The Tribunal's Decision
43 The Tribunal notes at [14] that all earlier determinations of the applicant's incapacity had been made on the footing that the applicant's sole prescribed impairment was alcoholism. In the proceedings before the Tribunal the applicant contended that his personality disorder; upper left limb injuries as a result of motor vehicle accidents in 1975 and 1976; and a condition of chronic dysthymia (described as "a chronically low mood") ought to be accepted as impairments causally connected with his accepted prescribed impairment of alcoholism. At [34]-[[38] the Tribunal finds that the upper limb injuries are not causally connected to alcohol consumption on the evidence and thus s 34(1B)(b) is not made out. At [39] - [41], the Tribunal finds that it is not satisfied that Mr House suffers from the condition chronic dysthmyia.
44 There is no challenge to those findings.
45 The Tribunal's findings at [28] and [29] concerning the relationship between Mr House's alcoholism and his personality disorder have already been noted. The Tribunal however begins that discussion at [26] by observing at the outset that whether Mr House's personality disorder ought to be regarded as a "prescribed condition [impairment]" is "controversial". The Tribunal notes at [26] that there is no issue, on the evidence, that Mr House has a personality disorder. The Tribunal refers to the evidence of Dr Barbara McGuire, a consulting psychiatrist, and notes that in her report of 19 April 2006 (AB, Part B, 402) Dr McGuire refers to reports of other psychiatrists as early as 1983 describing Mr House's personality disorder. The Tribunal notes the oral evidence of Dr McGuire that Mr House suffers from a personality disorder and that the disorder caused him to drink. The Tribunal also notes at [26] the opinion of Dr McGuire that the two conditions of alcoholism and personality disorder "are so intertwined as to make attempts at teasing them apart at best only an academic exercise".
46 At [27] the Tribunal notes the evidence of Dr Jill Reddan a consulting psychiatrist who provided three reports in evidence dated 22 June 1997 (AB, Part B, 287), 8 May 2000 (AB, Part B, 334) and 15 January 2003 (AB, Part B, 567). The Tribunal notes the opinion set out at pages 10, 11 and 12 (AB, Part B, 296, 297 and 298) of Dr Reddan's report of 22 June 1997 that Mr House has a personality disorder and particularly notes Dr Reddan's observation about primacy and the difficulty of sequential isolation of the affects of the two conditions, at p 12 of the report (AB, Part B, 298), in these terms:
(ii) The relationship between Mr House's personality disorder and his alcohol consumption is complicated and it is impossible to state which is the primary problem and which is the secondary.
47 The remaining part of the quote at point (ii) on page 12 of Dr Reddan's report is this:
It is likely however, that Mr House sought to deal with any uncomfortable affects or anxieties by alcohol abuse but, because of his need to project blame onto others and refusal to see any problems within himself, he has consistently refused to address his alcohol problem. It is likely, however, that is ongoing alcohol consumption did narrow his ability to think through the consequences of his actions and assisted in maintaining the rigidity and self-absorption of his personality.
48 There is no doubt that by these references the Tribunal is conscious of the complexity of the inter-relationship between or intertwining of the two conditions based on an assessment of the reports of the psychiatrists.
49 At [28] the Tribunal accepts the opinion of Dr McGuire that the applicant's drinking was caused by the personality disorder. The Tribunal notes that it is plain that Mr House was retired from the Defence Force on the ground of his alcoholism impairment. At [29] the Tribunal recognises and accepts, based on the evidence of the difficulty of sequential isolation of primary and secondary factors and the demonstrated interrelationship between the two conditions, that it is "artificial in the extreme" to "seek to separately consider the two conditions".
50 The Tribunal at that point in its methodological treatment of the evidence of the two conditions makes its acceptance of the extreme artificiality of separate consideration of the affects of each condition (impairment), plain. At [29] the Tribunal also recognises the long-standing inter-relationship of the two conditions by observing in the following terms that:
… in all likelihood Mr House's long-standing personality disorder pre-dated his discharge from the Australian Army … [and] it was the drinking [impairment] which caused the incapacity that was the reason for the discharge [emphasis added].
51 The Tribunal at [29] notes that the drinking may have been the "overt manifestation of the underlying personality [disorder]".
52 At [29], as already noted, the Tribunal finds the alcoholism impairment to be the "proximate cause" of the discharge and thus the applicant's personality disorder ought not to be accepted as a mental impairment falling within s 34(1B), and by so finding, the Tribunal fell into error. Notwithstanding that error, the Tribunal at [30] notes, having regard to the earlier references, that the medical evidence recognises the "difficulties inherent in trying to separate the extent of incapacity arising from alcoholism from that arising from personality disorder".
53 The Tribunal also notes however at [30] that the task of separation is "now easier given that Mr House has been abstaining from alcohol for a considerable period of time". The Tribunal at [30] sets out its essential analytical method in these terms:
… I propose to first consider the totality of … [Mr House's] mental conditions and the extent to which they lead to incapacity for employment before determining whether there is an apparently logical basis for differentiating between the consequences of the two conditions.
54 The Tribunal notes at [31] that there is a "considerable body of psychiatric evidence … available" including "the evidence referred to in … [26] and [27] … , of the interconnection between the two conditions". In terms of method, the Tribunal also said at [33] that it was logical, helpful and a useful task to compare Mr House's condition as determined by the Tribunal's decision of June 2004 with his condition as disclosed in the evidence before the Tribunal in the course of the subject hearing, to consider what might have changed. This approach was also thought to be useful because Mr House was no longer drinking; was in a stable relationship; and was undertaking voluntary work three days per week. The abstention from alcohol was earlier identified at [30] as one factor making separation of analysis easier. Nevertheless, at [42] the analytical course adopted is described in this way:
It follows that I propose to consider the extent of Mr House's incapacity by reference only to the condition of alcoholism accepting the reality that it may not be possible to differentiate between incapacity attributable to that cause and that attributable to underlying personality disorder.
55 The implementation of that course is further described at [43] in this way: "As it seems to me, the first step is to consider the evidence that touches upon the question of incapacity arising from prescribed impairments [alcoholism] to examine what that evidence says of the relevant consequences to Mr House's capacity from the impairments".
56 At [44], the logical starting point for the Tribunal as it had suggested at [33] was the decision the earlier Tribunal reached in June 2004 as to incapacity. That was a decision of 29 June 2004 affirming the Authority's decision of July 2001 (affirmed on reconsideration by the Authority on 15 February 2002) to classify Mr House's incapacity as Class C at 20%. By that decision the Authority recognised Mr House's prescribed impairment as alcoholism but excluded alcoholic liver disease as a prescribed impairment. Mr House did not contend in the earlier Tribunal hearing (leading to the decision of 29 June 2004) that his personality disorder was a prescribed impairment.
57 Deputy President Hack SC notes at [44] that because Mr House had abstained from alcohol; was in a stable relationship; was a carer for his spouse; and, was undertaking voluntary work assisting blind people three days a week, his "level of incapacity … on one view … ought to be reduced … as [t]hose matters … suggest[ed] a marked improvement rather than a worsening of his capacity".
58 That assessment as a matter of impression, of course, does not in terms take into account at the outset any aspect of Mr House's personality disorder unless the emotional factors of a stable relationship; acting as a carer; and performing voluntary work assisting blind people are factors the Tribunal treated as bearing upon the expression (or not) of aspects of Mr House's accepted personality disorder. Those factors, however, seem to be directly related to anticipated improvements in Mr House's capacity for civilian employment by reason of his abstention from alcohol.
59 At [45], the Tribunal, having noted what might be, on one view, a marked improvement in Mr House's capacity, said it was nevertheless necessary to look at the evidence.
60 The Tribunal began that examination at [46] by considering the neuropsychological evidence of the extent of any cognitive impairment suffered by Mr House. The Tribunal notes that as long ago as 1992, Mr House was assessed by a clinical neuropsychologist, Ms Maureen Field, and in her report of 21 January 1992 she described cognitive impairments in several areas suffered by Mr House including "significant memory impairment". The Tribunal notes a further neurological assessment of Mr House undertaken in March 2007 by Ms Chris Schumann and notes Ms Schumann's report of 17 April 2007 describing Mr House's memory as being "moderately impaired for immediate recall and learning". The Tribunal notes Ms Schumann's observation that Mr House suffered "a retrieval deficit which was consistent with his history of chronic alcohol excess". The Tribunal also notes at [46] the result of Ms Schumann's testing which indicated the following problems:
1) Moderate depression,
2) Mildly slow processing speed on some tasks,
3) Mild verbal fluency deficit,
4) Memory problems that included:
a. Moderate retrieval deficit,
5) Executive problems that included:
a. Mild conceptual shifting problems,
b. Mild to severe planning and organising deficit,
c. Mild to moderate visuoperceptual organization deficit
61 The Tribunal at [47] notes that Ms Schumann described the results as consistent with the assessment in 1992 and that there had been no change between 1992 and 2007. At [48], the Tribunal observes that Dr McGuire, in her report of 19 April 2006 had said that Mr House suffered "no obvious cognitive deficits". That observation of Dr McGuire was consistent with Deputy President Hack SC's own observations of Mr House in the course of the hearing.
62 These observations at [46], [47] and [48] address the extent of any cognitive impairments evident in Mr House in the context of his history of chronic alcohol excess. At [49], the Tribunal turns to the psychiatric evidence and observed that the extent of Mr House's memory deficits were the subject of a report from a consulting psychiatrist, Dr Philip Morris. The Tribunal notes the view expressed by Dr Morris in his report and evidence, in these terms:
On examination on various occasions he has been cooperative and showed no obvious distress. His speech shows difficulty with verbal fluency, and with word finding difficulties. His speech is coherent. His affect showed good range and was appropriate. His mood was euthymic. No psychotic features were noted. He does not have any suicidal or homicidal intent now but has had suicidal thoughts in the past. He has been alert on all assessments. His is of average intelligence. His judgment and insight are preserved. Cognitive examination using the Addenbrooke Cognitive Exam revealed problems with verbal memory recall and impaired phonemic verbal fluency. The remainder of his cognitive functions, including attention and orientation, language and visuospatial capacities were impaired. His mini mental state exam score was 29/30 and his ACER score was 96/100. Neither indicates dementia.
Computer based neuropsychological testing … revealed impairments in switching of attention … and verbal interference … and his verbal memory recall after a short and long delay was well below what would be expected based on his premorbid intelligence. These results indicate a mild disturbance of cognition in the areas of attention and concentration, executive function and memory recall that are consistent with his subject complaints.
63 At [49], the Tribunal notes that in oral evidence Dr Morris said that the deficits he had observed were not recent and were consistent with heavy consumption of alcohol.
64 At [50], the Tribunal concludes:
This evidence leads me to conclude that the degree of demonstrable impairment is objectively quite minor and is, at best for Mr House, unchanged over the past few years.
65 Although the Tribunal at [49] refers to the psychiatric evidence of Dr Morris, that evidence is assessed in the context of Dr Morris's view of any cognitive impairment suffered by Mr House in the context of Mr House's heavy consumption of alcohol.
66 At [51], the Tribunal notes Mr House's reliance on the additional matter of "manifestations of his personality that he contends affect his capacity to engage in employment". The Tribunal notes that the particular manifestations relied upon are "character traits" described by Dr Reddan in her report of 22 June 1997 following a consultation with Mr House on 19 June 1997. The Tribunal notes the content of that view, drawn from Dr Reddan's report, as follows:
Mr House has difficulty in seeing the points of view of others. His thinking is inflexible and marked by grandiosity and a sense of entitlement. He tends to overstate his case and to project blame onto others for all of his own misfortunes. He thus refuses to accept any responsibility for his situation in life and pursues compensation as part of his drive to prove that others are responsible for any misfortune he has. He is selfabsorbed and unwilling to look at the effect of his behaviour on his family. He consciously and determinedly refuses to change.
67 The Tribunal then notes the further report of Dr Reddan of 15 January 2003 in the following terms:
There have been some shifts in his presentation in that on this occasion [28 November 2002] he expressed more concern for others and a greater capacity for empathy. He also appeared to have insight into certain aspects of his belief patterns. However, he continues to exhibit paranoid traits and he defends against his low self esteem and feelings of inferiority by some narcissistic defences. He has long been reluctant to accept responsibility and he has been absorbed in selfpity (which he describes as a sense of victimisation) for many years. He has been rigid and inflexible in his thinking, but this has been challenged of recent times. His alcohol use has been selfdefeating.
68 At [52], the Tribunal notes that Dr McGuire generally agreed with this aspect of Dr Reddan's evidence.
69 At [53], the Tribunal notes that the attributes identified by Dr Reddan are said to affect Mr House's "soft skills" of "initiative, communication, team work, ability to problem solve, selfmanage, plan and learn", according to the evidence of an occupational therapist, Ms Rowe. The Tribunal notes that Dr Reddan and Dr McGuire had said that as Mr House had stopped drinking, he could no longer be diagnosed as having either alcohol abuse or alcohol dependence, "the relevant psychiatric diagnoses". The Tribunal notes Dr McGuire's evidence that Mr House's relationship, role as a carer and voluntary work was indicative of empathy, care and compassion and shows somebody who is improving. In this context, the Tribunal also notes the evidence of Dr Reddan that those factors reflect "an improvement in his mental state". As to the relationship between the physical effects of ceasing to drink, and disposition, moods and personality, the Tribunal notes Dr Reddan's comments as follows:
First of all there is the recovering effects physically on the brain and the improvement of overall competent functioning … [i]f you are not subjecting the brain to a drug that is actually - the central nervous system depresses. So, gradually the brain does recover. Very often it also leads to more stabilisation of moods. Often an improvement in motivation in particular. There is a general decrease in irritability and what we would call dysphoric or unhappy feelings. Alcohol tends to be a drug that over time makes people miserable. You usually find when people have abused alcohol, even if there's a binge pattern of drinking or its intermittent abuse, that their mood improves when they either sip or drink at low levels.
70 At [54], the Tribunal generally preferred the evidence of Dr Reddan and said this:
But Dr Reddan's evidence, and that of Dr McGuire, satisfies me that the personality traits earlier identified by Dr Reddan would be less marked now that Mr House is no longer drinking and is in a stable relationship. … I am then satisfied that by the time of the present application to the Authority, Mr House was no longer abusing alcohol which had the effect of considerably improving his capacity for care, compassion and empathy as well as leading to an improvement in his "soft skills".