Knight and Repatriation Commission
[2007] AATA 1520
•6 July 2007
Administrative Appeals Tribunal
DECISION AND REASONS FOR DECISION [2007] AATA 1520
ADMINISTRATIVE APPEALS TRIBUNAL )
) No V 200500132
VETERANS' APPEALS DIVISION ) Re BRUCE WILLIAM KNIGHT Applicant
And
REPATRIATION COMMISSION
Respondent
DECISION
Tribunal Regina Perton, Member Date6 July 2007
PlaceMelbourne
Decision The Tribunal affirms the decision under review. (sgd) Regina Perton
Member
VETERANS' AFFAIRS ‑ veterans’ entitlements ‑ psoriasis ‑ psoriatic arthropathy ‑ hypertension – anxiety ‑ alcohol dependence ‑ paranoid personality disorder ‑ whether defence-caused – decision affirmed
Veterans’ Entitlements Act 1986 ss 70(5), 120(4), 120B(3), 196B(14),
Lees v Repatriation Commission [2002] FCAFC 398
Repatriation Commission v Cornelius [2002] FCA 750
REASONS FOR DECISION
6 June 2007 Regina Perton, Member 1. Bruce William Knight served in the Royal Australian Army (the army) from 6 September 1972 until 30 April 1976. Mr Knight’s service from 7 December 1972 until his discharge on 30 April 1976 constitutes defence service under the Veterans’ Entitlements Act 1986 (the Act).
2. On 11 June 2003, Mr Knight lodged a claim to have the medical conditions of anxiety state and alcohol dependence, hypertension, psoriasis, and psoriatic arthropathy recognised as defence-caused. On 21 November 2003, a delegate of the Repatriation Commission (the Commission) refused the claim. On 14 December 2004, the Veterans’ Review Board (VRB) affirmed the Commission’s decision. On 21 February 2005, Mr Knight lodged an application with the Tribunal.
3. Mr Knight believes that the treatment meted out to him by officers during his army service constituted severe psychosocial stressors and have contributed to the medical conditions which he is claiming are defence-caused.
4. The Tribunal must decide what the pertinent medical conditions are from which Mr Knight suffers, and whether the medical conditions meet the criteria set out in the Act and in the relevant Statement of Principles (SoP) made under the Act.
Mr Knight’s Medical Conditions
5. Mr Knight has lodged claims seeking a veteran’s disability pension or an increase in the level of pension for several conditions over the last two decades. In 1998, the Commission accepted bilateral sensorineural hearing loss and bilateral tinnitus as defence-caused conditions. In 1999, the Commission did not accept that headaches, fractured maxilla and localised osteoarthrosis of the right hand were defence-caused. In 1991, the Commission decided that psoriatic arthropathy was not defence-caused. In 1998, a claim for recognition of hypertension as defence‑caused was rejected. Psoriatic arthropathy and hypertension constitute two of the conditions in the claim under consideration by the Tribunal.
6. The Tribunal is required to determine to its reasonable satisfaction whether Mr Knight suffers from any particular injury or disease. It will then apply the relevant legal tests set out in the Act.
EVIDENCE
Mr Knight
7. In his claim form lodged on 11 June 2003, Mr Knight stated that his disabilities of anxiety state and alcohol dependence were the outcome of:
Verbal abuse by senior officers in 5.R.A.R. At one stage was told I was undesirable & should be shot by C.O. Also Company 2.I.C. continually was singling me out & stating I was obese undesirable soldier. This caused me substantial distress.
8. Mr Knight stated that his hypertension resulted from his alcohol intake and that he first became aware of the symptoms of hypertension in 1994. Mr Knight stated that he had never smoked. He stated that he had ceased work in 1977 and had relied on a disability pension since then.
9. At his hearing before the VRB in December 2004, Mr Knight said that he first sought treatment for his emotional problems in around 2000. His general practitioner referred him to a psychiatrist, Dr Rob Peterson. He said that Dr Peterson had prescribed medication but that he had not taken it as he already took several types of medication. He said that he now consumed about 15 full nips of rum and coke daily but was able to manage that volume. He said that a friend distilled rum at home so he could obtain it fairly cheaply. Mr Knight said that he had worked for a brief time after leaving the army. He has been unable to work since 1977 because of the effect of his arthritis. He relies on a Centrelink disability pension and a part pension from the Department of Veterans’ Affairs (DVA) for income. He does not qualify for a military pension.
10. In unsworn statements dated 15 June 2005 and 30 August 2005, Mr Knight stated that he joined the army in 1972 hoping to have had an enjoyable career. He stated that he had no difficulties in army service until he was marched into 5 RAR D company. He stated that the Captain in charge bullied him for reasons unknown to him. Mr Knight indicated that he was denied trips overseas with his unit at the Captain’s direction. He stated that the Captain had told him that he was untrustworthy as a soldier. Mr Knight stated that he went AWOL a few times just to escape the tension. Mr Knight recalled passing a test to use certain weapons which would have entitled him to wear a cross-rifles insignia. After he passed the test, Mr Knight went to the Q store, obtained the insignia and had it sewn on his uniform. He said that when the Captain saw the insignia, he told Mr Knight to remove it because he was not entitled to wear it until its award had been recorded in standing orders. Mr Knight stated that he had refused to do so and had subsequently been charged by the Captain with insubordination.
11. Mr Knight alleged that the Captain set out to destroy his self esteem as a person and a soldier. He stated that he did not have the opportunity to go to New Zealand for exercises with the whole unit because he was in the lock-up due to an argument with the Captain. Furthermore, he was prevented by the Captain from going to Malaysia 5 RAR C which had sought volunteers from others in 5 RAR. He stated that he was insulted while collecting his pay. He stated that the Captain abused him for being overweight. Mr Knight stated that the Captain had told him on numerous occasions that he was unfit to wear the uniform. Mr Knight stated that if it were not for the Captain, he would have been in the army for much longer.
12. Mr Knight stated that he had also been harshly treated by the Lieutenant Colonel in charge of the 5 RAR. He was particularly disturbed when the Lieutenant Colonel called him a trouble-maker and told him that he should be shot. Mr Knight said that the latter comment had upset him quite a bit.
13. In his oral evidence, Mr Knight said that he did not have any difficulties during his twelve weeks of basic recruit training at Kapooka or at the Infantry Training Centre at Ingleburn. Mr Knight said that he spent an extra 3 weeks at Ingleburn due to a hand injury so he had not completed the infantry course with the recruits he had started with. After Ingleburn, he was marched into 5 RAR D company. Mr Knight said that after 3 or 4 months in 5 RAR D company, he was targeted by the captain who was second in charge of the company. He said that the Captain had verbally abused him for the next three years. He said that the Lieutenant Colonel had treated him unfairly by describing him as a troublemaker and saying he should be shot. Mr Knight said that he believed that the only reason he was charged with so many offences was because of problems between himself and the Captain. He said he had no trouble with any NCOs or other officers in the unit. Mr Knight said that he was regularly verbally abused on the parade ground by the Captain.
14. Mr Knight underwent extensive cross-examination by Ms Jane Macdonnell, counsel for the Commission. Evidence was presented concerning Mr Knight’s attempt to join the Royal Australian Navy before the army and an adverse assessment by a naval psychologist that resulted in a failure to be accepted. Mr Knight could not recall details of the naval interview nor of his initial army interview, both of which were over forty years ago. He said that he had tried to join the police force prior to joining the army but was unsuccessful as he did not meet the then minimum height requirement for entry. Mr Knight agreed that he had been required to lose weight between his interview and his army enlistment date and said that he had done so.
15. Mr Knight reiterated that he had no difficulties with his army career until he joined 5 RAR. Ms Macdonnell referred to a comment in Mr Knight’s army records in which a second-lieutenant described Mr Knight, while at Kapooka as idle, lacks drive, is irresponsible. Mr Knight said that he did not recall being told that and disagreed with the comment. Mr Knight was referred to weekly reports made on the progress of recruits during training at Ingleburn:
Week of Training Comment by Section and Platoon Commander
1This soldier appears to be a little idel [sic] He needs to be pushed along to give his best. Improvement needed…
2In the bush this soldier is improving as time goes on, in new training, he works at a fair rate but needs to improve to keep up with the training.
3In his first lessons on M60, M16,…this soldier didn’t have any great problems, is slowly improving.
4This soldier is going down hill fast needs constant supervision. On the range this week he has given an average…NEED TO IMPROVE. Poor attitude
5In my opinion this soldier is a malingerer and is also useless. He is NOT PULLING HIS WEIGHT. IMPROVEMENT NEEDED.
…
8A definite improvement in attitude. This man seems to be the type who will work hard with understanding supervision and happy surroundings
16. In response to these reports, Mr Knight said that this was the first time he had been made aware of them. He believed he had not been slack and had been doing his job well. Because of his hand injury in the seventh week, Mr Knight joined 5 RAR three or four weeks later than the recruits he had enlisted with. Therefore he had a new platoon commander for the last weeks and Mr Knight suggested the comment in week 8 reflected the change. He expressed surprise and concern that he had not been told about the earlier assessments or the comment on his training overall which was with careful direction will improve, however he lacks any real responsibility and must be supervised.
17. Mr Knight was referred to army records that indicated that the New Zealand exercise in which 5 RAR participated, took place from 30 March 1973 to 16 April 1973. The latter date was the date on which Mr Knight was transferred to 5 RAR from Ingleburn. Mr Knight doubted the accuracy of these records. He said that he recalls sitting in the battalion lock‑up as the others marched out so either the dates are incorrect or there was a later trip to New Zealand. Mr Knight confirmed that he was not in detention in April 1973 stating that his problems started about three months later. Some army records suggested that Mr Knight had joined 5 RAR in March 1973 and others April 1973. Ms MacDonnell highlighted documents that showed it would have been in mid April 1973 because of the three week delay in completing Ingleburn training as a result of the hand injury. However Mr Knight insisted that he went to 5 RAR at the end of March 1973.
18. Ms Macdonnell referred to Mr Knight’s army records and informed Mr Knight that on 14 May 1973, a month after he started with 5 RAR, he was charged with being AWOL and as a result he was fined $10 and confined to barracks (CB) for 4 days. Mr Knight agreed that this had occurred. His next offence was a week later on 21 May 1973 when he did not appear at the afternoon CB parade. In response, Mr Knight said that he did not know why he did not attend the parade. He received another 2 days CB. He again failed to turn up to CB parade on 29 May 1973 and received a further 4 days CB. Mr Knight said he could not recall that these incidents were all so close to each other. When it was brought to his attention that he would have been confined to barracks until 3 June 1973 and yet charged with being AWOL from 2 June 1973 to 6 June 1973, Mr Knight said that he could not recall where he was. He said that when he went AWOL, he was never out of the barracks but failed to attend parade. He said that he would just go to town for the day and then come back at night. He agreed that he received 167 hours detention and a fine of $20 for going AWOL.
19. When it was suggested to Mr Knight that it was not surprising that his Lieutenant Colonel had given him two warnings given his history, he did not agree. He said that on the second warning from his Lieutenant Colonel, he had been threatened with being shot because he was a troublemaker. He said that he was never told to pull his socks up. He said that he classified the Lieutenant Colonel’s comments as verbal threats and abuse rather than being told off. Mr Knight said that he did not believe he was a troublemaker. He clarified that the lieutenant colonel said that he should be shot rather than threatening to personally shoot him. Mr Knight said that he was only 18 years old so he took this comment seriously.
20. There was discussion of the circumstances of Mr Knight’s other charges. He indicated that on one of the occasions he was AWOL, he was returning from a trip to Adelaide with some companions when their car broke down so they returned to the barracks late. He said that he and his companions had rung the base to advise what had happened to them.
21. Mr Knight agreed that it was 5/7 RAR C company that went to Butterworth, not D company of which he was a member. He said that routine standing orders were posted through orderly rooms asking for extra personnel to volunteer to go. Mr Knight said that he put his name on the list but the Captain had removed his name from the list. Mr Knight agreed that he was not in detention when the departure for Malaysia took place on 5 March 1974.
22. Mr Knight agreed that he went AWOL again on 4 June 1974 for 24 hours. He said that it may have been the date when a friend, Mr Miles, returned from Malaysia. Mr Knight recalled going to Mr Miles’ house to celebrate. He said that Mr Miles lived off base at that time. Mr Knight could not recall an incident where he was asked to empty a garbage bin by his Corporal and refused to do so, swearing at the Corporal. Mr Knight could not recall being charged with fighting another soldier in the back of an army truck. Ms Macdonnell asked Mr Knight about another incident where he went AWOL for 3 days in November 1975. Mr Knight could not recall this incident and could not explain why he had done so. He said it was unreasonable to expect him to remember all the charges he faced.
23. Mr Knight said that he was refused a transfer to Armoured Corps in March 1975 on the recommendation of his commanding officer. He was informed that army records showed that his commanding officer was willing to transfer him but that it was the receiving corps that refused to accept him. Mr Knight said that this was new to him as the paperwork he has at home states otherwise. Mr Knight said he still believed it was his Captain that had blocked the transfer.
24. When Mr Knight was informed that there was no record of any charges being laid against him by the Captain, Mr Knight disagreed. He said that when he put his name of the list of volunteers for Malaysia, the Captain had walked over and scrubbed it out. The Captain told Mr Knight that he did not think much of him and that he had no entitlement to go. Mr Knight said that he had a go at him and was charged and subsequently fined. When told there was no record of this, Mr Knight said that there should be. Mr Knight said that if he was told off and felt threatened, he might give a mouthful back.
25. In relation to going AWOL on 23 January 1976 and not returning, Mr Knight said that he did not realise that he had been gone for 3 months. He said that he tried to hand himself in but found out that he had been discharged. He said that he went for a holiday to visit Mr Miles who was no longer in the army and time got away.
26. Mr Knight agreed that he had tried to re-enlist in May 1976. He stated that this was because he had enjoyed service in the army. In his letter of request, he stated that he had not gone AWOL intentionally and Mr Knight confirmed that was the case in his oral evidence. He said that he had come to Victoria for a holiday to see his mate. He said that Mr Miles supported him during the period he spent with him. He said that Mr Miles was travelling around, working as a furniture removalist and that he just jockeyed with him. When not travelling around, he stayed at Mr Miles’ home.
27. When Mr Knight was asked why he had seen a psychiatrist, Dr Peterson, in 2000, he said that his general practitioner had referred him. He said that he had many worries at that time and still does.
28. In response to the comment that Dr Peterson’s notes described him as a non‑drinker, Mr Knight said that he didn’t have to tell him everything, did I. Mr Knight said he did not drink beer any more, only rum and coke. Mr Knight said that he was still seeing Dr Peterson. He said that he refused to take the medication that Dr Peterson had suggested as he was concerned about the side effects.
Ray Parlett
29. Mr Parlett provided a letter in support of Mr Knight on 15 June 2004. In that letter he stated that he had served with Mr Knight until 1976. He stated that Mr Knight received verbal abuse from the then second in charge (2.I.C) of 5 RAR. He said that the battalion made trips to Malaysia and New Zealand but that Mr Knight was not included. Mr Parlett stated that he had heard that the then 2.I.C. was responsible for Mr Knight not going on the trips. He also stated that Mr Knight had a few stays in the Battalion lock-up because he was abused by the 2.I.C. The signature on Mr Parlett’s letter was somewhat different to the signatures in his records.
30. Mr Knight said that he had resumed contact with Mr Parlett eight or nine years earlier after tracing him through the electoral roll. Mr Knight said that he had tried to contact Mr Parlett again recently without success. Therefore Mr Knight was unable to call him as a witness or clarify issues such as why Mr Parlett stated that he had served in the army until 1976 when he had actually been dishonourably discharged on 1 August 1974. Mr Knight said that he was asked by DVA to provide letters of reference and that he had told Mr Parlett the type of information required.
Ray Saunders
31. Mr Saunders provided a letter of support to Mr Knight on 19 June 2004. Mr Saunders stated that he had also been at Ingleburn with Mr Knight in 1972. He indicated that Mr Knight did not march out with the rest of the platoon from Ingleburn because of an injury. Mr Saunders stated that Mr Knight had not suffered from any abuse by superiors prior to joining 5 RAR but that things started to go wrong for Mr Knight about two months later. He stated that the Captain who was then second in command verbally abused all of them but singled out Mr Knight in particular. He stated that Mr Knight was denied a trip to Malaysia with 5 RAR for no reason other than that the Captain believed Mr Knight was an undesirable person. Mr Saunders stated that Mr Knight had told him that he was going to try and go as far as he could in the Army but that the Captain’s abuse caused Mr Knight’s career to come to an end.
32. Mr Saunders’ army record showed that he was discharged on 12 June 1975. When Mr Knight was asked how Mr Saunders knew when and why Mr Knight’s career came to an end, Mr Knight said that he had told Mr Saunders about it. Mr Knight said that he had now lost contact with Mr Saunders who had moved from the address cited in his letter of support. He said that he had found Mr Saunders through the electoral office some eight or nine years earlier, around the same time that he found Mr Parlett. He said that the telephone number he had for Mr Saunders was now disconnected. Hence, Mr Saunders was not available as a witness.
Howard Miles
33. Mr Miles, who served in the army from 1972 to 1975, made a statement in June 2004 that he served with Mr Knight at Kapooka, Ingleburn and then 5 RAR. Mr Miles was in B company and Mr Knight in D company. Mr Miles stated that he, Mr Knight and other friends would all go into town after being stood down at 4.30 pm to hit the pubs. He said that Mr Knight had told him that the Captain who was second in command of D company had taken a dislike to Mr Knight. Mr Miles stated that he had heard the Captain yelling abuse at Mr Knight. He stated that Mr Knight did not seem to have trouble with any other officers or NCOs. Mr Miles stated that Mr Knight went AWOL to avoid being abused by the Captain.
34. In oral evidence, Mr Miles confirmed that he and Mr Knight had started in the army together. He said that he had on one occasion personally observed the Captain verbally abusing Mr Knight even though he was two parade grounds away (100 metres approximately) with his company. He said that the Captain had personally intervened to stop Mr Knight going to Malaysia. When asked how he knew that, Mr Miles said that it was because Mr Knight, who is his best mate and like a brother, would not lie to him and it was Mr Knight who told him. Mr Miles conceded that he had not seen Mr Knight write his name on the list. Mr Miles said that he was with Mr Knight on one of the occasions he was AWOL when their car broke down. On another occasion, Mr Miles was on guard duty and had to lock his friend up for going AWOL.
35. Under cross-examination, Mr Miles confirmed that he and Mr Knight did not finish corps training together. He said that Mr Knight had joined 5 RAR three or four weeks after he did. Mr Knight agreed that most diggers would be told off by their NCOs at some stage, commenting Now I don’t care if you were overweight, under weight, whatever, you were told off. Mr Miles said that although he was posted to 5 RAR a week before 5 RAR went to New Zealand, he did not go because he had to appear in civilian court on a drink driving charge. Mr Miles said that both he and Mr Knight were heavy drinkers when doing corps training. He confirmed that when they were stood down at the end of the day, they would either go to the canteen or the pub in town to have a few ales.
36. Mr Miles said that he had left the army in mid 1975 because he had married and his wife wanted him to be home more often. He said that he could have been working as a furniture removalist in January 1976. Mr Knight said that he had a two bedroom home in Richmond at that time. He could not recall whether Mr Knight came to his house in January 1976 and stayed for three months but said that Mr Knight probably did. Mr Miles confirmed that he had discussed with Mr Knight what he wanted him to put in his statement.
The Second in Command
37. On 10 May 2005, the relevant Captain of 5/7 RAR between 1973 and 1976 responded to a letter from Mr Knight’s representative, Mr Bruce Turner. He noted that he had not received any specific details of the harassment and verbal abuse which Mr Knight alleged he had inflicted on him. He stated that:
…it was not in my nature or my command style at the time, nor since, to subject soldiers to the sort of harassment or abuse that is alleged in general terms, by Mr Knight.
38. In a further letter dated 15 September 2005, the then captain stated that he had no particular memory of Mr Knight or of the alleged incidents he had cited. He also stated that he could see no record of Mr Knight being charged for swearing at him. Furthermore, he noted that Mr Knight had initially accused him of stating that he should be shot but now attributed that comment to the Lieutenant Colonel in charge of the unit.
Writeway Reports
39. The Tribunal was presented with seven reports dated between 21 September 2005 and 11 August 2006 documenting research undertaken as a result of the issues raised by Mr Knight. The outcomes of the research included the following:
·Mr Knight contended that although he had been discharged in absentia, he rang up later to be told of the discharge. He attended an appointment at Watsonia for a discharge medical. Writeway reported that when soldiers were discharged in absentia after being AWOL for 3 months, at the time of Mr Knight’s discharge, disciplinary action could still be taken against the soldier if he presented himself or was apprehended within the following 6 months. There is no evidence on Mr Knight’s file or in other records of a medical board appointment after discharge. There was no record of the telephone call allegedly made by Mr Knight to Watsonia or of a letter he stated he wrote in approximately May 1976. There was also no record of a transfer of Mr Knight’s earlier medical records to Watsonia which would have been a prerequisite to a discharge medical.
·Mr Knight stated that he qualified for crossed-rifles (marksman) but that the insignia was taken off him by his captain. The Central Army records indicated that there is no reference on Mr Knight’s dossier to suggest that Mr Knight was entitled to crossed-rifles or that he had his entitlement to the award removed. This information is consistent with Mr Knight’s record of service.
·Army records show that an exercise, entitled Jack Horner, was conducted in New Zealand from 30 March 1973 to 16 April 1973. Mr Knight was still serving at Ingleburn until 16 April 1973 when he joined 5 RAR.
·Mr Knight’s service records were obtained. None of the disciplinary records listed below show that the Captain was responsible for the charges as alleged by Mr Knight or that the Captain was witnessed the breaches:
November 1975 Absent without leave from 20 to 22 November 1975. Fined $40 and 7 days CB
August 1975 Conduct to the prejudice of good order and military discipline. Fighting with another soldier in rear of army truck. Fine $10 and 7 days CB
August 1975 Civil conviction. Brisbane on 7 August. Drunk in a public place. Released on 10 cents bail, failed to appear in court and bail forfeited. No further action
December 1974 Using insubordinate language to his superior officer (3 charges). Fined $10 and 4 days CB
January 1974 Conduct to the prejudice of good order and military discipline. Wearing uniform incorrectly. Fine $5
November 1973 Administrative warning by Lt-Colonel that discharge will be recommended unless improvement within 3 months
October 1973 Neglect to obey routine orders and lawful command. Incorrect uniform in town and failing to return to unit as directed. $10 fine and 3 days CB
July 1973Administrative warning by Lt-Colonel on 27 July that discharge will be recommended unless improvement within 3 months
Absent without leave on 19 & 20 July. 72 hours detention
June 1973Neglect to obey unit routine orders by incorrect dress in town on 16 May. Absent without leave, while confined to barracks from 2 June to 6 June. 167 hours detention and $20 fine (5 RAR)
May 1973Failing to appear on parade on 29 May. 4 days CB.
Failing to appear on parade on 21 May. 2 days CB
Absent without leave on 14 May. 4 days CB and $10 fine
40. Writeway checked the records of Mr Parlett, Mr Saunders and Mr Miles who provided supporting statements in June 2004 in relation to Mr Knight’s claims:
·Mr Parlett served in the army from 3 October 1972 to 1 August 1974. He was discharged for having been guilty of misconduct. Mr Parlett served much of his time in the same unit as Mr Knight. He was disciplined over several matters but a lesser number than Mr Knight. He was not charged with going AWOL but was discharged over a more serious matter.
·Mr Saunders served in the army from June 1972 to June 1975. There were no records found beyond his record of service cover sheet to confirm that he was a member of 5 RAR.
·Mr Miles served in the regular army from September 1972 to September 1975 and then in the army reserve between 1977 and 1983. He was discharged at the expiration of his engagement. He served in Malaysia for 3 months from March 1974 to June 1974. There were only 2 disciplinary breaches on his record, one for being AWOL for 7 hours on 19 July 1973 for which he was fined $6 and given 3 days CB and the other for leaving his post as a sentinel on 17 November 1974 and being found in the company of a female for which he was fined $10 and given 14 days CB.
MEDICAL EVIDENCE
41. Army medical records show that Mr Knight had recurring problems with his toes from December 1972. He injured his right hand in January 1973. He saw the medical officers regarding headaches on several occasions. He also suffered from pharangitis more than once. He is recorded as overweight in June 1973 and in June 1974, it is noted that he had gained 26 kilograms since enlistment. His Corporal referred him to the medical officer on 26 June 1974. On 16 September 1975, a medical officer reported that Mr Knight was a rather obese and undesirable soldier but who was nonetheless fit for full duty. There are many indecipherable words in the photocopied documents.
42. On 26 October 1990, Dr D G Campbell, Director of Medical Services at the Royal Melbourne Hospital (RMH) stated in a letter to DVA that Mr Knight first developed psoriatic arthopathy in 1977. He had hospital admissions in 1981 and 1983 in relation to the condition. Dr Campbell stated that he has had very active disease. Mr Knight’s pain level fluctuated and mainly involved his knees and ankles.
43. On 8 November 1990, Dr Guy Hibbins gave an opinion that the cause of Mr Knight’s psoriatic arthopathy was unknown although automimmune factors are thought to be involved. Dr Hibbins stated that the condition was not related to any incidents in Mr Knight’s eligible service. He stated that wet conditions and bush exercises are not recognised risk factors in this condition.
44. On 20 August 1998, Dr Tim Linton, Mr Knight’s medical practitioner at the time completed questionnaires sent to him by DVA. Dr Linton answered no to a question on DVA’s form asking if Mr Knight had developed hypertension secondary to renal injury or to the clinical management of another medical condition. Dr Linton stated that Mr Knight took medication for his hypertension which kept it well controlled and had no persistent side effects. In relation to obesity, Dr Linton stated that Mr Knight had never suffered from a binge eating disorder, a hypothalamic disorder or a number of other listed conditions related to obesity. Dr Linton stated that Mr Knight’s severe psoriatic arthritis resulted in crippled hands and difficulty with mobility. This had also caused him to gain weight.
Dr Peterson
45. Dr Peterson, Mr Knight’s treating psychiatrist, prepared a report on 9 November 2003. Dr Peterson stated that Mr Knight had been referred to him by Dr Sooknandan, his then general practitioner. Dr Peterson first saw Mr Knight on 17 May 2000. Mr Knight continued to attend for supportive counselling periodically. Dr Peterson stated that Mr Knight had provided a history of an unsettled service life marked by what he considers to be frequent unjust and harsh treatment at the hands of his superior officers. Dr Peterson suggested that his patient might qualify under the SoP for anxiety disorder on the basis of his inability to obtain clinical management for anxiety disorder during his service.
46. In oral evidence, Dr Peterson said that based on the history presented to him by Mr Knight, it was his opinion that the verbal abuse described could amount to a severe psychosocial stressor in someone of Mr Knight’s vulnerability.
47. Most of Dr Peterson’s evidence was under cross-examination. Dr Peterson said that he was not seeking to advance Mr Knight’s case generally but was aware of the impact of it on his anxiety state. He commented that as Mr Knight’s clinician, his primary role is to assist in managing Mr Knight’s condition rather than to report to third parties as a diagnostician. He pointed out that his report may well have read differently if he was in the role of a diagnostician who interviewed Mr Knight only once or twice.
48. Dr Peterson confirmed that the original referral by Mr Knight’s general practitioner was in relation to Mr Knight’s anxiety and depression related to osteoarthritis in Mr Knight’s hands. He agreed that there had been no mention of other incidents by the general practitioner or Mr Knight at the time of referral. He agreed that during his initial interview, Mr Knight had told him that he did not drink alcohol. Dr Peterson said that he was not surprised to hear that Mr Knight drinks around 2 litres of rum per week.
49. Dr Peterson stated that there was no doubt that Mr Knight’s arthritis and the associated deformity has resulted in personal distress amounting to anxiety. In a note dated 5 August 2000, he wrote that Mr Knight experienced extreme frustration at the limitations imposed by the physical deformities of the arthritic condition. However, in oral evidence, Dr Peterson expressed the opinion that this was not the sole and only contributor to Mr Knight’s anxiety state. He said that there was always a multiplicity of factors involved. Dr Peterson agreed that in 2000 and the following three years, Dr Peterson focussed on Mr Knight’s anxiety state that resulted from his medical condition. Dr Peterson said that he provides a sounding board for Mr Knight to discuss his difficulties. He indicated that pharmacotherapy is not the only mode of managing people’s distress and confirmed that Mr Knight was reluctant to take medication. He said that most of Mr Knight’s stressors were environmental.
50. Ms Macdonnell asked Dr Peterson why he had changed his diagnosis in November 2003 from anxiety due to a medical condition to generalised anxiety disorder. Dr Peterson said it was the same anxiety state but he had looked at it from a different perspective after being requested by DVA to complete pro-forma documents. He explained that although the two conditions had similar symptoms, there were different ways of looking at his patient’s disorder. He reiterated that as a clinician, causation is not crucial to management of the condition. In managing veterans such as Mr Knight, he is obliged to communicate in the terms that others such as DVA request. The symptoms could be grouped together for more than one condition. He said that anxiety disorder due to a medical condition can be a sub-set of generalised anxiety disorder although not recognised in the SoPs as such.
51. There was in-depth questioning of Dr Peterson in relation to his clinical notes. Ms Macdonnell focussed on the entries made at the time Dr Peterson provided his report to DVA and at the time of the VRB hearing. She also examined the entries that referred to contact with persons that had assisted Mr Knight with his claim. Dr Peterson stated that Mr Knight’s dealings with DVA caused stress that adversely affected his treatment. However, Dr Peterson said that he only assisted Mr Knight in an ethical and appropriate manner. He said that medical opinions can change over time as more information becomes available and his, too, might change. His current diagnosis was that Mr Knight suffered from anxiety disorder. He said that Mr Knight’s condition has improved somewhat on occasions, however particular events can result in deterioration. He reiterated that Mr Knight is a particularly vulnerable individual who may have interpreted disciplinary action as persecution.
Dr Byrne
52. Dr Kenneth Byrne, consultant psychologist, prepared a report for DVA on 5 December 2005 based on two interviews with Mr Knight. Dr Byrne diagnosed Mr Knight as suffering from a Paranoid Personality Disorder. He stated that the essential feature of this disorder is a long standing pattern of pervasive distrust and suspiciousness of other people. Dr Byrne stated that one of the characteristics of the disorder is that the person tends to carry grudges and has difficulties forgiving any perceived insult or slight and is always ready to blame others without accepting any criticism of themselves. Dr Byrne believed that the clinical onset of the disorder was when Mr Knight sought entry to the navy and was rejected. Dr Byrne expressed the opinion that Mr Knight’s alcohol abuse is caused by his paranoid personality disorder, the cause of which is exceedingly likely to be found in his family history and early developmental years. Dr Byrne expressed the opinion that on the balance of probabilities, Mr Knight would not meet any of the factors for the SoP concerning Personality Disorder (Instrument Nº 144 of 1995).
53. In oral evidence, Dr Byrne stated that it is not unusual for there to be a number of possible explanations for a particular set of symptoms. In summary, he suggested that the clinician needs to look at which of the different possibilities seems to be most likely for a particular person at a particular time. He agreed that diagnoses can change over time. However, he maintained the view that Mr Knight fits the clinical picture of paranoid personality disorder.
Dr Walton
54. Dr Lester Walton, consultant psychiatrist, prepared a report dated 15 March 2006. He stated that he had not undertaken a personal examination of Mr Knight due to Mr Knight’s refusal to attend an interview. His report was based on a large range of documents available at that time, including reports by Mr Knight’s treating psychiatrist and service medical documents. Dr Walton concurred with Dr Byrne that the probable principal diagnosis is that of a paranoid personality disorder. He stated that it was probable that the condition would have been present in Mr Knight’s late teenage years or early 20s. Dr Walton stated that there is no known treatment for the condition and that it is not caused by catastrophic experiences. He indicated that it could never be a service-related condition.
55. Dr Walton stated that taking into account Dr Peterson’s account, Mr Knight may also satisfy the criteria for a generalised anxiety disorder. However, none of the material supplied to Dr Walton appeared to him to document sufficiently well-defined events which might constitute a severe psychosocial stressor during army service. Dr Walton stated that from the evidence he had available, it appeared that Mr Knight may satisfy the criteria for alcohol abuse. However, Dr Walton was of the opinion that Mr Knight did not appear to be suffering from a service‑related condition.
56. In oral evidence, Dr Walton was asked about the difference between anxiety disorder due to a general medical condition and generalized anxiety disorder. Dr Walton replied that the clinical manifestations may be quite similar, namely anxiety and related phenomena. He stated that the fundamental difference is that one is attributable to a physical cause and the other a psychological reaction or spontaneously arising anxiety not attributable to some definable physical normality. The treatment for each differs. Dr Walton said that to quell anxiety, medication may be appropriate but if there is an identifiable cause, one would seek to address that. Dr Walton commented that a person with psoriatic arthropathy, which is routinely distressing and painful, may well suffer anxiety and/or depression as a reaction to it. He agreed that the symptoms cited for anxiety disorder could also be observed in persons who suffered from sleep apnoea (Dr Peterson’s notes indicate that Mr Knight suffered from that condition). Asked whether paranoia is usually a feature of anxiety disorder, Dr Walton answered it was not. Dr Walton said that Dr Byrne’s diagnosis of a paranoid personality disorder could be clinically valid. However, just because someone is feeling persecuted, does not mean that he has a paranoid personality. He indicated that it was not uncommon that a person could suffer from both a generalised anxiety condition and a paranoid personality disorder at the same time. Dr Walton said that based on the documentary evidence before him, he could not find any identifiable severe psychosocial stressor related to Mr Knight’s service as defined in the pertinent SoP. In answer to a question posed in cross-examination by Mr Turner, Dr Walton said that it was possible that Mr Knight was already suffering from a generalised anxiety disorder when he joined the army. However, given it was more than thirty years ago and was not diagnosed at the time, it was not probable.
CONSIDERATION OF THE ISSUES
57. Section 70(5) of the Act provides:
For the purposes of this Act, … 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;
…
(d)…
(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…
58. For claims made after 1984, it is necessary to apply any relevant SoP issued by the Repatriation Medical Authority. Where there is an SoP in force for a particular medical condition, the Tribunal must determine whether the material before it raises a connection between the applicant’s condition and his or her service. The Tribunal has to decide whether the applicable SoP upholds the contention that the applicant’s injury is, on the balance of probabilities, connected with the applicant’s service (s 120B(3)(b)). The relationship to service must be one of the relationships prescribed in s 196B(14) of the Act.
59. Section 196B(14) of the Act provides:
A factor causing, or contributing to, an injury, disease or death is related to service rendered by a person if:
(a)it resulted from an occurrence that happened while the person was rendering that service: or
(b)it arose out of, or was attributable to, that service; or
…
(d)it was contributed to in a material degree by, or was aggravated by, that service…
60. In coming to a decision, the Tribunal must form an opinion whether the contention raised by the applicant fits within, or is consistent with a factor set out in the SoP.
61. There was no dispute between the parties that Mr Knight had rendered defence service from December 1972 so that s 120(4) and s 120B of the Act apply. This means that the Tribunal must decide the matter to its reasonable satisfaction.
62. There is no disagreement between the parties that Mr Knight suffers from psoriasis, psoriatic arthropathy, hypertension and alcohol abuse. However, there is disagreement over the nature of his psychiatric condition, namely whether it is generalised anxiety disorder, anxiety disorder due to a medical condition, paranoid personality disorder or one of the first two conditions combined with the latter.
The Psychiatric Condition(s)
63. Until January 2000, there were separate SoPs for generalised anxiety disorder and anxiety disorder due to a general medical condition. This is no longer the situation. There is one SoP being Instrument Nº 2 of 2000 concerning anxiety disorder that also covers both conditions.
64. There are a number of relevant definitions set out in clause 8 of the SoP:
“anxiety due to a general medical condition” means a psychiatric disorder where:
A. Prominent anxiety, panic attacks, obsessions or compulsions predominate in the clinical picture; and
B. There is evidence from the history, physical examination, or laboratory findings that the anxiety, panic attacks, obsessions or compulsions are the direct physiological consequence of a general medical condition; and
C. The anxiety, panic attacks, obsessions or compulsions are not better accounted for by another mental disorder; and
D. The anxiety, panic attacks, obsessions or compulsions do not occur
exclusively during the course of a delirium; and
E. The anxiety, panic attacks, obsessions or compulsions cause clinically significant distress or impairment in social, occupational, or other important areas of functioning;
“anxiety disorder not otherwise specified” means a psychiatric disorder with prominent anxiety or phobic avoidance that does not meet criteria for any specific anxiety disorder, adjustment disorder with anxiety, or adjustment disorder with mixed anxiety and depressed mood;
“clinically significant” means sufficient to warrant ongoing management by a psychiatrist, clinical psychologist or General Practitioner;
…
“generalised anxiety disorder” means a psychiatric disorder with the following features:
A. Excessive anxiety and worry (apprehensive expectation), which occur on more days than not for a continuous period of at least six months, about a number of events or activities; and
B. The person finds it difficult to control the worry; and
C. The anxiety and worry are associated with three or more of the following six symptoms, with at least some symptoms present for more days than not during the previous six month period:
(1). restlessness or feeling keyed up or on edge
(2). being easily fatigued
(3). difficulty concentrating or mind going blank
(4). irritability
(5). muscle tension
(6). difficulty falling or staying asleep, or restless unsatisfying sleep; and
D. The focus of the anxiety and worry is not confined to features of any other Axis I disorder; and
E. The anxiety, worry, or physical symptoms (as described in C. above) cause clinically significant distress or impairment in social, occupational, or other important areas of functioning; and
F. The anxiety and worry are not due to the direct physiological effects of a substance or a general medical condition and do not occur exclusively during a mood disorder, a psychotic disorder, or a pervasive developmental disorder;
…
“major illness or injury” means a disease or injury that is life threatening or seriously disabling;
...
“severe psychosocial stressor” means an 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), major illness or injury, experiencing a loss such as divorce or separation, loss of employment, major financial problems or legal problems;
…
65. Clause 5 of the SoP sets out a list of factors that must exist before it can be said that, on the balance of probabilities, the anxiety disorder is related to a person’s service. The following factor have been raised as possibilities in this matter:
(a) for generalised anxiety disorder or anxiety disorder not otherwise specified, only
(i) experiencing a severe psychosocial stressor within one year immediately before the clinical onset of anxiety disorder; or
(ii) having a clinically significant psychiatric condition within one year immediately before the clinical onset of anxiety disorder; or
(iii) having a major illness or injury within one year immediately before the clinical onset of anxiety disorder; or
(iv) experiencing a severe psychosocial stressor within one year immediately before the clinical worsening of anxiety disorder; or
(v) having a major illness or injury within one year immediately before the clinical worsening of anxiety disorder; or
(vi) having a clinically significant psychiatric condition within one year immediately before the clinical worsening of anxiety disorder; or
(b) for anxiety disorder due to a generalised medical condition only, having an endocrine, cardiovascular, respiratory, metabolic or neurological disorder, where the disorder is a direct physiological cause of the anxiety at the time of the clinical onset of the anxiety disorder; or
(c) inability to obtain appropriate clinical management for anxiety disorder.
6. Paragraphs 5(a)(iv) to 5(a)(vi) and 5(c) apply only to material contribution to, or aggravation of, anxiety disorder where the person’s anxiety disorder was suffered or contracted before or during (but not arising out of) the person’s relevant service; paragraph 8(1)(e), 9(1)(e) or 70(5)(d) of the Act refers.
66. Notwithstanding that Mr Knight is unable to be diagnosed as suffering from both generalised anxiety disorder and anxiety disorder due to a general medical condition at the same time, the Tribunal will nonetheless examine all the possible factors in this SoP to ascertain whether either condition can be linked to his defence service.
67. The key factor in determining whether Mr Knight’s anxiety condition is related to service is the date of its clinical onset. There is no definition of the term clinical onset in the relevant SoP or in the Act. The Federal Court has determined that clinical onset is said to occur either when the symptoms of a condition have become sufficiently specific and severe for a medical practitioner to diagnose that particular condition within the definition of the condition in the relevant SoP, or when the condition is actually found on diagnostic testing, regardless of the extent of symptoms (Lees v Repatriation Commission (2002) 125 FCR 331, Repatriation Commission v Cornelius [2002] FCA 750].
68. Mr Turner submitted that the clinical onset of generalised anxiety disorder was in 1975 when Mr Knight started demonstrating disloyalty, disrespect and disregard for the military system. He referred to the evidence about Mr Knight’s suitability for the navy and the army and suggested that this constituted evidence that Mr Knight’s psychiatric condition might already have been evident at that time. Such a finding would be inconsistent with the pertinent case law.
69. Based on the evidence presented, the Tribunal finds that the clinical onset of Mr Knight’s anxiety disorder was around 2000, when his general practitioner referred him to Dr Peterson. Therefore the Tribunal is not satisfied that Mr Knight satisfies any of the requirements of factor 5(a)(i), (ii) and (iii). Having determined that Mr Knight was not diagnosed with a psychiatric condition before or during his army service and bearing in mind the requirements of clause 6 of the SoP, the Tribunal finds that Mr Knight is unable to satisfy any of the factors set out in factors 5(a) of the SoP. He also fails to satisfy factor 5(c) and factors 5(a)(iv) to (vi) because he was not diagnosed with the anxiety condition before or during service. Mr Knight also fails to meet the requirements of factor 5(b) due to the date of clinical onset.
70. Regardless of which type of anxiety condition Mr Knight suffers, he is unable to satisfy any of the factors set out in the SoP. Therefore, the Tribunal is reasonably satisfied that Mr Knight’s anxiety disorder is not defence-caused.
Personality Disorder
71. Dr Byrne suggested that Mr Knight suffered from paranoid personality disorder rather than anxiety. There is an SoP for paranoid personality disorder, namely Instrument Nº 144 of 2005 as amended by Instrument Nº 14 of 1997. The Tribunal notes the comments made by both of the psychiatrists and by Dr Byrne that similar symptoms can be diagnosed as various named conditions. It will therefore examine this SoP without making a finding that Mr Knight necessarily suffers from this condition.
72. For a personality disorder to be connected to a person’s service, there are two alternative factors. The first factor requires a person to suffer a catastrophic experience that immediately preceded an enduring personality change to the level of disorder. The Tribunal is not satisfied that any of Mr Knight’s experiences in the army can be described as a catastrophic experience or being exposed to catastrophic stress. The other factor is an inability to obtain appropriate clinical management for the personality disorder. Mr Knight has only been diagnosed with this condition by Dr Byrne in recent times. Dr Byrne and all the psychiatrists stated that the condition is untreatable. Even if Mr Knight suffers from a personality disorder, the Tribunal is not satisfied that the disorder is related to Mr Knight’s service.
73. The Tribunal finds that if Mr Knight is suffering from a personality disorder, it is not defence-caused.
Psoriatic Arthropathy
74. There is no dispute that Mr Knight suffers from psoriatic arthropathy. The relevant SoP is Instrument Nº 28 of 1998. There are only two possible factors connecting this condition with service. The first is that the person is suffering from psoriasis at the time of clinical onset of the condition (factor 5(a)). The medical evidence from RMH particularly that of Mr Moran, is that psoriasis succeeded the clinical onset of psoriatic arthropathy. There was no evidence before the Tribunal to the contrary. Therefore Mr Knight does not meet factor 5(a) of this SoP. The alternative factor is an inability to obtain appropriate clinical management for the condition. Mr Knight has received extensive treatment over the years from RMH. He does not meet the second factor.
75. The Tribunal finds that psoriatic arthropathy is not a defence-caused condition.
Alcohol Abuse and Alcohol Dependence
76. Mr Knight gave evidence that he is a regular heavy drinker. He gave evidence that he was drinking while undertaking his army service and continued to do so. While his level of alcohol consumption may now satisfy the levels set out in Instrument Nº 77 of 1998, the Tribunal is required to determine the date of clinical onset of the condition in order to decide whether he meets any of the relevant factors set out in clause 5 of the SoP as follows:
(a) suffering from a psychiatric disorder at the time of the clinical onset of alcohol dependence or alcohol abuse; or
(b) experiencing a severe stressor within the one year immediately before the clinical onset of alcohol dependence or alcohol abuse; or
(c) suffering from a psychiatric disorder at the time of the clinical worsening of alcohol dependence or alcohol abuse; or
(d) experiencing a severe stressor within the one year immediately before the clinical worsening of alcohol dependence or alcohol abuse; or
(e) inability to obtain appropriate clinical management for alcohol dependence or alcohol abuse.
77. Experiencing a severe stressor is defined in clause 9 of the SoP as follows:
“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 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;
78. There is no evidence before the Tribunal that Mr Knight was diagnosed with an alcohol related condition until recently. Mr Turner postulated that the clinical onset of Mr Knight’s alcohol abuse arose as a consequence of a psychiatric condition from which he suffered before or during his army service. Mr Turner referred to the incident during Mr Knight’s army service when he was charged with being drunk in a public place. On another occasion, Mr Knight drank a whole bottle of whisky at one sitting and ended up in hospital. Mr Miles also gave evidence of Mr Knight’s drinking. However, as indicated earlier, clinical onset requires a medical diagnosis rather than speculation based on a person’s binge drinking from time to time as demonstrated by examples such as those given above.
79. There is no evidence of a medical diagnosis of alcohol abuse or alcohol dependence in the army medical records or of those obtained from RMH. Mr Knight initially told Dr Peterson that he does not drink. Dr Peterson did not diagnose alcohol abuse. Based on the history he obtained, Dr Byrne diagnosed the condition as did Dr Walton. There was no evidence presented to the Tribunal which indicated an earlier diagnosis of alcohol abuse.
80. In terms of the possible factors set out above, Mr Knight was diagnosed with a psychiatric disorder before he was diagnosed with alcohol abuse. However, the Tribunal has found that Mr Knight’s psychiatric condition is not connected with the circumstances of his service. The Tribunal finds that he does not satisfy factor 5(a) in the SoP. The Tribunal is not satisfied that Mr Knight experienced a severe stressor within one year before clinical onset of alcohol abuse. This finding is based on the date of clinical onset being at least 25 years after his army service. Furthermore, the Tribunal is not satisfied that the army experiences described by Mr Knight meet the definition of experiencing a severe stressor as set out in this particular SoP. The Tribunal finds that Mr Knight does not satisfy any of the other factors in the SoP.
81. The Tribunal finds that Mr Knight’s alcohol abuse and alcohol dependence is not defence-caused.
Psoriasis
82. The Tribunal accepts that Mr Knight suffers from psoriasis. The relevant SoP for psoriasis is Instrument Nº 57 of 2002. There is a list of possible factors that must be service related for the condition to be accepted as defence-caused. All of them require the Tribunal to determine a date of clinical onset of psoriasis.
83. There is no mention in the medical records of Mr Knight suffering from psoriasis during his army service nor did he give evidence that he suffered from the condition during that time. Dr Campbell of RMH stated that Mr Knight first suffered from the condition in 1977. This date is supported by RMH clinical notes prepared in 1983 attached to Dr Campbell’s report. On the evidence before it, the Tribunal finds that clinical onset of psoriasis was in 1977.
84. Factors that could possibly be relevant to Mr Knight are as follows:
5.(a) suffering skin injury to the affected site within the 30 days immediately before the clinical onset of psoriasis; or
(b) undergoing treatment with a drug from the specified list at the time of the clinical onset of psoriasis; or
(c) undergoing treatment with a drug at the time of the clinical onset of psoriasis, where the drug has been assessed as having caused the clinical onset of psoriasis in the peer reviewed medical literature; or
(d) suffering from alcohol dependence or alcohol abuse involving regular consumption of at least an average of 420 g/week of alcohol at the time of the clinical onset of psoriasis; or
(e) suffering from a clinically significant anxiety disorder or a clinically significant depressive disorder at the time of the clinical onset of psoriasis;
…
85. There is no evidence to suggest that Mr Knight meets any of the factors set out above. Mr Turner referred to Mr Knight’s alcohol consumption and submitted that his use of alcohol may have satisfied factor 5(d). However there was no evidence before the Tribunal to support the contention that Mr Knight was diagnosed with alcohol abuse or dependence at the time of the clinical onset of psoriasis. In similar vein, he was not suffering from a clinically significant anxiety disorder in 1977 at the time of clinical onset.
86. The Tribunal finds that psoriasis is not a defence-caused condition.
Hypertension
87. Instrument Nº 36 of 2003 as amended by Nº 4 of 2004 sets out the requirements for hypertension. The factors that must exist before it can be said that hypertension is connected with the circumstances of a person’s service are set out in clause 5 of the SoP. There is a list of some 26 possible factors, some containing sub-factors.
88. Medical records show that Mr Knight now takes medication to control his hypertension. The earliest mention of hypertension was in January 1999 in a record from the Scott Street Medical Centre. In his evidence to the VRB, Mr Knight said that the clinical onset of his hypertension was in 1994. The Tribunal is prepared to accept this date on the basis that in August 1998 the Commission refused an earlier claim for hypertension. Furthermore, there are no clinical notes for that year available. The Tribunal is reasonably satisfied that the clinical onset of hypertension was around 1994.
89. Mr Knight linked his hypertension to his alcohol consumption. Factor 5(b) requires an average of at least 300 grams of alcohol per week at the time of the clinical onset of hypertension. There is no independent evidence before the Tribunal attesting to the amount of alcohol consumed by Mr Knight in a week in 1994, the date of clinical onset of hypertension. Mr Knight said that he currently drinks home‑brewed rum from a friend at the rate of about 15 serves of rum and coke a day. The Tribunal cannot be certain that that was the case in 1994. However, even if Mr Knight did meet the alcohol requirements, there is no evidence to suggest that his level of consumption was related to his army service. Other factors in the SoP include being obese at the time of clinical onset. The Tribunal has scrutinized the medical evidence before it but can find no information about Mr Knight’s weight in 1994 or around that time. In any case, the Tribunal is not satisfied that Mr Knight’s obesity, if it did indeed exist at the time of clinical onset, was due to his army service. The Tribunal is not satisfied that Mr Knight can meet any of the other factors set out in the SoP.
90. The Tribunal finds that Mr Knight’s hypertension is not defence-caused.
DECISION
91. The Tribunal affirms the decision under review.
I certify that the ninety-one [91] preceding paragraphs are a true copy of the reasons for the decision of:
Regina Perton, Member
(sgd) Olympia Sarrinikolaou
Clerk
Dates of hearing: 3 August 2006, 4 August 2006, 13 September 2006, 14 September 2006
Date of final submission: 6 November 2006
Date of decision: 6 July 2007
Advocate for applicant: Mr B Turner, RSL Advocate
Counsel for respondent: Ms J Macdonnell
Solicitor for respondent: Australian Government Solicitor
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