Consideration
52 The respondent's submission must be accepted.
53 At the outset it is appropriate to recall three factual matters.
54 First, the chronology of events recited above as well as the factual findings made by the Tribunal are unchallenged. This reflects that the applicant suffered from a longstanding and significant pre-existing psychiatric disease which had been the subject of ongoing intensive medical treatment, including prescription of medication, and that was subject to worsening of symptoms in previous employment. However, at the time that the applicant was employed by ASIC in May 2010, for the first 12 months, his own evidence was that he was happy with his job, and thereafter in August 2011 he voluntarily ceased taking his medication. He presented himself to the emergency department of a hospital with a florid intensification of symptoms accompanied by suicidal ideation in April 2012, about halfway through his employment at ASIC.
55 Second, the Tribunal found that the applicant had ceased taking his medication. The applicant's evidence-in-chief was that notwithstanding that this was an idea floated by his treatment providers before or at the time of his employment with ASIC, he did not receive advice to go off his medication and he never did. That is, there was a factual dispute as to whether the applicant ceased taking his medication, which was resolved against him. It was open to the Tribunal to so find. Although he was given prescriptions from his treatment providers he did not have them filled. At [92]-[93] the Tribunal concluded:
[92] In my view the most relevant issue is the fact that Mr De Tarle's DHS-Individual Prescribing reveals that the last prescription for paroxetine was supplied 5 August 2011 and that there is no record of any other antidepressant, or any other medication, being supplied until sertraline was supplied on 22 April 2013 in respect of a prescription provided by Dr Unsen, dated 28 February 2013.
[93] As the only access, in Australia, to subsidised antidepressant medication is by prescription via the Pharmaceutical Benefits Scheme, the only conclusion I can make is that at some time after August 2011, Mr De Tarle stopped taking his antidepressant medication and did not start with the new medication until on, or after 22 April 2013. The reason for Mr De Tarle's cessation of his long term antidepressant is unclear.
56 Third, the Tribunal concluded that although the applicant's symptoms of depression and paranoia increased over some of the period he was employed at ASIC this did not reflect or comprise any "accompanying psychiatric change" in the state of his underlying ailments but rather, when the applicant ceased taking medication in the period from early September 2011 to late April 2013, this caused the symptoms of his underlying conditions to increase in accordance with the nature and incidents of those pre-existing conditions. That factual finding was open on the evidence with the Tribunal preferring the evidence of Dr Champion to that of Dr McClure, as it was plainly entitled to do. Moreover, the Tribunal concluded that even assuming aggravation of the applicant's underlying ailment, it was not contributed to, to a significant degree, by his employment.
57 Against that background, I turn to the applicant's submissions. As the respondent correctly observed, the submissions do conflate the relevant issues. The two issues, correctly identified by the respondent, are separate and distinct: May at [43], [49]-[50]. In May at [49]-[51] the plurality observed (footnotes omitted):
[49] It is against that background that the Act requires the tribunal of fact to give consideration to "the precise evidence, on a fact by fact basis…accepted at trial" and then to ask certain questions in order to determine whether an employee is suffering a "disease" or an "injury (other than a disease)".
[50] First, does the evidence amount, relevantly, to something that can be described as an "ailment", being a physical or mental ailment, disorder, defect or morbid condition? Secondly, if so, was that state contributed to in a material degree by the employee's employment by the Commonwealth?
[51] If the answer to both those questions is "Yes", there is a "disease" within para (a) of the definition of "injury". Of course, in some cases, the answer to those questions may be admitted. That is, the employee may admit that the answer to the first question, or both the first and the second questions, is "No".
58 The first issue is whether the Tribunal erred in law in finding that the increase in symptoms which the applicant experienced for some of the period he was employed by ASIC comprised an "aggravation" of pre-existing ailments.
59 The applicant contends that the Tribunal erred in its reliance on May, but rather reliance ought to be placed on Semlitch and Chemler. The applicant's submission proceeds on the premise that a conclusion that there is an increase in symptoms necessarily means that there is an aggravation of the ailment, within the SRC Act. That is incorrect. The submission also appeared to suggest that the Tribunal's conclusion reflects a misunderstanding of the nature of psychiatric illness. As explained below, that submission conflates the issues involved. It is rather circular. In any event, the Tribunal concluded contrary to that submission, that the applicant's employment was not a significant contribution to any aggravation.
60 Relevantly, 5B is in the following terms:
5B Definition of disease
(1) In this Act:
disease means:
(a) an ailment suffered by an employee; or
(b) an aggravation of such an ailment;
that was contributed to, to a significant degree, by the employee's employment by the Commonwealth or a licensee.
(2) In determining whether an ailment or aggravation was contributed to, to a significant degree, by an employee's employment by the Commonwealth or a licensee, the following matters may be taken into account:
(a) the duration of the employment;
(b) the nature of, and particular tasks involved in, the employment;
(c) any predisposition of the employee to the ailment or aggravation;
(d) any activities of the employee not related to the employment;
(e) any other matters affecting the employee's health.
This subsection does not limit the matters that may be taken into account.
(3) In this Act:
significant degree means a degree that is substantially more than material.
61 Aggravation is defined in s 4 as "includes acceleration or recurrence".
62 The relevant passages in the Tribunal reasons are at [105]-[112]:
[105] I am satisfied that the evidence before the Tribunal points to a conclusion that during his employment with ASIC, Mr De Tarle did suffer a change in his mental health, in that he suffered an increase in his depressive symptoms.
[106] The issue for the Tribunal is, whether this change in Mr De Tarle's mental health was an aggravation of his pre-existing psychiatric condition and, if so, whether the aggravation was contributed to, to a significant degree, by his employment.
[107] In Military Rehabilitation and Compensation Commission v May (2016) 257 CLR 468 (May), the High Court noted the Full Court's conclusion that "the inquiry demanded by the statutory definition of "injury" was "whether the person has experienced a physiological change or disturbance of the normal physiological state (physical or mental) that can be said to be an alteration from the functioning of a healthy body or mind". The High Court further noted in May, however, that this conclusion should be rejected to the extent that such a conclusion suggests that symptoms subjectively experienced by an individual, without "accompanying physiological or psychiatric change" will not engage section 14 of the SRC Act.
[108] In Re Whitlock and Comcare [2020] AATA 1353, the Tribunal took into consideration the High Court's judgments in May and Canute v Comcare (2006) 226 CLR 535, and applied them to the "aggravation" provisions within sections 5A and 5B of the SRC Act. The Tribunal concluded as follows at [196]-[197]:
The evidence must demonstrate that, in addition to symptoms or pain experienced by the employee, there is a discernible or diagnosable physiological or psychiatric change to the employee's body or psyche.
Accordingly, in the circumstances of this case, in the circumstances of this case, the Tribunal must be satisfied that there is evidence that there was a physiological or psychiatric change to the Applicant's pre-existing condition in order for there to have been an 'aggravation' of an ailment for the purposes of the SRC Act.
[109] The available evidence, in my view, supports a conclusion that Mr De Tarle's co-morbid personality disorder had a significant impact on his performance issues at work and the difficult relationships he had with his senior managers. I accept that this may have contributed to some degree to an increase in his depressive symptoms during 2012 and 2013.
[110] However, I am not persuaded that the evidence before the Tribunal supports a conclusion that there was a psychiatric change in his pre-existing conditions.
[111] In my view, the evidence points to a conclusion that, in 2012 and early 2013, the combination of Mr De Tarle's pre-existing personality disorder and the fact that he had ceased his antidepressant medication caused a temporary increase in his depressive symptoms and that there was no change in the pre-existing condition.
[112] Therefore, I am satisfied that Mr De Tarle did not suffer an aggravation of his pre-existing psychiatric conditions that was contributed, to a significant degree by his employment at ASIC.
63 Before addressing the submissions, it is appropriate to observe that after this matter was reserved for judgment, it became apparent that at approximately the same time this matter was argued, an appeal was conducted in the Full Court in which the appeal grounds appear, inter alia, to relate to the interpretation of May: an appeal in Wuth and Comcare [2020] AATA 3625 (Wuth). Neither party brought this appeal to the Court's attention.
64 In that event, on 24 January 2022, chambers communicated with the parties as follows:
Dear Parties
I refer to the above matter.
I note that this matter was heard before her Honour on 27 September 2021 and that judgment is reserved.
Her Honour wishes to raise with the parties whether ACD49/2020 - Wuth v Comcare (Wuth) raises any of the legal issues which arise in connection with the judgment presently reserved. If so, her Honour would like to enquire whether the parties consider that judgment delivery in this matter should be delayed until after the Full Court has delivered its judgment in Wuth. Can the parties please indicate their views to chambers on whether or not that may be an appropriate course.
I note for reference that Wuth was heard by the Full Court on 28 September 2021 and judgment in that matter is reserved.
If the parties consider that it is appropriate to delay delivery of judgment in this matter, her Honour would be minded to allow the parties an opportunity to put on further short written submissions in light of the Full Court's decision in Wuth (should that decision be relevant to the issues in this matter). The parties are to contact chambers in due course if they wish to provide any further submissions on that issue.
Please contact chambers if there are any questions or concerns.
65 On 10 February 2022, the parties responded that:
Dear Associate.
I am sending this email following agreement with the applicant's lawyer, Mr Whiffin, as to its contents.
Comcare accepts that in Wuth the Full Court is likely to consider the effect and implications of the decision of the High Court in May. Comcare notes that that same question arises, to an extent, in the present proceedings - although the factual context is very different noting, in particular, that in Wuth there was no factual finding to the effect that any worsening in symptoms was a consequence of the applicant ceasing medication for a pre-existing condition, thereby resulting in that condition expressing itself according to its nature and incidents. Although Comcare considers that the outcome of the appeal in Wuth is unlikely to affect the outcome in these proceedings, Comcare does not object to awaiting the outcome of that appeal.
The Applicant also does not object to awaiting the outcome of the appeal in Wuth.
In the event that Her Honour decides to delay judgment in this matter until after the Full Court has delivered its judgment in Wuth, the parties propose that directions are made to the effect that the applicant is to put on any further submissions he wishes to make within 28 days after the Wuth decision is handed down and the respondent to put on any further submissions it wishes to make in reply, 28 days thereafter.
66 Neither party suggested that the resolution of this matter ought to await the outcome in Wuth. Notably, although not opposing that approach, the applicant does not suggest that approach should be adopted.
67 In those circumstances, it is not necessary to await the outcome in Wuth. That is particularly so given the Tribunal's conclusion as to the second issue referred to in May at [50], that of causation. As the respondent observed, this case is factually distinguishable from Wuth and, as referred to in [56] above, the Tribunal made a factual finding that any increase in symptoms were a consequence of the applicant ceasing to take his medication which caused the symptoms of his underlying conditions to increase in accordance with the nature and incidents of those pre-existing conditions. The Tribunal addressed this issue on the assumption there was an aggravation of his injury, and concluded that the applicant's employment was not a significant contribution to any aggravation. Given that, it is difficult to see how Wuth could affect the outcome. The parties did not suggest otherwise. As I explain below, no error has been demonstrated in that conclusion.
68 In any event, that said, in so far as the applicant's submission is directed to the Tribunal's reliance on May being inapt because that reasoning concerned frank injury, not disease injury, it cannot be accepted: see May at [49]-[51] recited above at [57]. I note that May has been applied by the Full Court in the context of the disease limb of the definition: see for example, Prain v Comcare [2017] FCAFC 143; (2017) 256 FCR 65 (Prain) at [74]-[76].
69 Although the Tribunal in May found that the claimant had not suffered a "disease", which was not challenged in the High Court: see May at [65], a proper reading of May at [49]-[51], recited above at [57], reflects that the questions there posed and the reasoning thereafter were directed to the existence of both diseases and frank injuries. So much is also apparent from [57] where the plurality observed:
The Full Court concluded that the inquiry demanded by the statutory definition of "injury" was "whether the person has experienced a physiological change or disturbance of the normal physiological state (physical or mental) that can be said to be an alteration from the functioning of a healthy body or mind" (emphasis added). To the extent that conclusion suggested that subjectively experienced symptoms, without an accompanying physiological or psychiatric change, are sufficient to provide a positive answer to the first or third questions set out above, that conclusion should be rejected.
70 The Tribunal did not misapply May, but rather applied the correct approach to the facts which it accepted in this case. May required the Tribunal to have regard to "the nature and incidents" of any alleged "psychological change" suffered by the applicant: May at [62], [67], and see Prain at [75]-[76]. It made clear that subjectively experienced symptoms, without an accompanying physiological or psychiatric change, are insufficient. Apart from submitting that May is inapt in this case, the applicant did not address or grapple with the principles as to the meaning of the relevant provision espoused therein.
71 It is apparent from May that care needs to be taken not to conflate the concept of symptoms of a disease with the existence or aggravation of an underlying disease. The existence of symptoms without more is not sufficient to establish the existence of disease in the context of the SRC Act. Contrary to the applicant's contention, that the tribunal of fact is satisfied of the existence of symptoms in the case of onset of disease, or the existence of increased symptoms in respect of alleged aggravation, does not necessarily demonstrate the existence of disease or its aggravation for the purposes of the SRC Act.
72 I note that although Semlitch did address both relevant issues, Chemler considered only the issue of causation and not whether there was an injury. I will return to Chemler below.
73 In Semlitch, which predates May, the principal question was whether, on the basis of the facts proved, it was open to the Workers' Compensation Commission (Commission) to find that there was "an aggravation, acceleration, exacerbation or deterioration of any disease" within the meaning of s 6(1) of the Workers' Compensation Act 1926-60 (NSW). There was no expert evidence as to whether or not the condition in question was an aggravation. The tribunal of fact drew an inference from the evidence, but there was no direct evidence on that question or competing evidence. It was on that basis that the issue was whether the state of the evidence meant that it was open to the tribunal of fact to find in favour of aggravation. No member of the High Court found that a tribunal of fact is, as a matter of law, bound to regard every intensification of a disease-based symptom as comprising or satisfying the statutory definition of an aggravation of the disease.
74 Turning then to the second issue, whether the Tribunal erred in law in finding that any such aggravation was not, in any event, "contributed to, to a significant degree" by the applicant's employment.
75 It is to this issue which the applicant's submission as to the "eggshell psyche" rule properly relates. It can be accepted that an employee can have an "eggshell psyche", in the sense that they may be more vulnerable or hypersensitive than the average person to either the onset or the aggravation of an ailment. That this relates to the issue of causation is apparent from s 5B, which is recited above. Section 5B(2) addresses matters which may be taken into account in determining the issue of causation, with subsection (c) concerning what has been described as the "eggshell psyche" rule. This reflects the potential relevance of that concept to the assessment of whether the aggravation of an employee's ailment was contributed to, to a significant degree, by the employee's employment.
76 Section 5B(2)(c) identifies "any predisposition of the employee to the ailment or aggravation" as merely one of a number of non-mandatory, non-decisive, and non-limiting considerations which may be taken into account when determining whether employment has made a significant contribution to the onset or aggravation of a disease. It represents an acknowledgment by the legislature that an employee, even one with a pre-existing injury, might be more susceptible to suffering an aggravation due to a particular predisposition or vulnerability. However, that does not in and of itself establish the existence of a significant contribution, as it may be that, in the vast array of facts which might come before the Tribunal, the existence of an eggshell skull or psyche might not oblige a finding in favour of significant contribution.
77 That an employee may have a predisposition to an ailment or aggravation, in the sense that they have an "eggshell psyche", does not, when considered in its proper statutory context, ordain the outcome in all cases in which that principle is invoked.
78 The applicant does not address the "eggshell psyche" rule in the context of the statutory scheme, but rather contended:
What is omitted, but what ought to have been central, was the identification of the applicant's propensity to psychiatric injury (ie his "eggshell psyche"). Causation is not a purely objective external question - rather, it involves an analysis of the person affected, and that person's mind, by the perception of the stressors to which the applicant was exposed in the course of his employment with ASIC.
79 The submission elevates the application of this concept to a position it does not have in the statutory scheme.
80 This is also reflected in the applicant's submission, where he contended that:
The respondent suggests at [14] that "the most relevant fact" concerning the applicant's condition was his failure for a period to take his medication. This a distraction from the legal principles set out in Chemler and Semlitch in a psychiatric case of taking the victim as one finds them and has the underlying condition worsened.
81 This submission accords with what the applicant said during the Tribunal hearing when asked as to the relevance of the fact he went off his medication, replying:
The relevance of that is you take the victim as you find them. And this is the person we have here. That may ultimately have an effect upon foreseeability or contributory negligence, but here we have a person you take - if one uses the eggshell psyche rule. And of course, the reason he went off the medication, I think it comes out of what's stated in the - the learned member below identified in the decision, where he quoted from Dr Champion, and Dr Champion was the - was the doctor who was briefed on behalf of Comcare. And it appeared that he went off the medication because the GP told him to go - his general practitioner suggested it.
82 Three points can be made about that. First, to suggest that the applicant going off his medication is irrelevant in this case because of the "eggshell psyche" rule, is inconsistent with the statutory scheme. What, if any, effect it has was a matter of fact for the Tribunal. Second, as explained above at [55], there is no evidence and no finding that the applicant went off the medication because he was told to by his GP. Indeed, his evidence was he did not stop taking it. Third, on the applicant's submission his conduct in ceasing to take his medication can only be used in a positive manner in support of his case, as it made him more vulnerable. That submission cannot be accepted in the context of the statutory scheme. As explained above, any predisposition of the employee to an ailment or aggravation is only one of a number of considerations referred to in s 5B(2). For example, amongst the considerations in s 5B(2) that may be taken into account in determining whether an aggravation was contributed to, to a significant degree, by the employee's employment, are any activities of the employee not related to the employment: s 5B(2)(d) and "other matters affecting the employee's health": s 5B(2)(e). The applicant's failure to take his medication would fall within those descriptions.
83 As one final example of the applicant's submission, I note that he contends that at [19] of the Tribunal's reasons, it has "(wrongly) defined the issues excluding the eggshell psyche considerations. As a result, the Tribunal misdirected itself to the real issues in the case". At [19], recited above at [10], the Tribunal identified the issues that arose in an entirely uncontroversial manner.
84 No error is reflected in that approach.
85 The Tribunal applied the relevant statutory provisions to the evidence in this case, and nothing in Chemler or Semlitch reflects any error on its part. Nor, in the statutory scheme, does anything in Chemler or Semlitch ordain a different conclusion.
86 Rather, a consideration of the Tribunal's reasons reflect that, as the respondent correctly submitted, in reaching its conclusion the Tribunal gave significant weight to various factors which are referred to above at [48], and which are not challenged by the applicant. Although as noted above, the applicant submitted that his going off his medication was not relevant, there is no ground challenging the Tribunal's finding that "the most relevant fact" is that he ceased taking medication for his underlying conditions for approximately 18 months. As the respondent correctly submitted, that fact falls within s 5B(2)(d) and (e) of the SRC Act.
87 Considered in that light, the applicant's submission based on the "eggshell psyche" rule does not assist him, as in reality, it is a challenge to the weight attached by the Tribunal to various matters, which are a matter for the Tribunal: see for example: Abebe v The Commonwealth [1999] HCA 14; (1999) 197 CLR 510 at [197] per Gummow and Hayne JJ; Minister for Immigration and Citizenship v SZJSS [2010] HCA 48; (2010) 243 CLR 164 at [33].
88 The same applies to the applicant's reliance upon perceptions of real events. As the respondent correctly submitted, the applicant's perceptions of events in the workplace were referred to repeatedly and were taken into account. The Tribunal concluded that, even assuming those perceptions contributed to an actual aggravation of the applicant's underlying ailments, that contribution was not "a significant contribution". Those conclusions are based on an acceptance by the Tribunal of the evidence of Dr Champion over that of Dr McClure, which as previously mentioned, was plainly open on the evidence. That the applicant may have an unwavering belief that his employment made a significant contribution, does not make it so: Kirkpatrick v Commonwealth (1985) 9 FCR 36 (Kirkpatrick) at 39-41.
89 It is appropriate to note also in this context, that at the time Semlitch was decided, the relevant statutory scheme was such that any discernible level of employment contribution, no matter how small, was sufficient to attract compensation. This is to be contrasted with the current scheme whereby s 5B expressly requires that employment make a contribution of "significant degree" to the onset or aggravation of a disease. "Significant degree' is defined in s 5B(3) to mean "a degree that is substantially more than material". Although at the time Wiegand was decided, the concept of a "material contribution" had been introduced, the Court noted at [23], this was "held not to be a ground for differently construing the requirements for the definition of 'disease' in Treloar v Australian Telecommunications Commission (1990) 26 FCR 316 at 323". These distinctions necessarily affect the extent of the reliance that can be placed on Semlitch and Wiegand.
90 On the other hand, Chemler at [48], [54] and [69], which only addressed the issue of causation, makes clear that an employee's perceptions of real events in the workplace will not necessarily satisfy the work-connection threshold. In so far as the applicant contended otherwise, those passages in Chemler do not support that statement and the submission cannot be accepted. Moreover, the issue in Chemler was whether, under the New South Wales legislation, it was there open to the Commission to conclude that the psychological injury arose by reason of an accurate perception of actual events in the workplace. The conclusion in Chemler, based on the evidence in that case, does not dictate the outcome in the Tribunal in this matter. Each case is necessarily fact-specific. In so far as the applicant contends Chemler does stand for that proposition, he is incorrect.
91 No error has been established in relation to these grounds.