Prodger and Comcare
[2003] AATA 1038
•14 October 2003
Administrative
Appeals
Tribunal
DECISION AND REASONS FOR DECISION [2003] AATA 1038
ADMINISTRATIVE APPEALS TRIBUNAL )
) No D2002/26
VETERANS’ APPEALS DIVISION ) Re IAN GLEN PRODGER Applicant
And
REPATRIATION COMMISSION
Respondent
DECISION
Tribunal Deputy President, Don Muller Date14 October 2003
PlaceBrisbane
Decision The Tribunal sets aside the decision under review and in substitution determines that:
1. The Depressive Disorder, Anxiety Disorder and Hypertension suffered by Ian Glen Prodger are defence-caused within the meaning of those terms in the Veterans’ Entitlements Act 1986, with effect from 27 November 2000.
2. The matter is remitted to the Respondent for assessment.
..............(Signed).................................
Deputy President
CATCHWORDS
VETERANS' AFFAIRS-–whether Depressive Disorder, Generalised Anxiety Disorder and Hypertension was defence caused
Veterans Entitlements Act 1986 ss120 (4), 120B
REASONS FOR DECISION
Deputy President, Don Muller 1. This is an application made by Ian Glen Prodger (“the Applicant”) for a review of a decision made by the Repatriation Commission, to refuse his claim for disability pension and medical treatment for Depressive Disorder, Anxiety Disorder and Hypertension on the basis that the conditions claimed were not defence caused within the meaning of that term in the Veterans’ Entitlements Act 1986.
2. The Applicant claims that his service in the Royal Australian Navy (“RAN”) particularly as a submariner from 1974 to 1991 exposed him to severe psychosocial stressors that caused him to develop Depressive Disorder and Generalised Anxiety Disorder. In addition, the Applicant claims his Hypertension is due to the alcohol dependence/abuse and obesity, which arose through the course of his service in the RAN.
3. At the hearing the Applicant was represented by Mr Piper and the Respondent was represented by its advocate, Mr Doube.
4. The Tribunal heard oral evidence from the Applicant and had the following documents before it :
(a)The documents filed pursuant to section 37 of the Administrative Appeals Tribunal Act 1975, exhibit 1 ;
(b)Report of Dr Adil Vaghaiwala dated 12 March 2003, exhibit 2;
(c)The Applicant’s statement dated 1 February 2003, exhibit 3;
(d)Writeway Report dated 8 May 2003,exhibit 4; and
(e)In Depth Newsletter dated May 2003 , exhibit 5.
5. The following matters are not in dispute and the Tribunal finds as follows:
(a)The Applicant was born on 31 March 1955 and is currently 48 years of age.
(b)The Applicant served in the Royal Australian Navy from 8 April 1971 to 9 December 1991.
(c)He rendered eligible defence service from 7 December 1972 to 9 December 1991.
(d)While in the RAN the Applicant trained as a marine engineer and served on the following submarines:
(i)1974 to 1976 on HMAS Otway;
(ii)1977 to 1979 on HMAS Orion;
(iii)1980 to 1983 on HMAS Otama;
(iv)1983 to 1986 on HMAS Onslow; and
(v)1986 to 1989 on HMAS Ovens.
(e)The Applicant was a panel watch keeper. This is a position in the engineering department. He was responsible for the mechanical control of the submarine including trimming, ballasting and the operation of the periscope.
(f)Submarine service is purely voluntary.
(g)From 1989 to 1991 the Applicant was posted to an on-shore job in Canberra as Personnel Liaison Assistant to Chief of Naval Staff (Personal).
(h)In 1991 the Applicant retired from the RAN.
6. On 27 February 2001 the Applicant made a claim for Disability Pension and Medical Treatment for the following conditions:
(a)Hypertension;
(b)Ischaemic Heart Disease; and
(c)Generalised Anxiety Disorder.
The Applicant also included in his claim for Hypertension the diagnosis of Aortic Stenosis.
7. In a decision dated 19 October 2001 a delegate of the Repatriation Commission concluded that the Applicant’s claimed conditions should be amended to read hypertension, aortic stenosis, depressive disorder and anxiety disorder. The delegate went on to find that the circumstances of the Applicant’s case did not satisfy the relevant Statements of Principles relating to any of the conditions. Consequently, the claims were refused.
8. On 5 June 2002 the Veteran’s Review Board affirmed the decision under review.
9. On 1 July 2002 the Applicant applied to this Tribunal for a review of the decisions relating to Hypertension, Depressive Disorder and Generalised Anxiety Disorder. In support of his claim he provided oral evidence and a written statement dated 1 February 2003. The Applicant identifies in his statement the stressful events which he claims led to his conditions of Depressive Disorder and Generalised Anxiety Disorder, as follows:
“9. The majority of my service involved operational activities in the nature of patrols which would last from several weeks up to three months at a time. That is, it could be three months from the time that we boarded a submarine to the time that we disembarked at the end of a patrol.
10. Patrols involved intelligence gathering in international waters, and at times involved entering the national waters of unfriendly countries.
11. In the early part of my career, my patrols and training periods often extended to the North Atlantic, and my officials would be under the control of the Royal Navy Submarine Command.
12. In the latter part of my career, we would do a great deal of patrolling in South East Asia and the Indian Ocean.
13. I will attempt to describe some of the stresses that we were placed under from training and operational service.
14. As a submariner, training was an ongoing issue, and a very important part of training involved drills and exercises to test our ability to cope in emergencies.
15. One such drill was known as ‘emergency surfacing’. This involved rapid surfacing of the vessel from a depth of 600 feet. It was a procedure to be adopted in the event of a hydraulic burst, flood or fire on board the vessel.
16. As a trainee, the first I knew of it was the experience of the vessel ascending rapidly, rolling everywhere, toppling and spiralling before hitting the surface. Everything would roll everywhere, and people could easily be injured, e.g. in the event of a bulk door hitting someone or a person otherwise being thrown around, during the exercise.
17. The emergency surfacing exercises would not be announced. The first time that emergency surfacing occurred, I was terrified, and believed that my life was in danger. After the first time, the drill was performed many more times. Over time I became more used to the sensations that were experienced, and what was going on. However, I maintain that even subsequent drills were frightful experiences, as (a) things can go wrong in exercises, and (b) being in a rolling and spiralling submarine is a frightening experience in any circumstances, although I learnt to deal with it better as time went on.
18. Another exercise, again which would be conducted unannounced, to test our skills, would be flooding. In such cases, simulated seawater would be allowed in to a compartment of the vessel. Aside from fearing for my life, as these exercises were without warning, I would also be responsible for dealing immediately with the threat. Having control of the vessel itself, I was required to hit the appropriate controls on the panel to deal with the emergency, and if I did not do so within a period of 12 seconds, then the safety of those aboard the submarine, including myself, would be jeopardised.
19. Another exercise which would take place without warning, and which, especially on the first couple of occasions, caused me immense fear for my safety, was the setting off of smoke bombs on board the vessel. During these exercises, a person, unannounced, would place a smoke bomb into your compartment. I would be completely blinded and find it very difficult to breath because of the smoke. In these situations, again I would need to take measures to ensure my safety and also, operate the controls in a manner to deal with the emergency situation that was presented. Again, as time went on, I became better at coping with these, however in every instance, these exercises caused intense fear for my personal safety, as a young person on board a submarine, hundreds of feet under the sea.
20. Another exercise that would be carried out to train submariners to handle emergencies was for charges to be dropped within the submarine, without warning, causing a loud banging noise. The immediate affect of this, when one is submerged, is the instant feeling that there is an emergency, and one’s life is in danger. As time goes on, one can be more confident that what is occurring is only an exercise, however, the perception of a real threat to one’s safety was present on every occasion.
21. As indicated above, operational patrols in which I was involved would last many weeks, or even months, and during that time, we had, as individuals, no contact with the outside world.
22. We would be sent to distant locations on the globe, and be charged with conducting surveillance of foreign vessels, both military, and other.
23. The process of intelligence gathering often involved my submarine tracking and then approaching non friendly vessels and photographing the “undercarriage” of those vessels from close range. When I say close range, I mean that the periscope would come within one to two feet of the propellers of vessels on occasions, to take close and detailed photographs.
24. During the course of operational patrols, in foreign waters, a submarine would be on various different stages of alert. The vessel may be in normal patrol state, or in patrol quiet state. If the vessel was not in patrol quiet state, then it would be at a level of high alert being “shut off for action” or highest alert, being “shut off for counter attack”.
25. The levels of alert were represented by the amount of noise which the submarine could make, with the “shut off for counter attack” level of alert meaning that all engines and generators aboard the vessel were to be turned off and absolute silence was required. In this state, there would be no ventilation, as the fans circulating air throughout the submarine were also turned off. We could be in this stage for up to a full day, by the end of which one was sweating profusely and short of breath. On such occasions it would cross one’s mind from time to time that one’s life was in actual danger, if not from being attacked by an enemy vessel, which was clearly close by, then from suffocation if something went wrong.
26. On a number of occasions we were required to evacuate an area quickly. These would be when, for example, we were in the road of a Chinese or Russian ship, whilst intelligence gathering. We always had a torpedo ready to fire in these dangerous situations. I did fear for my safety on such occasions and I believe that it is to the credit of our crew that there were no major incidents.
27. On one occasion, in the early 1980s, when I was on the HMAS Otama, the engine restarted after a complete shut off, with one of the exhaust valves still shut. The result was the engine room (where I was on watch) filling with carbon monoxide, causing a number of sailors to pass out, though I did not, before the problem was rectified. A crewman on the HMAS Onslow was lost in this way not long prior to this incident, to the best of my recollection.
28. Toward the end of my service, I was allotted an educational and training role SSTG, which would involve myself being one of those persons who ‘sprung’ emergency situations on other submariners. I would be responsible for dropping charges to scare them, and on board vessels, creating situations where there was flooding or smoke for them to respond to.
29. In this role, as with in my previous roles, I became closely attached and concerned for the well being of the submariners.
30. Therefore, when, shortly after I had finished giving exercises to members on board the HMAS Otama in 1988, the submarine lost two sailors in heavy seas off the coast of Sydney, I was very upset and traumatised.
31. When I was transferred to Canberra in 1989, I found that I was not compatible with working in an office environment.
…
42. I maintain that I would suffer anxiety as a result of the stressors of being a submariner, during the course of my service. I would have episodes of feeling extremely vulnerable and depressed, such as on a long patrol in about 1980 aboard HMAS Otama. At that time, for various reasons, the morale of the submariners on this particular vessel was low. The very fact of there being low morale aboard a vessel, was dangerous, as a submarine required its members to be in good morale and working together as a team.
43. I recall that I suffered a panic attack on board the submarine at this time, however I was not commonly prone to panic attacks. When I say panic attack, I mean a sudden onset of terror, with symptoms including fear for my life, shaking and sweating.”
10. The Applicant also described the circumstances of alcohol abuse in the Navy that led to his Hypertension:
“32. When I enlisted in the Navy at the age of 16 I was healthy. I had suffered a head injury as a 7-month-old baby and a metal plate was put in my head. However this had been asymptomatic and remains asymptomatic.
33. I did not drink until I commenced with the submarine corps in about 1974.
34. Once I joined the submarine core, I found that the lifestyle involved returning to land after long periods of sea and '‘binge drinking'’ with other submariners.
35. Submariners were a close knit group who understood each other and the pressures of their own lives, and a typical day on a break from being at sea would involve going to a mess at around (or before even) the middle of the day, and starting drinking. Beer at the mess would be cheaper than at normal bars – say 20c a Schooner and we would drink several of these, before going into town.
36. In town, we would go to bars as a group, and would invariably become extremely drunk. We would do this virtually every day that we were not at sea.
37. I recall that it was not unusual for us to be taken to the cells at some stage during the evening, as a result of drunken behaviour, where we would sober up, and we were known to the Police, and did not have a poor relationship with them, despite this.
38. In about 1974, I had a motor vehicle accident whilst drink driving, and suffered lacerations to my face and arms, as well as more general abrasions.
39. As time went on, I became more accustomed to binge drinking, and can say that as a rule, I would drink between the equivalent of one and one and half cartons per day when on shore leave.
40. I did get married, however this marriage did not last, and I believe my separation in around 1983 was caused, at least in part, by my excessive drinking habits as well as continual separation due to operational deployments.
41. In about 1988, I did attend Alcoholics Anonymous, and was successful in giving up drinking for a period of 12 months.
…
45. Whereas my normal weight had generally been around 71 kg, by 1987, my weight was 82 kg and by the time I was discharged on 9 December 1991, I weighed 92 kg and was diagnosed as having borderline hypertension.”
11. The medical evidence presented to the Tribunal included a letter from general practitioner, Dr Jennifer Gray , dated 25 February 1999 (t5):
“Ian Prodger has been seen here since April 1997. He first saw Richard John about a funny turn. He has a possible past history of aortic incompetence. He found him to be hypertensive at 170/115. He started him on coversyl increasing to eight mg a day, and ordered another echocardiogram, which we don’t have a report of.
He has seen us a few times with what seems to be panic attacks or vaso-vagal attacks. He has some sources of anxiety in his life but when I saw him in January things seemed to be going O.K. His last blood pressure was 140/85.”
12. Clinical Psychologist, Michael Tyrrel in a letter dated 22 August 2001 confirmed the Applicant’s diagnosis of Mixed Anxiety and Depressive Disorder (T7).
13. On 11 April 2002 psychiatrist, Dr Marty Ewer, interviewed the Applicant by video–conference link. On 12 April 2002 he provided his report. The relevant sections of that report are as follows (T12):
“HISTORY OF ELIGIBLE SERVICE
Mr. Prodger joined the Royal Australian Navy in 1971 and he was discharged in 1991. I note he has a period of eligible service from the end of 1972 until discharge. Mr. Prodger became a Submariner in 1974 and he worked in submarines for a number of years.
Mr. Prodger was exposed to a number of stressful experiences during his time in the Navy. These experiences adversely affected his mental state both at the time and subsequently. The experiences Mr. Prodger spoke to me about were:
1.Mr. Prodger told me about a number of events which occurred in the late 1970s. He was in a submarine engaged in intelligence gathering activity. This activity was conducted in close proximity to hostile Russian and Chinese vessels during the Cold War. Mr. Prodger said ‘we had some very close calls where we had to get out of the road of hostile ships in a real hurry. We always had a torpedo ready to go’. Mr. Prodger said that he felt very anxious and often feared for his life during these events.
2.Mr. Prodger told me that he had been serving on the submarine Otoma. He had just left the submarine in 1989. Mr. Prodger said the submarine dived just near Sydney and two sailors were caught in the tower and drowned. Mr. Prodger knew them both and he was very distressed.
PSYCHOLOGICAL EFFECTS OF SERVICE
Mr.Prodger experienced intense fear and anxiety during the abovementioned stresses.
Mr. Prodger told me that he became more and more anxious during the late 1970s. He developed hypertension and he said ‘I was irrational and life seemed uncoordinated’. Mr. Prodger had begun abusing alcohol soon after he joined the Navy and this continued.
Mr. Prodger said that his mental state deteriorated in 1989 and that he became more nervous and anxious. He had difficulty coping and he had difficulty sleeping. He continued to abuse alcohol.
Mr. Prodger has continued to experience psychiatric symptoms over the years. In more recent years he has felt ‘very nervy’. His short term memory has been poor. He has difficulty coping with people and he is often irritable and ‘vague’. His work performance has declined and he said ‘I’m hung over a lot’. He has often been irritable.
Mr. Prodger saw his General Practitioner last year and he was referred to a Psychologist. He was also prescribed antidepressants.
Mr. Prodger continues to frequently feel anxious but he has felt much better since reducing his workload. He said ‘I still get very anxious and my body becomes unstable and sometimes shuts down’.. When anxious Mr. Prodger perspires excessive and he becomes tremulous. He said ‘I tingle and get clammy skin and my heart races’. He said that he feels depressed quite a lot and is often weeping. He is less irritable on medication.
Mr. Prodger is troubled by initial insomnia. He often wakes feeling anxious and panicky with his heart racing. His sleep is restless and he said ‘I toss and turn’. His energy is still diminished.
Mr. Prodger’s memory and concentration are poor and he is often ‘very vague’. Mr. Prodger worries excessively and he has a reduced ability to cope.
Over the years Mr. Prodger has tried to manage his symptoms by busying himself with work.
Mr. Prodger avoids stress and people.
MEDICATION
Mr. Prodger has been taking Venlafaxine XR 75 mg per day for the last six weeks. He also takes Coversyl.
Mr. Prodger stopped smoking in 1983. He drinks twelve to twenty-four stubbies of mid strength beer per day as well as some wine. He has never taken illicit drugs.
…
PERSONAL HISTORY
Mr. Prodger was born in Lismore and he described an unremarkable childhood.
Mr. Prodger left school at the age of sixteen and joined the Navy. After discharge Mr. Prodger had difficulty settling into work and he initially had a lawnmowing round. He had difficulty coping and he was often in conflict with others. He then became a Liquor Attendant and worked his way up to an Assistant Manager. He worked as a Manager in a caravan park. He was then a Council Inspector and he then ran a remote roadhouse. Four years ago he set up his own gardening and cleaning business. Up until recently he was working long hours. He has had increasing difficulties coping at work and he now can only work alone.
Mr. Prodger’s first marriage ended due to conflict. Mr. Prodger has not seen his only son for some years. Mr. Prodger remarried at the age of forty-four and he described a good relationship with his second wife.
Mr. Prodger has lost interest in golf and playing sport. He has a number of friends.
Mr. Prodger was an active and confident person prior to the subject stressors.
MENTAL STATE EXAMINATION
On mental state examination Mr. Prodger was a casually dressed man wearing a polo shirt. He had dark hair and his body posture was tense. His arms were folded. Mr. Prodger’s mood was anxious and his concentration was poor. He was worrying excessively.
…
DIAGNOSIS
Mr. Prodger fulfils the DSM-IV diagnostic criteria for a Generalized Anxiety Disorder. Mr. Prodger reported excessive anxiety and worry which has lasted for many years. He has difficulty controlling the worry. The anxiety and worry are associated with a range of additional symptoms including fatigue, difficulty concentrating, irritability, muscle tension and insomnia. The anxiety leads to clinically significant distress and impairment of his social and occupational functioning.
Mr. Prodger continues to suffer from Alcohol Dependence.
THE RELATIONSHIP OF HIS PSYCHIATRIC CONDITIONS TO HIS ELIGIBLE SERVICE
I believe Mr. Prodger’s Generalized Anxiety Disorder was caused by his eligible service. Firstly, I note Mr. Prodger did not suffer from anxiety prior to the subject stressors. I note Mr. Prodger’s Anxiety Disorder came on within a year of the subject stressors. Mr. Prodger’s Anxiety Disorder can be well understood in the context of the stressors he described.
Mr. Prodger’s Alcohol Dependence was a pre-existing condition.
DISABILITY
I will now quantify Mr. Prodger’s disability by referring to chapter four of the Guide to the Assessment of Rates of Veteran’s Pensions (GARP), edition 5. This chapter addresses the emotional and behavioural impact of formally diagnosed psychiatric illnesses.
Table 4.1 subjective distress
Mr. Prodger reported persistent psychiatric symptoms causing him considerable distress. He is particularly distressed by his anxiety, insomnia and excessive worry. He has difficulty obtaining relief from his distress despite a high level of support and reassurance from his wife. This equates to an impairment rating of 15.
Table 4.2 manifest distress
Mr. Prodger’s distress is often apparent to his wife but he conceals his distress from most other observers.
This equates to an impairment rating of 6.
Table 4.3 functional effects
Mr. Prodger has difficulty coping with the pressures of everyday life. This moderate interference with his ability to function in some everyday situations equates to an impairment rating of 2.
Table 4.4 occupation
Mr. Prodger has had difficulties coping in the workplace due to:
· Difficulty relating to people
· Reduced ability to cope with pressure
· Anxiety
· Poor memory and concentration
· Lethargy and insomnia
When considered together these equate to an impairment rating of 5.
Table 4.5 domestic situation
Mr. Prodger’s first marriage ended due to conflict. He does not see his son. He is alienated from his siblings. This level of family dysfunction equates to an impairment rating of 5.
Table 4.6 social interaction
Mr. Prodger said ‘I don’t socialize a lot anymore except going to the RSL’.. This substantial reduction in social interaction equates to an impairment rating of 5.
Table 4.7 leisure activities
Mr. Prodger has lost interest in various activities and he now does little with his leisure time. He said ‘I just try and switch off’.. This significant reduction in recreational activities equates to an impairment rating of 3.
Table 4.8 current therapy
I would recommend that Mr. Prodger attend a Psychiatrist for psychotherapy and psychotropic medication. I would also recommend Mr. Prodger have a trial of Campral or Naltrexone. In particular I would recommend an SSRI medication and Thiamine. I would suggest his General Practitioner perform an MBA20, CBP and TFT. He would also benefit from seeing a Psychologist or attending the Vietnam Veterans’ Counselling Service. He could be treated as an outpatient. This description equates to an impairment rating of 3.
Mr. Prodger’s overall impairment rating is 15 plus 6 plus 5 plus 5 plus 5 giving a total of 36. I would attribute 90% of Mr. Prodger’s impairment to his Generalized Anxiety Disorder and 10% to his Alcohol Dependence.
Mr. Prodger can work eight to twenty hours per week when taking into account his psychiatric problems which are service related.
I note Mr. Prodger’s psychiatric symptoms have been persistent and unremitting despite a comprehensive treatment programme. I therefore consider his psychiatric symptoms to be ‘permanent’ from a medico-legal point of view.”
14. The Applicant provided a report dated 12 March 2003 by his treating general practitioner, Dr Adil Vaghaiwala. In his report Dr Vaghaiwala concludes:
“Mr. Prodger does suffer from HYPERTENSION. He is currently on anti-hypertensive medication (Coversyl 8mgs) on a regular basis. His blood pressure tends to fluctuate when his anxiety is exacerbated.
Excessive alcohol intake would contribute towards his developing hypertension.
In my opinion, Mr. Prodger does suffer from a ‘mixed’ anxiety & depressive disorder.
I’ve studied Mr. Prodger’s statement regarding his service as a submariner. Base on my assessment, I do believe that his anxiety/depression did develop during the course of his service as a submariner from 1974 to 1991.
I am unable to state that his anxiety started off within the 1st 12 months of his service but I firmly believe that the stressors during the crucial 1st 12 months as a trainee did have a significant impact on his developing anxiety.
I do believe, based on the history & assessment that Mr. Prodger does suffer from a depressive illness. He is currently on a anti-depressant (Efexor 150mg) on a daily basis. He has also been consulting a psychologist (Mike Tyrrell) for counselling & treatment of his anxiety/depression.
I am again ‘unable’ to opine whether this condition developed within the 1st 12 months of his service but certainly did develop because of the stressors during the course of his service.”
15. The Tribunal is required to apply the standards of proof set out in sections 120(4) and 120B of the Act. That is, to determine this claim the Tribunal has to be reasonably satisfied that the diseases contracted by the Applicant are defence-caused only if the relevant Statements of Principles uphold the contentions that the diseases are connected with his service on the balance of probabilities.
16. The relevant Statement of Principle for Depressive Disorder is Instrument No. 59 of 1998 , specifically factor 5 (a):
“Factors
5.The factors that must exist before it can be said that, on the balance of probabilities, depressive disorder or death from depressive disorder is connected with the circumstances of a person’s relevant service are:
(a)experiencing a severe psychosocial stressor or stressors within the one year immediately before the clinical onset of depressive disorder;”
17. The relevant Statement of Principles for Generalised Anxiety Disorder is Instrument No. 2 of 2000 and in particular factor 5 (a) (i):
“Factors
5.The factors that must exist before it can be said that, on the balance of probabilities, anxiety disorder or death from anxiety disorder is connected with the circumstances of a person’s relevant service are:
(a)for generalised anxiety disorder or anxiety disorder not otherwise specified, only
(i)experiencing a severe psychosocial stressor within one year immediately before the clinical onset of anxiety disorder; ”
18. Severe psychosocial stressor is defined in the both Depressive Disorder and Generalised Anxiety Disorder ‘s Statement of Principles as:
“severe psychosocial stressor” means an identifiable occurrence that evokes feelings of substantial distress in an individual, for example, being shot at, death or serious injury of a close friend or relative, assault (including sexual assault), major illness or injury, experiencing a loss such as divorce or separation, loss of employment, major financial problems or legal problems;”
19. The relevant Statement of Principles for Hypertension is Instrument No. 32 of 2001. The relevant factors are as follows:
“Factors
5.The factors that must exist before it can be said that, on the balance of probabilities, hypertension or death from hypertension is connected with the circumstances of a person’s relevant service are:
(a)being obese at the time of the clinical onset of hypertension; or
(b)suffering from alcohol dependence or alcohol abuse, involving consumption of an average of at lest 300 grams per week of alcohol (contained within alcoholic drinks) at the time of the clinical onset of hypertension; or”
20. The relevant Statement of Principles for alcohol dependence/abuse is No. 77 of 1998. The relevant factor is:
“Factors
5.The factors that must exist before it can be said that, on the balance of probabilities, alcohol dependence or alcohol abuse or death from alcohol dependence or alcohol abuse is connected with the circumstances of a person’s relevant service are:
….
(b)experiencing a severe stressor within the one year immediately before the clinical onset of alcohol dependence or alcohol abuse;
“experiencing a severe stressor” means, the person experienced, witnessed or was confronted with, an event or events that involved actual or threat of death or serious injury, or a threat to the person’s or other people’s physical integrity, which event or events might evoke intense fear, helplessness or horror;
In the setting of service in the Defence Forces, or other service where the Veterans’ Entitlements Act applies, events that qualify as severe stressors include:
(1) threat of serious injury or death;
“alcohol dependence” means the presence of a constellation of cognitive, behavioural and physiological symptoms indicating the use of alcohol despite significant alcohol-related problems. The pattern of repeated self administration may result in tolerance, withdrawal and compulsive alcohol use behaviour.
“alcohol abuse” means the presence of cognitive, behavioural or physiological symptoms indicating the use of alcohol despite significant alcohol-related problems, however these symptoms have never met the criteria for alcohol dependence. Additionally, signs of tolerance or withdrawal are absent.”
21. The Tribunal notes the following from the Applicant’s medical records (T4):
(a)On 10 November 1974 the Applicant was admitted to the hospital with facial lacerations after crashing a motor vehicle while drunk. The applicant was 19 years old at the time of this incident.
(b)The medical notes state that on 9 March 1983 the Applicant had a heavy night drinking 7-10 schooners of beer and woke up the next morning feeling ill and vomited 4 times.
(c)The notes dated 18 March 1986 state that the applicant “…drinks up to 6 cans /day”.
(d)Further notes dated 16 March 1989 state, “..Move to decrease alcohol consumption. Attend Alcohol Anonymous to good effect no alcohol since 1 January 1989.”
(e)Notes dated 24 July 1991 state:
“Nonsmoker. 20 + drinks /week … Obese 92 Kg and Borderline Hypertension BP 136/96 “
22. It is the Applicant’s claim that during 17 years as a submariner he was constantly confronted with severe stressors. He has given evidence about specific stressful incidents to illustrate the nature of his work. His claim is that the stress was relentless.
23. The Tribunal finds that the Applicant was a truthful and reliable witness. The Tribunal accepts that the Applicant did not begin to consume alcohol to excess until he became a submariner. The Tribunal also accepts that the Applicant was suffering from panic attacks and other signs of psychiatric disorders such as depression and anxiety disorders before he finished his service in submarines.
24. The Tribunal accepts that the Applicant experienced many situations in his 17 years in submarines in which he believed that his life was threatened. Those life-threatening situations were not only numerous but they were also of significant duration, lasting for days at a time on some occasions.
25. The Tribunal is satisfied that the Applicant experienced many incidents which satisfy the descriptions of severe psychosocial stressors, or severe stressors throughout his submarine service.
26. The Tribunal accepts the medical evidence put before the Tribunal and is satisfied that the Applicant suffers from Depressive Disorder, Anxiety Disorder and Alcohol Abuse (which has contributed to his Hypertension).
27. The Tribunal finds that the Applicant’s psychiatric problems and alcohol abuse had their clinical onset whilst he was serving as a submariner and within one year of experiencing the respective severe psychosocial stressors or severe stressors as the case may be.
28. The decision under review is set aside and in substitution the Tribunal determines that the Depressive Disorder, Anxiety Disorder and Hypertension suffered by Ian Glen Prodger are related to his service in the Navy.
I certify that the 28 preceding paragraphs are a true copy of the reasons for the decision herein of Deputy President, Don Muller
Signed: .......................................................................................
C. O’Donovan, AssociateDate/s of Hearing 27 May 2003
Date of Decision 14 October 2003
Solicitor for the Applicant Pipers
Respondent Mr. G. Doube, departmental advocate
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