Treadwell and Repatriation Commission - [2001] AATA 14

DECISION AND REASONS FOR DECISION [2001] AATA 14

ADMINISTRATIVE APPEALS TRIBUNAL )

) No. N1999/764

VETERANS' APPEALS DIVISION          )
           Re      Trevor TREADWELL
  Applicant
           And    REPATRIATION COMMISSION
  Respondent

DECISION

Tribunal Mrs M T Lewis, Senior Member

Date15 January 2001
PlaceSydney

Decision      The Tribunal – 1. Affirms that part of the decision of a delegate of the Repatriation Commission ("the Respondent") dated 10 August 1996 that determined that the claim of Trevor Treadwell ("the Applicant") for hypertension and glaucoma with right retinal haemorrhage was not war-caused; 2. Sets aside that part of the Respondent's decision, as varied by the Veterans' Review Board on 29 March 1999, in respect of generalised anxiety disorder, and 3. Substitutes therefore its decision that the Applicant's condition of generalised anxiety disorder is war-caused pursuant to s9 of the Veterans' Entitlements Act 1986, and that pension is payable to the Applicant in respect of that condition with effect on and from 18 December 1995; and 4. Remits the matter to the Respondent for assessment of the rate of pension payable to the Applicant in respect of all his war-caused disabilities.
  ..............................................
  M T Lewis,
  Senior Member
CATCHWORDS
VETERANS' AFFAIRS – entitlement - whether Applicant suffers from Generalised Anxiety Disorder – whether Generalised Anxiety Disorder is war caused – whether a reasonable hypothesis has been raised – relevant Statement of Principles - whether Applicant meets the Statement of Principles

Veterans' Entitlements Act 1986 s120(1), (3) and s120A
Statement of Principles Instrument No 48 of 1994 as amended by No 275 of 1995

Repatriation Commission v Keeley (2000) 98 FCR 108
Repatriation Commission v Deledio (1998) 83 FCR 82

REASONS FOR DECISION

15 January 2001 Mrs M T Lewis, Senior Member

This is a review of a decision of a delegate of the Repatriation Commission ("the Respondent") dated 10 August 1996 as varied by a decision of the Veterans' Review Board dated 29 March 1999, which refused the claim of Trevor Treadwell ("the Applicant") determining that his conditions of hypertension and glaucoma with right retinal haemorrhage and generalised anxiety disorder were not war-caused pursuant to s9 of the Veterans' Entitlements Act 1986 ("the Act"). That decision also granted pension at 20 percent of the General Rate with effect from 18 December 1995. The Applicant lodged an application for review by this Tribunal on 21 May 1999. All applications for review were in time.
The Tribunal had before it the documents provided by the Respondent pursuant to s37 of the Administrative Appeals Tribunal Act 1975. The Applicant tendered a report from Dr L Lambeth, psychiatrist, dated 3 December 1999 (exhibit A), a statement of Mrs Lizette Theodora Treadwell dated 14 February 2000 (exhibit B), and a Certificate of Service and Discharge from the Royal Australian Air Force (exhibit C). The Respondent tendered a report from Dr Graham Vickery, psychiatrist, dated 30 August 1999 (exhibit 1).

The Applicant advised that he did not seek to pursue that part of his claim in respect of hypertension and glaucoma with right retinal haemorrhage, and therefore the Tribunal will affirm that part of the decision under review in respect of those conditions. The only issue in these proceedings is whether the Applicant's generalised anxiety disorder is war-caused. The Applicant also did not wish to pursue the issue of assessment as part of the decision under review, and therefore that part of the decision under review is affirmed.

The Applicant was born on 6 July 1919. He enlisted in the RAAF on 15 July 1940 and was discharged on 26 October 1945. He served in New Guinea from 16 June 1943 to 16 October 1944, and therefore his service constitutes operational service for the purpose of the Act. The matter therefore falls for determination pursuant to ss120(1) and (3) of the Act, that requires the Tribunal to determine that the Applicant's condition was war-caused unless it is satisfied beyond reasonable doubt that there is no sufficient ground for making that determination. The Tribunal shall be satisfied beyond reasonable doubt that there is no sufficient ground for determining that the condition was war-caused, if after consideration of the whole of the material, it is of the opinion that the material before it does not raise a reasonable hypothesis connecting the condition with the circumstances of the Applicant's service. As the Applicant's claim was lodged after 1 June 1994, s120A requires that the Tribunal consider whether a reasonable hypothesis has been raised by considering whether the Applicant meets any of the factors set out in the relevant Statement of Principles.
The Applicant sought to rely on the Statement of Principles for Generalised Anxiety Disorder, Instrument No. 48 of 1994 amended by No. 275 of 1995. The Tribunal notes that those Statements of Principles were in place at the time of the primary decision. Following the decision of the Full Federal Court in Repatriation Commission v Keeley (2000) 98 FCR 108, the Applicant is able to rely on his accrued right to have the matter determined by the Tribunal using the Statements of Principles in place at the time the primary decision was made.
the applicant's evidence
When the applicant was in the RAAF he reached the rank of Sergeant and had six men under his command. When he was the NCO he was in charge of the instrument section at 79th Squadron. His duties included keeping all the instruments, navigational engine instruments and oxygen breathing equipment in order.
In respect of the Applicant's New Guinea service, he said that the Americans had gone in before he landed at Manus Island. His Squadron went to the airfield upon landing on the beach. He said:
We landed by the Liberty ship and there was only a strip … about 150 yards and the American artillery, they were firing over the top. The Japs (sic) were over the other side. … our escorting naval ship, it was bombarding the Japanese positions when we came in too, and there was a Japanese naval gun was firing at us, …

He said that upon landing they were shot at by Japanese snipers. He said that by the time they landed at Manus Island "the Japanese had shelled all the Japanese enclosures there". He described dead bodies of the enemy lying around the 100 acre coconut plantation and there was "hardly a coconut palm that wasn't chopped off or damaged in some way". He said they had to get bulldozers and "dig a trench and just push the bodies in". He said he had never "smelt anything like it before. Like its something you seem to keep in your memory all the time and we had to live and eat there". He said that initially they slept on the beach with all their equipment. There was 200 yards between the beach and the airstrip and the Japanese were on the other side. He said "the American guns were shelling over the top of us while we were on the ground". This occurred in early 1944. This is consistent with a written statement he provided at the time of his claim, and dated 6 May 1996 (T8).

The Applicant described his journey on the Liberty ship to Manus Island. He said there was no accommodation on the ship and they had to sleep in the holds or on the steel deck. They were given two meals a day while on board. There was a submarine "scare" during the journey. The ship was carrying a cargo of bombs.
The Applicant said that prior to his enlistment he did not drink alcohol regularly or smoke. He described the squadron as "a big family" where "we could talk among ourselves". There were plenty of cigarettes that he said were "the only thing we had to comfort us". He said he first began smoking in Laverton, but he did not become a "smoker" until he was given "free rations of cigarettes and tobacco from the airforce". He said that at Manus Island the Americans freely distributed cartons of cigarettes. He said that he smoked at least 30 cigarettes a day whilst on Manus Island and had "a few beers" at night. The Applicant said that in late 1943 or early 1944 they were given a "bottle of beer a week to the troops, and the sergeants and officers had greater access, but we could get alcohol from the Americans, as much as we liked, more or less". He said he drank four or five stubbies of American beer a day. While at Kiriwana they made jungle juice.
The Applicant said "there was a lot of stressful times" while he was at Manus Island. He described when his commanding officer, the "father figure" of the squadron, was killed in 1944 when a spitfire was taking off. The Applicant said it "was pretty hard to take". He said "we had to salvage what we could of the aircraft… and it's not very nice when you have to work under those conditions". He said that any time there was a crash they had to salvage what they could from the aircraft and repair it for further use because supplies were short.
In his statement he described a "devastating" incident that occurred a few months after landing at Manus Island. A Liberator crashed on take off into an American camp with a full load of bombs on board, killing scores of Americans and injuring some Australians. The Applicant said he was approximately 100 yards away when he witnessed the crash. He did not attend the crash scene as they had to keep the other aircraft going.
The Applicant described one other upsetting incident that occurred whilst he was at Kiriwana. He recalled a fighter pilot who had shot down the first enemy aircraft for the squadron whom they had celebrated as a hero, only to have him killed the next day when taking off in a spitfire. He also recalled that during an electrical storm at Kiriwana one of the men was killed by lightning.
The Applicant returned to Australia from Manus Island in October 1944 and was then posted to the air force base at Werribee. He said he missed his comrades, having spent 18 months with them on active service. He said he could not settle and was apprehensive about the future. He felt a "generalised anxiety". In order to cope with his feelings he started drinking heavily in the evenings. The Applicant considered that his nervous condition developed from the time he returned from overseas service.
The Applicant described the difficulty he now has sleeping. He said he became very restless after about three hours' sleep, and he wakes in a sweat. He said he then mulled over past incidents, sometimes wartime incidents. He also said he was irritable and morose and sometimes suffered from headaches. He also suffers from dermatitis and when he wakes in a sweat he needs to shower and apply cortisone cream to stop the irritation.
The Applicant was an apprentice boilermaker and was on leave from the Victorian Railways when he joined the Airforce. On discharge he finished 12 months of his apprenticeship with the railways and then went to Trans Australian Airlines as a ground engineer.
The Applicant then worked for a period of time as a farmer. He said he experienced anxiety attacks prior to becoming an orchardist. He said being an orchardist was very hard, but it was also rewarding. He left the orchard in 1974 and then went with his wife to Yeppoon in Queensland. He said "both my wife and I were getting older and we couldn't get labour and we were working seven days a week …" . At Yeppoon he worked as a maintenance engineer at a ceramics factory for 6 or 7 years. He left work because "it was more or less time for retirement".
The Applicant's wife had two hip replacements and laminectomies on the lumbar and sacral spine, as well as an accident about three years ago. The Applicant noted that she was in good health when they retired. The main reason the Applicant left Yeppoon was because his wife needed a hip replacement, their house was built on three levels, and the doctor advised that she should live on flat ground so as not to aggravate her hip. He said the humidity at Yeppoon also affected his dermatitis.
The Applicant and his wife moved to Forster in 1986 because it is flat and to be close to his family. However, his family has since moved away. He said that they have some social contacts in Forster - two other retired couples who moved to Forster at around the same time. However, two of those friends have since been diagnosed with cancer.
The Applicant said they played indoor bowls but stopped doing this because of his wife's condition. He said that he and his wife go out for dinner once a week, but apart from this he has done the cooking for the last three years. He also does all their housework, washing and cleaning. He commented that being his wife's carer is "very hard" and it is difficult to get help.
In cross-examination he said since 1986 he has noticed an increase in anxiety. He said "I'll sleep for about two hours, maybe and then I just wake up, get into a sweat and sometimes I only get three or four hours' sleep a night, very fitful sleeper". These problems did not occur to the same extent when he was on the farm. He said "the anxiety and stress has been with me right through" but he considered he was a successful farmer and although they had a few problems on the farm there was nothing they could not overcome.
When experiencing an anxiety attack the Applicant experiences headache, sweating, and he feels "a bit shaky". These attacks mainly occur at night –
If I can't get to sleep I might hear a sound when you're in bed and just start thinking and then it keeps mulling over and over and I think of the most stupid things that have happened in the past – in the islands … it's just some stupid thing that seems to manifest up … – sometimes I think about the fruit block – like I did this and I should have done that and it's general anxiety of not knowing if I'd done the right thing at the time or how I could have improved it in another way.

He said that his attacks affected his family life and his children. He said his problems of not being able to sleep and mulling things over happened shortly after he came back from the islands. He said that fairly regularly in his sleep he can "still smell those horrible smells" – he said the last time this happened was the night before he gave his evidence to the Tribunal. However, since his retirement it has become more regular "I think sort of dwelling a bit more in the past in a lot of ways".

The Applicant said he found Dr Lambeth to be a "very understanding man" and easy to talk to. He recalled that in his interview with Dr Vickery the only question he was asked was "do people laugh at you behind your back". He said that he could not answer this question. He said that Dr Vickery appeared to be writing all the time and not asking him specific questions, and he did not feel comfortable. The Applicant also had a consultation arranged by the Respondent in 1996 with Dr Akkerman, psychiatrist, when he arrived in Forster. He said that the Dr Ackerman recorded that he was late for the appointment, whereas he was actually 20 minutes early. He said Dr Akkerman appeared to consider mainly that the Applicant was 'non-combatant".
Evidence of Lizette Theodora Treadwell
Mrs Treadwell was born on 25 August 1918. She and the Applicant married in 1940. When the Applicant returned from Manus Island and was stationed at Werribee she lived nearby - at Altona. The Applicant used to stay with her two or three times a week.
Mrs Treadwell said that her husband has had difficulties sleeping, particularly so when he returned from the Islands, but he did not have this problem when she married him in 1940. She observed that the Applicant was always tired. She recalled an occasion when he first came back from the war when she dropped something in the kitchen that made a noise and he crawled under the table to try to get away from the noise.
Mrs Treadwell said that lately the Applicant has experienced sweats every night, but sometimes he goes a couple of nights without sweating. She said "I'm forever … washing sheets, even goes right through the blankets …". She noted that the Applicant also has sweats at other times of the day. She said that he did not experience sweats in 1940 when she married him.
She commented –
He's got some ideas that he's still in the Islands. Sometimes … he gets a bit orderly about it and other times he just thinks that I'm at fault which I haven't been. We've been very much in love with each other …
Mrs Treadwell agreed that the Applicant often experiences headaches, for which he takes medication. She said he first began to experience headaches when he returned from the war, and he has them nearly every night now. She believed they were caused by his war experiences.
Mrs Treadwell recalled that the Applicant drank with his mates for a few years after the war, but she could not recall how often. She noted that he would only get upset with the children when he drank. She said he did not do this as often on the farm, commenting that -
… it sort of gave him a little bit of different things to think about. I was thinking of leaving him at the time when it was at his worse but I love him too much to do that.

medical evidence

Dr Lambeth, psychiatrist, provided two reports dated 19 September 1997 (T13) and 3 December 1999 (exhibit A). Dr Lambeth noted that he was able to establish rapport with the Applicant. He said that the Applicant told him that his symptoms have been present "since the war and worse over the past ten years". He said that most of the Applicant's symptoms have been present over the entire period, namely difficulties with sleep and irritability. He said he could only "conjecture" about the increase in severity of the Applicant's symptoms over the past ten years, but noted that Mrs Treadwell's illness has probably contributed. He recorded a history that the Applicant came under a great deal of fire during his service. He was involved in the landings on Manus Island and had colleagues who were killed or wounded. He noted an incident in the landing at Manus Island where there were dead Japanese soldiers and an horrific smell. Dr Lambeth said that the Applicant reacted to that incident with a "degree of horror" when giving the history. Dr Lambeth noted that the smell remains with the Applicant all the time.
Dr Lambeth opined that the Applicant developed symptoms of generalised anxiety disorder during his war service. He based his opinion on the history he obtained from the Applicant and the written statement made by Mrs Treadwell (exhibit B) to the extent that it supported the Applicant. Using the criteria in DSM-IV Dr Lambeth diagnosed generalised anxiety disorder. He described the Applicant's current condition as "mildly anxious with sufficient symptoms to meet the criteria for generalised anxiety disorder, and he believed the condition was able to be treated. He noted that there was no history of a psychiatric condition prior to the Applicant's service. When he examined the Applicant in 1997 the presenting symptoms on which he based his diagnosis were insomnia, anxious mood, sweats, tension headaches, irritability, and tinnitus which could be exacerbated by anxiety. He also administered the Hamilton Anxiety Rating Scale, a well validated scale used in psychiatry, that rates symptoms of anxiety from all systems associated with anxiety. Using this scale Dr Lambeth confirmed that the Applicant suffered from anxiety albeit to a mild degree. In his first report (T13) he noted that the Applicant scored 24 out of 56 on that scale. A score between 20 and 28 is considered a mild degree of anxiety.
Dr Lambeth disagreed with the opinion of Dr Vickery who did not consider that the Applicant suffered generalised anxiety disorder but that he has "decompensating obsessional personality traits". Dr Lambeth maintained that the Applicant fulfilled the DSM-IV criteria for generalised anxiety disorder to a mild degree. He also noted that "many successful people have obsessional personality traits" and disagreed that the Applicant has decompensating personality traits. He questioned whether Dr Vickery meant that the Applicant simply wanted to do everything right or that he was obsessional to the point where he could not function. He agreed that the Applicant's awareness of having increased tension and feeling keyed up due to his intolerance, was consistent with an obsessional personality, but equally it could refer to someone with an anxiety disorder or PTSD. He agreed that the Applicant does not suffer from PTSD and that the symptoms described by Dr Vickery are not related to generalised anxiety disorder alone.

Dr Lambeth did not agree with the conclusion reached by Dr Akkerman. He said that on the basis of the symptoms recorded by Dr Akkerman, according to DSM-IV one could make a diagnosis of generalised anxiety disorder. He considered it was conceivable that the Applicant could have a generalised anxiety disorder and obsessional personality traits. He also said that it was conceivable that the Applicant could have presented at his interview with Dr Vickery without demonstrating a generalised anxiety disorder unless specific questions were asked of him.
Dr Lambeth acknowledged that the Applicant's existing generalised anxiety disorder could be the result of another more recent stressor, but in light of Mrs Treadwell's statement and the Applicant's statement that the symptoms date back to the war, he believed this was less likely.
Dr Lambeth considered that the Applicant's present condition was the same pathological state that had been in existence since his war service, but that there had been an increase in symptoms.
Dr Lambeth commented that the Applicant's irritability, which is part of his anxiety disorder, causes difficulties in his interpersonal relationships. The Applicant is known to be a "cranky" person and this causes "a certain distance between people in interpersonal relationships". Dr Lambeth understood from information from the Applicant that there were difficulties in relationships, but he did not obtain any direct evidence of this. Dr Lambeth said there were no other symptoms to satisfy factor 4(a)(v) of the Statement of Principles, unless sleep was included. He said that the Applicant described middle insomnia to him and initial insomnia to Dr Ackerman. Middle insomnia includes waking several times as well as difficulty getting back to sleep. He also recognised the relationship between sleep and aging and the difficulty in deciding whether the Applicant's sleep disorder was caused by ageing, depression or anxiety, as it is present in all three.
Dr Lambeth said he asked questions of the Applicant about physical illness but did not carry out any tests to determine whether the sweats had a physical origin. He noted that the Applicant had high blood pressure and dermatitis. Dr Lambeth said it was equally possible that the Applicant's tinnitus was associated with either his deafness or an anxiety condition.
Dr Vickery, psychiatrist, provided a report dated 30 August 1999 (exhibit 1). Dr Vickery considered the Applicant to have been relaxed, comfortable, spontaneous, responsive and able to give a clear concise history during the consultation. He considered there was no evidence that the Applicant was in an anxious state. In his oral evidence he said he noted that there was -
a long history of perfectionist behaviour, of needing to maintain control over situations in which he was, of criticism of even minor faults or failings, of difficulties in relationships, largely because of … his personality traits of having to have everything done according to the way he liked it. In spite of this in his earlier years he has actually done quite well. He held down a job, … had a citrus farm for some 30 years, ...was married … for some 50 or more years, raised five children all of whom are well. He's actually ... been very successful overall, and in the last probably five or more years, maybe five to ten, I think most of these symptoms have become more noticeable. In that time I think his wife has developed a disability which he has found difficult to cope with. It's certainly stressed him recently. That was the reason ... they moved up north to this area so they could be on a flat house … He … noticed himself that he doesn't get along well with people, he doesn't really mix that well with people, and a large part of this is his criticism, and getting keyed up when he sees people not doing the right thing … and he's become more argumentative with family and other people that he meets and more withdrawn. So, on that diagnosis, I really pinpointed largely personality traits that gave rise to symptoms of irritability, raised tension, certainly some anxiety, and difficulty in relating to others, and a general reduced quality of lifestyle. That, to me, would fit into the classification of an obsessive personality who almost invariably de-compensate between the ages of 50 and 60 because just with age their condition tends to deteriorate, they tend to become more critical, and people generally don't tolerate them well.
From that history Dr Vickery did not see any relationship between the symptoms experienced by the Applicant and his war service. Dr Vickery opined that the Applicant's experience of landing at Manus Island did not "qualify him for PTSD" and he understood there were no symptoms, nightmares or flash backs.
Dr Vickery said that a diagnosis of generalised anxiety disorder is difficult to make and involves tracing the history back to adolescence. He said that it is primarily associated with panic disorder, which the Applicant did not display. He noted that the Applicant did not give a history of being anxious for no reason and he was able to point to problems that gave rise to anxiety. He noted that obsessional people are usually anxious because they are in continual conflict with others. In Dr Vickery's opinion the Applicant did not satisfy the criteria set out in the DSM-IV for generalised anxiety disorder. He noted that with generalised anxiety disorder the "anxiety is not related to particular situations. It is not a reactive anxiety to triggers".
Dr Vickery stated that a mild generalised anxiety disorder as diagnosed by Dr Lambeth would be a particularly difficult diagnosis to make, because mild anxiety symptoms are present also in many other diagnostic categories. He commented that an anxiety rating scale such as the Hamilton Anxiety Rating Scale depends on the objectivity of the person conducting the interview. He considered it to be a subjective test, useful in identifying anxiety symptoms, but it does not clarify whether those symptoms are related to obsessive disorder, paranoid disorder, depressive disorder or a generalised anxiety state. He had observed lots of variance in scores obtained by different doctors administering the scale and even between his own applications of the scale. He said he no longer uses it.

Dr Vickery said he did not obtain any history in relation to impairment of occupational or social functioning. The Applicant successfully carried out his occupation, he appeared to be a good father to his children, and his marital relationship appeared stable. He considered that the symptoms recorded by Dr Akkerman indicated a diagnosis of obsessional personality disorder; in particular, doing things more slowly to ensure correctness, feeling easily annoyed or irritated, critical of others, worried about sloppiness or carelessness, temper outbursts that he cannot control, worrying too much about things, being easily hurt, and feeling that he is being watched or talked about. Dr Vickery opined that these symptoms are more related to obsessional complaints, paranoia and insecurity. He considered that the Applicant's tension was probably brought out in the family situation.
Dr Vickery agreed that the Applicant could be irritable and this happens when "people don't measure up to his standard, or when he feels that they are not doing the right thing, or when they don't agree with him". He did not ask whether the Applicant suffered from irritability during his overseas service, or indeed how long he experienced this symptom. However, he opined it was "possibly all his life".
Dr Vickery noted that the Applicant felt fearful on landing at Manus Island, but did not record any problems following that incident. He agreed that this would have been a stressful event. He did not obtain a smoking or drinking history from the Applicant. He did not elicit information about any other service experiences that the Applicant may have found stressful. He agreed that the s37 documents were available to him before interviewing the Applicant. Despite this he did not ask the Applicant about the Liberator crash. Dr Vickery failed to elicit information concerning the commencement of the Applicant's sleep disorder, particularly whether it was present before or after his service. He said that he asked the Applicant what caused him to wake at night and "he said he didn't know". He understood that the Applicant did have nightmares. Whilst he was aware that the Applicant had difficulty sleeping, he was not aware that this problem occurred most nights. However, he noted that over 50 percent of people who claim they have nightly insomnia do not demonstrate such a pattern. Likewise, he did not clarify with the Applicant when he first began to have sweats, or how frequently he now experiences them.
Dr Vickery considered that the cause of the Applicant's sleep disorder and cold sweats could be attributable either to a physical condition or to anxiety. He said "obsessional people are very anxious people. They usually have a sleep disorder. Sleep disorder is very common in personality disorder". Dr Vickery was unable to comment on what aspect of the Applicant's physical condition could cause his sleep disorder. He did not take a general medical history from the Applicant about his current medical condition or any medications he might be taking.
Dr Vickery concluded that the Applicant does not have generalised anxiety disorder because –
You have to look … where the anxiety comes from and I believe it comes very clearly and definitely from his personality traits and the way he relates to the world and he himself is aware of that too. He's aware that he has a personality that is perfectionist. He's aware that he is critical of other people. He's aware that other people see him as being critical as well. He's aware that this has caused a lot of problems for him … There was no doubt in his mind and certainly I didn't find any doubt in taking his history that his personality traits were extremely obsessional and that that would cause him a lot of conflict, hence anxiety. There was no indication of him when he was sitting there and we were talking, that he was anxious. Now, if he had generalised anxiety disorder I would have thought that would have been quite evident.
Dr Vickery said one might look for physical symptoms of generalised anxiety disorder in a clinical setting such as pulse rate, sweating and blood pressure. However he did not undertake any of these tests because he believed "it would be invasive because he wasn't anxious".
Dr Vickery said the difference between generalised anxiety disorder and decompensating obsessional personality traits was that the former was generalised and not limited to specific situations. He said "it's there fairly consistently although again, ebbs and flows according to stresses that the person might encounter throughout his … day to day life". He diagnosed obsessional personality disorder because of the clear history the Applicant gave that he was aware of what led him into conflict with people and in situations where he experienced anxiety. However, Dr Vickery said that although he did not make this diagnosis against the criteria in the DSM-IV, he believed the Applicant 'would come close'. It was Dr Vickery's opinion that these traits were genetically determined.
Dr Vickery opined that when one is under stress of the magnitude experienced by the Applicant upon his landing at Manus Island, one would be affected by obsessional personality traits if they existed. Furthermore Dr Vickery said –
Situational stresses like this such as trauma, whether they be war-related or in other cases of trauma, can influence personality traits in a – for the rest of their life ... if they were to happen at a vulnerable age such as … 20 or even younger.
Dr Vickery said he was unable to establish rapport with the Applicant when he interviewed him for an hour, and believed that it would be difficult to do so in such a limited period of time. The Tribunal established that the one hour time limit was imposed by Dr Vickery - not by the Respondent.
Dr Vickery agreed that he made no attempt to assess the Applicant's functioning during his adolescence to establish whether he had an obsessional personality disorder or merely obsessional personality traits. He also agreed that the Applicant's headaches could have been associated with a psychological condition but as he did not take a full physical history he was not able to exclude a physical cause. Furthermore, given the problems the Applicant was facing with his wife's disability and his own problems, it was "not unlikely" that his headaches were tension related.
Dr Vickery opined that the symptoms described by Mrs Treadwell are largely "post-traumatic type symptoms" experienced by many World War II veterans, particularly those who have been to New Guinea and have contracted malaria or dengue fever. However Dr Vickery believed that if the Applicant's sweats had continued for over ten years it is unlikely they are associated with either aforementioned diseases. He noted that there is some recent literature on PTSD that shows that World War II veterans can develop PTSD symptoms at an elderly age. Dr Vickery opined that the Applicant's drinking habit on return from service would fit with a diagnosis of PTSD, of which he still has residual symptoms. He believed that it was probable that the Applicant would fit the criteria for PTSD. However Dr Vickery indicated later that he did not consider it necessary to re-interview the Applicant and that he was unlikely to change his present diagnosis.
Dr Vickery agreed that the Applicant's experiences at Manus Island could have caused or contributed to the symptoms he now describes, particularly his sleep disorder. He opined that if the Applicant did have PTSD, it is likely that his deteriorating ability to cope with life generally over the last decade or so would have contributed to its clinical onset.
submissions
The Applicant's advocate noted that the Statement of Principles derives the definition of generalised anxiety disorder from the DSM-IV. It was submitted for the Applicant that on the balance of probabilities the correct diagnosis of the Applicant's claimed condition is generalised anxiety disorder. It was conceded for the Respondent that the Applicant did experience stressors, particularly on Manus Island and the crash of the Liberator aircraft. It was submitted for the Respondent that if the Applicant did have generalised anxiety disorder, it had resolved by 1952, and that, on the basis of the current symptoms, if Dr Lambeth's diagnosis is to be relied on, the condition commenced in 1996.
It was submitted for the Applicant that the correctness of the diagnosis of the doctors depended, in part, on their ability to establish rapport with the Applicant to enable him to divulge personal particulars. The Applicant was able to establish rapport with Dr Lambeth but not with Dr Vickery. Dr Vickery did not rely on a method of direct questioning, and this posed a problem for the Applicant. Therefore Dr Lambeth was in a better position than Dr Vickery to assess the Applicant's symptoms.
It was submitted for the Applicant that the evidence raised a reasonable hypothesis that his condition is connected with his service. The Applicant experienced two stressful events in 1944 whilst on Manus Island during his operational service and two stressful events at Kiriwina in 1943. The Full Federal Court in Repatriation Commission v Deledio (1998) 83 FCR 82 sets the test the Tribunal must apply in determining whether the hypothesis is reasonable. It is reasonable if it fits the template found in the Statement of Principles.
It was submitted that the evidence fits the template insofar as the Applicant meets factor 1(b), as he experienced a stressful event on service not more than two years before the clinical onset of generalised anxiety disorder. The Applicant's wife observed that he did not have the symptoms of generalised anxiety disorder prior to service overseas or when she married him in 1940. However, on return from Manus Island in October 1944 he was easily startled, extremely nervous and on edge, he had problems sleeping and he experienced night sweats. He physically trembled, had nightmares related to his service, tired easily, was irritable and short tempered and he abused alcohol.
It was submitted that the Applicant has continued to demonstrate symptoms of generalised anxiety disorder to the present time and that he meets the criteria for generalised anxiety disorder in the Statement of Principles. Assessment of the rate of pension payable to the Applicant should be remitted to the Respondent.
The Respondent referred to paragraph 4(a)(v) of Instrument No. 48 of 1994, which requires –
Either the anxiety or worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning;

and submitted that from the evidence such impairment occurred initially after the stressors were experienced. However, from approximately 1952 to 1986 there was no maladaptive pattern. The Applicant was an exceptionally successful farmer. He had a happy marriage for a period of 60 years. Although Mrs Treadwell did indicate that at one stage she contemplated leaving her husband, it remains from the Applicant's point of view that he was satisfied that there were no difficulties in the marriage.

It was submitted for the Respondent that if the Applicant did have a generalised anxiety disorder, it had resolved by 1952. It was submitted that, if Dr Lambeth's diagnosis of generalised anxiety disorder is relied upon, the current symptoms experienced by the Applicant started in 1996. The Respondent submitted that it is inconsistent that the Applicant could have had a mild generalised anxiety disorder, which represents 10 years of worsening from 1986, yet it is now only a mild disorder. It was submitted that there is no clear evidence before the Tribunal about any condition suffered by the Applicant between 1952 and 1996, and Dr Lambeth had no knowledge of this period. It was submitted that the symptoms described by the Applicant could be fairly ascribed to other disorders - Dr Vickery suggested that some of the symptoms were similar to PTSD. Both Dr Vickery and Dr Akkerman agreed that the Applicant did not have a generalised anxiety disorder.
It is submitted for the Respondent that the Hamilton Anxiety Scale is more of a guide to symptoms rather than a method of diagnosis. Dr Vickery did not consider that the Applicant met the criteria outlined in the DSM-IV.
None of the doctors took a medical history from the Applicant in relation to the period between the late 1940's and the mid 1980's. That information is also absent from the evidence. The Respondent submitted that if the Tribunal finds a diagnosis of generalised anxiety disorder, then it began in 1986, some 42 years after the Applicant experienced the stressors.
consideration of evidence and finding of fact
The Tribunal has considerable difficulty with the evidence before it, but accepts that it is the best evidence available. The Tribunal finds that the evidence of the Applicant was limited by his tendency not to keep to the point and in the process not answering questions put to him. The effect of this was that it was extremely difficult to obtain specific information from him, especially in respect of his symptoms during the lengthy period he spent on the citrus farm. The evidence of Mrs Treadwell did not assist the Tribunal further. The Tribunal was prepared to accept the evidence of the Applicant without corroboration, as the Tribunal found him to be a credible witness. The Tribunal found that Mrs Treadwell was overly prone to be agreeable, and her evidence was also extremely generalised and not specific in relation to the period they spent on the citrus farm. The Respondent did concede that the Applicant had significant stressors during his operational service. The Tribunal agrees that that concession was properly made.

The medical evidence from the three psychiatrists also had its limitations. Unfortunately Dr Vickey did not, in the Tribunal's view, take an adequate history. His oral evidence demonstrated the limitations of his knowledge about the Applicant. His evidence does not cause the Tribunal to be reasonably satisfied about the diagnosis he provided in his medical report, nor of the alternative suggestions he made in his oral evidence. It is noteworthy that although in his oral evidence, when presented with the evidence before the Tribunal, he raised the real possibility that the Applicant might be suffering from post-traumatic stress disorder, when given the opportunity to undertake a further examination and review, he advised that this was unlikely to change his opinion. The Tribunal can give little weight to his evidence, and notes that the Respondent made no submissions in respect of his evidence.
The evidence of Dr Akkerman was not tested by cross-examination. The Tribunal notes that Dr Akkerman outlined the criteria in the DSM-IV for generalised anxiety disorder and he reproduced the Applicant's responses to a questionnaire completed at the end of the consultation that Dr Lambeth considered were symptoms of generalised anxiety disorder. However, Dr Akkerman concluded that the Applicant did not reach the DSM-IV criteria for the condition. He did not indicate how he arrived at that opinion, and therefore, in the light of Dr Lambeth's evidence in rebuttal, the Tribunal is unable to give much weight to Dr Akkerman's evidence.
On the evidence of the Applicant and taking into account the opinion of Dr Lambeth, the Tribunal is reasonably satisfied that the Applicant suffered from generalised anxiety disorder when he returned to Australia following his operational service, and the condition arose out of his operational service. The Respondent does not appear to have much difficulty with that, but submitted that the condition had resolved after the Applicant took up farming on his citrus property. The Respondent also does not appear to have much difficulty with the opinion of Dr Lambeth that the Applicant now suffers from generalised anxiety disorder, particularly after Dr Vickery's evidence was shown to be weak. The Tribunal finds, on the evidence of Dr Lambeth, that the Applicant suffers from generalised anxiety disorder. The Tribunal is reasonably satisfied that this is the diagnosis of the claimed condition.
The Respondent, in effect, appeared to be of the view that the Applicant's post-war generalised anxiety disorder had resolved after he commenced citrus farming and that the present generalised anxiety disorder did not manifest itself until some time between 1986 and 1996, having arisen as a result of the Applicant's wife's illness, his increasing age and retirement, and his underlying obsessional personality. While this hypothesis is attractive and has much to commend it, to come to such a conclusion on the evidence is to abandon the reasoning that the Tribunal must follow in considering whether a reasonable hypothesis has been raised and whether it has been dispelled beyond reasonable doubt.
Once the Tribunal is reasonably satisfied that the diagnosis of the claimed condition is generalised anxiety disorder, it is then necessary to apply the four stage test outlined by the Full Federal Court in Deledio (supra). The hypothesis raised by the evidence is that the Applicant experienced significant stressors on service, he developed a generalised anxiety disorder within two years of those stressors being experienced, and that he continues to suffer from that condition. The difference between this hypothesis and the Respondent's case is that the hypothesis relies on the evidence that the Applicant continued to suffer from the generalised anxiety disorder throughout his life notwithstanding that it improved significantly after he commenced work on his citrus farm. Dr Lambeth noted in his report of 3 December 1999 (exhibit A) that the Applicant "described his symptoms as being present on and off since the war years". On one interpretation of the Applicant's evidence to the Tribunal that is consistent with the history recorded by Dr Lambeth. In his oral evidence Dr Lambeth noted the Applicant's symptoms of sleep disturbance and irritability that had been present since the war and "were worse over the past ten years". When questioned by the Tribunal specifically on this issue, Dr Lambeth said that he considered the Applicant suffered from the same pathological state since he returned from the war, but that more recently he perceived it to have increased in severity, and this could be because of the additional stresses he now has in his life. However, it is the same pathological state.
Dr Lambeth agreed that the Applicant could have both generalised anxiety disorder and obsessional personality traits. Dr Vickeryhad raised the issue of the Applicant's obsessional personality traits. He said in his oral evidence that situational stresses such as the Applicant experienced during his operational service, can influence personality traits for the rest of one's life, particularly if one is at the vulnerable age of about 20 years at the time of experiencing the stressors.
The Tribunal considers that the evidence fits factor 1(b) of the Statement of Principles. The Tribunal notes the Respondent's submission in respect of paragraph 4(a)(v) of the Statement of Principles. The Tribunal considers that this part of the definition of "generalised anxiety disorder" is met. His anxiety caused impairment in important areas of his functioning arising from his sleep disturbance and irritability, notwithstanding that he functioned as a successful citrus farmer and that he had a long and happy marriage. Moreover, the Tribunal considers that the hypothesis raised meets the definition of "generalised anxiety disorder" in the Statement of Principles. The raised facts therefore fit the template of the Statement of Principles, and hence a reasonable hypothesis has been raised pursuant to s120(3) of the Act.
Moving now to s120(1), the Respondent's case is that there was a gap from approximately 1952 to 1986 when the Applicant did not suffer from generalised anxiety disorder. While this is a period of particular vulnerability in the Applicant's case, the evidence does not enable the Tribunal to be satisfied beyond reasonable doubt that the condition had resolved by 1952. The Tribunal is also not satisfied beyond reasonable doubt that the condition from which the Applicant now suffers is not the same condition as that from which he suffered post-war and until about 1952. This condition, however obviously has been affected to a material degree by his concern about his wife, the stress of caring for her, his increasing age and his retirement. Indeed, Dr Lambeth's evidence is that it is the same condition, and neither Dr Akkerman nor Dr Vickery has caused Dr Lambeth's evidence to be dispelled beyond reasonable doubt. All that their evidence has done is to raise conflicting medical opinions. The Tribunal notes the evidence of Dr Lambeth that the Applicant now suffers from mild generalised anxiety state. It was of concern to the Respondent that the condition is said to be mild, yet it is the Applicant's evidence that his condition has worsened over the last ten years or more. The Tribunal considers that within the classification of having a mild form of the condition, it is still possible that the condition has deteriorated but nevertheless still remained mild.
The Tribunal is not satisfied beyond reasonable doubt that the Applicant's generalised anxiety disorder is not war-caused. Therefore the decision of the Respondent is set aside, and in substitution the Tribunal determines that the Applicant's generalised anxiety disorder is war caused. The effective date from which pension is to be paid in respect of this condition is 18 December 1985, being a date not earlier than three months before the Applicant lodged his claim.
Noting the Applicant's submission in respect of assessment, the matter will be remitted to the Respondent for assessment of pension payable to the Applicant for all his war-caused disabilities.
I certify that the 72 preceding paragraphs are a true copy of the reasons for the decision herein of Mrs M T Lewis, Senior Member
Signed:         .....................................................................................
  Associate
Date/s of Hearing  15 February 2000
Date of Decision  15 January 2001
Representative for the Applicant   Ms Buchanan, Legal Aid Commission
Solicitor for the Respondent         Mr Richard Wallis, Department of Veterans' Affairs