Meehan and Repatriation Commission
[2000] AATA 987
•14 November 2000
DECISION AND REASONS FOR DECISION [2000] AATA 987
ADMINISTRATIVE APPEALS TRIBUNAL )
) No N1999/861
VETERANS' APPEALS DIVISION )
Re JAMES SYDNEY MEEHAN
Applicant
And REPATRIATION COMMISSION
Respondent
DECISION
Tribunal Mr B. H. Pascoe, Senior Member
Date14 November 2000
PlaceSydney
Decision The Tribunal affirms the decision under review
...….(Sgd) B. H. Pascoe..........
Senior Member
CATCHWORDS
VETERANS' AFFAIRS – whether suffering from post traumatic stress disorder – whether exposed to traumatic event – whether suffering generalised anxiety disorder – whether stressful event – whether less than two years before clinical worsening – whether suffering personality disorder – whether inability to obtain appropriate clinical management – whether war-caused
Veterans' Entitlements Act 1986
REASONS FOR DECISION
14 November 2000 Mr B. H. Pascoe, Senior Member
This is an application to review a decision of the Veterans' Review Board ("VRB") of 16 March 1999 which affirmed a decision of the respondent dated 3 June 1996 refusing a claim by the applicant to have the condition of post traumatic stress disorder ("PTSD") and other left bundle branch block accepted as war-caused. In an earlier decision of the VRB on 12 August 1998, the decision of the respondent refusing claim for Impotence, alcohol abuse, left knee problem and hypertension was affirmed. At that time the VRB adjourned the hearing of the application in relation to PTSD and other left bundle branch block pending further investigation. It was the second decision, on these two conditions only, which was the subject of the application to this Tribunal.
At the hearing, the applicant was represented by Mr C. Colborne of counsel and the respondent by Ms M. Doggett, an advocate with the Department of Veterans' Affairs. Evidence was given by the applicant, Mr J. Meehan; his wife, Mrs K. Meehan; and three consultant psychiatrists, Dr A. Dinnen, Dr G. Altman and Dr M. Walden. The Tribunal had the documents provided by the respondent pursuant to section 37 of the Administrative Appeals Tribunal Act 1975 (T1-T47). In addition to reports from the three psychiatrists who gave evidence (A2, A3 and A5 respectively), the following exhibits were tendered:
A1 Statement of the applicant dated 13 January 2000
A4 Report by Dr M. Baz dated 7 June 2000
R2 Report by Dr M. Burns dated 6 October 2000
R3 Report by Professor J. Grey dated 7 January 2000
R4 Records of service, Department of Defence letter dated 30 June 2000
R5 Report by Commodore P. Mulcare dated 2 August 2000.In the statement of issues filed for the applicant prior to the hearing, it was said that the relevant issues were the appropriate diagnosis of the applicant's psychiatric condition, whether such psychiatric condition, a condition of alcohol abuse and the left bundle branch block were war-caused conditions and whether the applicant was entitled to pension at the special rate. At the hearing, it was accepted for the applicant, that the issue of left bundle branch block was not to be pursued. It was accepted, further, that the condition of alcohol abuse was not covered by the relevant reviewable decision of 16 March 1999 and could be considered by the Tribunal only if it could be said to be a symptom of the psychiatric condition and not a separate condition. Finally, it was submitted that, if the Tribunal was to find in favour of the applicant, the matter should be remitted to the respondent for assessment rather than seeking to have the Tribunal attempt that task, given the need for further information.
The veteran, Mr Meehan, served in the Royal Australian Navy from 3 January 1968 to 2 January 1980. After a year's training in Fremantle he joined HMAS Sydney on 7 January 1969 until 14 July 1969. Subsequently, he served on several ships and some shore postings including 11 days in hospital with a fractured skull in 1970. Naval records show that HMAS Sydney made two trips to the Vietnam port of Vung Tau while the veteran was aboard, on 15 February 1969 and 19 May 1969. In the decision of the VRB of 12 August 1998, it was incorrectly stated that the veteran had five periods of operational service in February 1968, April 1968, November 1968, February 1969 and May 1969. These were the dates on which HMAS Sydney made trips to Vietnam but the veteran was still in training at Fremantle during the first three of these trips. Consequently, his operational service was in February and May 1969 only.
Mr Meehan was born on 24 February 1952. His father was killed in Korea in 1954 and his mother was ill for many years. He was raised primarily by his maternal grandparents. He left school at first year high school level. He maintained that he had a good childhood in a coastal village in New South Wales although his grandfather was a strong disciplinarian. Mr Meehan said that he had his first drink of beer at the age of eight when a plastic cup of beer was given to him at a local surf carnival. He said it was some time later before the next as he was flogged by his grandfather after his grandmother smelt the beer. He maintained that he did not get into any serious trouble other than what he described as normal kid's problems, such as breaking lights with a shanghai, until he was 12 years of age. He was then convicted of drunkenness and assault and was sentenced to a juvenile correction centre for three years. He said that, at the time, he had two bottles of beer, had drunk one, when another older boy tried to take the other from him and he hit the other boy over the head with the full bottle. Mr Meehan said that, at school, he would fight with any one if provoked. He had only one friend at school and thought that, perhaps, he did not want a lot of friends. He said that he did not really get into any fights at the detention centre although was in the usual trouble of "being slack" and not doing chores. He accepted that there had been times of truancy when at school but "not very often".
After completing his sentence at the juvenile detention centre, Mr Meehan returned to his grandparents then joined the Navy before he turned 16 years of age. He said that he "was not drinking much then". He said that he did very little drinking at recruit school but, although he was under age, drink was available. He said that he concentrated on sport and had ambitions of becoming a physical training instructor after he attained a Leading Seaman level. He maintained that he started to drink seriously on the way back from the first trip to Vietnam in order to block out the thoughts of that trip. He said that the ration was one large can of beer per night and, although under age and not entitled to a ration, he was readily able to obtain beer from those who did not drink. While each can was punctured on being handed out, he said that it was easy to arrange for the duty electrician to solder over the puncture and store the can for later use. Mr Meehan said that his drinking became regular and more extensive over the period of his service. He accepted that, on at least two occasions, he had been committed to a military prison for assaulting a senior officer. In October 1973 he was admitted to hospital for investigation of enuresis and alcohol abuse and diagnosed as "alcoholism/personality disorder". He was placed on a regime of Antabuse with a recommendation that he continue taking Antabuse for six months. Mr Meehan said that it was supposed to prevent him drinking but it did not and he ceased the medication on discharge from hospital as he considered there was no reason not to drink and he wanted to continue.
Mr Meehan was discharged from the Navy on 2 January 1980 and said that he was told by his Divisional Officer that, with his record of drunken violence, being late returning to ships and number of days off, he was not good material for re-engagement. After leaving the Navy he had many short term jobs in hotels, as a cook in a hostel, with a boat builder, with a builder of water tanks and finally, in 1994, as a painter with his brother-in-law. He has not worked since. Most of his employment positions were terminated as a result of his excessive drinking or violence. In 1980 he was committed to gaol for armed robbery for five years. He first married at the age of 18 to a girl who had become pregnant and pressure from her parents and his mother resulted in the marriage. The marriage was short-lived and a son, now 29, has had no contact with him for most of that time. In 1987, he entered a rehabilitation centre to cure his alcoholism and joined Alcoholics Anonymous. He met his second wife at that time and was married again in 1990. Mr Meehan said that he had not had a drink since 1988.
In his written statement, filed prior to the hearing, Mr Meehan said:
"3. During my service I encountered a number of severely stressful situations. One of these was being the only sentry on the landing craft in Vietnam. I was the only one visible at these times and I expected that I would be shot. The juniors were used for sentry duty. I was just a kid, 16 years old and terrified. This happened on each trip, with the juniors taking turns.
4. On sentry duty on the ship in Vung Tau Harbour the ship was completely blacked out. I was terrified the whole time. I couldn't see further than a couple of feet. We were told to be on the look out for enemy divers and I couldn't see if they were there or not. This happened each of the 5 times I was there.
5. Scare charges were dropped along side the ship at random, day and night, whether you were awake or asleep. You could not relax at any time. I always thought that the next one would blow up the ship. The noise from the explosions would leave you totally deaf each time. I felt there was no way of defending myself and was mentally and physically exhausted all of the time.
6. When we loaded the troops aboard to bring them home we brought the body bags too. I felt so guilty when we left the troops on shore. I felt like we were abandoning them. Death was constantly on my mind and on the mind of others, but there was nothing we could do about it. Coming back from Vietnam on the first trip I began drinking to excess because I found it blocked out everything. I bought the non-drinkers' alcohol issue from them. It was the only way I could sleep. We worked 6 hours on duty and 4 hours off. I often couldn't sleep and walked around like zombie.
…"
In a report from Dr Altman of 10 December 1996 (T10), the history recited stated:
"He served in Vietnam in 1968 to 1969 for approximately five months. He served in the Navy. He served on HMAS Sydney – 'a troop carrier'. He stated that his function was 'a sentry – on watch – and did clearance diving'. He saw people getting killed and wounded and he saw corpses."
In his later report of 23 March 2000, Dr Altman (Exhibit A2) said that, following further discussions with Mr Meehan, the history was correct except for the incorrect statement that "he saw people getting killed and wounded and he saw corpses". In a history recited by Dr Dinnen in his report of 26 May 2000 (Exhibit A3) it was stated that Mr Meehan had "said he had four trips to Vietnam":
"He was the sentry in the bow of the landing craft taking the soldiers ashore from the Sydney to Vietnam when they were anchored in harbour. He said it was pitch black. …"
and
"The patient said that he recalled the cramped conditions lying in a hammock. Charges could be dropped over side while he was resting there during his four hours off duty. There would be no warning for these explosions. He also recalled that they were fired upon from 'Radar Hill' by the enemy. 'They fired a couple of rockets at us', during the Tet Offensive. He said that he didn't witness these rockets, but presumes that he was in the mess at the time and certainly the news of the attack went around the ship within a couple of minutes."
Dr Walden, in her report of 14 September 1999 (Exhibit R1) had taken a history of five trips to Vietnam.
In his oral evidence, Mr Meehan accepted that he had two trips to Vietnam having seen the documentation but had thought previously that there were five trips. He was unable to recall his precise duties but said, at times he was the upper deck sentry with responsibility to watch for divers or debris which could disguise mines. He was armed with an SLR rifle. The ship was blacked out for some 24 hours covering the period from some time prior to entering the harbour to some period after leaving. He said that he acted as bowman in the landing craft ferrying soldiers and equipment to and from the ship. His role was to secure the lines and lower and raise the ramp. He thought he had been issued with a 9 mm Browning but could not be certain. He said that, at all times as sentry and bowman, he was afraid and thought he could die being in a war zone with no knowledge of how far away were any enemy. Scare charges were dropped near the ship with no set pattern or timing and they were very loud and startling particularly when off duty in the mess which was under the water-line. He could not recall whether scare charges were dropped when the ship was moving or only while at anchor. He accepted that no shots were fired and he did not see any killed or injured. He said that some large canvas-type bags were carried on to the ship and, not having seen them before, assumed that they were body bags. He said that the returning soldiers appeared old, tired and "cranky" and he became concerned at leaving new troops behind if they were to finish in the same state. He was firm in his recollection of seeing two rockets fired towards "Radar Hill" which was some 1000 metres from the ship. He did not know who fired them or anything else about them.
Mr Meehan maintained that he lost all interest in sport after his duty on HMAS Sydney and had no desire to participate. He was in trouble regularly for aggression, became isolated and did not socialise with others. Prior to this, he believed he was sociable and able to laugh and drink with others. He said that he went from being able to sleep all night to having a "couple of hours" only. He believes he suffers from nightmares in that he wakes sweating and shaking although he has no recollection of what the nightmares are about. Although he could not recall when they started, he said that he has suffered from panic attacks for "a few years". He becomes startled by loud noises. He is conscious of seeking to sit with his back to a wall and being concerned to have an "escape route". He is more comfortable if he can see where other people are coming from. He suffers from a "churning feeling" in the stomach when anxious or stressed and has tightness in the chest "like a clamp". He said that he believed that his major symptoms are depression, aggression, claustrophobia, fear and anxiety, chest tightening and pain, sweating and shaking.
Mrs Meehan gave evidence that she met her husband in early 1988 and they married in February 1990. He was cooking at the rehabilitation centre. She said there was no peace or calmness about him, he never kept still and acted like "he had a red hot poker on his tail". She said he kept to himself, either in the kitchen, where he preferred no other person to be there at the same time, or in his room. He would do his work before others were out of bed in the morning or after others had gone to bed. Currently, Mr Meehan has his only good sleep in the afternoon unless he takes sleeping tablets. Mrs Meehan said that he was a very light sleeper and she has been "attacked" by him in bed when agitated with his nightmares. His concentration is poor, he is excessively startled by any sudden noise and he becomes agitated when unable to control a situation. She said he "gets the shakes" regularly and has sweating periods with no particular patterns. Mrs Meehan said that she left her husband for a week some years ago when he became aggressive, would not listen and she felt she was unable to reach him. After that episode, she convinced him to seek psychiatric help. Mrs Meehan said that he gave the impression of having had a happy childhood and having adored his grandparents. She said that, after 12 years, details of his Navy experience were still emerging. She believed that his experience in Vietnam was the main contributor to his condition.
Dr Altman has been treating Mr Meehan for some four years and said that he had seen Mr Meehan approximately 46 times over that period. He was of the opinion that Mr Meehan suffers from severe chronic PTSD with major depression. While he accepted that there were problems since childhood with a possible personality disorder, he did not believe that such disorder excludes PTSD. He believed that the nightmares, the sweating on awaking, hyper vigilance and avoidance of thoughts of war were features relevant to a diagnosis of PTSD. In the opinion of Dr Altman, the fact that drugs appeared to have improved the condition of Mr Meehan was a further factor pointing to a diagnosis of an anxiety disorder as drugs are less likely to assist a patient with an anti-social personality disorder. Dr Altman accepted that psychiatrists will normally agree on a precise diagnosis of a disorder in some 50% of cases. He believed that, if he was wrong in diagnosing PTSD, then the next most obvious diagnosis was generalised anxiety disorder with major depression. In relation to concerns on the correctness of the history taken of the Vietnam experience, Dr Altman said that Mr Meehan was reluctant to elaborate in response to questions and considerable time was needed to obtain full information from him.
Dr Dinnen examined Mr Meehan on 16 May 2000 and provided a report dated 26 May 2000. His report concludes with the opinion that:
"I believe this patient suffers from generalised anxiety disorder and psychoactive substance dependence, the second condition being in remission. Both conditions appear to have been aggravated by service. Both conditions apparently were present prior to service, but it seems clear that the generalised anxiety disorder has only become demonstrated in recent years since the patient stopped drinking on a chronically heavy basis.
He has a personality disorder, with antisocial features, unrelated to but aggravated by service.
The patient's condition causes moderately severe incapacity and the prognosis is guarded and he is likely to benefit from ongoing psychiatric management."
Dr Dinnen believed that it was appropriate to conclude that Mr Meehan suffered from a personality disorder and a generalised anxiety disorder prior to service with the Navy. He felt that the alcohol abuse pre-service, during service and post-service masked the symptoms and acted in the same way as drugs reduce symptoms. He accepted that there was an element of underlying personality disorder. He said that, with most personality disorders, the patient is egocentric, does not accept that there is anything wrong in his behaviour and, needing some external factor to blame, tends to exaggerate and be facile with the truth. Dr Dinnen recorded a history from Mr Meehan of being a sentry in the bow of a landing craft when it was pitch black, of charges being dropped over the side while he was resting during his four hours off duty and of being fired upon by rockets during the Tet Offensive.
Dr Walden examined Mr Meehan on 9 September 2000 and provided a report dated 14 September 2000 with a further report dated 9 October 2000. After reciting a history taken from Mr Meehan and, noting some discrepancies between that history and the history given to other psychiatrists, Dr Walden concluded:
"As a child, Mr Meehan would have satisfied the DSM-IV Diagnosis for Conduct Disorder, having a repetitive and persistent pattern of behaviour which violated the basic rights of others or major age appropriate societal norms or rules. He often initiated physical fights. He truanted from school. He consumed alcohol from age 8. He admitted to setting a fire, but said that this was not deliberate. Conduct disorder is often a precursor to Antisocial Personality Disorder.
Mr Meehan fulfils the DSM-IV Criteria for Antisocial Personality Disorder, having had a pervasive pattern of disregard for and violation of the rights of others, occurring since age 15. He has failed to conform to social norms with respect to lawful behaviours. He admitted to repeated theft and was gaoled for an armed bank hold-up. He has a history of irritability and aggressiveness, indicated by repeated physical fights or assaults and has been gaoled on several occasions for this. There has been repeated failure to sustain consistent work behaviour. There was evidence of Conduct Disorder with onset before age 15. Substance Abuse or Dependence is common in those with an underlying Antisocial Personality Disorder.
With regards to the diagnosis of Post-traumatic Stress Disorder, I do not consider that Mr Meehan fulfils the DSM-IV Criteria for this diagnosis. The history of incidents and associated feelings in Vietnam that Mr Meehan described to me is consistent with the history taken by Dr Akkerman. It is not consistent with the history obtained by Dr Altman in his report of 10 December 1996 in which he states, 'He (Mr Meehan) saw people getting killed and wounded and he saw corpses.' Mr Meehan has subsequently confirmed that this is not true. Mr Meehan does describe being frightened of the dark, of the silence, of the sudden noises, and a generalised fear that he could be shot. I cannot satisfy myself that this really fulfils Criterion A of the DSM-IV Criteria for Post-traumatic Stress Disorder, 'The person has been exposed to a traumatic event in which both of the following were present:-1.The person experienced, witnessed or was confronted with an event or events which involved actual or threatened death or serious injury or a threat to the physical integrity of self or others.
2.The person's response involved intense fear, helplessness or horror.'
Mr Meehan describes sometimes thinking about the fear he felt with the darkness and the silence. As he described it to me, his thoughts about Vietnam are of a more generalised nature about the waste and futility of war rather than particular events in which he was involved. He does not have recurrent distressing dreams of experiences in Vietnam. Rather, he describes the assumption that he is having nightmares because he wakes up sweaty a lot of the time. When he does recall a nightmare, they are usually of being in a physical fight or of being chased by an animal. As previously indicated, Mr Meehan has a long history of being involved in physical fights from childhood through to 1987. They are not particularly associated with his experience in Vietnam. I do not see a connection between being chased by animals and his experiences in Vietnam. He does describe tending to walk away from the television if there are items about wars or violence. This symptom is not sufficient to make the diagnosis of Post-traumatic Stress Disorder.
…"
Dr Walden disagreed with Dr Dinnen's diagnosis of an anxiety disorder and considered that what Mr Meehan described as anxiety was more accurately described as aggressiveness. She accepted that there was considerable overlap between symptoms of anxiety and aggression and believed that Mr Meehan found it easier to believe he was anxious rather than angry. Dr Walden was unable to relate Mr Meehan's symptoms to war service and said that any aversion to war was more against the futility of war rather than having nightmares about or reliving his experience during the war service. Dr Walden said that there was little in the way of specific treatment available in the 1960's and 1970's for personality disorder and not a great deal available now, although there was a tendency for improvement of the condition with age. While Dr Walden accepted that Mr Meehan may have some anxiety, she was firm in her view that his history and symptoms were more consistent with an anti-social personality disorder from an early age. She accepted that there may have been some aggravation of the disorder during Navy service.
It was submitted for the applicant that he suffers from PTSD and that the requirements of the relevant Statement of Principles ("SoP") were satisfied. The opinion of Dr Altman was relied upon. It was argued that, if the Tribunal did not accept a diagnosis of PTSD then a diagnosis of generalised anxiety disorder ("GAD") should be accepted which, it was said, satisfied the relevant SoP for that disorder. In the ultimate, Mr Colborne submitted that if neither of these disorders were accepted then Mr Meehan's personality disorder should be accepted as war-caused as a result of a failure to receive appropriate clinical management when diagnosed with the disorder in 1973.
For the respondent it was submitted that Mr Meehan's condition did not satisfy the SoP for either PTSD or GAD. It was said that the appropriate diagnosis was personality disorder which was present prior to service and that this was not a case where Mr Meehan was unable to obtain appropriate clinical management at the hands of the Navy.
There are two issues in this case. The first is to establish the appropriate diagnosis of the condition from which the veteran suffers. Pursuant to section 120 of the Veterans' Entitlements Act 1986 ("the Act") the diagnosis has to be made out to the reasonable satisfaction of the Tribunal standing in the shoes of the respondent, that is, on the balance of probabilities. Having established the diagnosis, section 120(3) of the Act requires the material before the Tribunal to raise a hypothesis connecting the conditions claimed with the circumstances of the veteran's operational service. Under section 120A, if there is in force a SoP issued by the Repatriation Medical Authority in relation to the condition, then the hypothesis is reasonable only if the relevant SoP upholds such hypothesis. The relevant SoPs here are those concerning PTSD (Instrument No. 15 of 1994), GAD (Instrument No. 48 of 1994 as amended by Instrument No. 275 of 1995) and personality disorder (Instrument No. 143 of 1995). The SoPs list the factors, one of which must, as a minimum, exist before it can be said that a reasonable hypothesis has been raised. For the condition of PTSD, the applicant relied on factor 1(a) "experiencing a stressor prior to the clinical onset of post traumatic stress disorder". For the condition of GAD, the applicant relied on factor 1(b) "experiencing a stressful event not more than two years before the clinical onset of generalised anxiety disorder". For the condition of personality disorder the applicant relied on factor 1(b) "inability to obtain appropriate clinical management for personality disorder".
It is appropriate to deal with each alleged condition in turn. Instrument No. 15 of 1994 defines PTSD as a psychiatric condition meeting the following description:
""(a)the person has been exposed to a traumatic event in which:
(i)the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others; and
(ii)the person's response involved intense fear, helplessness, or horror, and
(b)the traumatic event is persistently re-experienced in one or more of the following ways:
(i)recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions;
(ii)recurrent distressing dreams of the event;
(iii)acting or feeling as if the traumatic event were recurring (including a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated);
(iv)intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event;
(v)physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event; and
(c)persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three or more of the following:
(i)efforts to avoid thoughts, feelings, or conversations associated with the trauma;
(ii)efforts to avoid activities, places, or people that arouse recollections of the trauma;
(iii)inability to recall an important aspect of the trauma;
(iv)markedly diminished interest or participation in significant activities;
(v)feeling of detachment or estrangement from others;
(vi)restricted range of affect (eg, unable to have loving feelings);
(vii)sense of a foreshortened future (eg, does not expect to have a career, marriage, children, or a normal life span); and
(d)persistent symptoms of increased arousal (not present before the trauma), as indicated by two or more of the following:
(i)difficulty falling or staying asleep'
(ii)irritability or outbursts of anger;
(iii)difficulty concentrating;
(iv)hypervigilance;
(v)exaggerated startle response; and
(e)duration of the disturbance (indicated by the relevant symptoms set out in paragraphs (b), (c) and (d)) is more than one month; and
(f)the disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning."
In addition to the three psychiatrists who gave evidence at the hearing, Mr Meehan had been examined by two other psychiatrists, Dr M. Richardson in 1996 and Dr K. Akkerman in 1998. The former diagnosed PTSD but with little explanation for his diagnosis and the latter found no evidence of PTSD. Based on the totality of psychiatric evidence and the evidence given to the Tribunal by Mr Meehan, I am not satisfied that he suffers from PTSD. He gave no evidence of recurrent and intrusive recollections of Vietnam, recurring distressing dreams of the event, having flashback episodes or reaction to any cues that symbolise or resemble an aspect of a traumatic event. As stated by several psychiatrists, many of his symptoms are common to an anxiety disorder and a personality disorder. Even if I am wrong in not accepting this diagnosis, I do not accept that factor 1(a) of the SoP applies. Experiencing a stressor is defined as:
"(a)the person experienced, witnessed, or was confronted with an event that involved actual or threatened death or serious injury, or a threat to the person's, or other people's, physical integrity; and
(b)the person's response to that event involved intense fear, helplessness or horror; "
It is clear that Mr Meehan did not experience, witness or was not confronted with anything that involved actual or threatened death or serious injury or a threat to physical integrity. I accept that he may well have been nervous or fearful that some threat might emerge but it is clear that it did not. An expectation of a possible threat is not sufficient to satisfy the factor. Equally, I am not satisfied that his concerns amounted to "intense fear" or "horror". There may have been a feeling of helplessness as a 16 year old with limited knowledge or information but that appeared to be the most that occurred. While accepting that the events were some 39 years ago, his memory of those events was clearly faulty. The historic evidence was that the HMAS Sydney was at anchor in daylight hours only and for a maximum of five and a half hours on each occasion. Scare charges were dropped randomly while the ship was at anchor but not while it was under way. The ship's company were all turned to while the ship was anchored in Vung Tau and it is extremely unlikely that Mr Meehan would have been off duty and in his bunk when the explosions occurred.
It is possible that Mr Meehan suffers from GAD. The SoP for generalised anxiety disorder defines that condition as follows:
"generalised anxiety disorder" means a psychiatric disorder that is a generalised anxiety disorder attracting ICD code 300.02, and which meets the following description (derived from DSM-IV):
(a)excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least six months, about a number of events or activities (such as work or study), which:
(i)the person finds difficult to control; and
(ii)which is associated with three or more of the following six symptoms, at least some of which are present for more days than not for the previous six months:
(A) restlessness or feeling keyed up or on edge;
(B) being easily fatigued;
(C) concentration difficulties or mind going blank;
(D) irritability;
(E) muscle tension;(F) sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep); and
(iii)the focus of which is not confined to features of an Axis I disorder, for example, it is not about:
(A) having a Panic Attack (as in Panic Disorder); or
(B) being embarrassed in public (as in Social Phobia); or
(C) being contaminated (as in Obsessive-Compulsive Disorder);
or
(D) being away from home or close relatives (as in Separation Anxiety Disorder); or
(E) gaining weight (as in Anorexia Nervosa); or
(F) having multiple physical complaints (as in Somatization Disorder); or
(G) having a serious illness (as in Hypochondriasis); and
(iv)it does not occur exclusively during Post-Traumatic Stress Disorder; and
(v)either the anxiety or worry, or physical symptoms, cause clinically significant distress or impairment in social, occupational, or other important areas of functioning; and
(b)which is not due to the direct physiological effects of:
(i)a drug of abuse; or
(ii)a medication; or
(iii)a general medial condition (such as hyperthyroidism); and
(c)which does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder."
Given the difficulty of obtaining agreement between psychiatrists of a precise diagnosis of psychiatric disorders, it is difficult to form a clear opinion of Mr Meehan's condition. The majority of psychiatrists who have examined him have formed the view that he suffers from an anxiety disorder. Certainly, the symptoms described by him appear to satisfy the definition in the SoP. However, it also appears more likely than not that, if he suffers from an anxiety disorder, that disorder was present prior to his service with the Navy. In addition, there is no evidence to satisfy me, on the balance of probabilities, that the accepted stressful event in Vung Tau in 1969 occurred less than two years "before the clinical worsening of generalised anxiety disorder". As a consequence, Mr Meehan does not satisfy the requirements of the relevant SoP for GAD.
It would appear that all psychiatrists agree that Mr Meehan has a personality disorder and has had this disorder since well before his Navy service. The factor relied upon for acceptance of the disorder to be war-caused is "inability to obtain appropriate clinical management for personality disorder". This was said to be relevant because of the diagnosis in October 1973 of "alcoholism/personality disorder". The hospital notes state that "possibly Dr Rowe might consider him for his alcoholic group", "he should continue to take Antabuse 500 mg daily for six months" and "recommend support frequently by M. O. Cresswell". Mr Meehan's evidence demonstrated that he would not accept the recommended treatment and wanted to continue drinking. The psychiatric evidence was that personality disorder is difficult to treat and manage and there is little available currently for such disorders. It is clear that, in 1973, Mr Meehan had access to whatever clinical management which may have been available at that time, but quite deliberately chose not to avail himself of any assistance. As a result it is not accepted that his personality disorder can be attributed to war service.
On balance, it would appear that Mr Meehan suffers from a longstanding personality disorder with an overlay of an anxiety disorder. A feature of the former disorder which was noted by the psychiatrist who gave evidence was the likelihood of the sufferer exaggerating an external event as the cause of his problems. I am not satisfied that the events in Vietnam, while somewhat stressful to a 17 year old, were as stressful or traumatic as Mr Meehan's now unreliable memory sees them.
Given my findings that the psychiatric disorder of Mr Meehan was not war-caused, it is unnecessary to consider whether alcohol abuse is a symptom of his psychiatric condition or a separate condition. However, for completeness, I am of the view that the alcohol abuse would be seen as a separate condition and Mr Meehan would need to satisfy the relevant SoP for that condition. Given his history of drinking from an early age and convictions relevant to drinking, it would seem unlikely that the required factor in the SoP would be satisfied.
It follows from the foregoing that the decision under review should be affirmed.
I certify that the twenty-four (24) preceding paragraphs are a true copy of the reasons for the decision herein of
Mr B. H. Pascoe, Senior Member
Signed: ......Lou Coffey...............................
Personal AssistantDate/s of Hearing 11 October 2000
Date of Decision 14 November 2000
Counsel for the Applicant Mr C. Colborne
Solicitor for the Applicant RL Whyburn & Associates
Solicitor for the Respondent Ms M. Doggett, Departmental advocate
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