Sunday, 3 March 2013

8. Paid to be Sick

You will catch flak from the welfare lobby if you say this, but some of the people on unemployment benefits are not serious about finding work. Not all of them, not most, probably not even a large minority, but some. It is an inescapable drawback of the welfare system that, in helping genuinely needy people you are also financing antisocial behaviour. Thus, in giving money to the needy unemployed, you are also paying people not to work. Obviously, of course, if the dole were a pittance, far fewer people would take up the offer than if it were a fortune, but even in the Bad Old Days, there were individuals who preferred the idleness of begging for the prosperity of hard work.
Likewise, in providing a supporting parent’s pension, you are paying single women to have illegitimate children, and encouraging married couples to split up. In supporting homeless teenagers, you are paying children to run away from home. And in compensating people for their illnesses, you are paying people to be sick.
What’s that you say? That’s impossible! Sickness is a result of external forces, outside of the victim’s control. You cannot choose to be sick. Think again. You have all probably been brought up on stories of the Aboriginal custom of “pointing the bone”. Believe me, human beings are very much the same under the skin. If a black man can will himself to die because a witchdoctor places a curse upon him, then a white man can get sick, or at least stay sick, or get sicker, if he is offered money to do so.
It has to be emphasized once again that there are infinite gradations between outright, conscious malingering and totally objective incapacity. The unconscious mind is a powerful agent, and affects the way the body functions. A positive attitude to life tends to lead to a shorter convalescence and fewer limitations. On the other hand, there are many who subconsciously fall into the invalid role, when the secondary advantage of attention and reduced responsibilities is seen to outweigh the difficulties of mastering one’s incapacity.
It has long been known that compensation litigation tends to prolong the process of convalescence. When someone is suing another for injury, it is in the interests of the defendant to delay the court decision until the plaintiff’s condition has improved, and damages are consequently reduced. Conversely, it is in the plaintiff’s interest for his symptoms to remain severe until a larger settlement has been reached. Similarly, victims of orthopaedic injuries which are not covered by worker’s compensation tend to return to work earlier than those who are. This is not, as you might think, because they need to earn money before they have fully recovered. Instead, they actually complain of less pain and restrictions than those who are being paid to stay sick.
Needless to say, such effects are likely to be magnified when the disability is psychiatric rather than physical. Let me illustrate with two cases I personally dealt with, both genuine and meritorious.
  • P was a national serviceman from the country, who found himself clearing mines in Vietnam. For six months after he came home, his hands were shaking so much he could not hold a cup of tea without spilling it. His parents decided it would be best if they moved further west to a more isolated property, where there were fewer people to get under his skin. Later, he moved even farther out. He never sought any treatment, but he did not make the mistake of self-medicating with alcohol. When he did finally lodge a claim a quarter of a century after the event, his symptoms had settled down to a fairly mild level, and he had many good reasons to be anxious: the area was in the middle of a severe drought, there was an economic crisis, and his wife was living away from home to earn money while he struggled to make ends meet on the home front.
  • Q had been a forward scout in Vietnam. When he claimed, and received, a pension for PTSD, his impairment rating under G.A.R.P. was 20 points. This is a moderate degree of impairment, which would be noticeable to those familiar with him. It would require medication and supportive therapy, and would a moderate degree of disruption to work, leisure, and family life. This was what he had been able to put up with for the previous quarter century. Yet, the following year, he applied for an increase in pension, and his impairment rate was 30 points. A year later, it had increased to 45 points, and he was no longer able to work – despite the fact that he was seeing a psychiatrist every six weeks and a psychologist every fortnight. (This, of course, begs the question as to what was the benefit of such intensive treatment if it failed to even stabilise his condition. And if it were so ineffective, why was the Department continuing to pay for it?)
It is hard to think of a better example than this of the corrosive effect of the system. Looked at objectively, who got the better deal: Mr Q, who received his money, but cannot enjoy it, or Mr P, who asked, and received, nothing for his severe mental problems, but who watched it slowly subside to manageable proportions?
And yet – here is the irony and tragedy of it all: I was not able to follow up P’s case, but it is more than likely that the modest pension I awarded him was the beginning of his downfall. Where he lived, there were few facilities for psychiatric treatment. He had a lot of genuine causes of anxiety. His farm income was low, and there would be the constant temptation to apply for an increase in pension. In any case, his ex-service advisers would certainly urge him to appeal the decision. This would likely drag on and on, with constant to-ing and fro-ing between him and his advocate, adding even more to his worries. In short, he was now being paid to be sick.

Where considering payment for being sick, the trail sooner or later leads to the big issue of the Special Rate, or TPI. When the term, “totally and permanently incapacitated” is raised, you probably visualise a battle-scarred veteran valiantly trying to hold onto his job, taking more and more time off work, perhaps even reducing his hours of work, until eventually either his boss or his doctor tells him he cannot keep it up any longer. At least it may be said that the majority of claimants in that predicament generally have an easy run through the system, but most TPI cases are quite different
As far back as 1969, Dr Whiting alleged [Be In It, Mate!] that, for many veterans, it was considered their ultimate financial goal, that it was being handed out to many who were still capable of working, that, indeed, it was often a retirement present for the Department’s staff, who were all veterans at that stage. Now, fast track to 1992. In that year he Auditor-General reported that nearly all the TPI grants to World War II veterans involved either:
(a) a veteran having a reasonably full working life,
(b) a professional or self-employed man retiring after the age of 65,
(c) a weak link between service and the conditions that made him cease work, or
(d) circumstances which did not appear to correspond to what the average person would call “totally and permanently incapacitated”.
Since then, the Korean, Malayan, and now the Vietnam veterans have been approaching retirement age, and I am prepared to state that the same thing applies to them.

At that time, a grant of TPI was estimated to amount to a million dollars over the life of a veteran. Perhaps this was an overestimate, because the alternative is not zero pension, but pension at the 70% to 100% rate. On the other hand, the rates of pension have increased with inflation, so it is still known as the Million Dollar Decision. And Departmental staff, under pressure and often inexperienced, are required to make it all the time.
Since pension rates are adjusted regularly, any comment I make about monetary value will be out of date by the time you read this. So I shall discuss it in terms of the MTAWE, the Male Total Average Weekly Earnings. What does this mean?
Suppose you have ten men earning, respectively, 10, 20, 30, 30, 40, 60, 80, 100, 120, and 140 dollars per hour. What are their average earnings? Most people are unaware that the term “average” applies to three different measurements, which coincide only under special circumstances. The first is the mode, the most frequent figure, the high point of the graph, if the figures were graphed. In this case, it is 30, because that amount occurs twice. The second is the median, the figure which divides the sample in two. In the above example, the median would be 50, because there are five items above that amount, and five below. This is what most people assume is the “average”. They intuitively expect that half the population will be earning less than the average, and half more.
Wrong! The average implied by the MTAWE is the mean: the sum of all the values divided by the number in the sample. In the above case, it would be (10 + 20 + 30 + 30 + 40 + 60 + 80 + 100 + 120 + 140 = 630) ÷ 10 = 63. You will note, however, that only four men in the sample earn more than the mean, and six earn less. This is typical. Minimum wage laws, and well as the law of supply and demand as regards to labour, mean there is a lower limit to wages, but no upper limit. The minority of high flyers drag the mean upwards. In real life, 62% of male full time employees earn less than the average. And, of course, not everybody works full time.
Now, let us apply this to the Veterans’ Affairs pensions. The percentages will have changed slightly by the time you read this, but only marginally. The TPI rate is approximately 57% of the after-tax MTAWE. That might not sound much, but remember: if the veteran’s wife or de facto is not working, he will normally be eligible for the service pension, which will bring his income up to 89% of the average wage. If he had no qualifying service, he cannot get the service pension, but he will be eligible for a Centrelink pension, which is much the same. If his wife or cohabitee is unable to work, or is at an age where she can no longer be expected to work, she can get one too.
The conclusion is obvious: a majority of people would be better off on a TPI plus service pension than working.
Well, perhaps a small reservation may be admitted. Few people go straight from zero to TPI in one hit. Typically, the veteran will have been supplementing his wages with a modest disability pension, say for hearing loss or solar skin damage, and has been relying on that as a regular income. Therefore, the issue becomes: how does (wages plus disability pension) stack up against (TPI plus service pension)?
But, of course, money is not the whole issue. To quote a Garfield poster, “Work is so horrible, they have to pay you to do it?” So, be honest with yourself. Suppose you could get by more or less comfortably on 80% of your current income. What would you prefer to do: retire on 80%, or continue slaving 35 or 40 hours a week for the other 20%? What if you were sick, and were finding work a burden?
Considering all of the above, is it any wonder that the TPI rate exerts such a magnetic attraction to veterans one they step on the compensation bandwagon, and the ex-service organisations urge all those who may be hesitant to apply?

In Chapter 2 I explained that the TPI provisions are the most complex and litigated section of the law, and it is not possible to summarise it without becoming misleading. Here, therefore, are the most important sections, verbatim. The barrier has been deliberately set high, for the reasons outlined above. If they appear a bit unfair at first sight, there are a few things you should remember. Firstly, decision makers tend to cut a bit of slack for the really genuine cases: those who have struggled manfully to hold onto their jobs, but have been forced out by ever increasing sick leave and medical advice. Secondly, there are provisions in the law for the unemployed. Thirdly, as you will have appreciated from reading earlier chapters, most of the “war caused” disabilities are not really caused by the war. And, finally, despite the height of the hurdle, it is amazing how many get over it.

Section 24 of the Veterans’ Entitlements Act
24 (1)(a) either:
(i) the degree of incapacity of the veteran from war-caused injury or war-caused disease, or both, is determined under section 21A to be at least 70% or has been so determined by a determination that is in force; or
(ii) the veteran is, because he or she has suffered or is suffering from pulmonary tuberculosis, receiving or entitled to receive a pension at the general rate; and
(b) the veteran is totally and permanently incapacitated, that is to say, the veteran’s incapacity from war-caused injury or war-caused disease, or both, is of such a nature as, of itself alone, to render the veteran incapable of undertaking remunerative work for periods aggregating more than 8 hours per week; and
(c) the veteran is, by reason of incapacity from that war-caused injury or war-caused disease, or both, alone, prevented from continuing to undertake remunerative work that the veteran was undertaking and is, by reason thereof, suffering a loss of salary or wages, or of earnings on his or her own account, that the veteran would not be suffering if the veteran were free of that incapacity.

There is more to it, of course. Veterans’ legislation is nothing if not complex. Because finding a job is harder than keeping a job, there is an ameliorating provision for those who are looking for work. Also, this only applies to those under 65. The barriers for veterans over 65 are raised higher. However, they are enough to illustrate the general principles. I don’t wish to confuse, or bore, the lay reader with the fine details of the case law I had been arguing before the Tribunal for nine years. [Anybody who is interested is invited to read the 2003 Special Issue of Verbosity put out by the VRB.]

We shall start with subsection (c), which is the stumbling block of many claims. The operative word is “alone”. The veteran’s accepted disabilities (A/Ds) may be the predominant, indeed crucial, factor in preventing him from continuing to work, but if any other factor is involved, the “alone” test is not satisfied. Most veterans intuitively fail to understand this, and many veterans’ advocates refuse to understand it, no matter how well they have been trained, because they continue to make the same false contention time and time again. They come out with such statements as: “It was his bad back (an A/D) which caused him cease work. His neck trouble (a non-A/D) gave him trouble, but it never prevented him from working.” That is beside the point. The non-A/D does not have to prevent a man from working; it only has to contribute.
It is an unfortunate fact of life that older workers are discriminated against in the labour market. If an employer is looking for a suitable worker, he is less likely to choose someone just five years off retirement age than someone with another twenty years to run. The result is that, if a veteran loses his job in his later years – say by reason of redundancy or business failure - he is unlikely to get back into the work force. He will not qualify under subsection (c). It is tough, but the Special Rate pension was designed to compensate for loss of employment. You cannot be compensated for chances you never had in the first place. Also, when a man is close to 60, he has had a pretty full working life.
For many people, the choice to take early retirement means a balance of finances, and other factors such as health. Perhaps your superannuation scheme allowed you to retire at 60, or even 55, with a higher payout the longer you wait. If you are a veteran, you are entitled to a service pension at age 60. Or your company may be “downsizing”, and you have the option of taking a redundancy package. If you were healthy, you may have been prepared to stay the course, but if you are sick, and finding work a burden, this might be the opportunity to get out. In that sense, health was the crucial factor tipping the balance in favour of retirement, but it cannot be said to have been the only one.
If a veteran really has been taking extending sick leave before losing his job, he usually lodges a claim about the same time, and the case is fairly straightforward. However, it not infrequently occurs that the claim is lodged several years after he ceased work, after he has had a talk with members of an ex-service organisation, and there has been minimal sick leave. The result is some creative pleading from the veteran and his advocate. In many cases, he had first applied for a service pension on the basis of permanent invalidity, and had listed all his significant impairments – including some which later failed to be accepted as war-caused. He must now explain that these conditions really did not affect him much at all. Or else he contends that the involuntary redundancy he was handed was really a constructive dismissal because of his medical conditions. Or else the argument with his boss which caused him to resign was really a manifestation of his undiagnosed PTSD. And all the time, the Department’s delegate is left with nagging thought: he was working, albeit with difficulty, right up to the redundancy/resignation, so he must have been capable of working. If he could come in on Friday, why couldn’t he come in on Monday?
I have no intention of disparaging people who, after all, have found themselves in the difficult situation of being unable to support themselves. Nevertheless, most of them are close to the traditional retirement age in any case, and the social security network does provide for the unemployed and invalids. Most of the above contentions are no doubt made in complete sincerity, but they are more believable to the veteran than the decision maker. But you never can tell. One man I knew announced to his employer that he would have to retire for health reasons. But to allow his boss time to train a replacement, he gave him twelve months’ notice. You might conclude from this that he was still capable of working, but the Tribunal gave him his TPI.
Particularly in the case of mental illnesses, it is often several years after the veteran has ceased work before he consults a specialist. Indeed, according to many, it never occurred to them that they had a psychiatric disorder until it was suggested to them by someone at the R.S.L. or some other ex-service organisation. (Refer back to the previous chapter for how this affects his presentation.) The result is that we no way of knowing how severe it was when he gave up work. However, sometimes that evidence is available, and it turns out his condition wasn’t too bad at the time. In fact, sometimes the psychiatrist actually reports: “He says that he has got worse in the last x years”. The fact is, in many cases, they go to pieces after they finish work because they have nothing to distract them from their symptoms. What such people really need is a reduction in work hours, along with appropriate medication.
So much for the minefield of subsection (c). Let us turn our attention to subsection (a). Essentially, this states that, before TPI can even be considered, the veteran’s pension must be at least 70%. Originally, it was 100%, but this was rather difficult to attain, so the Government reduced it to 70%. The intention was good, but hindsight reveals that it was too generous. Once a veteran’s pension reaches 60%, the great neon glow of “TPI” looms in front of him. After that, rehabilitation, or even effective treatment, becomes impossible. He needs only another 10%, and he has a “Get Out of Work Free” card, to be played whenever he finds it convenient.
A 70% pension equates to 40 impairment points. An orthopaedic, heart, or psychiatric disorder of such magnitude would indeed be severe, and place the sufferer’s ability to work in jeopardy. However, as likely as not the applicant is already being bolstered by such A/Ds as hearing loss, solar skin damage, tinea, or even impotence, whose effect on his work is minimal. If, for instance, a veteran has 20 points for a hearing loss (but can hear reasonably well with a hearing aid), he needs only 23 points for PTSD or alcoholism to cross the 40 point threshold.
Added to this is a certain amount of good natured fudging on the part of doctors – most likely unconscious. It has already been mentioned that tame psychiatrists always rate psychiatric impairment higher – often outrageously higher – than disinterested psychiatrists. Other conditions are usually assessed by the veteran’s own GP, who is usually a decent fellow, but who has a good rapport with his patient, sees things through the patient’s eyes, and regards filling out form as a tedious bureaucratic necessity. It has been shown time and time again that an orthopaedic specialist will find more range of movement in a limb than the patient’s own GP will. Heart conditions can often be assessed by means of a stress test. Almost invariably, they reveal that the patient’s capacity for exercise is greater than he told his GP.
A 70% pension is thus not so difficult to achieve as you might think.

Now we come to the next step: subsection (b). The veteran’s A/Ds alone must be sufficient to prevent him from working eight hours a week. (For the Intermediate Rate, the test is set at half the normal working hours, or 20 hours per week.) The veteran may have other, serious non-A/Ds, and these would likely be a barrier under subsection (c), but providing the A/Ds are bad enough to prevent work for eight hours a week, subsection (b) is satisfied.
An important point to note is that, whereas subsection (c) refers to work he was already doing, subsection (b) is concerned with any sort of work he would be capable of undertaking. Another part of the Act, section 28 requires the decision maker to consider only the effects of the A/Ds on his ability to work in any capacity which his “vocational, trade and professional skills, qualifications and experience” would permit. There is case law that this includes work of a lower skill than that of his last employment. It also covers only the ability to work, not the ability to obtain work. The state of the labour market is not to be taken into account.
“It is agreed,” I said to a tame psychiatrist at a Tribunal hearing, “that he can no longer work at his last field of employment. But why can’t he work as, say, a car park attendant for eight hours a week? That’s only two hours a day, four days a week.”
“Well, if you put it that way,” the doctor replied, “most of my TPI patients could work at that level.”
From this you might conclude that TPI is very hard to obtain. It would be, except that the rules are not correctly applied. As the above psychiatrist so aptly demonstrated, doctors do not understand the law. They invariably think in terms of the patient’s last job, not all those he was qualified for, and they look at employability, not workability. Also, realistically, not many doctors are familiar with the requirements of workplaces other than their own.
Time and time again, the following scenario is played out. A veteran applies to have certain conditions accepted. He is granted pension at 70% or 80%. He appeals to the VRB – because appealing is something everybody does, he has nothing to lose, and his advocate advises him to do so. Then, some months later, but certainly before the VRB hearing, he resigns from his job, and requests TPI.
Typically, the veteran’s sick leave has not been spectacular. If the issue is PTSD, or some other mental illness, then, no matter who made the original diagnosis, he will be getting treatment from a tame psychiatrist who, as you will recall from last chapter, are consistently inadequate in their treatment. In some cases, the veteran has never returned to the psychiatrist after the initial consultation, or sought any treatment whatsoever, until he comes back for a report that he can no longer work. In any case, even if he receiving treatment, the psychiatrist will have no hesitation in certifying that the condition has worsened, without any shame at what this says about his own treatment régime. As for the GP, he is the patient’s friend. If the patient says he can no longer work, who is he to ask questions?
The timing of such resignations raises serious suspicions. So does its all-or-nothing character. Surely, the normal progression of most diseases is that, at some stage, the sufferer can no longer work full time, or can do so part time? In few of these cases has any attempt been made to cut down the hours of work, or to work on a casual basis. Not every employer can, or will, accede to such a request, but it would be useful to at least ask. Why don’t the doctors recommend that course to their patients when the latter raises the spectre of resignation? No matter. The patient wants out; the doctor will oblige him.
Strictly speaking, in such cases, the proper course would be to refer the veteran to an occupational specialist, to determine whether he is still capable of working, at least part time, and whether he is qualified, or capable, of working in any alternative employment. In practice, this is rarely done unless subsection (c) is also an issue and, in any case, the Department seldom performs investigations when the case is under appeal to the VRB. Besides, an occupational specialist is in no position to assess psychiatric impairment, but must rely on the tame psychiatrist. So, unless the veteran has some significant non-A/D, it is a lay down misère.
In short, nothing has changed since the 1992 audit. TPI is still a million dollar industry. People are still being paid not to work. Its lure leads veterans, advocates, and doctors into all sorts of questionable artifices. It is still being treated as a veterans’ superannuation scheme. It is still being handed out to men who have achieved a more or less full working life, many of whom could not hope to earn as much as the combined TPI and service pensions provide. It is not uncommon for 64 year olds to be granted TPI pensions.

The 1992 Audit also reported that the legislation and administration provided little incentive for younger veterans to gain rehabilitation. How could they, when the pension is at least as good as their possible wages? The Veterans’ Entitlements Act, in fact, contains no real provision for rehabilitation. It offers treatment, and mandates pensions. But treatment is voluntary, and if it is effective, the pension is reduced. If you talk about rehabilitation to groups of veterans – especially those in the PTSD club – they look on it as a sinister plot to take away their pensions. Finally, the Department produced a scheme whereby veterans could voluntarily make an attempt at a return to work, with their wages topped up to the TPI level, with the option for them to cease, and revert to TPI whenever they feel they can no longer cope or (to take a cynical view) decide it is time to retire. The candidates who presented themselves could easily be predicted: a handful of professional people who could earn more than the MTAWE. It is commonly held that many of these are not really incapacitated, but have simply found a way to manipulate the system.

The TPI racket has one other interesting sequela. After gaining their TPI pension, often by means of PTSD or some other psychiatric condition, quite a few veterans have found their purpose in life helping other veterans do the same. They serve as volunteer pension officers, advisers, and advocates for the local ex-service organisation, arranging and advising on claims, writing submissions, and even appearing before the VRB. Often this involves a considerable amount of time, not to mention creative pleading. But in the process, a nagging worry kept recurring: what is to stop the Department from ruling that they have proved themselves capable of working, and then cancelling their pension?
Therefore, they came to the Commission and asked for an assurance that it wouldn’t take such dastardly, if logical, action. And the Commission, for the sake of good relations with the ex-service organisations, gave them its word. The official rationale is that such voluntary work is different from paid employment, with its concomitant deadlines, quality control, regular schedules, and supervision. If the Commission really believes that, it is deceiving itself. The RSL, in particular, has paid pension officers and advocates doing what these volunteers are doing. If they really have difficulty adhering to specific working hours, they can be paid on a pro rata basis. And eight hours a week is only two hours a day, four days a week. These characters are disqualified under section 24(1)(b), and everyone knows it.

Not only does the system pay people to be sick, it also encourages bad medical practice. Veterans are entitled to free treatment for PTSD, anxiety, or depression, whether or not it is service related, and this itself is a good thing. But there is no quality control of the treatment. One psychiatrist, who does treat PTSD patients with some degree of success, spoke to me contemptuously about the “PTSD Industry”, where veterans are booked into various clinics for several weeks at a time, all at government expense, on a regular basis, without any real progress being made.
Recall the psychiatrist who told me at the Tribunal hearing: “Most of my TPI patients…” If I had had my wits about me, I could have asked a few further questions – like: What proportion of your veteran patients are on TPI, and why aren’t you able to improve their condition?
Recall poor Mr Q., who was attending a psychiatrist every six weeks, and a psychologist every fortnight, yet his affliction was not even stable, but was steadily, and rapidly, deteriorating, and he could no longer work. Why did the Department continue to pay for such treatment? In no other field of medicine would such a thing be tolerated. The Department would never agree to pay for an open-ended physiotherapy course. It would approve only a limited course of treatment, and if no progress was made, no more treatment would be approved without at least an orthopaedic report and recommendation.
Let me propose a scenario. Suppose a veteran lodges an application for an increase in pension, and his psychiatrist reports that he has got worse under his treatment. Suppose then, the Department accepts this report for pension purposes, but insists that the psychiatrist come up with an alternate treatment plan to reverse the process. If this fails, then the Department will say, in effect: That’s it; we are no longer paying for the treatment. The Department would then refer the veteran to a member of a team of psychiatrists who have a good track record for treating PTSD and related illnesses. Attendance by the veteran would be voluntary, but his treating psychiatrist would not be paid until the super team had established a successful treatment plan, or determined that his case was intractable.
What reaction would such a scheme provoke? A very loud one, I would suggest. For a start, it would create a conflict of interest between the veteran (who wants an increase in pension) and the doctor (who wants his fees). The latter would also face the prospect (shock! horror!) of coming under peer review. Many would be hesitant to claim their patient had deteriorated. Conversely, even if a veteran did improve under alternate treatment, many would be reluctant to admit it. Ex-service organisations would resist the move, seeing it, not incorrectly, as an attempt to prevent TPI payments.
Yet, the policy would be easily defensible. Veterans are entitled to the best treatment available for their war-caused disabilities. If the initial treatment régime fails, it is incumbent on the Department to look for a more effective plan. Nobody should be written off in the first instance.
Indeed, if the Department dug in its heels, and refused to compromise, there is the possibility of a slow change in medical culture. Having realised that they cannot go on providing ineffective treatment indefinitely, psychiatrists might see that their best interest lay in modifying the treatment as soon as it became clear that it was not working, even seeking second opinions from those more experienced. Psychiatry would be seen as a collaborative affair in developing best practices.
Is this being overly optimistic? Probably. Still, the possibilities should at least be looked at before being rejected.

Mental pain can be one of the worse forms of suffering. After all, it is possible to be happy despite your physical infirmities, but if you are depressed or anxious then, by definition, you are not happy. Suppose it happened to you when you were in your early twenties, and you still had your whole life, including potentially forty years of productive work, ahead of you. Suppose, too, that you psychiatrist told you, in effect: You’ll never get better. I shall continue to treat you, of course – and take the government’s money – but you’ll never be well enough to work even eight hours a week. No, there is no point in seeking a second opinion, because I know more than all the other doctors about the matter. I’m also psychic, and I know that nobody will ever find an effective treatment for you over the next forty years. Resign yourself to being a psychiatric wreck for the rest of your life.
If your doctor said that to you, wouldn’t your immediate response be: “I want a second opinion!” ?
Well, it happened to one young soldier, who had a bad experience on his first assignment to East Timor. The Commission, and later the VRB, granted him a TTI (total and temporary incapacity) pension, on the optimistic hope that he might improve. But he didn’t go to another doctor; he went to the AAT, because his minders told him he should be on TPI, not TTI. At the hearing, his treating doctor testified that he was a lost cause. A second psychiatrist, commissioned by the Department, suggested it was too early for such a pessimistic assessment. With appropriate treatment, there was a fighting chance he could get back into the workforce, at least part time. The Tribunal agreed, and the following year, so did the Federal Court.
Will he ever improve? He still wants TPI. His advisers tell him he should be getting it. And he is still receiving treatment from the same tame psychiatrist who branded his plight intractable. So what do you think?
Nor was this an isolated case. In absolute terms, veterans of more recent wars and peacekeeping operations are not numerous, in comparison to earlier wars. But those who are traumatised are young. And already the same rogues’ gallery of tame psychiatrists and well-meaning but misguided advocates are writing off all their hopes for the future for the sake of a pension which they have been taught to regard as their ultimate economic goal.

What happens on the rare occasions when a veteran does successfully rehabilitate himself? One case which crossed my path concerned a man whose mental anguish had been (I suspect inappropriately) determined to be war-caused. However, because his treating psychiatrist suggested there was hope of an improvement, he was granted a TTI pension, with a review date a few years in the future. At that point, he took the road less travelled: he found God, and He worked His healing power. By the time his case came up for review, he was in a Baptist seminary, studying for holy orders. He still had the occasional bad day, he reported, but otherwise he was getting on more or less fine.
As anyone who had done tertiary studies knows, studying, preparing assignments, and taking exams are a lot more stressful than the average nine to five job – especially the less skilled occupations covered by section 24(1)(b). I had no choice but to cancel his pension.
That’ll teach him!