Treloar and Repatriation Commission

[2011] AATA 868

Administrative Appeals Tribunal

DECISION AND REASONS FOR DECISION [2011] AATA 868

ADMINISTRATIVE APPEALS TRIBUNAL      )

)        No 2010/4752

VETERANS' ENTITLEMENTS DIVISION		)
Re		WILLIAM THEODORE TRELOAR

Applicant

And REPATRIATION COMMISSION

Respondent

DECISION

Tribunal G. D. Friedman, Senior Member

Date7 December 2011

PlaceMelbourne

Decision The Tribunal affirms decision under review.

....................[sgd]......................

Senior Member

VETERANS' AFFAIRS - veterans’ entitlements - hypertension - erectile dysfunction -  whether conditions related to service

Administrative Appeals Tribunal Act 1975 s 34J

Veterans' Entitlements Act 1986 ss 120(4), 120B

REASONS FOR DECISION

7 December 2011 G. D. Friedman, Senior Member

1.        William Treloar served in the Royal Australian Air Force (RAAF) from 10 January 1966 until 18 February 1987.  He is currently receiving disability pension at the rate of 100 per cent of the general rate, and claims that his medical conditions of hypertension and erectile dysfunction are related to his service.  His application was refused by the respondent and the Veterans’ Review Board.

2. Under s 34J of the Administrative Appeals Tribunal Act 1975 and with the consent of the parties the Tribunal decided to review the decision by considering the material lodged by the parties and without holding a hearing.

LEGISLATIVE FRAMEWORK

3.        The period of Mr Treloar’s service in the RAAF from 7 December 1972 to 18 February 1987 constitutes eligible service under the Veterans’ Entitlements Act 1986.

4.Section 120(4) of the Act requires the Tribunal to decide whether the veteran’s conditions were defence-caused to the Tribunal’s reasonable satisfaction. The Tribunal is also required to apply a Statement of Principles (SoP) for each condition (where one exists), as formulated by the Repatriation Medical Authority, which provides a connection to service through factors contained in the SoP. Section 120B of the Act requires the Tribunal to decide matters to its reasonable satisfaction in accordance with the SoPs.

5.        The relevant SoPs concerning hypertension are SoP No. 36 of 2003 as amended by SoP No. 4 of 2004 and SoP No. 12 of 2008.  Factor 5(k) of SoP No. 36 of 2003 provides:

(k) undergoing treatment with a drug for a condition for which the drug cannot be ceased or substituted and which drug has caused an increase in blood pressure, at the time of the clinical onset of hypertension;

The relevant SoP concerning erectile dysfunction is SoP No. 18 of 2005.  Factor 5(c) provides:

(c) the presence of hypertension at the time of the clinical onset of erectile dysfunction;

ISSUES

6.        There was no dispute that Mr Treloar suffers from hypertension and erectile dysfunction.  The issues before the Tribunal are whether these conditions are related to his eligible service.

IS HYPERTENSION RELATED TO MR TRELOAR’S ELIGIBLE SERVICE?

7.        In documents lodged with the Tribunal Mr Treloar explained that he suffers from the following medical conditions which have been accepted by the respondent as service-related: sensorineural hearing loss; injury to the right foot; sprain of the left wrist; and osteoarthrosis of the right knee.

8.        From 1982 to 1985 he was posted to the United States of America in relation to the purchase of equipment for the F/A18 fighter jet aircraft, and he injured his right knee.  He was prescribed anti-inflammatory medication (Indocin).  He commenced taking Celebrex in 2000 and has continued to do so since consulting his current general practitioner (Dr G Greig) from 2006 for relief of pain from his foot, wrist and arthritis conditions.  He said that this medication has contributed to the development of hypertension.  Celebrex is the brand name of celecoxib, which is a non-steroidal anti-inflammatory drug (NSAID) and works by reducing hormones that cause inflammation and pain in the body.  It is used to treat pain or inflammation caused by many conditions such as arthritis.

9.       Mr Treloar referred to MIMS (medical information provided to Australian health professionals) which states in respect of Celebrex (at page 14):

Hypertension.  As with all NSAIDs, celecoxib can lead to the onset of new hypertension or worsening of pre-existing hypertension, either of which may contribute to the increased incidence of CV [cardiovascular] events.  NSAIDs, including celecoxib, should be used with caution in patients with hypertension.  Blood pressure should be monitored closely during the initiation of therapy with celecoxib and throughout the course of therapy.

10.      In a letter dated 2 June 2011 to Mr Treloar’s representative, Dr Greig stated that he has been the treating general practitioner since 2006, and that Mr Treloar has presented with widespread osteoarthritis in the neck, hands and right knee.  Dr Greig confirmed that he continued to prescribe Celebrex to treat the arthritis, but one of its chief side effects of the medication is a tendency to raise blood pressure.  According to Dr Greig this factor, combined with others, has led to Mr Treloar being treated for hypertension which was first noted in 2007 but which has since escalated, and Mr Treloar has been unable to cease taking Celebrex because this would cause stiffness and would affect his quality of life.

11.      In a report dated 17 August 2011 Professor R Harper, consultant & interventionist cardiologist, noted that Mr Treloar has been taking Celebrex since 2000.  He stated that, based on the material provided to him, it is unlikely that Celebrex caused Mr Treloar’s mild hypertension.  He said that in general Celebrex does not cause an elevation of blood pressure in the majority of people who use the medication, and for those who do experience an increase the rise is usually small (less than 5 mm).  He added that hypertension is extremely common in the general community in Mr Treloar’s age group, and in most cases no underlying cause is found.  Professor Harper concluded that Mr Treloar suffers from idiopathic (unknown cause) hypertension, with the date of clinical onset being October 2007 when the blood pressure reading was in the hypertensive range.  He also concluded that if Celebrex were to cause hypertension the condition would occur much sooner than about seven years after commencing to take the medication.

12.      The Tribunal takes into account the general comments in MIMS about the possible consequences of taking celecoxib medication in certain circumstances.  The Tribunal accepts the evidence from Professor Harper, an experienced and eminent cardiologist who is also Emeritus Director of Cardiology at Monash Medical Centre, which was not contested and was supported by the clinical notes from Dr Greig, that clinical onset of hypertension occurred in October 2007, about seven years after Mr Treloar commenced taking Celebrex.  The Tribunal also accepts Professor Harper’s evidence that in general Celebrex does not cause an elevation of blood pressure in the majority of people who take it; and if the medication did cause hypertension then this condition would have become evident sooner than seven years after Mr Treloar began taking Celebrex.  Further the Tribunal accepts Professor Harper’s conclusion that hypertension is common in the general community in Mr Treloar’s age group and that in most cases no underlying cause of hypertension is found.  This appears to be consistent with the evidence from Dr Greig that the increase in Mr Treloar’s blood pressure, which was observed in 2007 after a number of years of taking Celebrex, combined with other factors, led to treatment for hypertension.                   

13.      After considering all the material the Tribunal finds that Celebrex did not cause an increase in Mr Treloar’s blood pressure, so factor 5(k) of SoP No. 36 of 2003 is not made out, and the Tribunal is reasonably satisfied that the material does not raise a connection between Mr Treloar’s hypertension and his eligible service.

IS ERECTILE DYSFUNCTION RELATED TO MR TRELOAR’S ELIGIBLE SERVICE?

14.      In material lodged with the Tribunal Mr Treloar said that he first became aware of symptoms of erectile dysfunction in 1999, about eight years before the clinical onset of hypertension.  In any event, based on the Tribunal’s findings that hypertension is not connected to Mr Treloar’s eligible service, factor 5(c) of SoP No. 18 of 2005 cannot be made out, and the Tribunal is reasonably satisfied that the material does not raise a connection between Mr Treloar’s erectile dysfunction and his eligible service.    

DECISION

15.      The Tribunal affirms the decision under review.

I certify that the fifteen [15] preceding paragraphs are a true copy of the reasons for the decision of:

G.D. Friedman, Senior Member

(sgd) Michael Heffernan

Associate

Date of hearing:  Not applicable: decision on the papers

Date of decision:  7 December 2011

Advocate for the applicant:          Mr B Turner, Returned & Services League of Australia

Advocate for the respondent:       Ms T Chant, Department of Veterans’ Affairs