SRUUU and Repatriation Commission - [2002] AATA 792

DECISION AND REASONS FOR DECISION [2002] AATA 792

ADMINISTRATIVE APPEALS TRIBUNAL )

) No N2000/624

VETERANS' APPEALS DIVISION       )
           Re      SRUUU
  Applicant
           And    REPATRIATION COMMISSION
  Respondent

DECISION

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

Date11 September 2002
PlaceSydney

Decision      The tribunal affirms the decision under review.
   [SGD] M J SASSELLA
  Senior Member
CATCHWORDS
VETERANS' ENTITLEMENTS – Disability Pension – eligible defence service – veteran fell from aircraft - standard of proof is reasonable satisfaction – whether veteran suffered from defence-caused post-traumatic stress disorder – delayed onset post-traumatic stress disorder – whether veteran suffered from defence-caused alcohol dependence or alcohol abuse – whether veteran suffered from defence-caused drug dependence or drug abuse – whether veteran experienced a severe stressor – whether veteran suffered from defence-caused anxiety disorder – whether veteran suffered from defence-caused personality disorder – whether veteran experienced a defence-related catastrophic event – whether psoriasis a defence-caused disease – whether veteran suffered from alcohol dependence or alcohol abuse involving regular consumption of an average of 420 g a week of alcohol at time of clinical worsening of psoriasis – whether veteran suffered from clinically significant anxiety disorder or depressive disorder at time of clinical worsening of psoriasis.

Veterans' Entitlements Act 1986 ss 20(1), 120(4).
Statement of Principles 4/99 concerning post-traumatic stress disorder as amended by Statement of Principles 55/99
Statement of Principles 77/98 concerning alcohol dependence or alcohol abuse
Statement of Principles 79/98 concerning drug dependence or drug abuse
Statement of Principles 22/98 concerning psoriasis
Statement of Principles 2/2000 concerning anxiety disorder
Statement of Principles 144/95 concerning personality disorder as amended by Statement of Principles 14/97

Gorton, Repatriation Commission v (2001) 33 AAR 370
Smith, Repatriation Commission v (1987) 74 ALR 537
Williams, Repatriation Commission v [2001] FCA 1195

REASONS FOR DECISION

11 September 2002 Mr M J Sassella, Senior Member Dr P D Lynch, Member

HISTORY OF APPLICATION

On 26 August 1998 the applicant lodged a claim for a Disability Pension in respect of post traumatic stress disorder, alcoholism, hearing loss, stress headaches and "skin problems" with the Department of Veterans' Affairs ("the DVA") (T4). It was his contention that these conditions were related to his service in the Royal Australian Air Force ("RAAF"). No mention was made on the claim form of an incident whereby he allegedly fell from an aircraft.
On 21 April 1999 the Repatriation Commission ("the respondent") handed down a decision in relation to the above application (T8). The applicant's claims in respect of bilateral sensorineural hearing loss with tinnitus, folliculitis and solar keratoses were accepted as service-related conditions. However the claims for personality disorder with secondary alcohol abuse, psoriasis and tension headaches were all refused. The applicant was granted a Disability Pension at 50% of the general rate, the date of effect being 26 May 1998.
On 21 May 1999 the applicant lodged an application for review of this decision with the Veterans' Review Board ("the VRB") (T10). It was his contention that the rejected conditions referred to above were causally related to his eligible defence service.
On 15 July 1999 the respondent wrote to the applicant informing him that it had elected not to conduct a review of his application pursuant to s 31 of the Veterans' Entitlements Act 1986 (T12).
reviewable decision
On 2 February 2000 the VRB varied the diagnosis of personality disorder with secondary alcohol abuse to post traumatic stress disorder with secondary alcohol abuse (T15). Otherwise, the Repatriation Commission decision was affirmed, none of the contested conditions being accepted as causally linked to service. It was the applicant's contention that progress reports from his supervisors showed that he was a consistently good performer in the RAAF in his early service life and that his demise had been caused by an incident when he fell from an aeroplane during parachuting duties. Further, the applicant had suffered from a personality clash with one of his supervisors. Regarding the aircraft incident it was the applicant's contention that he had experienced a catastrophic and stressful event during which he was threatened with actual death and experienced helplessness and horror. The VRB noted that there was no actual record of the incident since neither the Flight Captain nor the applicant had reported it. In the mid-1980s it was not a personality disorder that was being exhibited by the applicant but the effects of a post-traumatic stress disorder as a result of the parachuting incident.
In relation to psoriasis the applicant contended that he satisfied factor 5(f) of the Statement of Principles ("SoP") concerning psoriasis, no 22 of 1998, in that he was suffering from a clinically significant anxiety and depressive disorder. Further he satisfied factor 5(e) of the same SoP in that he was suffering from alcohol dependence and abuse. Both contentions were supported by the opinion of Dr K Koller, a psychiatrist.
The VRB noted that on the formal claim form (T4) the applicant had referred to severe stress and anxiety on flying duties in New Guinea and becoming a regular user of tobacco and alcohol. Subsequently the applicant recorded details of the incident that occurred in 1982 when he fell from a plane. He could not remember the exact date of the incident. He said that it was decided in consultation with the two pilots and the instructor that the incident would be concealed because no injury was suffered. In 1983, in New Guinea, the applicant noticed that he was having nightmares about the incident. He medicated himself with alcohol. At this time the applicant's mother was dying from cancer and the applicant believed at the time that the stress was more related to her condition than the aircraft incident.
The VRB noted the diagnosis of personality disorder with secondary alcohol abuse but noted also that in the late 1970s and early 1980s the applicant's performance was satisfactory and he was considered fit for service. The VRB accepted the opinion of Dr Koller in amending the diagnosis to post traumatic stress disorder with secondary alcohol abuse. The VRB then turned to the relevant SoP to ascertain whether any of the minimum factors were met such that the disease could be regarded as caused by the applicant's defence service.
The VRB noted that the applicant was unable to remember precisely when the incident occurred and found it difficult to accept that such an incident went unreported. Further, the applicant made no mention of the incident until 1998. The VRB found that the applicant's concerns from 1983 onwards were more likely to have been caused by the illness and death of his mother and the illness of his father. The VRB also noted that on the alcohol questionnaire that the Applicant completed for the DVA he stated that he was in a state of nervous collapse upon landing, while in oral evidence before the VRB he said that he was "fine" upon landing. The VRB could not be satisfied that the incident occurred and therefore found that factor 5(a) of the SoP was not satisfied.
Similarly the condition of psoriasis was found to be more likely related to his family grief rather than to any service-related incident. Apart from the amendment made to the diagnosis, the VRB affirmed the decision under review.
On 26 April 2000 the applicant lodged with the Administrative Appeals Tribunal ("the tribunal") an application for review of the VRB decision (T1).
BACKGROUND
The applicant was born on 26 June 1959, making him 42 years of age at the time of the hearing. When the applicant was growing up his father spent much of the weekend drinking and gambling, causing domestic arguments with his wife. The applicant's mother died on 30 November 1985. The applicant's parents were married for over 40 years. He has two sisters and a brother.
The applicant left school at the age of 15 and he stated that he was "in with a bad bunch of blokes." He was subsequently employed as a labourer, storeman and as a railway worker. He left the latter of these positions when he was accused of stealing money.
He joined the RAAF at the age of 16 as an apprentice airforce fitter and eventually became a flight engineer (T4/62). The applicant flew for six years.
The Applicant was engaged to be married at one stage in his service career but the relationship ended by mutual agreement after four years. He subsequently lived with another woman for two years but this also ended by mutual consent. His girlfriend became annoyed by his regular absences on flying duties. He was discharged from the RAAF in 1987.
The Applicant was unemployed from 1987 to 1992. From 1992 to 1995 he undertook survey work for Hurstville and Rockdale City Councils. He was unemployed then until 1996 when he became a self-employed cleaning contractor (T4/58).
HEARING AND DOCUMENTATION
The tribunal convened a hearing in this matter in Sydney on 18 September 2001. Mr B Winship of Rockliffs, Solicitors & Attorneys, represented the applicant. Mr S Modder of the DVA Advocacy Service represented the Repatriation Commission. A RAAF colleague, the applicant's father, the applicant's partner and the applicant all gave evidence in person at the hearing.
The tribunal had access to the following documentary material which was taken into evidence:

Exhibit TD1 – Section 37 Statement and associated documents (exhibits T1 – T22) provided by the respondent.
Exhibit A1 – Photograph – interior of Caribou aircraft.
Exhibit A2 – Sketch by applicant's RAAF colleague.
Exhibit A3 – Photograph - rear of Caribou aircraft.
Exhibit A4 – Photograph - interior of Caribou aircraft.
Exhibit A5 – Statutory declaration of applicant's RAAF colleague, 8 December 2000.
Exhibit A6 – Aircraft flying log book.
Exhibit A7 – Photograph – applicant in early 1981.
Exhibit A8 – Photograph – applicant in 1986.
Exhibit R1 – Respondent's statement of facts and contentions, 13 February 2001.
Exhibit R2 – Report by Dr R Kaplan, psychiatrist, 7 December 2000.
Exhibit R3 – Report by Dr Kaplan, 7 May 2001.
Exhibit R4 – Report by Dr Kaplan, 19 August 2001.
Exhibit R5 – Report by Dr M Burns, occupational physician, 27 November 2000.
Exhibit R6 – Report by Professor R P Mattick, 23 November 2000.
Exhibit R7 – Report by Professor Mattick, 27 April 2001.
Exhibit R8 – Report by Mr B G O'Keefe, consulting historian, 18 December 2000.
Exhibit R9 – Report by Mr J Tilbrook, Write-way Research Service, 15 September 2001.
Exhibit R10 – VRB transcript, 2 February 2000.
Exhibit R11 – Centrelink documentation.

At the applicant's request the tribunal issued an order in accordance with s 35 of the Administrative Appeals Tribunal Act 1975 in the following terms:
"The tribunal, being satisfied that it is desirable to do so by reason of the confidential nature of certain evidence orders that the publication of the names and addresses of witnesses appearing in this matter is prohibited."

FINDINGS ON MATERIAL QUESTIONS OF FACT WITH REFERENCE TO THE EVIDENCE AND OTHER MATERIAL IN SUPPORT OF THOSE FINDINGS

The applicant was seeking recognition of post-traumatic stress disorder as an accepted disability with secondary alcohol abuse. He was also seeking recognition of psoriasis as an accepted disability. The matter was to be remitted for assessment with recognition of any of these conditions. The respondent was relying on reports by Dr Kaplan and Professor Mattick to argue that the applicant had a personality disorder that was not service-related.
The tribunal makes the following uncontroversial findings.
The applicant served in the RAAF and rendered eligible defence service from 7 January 1976 until 8 October 1987 (T7).
The applicant lodged a valid claim for Disability Pension on 26 August 1998 (T4).
The date of effect of any decision favourable to the applicant would be 26 May 1998 (s 20(1) of the Act).
The standard of proof in relation to whether his post-traumatic stress disorder is a defence-caused disease is that of reasonable satisfaction (s 120(4) of the Act). This standard equates to acceptance on the balance of probabilities (Repatriation Commission v Smith (1987) 74 ALR 537, 547).
The SoPs relevant to the determination of this matter are, prima facie, SoP 4/99 concerning post-traumatic stress disorder as amended by 55/99, SoP 77/98 concerning alcohol dependence or alcohol abuse, SoP 79/98 concerning drug dependence or drug abuse and SoP 22/98 concerning psoriasis. If the matter fails in relation to SoP 55/99 concerning post-traumatic stress disorder then SoP 4/99 as unamended, because that was the state of the SoP on post-traumatic stress disorder in force at the time of the primary decision (21 April 1999), can be considered (Repatriation Commission v Gorton (2001) 33 AAR 370 and Repatriation Commission v Williams [2001] FCA 1195).
For the applicant to succeed in his quest to have post-traumatic stress disorder accepted as a defence-caused disease the tribunal must be reasonably satisfied that he suffers from post-traumatic stress disorder and, if so, that the requirements in the relevant SoP are met. It is not clear that the applicant suffers from post-traumatic stress disorder. Post-traumatic stress disorder is defined as follows in the SoP:
(b) For the purposes of this Statement of Principles, "post traumatic stress disorder" means means a psychiatric condition meeting the following description (derived from DSM-IV):
(A) the person has been 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 symbolize 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;
(iii) difficulty concentrating;
(iv) 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,
attracting ICD-9-CM code 309.81.
The applicant's evidence before the tribunal about the incident involving his fall from as Caribou aircraft was as follows. Referring to ex A6, the flying record book, the applicant estimated that the date of the incident was between 20 and 22 January 1982. He was engaged in what he described as static line paratrooping. It was the last sortie of the day. Bags which contained parachutes utilised by previous jumpers remained on the static line cable. There was a winch utilised to bring such bags back inside the aircraft. The retrieval cable could, however, break and in this instance it did. The bags could not be winched back in. When this occurred the flight engineer would move to the back of the aircraft in a safety harness and manually retrieve the bags. The flight engineer would hold on to the aircraft with the left hand and swoop on the bags with his free arm, pulling them back in. Eight bags were outside the aircraft on this occasion. The applicant had performed this manoeuvre once before when only two or three bags were involved.
While the applicant was some way down the exit ramp at the back of the aircraft in mid air, preparing to grab at the bags, the pilot corrected the rudder when the applicant's harness strap was fully extended. The applicant lost his footing and fell out of the aircraft at the rear. He was rotating in mid air behind the aircraft and he hit his head on the side of the aircraft. He was wearing a helmet at the time. The paratroop instructor hefted the applicant backed onto the chute. The applicant told the tribunal that he was in shock at this stage, however his rescuer thought that it was humorous.
The applicant mentioned the event to the pilots of the aircraft and discovered that they were unaware of what had occurred. They believed the story, however, when they saw the applicant and the effect that the incident had had upon him. The applicant was relieved of any further flying on that day. He agreed with the pilots not to report the incident, something that was consistent with the prevailing culture in the RAAF at the time. One would complain only if there had been injury or property damage. The applicant had not been injured. He was, however, "pretty shaken up". He fell severe embarrassment and was upset psychologically. He discussed the matter further with the pilots over drinks on that night but the incident was effectively covered up and never reported. The applicant later admitted that he had been somewhat at fault in not wearing the harness tightened further. Both he and the pilot may have been in trouble had the incident been reported. Had it been reported it would have appeared as an air incident memorandum.
After this incident the applicant stated that he experienced no immediate change. He returned to normal flying duties the next day. He flew for four more years after the incident. He said that six months later he did experience character changes and became anxious for much of the time. During flying this became worse, especially if he was flying with the rear door of the aircraft open. The applicant told the tribunal that he drank alcohol as a form of self-medication. It helped the applicant to relax.
On 18 August 1998 Dr Karl Koller, psychiatrist, reported on the applicant (T4/61-64). The applicant told him of the incident where he fell from the rear of a Caribou transport plane during a paratroop drop near Newcastle. He was saved by a parachute instructor. Dr Koller noted that the applicant could have been killed if not for the presence of someone else at the rear of the plane. The applicant told him that the incident had "changed" him and that the experience was particularly terrifying. The applicant listed the following complaints:

Excessive drinking after the Caribou incident in 1982 and self-medication with analgesics.
A feeling of being isolated since the incident.
Irritability and mood swings.
Restless sleeping patterns.
Nightmares of the incident.
A feeling of distress when he hears or learns something of the RAAF.
Headaches related to stress and tension.
Lack of "social urge".
Psoriasis, especially in the groin area when he is stressed.
Suffering from tinnitus.
Ruminations about the incident and regret that his RAAF career came to an end.

Dr Koller noted that in 1990 the applicant had had himself admitted to Langton Clinic for treatment of alcohol abuse. Later, in 1992 he lost his job with Rockdale Council because of "a break of regulations." In February of 1997 the applicant hurt his left foot and, although it recovered, the applicant returned to alcohol and analgesic abuse. In March 1998 he was admitted to a private psychiatric hospital in Kogarah for treatment of alcohol and misuse of analgesics such as Endone and Panadeine Forte. Dr Koller diagnosed chronic post-traumatic stress disorder "that stems from an extraordinary life threatening incident in the RAAF in 1982." He noted that the applicant attempted to relieve the symptoms of this condition with alcohol and analgesics. As a result of this his work performance declined and he was discharged from the RAAF. Dr Koller assessed his rating under the Guide to the Assessment of Rates of Veterans' Pensions (5th ed) ( at 36 points.
On 7 June 1999 Dr Koller reported that there was no basis for the Applicant to be diagnosed with a personality disorder (T11). Dr Koller stated that this would have been picked up by psychological testing before he became a flight engineer. He stated that "[the applicant's] symptoms and presentation indicates [sic] that something serious occurred in 1982."
On 9 September 1998 Dr M Simpson completed a number of medical reports in respect of the applicant's conditions (T6). Dr Simpson noted that the clinical onset of psoriasis was in 1983 and was related to stress, anxiety and post-traumatic stress disorder. In relation to post-traumatic stress disorder Dr Simpson referred to the difficulties suffered by the applicant such as anxiety, restlessness, nightmares and excessive drinking and bursts of anger. The applicant's concentration was reduced and he had difficulty taking instructions. Further, in relation to the applicant's psoriasis, he experienced the condition on his groin, ears and elbow.
Lay evidence was provided by a former RAAF colleague of the applicant. He had not been with the applicant on the aircraft when the applicant got into difficulties. However, he was well aware of the function that the applicant was performing on the craft. In passing he mentioned that the flight engineer position had been won by the applicant from the field of about 400 candidates when he was one of six selected. As part of the selection process he was psychologically tested. The witness was also a flight engineer who had been one of eight selected from the field of some 400 candidates. He had been selected a year or two after the applicant.
Addressing the problem of a broken retrieval winch cable, the problem which required the applicant to manually retrieve the bags, the witness said that this happened quite a lot. He said that the bags trailed five or six feet behind the aircraft. He said that retrieval was difficult if there were lots of bags. He said it was quite dangerous and that the rear motion of the caribou was unsafe in that it would corkscrew around.
The applicant had mentioned the incident to the witness in 1984 when the two of them were on a trip to New Zealand. The witness told the tribunal of a similar incident where a Warrant Officer had fallen out. He had been left trailing below the level of the escape ramp. He had rotated himself back onto the ramp. The witness considered the applicant to be in the worse position because he was mixed up amongst the bags and off to one side. In a statutory declaration completed by the witness (ex A5) he covered somewhat similar territory that made the point that these incidents involving falls from aircraft were generally unreported. He said that many such incidents as close-call mid-air collisions occurred regularly but would usually not be reported.
The witness was asked to address exhibits R8 and R9, the historical reports. In relation to ex R8 and he explained that unit history sheets were completed by the junior pilot. They did not cover all the flying that occurred on one day. A comprehensive listing would be found only in the flight authorisation books for the squadron. However, the witness agreed that an incident such as that involving the applicant would have been mentioned had it been known to the compiler. In relation to ex R9 he noted that the researcher had contacted only army parachutists and that he had the benefit of no information from flight engineers. The researcher cited a witness named Costello who had referred to "monkey straps". The witness explained that these were used only in helicopters. There was also reference to the ramp opening to a 38 degree angle. This could not be correct as the maximum opening was 30 degrees. The other statements in this exhibit did not relate to what a flight engineer was required to do in the aircraft after parachutists had jumped. The witness said that in the final summary references appeared to be to only a scare or a slip on the ramp, not a fall from the aircraft.
This witness was aware that the applicant had been concerned about illnesses experienced by his parents in 1985. The witness noticed the main change in the applicant as occurring after the witness left the RAAF. He had gone to the applicant's home and found him asleep in the middle of the day and uninterested in all that was going on.
There was considerable discussion of the absence of immediate post-traumatic stress disorder-like after-effects of the incident. The applicant told Mr Modder that from 1982 he felt anxious every day but was uncertain of the cause. When he engaged in an Alcohol Rehabilitation Program ("AREP") in 1986 the applicant had been uncertain of the connection between the incident and his anxiety. In T3/17 he had listed his problems when admitted to AREP. These had included coping with an alcoholic father, his own personality problems, his weight and cholesterol problems, a then current upper respiratory tract infection and difficulty sleeping. He had not referred to the aircraft incident because of uncertainty as to its relevance. His mind had been on more immediate matters.
In final submissions Mr Modder pointed out that it was only 16 years after the incident, when the applicant saw Dr Koller in 1998 (T4/64), that he mentioned the aircraft incident in a clinical context.
Certain of the experts expressed doubts about the diagnosis of post-traumatic stress disorder. On 23 November 2000 Professor Mattick provided a report on the applicant (ex R6). He noted that the applicant reported a sense of "horror" after the aircraft incident. The applicant subsequently had problems at work and his attitude to work changed. He gained weight and became less physically active. He also had trouble sleeping. In conclusion Professor Mattick stated that the applicant "worked well for many years until the illness and death of his mother and subsequent illness and drug abuse by his father." This period was when the applicant started to have problems with his superior officers. He concluded:
"I cannot find any evidence that the event in 1982, when he reportedly fell out of an aeroplane, caused him any ongoing emotional or behavioural disturbance. I point out again that thereafter he retrieved parachutes 900 times per year, by his own account. This does not suggest that the reported event was traumatic or that it caused any ongoing impairment.
"The most likely explanation, on the balance of probabilities, is that his emotional disturbance, alcohol dependence and opiate dependence were caused by the illness and death of his mother and difficulties with his father. I cannot find a basis to form a link between his eligible service and his alcohol dependence, opiate dependence, or any emotional disturbance."
On 27 April 2001 Professor Mattick provided a supplementary report on the applicant (ex R7). He emphasised that the details in his first report were as told to him by the applicant. Professor Mattick stated that if the applicant had post-traumatic stress disorder he would not be able to bear the work of a flight engineer. A diagnosis of post-traumatic stress disorder is not consistent with the history given by the applicant and the inconsistencies and exaggerations that the applicant presented were consistent with narcotic and alcohol abuse.
On 7 December 2000 Dr Robert Kaplan, a consultant psychiatrist, reported on the applicant (ex R2). He noted that the applicant had a seemingly normal service record until the early 1980s and that the applicant had suffered a breakdown as a result of the Caribou incident. The applicant suffered nightmares, his relationship fell apart and he felt anxious and isolated. Although his mother died around this time the applicant insisted that the RAAF was mistaken in seeing this as the cause of his problems. The applicant did not mention the presence of any flashbacks, emotional numbing, hypervigilance or depersonalisation. The applicant's behaviour at the examination was described by Dr Kaplan as "superficial to the point of being glib. At no point did he display any signs of anxiety or depression…he explained that he had injected amphetamines intravenously just prior to leaving home, a practise he now engaged in three times a week." Dr Kaplan noted that there was no report of the Caribou incident until 1998 when he went to see Dr Koller. Although a claim of this nature would be described as delayed onset post-traumatic stress disorder, Dr Kaplan stated that the late development of such a condition as a result of such an incident would be unlikely. There is considerable controversy over this condition and an authority in the field of post-traumatic stress disorder had recently stated that it was unlikely to account for even 5% of cases. There was no behaviour upon examination, such as anxiety, arousal and hypervigilance, that would indicate a diagnosis of post-traumatic stress disorder. Further, there was no account of flashbacks, phobic avoidance or emotional numbing. Dr Kaplan opined that the evidence for personality disorder was stronger for the following reasons:

There is a history of dysfunctional behaviour going back two decades, confirmed by several people who examined the applicant at that time.
Drug and alcohol abuse, as well as relationship problems, often occur with personality disorder.
The applicant presented poorly at interview, he is glib, disingenuous and lacks credibility.
Casually admitting that he injected himself with amphetamines before coming to the interview indicates an indifference to the opinions of others and inability to delay gratification regardless of the consequences.

On the balance of probabilities Dr Kaplan found that the applicant did not suffer from post-traumatic stress disorder:
"He has a mixed drug abuse [?dependence] and a personality disorder, mixed features [dependent, antisocial, narcissistic]. He also has a primary sleep disorder, although it is unclear whether it is breathing-related or due to other causes, such as substance abuse.
"On the same basis, I am unable to attribute Mr Davis' problems to his service in the RAAF. It can be speculated that there are issues in his family life, upbringing, development and character which contribute to this, but that is not germane to this report."
On 7 May 2001 Dr Kaplan provided a supplementary report on the applicant (ex R3). He restated his diagnosis of personality disorder with mixed drug abuse and sleep disorder. He also stated that these problems were not related to his service in the RAAF. Dr Kaplan did however state that in his initial report he did not stress enough that the applicant was suffering from anxiety, panic attacks and mild agoraphobia. He suspected that these were caused by the applicant's drug abuse. Dr Kaplan stated that the applicant was currently unfit for work until his drug and anxiety problems were treated.
In another report of 19 August 2001 (ex R4) Dr Kaplan responded to the comment from Professor Mattick that if the applicant "truly had a post-traumatic disorder…he would not be able to bear this work." Dr Kaplan firstly agreed that it would have been unusual for the applicant to continue working in the same field. He also stated that it was possible, but on the balance of probabilities unlikely, that the symptoms did not manifest themselves until some time later.
This led Mr Modder for the respondent to submit that the applicant's career in fact went quite well until he experienced family-related problems. There was some additional evidence to this effect. T15 includes a series of documents relating to the applicant's RAAF career. His efforts were appreciated from January 1976 until 1980, with some slight hiccoughs where counselling was mentioned in August 1978 and July 1979. By 3 September 1984 he was assessed by a Squadron Leader as fit for promotion above his then level of sergeant (T15/159). This was, of course, after the aircraft incident but before the onset of his worst family problems.
Reference has been made to the historical reports in ex R8 and ex R9 (paragraph 39 above). It seems to the tribunal that the witness's comments in paragraph 39 were appropriate. Exhibit R8 really says very little other than the alleged incident was not reported. Exhibit R9 is richer in its information. The conclusion, that an incident most probably occurred but was insignificant and so not reported, is credible. Given that the applicant was harnessed it would seem that he was in no danger of actually falling to the ground, although such an incident would be unsettling and could arouse subjective anxiety and fears of insecurity.
The tribunal notes that the veteran in this case, unlike in many other cases, did cite his anxiety and his psoriasis as conditions of concern when he had his discharge medical examination (T3/9).
The tribunal is reasonably satisfied that the incident occurred. The tribunal found the applicant's RAAF colleague a very credible witness. His explanation of a culture of not reporting safety breach incidents was thoroughly credible.
The tribunal is, however, not reasonably satisfied that the applicant suffers from post-traumatic stress disorder attributable to the incident. The doubts raised by the respondent's expert witnesses (paragraphs 43-48 above) are relevant. The tribunal had some concerns with Dr Kaplan's tendency to presume against a diagnosis of post-traumatic stress disorder and the tribunal would not rule out a late onset post-traumatic stress disorder, but the absence of hard evidence of the presence of a number of the phenomena required for post-traumatic stress disorder (see paragraph 27 above) has made it difficult for the tribunal to reach the required state of satisfaction. Ignoring the impact of the amending SoP 55/99 does not advance the applicant's case because the amendments did not affect the description in the SoP of post-traumatic stress disorder.
The applicant may, however, suffer from anxiety disorder. SoP 2/2000 concerning anxiety disorder contains a definition of anxiety disorder not addressed by any of the experts in this case. It includes a spectrum of anxiety disorders such as generalised anxiety disorder which is defined in clause 8 as:
"generalised anxiety disorder" means a psychiatric disorder with the following features:
A. Excessive anxiety and worry (apprehensive expectation), which occur on more days than not for a continuous period of at least six months, about a number of events or activities; and
B. The person finds it difficult to control the worry; and
C. The anxiety and worry are associated with three or more of the following six symptoms, with at least some symptoms present for more days than not during the previous six month period:
(1). restlessness or feeling keyed up or on edge
(2). being easily fatigued
(3). difficulty concentrating or mind going blank
(4). irritability
(5). muscle tension
(6). difficulty falling or staying asleep, or restless unsatisfying sleep; and
D. The focus of the anxiety and worry is not confined to features of any other Axis I disorder; and
E. The anxiety, worry, or physical symptoms (as described in C. above) cause clinically significant distress or impairment in social, occupational, or other important areas of functioning; and
F. The anxiety and worry are not due to the direct physiological effects of a substance or a general medical condition and do not occur exclusively during a mood disorder, a psychotic disorder, or a pervasive developmental disorder;
There is evidence that the applicant has had a long history of anxiety and worry (eg his RAAF discharge medical at T3/9). There is evidence that he has had difficulty controlling the worry, resorting to alcohol as self-medication according to his oral evidence. There is evidence from the applicant's partner that he satisfies paragraph C of the definition in that he has odd sleeping patters with nightmares (as in subparagraph (6) of the definition), that he has difficulties solving problems (as in subparagraph (3) of the definition) and that he is erratic and prone to outbursts (as in subparagraphs (1) and (4) of the definition), and that he has these symptoms on more days than not.
There appears, however, to be another American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (4th ed, 1995) ("DSM-IV") Axis I disorder that is more applicable. This would be substance abuse or dependence. Thus paragraph D of the definition is not satisfied.
The tribunal is satisfied that the applicant suffers from alcohol dependence or alcohol abuse and from drug dependence or drug abuse. Professor Mattick (ex R6) said that the applicant suffered from alcohol and opiate dependence. Dr Kaplan diagnosed personality disorder with mixed drug abuse and sleep disorder (ex R3). While not all items on the checklists in the SoPs for these diseases were addressed by these experts, the tribunal considers that they would not have made the diagnoses they did in the absence of satisfaction that the SoP definitions were met by the applicant. There was the evidence of the applicant's partner about his arrangements for the delivery and use of proscribed drugs, in addition to the applicant's presentation before Dr Kaplan which support for the tribunal's findings in this respect.
For alcohol dependence or alcohol abuse to be accepted as a defence-caused disease the SoP requires that the applicant must have experienced a severe stressor within one year immediately before the clinical onset of alcohol dependence or alcohol abuse (SoP 77/98, factor 5(b)). For drug dependence or drug abuse to be accepted as a defence-caused disease the applicant must have experienced a stressor similar to that for alcohol dependence or abuse (SoP 79/98, factor 5(b)). In both SoPs the definition of "experiencing a severe stressor" is found in clause 8 and is:
"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:
(i) threat of serious injury or death; or
(ii) engagement with the enemy; or
(iii) witnessing casualties or participation in or observation of casualty clearance, atrocities or abusive violence;

There is an immediate difficulty in the present case in that it is unlikely that the veteran experienced an event that involved actual or threat of death or serious injury. The tribunal relies on the assessments in ex R9 in forming this view. While unpleasant and frightening, falling from an exit chute while harnessed was most unlikely to cause death or injury to a flight engineer such as the applicant. The tribunal therefore finds that the applicant did not experience a severe stressor as required by the relevant SoPs for recognition of his substance abuse disabilities as defence-caused.
Dr Kaplan considered that the applicant suffered from a personality disorder (paragraphs 45-47 above). There is a SoP concerning personality disorder (SoP 144/95 as amended by 14/97). There are three difficulties in finding that the applicant's personality disorder satisfies the SoP. While the applicant would seem to satisfy the definition of "personality disorder" in clause 2 of SoP 14/97 in that the applicant has "an enduring pattern of inner experience and behaviour that deviates markedly from the expectations of [his] culture", manifested in … (iii) interpersonal functioning; (iv) impulse control (as borne out by the evidence of the applicant's partner and by Dr Kaplan's observations in paragraph 45 above), the definition also requires that the onset of the pattern can be traced back to at least adolescence or early adulthood and that the pattern is not due to the direct physiological effects of a substance (eg a drug of abuse).
In the present case T15/125-159 suggested nothing untoward in the applicant's pattern of behaviour from 1976 (age 16) to 1984 (age 24). It is also, in the tribunal's view, more likely than not that the applicant's substance abuse problems better explain his difficulties than a personality disorder.
The final difficulty in applying SoP 144/95 is that the veteran must have suffered a "catastrophic experience" related to his defence service that immediately preceded an enduring personality change to the level of disorder. The SoP does not define a catastrophic experience, however the dictionary definitions refer to a catastrophe and relevantly define a catastrophe as:
"1. a sudden and widespread disaster. 2. A final event or conclusion, usu. An unfortunate one; a disastrous end. …" (The Macquarie Dictionary)
"… 2. 'A final event; a conclusion generally unhappy; overthrow, ruin …' 4. A sudden disaster." (The Shorter Oxford English Dictionary)
It is difficult for the tribunal to see in the applicant's extremely unfortunate incident the necessary elements of "finality" or of widespread effect required by the dictionary definitions. For all of these reasons the tribunal finds that the applicant does not suffer from a personality disorder related to his defence service.
The applicant pressed his claim in respect of psoriasis. To succeed in that claim he relied on factors 5(e) and (f) of SoP 22/98. Factor 5(e), "suffering from alcohol dependence or alcohol abuse involving regular consumption of" a certain quantity of alcohol each week at the time of clinical worsening of the disease, was based on the proposition that the applicant's alcohol dependence or alcohol abuse was defence-caused. The tribunal has found itself not reasonably satisfied that this was the case. Factor 5(e) cannot, therefore, be satisfied.
Factor 5(f), "suffering from a clinically significant anxiety disorder … at the time of the clinical worsening of psoriasis", likewise depends on a finding that the applicant suffered from a defence-caused anxiety disorder. The tribunal has found itself not reasonably satisfied that the applicant had such a defence-caused disease.
The applicant's claim for Disability Pension in respect of psoriasis therefore fails.
CONCLUSION
The tribunal accepts that the applicant experienced the fall from the aircraft that has been described in his and his evidence. However, for the reasons advanced in relation to each of post-traumatic stress disorder, anxiety disorder, alcohol dependence or alcohol abuse, drug dependence or drug abuse, personality disorder and psoriasis, the tribunal has found itself not reasonably satisfied that the applicant suffers from any of these as a defence caused disease.
The tribunal therefore considers that decision under review was correctly made.
DECISION
The tribunal affirms the decision under review.
I certify that the 69 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  18 September 2001
Date of Decision  11 September 2002
Counsel for the Applicant        Mr B Winship
Solicitor for the Applicant         Rockliffs, Solicitors and Attorneys
Counsel for the Respondent    Mr S Modder, DVA Advocacy Service
Solicitor for the Respondent    Mr J Marsh, DVA