Oliver and Repatriation Commission - [2002] AATA 408

DECISION AND REASONS FOR DECISION [2002] AATA 408

ADMINISTRATIVE APPEALS TRIBUNAL )

) No S2000/279

VETERANS' APPEALS DIVISION       )
           Re      GLENNIS EILEEN OLIVER
  Applicant
           And    REPATRIATION COMMISSION
  Respondent

DECISION

Tribunal Senior Member J.A. Kiosoglous MBE

Date29 May 2002
PlaceAdelaide

Decision The Tribunal sets aside the decision under review and remits the matter to the respondent for reconsideration in accordance with the direction that the veteran's death was war caused within the meaning of section 8 of the Veterans' Entitlements Act 1986.

(Signed)
J.A. KIOSOGLOUS
(Senior Member)

CATCHWORDS
VETERANS' AFFAIRS - veterans' entitlements - whether death war-caused - relevant SoP considered – whether the applicant's high fat diet led to development of dyslipidaemia and ischaemic heart disease – reasonable hypothesis.

Veterans' Entitlements Act 1986 ss.8, 120, 120A
Statement of Principles No. 38 of 1999 concerning ischaemic heart disease

East v Repatriation Commission (1987) 16 FCR 517
Repatriation Commission v Bey [1997] FCA 1347

REASONS FOR DECISION

29 May 2002 Senior Member J.A. Kiosoglous MBE

This is an application by Mrs Glennis Eileen Oliver (the applicant) for review of a decision of a delegate of the respondent dated 6 October 1999 (T26) as affirmed by a decision of the Veterans' Review Board ("VRB") dated 31 May 2000 (T2) rejecting the death of the applicant's husband Mr Harold Wesley Oliver (the veteran) as war-caused within the meaning of section 8 of the Veterans' Entitlements Act 1986 ("the Act").
The Tribunal received into evidence the documents lodged pursuant to section 37 of the Administrative Appeals Tribunal Act 1975 (T1-T32), together with eight exhibits, six lodged by the applicant (Exhibits A1-A6) and two lodged by the respondent (Exhibits R1-R2). In addition, the Tribunal heard evidence from the applicant and Dr John Fraser Sangster, Cardiologist. The applicant was represented by Mr Graham Hemsley of counsel, and the respondent by Mr Greg Doube, a departmental advocate.
The issue before the Tribunal is whether or not the death of the veteran was due to war service pursuant to section 8 of the Act and in particular whether or not the veteran satisfies factor (d) of the relevant Statement of Principles ("SoP"), Instrument No.38 of 1999 concerning ischaemic heart disease (T32/178) namely the presence of dyslipidaemia prior to the clinical onset of ischaemic heart disease.
history of the application
The veteran was born on 18 February 1922 and served with the Australian Army as a signaller from 6 October 1941 to 10 April 1946 during which time he performed operational service from 2 October 1942 to 10 April 1944.
The veteran died on 26 November 1988, aged 66 years. The death certificate (T5/56) lists the cause of death as being:
"Acute myocardial infarction             instant
Coronary occlusion  instant
Coronary atheroma  years
Essential hypertension  10 years"
Mr Hemsley in his opening submissions stated that the hypothesis propounded by the applicant is that the veteran suffered either a "Helicobacter pylori infection" during the course of his service or alternatively that he had an existing infection which was aggravated by the stress of the service, namely the said Helicobacter pylori infection. The hypothesis is that that then led to the development of a duodenal ulcer which was diagnosed in 1961 and accepted by the respondent as being war-caused in 1962. Following on from that is that as a consequence of the duodenal ulcer the veteran went onto a diet which was alleged to be bland so as not to aggravate the ulcer but then had the corollary that it was high in saturated fats. The applicant's contention is that that diet over some twenty-five years or more produced a condition known as "dyslipidaemia" which is otherwise known as "high cholesterol".
It was not disputed that the veteran suffered from a duodenal ulcer nor that he went on a diet high in saturated fats. What was not conceded was that the latter was in any way a material contribution to death. The hypothesis contended by the applicant was that the veteran had dyslipidaemia which was a factor which gave rise to the ischaemic heart disease which was a material contribution to his death. The respondent does not concede that the veteran was suffering from dyslipidaemia at the time of his death.
The applicant submitted a claim to the respondent on 29 September 1999 (T5/47-54) which was rejected by a delegate of the respondent on 6 October 1999 (T26/122-130). The VRB affirmed this decision upon review dated 31 May 2000 (T2). An application for review was lodged with the Administrative Appeals Tribunal on 19 July 2000 (T1).
applicant's evidence
The applicant told the Tribunal that she met her husband (the veteran) in February 1944 and not 1943 as described in her statement (Exhibit A2). Other than the date of meeting her husband she agreed that her statement was correct. According to the Certificate of Marriage the applicant and the veteran married on 17 November 1945 (T5/55). In her statement, the applicant stated that the veteran was a signals mechanic but that due to his health was given a grading of "B2" in lieu of "A1" and that he was not accepted for overseas service.
The applicant stated that the veteran had been experiencing problems for some time prior to his ulcer being diagnosed and that from the time she had met him he was always taking something to ease his indigestion and discomfort. She further stated that the veteran commenced his diet in 1962 and the amount of things he could eat was very limited. His diet was a high fat diet, being a common method of treatment for duodenal ulcer at that time.
When asked as to his diet and what foods the veteran was able to eat the applicant stated that it was directed to being very bland. She also stated that generally his eating of fruit was restrictive. He could eat bananas; stewed apple, apricots or plums; preserved fruit like peaches; and very occasionally a quarter of soft apple. Apart from bananas he could not eat fresh fruit and certainly none of the acidic fruits such as pineapple and oranges. As to vegetables he could eat fresh beans finely cut and cauliflower and sometimes beetroot. He was unable to eat tomatoes unless the skin and seeds were removed, nor could he eat lettuce and cucumber. Furthermore, he never ate fried vegetables, takeaway foods nor onions, garlic, herbal spices and curries.
The applicant stated that the veteran was able to eat plain cake if it did not have in it coconut, dried fruit or seeds of any kind. The veteran only ate plain white bread and nothing with seeds and as for breakfast foods he could not eat anything like muesli. All that he ate were Corn Flakes or Rice Bubbles.
Mrs Oliver stated that the veteran loved dairy products. He found comfort in full cream milk of which he drank "a tremendous amount". He would not have skim milk. She also stated that he ate "lots of cream, lots of ice-cream" and appeared to obtain relief from these. In particular when he experienced "nauseating pain" he would always drink milk. She stated that on average he drank one and a half litres of milk per day including a milk drink before going to bed each night.
During cross-examination Mrs Oliver stated that from the time of their marriage the veteran had a problem with his diet and that they both took care to attempt to identify the food he could eat. She stated that he constantly had Quick-Eze or Mylanta and that the symptoms due to the undiagnosed duodenal ulcer became so bad that upon seeing the doctor in 1962 he was then diagnosed as having the duodenal ulcer. She further stated that prior to the diagnosis the applicant had commenced to eat many of the food items that he needed to eat after the diagnosis. She also stated that prior to 1962 he loved plain cheese and ate it daily mainly at lunchtime and that it also gave him relief. It was further stated that when he kept to the exact diet he did not seem to have so much discomfort.
Mrs Oliver stated that when she first met the veteran "he was very very thin" weighing about six stone and "looked as if he had come out of some prisoner of war camp". She was unable to dispute the statement of service records that stated he weighed nine stones eight pounds in 1943. However, she was adamant that when they met he was extremely thin and that when they married the veteran "stuffed" his pockets with newspaper to make himself look bigger and a little bit more presentable. She explained his loss of weight during war service to his not eating very much and that he had a tremendous number of boils and migraines.
She agreed that at the time the duodenal ulcer had been diagnosed in 1962 the veteran had put on a lot of weight, being eleven stone six pounds. She attributed this weight increase to the diet he maintained through her cooking and preparation of a high fat diet which she described as bland. This was in contrast to the army diet being high in saturated fat. The veteran remained on this diet until his death in 1988.
Mrs Oliver was not aware of any time that the veteran ever had his cholesterol checked nor was she aware at any stage of his cholesterol level. She stated that she was aware that prior to his death he was receiving treatment of some ten years duration for hypertension. She also stated that for hypertension the medication being taken was Mygratin.
mr j.r. hendrickson
In his statement (Exhibit A3) Mr Hendrickson stated that he, the veteran and Mr Cecil Ireland were all conscripted into the army together and that he shared a tent with them and knew them well. At the time of being conscripted he stated that the veteran was in good health and that he was not aware of any health problems nor was he able to comment in relation to the veteran's diet. He stated that he could recall the veteran frequenting the Regimental Aid Post ("RAP") quite often and knew the veteran was unwell. However, he was unable to say what it was that made the veteran ill as the veteran did not discuss health problems with him. He recalled that the veteran had boils and that he frequently attended the hospital in relation to this problem.
mr c.w. ireland
In his statement (Exhibit A4) Mr Ireland recalled his being conscripted together with the veteran and that they shared a tent. He stated that when he and the veteran were conscripted the veteran seemed healthy. He also stated that the veteran's biggest problem was that of boils and he could not recall the veteran ever being without a boil on his body and that the veteran was in continual pain as a result. He further recalled that the veteran frequently visited the RAP but that the veteran never talked about his problems. Mr Ireland stated that the type of food given them "was tinned beef containing a fair bit of fat, meat and vegetable stew, which was not very appetizing and tinned fish which everyone disliked". He recalled the veteran as being very thin, but was not aware that the veteran suffered from problems with his stomach, or that the army food was not agreeable.
dr h. harley
Dr Harley, Consultant Gastroenterologist, provided a report dated 15 March 2001 (Exhibit A5) in which he stated, inter alia:
"… It is now well recognised that Helicobacter pylori infection is the most important factor and contributes to the majority of peptic ulcers. … I am not aware of any compelling scientific evidence that links stressful events with the development of Peptic Ulcer Disease although it is my strong clinical conviction that patients often present with their symptoms of Peptic Ulcer Disease during periods of stress. … The major issue in respect to the case of Harold Wesley Oliver is that of at what stage he was infected with Helicobacter pylori. The assumption throughout the documentation that I have read is that he developed the Helicobacter infection in childhood but there is a strong possibility that this infection occurred during his period of Service where conditions of crowding and less than ideal personal hygiene may have prevailed. If one assumes that the infection did occur during his period of service then there would certainly have been sufficient time for a peptic ulcer to develop as a result of this primary infection.
I am asked to assume, quite reasonably so, that the management of his Peptic Ulcer Disease was largely focused on dietary manipulation. Ms Wilkinson's (Dietician) assessment is that this diet was high in unsaturated fat and that it could therefore contribute to hyperlipidaemia.
Dr John Sangster (Cardiologist) has stated that "a diet high in cholesterol … to control his symptoms from that ulcer … could well have caused an elevated blood cholesterol which would be a significant factor in the development in Coronary Artery Disease." In the absence of any laboratory evaluation of Harold Oliver's serum lipids I am unable to confirm unambiguously whether he had a lipid profile that would have contributed to Coronary Artery Disease.
A scenario which depicted de novo infection of Harold Oliver's stomach with Helicobacter during war service, followed by development of peptic ulcer disease during or soon after his time in the services, followed by a long period on a diet high in unsaturated fats would provide a possible nexus between his war service and acute cardiac event associated with coronary atheromatous artery disease. This sequence of events would fall within the Statements of Principle relating to Ischaemic Heart Disease and Peptic Ulcer Disease, the latter accepted previously as a consequence of his service."

ms g. wilkinson

Ms Wilkinson, Dietician, set out in her report (T30/168) as follows:
"The diet followed is one which was prescribed many years ago for ulcers. Not only was it bland, but unfortunately, excessively high in saturated fat, which is the very type of diet the Heart Foundation and modern research have shown to predispose to heart attack.
The recommendation is that saturated fat be kept to a minimum and replaced with mono and polyunsaturated fats and that the total fat content be kept to less than thirty per cent of energy requirements.
The fat content of the diet followed was extremely high in saturated fat and low in fibre, with fat being the major energy contributor to the diet."

dr j.f. sangster

Dr Sangster, Cardiologist, in his report dated 3 February 2000 (T29/135) stated that he was asked to review the medical evidence concerning the death of the veteran and to see whether there could be any possible relationship to his war service. In his report he stated, inter alia, as follows:
"I note the history which included sudden death whilst playing tennis back in 1988 which was almost certainly due to an acute myocardial infarction. I note that he has an accepted disability for duodenal ulcer and that for many years he had a diet high in cholesterol (e.g. dairy products) to control his symptoms from that ulcer. This in itself could well have caused an elevated blood cholesterol which would be a significant factor in the development of coronary artery disease.
I note that he had hypertension 1982 but it was almost certainly present considerably longer than that and I note the readings in 1959 of 160/90 and 150/100. In current standards these readings would be regarded as significantly elevated. His hypertension would clearly have contributed to the development of his premature coronary artery disease. It is clear that he was described as a fairly stressful individual and there is of course considerable discussion in the literature as to the relevance of stress and hypertension. There is some evidence supporting the view that systolic hypertension may be caused by chronic stress and this may have been a factor in this particular case.
Thus although it is impossible to prove a cause or relationship between this man's war service and his subsequent coronary artery disease and sudden death, I believe the Tribunal should consider reviewing the case in the light of the evidence presented above. …"
In his oral evidence Dr Sangster upon being referred to the veteran's diet (T30/169-173) stated that a diet high in dairy products was the standard diet for the treatment of duodenal ulcers "in those early days". He also stated that such a high dairy product diet had the likelihood of raising cholesterol by about 15 to 20 per cent and that this was generally the case. He further stated that such an increase would qualify the veteran as having dyslipidaemia as described in the SoP concerning "ischaemic heart disease" and that the odds are that the veteran would have had a cholesterol level greater than 5.5. The Tribunal is mindful that Dr Sangster stated that such evidence is speculative and that Dr Sangster did not have the benefit of knowing nor having any reading of the veteran's cholesterol level. Dr Sangster said that whilst it may have been high he could not rule out the possibility of it being low. When asked to comment on the inter-relationship between the condition of elevated blood cholesterol and the presence of hypertension, Dr Sangster stated that both of these in their own right are risk factors for the development of atherosclerosis and coronary artery disease.
During cross-examination Dr Sangster in answer to the question as to whether he had any evidence on which to base the speculation about dyslipidaemia in this case he stated that the difficulty is there being no measurements of the veteran's cholesterol level. He further stated that his views are based on speculation from statistical populations and suggested that the veteran had a greater than fifty per cent chance of having a cholesterol level of greater than 5.5 which would qualify the veteran as having dyslipidaemia. He based this on the fact that the veteran was on a diet high in dairy products. Such a high cholesterol diet, on average, will increase the basic cholesterol level by about twenty per cent.
When asked to speculate as to the date of onset of dyslipidaemia, Dr Sangster stated that he expected it to have been present for probably 15 to 20 years, possibly longer. In fact he agreed that it may have been present prior to 1962 but he could not be certain. He stated that it would be speculation to say when dyslipidaemia actually began.
As far as ischaemic heart disease was concerned Dr Sangster was aware that the veteran died suddenly and would have had coronary atherosclerosis prior to the sudden death. He stated that this would have been present for at least a few years prior to death, but not in a form that was causing any clinical problem.
Dr Sangster stated that it would be unlikely that the coronary artery disease would have been present for twenty-six years without some symptoms. He further stated that it is more likely that that developed in the last 5 or 10 years or that significant problems developed in the last few years of the veteran's life. He was aware that the veteran was suffering from hypertension at the time of death. He also stated that the veteran was probably receiving treatment for hypertension as early as 1959. In any event he agreed that based on the available evidence the hypertension had been present for longer than ten years and for which the veteran had been receiving treatment. He stated that the veteran died of ischaemic heart disease and the contributing factor was hypertension. Dr Sangster saw no reason to amend the death certificate, which, as previously set out, provided (T5/56):
"Acute myocardial infarction  Instant
Coronary occlusion  Instant
Coronary atheroma  Years
Essential hypertension  10 years"

Dr Sangster further stated that it was not normal to put dyslipidaemia on the death certificate unless it was quite grossly abnormal.

When it was put to Dr Sangster that the evidence indicates that the veteran's death was attributable to a myocardial infarction and ischaemic heart disease attributable to longstanding essential hypertension that could have been initiated as early as 1959, some 29 years prior to death, Dr Sangster stated that this was entirely consistent with the actual evidence. He also stated that to postulate anything else would require speculation, because there is no other evidence.

Dr Sangster stated that the better that high blood pressure is treated the more the risk of developing early atherosclerosis is lessened. It is a cumulative condition that can be a product of multiple risk factors. He agreed that in relation to the veteran, actual clinical data is only available in relation to hypertension. He agreed that in the normal course of events cholesterol would have also played a factor given that there was probably a better than fifty per cent chance the veteran's cholesterol was elevated. He stated that whilst this is an additional risk factor it was pure speculation as to what the veteran's individual level was because this is not known. He further stated that many people with high blood pressure do not have heart attacks but one is more likely to do so if the blood pressure is high in the same way as if the cholesterol level is high and even more so if more than one of the risk factors are elevated.
dr b.r. goode
In a report dated 10 January 1999 (T18), Dr B.R. Goode stated, inter alia, as follows (T18/93):
"This man had a longstanding essential hypertension which was well controlled with diuretic medication. Although physical examination did not reveal any cardiac abnormality there was no history of exertion angina. I considered the hypertension was the primary cause of his coronary atheroma which led to his fatal occlusion on 26 November 1988."
This comment of Dr Goode was put to Dr Sangster in his oral evidence during cross-examination and Dr Sangster was asked if he disagreed with it. Dr Sangster stated that the risk factors for coronary heart disease are basically age and sex and that if you are male and the older you are the more likely you are to have it. He further stated that of all the risk factors the only one definitely known to be present was that the veteran had hypertension but because his cholesterol was not recorded it is not known whether or not the veteran had dyslipidaemia.
applicant's submissions
Mr Hemsley submitted on behalf of the applicant that the veteran suffered from symptoms prior to his diagnosis and the Tribunal needs to consider the evidence of Dr Sangster as to the connection between the increased cholesterol and the development of arterio-sclerosis. He further submitted that there is no record of the veteran's lipid reading or what the cholesterol reading was but notwithstanding this, there are facts from which the Tribunal can infer and determine that there is a hypothesis which is reasonable. He stated that the cause of the death was atherosclerosis, a narrowing of the arteries. Whilst nobody knows what causes it there are a number of risk factors. The existence of hypertension is relevant in this case because of the fact that the veteran's blood pressure was measured and found to be elevated.
Mr Hemsley submitted that Dr Sangster in his evidence stated that there is a greater than fifty per cent chance that the veteran had an elevated cholesterol level above the level required to establish dyslipidaemia. He submitted that it is more likely than not that that played a role in the veteran's death. He further submitted that there was a combination of factors such as age, sex, hypertension and cholesterol, all of which played a role in the development of arteriosclerosis. There is present a longstanding history of a high fat diet, a high probability factor, and certainly greater than fifty per cent of that having a known effect, and the death of the veteran associated with these factors.
Mr Hemsley in his submissions referred to Dr Sangster saying that much was based on speculation but submitted that this was not unreasonable. He submitted that it is speculation based on experience and a level of probability which is comparatively high in the circumstances. Accordingly, he submitted that the hypothesis has been made out and that there can be no doubt that the hypothesis is reasonable. Dr Sangster was quite clear with respect to the timing and he would have expected an increase in the cholesterol within three months of the change of the diet and that he also would have expected the onset of the heart disease to manifest itself with some symptomatology much closer to the veteran's death. Mr Hemsley also submitted that there was no suggestion that the heart disease preceded the change in cholesterol.
In concluding his submissions Mr Hemsley referred to the consistency of the evidence given orally by Mrs Oliver and of her statement to the VRB (T24/114) wherein she stated, inter alia:
"… The prescribed ulcer diet was strictly adhered to through the years and veteran never ate, as has been suggested 'Western-style' food, as such. He did enjoy many dairy products, butter, cream, full-cream milk, cheeses and seafoods, … He was never forewarned as to the pitfalls of a high-content cholesterol diet as was his ulcer diet, but did forgo salt with a view to reducing his blood pressure."

submissions of the respondent

In his submissions Mr Doube stated that the death certificate records the veteran as having died from a myocardial infarction which was essentially due to ischaemic heart disease which has been caused by essential hypertension. He submitted that it was not in dispute between the parties that essential hypertension could not be considered to be a war-caused condition. He also stated that the Statement of Principles before the Tribunal is that for ischaemic heart disease (Instrument No.38 of 1999) and that the only factor in issue is that relating to dyslipidaemia and whether or not the veteran had this prior to his death.
Mr Doube stated that the hypothesis put in this case is the veteran's accepted war-caused condition of duodenal ulcer which was treated by a high fat diet upon the discovery of this condition in 1962. The dietary changes in 1962 were then so significant as to cause dyslipidaemia which then became a factor contributing to the development of ischaemic heart disease.
Mr Doube submitted that in her evidence Mrs Oliver indicated that she did not have to actually change the veteran's diet a great deal when the duodenal ulcer was diagnosed. Already fried food had been eliminated from the diet and fat was removed from meat. He also stated that the veteran had a sweet tooth and liked lots of sugar and cream and that the army diet had been high in saturated fats. It was submitted that Mrs Oliver never cooked in butter or dripping and that even prior to 1962 milk was one of the things the veteran enjoyed. He further submitted that the diet after 1962 had not been a major change and that the matter rested on whether or not the veteran had dyslipidaemia prior to his death.
Mr Doube submitted that Dr Sangster conceded that whilst the diet could well have caused an elevated blood cholesterol, it was still pure speculation. Mr Doube submitted that on the evidence before the Tribunal it was questionable whether the criteria in the definition of "dyslipidaemia" set out in the SoP (T32/182) was even met as all there was before the Tribunal was conjecture and speculation. All the evidence given by Dr Sangster was based on statistical populations. There was no knowledge of any cholesterol reading of the veteran at any time. He further submitted that Dr Sangster stated that the veteran could well have been hypertensive as early as 1959 and this comment was based upon factual evidence in the form of blood pressure readings. On the factual evidence the veteran had had hypertension for some 29 years at the time of his death although he had only been receiving treatment for that for the last ten years prior to his death.
In reference to the report of Dr Goode (T18/92) Mr Doube submitted that in mentioning to Dr Sangster about the longstanding hypertension, ischaemic heart disease and the myocardial infarction as well as the blood pressure readings, Dr Sangster did not think that the death certificate (T5/56) was wrong or needed to be amended.
Both Mr Hemsley and Mr Doube referred to the Full Federal Court decisions in East v Repatriation Commission (1987) 16 FCR 517 and Repatriation Commission v Bey [1997] FCA 1347. Mr Doube submitted that in East the Full Federal Court considered what was a reasonable hypothesis and essentially stated that it must be something pointed to by the facts in a particular case. The Court went further and stated that it was not sufficient that a finding be left open. He went on to submit that the speculation in the current case is based purely on statistical populations and there is no known evidence about the veteran's cholesterol readings at any time.
On the evidence before the Tribunal, Mr Doube submitted that it could not be stated whether the definitions in the SoP have been met. Mr Doube added that the evidence of Dr Goode, Dr Sangster and the Royal Adelaide Hospital all indicate that the factual evidence is entirely consistent with death caused by a myocardial infarction due to ischaemic heart disease which in turn is due to essential hypertension. He further submitted that it is agreed between the parties that essential hypertension cannot be a war-caused condition. He stated that there is no evidence before the Tribunal pointed to by the facts that the veteran had dyslipidaemia. In fact the veteran never had a lipid profile done. There is no cholesterol level reading prior to death and so it is not known if it was high, low or normal.
Mr Doube submitted that it is now known that helicobacter is the cause of over ninety per cent of peptic ulcers whereas the notion of helicobacter was not known prior to the war and hence to have argued helicobacter at that time would have been speculative. He reminded the Tribunal that the respondent had not conceded helicobacter as the reason for accepting duodenal ulcer. He further submitted that there is a significant difference between speculating about helicobacter and speculating about the lipid profile in this case. The Tribunal just does not know what the veteran's lipid profile was – it is a finding that can only be left open on the facts before the Tribunal and in view of the Full Federal Court decisions of East and Bey, that does not constitute a reasonable hypothesis.
discussion and findings
The Tribunal in arriving at its conclusion has considered the evidence as a whole and in particular the medical evidence. The Tribunal accepts that the applicant's oral evidence was given honestly and in good faith. The Tribunal accepts and is satisfied that Dr Sangster pondered carefully and sympathetically as to how he could provide some medical basis for a link between the veteran's war service and his death. Dr Sangster's evidence on his own admission was based on presumption and speculation. However, notwithstanding this, the Tribunal is satisfied that he is a person with considerable experience developed over many years. His explanation of the events and likely outcome are quite acceptable and hence the Tribunal is satisfied and accepts his speculation that the veteran's high dairy product diet had the likelihood of raising cholesterol which in turn would qualify the veteran as having dyslipidaemia as described in the SoP. Furthermore, the Tribunal is satisfied and accepts Dr Sangster's view that both the conditions of elevated blood cholesterol and the presence of hypertension are risk factors in their own right for the development of atherosclerosis and coronary artery disease. The Tribunal is also satisfied and finds that such a high cholesterol diet, on average, will increase the basic cholesterol level by about twenty per cent.
The Tribunal is also satisfied and so finds that at the time of his death the veteran was suffering from hypertension. It further accepts as valid the explanation of Dr Sangster that the veteran was probably receiving treatment for hypertension as early as 1959 but in any case it had been present for longer than ten years. The Tribunal is also satisfied and finds that the veteran died of ischaemic heart disease of which a contributing factor was hypertension.
In so being satisfied the Tribunal is further satisfied beyond reasonable doubt that the speculation is based on experience and on a level of probability which is high in the circumstances and that a reasonable hypothesis has been made out. The Tribunal is satisfied upon the evidence before it that the veteran's death was contributed to by his war-service pursuant to section 8 of the Act having first satisfied the applicable SoP.
Accordingly, the Tribunal sets aside the decision under review and remits the matter to the respondent for reconsideration in accordance with the direction that the veteran's death was war-caused within the meaning of section 8 of the Act.

I certify that the 47 preceding paragraphs are a true copy of the reasons for the decision herein of Senior Member J.A. Kiosoglous MBE.
Signed:   (Signed)
  Barbara Armstrong, Associate
Date of Hearing  13 December 2001
Date of Decision  29 May 2002
Counsel for the Applicant        Mr G. Hemsley
Solicitor for the Applicant         Mr G.Hemsley
Counsel for the Respondent    Mr Greg Doube
Solicitor for the Respondent    DVA