Mulquiney and Military Rehabilitation and Compensation Commission (Compensation)

Mulquiney and Military Rehabilitation and Compensation Commission (Compensation) [2023] AATA 2480 (11 August 2023)
Division:VETERANS' APPEALS DIVISION
File Number(s):2021/4308
Re:Susheela Mulquiney
APPLICANT

AndMilitary Rehabilitation and Compensation Commission
RESPONDENT

DECISION
Tribunal:Mr S. Webb, Member
Date:11 August 2023
Place:Canberra

The decision under review is set aside and in substitution thereof the Tribunal decides Ms Mulquiney suffered an adjustment disorder, which is a service disease for which the Military Rehabilitation and Compensation Commission is liable.
.................[SGD]............................
Mr S. Webb, Member
Catchwords
MILITARY COMPENSATION – compensation claim for service injury or disease – depression – adjustment disorder – female sexual dysfunction – borderline personality traits or structure – diagnosis – liability – applicable statements of principles – category 2 stressor – pain – connection between disease and service raised on material – contribution to a material degree – service disease – entitlement to compensation – decision set aside and substituted
Legislation
Military Rehabilitation and Compensation Act 2004 ss 3, 23, 27, 29, 30, 319, 335, 337, 339
Veterans’ Entitlements Act 1986 ss 196B
Statement of Principles concerning adjustment disorder (Balance of Probabilities) (No.24 of 2016)
Statement of Principles concerning depressive disorder (No. 84 of 2015)
Statement of Principles concerning female sexual dysfunction (Balance of Probabilities) (No.96 of 2016)
Cases
Wright and Repatriation Commission [2009] AATA 187
REASONS FOR DECISION
Mr S. Webb, Member
11 August 2023

Susheela Mulquiney served in the Royal Australian Air Force (RAAF). She claimed compensation for ailments she alleged were causally connected to her service. The Military Rehabilitation and Compensation Commission (Commission) determined to accept the claim insofar as the ailments were aggravated by circumstances in Ms Mulquiney’s service. Unhappy with this result, Ms Mulquiney applied for review. The Veterans’ Review Board (VRB) decided to set aside the determination and instead decided Ms Mulquiney’s conditions are not related to her service. Ms Mulquiney applied to the Tribunal for review of this decision.
The proceedings have been protracted. At hearing, an expert witness gave evidence which triggered an application for allowance of additional time for parties to conduct further evidentiary investigations, to adduce further evidence, including on recall of a witness, and to make further submissions. For reasons of procedural fairness, additional time was allowed under direction. The hearing was adjourned, and further hearings were set down. In the result, the parties made further submissions without further witness evidence. Ms Mulquiney provided a further report by Dr Adesanya, dated 2 February 2023 with a briefing email dated 13 November 2022. I have taken these documents into evidence in Exhibit 4.
Facts
Ms Mulquiney enlisted in the RAAF on 14 May 1985 and she was discharged on 31 December 2018. She attained the rank of Sergeant and reached compulsory military retirement age on 1 January 2019, whereupon she transferred into the Active Reserve Force.[1]
[1] Exhibit 2, page 1.
Ms Mulquiney has defence service within the meaning of that term under s 6(1) of the Military Rehabilitation and Compensation Act 2004 (MRC Act).
Ms Mulquiney has a number of conditions and injuries for which liability has been accepted under the Veterans’ Entitlements Act 1986 (VE Act), the Safety, Rehabilitation and Compensation Act 1988 (SRC Act) and the MRC Act,[2] including:
[2] Ibid, Accepted claims, 5 October 2022, pages 1-7.
(a)lumbar spondylosis;
(b)L4-5 disc protrusion;
(c)musculoligamentous sprain of the neck;
(d)musculoligamentous sprain of the thoracic spine;
(e)cervical spondylosis with degenerative disc protrusions;
(f)right shoulder osteoarthritis;
(g)labral tear of the right shoulder;
(h)right shoulder rotator cuff syndrome;
(i)left shoulder acromioclavicular joint synovitis; and
(j)right lateral epicondylitis.
There is no dispute Ms Mulquiney has a history of depression and other mental health issues over many years, from 1986. The parties agree the factual details of this history are set out in a report by Dr Marty Ewer, a consultant psychiatrist, commissioned for the purposes of these proceedings by the Australian Government Solicitor, acting for the MRCC.[3] The historical factual details Dr Ewer reported are supported by medical and psychological records in evidence,[4] and I am satisfied they are correct.
[3] Exhibit 3, R2, report of Dr Ewer, 26 October 2021, pages 3 to 13.
[4] T3, T4, T5, T6, and T9; Exhibit 3, R4, R5 and R7.
It is not necessary to set out Ms Mulquiney’s psychiatric history prior to 2017 in great detail, other than to note the following:
(a)Dr Lowernstern, a consultant psychiatrist, reported clinically significant psychiatric symptoms relating to situational crises unrelated to her service in the period from 2 November 1994 to 6 March 1996.
(b)Ms Mulquiney obtained psychological treatment and counselling from Anne Macdonald, a psychologist, from October 1997 to April 2018.[5]
(c)On 4 June 2009, Ms Macdonald reported Ms Mulquiney “no longer requires psychological treatment” as her “mood and overall functioning has improved markedly” and she “continued to cope with the demands of her somewhat dysfunctional family origin” as well as “the frequent long absences of her partner as part of his role in the RAN”.[6]
(d)On 17 March 2016, Dr Randell, a general practitioner, referred Ms Mulquiney for psychological treatment relating to Menopause.[7]
[5] Exhibit 3, R4, Report of Ms Macdonald, page 2 (page 134).
[6] Ibid, page 203.
[7] T7, folio 218.
In October 2016, Ms Mulquiney underwent abdominal hysterectomy and bilateral salpingo-oophorectomy surgery.[8] She was absent from work for an extended period and, on returning to work on 1 November 2016,[9] she was permitted to work part time hours from home.[10] She was placed under medical restrictions for 3 months from 6 October 2016.[11]
[8] Ibid, folios 148-149.
[9] Ibid, folio 145; Exhibit 2
[10] Ibid, page 157; Exhibit 2, page 4.
[11] Ibid, folios 208-209.
Ms Mulquiney has a history of allergic urticaria and asthma which required treatment and resulted in incapacity for work at various times in and after 2016.[12]
[12] Ibid, folios 126-151.
Ms Mulquiney experienced dental issues which required surgical and other treatments in and after 2015.[13]
[13] Ibid, 121-159, for example.
On 16 January 2017, Ms Mulquiney was posted to Cyber Watch Coordination in the Defence Security Operations Centre (DSOC).
In Ms Mulquiney’s service medical records, Lieutenant Jamieson, a medical officer, recorded:
09/02/2017… [Ms Mulquiney] has been getting a lot of pressure from her workplace wrt her shift working conditions. I received an email 3/7 ago from the member’s supervisor, requesting clarification on the previous PM101 which stated the member was not fit for shift work. During previous discussions with the member, she had indicated she could do daytime shifts, so I advised her supervisor she could complete morning, day or evening shifts, just not complete overnight shifts. Member was advised of this by her workplace and was very upset that her supervisor had not discussed with her that he was going to question the PM101. Mbr’s supervisor also questioning Mbr’s rehab program as there is no documented return to work or rehab program in place for the new workplace. Have tasked Rehab at Duntroon to attempt to contact the member’s rehab provider to provide this information.[14]
…
28/02/2017 Rehab consultant also present – has drafted new return to work program …
Mbr had multiple other concerns with workplace/supervisor as well and requests for paperwork for rehab. Tried to reassure mbr this was not “targetted” at her, however likely that her Army OIC now has different requirements for documentation than her previous RAAF supervisors. encouraged to try not to get upset about it, as long as she is not asked to do anything outside her restrictions…
…
Also has appointment with Anne Macdonald (psychologist) this week, will discuss with her.
feeling tired, fatigue and “laziness” for past 2 months – since posting into new job. Has been stressed since starting back at work this year, worried that boss is going to “target” her for various things. Gets home from work and feels so relieved and does nothing. Wondering if anything else is going on. Still having hormones altered by gynaecologist…
…[15]
[14] T7, folios 144 and 203.
[15] Ibid, folios 143 and 201-202.
I note on 22 February 2017, Raymond Ellett, a physiotherapist, recorded:
… Has been struggling with requirements of work PT – finding that PT staff are expecting member to join in with PT rather than rehab.
Will write PM101 to indicate that ember should be availed time to do rehab exercises – in accordance with J31
Has be sore around the R shoulder blade – following stretching through lat pulldowns.
Cervical ROM. Short left rotation
TOP R post cuff. Left UTs.
Fit for limited duties. duration 28 days.
…[16]
[16] Ibid, folio 202.
On 2 March 2017, Ms Macdonald reported:
I reviewed [Ms Mulquiney] today – I had not seen her for several months…
1.    … she returned to work this year in a new position with what sounds like the opposition to her being unable to work under shift conditions has been a source of stress and anxiety for her.
2.    I am particularly concerned that she has had to manage this return to work herself which has included advising her workplace of her medical limitations both in terms of working hours and physical training…
3.    She is reporting significant levels of fatigue when she does complete a shift in her new role in DSOP…[17]
[17]Exhibit 3, R5, page 154.
On 16 March 2017, Lieutenant Jamieson recorded:
Fatigue has improved since speaking to psychologist…
Rehab consultant has now finalised return to work schedule and RAS and has had meeting with Mbr and supervisor regarding this. Mbr’s supervisor requested to specify “only to work from 0830-1600” as he felt this would be more useful in the workplace to work around. PTI and Physio are still completing activity schedule to work up to PT test…
Mbr much happier and more comfortable now with how things are going at work, as there is the appropriate rehab paperwork in place. Nil major concerns currently.[18]
[18] T7, folio 201.
On 6 April 2017, Ms Macdonald noted “RTW [return to work] plan has been developed” and Ms Mulquiney was feeling “a great deal better”.[19]
[19] Exhibit 3, R5, page 153.
Ms Mulquiney’s medical restrictions were subsequently reviewed by Lieutenant Jamieson, who recorded:
28/04/2017 7-1. Rehabilitation under medical officers direction. Specific restrictions are to be detailed on form PM101 Restriction Removed 28/04/2017
2-4. Unfit repetitive bending or stooping Restriction Removed 28/04/2017
1-6. No abdominal physical training Restriction Removed 28/04/2017
1-5. Exempt a component of physical training Restriction Removed 28/04/2017
No running Restriction Removed 28/04/2017
Removed Restrictions
1-9. Exempt physical testing exempt abdominal component
1-3. No lifting heavy weights greater then 15kg
1-2. Running at own pace
Added Restrictions
4-3. Requires periodic access to specialist care
4-2. Requires access to medical logistics support; requires access to pharmaceutical resupply or medical logistics support whilst deployed at seas
4-1. Requires access to pharmaceutical supply
1-9. Exempt physical testing exempt abdominal component
1-7. Physical training at own pace
1-3. No lifting of heavy weights greater than 15kg
1-2. Running at own pace
…
Otherwise going well, looking forward to being off restrictions and possibility of upcoming USA trip for an exercise. Has been on a recent holiday, really enjoyed this. MH stable currently, still sees psychologist as required.[20]
[20] T7, folios 141-142.
On 5 May 2017, Ms Macdonald noted Ms Mulquiney passed a fitness test and would be upgraded with “restrictions related to activities involving abdominal work”, in consequence of which her mood was “quite good”.[21]
[21] Exhibit 3, R5, page 151.
On 10 May 2017, Lieutenant Jamieson noted:
… Advised it would be in Mbr’s best interest to allow her to continue with rehab PT program for now to continue working on the specific areas she requires and avoid pushing her to do too much too soon. Workplace agreed to this. No further working hours restrictions, however Mbr’s supervisor agreed to wait until return from O/S exercise to USA to put her on shift roster. Mbr was advised there would be long/extended hours for upcoming exercise – she is aware of this and confident she will be able to manage.[22]
[22] T7, folio 199.
On 6 July 2017, Ms Mulquiney consulted a physiotherapist, Mr Ellett, who recorded:
Has been away in USA for work, using gym regularly, has dropped a little weight and is generally moving well. Has a sore R shoulder from baggage carrying.[23]
[23] Ibid, folio 140.
In subsequent consultations, Mr Ellett recorded:
25/07/2017 … Has been getting sore through R traps with bent over bent over Row.
Feels very tight and sore afterwards…
01/08/2017 … (SICK pARADE) Noted onset of niggly pain through shoulder and whole arm at work yesterday.
Worsened at night – no change from NSAIDs
R arm feels heavy and numb – and still feels weak this morning – all the way to the R hand. Was feeling good after last Rx (25/07) but noted yesterday that there was some increasing stiffness through R shoulder and neck…[24]
03/08/2017 … Had a flare up of R arm pain with some sharp pain through the right hand and shooting pain from the R elbow and into the hand.
Currently has pain from R cervical spine through shoulder and into R chest and upper arm – ache and throb but not P+N
Saw MO, time off work, taking mersyndol and had US of R shoulder[25] – identifies mild SSpin tendinopathy.[26]
[24] Ibid, folio 139.
[25] Ibid, folio 195 refers.
[26] Ibid, folio 138.
On 29 August 2017, Ms Mulquiney sought a consultation with Dr Barry, a Defence Medical Officer, due to “emotional upheaval over the weekend” involving a personal situation relating to her husband.[27] Related matters are recorded in notes on 30 and 31 August 2017,[28] and in Ms Macdonald’s clinical notes on 14 September 2017 and 6 March 2018.[29]
[27] Ibid, folio 136.
[28] Ibid, folios 135-136.
[29] Exhibit 3, R5, pages 144 and 149.
On 16 October 2017, Dr Heron requested an MRA scan of Ms Mulquiney’s right shoulder and noted:
… R shoulder pain not really improving with steroid injections (HAD 10 of same) With Dr Charles Howse.
Pain on all movements. power normal. Sensation normal.
…
Referral to orthopaedic surgeon…[30]
[30] T7, folio 134.
On 27 February 2018, Dr Heron downgraded Ms Mulquiney’s fitness status and recorded the following restrictions:
Restrictions
1-2. Running own pace
1-3. No lifting of heavy weights greater than 15kg
1-7. Physical training at own pace
1-9. Exempt physical fitness testing
2-7. Unfit pushing, lifting or throwing
2-9. Unfit reaching R arm
2-10. Unfit gripping R arm
3-5. Unfit weapons handling
3-8. Unfit to drive ADF vehicles
…[31]
[31] Ibid, folio 183.
On 6 March 2018, Ms Mulquiney consulted Ms Macdonald, who recorded:
…
-    wants to make claim for mental health but I discouraged this based on the fact that a lot of her issues based on childhood and family issues
-    …
-    new boss who spelt out his increased demands in what [Ms Mulquiney] described as a bullying manner – I asked if he was just making his requirements v. clear
-    arced up when he asked her why her CRA [compulsory retirement age] had been extended to end of the year (suggested to her that he was entitled to ask this)
-    apparently he has a reputation of being a bully
-    …[32]
[32] Exhibit 3, R5, page 144.
On 26 April 2018, Ms Mulquiney underwent surgery on her right shoulder[33]: an arthroscopic repair of a type 2 SLAP lesion of the biceps anchor and a 20 percent partial thickness tear of the anterior supraspinatus tendon was noted.[34] She was put off work under medical restrictions and experienced post-surgical complications, adhesive capsulitis and pain. [35]
[33] T7, folio 182.
[34] Ibid, folio 178.
[35] Ibid, folios 175-178.
On 29 May 2018, Dr Heron referred Ms Mulquiney to a psychologist for “ongoing management of her low grade anxiety and self esteen [sic] issues”.[36]
[36] Ibid, folio 117.
On 27 July 2018, in an informal meeting with Ms Jung Chung, a rehabilitation consultant, Ms Mulquiney described workplace issues. She was accompanied by her husband, Peter Mulquiney. Ms Mulquiney was referred to Member Support Coordination – Air Force by Ms Chung. Subsequently, on 8 August 2018, Warrant Officer Dimech was assigned as Ms Mulquiney’s Member Support Coordinator. He continued in this role until Ms Mulquiney’s separation from the Permanent Air Force.[37]
[37] T23.
On 20 August 2018, Flight Lieutenant Clarke recorded:
…
Fit for Limited Duties, duration 16 days
LD – Limitation status: Fit to work specific work hours only
EMIS attachment reference code 3 days per week, 4 hours per day for 16 days
…
Surgeon cleared her to drive short distances
Is starting strengthening exercises with physio
Stressed about returning to work
…[38]
[38] T7, folio 175.
On 4 September 2018, Ms Mulquiney’s work restrictions were extended for a further 14 days.[39]
[39] Ibid, folio 174.
On 2 October 2018, Flight Lieutenant Clarke recorded:
… Fit for 4 days per week, 4 hours per day – 28 days
Presenting for review of shoulder and multiple other issues…
1. Shoulder – improvement in ROM; ongoing physiotherapy. Currently working 4 days, 4 hours per day. Has been posted into unit for transition. Would like to be upgraded and complete PFT prior to separation (21 Dec 2018) as she would like to transfer to SERCAT3. Unlikely that she will be able to complete the upper body component – may need permanent restriction for exemption from component of PFT
…
5. New referral to psychologist – Previous psychologist retired – recommended psychologist to take over case. Was given generic referral and saw a psychologist in Deakin who specialises in ?psychological disorders – doesn’t think that he is a good fit and would like to be referred to the recommended psychologist
…[40]
[40] Ibid, folio 172.
In the period from 4 October 2018 to 8 October 2018, Ms Mulquiney raised issues about her treatment in the workplace.[41]
[41] T22.
On 12 October 2018, Mr Ellett recorded:
… Has had some issues at work with expectations and supervisors. Has had a (per member) mini IWB [an Individual Welfare Board meeting facilitated by WO Dimech[42]] last week – with positive outcomes?
Has been quite stressed and upset as a consequence, is sleeping poorly and has not been able to do much in the way of rehab exercises
…[43]
[42] T23.
[43] T7, folio 171.
On 23 October 2018, Flight Lieutenant Clarke referred Ms Mulquiney to a psychologist and to a psychiatrist, noting “Anxiety”,[44] and recorded:
…
Fit for Limited Duties, duration 28 days
LD – Limitation status: Fit to work specified hours only
Presenting for review
Following IWB has been moved to a new work location
Very happy about new location. Feels as though she is being supported by Group Captain in area
Able to focus on rehab and transition
…[45]
[44] Ibid, folios 112 and 117.
[45] Ibid, folio 170.
Later on 23 October 2018, Mr Ellett recorded Ms Mulquiney “Feels that she is in a ‘better place’ psychologically”.[46]
[46] Ibid.
In a rehabilitation assessment consultation on 29 October 2018, Lee Purkiss, a rehabilitation consultant, recorded:
… Mbr reported she is working on her transitions from ADF while aiming for a MEC upgrade on or around 19 November 2018. Mbr has final dental, SHE booked. Mbr will see her psychiatrist Dr Adesanya prior to separation late December 2018. Mbr reported she will have ongoing car with Sean Ford who recognises and treats DVA clients. Mbr has requested RC Purkiss contact Supervisor MAJ Thomson while current supervisor is away overseas… Mbr reported previous workplace stressors have been removed and there should be no significant barriers around effecting transition tasks. Mbr currently working 4 hour 4 days a week.[47]
[47] Ibid, folio 169.

On 14 November 2018, in a periodic health review, Ms Mulquiney undertook a K10 questionnaire:
… K10 score. , 44
K10 score >20 action. Mbr should be given relevant psycho-education.
…[48]
[48] Ibid, folio 167.
On 27 November 2018, Mr Purkiss recorded:
…
Member contact… Mbr reported she has been given the flexibility to action admin tasks to help separate… RC Purkiss stated he is considering closure of ADFRP as mbr is well supported in the workplace, no major workplace stressors/barriers, support from MSC Dimech…[49]
[49] Ibid, folio 164.
On 30 November 2018, Ms Mulquiney consulted Dr Adesanya, a consultant psychiatrist. The doctor noted:
Diagnosis: 1. Major Depressive Disorder (Recurrent but in partial remission).
2. Obsessional personality traits.
Treatment/Plan: 1. [Ms Mulquiney] to continue therapy sessions for her condition under the care and supervision of the ADF MO.
2. Further review in 3 months.[50]
[50] Exhibit 3, R7, page 529.
On 13 December 2018, Flight Lieutenant Clarke recorded:
…
PMhx:
…
Anxiety/Depression
Onset of symptoms mid 2018 in relation to workplace stressors. Was referred to psychologist (Sean Ford) for CBT to manage symptoms. I currently seeing psychologist every 3 weeks.
…
Discussed with member that she is currently not fit for upgrade as she is still undergoing treatment for adhesive capsulitis and will be discharged with a MEC J31. Would like to transfer to reserves so will need a MEC review next year.
…[51]
[51] T7, folios 163-164.
On 31 December 2018, Ms Mulquiney’s Defence employment ended. On 1 January 2019, she was transferred to the Active Reserve Force.[52]
[52] Exhibit 2, page 1.
Ms Mulquiney consulted Dr Adesanya on 28 February 2019.The doctor noted:
…
[Ms Mulquiney] sees her psychologist for monthly therapy sessions, and working with a DVA Advocate towards a claim for compensation…
Examination: [Ms Mulquiney] was brighter but still anxious and intermittently close to tears during this consult.
…
Diagnosis: 1. Major Depressive Disorder (Recurrent but in partial remission).
2. Adjustment disorder with mixed anxiety and depressed mood.
3. Obsessional personality traits.
4. Sexual dysfunction (? Cause, Rule out depression).
…[53]
[53] Exhibit 3, R7, page 530.
Also on 28 February 2019, Dr Adesanya completed an Injury or Disease form and stated:
Medical diagnosis      Adjustment disorder with mixed anxiety and depressed mood.
Basis for diagnosis     [Ms Mulquiney] presented with a clinical history of intermittent anxiety and depressive symptoms that started in the context of alleged bullying and harassment during her employment at HMAS Harman in 2017. [Ms Mulquiney’s] history and examination findings were consistent with the DSM V criteria of the above diagnosis…[54]
Medical diagnosis      Sexual dysfunction.
Basis for diagnosis     Historical accounts of poor libido and lack of sexual arousal in the context of work stress and associated psychological symptoms…[55]
Medical diagnosis      Major Depressive Disorder.
Basis for diagnosis     [Ms Mulquiney] presented with a clinical history and features that were consistent with the DSMV criteria for Major Depressive Disorder during her initial consultation with this author …[56]
[54] T10, folio 242.
[55] Ibid, folio 243.
[56] Ibid, folio 244.
On 18 March 2019, Ms Mulquiney lodged a claim for compensation,[57] in which she stated:
[57] T11.

Injury or disease Mental Health Injury - Depression

When did you first become aware of the signs or symptoms? 10/03/2017

Did the condition result from a specific event or incident that occurred during your service? No

How do you believe your service caused, contributed to or aggravated this injury or disease? I believe being in chronic pain due to my injuries caused during my Defence service and taking a variety of Defence prescribed pain medications cause my depression[58]

…

Injury or disease Mental Health Injury – Adjustment Disorder

When did you first become aware of the signs or symptoms? 10/04/2017

Did the condition result from a specific event or incident that occurred during your service? No

How do you believe your service caused, contributed to or aggravated this injury or disease? I believe having a significant mental health condition, working in a stressful and bulling workplace, with a lack of support from my superiors, undue pressure to perform after surgery and the persistent pain long term from my Defence injuries have caused my mental health problems[59]

…

Injury or disease Mental Health Injury – Female Sexual Dysfunction

When did you first become aware of the signs or symptoms? 15/03/2017

Did the condition result from a specific event or incident that occurred during your service? No

How do you believe your service caused, contributed to or aggravated this injury or disease? I believe being having a chronic mental health condition and the persistent long term pain from my Defence injuries have caused my sexual problems[60]
[58] Ibid, folio 248.
[59] Ibid, folio 249.
[60] Ibid, folio 250.

I note Ms Mulquiney completed an undated online form in which she described the 3 claimed conditions and related diagnoses as aggravations. Each specified 02/08/2017 as the date of onset or worsening, being the “Date based on when the diagnostic protocols were met”.[61] It appears this information was drawn from a report by Dr Adesanya on 17 September 2019.[62]
[61] T8, folios 238-240.
[62] T15.
On 2 December 2019, a delegate in the Department of Veterans’ Affairs issued a determination (original determination),[63] accepting Ms Mulquiney’s claim for:
-    aggravation of the signs and symptoms of major depressive disorder with effect from 2 August 2017
-    aggravation of the signs and symptoms of adjustment disorder with effect from 2 August 2017
-    aggravation of the signs and symptoms of female sexual arousal with effect from 2 August 2017.[64]
[63] T17.
[64] Ibid, folio 284.
On 16 March 2020, Ms Muilquiney’s advocate, Geoff Bolwell of the Veterans Support Centre, lodged “an appeal”, stating:
Ms Mulquiney believes the determination is incorrect.
Ms Mulquiney contends:
…
- She could not find in Dr Adesanya’s report where he mentions “Aggravation of the signs and symptoms…”
- DVA does not have the authority to change or modify the treating psychiatrist diagnosis.
…[65]
[65] T18.
In a supplementary report on 7 May 2020,[66] Dr Adesanya provided a supplementary report and a Medical Impairment Assessment form. The doctor stated:
Sergeant Mulquiney is currently diagnosed with the following conditions:
(a) Major Depressive Disorder (Recurrent but currently in remission).
(b) Adjustment disorder with mixed anxiety and depressed mood.
(c) Sexual dysfunction (Female Sexual Arousal/Interest Disorder).[67]
[66] T20.
[67] Ibid, folio 298.
The doctor also stated that aggravation of the signs and symptoms of each condition was permanent and stable as of 2017.[68]
[68] Ibid, folio 299.
On 4 September 2020, Peter Mulquiney, Ms Mulquiney’s husband, made a statutory declaration setting out his knowledge and recollection of Ms Mulquiney’s workplace experiences in 2017 and 2018.[69]
[69] T26.
On 14 September 2020, Sunita Murphy, Ms Mulquiney’s daughter made a statutory declaration in which she described her knowledge and recollections of Ms Mulquiney’s work-related experiences and mental health in the period from January 2017 to December 2018.[70]
[70] T28.
I note other supporting materials and statutory declarations of Janet Morgan, Nancy Sim and Belinda McIntosh.[71]
[71] T24, T25 and T27.
On 22 October 2020, Dr Adesanya provided a further report,[72] in which he stated:
[72] T29.
This is to advise that [Ms Mulquiney] was diagnosed with the following injuries from her past employment with the Australian Defence Force (ADF):
(a) Adjustment disorder with anxiety,
(b) Major Depressive Disorder,
(c) Female Sexual Dysfunction.
The clinical rationale for the diagnoses were as outlined in my report to the DVA dated 17 September 2019. However, the DVA subsequently decided to accept the following conditions in relation to [Ms Mulquiney’s] work injury claims:
(a) Aggravation of adjustment disorder with anxiety,
(b) Aggravation of major Depressive Disorder,
(c) Aggravation of female Sexual Dysfunction.
The bases and justification for the DVA’s accepted conditions remain unclear to me. However, I am of the opinion the aggravation of [Ms Mulquiney’s] conditions were principally from the stress from her dealing with the DVA regarding her claims, and her recent employment in the RAAF Reserves.
None of [Ms Mulquiney’s] claimed conditions are currently in remission…
On 4 March 2021, the Veterans’ Review Board (VRB) decided to set aside the original determination and substitute a decision Ms Mulquiney suffered from “major depressive disorder, anxiety disorder and female sexual arousal/interest disorder but these conditions are not related to service”.[73]
[73] T1.1.
On 30 June 2021, Ms Mulquiney applied for review of the VRB decision.[74]
[74] T1.
On 13 October 2021, Dr Adesanya provided a further report,[75] in which he clarified his opinion the date of onset of Ms Mulquiney’s diagnosed conditions was not before 2 August 2017.[76] Dr Adesanya gave oral evidence at the hearing in this application, and he was closely cross-examined about the content of his reports and his opinions.
[75] Exhibit 3, A3 (see related briefing letter in A1).
[76] Ibid, page 43 (page 7 of the report).
On 26 October 2021, Dr Ewer reported:
When taking into account the factors I have discussed, it is my clinical opinion, based upon a reasonable degree of medical probability that Ms Mulquiney is suffering from a chronic adjustment disorder with depressed and anxious mood.
Ms Mulquiney has dysfunctional personality traits which are borderline in nature…
Ms Mulquiney has some unprocessed trauma but she is probably not suffering from PTSD…
Ms Mulquiney may be suffering from female sexual interest/arousal disorder.
…
Ms Mulquiney has a long history of fluctuating psychiatric symptoms and it is possible that she may have developed depression and anxiety in early 2017 independent of the external stressors but it is probable that her daughter’s psychiatric problems and her husband having an affair contributed to her psychiatric problems getting worse in 2017… In my opinion, at the beginning of 2017, Ms Mulquiney was very vulnerable and if the decision maker determines Ms Mulquiney was forced to perform duties outside her medical restrictions and she was bullied every day, then this probably exacerbated her pre-existing psychiatric problems…
If Ms Mulquiney is suffering from female sexual dysfunction, it is probably secondary to her personality structure and adjustment disorder.[77]
[77] Exhibit 3, R2, pages 109 and 113 (pages 27 and 31 of the report).
Dr Ewer gave oral evidence at the hearing in this application, and he was closely examined and cross-examined about the content of his report and his opinions.
On 3 May 2022, Ms Macdonald provided a report.[78] Ms Macdonald was not called or required to give oral evidence at the hearing of this application. Her report was admitted into evidence without testing. In the report, Ms Macdonald set out her opinions about Ms Mulquiney’s mental health history and treatment from 1997, and reported:
… I formed the opinion that Ms Mulquiney had a number of characteristics consistent with a diagnosis of Borderline Personality Disorder. While her presentation at the time did not qualify for a full diagnosis of the disorder, there were sufficient characteristics for me to factor this in to my treatment. There was also a strong history of depression particularly in response to relationship breakdowns.
…
In September 2017, Ms Mulquiney’s mood deteriorated significantly as a consequence of learning about her husband having what was described as an “emotional affair” with another woman… This was resolved over a period of time. She reported she had been off work initially for physical concerns but that she had not been able to return to work since she had heard about the affair. She reported severely disturbed sleep and that she had been eating very poorly since the end of August. She reported that felt all of dreams, confidence and future had been shattered by her husband’s disclosure.
…[79]
[78] Exhibit 3, R4 (see briefing letter in R3).
[79] Ibid, pages 135 and 138 (pages 3 and 6 of the report).
On 2 February 2023, Dr Adesanya reported his response to Dr Ewer’s oral evidence in respect of Ms Mulquiney’s alleged borderline personality structure, asserting borderline personality structure is not a recognised diagnosis and setting out his opinion a diagnosis of borderline personality disorder cannot be made on the available materials.
Issues and legislation
The issue to be decided in this review is whether the MRCC is liable to pay compensation to Ms Mulquiney in respect of the alleged injuries claimed.
For Ms Mulquiney to be entitled to compensation pursuant to her claim, it must be established one or more of the alleged injuries is a ‘service injury’ or a ‘service disease’ for which the MRCC is liable under s 23 of the MRC Act:
(1) The Commission must accept liability for an injury sustained, or a disease contracted, by a person if:
(a) the person’s injury or disease is a service injury or disease under section 27; and
(b) the Commission is not prevented from accepting liability for the injury or disease by Part 4; and
(c) a claim for acceptance of liability for the injury or disease has been made under section 319.
Note 1:       The standard of proof mentioned in subsections 335(1) and (2) applies to claims that the injury or disease is a service injury or disease that relates to warlike or non‑warlike service.
Note 2:       The standard of proof mentioned in subsection 335(3) applies to the following:
(a)    claims that the injury or disease is a service injury or disease that relates to peacetime service;
(b)    all claims when determining whether a person sustained a particular injury or contracted a particular disease;
(c)    all claims when determining whether the Commission is prevented from accepting liability for the injury or disease by Part 4.
When Commission must accept liability for service injuries and diseases arising from Commonwealth treatment
(2) The Commission must accept liability for an injury sustained, or a disease contracted, by a person if:
(a) the person’s injury or disease is a service injury or disease under section 29 (arising from treatment provided by the Commonwealth); and
(b) a claim for acceptance of liability for the injury or disease has been made under section 319.
Note:          The standard of proof mentioned in subsection 335(3) applies to all claims:
(a)    that an injury or disease is a service injury or disease under section 29; and
(b)    when determining whether a person sustained a particular injury or contracted a particular disease.
When Commission must accept liability for service injuries and diseases arising from aggravations of signs and symptoms
(3) The Commission must accept liability for an injury sustained, or a disease contracted, by a person if:
(a) the person’s injury or disease is a service injury or disease under section 30 (aggravations etc. of signs and symptoms); and
(b) the Commission is not prevented from accepting liability for the injury or disease by Part 4; and
(c) a claim for acceptance of liability for the injury or disease has been made under section 319.
Note 1:       The standard of proof mentioned in subsections 335(1) and (2) applies to claims that the injury or disease is a service injury or disease that relates to warlike or non‑warlike service.
Note 2:       The standard of proof mentioned in subsection 335(3) applies to the following:
(a)    claims that an injury or disease is a service injury or disease that relates to peacetime service; and
(b)    all claims when determining whether a sign or symptom was aggravated etc.; and
(c)    all claims when determining whether the Commission is prevented from accepting liability for the injury or disease by Part 4.
Acceptance of liability for aggravations etc. of injuries and diseases
(4) A reference in this section to acceptance of liability for an injury or disease is taken to include a reference to acceptance of liability for an aggravation of an injury or disease.
Note:          The definitions of injury and disease exclude aggravations (see section 5).
There is no controversy, and I am satisfied, Ms Mulquiney lodged a claim under s 319 of the MRC Act.
The terms ‘service injury’ and ‘service disease’ are given meaning in s 27, s 29 and s 30. Section 27 is in the following relevant terms:
27 Main definitions of service injury and service disease
For the purposes of this Act, an injury sustained, or a disease contracted, by a person is a service injury or a service disease if one or more of the following apply:
(a) the injury or disease resulted from an occurrence that happened while the person was a member rendering defence service;
(b) the injury or disease arose out of, or was attributable to, any defence service rendered by the person while a member;
(c) in the opinion of the Commission:
(i) the injury was sustained due to an accident that would not have occurred; or
(ii) the disease would not have been contracted;
but for:
(iii) the person having rendered defence service while a member; or
(iv) changes in the person’s environment consequent upon his or her having rendered defence service while a member;
(d) the injury or disease:
(i) was sustained or contracted while the person was a member rendering defence service, but did not arise out of that service; or
(ii) was sustained or contracted before the commencement of a period of defence service rendered by the person while a member, but not while the person was rendering defence service;
and, in the opinion of the Commission, the injury or disease was contributed to in a material degree by, or was aggravated by, any defence service rendered by the person while a member after he or she sustained the injury or contracted the disease;
Note: This paragraph might not cover aggravations of, or material contributions to, signs and symptoms of an injury or disease (see Repatriation Commission v Yates (1995) 38 Administrative Law Decisions 80). This is dealt with in section 30.
(e) the injury or disease resulted from an accident that occurred while the person was travelling, while a member rendering peacetime service but otherwise than in the course of duty, on a journey:
(i) to a place for the purpose of performing duty; or
(ii) away from a place of duty upon having ceased to perform duty.
29 Definitions of service injury, service disease and service death arising from treatment provided by the Commonwealth
Liability for injuries and diseases caused by treatment
(1) For the purposes of this Act, an injury (the relevant injury) sustained, or a disease (the relevant disease) contracted, by a person is a service injury or a service disease if:
(a) all of the following apply:
(i) the person receives treatment for an earlier service injury or service disease;
(ii) the treatment is paid for or provided wholly or partly by the Commonwealth;
(iii) as a consequence of that treatment, the person sustains the relevant injury or contracts the relevant disease; or
(b) the person receives any treatment under regulations made under the Defence Act 1903 for an earlier injury or disease that is not a service injury or service disease and as an unintended consequence of that treatment, the person sustains the relevant injury or contracts the relevant disease.
Liability for injuries and diseases aggravated by treatment
(2) For the purposes of this Act, an injury (the relevant injury) sustained, or a disease (the relevant disease) contracted, by a person is a service injury or a service disease if:
(a) all of the following apply:
(i) the person receives treatment for an earlier service injury or service disease;
(ii) the treatment is paid for or provided wholly or partly by the Commonwealth;
(iii) as a consequence of that treatment, the relevant injury or relevant disease, or a sign or symptom of the relevant injury or relevant disease, is aggravated by the treatment; or
(b) the person receives any treatment under regulations made under the Defence Act 1903 for an earlier injury or disease that is not a service injury or service disease and, as an unintended consequence of that treatment, the relevant injury or relevant disease, or a sign or symptom of the relevant injury or relevant disease, is aggravated by the treatment.
Liability for deaths caused by treatment
(3) For the purposes of this Act, the death of a person is a service death if:
(a) either:
(i) the person receives treatment under this Act for a service injury or disease and the treatment is paid for or provided wholly or partly by the Commonwealth; or
(ii) the person receives any treatment under regulations made under the Defence Act 1903; and
(b) as a consequence of that treatment, the person dies.
30 Definitions of service injury and service disease for aggravations etc. of signs and symptoms
For the purposes of this Act, an injury sustained, or a disease contracted, by a person is a service injury or a service disease if:
(a) the injury or disease:
(i) was sustained or contracted while the person was a member rendering defence service, but did not arise out of that service; or
(ii) was sustained or contracted before the commencement of a period of defence service rendered by the person while a member, but not while the person was rendering defence service; and
(b) in the opinion of the Commission, a sign or symptom of the injury or disease was contributed to in a material degree by, or was aggravated by, any defence service rendered by the person while a member after he or she sustained the injury or contracted the disease.

The terms ‘injury’ and ‘disease’ are given meaning in s 5:
disease means:
(a) any physical or mental ailment, disorder, defect or morbid condition (whether of sudden onset or gradual development); or
(b) the recurrence of such an ailment, disorder, defect or morbid condition;
but does not include:
(c) the aggravation of such an ailment, disorder, defect or morbid condition; or
(d) a temporary departure from:
(i) the normal physiological state; or
(ii) the accepted ranges of physiological or biochemical measures;
that results from normal physiological stress (for example, the effect of exercise on blood pressure) or the temporary effect of extraneous agents (for example, alcohol on blood cholesterol levels).
injury means any physical or mental injury (including the recurrence of a physical or mental injury) but does not include:
(a) a disease; or
(b) the aggravation of a physical or mental injury.
A person’s entitlement to compensation for a service injury or a service disease is to be worked out under the applicable provision in Chapter 4.
Under s 337, there is no onus on Ms Mulquiney to prove any matter relating to her claim. The applicable standard of proof is set out in s 335(3), namely the reasonable satisfaction standard, subject to the matters set out in s 339, relevantly:
(3) In applying subsection 335(3) to determine a claim, the Commission is to be reasonably satisfied that an injury sustained, or a disease contracted, by a person, or the death of a person, is a service injury, a service disease, or a service death, only if:
(a) the material before the Commission raises a connection between the injury, disease or death of the person and some particular defence service rendered by the person while a member; and
(b) there is in force:
(i) a Statement of Principles determined under subsection 196B(3) or (12) of the Veterans’ Entitlements Act 1986; or
(ii) a determination of the Commission under subsection 340(3) of this Act; and
(c) the material, and the Statement of Principles or the determination (as the case may be), upholds the contention that the injury, disease or death of the person is, on the balance of probabilities, connected with that service.
In order to determine applicable SOPs in this case, it is necessary to determine the kind of disease under claim. Ms Mulquiney’s claim is in respect of “depression”, “adjustment disorder” and “female sexual dysfunction”.
The following relevant Statements of Principles (SOPs) have been determined by the Repatriation Medical Authority:
(a)Statement of Principles concerning depressive disorder (No. 84 of 2015), as amended on 24 September 2018 (Depression SOP);
(b)Statement of Principles concerning adjustment disorder (Balance of Probabilities) (No.24 of 2016), as amended on 24 September 2018 (Adjustment Disorder SOP); and
(c)Statement of Principles concerning female sexual dysfunction (Balance of Probabilities) (No.96 of 2016), as amended on 24 September 2018 (FSD SOP).
When applying the SOPs, the Tribunal must be reasonably satisfied of the following matters:
(a)the ailments under claim are within the terms of the applicable SOP;
(b)any of the factors specified in each applicable SOP exist, including the date of the ‘clinical onset’ or ‘clinical worsening’ of the ailment: and, if so
(c)whether the existence of the factor is related to the relevant service of the person.
Kind of disease
Ms Mulquiney contends she suffered from the claimed diseases in 2017 and the clinical onset of the diseases was on 2 August 2017. She gave evidence she suffered the onset of symptoms of the claimed diseases as a result of bullying, harassment and pressure to undertake duties outside medical restrictions following her return to work in November 2016, and the symptoms persisted to varying degrees thereafter. In support of these contentions, Ms Mulquiney relies on the diagnoses and evidence of Dr Adesanya. She asserts Dr Adesanya’s opinion as a treating psychiatrist should be preferred to the opinions of Dr Ewer who examined her on one occasion only in a medico-legal context.
The MRCC contends Ms Mulquiney did not suffer from the claimed conditions in 2017 and any psychological symptoms she experienced were the result of pre-existing borderline personality traits or factors unrelated to her Defence service. In support of these contentions, the MRCC relies on the expert opinions of Dr Ewer and argues his expert evidence should be preferred to the evidence of Dr Adesanya, who relied heavily on what he was told by Ms Mulquiney without access to her full medical history.
The available evidence clearly establishes Ms Mulquiney has a long history of psychological issues for which she has obtained psychiatric and psychological treatment over many years. Ms Mulquiney has suffered episodes of psychological symptoms in response to psychosocial stressors, including depression and anxiety, since 1994. The episodic course of her psychological symptoms is probably attributable to situational crises and the underlying borderline personality traits identified by Ms Macdonald, Dr Adesanya and Dr Ewer, who also considered unprocessed childhood trauma to be a relevant factor. The available service medical, psychiatric and psychological records in evidence, and Ms Macdonald’s clinical records over an extended period, clearly establish Ms Mulquiney experienced situational stresses in her family from time to time, including marital, parental, health and behavioural issues involving conflict, violence, safety and trust. It is also clear, Ms Mulquiney experienced situations in the context of her Defence service and employment from time to time, including in 2005, 2009, 2010, 2013 and 2016 for example, which caused her to experience stress and psychological symptoms. On the available materials, it is difficult to determine the particular factual circumstances of each such situation, although I note Ms Mulquiney’s December 2005 complaint was investigated and substantially upheld. Nevertheless, on the relevant service medical records and the clinical notes of Ms Macdonald, it is clear enough Ms Mulquiney’s experience of stress and psychological symptoms in such circumstances occurred in a context of other medical and family issues were strongly related to negative perceptions she formed, including unfair treatment, lack of support, derogatory comments, reputational harm, and being targeted, pressured and intimidated by superiors. The records reveal Ms Mulquiney has experienced symptoms, including pain, attributable to physiological conditions affecting her spine, previous injuries and dental issues over a long period. She has obtained manual, pharmacological (including strong opioid analgesic medications) and surgical treatments.
The difficulty of diagnosing Ms Mulquiney’s psychological symptoms has been noted by Ms Macdonald, Dr Klar and Dr Ewer.
On 6 March 2006, Dr Klar commented on the difficulty of diagnosis at that time:
… I am not sure which came first. Are the physiological causes giving her a depression and therefore she is not coping with work – or is it that work is causing a situational depression and exacerbating her physical symptoms? …
…
… I think it is too soon today to start antidepressants (& [Ms Mulquiney] was reluctant even with considering a diagnosis of depression) however if she were to stay like this for a period of time, they may be required.[80]
[80] T9, folio 241.
Dr Adesanya first examined and assessed Ms Mulquiney on 30 November 2018. At that time, he noted diagnoses of Major Depressive Disorder (recurrent in partial remission) and obsessional personality traits. He recorded, on examination, she was “anxious in her mood/affect but not clinically depressed, psychomotor retarded, psychotic or cognitively impaired” at the time.[81] He did not prescribe pharmaceutical treatments for depression, but recommended she continue therapy sessions for her condition.
[81] Exhibit 3, R7, page 529.
Without being in any way critical of Dr Adesanya, there are some difficulties with his evidence, including apparent inconsistencies. The difficulties are related, in part, to a lack of detail in the doctor’s clinical notes which, most significantly, do not contain detailed findings on his clinical examination of Ms Mulquiney. Dr Adesanya gave evidence, as Ms Mulquiney’s treating psychiatrist, he accepted and relied on the information he was given by Ms Mulquiney. I understand, on 6 September 2021, the doctor was given documentary materials which are before the Tribunal for the purposes of producing a report for the purposes of these proceedings.[82]
[82] Exhibit 3, A3.
While Dr Adesanya has adhered to the diagnoses he reported on 28 February 2018, despite close examination on related considerations, he has not provided a detailed rationale to explain the basis for his diagnostic conclusions. Simply asserting the clinical history and symptoms or features are consistent with the diagnostic criteria set out in the Diagnostic and Statistical Manual of Psychiatric Disorders (5^th edition) (DSM V) does not amount to a detailed rationale.
At first blush, Dr Adesanya’s 30 November 2018 clinical finding Ms Mulquiney was not clinically depressed does not align with his diagnosis of major depressive disorder in partial remission. On Dr Adesanya’s evidence, the reference to partial remission should be understood to mean Ms Mulquiney was not severely depressed at the time. If that is correct, the nature of any symptoms Ms Mulquiney was exhibiting at the time which supported the diagnosis of Major Depressive Disorder (Recurrent in partial remission) remains opaque.
Similar issues arise when attempting to understand Dr Adesanya’s evidence in respect of subsequent consultations and his diagnostic conclusions. On 28 February 2019, in a clinical note Dr Adesanya referred to Ms Mulquiney’s major depressive disorder being in partial remission,[83] but in the Injury or Disease Details Sheet he completed on that day he included no reference to Ms Mulquiney’s major depressive order being in remission.[84] On 17 September 2019, Dr Adesanya reported his diagnosis of major depressive disorder without reference to this ailment being in remission or partial remission,[85] despite making a clinical finding on examination that Ms Mulquiney “was anxious in her mood/affect, but not clinically depressed, psychomotor retarded, psychotic or cognitively impaired”.[86] On 7 May 2020, in the context of a claim for permanent impairment compensation, Dr Adesanya reported Ms Mulquiney’s major depressive disorder was currently in remission and it was permanent, having stabilised in 2017.[87] In a further report on 22 October 2020, also in the context of issues relating to permanent impairment compensation, Dr Adesanya stated None of [Ms Mulquiney’s] claimed conditions are currently in remission.[88] On 13 October 2021, having review documents before the Tribunal, Dr Adesanya produced a further report, in which he stated:
.. There was no evidence in the “T Documents” of [Ms Mulquiney] being diagnosed with “Major Depressive Disorder”; “Adjustment Disorder”; or “Female Sexual Arousal/Interest disorder” in the years before the alleged workplace bullying experiences in 2017 or before was diagnosed with them by this author in 2018.
…
Based on the available information to date, I estimate the date of onset of [Ms Mulquiney’s] diagnosed/claimed conditions to be 2^nd August 2017.
…
… [Ms Mulquiney] experienced “mild to moderate episodes of depression” in the context of various psychosocial stressors in the years before 2017. My interpretation of such episodes are consistent with the DSM V diagnosis of “Adjustment disorder with depressed mood”.
[83] Exhibit 3, R7, page 530.
[84] T10, folio 244.
[85] T15, folios 269 and 271.
[86] Ibid, folio 268.
[87] T20, folios 298-299; folios 309-311 refer.
[88] T29, folio 339.
Dr Adesanya first diagnosed adjustment disorder and female sexual dysfunction on 28 February 2019.[89] He reported Ms Mulquiney suffered from an adjustment disorder which started in the context of alleged bullying and harassment during her employment in early 2017.[90] For similar reasons to those I have discussed above, the basis of these diagnoses is not clear from the clinical notes of Dr Adesanya’s consultation with Ms Mulquiney or his examination of her on that day or subsequently. He noted:
… She felt abandoned and unacknowledged by the ADF following her discharge, and was saddened by this. She has reflected on her past symptoms and realises her libido has deteriorated since she started experiencing the issues in her former workplace. [Ms Mulquiney] also continues to avoid sexual/physical intimacy, anergic, amotivated, but has recently resumed gym eercises [sic]
…[91]
[89] Exhibit 3, R7, page 530; T10, folio 242.
[90] T10, folio 242 and T15, folio 272; T20, folios 299-300 refer.
[91] Exhibit 3, R7, page 530.
The doctor stated Ms Mulquiney “presented with a clinical history of intermittent anxiety and depressive symptoms that started in the context of alleged bullying and harassment during her employment at HMAS Harman in 2017”.[92] In his oral evidence, Dr Adesanya explained he could not recall if he was given any of Ms Mulquiney’s medical or clinical history records by Defence or Ms Mulquiney on first consultation, and he relied upon a history provided by Ms Mulquiney. On 17 September 2019, Dr Adesanya reported, during the consultation on 30 November 2018, Ms Mulquiney reported “that she developed anxiety, depression, hypertension and skin rashes/stress hives in the context of bullying and harassment at her place of work at HMAS Harman in 2017”.[93] In his 13 October 2021 report, Dr Adesanya estimated the date of onset of Ms Mulquiney’s adjustment disorder and female sexual dysfunction disorder to be 2 August 2017.[94] When questioned about the basis of this estimated date in oral evidence, Dr Adesanya admitted he might have been influenced by the briefing letter he was provided.
[92] T10, folio 242.
[93] T15, folio 267.
[94] Exhibit 3, A3, page 43 (page 7 of the report).
It is difficult to know what to make of Dr Adesanya’s evidence on these points, which were not adequately explained in his oral evidence despite relevant questions being put.
Ms Macdonald’s clinical notes and the service medical records in T3, T4, T5, T6 and T7 are of assistance in understanding the factual background and the episodes of depression prior to 2017, to which Dr Adesanya is referring.
Ms Macdonald’s clinical records suggest Ms Mulquiney experienced stress and fatigue on returning to work in November 2016, following abdominal surgery. The records establish in the period from 1 November 2016 to 16 March 2017, at least, Ms Mulquiney was stressed about rehabilitation and graduated return to work arrangements in her new workplace, and perceived expectations she would be “targeted” and should undertake work and physical training outside medical restrictions. These issues appear to have been substantially, if not completely, resolved by 16 March 2017, at which point the service medical records notes Ms Mulquiney was “much happier and more comfortable now with how things are going at work” and she was working towards an exercise in the United States of America which she wanted to attend.[95] The service medical record on 10 May 2017 aligns with Ms Macdonald’s clinical record of a consultation with Ms Mulquiney on 4 May 2017, in which Ms Mulquiney’s mood was noted to be “quite good”, having recently passed her fitness training, although at that time she was experiencing pain and family issues.[96]
[95] T7, folio 201.
[96] Exhibit 3, R5, page 151.
The records establish Ms Mulquiney experienced dental, right shoulder and arm pain symptoms in July on a background of dental and cervical spine or neck issues over an extended period. Ms Mulquiney required right shoulder surgery on 26 April 2018 and dental surgery later in 2018, prior to her separation on reaching compulsory retirement age.
Ms Mulquiney’s mental health was affected by events outside work in August 2017. The service medical record on 29 August 2017 aligns with Ms Macdonald’s clinical notes of the consultation with Ms Mulquiney on 14 September 2017, in which she notes Ms Mulquiney “began to self destruct – started smoking again, drank heavily” and “hasn’t slept for more than 2h since 25/8 and has been eating v. poorly” after finding out about her husband’s affair.[97] Ms Macdonald’s clinical notes clearly establish Ms Mulquiney experienced related symptoms for a period, probably until 6 March 2018, when Ms Macdonald noted Ms Mulquiney wanted to make a claim in respect of mental health and she was feeling more settled about her husband’s affair.[98]
[97] Ibid, page 149.
[98] Ibid, page 144.
On 29 May 2018, Dr Heron recorded Ms Mulquiney experienced further stress and psychological symptoms in the context of returning to work following right shoulder surgery on 26 April 2018. On Ms Macdonald’s clinical notes and the relevant service medical records, it is probable these symptoms substantially resolved by 29 October 2018.[99] I note Ms Mulquiney obtained a score of 44 on a K10 psychological test administered on 14 November 2018, indicating the likelihood of some persisting symptoms which required psycho-education.[100]
[99] T7, folios 169-170.
[100] Ibid, folio 167.
Dr Ewer examined Ms Mulquiney on 26 October 2021. Dr Ewer produced a lengthy and detailed report, redolent with scientific discussion of principles, risk factors and psychiatric tests or measurements, and observations about medico-legal assessment methodology. Dr Ewer explained in his oral evidence the documents he was provided when briefed to produce the report.
Dr Ewer confirmed in his oral evidence he did not consider it probable Ms Mulquiney suffered from major depressive disorder, rather he considered she had a borderline personality structure which does not meet the threshold for a personality disorder. It is Dr Ewer’s opinion Ms Mulquiney’s borderline personality structure was susceptible to exacerbation in a context of trauma. This, he explained, would also apply to an adjustment disorder. While in his report, Dr Ewer expressed his “clinical opinion, based on a reasonable degree of medical probability” Ms Mulquiney was suffering from a chronic adjustment disorder with depressed and anxious mood,[101] he was more equivocal in his oral evidence. On Dr Ewer’s evidence, if the factual circumstances alleged by Ms Mulquiney in respect of the bullying, harassment and pressure to work outside medical restrictions are established, this would probably have exacerbated her pre-existing psychiatric problems.[102] Dr Ewer was not able to be confident of the onset of any exacerbation, although he noted some worsening of Ms Mulquiney’s symptoms in 2017.
[101] Exhibit 3, R3, page 109 (page 27 of the report).
[102] Ibid, page113 (page 31 of the report).
Further, it is Dr Ewer’s evidence, if Ms Mulquiney is suffering from female sexual dysfunction, it is probably secondary to her borderline personality structure and any adjustment disorder, if established. The doctor explained he was not confident of the diagnosis, but he could not rule it out.
Ms Macdonald offered a tentative explanation for Ms Mulquiney’s perceptions of bullying, namely “Ms Mulquiney may have believed the workplace Major was doubting that she should have workplace restrictions – i.e. that she was faking or exaggerating her symptoms in some way”.[103]
[103] Exhibit 3, R4, page 140 (page 8 of the report).
On balance, I am reasonably satisfied Ms Mulquiney perceived she was being bullied and harassed, and she was pressured to work beyond her medical restrictions, following her return to work in November 2016, after major abdominal surgery. The perception she formed is supported by service medical records, Ms Macdonald’s clinical records, the statements of Warrant Officer Dimech, Janet Morgan, Nancy Sim, Peter Mulquiney, Belinda McIntosh and Sunita Murphy,[104] and the documents in T22. I am satisfied, in the transition into a new posting on 1 November 2016 and 16 January 2017, her medically authorised graduated return to work program, and her rehabilitation during the post-surgery recovery period, were not clearly communicated to her new supervisors by her rehabilitation case manager. In consequence of this, it was left to Ms Mulquiney to explain such matters to her new supervisor and questions were raised about her capacity to undertake work and training in her new workplace. Once the factual basis of Ms Mulquiney’s negative perceptions resolved, her mood and capacity evidently improved in March and April 2017. On Lieutenant Jamieson’s contemporaneous notes on 16 March, 28 April 2017, 10 May, 19 May and 5 June 2017,[105] it is probable Ms Mulquiney continued to experience symptoms of low mood which resolved by 28 April 2017. This is consistent with Ms Macdonald’s contemporaneous clinical notes on 5 May 2017.
[104] T23, T24, T25, T26, T27 and T28.
[105] T7, folios 197, 198, 199 and 201.

Importantly, as the evidence of Dr Ewer, Dr Adesanya, Ms Macdonald and the relevant service medical records clearly establish, Ms Mulquiney was in a vulnerable psychological condition during this period. Noting the observations made by Dr Ewer about Ms Mulquiney’s borderline personality structure and Ms Macdonald’s observations about Ms Mulquiney’s borderline personality traits, it is possible these were exacerbated by the negative perceptions she formed about actual events in her workplace. As her negative perceptions have a factual basis, on Dr Ewer’s evidence and the evidence of Dr Adesanya, the alternative conclusion is Ms Mulquiney experienced reactive psychological symptoms which are consistent with an adjustment disorder. I am reasonably satisfied this is preferred conclusion which is supported by and consistent with the evidence of Dr Adesanya (despite the difficulties to which I have referred above), Dr Ewer, Ms Macdonald’s contemporaneous records, the relevant contemporaneous service medical records, and Ms Mulquiney’s leave records.
It is possible Ms Mulquiney suffers from major depressive disorder and female sexual dysfunction (or female sexual arousal/interest disorder) as diagnosed by Dr Adesanya. But possibility is not sufficient to make a positive finding. Dr Adesanya stands alone in his diagnosis of these ailments and, in the context of all the material before the Tribunal, his evidence is not sufficient to establish to my reasonable satisfaction that Ms Mulquiney suffered from major depressive disorder or female sexual dysfunction in early 2017 or at any time thereafter during the period of her service, which ended on 31 December 2018.
From this, two things follow. Firstly, I am reasonably satisfied the kind of disease Ms Mulquiney suffers is adjustment disorder with depressed and anxious mood.
Secondly, Ms Mulquiney’s claims in respect of major depressive disorder and female sexual dysfunction (or female sexual arousal/interest disorder) are not made out and are refused.
Service disease
Ms Mulquiney asserts her claim in respect of adjustment disorder aligns with the template of the Adjustment Disorder SOP. In Ms Mulquiney’s submission, it is not possible to determine the date of clinical onset of her adjustment disorder disease with precision. She asserts clinical onset did not occur prior to 2017, but it did occur before the marital issues she experienced in late August 2017. In her submission, the Tribunal should accept Dr Adesanya’s evidence and adopt 2 August 2017 as the date of clinical onset of her adjustment disorder
Ms Mulquiney alleges she experienced a Category 2 stressor within the 3 months before the clinical onset of her adjustment disorder, and she had persistent pain for at least 3 months at the time of the clinical onset of the disorder. These factors, Ms Mulquiney argues, are related to her service. On this basis, Ms Mulquiney contends the adjustment disorder is a service disease under s 27 of the MRC Act.
The MRCC disagrees and asserts the Tribunal cannot be reasonably satisfied of the date of clinical onset of Ms Mulquiney’s adjustment disorder, and it should not accept Dr Adesanya’s evidence on this point.
In the MRCC’s submission, relying on Wright and Repatriation Commission (Wright),[106] the work stressors Ms Mulquiney alleges did not have a chronic effect, rather these were isolated and not chronic in nature, and any effect ceased as at 16 March 2017, when a rehabilitation consultant was appointed. The MRCC argues, while Ms Mulquiney’s marital difficulties might amount to a Category 2 stressor, these circumstances are not related to her service. With regard to the allegation of persistent pain as a causal factor, the MRCC asserts Ms Mulquiney’s pain was not related to her service in the period prior to the clinical onset of adjustment disorder and, furthermore, in respect of pain Ms Mulquiney may have experienced from service-related injuries or diseases, the definition of persistent pain in the Adjustment Disorder SOP was not met in the 6 months prior to clinical onset.
[106] [2009] AATA 187 at [31].
In order to satisfy the template of the Adjustment Disorder SOP, at the minimum, Ms Mulquiney’s adjustment disorder must be within the meaning of Adjustment Disorder in s 7(2), at least one of the factors set out in s 9 must exist, and the factor must be related to Ms Mulquiney’s service for the purposes of s 9.
The following meaning is given to the term Adjustment Disorder in s 7(2):
For the purposes of this Statement of Principles, adjustment disorder means a disorder of mental health meeting the following diagnostic criteria (derived from DSM-5):
(a) The development of emotional or behavioural symptoms in response to an identifiable stressor(s) occurring within three months of the onset of the stressor(s).
(b) These symptoms or behaviours are clinically significant, as evidenced by one or both of the following:
(i) Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation; or
(ii) Significant impairment in social, occupational, or other important areas of functioning.
(c) The stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder.
(d) The symptoms do not represent normal bereavement.
(e) Once the stressor or its consequences have terminated, the symptoms do not persist for more than an additional six months.
The particularity of the elements of this definition were not squarely addressed by the parties. The difficulties with Dr Adesanya’s evidence notwithstanding, considering the relevant service records and clinical notes in evidence, I am reasonably satisfied Ms Mulquiney’s adjustment disorder is within the terms of the definition. I am not persuaded by Dr Ewer’s oral evidence Ms Mulquiney’s disorder is better described as a borderline personality structure, and I accept Dr Adesanya’s evidence a borderline personality structure is not a recognised mental disorder. I am also satisfied Ms Mulquiney’s adjustment disorder is not merely an exacerbation of a previously existing mental disorder.
With regard to the relevant factors set out in s 9, only the factors in s 9 (5) and (8) might be applicable:
At least one of the following factors must exist before it can be said that, on the balance of probabilities, adjustment disorder or death from adjustment disorder is connected with the circumstances of a person’s relevant service:
(1)experiencing a category 1A stressor within the three months before the clinical onset of adjustment disorder;
Note: category 1A stressor is defined in the Schedule 1 - Dictionary.
(2)experiencing a category 1B stressor within the three months before the clinical onset of adjustment disorder;
Note: category 1 B stressor is defined in the Schedule 1 - Dictionary.
(3)being exposed to repeated or extreme aversive details of severe traumatic events within the three months before the clinical onset of adjustment disorder;
Note: being exposed to repeated or extreme aversive details of severe traumatic events is defined in the Schedule 1 - Dictionary.
(4)having a significant other who experiences a category 1A stressor within the three months before the clinical onset of adjustment disorder;
Note: category 1A stressor and significant other are defined in the Schedule 1 - Dictionary.
(5)experiencing a category 2 stressor within the three months before the clinical onset of adjustment disorder;
Note: category 2 stressor is defined in the Schedule 1 - Dictionary.
(6)experiencing the death of a significant other within the three months before the clinical onset of adjustment disorder;
Note: significant other is defined in the Schedule 1 - Dictionary.
(7)having, or being diagnosed with, a medical illness or injury which is life-threatening or which results in serious physical or cognitive disability, within the three months before the clinical onset of adjustment disorder;
(8)having persistent pain of at least three months duration at the time of the clinical onset of adjustment disorder;
Note: persistent pain is defined in the Schedule 1 - Dictionary.
(9)having a severe, chronic medical condition within the three months before the clinical onset of adjustment disorder;
Note: severe, chronic medical condition is defined in the Schedule 1 - Dictionary.
(10)having a miscarriage, foetal death in-utero or stillbirth, within the three months before the clinical onset of adjustment disorder;
Note: miscarriage is defined in the Schedule 1 - Dictionary.
(11)inability to obtain appropriate clinical management for adjustment disorder.
I am satisfied no other factors set out in s 9 other than (5) or (8) arise on the available materials and in the particular circumstances of this case.
The term category 2 stressor is given meaning in Schedule 1:
category 2 stressor means one of the following negative life events, the effects of which are chronic in nature and cause the person to feel on-going distress, concern or worry:
(a)being socially isolated and unable to maintain friendships or family relationships, due to physical location, language barriers, disability, or medical or psychiatric illness;
(b)experiencing a problem with a long-term relationship including the break-up of a close personal relationship, the need for marital or relationship counselling, marital separation, or divorce;
(c)having concerns in the work or school environment including on-going disharmony with fellow work or school colleagues, perceived lack of social support within the work or school environment, perceived lack of control over tasks performed and stressful workloads, or experiencing bullying in the workplace or school environment;
(d)experiencing serious legal issues including being detained or held in custody, on-going involvement with the police concerning violations of the law, or court appearances associated with personal legal problems;
(e)having severe financial hardship including loss of employment, long periods of unemployment, foreclosure on a property or bankruptcy;
(f)having a family member or significant other experience a major deterioration in their health; or
(g)being a full-time caregiver to a family member or significant other with a severe physical, mental or developmental disability.
As can be seen, when deciding if a category 2 stressor exists, there are two elements to consider: firstly, whether one of the negative life events exists; and secondly, whether the effects of the event are chronic in nature and cause the person to feel on-going distress, concern or worry. Both elements must be established on the balance of probabilities before a category 2 stressor arises for the purposes of s 9(5).
Ms Mulquiney asserts both elements are met in respect of (b) and (c).
The service medical records and the evidence of Dr Adesanya, Dr Ewer and Ms Macdonald support the following findings on the balance of probabilities:
(a)Ms Mulquiney perceived a lack of support, a lack of control over tasks (particularly with regard to medical restrictions) and bullying in her workplace following her return to work after major abdominal surgery on 1 November 2016;
(b)Ms Mulquiney felt on-going distress, concern and worry for an extended period, until 16 March 2017, at least;
(c)this period is consistent with a chronic effect, being an effect which is long or continued, rather than acute;
(d)Ms Mulquiney experienced a problem with a long-term relationship from in or about 29 August 2017; and
(e)The effect of this was chronic in nature - she felt ongoing distress, concern and worry about this until 6 March 2018, at least.
Insofar as the parties raised issues in respect of Ms Mulquiney’s circumstances in the period following right shoulder surgery on 26 April 2018, and her negative perceptions and concerns about work stressors in the context of returning to work with post-surgical complications, I am not persuaded this amounts to a category 2 stressor. It can be accepted Ms Mulquiney perceived a lack of support in her workplace in or about 27 July 2018 prior to commencing a graduated return to work on 18 August 2018.[107] It is not established as a probability she felt on-going distress, concern or worry about this or that the effect of her negative perception was chronic in nature. It is not necessary to go any further on this point.
[107] Exhibit 2, page 4; T7, folios 174-175.
I am satisfied Ms Mulquiney experienced category 2 stressors for the purposes of s 9(5).
At this point the issue of clinical onset of Ms Mulquiney’s adjustment disorder is to be determined.
Ms Mulquiney asserts the date of clinical onset is 2 August 2017. Dr Adesanya gave evidence in support of this contention.
On close examination of the materials before the Tribunal, I have found no factual basis for this proposition. It appears to be entirely speculative. I have not been taken to, and I have not found, relevant probative material, and no rational basis has been set out in Dr Adesanya’s evidence, or in submissions. It is not appropriate or permissible to simply pluck a date from thin air on the basis of convenience, and I cannot proceed in such a manner.
I should immediately make 2 observations. Throughout these proceedings, during and after the hearing and in submissions, there has been a great deal of uncertainty about the clinical onset issue and the case advanced for Ms Mulquiney on this point, albeit that Ms Mulquiney’s lay representative, Ross Dunn OAM, appears to have fixed on 2 August 2017. Ms Mulquiney’s claim asserts she first became aware of the adjustment disorder on 10 April 2017. Dr Adesanya has given conflicting evidence on this point, suggesting on one hand the clinical onset was early in 2017 and, on the other, adopting Mr Dunn’s date of 2 August 2017. In these circumstances, there is no surprise sprung upon the MRCC in respect of the clinical onset date which would necessitate a resumption of the hearing on procedural fairness grounds. The MRCC has had a reasonable opportunity to address the evidence and the matters advanced in submissions by Mr Dunn.
Secondly, the Tribunal is not bound to consider and address only the case advanced by any party. Rather, it must make the correct or preferable decision on the materials placed before it, dealing with any relevant issues raised by the materials. In this instance, the Tribunal is not bound by Ms Mulquiney’s assertions when determining the correct or preferable date of clinical onset of her adjustment disorder on the relevant materials.
The clinical symptoms necessary to determine the date of clinical onset of the adjustment disorder are those within the terms of the definition in s 7(2).
The observations of Lieutenant Jamieson on 9 and 28 February 2017, shortly after Ms Mulquiney was posted to DSOC on 16 January 2017, point to Ms Mulquiney experiencing stress and fatigue.[108] Ms Macdonald’s contemporaneous notes on 2 and 3 March 2017 and her 2 March 2017 letter to Dr Jamieson confirm the symptoms of fatigue, and point to Ms Mulquiney being concerned about her daughter’s mental health. On the evidence of Dr Adesanya and Dr Ewer, I am satisfied Ms Mulquiney’s stress and fatigue are clinically significant behavioural responses to the work stressors she perceived. Doing the best with the available materials, it is probable the adjustment disorder was clinically apparent, albeit not diagnosed, on 9 February 2017. I am reasonably satisfied the date of clinical onset of the Disorder is 9 February 2017.
[108] T7, folios 202-203.
That being so, I am reasonably satisfied Ms Mulquiney experienced a category 2 stressor within the 3 months prior to the clinical onset of her adjustment disorder.
From this it follows the factor in s 9(5) of the Adjustment Disorder SOP is made out and exists.
It is not necessary to say much about the second stressor pressed by Ms Mulquiney in s 9(5). I am satisfied her marital problems on and after 29 August 2017 satisfy the definition of a category 2 stressor. I am also satisfied Ms Mulquiney experienced on-going feelings of distress, concern and worry about this which were of a chronic nature and persisted until March 2018, at least. This does not assist Ms Mulquiney’s case, however, as the evidence does not establish the marital stress factor is related to her service.
With regard to Ms Mulquiney’s assertions in respect of the factor in s 9(8) relating to persistent pain, this, too is not made out. The term persistent pain is defined in Schedule 1 in the following terms:
persistent pain means:
(a) continuous pain; or
(b) almost continuous pain; or
(c) frequent, severe, intermittent pain;
which is severe enough to interfere with usual work or leisure activities or activities of daily living.
It may be accepted Ms Mulquiney experienced pain following abdominal surgery in October 2016, and the pain endured to varying degrees for at least 3 months thereafter and this interfered with her usual work activities. It is not established the pain was related to her service, however.
I note Ms Mulquiney’s evidence, including her statement in respect dated 11 April 2022, that she suffered continuous pain from previously accepted service-related cervical and lumbar spondylosis.[109] The evidence does not support the assertion Ms Mulquiney experienced persistent pain from these service diseases of at least 3 months duration at the time of the clinical onset of her adjustment disorder on 9 February 2017. Even if I am wrong about this, no different result is obtained.
[109] Exhibit 2.
The final matter to be determined is whether the factor in s 9(5) is related to Ms Mulquiney’s service for the purposes of s 10 of the Adjustment Disorder SOP.
The materials I have discussed above, including the notes of Lieutenant Jamieson and the records of Ms Macdonald, clearly establish the service contribution to the adjustment disorder was material, at least. Ms Mulquiney’s concerns about the mental health of her daughter or her previous surgery and related hormonal issues may also have contributed to the Disorder, as may her previously existing psychological vulnerability and borderline personality traits. Nevertheless, I am satisfied the factual basis of her negative perceptions about events which actually occurred in her workplace gave raise to the category 2 stressor which was material in her psychological response and the onset of the adjustment disorder subsequently diagnosed by Dr Adesanya.
I am satisfied the template of the Adjustment Disorder SOP is met and Ms Mulquiney’s adjustment disorder is a service disease under s 27(b) for which the MRCC is liable under s 23(1) of the MRC Act.
There are 2 further things to note, for completeness. Firstly, it is not established Ms Mulquiney experienced an aggravation of a previously existing mental health disorder for the purposes of s 30 of the MRC Act. Secondly, Ms Mulquiney raised but then withdrew an assertion in respect of service injury or service disease consequent to medical treatment. No claim for injury or disease was squarely made or put on the basis of s 29 of the MRC Act. On the available materials, Ms Mulquiney’s assertion is not made out.
Conclusion
Ms Mulquiney’s claims in respect of depression (or major depressive disorder) and female sexual dysfunction (or female sexual arousal/interest disorder) are not made out.
Her claim in respect of adjustment disorder is made out. Ms Mulquiney suffered an adjustment disorder for a period commencing on 9 February 2017. In all likelihood, the adjustment disorder substantially resolved by 16 March 2017, with some symptoms of low mood persisting until on or about 28 April 2017.

The decision under review must be set aside and the matter remitted to the MRCC to assess and determine Ms Mulquiney’s entitlement to payment of compensation under Chapter 4 of the MRC Act.
Decision
The decision under review is set aside and in substitution the Tribunal decides Ms Mulquiney suffered an adjustment disorder, which is a service disease for which the MRCC is liable.

I certify that the preceding 133 (one hundred and thirty-three) paragraphs are a true copy of the reasons for the decision herein of Mr S. Webb, Member.

...............[SGD]...........................
Associate
Dated: 11 August 2023

Dates of hearing

5-6 October 2022

Date final submissions received

13 June 2023

Advocate for Applicant:

Mr Ross Dunn OAM, Veterans Support Centre Belconnen ACT

Solicitor for Respondent:

Ms Emma Gorman, Australian Government Solicitor

[2023] AATA 2480

11 August 2023

Key Legal Topics

Areas of Law

Administrative Law

Statutory Interpretation

Legal Concepts

Judicial Review

Procedural Fairness

Causation

Statutory Construction

Remedies

Appeal

Injury or disease	Mental Health Injury - Depression
When did you first become aware of the signs or symptoms?	10/03/2017
Did the condition result from a specific event or incident that occurred during your service?	No
How do you believe your service caused, contributed to or aggravated this injury or disease?	I believe being in chronic pain due to my injuries caused during my Defence service and taking a variety of Defence prescribed pain medications cause my depression[58]
…
Injury or disease	Mental Health Injury – Adjustment Disorder
When did you first become aware of the signs or symptoms?	10/04/2017
Did the condition result from a specific event or incident that occurred during your service?	No
How do you believe your service caused, contributed to or aggravated this injury or disease?	I believe having a significant mental health condition, working in a stressful and bulling workplace, with a lack of support from my superiors, undue pressure to perform after surgery and the persistent pain long term from my Defence injuries have caused my mental health problems[59]
…
Injury or disease	Mental Health Injury – Female Sexual Dysfunction
When did you first become aware of the signs or symptoms?	15/03/2017
Did the condition result from a specific event or incident that occurred during your service?	No
How do you believe your service caused, contributed to or aggravated this injury or disease?	I believe being having a chronic mental health condition and the persistent long term pain from my Defence injuries have caused my sexual problems[60]

Dates of hearing	5-6 October 2022
Date final submissions received	13 June 2023
Advocate for Applicant:	Mr Ross Dunn OAM, Veterans Support Centre Belconnen ACT
Solicitor for Respondent:	Ms Emma Gorman, Australian Government Solicitor