Murfey and Repatriation Commission

[2003] AATA 1043

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DECISION AND REASONS FOR DECISION [2003] AATA 1043

ADMINISTRATIVE APPEALS TRIBUNAL)

)No V01/1499

VETERANS' APPEALS DIVISION)ReNANCY MAY MURFEY Applicant

AndREPATRIATION COMMISSION Respondent

DECISION

TribunalMrs Joan Dwyer, Senior Member

Dr P. Fricker, Member

Assoc. Professor J. Maynard, Member Date15 October 2003

PlaceMelbourne

DecisionThe Tribunal affirms the decision under review.(Sgd)Joan Dwyer

Senior Member

VETERANS? ENTITLEMENTS ? whether death war-caused ‑ causes of death pulmonary embolism, septicemia and cholangiocarcinoma ‑ whether material before AAT raised or pointed to any hypothesis connecting death with circumstances of service ‑ no hypothesis raised ‑ decision affirmed

PRACTICE AND PROCEDURE ? CONCURRENT EXPERT EVIDENCE ? proposed by Tribunal ‑ information sheet forwarded to parties ‑ ?Concurrent Expert Evidence: A Guide to the Use of Concurrent Evidence Procedures in the Tribunal? (?the Guide?) ? doctors met prior to giving evidence as suggested in the Guide ? agreed they should further inspect medical records ‑ hearing adjourned ‑ further reports lodged-parties did not seek resumption of hearing-written submissions received

PRACTICE AND PROCEDURE ‑ new hypothesis may not to be raised after respondent?s final written submission

PRACTICE AND PROCEDURE ‑ Tribunal has no power to reconsider earlier AAT decision which was not the subject of an appeal

Veterans' Entitlements Act 1986 ss?8, 120(1) and (3) and 120A

 TOA \h \c "1" \p 

Bushell v Repatriation Commission (1992) 109 ALR 30

Gorton v Repatriation Commission [2001] FCA 1194 (29 August 2001)

Re Murfey and Repatriation Commission (AAT 11927, 5?June 1997)

Repatriation Commission v Deledio (1998) 49 ALD 193



REASONS FOR DECISION

Mrs Joan Dwyer, Senior Member

Dr P. Fricker, Member

Assoc. Professor J. Maynard, Member

This is an application under s 175 of the Veterans? Entitlements Act 1986 (?the Act?) for review of a decision of the Repatriation Commission (?the Commission?) made 16 February 2000 and affirmed by the Veterans? Review Board (?VRB?) on 27?August 2001.That decision refused Mrs Murfey?s claim for a widows? pension under the Act, on the ground thatthe death of her husband Reginald Murfey was not war-caused.

Mr Larkin of Counsel appeared for Mrs Murfey.Mr Purcell of Counsel appeared for the Repatriation Commission.Mr Larkin called Mrs Murfey, who gave evidence.The Tribunal had before it the documents (?the T documents?) lodged pursuant to s 37 of the Administrative Appeals Tribunal Act 1975 (?the AAT Act?) and also the exhibits tendered during the hearing.The exhibits included medical records relating to Mr Murfey and medical reports from Dr Collins, for the applicant (A2), and from Professor Cade, for the respondent (R1).

Prior to the hearing of this matter, the Tribunal, having read the reports of Dr?Collins and Professor Cade, arranged for the parties to be advised that it considered it would be appropriate for the medical witnesses to give concurrent expert evidence.The Tribunal arranged for the Tribunal?s information sheet, Concurrent Expert Evidence:A Guide to the Use of Concurrent Evidence Procedures in the Tribunal (?the Guide?) to be forwarded to the parties representatives.

Dr Collins and Professor Cade were present at the Tribunal on the day of hearing.They advised the Tribunal that prior to the hearing they had discussed the issues in the matter between themselves as suggested in the Guide.They had agreed that they would prefer to inspect the original medical documents, including X-ray films, prior to giving evidence.

The Tribunal therefore adjourned the hearing to a date to be fixed.The Tribunal requested that the parties seek to obtain more complete notes and in particular that Dr Collins and Professor Cade inspect the original medical notes and X-rays from the Western Hospital, where Mr Murfey was an inpatient from 24?January 1994 to 23 February 1994.After that medical material had been inspected the Tribunal received further reports which were taken into evidence as follows:

Report of Dr Collins dated 17 June 2003 (A3)

Report of Professor Cade dated 11 June 2003 (R4)

At a telephone directions hearing in the matter on 30 June 2003, the Tribunal was advised that the parties did not wish to have the hearing resume, but instead wanted to make written submissions.The Tribunal made directions as requested.The Tribunal has considered the following written submissions:

Applicant?s submission dated 16 July 2003

Respondent?s final submission dated 28 July 2003

Applicant?s reply to respondent?s final submission dated 4 August 2003

Mr Murfey was born on 5 October 1922 and died on 23 February 1994 aged 71.He served with the Australian Army from 5 January 1942 to 24 June 1946.He served in Morotai, Borneo, Madang and Balikpapan.His service is ?operational service? as that term is defined in s 6 of the Act.

Mr Murfey?s sole accepted war-caused disability was bilateral sensorineural hearing loss.

The causes of death as stated in the death certificate (T11 p49) were:

Pulmonary embolism ? 2 weeks

Septicemia ? 2 weeks

Cholangiocarcinoma ? 7 months

RELEVANT LEGISLATIVE PROVISIONS

Section 8 of the Act provides the circumstances in which a death shall be taken to have been war-caused.So far as relevant it provides:

(1)Subject to this section, for the purposes of this Act, the death of a veteran shall be taken to have been war-caused if:

(a)the death of the veteran resulted from an occurrence that happened while the veteran was rendering operational service;

(b)the death of the veteran arose out of, or was attributable to, any eligible war service rendered by the veteran;

As Mr Murfey had operational service the relevant standard of proof is that set out in s?120(1) and (3) of the Act.They provide as follows:

120Standard of proof

(1)Where a claim under Part II for a pension in respect of the incapacity from injury or disease of a veteran, or of the death of a veteran, relates to the operational service rendered by the veteran, the Commission shall determine that the injury was a war-caused injury, that the disease was a war-caused disease or that the death of the veteran was war-caused, as the case may be, unless it is satisfied, beyond reasonable doubt, that there is no sufficient ground for making that determination.

Note:This subsection is affected by section 120A.

. . .

(3)In applying subsection (1) or (2) in respect of the incapacity of a person from injury or disease, or in respect of the death of a person, related to service rendered by the person, the Commission shall be satisfied, beyond reasonable doubt, that there is no sufficient ground for determining:

(a)that the injury was a war-caused injury or a defence-caused injury;

(b)that the disease was a war-caused disease or a defence-caused disease; or

(c)that the death was war-caused or defence-caused;

as the case may be, if the Commission, after consideration of the whole of the material before it, is of the opinion that the material before it does not raise a reasonable hypothesis connecting the injury, disease or death with the circumstances of the particular service rendered by the person.

Note:This subsection is affected by section 120A.

Section 120 is affected by s?120A which so far as relevant provides as follows:

120AReasonableness of hypothesis to be assessed by reference to Statement of Principles

(1)This section applies to any of the following claims made on or after 1 June 1994:

(a)a claim under Part II that relates to the operational service rendered by a veteran;

. . .

. . .

(3)For the purposes of subsection 120 (3), a hypothesis connecting an injury suffered by a person, a disease contracted by a person or the death of a person with the circumstances of any particular service rendered by the person is reasonable only if there is in force:

(a)a Statement of Principles determined under subsection 196B (2) or (11); or?..

that upholds the hypothesis.

The following Statements of Principles (?SoPs?) are relevant to this matter: Malignant Neoplasm of the Bile Duct, No 34 of 1999, which was revoked and replaced by No 17 of 2000 from 17 July 2000, Chronic Bronchitis & Emphysema, No?73 of 1997, and Pulmonary Thromboembolism, No 3 of 2001.

The Full Court of the Federal Court, in Repatriation Commission v Deledio (1998) 49 ALD 193 at p206,  TA \l "Repatriation Commission v Deledio (1998) 49 ALD 193" \s "Repatriation Commission v Deledio (1998) 49 ALD 193" \c 1  has clearly explained the four step process to be adopted in applying s?120(1) and (3) of the Act:

1.The tribunal must consider all the material which is before it and determine whether that material points to a hypothesis connecting the injury, disease or death with the circumstances of the particular service rendered by the person. No question of fact finding arises at this stage. If no such hypothesis arises, the application must fail.

2.If the material does raise such a hypothesis, the tribunal must then ascertain whether there is in force an SoP determined by the authority under s 196B (2). . .

3.If an SoP is in force, the tribunal must then form the opinion whether the hypothesis raised is a reasonable one. It will do so if the hypothesis fits, that is to say, is consistent with the "template" to be found in the SoP. The hypothesis raised before it must thus contain one or more of the factors which the authority has determined to be the minimum which must exist, and be related to the person's service (as required by ss 196B (2) (d) and (e)). If the hypothesis does contain these factors, it could neither be said to be contrary to proved or known scientific facts, nor otherwise fanciful. If the hypothesis fails to fit within the template, it will be deemed not to be "reasonable" and the claim will fail.

4.The tribunal must then proceed to consider under s 120 (1) whether it is satisfied beyond reasonable doubt that the death was not war-caused, or in the case of a claim for incapacity, that the incapacity did not arise from a war-caused injury. If not so satisfied, the claim must succeed. If the tribunal is so satisfied, the claim must fail. It is only at this stage of the process that the tribunal will be required to find facts from the material before it. In so doing, no question of onus of proof or the application of any presumption will be involved.

THE EVIDENCE

Mr and Mrs Murfey were married in 1959.Mrs Murfey gave evidence of her husband suffering severe bowel problems, which she said he attributed to his war service, from the time they were married.That evidence was given, as we understood the applicant?s case, because it was seen as possibly relevant to the cholangiocarcinoma or cancer of the bile duct stated as a cause of death on the death certificate.

Both Dr Collins and Professor Cade agreed that cholangiocarcinoma was the primary cause of death.Ulcerative colitis is recognised as a factor causing or contributing to cholangiocarcinoma.The difficulty facing Mrs Murfey?s claim, in so far as it sought to rely on ulcerative colitis, was that there was no medical evidence that Mr Murfey had suffered from ulcerative colitis at any time.Dr Collins wrote in his report (A2):

In the materials provided, I can identify no evidence to support the view that the late Mr Murfey possibly suffered from either ulcerative colitis or cirrhosis?

Professor Cade did not expressly address that issue in his report, but he certainly gave no support for any hypothesis that Mr Murfey had suffered from ulcerative colitis before the clinical onset of the cholangiocarcinoma or cancer of the bile duct.

The Tribunal forwarded copies of the transcript of Mrs Murfey?s evidence as to her husband?s bowel problems, to both Dr Collins and Professor Cade before they wrote their second reports.Neither doctor referred to that evidence as raising any hypothesis connecting Mr Murfey?s death from cholangiocarcinoma with the circumstances of his service.

In his first report (A2) Dr Collins had raised an alternative hypothesis linking the septicemia referred to in the death certificate with a chest infection.He wrote:

It is stated in the Inpatient Progress Notes for the entry dated 12/2/94 (p72 of documents), that the source for the septicaemia (organisms actively growing within the circulatory system) was ?most likely biliary.?This is not unreasonable, as infections are well-known complication of biliary tract obstruction, such as by carcinoma in this particular case, however other sites/sources for the organisms to gain entry into the blood stream have not, in my view, been definitively excluded.Blood cultures collected on 9th February 1994 grew Enterobacter cloacae organisms which are commonly found, amongst other habitats, in the human gastrointestinal tract.These organisms may cause extra-intestinal infections such as in the urinary tract, respiratory and central nervous systems.

It is possible that the chest infection from which the deceased was intermittently suffering during the initial days of his terminal admission provided a source of these organisms, which then entered the blood stream, producing the septicaemia which was a significant factor in his demise.

In this regard, it would be important to obtain from the late veteran?s wife/General Practitioner, any history which may indicate that he suffered from chronic obstructive airways disease.If this were established, then there may be a link between war service and death through a war-related cigarette smoking habit, chronic airways disease predisposing to acute chest infection, with the subsequent development of septicaemia and death.It would have to be conceded however that, at best, the septicaemia only hastened the death, as the advanced malignancy of the biliary tree could have resulted in his demise of its own accord in due course.

Dr Collins noted that on 1 May 1998 Mr Murfey?s General Practitioner, Dr Lewi, had written that Mr Murfey had been ?handicapped with a profound Chronic Bronchitis which was directly linked with his smoking habit? (T12 p56).

Professor Cade in his first report (R1) had commented on the suggestion that septicemia was a contributory cause of death.He wrote:

2.What organism caused the septicaemia and what was its origin?

The septicaemia was shown to be due to blood stream infection with Enterococcus faecium (21 January) and Enterobacter cloacae (9 February).These two organisms are both enteric (i.e. gut) bacteria.It is not possible to say for certain whether these organisms came directly from the gut (or biliary tree) or indirectly via another site (e.g. urinary or respiratory tracts), but as they were not cultured from any clinical site apart from the bloodstream, it is almost certain that they came directly from the gut.This sequence would be typical of these infections in such cases.

3.Was septicaemia a contributory cause of death?

Septicaemia (severe sepsis) was well documented during the patient?s terminal admission, and it is a complication which carries a substantial acute mortality in its own right.Although there appeared to be little systemic disturbance related to this complication during the last week of life (e.g. minimal fever or hypotension) and specialist opinion had been that it was under clinical control, it would be hard to deny that septicaemia would have made; some significant contribution to death.However, as Dr Collins rightly pointed out, death in this patient was inevitable from the advanced malignancy itself, so that the amount of any contribution from septicaemia (or any other complication) could not have; been great.

4.Was chronic bronchitis a contributory cause of death?

The patient almost certainly had chronic bronchitis, no doubt smoking-related, and the clinic notes suggest that this was subject to repeated acute infective exacerbations over the years.However, during the patient?s terminal admission, his chest was clinically clear, there were no recorded features of an acute chest infection, and the chest X-ray did not show pneumonia.Chronic bronchitis of the type suggested cannot contribute to death in such a patient except via a significant acute chest infection and this complication has been effectively excluded.

APPLICATION OF THE DELEDIO PRINCIPLES

Applying Step 1 of the Deledio principles, on the medical evidence at the commencement of the hearing there was no material that pointed to a hypothesis connecting Mr Murfey?s death with his service.It was to allow the medical experts to further consider that issue, that the Tribunal, at the parties? request, adjourned the hearing.The Tribunal sent the expert witnesses the transcript of Mrs Murfey?s evidence, and it was understood that they would inspect the hospital records, and, in particular, chest X-rays taken during the last admission.That was in order to see whether there may have been some material, which had not been identified earlier, raising or pointing to a relevant hypothesis which had been suggested by Dr Collins.

The further reports of both Dr Collins and Professor Cade made it clear that they had found no material raising or pointing to any hypothesis which had been suggested in the material before the Tribunal, which would help Mrs Murfey succeed in this application.Dr Collins wrote in his report of 17 June 2003 (A3):

The following are my additional comments which I understand express a similar view to that of Professor Cade.

1.Apart from the chest X-ray performed on 14th February, 1994 which had been reported on as findings in the lower lobe of the left lung being ?consistent with infection or infarction,? there was no other robust evidence, either clinical or on X-ray/pathological investigation, to support the hypothesis that an acute chest infection had developed during this admission and had therefore played a role in his demise.In my view, the presence of such a condition could not be excluded, but it cannot be supported by hard data.

Professor Cade wrote in his report of 11 June 2003 (R4):

I confirm that Dr Collins and I have today examined, firstly separately and then together, this patient?s original medical record from the Western Hospital.

While we are agreed that unfortunately no support can be identified in those documents to support (radiologically or clinically) any proposition of a significant terminal chest infection in this case, we believe that it is proper for us each to make a separate report on the matter.

I thus confirm my original view that there appears to be no plausible hypothesis which can be currently raised linking death with service in this case.

As explained in paragraph 6 of these reasons, the hearing did not resume after the adjournment requested by the proposed medical witnesses, because the parties chose to make written submissions without calling further evidence.The applicant lodged a written submission on 10 July 2003.The respondent?s final submission was dated 28 July 2003.The applicant?s reply to the respondent?s final submission, dated 4 August 2003, for the first time, referred to a possible hypothesis connecting the pulmonary embolism, which was referred to in the death certificate, with venous thrombosis.That matter had not been relied on at any stage of the hearing.Nor had there been any evidence as to the existence of venous thrombosis or as to how it may have been related to service.The processes and procedures of the Tribunal are well known to the representatives of the parties in this matter.The applicant has had a reasonable opportunity to present her case as required by s 39 of the AAT Act.That case made no reference to any hypothesis connecting pulmonary embolism with the circumstances of Mr Murfey?s service.A totally new hypothesis cannot be raised, without any evidentiary basis, in a written submission received by the Tribunal after the respondent?s final written submission.

We have considered all the material which is before the Tribunal and have concluded that the material does not point to a hypothesis connecting Mr Murfey?s death with the circumstances of his service.This application must therefore fail, as explained at Step 1 of the Deledio principles.

REFERENCE TO AAT 1997 DECISION

Professor Cade, in his report (R4), after stating that there was no plausible hypothesis which could be ?currently raised? linking Mr Murfey?s death with his service, added:

However, we are both disturbed on behalf of the widow by the fact that at the initial hearing in 1997 the AAT clearly made an error in not accepting the veteran?s smoking habit as being service-related.If the AAT had accepted this in the way it should have, the widow would have succeeded in her case, because prior to the subsequent issuing of a specific SoP for cholangiocarcinoma, a contributory aetiology from smoking would have been probably accepted for this form of cancer.It is ironic for her presently that while her husband?s smoking is now (correctly) able to be related to service, the subsequent SoP does not include a smoking aetiology.We therefore wonder whether there is any avenue for legal appeal for her, given these somewhat contrary circumstances.

The reference there to the ?initial hearing in 1997? is a reference to a decision of Deputy President Gerber, Re Murfey and Repatriation Commission (AAT 11927, 5?June 1997), TA \l "Re Murfey and Repatriation Commission (AAT 11927, 5?June 1997)" \s "Re Murfey and Repatriation Commission (AAT 11927, 5 June 1997)" \c 1  which affirmed a decision rejecting an earlier claim by Mrs Murfey to have her husband?s death recognised as war-caused.The basis of that claim was that there was a reasonable hypothesis that service related smoking had contributed to the cholangiocarcinoma which caused the death.

There is no mention in the reasons for decision of Deputy President Gerber of a SoP in respect of cholangiocarcinoma, even though the first SoP concerning cholangiocarcinoma was No 39 of 1995.It is not clear from the reasons for decision when the claim was lodged.It is only necessary to refer to SoPs if the claim was lodged after 1 June 1994 (s 120A).It would appear that either the earlier claim was lodged before that date, or it was decided by the Repatriation Commission before SoP No 39 of 1995 came into force.The Tribunal was therefore free to decide whether or not a reasonable hypothesis was raised on the basis of the medical evidence, as explained in Bushell v Repatriation Commission (1992) 109 ALR 30 TA \l "Bushell v Repatriation Commission (1992) 109 ALR 30" \s "Bushell v Repatriation Commission (1992) 109 ALR 30" \c 1 .

There is now a SoP dealing with Malignant Neoplasm of the Bile Duct, which applies to cholangiocarcinoma.It seems that there have been three such SoPs.No?39 of 1995 was revoked and replaced by No 34 of 1999, which concerns Malignant Neoplasm of the Bile Duct, with effect 27 April 1999.The current SoP, No 17 of 2000, also concerns Malignant Neoplasm of the Bile Duct.It revoked and replaced No 34 of 1999, with effect from 17 July 2000.Mrs Murfey would be entitled to rely on either the current SoP or that which was in effect on 16 February 2000 (see Gorton v Repatriation Commission [2001] FCA 1194 (29 August 2001) TA \l "Gorton v Repatriation Commission [2001] FCA 1194 (29 August 2001)" \s "Gorton v Repatriation Commission [2001] FCA 1194 (29 August 2001)" \c 1  Neither of those SoPs recognises smoking as a causative factor for cholangiocarcinoma or cancer of the bile duct.

We note that Mr De Marchi stated in the applicant?s written submission dated 16 July 2003, that the SoP for cholangiocarcinoma had been revoked and there is now no SoP for the condition.So far as we are aware SoP No 17of 2000, which covers cholangiocarcinoma is still in force.Thus, as Professor Cade wrote, the position may be ?ironic?, but there is nothing which we can now do to enable Mrs?Murfey to have death from cholangiocarcinoma recognised on the basis of smoking (even if it should be accepted as service related) having been a causative factor in the development of the condition.

However, because of Professor Cade?s reference to the AAT in 1997 having ?clearly made an error? we have decided to make some comment about our lack of power to reconsider that decision.Deputy President Gerber decided that there was a reasonable hypothesis that smoking was a risk factor in cholangiocarcinoma. Mrs?Murfey?s case failed because the Deputy President described himself as ?having not been persuaded that the disease . . . resulted from an occurrence that happened while [Mr Murfey] was rendering operational service.?

The Deputy President was apparently referring to his finding earlier in his reasons in the following terms:

Weighing up these competing propositions - the veteran's statement to Dr Jenkins on the one hand and Mr Turton's "impression" based largely on hearsay evidence - I am not satisfied that the onus of establishing that the war caused the veteran to change his smoking habit, let alone that war-related smoking was a factor in the veteran's condition of CBT, has been made out.True it is that exhibit 4 (the Jenkins' report) was only handed to Mr De Marchi shortly before the proceedings commenced.However, I am satisfied that he was on sufficient notice that the issue between the parties was not merely to be decided by weighing up competing epidemiological conclusions on the effect of smoking on biliary tract cancers, and had Mr De Marchi sought an adjournment to enable him to attempt to collect some evidence to support the beleaguered evidence of Mr Turton, which was clearly contradicted by the Jenkins report, I would have granted it without hesitation.Alas, no such application was made.Indeed, it was only at my suggestion that Mr De Marchi was persuaded to call Mr Turton.

In the result, I find that this claim must fail on the ground that there is no, or no sufficient, evidence of a causal connection between the veteran?s smoking habit and his war service, in the sense that it has not been shown to my satisfaction that he only began to smoke after enlisting in the armed forces and/or increased his cigarette consumption during war service.To the extent that it was sought to establish that critical link, I find the evidence of Mr Turton as well-intentioned, but unreliable.

I am mindful that I am not bound by strict rules of evidence and that I am dealing with remedial legislation which demands no more than that the material before the Tribunal raises a reasonable hypothesis that the veteran's death was connected with his service (Bushell v Repatriation Commission (1992) 109 ALR 30).Be that as it may, the "reasonable hypothesis" test applies only at the point where the veteran has passed the evidentiary threshold linking the incriminating feature relied on to his war service - and that threshold must meet the ordinary civil standards of proof.No matter how benevolently I approach this case, I find it impossible to conclude that there is any reliable evidence to rebut the veteran's own admission that he smoked heavily before the war and smoked "same quantity war service".Whilst I am perplexed why the veteran should have stated on that occasion that he gave up smoking 20 years ago, when I am satisfied that at the time he made that statement he had given up smoking only six years before, I have not been persuaded that this inconsistency justifies me in discounting the reliability of his other statement, a statement at odds with all the oral evidence given at the hearing.

Those findings are expressed in language which is unusual in a matter where the reasonable hypothesis standard of proof is applicable.Although they appear to be findings of fact, there could have been an appeal to the Federal Court, if the view was taken that the standard of proof applied was not in accordance with s?120(1) and (3) of the Act.However, there was no appeal of the 1997 AAT decision.We have no power in this proceeding to reconsider the earlier AAT decision.

CONCLUSION

The decision under review will be affirmed.

I certify that the 34 preceding paragraphs are a true copy of the reasons for the decision herein of

Mrs Joan Dwyer, Senior Member

Dr P. Fricker, Member

Assoc. Professor J. Maynard, Member

Signed: Nick Fletcher

Associate

Date/s of Hearing15 April 2003

Date of Decision15 October 2003

Counsel for the ApplicantMr A Larkin

Solicitor for the ApplicantDe Marchi and Associates

Counsel for the RespondentMr G Purcell

Solicitor for the RespondentDepartment of Veterans' Affairs

PAGE

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