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VeRBosity
Journal of the Veterans' Review Board
�Selected Decisions of the
Administrative Appeals Tribunal
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Diabetes - alcohol, smoking & obesity
Re E W Snelling and Repatriation Commission
Kiosoglous
A96/479
6 August 1998
[Full Text]
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Mr Snelling applied to the Tribunal for review of a decision that his condition of non-insulin dependent diabetes mellitus (NIDDM) was not war-caused or defence-caused. He had operational service in Malaya in 1961-63 and in Vietnam in 1968-69. His eligible defence service was from 1972 to 1993. As his claim was lodged prior to 1 June 1994, the Tribunal was not bound by Statements of Principles in respect of the condition.
Mr Snelling contended that there was a reasonable hypothesis or a reasonable connection between his diabetic condition and his war service or defence service by reason of a service-related smoking habit, a service-related alcohol habit and obesity caused by his service.
Medical evidence
Dr J S Howe, general practitioner, reported that in his opinion, the veteran's NIDDM resulted directly from pancreatic disease caused by excessive alcohol consumption. The Tribunal commented that it appeared that Dr Howe arrived at this conclusion after discussing the matter with the veteran and obtaining a history from him. There was no evidence to suggest that he undertook any tests to substantiate his conclusion nor to ascertain whether the veteran in fact suffered from pancreatic disease.
Dr M G Miller, consultant physician, reported that although the veteran had a clear cut history of alcohol abuse, there was no history of any abdominal pain consistent with pancreatitis. In his opinion, there was not enough to support a reasonable hypothesis that the veteran's alcohol abuse contributed to diabetes mellitus, as he reduced his drinking in 1973 and diabetes was not diagnosed until 1987.
Dr Miller stated that although the Statement of Principles for diabetes recognised a causal link with heavy smoking, he was personally unaware of any relationship between smoking and the development of diabetes and did not consider that there was a reasonable hypothesis on this basis.
Dr Miller stated that obesity is considered to be a major factor in the development of NIDDM and there is no doubt that the veteran was significantly obese when the condition was diagnosed. While he had no weight records of the veteran prior to 1973, Dr�Miller was able to ascertain from Army records that on enlistment, his weight was 65 kg and he commenced putting on weight after his service in Malaya as his weight on 8 July 1965 was 69 kg and on 6 June 1966 was 78.5 kg. He was told by the veteran that while serving in Vietnam his weight dropped from 80 to 75 kg but increased after his return to Australia.
Dr Miller stated that it is apparent from the recorded weight history that the veteran's weight between 1973 and 1979 averaged about 76 kg. He noticed a reduction in 1980 to 72 kg but in 1982 the veteran's weight increased significantly to 79 kg and continued to increase steadily until about the time of the development of diabetes when he weighed 86.2 kg. Dr�Miller also stated that the veteran had told him that his weight increase after 1983 was associated with being posted to sedentary duties. Dr Miller said that there is evidence showing that the veteran's weight increased by some 10 kg during his eligible service and therefore he considered that, on the balance of probabilities, the veteran's eligible service contributed to his weight gain and therefore to his diabetes.
Dr J N Carter, consultant endocrinologist, stated that although there was evidence of increased alcohol intake during the veteran's service, there was no evidence that it had caused permanent pancreatic damage. Dr Carter was of the opinion that the most likely explanation for the veteran's diabetes was a genetic predisposition and that there was no connection between his diabetes and his war service and defence service.
Alcohol consumption
The Tribunal noted that the hypothesis, supported by Dr�Howe, relied on the existence of pancreatic disease resulting from alcohol abuse and was not supported by either of the specialists because they found no pancreatic disease. The Tribunal also noted that the conclusions of Dr Howe in relation to the existence of pancreatic disease were in conflict with those of both Drs Miller and Carter who found no evidence that the veteran suffered from pancreatic disease. The Tribunal said:
"Upon a careful consideration of the evidence and, in particular, of the letter of Dr Howe which asserts the existence of pancreatic disease without any reference to clinical findings, the Tribunal is satisfied beyond reasonable doubt that the contrary opinions of the two specialists, both based upon clinical findings, exclude the existence of pancreatic disease. Thus the Tribunal finds that an essential element of the hypothesis is disproved and therefore decides that this ground for the applicant's claim cannot succeed."
Smoking
The Tribunal was satisfied that there was no connection between the veteran's smoking and his diabetes. Even if he sought to rely on the factor in the Statement of Principles which supports such a connection, his smoking history was not of sufficient duration or intensity to satisfy that factor.
Obesity
Mr Snelling's counsel submitted that the dietary habits established by the veteran during his war service and the conditions of his defence service were such that his obesity arose out of or was attributable to his service. The veteran's weight varied considerably over the period of his service. The Tribunal noted the following recorded weights:
May 1973 ............. 80.9 kg
August 1977
September 1980 ...... 72 kg
November 1982 ....... 79 kg
October 1986 .......... 86.5 kg
October 1987 .......... 86.2 kg
March 1989 ............ 83.6 kg
September 1989 ...... 71.8 kg
April 1990 ............. 70.9 kg
November 1990 ....... 78.4 kg
May 1991 ............... 80.1 kg
1992 ........................ 83 kg
October 1993 ......... 87 kg
The Tribunal was satisfied on the evidence that there was no causal connection between the veteran's obesity via his eating habits during war service or defence service, and his condition of NIDDM. The Tribunal said on this point:
"There is nothing to support the view that his more sedentary duties as an officer were responsible for an immediate weight gain, as his weight was stable for three years after he received his commission, at the same level as it had been for the three years prior. The records do not show a significant rise until sometime later than six years after he became an officer which was at about the age of 38 years. Furthermore, on the applicant's evidence, he was warned about his weight in 1982, prior to moving to Canberra and about the time that the records show a marked increase in his weight began. He was further warned in 1989, at the time the NIDDM was diagnosed, and at that time took steps through exercise to reduce his weight.
"The Tribunal holds the view that the applicant cannot rely on evidence of the conditions of his service without also acknowledging that he did receive a warning about his weight from an Army medical officer in 1982 which he chose to ignore. Some responsibility must be borne by the applicant for this personal choice. The Tribunal is of the view that the generosity of the veterans' legislation is not intended to override the need for service personnel to exercise a reasonable degree of common sense and personal responsibility in relation to their health, especially in circumstances removed from those special stresses associated with service life such as combat. Such considerations affect the Tribunal's assessment of whether a real causal connection can properly be said to exist between habitual behaviour alleged to have arisen out of conditions of war service and a subsequent medical condition. Having regard to the evidence, the Tribunal does not accept the applicant's assertion that his war or defence service can be causally connected to obesity and thence to NIDDM. He was under a general duty to maintain a level of fitness as a soldier and, presumably in that context, was warned about his weight in 1982. He chose to ignore that warning, a fact to which the record of his weight at subsequent medical examinations attests. In the Tribunal's view, there were factors associated with his life as a soldier which equally run converse to the assertion that his weight gain was caused by his service and, given the reasonable responsibility which he owed to himself as well as to his profession to keep his weight within healthy limits, the assertion is untenable."
Formal decision
The Tribunal affirmed the decision that the veteran's diabetes mellitus was not war-caused or defence-caused.
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