Ground 1 (par 4.1(b) of grounds in the amended notice of appeal) - failure to afford natural justice (procedural fairness)
10 Mr Symons submits that the Tribunal failed in its obligation to accord him natural justice (procedural fairness) because it considered and dealt with the hypothesis that he had a "Depressive Disorder" when it had not raised that possibility so as to afford him an opportunity to make submissions and, if he thought fit, to lead further evidence, in relation to that diagnosis.
11 At [144] of its Reasons for Decision the Tribunal stated:
"That the Applicant suffers from a psychiatric condition is not at issue, although the diagnosis of the condition from which he suffers is at issue."
Mr Symons submits that this statement was erroneous because the Commission had argued that he did not suffer from a psychiatric condition of any kind. In response, the Commission draws attention to evidence given by Dr Robert David Lewin, Psychiatrist, who had been called by the Commission, that Mr Symons suffered from a "mixed personality disorder" rather than PTSD, (although, according to Dr Lewin, a conclusion to this effect could be only a qualified one in view of the lack of a clear history).
12 Mr Symons' attack does not depend on his submission that the Tribunal misstated the parties' positions in the respect mentioned. The thrust of his attack lies in what followed. After considering the question of PTSD against the definition contained in the Statement of Principles and concluding that Mr Symons failed to meet essential aspects of that definition so that the hypothesis of PTSD related to war service failed, the Tribunal went on to consider an alternative possible diagnosis of "Depressive Disorder". In this respect the Tribunal's Reasons for Decision contained the following heading and paragraphs:
"Depressive Disorder
147. It is now necessary to consider evidence in respect of alternative diagnoses that have been proposed. The real difficulty with the evidence of Dr Altman is his propensity to generalise rather than providing evidence specific to the case at issue. Doing the best we can with his evidence and the other psychiatric evidence before us, the Tribunal is reasonably satisfied that the Applicant has at an earlier point in time suffered from major depression, associated with his domestic and marital problems that commenced in 1974 and were exacerbated in 1983. Taking into account all the psychiatric evidence and the evidence of the Applicant, the Tribunal is reasonably satisfied that depressive disorder is now the correct diagnosis for the Applicant's claimed condition. The Tribunal is reasonably satisfied that he continues to suffer from a depressive disorder.
148. The parties did not make any submissions about an alternative diagnosis for the claimed condition, although the Tribunal made it apparent to the parties at the end of the first day of hearing that the differential diagnosis of the Applicant's psychiatric condition should be addressed in further evidence. Therefore, doing the best we can with the evidence now before us, the Tribunal will consider whether a reasonable hypothesis has been raised in respect of the relationship between the Applicant's depressive disorder and his operational service. There was no suggestion in the evidence that his later defence service was implicated causally." (my emphasis)
13 Later, the Tribunal concluded that the Statement of Principles for "Depressive Disorder" (Instrument No 65 of 1996) was not satisfied and that the hypothesis of Depressive Disorder was "no more than left open by the evidence".
14 Mr Symons does not dispute that the Tribunal was required to investigate, and make up its mind about, alternative diagnoses, that is, diagnoses alternative to PTSD, but he submits that the Tribunal erred by failing to give the parties an opportunity to make submissions, and, if appropriate, to gather and present further evidence, in relation to the alternative diagnosis with which it proposed to deal. Mr Symons relies on Repatriation Commission v McLean (1998) 27 AAR 136. In that case Davies J held that the Tribunal's decision was flawed because the Tribunal had failed to accord procedural fairness to the Commission. The Tribunal had not told counsel for the Commission that it was considering the application of a particular clause of the relevant Statement of Principles which had not been mentioned during the hearing by the doctor who had given evidence in support of the applicant's claim or by counsel for the applicant. Davies J said that if counsel for the Commission had been aware that the particular clause was to be relied upon, he would have wished to ask further questions of the doctor and may have wished to adduce evidence on the point. His Honour said (at 141):
"This is a plain case where the Tribunal based its decision on a point which was not raised as an issue in the proceedings before the Tribunal. The Commission therefore did not have a fair opportunity to bring forward the matters on which it would have wished to rely had it known that the point was an issue."
His Honour remitted the matter to the Tribunal for re-hearing because of the lack of procedural fairness.
15 Counsel for the Commission, on the other hand, submits that "just what psychiatric disorder the appellant suffered from was the subject of extensive evidence brought by both parties" and that it is not open to Mr Symons to argue now that the Tribunal was wrong to consider the diagnosis of Depressive Disorder. This submission requires that attention be given to the course of the hearing before the Tribunal.
16 The oral hearing took place on 3 June 1999 and 3 April 2000. The members of the Tribunal were Mrs M T Lewis, Senior Member and Dr P D Lynch, Member. On the first day there were reports from three doctors in evidence before the Tribunal relating to Mr Symons' claim of PTSD. First, there were two reports, dated 17 March and 20 October 1997, of Dr Graham Mark Altman, Consultant Psychiatrist, Mr Symons' treating psychiatrist, which were among the documents lodged with the Tribunal by the Commission pursuant to s 37 of the Administrative Appeals Tribunal Act 1975 (Cth). The final paragraph of Dr Altman's first report was as follows:
"In summary, in my opinion as a result of his Vietnam experience Mr Symons suffers from a severe chronic Post-traumatic Stress Disorder with an associated Major Depression and Alcohol Dependence." (my emphasis)
Dr Altman's second report stated that Mr Symons continued to have severe symptoms of PTSD.
17 Secondly, there was a report dated, 28 May 1998, of Dr Lewin, Forensic Psychiatrist, to the Department of Veterans' Affairs, which concluded that it was likely that Mr Symons had a "mixed Personality Disorder" and "a trait of obsessionality" but that he was not suffering any current psychiatric illness, that he (Dr Lewin) did not find evidence of an anxiety disorder or depressive condition and that there was no sign of morbid mental illness.
18 Thirdly, the Tribunal had before it a report, dated 5 March 1999, by Dr Malcolm Dent, Consultant Psychiatrist, to Mr Symons' solicitors, which stated:
"I don't believe he now suffers from Major Depression, although I believe there is a significant depression evident.
His description of symptoms given to me is in accord with diagnosis of Dysthymia, but again if that is argued then I would settle for the diagnosis of Depressive Disorder (NOS [Not Otherwise Specified]), which exists for the same purpose in the DSM IV at point 311.
We are looking at an illness that has got a depressed mood for most of the day for more days than not for over 2 years, where there are the presence of low energy or fatigue, low self-esteem, inertia and suicidal feelings at times then this equates with a significant Depression and not one that is based on effects of alcohol, but rather another contributory cause to the reason why he abuses alcohol; he's described how alcohol makes it worse.
On reflection, I think the Depressive Disorder (NOS) is probably also suitable and appropriate in diagnoses, by way of category." (my emphasis)
The use of capital letters in the expression "Major Depression" suggests a recognised diagnosis.
19 At the beginning of the first day of the hearing before the Tribunal, counsel for Mr Symons stated that his client's claim had been initially presented as one of PTSD but that Dr Dent had offered a "more generalised diagnosis of anxiety disorder not otherwise specified". There followed the following exchanges between the presiding Member and counsel for Mr Symons:
"MRS LEWIS: Well, that would go to the SOP [Statement of Principles] generalising anxiety disorder, which is numbers 275 and 276 1995.
MR VINCENT: What I would submit is that the diagnosis of anxiety disorder not otherwise specified actually does not fall within the generalised anxiety disorder SOP, but this basis that the generalised anxiety disorder SOP is given an ICD code of 300.02 and the ICD code for anxiety not otherwise specified is 300.00. Thus, the issue of the SOP doesn't arise."
20 Towards the end of the first day, the following exchanges took place between counsel for Mr Symons and the presiding Member:
"MRS LEWIS: ĽAs I see the psychiatric question at the moment, we have Dr Altman saying he has PTSD and he's the treating psychiatrist. We are not planning to hear from him. We have Dr Dent saying that he has a generalised anxiety condition for which there is no SOP and we are not planning to hear from him.
MR VINCENT: He also of course talks of alcohol abuse and depression.
MRS LEWIS: Yes. The depression comes in under his generalised anxiety diagnosis which, when you look at DSM4, has got a depression component to it.
MR VINCENT: Yes but I would submit that he has also separately identified it as depressive disorder which does come within the depressive disorder Statement of Principles. There are two separate arms to it.
MRS LEWIS: Thank you. Then we have Dr Lewin who says he doesn't suffer from anything at all, no psychiatric condition. Then we have peppered through the documents, including the service documents that have just been provided, evidence of frequent psychiatric consultation and treatment over quite an extended period. I don't want to determine what you do but there's a very diverse set of alternative[s] there that at the end of the day the Tribunal is going to have to pull together. I just hope you believe that at the end of the day we are going to have the best evidence to be able to pull them together.
MR VINCENT: I have no doubt that you won't have the best evidence but I am able to indicate that the reason Dr Dent or indeed any until Dr Benanzio was arranged that the applicant was not calling any medical witnesses was because there was no funding to permit same. That policy decision in respect of this matter was changed within the last week and Dr Benanzio was able to be obtained at short notice.
I have no instructions on this, but it may well be that Dr Dent can be called or Dr Altman now and I think if they can it would certainly cut down the scattergun problem." (my emphasis)
21 In the second passage attributed to Mr Vincent, counsel for Mr Symons, he was relying on the alternative diagnosis by Dr Dent of Depressive Disorder within the Depressive Disorder Statement of Principles. Counsel for Mr Symons on the present appeal, again Mr Vincent, submits that the entire passage set out above was merely "exploratory" in nature and that it was the evidence of Dr Altman called by Mr Symons and Dr Lewin called by the Commission on the resumed hearing on 3 April 2000 that mattered.
22 In my opinion, in the passage set out above counsel for Mr Symons squarely raised both possible diagnoses, PTSD and Depressive Disorder, and the presiding Member made it clear that the Tribunal would consider both and invited counsel for Mr Symons to lead further evidence as to the correct diagnosis. Accordingly, what the Tribunal said in the first sentence of par 148 of its Reasons for Decision (emphasised by me in [12] above) was in substance correct.
23 On the resumed hearing on 3 April 2000, Dr Altman and Dr Lewin testified. After the evidence on that date concluded, there were exchanges between Senior Member Lewis and both Mr Wright who appeared for the Commission on that occasion and Mr Vincent who again appeared for Mr Symons. The exchanges included the following:
"MS LEWIS: ĽI think the question, particularly if the applicant doesn't have a GARP5 assessment is, have we got enough evidence to assess. You don't need to answer that now, you may need to consider that question.
MR VINCENT: Yes, I think I can indicate the view though which is I think there is probably not sufficient to assess on the psychiatric component in that all we have, of all the various people that have seen the applicant and the only person to offer a GARP 5 assessment is Dr Dent and that of course is under a slightly different diagnosis which may not satisfy you in some way and I think it is probably appropriate that it be remitted. That's what I have indicated to Mr Wright today. There is evidence, but there is a relative course and I think it probably appropriate to remit. You are…
MS LEWIS: You see if you remit you are able to rectify the paucity of the evidence before, if you do it quickly, before the assessment is made and then of course it can be appealed if necessary. If you ask the Tribunal to make a decision on poor evidence then you've got nowhere to go.
MR VINCENT: That's right and Dr Dent's report is nearly 13 months old in any eventĽ." (my emphasis)
24 Mr Symons submits that this passage is irrelevant because it related only to the rate of pension, not to the question of the correct diagnosis. I do not agree. While it is related to the assessment of a rate, in the passage emphasised by me counsel for Mr Symons was referring to Dr Dent's alternative diagnosis of Depressive Disorder, albeit as a diagnosis which might not satisfy the Tribunal.
25 Following the hearing, written submissions were made on behalf of Mr Symons on or about 12 July 2000 and written submissions in response were made on behalf of the Commission on or about 24 October 2000. The former contained the following:
"It is submitted that the Applicant should be determined by the Tribunal to be found to be suffering from a psychiatric disorder, for which the appropriate diagnosis is Post Traumatic Stress Disorder with associated Major Depression and Alcohol Dependence, as diagnosed by Dr Altman."
Again, the capitalised initial letters suggest a recognised diagnosis.
26 The Commission now submits as follows:
"In circumstances where, as apparently conceded by the Appellant before the Tribunal, the evidence concerning PTSD was weak, and where his own witnesses had referred to Depressive Disorder, it was entirely appropriate for the Tribunal to consider the latter diagnosis."
27 I accept this submission. While Dr Altman used the expression "associated Major Depression" (my emphasis), this was sufficient, in the context of the exchanges between the Tribunal and counsel, to alert counsel to the likelihood that the Tribunal would consider the alternative diagnosis of "Depressive Disorder". In any event, Dr Dent in his report, and counsel for Mr Symons on the first day of the hearing, clearly referred to "Depressive Disorder" as an independent diagnosis.
28 I do not accept Mr Symons' submission that the statement made by his counsel on that occasion that he suffered from a "Depressive Disorder" within the Depressive Disorder Statement of Principles somehow lost its significance for present purposes by reason of anything that happened at the resumed hearing on 3 April 2000. On the contrary, in my view the events on the latter occasion confirmed that the alternative diagnosis of Depressive Disorder was an issue in the case.
29 In my view the hypothesis of Depressive Disorder was sufficiently clearly articulated to alert Mr Symons to the fact that the Tribunal proposed to deal with it on the evidence that was before it.
30 For the above reasons, the first ground of appeals fails.