Mann and Repatriation Commission
[2006] AATA 256
•17 March 2006
Administrative
Appeals
Tribunal
DECISION AND REASONS FOR DECISION [2006] AATA 256
ADMINISTRATIVE APPEALS TRIBUNAL )
) No Q2005/377
VETERANS’ APPEALS DIVISION )
Re WILLIAM ROY MANN Applicant
And
REPATRIATION COMMISSION
Respondent
DECISION
Tribunal Ms M J Carstairs, Member Date17 March 2006
PlaceBrisbane
Decision The Tribunal affirms the decision under review.
. ........[Sgd]........
M J Carstairs
Member
CATCHWORDS
VETERANS’ ENTITLEMENTS –– anxiety disorder – alcohol abuse/dependence – gout – operational service in Far Eastern Strategic Reserve and Vietnam - application of statement of principles – no severe psychosocial stressor – decision affirmed.
Veterans’ Entitlements Act ss 9, 120, 120A
Hardman v Repatriation Commission [2005] FCAFC 83
Byrnes v Repatriation Commission (1993) 177 CLR 564
Deledio v Repatriation Commission (1997) 47 ALD 261
White v Repatriation Commission (2004) 39 AAR 67
Lees v Repatriation Commission (2002) 36 AAR 484
REASONS FOR DECISION
17 March 2006 Ms M J Carstairs, Member 1. William Mann has claimed pension for three medical conditions – anxiety disorder, alcohol dependence and gout – he claims relate to his service with the Royal Australian Navy. Mr Mann served with the navy for 20 years from 1960 to 1980. He had several periods of overseas or operational service; these are eligible war service under the Veterans’ Entitlements Act 1986 (the Act), and include his service on voyages with the Far Eastern Strategic Reserve (FESR) and to Vietnam. Outside of his operational service, Mr Mann does not rely on the rest of his defence service in relation to these claims.
2. Mr Mann says that he has suffered from anxiety disorder and alcohol dependence from about the mid-1960’s and from gout since about 1970. He relates these conditions to his experience of a stressful incident which took place during his service with the FESR in late 1964 and says that he suffered anxiety symptoms from about 1965 and either alcohol dependence or abuse from about that time.
3. The respondent agrees that Mr Mann suffers from alcohol dependence and from anxiety disorder but contends the incident on which he relies was not sufficiently stressful to cause anxiety disorder or alcohol dependence, and that the clinical onset of anxiety disorder was not as early as Mr Mann claims. The date of clinical onset of Mr Mann’s conditions has importance because, as will be seen below, clinical onset must occur within specified time limits, and must be related to service, for a person to satisfy the Statements of Principle (SoPs) for anxiety disorder and alcohol abuse/dependence.
4. In considering Mr Mann’s overall claim, I put to one side the claim for gout, as the parties agreed that the acceptance of gout would follow automatically if Mr Mann’s claim for alcohol dependence is successful.
ISSUES
5. A veteran is entitled to be paid a pension if his conditions are war-caused within the meaning of s9 of the Act. Whether a condition is war-caused is governed by s120 of the Act, which prescribes the standard of proof where a person has operational service, and by s120A which deems the standard of proof met when an hypothesis conforms to a factor(s) set out in a relevant SoP. This legislative framework was interpreted by Heerey J in Deledio v Repatriation Commission (1997) 47 ALD 261 as requiring 4 steps to be taken by decision makers when determining whether a condition is war-caused.
6. Given the contentions by the parties, this statutory framework and the steps set out in Deledio, the issues I must consider are:
· the correct diagnoses of Mr Mann’s conditions;
· whether the material or evidence raises an hypothesis or hypotheses connecting the conditions with the circumstances of Mr Mann’s service and whether there are SoP’s in force relevant to Mr Mann’s conditions;
· whether the hypotheses contain one or more of the factors set out in the SoP’s. This, in turn, will require an examination of the elements of the relevant factors of the SoP’s. As already noted in regard to Mr Mann’s claim, the nature of the stressor alleged by Mr Mann and the date of clinical onset of his conditions are important; and
· whether Mr Mann’s hypotheses are disproved beyond reasonable doubt.
WHAT ARE THE DIAGNOSES?
7. The diagnoses of anxiety disorder and alcohol dependence were confirmed by medical reports. In a report dated 16 July 2001(T4), Dr J Gelb, consultant psychiatrist, stated, rather tentatively, that Mr Mann appears to suffer from alcohol abuse and had some signs of generalised anxiety. In two reports dated 11 May 2004 and 24 March 2005 (T4 pp92-94, 134-136) Dr B Anderson, psychiatrist, diagnosed him as suffering generalised anxiety disorder, as well as alcohol abuse and dependence.
8. His symptoms as described to both psychiatrists by Mr Mann reflected the necessary aspects of the diagnostic criteria for anxiety disorder as contained in the Diagnostic Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). I accept on the basis of the agreed medical evidence that Mr Mann suffers from anxiety disorder.
9. The symptoms that Mr Mann described in relation to his alcohol intake over many years and the effects of alcohol on his domestic and working life accord with the diagnostic criteria for alcohol dependence in DSM-IV. I accept the medical reports of Dr Anderson and Dr J Mitchell, Mr Mann’s general practitioner, which concluded that Mr Mann suffers from alcohol dependence.
IS THERE AN HYPOTHESIS AND RELEVANT STATEMENT OF PRINCIPLES?
10. The stressful event that Mr Mann described in relation to his claims took place at the end of 1964 when he was serving on HMAS Derwent, patrolling the waters off Tawau during night time operations with the FESR. These patrols were to detect possible Indonesian infiltrators into Malaysian territory. Mr Mann described the following incident (the boarding party incident).
The Boarding Party Incident
· In his statement dated 3 December 2003 (T4, p78) Mr Mann said that HMAS Derwent intercepted an Indonesian vessel at night in the boarding party incident. As background Mr Mann said that before HMAS Derwent left Singapore Harbour they had observed a Royal Navy minesweeper that had been damaged when explosives were thrown from a junk that had been intercepted by the minesweeper. On the night of the boarding party incident, Mr Mann was part of the mortar crew defence watch, positioned towards the stern on the upper deck, from where he could see down into the vessel being boarded. Mr Mann said that HMAS Derwent travelled during night patrols with lights darkened. He said that during the boarding, a volley of gun fire broke out, which he said was quite terrifying, and he thought his life was under threat. He said that he moved quickly to the centre of the ship and crouched low, and could hear yelling of orders to cease fire and calls of who fired those shots? He stated that his thoughts were of the minesweeper they had seen at Singapore.
· Mr Mann had told the Veterans Review Board (the VRB) that he was out of sight of the boat when he heard the volley of 4-5 shots. He told them he was not sure where the shots came from but thought the Indonesian boat may have fired them. In his oral evidence to me he said that he got quite a start from the gun fire, and all he could think of was getting away from the side of the ship, and moving to a position of safety in the centre beside the bulkhead. He stated that he learned later that Malay police had asked the boarding officer, Leading Seaman Logan, to fire a volley into the air above the Indonesians’ heads as a warning.
· Mr Mann stated (T4, p79) that the Indonesians were brought on board, searched, and held prisoner on the deck of HMAS Derwent. He said that normal procedure would be to restrain prisoners but on this occasion they were only required to clasp their hands behind their heads.
· Mr Mann stated that those on watch, like him, were the only ones outside the ship without protection. He stated that on subsequent nights he noticed reluctance by others with him on duty to be isolated on deck when a boat or junk was alongside. He also stated that as leading seaman in charge of the watch he had to set the example for the ordinary seamen.
· In a statement dated 22 April 2004 (T4, p154), Mr A Roberts confirmed that when he and Mr Mann served on board HMAS Derwent they took on board a group of Indonesian insurgents who were held under the directions that they sit in a squat position with hands behind their heads and were supervised by two armed navy guards. In his statement Mr Roberts did not mention shots being fired during the boarding party incident. However Mr V. Elwell did, in his statement dated 21 April 2005 (T4, p153). Mr Elwell said that he was part of the boarding party and the operation was conducted at night under lights trained from HMAS Derwent onto the Indonesian boat. He said that shots were fired from the boat which brought our alertness to the highest degree. He said that the gunnery officer then ran out and gave the order to stop firing.
· In his statement dated 30 October 2004 (T4, p141-2) Mr Mann said the Indonesians were taken on board under guard and kept on deck, but were unrestrained. He said that if those guarding them had occasion to fire upon them, and if Mr Mann was traversing the area to carryout his duties, which included maintaining contact with the bridge, he might have been hit by gunfire. He said that he was terrified and his stomach was in a knot. When his watch finished he went to his mess deck and had several cigarettes to settle his nerves, and he said that obtained extra cans in subsequent beer issues.
11. Mr Mann gave similar evidence about the boarding party incident when he was seen by the two psychiatrists, Dr Anderson and Dr Gelb. Mr Mann raised the boarding party incident as one of two stressful experiences that he discussed with Dr Gelb. Dr Anderson referred to numerous stressful incidents, of which the boarding party incident was only one.
12. I am required, at this first step in the series of steps set out in Deledio, to have regard to all of the material before me. There was material that points away from the occurrence of a stressful incident (T4, p118-125) of the kind described by Mr Mann. There was also material that pointed away from the boarding party incident having a significant stressful impact on Mr Mann. In addition there was material before me that points away from Mr Mann having suffered the clinical onset of anxiety disorder within 2 years after a relevant stressful incident. However, no fact finding occurs at this stage (Deledio) and the existence of material that does not support Mr Mann’s hypotheses as they relate to anxiety and alcohol dependence does not allow me to disregard the hypotheses. There was material that points to hypotheses of war causation, thus satisfying the first step in the Deledio tests.
13. There was no dispute that there are two SoPs in force that are relevant (step 2 of Deledio):
§SoP No 1 of 2000 for anxiety disorder ; and
§SoP No 76 of 1998 for alcohol dependence.
DOES THE HYPOTHESES CONFORM WITH FACTORS IN THE SOP’s?
14. In relation to this question I am guided by the decision of the Full Federal Court in Hardman v Repatriation Commission [2005] FCAFC 83. The Tribunal in Hardman had found that the material before it overwhelmingly suggested a clinical onset of depression more than two years after any relevant stressor. The Full Court setting aside the decision held that the Tribunal had impermissibly entered upon fact finding and negated the possibility of a reasonable hypothesis upon its view of the weight of the evidence. The Full Court said:
To reject that hypothesis on the basis that it was swamped by countervailing material is a finding which preferred some facts to others and so rejected those facts upon which the relevant hypothesis could be based. That is directly contrary to the three steps as described in Deledio. (paragraph 28)
Anxiety Disorder
15. The factor in SoP No 1 of 2000 concerning anxiety disorder that most closely relates to the hypothesis raised by Mr Mann is factor 5(a)(ii):
Experiencing a severe psychosocial stressor within the two years immediately before the clinical onset of anxiety disorder;
16. The evidence will need to point to the existence of the stressor and the onset of anxiety disorder within the two year period. Turning firstly to the requirement of clinical onset within two years of the relevant stressor, this issue must be dealt with on the basis that the question of the date of clinical onset, when posed by a factor in a SoP, goes to war-causation and so the reasonable hypothesis standard of proof applies. There may be no fact finding by the Tribunal at this stage.
17. In Leesv Repatriation Commission (2002) 36 AAR 484 the Full Federal Court held that the symptoms or features of a condition must be revealed within two years of a veteran experiencing a stressor. This requires reference to the diagnostic criteria for the condition which are contained in the SoP and which duplicate the criteria contained in DSM-IV. The criteria (which are set out more fully below at (para 20) include the presence of excessive anxiety and worry which a person finds it difficult to control and which is associated with symptoms such as restlessness edginess, fatigue, difficulty concentrating, irritability and sleep problems.
18. Mr Mann gave evidence of a number of matters relevant to the question of when he developed the symptoms and signs set out in the diagnostic criteria. The following material relates to the symptoms experienced by him, some of which referred to the period about 1965:
· Mr Mann told Dr Gelb (T4 p55) that he felt very stressed by his service and suffered from mood swings lack of sleep and was always on edge. He also described concentration difficulties, indecisiveness, irritability and tearfulness. I took this reference to service as meaning operational service because this was the context of Dr Gelb’s remarks in his report.
· Cidrel Mann, Mr Mann’s wife, told Dr Gelb that she believed that her husband suffered stress and anxiety for many years and was irritable and on edge much of the time. She said that he sleeps restlessly, has difficulty concentrating, has no close friends, little interest in relatives outside the immediate family, and has no hobbies or sports.
· Mrs Mann prepared a written statement for Dr Anderson that included her observation that before his overseas service her husband was thoughtful and loving, but when he returned after 5 months away at sea at the end of 1964 he was a changed man. She said that he was controlling, drinking heavily, physically and mentally abusive and very aggressive (T4 142-47).
19. Dr Gelb reported that when Mr Mann left the navy he found it hard to settle back into civilian life. He worked as a vessel-tracking service operator with Queensland Transport for 20 years and worked alone, which he told Dr Gelb was stressful and isolating. He also experienced stress when required to adjust to computers in the workplace. Dr Gelb stated that Mr Mann’s anxiety was demonstrated by insomnia, irritability, mood swings and general edginess. Dr Anderson said that Mr Mann was highly anxious, agitated, lacked concentration, and experienced social and marital problems.
20. I noted that the main thrust of the medical reports was Mann’s current mental health. There was little focus on the question of the clinical onset of anxiety disorder, apart from Dr Gelb’s remarks and Dr Anderson’s comment (T4, p92) that Mr Mann had symptoms at the time of his service in the FESR. Dr Anderson said in his oral evidence that Mr Mann would have experienced symptoms of anxiety as early as 1964. However Dr Anderson acknowledged that he had not expressed this view clearly in any of his written reports. The Tribunal requested Dr Anderson’s clinical notes. When Dr Anderson provided these after the hearing he additionally provided a new report dated 14 November 2005 (that is, after the hearing on 2 November 2005) in which he expressed the following views against each of the criteria for anxiety disorder in DSM-IV:
§ That Mr Mann had excessive anxiety and worry since 1964 which escalated in 1965 when he knew he was going back to the same operations. He was Petty officer in 1967 and had to instruct sailors and was concerned re his competence and he had lost confidence. He was promoted to Leading Seaman and had more responsibility. Left the navy in 1980 and high anxiety since then… In 1968 after a helicopter crash in 1968 his Anxiety worsened.
§ Mr Mann finds it difficult to control worry;
§ He has been easily fatigued since leaving HMAS Derwent in 1967; is obsessive and demanding about order, suffers muscle tension; and has had difficulty staying asleep since 1965 especially when at sea. Sleep is assisted by alcohol.
Neither party sought leave to re-call or cross-examine Dr Anderson on this report.
21. The material points to excessive anxiety in the form of nervousness, and irritability that manifested in sleep problems and variable mood that fit with paragraph C of the criteria for anxiety disorder and a concurrent increase in alcohol use. This last feature might indicate an inability to control anxiety and Mr Mann certainly claimed that he had used alcohol to self-medicate anxiety (T4, p43). The material also points to distress or impairment in functioning in the areas of marriage and his employment: paragraph E of the criteria. Some of the material, including the evidence of Mrs Mann and that of Dr Anderson, points to the presence of the diagnostic criteria for generalised anxiety disorder being present from 1965.
22. In regard to the requirement in factor 5(a) of the SoP for experiencing a severe psychosocial stressor within the two years … the term severe psychosocial stressor is defined as:
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.
23. In White v Repatriation Commission (2004) 39 AAR 67 Spender J construed a severe psychosocial stressor as an occurrence that, objectively, would evoke feelings of substantial distress in a person exposed to that occurrence and that, subjectively, did evoke feelings of substantial distress in the particular individual concerned.
24. The Report of Proceedings of HMAS Derwent (T4,p121-125) included a report that on 21 December 1964 HMAS Derwent had intercepted a trading boat off Tawau, and had searched and interrogated the 7 crew and 29 passengers on board. The boarding party arrested all Indonesians after they refused to answer questions about documents found on board, and the boat was towed back to Tawau and the prisoners were unloaded. I noted that the Report of Proceedings did not refer to shots being fired during the boarding of the vessel.
25. The boarding party incident, as described by Mr Mann, satisfies and points towards the objective element of the definition of “severe psychosocial stressor” in that there was an occurrence, which was one capable of evoking feelings of substantial distress in a person. On Mr Mann’s and Mr Elwood’s evidence there was gun fire, which would raise a threat to personal safety, one of the examples listed with the definition of psychosocial stressor in the SoP (being shot at).
26. I took into account the respondent’s submission that what Mr Mann described was not like the cited examples in the SoP because Mr Mann did not suggest that he was directly shot at, and so did not meet a threshold test of severity. However that submission misunderstands Mr Mann’s evidence, which was that he was uncertain where the shots had come from and whether it was friendly or unfriendly fire. He has repeatedly stated that he felt his life threatened and it seems to me that the boarding party incident does not fall outside the stated examples in the SoP definition, given the uncertainty for someone exposed to seemingly random firing of gunshots.
27. Less clear was whether Mr Mann experienced substantial distress (the subjective component of the definition) as a result of the boarding party incident. However I am mindful that this is not a stage in the decision-making process when facts are to be found. Taken as a whole the material before me points to compliance with the that part of factor 5(a) in the SoP for anxiety disorder, that in the boarding party incident Mr Mann experienced a severe psychosocial stressor. Thus the hypothesis raised by Mr Mann is a reasonable hypothesis, as it fits with Factor 5(a) of the SoP.
28. I note that Mr Mann has also referred in his claim to the possible danger to which he was exposed if the Indonesians, once taken on board, had concealed arms, and if firing broke out later while Mr Mann continued on watch. It seems to me that this would not be a severe psychosocial stressor. There was no objective element. Mr Mann merely speculated about possible scenarios which did not actually take place.
Alcohol Dependence
29. The factors in SoP No.76 of 1998 concerning alcohol dependence or alcohol abuse that most closely relate to the hypothesis raised by Mr Mann are factors 5(a) and 5(b):
5 (a)suffering from a psychiatric disorder at the time of the clinical onset of alcohol dependence or alcohol abuse;
(b)experiencing a severe stressor within the two years immediately before the clinical onset of alcohol dependence or alcohol abuse.
30. There is no dispute that the material points to the clinical onset of alcohol abuse/dependence by at least the mid-1960’s. Mr Mann stated that he commenced drinking alcohol in about 1960, at which time he consumed about 6 standard drinks per week. He commented in regard to the relatively low consumption that recruits were allowed weekend leave only once a fortnight. He said that between 1965 and 1966 his drinking had increased and had reached 20 standard drinks per day. He said that on occasions he would not go home at all and would stay in the mess from Friday afternoon until Monday morning. He told Dr Anderson that he started drinking heavily after his service on HMAS Derwent when he was posted to shore at HMAS Creswell at Watson’s Bay. In an undated statement (T4, p11) Mr Mann said however that he did not consider he had a drinking problem until he was posted to the shore base, HMAS Nirimba in 1970 and was president of the petty officers’ mess, where he had ready access to alcohol.
31. Mr Mann noted that he had reduced his drinking to 8 standard drinks when his wife left him for about 6 months in 1967, taking their child with her. However he said she came back and he returned to drinking 20 standard drinks again by 1972. He attended Alcoholics Anonymous briefly for about three months in 1972 and abstained from alcohol during that time.
32. Mr Mann told Dr Gelb that during his first tour with the FESR (1960/1961) he drank little and mostly gave his daily allocation of one can of beer to others but as time went on he increased his intake. He said that at one time was responsible for the wet canteen when he was able to, and did, drink whatever amount of alcohol he wanted. When he saw Dr Gelb in 2001 (T4 p56-58) Mr Mann reported his current consumption as 16-20 standard drinks per day. He told Dr Anderson that that he drinks between 2 and 4 tall bottles per night.
33. A diagnosis of the condition of alcohol abuse/dependence is not confirmed simply on quantities of alcohol consumed, but there is sufficient evidence that Mr Mann substantially increased his alcohol consumption in the mid-1960’s and needed help from Alcoholics Anonymous in 1972. At other parts of his evidence he referred to discipline issues arising during his service because of his alcohol intake. His evidence was that his consumption was related to his service, and that substantial increases to a level of problem drinking were related to his operational service. This was not challenged seriously in cross-examination.
34. Factor 5(a) of the SoP for alcohol dependence would be satisfied by a date of clinical onset in the mid-1960’s, provided that a psychiatric disorder, connected to Mr Mann’s service, was suffered by him at that time. The substance of Mr Mann’s hypothesis in relation to his anxiety disorder was that clinical onset was about 1965. If his anxiety disorder is war caused, then he will satisfy factor 5(a) of the SoP in respect of his alcohol dependence. This seems to be the effect of Mr Mann’s counsel’s submissions filed on 1 December 2005 at paragraph 2.3.
35. I note however that other parts of counsel’s submissions referred to factor 5(b) experiencing a severe stressor within the two years immediately before the clinical onset of alcohol dependence or abuse. It does not seem to me that the boarding party incident meets the definition of experiencing a severe stressor because, however the objective features of the incident itself are viewed, Mr Mann’s reactions do not suggest intense fear helplessness or horror. These are required for the definition to be met. This means that the boarding party incident does not match the definition of experiencing a severe stressor and so Mr Mann’s hypothesis based on factor 5(b) does not match the template in the SoP: step 3 from Deledio.
36. It is appropriate, because the claim for alcohol dependence relates to the acceptance of a psychiatric condition, namely anxiety disorder, present at or about the time of Mr Mann’s operational service, to proceed to the next and final issue of whether Mr Mann’s anxiety disorder is war caused. It will be war-caused unless I am satisfied beyond reasonable doubt one or more of the facts necessary to support the hypothesis are disproved or the truth, of another fact inconsistent with the hypothesis, is proved beyond reasonable doubt: Byrnes v Repatriation Commission (1993) 177 CLR 564.
IS THE HYPOTHESIS DISPROVED BEYOND REASONABLE DOUBT?
37. Mr Mann has given reasonably consistent accounts of the boarding party incident when he has made two claims for anxiety. His evidence was supported by Mr Elwood. I accept their evidence concerning shots being fired during the boarding party incident even though that occurrence was not recorded in the Report of Proceedings, nor were shots recalled by the other witness to the boarding party incident, Mr Roberts.
38. I took into account Mr Mann’s evidence about his uncertainty about whether the shooting was friendly or unfriendly fire. I also took into account his statements that he felt terrified and helpless. His evidence to me that he got quite a start. His reaction described to the VRB was that he dropped to the deck in fright and crawled to a position of safety under the bulk-head. The VRB recorded that Mr Mann said that after four to five minutes he could see that the guards were still in control and he felt relief. Mr Mann confirmed under cross-examination that he had felt relief. These reactions all seem to be normal. I was satisfied beyond reasonable doubt that the boarding party incident did not have a significant effect on him. His descriptions of his subsequent actions support that finding. Mr Mann described continuing on with his watch, albeit with some apprehension and that after going off duty he smoked several cigarettes and made sure that he had extra beer when it was next being issued. Nowhere in the material did Mr Mann describe ongoing impacts from the boarding party incident and I do not accept that he had them.
39. Dr Gelb was made aware of the boarding party incident but did not consider that it could be a trigger for a psychiatric disorder of any description. Mr Mann gave a history of the boarding party incident to Dr Anderson that was similar to the version of the incident that Mr Mann gave to the VRB. However when Dr Anderson’s three reports are taken along with his clinical notes, it is clear that Mr Mann described quite a large number of possible stressors. From Dr Anderson’s three reports these include:
§ General background stressors, which Dr Anderson seems to have derived from an article of unknown source entitled The Short Straw which referred generally to the ardours of naval service.
§ Being confronted with an Indonesian destroyer in the Malacca Straits when Mr Mann was locked down in the bomb room, feeding mortars for firing and was fearful in case the ship came to grief.
§ Mr Mann described having fifty men on his mess deck and only two small exits, which would put them in peril in a state of emergency (this stressor was also discussed by Mr Mann when he saw Dr Gelb).
§ While in Vung Tau harbour Mr Mann had to prepare scare charges.
§ one man tried to kill all of the officers on board the ship with a bren gun during his 1964/1965 service
§ the boarding party incident.
§ in 1968 Mr Mann’s anxiety worsened after a helicopter crash at HMAS Cresswell.
40. In his statement (undated,T4 pp102) Mr Mann referred to other incidents including a sailors arm being caught in the breech of a gun on HMAS Parramatta when Mr Mann served on that ship between 1961 and 1963; and a helicopter crash body recovery when he serving at HMAS Creswell between 1967-1969.
41. I found Dr Anderson to be a very unsatisfactory witness. Dr Anderson seems to have relied upon a number of stressors in reaching his conclusions, which are then expressed in the most general terms, referring to Mr Mann’s anxiety disorder and alcohol dependence being a consequence of his Navy service (T4, p134) without any real connections being drawn between particular stressors or particular parts of service. Dr Anderson also could not satisfactorily explain his conclusion that Mr Mann had anxiety disorder from about 1965. He acknowledged that deficiency in his oral evidence. A close reading of his clinical notes does not provide assistance in establishing how Dr Anderson drew the conclusions that he said he did regarding the clinical onset of anxiety disorder. I accept that Dr Anderson took account of Mrs Mann’s written statement that Mr Mann was a changed man when he came back in 1965. But Dr Anderson’s clinical notes of discussions with Mrs Mann on 11 March 2004 include her telling Dr Anderson that he was worse after the helicopter crash at HMAS Cresswell in 1968.
42. In Dr Anderson’s first medical report, the boarding party incident is not mentioned at all. In his first report, Dr Anderson emphasised the impact of the incident on HMAS Parramatta, where the sailor who trapped his arm in the breech main gun, had his arm trapped for some hours. Dr Anderson stated that this reinforced to Mr Mann the dangerous nature of his work. From an examination of his clinical notes as a whole it was clear that Dr Anderson’s focus, quite properly as the treating psychiatrist, has been on Mr Mann’s recent symptoms and his ongoing treatment.
43. In the absence of clear medical evidence I could draw no firm conclusions on when Mr Mann developed an anxiety disorder. It seems evident that there was much that occurred in Mr Mann’s later life that could account for anxiety. Dr Anderson’s clinical notes record that Mr Mann told him that he was very stressed in his twelve years of civilian employment at a signal station, where he was locked in a building with automatic gates and worried that if he had an accident or heart attack he would not be found quickly enough. He had also told Dr Gelb that in his civilian work in vessel tracking his job was stressful and isolated.
44. I was satisfied beyond reasonable doubt that what occurred in the boarding party incident was not an occurrence that meets the requirements of experiencing a severe psychosocial stressor, thus providing a basis to attribute causation within s9 of the Act. As noted above, that was also Gelb’s opinion.
45. I am satisfied beyond reasonable doubt that the evidence does not disclose a reaction by Mr Mann which equates to substantial distress and that means that he did not experience a severe psychosocial stressor in the boarding party incident. I accept that Mr Mann would have been fearful briefly and reacted quickly by dropping to secure his cover. This was quite within the range of normal reactions to perceived danger, and does not suggest substantial distress. After the first reaction of self protection and after the shouting died down, he acknowledged that he could see that things were under control, and he felt relief. He also acknowledged in his written statements that as the leading seaman it was up to him to set the example.
46. It flows from my conclusion that Mr Mann’s anxiety disorder is not war caused, that his alcohol dependence is also not war caused. As set out above his hypothesis relying on factor 5(b) was not sustained, and in the absence of war-caused anxiety disorder, factors 5(a) the SoP for alcohol dependence does not provide a link through a psychiatric condition that itself is war caused, to provide the basis for accepting alcohol dependence as war-caused. In turn Mr Mann’s claim for gout also fails.
DECISION
47. The Tribunal affirms the decision under review.
I certify that the 47 preceding paragraphs are a true copy of the reasons for the decision herein of Ms M J Carstairs, Member
Signed: J Mills
Legal Research Officer
Date/s of Hearing 2 November 2005
Dates of Written submissions 1 and 5 December 2005
Date of Decision 17 March 2006
Counsel for the Applicant Ms B Carter-Nicoll
Solicitor for the Applicant Haney Lawyers
For the Respondent Mr M Smith, departmental advocate
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