Schofield and Repatriation Commission - [2000] AATA 1048

DECISION AND REASONS FOR DECISION [2000] AATA 1048

ADMINISTRATIVE APPEALS TRIBUNAL )

) No N1996/1146

VETERANS' APPEALS DIVISION       )
           Re      MARY AGNES SCHOFIELD
  Applicant
           And    REPATRIATION COMMISSION
  Respondent

DECISION

Tribunal Mr M J Sassella, Senior Member Dr P D Lynch, Member

Date28 November 2000
PlaceSydney

Decision      The decision under review is set aside. In substitution therefor the Tribunal decides that the Applicant qualifies for a War Widow Pension with a date of effect of 22 July 1995.
  ..............................................
  Senior Member
CATCHWORDS
VETERANS' AFFAIRS – war widow pension – war-caused death – cerebrovascular accident – ischaemic heart disease – clinical onset – statement of principles

Veterans' Entitlements Act 1986 ss 6A, 7(1)(a), 8(1), 11, 13, 120, 120A

Keeley v Repatriation Commission (2000) 98 FCR 108
Repatriation Commission v Deledio (1998) 27 AAR 144

REASONS FOR DECISION

28 November 2000 Mr M J Sassella, Senior Member Dr P D Lynch, Member

APPLICATION

On 18 September 1995 Mary Schofield ("the Applicant") lodged a claim for a War Widow Pension under s 14 of the Veterans Entitlements Act 1986 ("the Act") (T5). On 9 October 1995 the Repatriation Commission ("the Respondent") decided (T2) to reject the Applicant's claim on the basis that the death of the deceased veteran, Mr Charles Schofield, was not causally related to service.
On 22 January 1996 the Department of Veterans' Affairs ("DVA") received a letter from the Applicant seeking to appeal against the decision (T12). This request was referred as normal to the Veterans' Review Board ("VRB").
On 23 July 1996 the VRB decided to affirm the decision under review (T15). On the same day the VRB sent a letter to the Applicant to inform her of the decision (T16).
On 24 September 1996 the Applicant lodged with the Tribunal an application for review of the decision (T1).
At the hearing the Applicant was represented by Mr Vincent of counsel and the Respondent was represented by Mr Modder, an advocate from the Department of Veterans' Affairs.
The documents produced pursuant to section 37 of the Administrative Appeals Tribunal Act 1975 were taken in as evidence (Exhibit TD1) in addition to the following material:
Exhibit No Description Date
A1 A2 A3 A4 A5 A6 A7 A8 A9 R1 R2 Report of Dr Cameron Report of Dr Cameron Applicant's Statement of Facts and Contentions Report of Dr Schiller Report of Dr Cameron Applicant's Hypotheses Report of Dr Foster Report of Dr Foster Report of Dr Foster Respondent's Statement of Facts and Contentions Clinical records from Calvary Hospital 3 March 1997 29 May 1997 11 August 1998 1 September 1998 8 May 2000 undated 13 February 1990 17 April 1990 20 July 1990 19 August 1998 various

LEGISLATION

Section 13 of the Act provides that a pension is payable to dependants of a veteran whose death is "war-caused". Section 11 of the Act defines dependant as including the widow of a veteran.
The veteran rendered operational service as defined by section 6A of the Act from 19 January 1942 until 17 April 1946. By section 7(1)(a) a veteran who has rendered operational service is taken to have also rendered eligible service.
Section 8(1) of the Act defines war-caused death and provides, as relevant:
"8 War-caused death
(1)Subject to this section, for the purposes of this Act, the death of a veteran shall be taken to have been war-caused if:
(a)the death of the veteran resulted from an occurrence that happened while the veteran was rendering operational service;
(b)the death of the veteran arose out of, or was attributable to, any eligible war service rendered by the veteran;
(c)the death of the veteran resulted from an accident that occurred while the veteran was travelling, while rendering eligible war service but otherwise than in the course of duty, on a journey to a place for the purpose of performing duty or away from a place of duty upon having ceased to perform duty;
(d)in the opinion of the Commission, the death of the veteran was due to an accident that would not have occurred, or to a disease that would not have been contracted, but for his or her having rendered eligible war service or but for changes in the veteran's environment consequent upon his or her having rendered eligible way service; or
(e)the injury or disease from which the veteran died:
(i)was suffered or contracted while the veteran was rendering eligible war service, but did not arise out of that service; or
(ii)was suffered or contracted before the commencement of the period, or last period, of eligible war service rendered by the veteran, but not while the veteran was rendering eligible war service;
and, in the opinion of the Commission, the injury or disease was contributed to in a material degree by, or was aggravated by, any eligible war service rendered by the veteran, being service rendered after the veteran suffered that injury or contracted that disease; or
(f) the injury or disease from which the veteran died is an injury or disease that has been determined in accordance with section 9 to have been a war-caused disease, as the case may be
…;
but not otherwise."
Sections 120(1) and 120(3) of the Act require, in the case of a veteran who has rendered operational service, that the Tribunal find his or her death was war-caused unless the material before it does not raise a reasonable hypothesis connecting the death of the veteran to his or her service.
The Applicant's claim was lodged after 1 July 1994, therefore section 120A of the Act applies. It provides, as relevant:
"120A Reasonableness of hypothesis to be assessed by reference to Statement of Principles
…
(3)For the purposes of subsection 120(3), a hypothesis connecting an injury suffered by a person, a disease contracted by a person or the death of a person within the circumstances of any particular service rendered by the person is reasonable only if there is in force:
(a)a Statement of Principles determined under subsection 196B(2) or (11); …
that upholds the hypothesis.
…"

The Tribunal must assess the reasonableness of the Applicant's hypotheses connecting the veteran's death with operational service in accordance with applicable Statements of Principles determined by the Repatriation Medical Authority.

The Statement of Principles ("SoP") applied in this decision is Instrument No 326 of 1995 relating to cerebrovascular accident. It provides, as relevant:
"1. Being of the view that there is sound medical-scientific evidence that indicates that cerebrovascular accident and death from cerebrovascular accident can be related to operational service rendered by veterans…the Repatriation Medical Authority determines, under subsection 196B(2) of the Veterans' Entitlements Act 1986 (the Act), that the factors that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting cerebrovascular accident or death from cerebrovascular accident with the circumstances of that service, are:
…
(b)an inability to undertake vigorous or moderate physical activity for a continuous period of at least five years immediately before the clinical onset of cerebrovascular accident; or
…"

FACTS

The relevant facts relate to the veteran rather than to the Applicant because Mrs Schofield will succeed in her application if the condition or conditions that caused Mr Schofield's death were service-related.
Charles Schofield was born on 5 December 1916. He died on 8 February 1995. His death certificate (T6) shows that the cause of death was "metastatic adenocarcinoma of colon (11 months)".
After completing his schooling the veteran worked as a grocer (T3, folio 16). He enlisted in the army with effect from 19 January 1942 until 17 April 1946 (T8). Mr Schofield engaged in operational service between those same dates (T2
While in the army Mr Schofield suffered from elevated blood pressure (T3, folio 12). This was discovered in April 1943 and was treated in 1943 and 1944. As at 29 October 1945 he had a blood pressure reading of 148/90 (T3, folio 13). It was noted that psychologically he seemed to be suffering from a mild anxiety state related to his heart (T3, folio 13).
On 18 January 1951 Mr Schofield signed an application for acceptance of his disability which was described as "nerves" (T3, folio 14). The medical officer who saw him (T3, folio 14) on 23 January 1951 said he complained of chest pains which were treated by Mr Schofield's doctor, Dr Lehman, in about October 1950. He was not a smoker. His blood pressure was 136/86. Follow-up investigations were ordered. Mr Schofield's anxiety was rejected as a war-caused disability (T11).
In 1971 he was again seen by a doctor for the Respondent (T3, folios 15-18). He complained of nerves and duodenal ulcer. He said he first noticed them in 1943 and 1967, respectively. Mr Schofield said he was treated in 1943 for anxiety state with dyspnoea and giddiness. In 1971 he said he had feelings of tension associated with fatigue, tremors, perspiration, pallor and palpitations. The examining doctor observed these. Earlier he had experienced tension pains in his chest. As regards the ulcer he said he had nausea and heartburn and high epigastric pain dating from 1945. It was controlled after diagnosis in 1967. His blood pressure on 2 February 1971 was recorded as 200/115. Five minutes later, after rest, it was 180/115. Mr Schofield was diagnosed as having anxiety state, a duodenal ulcer and hypertension. Further investigations were recommended. Mr Schofield's conditions of anxiety and peptic ulcer were accepted as war-caused (T11).
In 1973 Mr Schofield was again examined by a doctor associated with the Respondent (T3, folios 19-22). He had experienced numbness and loss of power in the right arm and hand three times in the previous year. It was associated once with speech and visual disturbances. This had been treated with medications including valium. His blood pressure was 175/110, 180/120 and 200/130 during that visit. He was diagnosed as having had a cerebral vascular spasm and hypertension. Further investigations were recommended.
The veteran's medical history appears in T11. In addition to the above conditions, it records Mr Schofield as suffering from:

Atherosclerosis, 1974 – a condition rejected as war-caused by "Tribunal".
Ischaemic heart disease ("IHD"), 6 June 1981.
Myocardial ischaemia – unstable angina (1992), stent/angioplasty (1992), atrial flutter (1993).
Peptic ulcer haemorrhage, 1983.
Skin cancer [legibility dubious], 1990.
Carcinoma of colon, 1994.
Possible carcinoma of prostate, 1993.
Rotator cuff, left shoulder, 1993-1994.

THE APPLICANT'S EVIDENCE

In her claim form (T5) Mrs Schofield had suggested that Mr Schofield's death was contributed to by his war service. He served in the South West Pacific while suffering from "extreme high blood pressure" and an anxiety state which was affecting his heart. These conditions were verified on his discharge "in 1945". In civilian life the hypertension increased to such an extent that he developed IHD. He also underwent psychological and psychiatric assessments because of war-related hallucinations and nightmares he endured. She said that Mr Schofield's highly nervous state played some part in his continuing hypertension. Mr Schofield was finally admitted to Calvary Hospital, Kogarah, because of a stroke which caused impaired swallowing and aspiration pneumonia, both of which contributed to his death. She therefore argued that Mr Schofield's death was directly related to a war-caused disability, hypertension. This led to IHD and culminated in a stroke. Although the death certificate says that Mr Schofield died of metastatic adenocarcinoma of the colon, she believed he died as a result of the stroke. Mrs Schofield cited a letter by Dr L Rodrigues, staff specialist in palliative care at Calvary Hospital (T7, 29 August 1995), as supporting her theory.
Mr Vincent submitted that the death certificate (T6) was incomplete as regards cause of death. It had not been prepared by Mr Schofield's treating doctor. It did not refer to Mr Schofield's anxiety state which was extreme in many ways and had been accepted as a war-caused condition. He referred to newly discovered reports by a psychiatrist, Dr Foster (Exhibits A7, A8 and A9), which refer to Mr Schofield suffering panic attacks. These reports date back to 1990.
In her oral evidence Mrs Schofield described her husband's anxiety condition. He was nervous generally but especially of groups of people, and of almost everything. He "got cranky" easily. He was panicky. He hyperventilated a couple of times. This was not brought about by anything in particular. It was "just him". He was prone to tremble and shake and perspired somewhat at night. He was vague at times.
Mr Schofield had no particular fears but he did not like crowds. He had a panic attack in a retail shop one day.
In his spare time he played golf (twice a week) and tennis. He gave these up because of his heart condition.
Mrs Schofield could not say when the heart condition began. He had a bypass operation in 1981 but that was preceded for years by heart problems. He reduced his golf to once a week after that operation and ceased entirely about five years before he died (ie 1990). His interests then became reading and listening to music.
He had "bad nerves". Anything could "set him off". He was impatient, irritable, cranky and unhappy with himself. He found people would disappoint him and he would then "get uptight".
Mrs Schofield could not recall the veteran discussing flushes or chills or pins and needles.
He was on medication prescribed by Dr Cameron whom Mr and Mrs Schofield had been seeing since 1984. Mr Schofield's concentration was not good. He slept a lot. He would go for a walk around the retirement village for about a half an hour at a time, returning home exhausted.
Mr Schofield was not a good communicator. He tended to indicate that something was the matter by his silence.
Mr Schofield had an unpleasant final year of life. He was diagnosed with cancer of the colon. He spent a lengthy time in hospital. He had hallucinations in which he thought he was back in the army. He did not trust doctors with needles. He found it difficult in hospital to recover from his stroke and his operation.
DR CAMERON'S EVIDENCE
Dr Cameron had provided a number of reports. These included T14 (6 June 1996), Exhibit A1 (3 March 1997), Exhibit A2 (29 May 1997) and Exhibit A5 (8 May 2000).
In T14 Dr Cameron said he could not link Mr Schofield's colon cancer or alcohol consumption to his war service. However, he suffered from anxiety neurosis which was war-caused. Mr Schofield's death from colon cancer "definitely was hastened by his chronic severe anxiety and stroke." Had he signed the death certificate he would have added the anxiety and "CVA" to the list of contributing factors on the death certificate.
In Exhibit A1 Dr Cameron said that in over 20 years of busy general practice Mr Schofield was by far the most severely anxious patient he had seen. Dr Cameron wrote that he believed that the colon cancer killed Mr Schofield but he could have continued living at home longer if he had not been afflicted with anxiety. His death was therefore hastened by his chronic severe anxiety and stroke.
In Exhibit A2 Dr Cameron referred to Mr Schofield's mild persistent hypertension between 1984 and 1995. He had episodes of moderate hypertension during bouts of extreme anxiety. His hypertension was well controlled but definitely occurred and was a risk factor for his cardio-vascular accident ("CVA"). Anxiety can cause increase in blood pressure and Mr Schofield had severe chronic anxiety to such a degree that the link was acceptable. He could not attribute Mr Schofield's blood pressure to direct war service, except as due to anxiety.
In Exhibit A5 Dr Cameron addressed the Statements of Principles ("SoPs") relevant to strokes, IHD and hypertension. He said there was a reasonable hypothesis that Mr Schofield's CVA was related to his war service in that, as required in the SoP, he suffered from panic disorder before the clinical onset of the stroke; he was unable to do more than mild physical activities for at least five years before the CVA; and labile hypertension existed before the stroke.
Mr Schofield had the most severe, chronic phobia anxiety and panic attack disorder possible and this did not cease before the stroke. The criteria for panic disorder and minimum symptoms as described in the SoP on IHD were easily met. Dr Cameron believes that Mr Schofield did not reach any physical activity greater than a slow walk (less than 120 metres) which is about 3 METS. Mr Schofield suffered labile hypertension associated with his panic states.
None of these conditions have any causal relationship to colorectal cancer. However, the discharge note from Calvary Hospital (T7 by Dr Rodrigues) indicated that his stroke had left him confused with possible impaired swallowing and aspiration pneumonia. It is not unreasonable to suggest that this state hastened his death and should have been included as a contributing cause on the death certificate.
Dr Cameron also thought that factor (o) in the IHD SoP suggested that Mr Schofield had a reasonable case for his IHD being accepted as due to his severe anxiety and panic disorder.
In his oral evidence Dr Cameron addressed Mr Schofield's panic disorder. SoP 52 of 1999 concerning CVA includes as factor 5(c), that the veteran was suffering from panic disorder before the clinical onset of CVA. The recently produced reports by Dr Foster from 1990 mention that Mr Schofield was suffering from panic attacks and symptoms.
Dr Foster's reports make mention of panic attacks as such only once. He noted that they had occurred over the years and woken Mr Schofield (Exhibit A7, 13 February 1990). Dr Cameron had not himself witnessed Mr Schofield having a panic attack. He had seen him lying on the floor in the shower recess at home on one occasion in 1994. This could have been a tremor effect but caused for psychological reasons.
Mr Schofield gradually could do less and less. He reduced his golf and church activities. He walked to Dr Cameron's surgery, about 120 metres away. In Dr Cameron's view the veteran could have physically done more but he was a mess mentally. His fear of stress led to him not applying for a higher rate of Disability Pension.
In relation to SoP 52 of 1999 on CVA reference was made to factor 5(d), an inability to undertake more than a mildly strenuous level of physical activity for at least five years immediately before the clinical onset of CVA. The definition of "an inability to undertake more than a mildly strenuous level of physical activity" in clause 8 of the SoP states that it means the presence of an incapacity which prevents any physical activity greater than 3 METS. Dr Cameron placed Mr Schofield's ability at between 2 and 3 METS. This equates to walking slowly and doing light household duties at the most.
Dr Cameron considered an earlier SoP on CVA also satisfied. This was SoP 326 of 1995. Factor 1(b) then was "an inability to undertake vigorous or moderate physical activity". A five year period again applied. That phrase was also defined by reference to a measurement of 3 METS.
Dr Cameron was then referred to the SoP on IHD, SoP 38 of 1999. Factor 5(y) was virtually identical to factor 5(d) in SoP 52 of 1999 on CVA, except that it refers to the clinical worsening (not onset) of IHD. The definition of "an inability to undertake more than a mildly strenuous level of physical activity" was the same as in SoP 52 of 1999. The difficulty here was whether the inability to undertake such physical activity had existed for at least five years before the clinical onset of IHD in 1992. On balance Dr Cameron thought the worsening of the underlying condition of IHD while its symptoms were being controlled might suffice.

As regards the earlier SoP on IHD, SoP 85 of 1995, Dr Cameron was referred to factor 1(s) which was an inability to undertake vigorous or moderate leisure time activity for five years immediately before the clinical worsening of IHD. This criterion was not defined. Dr Cameron considered this criterion was met because of Mr Schofield giving up golf and similar things.
Dr Cameron was asked why he saw Mr Schofield's anxiety state as a contributing factor to his death as he had written in his report of 3 March 1997 (Exhibit A1). Dr Cameron referred to Dr Rodrigues's references to Mr Schofield's impaired swallowing and confusion and memory problems as significant in the period leading up to his death. It was suggested he may have had asphyxiation pneumonia. Dr Cameron said, "I think that I would have put part of that down and the anxiety as a contributing cause, but not directly the cause of his death (transcript, 31)."
Dr Cameron agreed with Mrs Schofield's counsel that the veteran may have satisfied factor 5(c) in SoP 52 of 1999 on CVA, ie that Mr Schofield was suffering from a panic disorder before the clinical onset of CVA. Dr Cameron said the veteran certainly at times had a number of the symptoms attributed in the SoP to panic disorder. They were very frequent and had a significant behavioural effect.
Dr Cameron then referred to SoP 38 of 1999 on IHD. Factor 5(zd) referred to a clinical worsening of IHD demonstrated by myocardial infarction or arrhythmia with ECG evidence of myocardial ischaemia only which occurred when the veteran was suffering for panic disorder or phobic anxiety with panic attack at the time of the clinical worsening of IHD. "Panic disorder" and "panic attack" are defined in clause 8 of that SoP. Dr Cameron had some problem saying with certainty that the veteran would have experienced at least four of 13 listed symptoms in any one panic attack, a requirement of the definition. He usually saw Mr Schofield after an attack. He was certain however that, over time, he would have had 12 of the 13 symptoms frequently. He was prepared to presume that the veteran had four of the symptoms at the one time.
Factor 5(zd) requires a panic attack "at the time of the clinical worsening of" IHD. There was discussion as to what this meant. Dr Cameron was not present when the veteran was admitted to hospital in November 1994. It was thought that some observation of a panic attack occurring around the time he was admitted to hospital with the stroke in November 1994 would suffice. Dr Cameron said that Mr Schofield's panic attacks occurred much more frequently than once a month. He considered the requirement in factor 5(zd) met.
In cross-examination Dr Cameron was asked how much longer Mr Schofield would have lived had he not had the stroke. Dr Cameron considered one to three months longer would be a reasonable estimate.
APPLICANT'S FINAL SUBMISSIONS
At the time of his death Mr Schofield still suffered from a number of conditions. This is clear from Exhibit R2, the Calvary Hospital clinical notes. Dr Rodrigues in those notes referred to Mr Schofield's CVA and the effects that produced, ie impaired swallowing and, aspiration pneumonia. These symptoms contributed to his death, according to Dr Rodrigues who treated Mr Schofield in the hospital. Dr Cameron agreed entirely with Dr Rodrigues.
Dr Cameron considered that Mr Schofield would have lived one to three months longer had he not had the stroke. Mr Vincent referred also to the other conditions, the anxiety which was manifested in an extreme form by the time leading up to death, and the IHD.
In considering the relationships between Mr Schofield's conditions and service, the clearest was the anxiety state. This was an accepted condition. This led to Mr Schofield's inactivity for five to seven years. His physical activity in that period was at or below 3 METS.
It then becomes straightforward to satisfy the requirements of either of the SoPs on CVA. The description of the relevant factor is different as between SoP 52 of 1999 and SoP 326 of 1995 but the definition remains constant in each version. Mr Schofield's lack of exercise over an extended period therefore satisfies the relevant factors in the SoPs on CVA.
The SoPs on IHD contain similar factors related to a clinical worsening of IHD. Mr Vincent argued that Mr Schofield satisfied these also.
Under the applicable SoPs, then, Mr Vincent argued that the hypothesis of a link between service and CVA and IHD had been raised.
Mr Vincent then argued that the 1999 SoPs could be applied in this case, even though the primary decision was made on 9 October 1995.
After the Respondent's final submissions had been presented Mr Vincent reminded the Tribunal that the Respondent's task, if it intended to dislodge a reasonable hypothesis, was to disprove it on the facts beyond a reasonable doubt. He suggested that all that Mr Modder had done was to offer an alternative hypothesis. He had not disproved Mrs Schofield's hypothesis beyond a reasonable doubt.
FINAL SUBMISSIONS FOR THE RESPONDENT
Mr Modder queried whether the accepted disability of anxiety state could or should be taken to have led to an inactive lifestyle on Mr Schofield's part. He played tennis for many years after the war and gave up golf only in about 1987 or 1988. He was still playing golf at 75 years of age. Mr Modder argued that Dr Cameron attributed to the Applicant a lesser level of exercise in his later years than Mrs Schofield had done in her evidence.
The conditions said to have stemmed from the anxiety induced inactivity are common amongst older men. These are such conditions as CVA and IHD. Even colon cancer, which is not pressed here as a war-caused condition, is reasonably common amongst older men.
Mr Modder suggested that the death certificate was more likely correct in attributing Mr Schofield's death to colon cancer than if it had referred to contributions by conditions such as CVA. Dr Cameron believed that Mr Schofield's CVA contributed to his death on the basis of Dr Rodrigues's report about Mr Schofield's eating difficulty and state of confusion. Mr Modder reminded the Tribunal that Dr Cameron had admitted in evidence that he had not seen Exhibit R2, the Calvary clinical notes. Mr Modder referred to records at pages 26 and 28 of Exhibit R2 showing that Mr Schofield was tolerating a full diet in December 1994.
Mr Modder questioned whether Mr Schofield's panic attacks had been as common as Dr Cameron suggested. Mrs Schofield had mentioned only one incident in a retail store.
THE TRIBUNAL'S FINDINGS
In reaching its findings the Tribunal is guided by the principles laid down in Repatriation Commission v Deledio (1998) 27 AAR 144. Their Honours said (at 159-60):
"[T]he course which the Tribunal is to take in a case, such as the present, (ie one involving a claim to be decided after the 1994 Amendments) in respect of the incapacity of a person from injury or disease, or in respect of the death of a person related to service rendered by that person as follows:
1. The Tribunal must consider all the material which is before it and determine whether that material points to a hypothesis connecting the injury, disease or death with the circumstances of the particular service rendered by the person. No question of fact finding arises at this stage. If no such hypothesis arises, the application must fail.
2. If the material does raise such a hypothesis, the Tribunal must then ascertain whether there is in force a SoP determined by the Authority under s 196B(2) or (11) of the 1986 Act… .
3. If a SoP is in force, the Tribunal must then form an opinion whether the hypothesis raised is a reasonable one. It will do so if the Hypothesis fits, that is to say, is consistent with the 'template' to be found in the SoP. The hypothesis raised before it must thus contain one or more of the factors which exist, and be related to the person's service (as required by s 196B(2)(d) and (e)). If the hypothesis does contain these factors, it could neither be said to be contrary to proved or known scientific facts, nor otherwise fanciful. If the hypothesis fails to fit within the template, it will be deemed not to be 'reasonable' and the claim will fail.
4. The Tribunal must then proceed to consider under s 120(1) whether it is satisfied beyond reasonable doubt that the death was not war-caused, or in the case of a claim for incapacity, that the incapacity did not arise from a war-caused injury. If not so satisfied, the claim must succeed. If the Tribunal is so satisfied, the claim must fail. It is only at this stage of the process that the Tribunal will be required to find facts from the material before it. In so doing, no question of onus of proof or of the application of any presumption will be involved.
…"

In the present application the first step in the hypothesis is that Mr Schofield's death was caused by both metastatic adenocarcinoma of the colon and symptoms from the CVA that occurred several months before his death. Dr Cameron said that these symptoms were present and reduced the veteran's life by from one to three months. The IHD was also present at the time of his death and contributed to it.

The CVA ad IHD were war-caused because of their connection with Mr Schofield's lack of exercise which was, in turn, attributable to his anxiety state, an accepted condition.
Alternatively, the CVA and IHD were war-caused because of their connection with panic attacks or panic disorder.
There is, therefore, a hypothesis under the first step in the Deledio case (supra).
The second step in the Deledio case (supra) requires the Tribunal to ascertain whether a relevant SoP exists. In this application there are several that apply. The SoPs concerning CVA (SoP 52 of 1999 and SoP 326 of 1995) and IHD (SoP 38 of 1999 and SoP 85 of 1995) are applicable.
The third step is to see whether the hypothesis is consistent with the template found within the relevant SoP.
In the present application the Tribunal finds that the veteran's CVA was war-caused because the applicable SoPs are satisfied. Factor 1(b) of SoP 326 of 1995 required that the veteran have an inability to undertake vigorous or moderate physical activity for at least five years before the clinical onset of CVA. The definition of that level of activity was that the veteran's incapacity must prevent any physical activity greater than 3 METS.
Dr Cameron was satisfied that the veteran satisfied these requirements. The Tribunal was impressed by the fact that Dr Cameron had cared for the veteran for many years at the time of his death and saw him often. He was, in the Tribunal's view, well acquainted with the veteran's lifestyle and habits. In his oral evidence he clearly agonised at times to address the criteria in this and other SoPs. He did not readily leap in and assert that the veteran satisfied the criteria. This lent an authority to his opinions that might otherwise have been absent.
Dr Cameron in Exhibit A5 (8 May 2000) said that the panic symptoms and anxiety stopped Mr Schofield from playing golf by the late 1980s and he did not do any exercise after that or even small chores around the house. The anxiety state was an accepted condition. This provides the link between the factor in the SoP and Mr Schofield's operational service.
It was argued that SoP 52 of 1999 was applicable in this case. The Tribunal has no need to decide that matter because the Applicant succeeds on the basis of the earlier SoP which is available without any controversy as a result of the Federal Court's decision in Keeley v Repatriation Commission (2000) FCR 108.
This finding also means that it is unnecessary to address the question of whether the SoPs on IHD are satisfied in this case. However, the Tribunal considers that it would be strange if they were not satisfied as they are very similar to those on CVA, although it is less clear that the five year period of symptomatology required before the clinical onset of IHD was present in this case. At the same time, the Tribunal considers that the factors in the IHD SoPs relating to panic disorders and panic attacks would likely be satisfied.
The Tribunal therefore finds that the third step in the Deledio case (supra) has been satisfied in this case.
The fourth step is to consider whether it is satisfied beyond reasonable doubt that the veteran's death was not war-caused.
The Tribunal finds that there is no basis for deciding beyond a reasonable doubt that Mr Schofield's death was not war-caused. The Tribunal considered Mr Modder's arguments which he put in final submissions. However, it agrees with Mr Vincent, that these amounted in large part to an alternative hypothesis, not to evidence displacing the Applicant's hypothesis beyond a reasonable doubt.
CONCLUSION
The Tribunal has concluded that Mr Schofield's death was war-caused in accordance with s 13 of the Act.
DECISION
The decision under review is set aside and substituted by a decision that the Applicant qualifies for a War Widow Pension with a date of effect of 22 July 1995.
I certify that the 79 preceding paragraphs are a true copy of the reasons for the decision herein of Mr M J Sassella, Senior Member and Dr P D Lynch, Member
Signed:         .....................................................................................
  Associate
Date of Hearing  4 July 2000
Date of Decision  28 November 2000
Counsel for the Applicant  Mr M Vincent
Representative for the Respondent        Mr S Modder