Decision: The decision under review is affirmed.

VETERANS' AFFAIRS - permanent impairment compensation - previous compensation paid - whether applicant is entitled to additional permanent impairment compensation - major depressive disorder - calculation of whole person impairment - where multiple conditions causing impairments - the need to establish a causal link between the impairment observed and the accepted injury - decision under review affirmed.

Safety, Rehabilitation and Compensation Act (Defence-related Claims) Act 1988 (Cth) ss 5A, 5B, 24, 25.

Safety, Rehabilitation and Compensation (Defence-related Claims Act 1988) - Guide to the Assessment of the Degree of Permanent Impairment, Edition 2.1

1. The late Judith Hartikainen served in the Australian Defence Force from 8 August 1984 until 23 June 1989. She suffered a serious knee injury while serving. To treat the injury Ms Hartikainen had her patella (kneecap) removed. This surgery failed to successfully treat the knee injury and set in train a series of events that led to her suffering a number of additional injuries and ailments including major depressive disorder, pancreatitis, alcoholic hepatitis and alcohol use disorder. These ailments and injuries caused differing degrees of permanent impairment and ultimately led to her premature death. Prior to her death in November 2020 Ms Hartikainen submitted claims for permanent impairment compensation in relation to a number of conditions.
2. In 2022 a delegate of the respondent assessed Ms Hartikainen's degree of whole person impairment in relation to her alcohol use disorder at 50%. Review was sought in the Administrative Appeals Tribunal (AAT) of that assessment. The AAT proceedings were resolved by consent dismissal on 8 April 2024. The pancreatitis claim was the subject of a contested hearing in this Tribunal and Ms Hartikainen's degree of whole person impairment as a result of the pancreatitis was determined to be 20% in a decision dated 11 February 2025. The alcoholic hepatitis claim was resolved by a consent decision on 7 August 2025, which assessed her degree of whole person impairment as a result of that disease at 60%.
3. In this application the matter in issue is the degree of whole person impairment that should be assessed in relation to Ms Hartikainen's major depressive disorder. On 17 February 2015, the respondent determined the claimant was entitled to compensation for a 20% WPI as a result of major depressive disorder pursuant to Table 5.1 of the approved Guide which for present purposes is the Safety, Rehabilitation and Compensation (Defence-related Claims Act 1988) - Guide to the Assessment of the Degree of Permanent Impairment, Edition 2.1 (Guide).
4. On 7 November 2020, the applicant claimed for an increase in permanent impairment.
5. On 19 October 2021, the respondent determined that no additional permanent impairment compensation was payable above 20% for MDD.[1]
6. On 10 February 2022, the respondent affirmed the determination dated 19 October 2021.[2]
7. The applicant contended at the hearing that the impairment from major depressive disorder should be assessed at 60%. The respondent contends that it should be assessed at 25%.
8. Having considered the evidence I am satisfied that Ms Hartikainen's degree of whole person impairment as a result of the major depressive disorder should be assessed at 25%. As Ms Hartikainen's degree of permanent impairment did not increase by the required 10% for a further payment to be made.[3] For the reasons which follow the decision under review is affirmed.

1. Two other applications for permanent impairment compensation were heard at the same time as this application. The evidence tendered in those proceedings is treated as evidence in this proceeding. The evidence available to me for the determination of this claim consists of the following:
   • T-Documents (2022/2106), documents T1 to T46, pages 1 to 411.
   • T-Documents (2022/2107), documents T1 to T39, pages 1 to 1,225.
   • T-Documents (2022/4696), Documents T1 to T54, pages 1 to 747.
   • Statement of Kenneth Bridges, including annexures KRB1 - KRB10.
   • Report of Dr Shiva Gunapu, consultant psychiatrist, including letter of instruction dated 8 December 2022.
   • Report of Dr Christopher Bell, orthopaedic surgeon concerning left knee condition, including letter of instruction dated 19 November 2025.
   • Report of Dr Christopher Bell, orthopaedic surgeon concerning lumbar spondylosis, including letter of instruction dated 19 November 2025.
   • Supplementary report of Dr Christopher Bell, orthopaedic surgeon including email requesting clarification dated 3 December 2025.
   • Report of Dr Simon Journeaux, consultant orthopaedic surgeon, including letter of instruction dated 24 May 2023.
   • Supplementary report of Dr Simon Journeaux, consultant orthopaedic surgeon, including letter of instruction dated 8 May 2024.
   • Supplementary report of Dr Simon Journeaux, consultant orthopaedic and trauma surgeon, including letter of instruction dated 12 January 2026.
   • Extract of s 26 bundle (2022/2106), pages 4-13;
   • Supplementary Section 26 Documents (2022/2107) p 1-31.
2. In addition to that material, consultant psychiatrist Dr Shiva Gunapu was called by the respondent and gave oral evidence at the hearing. He was cross-examined by the applicant's representative.
3. Mr Bridges also gave evidence and was cross examined and filed submissions after the hearing to which I have had regard.

1. Section 14(1) of the Safety, Rehabilitation and Compensation (Defence-related Claims) Act 1988 (Cth) (DRCA) provides that the Commonwealth is liable to pay compensation in accordance with the DRCA in respect of an injury suffered by an employee if the injury results in death, incapacity for work, or impairment.
2. Section 5A(1) of the DRCA relevantly provides that 'injury' means:

• A disease suffered by an employee; or
  • An injury (other than a disease) suffered by an employee, that is physical or mental injury arising out of, or in the course of, the employee's employment; or
  • An aggravation of a physical or mental injury (other than a disease) suffered by an employee (whether or not that injury arose out of, or in the course of, the employee's employment), that is an aggravation that arose out of, or in the course of, that employment;

but does not include a disease, injury or aggravation suffered as a result of reasonable administrative action taken in a reasonable manner in respect of the employee's employment.

3. Section 5B(1) of the DRCA relevantly provides that 'disease' means:

• An ailment suffered by an employee; or
  • An aggravation of such an ailment;

that was contributed to, to a significant degree, by the employee's employment by the Commonwealth.

4. Section 24(1) of the DRCA provides the Commonwealth is liable to pay compensation to an employee where an injury results in a permanent impairment.
5. Section 24(5) of the DRCA provides that the degree of permanent impairment of the employee resulting from an injury shall be determined under the provisions of the Guide.
6. Table 5.1 of the Guide is used to assess the percentage of whole person impairment (WPI) for psychiatric conditions including major depressive disorder. A copy of the table is annexed to these reasons.
7. Section 25(4) of the DRCA provides that where a final assessment of the degree of permanent impairment has been made[4] no further amounts of compensation shall be payable to the employee in respect of a subsequent increase in the degree of impairment, unless the increase is 10% or more.

1. Ms Hartikainen was born in Broken Hill in 1965. She enlisted in the Army in 1984. In 1986 she aggravated a pre-existing knee condition playing a game of netball related to her service. When the aggravation did not settle, on medical advice, she had her patella (kneecap) removed. The operation was not a success. Ms Hartikainen was left with permanent pain and disability as a consequence of the surgery. She left the Army in 1989.
2. After leaving the Army Ms Hartikainen worked in a variety of positions and retrained as a nurse. Over time her knee deteriorated, and her pain levels increased.
3. In 2005 Ms Hartikainen met her partner Kenneth Bridges. He observed gradual but significant deterioration in her mental and physical health. Initially it manifested as reduced functional capacity, then resulted in Ms Hartikainen stopping work as a nurse in 2011. As her pain increased and her physical capacity declined Ms Hartikainen's mental health deteriorated.
4. As a result of her chronic pain Ms Hartikainen developed major depressive disorder.
5. On 27 February 2013, Ms Hartikainen submitted a claim for major depressive disorder.[5] The respondent accepted liability for that condition under s 14 of the DRCA on 4 September 2013.[6]
6. She was reviewed by a psychiatrist Dr Majumdar in late 2014. At that time she was taking anti-depressants. Her mood was depressed and she was unable to go out socially however her alcohol consumption was not a problem. Dr Majumdar confirmed the diagnosis of major depressive disorder.
7. On 17 February 2015, the respondent determined that Ms Hartikainen was entitled to compensation for a 20% whole person impairment as a result of major depressive disorder.[7] It did so on the basis of the report provided by Dr Ashim Majumdar. Dr Majumdar confirmed that Ms Hartikainen's disorder was permanent, and she had a 20% degree of WPI which could not be reduced with further medical treatment.[8]
8. In July 2015, Ms Hartikainen was assessed by psychiatrist Dr Christopher Slack, who reported that she was wholly incapacitated for work due to major depressive disorder.[9]
9. The notes of her GP record that from 2013 Ms Hartikainen was diagnosed with depression and that attempts were made to treat it. In 2016 the applicant was initially on the anti-depressant Zoloft. However, because Zoloft was ineffective a plan was made to start the applicant on Lexapro.
10. In October 2018 Ms Hartikainen's stepson drowned which caused her considerable anguish and around this time she began abusing alcohol.
11. In July 2019 Ms Hartikainen was admitted to hospital following an incident with her sister. She had been expressing suicidal thoughts to both her sister and to Mr Bridges. She was discharged five days later to Mr Bridges' care.
12. On 7 August 2019 Ms Hartikainen consumed 1 bottle of vodka and took 49 Valium tablets with the intent to end her life. She was admitted to hospital on 7 August and stayed until 19 August 2019. She described this suicide attempt as an impulsive decision. She had been feeling worse after finding out that her son wanted repayment of a $100,000 loan and was intending to take legal action.[10] Immediately prior to discharge she had significantly improved. She was reported as 'bright in her mood and cheerful'.[11] She was taken to the emergency department at Caboolture hospital again on 19 October 2019 after being found passed out on the ground from alcohol consumption. She was admitted to the ICU. She was eventually transferred to the mental health ward where she stayed until 5 November 2019. She was discharged to the care of a friend. In follow up she denied any plan or intent to self-harm or suicide.[12] However, on 18 December 2019 police were called to her home following threats by her to end her life.[13]
13. On 22 September 2020 the applicant was found intoxicated on a footpath at a motel. She was admitted to hospital again. She was discharged from hospital on 16 October 2020. On 8 November 2020, Ms Hartikainen passed away. The causes of death listed on her death certificate were cardiorespiratory arrest, pancreatitis, chronic alcohol, and depression.[14]
14. In a statement dated 8 January 2026, Mr Bridges, Ms Hartikainen's widower, described a deterioration of her mental health throughout their relationship from 2005 to her death in 2020. He describes her exhibiting a cognitive and emotional decline and recurring depressive episodes.[15]
15. On 19 October 2021, the respondent, apparently in response to a claim for additional permanent impairment compensation made on 7 November 2020, determined that no additional permanent impairment compensation was payable above 20% WPI for major depressive disorder. That determination was affirmed by a reviewable decision dated 10 February 2022. Review was sought on behalf of the late Ms Hartikainen's estate in the AAT, and the proceedings was transferred to this Tribunal upon commencement of the Administrative Review Tribunal Act 2024.
16. Two posthumous independent medical reports were produced by psychiatrists Associate Professor Abdul Khalid and Dr Scott Chambers on 13 September 2021, based on an interview with Mr Bridges and review of Ms Hartikainen's medical records.
17. Dr Chambers diagnosed major depressive disorder and alcohol use disorder. He concluded that major depressive disorder developed 'in the context of chronic pain symptoms', and alcohol use disorder developed subsequently 'in the context of her chronic pain symptoms becoming increasingly difficult to control'.[16]
18. Similarly, Associate Professor Khalid in his report confirmed Ms Hartikainen's diagnoses of major depressive disorder and alcohol use disorder, both as a result of her chronic pain.[17]
19. The respondent briefed consultant psychiatrist Dr Shiva Gunapu to prepare a report for the purposes of these proceedings. In his report dated 22 March 2023, Dr Gunapu concludes as follows:

...impairment of 25% is appropriate and reflects the wholistic representation about the levels of impairment. This also includes understanding some of the factors driving the alcohol use disorder were related to the psychosocial upheaval in [the] few year[s] preceding death. Importantly the military related factors were not the main reason for the acceleration of her condition since 2018. If not for the psychosocial upheaval she would not have accelerated with the alcohol use disorder and therefore would have maintained a degree of relative stability... The admissions were not for acute decline in MDD as such as there was no decline of MDD.

Ms Hartikainen does not necessarily suffer from 60% WPI... If Ms Hartikainen had engaged with detoxification program and reduced intake, her impairment levels would have dropped dramatically. The intoxication and general medical conditions gives a temporary worsening, falsely high apparent impairment.[18]

1. The respondent accepts that the applicant's major depressive disorder is a disease (and therefore an injury) that has resulted in a permanent impairment.
2. The applicant contends that on the basis of the symptoms that Ms Hartikainen displayed in the period leading up to her death, her degree of permanent impairment should be assessed at 60%. To meet that percentage the Tribunal must be reasonably satisfied that the applicant exhibited both of the following:
   • severe disturbances of thinking and/or behaviour which entails potential or actual harm to self and/or others; and
   • need for supervision and direction in a confined environment.[19]
3. The respondent contends that, based on the assessment of its independent medical examiner, Ms Hartikainen's degree of permanent impairment should be assessed at 25% on the basis that her major depressive disorder resulted in all the following features, accompanied by a need for some supervision and direction in activities of daily living:
   • Reactions to stresses of daily living which cause modification of daily living patterns.
   • Marked disturbances in thinking.
   • Definite disturbances in behaviour.[20]
4. In essence the disagreement between the parties is as follows. The applicant contends that any assessment of Ms Hartikainen should be made as if she were suffering from only one injury - the major depressive disorder. If she was exhibiting the symptoms or behaviours set out in the relevant table (even if not the result of the major depressive disorder) then she should be assessed with that degree of permanent impairment.
5. The respondent on the other hand contends that only symptoms or behaviours causally connected to the major depressive disorder should be used to assess the degree of impairment.
6. If the applicant's approach is taken then Ms Hartikainen should be assessed has having an impairment rating of 60% because, primarily as a result of her alcohol use disorder and other issues arising within the family, she was exhibiting symptoms and behaviours consistent with an assessment of that degree. If the respondent's approach is taken, many of the symptoms and behaviours that Ms Hartikainen exhibited should be excluded because they have no causal connection to her major depressive disorder. Only the symptoms and behaviours associated with her major depressive disorder should be included.
7. I am satisfied that the approach contended for by the respondent is the correct approach.
8. Section 24(5) of the DRCA provides as follows:

The MRCC shall determine the degree of permanent impairment of the employee resulting from an injury under the provisions of the approved Guide.

1. The words 'resulting from an injury' require a causal connection between the identified injury and the impairment suffered. It is not sufficient to say that impairment of a particular kind is observable and an injury of a particular kind has been accepted. It is necessary to establish a causal link between the impairment observed and the accepted injury.
2. In this case, the best evidence that deals with the question of causal connection is the evidence of consultant psychiatrist Dr Gunapu.
3. Dr Gunapu prepared a report dated 22 March 2023. He was also the subject of cross-examination. His evidence was clear. Notwithstanding that Ms Hartikainen may have met certain criteria associated with a higher assessment under Table 5.1, that was not as a result of the worsening of her major depressive disorder. In particular Dr Gunapu noted:

The needs for supervision and in confined space was related to both the general medical morbidities and intoxication and the effects of intoxication. The admissions were not for acute decline in MDD as such as there was no decline in MDD.[21]

1. Dr Gunapu was clear that the impairments that Ms Hartikainen exhibited that would allow an assessment of 60% under Table 5.1 were not the result of permanent impairments resulting from Ms Hartikainen's major depressive disorder. He states:

If Ms Hartikainen had engaged with detoxification program and reduced [alcohol] intake, her impairment levels would have dropped dramatically. The intoxication and general medical conditions gives a temporary worsening, falsely high apparent impairment.[22]

1. In those circumstances Dr Gunapu's assessment was that the appropriate assessment of the permanent impairment resulting from Ms Hartikainen's major depressive disorder was only 25%.
2. The applicant's main argument against this assessment was that Dr Gunapu was undertaking his assessment in an impermissible way - effectively excluding impairments that were demonstrated because they were caused by other conditions. I am satisfied that Dr Gunapu was applying the Tables in the manner he was legally required to do - by asking what impairments suffered by Ms Hartikainen were the result of her major depressive disorder. In addition, he was considering whether any such impairments were permanent. He was correct to discard the impairments that were the result of her alcohol use disorder and other factors and not the result of her major depressive disorder. I am satisfied that his assessment of Ms Hartikainen's degree of permanent impairment was correct and should be accepted.
3. The applicant also contends that there were significant deficiencies in the briefing of Dr Gunapu. I do not accept that submission. The critical question for Dr Gunapu to answer was whether the evident increase in impairment that Ms Hartikainen suffered, particularly in the last two years of her life when her mental health declined dramatically, evidenced an increase in her degree of permanent impairment as a result of her major depressive disorder. Dr Gunapu's report demonstrates a very good understanding of Ms Hartikainen's decline and the hospital admissions that the decline prompted. I am satisfied that the assessments he made were based on a correct understanding of Ms Hartikainen's history.
4. The applicant also contends that reports of psychiatrists Dr Chambers and Associate Professor Khalid should be given greater weight. Neither of these experts express a view on the question of any increase in the degree of permanent impairment. Those reports do not assist me.

1. I am satisfied that the assessed level of whole person impairment did not increase by at least an additional 10% WPI since the previous compensation assessment. The applicant is therefore not entitled to additional permanent impairment compensation.
2. The decision under review is affirmed.

Dates of Hearing 27 January 2026 and 6 February 2026

Respondent's solicitor Australian Government Solicitor

Annexure: Table 5.1 of the Safety, Rehabilitation and Compensation (Defence-related Claims Act 1988) - Guide to the Assessment of the Degree of Permanent Impairment, Edition 2.1

[3] Safety, Rehabilitation and Compensation (Defence Related Claims) Act 1988 (Cth) (DRCA) s 25(4)

[15] Statement of Kenneth Ronald Bridges dated 8 January 2026.

[18] Report of Dr Shiva Gunapu dated 22 March 2023 (Hearing book, 134).

[21] Report of Dr Shiva Gunapu dated 22 March 2023 (Hearing book, 134).