and his wife married in 1978. He has never talked with his wife about his experiences in Vietnam. The first time he spoke to anyone about them was to Dr Koller, who is now his treating psychiatrist. He attends Dr Koller for counselling every two to three months. The focus of counselling has been on his relationship difficulties. He said his son, aged 16 years, is a "difficult boy" and there are problems in their relationship. He thought this had improved a little since the counselling sessions with Dr Koller. He said he gets moody and argues a lot with his wife. His wife becomes angry because he will not talk about his problem. There are periods when he and his wife do not talk to each other. The Applicant said that he gets angry but he bottles it up rather than showing it. He said that he has severe migraine headaches about monthly but sometimes weekly, that have increased recently.
The Applicant said that his current work with the Department of Defence involves the training of plant operators but he is not involved in instructing people and he has no direct supervision responsibility, nor is he subject to much direction from his superiors. He works on his own as much as possible. He said he has problems relating to people at work and gets "frustrated with the system" when he is unable to "improve the situation". At those times he normally goes to a quiet area on his own. This happens between once a week and once a month.
The Applicant said that although he belongs to the RSL he has not been to the RSL club for twelve months because it brings back memories and he does not like being there. He said that when reading the reports of Mr Tilbrook this brought back memories of Vietnam, and so he did not complete reading the second report.
The Applicant said that his wife works night shifts and they do not socialise. He stays at home and does not like going out. He said he feels "down" at times and does not know why. In cross-examination he agreed that during the recent summer he had visited the local swimming pool on three occasions, sometimes with his son. At times he had attended the children's sporting activities but the children no longer participate in such activities. At home he cleans the bathroom each week, and attends their small garden and lawn.
The Applicant said that since his Army service there have been several occasions when his hands "broke down into a rash", involving blisters on the palms of his hands and dry skin on the back of his hands. The Applicant said that this type of skin eruption "comes and goes all the time". The last severe attack was when he saw Dr King, and that was also the last time that he needed treatment with ointments.
The Tribunal notes that the Applicant was referred to Dr King by Dr Edwards, his local medical officer, in 1987 (T5, p30). Dr King noted that the Applicant handled oil, grease and solvents from time to time, although at that time his job was largely supervisory. Dr King diagnosed chronic eczema that he considered was "largely endogenous in nature but with possible contact aggravation". At the time of his consultation Dr King recorded a history that "a recurrent irritable eruption" occurred on the palms and fingers "which first commenced some three years ago".
The Applicant said that at that time the problem was severe for "a long time". He said that he still has the problem "every few weeks" and he treats it himself with sorbelene cream. He said he now has very little contact with solvents, other than diesel. He said he has not noticed an association between his rash and his mental state, but after "mentally down periods" he notices the appearance of the rash on his hands. He said he normally drinks 3 or 4 stubbies a night, but this increases to 6, 7 or 8 when he is "wound up". He does not drink at work because he is working with machinery.
Submissions, consideration of evidence and findings of fact
The parties agreed that there is no relevant Statement of Principles concerning dyshidrotic eczema. Both parties relied on the report of Dr Lobel dated 3 August 2000, and indeed that report was jointly sought by both parties. Neither party chose to call Dr Lobel, but they came to the hearing with different interpretations of the diagnosis made by Dr Lobel.
It was submitted for the Respondent that the Applicant suffers from two conditions, those being dyshidrotic eczema (an endogenous condition), and chronic irritative contact dermatitis associated with long term exposure to solvents. It was submitted that it is the latter condition that was first manifested in Vietnam and has now resolved. The terms "dermatitis" and "eczema" are used synonymously. It was submitted for the Applicant that on the evidence of Dr Lobel the Applicant suffers from dyshidrotic eczema, that in his case was triggered by the use of harsh solvents and by stress, both of which were related to his service.
The Tribunal does not find the report of Dr Lobel absolutely clear on the issue of diagnosis, despite the Respondent's attempt to clarify it by obtaining the supplementary report dated 20 September 2000. Ideally, Dr Lobel should have been called to give oral evidence when the parties realised that his reports were capable of different interpretations. The Tribunal considered, at the end of the Applicant's evidence, whether it would call Dr Lobel as a Tribunal witness as neither party wished to call him. However, after considerable discussion with the parties the Tribunal considered that the report was sufficiently clear for it to be reasonably satisfied as to the correct diagnosis of the claimed condition. Therefore, this decision rests on the documentary evidence of Dr Lobel.
The diagnosis of dyshidrotic eczema is supported by Dr Lobel and Dr King. Unfortunately, the history obtained by Dr Lobel was that the earlier skin eruptions suffered by the Applicant in Vietnam and which continued well into the 1970s eventually ceased. However, it was the Applicant's evidence, which the Tribunal accepts, that indeed after Vietnam the condition continued from time to time throughout his life, but that it did not reappear in a severe form until the mid 1980s. After a number of years that second episode subsided, and he was again left with the chronic condition that erupts in a minor way every few weeks but more so in the hot humid weather. The condition was not evident in July 2000 when examined by Dr Lobel, but Dr Lobel does not appear to doubt its continued existence in a low grade chronic form. Hence, the distinction that Dr Lobel makes, on the basis of the history he has, between the condition contracted in Vietnam and the condition now existing, is flawed.
Nonetheless, the Tribunal relies on that part of Dr Lobel's opinion that the Applicant was genetically predisposed to develop dyshidrotic dermatitis from birth, and that stress has been a contributory factor in triggering the recurring episodes of endogenous dyshidrotic dermatitis since 1970. Dr Lobel also said that grease, oil and solvents are skin irritants known to cause contact dermatitis, "and may at the same time trigger an endogenous dermatitis such as dyshidrotic dermatitis". On the basis of this reasoning, the Tribunal is reasonably satisfied that the Applicant now suffers from a condition best diagnosed as dyshidrotic eczema and that this is the diagnosis of his claimed "skin problems".
The Tribunal also notes that Dr Lobel identified pre-malignant actinic hyperkeratoses on the dorsal surfaces of both hands. This condition could be included under the head of the Applicant's claim for "skin problems". However, when this was drawn to the attention of the Applicant's solicitor after the completion of the hearing, he advised that the Applicant did not seek to pursue that condition, and if necessary it could become a separate claim in the future.
It was submitted for the Respondent that there was no relationship between the Applicant's skin condition and his war service because the condition from which he now suffers did not emerge until the mid 1980s. The Tribunal notes that the consultation with Dr King was based on that history and similarly the clinical notes of Dr Edwards (exhibit 2). The hypothesis raised, however, is that the Applicant developed the condition on service, and it has continued, albeit in a mild form, since that time, with the exception of a severe exacerbation in the mid 1980s that resolved after a few years. Pursuant to s120(3) of the Act, it is not necessary to make any findings of fact at this stage. The Tribunal merely needs to consider whether the fact has been raised on the evidence and the Tribunal is satisfied that the hypothesis has indeed been raised on the evidence before it. It was also submitted for the Applicant that his ongoing stress arising from his war service has acted as a trigger for the later exacerbation of the skin condition. The Tribunal also finds that that hypothesis has been raised on the evidence before it.
The Tribunal notes the evidence regarding the Applicant's stress on service and its continuation after service. The Tribunal also notes the relationship between the Applicant's current stress and his service. He is being treated for this condition by Dr Koller. The Respondent submitted that the history recorded by Dr Koller is not correct. The Tribunal finds, nonetheless, that an hypothesis linking the Applicant's stress with his service has been raised, taking into account the evidence of Dr Lobel regarding the aetiology of dyshidrotic eczema and the link between the Applicant's current stress and his war service. The Tribunal finds that the hypothesis raised is reasonable. Ultimately the Respondent conceded that point.
It was submitted for the Respondent that, pursuant to s120(1) of the Act, the Tribunal could be satisfied beyond reasonable doubt on the evidence, that there was no connection between the Applicant's skin condition and his war service. Firstly, it was submitted that the Tribunal should be satisfied beyond reasonable doubt that the current skin condition suffered by the Applicant did not commence until the 1980s. It was not the same condition that he suffered on service. Secondly, it was submitted that, on the Applicant's own admission, he was not shot at during his service, nor was he involved in a mine clearance. Therefore the history given to Dr Koller, as the basis of his opinion that the Applicant suffered a war-caused PTSD, was not valid.
It was the Applicant's case that he has PTSD as an accepted disability, that he suffered a stressful war service and that the Tribunal had no jurisdiction to look behind the Respondent's decision that his PTSD was war-caused.
The Tribunal finds, that the Applicant continued to suffer intermittently from his skin condition, on service and after his discharge from the Army. The Applicant inferred in his evidence that he did not report his skin condition on discharge because, compared with his adverse vaccination reaction, which caused his admission to hospital, his skin condition was minor. The Tribunal finds, on the Applicant's evidence, that apart from the severe exacerbation of his skin condition in the 1980s, it has been low-grade and he has tolerated it and applied cream as required without consulting a doctor. The history recorded by Dr King and Dr Edwards about the commencement of the condition in the 1980s does not prove beyond reasonable doubt that there was no existence of the condition, albeit in a minor form, prior to that time.
The Tribunal considers that it has no jurisdiction to look behind the acceptance of PTSD as war-caused. The Respondent appeared to agree with that. There is evidence before the Tribunal that the Applicant suffered stressful incidents on service. Of particular note was his sighting of the blood stained dead body on a journey to Nui Dat, and the explosion on his return from the Horseshoe to Nui Dat. The Tribunal is not satisfied beyond reasonable doubt that those incidents did not occur or that they were not incidents causing the Applicant to feel frightened and horrified. The Tribunal is not satisfied beyond reasonable doubt that the Applicant does not suffer from flashbacks and nightmares about these incidents, or that he does not suffer from a stress reaction in the form of poor sleeping patterns, irritability, anger and lack of sociability, related to his war service. This being so, the Tribunal cannot be satisfied beyond reasonable doubt that the Applicant's dyshidrotic eczema is not war-caused.
In conclusion, the Tribunal determines that that part of the decision under review relating to chronic eczema is set aside. The diagnosis of the claimed condition is varied from chronic eczema to dyshidrotic eczema. The Applicant's dyshidrotic eczema is war-caused, and he is entitled to payment of disability pension in respect of that condition with effect on and from 21 June 1998.
Assessment
The Respondent obtained a report from Dr Burns, occupational physician, dated 2 August 2000 (exhibit 1). He made the following assessments of medical impairment, using GARP-V:
Disability  Impairment rating
Bilateral sensori-neural hearing loss                   1
Tinnitus  5
Tinea  )
  )  5
Chronic eczema      )
PTSD  31
Dr Koller provided an assessment of 26 impairment points in respect of PTSD in his report dated 17 November 1998 (T6). In relation to the PTSD assessment, Dr Burns and Dr Koller gave the following ratings in respect of Table 4:
Dr Burns       Dr Koller
Table 4.1         10                   6
Table 4.2           6                 6
Table 4.3           1                 -
Table 4.4           2                 nil
Table 4.5           5                 3
Table 4.6           5                 5
Table 4.7           5                 6
Table 4.8           3                 3
It was submitted for the Respondent that on the basis of the Applicant's evidence the assessment for Table 4.1 (subjective distress) should be 6 and not 10. It was also submitted that the assessment for Table 4.6 (social interaction) should be 3 and not 5 on the basis that he participated in a roster to hand out hymn books when he attended church. It was submitted for the Applicant that Table 4.2 (manifest distress) should be assessed at 10 and not 6, on the basis of the Applicant's evidence that at work people will say to him "what's wrong with you" when he attempts to isolate himself.
The Tribunal has taken into account the medical evidence, the evidence of the Applicant and the submissions of the parties, and in respect of the scores for each of the tables the Tribunal finds that the assessment of Dr Koller most accurately reflects the evidence. Therefore, an assessment of 26 impairment points for PTSD is appropriate.
Using the Combined Values Chart, the Tribunal calculates a combined impairment rating of 35. Dr Burns has assessed a lifestyle rating of 3, and there appears to be no disagreement on this between the parties. Therefore, the Tribunal finds that a lifestyle rating of 3 is appropriate. Using the conversion chart, an impairment rating of 35 and a lifestyle rating of 3 provides a General Rate assessment of sixty percent. As the Applicant is already assessed at sixty percent, the Tribunal determines that on and from 21 June 1998 pension should continue to be paid at 60 percent of the General Rate.
I certify that the 49 preceding paragraphs are a true copy of the reasons for the decision herein of Mrs M T Lewis, Senior Member
Signed:         .....................................................................................
  Associate
Date/s of Hearing  15 March 2001
Date of Decision  22 March 2001
Counsel for the Applicant              Mr Matthew Smith
Solicitor for the Applicant              Rockliffs
Solicitor for the Respondent         Mr Peter Godwin, Department of Veterans' Affairs