Hardman and Repatriation Commission
[2007] AATA 2069
•19 December 2007
Administrative Appeals Tribunal
DECISION AND REASONS FOR DECISION [2007] AATA 2069
ADMINISTRATIVE APPEALS TRIBUNAL )
) No N2005/785
VETERANS’ APPEALS DIVISION ) Re Gary Hardman Applicant
And
Repatriation Commission
Respondent
DECISION
Tribunal Professor GD Walker, Deputy President
Ms N Bell, Senior Member
Dr J Campbell, MemberDate19 December 2007
PlaceSydney
Decision The decision under review is affirmed
................[sgd]..............................
Professor GD Walker
Deputy President
CATCHWORDS:
Veterans’ Affairs – Disability Pension – Post Traumatic Stress Disorder – Ischaemic Heart Disease and Diabetes Mellitus – War Caused Diseases Arising out of Operational Service -Diagnosis of PTSD cannot be Sustained – Does Not Suffer from Depressive Disorder Not Otherwise Specified – Does Not Meet the Diagnostic Criteria for Having Experiences a Major Depressive Episode- Chronic Adjustment Disorder with Depressed Mood – Adjustment Disorder is not War Caused – The Decision under Review is Affirmed.
…..
RELEVANT ACT/S:
Veterans’ Entitlements Act 1998
REASONS FOR DECISION
19 December 2007 Professor GD Walker, Deputy President
Ms N Bell, Senior Member
Dr J Campbell, Member1. In December 2000 Gary Hardman lodged a claim for a disability pension under the Veterans’ Entitlements Act 1986 for post traumatic stress disorder, ischaemic heart disease and diabetes mellitus as war caused diseases arising out of his operational service. Almost seven years later his claim is again before the Tribunal on remittal from the Full Federal Court.
2. Over the period of those seven years the complexion of Mr Hardman’s claim and the issues arising out of it have been examined, refined and recast. When the claim initially came before the Tribunal it primarily concerned the question of whether Mr Hardman suffers from post traumatic stress disorder (PTSD) and whether that condition is war caused, with the consequence that his other conditions were also war caused according to the hypothesis raised by him. The Tribunal found that Mr Hardman suffered from PTSD but that it was not war caused. The Federal Court then considered, after the parties agreed that post traumatic stress disorder was not war caused, whether the Tribunal erred in rejecting an alternative claim for depressive disorder. The Federal Court found that the Tribunal had not erred and that decision was appealed to the Full Federal Court. The focus of the Full Court’s examination was the date of clinical onset of depressive disorder, required for a reasonable hypothesis of war causation under the relevant Statement of Principles (SoPs) to be no more than two years after the date of any relevant stressor. In particular, the question was whether the Tribunal had impermissibly found fact by concluding that the material before it “overwhelmingly” suggested clinical onset at a date more than two years after any relevant stressor. The Full Federal Court found that the Tribunal had impermissibly found fact and remitted the matter to the Tribunal for reconsideration according to law.
3. There is no dispute that Mr Hardman had operational service with the Royal Australian Navy from 24 February to 1 September 1965.
Issues
4. The first question for us to address is whether Mr Hardman suffers from a disease and, if so, what disease. The focus of these proceedings has been on Mr Hardman’s psychiatric condition and there is no dispute that he suffers from a psychiatric disease. We agree.
5. It is settled law that questions of diagnosis are to be answered on the balance of probabilities. Broadly, two diagnoses have been urged on us. The first, by Mr Hardman, is depressive disorder and, in particular, depressive disorder not otherwise specified. The second, adjustment disorder, is urged on us by the Commission.
6. Our finding on diagnosis will determine which SoP is relevant to the question of whether Mr Hardman’s condition is war caused, that is, whether there is a reasonable hypothesis connecting his condition to his operational service. To establish that, there must be material before us that points to such a connection and where there is an SoP in place, the connection will be indicated by conformity with one of the factors specified in the SoP.
7. The diagnosis we find is particularly important. If we find that Mr Hardman suffers from adjustment disorder then there is no reasonable hypothesis of war causation available to him; the factors specified in the SoP concerning adjustment disorder (experiencing an identifiable psychosocial stressor within three months immediately before clinical onset or clinical worsening) preclude that on the material before us. We note that the parties are in agreement on this.
8. If we find that Mr Hardman suffers from depressive disorder, then, we must consider whether there is material before us which points to conformity with one of the factors in the SoP concerning depressive disorder. The factor relevant to Mr Hardman’s circumstances requires material pointing to Mr Hardman having experienced a severe traumatic event, of a kind described in the SoP, within the five years before the clinical onset of depressive disorder.
9. For completeness, and given the history of this matter, we will also turn our minds to whether Mr Hardman suffers from PTSD. If we find that he does, then we will have to undertake a similar but not identical process of consideration of whether there is material pointing to conformity with a factor in the SoP concerning post traumatic stress disorder.
10. We turn now to the question of diagnosis and, first, to whether Mr Hardman suffers from PTSD.
diagnosis
post traumatic stress disorder
11. In the claim lodged in December 2000, Mr Hardman sought to have a condition of PTSD accepted as a war caused disease. In making such an application, Mr Hardman was relying upon the opinion of his treating psychiatrist, Dr Frank Lumley, who in a series of reports (9 August 1996, 7 May 1997, 16 July 1997 and 18 November 1998) concluded that Mr Hardman was suffering from PTSD and by November 1988, there was in addition a major depressive disorder. Dr Lumley, in oral examination at a previous hearing, stated that his diagnosis of PTSD was made after Mr Hardman had told him that he had witnessed events involving the execution of an Indonesian patient by Malaysian servicemen, the interrogation of Indonesians captured by Malaysian military personnel on board his ship and a fire fight at the Tawau airstrip.
12. Mr Hambridge, a clinical psychologist, assessed Mr Hardman between May 1996 and June 1997. Mr Hambridge, in noting that Mr Hardman’s traumatic experiences were becoming more salient, as he was required to present a more detailed history of his experiences, concluded that Mr Hardman suffered from chronic PTSD.
13. Dr Gertler, a consultant psychiatrist, set out in his report of 6 July 1999 details of Mr Hardman’s traumatic experiences in Borneo in 1965. They are similar to those nominated by Dr Lumley. Dr Gertler also notes a history detailed to him by Mr Hardman that he continues to fear sleep and that he has recurrent nightmares in relation to his experience when under attack in 1965. Dr Gertler considered that Mr Hardman was suffering from severe chronic PTSD.
14. Professor Quadrio, a consultant psychiatrist, specialising mainly in child and family psychiatry, saw Mr Hardman on one occasion. Professor Quadrio, as a consequence of the history detailed to her by Mr Hardman – a history that involved a similar set of traumatic experiences witnessed by Mr Hardman in Borneo in 1965, concluded that Mr Hardman was suffering from PTSD with a major depressive disorder. That was the diagnosis formulated and upon which Professor Quadrio was cross-examined at an earlier hearing.
15. Consequently upon a thorough examination of Mr Hardman’s claims as to the traumatic experiences witnessed in Borneo in 1965, no evidence has been forthcoming as to whether such events ever occurred, while material has been forthcoming that they did not occur. This Tribunal notes the decision of an earlier Tribunal that the events did not occur. Such a decision has not been challenged and in this hearing such issues have not been further canvassed or pursued.
16. A remaining event to be considered is Mr Hardman’s admission to and treatment at a Cottage Hospital in Borneo 1965 for appendicitis. The day after his appendix was removed, a naval officer from his ship visited Mr Harman
and a few days later he was transferred to another service hospital, where it would appear that he may have had a wound discharge prior to him being returned to his ship.17. Mr Hardman has been particular in defining his concerns about this experience. Both Professor Quadrio and Dr Haik, a consultant psychiatrist, noted that Mr Hardman had attributed his ensuing difficulties (nightmares, dreams etc) to the traumatic events that he had witnessed (and now discredited by the earlier tribunal as having not occurred). While both doctors recognised that having appendicitis with subsequent removal could be considered a life-threatening event (as indeed any operation can) in the medical community, the reaction of a non-medical individual would be one of fear, apprehension and anxiety. Both psychiatrists noted that Mr Hardman did not express any symptomology that could be equated to a response that involved intense fear, helplessness or horror. Further, it is noted that Mr Hardman’s dreams and nightmares were stated to involve circumstances other than issues surrounding the clinical condition of appendicitis and the clinical treatment received for that condition.
18. In such circumstances, we conclude that a diagnosis of PTSD cannot be sustained on the material that has been presented. We conclude that on the evidence before us, as to events experienced and/or witnessed by Mr Hardman in Borneo in 1965, such events do not involve Mr Hardman witnessing and/or experiencing circumstances, which are consistent with the clinical finding of experiencing a severe stressor, a criteria necessary for the diagnosis of PTSD. We also note that the characteristic symptoms resulting from the exposure to the extreme trauma, which include persistent re-experiencing of the traumatic event are not in evidence, as any dreams/flashbacks are not related to actual events. In such circumstances, we conclude that a diagnosis of PTSD cannot be entertained.
adjustment disorder, depressive disorder or both?
19. In assessing the diagnostic issues, we acknowledge the following psychiatric opinions:
(a) The report of Dr Lumley dated 18 November 1998 in which he considered Mr Hardman to be suffering from a major depressive disorder (as well as PTSD). Dr Lumley believed the depressive disorder was related to both his physical disabilities and his war service. The reports and clinical notes of Dr Wallace, a senior specialist psychiatrist at St Vincent’s Hospital during the period August 2002 and April 2003, clearly indicated that Dr Wallace considered that Mr Hardman had chronic major depression against the background of his multiple serious medical illnesses and resultant disability (report of 2 September 2002).
(b) Dr Kelly, Director of St Vincent’s Hospital Mental Health Service, in his report dated 10 October 2003, expressed his conclusion that Mr Hardman “has persistent chronic depression in the context of a severe disabling physical …”
(c)The reports and oral evidence of Professor Quadrio demonstrate that her initial diagnostic position was that of PTSD with a major depressive disorder. Professor Quadrio believed there was sufficient material to suggest that the depressive disorder was in evidence following Mr Hardman’s return to his ship following his appendectomy in the Cottage Hospital in 1965. Professor Quadrio considered that Dr Wallace's opinion of chronic depression secondary to severe multiple medical problems was describing the same phenomenology as she was, but was ascribing a more limited causation to it. In so doing, Professor Quadrio considered that Dr Wallace did not appear to think that the service related experiences were significant or part of Mr Hardman’s current problems. Professor Quadrio concluded that if it were accepted that a depressive disorder was present it was impossible to determine whether it was primary, due to a medical condition or substance induced. In such circumstances she considered it reasonable that Mr Hardman was suffering from a depressive disorder not otherwise specified.
(d) Dr Haik, a consultant psychiatrist, considered in a report dated 8 March 2006 that Mr Hardman was suffering from a depressive disorder, with a probable date of clinical onset in the mid 1990s and associated with a chronic life-threatening, inoperable cardiac condition. Dr Haik was clearly of the view that Mr Hardman’s service experience in Borneo and immediately thereafter did not involve or result in Mr Hardman suffering a depressive disorder at that time. At best in Dr Haik’s opinion, if indeed Mr Hardman had suffered from any psychological disturbance at that time, of which he was not certain, it was an adjustment disorder - one of limited time span (limited by the existence of the stressor, the hospital event).
In further evidence, Dr Haik did not think that Mr Hardman met the five criteria necessary for the diagnosis of a major depressive episode. Although he had earlier expressed an opinion that Mr Hardman was suffering from a depressive disorder, Dr Haik, having regard to the evidence he had heard on the day and being able to consider the clinical notes of Dr Wallace, which indicated an episodic depressive disorder, considered that the appropriate diagnosis was adjustment disorder with depressed mood.
20. In summary at this point we observe that the psychiatric evidence, as briefly notated, points to three clinical entities:
(a) Mood disorder (depression) due to the general medical conditions of severe inoperable ischaemic heart disease, diabetes mellitus and peripheral neuropathy (Drs Wallace and Kelly);
(b) Depressive disorder not otherwise specified (Professor Quadrio); and
(c)Adjustment disorder with depressed mood (Dr Haik).
21. We note the diagnostic criteria for each of the following conditions nominated in DSM-IV-TR, namely:
(a) major depressive episode
(b) mood disorder due to a general medical condition
(c) depressive disorder not otherwise specified
(d) adjustment disorder with depressed mood
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22. Central to a diagnosis of depressive disorder not otherwise specified is the requirement that there be a depressive disorder present, but the clinician is unable to determine whether it is primary, due to a medical condition or substance induced.
23. The essential diagnostic criterion of major depressive disorder is a clinical course characterised by one or more major depressive episodes without a history of a mood disorder due to a general medical condition (DSM-IV-TR).
24. The criteria to satisfy a diagnosis of a major depressive episode are listed in DSM-IV-TR:
…
“major depressive episode” means a psychiatric condition that meets all the following diagnostic criteria (derived from DSM-IV-TR):
(a)five (or more) of the following symptoms have been present during the same two-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed meed or (2) loss of interest in pleasure. Symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations, should not be included.
(i)depressed mood most of the day, nearly every day, as indicated by either subjective report (eg, feels sad or empty) or observation made by others (eg, appears tearful). In children and adolescents, it can present as irritable mood;
(ii)markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others);
(iii)significant weight loss when not dieting or weight gain (eg, a change of more than five percent of body weight in a month), or decrease or increase in appetite nearly every day. In children, consider failure to make expected weight gains;
(iv)insomnia or hypersomnia nearly every day;
(v)Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down);
(vi)fatigue or loss of energy nearly every day;
(vii)feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick);
(viii)diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others); or
(ix)recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
(b)The symptoms do not meet criteria for a mixed episode.
(c)The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
(d)The symptoms are not due to the direct physiological effects of a substance (eg, a drug of abuse, a medication) or a general medical condition (eg, hyperthyroidism).
(e)The symptoms are not better accounted for by bereavement, ie, after the loss of a loved one, the symptoms persist for longer than two months or are characterised by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.
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25. Assessing the diagnostic evidence for a major depressive episode, it is evident that Mr Hardman has a depressed mood (all psychiatrists). In relation to criterion (a)(i), we note the evidence contained in the clinical notes of Dr Wallace. He speaks of mood variations for periods of up to half a day, three days a week, during which he experienced a sense of increased energy and motivation (11 February 2003). We also note the extract from the Newcastle Herald on 24 August 2000 where following the insertion of a spinal cord stimulator to assist in the control of his angina, Dr Steel, the attending neurosurgeon, stated that Mr Hardman was doing things he could not have dreamed about four months ago. In relation to criterion (a)(ii), we observe that Dr Haik was of the opinion that he could not find anything that suggested Mr Hardman had diminished pleasure and interest in most things, most of the day or nearly every day. In relation to significant weight loss (a)(iii), we acknowledge that his weight loss was a consequence of dietary advice to assist in the management of both his cardiac conditions and his diabetes mellitus. Further in relation to criterion (a)(iv) and (v), we note that Dr Haik stated that there is no mention of either psychomotor agitation or retardation or poor sleep. In relation to criterion (a)(vi), Dr Haik noted that he was uncertain as to the presence of fatigue or a lack of energy, but if they were present they more than likely associated with his physical illnesses. In considering criterion (a)(vii), we note that Dr Haik considered that Mr Hardman experienced a feeling of worthlessness. With regards to criterion (a)(viii), Dr Haik was of a view that any diminished ability to think or concentrate was more likely related to distraction arising from his physical illnesses. In relation to criterion (a)(ix), Dr Haik noted that while Mr Hardman has recurrent thoughts of death, he is concerned about dying from his cardiac disease. We also note the clinical material of Dr Wallace and Dr Kelly detailed a variable level of suicide ideation.
26. We note that, in 2002 Professor Quadrio stated that Mr Hardman had quite a severe depressive illness, as evidenced by weight loss, slow to talk, think and move, and was gloomy in his affect. Professor Quadrio also acknowledged that Mr Hardman’s observed slow and laboured manner could be accounted for by the large quantities of serapax, valium and panadiene forte that he was taking. Professor Quadrio indicated that the best evidence for Mr Hardman suffering a depressive disorder was to be found in the clinical notes of Dr Wallace.
27. In considering the remaining criteria, we note that Mr Hardman’s symptomatology do not meet the criteria for a mixed episode in that there is no evidence of hypomania (criterion (c)); his symptoms do not cause clinically significant distress or impairment (criterion (a)); they may well be due to the direct physiological effects of his medication or his general medical conditions (criterion (d)); and they are not accounted for by bereavement (criterion (e)).
28. In considering the proposed diagnosis of depressive disorder not otherwise specified, we are not satisfied that the criteria necessary to formulate a diagnosis of depressive disorder have been demonstrated. While the issues are clouded by both his major physical conditions and prescribed medications, we are not satisfied on the balance of probabilities that at the present time Mr Hardman satisfies five or more of the factors listed in criterion (a), noting in turn that symptoms due to a general medical condition are not to be included. In that regard we are not satisfied that he meets factors (i) to (vii) for the reason already outlined. Further, in relation to the other criteria, we are satisfied that he meets criteria (b) and (e) and probably (c), but not (d) for reasons discussed earlier. In so doing we have considered the opinions and material nominated by Drs Haik, Wallace and Kelly and Professor Quadrio.
29. In conclusion we are satisfied on the balance of probabilities that Mr Hardman does not suffer from a depressive disorder not otherwise specified. We consider that on the balance of probabilities that Mr Hardman does not meet the diagnostic criteria for having experienced a major depressive episode, that being an essential criteria for the diagnosis of a depressive disorder.
30. For the reasons already outlined, we consider that Mr Hardman’s symptomatology is more consistent with a depressed mood associated with either a general medical condition or an adjustment disorder. In reaching such an outcome we have been mindful of the opinions of Drs Wallace, Kelly and Haik and the diagnostic criteria for the two conditions under consideration as outlined in DSM-IV-TR.
31. Diagnostic criteria for a mood disorder with depressive features due to major cardiac disease, diabetes mellitus and peripheral neuropathy can only be diagnosed if:
(a) The predominant mood is depressed, but the full criteria for a major depressive episode are not met;
(b) There is evidence from the history, physical examination, or laboratory findings that the mood disturbance is the direct physical consequences of a general medical condition;
(c) The disturbance is not better accounted for by another mental disorder (eg, adjustment disorder with depressed mood in response to the stress of having a general medical condition);
(d) The disturbance does not occur exclusively during the course of a delirium;
(e) The symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning.
32. In assessing Mr Hardman’s symptomatology against such criteria, we were assisted in part by the clinical notes and options of Drs Wallace and Kelly and the opinions expressed by Dr Haik and Professor Quadrio during concurrent evidence.
33. We are mindful that both Dr Haik and Professor Quadrio shared an opinion that Mr Hardman lacked the necessary personality resources to cope in adverse situations. Further, we note agreement between those two psychiatrists that Mr Hardman had a relatively non-significant mental health history between 1970 and the mid 1990s. Further neither psychiatrist viewed the three suicidal gestures as necessarily indicative of longitudinal mental health illness. Professor Quadrio considered that Dr Wallace, while sharing a common understanding that Mr Harman’s severe medical conditions in the mid 1990s were responsible for the onset of his depressed mood at that time, failed to acknowledge any contribution to the depressed mood by his service experiences.
34. In considering the criteria as nominated, we are satisfied that all except criterion (c) for mood disorder are met. In finding that the disturbance is better accounted for by another mental disorder, for example, adjustment disorder with depressed mood, we are mindful of our earlier findings that his depressed mood symptomatology was variable in presentation during the course of some days, some weeks and some months. Further, while the clinical history suggests an association with Mr Hardman’s severe clinical conditions, there is an absence of composite evidence suggesting that the mood disturbance is a physiological consequence of a general medical condition. However, we acknowledge that the insertion of the spinal cord stimulator and his apparent improvement in mood would perhaps indicate a cause and effect relationship, but in turn we also acknowledge an absence of material demonstrating that the depressed mood is a direct physiological consequence of his stated physical conditions. More particularly and in such circumstances and as suggested by Dr Haik, the depressed mood is best explained as a response to a stressor, with the depressed mood remaining at least as long as the stressor remains – this being essentially the definition of an adjustment disorder.
35. Accordingly we find on the balance of probabilities that Mr Hardman does not satisfy the criteria for a diagnosis of a mood disorder with depressive features due to Mr Hardman’s major cardiac disease, diabetes mellitus and peripheral neuropathy.
36. In considering the diagnosis of adjustment disorder with depressed mood, we acknowledge the diagnostic criteria for such a condition nominated in DSM-IV-TR:
(a) The development of emotional or behavioural systems in response to an identifiable stressor(s) occurring within three months of the onset of the stressor(s);
(b) These symptoms or behaviours are clinically significant as evidenced by either of the following:
(i)marked distress that is in excess of what would be expected from exposure to the stressor;
(ii)significant impairment in social or occupational (academic) functioning;
(c) The stress-related disturbance does not meet the criteria for another specific Axis I disorder and is not merely an exacerbation of a pre-existing Axis I or Axis II disorder;
(d) The symptoms do not represent bereavement;
(e) Once the stressor (or its consequences) has terminated, the symptoms do not persist for more than an additional 6 months.
Specify if:
Acute: if the disturbance lasts less than 6 months;
Chronic: if the disturbance lasts for 6 months or longer
37. We acknowledge that Dr Haik considered that adjustment disorder with depressed mood was the appropriate diagnosis of Mr Hardman’s mental health condition. In arriving at the diagnosis during the hearing process, Dr Haik was reliant upon access to new material during the hearing process (reports of Drs Wallace and Kelly) and an ability to consider Mr Hardman’s symptomatology against a wider background. Dr Haik was particular in stating that the inoperable life-threatening cardiac condition constituted the stressor, which as a consequence of Mr Hardman’s diminished personality resources resulted in a mood-disturbance in excess of what would be expected of an exposure to the stressor. We further note that over time other stressors arising from his diabetes and peripheral neuropathy were added. Dr Haik noted that such a depressed mood commenced in the mid 1990s and has continued since. We note that however a period of amelioration of such symptomatology, perhaps in evidence for some months, when the spinal cord stimulator was implanted in an attempt to control the anginal pain, which it did for a limited period.
38. We note that Professor Quadrio disagreed with such a diagnosis on the grounds that the stressor had continued for in excess of ten years. We note Dr Haik’s response that while the stressor remains, the depressed mood, remains and the adjustment disorder is by definition chronic.
39. We acknowledge that the diagnosis of chronic adjustment disorder with depressed mood was arrived at by Dr Haik late in the day. We also acknowledge that of the psychiatrists involved over time in this matter, only Professor Quadrio has had an opportunity to express an opinion on such a diagnosis. We note her reservations, but consider such reservations do not fundamentally alter the soundness of Dr Haik’s diagnosis.
40. Having considered all the relevant issues in relation to the questions of diagnosis, we are satisfied on the balance of probabilities that the diagnosis of Mr Hardman’s mental health condition is chronic adjustment disorder with depressed mood. In reaching such a finding we have considered the diagnostic criteria for each nominated condition and accepted or not accepted a diagnostic category after assessments of the factual and opinion material. We also acknowledge that the constructive and deductive reasoning inferred in Dr Haik’s opinion, coupled with the clinical material from Dr Wallace and Dr Kelly, was more instructive in assisting in our assessment of Mr Hardman’s current diagnostic category. We observed that much of Professor Quadrio’s oral evidence was directed towards establishing a clinical onset for depressive disorder, which may or may not have been relevant. Nevertheless, we consider that Professor Quadrio’s focus on such did little to assist us in establishing the criteria necessary for a diagnosis of the current mental health conditions.
is mr hardman’s adjustment disorder war caused?
41. For Mr Hardman’s adjustment disorder to be war caused, the material before the Tribunal must point to a hypothesis of causation that conforms with a factor in the relevant SoPs. The relevant SoP is No. 57 of 1996. Paragraph 4 of that SoP provides that the factor must be related to any relevant service rendered by the veteran. Paragraph 5 of the SoP sets out the factors that must exist before a reasonable hypothesis can be raised:
“ (a) experiencing an identifiable psychosocial stressor or stressors within the three months immediately before the clinical onset of adjustment disorder; or
(b) experiencing an identifiable psychosocial stressor or stressors within the three months immediately before the clinical worsening of adjustment disorder; or
(c) inability to obtain appropriate clinical management for adjustment disorder.”
42. We note the parties agree there is no material before the tribunal that points to those factors. In particular, we note the evidence of Dr Haik that the stressor relevant to Mr Hardman’s adjustment disorder was his heart condition in the 1990s. Clearly, this was more than three months after his eligible service.
43. It follows that Mr Hardman’s adjustment disorder is not war caused.
decision
44.The decision under review is affirmed.
I certify that the 44 preceding paragraphs are a true copy of the reasons for the decision herein of Professor GD Walker, Deputy President
Signed: ..................[sgd].....................................................
Renee Wallace, AssociateDate/s of Hearing: 10 May 2005;
6 and 13 November 2006; and
19 and 20 July 2007
Date of Decision: 19 December 2007
Solicitor for the Applicant: Mr Paul Jones, Legal Aid Commission
Counsel for the Applicant: Mr Craig Colborne
Solicitor for the Respondent: Ms Angela Nanson, Australian Government Solicitor
Counsel for the Respondent: Ms Jane McDonnell
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