LESLIE MCANALLY and REPATRIATION COMMISSION
[2009] AATA 354
•15 May 2009
Administrative Appeals Tribunal
DECISION AND REASONS FOR DECISION [2009] AATA 354
ADMINISTRATIVE APPEALS TRIBUNAL )
) No 2008/1666
VETERANS' APPEALS DIVISION ) Re LESLIE MCANALLY Applicant
And
REPATRIATION COMMISSION
Respondent
DECISION
Tribunal Ms N Isenberg, Senior Member
Dr S H Toh, MemberDate15 May 2009
PlaceSydney
Decision The Administrative Appeals Tribunal decides to:
1. Affirm the decision under review in relation to alcohol dependence;
2. Vary the decision under review in relation to post traumatic stress disorder by substituting a diagnosis of depressive disorder, and affirm the decision under review as varied.
.....................[Sgd].........................
Ms N Isenberg
Senior Member
CATCHWORDS
VETERANS' ENTITLEMENTS – review of decision that post traumatic stress disorder and alcohol dependence are not related to service – applicant claims that he suffers post traumatic stress disorder and alcohol dependence and that these conditions are war-caused – evidence does not support applicant's claims – does the applicant suffer any other psychiatric condition and if so is it war caused.
RELEVANT ACT/S:
Veterans’ Entitlements Act 1986 (Cth) ss 9, 13(1), 120, 120(1), 120(3), s120(6) 196A, 196B(2) and 196B(14).
CITATIONS
Gorton v Repatriation Commission [2001] FCA 1194
Repatriation Commission v Keeley (2000) 98 FCR 108
Fogarty v Repatriation Commission (2003) 37 AAR 363
Repatriation Commission v Cooke (1998) 90 FCR 307
Gerzina v Repatriation Commission [2004] FCAFC 96
Repatriation Commission v Budworth (2001) 116 FCR 200
Repatriation Commission v Deledio (1998) 83 FCR 82
Lees v Repatriation Commission (2002) 125 FCR 331
Bull v Repatriation Commission (2001) 66 ALD 271
Hardman v Repatriation Commission (2004) 82 ALD 433
Elliott v Repatriation Commission (2002) 73 ALD 377
Repatriation Commission v Bey (1997) 79 FCR 364
Youngnickel v Repatriation Commission [2004] FCA 1691
Repatriation Commission v Hill [2002] FCAFC 192
Repatriation Commission v Lees (2002) 36 AAR 484
Bushell v Repatriation Commission (1992) 175 CLR 408
Stoddart v Repatriation Commission (2003) FCA 334
Repatriation Commission v Cornelius [2002] FCA 750AUTHORITIES
Statement of Principles concerning posttraumatic stress disorder No. 5 of 2008.
Statement of Principles concerning posttraumatic stress disorder No. 3 of 1999
Statement of Principles concerning depressive disorder No. 28 of 2008.
Statement of Principles concerning depressive disorder No. 58 of 1998
Statement of Principles concerning alcohol dependence and alcohol abuse No. 1 of 2009.
Statement of Principles concerning alcohol dependence and alcohol abuse No. 76 of 1998
REASONS FOR DECISION
15 May 2009 Ms N Isenberg, Senior Member
Dr S H Toh, MemberBackground
1. Mr McAnally served in the Royal Australian Navy between 8 July 1967 and 8 April 1988. His “operational service” as defined in the Act was from 16 March 1970 to 9 October 1970.
2. Mr McAnally also rendered eligible defence service between 7 December 1972 and 8 April 1988, but this was not relevant to his claim.
3. Mr McAnally claimed for ‘stress problems’ and contends that he suffers PTSD and alcohol dependence because of aspects of his service in Vietnamese waters aboard HMAS Hobart.
4. Mr McAnally seeks review of the decision of the Repatriation Commission dated 8 August 2006 as affirmed by the Veterans’ Review Board (“the VRB”) on 21 February 2008 that refused his claim that his conditions are related to operational service.
Issues
5. The issues before the Tribunal are:
(a)Does Mr McAnally suffer from PTSD and alcohol dependence, or some other psychiatric condition?
(b)If so, were those conditions war-caused?
Legislative Background
6. Section 9 of the Veterans’ Entitlements Act 1986 (“the VE Act”) provides that a injury or disease is taken to be war-caused if it resulted from an occurrence that happened while the veteran was rendering operational service or arose out of, or was attributable to, that service.
7. Section 13(1) of the VE Act provides, in effect, that where a veteran has become incapacitated from a war-caused injury or a war-caused disease, the Commonwealth is liable to pay a pension by way of compensation to the veteran.
8. As the veteran had operational service, the determination of whether his claimed conditions are war-caused is to be made by applying ss 120(1) and 120(3) of the VE Act. Those subsections require us to find that the veteran’s conditions were war‑caused unless we are satisfied beyond reasonable doubt that there is no sufficient ground for making that finding.
9. The Repatriation Medical Authority (“RMA”) was established under section 196A. If the RMA is of the view that there is sound medical-scientific evidence that indicates that if a condition can be related to veterans’ service, the RMA must determine a Statement of Principles (“SoP”) (section 196B). The SoP sets out the factors, one of which as a minimum must exist (and which must be related to the veteran’s service) before it can be said that a reasonable hypothesis has been raised connecting the condition with that service. The reference in section 196B(2) to a particular kind of injury, disease or death being “related to service” is expounded in section 196B(14). This provides relevantly, in effect, that a factor causing an injury is “related to service” rendered by a person if it resulted from an occurrence that happened while the person was rendering that service, or if it arose out of, or was attributable to, that service.
10. The relevant SOPs in this matter are:
(a)PTSD: No.5 of 2008 and No. 3 of 1999;
(b)Alcohol dependence: Number 1 of 2009 and Number 76 of 1998; and
(c)Depressive disorder: Number 28 of 2008 and Number 58 of 1998.
11. We are obliged to consider Mr McAnally’s claim in the context of the latter Statement of Principles for each condition unless the Statement of Principles at the date of the original decision is more favourable: Gorton v Repatriation Commission [2001] FCA 1194; Repatriation Commission v Keeley (2000) 98 FCR 108. The Respondent conceded, and we agree, that the Statements of Principles in effect at the date of the original decision are more favourable to Mr McAnally. We note though, the outcome would be the same irrespective of which Statements of Principles were used.
Evidence
12. We had documents lodged with the Tribunal pursuant to section 37 of the Administrative Appeals Act 1975. The following documents were tendered at the hearing:
Exhibit A2 – Writeway historical report dated 16 September 2008;
Exhibit A3 – Report of Dr. Lewin dated 24 November 2008; and
Exhibit A4 – Report by Dr. A E Pusic dated 13 June 2006.
13. Mr McAnally gave evidence. We read evidence from Mr McAnally’s treating psychiatrist, Dr Pusic, and Dr Lewin, consultant psychiatrist, who also gave oral evidence.
14. Mr McAnally had previously provided several statements in support of his claim:
§Statement of Mr McAnally dated 28 August 2006
§Statement of Mr McAnally dated 23 June 2008
§Statement of Mr McAnally undated
§Letter from Mr McAnally to Ms Gardner dated 27 November 2006
15. The essence of his evidence at the hearing was that he had joined the Royal Australian Navy in 1967 at age 15½. Initially he served in HMAS Leeuwin and then in HMAS Melbourne. His first sea posting was aboard HMAS Vendetta for about 6 months from November 1968. In October 1969 he was posted to HMAS Hobart where he mainly worked in the boiler room. At the direction of his Petty Officer supervisor, one of his tasks was to clean the bilges, which involved working with some regularity in cramped and hot conditions.
16. On his posting to HMAS Hobart he learned that she had previously been hit by “friendly fire”. There were also rumours in the mess that the ship had previously “rammed” sampans. He also understood that the captain was under instruction to ram sampans that might come close to the ship because they might be North Vietnamese and that ammunition was not to be wasted on the sampans.
17. He related an occasion, which, since reading the report of proceedings and the Writeway historical report, he now thinks to be in about April 1970, he was on duty in the boiler room. He was instructed to take garbage onto the upper deck to throw overboard. On the way to the upper deck he felt the ship ‘shudder’ and go into reverse. While on the upper deck he thought he saw 4 bodies in the water and saw the bodies go under the propellers. At the time it was either dark or foggy. He said he went inside and told his “offsider” what he had seen but continued with the remainder of his watch, which was at least another three hours. Although he learned later that day that there had been five casualties all of whom had been brought on board safely, and that what he had seen might have been ’rubble’ off the sampan, he still believed he saw bodies. He believed the sampan had been deliberately rammed.
18. As to alcohol consumption, he said that he commenced drinking regularly after 1970 and that he had two driving under the influence convictions in the early 1970s and was reduced in rank in about 1980 for being drunk on duty.
19. He completed an alcohol questionnaire on 25 August 2006 and stated there that he started to drink alcohol after his tour of Vietnam in 1970. He said he drank 12 cans of beer when on board ship and ‘six OP rum’ on shore and would smuggle a flagon of wine onto the ship whenever he could. He said in his evidence that he drank to convince himself he was ‘normal’ because of the unpopularity of the Vietnam war. He increased his consumption to 18 cans of beer and 18 nips of OP rum in 1978 because of his depressed state and stress, which he said in his evidence, was pre-deployment to the Persian Gulf. He thought this was before Gulf War I, although Gulf War I commenced in 1990.
20. There was ‘service intervention’ in 1979 which produced some reduction in consumption.
Consideration
21. Only after we determine that a veteran is suffering from a particular condition does the question arise as to whether the particular condition is war-caused: Fogarty v Repatriation Commission (2003) 37 AAR 363.
22. The issue whether a disease exists, which is a question of fact, is to be decided to the reasonable satisfaction of the Tribunal: Repatriation Commission v Cooke (1998) 90 FCR 307; Gerzina v Repatriation Commission [2004] FCAFC 96; Repatriation Commission v Budworth (2001) 116 FCR 200..
Does Mr McAnally suffer from PTSD?
23. Dr Pusic, in his report of 13 June 2006 provided a diagnosis of PTSD. Dr Lewin did not find Mr McAnally to suffer PTSD. One of the reasons was that Mr McAnally did not, in his view meet the diagnostic criteria for PTSD which are outlined in the SOP for PTSD and which are derived from DSM-IV. In particular, Mr McAnally did not meet criterion A(ii), in that his response to the alleged stressor was not one of “intense fear, helplessness, or horror”.
24. Unfortunately, we did not have the benefit of hearing oral evidence from Dr Pusic which might have elaborated upon and clarified the contents of his report. Dr Pusic’s report does not specifically address the diagnostic criteria for the making of a diagnosis of PTSD. He reported that Mr McAnally ‘recalls experiencing significant distress whilst serving on the Hobart’, but linked this more to Mr McAnally’s dealings with his supervisor than the event involving the sampan. In our view, the interaction with his supervisor does not amount to an event in accordance with criterion A(i). Similarly, the directions to work in difficult conditions in the bilges was only mentioned in passing and this also does not amount to an event in accordance with criterion A(i). We therefore preferred the evidence of Dr Lewin.
25. Most significantly, Mr McAnally’s evidence before us also did not relate a response of the required intensity, although he is steadfast in his belief that he saw bodies. He went about his duties for several hours and he did not give evidence at all that he was distressed by what he saw to the extent necessary to meet the diagnostic criteria.
26. The scheme of the VE Act contemplates that SoPs are to be used only for the purpose of determining whether an injury or a disease is war-caused or defence-caused, and, accordingly, SoPs are not relevant to the determination of the appropriate diagnosis of an injury or a disease: Benjamin v Repatriation Commission (2001) 34 AAR 270 at 280. As previously mentioned, however, the definition of PTSD in the relevant SoPs substantially reproduces the DSM-IV diagnostic criteria in respect of PTSD.
27. Having regard to the whole of the evidence before us, we are reasonably satisfied that Mr McAnally is not suffering from PTSD for the purposes of the VE Act, because his response to any event was not of the required intensity, that is, it was not one of “intense fear, helplessness, or horror”.
Does Mr McAnally suffer from alcohol dependence?
28. Both psychiatrists agree that Mr McAnally suffers alcohol dependence, and we accept that diagnosis.
Is Mr McAnally’s alcohol dependence war-caused?
29. Where a SoP exists we must apply the test prescribed by s120A(3) of the VE Act, as explained in Repatriation Commission v Deledio (1998) 83 FCR 82 at 97 in the following way:
…
1.The Tribunal must consider all the material which is before it and determine whether that material points to a hypothesis connecting the injury, disease or death with the circumstances of the particular service rendered by the person. No question of fact finding arises at this stage. If no such hypothesis arises, the application must fail.
2.If the material does raise such a hypothesis, the Tribunal must then ascertain whether there is in force an SoP determined by the Authority under s 196B(2) or (11). ….
3.If an SoP is in force, the Tribunal must then form the opinion whether the hypothesis raised is a reasonable one. It will do so if the hypothesis fits, that is to say, is consistent with the "template" to be found in the SoP. The hypothesis raised before it must thus contain one or more of the factors which the Authority has determined to be the minimum which must exist, and be related to the person’s service (as required by ss 196B(2)(d) and (e)). If the hypothesis does contain these factors, it could neither be said to be contrary to proved or known scientific facts, nor otherwise fanciful. If the hypothesis fails to fit within the template, it will be deemed not to be “reasonable” and the claim will fail.
4.The Tribunal must then proceed to consider under s 120(1) whether it is satisfied beyond reasonable doubt that the death was not war-caused, or in the case of a claim for incapacity, that the incapacity did not arise from a war-caused injury. If not so satisfied, the claim must succeed. If the Tribunal is so satisfied, the claim must fail. It is only at this stage of the process that the Tribunal will be required to find facts from the material before it. In so doing, no question of onus of proof or the application of any presumption will be involved.
…
Steps 1 and 2: Is there a hypothesis and is there a SoP?
30. The hypothesis is that Mr McAnally’s alcohol dependence was because of severe stressors which he experienced aboard HMAS Hobart and that the condition is therefore war-caused.
31. It was not in dispute that the relevant SOP is No 76 of 1998.
Step 3: Does the hypothesis conform to the template in the SoP?
32. Under clause 5 of the SoP, at least one of the factors set out in clause 5 must be related to the veteran’s operational service. Mr McAnally’s hypothesis relied on factors 5(a) and (b) as follows:
1.The factors that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting alcohol dependence or alcohol abuse or death from alcohol dependence or alcohol abuse with the circumstances of a person’s relevant services are:
(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 two years immediately before the clinical onset of alcohol dependence or alcohol abuse.
…
33. Severe stressor is defined under clause 8 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 another person’s, physical integrity.
…
34. As to factor 5(a) we have found that Mr McAnally does not suffer war-caused PTSD, or war-caused depressive disorder (as discussed below), and therefore need not be considered further.
35. This step entails determining whether the relevant hypothesis complies with one or more of the factors referred to in the relevant SoP. This step involves considering all of the material before us, but without making any findings of fact at this stage of the process. The history given by a veteran to a medical practitioner can constitute material before the Tribunal for this purpose: Lees v Repatriation Commission (2002) 125 FCR 331.
36. At this stage we must consider all of the material before us, whether or not that material supports the hypothesis: Bull v Repatriation Commission (2001) 66 ALD 271, Hardman v Repatriation Commission (2004) 82 ALD 433, and Elliott v Repatriation Commission (2002) 73 ALD 377. In the last of these cases Stone J, likened the decision-maker’s task to striking out a statement of claim as failing to disclose a course of action, where no consideration is given to whether the facts pleaded can be substantiated.
37. A “reasonable hypothesis” involves more than a mere possibility: Repatriation Commission v Bey (1997) 79 FCR 364.
38. The question for us at this stage is therefore: is there material pointing to each element of the factor? Each element of the hypothesis must be raised by the material: Youngnickel v Repatriation Commission [2004] FCA 1691. Whether a hypothesis is consistent with a factor in the SoPs requires an examination of the totality of the material, and every essential element of the factor must be pointed to by that material.
39. A hypothesis connecting a disease with war service will only be reasonable if the material that raises it includes all of the essential elements prescribed by the SoP: Repatriation Commission v Hill [2002] FCAFC 192.
40. From his alcohol questionnaire, Mr McAnally started to drink alcohol after 1970 and did so in significant quantities. We observe that his medical records contain an entry in August 1979 where he was diagnosed with alcohol intoxication while aboard HMAS Brisbane.
41. Dr Pusic recorded that Mr McAnally had told him that he abused alcohol since his return from Vietnamese waters, that he would drink on a daily basis to the point of intoxication, and that he would suffer early withdrawal symptoms if he were not to drink on a daily basis. He also told Dr Pusic that in the early 1970s he had twice been caught for drink driving.
42. Mr McAnally told Dr Lewin that he had been drinking daily since 1970 or 1971, but prior to that there was a history of episodic binge drinking when on shore leave. From the history given by Mr McAnally ‘features of alcohol dependence’ were evident at that stage. Dr Lewin noted that clinical onset of alcohol dependence could have been in the five or more years before Mr McAnally’s first abnormal liver function tests, which, Mr McAnally reported having had for at least a decade. Mr McAnally told Dr Lewin that his doctor had commented on abnormal liver function tests in the 1970s and had prescribed thiamine for prophylactic purposes. In Dr Lewin’s view, the only reason for the prescription of thiamine would be to prevent brain damage associated with alcoholism, by which time his alcohol problem would have ‘been in evidence’ for over 5 years. Mr McAnally told Dr Lewin that he had turned up late for work over a prolonged period for about a decade before he ceased work in 2005. Dr Lewin was satisfied that Mr McAnally was addicted to alcohol ‘for many years’, although, if thiamine was first prescribed in 2005 or 2006, as appears from the available medical evidence, then clinical onset may have been later than the 1970s.
43. We accept though that there is material pointing to the clinical onset of alcohol abuse within 2 years of his operational service in Vietnamese waters in that he had manifested all of the requisite symptomatology in the diagnostic criteria by that time: Repatriation Commission v Lees (2002) 36 AAR 484. Further, we accept that subsequently his alcohol abuse developed into alcohol dependence.
Did Mr McAnally suffer a severe stressor as defined?
44. The stressors articulated by Mr McAnally in his Statement of Facts and Contentions are as follows:
(a)The applicant believes that there was a possibility that he would suffer death or personal serious injury as a result of being aware of past casualties on, and damage to, HMAS Hobart;
(b)The Applicant believed that his superior intentionally, on numerous occasions, placed him in situations where he was at greater risk of death or injury than his shipmates; and
(c)The applicant believes that he saw human bodies as causalities in the water alongside HMAS Hobart.
45. As discussed above there was little evidence about his work and how it might endanger him, and in our view there is insufficient material pointing to this being a severe stressor as defined.
46. As to the “human bodies as casualties”, we accept there was material pointing to persons in the water as a result of the collision between HMAS Hobart and a sampan on 22 April 1970 and that what Mr McAnally had seen was those “bodies”.
47. Therefore, we have come to the view that every essential element of the hypothesis is pointed to by the material before us. A reasonable hypothesis has been raised.
Step 4: Can we be satisfied beyond reasonable doubt that Mr McAnally’s alcohol abuse/alcohol dependence was not war caused?
48. This step involves making findings of fact from the material before the Tribunal. Section 120(1) of the VE Act provides that the claim will succeed, unless we are satisfied beyond reasonable doubt that there are no sufficient grounds for determining that the veteran’s condition was war-caused. If we are not so satisfied, Mr McAnally’s claim must succeed: section 120(1) of the VE Act. In examining this question, we note that there is no onus of proof: section 120(6) of the VE Act, and Bushell v Repatriation Commission (1992) 175 CLR 408.
49. We considered the evidence in the light of Stoddart v Repatriation Commission (2003) FCA 334, the effect of which is that there is both an objective and subjective element to the assessment of a hypothesis. In respect of the subjective element, we accept that Mr McAnally believed he saw bodies which went under the propellers. However we cannot accept that a reasonable person in the position and with the knowledge of the Applicant would objectively perceive the event relied upon as a threat of death or serious injury or to physical integrity. The ‘bodies’ were not ‘dead’ bodies, as Mr McAnally conceded. The evidence of the ship’s proceedings was that the ‘bodies’ were all recovered, checked by the medical officer and ‘apart from obvious fright and a soaking’ were unharmed and were able to be sent on their way within an hour. Notwithstanding that information being available to the ship’s company, as was conceded by Mr McAnally, he persisted in his view. By the time of the incident he had been in the Navy for nearly 3 years, and had previous sea postings. He had already been in HMAS Hobart for several months and in Vietnamese waters for weeks.
50. We do not accept that Mr McAnally ‘experienced a severe stressor’ as defined because, having regard to his knowledge and in his experience, could reasonably be so perceived.
51. In all of the circumstances, we are satisfied beyond reasonable doubt that there is no sufficient ground for determining that Mr McAnally’s alcohol dependence related to his operational service. We therefore find his alcohol dependence not to be war-caused.
Does Mr McAnally suffer from a psychiatric disease other than PTSD or alcohol dependence?
52. Dr Lewin diagnosed Mr McAnally as suffering major depressive disorder and we accept that diagnosis.
Steps 1 and 2: Is there a hypothesis and is there a SoP?
53. The hypothesis, although not articulated, is that Mr McAnally’s depressive disorder was because of severe psychological stressors which he experienced aboard HMAS Hobart and that the condition is therefore war-caused.
54. It was not in dispute that the relevant SOP is No 58 of 1998.
Step 3: Does the hypothesis conform to the template in the SoP?
55. Under clause 5 of the SoP, at least one of the factors set out in clause 5 must be related to the veteran’s operational service. The veteran’s hypothesis relied on factors 5(b) and (c) as follows:
…
Factors:
5.The factors that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting depressive disorder or death from depressive disorder with the circumstances of a person’s relevant service are: …
(a)…
(b)experiencing a severe psychological stressor or stressors within the two years immediately before the clinical onset of depressive disorder; or
(c)having a clinically significant psychiatric condition within the two years immediately before the clinical onset of depressive disorder; or
…
56. Severe psychosocial stressor is defined as follows:
… 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), severe illness or injury, experiencing a loss such as divorce or separation, loss of employment, major financial problems or legal problems
…
57. In attributing his condition to the incident aboard HMAS Hobart the clinical onset of depressive disorder must, on the balance of probabilities, be within two of the incidents, that is by 1972. The earliest available medical evidence is Mr McAnally had told Dr Lewin that his symptoms dated from the late 1970s or early 1980s.
58. There is no definition of the term “clinical onset” in the SoPs or in the Veterans’ Entitlements Act 1986 (“the Act”). The meaning of “clinical onset” was considered by the Full Court of the Federal Court in Lees v Repatriation Commission (2002) 125 FCR 331. The Court referred to the analysis of the Tribunal in Re Robertson and Repatriation Commission (1998) 50 ALD 668 where the Tribunal concluded at 670 that:
… there is a clinical onset of a disease, either when a person becomes aware of some feature or symptom which enables a doctor to say the disease was present at that time, or when a finding is made on investigation which is indicative to a doctor of the disease being present at that time.
…
59. That analysis was specifically endorsed by Branson J in RepatriationCommission v Cornelius (“Cornelius”) [2002] FCA 750.
60. The accepted definition of clinical onset referred to in Robertson and Cornelius relies on the classification by a doctor of symptoms upon presentation by the patient. There was no medical evidence suggesting that the condition was diagnosed at any time close to Mr McAnally’s military service.
61. We therefore find that the clinical onset of depressive disorder was not until a date outside the two years required by factor 5(b).
62. Therefore, we have come to the view that every essential element of the hypothesis is not pointed to by the material before the Tribunal. A reasonable hypothesis therefore has not been raised.
63. As to factor 5(c) we have found that Mr McAnally does not suffer war-caused PTSD or war-caused alcohol dependence.
64. It follows, by virtue of section 120(3) of the VE Act, we must find beyond reasonable doubt that there is no sufficient ground for determining Mr McAnally’s depressive disorder was war-caused. Having come to this view, it was unnecessary then to proceed with the final Deledio step.
Conclusion
65. In all of the circumstances, we are satisfied, beyond reasonable doubt, that there is no sufficient ground for determining that Mr McAnally’s claimed ‘stress problems’ are related to his operational service.
Decision
66. The Administrative Appeals Tribunal decides to:
(a)Affirm the decision under review in relation to alcohol dependence; and
(b)Vary the decision under review in relation to post traumatic stress disorder by substituting a diagnosis of depressive disorder, and affirm the decision under review as varied.
I certify that the sixty-six [66] preceding paragraphs are a true copy of the reasons for the decision herein of Ms N Isenberg, Senior Member
Signed...............................[Sgd]................................................
Shanthi Silva, AssociateDates of Hearing 20 April 2009
Date of Decision 15 May 2009
Representative for the Applicant Kenneth H Foster
Representative for the Respondent Jane Warmoll
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