Letts and Military Rehabilitation and Compensation Commission (Veterans' entitlements)
[2025] ARTA 1032
•16 July 2025
Letts and Military Rehabilitation and Compensation Commission (Veterans' entitlements) [2025] ARTA 1032 (16 July 2025)
Applicant:John Letts
Respondent: Military Rehabilitation and Compensation Commission
Tribunal Number: 2024/1908, 2024/1909
Tribunal:Senior Member D Thomae
Place:Brisbane
Date:16 July 2025
Decision:The Tribunal affirms the decision under review.
................................[SGD]...........................
Statement made on 14 July 2025 at 4:40pm
CATCHWORDS
VETERANS’ AFFAIRS – claim for ischemic heart disease and essential tremor – veteran conscripted for national service within Australia – are medical conditions connected to service in the Australian Army – medical evidence of clinical onset and causation – decision under review affirmed.
Legislation
Administrative Review Tribunal Act 2024 (Cth)
Safety, Rehabilitation and Compensation (Defence-related Claims) Act 1988 (Cth)
Cases
Beezley v Repatriation Commission [2015] FCAFC 165
Comcare v Mooi [1996] FCA 1587
Comcare v Power [2015] FCA 1502
Comcare v Sahu-Khan [2007] FCA 15
Dekker and Australian Postal Corporation [2018] AATA 682
De Tarle v Comcare [2022] FCA 175
Kattenberg v Repatriation Commission [2002] FCA 412
Military Rehabilitation and Compensation Commission v May (2016) 257 CLR 468
Rodriguez v Telstra Corporation [2002] FCA 30Smith and Comcare [2013] FCAFC 65
Vivian and Military Rehabilitation and Compensation Commission [2005] AATA 875
Secondary Materials
Statement of Principles concerning Ischaemic Heart Disease (Balance of Probabilities) No. 28 of 2025
Statement of Reasons
INTRODUCTION
On 22 March 2024, the applicant, Mr Letts, made an application for review[1] to the General Division of the Administrative Appeals Tribunal (the AAT)[2] of the decision by the Military Rehabilitation and Compensation Commission (the Commission) to affirm the determination denying liability under s 14 of the Safety, Rehabilitation and Compensation (Defence-related Claims) Act 1988 (DRCA) for ‘essential tremor and ischaemic heart disease’.
[1] Exhibit R1.
[2] On 14 October 2024, the Administrative Appeals Tribunal became the Administrative Review Tribunal (the Tribunal). Under the transitional provisions in the Administrative Review Tribunal (Consequential and Transitional Provisions No. 1) Act 2024 (the Transitional Act), proceedings in the AAT that were not finalised before 14 October 2024 are to be continued and finalised by the Tribunal. Anything done in relation to the proceeding before 14 October 2024 is taken to have been done by the Tribunal.
Mr Letts gave evidence at the hearing. Mr Letts was self-represented. Ms Audsley,of the Australian Government Solicitor, represented the Commission.
The Tribunal admitted into evidence the exhibits which are listed in the annexure to these reasons.
BACKGROUND
Mr Letts was born in 1947 and is now aged 78 years old.
Mr Letts served in the Australian Army (Army) as a national serviceman for 2 years between July 1967 and July 1969 as a private, air despatcher, in the Royal Australian Army Corps of Transport.
On 10 July 2021, Mr Letts made separate claims for ‘essential tremor’ and ‘coronary artery disease’ (the Claim).[3]
[3] Exhibit R3 & R4.
By a determination dated 29 August 2022, the Commission denied liability for the Claim (the Primary Determination). [4]
[4] Exhibit R5.
On 19 September 2022, Mr Letts submitted a request for reconsideration.[5]
[5] Exhibit R6.
On 12 February 2024, the Commission affirmed the decision which is now under review before the Tribunal (the Reviewable Decision). [6]
[6]Exhibit R7.
ISSUES
The Commission made no submissions to the Tribunal relying on a s 53(1)(a) of the DRCA defence for the 52 years between the end of Mr Letts’s service (1969) and the Claim (2021).
The Commission framed the issues before the Tribunal as:[7]
(a)Whether Mr Letts suffered an ailment pursuant to ss 5A or 5B of DRCA.
(b)Whether the ailment or aggravation arose out of the course of his service and/or was contributed to, to a material or significant degree, by his service.
(c)If the answer is yes, what is the date of injury for the purpose of s 7(4).
[7] Respondents Statement of Issues, Facts and Contentions (Respondents SOFIC) dated 20 January 2025 at [4].
The issue for the Tribunal to primarily determine is whether Mr Letts’s service in the Army made, depending on the date of clinical onset, made a ‘material’ or ‘significant’ contribution to Mr Letts’ diagnosis of ‘essential tremor’ and ‘ischemic heart disease’ (his Claimed Medical Conditions) pursuant to the DRCA.
EVIDENCE
Mr Letts
At the hearing, Mr Letts read from a document that was his oral evidence and his submissions.[8] Mr Letts described his conscription into the Army as a national serviceman and his experiences of his service within Australia at the time of the Vietnam War.
[8] Exhibit A7.
The Tribunal accepts that Mr Letts has strongly held beliefs about the negative impact on his health caused by his conscription into and his service in the Army in the late 1960s.
His evidence referred to the application of the statement of principles made by the Repatriation Medical Authority (RMA) to his experiences in the Army. Mr Letts also referred to medical definitions from a number of sources, including the Victor Chang Cardiac Research Institute and American Psychological Association to support his contentions that his Claimed Medical Conditions were caused by his service in the Army.
Medical Evidence
Doctor Herman
Dr Herman, a consultant cardiologist, provided a written report, dated 16 October 2024, that relevantly provides:[9]
[9] Exhibit R28.
(a)Dr Herman’s diagnosis is that ‘Mr Letts has coronary heart disease requiring a drug-eluting stent deployed to the left anterior descending artery in April 2019’.
(b)Mr Letts diagnosis of coronary heart disease was from March 2019.
(c)Mr Letts has no incapacity for work arising from the diagnosis.
(d)Mr Letts was not hypertensive during his Army service because:
It appears that he had a blood pressure of 140/85mmHg noted on 15 May 1967, but the measurement was taken on one occasion only, not confirmed with serial testing and with no diagnosis of hypertension was made. No therapy was initiated.
On 27 May 1969, his blood pressure was 130/80 within normal range.
Anxiety/depression/PTSD is a risk factor for the development of coronary artery disease. If this condition was indeed related to his service, his army service contributed to his coronary atherosclerosis and ultimate need for coronary stenting.
(e)Mr Letts condition was contributed to by non-service-related factors:
Non-service-related factors contributing to his heart condition include hypertension, hyperlipaemia and his age. Significant contribution.
I do not believe that heavy lifting, alcohol, strenuous exercise, and fatigue during his service provoked coronary artery disease.
However, stress, poor diet, social isolation and especially anxiety/depression have played a role. Material contribution.
(f)Mr Letts would have likely ‘developed his coronary artery disease irrespective of his army service’ and his ‘non-service-related condition have indeed overtaken the effects of his service-related condition’.
Dr Krishnan
Dr Krishnan, a consultant neurologist, provided a written report, dated 21 October 2024, that relevantly states:[10]
(a)Dr Krishan’s diagnosis of Mr Letts is ‘essential tremor’ and ‘there has been no significant impairment in that he has been able to work for 27 years as a police officer’.
(b)There is no contribution to the diagnosis of ‘essential tremor’ from Mr Letts service in the Army.
(c)The condition is a genetic condition and Mr Letts would have developed the condition as a natural progression of a pre-existing condition irrespective of his Army service.
[10] Exhibit A6.
Dr Garrity
Dr Garrity, a consultant psychiatrist, provided a letter, dated 26 November 2019, that relevantly states:[11]
In summary, I think that he has a history of Chronic Depression, dating back to his 20s, with some, but not all, of the features of Post Traumatic Stress Disorder accompanying this, complicated by excessive daily alcohol use and some personality issues (related to his self esteem and his sense of obligation to other).
[11] Exhibit R10.
Dr Puhl
Dr Puhl, a neurologist, provided a letter, dated 7 December 2020, that provides a diagnosis of ‘right-hand tremor’ and the clinical examination was ‘suggestive of a mild essential tremor’.[12]
[12] Exhibit R33 at p619.
Dr Puhl does not make a causal connection of Mr Letts’ diagnosis of ‘essential tremor’ with his Army service.
CONTENTIONS
Mr Letts’s Contentions
Mr Letts contends that his conscription into the Army caused his Claimed Medical Conditions because he was exposed to passive smoking, alcohol consumption, high cholesterol diet, social isolation, stress and depression during his service.
Mr Letts refers to the RMA statement of principles concerning ischaemic heart disease[13] (the SoP) and the decision of Kattenberg v Repatriation Commission [2002] FCA 412 for the contention that his Army service made a material contribution to his condition of ‘ischemic heart disease’.
[13] Statement of Principles concerning Ischaemic Heart Disease (Balance of Probabilities) No. 28 of 2025.
Mr Letts cites the factors in the SoP of hypertension, exposure to second hand smoke and mental illness as the connection between his service and his ‘ischemic heart disease’.
In respect to Mr Letts diagnosis of ‘essential tremor’ he contends that there is no incidence of that condition in his family history. Mr Letts says stress, hypertension, panic, alcohol use and anxiety because of conscription, caused his condition of ‘essential tremor’.
Commission’s Contentions
The Commission contends:[14]
[14] Respondent’s SOFIC at [50]- [59].
(a)That there is no medical evidence to support that Mr Letts Claimed Medical Conditions were contributed to by his service to the requisite degree required or at all.
(b)That the likely date of clinical onset of Mr Letts Claimed Medical Conditions is:
(i)On or around December 2020 for ‘essential tremor’ based on when Mr Letts first sought treatment from a Dr Puhl.
(ii)In March 2019 for ‘ischemic heart disease’ based on the opinion of Dr Herman and Dr Saunders, Mr Letts general practitioner.
(c)That Mr Letts essential tremor is unrelated to his Army service and is in fact, a genetic condition, supported by the opinion of Professor Krishnan.
(d)The Tribunal must first need to be satisfied that liability exists under s14 of the DRCA before turning to the deeming provision under s7(4) to determine the date of injury, citing Smith and Comcare [2013] FCAFC 65.
CONSIDERATION
Diagnosis
The High Court in Military Rehabilitation and Compensation Commission v May (2016) 257 CLR 468 at [49] explained that the first task the Tribunal must undertake under the SRC Act (the DRCA is relevantly in the same terms) is to consider the facts to determine if the employee is suffering a ‘disease’ or an ‘injury’.
There is no controversy in the medical evidence before the Tribunal. The Tribunal is reasonably satisfied that the correct diagnosis of the Claimed Medical Conditions is ‘essential tremor’ and ‘ischemic heart disease’.
Was Mr Letts’s ‘essential tremor’ and ‘ischemic heart disease’ contributed to, to a ‘material’ or ‘significant’ degree, by his employment so as to constitute a ‘disease’?
The definition of ‘injury’ under ss 5A(1) of the DRCA includes ‘a disease suffered by an employee’. Subsection 5B(1) of the DRCA defines ‘disease’ to mean either ‘an ailment suffered by an employee’ or ‘an aggravation of such an ailment’, that was ‘contributed to, to a significant degree, by the employee’s employment by the Commonwealth’.
The Tribunal is reasonably satisfied based on the uncontroversial medical evidence that Mr Letts medical conditions of ‘ischemic heart disease’ and ‘essential tremor’ are each a disease and s 5B of the DRCA applies in determining whether the Commission is liable under s 14 of the DRCA.
The application of the term ‘contributed to a significant degree by the employee’s employment by the Commonwealth or a licensee’ in s 5B of the SRC Act, in the same terms as s 5B of the DRCA, was considered in Comcare v Power [2015] FCA 1502 by Katzmann J at [93]-[94]:[15]
There is no room for doubt that the purpose of the 2007 amendments was to strengthen the connection necessary between the employment and the contraction or aggravation of a disease. Including a definition of “significant” as “substantially more than material” makes this abundantly clear. In other words, it is insufficient that the contribution of the employment be “more than trivial”; it had to be substantially more than trivial. The Tribunal did not recognise this, despite its reference to the definition. The error the Tribunal made is similar to the one made by the Tribunal in Sahu-Khan. In a valiant attempt to save the decision Ms Robinson drew attention to the fact that Dr Lewin had said “certainly more than trivial”, but this was no more than an emphatic way of saying “more than trivial”. It did not satisfy the statutory test and the Tribunal was mistaken in thinking otherwise.
Moreover, the current test of contribution also requires an evaluative exercise to be undertaken. That is apparent both from the words used in subs (1) of s 5B and also the matters to which subs (2) draws attention. The Tribunal did not engage with any of them. Indeed, it did not mention subs (2) at all. While the chapeau to the subsection states that those matters “may” (not “shall”) be taken into account, a word which is generally permissive, properly construed it is at least arguable that in this context it is directory; in other words that “may” means “shall”: see Julius v Lord Bishop of Oxford (1880) 5 App Cas 214 at 222–223 (Earl Cairns LC); NorthAustralian Aboriginal Justice Agency Ltd v Northern Territory [2015] HCA 41 at [209] (Nettle and Gordon JJ). In the absence of argument on this question I refrain from expressing a concluded view. Nevertheless, there is nothing in the Tribunal’s reasons to indicate that it carried out the kind of evaluative exercise required by the statute.
[15] [2015] FCA 1502 at [93]-[94].
Mr Letts contended that the Tribunal should have regard to the SoP in respect to his diagnosis of ‘ischemic heart disease’ and the causal connection to his Army service. The SoP relevantly applies to the determination of liability for veterans under the Veterans’ Entitlement Act 1986 (Cth).
Whilst Mr Letts is a veteran, consistent with the decision of Deputy President Muller in Vivian and Military Rehabilitation and Compensation Commission [2005] AATA 875, the Tribunal is satisfied that the SoP has no evidentiary basis in Mr Letts’ claim under the DRCA and gives it no consideration in determining the present application for review.
Ischemic heart disease
The opinion of Dr Herman that if Mr Letts had a mental illness, and that if it was service related, could have made a material contribution to his condition of ‘ischemic heart disease’ is not supported by any accepted condition of such a mental illness by the Commission.
The Tribunal acknowledges the submission made by Mr Letts about his service in the Army causing him mental harm and the letter of Dr Garrity, his psychiatrist. However, absent an acceptance of, or a reviewable decision, the jurisdiction of the Tribunal is not at large to find that Mr Letts has a diagnosis of a mental illness that is connected to his service.
The Tribunal is reasonably satisfied because of Dr Herman’s opinion that there is no connection with Mr Letts’ condition of ‘ischemic heart disease’ and his Army service and the clinical onset is in and around 2019.
Essential Tremor
There is no medical evidence before the Tribunal that Mr Letts’ condition of ‘essential tremor’ has any causal connection with his Army service. Dr Puhl does not opine on causation at all, and Dr Krishnan opines that it is a genetic condition not connected to Mr Letts’ Army service.
The Tribunal is reasonably satisfied because of Dr Puhl’s and Dr Krishnan’s opinions that there is no connection with Mr Letts’ condition of ‘essential tremor’ and his Army service and the clinical onset is in and around 2020.
CONCLUSION
Despite the heartfelt submissions made by Mr Letts, there is no medical evidence before the Tribunal that Mr Letts’ Army service made a ‘material’ or ‘significant’ contribution, or any at all, to his ‘ischemic heart disease’ and ‘essential tremor’ as required by the DRCA.
The Tribunal is not reasonably satisfied that Mr Letts’s Army service contributed to his ‘ischemic heart disease’ and ‘essential tremor’ under s 14 of the DRCA because:
(a)The opinion of Dr Herman in respect to ‘ischemic heart disease’ was clear that there was no causal connection to Mr Letts Army service.
(b)The opinion of Dr Krishnan in respect to ‘essential tremor’ was clear that there was no causal connection to Mr Letts Army service.
(c)Dr Puhl did not make a causal connection of Mr Letts’ condition of ‘essential tremor’ to Mr Letts Army service.
(d)The opinion of Dr Garrity diagnoses Mr Letts with the condition of ‘Chronic Depression, with some features of Post Traumatic Stress Disorder’, but does not opine as to that diagnosis being caused by his service in the Army or his subsequent 27 years as a police officer.
(e)In any event, Mr Letts does not have an accepted mental health condition by the Commission.
(f)Mr Letts did not provide any medical evidence to the Tribunal from any medical expert or treating doctor that connected his service to his ‘ischemic heart disease’ and ‘essential tremor’.
(g)The RMA statement of principles is not applicable to the Claim.
DECISION
The Tribunal affirms the decision under review.
Date(s) of hearing: 28 May 2025 Date final submissions received: 28 May 2025 Representation for the Applicant: Mr Letts, self-represented Solicitors for the Respondent: Ms Audsley, Australian Government Solicitor ANNEXURE
Schedule of Exhibits
Exhibit No. Date Description
Exhibit R1 22/03/2024 Application for review (T1)
Exhibit R2 202/08/2020 Claim for Compensation- Hypertension (T16)
Exhibit R3 10/07/2021 Claim for Compensation – Essential Tremor (T17)
Exhibit R4
10/07/2021 Claim for Compensation – Ischaemic Heart Disease (T18) Exhibit R5
29/08/2022 Determination (T20)
Exhibit R6 19/09/2022 Request for Reconsideration (T21)
Exhibit R7 12/02/2024 Reviewable Decision (T1.1)
Exhibit R8
Various ADO Medical Records (T3) Exhibit R9
Undated List of claimed conditions (T7) Exhibit R10
26/11/2019 Report of Dr Garrity (T11) Exhibit R11
19/07/2020 Injury or Disease Details sheet for Hypertension, Dr Saunders (T15)
Exhibit R12
20/08/2020 Claim for Compensation for Hypertension (T16) Exhibit R13
10/07/2021 Claim for Compensation for Essential Tremor (T17) Exhibit R14
10/07/2021 Claim for Compensation for Ischaemic Heart Disease (T18) Exhibit R15 28/09/2022 Email from DVA regarding request for further information (T22)
Exhibit R16 13/10/2022 Email from Applicant (with attachments) (T23)
Exhibit R17 08/12/2023 Email from Applicant (with attachments) (T24)
Exhibit R18 09/01/2024 Email from DVA to Applicant (T25)
Exhibit R19 28/01/2024 Email from Applicant (with attachments) (T26)
Exhibit R20 07/02/2024 CMA Opinion on Coronary Artery Disease (ST2)
Exhibit R21 07/02/2024 CMA Opinion on Essential Tremor (ST3)
Exhibit R22 21/09/2022 CMA Opinion on Coronary Artery Disease and Ischaemic Heart Disease (ST4)
Exhibit R23 19/03/2021 CMA Opinion on Hypertension (ST5)
Exhibit R24 07/03/1969 Record of Service (ST7)
Exhibit R25 21/07/1967 Result of Medical Examinations (ST8)
Exhibit R26 25/09/2024 Briefing letter to Dr Herman (TB B1)
Exhibit R27 08/10/2024 Briefing letter to Dr Krishnan (TB B2)
Exhibit R28 16/10/2024 Report of Dr Herman (TB B3)
Exhibit R29 21/10/2024 Report of Dr Krishnan (TB B4)
Exhibit R30 Various Extract of documents from Warringah Medical & Dental Centre (TB B5)
Exhibit R31 Various Extract of documents from Vale Medical Practice (TB B6)
Exhibit R32 Various Extract of documents from Dr Ward (TB B7)
Exhibit R33 Various Extract of documents from Northern Beaches Neurology (TB B9)
Exhibit R34 Various Extract of documents from Macquarie Heart (TB B11)
Exhibit A1 Undated Applicant’s Statement (TB C5)
Exhibit A2 Various Service Records (ST1)
Exhibit A3
Undated Letter of Applicant to family re Air Dispatch (T4) Exhibit A4
Undated Statement of Applicant regarding Hypertension (T6) Exhibit A5
Various Extract of documents from Dr Garrity (TB B8) Exhibit A6
Undated Dr Garrity – Diagnosis (TB C.1.16) Exhibit A7 25 May 2025 Opening submission
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