Traves and Repatriation Commission - [2001] AATA 272

DECISION AND REASONS FOR DECISION [2001] AATA 272

ADMINISTRATIVE APPEALS TRIBUNAL )

) No N1999/457

VETERANS' APPEALS DIVISION          )              N1999/1814
           Re      MICHAEL TRAVES
  Applicant
           And    REPATRIATION COMMISSION
  Respondent

DECISION

Tribunal M J Sassella, Senior Member

Date5 April 2001
PlaceSydney

Decision      The Tribunal sets aside the decisions under review and in substitution for those decision decides: 1) that the accepted disabilities as of 29 April 1998 are osteoarthritis of the right knee, meniscal lesion of the right knee, hypertension, and psychoactive substance abuse or dependence involving alcohol; and 2) that the accepted disabilities as of 16 August 1998 are osteoarthritis of the right knee, meniscal lesion of the right knee, hypertension, psychoactive substance abuse or dependence involving alcohol and malignant neoplasm of the colon; and 3) that the accepted disabilities as of 14 September 1998 are osteoarthritis of the right knee, meniscal lesion of the right knee, hypertension, psychoactive substance abuse or dependence involving alcohol, malignant neoplasm of the colon and atherosclerotic peripheral vascular disease; and 4) that the rate of Disability Pension payable is 40% of the general rate on the first pension payday falling on or after 29 April 1998; 60% of the general rate on the first pension payday falling on or after 16 August 1998 and 70% of the general rate on the first pension payday falling on or after 14 September 1998.
   [Sgd] M J Sassella
  Senior Member
CATCHWORDS
Veterans' Affairs – hypertension – diverticular disease of the colon – psychoactive substance abuse – clinically definable condition - alcohol abuse – reasonable hypothesis - operational service in Vietnam and Thailand - artherosclerotic peripheral vascular disease – hypertension - malignant neoplasm of the colon - statement of principles - eligible service period - causal link between alcohol abuse and service- Guide to the Assessment of Rates of Veterans' Pensions – medication - alcohol dependent - high-risk overseas situations – 15 pack years of cigarette smoking – a stressful event prior to the clinical onset of the condition - subjective symptoms of increased stress
Veterans' Entitlements Act 1986
Deledio v Repatriation Commission (1997) 47 ALD 261
Dixon v Repatriation Commission (1999) 29 AAR 235
Ferriday v Repatriation Commission (1996) 42 ALD 526

REASONS FOR DECISION

5 April 2001 M J Sassella, Senior Member

History of Applications
N1999/457

On 13 February 1998 (T4), the Applicant lodged a claim for Disability Pension for conditions of hypertension, diverticular disease of the colon and psychoactive substance abuse. He already had accepted disabilities relating to the right knee.
On 24 June 1998 (T11) the Repatriation Commission refused the Applicant's claim. It found that the Applicant did not have any clinically definable condition of psychoactive substance abuse, and since it was the Applicant's claim that hypertension was secondary to his substance abuse, it was also refused. It was further found that the Applicant's service circumstances did not cause diverticular disease of the colon. His disability pension was continued at 30% of the General Rate, effective from 10 November 1997.
On 29 October 1998 (T13) the Applicant lodged an application for review with the Veterans' Review Board (VRB) in respect of these conditions.
On 25 February 1999 (T15) the VRB affirmed the decision of the Repatriation Commission. The VRB accepted the evidence of Drs Watson and Brigden in relation to the Applicant's alcohol abuse, found that the material did not raise a reasonable hypothesis connecting the conditions to operational service and therefore affirmed the decision in relation to substance abuse. Because hypertension was contended as being secondary to alcohol abuse, and substance abuse was not found to exist, this part of the Respondent's decision was also affirmed.
The Applicant did not satisfy the relevant Statement of Principles ("SoP") in regard to diverticular disease of the colon, and this part of the decision was also affirmed.
On 26 March 1999 the Applicant lodged with the AAT an application for review.
N1999/1814
On 16 November 1998 the Applicant lodged a Disability Pension claim for malignant neoplasm of the colon, stating that this was due to war caused drinking and smoking (T4). He also claimed for "alcohol abuse" and "smoking".
On 8 February 1999 the Repatriation Commission addressed malignant neoplasm of the colon, alcohol abuse and smoking (atherosclerotic peripheral vascular disease affecting both legs). The claim for alcohol abuse was the subject of an appeal at the time (dealt with in Tribunal application N1999/457) and therefore was not examined. Both claims were refused.
In the Respondent's view the Applicant's history of alcohol use and smoking did not meet the SoP for malignant neoplasm of the colon.
Likewise the SoP relating to atherosclerotic peripheral vascular disease was considered not met. This was because the hypertension and cigarette smoking factors called into aid the Applicant in qualifying under the SoPs, were not met by the Applicant's condition as found by the Respondent (T6).
On 18 February 1999 (T7) the Applicant lodged an application for review with the VRB.
On 13 October 1999 (T11) the VRB rejected the application in relation to the claimed conditions. It found that the Applicant's smoking habit began during a period of non-eligible service, and therefore it cannot assist the veteran in his claim. It found similarly in relation to alcohol consumption. Because the Applicant's smoking and drinking were found not to be caused by or during an eligible service period, the conditions of atherosclerotic peripheral vascular disease and malignant neoplasm of the colon were found not service related.
On 26 November 1999 the Applicant lodged with the Tribunal an application for review of the VRB decision.
The Hearing
A hearing was held before the Tribunal on 6 September 2000. The Applicant was represented by Mr Vincent of Counsel, the Respondent by Mr Wallis, an advocate from the Department of Veterans' Affairs.
The following material was taken into evidence at the hearing:
Documents prepared pursuant to section 37 of the Administrative Appeals Tribunal Act 1975 for application N1999/457 Exhibit TD1
Documents prepared pursuant to section 37 of the Administrative Appeals Tribunal Act 1975 for application N1999/1814 Exhibit TD2
Report of Dr Egerton dated 7 April 1997 Exhibit A1
Report of Dr Egerton dated 26 May 1997           Exhibit A2
Report of Dr Egerton dated 10 June 1997         Exhibit A3
Report of Dr Beim dated 5 July 1989      Exhibit A4
Report of Dr Harding Burns dated 29 July 1999 Exhibit A5
Report of Dr Harding Burns dated 8 November 1999   Exhibit A6
Report of Dr Harding Burns dated 9 November 1999   Exhibit A7
Report of Dr Dinnen dated 22 November 1999 Exhibit A8
Report of Dr Lukins dated 21 December 1999   Exhibit A9
Statement of Michael Traves dated 25 August 2000    Exhibit A10
Statement of John Winter dated 28 August 2000         Exhibit A11
"List of bowel problems" undated Exhibit A12
Two pages of tables and graphs relating to alcohol consumption, undated Exhibit A13
Report of Dr Baz, dated 16 December 1999      Exhibit A14
Report of Dr Chapman dated 2 March 2000      Exhibit R1
Report of Professor Mattick dated 6 March 2000          Exhibit R2
Report of Professor Tracy dated 14 March 2000          Exhibit R3
Report of Professor Levi dated 14 April 2000     Exhibit R4
Report of Dr Burns dated 18 April 2000   Exhibit R5
Report of Dr Lewin dated 12 July 1999    Exhibit R6
Legislative Framework
The relevant legislation in this matter is the Veterans' Entitlements Act 1986, subsections 120(1) and (3) and 120A:
"120 Standard of proof
(1)       Where a claim under Part II for a pension in respect of the incapacity from injury or disease of a veteran, or of the death of a veteran, relates to the operational service rendered by the veteran, the Commission shall determine that the injury was a war-caused injury, that the disease was a war-caused disease or that the death of the veteran was war-caused, as the case may be, unless it is satisfied, beyond reasonable doubt, that there is no sufficient ground for making that determination.
…
(3)       In applying subsection (1) or (2) 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 the person, the Commission shall be satisfied, beyond reasonable doubt, that there is no sufficient ground for determining:
(a)       that the injury was a war-caused injury or a defence-caused injury;
(b)       that the disease was a war-caused disease or a defence-caused disease; or
(c)       that the death was war-caused or defence-caused;
as the case may be, if the Commission, after consideration of the whole of the material before it, is of the opinion that the material before it does not raise a reasonable hypothesis connecting the injury, disease or death with the circumstances of the particular service rendered by the person."
"120A Reasonableness of hypothesis to be assessed by reference to Statement of Principles
(1)       This section applies to any of the following claims made on or after 1 June 1994:
(a)       a claim under Part II that relates to the operational service rendered by a veteran;
(b)       a claim under Part IV that relates to:
(i)the peacekeeping service rendered by a member of a Peacekeeping Force; or
(ii)       the hazardous service rendered by a member of the Forces.
Note 1: Subsections 120 (1), (2) and (3) are relevant to these claims.
Note 2: For peacekeeping service, member of a Peacekeeping Force, hazardous service and member of the Forces see subsection 5Q (1A).
(2)       If the Repatriation Medical Authority has given notice under section 196G that it intends to carry out an investigation in respect of a particular kind of injury, disease or death, the Commission is not to determine a claim in respect of the incapacity of a person from an injury or disease of that kind, or in respect of a death of that kind, unless or until the Authority:
(a)       has determined a Statement of Principles under subsection 196B (2) in respect of that kind of injury, disease or death; or
(b)       has declared that it does not propose to make such a 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 with 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); or
          (b)       a determination of the Commission under subsection 180A (2);
that upholds the hypothesis.
Note:   See subsection (4) about the application of this subsection.
(4)       Subsection (3) does not apply in relation to a claim in respect of the incapacity from injury or disease, or the death, of a person if the Authority has neither determined a Statement of Principles under subsection 196B (2), nor declared that it does not propose to make such a Statement of Principles, in respect of:
          (a)       the kind of injury suffered by the person; or
          (b)       the kind of disease contracted by the person; or
          (c)       the kind of death met by the person;
as the case may be.
120B   Reasonable satisfaction to be assessed in certain cases by reference to Statement of Principles
(1)       This section applies to any of the following claims made on or after 1 June 1994:
          (a)       a claim under Part II that relates to the eligible war service (other than operational service) rendered by a veteran;
          (b)       a claim under Part IV that relates to the defence service (other than hazardous service) rendered by a member of the Forces.
Note 1: Subsection 120 (4) is relevant to these claims.
Note 2: For hazardous service and member of the Forces see subsection 5Q (1A).
(2)       If the Repatriation Medical Authority has given notice under section 196G that it intends to carry out an investigation in respect of a particular kind of injury, disease or death, the Commission is not to determine a claim in respect of the incapacity of a person from an injury or disease of that kind, or in respect of a death of that kind, unless or until the Authority:
          (a)       has determined a Statement of Principles under subsection 196B (3) in respect of that kind of injury, disease or death; or
          (b)       has declared that it does not propose to make such a Statement of Principles.
(3)       In applying subsection 120 (4) to determine a claim, the Commission is to be reasonably satisfied that an injury suffered by a person, a disease contracted by a person or the death of a person was war-caused or defence-caused only if:
(a)       the material before the Commission raises a connection between the injury, disease or death of the person and some particular service rendered by the person; and
(b)       there is in force:
(i)a Statement of Principles determined under subsection 196B (3) or (12); or
(ii)       a determination of the Commission under subsection 180A (3);
that upholds the contention that the injury, disease or death of the person is, on the balance of probabilities, connected with that service.
(4)       Subsection (3) does not apply in relation to a claim in respect of the incapacity from injury or disease, or the death, of a person if the Authority has neither determined a Statement of Principles under subsection 196B (3), nor declared that it does not propose to make such a Statement of Principles, in respect of:
          (a)       the kind of injury suffered by the person; or
          (b)       the kind of disease contracted by the person; or
          (c)       the kind of death met by the person;
as the case may be."

The relevant Statements of Principles (SoPs) in this matter are Instrument No 5 of 1994 concerning psychoactive substance abuse of dependence, Instrument No 83 of 1995 concerning hypertension, Instrument No 67 of 1994 concerning diverticular disease of the colon, Instrument No 23 of 1996 concerning malignant neoplasm of the colon and Instrument No 87 of 1995 concerning atherosclerotic peripheral vascular disease:
"Instrument No 5 of 1994 concerning psychoactive substance abuse or dependence
1. Being of the view that there is sound medical-scientific evidence that indicates that psychoactive substance abuse or dependence and death from psychoactive substance abuse or dependence can be related to operational service rendered by veterans, peacekeeping service rendered by members of Peacekeeping forces and hazardous service rendered by members of the Forces, the Repatriation Medical Authority determines, under subsection 196B(2) of the Veterans' Entitlements Act 1986, that the factors that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting psychoactive substance abuse or dependence or death from psychoactive substance abuse or dependence with the circumstances of that service, are:

(a)experiencing a stressful event prior to the clinical onset of psychoactive substance abuse or dependence, and maintaining the abuse or dependence post-service; or
(b)…

2. Subject to clause 3 (below) at least one of the factors set out in paragraphs 1(a) to 1(e) must be related to any service rendered by a person.
…
4. For the purposes of this Statement of Principles:
…
"ICD code" means a number assigned to a particular kind of injury or disease in the International Classification of Diseases 9th Revision, US Department of Health and Human Services, Pub. No 80-1260;
…
"psychoactive substance abuse or dependence" means a maladaptive pattern of use, attracting ICD code 303 or 304, that is indicated by either:

(a) continued use of the substance despite knowledge of having a persistent or recurrent social, occupational, psychological or physical problem that is caused or exacerbated by use of the substance; or

(b) recurrent use of the substance when use is physically hazardous (for example, driving while intoxicated);

"stressful event" means an incident in which there were external stimuli (such as combat) that would result in psychological stress, and where there were subjective symptoms of increased stress."

Instrument No 83 of 1995 concerning hypertension
"1. Being of the view that there is sound medical-scientific evidence that indicates that hypertension and death from hypertension can be related to operational service rendered by veterans, peacekeeping service rendered by members of Peacekeeping forces and hazardous service rendered by members of the Forces, the Repatriation Medical Authority hereby determines, under subsection 196B(2) of the Veterans' Entitlements Act 1986, that the factors that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting hypertension or death from hypertension with the circumstances of that service, are:
…

(b) suffering from psychoactive substance abuse involving daily consumption of alcohol before and continuing at least until the accurate determination of hypertension; or

…
2. Subject to clause 3 (below) at least one of the factors set out in paragraphs 1(a) to 1(x) must be related to any service rendered by a person.
…
4. For the purpose of this Statement of Principles:
"accurate determination of hypertension" generally means the accurate measurement of blood pressure on a number of occasions. As stated in The Management of Hypertension: a consensus statement The Medical Journal of Australia Vol 160 Supplement, 21 March 1994, to obtain accurate measurement of blood pressure, the conditions for measurement should be standardised as much as possible before readings by ensuring the following:

a mercury sphygmomanometer should be used in the diagnosis of hypertension;
patients should be relaxed and seated. Additional information may be provided by supine and standing readings. This is particularly important in the elderly and diabetics, as both groups are prone to postural hypotension;
the bare arms should be supported and positioned at heart level;
a cuff of suitable size should be applied evenly to the exposed upper arm, with the bladder of the cuff positioned over the brachial artery. the bladder length should be at least 80%, and the width at least 40%, of the circumference of the upper arm;
the cuff should be snugly wrapped around the upper arm and inflated to 30 mmHg above the pressure at which the radial pulse disappears;
in older patients, if the radial artery remains palpable when the cuff pressure exceeds the expected systolic pressure, the cuff reading may be inappropriately high (pseudo-hypertension);
the cuff should be deflated at a rate no greater than 2 mmHg/beat (2 mmHg/sec);
if initial readings are high, several further readings should be taken after five minutes of quiet rest;
on each occasion two or more readings should be averaged. If the first two readings differ by more than 4 mmHg systolic or 4 mmHg diastolic, further readings should be taken. For the diastolic reading, the disappearance of sound (phase V Korotkoff) should be used. Muffling of sound (phase IV Korotkoff) should only be used if sound continues towards zero.

At the same time heart rate and rhythm should be measured and recorded. When the cardiac rhythm is irregular, eg. atrial fibrillation, the systolic pressure should be recorded as an average of a series of phase 1 readings, and diastolic pressures should be recorded as an average of phases IV and V.

For adequate standardisation, caffeine ingestion and smoking should be avoided for two hours before blood pressure measurement;

…
"hypertension" means:

(a) a usual blood pressure reading where the systolic reading
is greater than or equal to 140 mmHg and/ or where the diastolic reading is greater than or equal to 90 mmHg;or
(b) where treatment for hypertension is being administered,
attracting an ICD code in the range 401 to 405;

"ICD code" means a number assigned to a particular kind of injury or disease in the tenth edition of the International Classification of Diseases 9th Revision, effective date of 1 October 1993, copyrighted by the US Commission on Professional and Hospital Activities, and having the Library of Congress number 77-94472;
…
"psychoactive substance abuse or dependence" means a maladaptive pattern of use, as derived from DSM-IV, attracting ICD code 303 or 304, that is indicated by either:

(a) continued use of the substance despite knowledge of having a persistent or recurrent social, occupational, psychological or physical problem that is caused or exacerbated by use of the substance; or
(b) recurrent use of the substance when use is physically hazardous (for example, driving while intoxicated);

…"

Instrument No 67 of 1994 concerning diverticular disease of the colon
"1. Being of the view that there is sound medical-scientific evidence that indicates that diverticular disease of the colon and death from diverticular disease of the colon can be related to operational service rendered by veterans, peacekeeping service rendered by members of Peacekeeping forces and hazardous service rendered by members of the Forces, the Repatriation Medical Authority determines, under subsection 196B(2) of the Veterans' Entitlements Act 1986, that the factors that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting diverticular disease of the colon or death from diverticular disease of the colon with the circumstances of that service, are:

(a) suffering from scleroderma before the clinical onset of diverticular disease of the colon; or
(b) changing to a diet lower in dietary fibre more than three months before the clinical worsening of diverticular disease of the colon;
or
(c) inability to obtain appropriate clinical management for diverticular
disease of the colon.

…
4. For the purposes of this Statement of Principles:
"diverticular disease of the colon" means the clinical consequences of a herniation or sac-like protrusion of the colonic mucosa and the submucosa through the muscular coat of the colon, attracting ICD code 562.1;
…"

Instrument No 67 of 1994 concerning diverticular disease of the colon
"Kind of injury, disease or death
2. (a) This Statement of Principles is about malignant neoplasm of the colon and death from malignant neoplasm of the colon.
(b) For the purposes of this Statement of Principles, "malignant neoplasm of the colon" means a primary malignant neoplasm of the mucosa of colon, which is part of the large intestine which extends from the caecum to the rectosigmoid junction, attracting ICD code 153.
Basis for determining the factors
3. The Repatriation Medical Authority is of the view that there is sound medical-scientific evidence that indicates that malignant neoplasm of the colon can be related to relevant service rendered by veterans, members of Peacekeeping Forces, or members of the Forces.
4. Subject to clause 6, at least one of the factors set out in the paragraphs in clause 5 must be related to any relevant service rendered by the person.
Factors
5. The factors that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting malignant neoplasm of the colon or death from malignant neoplasm of the colon with the circumstances of a person's relevant service are:
…
(c) drinking at least 250 kilograms of alcohol (contained within alcoholic drinks) within any 25 year period before the clinical onset of malignant neoplasm of the colon; or
…
Other definitions
7. For the purposes of this Statement of Principles:
…
"alcohol (contained within alcoholic drinks)" is measured by the alcohol consumption calculations utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink;
…
"ICD code" means a number assigned to a particular kind of injury or disease in the Australian Version of The International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM), effective date of 1 July 1995, copyrighted by the National Coding Centre, Faculty of Health Sciences, University of Sydney, NSW, and having ISBN 0 642 22235 5;
…"

Instrument No 5 of 1998 concerning malignant neoplasm of the colon
"1. The Repatriation Medical Authority amends, under subsection 196B(2) of the Veterans' Entitlements Act 1986 (the Act), Instrument No.23 of 1996, (Statement of Principles concerning malignant neoplasm of the colon), by:

A. omitting the definition of "malignant neoplasm of the colon" in paragraph 2(b) and replacing it with the following:
"(b) For the purposes of this Statement of Principles, 'malignant neoplasm of the colon' means a primary malignant neoplasm arising from the cells of the colon, attracting ICD code 153, but excluding soft tissue sarcoma, non-Hodgkin's lymphoma and Hodgkin's disease. The colon is defined as the part of the large intestine which extends from the caecum, including the ileocaecal junction, to the rectosigmoid junction.

…

C. omitting the definition of "ICD code" in paragraph 7 and replacing it with the following definition:
"'ICD code' means a number assigned to a particular kind of injury or disease in the Australian Version of The International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM), effective date of 1 July 1996, copyrighted by the National Coding Centre, Faculty of Health Sciences, University of Sydney, NSW, and having ISBN 0 642 24447 2;"

…"

Instrument No 87 of 1995 concerning artherosclerotic peripheral vascular disease
"1. Being of the view that there is sound medical-scientific evidence that indicates that atherosclerotic peripheral vascular disease and death from atherosclerotic peripheral vascular disease can be related to operational service rendered by veterans, peacekeeping service rendered by members of Peacekeeping forces and hazardous service rendered by members of the Forces, the Repatriation Medical Authority determines, under subsection 196B(2) of the Veterans' Entitlements Act 1986, that the factors that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting atherosclerotic peripheral vascular disease or death from atherosclerotic peripheral vascular disease with the circumstances of that service, are:

(a) smoking at least five cigarettes per day or the equivalent thereof, in other tobacco products, for at least three years before the clinical onset of atherosclerotic peripheral vascular disease and, where smoking has ceased, the clinical onset has occurred within 15 years of cessation; or
…
(c) suffering from hypertension before the clinical onset of atherosclerotic peripheral vascular disease; or
…

2. Subject to clause 3 (below) at least one of the factors set out in paragraphs 1(a) to 1(m) must be related to any service rendered by a person.
…
4. For the purposes of this Statement of Principles:
"atherosclerotic peripheral vascular disease" is the partial or total occlusion by atherosclerotic plaques, of blood supply to the extremities (usually the lower limbs), attracting ICD code 440.2;
…
"hypertension" means
(a) a usual blood pressure reading where the systolic reading is persistently greater than or equal to 140 mmHg and/ or where the diastolic reading is greater than or equal to 90 mmHg; or
(b) where treatment for hypertension is being administered;
and attracting ICD code in the range 401 to 405;
"ICD code" means a number assigned to a particular kind of injury or disease in the tenth edition of the International Classification of Diseases 9th Revision, effective date of 1 October 1993, copyrighted by the US Commission on Professional and Hospital Activities, and having the Library of Congress number 77-94472."

The Evidence

The Tribunal records that these reasons have been prepared without the benefit of access to a transcript of the proceedings.
The Applicant is 56 years of age. He was born on 2 May 1944. He is married with two sons aged 24 and 28. He joined the RAAF in 1960 as an electrical fitter, having completed his intermediate certificate. He was posted after qualifying as an aircraft fitter to Butterworth in Malaysia in 1965. He did three two-month postings at Ubon in support of US operations in Vietnam. He worked primarily on Sabre aircraft. Further details of his service are in his statement, Exhibit A10, and are discussed below.
He has the accepted conditions of osteoarthritis of the right knee and meniscal lesion of the right knee.
His eligible, also operational, service history is as follows (N1999/457, T15):

Operational service in North East Thailand - 18 November 1965 to 13 January 1966
Operational service in North East Thailand - 10 March 1966 to 5 May 1966
Operational service in North East Thailand - 9 February 1967 to 6 April 1967
Operational service in Vietnam - 25 June 1969 to 29 May 1970
Defence service - 7 December 1972 to 17 January 1980

The Applicant left the air force in 1980, working next for a food company in Toowoomba, then with Grainco and then for the Department of Works from 1995 (N1999/457, T12). The Applicant was transferred to Hobart and was retrenched in July 1998 (Exhibit A8). He also worked as an electrician after leaving the RAAF (N1999/457, T12).
John Winter, in a statement of 28 August 2000, confirmed the Applicant's drinking habits, and more generally the drinking habits of servicemen in Vietnam and Thailand (Exhibit A11).
The Applicant had a bowel pathology as follows:

1961 - ruptured appendix, peritonitis
1978 - surgery for anal fissure
1985 - Toowoomba hospital with severe abdominal pain, no known diagnosis
1995 - haemorrhoid surgery
1996 - surgery for anal fissures and polyps
1998 – adenocarcinoma of hepatic flexure (Exhibit A12).

On 7 April 1997 an endoscopic report indicated that the Applicant had "significant sigmoid diverticular disease" (Exhibit A1).
On 5 July 1997 a barium meal report diagnosed the Applicant as having gastritis in the antrum (Exhibit A4).
On 12 February 1998 the Applicant completed a cigarette smoking questionnaire for the Respondent (N1999/457, T5). He stated on the form that he started smoking when he joined the air force in 1960 and smoked 4oz of ready rub tobacco per week. He stopped smoking permanently in 1988. He further wrote that in 1965 he was smoking 20 cigarettes per day until April 1970 when he smoked approximately 30 cigarettes per day. His stated reasons for smoking were because they were cheap, to relieve tension and stress and out of boredom.
Also on 12 February 1998 the Applicant completed a similar statement in regard to his consumption of alcohol (N1999/457, T6). He stated that he started drinking alcohol when serving in Malaysia in 1965, the reasons being that it was inexpensive and in order to relieve tension and boredom. At that time he drank beer and rum every day, consuming 10 x 10oz glasses of beer and, on occasions, rum. He further wrote that between 1965 and 1967 in Ubon, Thailand this consumption increased to 20 beers per day plus vodka. In Vietnam in 1969-1970 he drank 12 cans of beer daily. The Applicant stated that currently he drinks four stubbies a day and about 15 middies on Friday nights. He also drinks wine with meals in addition to the beer.
On 16 May 1998 (N1999/457, T9) Dr I P Burges Watson, a psychiatrist, recorded that the Applicant gave up smoking at Christmas 1988. He had smoked an average of 20 a day. The Applicant said that he would have smoked "a lot more" when in Ubon and especially when in Vietnam. His pattern of drinking was recorded as starting in Malaya and remaining essentially the same until recent times. This involved mainly beer. Regularly on a Friday afternoon he would drink fifteen 10-ounce beers. During the week he would average about four stubbies a night and have wine with his meals. He told Dr Burges Watson that he started smoking and drinking as an apprentice after he joined the RAAF. However, although finding that Mr Traves' alcohol habit "was determined by his service life…Mr Traves has not seen it has a problem, has not required any treatment for it and has been able to cut down when so advised."
On 24 June 1998 Dr H Brigden, a Veterans' Affairs departmental medical officer, in a departmental minute (N1999/457, T10), found that the Applicant's "AD relating to his right knee is stable, possibly even improving…" He further found that his hypertension was mild and well controlled and that it was unlikely that the Applicant has diabetes. He said that from talking to the Applicant and from reading the report of Dr Burges Watson, the Applicant does not suffer from psychoactive substance abuse.
On 12 July 1999 Dr R D Lewin, a psychiatrist, found in Exhibit R6 that the Applicant was not alcohol dependent. There were no major indications of consequences in regard to the Applicant's drinking. Dr Lewin found no causal link between alcohol abuse and his service. There was also no evidence of a stressor to satisfy the diagnostic criteria. Dr Lewin assessed the Applicant as scoring a nil rating under the Department of Veterans' Affairs Guide to the Assessment of Rates of Veterans' Pensions (5th edition) ("GARP"). He believed that the Applicant was no longer seeking work, although able to work.
On 29 July 1999 Dr F Harding Burns, a physician, confirmed a long history of bowel disorders in Exhibit A5. He also found that "Mr Traves' history readily satisfied the criteria for the alcohol dependence syndrome and alcohol related disability due to harmful drinking" and that "carcinoma of the colon would also be considered an alcohol related disability." He found also that this alcohol pattern was formed by his youth in the service, and led to harmful drinking, smoking and hypertension. He states that there is a reasonable hypothesis between his medical conditions and smoking and drinking from his war service.
In a further report of 8 November 1999 (Exhibit A7) Dr Harding Burns confirmed the effects of alcohol consumption and smoking on the health of the Applicant and his daily activities and social life. He also stated there were few educational units to teach about alcohol abuse. He identified the constant activity of planes taking off and landing as being the stressor that could have led to the Applicant's alcohol abuse. He confirmed the reasonableness of the hypothesis in relation to war service and this abuse.
Dr Harding Burns also gave oral evidence. He confirmed that the Applicant is alcohol dependent. His sleep pattern is a manifestation of his dependence. Mr Traves had not experienced withdrawal symptoms in hospital because his sedation masked those symptoms. In any event, the Tribunal notes, it is the Applicant's evidence that he had some alcohol while in hospital.
The physical indicia of dependence are the Applicant's overweight problem, his large parotid glands, his florid complexion and his abnormal blood pressure. The Applicant takes Warfarin for his hypertension. He should drink only one standard measure a day because any more will impede the absorption of Warfarin. The Applicant's only social activities involve alcohol consumption. He seems to satisfy the criteria in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (4th ed) ("DSM-IV").
In oral evidence Dr Harding Burns addressed SoP 5 of 1994. He considered that the Applicant satisfies factor 1(a), "experiencing a stressful event prior to the clinical onset of psychoactive substance abuse or dependence, and maintaining the abuse or dependence post-service." He considered that the Applicant was exposed in Ubon to stressful events.
In paragraph 4 of the SoP "psychoactive substance abuse or dependence" is defined. It "means a maladaptive pattern of use … that is indicated by either:

(a)Continued use of the substance despite knowledge of having a persistent or recurrent social, occupational, psychological or physical problem that is caused or exacerbated by use of the substance; or

(b)Recurrent use of the substance when use is physically hazardous (for example, driving while intoxicated) …"

As regards criterion (a), the Applicant must have a sense that things are not right. The doctor cited the expenditure on alcohol each week, his attempts to hide consumption from his wife, not taking advice that he should not drink, accumulating drink-related disabilities such as overweight, hypertension, the risk of a stroke and sleep problems. Mr Traves drove regularly in Toowoomba under the influence of alcohol. This was physically hazardous, as in criterion (b).
When told that Associate Professor Mattick and Dr Lewin did not see the Applicant as suffering from psychoactive dependence Dr Harding Burns queried whether they knew of such factors as drinking in hospital and sleeping in a disturbed manner. Dr Harding Burns considered that Mr Traves has 30 to more than 40 drinks a week. This takes him well into the World Health Organisation's (WHO) classification of hazardous drinking and could even take him into the harmful drinking area (over 42 drinks a week).
In cross-examination Dr Harding Burns said that Mr Traves probably formed a drinking habit in high-risk overseas situations. He was drinking 10 to 20 glasses a day in Thailand. This posed a risk of physical dependence and hazardous/harmful drinking, as per the WHO classification. Even in Wagga he was drinking 10 middies a session. This is significant intoxication with accompanying risks of falling down, burning oneself, vomiting or haemorrhaging. Dr Harding Burns noted that Mrs Traves wants the Applicant to drink less.
Dr Harding Burns saw the clinical onset of dependence or abuse as 1967 when the Applicant's drinking became hazardous.
On 22 November 1999 Dr A Dinnen, a psychiatrist, reported on the Applicant in Exhibit A8. He considered that the Applicant's drinking rose markedly when in the services, especially overseas. He accepted the evidence of the Applicant in the T documents and medical reports as regards his drinking habits. Dr Dinnen believes that the definition of "alcohol abuse" in the relevant SoP for psychoactive substance abuse or dependence is satisfied. However, he states that he "cannot say that the patient's psychoactive substance abuse (alcohol) fully satisfies the requirements of the relevant SoP to enable this to be connected to service." This is because no specific stressor had been identified and the SoP seemed to require that.
On 16 December 1999 Dr M Baz, occupational physician, reported on the Applicant (Exhibit A14). On the basis that the conditions of alcohol abuse/dependence, hypertension, colon cancer and atherosclerotic peripheral vascular disease both legs are accepted disabilities she found a total impairment rating of 44 and a lifestyle rating of 4. She would recommend a Disability Pension at 80% of the General Rate.
On 21 December 1999 Dr H Lukins, vascular and general surgeon, stated that "I have no definite documentation of diverticulitis". He thought it unlikely that the Applicant's bowel cancer would mask the appearance of diverticulitis (Exhibit A9).
On 2 March 2000 Dr G Chapman, a gastroenterologist, reported on the Applicant (Exhibit R1). She found that the Applicant did not satisfy the SoP concerning malignant neoplasm of the colon because he does not satisfy the criterion of having smoked cigarettes for "at least 15 pack years". However she did find that he fulfils the criteria relating to alcohol consumption in the SoP in connection with carcinoma of the colon.
On 6 March 2000 Associate Professor R P Mattick (Exhibit R2) found that on the basis of the information provided to him by the Applicant, he did not meet the criteria for substance dependence involving alcohol. He also found that there was no evidence of emotional disturbance because of war service. He could not find any reasonable hypothesis or find on the balance of probabilities that the Applicant's operational or eligible service was related to his drinking or smoking.

On 14 March 2000 Prof G Tracy (Exhibit R3) reported that, because of the Applicant having stopped smoking in 1989 and not having excessive alcohol intake, there is no issue in regard to substance abuse of an addictive nature. She found, however, that the period of eligible service played a part in the genesis of his colonic diverticulitis.
On 14 April Prof J Levi (Exhibit R4), an oncologist, provided a report on the Applicant. He considered Mr Traves's self-reported history of cigarette and alcohol consumption. As regards smoking, he commenced in 1960 following enlistment in the RAAF. He generally smoked 15 cigarettes a day. This rose to 20 a day in 1964 and remained the same for operational service from 1965 to 1967 and also for 1972 to 1980. This adds up to the equivalent of approximately 11.5 pack years over the periods of operational and eligible service.
He commenced drinking alcohol on enlistment into the RAAF in 1960. His alcohol intake increased in 1965 during service at the RAAF Butterworth Base in Malaya to 100 grams of alcohol a day. During operational service in Thailand this increased to approximately 260 grams a day. During the one year of service in Vietnam the intake was approximately 180 grams a day. In Townsville between 1972 and 1975 (defence service) the intake was approximately 160 grams a day. During defence service in Melbourne from 1975 to 1980 it was approximately 70 grams a day. Total alcohol intake, taking into account operational service in Thailand and Vietnam and the defence service would amount to more than 400 kg of alcohol. However, the alcohol consumption prior to operational service was approximately 100 grams a day. This indicates that Mr Traves' increased alcohol intake principally relates to service in Thailand and Vietnam where the total increase in alcohol intake for that period would be about 240 kilograms. Alcohol intake during defence service involved an increase in consumption equivalent to approximately 60 kilograms in Townsville (over three years) and nil in Melbourne (five years). This total increase is about 300 kilograms of alcohol.
Professor Levi said that it was not possible to attribute a cause to the cancer. As regards the SoP for colon cancer he considered factors 5(b) and (c) in SoP 23 of 1996 as potentially relevant. As regards cigarette intake (5(b)), the total intake during operational and defence service is approximately 11.5 pack years – a total short of the 15 required.
As regards alcohol consumption (5(c)), the total amount of Mr Traves' alcohol intake during operational defence service is over 400 kilograms. It is therefore greater than the 250 kilograms required within any 25-year period before the clinical onset of the colon cancer. As Mr Traves' increased alcohol intake it amounted to 300 kilograms, more than the required 250 kilograms. He proceeded to accord ratings.
Dr M Burns, occupational physician, wrote on 18 April 2000 (Exhibit R5). He took an alcohol consumption history with the features: drinking (probably ten middies of beer a fortnight) commenced in Wagga soon after joining the RAAF and up to 1962; at Amberley from 1963 to 1965 consumption rose to about five middies of beer a day because of peer pressure and the RAAF messing system which was based on drinking; at Butterworth he increased drinking to about ten middies a day together with some spirits because of peer pressure and cheap supply; at Ubon drinking increased to probably 20 middies a day and six ounces of spirits because of peer pressure, boredom and noise-induced sleeplessness. After Ubon the daily consumption reduced to the Butterworth level. It rose again in Vietnam in 1969. It remained lower than in Ubon. The figure was about 16 middies a day plus two ounces of spirits. Mr Traves reported no significant stressor during military service in either Ubon or Vietnam.
After his return to Australia his alcohol consumption remained fairly steady at ten to 12 middies of beer plus an ounce of spirits a day until the mid-1970s. He then reduced to the level that pertained before he had gone overseas. In April 2000 he was drinking about six standard drinks a day, no spirits. This could increase two days a week when he visits the bowling club.
The Applicant reported no medical problems associated with his alcohol intake and there were no work problems associated with alcohol. When hospitalised for bowel cancer in 1998 he did not drink alcohol and he had no withdrawal symptoms. He gets on well with his family and friends. He has had no psychiatric treatment.
Mr Traves was diagnosed with hypertension in 1987. His diverticular disease was diagnosed in 1989. He had experienced abdominal pain for four years before the diagnosis.
Mr Traves' colon cancer was diagnosed in 1998. He had an operation in October 1998. The operation has been successful. Mr Traves told Dr Burns that he developed pains in the calf muscles of both legs after his cancer operation. The diagnosis was claudication. Vascular investigations disclosed significant peripheral vascular disease involving the popliteal and femoral vessels. On 25 March 1999 an unsuccessful left femoro-popliteal bypass was carried out. He has pain in both calf muscles after 300 metres of walking
Mr Traves admitted to smoking from when joining the RAAF in 1960. He smoked up to 15 cigarettes a day in Wagga and until going to Malaya and Ubon where he increased smoking to 20 a day. In Vietnam he smoked about 30 cigarettes a day. This was related to peer pressure and boredom and not to any particular stressor on service. He smoked about 20 cigarettes a day after Vietnam until giving up in 1988 or 1989.
Dr Burns gave Mr Traves a GARP rating of 15 and lifestyle rating of 1 for accepted disabilities (30% of general rate) and 32 with lifestyle rating of 3 (60% of the general rate) if the contended disabilities are accepted.
At the hearing the Applicant gave evidence. In evidence in chief and in the Applicant's statement (25 August 2000, Exhibit A10) the following new and relevant material emerged:

Mr Traves joined the RAAF as an apprentice electrical fitter in 1960, aged 15. He succeeded in becoming a Flight Sergeant in the RAAF. He worked as an electrical maintenance engineer.
The progress of his bowel condition and relevant claims was traced. He lodged a claim for bowel cancer in November 1998 (N1999/1814, T4). He moved a car trailer and felt faint. A scan, a colonoscopy, a biopsy and a blood test confirmed that he had colon cancer. He had claimed for diverticular disease of the colon in February 1998 (N1999/457, T4) as a result of symptoms of stomach ache and problems with bowel motions since 1989.

The Applicant provided a spreadsheet depicting his alcohol consumption as a function of time throughout service (Exhibit A13). It used the same figures as at folios 49-50 of the N1999/1814 T documents. This showed a maximum of 25 grams of alcohol a day consumed in Wagga, 50 a day at Amberley, 100 a day at Butterworth, 250 a day at Ubon, 200 a day in Vietnam, around 150 a day in Townsville and as low as around 50 a day in Melbourne.

The Applicant addressed his statement (Exhibit A10), dated 25 August 2000. He concentrated on his duties at Ubon where he worked with Sabre aircraft over two three-month periods. These were frightening machines that used a high intake engine type. The aircraft were armed. They were complex electrically with seven miles of wiring. He had to marshal Sabre aircraft after a sortie while in the line of fire of weapons. They had an explosive activated canopy and ejector seat. Teams of three worked on each plane. One electrician would service two aircraft. They were equipped with Sidewinder missiles which were tested by checking whether they would follow the path of a torch held by an electrician. The Applicant had to do this work and have the missiles point toward and follow him while he manipulated the torch. A weapon could fire unintentionally if there were an electrical fault. An Australian airman had been sucked down the intake of a Sabre and killed, although Mr Traves was not at Ubon when this happened.
An operation ready platform (ORP) was set up at the end of the strip with two aircraft always at the ready to take off. The sergeant supervisor was at the opposite end of the strip. The Applicant was "it" every four days as electrician when the ORP was empowered. The Applicant found this stressful. He was responsible for getting the plane going if something went wrong. He had to start the generator, a temperamental machine, and fire up the radio in the ORP huts. He could not see the aircraft until it was very close. When the aircraft was ready for take-off the Applicant and a colleague returned to the ORP hut and awaited the scramble. The planes flew daily for practice or for genuine purposes. During a scramble any malfunction of the ejector seat could kill the pilot and the electrician. There could be live scrambles at any time and there were practices in the afternoons. The aircraft returned within about an hour. Sometimes they returned in the dark. The Applicant found marshalling of the landed craft frightening. They had to be placed precisely within a context where they could suck up stones if too close to the edge. They had to make tight turns which increased the risk of a man being sucked into the intake.
The base at Ubon had a transitory feel to it. It was a temporary frontier set-up. This was a stimulus to drinking.
The Applicant was in a group at Ubon located near the fuel farm which contained open fuel in above ground tanks that were vulnerable to strike or sabotage action.
Mr Traves also lived and worked near US Air Force Phantom aircraft. They were heavily armed and generated a full afterburn early in their routine. They were noisy and caused ground vibrations. They operated all day and night and affected sleep. Mr Traves, then aged 21, had to drink alcohol to get to sleep.
The RAAF made up their own sulphuric acid for aircraft and ground support batteries. The chemical process involved could result in an explosion if done carelessly. Toxic solvents were also used as cleaning agents.
The base guards at Ubon were Thais. One had his throat cut. The Applicant knew these guards, including the murder victim. They were nervous after this incident.
The Applicant kept a weapon beside the bed at Ubon. He was continuously anxious the whole time he was in Ubon.
On one occasion the Applicant returned to camp in Ubon after curfew. He came via the fuel farm. A guard from behind put a gun to his head. He bribed his way out of the situation with some cigarettes.
At Ubon Mr Traves felt undertrained for the work.
In addition to drinking in Ubon to get to sleep, the Applicant drank after finishing at the ORP as a celebration. This involved beer and spirits. He punched a friend for no good reason after drinking one day. There was in fact little to do in Ubon other than drink. He would drink during outdoor movies. As discussed earlier in the medical evidence, the Applicant's alcohol consumption rose at Butterworth where there was a boat club with a bar, and rose again at Ubon where he was president of the social club. It fell back when he would move from Ubon back to Butterworth. In oral evidence the Applicant estimated that he had 20 drinks a day at Ubon and 10 a day at Butterworth. In Vietnam at Vung Tau there was the Ettamogah Club where many welcomes and farewells occurred. Mr Traves was president of the Ettamogah Club. While the Applicant was in Vietnam an aircraft landed in the jungle. The Applicant was called out to attend to the aircraft. This was a dangerous, frightening experience. Generally the Applicant was on higher pay in Ubon and Vietnam and beer was cheaper overseas than in Australia.
In Wagga for two years after joining the RAAF in1960 Mr Traves did not drink. They were not allowed to drink on base. At Amberley drinking on paydays was a custom. Additionally, he was promoted at Amberley and had more money to spend. Drinking was not a daily occurrence, however. After service overseas Mr Traves continued to drink. In Townsville he drank less than when overseas but still heavily because of his exposure to the mess arrangements. He drank alone once while awaiting his girlfriend. She broke off the relationship because of Mr Traves' drunkenness. He sought a committee position in the Airmen's Club Committee to have an excuse to drink. He drank stout in hospital after his operation in 1998 for colon cancer. His doctor permitted this in an attempt to improve Mr Traves's appetite, which was poor after the operation. He tries to hide evidence of his consumption of beer. He still drinks four or five cans of beer a day and has only ever abstained for a maximum of three days about five years ago. Mr Traves believes that his children may have been ashamed of his drinking at times.
Mr Traves did not identify any way in which his drinking had affected his career in the RAAF. He had obtained a citation for technical data control for Hercules aircraft acquisition. Mr Traves worked as an electrician after leaving the RAAF. His skills and abilities declined. He became a foreman at Assets Services when others were retrenched. He was not competitive on the open market.
Discussion with doctors about drinking commenced with Dr Burges Watson in Tasmania in 1998. The doctor thought his alcohol consumption excessive so he substituted alcohol with apple cider and foods. He did not keep to this. He stayed off drink for a while but relapsed. At the time of the hearing he was drinking from two to 10 beers a day with six a daily average. He drinks at home from 4.00 or 5.00 pm and at the bowling club a couple of times a week. He drinks more heavily at the club, about six beers over three hours depending on whether he is driving, because his wife disapproves of heavy drinking. He had begun to drink light beer just before the hearing because of stomach pains with a July 2000 onset. He was spending about $70 a week on alcohol. His income is $30,000-$35,000 a year. He drinks at barbecues that occur up to twice a week. In Toowoomba he frequently drove with a blood alcohol content of greater than 0.05. He would do this every Friday and often on Wednesday. Mr Traves said he always drinks at a social event.
The Applicant did not think he had employment problems as a result of drink. He had been disciplined in Vietnam for having a hangover while on duty. He lost a day's leave as punishment.
As regards smoking, this was stable from 1964. It peaked at its highest level of 30 cigarettes a day in Vietnam. He believes he smoked heavily in Ubon also. Back in Australia in Townsville he tried cigars in an effort to reduce consumption. He reduced cigarettes to about 20 a day in sale in Victoria. He gave up cigarettes in 1988 and cigars some time later.
Mr Traves reported that he has pain in his legs at all times when walking but he can walk for distances dependent on the state of the pavement and the degree of incline. He can walk about 300 metres without a problem. He walks slowly and needs rests of at least a minute to permit fresh blood flow into his lower legs. On stairs he uses the handrail. He finds stairs easier than sloped pavement. He has an arthritic right knee. The right knee can be working well and then deteriorate.
As regards colonic problems, Mr Traves was diagnosed with diverticulitis in 1989 (Exhibit A12). He had experienced some soiling of underwear before his colon cancer operation, as noted by Dr Baz in Exhibit A14, but had had none since July 2000. He evacuates his bowels from two to five times a day, although more than three times is unusual. He takes Metamucil and tends to constipation if he does not take that. Generally, however, his evidence was that his bowel condition had improved considerably after his operation.

Mr John Winter, the Applicant's friend, provided a statement dated 20 August 2000 (Exhibit A11). He also gave evidence at the hearing. In his evidence he confirmed what the Applicant had said about his restricted ability to walk. He spoke also of service at Ubon. No one there really wanted to be there. He referred to the guard whose throat was cut as a frightening incident. There was a resulting security alert.
In his written statement he said he had known Mr Traves since 1960. They served at the same locations in the RAAF from 1960 to June 1969, with the exception of 1967-March 1969. They have kept in touch since and, since 1998, have regularly visited each other at home. He wrote of the Applicant's heavy alcohol consumption in Ubon, the stressful ORP working conditions at Ubon and the tendency of airmen to drink heavily in Vietnam (Mr Winter was not there with the Applicant). He confirmed the Applicant's evidence as regards his current alcohol consumption. He said that Mr Traves hides "empties" from his wife. He commented that Mr Traves tends to understate his beer consumption. He said that Mr Traves can go a day without beer and he suffers no adverse effects, however, come 4.00 pm he tends to plot how and where he can get a drink. Mr Winter was confident that Mr Traves developed alcohol dependence in Ubon.
Findings on material questions of fact with reference to the evidence or other material on which the findings are based
The conditions contended for are best considered in the following order:
1) Psychoactive substance abuse or dependence.

2)Hypertension. This condition cannot be accepted if psychoactive substance abuse or dependence is not accepted. Mr Traves's hypertension is said to stem from his alcohol abuse or dependence.

3)Diverticular disease of the colon. This was the earlier diagnosed of Mr Traves's two colon conditions.

4) Malignant neoplasm of the colon.

5)Atherosclerotic peripheral vascular disease. This was the last condition to generate a claim by Mr Traves.

Psychoactive substance abuse or dependence

The parties agreed that the appropriate SoP was SoP no 5 of 1994. The Tribunal agrees with the parties. The primary decision on this issue was made on 24 June 1998. This was the SoP in force on that date.
Mr Traves had considerable operational service. The focus of argument in the case has been on any connection between Mr Traves's war service and his alcohol problem. Considering the principles in Deledio v Repatriation Commission (1997) 47 ALD 261, the four steps in this instance apply as follows.
The hypothesis as it applies to the consumption of alcohol is that the Applicant first drank alcohol on joining the RAAF and his consumption increased to the point of being substance abuse or dependence during operational service in Ubon and Vietnam because of the conditions he encountered in those places.
There is a relevant SoP, as noted above.
The elements of that SoP that are to be satisfied are (i) that Mr Traves suffers from psychoactive substance abuse or dependence ("the condition") as defined in the SoP at paragraph 3; (ii) that Mr Traves experienced a stressful event prior to the clinical onset of the condition; and (iii) that Mr Traves maintained the abuse or dependence post-service (factor 1(a)).
Heerey J said in Deledio (supra) at page 275 that, in applying the SoP template to the particular claim, if one of the disputed facts happens also to be a component of an SoP then the Repatriation Commission must disprove that fact beyond reasonable doubt, just like any other relevant fact. This is amplified by Wilcox J in Dixon v Repatriation Commission (1999) 29 AAR 235 at page 243 where he states:
"As the Full Court said in Deledio, it is only at the step 4 stage of the process 'that the Tribunal will be required to find facts from the material before it'. In the present case the Tribunal fused together steps 3 and 4. It should have resolved step 3 by determining whether the claims [judge's emphasis] made in the material before it satisfied the factor requirements of the Statement of Principles related to the generalised anxiety disorder; this is, still considering them as claims and without making any judgment about their truth. If the AAT had answered this question in the affirmative, the final step in carrying out the obligation imposed on the Tribunal by s 120(1) of the Act is to decide whether it is satisfied, beyond reasonable doubt, that there is no sufficient ground for determining that the disease was war-caused. If the Tribunal had been satisfied beyond reasonable doubt that Mr Dixon did not undergo the experiences he claimed, or that any experiences he did undergo did not cause the generalised anxiety disorder he claimed to suffer, this would have been a proper basis for achieving the satisfaction mentioned in s 120(1) and dismissing the appeal.

"The question whether a decision-maker reaches a conclusion adverse to a claimant at the step 3 stage or the step 4 stage is not a mere technicality. If belief is addressed at step 3 stage, there is a risk that the decision-maker will rule against a claimant simply because he or she is not persuaded the claimant's story is probably true. Although the decision-maker should not think in terms of onus of proof, in a practical sense at the step 3 stage the claimant is likely to be left with this burden. Moreover, the decision-maker is likely to reject the application even though he or she thinks the claimant's story may possibly [judge's emphasis] be true. This would defeat the protection for veterans embodied in s 120(1), whereby a claim which fits the factors in the relevant Statement of Principles must be accepted unless the decision-maker is satisfied, beyond reasonable doubt, that it is without justification [judge's emphasis].
"It was erroneous, in the present case, for the Tribunal to consider the truth of Mr Dixon's evidence at the third stage, when examining the issue of the reasonableness of the hypothesis. This should have been left to the final stage of the Tribunal's reasoning process."

Applying the Federal Court's approach, it is clear that Mr Traves is claiming (i) that he suffers from psychoactive substance abuse or dependence ("the condition") as defined in the SoP at paragraph 3; (ii) that he experienced a stressful event prior to the clinical onset of the condition; and (iii) that he maintained the abuse or dependence post-service. The Applicant therefore survives the application of step 3 of Deledio (supra).
Step 4 requires the Tribunal to consider whether it is satisfied beyond a reasonable doubt that the psychoactive substance abuse or dependence did not arise from a war-caused injury. If it is so satisfied beyond reasonable doubt then Mr Traves's claim will fail.
The Respondent attempted to raise doubts about the war-caused nature of any psychoactive substance abuse or dependence afflicting Mr Traves in the following way. The Respondent accepted the drinking history put forward by Mr Traves. It also accepted his description of the working conditions in Ubon and Vietnam, evidence largely corroborated by witness Mr Winter. While this might possibly amount to "psychoactive substance abuse or dependence" there was not a stressor of the type required by the SoP. The SoP defines a "stressful event" as "an incident in which there were external stimuli (such as combat) that would result in psychological stress, and where there were subjective symptoms of increased stress." (SoP paragraph 4.) The Respondent cited the Federal Court decision in Ferriday v Repatriation Commission (1996) 42 ALD 526 as some form of support. However, that case is of little use in deciding whether what might be termed the nature and conditions of a veteran's work at a particular location might be described as an "event" or, perhaps more correctly, an "incident".
The Applicant's representative argued that the definition of "stressful event" was satisfied. He argued that the passage of time can be an incident. The Tribunal takes this to mean that the existence of a state of affairs, such as at Ubon, over a period of time can constitute an incident. Alternatively, counsel argued that any of the stressful individual events that occurred at Ubon could be separated out and treated as an incident. These might include carrying a torch and being tracked by missiles during aircraft marshalling duties, or the risk of the ejector seat activating, or any of the various other stressful activities detailed earlier.
As is common in these circumstances the Tribunal has referred to the Macquarie Dictionary for the ordinary meanings of the terms in contention. The Macquarie says, relevantly, that an event is:
"anything that happens or is regarded as happening; an occurrence, esp. one of some importance. … something which occurs in a certain place during a particular interval of time."

It says, relevantly, that an incident is:

"an occurrence or event. … a distinct piece of action, or an episode, as in a story or a play."

The Tribunal finds that the concept of an incident is potentially more problematic for the Applicant than is the idea of an event. The dictionary definition of an event would seem to cover the situation at Ubon. The Applicant has indicated a range of things (stressful activities accepted by the Respondent as having occurred) that occurred at a particular place (Ubon) during a particular interval of time (on and off between late 1965 and mid-1966).
As regards an incident, the Tribunal notes that the primary definition is "an occurrence or event". The Tribunal is prepared to apply this definition which, of course, cross-refers to the concept of an event. This accords with the general tenor of the Veterans' Entitlements Act and the cases decided under it. It is manifestly beneficial legislation which should be interpreted so as to accord the veteran the benefit of the doubt where the Act or statutory instruments made under it are ambiguous.
Paragraph 2 of the SoP has the effect that the condition must be related to service if it is to be an accepted disability. In the present case the evidence of the veteran as to the stressful conditions in Ubon, notably his use of alcohol as a sleeping draught to counteract the noise from Phantom aircraft, evidence not contradicted, would appear to satisfy this requirement.
The Tribunal therefore finds that Mr Traves satisfies the criteria for him to be accepted as suffering from the war-caused disability of psychoactive substance abuse or dependence. In summary the reasons are:
1) Mr Traves has a condition of psychoactive substance abuse or dependence. The definition in SoP paragraph 4 is satisfied. Dr Harding Burns's evidence was that Mr Traves engaged in hazardous or harmful drinking. This would satisfy ICD code 303 or 304. Dr Dinnen found that Mr Traves was involved in alcohol abuse but he was less certain about alcohol dependence.

2) The Tribunal notes that Dr Harding Burns characterised Mr Traves's drinking before Butterworth and Ubon as essentially social. He also saw the alcohol consumption in Ubon as considerably more serious than in Butterworth. This tallies with the Applicant's evidence which he presented convincingly to the Tribunal. After excessive consumption in Ubon he continued to drink excessively in Vietnam, Townsville, Melbourne and continuously to the present day. Based on the evidence of Dr Harding Burns and Mr Winter the Tribunal finds that the date of clinical onset of substance abuse or dependence was 1967.

3) He continued drinking in this fashion despite having persistent or recurrent social and physical problems caused or exacerbated by use of the substance. His social problems were the domestic difficulties with his wife attested to by the Applicant. He very likely also caused or exacerbated his hypertension because of his drinking.

4) He also engaged in recurrent use of alcohol when its use was physically hazardous, such as when driving regularly under the influence.

5) Associate Professor Mattick in Exhibit R2 did not consider that Mr Traves satisfied the criteria in DSM-IV for a diagnosis of substance dependence. This was based on a number of factors. Mr Traves was not drinking more than he would want to do. He did not spend a great deal of time obtaining alcohol. He had not given up important social and similar activities because of drinking. Professor Mattick noted that he did consume alcohol when it might impede the beneficial effects of Warfarin. The Tribunal received some contrary evidence. Mr Winter in his statement referred to Mr Traves's feverish efforts to find alcohol at 4.00 pm of an afternoon. Professor Mattick was not apprised of Mr Traves drinking in hospital. He seems not to have been aware of Mr Traves hiding his alcohol consumption from his wife and continuing to drink in excess of what she sees as acceptable. The Tribunal has therefore decided to prefer Dr Harding Burns's view on this question.

6) Dr R D Lewin, a psychiatrist, considered that Mr Traves had no dependence on alcohol. He thought there was no stressor incident. He considered Mr Traves fit to return to work. In diagnosing an absence of alcohol dependence Dr Lewin referred to a number of factors including that there appeared to be no significant impact of drinking on his health, family relationships or past capacity to work. He has no criminal history. There was no evidence of tolerance or withdrawal symptoms. He was hospitalised without developing withdrawal symptoms or delirium tremens. Unfortunately he was operating from incomplete information, as was Professor Mattick. He was unaware of the drinking in hospital, his driving under the influence or Mr Traves's quest for alcohol at 4.00 pm of an afternoon. For similar reasons the views of Dr Burges Watson have been given less weight than those of Dr Harding Burns. Professor Tracy considered that Mr Traves's current alcohol consumption is not excessive but she appeared unaware of his full history. Her views were therefore subordinated to those better acquainted with Mr Traves's history.

7) The Tribunal finds that Mr Traves experienced a stressful event prior to the clinical onset of psychoactive substance abuse or dependence. The Tribunal has already explained the basis for this finding.

8) The Tribunal finds that Mr Traves has maintained the abuse or dependence post-service. Again, the Tribunal has explained this finding above.

Hypertension

The parties agreed that the appropriate SoP was SoP no 83 of 1995. The Tribunal agrees with the parties. The primary decision on this issue was made on 24 June 1998. This was the SoP in force on that date.
As discussed above, Mr Traves had considerable operational service. Considering the principles in Deledio (supra), the four steps in this instance apply as follows.
The hypothesis as it applies to the hypertension is that the Applicant first drank alcohol on joining the RAAF and his consumption increased to the point of being substance abuse or dependence during operational service in Ubon and Vietnam because of the conditions he encountered in those places. His alcohol intake led to the development of hypertension.
There is a relevant SoP, as noted above.
The elements of that SoP that are to be satisfied are (i) that Mr Traves suffers from hypertension ("the condition") as defined in the SoP at paragraph 4; (ii) that Mr Traves suffers from psychoactive substance abuse as defined in the SoP at paragraph 4; (iii) that this abuse involved the daily consumption of alcohol; and (iv) that Mr Traves maintained the substance abuse at least until the accurate determination of hypertension as defined in paragraph 4 of the SoP (factor 1(b)).
Applying the Federal Court's approach, it is clear that Mr Traves is claiming (i) that he suffers from hypertension as defined; (ii) that he suffers from psychoactive substance abuse as defined; (iii) that this abuse involved the daily consumption of alcohol; and (iv) that Mr Traves maintained the substance abuse at least until at least the accurate determination of hypertension as defined in paragraph 4 of the SoP. The Applicant therefore survives the application of step 3 of Deledio (supra).
Step 4 requires the Tribunal to consider whether it is satisfied beyond a reasonable doubt that the hypertension did not arise from a war-caused injury. If it is so satisfied beyond reasonable doubt then Mr Traves's claim will fail.
The Tribunal finds that it cannot be satisfied beyond a reasonable doubt that the hypothesis is unreasonable. This flows largely from the findings already made that, since 1967, Mr Traves has suffered from psychoactive substance abuse or dependence.
In more analytical terms, Mr Traves's claims can be regarded as established. His hypertension was diagnosed in 1987 (Dr Burns, Exhibit R5) or 1988 (Mr Traves, N1999/457, T4) or 1991 (Dr Baz, Exhibit A14).
Mr Traves suffers from psychoactive substance abuse for reasons given earlier.
Mr Traves's psychoactive substance abuse involves the daily consumption of alcohol. It is possible that he has gone for the odd day or so without drinking alcohol, but the Tribunal considers that this requirement in the SoP is substantially met.
The Tribunal is satisfied that Mr Traves continued his psychoactive substance abuse at least until the accurate determination of hypertension in, at the latest, 1991.
Paragraph 3 of the SoP has the effect that the condition must be related to service if it is to be an accepted disability. In the present case the evidence of the veteran as to the stressful conditions in Ubon, notably his use of alcohol as a sleeping draught to counteract the noise from Phantom aircraft, evidence not contradicted, would appear to satisfy this requirement.
The Tribunal therefore finds that Mr Traves satisfies the criteria for him to be accepted as suffering from the war-caused disability of hypertension.
Diverticular disease of the colon
The parties agreed that the appropriate SoP was SoP no 67 of 1994 as amended by SoP no 281 of 1995. The Tribunal agrees with the parties. The primary decision on this issue was made on 24 June 1998. These were the SoPs in force on that date.
There was at the time of the hearing no hypothesis pressed by the Applicant linking the Applicant's possible disability of diverticular disease with service. Counsel for the Applicant argued instead that Mr Traves's condition was malignant neoplasm of the colon. It may be true that Mr Traves had claimed in respect of diverticular disease but a veteran should not be expected to self-diagnose. The Respondent in reply pointed out that this was the diagnosis of Mr Traves's own doctor (N1999/457, T4) and it should stand. Dr Funnell, the Applicant's general practitioner, placed the onset of diverticulitis as in 1979.
It is easy to appreciate why the Applicant did not press the diagnosis of diverticular disease of the colon because the Applicant does not satisfy the SoPs and would fail when step 4 from the Deledio case (supra) is applied.
The Tribunal therefore finds that the Applicant does not suffer from a war-caused disability of diverticular disease of the colon.
Malignant neoplasm of the colon
The Applicant pressed that his bowel disease should be recognised as malignant neoplasm of the colon, the condition that led to his having surgery in October 1998 (Exhibit R6).
The parties agreed that the appropriate SoP was no 23 of 1996 as amended by SoP no 5 of 1998. The Tribunal agrees with the parties. The primary decision on this issue was made on 8 February 1999. These were the SoPs in force on that date.
As discussed above, Mr Traves had considerable operational service. Considering the principles in Deledio (supra), the four steps in this instance apply as follows.
The hypothesis as it applies to the malignant neoplasm of the colon is that the Applicant first drank alcohol on joining the RAAF and his consumption increased to the point of being substance abuse or dependence during operational service in Ubon and Vietnam because of the conditions he encountered in those places. His alcohol intake led to the development of malignant neoplasm of the colon.
There are relevant SoPs, as noted above.
The elements of the SoPs that are to be satisfied are (i) that Mr Traves suffers from malignant neoplasm of the colon ("the condition") as defined in the SoP at paragraph 2; and (ii) that Mr Traves drank at least 250 kilograms of alcohol (contained within alcoholic drinks) (as defined in paragraph 7) within any 25 year period before the clinical onset of the condition (factor 5(c)).
Applying the Federal Court's approach, it is clear that Mr Traves is claiming (i) that he suffers from the condition as defined; and (ii) that Mr Traves drank at least 250 kilograms of alcohol (contained within alcoholic drinks) within any 25-year period before the clinical onset of the condition.
Step 4 requires the Tribunal to consider whether it is satisfied beyond a reasonable doubt that the malignant neoplasm of the colon did not arise from a war-caused injury. If it is so satisfied beyond reasonable doubt then Mr Traves's claim will fail.
The Tribunal finds that it cannot be satisfied beyond a reasonable doubt that the hypothesis is unreasonable. This flows largely from the findings already made that, since 1967, Mr Traves has suffered from psychoactive substance abuse or dependence.
In more analytical terms, Mr Traves's claims can be regarded as established. His malignant neoplasm of the colon was diagnosed in October 1998 (N1999/1814, T4, folio 23).
Mr Traves suffers from psychoactive substance abuse or dependence for reasons given earlier.
Mr Traves's psychoactive substance abuse involves the daily consumption of alcohol in the form of alcoholic drinks. There may be some dispute as to whether Mr Traves has consumed 250 kilograms of alcohol in a 25-year period. The strongest evidence in support of Mr Traves is the report by Professor Levi (Exhibit R4) in which he considered factor 5(c) satisfied. He saw Mr Traves's alcohol intake during operational service as 400 kilograms, well in excess of the required 250 kilograms, and consumed within the requisite 25 years. The Respondent conceded that Mr Traves met the criterion related to consumption and did not argue against Professor Levi. The Respondent's arguments were based on the alleged lack of a connection with service. As earlier explained, the Tribunal has rejected that argument.
The Tribunal is therefore satisfied that Mr Traves consumed at least 250 kilograms of alcohol in alcoholic drink form in a 25-year period prior to the clinical onset of his malignant cancer.
Paragraph 4 of SoP 23 of 1996 has the effect that any condition must be related to service if it is to be an accepted disability. In the present case the evidence of the veteran as to the stressful conditions in Ubon, notably his use of alcohol as a sleeping draught to counteract the noise from Phantom aircraft, evidence not contradicted, would appear to satisfy this requirement.
Atherosclerotic peripheral vascular disease
The parties agreed that the appropriate SoP was no 87 of1995. The Tribunal agrees with the parties. The primary decision on this issue was made on 8 February 1999. This was the SoP in force on that date.
As discussed above, Mr Traves had considerable operational service. Considering the principles in Deledio (supra), the four steps in this instance apply as follows.
The hypothesis as to the atherosclerotic peripheral vascular disease is that the Applicant engaged in operational service related smoking and this led to the development of atherosclerotic peripheral vascular disease. There is a second hypothesis to the effect that the Applicant's war-caused hypertension led to his atherosclerotic peripheral vascular disease.
There is a relevant SoP, as noted above.
The elements of that SoP that are to be satisfied are (i) that Mr Traves suffers from atherosclerotic peripheral vascular disease ("the condition") as defined in the SoP at paragraph 4; and (ii) that Mr Traves smoked at least five cigarettes a day or the equivalent in other tobacco products for at least three years before the clinical onset of the condition; or (iii) if consumption has ceased, the clinical onset occurred within 15 years of cessation (factor 1(a)).
Alternatively the SoP could be satisfied if (i) Mr Traves suffers from atherosclerotic peripheral vascular disease ("the condition") as defined in the SoP at paragraph 4; and (ii) he suffered from hypertension before the clinical onset of the condition (factor 1(c)).
Applying the Federal Court's approach, it is clear that Mr Traves is claiming (i) that he suffers from the condition as defined; (ii) that Mr Traves smoked at least five cigarettes a day for three years before the clinical onset of the condition; and (iii) that he suffered from hypertension before the clinical onset of the condition.

Step 4 requires the Tribunal to consider whether it is satisfied beyond a reasonable doubt that the atherosclerotic peripheral vascular disease did not arise from a war-caused injury. If it is so satisfied beyond reasonable doubt then Mr Traves's claim will fail.
The Tribunal finds that it cannot be satisfied beyond a reasonable doubt that the hypothesis is unreasonable. This flows largely from the findings already made that, since 1987, Mr Traves has suffered from hypertension.
In more analytical terms, Mr Traves's claims can be regarded as established. His atherosclerotic peripheral vascular disease was diagnosed in November 1998 (N1999/1814, T4, folio 29).
Mr Traves suffers from war-caused hypertension for reasons given earlier and has done so since 1987.
Mr Traves apparently ceased smoking in 1988 (N1999/457, T5). The clinical onset of atherosclerotic peripheral vascular disease was within 15 years of that date (ie about 10 years). Professor Levi provided copious evidence in Exhibit R4 about Mr Traves's cigarette smoking. At its least, Mr Traves's consumption was 15 cigarettes a day from 1960 to 1964. This is sufficient to satisfy factor 1(a) of the SoP.
Paragraph 2 of SoP 87 of 1995 has the effect that any condition must be related to service if it is to be an accepted disability. In the present case the evidence of the veteran as to the stressful conditions in Ubon, notably his use of alcohol as a sleeping draught to counteract the noise from Phantom aircraft, evidence not contradicted, would appear to satisfy this requirement. It was this phenomenon that led to the veteran's hypertension. Likewise, the veteran has attributed aspects of his smoking pattern to service stress. In evidence he said he thought his consumption arose through the conditions in Ubon and Vietnam. It is noted, however, that he described his reason for smoking in the RAAF as "social" in his smoking questionnaire (N1999/457, T5). This tallies somewhat with Dr Burns's findings in Exhibit R4 on the reasons for the Applicant's smoking. The Tribunal considers that it would be wiser to rely on factor 1(c) in SoP no 87 of 1995 in finding in the veteran's favour as regards atherosclerotic peripheral vascular disease and that is what the Tribunal has done. Factor 1(c) relates the condition to the veteran's hypertension.
Conclusion as to entitlement
On the basis of the above the Tribunal has found that the following conditions are war-caused:

psychoactive substance abuse or dependence
hypertension
malignant neoplasm of the colon
atherosclerotic peripheral vascular disease

These are conditions additional to already accepted conditions related to the veteran's right knee.
The dates of effect vary, however. For psychoactive substance abuse the date of effect is 29 April 1998. For hypertension the date of effect is 29 April 1998. The date of effect for malignant neoplasm of the colon is 16 August 1998 and for atherosclerotic peripheral vascular disease it is 14 September 1998.
Assessment
The veteran currently receives a Disability Pension at 30% of the general rate. It is necessary to consider what effect acceptance of these additional conditions will have.
The available evidence is that provided by Drs Baz and Burns, the occupational physicians in Exhibits A14 and R5, respectively. The following table compares their ratings and provides the Tribunal's assessment. Dr Levi in Exhibit R4 awarded some ratings. On the whole these are unexplained and are nil ratings. However, he used table 14.2 in the GARP and awarded 10 points in relation to the malignant neoplasm on the basis of reduced life expectancy.

Accepted condition          Dr Baz          Dr Burns      Tribunal
Right knee osteoarthritis and meniscal lesion    20       15       20
Atherosclerotic peripheral vascular disease both legs 20       10       10
Hypertension 2         2         2
Colon cancer – 6.1.3          5         0         5
Colon cancer – 6.1.8          5         0         5
Colon cancer – 14.2 -          -          10
Psychiatric (alcohol) 2         9         3

Lifestyle factor       Dr Baz          Dr Burns      Tribunal
Personal relationships       2         1         2
Mobility         2         3         2
Community/Recreational activities          4         4         4
Domestic activities   5         4         5

The discrepancy between the doctors as regards the right knee condition is based on whether table 3.2.1 in GARP is applied. Dr Burns applies table 3.2.2 and table 19.1 which have the effect of allowing a rating of 20 for the limitations on walking which is reduced to 11 under table 19.1 when a deduction is made for the impact of a non-accepted condition. The non-accepted condition was atherosclerotic peripheral vascular disease which is now accepted. Dr Baz's rationale that if peripheral vascular disease is included as an accepted disability the knee condition rates 20 points seems sound to the Tribunal. Chapter 19 does not have to be applied.
Both Dr Baz and Dr Burns award a rating of 10 for the peripheral vascular disease. Dr Baz refers in her report to table 2.1.1 which is in fact appropriate for hypertension. It is unclear to the Tribunal how Dr Baz awarded a rating of 20 points in the final analysis for that condition. 10 points appears appropriate to the Tribunal.
Drs Baz and Burns are in accord as regards hypertension. The rating is 2 points. The Tribunal considers that 2 points is correct. The condition requires long-term medication but there is no evidence of target organ damage.
The colon cancer has elicited nil ratings from Dr Burns, but substantial ratings from Dr Baz. Dr Baz factored into her assessment episodes of faecal incontinence. The veteran gave evidence that this had ceased since the cancer surgery. Likewise, his constipation had improved in recent times. That was another basis for Dr Baz awarding the points score she did. The Tribunal referred above to Professor Levi's score of 10 points under table 14.2 and is inclined to adopt that. As between the approaches of Drs Baz and Burns the Tribunal prefers Dr Burns's assessment as regards the colon cancer as it better accords with the Applicant's own evidence at the hearing.
However, the decision concerning colon cancer will operate with effect from 16 August 1998. At that date the symptoms taken into account by Dr Baz did affect Mr Traves. Dr Baz's ratings have therefore been included by the Tribunal. In relation to table 6.1.8 this involves accepting that Metamucil, a preparation for bowel disorders, available without prescription is a "medication". The Macquarie Dictionary defines a medication by reference to a medicine. In essence a medicine is "any substance or substances used in treating disease". The Tribunal considers that Metamucil meets that description. It is efficacious in treating Mr Traves's bowel disease. It is openly available presumably because it is mild in character. The Tribunal's findings above as to the success of the cancer surgery would suggest that the ratings of 5 allowed in respect of each of tables 6.1.3 and 6.1.8 should be deleted as of July 2000. However, it is Repatriation Commission practice not to reduce rates. Therefore, these ratings are not disturbed in this decision.
Mr Traves's psychoactive substance abuse or dependence has elicited very different ratings from the doctors. Fortunately they each explain their ratings. Each has identified it as a mild disability, an assessment with which the Tribunal agrees. The tables in chapter 4 of GARP yield the following results.
Table 4.1 (subjective distress) receives a nil rating from Dr Baz, apparently because the problem causes him very few difficulties. Dr Burns thought it produced occasional symptoms of minor distress. There is nothing in Dr Burns's report to explain this. The Tribunal would agree with Dr Baz on this aspect.
Table 4.2 (manifest distress) has resulted in a rating of nil from Dr Baz and a rating of 3 from Dr Burns. A 3 rating suggests that distress is sometimes apparent and the veteran's preoccupation with symptoms is sometimes noticeable to more observant people. Again Dr Burns does not explain this finding in his report. Again the Tribunal tends to prefer Dr Baz's assessment.
Table 4.3 (functional effects) attracts a rating of 1 from both doctors. This suggests a minor interference with function in some everyday situations. Dr Baz says that after six to eight drinks there would be such interference. The Tribunal agrees and agrees that 1 is an appropriate rating.
Table 4.4 (occupation) attracts a nil rating from both doctors. Dr Baz does not comment but Dr Burns notes that Mr Traves reported no problems associated with his work and alcohol intake. During the hearing Mr Traves said he did not think his drinking caused problems in his employment. The Tribunal agrees with a nil rating.
Table 4.5 (domestic situation) attracted a 2 point rating from Dr Burns with nil from Dr Baz. Again there is no explanation for the 2 rating from Dr Burns. However, the Tribunal considers that there is some minor friction between Mr and Mrs Traves such that a rating of 1 would be appropriate.
Table 4.6 (social interaction) attracts a rating of 1 from Dr Burns and nil from Dr Baz. Dr Burns's rating suggests occasional friction with colleagues and friends. Dr Baz elicited no similar evidence and neither did the Tribunal. Dr Burns's report does not identify where he gained this impression. The Tribunal favours Dr Baz's nil rating.
Table 4.7 (leisure activities) attracted a nil rating from both doctors. The Tribunal does not see any evidence that Mr Traves is less able now than previously to enjoy pleasurable activities because of his alcohol consumption. The Tribunal agrees with the doctors' ratings.
Table 4.8 attracts a rating of 1 from Dr Baz and nil from Dr Burns. Dr Burns does not explain the nil rating. Dr Baz comments that supportive therapy could assist Mr Traves in finding other stress reduction techniques and help reduce his alcohol consumption to minimise further health effects. The Tribunal agrees with Dr Baz's assessment and this results in a 1 rating.
The overall rating for the psychiatric condition is therefore 3.
As regards the lifestyle ratings, the Tribunal notes that they are discrepant also as between the doctors.
On personal relationships the Tribunal considers that Dr Burns may have underrated the effect of Mr Traves's lower limb problems on his ability to join in family and social events. The Tribunal prefers Dr Baz's 2 rating.
On mobility the Tribunal considers that Dr Burns may have overrated the effect of Mr Traves's lower limb problems on his ability to drive and get around. The Tribunal prefers Dr Baz's 2 rating. The descriptor for a 2 rating in GARP for table 22.2 seems to the Tribunal to best fit Mt Traves's level of reduced mobility.
On community and recreational activities the Tribunal notes that the doctors agree on a 4 rating. He does seem to have a reasonable involvement in less physical recreational activities while having to put aside any strenuous activity. The Tribunal agrees that a 4 rating is correct.
On domestic activities the Tribunal notes that Dr Baz has awarded 5 points and Dr Burns 4. The essential difference is as to the lightness of household tasks able to be performed. There is not a great deal of difference between the descriptors for 4 and 5 in GARP at table 22.4. The Tribunal is inclined to accept Dr Baz's assessment as fair and reasonable. The Tribunal awards 5 points.
This averages to 3.25 which rounds to a lifestyle rating of 3.
The result is that, in accordance with chapter 23 of GARP an impairment rating of 40 (which is 42 rounded to the nearest 5 points) has been allotted. The lifestyle rating is 3. Scale 23.1 results in a degree of incapacity of 70%. That is the rate payable as at the date of the Tribunal's decision. However, as was noted earlier, different dates of effect apply in respect of the different accepted disabilities.
As at 29 April 1998 the accepted disabilities are now taken to have been right knee osteoarthritis and meniscal lesion, psychoactive substance abuse and hypertension. The rate payable as of that date is 40% of the general rate. The impairment rating is 25 when the later claimed conditions are excluded. The lifestyle rating of 3.25 would reduce slightly because of the cancellation of the effect of the peripheral vascular disease. However as the gross lifestyle rating of 3 is already a rounded down figure, the Tribunal considers that a lifestyle rating of 3 as at 29 April 1998 is fair and reasonable.
As at 16 August 1998 the accepted disabilities are as at 29 April 1998 but with the addition of the colon cancer. This raises the rate of payment to 60% of the general rate. The impairment rating is 35 and the lifestyle rating is 3.
As at 14 September 1998, when the peripheral vascular disease becomes an accepted disability, the rate payable is 70% as explained earlier.
Conclusion
The Tribunal has, for the above reasons, decided that the conditions of psychoactive substance abuse, hypertension, malignant neoplasm of the colon and atherosclerotic peripheral vascular disease should be accepted as war-caused conditions.
Further, the Tribunal has decided that the degree of incapacity under GARP is to rise progressively from the current rate of 30% of the general rate so that the appropriate rate becomes:

40% of the general rate as of the first payday on or after 29 April 1998; and

60% of the general rate as of the first payday on or after 16 August 1998; and

70% of the general rate as of the first payday on or after 14 September 1998.

It is possible that the Applicant qualifies for an intermediate or special rate pension. The matter is to be referred back to the Respondent for consideration in that regard.
Conclusion
The Tribunal sets aside the decisions under review.
The Tribunal decides that the accepted disabilities as of 29 April 1998 are osteoarthritis of the right knee, meniscal lesion of the right knee, hypertension, and psychoactive substance abuse or dependence involving alcohol.
The Tribunal decides that the accepted disabilities as of 16 August 1998 are osteoarthritis of the right knee, meniscal lesion of the right knee, hypertension, psychoactive substance abuse or dependence involving alcohol and malignant neoplasm of the colon.
The Tribunal decides that the accepted disabilities as of 14 September 1998 are osteoarthritis of the right knee, meniscal lesion of the right knee, hypertension, psychoactive substance abuse or dependence involving alcohol, malignant neoplasm of the colon and atherosclerotic peripheral vascular disease.
The Tribunal decides that the rate of Disability Pension payable is 40% of the general rate on the first pension payday falling on or after 29 April 1998; 60% of the general rate on the first pension payday falling on or after 16 August 1998 and 70% of the general rate on the first pension payday falling on or after 14 September 1998.
I certify that the 160 preceding paragraphs are a true copy of the reasons for the decision herein of Mr M J Sassella, Senior Member.
Signed:         .....................................................................................
  Associate
Date of Hearing  6 September 2001
Date of Decision  5 April 2001
Counsel for the Applicant  Mr M Vincent
Representative for the Respondent        Mr R Wallis