Hill and Repatriation Commission [2008] AATA 12 (8 January 2008)

Last Updated: 8 January 2008

Administrative Appeals Tribunal

DECISION AND REASONS FOR DECISION [2008] AATA 12

ADMINISTRATIVE APPEALS TRIBUNAL )

) No N2006/561

VETERAN'S AFFAIRS DIVISION		)
	Re		MAUREEN HILL

Applicant

And

REPATRIATION COMMISSION

Respondent

DECISION

Tribunal

Mrs Josephine Kelly, Senior Member Dr MEC Thorpe, Member

Date 8 January 2008

Place Sydney

Decision

The decision of the Veteran’s Review Board dated 13 April 2006 is set-aside and substituted therefor is the decision that Dr Walker’s death was war-caused. It follows that a war widow’s pension is payable to Mrs Hill.

....................[sgd]........................
Presiding Member
Senior Member Mrs Josephine Kelly

CATCHWORDS

VETERAN’S AFFAIRS – war widow’s pension – whether war veteran’s death was war caused – kind of death – no relevant statement of principles – two kinds of death found – renal failure and heart failure – material pointing to smoking habit being war-caused - hypothesis raised that smoking caused Ischaemic Heart Disease which contributed to death – hypothesis not disproved beyond reasonable doubt – held applicant’s husband’s death was war-caused – reviewable decision set aside – war widows pension payable

Veterans’ Entitlements Act 1986 ss 8, 120, 120A and 196B

Statement of Principles concerning Ischaemic Heart Disease No 53 of 2003

Bull v Repatriation Commission [2001] FCA 1832; (2001) 34 AAR 326

Bushell v Repatriation Commission [1992] HCA 47; (1992) 175 CLR 408

Byrnes v Repatriation Commission [1993] HCA 51; (1993) 177 CLR 564

Doolette v Repatriation Commission (1990) 21 ALD 489

East v Repatriation Commission [1987] FCA 242; (1987) 16 FCR 517

Repatriation Commission v Hancock [2003] FCA 711; (2003) 37 AAR 383

Repatriation Commission v Deledio [1998] FCA 391; (1998) 83 FCR 82

Repatriation Commission v Codd [2007] FCA 877; (2007) 95 ALD 619

Repatriation Commission v Law [1980] FCA 92; (1980) 47 FLR 57

Repatriation Commission v Towns [2003] FCA 1262; (2003) 38 AAR 77

REASONS FOR DECISION

8 January 2008	Senior Member, Mrs Josephine Kelly Member, Dr MEC Thorpe
INTRODUCTION

1. In 1955 Mrs Maureen Hill met Dr John Walker, who had served in the Royal Australian Air Force during World War II. She was his patient for many years. In 1987 she moved in with him, and in 1993 they married. They separated in 1997, but were never divorced. Dr Walker died on 21 June 2003. Mrs Hill seeks the review of a decision that Dr Walker’s death was not war-caused within the meaning of s 8 of the Veterans’ Entitlements Act 1986 (“the Act”). If she is successful she will be entitled to receive a war-widow’s pension.
2. In simple terms the argument put on Mrs Hill’s behalf was that Dr Walker developed a heavy smoking habit during and as a result of his war service which caused Ischaemic Heart Disease (“IHD”), which in turn caused or contributed to his death. IHD is an inadequate supply of blood to the heart muscle.

BACKGROUND

3. It was not disputed that Dr Walker had operational service during the period 9 October 1942 to 8 December 1945.
4. Death will be taken to be war-caused, pursuant to s 8 (1) (b) of the Act, if:

The death of the veteran arose out of, or was attributable to, any eligible war service rendered by the veteran; ...

5. This is a claim relating to “operational service” rendered on or after 1 June 1994. The death will be war-caused unless the Tribunal is satisfied to the contrary beyond reasonable doubt (see ss 120(1), 120(3) and 120A of the Act).
6. Justice Selway held in Repatriation Commission v Hancock (2003) 37 AAR 383; [2003] FCA 711, that two preconditions other than causation must be dealt with before step one of the methodology set out in Repatriation Commission v Deledio [1998] FCA 391; (1998) 83 FCR 82, is followed. There is no dispute in this case that Dr Walker was a veteran who has died and Mrs Hill is his widow.
7. The next pre-condition is to identify, on the balance of probabilities, the “kind of death” the veteran suffered “in order to ascertain whether a SoP [statement of principles] applies”. There can be multiple medical conditions that contribute to a particular death in the sense of a medical cause that expedited the death. If a medical condition contributed to the death and is relevantly related to service then that is sufficient to establish entitlement to pension (see Hancock at [8]-[9]).

THE ISSUES

8. At the hearing, it was apparent that counsel for the parties had different views about the nature of the case to be put on behalf of Mrs Hill.
9. The Statement of Facts and Contentions filed on behalf of Mrs Hill contended that Dr Walker developed a smoking habit during, and as a result of, his service which satisfied factor 5(f) of the Statement of Principles (“SoP”) for IHD (No. 53 of 2003 as amended by No. 9 of 2004), and proceeded to contend that IHD “caused or materially contributed” to Dr Walker’s death. While noting that the Repatriation Commission’s contention was that “renal insufficiency and dementia is the appropriate kind of death suffered by the veteran” it stated that “The applicant makes no contentions in this regard” and “reserves the right to alter or amend this” document.
10. Those statements led Mr Purcell, who appeared for the Repatriation Commission, to form the view that the argument to be put for Mrs Hill would be that the “kind of death” was IHD, that there is a SoP for IHD, and the SoP was satisfied. However, Mr Vincent, who appeared for Mrs Hill, did not rely on that argument to any significant extent. He put the case more broadly in terms of the language of s 8(1)(b) of the Act, as also stated in the SOFACS; that is that Dr Walker’s death arose out of, or was attributable to his eligible war-service. The case proceeded on this basis.
11. We understood Mr Vincent to argue during oral submissions that it is only relevant to consider “kind of death” (s 120A(4)) if there is a relevant SoP in force. Therefore, where there is no SoP, s 8 applies; s 120A does not apply, and how the Tribunal describes death is at large. He seemed to retreat from this in subsequent written submissions.
    
12. As we understand Mr Vincent's oral submission, there were two possible “deaths” (to use neutral language) that we could find. The first was heart failure, and the second was renal failure (or renal failure contributed to by heart failure contributed to by IHD). In either case, as there is no SoP in force for either "death", and no declaration made that one is not to be made, how the Tribunal describes the “death” is at large, and we should follow the methodology set out in Bushell v Repatriation Commission [1992] HCA 47; (1992) 175 CLR 408 and Byrnes v Repatriation Commission [1993] HCA 51; (1993) 177 CLR 564 to determine whether there is a reasonable hypothesis linking the “death” and service.
13. Mr Purcell relied on Justice Selway’s discussion in Hancock, summarised above, and argued that Mr Vincent’s submission “was putting the cart before the horse”, and that we could not look at the contribution to death outside the notion of “kind of death”. We understood him to argue that, for Mrs Hill to succeed, we have to find that IHD is a kind of death.
14. In our view, s 120A(4) of the Act makes it quite clear, as Justice Selway stated, that it is necessary to consider the “kind of death” in order to determine whether a SoP applies. If there is no relevant SoP, we accept Mr Vincent’s submission to the extent that we then proceed in accordance with Bushell and Byrne (see Hancock at [10], Bull v Repatriation Commission [2001] FCA 1832 at [14], Repatriation Commission v Towns [2003] FCA 1262; (2003) 38 AAR 77. The latter was a case dealing with a death claim where there was no relevant SoP).
15. The case of East v Repatriation Commission [1987] FCA 242; (1987) 16 FCR 517 (“East”) is also relevant, as it was concerned with a death claim before the SoP regime came into existence.
16. A further issue emerged when the parties were asked after the hearing to address the effect of the case of Repatriation Commission v Codd [2007] FCA 877; (2007) 95 ALD 619. Mr Purcell argued that Codd required in this case that the veteran's death must be found to have been a war-caused disease. Therefore, as the medical evidence was that "heart failure" was a condition and not a "disease", it cannot be regarded as a "contributing or underlying cause of the veteran's death" within the context of the Act as discussed by Gordon J in Codd.
17. We do not consider that the reasoning in Codd has that consequence. As we understand that decision, it is authority for the proposition that "kind of death" is the medical causation of death, "including the contributing or underlying medical cause of death". In our opinion, heart failure may be a "kind of death" within the meaning of s 120A of the Act, as may renal failure.

What was the “kind of death”?

18. On Dr Walker’s Death Certificate, next to the “Cause of death and Duration of last illness” the following appears:

(I) (a) Delirium secondary to acute on chronic renal failure-end stage, 1 year

(b) Heart failure, 2 weeks

(II) Progressive dementia, 2 years

19. We had expert reports and oral evidence on the question of what caused Dr Walker’s death, from Dr Butler, consultant physician with a major interest in clinical cardiology, and Professor O’Rourke, cardiologist.
20. The following was not in dispute. Dr Walker developed an acute focal necrotising glomerulonephritis, a disease of the kidney, in 1993. Scarring was apparent in 1994 without active inflammation. Around that time Dr Walker also developed hypertension as a consequence of the glomerulonephritis. In February 1996 his renal function was mildly impaired, and in November 2000 there was moderate renal dysfunction. Renal function deteriorated markedly in 2002.
21. In 1999 Dr Walker had a small myocardial infarct. He had a coronary angiogram which showed triple vessel disease necessitating coronary artery bypass surgery. That is, he had IHD. The surgery was undertaken, with apparently good results. Management of Dr Walker’s hypertension was apparently difficult at that time.
22. Dr Walker suffered an episode of cardiac failure in June 2002 associated with chest infection and deterioration of renal function.
23. Memory problems were noted in about 2000. In August 2002 Dr Walker was referred to a geriatrician who felt that he was suffering from an Alzheimer’s type of dementia.
24. Dr Walker was admitted to The Hills Private Hospital on 12 June 2003 because of breathing difficulties. There were conflicting accounts as to the presence or absence of chest pain in association with the breathing difficulties. He was found to have a slow heart rate and cardiac pacing was considered briefly, but his heart rate rose with changes to medication.
25. Professor O’Rourke attributed Dr Walker’s heart failure at the time of death to glomerulonephritis which caused hypertension and renal failure. He maintained that there was no evidence of IHD being a factor in his death. Professor O’Rourke acknowledged that Dr Walker had IHD, with clinical onset in September 1999, but said that he had no symptoms attributable to coronary artery disease following his successful coronary artery by-pass graft in 1999. That is, following the successful surgery in 1999, Dr Walker had made a complete recovery from IHD, and did not suffer from that condition at the time of his death.
26. The cardiac catheterisation report dated 14 October 1999 reported mild left ventricular dysfunction. Professor O’Rourke considered that the coronary angiography prior to surgery showed normal left ventricular contractility and triple vessel artery disease of a severe degree.
27. Dr Butler agreed that Dr Walker’s hypertension was secondary to his renal disease and that control of the hypertension may have been inadequate, but that it was very likely that the effects of the previous myocardial infarct played a contributing role in the heart failure. He reported that an echocardiogram prior to the by-pass surgery showed left ventricular function at the lower limit of normal with an ejection fraction of 45-50 per cent and an area of hypokinesis of the antero-lateral wall, apex and distal septum. Dr Butler also noted in relation to the June 2002 cardiac failure that there were residual signs suggesting cardiac decompensation on 8 July 2002. As we understood his evidence, he considered that the 2002 cardiac failure could have been attributable to IHD.
28. Professor O’Rourke did not refer specifically to the echocardiogram, but he did report that a value of 45-50 per cent for the ejection fraction did not constitute “significant impairment of left ventricular function”, but was within normal limits. This measurement was made in 1999.
29. Professor O’Rourke drew a distinction between diastolic left ventricular dysfunction caused by age and hypertension worsened by tachycardia, in the process of intercurrent disease, as opposed to systolic left ventricular dysfunction, subsequent to left ventricular scarring and coronary atherosclerosis as reported in three publications he provided to the Tribunal.^{[1] [2] [3]} Diastolic left ventricular dysfunction is described in these publications as heart failure with normal left ventricular ejection fraction and systolic ventricular dysfunction is heart failure with impaired left ventricular ejection fraction subsequent to ventricular scarring and coronary atherosclerosis
30. Professor O’Rourke argued that IHD did not play an integral part in Dr Walker’s death because of the absence of symptoms attributable to coronary artery disease following Dr Walker’s successful bypass surgery in 1999 and normal troponin levels at the time of his fatal illness almost excludes IHD as the cause of the chest pain around the time of death. Further, Dr Walker did not seek treatment for IHD from 1999 until his death. Professor O'Rourke's view was that Dr Walker’s heart failure was diastolic ventricular failure attributable to his hypertension, age and renal failure, and not heart failure due to ventricular systolic failure, as there was no evidence of ischaemia, and by inference, no evidence of myocardial damage, and by definition normal ventricular ejection fraction.
31. The publications referred to by Professor O’Rourke indicate that Doppler echocardiography has become the primary tool for the assessment of diastolic function and ventricular filling pressures, while accepting that this method has limitations. Dr Butler commented that unfortunately there was no comparison echocardiographic study performed after surgery, and we have no indication or measurement of left ventricular function during the period following surgery in 1999 until Dr Walker’s death in 2003.
32. Professor O’Rourke accepted that Dr Walker suffered from IHD resulting in myocardial infarction in 1999 but, in his opinion, Dr Walker had completely recovered subsequent to surgery, with no impairment of left ventricular function and no contribution to the cardiac failure.
33. Dr Butler did not accept this proposition. His opinion was that it was more likely than not that myocardial damage contributed to heart failure at the time of Dr Walker’s death. During oral evidence, Dr Butler said that heart failure worsens renal failure because it impairs renal perfusion. He also said that renal failure probably contributed to heart failure because Dr Walker would not have responded to diuretic therapy.
34. Professor O’Rourke said that severe renal failure was the primary cause of death but that heart failure probably contributed to death. That is, if Dr Walker had no heart failure, he would still have died in a matter of hours or days. He also stated that heart failure was independent of renal failure but later he said that each makes the other worse.
35. In Dr Butler’s opinion there was a likelihood in the order of 10 to 20 per cent that Dr Walker had systolic IHD at the time of death. He also said that you can have an ischaemic event without chest pain. We also understood Dr Butler to accept that the troponin levels at the time of death indicated that Dr Walker had not suffered recent cardiac damage. He then said that he was conjecturing that the damage previously suffered as a result of IHD could have impaired Dr Walker’s cardiac function at the time of his death.
36. Professor O’Rourke also accepted that the pre-existing damage could have contributed to the heart failure but said that that was different from saying that Dr Walker had IHD at the time of his death. In response to a question from Mr Vincent, Professor O’Rourke said that the likelihood of IHD playing a role in 2003 was less than 10 per cent.
37. In summary, we understood both doctors to accept that Dr Walker died of renal failure and heart failure and both accepted that the heart failure was a consequence of Dr Walker’s hypertension caused by the glomerulonephritis. The difference of opinion was the extent to which IHD contributed to the heart failure.
38. We understood Mr Purcell to argue that, if we accepted Professor O’Rourke’s evidence, there was no connection between the causes of death listed in the Death Certificate and Dr Walker’s service. Therefore the kind of death is not just the starting point in this case, but also the finishing point. We do not accept that that is so. We also do not accept Mr Purcell’s argument that there was only one kind of death, renal failure, because cardiac failure flowed from renal failure.
39. On the evidence, including that of Professor O’Rourke and Dr Butler, we find that there were two kinds of death: heart failure and kidney failure. We do not consider that either dementia or IHD was a “kind of death”. There is no SoP for either of the kinds of death we have found.

Is there a reasonable hypothesis connecting Mr Byrne’s death with his service?

40. As there is no SoP, we therefore proceed according to the principles outlined in Bushell and Byrne. Section 120 (3) of the Act provides, inter alia, that, for there to be no sufficient ground for determining Dr Walker’s death was war caused, the material before us must not raise a reasonable hypothesis connecting the injury, disease or death with the service rendered by Dr Walker:

(3) In applying subsection (1) or (2) in respect of the incapacity of a person from injury or disease, or in respect of the death of a person, related to service rendered by the person, the Commission shall be satisfied, beyond reasonable doubt, that there is no sufficient ground for determining:

(a) that the injury was a war-caused injury or a defence-caused injury;

(b) that the disease was a war-caused disease or a defence-caused disease; or

(c) that the death was war-caused or defence-caused;

as the case may be, if the Commission, after consideration of the whole of the material before it, is of the opinion that the material before it does not raise a reasonable hypothesis connecting the injury, disease or death with the circumstances of the particular service rendered by the person.

41. In considering whether there is a reasonable hypothesis, the following principles set out by the majority in Bushell apply. We are not concerned with conflicts of fact or opinion in the material before us. The question is: does the material raise “the relevant causal hypothesis” (Bushell at 413)? At 414 and 415 of Bushell the majority (Mason CJ, Deane and McHugh JJ) said:

“The material will raise a reasonable hypothesis within the meaning of s 120(3) if that material points to some fact or facts (“the raised facts”) which support that hypothesis and, assuming those raised facts are true.... So, in determining whether a hypothesis is reasonable for the purpose of s 120(3), it is not decisive that no connection has been proved between the kind of injury which occurred and the particular circumstances of the veteran's service. Nor is it decisive that the medical or scientific opinion which supports the hypothesis has little support in the medical profession or among scientists.

...

“However, a hypothesis cannot be reasonable if it is ‘contrary to proved scientific facts or to the known phenomena of nature [Commissioner for Government Transport v Adamcik [1961] HCA 43; (1961) 106 CLR 292 at 303]”

“...nor it is ‘obviously fanciful, impossible, incredible or not tenable or too remote or tenuous’ [East v Repatriation Commission [1987] FCA 242; (1987) 16 FCR 517 at 532].

“Leaving aside those possibilities, the case must be rare where it could be said that a hypothesis, based on the raised facts, is unreasonable when it is put forward by a medical practitioner who is eminent in the relevant field of knowledge. Conflict with other medical opinions is insufficient for the rejection of a hypothesis as unreasonable. ”

42. We note also the comments of the majority in that case at 415 that s 120 (3) does not require a choice:

“between competing hypotheses or to determine whether one medical or scientific opinion is to be preferred to another. This does not mean, however, that in performing its functions under s 120(3) the Commission cannot have regard to the medical or scientific material which is opposed to the material which supports the veteran’s claim. Indeed the commission is bound to have regard to the opposing material for the purpose of examining the validity of the reasoning which supports the claim that there is a connection between the incapacity or death and the service of a veteran”.

43. Justice Brennan also said in Bushell at 430:

“It would be an exceptional case in which it would be right for the A.A.T., forming its own view of competing medical theories, to hold an hypothesis of connection, favouring entitlement, to be unreasonable, when the hypothesis is supported by a “responsible medical practitioner, speaking within the ambit of his expertise”.

44. In Byrne the Court said at 570:

“In some cases, the hypothesis may assume the occurrence or existence of a “fact”. That itself does not make the hypothesis unreasonable. B's hypothesis was not unreasonable simply because it assumed that he sustained a severe injury when he dived into a swimming pool in Townsville, nothwithstanding that the material did not reveal the extent of the injury”.

45. In East the Full Federal Court approved the Tribunal’s analysis of what a reasonable hypothesis was and concluded at 533:

“A reasonable hypothesis requires more than a possibility, not fanciful or unreal, consistent with the known facts. It is an hypothesis pointed to by the facts, even though not proved upon the balance of probabilities”.

46. In Bull, the Court considered East in detail and said at 331:

“However, the Full Court did not say that if an hypothesis was not obviously fanciful or not impossible, or not incredible or tenable or not too remote or not too tenuous, it was therefore necessarily reasonable. The material must point to the connecting hypothesis”.

CONSIDERATION

47. Following is a summary of the material before the Tribunal relating to each element of the hypothesis linking heart failure and service.
48. The first element is that Dr Walker developed a heavy smoking habit during and as a result of his service and that he continued to smoke until at least 1999. Dr Walker’s enlistment medical papers record a smoking habit of 10 cigarettes per day. In Mrs Hill’s statement dated 1 September 2006 she said:

“John was always a very heavy smoker. He used to talk about being supplied with a carton of cigarettes per week by the Airforce – and if they ran out, they would be given another carton. Given the stresses of active war service, providing the servicemen with cigarettes was a form of therapy”.

49. Mrs Hill also stated that he told her that he smoked a carton a week for many years after his return from service. She said that he reduced his smoking slightly when they married. She estimated he went through a packet a day and gave up completely after his heart bypass surgery, which she thought was in the early 1990s. After they separated in 1997, she saw him several times a week and visited him at his home.
50. Mrs Hill was cross-examined about a file note of Dr Patel dated 11 October 1999 that stated that Dr Walker had not smoked for 25 years, which meant he would not have smoked since the mid 1970s. She said that was definitely wrong because she knew him right through those years. She was also asked about a record of Dr Johnson in 1993 of “tobacco nil”. She said that Dr Walker hated to admit any weakness and told other doctors that he did not smoke. She also said that when she lived with him from 1987 he smoked at home at night. She bought a packet a day for him. She said that you could smell the cigarettes on his clothes and that he always seemed to have one in his hand. Before the heart operation he was having difficulty breathing and she was putting him on a nebuliser. She did not live with him after that.
51. Dr Butler estimated Dr Walker’s tobacco consumption to be between 30 and 50 pack years. He also expressed the opinion that the requirements of the SoP would be met.
52. The next element of the hypothesis is the link between smoking and IHD. As set out earlier, both Dr Butler and Professor O’Rourke accepted Dr Walker had IHD in 1999. Mr Vincent argued that orthodox medical opinion is that smoking causes IHD and that we can refer to the SoP to support that proposition. Given the terms of s 196B we accept that the existence of the SoP for IHD, which includes smoking as a factor, is a relevant matter in respect of this element of the hypothesis.
53. In his report dated 29 September 2006, Professor O’Rourke expressed the opinion that the IHD was not related to war service and specifically not to cigarette smoking on several bases. They were that Dr Walker had been smoking prior to entering the RAAF; he was described as a non-smoker in 1993 and a former smoking in 1999, and his blood pressure had been normal up until 1993. In answer to a question from Mr Purcell, Professor O’Rourke said that, in his opinion, if Dr Walker had ceased smoking 25 years before the bypass surgery, smoking would not have been a risk factor in 1999. However, in response to a question from Mr Vincent, Professor O’Rourke accepted that if Dr Walker had smoked 6 pack years and was still smoking in 1999, then smoking played a role in IHD in 1999.
54. The final element of the hypothesis is that IHD contributed to Dr Walker’s death. As we understand the evidence of Dr Butler and Professor O'Rourke, they agreed that there was no evidence of damage as a result of ischaemia within the two weeks before Dr Walker's death, but previous damage could have contributed to heart failure. Further, Dr Butler said that there was 10 or 20 per cent likelihood of systolic failure on the basis of IHD. Professor O'Rourke also said that there was a less than 10 per cent probability that IHD played a role in Dr Walker's death. That is evidence from both doctors of a likelihood of a contribution from IHD to Dr Walker's death. In a letter dated 7 September 2005 Dr Patel wrote that in his opinion “it is possible the ischaemic heart disease contributed to his demise”.
55. Mr Purcell relied on discussion of the phrase "attributable to" in Doolette v Repatriation Commission (1990) 21 ALD 489, and the case of Codd, to submit that the death of the veteran could only be war-caused if that death had been hastened by the accelerated progress of a disease, which acceleration was caused by a war-caused condition. We consider that the quotation from Repatriation Commission v Law [1980] FCA 92; (1980) 47 FLR 57 at 68, also referred to in Doolette, is of assistance in this case:

"It seems clear the expression 'attributable to' in each case involves an element of causation. The cause need not be the sole or dominant cause: it is sufficient to show 'attributability' if the cause is one of a number of causes provided it is a contributing cause".

53. In our view the material before us points relevantly to one cause of Dr Walker's death being IHD.

CONCLUSION

56. We consider that the material before us raises each element of the hypothesis proposed by Mr Vincent linking Dr Walker’s service with his death from heart failure. Having been successful in relation to that hypothesis, it is unnecessary to address the alternative hypothesis linking renal failure with IHD. The hypothesis is therefore that Dr Walker developed a heavy smoking habit during and as a consequence of service, which continued until his bypass surgery in 1999, and which caused IHD, which in turn was a cause of his death. We find that hypothesis is reasonable.
57. The next question is: are we satisfied beyond reasonable doubt that Dr Walker’s death was not war-caused (s 120 (1))? We are not satisfied beyond reasonable doubt that any element of the hypothesis raised on the material before us has been disproved beyond reasonable doubt. Dr Walker's death was attributable to his service.
    

DECISION

58. For the above reasons we set aside the reviewable decision and substitute therefor the decision that Dr Walker’s death was war-caused. It follows that a war widow’s pension is payable to Mrs Hill.

I certify that the 58 preceding paragraphs are a true copy of the reasons for the decision herein of Senior Member, Mrs Josephine Kelly and Member, Dr MEC Thorpe.

Signed: Steven Mulipola

Associate

Date/s of Hearing: 26 June 2007

Final date of further submissions: 27 September 2007

Date of decision: 8 January 2008

Counsel for Applicant: Mr M Vincent

Solicitor for Applicant: Dibbs Abbott Stillman

Counsel for Respondent: Mr G Purcell

Solicitor for Respondent: Advocate, Department of Veterans Affairs

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^[1] Central Arterial Pressure and Arterial Pressure Pulse: New Views Entering the Second Century After Korotkov; Michael F. O’Rourke, MD, and James B. Seward, MD
Mayo Clin Proc.; 2006;81(8):1057-1068
^[2] Prolonged mechanical systole and increased arterial wave reflections in diastolic dysfunction; T Weber, J Auer, M F O’Rourke, C Punzengruber, E Kvas, B Eber
Heart 2006;92:1616-1622
^[3] McDonald’s Blood Flow in Arteries
Theoretical, experimental and Clinical Principles; Fifth Edition;2005
Wilmer W.Nichols PhD FACC. Michael F. O’Rourke MD DSc FACC FRACP FESC