During his examination in chief by counsel for Mr Noble, Dr Pain said:
Q Now, that brings us on to your second report of 20 October 1995. You say there that you believe that it is likely that the beta blocking agent, Visken, played a major role in the development of bronchial asthma?
A Correct.
Q You - is that an opinion fairly held by you?
A Yes, it is an opinion fairly held by most thoracic physicians that beta blockers are contrary indicated in patients that have established asthma and there's a fair incidence of them actually inducing asthma. In fact, the specific prescriber information says they are contrary indicated in those two groups of people, people with a pre-disposition and those with active asthma. I spend a lot of my time taking people off beta blockers.
Q Given the history that you have taken in this particular case, Dr Pain, and given the diagnosis that you have made, is it your opinion that more likely than not the asthma was caused by the beta blockers?
A I think the beta blocker was a major factor. There may have been other factors as well.
Q Yes?
A I noted that the occupation he was at - working at the time would expose him to some factors which could be asthmagenic, but I certainly think beta blockers - a beta blocking agent is most likely to have been a major factor.
THE D. PRESIDENT:So you - as an agent you discount the exposure during wartime because of the time interval, basically?
A If it played a part it would be a very minor part, I think. Mainly because of the - for that long time interval."
Dr Pain went on to give the following evidence:
"MR DE MARCHI: On that particular point, doctor, can you rule out beyond any reasonable doubt that it did not play any part?
A There is a lot about asthma we do not know and I think it probably is a multi-factorial condition. I can't rule it out entirely and give you a guarantee that those circumstances played no part whatever. In my experience it would be very unusual to be able to attribute factors like that to the onset of asthma 25 years later.
Q If we, perhaps to complete the picture and give you the full history, if we add to that period of approximately 18 months on the HMAS Shropshire during trials and action, an earlier period of gas training, where the veteran would have been exposed to unknown agents but during evacuation drill, mock-ups of ships would be filled with water and various gases would be released and although they had gas masks, they would be asked to take them off and get a feeling of what the gases smelt like, were those factors - could they possibly be a causative agent?
A The factors you've described would certainly be adverse for someone with established asthma. If they were factors that were important in the onset of asthma, I would expect the symptoms to have developed very close to the exposure.
THE D. PRESIDENT: This is for a two-week period, I might add, that he is exposed to these. Only back in 19 - when he is what, 19 years of age, I think?
A I really think its a very remote incident.
MR DE MARCHI: If we accept the veteran's evidence that once a week, once a fortnight, when he got out of the navy, immediately after he got out, he would have difficulty in breathing. Could that be - there is an indication that he is - he was prone at that stage to hay fever and certainly when he moved to Daylesford between October and January he would have trouble with hay fever, but given the difficulty in breathing but he also - perhaps I had better also tell you, Doctor, that he felt difficulty in breathing on ship, when the ship was closed down and it was in action station. And that occurred once a fortnight or so - I beg your pardon, I think I'm getting mixed up here.
THE D. PRESIDENT:Yes. I think - his evidence was that during the period he was on Shropshire that when the ship was closed down for various periods, that he - weekly or fortnightly, he might have experienced some difficulty in breathing. And that is when all the ventilation systems excepting the engine room, as I understood, were closed down?
A I tried to push Mr Noble very hard to tell me about breathlessness in relation to his war service and shortly afterwards, because it clearly was a key question in my mind as to the linkage, and he simply couldn't tell me anything about disorders of breathing until some time in the 1960s. He couldn't give me any pinpointed date. He didn't mention anything about breathlessness on board ship or in relation to anything. If, however, that is true, then I suspect it is possible to say that those circumstances added in an accumulative way, to the development of his asthma. But the history I got was not that.
MR DE MARCHI: But even so, you say that the major factor would have been in making the condition florid would have been the Visken?
A I think that is undoubtedly true." (Emphasis added).
The examination in chief concluded at that point.
In Bushell, above, Brennan J said (at 424-5):
"Section 120 governed the review by the A.A.T. of the decision of the Board on Mr. Bushell's claim.
This section is not concerned with an onus of proof. Sub-section (6) says so expressly. It is concerned with a standard of satisfaction to which the administrative decision-maker must attain in finding the relevant facts, and it directs the decision-maker to act on the material before the Commission, the Board or the A.A.T., as the case may be. Proceedings before the A.A.T. may sometimes appear to be adversarial when the Commission chooses to appear to defend its decision or to test a claimant's case but in substance the review is inquisitorial. Each of the Commission, the Board and the A.A.T. is an administrative decision-maker, under a duty to arrive at the correct or preferable decision in the case before it according to the material before it. If the material is inadequate, the Commission, the Board or the A.A.T. may request or itself compel the production of further material. The notion of onus of proof, which plays so important a part in fact-finding in adversarial proceedings before judicial tribunals, has no part to play in these administrative proceedings. Nor does s. 120 create any presumption which has to be dispelled by the material before the decision-maker."
In the present case there was before the Tribunal a great deal of material. The reality is that, in the light of the evidence, especially that cited above, Mr Noble's case before the Tribunal sought to place reliance upon the role of Visken. This was understandable in the light of the medical evidence of Dr Pain that the appellant's asthma developed in the 1960's and that in his opinion the onset of clinical asthma at that time was too remote to be causally linked to the appellant's war service.
In the hearing before the Tribunal, no real reliance was place upon the Scapa Flow training exercise or the absence of ventilation of HMAS Shropshire during action. In arriving at its decision on this issue the Tribunal was entitled to be guided by the issues that the parties choose to put before it for its consideration: see Sullivan v Department of Transport (1978) 20 ALR 323 at 342, Repatriation Commission v Hughes (1991) 23 ALD 270 at 274 and Tuite v Administrative Appeals Tribunal (1993) 40 FCR 483 at 487-489. As the arbiter of fact it was open to the Tribunal having regard to the case put to conclude, after consideration of the whole of the material before it and in particular the significance attached by Dr Pain to the lapse of time between war service and the onset of the bronchial asthma, that the material does not raises a reasonable hypothesis connecting the asthma with war service. Accordingly, no error on the part of the Tribunal in this respect can be demonstrated.
Criticism has also been made of the Tribunal's treatment of some of the psychiatric evidence. As has been seen, the Tribunal said that Mr Noble had been "exposed to stressful events during service" and that "[t]here is some evidence [from Dr Parkin] that, at most he suffered mild anxiety..." However, it will be recalled that the Tribunal added that:
"...but the evidence does not indicate that a psychiatric or psychological disorder existed, sufficient to be related to the development of a hypertensive state. Blood pressure on enlistment and discharge was normal."
In his written submissions, counsel for Mr Noble contended for the following:
"6. The result of not fully understanding its task was that the Tribunal failed to understand the full breadth of the hypothesis linking the conditions of service with stress and hypertension.
6.1 [The Tribunal] [h]aving found that stress was a factor in the development of hypertension, and that Dr Parkin found that the veteran suffered from mild anxiety, all this material pointed to an anxiety condition associated with service, and leading, according to established medical evidence, to hypertension. The hypothesis did not depend upon the time of onset of hypertension, but whether on the basis of a reasonable hypothesis that hypertension could be said to be service-related. Neither of these matters were examined by the Tribunal in its fact-finding task pursuant to S.120(3).
6.2 A failure to examine all of the material is a fundamental error in the assessment pursuant to S.120(3).
7. Similarly, the Tribunal and his Honour failed to consider the relationship of the factors of service, and the subsequent development of bronchial asthma.
7.1 The Tribunal focused on whether the bronchial asthma was related to the treatment of hypertension, and once that relationship failed, concluded that the condition was not service-related before examining the other factors; gas training on service, smoking on service and Dr Pain's evidence that he had discounted the hypothesis because of his understanding of the lack of symptoms on service or soon after discharge.
7.2 But the Tribunal had accepted this evidence. AB460.
7.3 Having found these factors to exist, the Tribunal appeared to have overlooked the evidence of the Appellant's exposure to gas training at Scapa Flow and his smoking period related to Navy service. The Appellant also smoked 1-2 packets of cigarettes following discharge for approximately 8-9 years.
7.4 In his evidence, Dr Pain believed that if all the material accepted by the AAT was true then it was possible to say that those circumstances add in a cumulative way to the development of his asthma. 'But the history I got was not that'. The AAT failed to comment on this, and if the evidence of the appellant was to be rejected, it ought to have been rejected pursuant to S.120(1).
8. The Tribunal and his Honour erred in requiring the hypothesis be raised by the Appellant."
As has been seen, in par 7.2 above, reference is made to Appeal Book p.460. This appears to be a reference to the following part of the Tribunal's reasons: