THE D PRESIDENT: That's right. Diagnosis is a pre-step step. That's right, isn't it?
MR STONER: Diagnosis is - just excuse me a moment.
THE D PRESIDENT: I'm sorry, I'm going to drive you fellows [mad] this week but ---
MR STONER: No, we're only too happy to help you, Deputy President, and in fact, we've had some discussions amongst ourselves that we, perhaps, should be a little bit fulsome in the first few cases to help you. So there's no problem there. But the process is this: it's well established now that first of all, the Tribunal must be reasonably satisfied about diagnosis. Once you have formed a view about diagnosis, and only then, can you turn your attention to the issue of causation. Once you turn your attention to the issue of causation, the time for diagnosing is over...
54 In the early part of this exchange, Mr Stoner and the Deputy President seem to have been ad idem that the concession was limited to pre-Deledio diagnosis and left the four steps of Deledio untouched.
55 In similar vein, not long afterwards, the following exchanges occurred:
THE D.PRESIDENT: That is, you do the diagnosis bit and whatever level you stop at the diagnosis, then you go through the stages of Deledio?
MR STONER: In relation to that diagnosis or diagnoses.
THE D.PRESIDENT: That diagnosis, yes.
…
THE D.PRESIDENT: Now, do you accept - well, perhaps I should give you some time to think about it. I don't want you to think that I've brow beaten you into this, but do you accept the diagnosis of PTSD?
MR STONER: Yes. Yes, I accept what you say and you're not browbeating me; let me put that on the record.
…
MR STONER: I've been around the traps long enough to know when there's going to be a finding made against me anyway, too, but I'm happy to put the Commission's case on whether or not the condition of PTSD is related to service through the Statement of Principles having regard to Deledio and the other cases, and I also put our case on the basis that there is no diagnosis present of an alcohol disorder.
…
THE D.PRESIDENT: So no causation on PTSD and then no diagnosis of alcohol abuse. Is that your case in a nutshell?
MR STONER: Yes.
THE D.PRESIDENT: All right. So no causation ---
MR STONER: And we are not saying that the events didn't happen; we're saying the events are not sufficient. Not trying to prove beyond reasonable doubt that a bullet wasn't fired or that there wasn't an angry guard on the gate. We're saying that when one has a look at the whole of the evidence, those events are not sufficient and the ---and I just ask you to read our facts and contentions ---
THE D. PRESIDENT:Yes, I ---
MR STONER: --- in the light of what I've just said.
[our emphasis]
56 Mr Stoner then referred the Tribunal to paragraph 25 of the Commission's "Facts and Contentions" document. That paragraph addressed factor 5(a) of the SoP for PTSD (see [16] above). Paragraph 25 set out the SoP definition of "experiencing a severe stressor". Succeeding paragraphs addressed the question of "experiencing a severe stressor". So did Mr Stoner's oral submissions to the Tribunal.
57 Although the initial exchanges set out above may be ambiguous, the later ones and Mr Stoner's references to the notion of "experiencing a severe stressor" in his written submissions to which he referred make it clear that the only issue that was by now being agitated by the Commission was whether the two incidents in which Mr Warren was involved in Vietnam (to which we referred at [29] above) constituted "severe stressors". That issue arose under cl 5(a) of the SoP for PTSD. It was not suggested that the issue related to cl 2(b)(A). Consistently with the position thus taken by the Commission through its counsel, the Commission's submissions were directed to the question whether in the light of Mr Warren's being an experienced soldier, the Tribunal should accept that the two incidents satisfied the characterisation of "severe stressor" in cl 5(a) of the SoP.
58 At T94, there is recorded an exchange that is to be understood in the light of paragraph 30 of the Commission's "Facts and Contentions" document. That paragraph asserted that it was not reasonable, objectively, to consider that an experienced career soldier placed as Mr Warren was, should have perceived himself to be under threat of serious injury or death (a concept relevant to both cl 2(b)(A)(i) and cl 5(a) of the SoP). The exchange was as follows:
THE D.PRESIDENT: So where do you say, in the Deledio continuum, that that kicks in, your paragraph 30? On the material.
MR STONER: You'd have to put that - to be fair, you'd have to put that in stage 4.
THE D.PRESIDENT: Yes. I mean, on the material, there is a hypothesis, so that's tick stage 1. There is a statement of principle, so that's tick to stage 2 - step 2. It is ---
MR STONER: It's really in 3 and 4, because what we're saying, effectively, is that the statement of principles doesn't uphold the hypothesis. Now, there is material, though, that says that - the material says that the hypothesis is upheld by the statement of principles, and Mr Honchin has taken you to that. So I would have to concede that on the particular facts in this case - unless you are satisfied beyond reasonable doubt, you would have to find in favour of Mr Warren. You know, essentially, we make the same submissions about each of the events.
59 The "events" referred to were, again, the two incidents to which we referred at [29] above.
60 In the passage quoted above, Mr Stoner began by acquiescing to the Deputy President's statement that steps 1 and 2 of Deledio were satisfied and that only steps 3 and 4 required attention. He then conceded that there was material to which Mr Honchin had taken the Deputy President, showing that the pre-Deledio diagnosis was "upheld" by the SoP. He can only have meant upheld by cl 2(b) of the SoP. In the result, it was only step 4 that remained to be considered. From that point on, counsel's submissions related exclusively to the question whether the two incidents in Vietnam constituted "severe stressors" within cl 5(a) of the SoP for PTSD.
61 The only qualification that this last statement calls for, one not related to PTSD, is that the Deputy President asked Mr Stoner whether he (the Deputy President) could not be satisfied of a diagnosis of AD, to which Mr Stoner replied that Dr Rogers' diagnosis of AD in 2002 to 2004 was "unchallenged" and that Dr Gillman had diagnosed AD in 1997, but that Mr Warren had given evidence contrary to that diagnosis.
62 The Commission contends that Mr Warren did not fulfil the criteria for a diagnosis of PTSD according to cl 2(b) of the SoP for PTSD and that the medical evidence did not substantiate such a diagnosis. Clause 2(b)(C) requires three or more criteria to be satisfied. Clause 2(b)(D) requires two or more symptoms to be present. The Commission submits that these requirements were not satisfied.
63 In effect the Commission argues that because it reserved its rights as to causation and causation required an analysis by reference to all of the criteria in the relevant SoP, the Tribunal was also obliged to consider cl 2(b) of the SoP's application to diagnosis.
64 As the primary judge observed, the SoP provides a diagnostic basis for 'particular kind[s] of injury, or disease or death' (s 196B(2)) for the purposes of entitlement to pension under the VE Act. The SoP for PTSD is derived from DSM-IV but it is an independent source of criteria having effect under the VE Act. Clause 2(b) makes that clear by providing that, for the purposes of the SoP, PTSD means a psychiatric condition meeting the description that follows (derived from DSM-IV).
65 Did the concession made by the Commission extend to an admission that Mr Warren suffered from PTSD meeting the description in the SoP for PTSD? We think that the passages from the transcript which we have set out at length above demonstrate that it did. Indeed, the question may be asked, what would be the purpose in the circumstances of admitting the diagnosis of PTSD otherwise?
66 The Commission did not argue before the Tribunal that, despite its concession, Mr Warren did not relevantly suffer from PTSD for the purposes of the SoP for PTSD. Why would the Commission have failed to draw to the Tribunal's attention the need to consider the criteria in cl 2(b) of the SoP and, in particular, cll 2(b)(C) and 2(b)(D), if they remained a relevant consideration?
67 It was reasonable for the Tribunal to understand that the concession, made in a hearing to determine the issue of an entitlement under the VE Act, extended to the factors that cl 2(b) of the SoP stated must as a minimum exist for the purposes of that determination.
68 We conclude that the concession made and accepted by the Tribunal was that, for the purposes of the SoP for PTSD, Mr Warren suffered from PTSD characterised and defined by the factors referred to in cl 2(b) of that SoP. There is some overlap between cll 2(b)(A) and 5(a). The "severe stressor" connection criterion (the connection between the PTSD and the war service) described in cl 5(a) remained to be satisfied, and to the extent that it is satisfied by the satisfaction of cl 2(b)(A), so be it.
69 The effect of the express concessions set out at [55] and [58] above and the course of the Commission's submissions before the Tribunal (including the failure to make submissions directed to cl 2(b)) was that Mr Warren was entitled to succeed unless the Commission was satisfied beyond reasonable doubt that cl 5(a) of the SoP for the PTSD was not satisfied.
70 There was no reason for the Tribunal to assume that any part of cl 2 of the SoP for PTSD needed further consideration. Only causation, in the sense of the connection between disease and service, remained in issue. Any one of the three factors specified in cl 5 of the SoP had to be present before it could be said that a reasonable hypothesis had been raised connecting PTSD with the veteran's service. That raised the relevance of the events experienced in Vietnam, as referred to in the transcript. The Tribunal dealt with the requirements of cl 5 and found that cl 5(a) was satisfied (at [17]).
71 On the appeal there was no dispute as to the true meaning of the concession concerning AD. That concession was that if the Tribunal should determine that Mr Warren was suffering from AD and should also determine the PTSD issue in his favour, it would be open to the Tribunal to find that cl 5(a) of the SoP relating to AD was satisfied.