MARY CRUMP and REPATRIATION COMMISSION
[2009] AATA 752
•30 September 2009
Administrative Appeals Tribunal
DECISION AND REASONS FOR DECISION [2009] AATA 752
ADMINISTRATIVE APPEALS TRIBUNAL )
) No 2008/6024
VETERANS' APPEALS DIVISION ) Re MARY CRUMP Applicant
And
REPATRIATION COMMISSION
Respondent
DECISION
Tribunal Mr Egon Fice, Member Date30 September 2009
PlaceMelbourne
Decision The Tribunal affirms the decision under review. (sgd) Egon Fice
Member
VETERANS’ AFFAIRS ‑ kind of death – medical cause of death – multiple myeloma – hypercalcaemia – mechanism of death – bronchopneumonia – accelerated time of death – not for resuscitation order – eligible war service
Veterans’ Entitlements Act 1986
Collins v Repatriation Commission [2009] FCAFC 90
REASONS FOR DECISION
30 September 2009 Mr Egon Fice, Member 1. Mrs M E Crump is the widow of Mr Raymond Arthur Crump, who died on 12 December 2007 aged 81 years. Mr Crump served in the Royal Australian Airforce between 3 March 1944 and 18 February 1946.
2. It is common ground that Mr Crump did not have operational service as that expression is defined in s 6A of the Veterans’ Entitlements Act 1986 (VE Act). His period of service constituted eligible war service within the meaning of s 7 of the VE Act. Mrs Crump contended that her husband’s death was war-caused as that expression is defined in s 8 of the VE Act. Mr Crump’s death certificate records the cause of death as:
· Bronchopneumonia – 5 days
· Multiple myeloma ‑ months
· Recent hypercalcaemia – 1-2 weeks
3. On 20 February 2008 the Repatriation Commission (the Commission) refused to grant Mrs Crump a widow’s pension on the ground that her husband’s death was not war-caused. On 25 November 2008 the Veterans’ Review Board (VRB) affirmed the Commission’s decision. Mrs Crump now seeks review of the VRB decision by this Tribunal.
4. The issues which arise for consideration are:
(a)the cause, or kind of death of Mr Crump; and
(b)whether Mr Crump’s death was war-caused.
KIND OF DEATH
5. Where the death of a veteran was war-caused, the Commonwealth is, subject to the VE Act, liable to pay a pension by way of compensation to the dependants of the veteran in accordance with the VE Act (s 13). If a veteran’s death was not war‑caused, his or her dependants may nevertheless be entitled to a pension by way of compensation, if they are able to satisfy s 13(2) of the VE Act. However, that section does not apply to Mr Crump. In order to be eligible to receive the pension, it is therefore essential that Mr Crump’s death be established as war‑caused.
6. Section 120(4) of the VE Act provides that, except when making a determination to which subsections (1) or (2) apply, the Commission, and the Tribunal standing in the shoes of the Commission for the purposes of this review, must decide the matter to its reasonable satisfaction. Sections 120(1) and 120(2) apply only to operational service or where the death of a member relates to peacekeeping service rendered by the member. They do not apply to this case.
7. The Full Court of the Federal Court (Mansfield, Stone and Edmonds JJ) said in Collins v Repatriation Commission [2009] FCAFC 90 (5 August 2009) at [40] and [41]
[40] Sections 8 and 13[VE Act] look to the “death” of a veteran, but do not use the term “kind of death”. Similarly, s 120 refers to the relationship of a veteran’s death with the operational service of the veteran. It also does not use the term “kind of death”. The term “kind of death” is introduced by ss 120A(2) and (4) and 196B(2) in the expression “particular kind of injury, disease or death”. That expression refers to the circumstances in which a Statement of Principles may be determined and then applied to decide whether an hypothesis connecting an injury or disease or death is reasonable as assessed under ss 120(1) and (3) as informed by s 120A(3).
[41] The proper construction of those different terms was not a matter of debate on the appeal. It was common ground that, where the word “death” appears in ss 8 and 13 it means the medical cause of the death.
8. As the Full Court in Collins’ case explained, the first question which needs to be determined is the nature of the death of the veteran. This question is anterior to and distinct from the question of the relationship of the death to the service of the veteran and the extent of entitlements to benefits under the VE Act in respect of that death. As to that first question, the Full Court said, at [44]:
[44] In our view, the word “death” used in s 8, and in the phrase “injury, disease or death” in s 13 has the same meaning, that is the nature of the condition which causes the death. To be more precise, it is the medical cause or causes of the death.
9. Dr P Nayagam, who describes himself as practising general internal and geriatric medicine, was Mr Crump’s treating physician upon his admission to Beleura Private Hospital on 3 December 2007. On admission, the hospital recorded that Mr Crump suffered multiple myeloma and anaemia. His physical assessment form completed on admission included the following significant medical history:
(a)anaemia;
(b)multiple myeloma;
(c)Paget’s disease;
(d)heart murmur; and
(e)polymyalgia.
10. Prior to his final admission to Beleura Private Hospital on 3 December 2007, Mr Crump was admitted to hospital on a number of occasions in 2007. He had previously been diagnosed with bronchitis and emphysema, which the Commission accepted were war-caused conditions. In January 2007 Mr Crump spent nearly two weeks at Rosebud Hospital due to a chest infection but he seemed to have made an excellent recovery from that illness. He was diagnosed with multiple myeloma in November 2006. Dr J Catalano, a haematologist/haemato oncologist, described Mr Crump’s cancer as: …very nasty myeloma. He was treated with radiotherapy for this condition.
11. In February 2007 Dr P Canty, a radiologist, reported that Mr Crump’s heart was moderately enlarged. In May 2007 Mr Crump developed hypercalcaemia. Mr Crump’s multiple myeloma was also treated with chemotherapy drugs.
12. On 20 June 2007 Dr Catalano reported to Dr M McLean, Mr Crump’s general practitioner, that Mr Crump’s hypercalcaemia had resolved with the use of steroids. He also reported that Mr Crump’s recent hospitalisation for a nasty chest infection was due to a combination of his underlying frailty and his multiple myeloma with its associated immune suppression treatment using steroids. On 3 November 2007 Mr Crump received a transfusion and the discharge summary noted that he was suffering from the associated conditions of mild congestive cardiac failure and tachybrady syndrome.
13. On 21 November 2007 Mr Crump was examined by Dr G Szto, Director of Cardiology, Peninsula Private Hospital. Dr Szto noted that on examination Mr Crump remained in arterial fibrillation with a ventricular rate of 51, blood pressure 160/80 with a loud ejection systolic murmur in the aortic area, and clear lung fields. He appeared pale and sallow in general. Dr Szto said that even though Mr Crump had moderate to severe aortic stenosis in the previous year, he did not consider him to be a candidate for any more cardiovascular intervention, given his myeloma status.
14. In a letter dated 13 December 2007, Dr Nayagam reported Mr Crump’s death to Dr McLean. He said Mr Crump was admitted to Beleura Private Hospital on 3 December 2007 suffering from anaemia. On admission, Mr Crump was transfused with two units of packed cells. He subsequently had problems with his calcium with levels up to 3.84; and he was treated with three or four lots of Aredia, intravenous fluids and Lasix. Mr Crump’s calcium levels began to settle but his general condition began to deteriorate. He became more chesty, developed significant bronchopneumonia and thereafter there was a marked deterioration in his overall condition. Mr Crump died on 12 December 2007.
15. In his report dated 28 April 2009, Dr Nayagam said that the rapidity with which Mr Crump succumbed to bronchopneumonia was, in part, due to his background chronic obstructive airways disease (COAD). He said he did not include this in the death certificate because it was not the main contributory cause and there was a limit as to how many diseases one can document in a death certificate. He said he only listed the three main conditions which directly led to the patient’s death. Although Dr Nayagam was of the opinion that the outcome for Mr Crump would not have altered even if he did not suffer from COAD, he was of the opinion that bronchopneumonia in a compromised lung was clearly worse than in normal lungs.
16. In his evidence-in-chief, Dr Nayagam said that on 10 December 2007, when he examined Mr Crump, he was clinically chesty. He detected a crackle in Mr Crump’s lungs and he decided to treat that condition with antibiotics. On the following day, Dr Nayagam noted dullness to percussion, which he said was clinically consistent with left basal pneumonia. Mr Crump was receiving morphine at this time and his family decided that he should not receive any further treatment.
17. Dr Nayagam was asked to comment on Mrs Crump’s observation that her husband had a tube down his throat and that he appeared to be discharging a yellow substance on 12 December 2007. Dr Nayagam said that usually indicated an infection with pusy sputum. He said if there was no infection, the sputum would be frothy white or colourless. There was no report in the nursing notes of a tube being inserted. When it was suggested to Dr Nayagam that such treatment would be recorded in the hospital notes, he said not everything was recorded. Dr Nayagam did not see the tube referred to by Mrs Crump.
18. Dr Nayagam was asked whether Mr Crump would have survived beyond 12 December 2007, if he did not have compromised lungs. Dr Nayagam said that he would be speculating if he were to say that Mr Crump would have survived beyond 12 December 2007. However, he insisted that Mr Crump’s rapid decline in the two days prior to his death was because of pneumonia. Dr Nayagam was asked about a report by Dr J Poynter of a chest x-ray he conducted on 10 December 2007. The report stated that Mr Crump’s heart was slightly enlarged, his lungs were slightly congested consistent with an element of left ventricular failure but the lungs were otherwise clear. Dr Nayagam agreed that the x-ray taken on 10 December 2007 indicated a failing heart. Nevertheless, he was of the view, having examined Mr Crump, that he was developing pneumonia late on Monday, 10 December 2007.
19. Under cross-examination, Dr Nayagam agreed that Mr Crump was given morphine on 10 December 2007 and that it was administered for some 36 to 48 hours. He agreed that medication was given as palliative care to ease Mr Crump’s discomfort in breathing. He agreed that Mr Crump’s COAD did not make a great deal of difference to his time of death.
20. Dr B Collins, a forensic pathologist, provided a written report dated 30 April 2009 and gave oral evidence. Dr Collins’ evidence was given on the basis of medical records and documents provided to him. In his view, Dr Nayagam could have listed COAD, amongst a number of other medical conditions from which Mr Crump suffered, as a cause of death on his death certificate. He was of the opinion that Mr Crump’s development of an acute chest infection during his terminal admission to hospital could reasonably be regarded as having hastened his death.
21. Dr Collins was also of the view that the clear lung fields and white blood cell count within the normal range, disclosed by the chest x-ray and blood test performed on 10 December 2007, were definitive indications of the absence of a chest infection. He said that the white cell count in debilitated elderly patients may not reflect inflammation or infection. He said that if it was accepted that Mr Crump suffered bronchopneumonia immediately prior to his death, it would be reasonable to state it at least hastened his death, as its development would be exacerbated by pre‑existing COAD.
22. Under cross-examination, Mr K Rudge, an advocate with the Department of Veterans Affairs, asked Dr Collins if patients suffering from multiple myeloma not infrequently developed pneumonia. He said that a chest infection is a common cause of death in those circumstances. Mr Rudge pointed out to Dr Collins that there was no reference in the medical notes to the administration of antibiotics. He was asked to explain why Mr Crump would be prescribed antibiotics at a time when the family agreed he should not be resuscitated. Dr Collins simply said that conditions can change.
23. Dr Collins also said that the hospital notes for 5 December 2007 record Mr Crump had a cough which was chesty and moist. Dr Collins agreed that the chest x-ray conducted on 10 December 2007 indicated left ventricular failure. When it was put to Dr Collins that a normal white cell count on 10 December 2007 would not be consistent with a chest infection, Dr Collins said he could not argue with that interpretation. Nevertheless, he said that, given Mr Crump’s multiple myeloma, all the cells which he produced were abnormal. Therefore, it may have been possible to not see a typical response to white cell counts. Dr Collins also pointed out that Mr Crump had a recent transfusion and that elderly patients may not necessarily respond in a typical way to such treatment.
24. Professor J F Cade, a principal specialist in intensive care at the Royal Melbourne Hospital, provided two written reports, dated 2 April 2009 and 9 June 2009. Professor Cade was of the view that advanced myeloma (bone cancer) was the principal cause of Mr Crump’s death. He explained that the condition was difficult to treat and was often fatal. Professor Cade also said that the most significant co‑morbidity (a condition existing simultaneously with and usually independently of another medical condition) was Mr Crump’s cardiac disease.
25. Professor Cade was also of the view that Mr Crump’s final respiratory problem was due to cardiac failure rather than chest infection. This was because, two days prior to his death, a chest x-ray disclosed left ventricular failure (due to a severe aortic stenosis) and not pneumonia. A blood examination on that day disclosed a normal white cell count without any toxic changes. He said the underlying cause of Mr Crump’s death was multiple myeloma. It was documented to have been advanced and incurable. The fact that Mr Crump had a variety of difficult complications prior to his death was to be expected in the setting of a frail, elderly patient. He also noted that hypercalcaemia was a well-documented and difficult complication of Mr Crump’s malignancy.
26. Professor Cade said Dr Nayagam’s opinion that Mr Crump’s chronic bronchitis and emphysema contributed to his final chest infection and therefore accelerated his decline did not stand up to a more detailed examination. He said if bronchopneumonia in fact occurred, that condition in a patient with advanced cancer is in fact a mechanism of death, but it is not a direct cause of death which would have occurred at about the same time regardless of the presence or absence of any other condition. He also said that the evidence supporting a diagnosis of bronchopneumonia was tenuous. In his opinion, a more plausible diagnosis was pulmonary oedema (left ventricular failure), which he believed would have been due chiefly to Mr Crump’s known severe aortic stenosis.
27. Professor Cade was also of the opinion that while COAD is known to predispose patients to acute chest infections, this was not the cause of Mr Crump’s chest infection. Mr Crump’s only recorded bronchopneumonia events were in June 2007 (when his specialist considered the cause was his frailty, myeloma induced immune suppression and corticosteroids) and in December 2007 (when he died). I understood Professor Cade to be distinguishing bronchitis, which involves inflammation of the mucus membranes of the bronchial tubes, from pneumonia which is a lung inflammation. Professor Cade also said that the decision made not to resuscitate Mr Crump from 10 December 2007 indicated that his death was imminent, regardless of the presence of any other condition.
28. Professor Cade was of the opinion that Mr Crump’s left ventricular failure without features of pneumonia (on the chest x-ray) and his normal white cell count would be most unusual in a case of serious pneumonia. Professor Cade also referred to blood samples analysed on 9 and 10 December 2007. He said they did not disclose any sign of infection. He was therefore of the opinion that Dr Nayagam’s diagnosis of bronchial pneumonia was an error.
29. Professor Cade said that Dr Collins’ opinion, regarding Mr Crump’s white cell count and the fact that he had a recent blood transfusion, was not correct. He said that in an elderly patient white cells can look abnormal. He explained that what would be observed were the white cell numbers and their appearance. If these cells were affected, the numbers might not be elevated in every case but the blood film would be examined to determine their appearance. He said it was not possible to find an infection where there was no abnormal appearance. As for the tube inserted in Mr Crump’s throat, Professor Cade was of the view that it was not inserted into his lungs but was rather a feeding tube or a tube to clear normal nasal secretions.
30. Under cross-examination, Professor Cade agreed that a person with early stages of a chest infection might nevertheless have a clear x-ray. However, he said that the person would have an elevated temperature. He also agreed that if a patient was frail he could decline rapidly if he had a chest infection. He was asked whether he was aware that Mr Crump had suffered recurrent chest infections from the 1990s onward. Professor Cade said that was not the information he had seen. He said that Mr Crump certainly had impaired immunity due to his treatment for multiple myeloma. When it was put to Professor Cade that Mr Crump suffered acute bronchitis, he again explained that was not a chest infection. He agreed that Mr Crump suffered from bronchitis and emphysema from at least the 1990s. He did accept that Dr McLean recorded a chest infection in 1998.
31. In my opinion, the evidence of Professor Cade is more likely to correctly state the cause of Mr Crump’s death. There are a number of reasons why I have formed this view. As Professor Cade said in a letter dated 22 February 2002 to the Department of Veterans’ Affairs, pneumonia has long been recognised as the terminal event (or mechanism of death) in patients dying from an advanced incurable disease. He described it as a universal phenomenon which cannot logically be attributable to some different underlying condition in some patients, but not in others. In that letter, Professor Cade described specific clinical features indicative of a terminal phase of an illness as extreme inanition, diminished consciousness and uncontrollable symptoms of pain or vomiting.
32. The nursing notes from 10 December 2007 indicate Mr Crump’s limited communications and the fact that he appeared to be in pain. He was restless and agitated at times and he was receiving regular doses of morphine. On 11 December 2007 his wife and family discussed his medical condition with the doctor attending him. The family indicated that it would like him to be kept comfortable and that a Not for Resuscitation Order would be placed in the event that he suffered an arrest. Quite clearly, by 10 December 2007, Mr Crump was in the terminal phase of his multiple myeloma. Therefore, even if the immediate mechanism of death was bronchopneumonia, the most likely cause of death was multiple myeloma.
33. Although Dr Nayagam was asked to comment about whether Mr Crump would have survived for longer than he did, he declined to speculate about that. In fact, Dr Nayagam was not even prepared to say that Mr Crump may have lived for a few more days. Even if Dr Nayagam had suggested that Mr Crump’s death would have occurred at a later date but for the development of bronchopneumonia, that would not have assisted Mrs Crump’s case.
34. Ms F Ryan of counsel appeared on behalf of Mrs Crump. She submitted that if Mr Crump’s death was hastened by an acceleration of his multiple myeloma; and that acceleration was itself caused by bronchopneumonia, which in turn was hastened by the fact that Mr Crump suffered from COAD, a war‑caused condition, that would be sufficient to conclude that his death could be described as war‑caused.
35. In my opinion, there are significant problems with Ms Ryan’s submission. The first is that all of the medical practitioners agreed that Mr Crump’s death would have occurred in any event, regardless of whether he developed bronchopneumonia over the last few days before his death. The second point is that even if Mr Crump developed bronchopneumonia and it hastened his demise, it may nevertheless not be the medical cause of death. The Full Court of the Federal Court dealt with this point in Collins’ case.
36. In that case, the Court had to decide whether, if a medical condition contributed to the death of the veteran only by affecting its timing, the death, or the kind of death (a medical cause of death) did not include that medical condition. The court said at [60]:
… The contention necessarily carries with it the proposition that any particular effect upon the time of death must as a matter of law be a death and a kind of death.
37. The Court examined a number of cases dealing with causation and it concluded, at [82]:
[82] Those provisions [s 5AB(2) of the VE Act] support the conclusion that the inquiry about the death or the kind of death for the purposes of the VE Act is, in essence, a question of fact about the medical cause or causes of the death. It does not support the proposition on behalf of Mrs Collins that there is a legislative intention that any medical condition which hastens the time of death of a veteran by a measurable period, even a short one, where in medical terms another medical condition is clearly the medical condition which accounts for the pathological changes leading to death, is itself a medical cause of the death.
38. Dr Nayagam said (in his written report of 28 April 2009) that he believed the rapidity with which Mr Crump succumbed to bronchopneumonia was in some part due to his background COAD. He said the reason he did not include COAD in the death certificate was that it was not the main contributory cause and there was a limit as to how many diseases one could document on a death certificate. He therefore listed the main three conditions which directly lead to Mr Crump’s death. He said Mr Crump’s bronchopneumonia was secondary to his prolonged immobility in the latter stages of his life which he developed on a background of his diagnosed myeloma and hypercalcaemia, both of which are poor prognostic factors. He said that at the end of the day, the outcome would probably have been the same, whether or not Mr Crump had COAD; but that bronchopneumonia in a lung which is compromised is clearly a worse scenario than in the case where the patient has normal lungs.
39. In my opinion, the evidence of Professor Cade and Dr Nayagam strongly suggests that the outcome in Mr Crump’s case was not significantly altered if in fact he developed bronchopneumonia in the last two days of his life. Therefore, even if I was satisfied that Mr Crump developed bronchopneumonia in the last two days of his life, given that the underlying pathological changes leading to Mr Crump’s death were as a result of his multiple myeloma and hypercalcaemia, I would find that it did not cause Mr Crump’s death.
40. In fact, I have formed the view that Professor Cade’s opinion that Mr Crump did not finally develop bronchopneumonia is probably correct. This is because the weight of evidence appears to be against Dr Nayagam’s clinical diagnosis of bronchopneumonia. He did not take into account the radiological evidence from a chest x-ray carried out on 10 December 2007 and that Mr Crump’s white cell count at that time was normal. The x-ray conducted on 10 December 2007 indicated left ventricular failure and Mr Crump was known to suffer from severe aortic stenosis.
41. Although Dr Nayagam said in cross-examination that heart failure was commonly bilateral and that his examination of Mr Crump indicated left basal consolidation, Professor Cade disagreed with Dr Nayagam on this point. He said it was not in accordance with the objective findings (which I understood to be the radiology and blood tests). Professor Cade referred to Mr Crump’s blood test results during the last week of his life, which he said indicated no inflammation or infection. Professor Cade also said that of Mr Crump’s co‑morbidities, the most significant was cardiac disease. In my opinion, the explanations given by Dr Nayagam and Dr Collins regarding the radiology findings and the blood tests results do not adequately explain the absence of indicators pointing to bronchopneumonia. I agree with Professor Cade that a logical explanation for this is that bronchopneumonia was not present on 10 December 2009 and that it is more likely that the mechanism of death was cardiac failure. Accordingly, I find that the kind of death suffered by Mr Crump was multiple myeloma in the presence of other co-morbid conditions, including aortic stenosis, cardiac failure, chronic renal impairment and COAD.
WAS MR CRUMP’S DEATH ATTRIBUTABLE TO ELIGIBLE WAR SERVICE
42. Mr Crump’s death must be taken to have been war-caused if his death arose out of, or was attributable to, any eligible war service which he rendered (s 8 of the VE Act). There was no issue about the fact that Mr Crump did not render operational service. Section 7 of the VE Act defines eligible war service. A person has rendered eligible war service if he has rendered continuous full time service as a member of the defence force during World War 2, being service that commenced before 1 July 1947 (s 7(1)(c)). Again, there was no issue about the fact that Mr Crump rendered eligible war service.
43. Mrs Crump also relied on s 8(1)(f) of the VE Act, which provides that the death of the veteran shall be taken to be war-caused if:
(f)the injury or disease from which the veteran died is an injury or disease that has been determined in accordance with section 9 to have been a war-caused injury or a war-caused disease, as the case may be;
Note:The effect of paragraph (f) is that, if the veteran has died from an injury or disease that has already been determined by the Commission to be war-caused, the death is to be taken to have been war-caused. Accordingly the Commission is not required to relate the death to eligible war service rendered by the veteran and sections 120A and 120B do not apply.
but not otherwise.
44. Although Mr Crump had a number of accepted war-caused medical conditions, multiple myeloma was not one of them. Therefore, I must find that s 8(1)(f) of the VE Act has no application in this case. Accordingly, I am required to apply the standard of proof set out in s 120 of the VE Act.
45. Sections 120(1) and (2) of the VE Act do not apply in Mr Crump’s case because he did not have operational service. Neither was he a member of a Peacekeeping Force nor did he render hazardous service, as the VE Act defines those expressions. Therefore, s 120(4) applies to Mr Crump’s case. That section requires me, in making a determination or decision, to decide the matter to my reasonable satisfaction. Furthermore, as set out in s 120B(1)(a), s 120B applies to a claim made under Part II that relates to the eligible war service (other than operational service) rendered by a veteran.
46. Where the veteran has rendered operational service, which requires the establishment of a reasonable hypothesis, I am required to apply s 120(1) regarding the standard of proof. However, in the case of eligible war service I am required to apply s 120B(3), which provides:
(3)In applying subsection 120(4) to determine a claim, the Commission is to be reasonably satisfied that an injury suffered by a person, a disease contracted by a person or the death of a person was war-caused or defence-caused only if:
(a)the material before the Commission raises a connection between the injury, disease or death of the person and some particular service rendered by the person; and
(b)there is in force:
(i) a Statement of Principles determined under subsection 196B(3) or (12); or
(ii) a determination of the Commission under subsection 180A(3);
that upholds the contention that the injury, disease or death of the person is, on the balance of probabilities, connected with that service.
(4)Subsection (3) does not apply in relation to a claim in respect of the incapacity from injury or disease, or the death, of a person if the Authority has neither determined a Statement of Principles under subsection 196B(3), nor declared that it does not propose to make such a Statement of Principles, in respect of:
(a)the kind of injury suffered by the person; or
(b)the kind of disease contracted by the person; or
(c)the kind of death met by the person;
as the case may be.
47. My first step in this process is to determine whether the material before me raises a connection between Mr Crump’s death and his eligible war service. As I have found, Mr Crump’s death was caused by multiple myeloma. Therefore, in order for Mrs Crump to succeed in this application, there must be material before me which connects her husband’s multiple myeloma with his eligible war service.
48. However, there was no such material before me because Mrs Crump contended that her husband’s death was, in part, caused by bronchopneumonia; and the rapidity with which he succumbed to that disease was due to his background COAD. There was no material before me regarding any connection between Mr Crump’s eligible war service and multiple myeloma. Therefore, I find that, on the balance of probability, the cause of Mr Crump’s death was not connected with his eligible war service. It follows that Mrs Crump’s claim cannot succeed.
CONCLUSION
49. I have found that the cause of Mr Crump’s death was multiple myeloma. While this occurred in the presence of a number of co-morbidities, none of those conditions would account for the pathological changes leading to Mr Crump’s death.
50. There was no material before me connecting Mr Crump’s multiple myeloma with his eligible war service. It follows that Mrs Crump’s claim as a result of her husband’s death cannot succeed. Therefore, I find that the decision made by the VRB on 25 November 2008 rejecting Mrs Crump’s claim that her husband’s death was war-caused was correct. I affirm that decision.
DECISION
51. The Tribunal affirms the decision under review.
I certify that the fifty-one [51] preceding paragraphs are a true copy of the reasons for the decision herein of
Mr Egon Fice, Member
[sgd]: Olympia Sarrinikolaou
Clerk
Date of Hearing 10 August 2009
Date of Decision 30 September 2009
Counsel for the Applicant Ms F. Ryan
Solicitor for the Applicant Williams Winter Solicitors
Counsel for the Respondent Mr K. Rudge
Solicitor for the Respondent Department of Veterans’ Affairs
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