4.2.3 Did the AAT consider and make findings upon alcohol consumption as a separate contributing factor?
43 Contrary to the Commission's submissions, I consider that the AAT did make findings which comprehensively considered and rejected the case put by the Commission, and by accepting Mr Sharp's characterisation of his alcohol dependence, inferentially rejected any issue raised by the material that alcohol consumption, even if not a diagnosed condition, was a separate contributing factor.
44 First, at [62] the AAT accurately described the Commission's submission "that the applicant clearly had a non-accepted [i.e. non-defence] disability of alcohol dependence, or as it is currently described, substance abuse disorder." In this regard the AAT agreed that there were "multiple references to [Mr Sharp's] inappropriate consumption of alcohol" in the evidence, referring back to medical notes as early as 1990 recording that the applicant had well-established episodic excessive alcohol consumption. However the AAT found that Mr Sharp's consumption history appeared to have fluctuated significantly over time, including with periods of abstinence, and referred to evidence supporting the view that Mr Sharp used alcohol "to self medicate" and "as a coping strategy". Thus at [62], the AAT found that:
As early as 1990 Dr Freed, psychiatrist, noted, in addition to the anxiety condition, that the applicant had well established "episodic" excessive alcohol consumption, which, even from that time, tends to support the applicant's contention that he used alcohol as a coping mechanism, rather than a separate condition. In June 2004 the applicant was treated as an in-patient for depression with suicidal ideation and excessive alcohol ingestion. Another admission the following year also noted alcohol abuse. In 2008 however, he was said to be drinking only moderately, and this had followed his return to work in a responsible position. An analysis of the records of Dr Thomson's practice from 2004 show multiple entries in relation to alcohol consumption. The consumption history was not consistent, and appears to have significantly fluctuated over time, including with periods of complete abstinence. The applicant's psychologist, Ms Gianakis recorded in 2012 that the applicant had a dependency on alcohol, using it to self-medicate, and, in 2013 described a reduction in his consumption but that it remained 'problematic'. She noted that he had periods of only minimal drinking and again referred to alcohol consumption as a coping strategy. In early March 2014 Dr Thomson recorded that the applicant was endeavouring to reduce to 2 beers a day, and by mid-March had achieved that goal. In early May 2014 he was under further stress and was drinking heavily again. The applicant's current treating psychiatrist, Dr Dunda recorded, amongst the applicant's current symptoms, a history of relationship breakdowns and "alcohol consumption".
45 Secondly, at [63] of its reasons the AAT, while referring to Dr Chase's evidence that in his opinion Mr Sharp was not working because of his alcohol abuse in addition to his anxiety disorder, pointed out that Dr Chase nonetheless conceded that Mr Sharp may have self-medicated with alcohol. Furthermore, while Dr Chase observed with respect to alcohol that there were multiple hospital admissions for "detox", the AAT found that "[t]his does not accord with the hospital admissions, all of which refer to the Applicant's anxiety state, with only subsidiary references, if at all to alcohol." (at [63] (emphasis added)). Moreover the AAT considered that Dr Chase's view that Mr Sharp failed to take any responsibility for workplace issues was inconsistent with the evidence of Mr Sharp's immediate supervisor over some years and who the AAT therefore considered was in a better position to assess the applicant's contribution to the workplace.
46 Thirdly, the AAT considered Dr Smith's expert evidence. For various reasons which the AAT spelt out carefully in its reasons, it did not accept his evidence. Thus while Dr Smith on the basis of a single appointment (as the AAT pointed out) considered that Mr Sharp suffered from three separate conditions, including substance use disorder which Dr Smith considered was an associated substantial contributor to Mr Sharp's generalised anxiety disorder, the AAT found that "[t]here was no evidence however that alcohol had played any part in bringing about the Applicant's generalized anxiety disorder, and the only evidence in that context was that the Applicant self-medicated as a coping mechanism." (at [64]). The AAT also referred to the fact that Dr Smith had conceded that self-medication with alcohol was a complication of some of the suite of anxiety disorders referred to in DSM III (at [64]) -a concession which I note was consistent with the case put by Mr Sharp. Furthermore, while Dr Smith considered that the applicant's use of Frisium could be responsible for his excessive sweating, the AAT found that that symptom of his anxiety had predated the prescription of Frisium by years (at [65]).
47 In the fourth place, and importantly to the Commission's case, at [65] the AAT found that:
While [Dr Smith] considered the applicant fulfils the diagnostic criteria for alcohol dependence" there was, to me, insufficient indication, on what basis he formed that view, especially as the applicant's long-standing GP, Dr Thompson, did not make such a diagnosis, notwithstanding the applicant's history of excessive alcohol consumption from time to time as a means of self-medication.
48 Furthermore at [67], as I explain below, the AAT found (in line with its earlier finding at [55]) that Dr Smith's view that Mr Sharp's alcohol use disorder was the main factor causing him to be impaired at work was not supported by Mr Sharp's history. The AAT also found at [68] that Dr Smith's disagreement with Dr Thomson's assessment of the applicant's work ability did not take into account the ongoing deterioration of Mr Sharp's condition over many years, with Mr Sharp ultimately accepting his doctor's long-standing advice to give up work.
49 Finally at [69] the AAT did not accept Dr Smith's view that it was unclear why Mr Sharp had relinquished work when "Dr Thomson's records and the applicant's evidence are clear: he simply, after years of struggle, could not continue, and he finally accepted her advice to leave work."; and considered that Dr Smith's view that anxiety improves over time and does not deteriorate "appears to be at odds with the applicant's documented increasing symptomology over the years" (at [69]).
50 In short, it is apparent that in a careful and reasoned manner, the AAT rejected Dr Smith's diagnosis that Mr Sharp suffered from a separate substance use disorder from his anxiety disorder on the basis that that diagnosis was not consistent with the evidence of the applicant's long-standing GP, Dr Smith had had only one appointment on the basis of which to assess Mr Sharp, some of Dr Smith's views were based upon assumptions which were not correct, and his views were not supported by the applicant's history of job difficulties and job loss. Rather the AAT accepted Mr Sharp's case that he self medicated with alcohol effectively as a complication, or as a result, of his anxiety disorder, that case being consistent with the evidence of Mr Sharp's GP, Dr Thomson, and with other evidence.
51 The Commission submitted that "the Tribunal (at least), [at [65] of its reasons] expressed doubt as to the basis for Dr Smith's diagnosis of 'alcohol dependence'. It is not clear from the paragraph whether the Tribunal was, in fact, rejecting Dr Smith's evidence as to diagnosis." In my view, however, it is plain that at [65] of its reasons the AAT found that it was not satisfied as to the correctness of Dr Smith's diagnosis in circumstances where the basis for the diagnosis was not sufficiently indicated, meaning that the basis was not sufficiently disclosed by Dr Smith, and it gave that lack of a demonstrated basis for the opinion particular weight, especially in circumstances where Mr Sharp's long-standing GP had not made that diagnosis. So understood, it is apparent that the AAT did no more than properly undertake its task of weighing up contrary evidence and reach a reasoned view as to which evidence on this issue to accept. It is not the case that the AAT merely expressed doubt about Dr Smith's evidence without resolving the issue. It is also the case as earlier explained that the AAT had other reasons as to why it did not accept Dr Smith's evidence.
52 The Commission also submitted that:
In any event, there is nothing in s 23(1)(c) and s 24(1)(c) of the VE Act that confined the operation of the 'alone' test to factors to diagnosed medical conditions. Accordingly, even if the Tribunal did intend to reject Dr Smith's evidence as to diagnosis, it was still required to consider whether Mr Sharp's use of alcohol was a factor that contributed to preventing him from continuing to engage in remunerative work.
53 Furthermore, while the Commission accepted that its case that Mr Sharp's alcohol consumption was a separate non-defence factor relevantly rested upon Dr Smith's evidence that his alcohol abuse was a separate and discrete disorder, the Commission nonetheless submitted that the AAT was under an obligation to consider all of the material before it and not to restrict its case to that articulated by the Commission (relying upon Grant v Repatriation Commission [1999] FCA 1629; (1999) 57 ALD 1 (Grant) at [17]-[18]). That said, the task of the AAT is not open-ended, notwithstanding that its function is inquisitorial. The AAT must comply with the natural justice hearing rule and could not therefore decide a point adversely against a party without affording that party the opportunity to respond. As such, as the Full Court held in Summers at [98], "[t]he Tribunal had an obligation to follow-up and consider any case which might reasonably appear from the materials…" (citing Grant) (emphasis added).
54 In this case, fairly read it is apparent that the AAT for the reasons earlier set out accepted Mr Sharp's case that the alcohol abuse was the means by which Mr Sharp self-medicated or coped with his anxiety disorder. This explains the finding at [71] that Mr Sharp's incapacity from the anxiety disorder was the only factor preventing him from continuing to undertake work in June 2014. In conceptual terms, a symptom, complication or consequence of a disorder cannot constitute a separate factor from the disorder itself for the purposes of determining what factor or factors are operating to prevent an applicant from working. The AAT implicitly therefore rejected any proposition arising from the materials that, even if the alcohol abuse did not warrant a separate diagnosis, it was nonetheless a separate factor preventing Mr Sharp from continuing to undertake work. So understood, no error in the AAT's application of the 'alone test' for the purposes of s 24(1)(c) of the Act has been established.