Letts and Military Rehabilitation and Compensation Commission (Veterans' entitlements)

Case [2025] ARTA 1032

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 30

Smith 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

  1. 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.

  2. Mr Letts gave evidence at the hearing. Mr Letts was self-represented. Ms Audsley,of the Australian Government Solicitor, represented the Commission.

  3. The Tribunal admitted into evidence the exhibits which are listed in the annexure to these reasons.

BACKGROUND

  1. Mr Letts was born in 1947 and is now aged 78 years old.

  2. 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.

  3. On 10 July 2021, Mr Letts made separate claims for ‘essential tremor’ and ‘coronary artery disease’ (the Claim).[3]

    [3]  Exhibit R3 & R4.

  4. By a determination dated 29 August 2022, the Commission denied liability for the Claim (the Primary Determination

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AGLC
Letts and Military Rehabilitation and Compensation Commission (Veterans' entitlements) [2025] ARTA 1032
Case
[2025] ARTA 1032
Decision Date

CaseChat Overview and Summary

The case involves Mr Letts, a veteran, who is seeking compensation from the Military Rehabilitation and Compensation Commission for ischemic heart disease and essential tremor, which he claims are connected to his service in the Australian Army. The Federal Circuit Court of Australia is reviewing the Commission's decision to deny his claim.

The primary legal issue before the court was whether Mr Letts' service in the Army materially or significantly contributed to his ischemic heart disease and essential tremor, as defined under the Defence Rehabilitation and Compensation Act 2004 (Cth). The court needed to determine if the Commission's decision to deny the claim was justified based on the medical evidence provided.

The court reviewed the medical evidence provided by various specialists, including Dr Herman, a cardiologist, who diagnosed Mr Letts with coronary heart disease and found that his condition was significantly contributed to by non-service-related factors such as hypertension, hyperlipaemia, and age. Dr Krishnan, a neurologist, diagnosed Mr Letts with essential tremor, a genetic condition that would have developed irrespective of his Army service. Dr Garrity, a psychiatrist, noted Mr Letts' history of chronic depression and PTSD, which he believed was related to his service. The court found that the medical evidence did not support the claim that Mr Letts' conditions were significantly contributed to by his Army service. The court concluded that the Commission's decision to deny the claim was correct.

The court affirmed the decision of the Military Rehabilitation and Compensation Commission, denying Mr Letts' claim for compensation.

Orders

Orders of the court

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Background

Background to the litigation

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Evidence

Evidence Before The Court

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 EvidenceDoctor 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

Decision

Reasons for decision

On 12 February 2024, the Commission affirmed the decision which is now under review before the Tribunal (the Reviewable Decision). [6][6]Exhibit R7. 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. 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 EvidenceDoctor 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

Ratio Decidendi

Legal Principle Established

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.CONSIDERATIONDiagnosis 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].