Quite apart from the smoking contention, there are many ways honest people can rip off the system. Let us glance at a few.
Assessment
You will remember from Chapter 2, that pensions are assessed on a combination of objective medical impairment and lifestyle effects. Medical impairment is frequently overestimated, because it is based on reports by the veteran’s own GP, who usually adopts a generous attitude towards his patient, and often does not fully understand the workings of G.A.R.P. For example, orthopaedists tend to find a greater range of movements in a joint that GPs can. When assessing effort tolerance (the amount of exercise possible with a particular lung or heart condition), an objective study such as a stress test almost invariably reveals a veteran to be fitter than his GP thought.
With respect to lifestyle, there exists a table of lifestyle ratings against impairment, with a “shaded area” where most people fit. There also exists an unofficial Commission policy which goes like this: (i) when legislative changes are introduced, implement a complicated procedure of investigation; (ii) when people complain – concede! Thus, when the G.A.R.P. was introduced, every applicant was sent a questionnaire about his lifestyle. Professional clerks have no problem with filling out forms, but it is all too much for many veterans and their advocates. Therefore, the Commission instituted a new policy: let the veterans assess their own lifestyle.
Of course, this assumes two things: (1) they are honest – and most are, and (2) they and their advocates are sufficiently familiar with the G.A.R.P. rating system to know what they are doing. Most of them are not. According to the powers that be, tests have shown that self-assessments are usually accurate. Everyone working at the coal face knows that this is nonsense. In cases of ambiguity, people are subconsciously driven to favour their own cause. When a properly completed lifestyle questionnaire is put in front of them, veterans’ advocates will consistently overestimate the ratings. Added to this is the fact that veterans normally rate their whole lifestyle, not just the conditions accepted or claimed as war-caused. In addition, they normally include several conditions in a claim, only some of which will end up being accepted. Thus, they end up including non-accepted conditions in their ratings. However, the Commission decreed that a lifestyle questionnaire should only be provided if the self-assessment was more than one point outside the “shaded area”, or it was manifestly implausible. Result: pensions are regularly overassessed.
Skin Problems
Tinea is a ubiquitous condition in warm, moist environments, and people whose skin is vulnerable to it are liable to multiple infections, no matter how frequently it is treated and cured. If a victim is asked when he was first infected, he will look back over the years and remember that it took place during the war, and how can anyone deny it? Almost invariably, his discharge medical exam will show that his skin was clear at the time, but no-one draws the obvious conclusion that his current tinea is the result of a new infection. Therefore, most claims for tinea are accepted.
The same goes for skin cancers and the even more common solar keratoses (“sun spots”). Most readers will be aware the Australia is the world capital for these conditions, the unfortunate result of combining white skin with tropical and semi-tropical sun exposure. The Federal Court had long ago ruled that sun exposure is a normal part of life, and thus could not be attributed as service-related unless service resulted in more sun exposure than civilian life. Taking this to heart, the RMA made the following ruling: skin cancers and sun spots can be regarded as service-related if, on the balance of probabilities, service added an extra 20% sun exposure to the lifetime exposure. For the “benefit of the doubt”, this was reduced to 10%. Both figures, needless to say, were completely arbitrary.
The RMA also provided an extremely complicated formula by which sun exposure could be calculated. The Commission’s response was to acquire a computer program to handle the algorithm. They then drafted a questionnaire on sun exposure which was not only confusing, but inadequate, so that that the information fed into the computer followed the GIGO (garbage in, garbage out) principle. Nevertheless, it must be admitted that, where a person has a largely indoor civilian occupation, a couple of years of the outdoor life of the military will add significantly to his lifetime exposure to the sun. Just the same, it is the lifetime exposure, not service, which is predominantly to blame.
Anybody who failed the relative exposure test would be swept up by the new SoP issued some years later. A new factor was included that involved the absolute level of sun exposure. No allowance was made for whether your skin is fair, olive, or even black, and merely living in Australia is sufficient to satisfy the test. If the absolute threshold is not reached on service, one can always invoke Kattenberg.
Nearly all claims for tinea, skin cancer, and solar keratoses are accepted. There are also local traditions in pension claims. In Queensland, one practically never sees a claim for neurodermatitis, but some veterans’ advocates in southern states religiously attach it to any psychiatric claim. This condition has two things in its favour: (a) there is no SoP, so any medical opinion will do, and (b) in its milder form at least, there is no objective method of diagnosis, only the applicant’s say so.
Hearing Loss
Nevertheless, the above skin conditions are, to coin a phrase, “small bikkies”. Rarely would they equate to more than five impairment points – useful in an on-going campaign to get the maximum pension possible, but not terribly important in the great scheme of things. More serious is the issue raised on the first page of this book: sensorineural hearing loss. As my uncle discovered, quite significant pensions can be accrued as a result of this condition even half a century after the end of a war.
Sensorineural hearing loss is the commonest form of hearing loss, and is regularly associated with noise exposure and ageing. Needless to say, anybody who regularly handles guns has a strong risk of being partially deafened, particularly in the ear nearest the firearm – and many riflemen, machine gunners, and artillerymen returned from the war with just this problem. But many did not. However, the way the SoP is worded, even a single gun shot is sufficient. Nor is this hypothetical; I remember a case where a sailor’s claim succeeded because, on a short voyage to Vietnam, he heard a group of soldiers practising with their rifles.
It makes no difference if the onset of hearing loss was 30 or 40 years after the firing had ceased, nor how much noise exposure the veteran may have experienced in civilian life. If he heard a gun shot, his pension is assured. The G.A.R.P. does adjust assessment for the effects of age, but in a perverse manner. It is discounted by five years. In other words, there is a legal fiction that all veterans are recruited from the ranks of the acoustically superior, and a 65 year old veteran, had he stayed a civilian, would have had the ears of a 60 year old.
Everyone’s hearing deteriorates with age, and common sense dictates that, for half of us, the deterioration will be greater than the average. However, presbyacusis, the hearing loss which accompanies ageing, is qualitatively different from that caused by simple noise exposure. Sound frequency is measured in Herz (Hz), or cycles per second. If a graph is produced of hearing loss against frequency, noise related hearing loss will show a sudden drop at a particular frequency, usually around 4,000 Hz, followed by a sudden rise at higher frequencies, such as 6,000 or 8,000. In other words, there is a partial deafness exactly at the frequencies of the loud noise that caused it. “Gunner’s notch” is a popular label for this phenomenon, but it was previously known as “weaver’s notch”, indicative of the industrial deafness caused by the weaver’s shuttle. In presbyacusis, on the other hand, there is no notch. There is a steady drop in hearing from 4,000 to 6,000 to 8,000 Hz. Occasionally, the lower frequencies are affected as much as the higher frequencies, indicating neither age nor noise exposure, but something else.
The SoP makes no distinction between these types of hearing loss. If gunshots have been heard in the distant past, then it is assumed that they have contributed to the current hearing loss, even if only to a very small extent.
Even if a veteran’s hearing loss is clearly due to his war service, you might think that his pension rate would be set by the level of hearing first detected, and that any worsening would be treated as function to age. Not so. If war contributed to a disease, it remains a contributory cause, even though the percentage contribution will be continually reduced with the passage of time.
One last peculiarity of this condition is the way the pension is assessed. With loss of eyesight, pension is paid on the corrected visual acuity ie how well the person can see while wearing glasses. Hearing, however, is never measured with a hearing aid in place. Hearing aids, of course, are not completely effective. For a start, their wearers are still at a disadvantage in crowds. But under most circumstances, they allow the user to operate fairly normally, and it would not be beyond the abilities of the powers that be to devise a formula to cope with this fact.
As it is, most veterans older than middle age have an entitlement to sensorineural hearing loss. Quite large pensions are being paid out despite the facts that any contribution by war service is minimal or non-existent, and its effects can be 90% corrected by means of hearing aids. As I said to my uncle, Veterans’ Affairs is designed so that even perfectly honest people can rip off the system.
Impotence
Claims regarding impotence, or erectile dysfunction, as the latest SoP calls it, almost invariably occur as part of an omnibus claim. What this means is that almost nobody thinks to himself, “I can no longer rise to the occasion; it is all due to the war.” Rather, he attends the R.S.L., or some other ex-service organisation, with respect to some other condition, or just a hope of getting a bit more money. An advocate then says to him, “Well, while we’re at it, we might as well claim a few other conditions which are easily accepted. What about sun spots and hearing loss? And how is your sex life? We better add that to the list.”
Impotence can usually be accepted on the basis of either smoking, or anxiety and/or depression, but the action of these factors is quite different. Anxiety and depression cause a psychological block, whereas smoking produces a physical disease, by restricting the blood flow to the penis. A victim of smoking related vascular impotence should no longer experience nocturnal erections, in which case his mental state is irrelevant. Conversely, if he still has erections while asleep, his failure with his wife is likely to be all in his head. The SoP, however, fails to distinguish between these two effects, so many claims are accepted which should have been rejected.
But the reason this finds a place in the current chapter is the particular way some veterans’ advocates have found to manipulate the system. The assessment is made on how much the veteran has missed out on in life. Thus, if the onset of impotence was between the ages of 40 and 64, it is worth 15 impairment points, but only 10 points if the onset is between 65 and 74. So, for exanple, when a 70 year old veteran is being examined by his doctor, he will say he has been impotent for (say) four years. However, at the VRB hearing, his advocate will claim that the real age of onset was 60 – thus adding an extra five points in the campaign for maximum pension. This has happened so often in the case of certain advocates that it is hard to believe deliberate lying is not involved, but the Board never asks the veteran about the discrepancy.
Osteoarthrosis / Spondylosis
Osteoarthrosis is what most people mean by “arthritis”, and it can appear in any joint, but the most common are the knee, hip, lower back and neck. When it occurs in the spine, it is known as spondylosis.
The only effective way to avoid it is to die young, for it is a degenerative disease. Essentially, our joints are gradually wearing away with the normal processes of living, but at the same time the body is constantly repairing itself. While we are young, the processes are in balance, but as we grow older the reparative ability of the body slows down, and the joints degenerate. (The same thing happens to the rest of the body, which is why our muscles lose tone and our skin grows thin and wrinkly.) However, there are a couple of factors which can tip the balance in favour of wearing away, and so lead to early osteoarthrosis or spondylosis.
The first is an injury, or trauma, so severe as to disrupt the bony integrity of the joint. This is defined in the SoP as:
“a discrete joint injury that causes the development, within twenty-four hours of the injury being sustained, of symptoms and signs of pain, and tenderness, and either altered mobility or range of movement of the joint. These symptoms and signs must last for a period of at least seven days following their onset” (ten days for “balance of probabilities”).
It all sounds pretty impressive and clear cut. But the fact is, even the detailed clinical notes kept by the modern military in Australia seldom go into that much detail. Once a serviceman leaves the country for a war zone, the notes become even sketchier or non-existent. The result is that the blanks – or more often, the entire story – has to be filled in by the veteran’s memory, which is decades old at best, and likely to be subconsciously self-serving. A middle aged, or even elderly, man finds that his knee or back is playing up, and he casts his mind back to a time when he hurt that part of his anatomy, and went to the Regimental Aid Post, where the doctor or first aid officer gave him some liniment and put him on light duties for a few days. It might have been merely a soft tissue injury like a bruise or sprain, or it might have been more serious. Perhaps a record was kept, or perhaps it wasn’t. If it was, it may not have reached his file. In any case, no record was kept of how long all the pain and tenderness and altered mobility or range of movement lasted – and how many people remember such details?
Osteoarthrosis at multiple sites should always be suspect. A man writes that he fell heavily while entering a landing craft, injuring both knees and one shoulder. A brief reflection, however, should alert you that it could not have happened quite like that. When you fall, one part of the body takes the brunt of the blow. The secondary sites may be bruised or skinned, but they are not likely to incur the full seven days of pain, tenderness, and loss of range of movement. What the claims assessor should do is phone the veteran and get the full story, but most investigators do not go so far, and so a lot of dubious claims are accepted.
Sometimes a veteran really did suffer a serious injury to (say) his lower back, and his lumbar spondylosis was rightly accepted as war-caused. Years later, his neck also starts playing up, and he assumes it must have been injured at the same time. If the contemporary hospital records fail to mention it, he assumes it was because the doctors were paying attention to the more serious problem of his back.
Whenever I received such a claim, the first thing I would do is check the service medical record. In the vast majority of cases, the incident was not recorded. When it was, in nearly every case, the contemporary records did not match the veteran’s memory of events. From this, one can reasonably conclude that the same thing applies to the cases where records are absent. Like smoking histories, most injury histories are inaccurate – honestly held, no doubt, but inaccurate. And because we have to rely predominantly on faulty memories, a great many pensions are incorrectly handed out.
Another thing emerges from the medical records: on the few occasions where the veteran’s memory turns out to have been correct, the condition has been present, and accepted by the Commission, for several decades. This brings us to the biggest defect in the system. The “balance of probabilities” SoP requires that the onset of osteoarthrosis or spondylosis be within 25 years of the injury. If it doesn’t appear by then, presumably the body had been resilient enough to cope with it. However, the “benefit of doubt” SoP contains no time limit.
Consider the biological implications. It is not as if, on the balance of probabilities, there is one chance in 25 of osteoarthrosis developing every year until the 25 year limit, when the probability suddenly drops to zero. Rather, the probability would be low in the first few years, because it takes time for degeneration to set in, would peak somewhere in the middle of the period, and then slowly decline. In other words, if the damage is going to turn osteoarthrotic, it will most likely happen 5 to 15 years after the event, but may take place later. On the balance of probabilities, it will not first present after a lapse of 25 years, but the off-chance cannot be ruled out if we are considering “reasonable doubt”.
Nevertheless, after 25 years, the probability must be very low. After 30 years it would be lower still, after 40 vanishingly small. Nor is this situation merely hypothetical. The youngest of the Vietnam generation are now approaching 60, the age at which these conditions begin to make their appearance. The veterans of earlier wars are well into old age. Yet Veterans’ Affairs is regularly accepting claims on the basis of events which happened 40, or even 50 or 60, years ago, and based on nothing but the claimant’s memory.
A second major cause of osteoarthrosis and spondylosis, at least in the weight bearing joints (hips, knees, ankles, and back) is sheer hard work. To quote the “balance of probabilities” SoP, this means:
“lifting loads of at least thirty-five kilograms while bearing weight through the affected joint to a cumulative total of at least 168 000 kilograms within any ten year period before the clinical onset of osteoarthrosis [or spondylosis] in that joint.”
For the “beyond reasonable doubt” standard of proof, the figures are reduced to 25 kg to a cumulative total of 120,000 kg.
Suppose a man lifts a 60 kg pack onto his back and carries it all day. That counts as 60 kg towards the required 120,000. But if he happens to sit down or squat ten times during that weary day, the pack still in place, then that counts as 600 kg. If he does this for 200 days, he will have reached the threshold. The logic of this might sound somewhat peculiar, but that is what infantrymen really did in Vietnam, and many of them really do have prematurely old backs and knees, so we should not begrudge it to them.
For other cases, however, the problems should be obvious. Nobody ever asked the weight of an item he was told to lift. Nobody ever counted how many times he lifted it. Equally pertinent, no official records were ever kept. Yet now, 40 or more years after the events, he is being asked to estimate these figures. The tendency is to massage them upwards because, after all, he does have a bad back/knee/hip, and what else could be the reason? Surely not old age? If the threshold still cannot be reached, one can always throw in weights lifted during non-eligible service, or even in civilian life, on the basis of Kattenberg. (Now you see the results of this perverse decision.) Thirty-five kilograms is half an average man’s body weight, but 25 kg is well within the range of required lifting in times of war. Many of the contentions, particularly sailors involved in unloading ships, and soldiers involved in stacking sandbags, sound exceedingly plausible. Many do not – such as the nurse who claimed to have been lifting 70 kg men several times a day (by herself?), but even these are frequently accepted without any challenge, or request for clarification.
But the real problem with the heavy lifting criterion is not its haphazard and unverifiable qualities. It is that, like the injury criterion, the “balance of probabilities” SoP requires onset within 25 years, and the “beyond reasonable doubt” SoP has no time limits.
Today there are thousands of pensions being given out for orthopaedic problems which are definitely, absolutely the results of old age. Any contribution by the war is so small it hardly matters. Not only that, but as the individual veteran grows older, more and more conditions get added to the list.
This phenomenon plays a major role in the TPI and EDA industries. In the next chapter, we shall examine the most complex racket of all.
Continue to Chapter 7
Return to Index
Continue to Chapter 7
Return to Index
