Osland and Repatriation Commission - [2002] AATA 198

DECISION AND REASONS FOR DECISION [2002] AATA 198

ADMINISTRATIVE APPEALS TRIBUNAL )

) No N2001/366

VETERANS' APPEALS DIVISION       )
           Re      Keith Osland
  Applicant
           And    Repatriation Commission
  Respondent

DECISION

Tribunal Mr R P Handley

Date26 March 2002
PlaceSydney

Decision      The Tribunal affirms the decision under review.
  ..............................................
  R P Handley
  Deputy President
CATCHWORDS
VETERANS' AFFAIRS – veterans' pension – assessment of war-caused injury or war-caused disease – requirement for "severe stressor" – whether the claimant's condition satisfied the requirements for Post Traumatic Stress Disorder

Veterans' Entitlement Act 1986 ss 6, 9(1), 13(1), 21A, 22, 120(1) (3) (4), 120A

Repatriation Commission v Deledio [1998] FCA 391
Repatriation Commission v Budworth [2001] FCA 1421
Repatriation Commission v Keeley (2000) FCR 108
Repatriation Commission v Gorton [2001] FCA 1194

REASONS FOR DECISION

March 2002 R P Handley

This is an application by Keith Osland ("the Applicant") for a review of a decision of the Veterans' Review Board ("the VRB") made on 15 November 2000 which affirmed a decision of a delegate of the Repatriation Commission ("the Respondent") dated 9 January 1998 to refuse the Applicant's claim that he is suffering from war-caused Post Traumatic Stress Disorder ("PTSD").
At the hearing, the Applicant was represented by Brian Winship of Rockcliffs, Solicitors, and the Respondent was represented by Philippa Hook of the Department of Veterans' Affairs. The Tribunal had before it the documents produced pursuant to s 37 of the Administrative Appeals Act 1975 ("the T Documents") together with the documents tendered by the parties. The Applicant and his wife, Phyllis Osland, gave oral evidence at the hearing.
BACKGROUND
Mr Osland was born on 3 June 1922 and is aged 79. He served in the Australian Army including in New Guinea and Borneo from 23 April 1942 to 1 July 1946. After discharge from the Army, Mr Osland worked as a self-employed farmer and grazier, ceasing work on 1 February 1990. In 1948, he married Phyllis and they had four children – three boys and a girl.
The Respondent had previously accepted that Mr Osland has the following war-caused conditions: malaria and sensori-neural hearing loss. On 20 November 1997, Mr Osland lodged a claim for acceptance of PTSD, "irritable bowel," tinnitus and groin/scalp rash as being war-caused. On 9 January 1998, a delegate of the Respondent refused Mr Osland's claim in respect of PTSD, inflammatory bowel disease, axillary dermatitis, and scalp rash on the ground that diagnosis of the conditions could not be confirmed. However, the delegate accepted Mr Osland's claims for bilateral sensori-neural hearing loss with tinnitus as being war-caused, effective from 20 August 1997, and increased the rate at which a disability pension was paid to Mr Osland to 40% of the General Rate.
On 14 April 1998, Mr Osland sought a review of the delegate's decision in relation to PTSD, inflammatory bowel disease and the rate at which a disability pension was paid. On 15 November 2000, the VRB decided to affirm the delegate's decision in relation to PTSD and inflammatory bowel disease and adjourn the hearing in relation to the assessment of the rate of disability pension payable pending further investigation. On 5 February 2001, the VRB set aside that part of the delegate's decision in relation to the rate of pension payable, and substituted a new decision that a pension should be paid at 40% of the General Rate from and including 20 August 1997 and 50% of the General Rate from 8 January 2001.
On 22 March 2001, Mr Osland lodged an application with the Tribunal for a review of the decision of the VRB made on 15 November 2000. However, he has since decided not to seek a review of that part of the VRB decision relating to inflammatory bowel disorder. The issue for the Tribunal, therefore, is whether Mr Osland is suffering from PTSD and whether this condition is war-caused in accordance with the provisions of the Veterans' Entitlements Act 1986 ("the Act").
APPLICABLE LEGISLATION
A war-caused injury or disease is defined in s 9(1) of the Act. The definition includes an injury suffered or a disease contracted by the veteran resulting from an occurrence that happened while the veteran was rendering operational service. Section 13(1) provides that where a veteran has become incapacitated from a war-caused injury or a war-caused disease, the Commonwealth is liable to pay a pension by way of compensation to the veteran.
Section 21A provides for the Respondent to "determine the degree of incapacity of a veteran from war-caused injury or war-caused disease, or both, according to the provisions of the approved Guide to the Assessment of Rates of Veterans' Pensions, which is currently in its fifth edition ("GARP"). Section 22 provides that pensions by way of compensation are paid to veterans who have attained the age of 65 at a percentage of the maximum General Rate of pension payable which constitutes the same percentage as the degree of incapacity determined by the Respondent in accordance with s 21A.
There is no dispute that Mr Osland's service in the Army during World War 2 is operational service as defined in s 6 of the Act. The standard of proof to be applied in relation to operational service in determining whether an injury or disease was war-caused is that provided for in subsections 120(1) and (3). Pursuant to these provisions, if the injury or disease relates to operational service, the Respondent shall determine that the injury or disease was war-caused unless it is satisfied beyond reasonable doubt that the material before it does not raise a reasonable hypothesis connecting the injury or disease with the circumstances of the person's service.
Subsection 120(4) provides that except in making a determination to which subsections (1) or (2) apply (subsection (2) is not relevant in this matter), the Respondent shall decide any other matter arising under the Act or the regulations "to its reasonable satisfaction". Because Mr Osland's claim was lodged after 1 June 1994, s 120A of the Act applies. This requires that where the Repatriation Medical Authority has determined a Statement of Principles ("SoP") in respect of a particular injury or disease, the Respondent (and therefore the Tribunal) must have reference to that SoP.
EVIDENCE
Keith Osland (the Applicant)
Mr Osland said he grew up on a farm in Gloucester and moved with his family to a farm in Bellingen when he was about 18 and not long before he joined the Australian Army. After being called up at the age of 19, Mr Osland was sent first to Dubbo for initial training and then to the Atherton Tablelands before travelling to New Guinea. He and other troops left from Townsville on "The Canberra" and disembarked at Port Moresby. From there, they travelled to Kaipit where, on arrival, they found between 35 and 40 Japanese soldiers had been shot and their bodies left in the open. Mr Osland said the stench was horrible and the bodies had blown up to twice their normal size. He and a mate had to dig a hole in rocky ground to bury one of them. From Kaipit, Mr Osland and his troop pursued the Japanese. On one occasion, they were shelled by a Japanese Mountain Gun and a soldier, who was near Mr Osland and whom he knew well, was hit by a shell and killed. Mr Osland remembers his friend lying in a horrible twisted position. They were also shot at on other occasions including when a soldier standing beside Mr Osland was very nearly hit.
Mr Osland said they had to go on patrol through the jungle, taking turns at leading. This was nerve racking because the enemy might suddenly jump out in front of them.
Altogether, Mr Osland spent six months in New Guinea before his troop was relieved and brought back to Australia. In Australia, they regrouped and were retrained in landing by sea in order to prepare for landing on Borneo. His troop again left from Townsville, and spent a few days in Moratai, from where they travelled by ship to Borneo landing from flat-bottomed barges. Mr Osland remembered being very sea sick and while landing, being shelled by the Japanese. Because Mr Osland was sick, his mate carried some of his gear. However, his mate ditched this when he was hit by shrapnel in the leg. Mr Osland said his troop undertook patrols from there looking for the enemy. They never found any because, by that time, the Japanese had pulled back.
Mr Osland remembered a rest day when he and his troop were camped along side a canal when there was yelling and shooting from further up the canal. This turned out to be other troops celebrating that the Japanese had surrendered and the War was over. However, from there, Mr Osland was sent to Nacassa in Indonesia for 6 months to keep the peace at a time of civil unrest, before returning to Australia. Mr Osland said he was not actually involved in any fighting in Indonesia. Initially, on arriving home in Australia, he worked as a clerk in the Army at Liverpool doing office work for 2 to 3 months, before being discharged.
Mr Osland said he returned to Bellingen where his parents helped him and his brother, who was 5 years younger, to buy a small farm. Within 2 days of his being home in Bellingen, he was back working on a farm and was glad to be out of the Army after 4 1/2 years. Mr Osland said he contracted malaria while in the Army and continued to have bouts of this in the 2 years after his discharge. He recalled having 3 bouts of malaria on the farm after the War. He first met his wife about 12 to 18 months after leaving the Army and 2 years later they arranged to be married. However, about a month before their wedding day, Mr Osland suffered a bout of malaria requiring hospitalisation. Nevertheless, he was out of hospital, in time for the wedding and he and his wife have been married for 54 years later this year.
Mr Osland said he did not enjoy his time "in action" while in the Army: he was always frightened for his life and afraid of being shot at – it was a terrifying experience. His wife asked him a certain amount about his war experiences, but he did not like talking about it and, to begin with, he did not tell anybody anything. For the first 20 to 30 years he never went to Army reunions because he did not want to have to relive his memories. He did not want to be reminded of what had happened. About 10 years ago, he agreed to go to a reunion when asked by a friend. Thereafter, he went twice a year for a few years, but he has not been recently because he is no longer very mobile and has had a mild stroke.
Mr Osland said he felt secure and relaxed on the farm and, by concentrating on the farm and the animals, he was able to forget about other things and put memories of the War to one side. When he and his wife purchased a television, he could not watch war movies because they used to upset him and bring back memories. Nevertheless, every now and then, he would think about his wartime experiences, even without the stimulation of a television program. After the War, he would also sometimes experience problems in sleeping and would lie awake thinking of "everything", including his time in the Army, although he acknowledged that he was never a good sleeper after joining the Army. Mr Osland said, in New Guinea, they spent 2 hours on guard with 4 hours sleep every night and never got a full night's sleep. When he returned to Australia, it took a while for his sleep pattern to readjust. Even now, he still has vivid memories of his Army experiences and he will never forget. He has, however, had more memories since he retired, with more leisure time and time to think. Mr Osland said he did not think of himself as a worrier. He does worry a bit now and then, but not all the time. He has probably become more of a worrier as he has got older because he is not so engrossed in his work.
Mr Osland said the farm he and his brother initially owned was successful and, after a while, they purchased and moved to a larger farm. Later, Mr Osland bought out his brother's share and his brother moved to a third farm. Mr Osland said his wife always helped him on the farm and was a great support to him. Theirs has been a happy marriage and, they have 4 children: 3 sons and a daughter. Mr Osland said he loves his wife very much and would have great difficulty coping without her. Indeed, life would not be worth living. One son, who had wanted to manage the farm, had to undergo heart surgery and was unable to do so. Therefore, after nearly 50 years of farming, Mr Osland sold his farm and retired. He said, generally, he enjoyed his working life, but it had its worrying times, especially with drought and fluctuating prices for primary produce. Mr Osland acknowledged that he had been a bit irritable at times with neighbours, although never with his wife. He said he has become more tolerant as he has got older.
Mr Osland said he had never been very close to his family doctor, essentially, because they have kept on changing. He has only been seeing his present general practitioner, Dr Radford, for about 3 or 4 years. Mr Osland said it was the pensions officer at the Coffs Harbour RSL who, about 5 or 6 years ago, advised him to apply for a pension on the grounds of "stress and anxiety". Mr Osland said he was aware of worrying and being stressed but, at that time, decided not to do anything about it because he was not prepared to travel to Sydney for a medical examination. He said he hates cities and does not like talking about Army things.
Mr Osland said his hearing is impaired and he suffers from tinnitus now and then. He went for many years without doing any thing about it, but eventually asked his doctor who advised him to make a claim for a pension. His first claim in 1989 was in respect of hearing loss in one ear, but he said he had had hearing problems long before that. Then, in 1997, he lodged a claim in respect of both ears.
Phyllis Osland
Mrs Osland said she and her husband met, probably at a dance in the Bellingen area, after his discharge from the Army. She was also from a farming family. Mrs Osland said she knew her husband's parents well and they treated her like a daughter. Her husband has 2 brothers and 3 sisters and she and her husband remain very close to one of his sisters who lives in Bellingen. After she and her husband met, they used to go round with groups of friends and have fun together. Her husband never talked about his War service and she did not press him about this, even though she was interested. They were married on 29 September 1948. About a month before they were married, Mr Osland had a bout of malaria and had to be hospitalised. The local Minister took her to see him in hospital where he remained for a week or more. However, about 10 days before the wedding he was released from hospital. Mrs Osland said they were in love and happy.
Mrs Osland said they had always shared a double bed and her husband was a "hot person". She could not remember how well he slept in the early years of their marriage, but said that about 15 years ago his sleeping pattern changed and he became restless, often waking at about midnight and staying awake until 2:00 pm. He used to get up and have a cup of tea and they might sometimes have a chat. Her husband did not say what was worrying him. Instead, they chatted about what was happening on the farm. As their daughter said on the day before the hearing, Mr Osland would never talk about his wartime experiences. They only began to find out more when he started to go to Army reunions. He did, however, attend meetings of the Bellingen RSL once a month after they were married, and she would go to the pictures.
Mrs Osland said they both worked hard on the farm. Her husband is a family man and always enjoyed the company of his children and they are very fond of him. He is very proud of his children and grandchildren. He used to take them out to dances, football etc. Sometimes in the evenings he watched television, but on other occasions he just went to bed. Mrs Osland said they coped through the bad times when she would sometimes get stressed. Mrs Osland said she worries about what would happen to her husband if something happened to her. He does not cope well without her and says he does not like to be alone. He is now more dependent on her than when they lived on the farm. This started after their retirement in about 1991 or 1992, and they became involved in the Garden Club and with the Museum, so that they could work together. Even now, her husband does not like people knowing what is wrong with him. Her husband retired from the farm about 11 or 12 years ago. Since that time, her husband has developed asthma after moving into Bellingen, and his hearing has deteriorated. Quite a few years ago, he stopped being President of the Bellingen RSL because of his hearing. Even before 1989, he was having hearing problems, and she sometimes used to have to tell him things 3 times which caused a bit of conflict.
SUBMISSIONS
Applicant
Mr Winship, for Mr Osland, said the parties agree that Mr Osland suffered a severe stressor whilst serving in New Guinea during the War. Mr Winship submitted that Mr Osland meets the SoP for PTSD and relies on the reports of Dr Wade dated 27 November 2001 (A1) and Dr McGrath dated 27 June 2001 (R1), and on the oral evidence. Mr Winship said Dr Wade's report was consistent with the oral evidence, for example as to the sleep problems experienced by Mr Osland. Mr Osland's evidence was that his sleep pattern has been disrupted since the beginning of his war service, and Mrs Osland remembers at least 15 years of her husband experiencing sleep problems. Dr Wade notes that the recurrent bouts of malaria that Mr Osland suffered in the post war years were a constant reminder of his wartime experiences. Mr Winship noted that Mr Osland had become upset during the hearing at having to relate his wartime experiences. Since the War, he has always been very aware of security and, when travelling, has always travelled with his wife. Mr Osland's evidence was that he could not now contemplate life without his wife.
Mr Winship pointed out that Dr Wade is a consultant psychiatrist who spent some time with Mr Osland in preparing his report and has provided a history which is consistent with that given by Mr Osland in oral evidence. Mr Winship noted that Mr Osland went to RSL meetings but not to Army reunions until about 30 years after the end of the War. Since Mr Osland has developed tinnitus, he has had a constant reminder of wartime shelling. Mr Winship referred the Tribunal to Dr Wade's clear diagnosis of PTSD, based on the correct criteria, for the reasons stated in his report. Mr Winship stated that Mr Osland satisfies the criteria for PTSD stated in the SoP or, in the alternative, satisfies the criteria stated in the SoP concerning Generalised Anxiety Disorder.
Respondent
Ms Hook, for the Respondent, said the Respondent accepts Mr and Mrs Osland as genuine and credible witnesses and as to the effects of Mr Osland's wartime service on his life style and well being. Nevertheless, the Tribunal must be satisfied that Mr Osland meets the diagnostic criteria for either PTSD or Generalised Anxiety Disorder as stated in the relevant SoP. The Respondent also accepts that Mr Osland was subjected to a traumatic event and suffered intense fear at the time. With regard to the relevant SoP for PTSD, Instrument No 3 of 1999, and the criteria for PTSD, the Respondent also accepts that Mr Osland persistently re-experiences the traumatic event, thereby satisfying criteria (B). However, the Respondent considers that Mr Osland does not meet criteria (C) insofar as he is able to recall the traumatic event (iii), there is no evidence of markedly diminished interest or participation in significant activities (iv), there is no evidence of a decrease in interest in his wife or family (v), there is no evidence of a decrease in loving feelings (vi), or of his having a sense of a foreshortened future (vii).

With regard to criteria (D), the Respondent recognises that while Mr Osland has difficulty staying asleep, he does not otherwise suffer from persistent symptoms of increased arousal. In relation to criteria (E), Mr Osland's evidence is that he thinks about his war service occasionally, but in relation to criteria (F) there is no evidence of Mr Osland suffering clinically significant distress or impairment. The evidence suggests that he has functioned well and successfully through his life. While Dr Wade states that Mr Osland has masked his symptoms through avoidance, the Respondent submits that Mr Osland's lifestyle has prevented the systems from becoming a full-blown disorder.
With regard to Generalised Anxiety Disorder, the Respondent submits that there is even less evidence that Mr Osland satisfies the criteria for this condition stated in the relevant SoP. In particular, Ms Hook noted that the factors that must exist as a minimum include clinical onset of Generalised Anxiety Disorder within 2 years of experiencing the stressful event. Finally, in the event that the Tribunal finds that either of the SoPs to be satisfied, then the matter should be remitted to the Respondent for further consideration and assessment.
CONSIDERATION OF LAW AND FINDINGS
The issue for the Tribunal to determine is whether Mr Osland is suffering from PTSD or, in the alternative, Generalised Anxiety Disorder, and whether, if so, this condition is war-caused in accordance with the provisions of the Act. The steps to be followed in making such a determination were stated by the Full Federal Court in RepatriationCommission v Deledio [1998] FCA 391. The first step requires the Tribunal to consider all the material 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. The connection must be established to the "reasonable satisfaction of the Tribunal", pursuant to s 120(4). In the Tribunal's view, Mr Osland's evidence of having experienced a stressful event during his war service in New Guinea and of his symptoms thereafter, points to a hypothesis connecting the claimed injury with Mr Osland's wartime service.
The second step, where the material raises such a hypothesis, requires the Tribunal to consider whether there is in force any relevant SoP. In this case, there are relevant SoPs both for PTSD and Generalised Anxiety Disorder. Having ascertained this, the third step requires the Tribunal to decide whether, in its opinion, the hypothesis raised is a reasonable one. As stated by the Full Federal Court in Repatriation Commission v Budworth [2001] FCA 1421, the standard of proof to be applied is that provided by subsection 120(4), that of "reasonable satisfaction". The Tribunal notes that where one SoP was in effect at the time of the claim but has later been revoked by another SoP in force at the time of the Tribunal's decision, then, following the decision of the Full Federal Court in RepatriationCommission v Keeley (2000) FCR 108 and Repatriation Commission v Gorton [2001] FCA 1194, if the SoP currently in effect at the time of the Tribunal decision does not uphold the hypothesis, then the claimant may contend that he or she has an accrued right under the earlier SoP in effect at the time that the claim was made.
In the present case, the relevant SoP for PTSD at the time Mr Osland's claim was lodged was Instrument No 15 of 1994. The most significant difference between that SoP and the SoP currently in force, Instrument No 3 of 1999 as amended by Instrument No 54 of 1999, is the additional requirement that the person must have experienced a "severe stressor". Since there is no dispute that Mr Osland did suffer a severe stressor, the parties accept that there is no detriment to Mr Osland by the application of the current SoP. With regard to the SoP applying in respect of Generalised Anxiety Disorder, the SoP in effect at the time Mr Osland's claim was lodged was Instrument No. 48 of 1994 as amended by Instrument No 275 of 1995. The current SoP concerning Anxiety Disorder is Instrument No. 1 of 2000.
In Mr Osland's case, the application both of the Generalised Anxiety Disorder SoP and the Anxiety Disorder SoP, would require the clinical onset of Generalised Anxiety Disorder or Anxiety Disorder within 2 years after the stressful event. In the Tribunal's view, the evidence does not support such clinical onset within a 2 year timeframe and, therefore, the Tribunal is not reasonably satisfied that the hypothesis with regard to General Anxiety Disorder or Anxiety Disorder is a reasonable one. In particular, neither Mr nor Mrs Osland's evidence supports a finding that the required criteria are met.
With regard to whether Mr Osland's condition is consistent with the template for PTSD, as noted above, the parties agree that Mr Osland suffered a severe stressor during his time in New Guinea. However, the Respondent disputes that Mr Osland meets the criteria required by the definition of PTSD in paragraph 2 (b) of Instrument No 3 of 1999. This states:
(A)      the person exposed to a traumatic event in which:
(i)the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others; and
(ii)the person's response involved intense fear, helplessness, or horror; and
(B)the traumatic event is persistently re-experienced in one or more of the following ways:
(i)recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions;
(ii)       recurrent distressing dreams of the event;
(iii)acting or feeling as if the traumatic event were recurring (including a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated);
(iv)intense psychological distress at exposure to internal or external cues that symbolise or resemble an aspect of the traumatic event;
(v)physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event; and
(C)persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three or more of the following:
(i)efforts to avoid thoughts, feelings, or conversations associated with the trauma;
(ii)efforts to avoid activities, places, or people that arouse recollections of the trauma;
(iii)       inability to recall an important aspect of the trauma;
(iv)      markedly diminished interest or participation in significant activities;
(v)       feeling of detachment or estrangement from others;
(vi)      restricted range of affect (eg, unable to have loving feelings);
(vii)sense of a foreshortened future (eg) does not expect to have a career, marriage, children, or a normal life span); and
(D)persistent symptoms of increased arousal (not present before the trauma), as indicated by two or more of the following:
(i)        difficulty falling or staying asleep;
(ii)       irritability or outbursts of anger;
difficulty in concentrating;
(iii)      hypervigilance;
(v)       exaggerated startle response; and
(E)duration of the disturbance (indicated by the relevant symptoms set out in paragraphs (b), (c) and (d) is more than one month; and
(F)the disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning,

The Tribunal proceeded to consider whether the evidence supported a conclusion that a Mr Osland's condition satisfies the above criteria. With regard to (A), there is no dispute that Mr Osland was exposed to a traumatic event, namely another soldier who was beside Mr Osland being killed as a result of which he suffered intense fear. With regard to (B), Mr Osland's evidence supports a finding that he persistently re-experiences distressing memories of this event and has done so for many years. With regard to (C), the Tribunal finds that Mr Osland for many years sought to avoid his memories of the stressful events during his wartime service by seeking to avoid talking about them, avoiding television and generally immersing himself on his farm, and also avoiding Army reunions. Nevertheless, he is able to recall important aspects of the trauma, he has not shown a markedly diminished interest or participation in significant activities, nor feelings of detachment or estrangement or restricted range of affect or a sense of a foreshortened future.
The Tribunal notes the strong and enduring relationship between Mr and Mrs Osland who clearly have a deep affection for one another, and that Mr Osland, in his later years, has become more dependent upon his wife and unwilling to be out of her company. The Tribunal finds that they have shared a happy life together and have raised 4 children with whom Mr Osland has a close relationship. They now also have grandchildren. Mrs Osland's evidence was that her husband has always enjoyed the company of his children and is proud of his family. In turn, his children are very fond of him
With regard to (D), Mr and Mrs Osland's evidence supports a finding that Mr Osland has had difficulty in sleeping from time to time, but there was little evidence of irritability or outbursts of anger, although the Tribunal notes that Dr Wade recorded these in his report (A1). There was no evidence of any difficulty for Mr Osland in concentrating nor of an exaggerated startle response, but there is some evidence of hypervigilance, which Dr Wade refers to in his report.
With regard to (E), the Tribunal finds that Mr Osland's symptoms have been ongoing for many years, and accepts, in relation to (F), that recollection or talking about his experiences causes him significant distress. In conclusion, while the Tribunal recognises that Mr Osland exhibits some symptoms of PTSD, he fails to meet sufficient criteria, in particular (C), to afford a diagnosis of PTSD. Nevertheless, the Tribunal also recognises that Mr Osland developed various coping strategies which have assisted in enabling him to come to terms with his war time experiences.
In coming to its conclusion, the Tribunal had regard to both the report of Dr McGrath (R1), whose opinion was that despite Mr Osland's distressing experiences, he has never "developed a full-blown" post traumatic stress disorder, as described in DSM – IV", and to Dr Wade's report (A1). Although the Tribunal disagrees with Dr Wade's conclusion, nevertheless, many of his findings as to how Mr Osland has coped with his trauma are clearly well-founded. 38. Having decided that neither the hypothesis raised in relation to PTSD nor Anxiety Disorder is a reasonable one, the Tribunal need not proceed to the fourth step required by the approach adopted in Deledio (supra), which would have required the Tribunal to consider whether, if a reasonable hypothesis was raised, it was satisfied beyond reasonable doubt that Mr Osland's condition did not arise from the war-caused injury.
The Tribunal affirms the decision under review.

I certify that the 39 preceding paragraphs are a true copy of the reasons for the decision herein of Mr R P Handley, Deputy President
Signed:         .....................................................................................
  Associate
Date of Hearing                  7 Februry 2002
Date of Decision                  26 March 2002
Solicitor for the Applicant                         Mr B Winship
Representative for the Respondent      Ms P Hook