Footnotes

[1] Submission 5, Regular Defence Force Welfare Association Inc, p. 1, paragraph 2.

[2] Hon John Clarke, QC et al, Report of the Review of Veterans' Entitlements, Canberra 2003.

[3] See below, Chapters 3 and 4.

[4] See Australian National Audit Office (ANAO), Audit Report No.34 1996-97 Australian Defence Force Health Services, Canberra 1997 and Audit Report No. 51 2000-2001 Australian Defence Force Health Services Follow-up Audit, Canberra 2001. For other reviews, see Defence Efficiency Review 1996, Defence Reform Program 1996/97 (see below, Chapter 2, paragraph 2.17, and Inspector General Department of Defence Inquiry HealthKEYS, 2002 (Submission 9A, Defence Organisation, Question 7). Defence also advised on the nature of another recent review: The purpose of the Defence Health Service (DHS) Review, conducted by Major General J.P. Stevens, AO (Retd), was to evaluate whether the DHS was able to meet Defences need for health services in the short to medium term and to propose any changes that may be necessary to achieve this, Submission 9B, Defence Organisation, p. 5, Q3additional details are contained in that document.

[5] See Chapter 2, paragraphs 2.12.5.

[6] See below, paragraph 1.7 and Chapter 2, paragraphs 2.922.93.

[7] See Chapter 2, paragraphs 2.922.93.

[8] The rates of death and serious personal injury encountered in garrison conditions across all Australian Services remain considerably higher than for matched industry groups. As a result of injuries, significant numbers of personnel are unavailable for deployment and are restricted in performance of their normal duties, Group Captain Peter S Wilkins, Occupational health and Safety Challenges for the ADF, ADF Health, 5 (2004) p. 1, and Chapter 2, paragraphs 2.922.97.

[9] Reference to veterans therefore generally means to persons who are not in the workforce or who have retired. However, many veterans of recent conflicts remain in the ADF or continue in employment as members of the Reserve or other forces. For those working for the Commonwealth, employmentrelated injury or health problems are dealt with under the Commonwealth Safety, Rehabilitation and Compensation Act (SRCA) which is managed by Comcare. Since 1999, DVA has managed SRCA claims for the ADF. The Military Rehabilitation and Compensation Act 2004 will also be used by ADF personnel and reservists.

[10] See Professor Peter Baume et al, A Fair Go: Report on Compensation for Veterans and War Widows, Canberra 1994.

[11] See Hon John Clarke, QC et al, Report of the Review of Veterans' Entitlements, Canberra 2003.

[12] For example, through the creation of the Repatriation Medical Authority in 1994, along with the requirement that the Authority rely on medicalscientific information in making Statements of Principle, see below paragraphs 1.161.25.

[13] This includes serious injury caused in a nondeployment situation.

[14] United Kingdom, Ministry of Defence, Veterans Agency/ Department for Work and Pensions, Pathways to Work: MoD and UK armed forces have a distinguished tradition in respect of successful rehabilitation and return to work. That tradition continues through the supported approach to medical downgrading (focus on rehabilitation at community level and by Headley Court), consideration of employability and the resettlement arrangements for those eligible.

Of these medically discharged each year, only a small number have serious disorders. The armed forces are a highly selected population and many medical dischargees leave only because of the very high standards of mental and physical health required for operational fitness and the relative lack of downgraded opportunities in the post Options for Change. at http://www.veteransagency.mod.uk/pdfolder/vasecpdfs/pathways_work.pdf, p. 2.

[15] The Hon John Clarke, QC et al, Report of the Review of Veterans' Entitlements, volume 1, paragraph 3.23: An important principle laid down in the legislation related to the onus of proof. Once the appellant had made out a prima facie case, the onus was on the Repatriation Commission to disprove it.

[16] Auditor General, Audit Report No. 8 199293: Efficiency Audit, Department of Veterans Affairs: Compensation Pensions to Veterans and War Widows, Canberra 1993.

[17] Bushell v. Repatriation Commission [1992] HCA 47; (1992) 175 CLR 408 F.C. 92/035 (1992) 29 ALD 1 (7 October 1992).

[18] Professor Peter Baume et al, A Fair Go: Report on Compensation for Veterans and War Widows, Canberra 1994.

[19] A brief outline of standards of proof in the legislation is given in the submission by the Vietnam Veterans Association of Australia to the Review Committee on the Veterans Entitlements Act, 2002 at www.vvaa.org.au, pp. 23. A more detailed history of the changes in legislation is given in Chapter 3 of the Hon John Clarke, QC, Report of the Review of Veterans Entitlements, Canberra 2003, volume 1. The United Kingdom provides that claims made for a war disablement pension after 7 years, reverses the onus of proof from the department to the claimant but reliable evidence could raise a reasonable doubt, which would be sufficient for the claimant to succeed: this appears much the same situation as Australian legislation prior to the 1994 amendments: Whilst it is true that the rule switches the onus from the Secretary of State to the claimant at the seven year point, for a claim to succeed it requires only that the claimant produces reliable evidence to raise a reasonable doubt. Therefore, were further research to show any reliable evidence of there being a servicerelated cause for an otherwise unexplained illness, claims for war pension could succeed.

This applies not only to Gulf conflict related claims, but to any medical condition suffered by any participant in any theatre. The seven year rule applies not from the end of any given conflict but from the point the individual ends their total service. Some Gulf veterans could still be benefiting from its provisions for over 20 years to come, United Kingdom, Ministry of Defence, Gulf Veterans Illnesses, Government Response to the House of Commons Defence Select Committee's Seventh ReportGulf Veterans' Illnesses, Financial Assistance, at http://www.mod.uk/issues/gulfwar/policy/gen_reports/hcdc7report.htm#7.

[20] See above, paragraph 1.11.

[21] Veterans Entitlements Act 1986.

[22] Veterans organisations have argued in the past that there is little external assessment of the SOPs because the process is medically dominated (Vietnam Veterans Association of Australia, Submission to the Review Committee on the Veterans Entitlements Act, p. 6, at www.vvaa.org.au) Additional arguments are that a single medical view has no status under the SOP (see the opinion of the Repatriation Commission on the work of one doctor on du, at Submission 8A, pp. 78), and that it has often taken considerable time for scientific research to prove or satisfactorily demonstrate links between events such as exposures to substances and ill health (Vietnam Veterans Association of Australia, Submission to the Review Committee on the Veterans Entitlements Act, pp.5-6, 13, at www.vvaa.org.au).

[23] Submission 8, Repatriation Commission, p. 16, paragraph 84.

[24] United Kingdom, Ministry of Defence, Gulf War IllnessesA New Beginning, at www.mod.uk/issues/gulfwar/policy/newbegin, paragraph 32.

[25] Veterans Entitlements Act 1986, S 120(1).

[26] Veterans Entitlements Act 1986, S 120A (3).

[27] Veterans Entitlements Act 1986, S 120A(2).

[28] See Veterans Entitlements Act 1986, Part X1B, S 196W.

[29] Veterans Entitlements Act 1986 S 196W(3).

[30] Veterans Affairs (1994-95 Budget Measures) Legislation Amendment Act 1994, No. 98 of 1994.

[31] The Repatriation Commission submission refers only to four diseases, Submission 8, pp.89: The Repatriation Commission has issued four S180A Statements, for the following conditions: Chronic myeloid leukaemia, Acute myeloid leukaemia, Acute lymphoid leukaemia, Chronic lymphoid leukaemia. This suggests that the other disorders were accepted by the RMA, with only certain leukaemia's requiring the benefit of the doubt, see Submission 8, Repatriation Commission, p. 17, paragraph 85.

[32] Hansard, House of Representatives, 13 October 1994, p. 2008, The Hon C A Sciacca. See also Submission 8, Repatriation Commission, p. 17, paragraph 85.

[33] Professors R McLennan and P Smith, Veterans and Agent Orange Health effects of Herbicides used in Vietnam (27 September 1994), pp. 67.

[34] Professors R McLennan and P Smith, Veterans and Agent Orange Health effects of Herbicides used in Vietnam, p. 9: If the association between leukaemia and smoking is accepted, the number of cases of leukaemia in non-smoking veterans would be small, and these should be given the benefit of the doubt.

[35] Submission 8, Repatriation Commission, p. 17, paragraph 85.

[36] Submission 9, Defence Organisation, p.7, paragraph 33.

[37] Submission 5, Regular Defence Force Welfare Association, pp. 56, paragraphs 2830: the current SOPs make it difficult for a Navy veteran to be successful for a claim relating to PTSD as the SOPs are written from an Army or landbased perspective (paragraph 28).

[38] Submission 6, Australian Peacekeepers & Peacemakers Association, p. 4.

[39] Submission 8, Repatriation Commission, pp. 15-16, paragraphs 7980.

[40] Submission 8, Repatriation Commission, p. 16, paragraph 82.

[41] See below, paragraph 1.40.

[42] See, for example, the statement made in respect of Gulf War claims in the United Kingdom, for cases proceeding in civil courts: It is likely that each claim will have to be considered on its merits because each individual's symptoms, degree of disability and personal circumstances, which would determine the level of award, will be different. However, it is possible that a pattern may emerge in handling the first cases which would facilitate the handling of the remainder, United Kingdom, Ministry of Defence, Gulf Veterans Illnesses, Government Response to the House of Commons Defence Select Committee's Seventh ReportGulf Veterans' Illnesses, at

http://www.mod.uk/issues/gulfwar/policy/gen_reports/hcdc7report.htm#15.

[43] See below, Chapter 4, paragraphs 4.28, 4.29, 4.42.

[44] See above, paragraph 1.25, and see below, Chapter 4, paragraph 4.50.

[45] See Chapter 4, paragraphs 4.454.46, 4.50.

[46] For example, there are some 697,000 Gulf War US veterans, and the UK Ministry of Defence maintains close contact with the US in terms of research. The US authorities have a significant programme of work underway in respect of Gulf veterans illnesses ($155M has been spent and 192 projects commissioned). Hence it is important for the UK Ministry of Defence to keep in close touch with developments there. The Ministry of Defence continues to have a full time Gulf Health Liaison Officer based in Washington DC, who is also the UK representative on the (US) Military Veterans Health Coordinating Boards (MVHCB) Research Working Group. Both directly and through the liaison officer, the Ministry of Defence maintain close links with the US authorities, including the Executive Office of the President, the Department of Defence (including the Office of the Special Assistant for Gulf War Illness (OSAGWI), the Department of Health and Human Services, and the Department of Veterans Affairs. http://www.mod.uk/issues/gulfwar/policy/hcdcmemo3.htm (April 2001).

[47] See Chapter 2, paragraphs 2.32.6.

[48] See below, Chapter 4, paragraphs 4.84.13

[49] United Kingdom, Ministry of Defence, Gulf Veterans IllnessesA New Beginning (July 1997), at www.mod.uk/issues/gulfwar/policy/newbegin, and below, paragraph 1.37.

[50] United Kingdom, Ministry of Defence, Gulf Veterans' Illnesses, Current Activity Relating to Gulf Veterans' IllnessesMemorandum 2, at

http://www.mod.uk/issues/gulfwar/policy/hcdcmemo.htm. See also House Lords, Official Report, 17 October 2001,Column 680700: 'We have made a concession to Gulf veterans by undertaking not to rely on the defence of limitation under the Limitation Act 1980 without giving solicitors prior notice. I tell the House that as of 30th September this year we had 1,890 active notices of intention to claim from veterans and members of their families in respect of illness allegedly arising from the Gulf conflict.

However, the Ministry has yet to receive any writs or claims of sufficient detail, reprinted in United Kingdom, Ministry of Defence, Gulf Update December 2001, p. 7, athttp://www.mod.uk/linked_files/gulf_updatedec01.pdf.

See also: Since the repeal of Section 10 of the Crown Proceedings Act 1947 on 15 May 1987, British Service personnel have had the same right to claim compensation from the MOD as any other employee against his or her employer. No writs or claims of sufficient detail have been received from Gulf veterans to allow MOD to handle these cases. If such claims are received, the MOD will try to resolve them as quickly as possible and will pay compensation where a legal liability exists. It is likely that each claim will have to be considered on its merits because each individual's symptoms, degree of disability and personal circumstances, which would determine the level of award, will be different. However, it is possible that a pattern may emerge in handling the first cases which would facilitate the handling of the remainder. Where a legal liability is established the vast majority of compensation payments made by the MOD are made without proceeding to court.( United Kingdom, Ministry of Defence, Gulf Veterans Illnesses, Government Response to the House of Commons Defence Select Committee's Seventh ReportGulf Veterans' Illnesses, at

http://www.mod.uk/issues/gulfwar/policy/gen_reports/hcdc7report.htm#15.

[51] United Kingdom, Ministry of Defence, Gulf Veterans IllnessesA New Beginning (July 1997), at www.mod.uk/issues/gulfwar/policy/newbegin.

[52] United Kingdom, Ministry of Defence, Gulf Veterans' Illnesses, Current Activity Relating To Gulf Veterans' Illnesses: Memorandum 3, at http://www.mod.uk/issues/gulfwar/policy/hcdcmemo3.htm.

[53] 'In 1999, an arrangement was set up whereby individuals, who in the opinion of the MAP physicians would benefit from a psychiatric assessment, can be referred at the Ministry of Defences expense to consultant psychiatrists with a specialist interest and expertise in post traumatic stress disorder (PTSD). A network of such consultants across the country has been set up. Treatment of ex-Service personnel is undertaken by the NHS in the usual way. If the patient is assessed as not suffering from stress reactions to trauma, but some other psychological problem, he/she can be referred on to an appropriate NHS specialist within his/her own area for further assessment and treatment. When these arrangements were reviewed in mid-2000 it became clear that some veterans were waiting too long for appointments and for the reports from these referrals. A fasttracking arrangement was introduced and is currently meeting targets of appointments within six weeks of referral and a report within four weeks. GVMAP also decided to conduct a follow-up of the effectiveness of the treatments recommended in these cases.

This will be done in conjunction with the referral network and aims to analyse the outcomes of treatment plans in 6080 cases', United Kingdom, Ministry of Defence, Gulf Veterans' Illnesses, Current Activity Relating To Gulf Veterans' Illnesses: Memorandum 3, at http://www.mod.uk/issues/gulfwar/policy/hcdcmemo3.htm.

[54] United Kingdom, Ministry of Defence, Gulf Veterans' Illnesses, Gulf Veterans IllnessesA New Beginning (July 1997), at www.mod.uk/issues/gulfwar/policy/newbegin.

[55] United Kingdom, Ministry of Defence, Gulf War Syndrome, at www.mod.uk/issues/gulfwar/gws

[56] United Kingdom, Naval, Military and Air Forces (Disablement and Death) Service Pensions Order 1983, as amended.

[57] United Kingdom, Ministry of Defence, Gulf War Syndrome, at www.mod.uk/issues/gulfwar/gws, emphasis added.

[58] United Kingdom, Ministry of Defence, Gulf Veterans Illnesses, Government Response to the House of Commons Defence Select Committee's Seventh ReportGulf Veterans' Illnesses, at http://www.mod.uk/issues/gulfwar/policy/gen_reports/hcdc7report.htm#15:For deaths arising, or disablement claims lodged within seven years of termination of service, the onus lies with Secretary of State to show beyond reasonable doubt that the disablement or death is not due to service. There is no onus on the claimant to show any link between disablement and service.

Even where a claim for disablement is made more than seven years after termination of service, or where death occurs more than seven years after service, the onus of proof is still more generous than the burden of proof in civil tort which rests on a balance of probabilities. Article 5 of the Naval, Military and Air Forces (Disablement and Death Service Pensions Order 1983, as amended provides that it is necessary for the claimant only to raise reasonable doubt, based on reliable evidence, that the death or disablement is due to service. The benefit of any reasonable doubt is always given to the claimant.

[59] Under 20 per cent disability usually will receive a oneoff payment/gratuity.

[60] UK Defence Today, September 2003

http://news.mod.uk/news/press/news_press_notice.asp?newsItem_id=2744: Approximately 4 out of 5 Disablement Pensioners have pensions awarded at the 50 per cent rate or less. The largest group are those at the 20 per cent rate. Approximately 4 per cent receive the 100 per cent disablement rate. The overall average weekly amount of war disablement pension and associated supplementary allowances is 61.33.

[61] UK Defence Today, September 2003

http://news.mod.uk/news/press/news_press_notice.asp?newsItem_id=2744. Payments to other service personnel are also made under different schemes in the United Kingdom, so 208,000 does not represent the total number of persons receiving some form of pension in respect of war service. There are 5 million veterans and 8 million dependants in the United Kingdom, Improving the Delivery of Cross Departmental Support and Services for VeteransA Joint Report of the Department of War Studies and the Institute of Psychiatry, Kings College London, July 2003, p. 5, paragraph 2.3, at

http://news.mod.uk/news_press_notice.asp?newsItem_id=2616.

[62] See in particular Improving the Delivery of Cross Departmental Support and Services for VeteransA Joint Report of the Department of War Studies and the Institute of Psychiatry, Kings College London, July 2003, at

http://news.mod.uk/news_press_notice.asp?newsItem_id=2616.

[63] Submission 8, Repatriation Commission, p. 16, paragraph 81.

[64] Submission 8, Repatriation Commission, p. 16, paragraph 81.

[65] Submission 9B, Repatriation Commission, p. 14.

[66] Although chemical warfare, including mustard gas and phosgene, obviously also had a substantial effect in the First World War and for long period afterwards.

[67] Better Living Through Chemicals, at

http://eport2.cgc.maricopa.edu/published/d/du/dduncan91/collection/1/3/upload.htm, notes that napalm (petroleum and detergent) was used in World War 2, and Korea as well as Vietnam: it also deoxygenates the air, which can cause asphyxiation, and often generates enormous quantities of carbon monoxide gas.

[68] See http://www.parl.gc.ca/37/3/parlbus/chambus/house/debates/049_2004-05-06/han049_1455-e.htm, question on use of chemicals in Korea, in Canadian Parliament, and The US Biological Warfare in Korea, South Korean documentary, at http://www.kimsoft.com/2000/mbc.htm.

[69] See the list of exposures including carbon tetrachloride, tin, lead, solder, electromagnetic fields, chlorinated solvents, for naval personnel in various occupations, US Navy Veteran Cohort, 19501997, in F.D. Groves et al, Cancer in Korean War Navy Technicians: Mortality Survey after 40 Years, American Journal of Epidemiology, 155 (2002) p. 812, Table 2. This supports the statement by the Repatriation Commission that exposure to a potential hazard may be related more to individual tasks within an occupational speciality rather than to an overall deployment, Submission 8, p. 15, paragraph 73.

[70] See Submission 8, Repatriation Commission, p.17, paragraph 87, which notes that some of these matters are still relevant subjects for research.

[71] See Chapter 4, paragraphs 4.40-4.42 on Korean war mortality rates.

[72] See Chapter 2, paragraphs 2.252.27, and Chapter 3, paragraphs 3.93.12.

[73] See Chapter 2, paragraphs 2.32.5.

[74] United Kingdom Parliament, Select Committee on Defence Seventh Report, Progress in Ascertaining the Causes of Gulf War Veterans Illnesses, paragraph 58, at

http://www.parliament.the-stationery-ffice.co.uk/pa/cm199900/cmselect/cmdfence/125/12506.htm#a13

[75] See Chapter 2, paragraphs 2.32.5.

[76] For example, ships logs (Farmer and Repatriation Commission [2004] AATA 781 (23 July 2004), and the equivalent for other forces; patrol records, interviews with other platoon members, historians etc (Committee Hansard, p. 81, Repatriation Commission). See also Chapter 3, paragraphs 3.363.41, and Chapter 4, paragraphs 4.734.74.

[77] Committee Hansard, p. 81.

[78] Farmer and Repatriation Commission [2004] AATA 781 (23 July 2004), paragraph 92.

[79] Benjamin and Repatriation Commission [2004] AATA 738 (13 July 2004), paragraph 62.

[80] See Committee Hansard, p. 81 (ADF) and see also Chapter 2, paragraphs 2.302.40, 2.512.53, 2.60, 2.642.66, 2.672.69.

[81] Chapter 2, paragraphs 2.532.54.

[82] Although, as is also discussed in Chapter 4, either research or the standard of reasonable satisfaction may result in otherwise unlisted information being accepted, as seen in the case of Organ and Repatriation Commission [2004] AATA 671 (29 June 2004), paragraph 76: Given the passage of time and the often encountered difficulty in finding relevant records, the Tribunal accepts the applicants accounts of what took place

[83] Submission 9, Defence Organisation, p. 4, paragraph 19.

[84] United Kingdom Parliament, House of Commons Select Committee on Defence Seventh Report, Progress in Ascertaining the Causes of Gulf War Veterans Illnesses, paragraph 49, at

http://www.parliament.the-stationery-ffice.co.uk/pa/cm199900/cmselect/cmdfence/125/12506.htm#a13.

[85] United Kingdom Parliament, House of Commons Select Committee on Defence Seventh Report, Progress in Ascertaining the Causes of Gulf War Veterans Illnesses, paragraph 49, at
http://www.parliament.the-stationery-ffice.co.uk/pa/cm199900/cmselect/cmdfence/125/12506.htm#a13.

[86] See above, paragraph 1.5.

[87] The ADF commissioned a review of health services which was originally expected to report by the end of March 2004, Submission 9, Defence Organisation, p. 1, paragraph 5. In evidence, the ADF stated that this report had not then been completed, Committee Hansard, p. 91.

[88] This issue is discussed at Appendix 3.

[89] Submission 5, Regular Defence Force Welfare Association Inc., p. 4, paragraph 21.

[90] Committee Hansard, p. 30, Australian Peacekeepers & Peacemakers Association.

[91] See United Kingdom, Ministry of Defence, JSP430 MOD Ship Safety Management, at www.mod.uk. linkedfiles/dpe/JSP430.doc, p. 5.

[92] Through legislation such as the Safety Rehabilitation and Compensation Act 1988 and the Military Rehabilitation and Compensation Act 2004.

[93] See Appendix 3, which notes the problems caused in this situation through not advising of the requirement prior to departure.

[94] Improving the Delivery of Cross Departmental Support and Services for VeteransA Joint Report of the Department of War Studies and the Institute of Psychiatry, Kings College London, July 2003, at http://news.mod.uk/news_press_notice.asp?newsItem_id=2616, p. 25, paragraph 3.9.3 .4: the Swedes are keen to make talking about trauma an everyday occurrence within their regiments. There is structured time for debriefing every evening, which is protected time (often accompanied by beer) British regiments [on the other hand] can be seen as the repressed leading the depressed (on peacekeeping in Bosnia).

[95] Committee Hansard, p. 2.

[96] Committee Hansard, p. 62.

[97] See Additional Estimates, FADT, 18 February 2004, Answers to questions on notice, Defence, part 2, p. 6, and also below, Chapter 3, paragraph 3.6.

[98] United States, Department of Defence Force Health Protection (FHP) at www.ha.osd.mil/forcehealth/about/main.

[99] United Kingdom, Defence Health Programme 2003-2007, p. 3 at www.mod.uk/publications/dhp. See also the concordat between the NHS and MoD at www.mod.uk/linked_files/publications/concordats/doh_mod_concordat.

[100] The United States uses the term Gulf War to cover both the 199091 war and the conflict in Iraq, distinguishing between these by the names of operations. This has facilitated access by veterans to various services set up after the first Gulf War as much of the administration work involved in determining conflict linked injury and disease has already been done.

[101] See www.nap.edu.books/0309071895, Executive Summary, p. 1.

[102] United States, National Science and Technology Council, A National Obligation, Planning for Health Preparedness for and Readjustment of the Military, Veterans, and Their Families after Future Deployments (1998), response to Presidential Directive No. 5 at www.ostp.gov.NSTC/html/directive5.

[103] See www.ostp.gov.NSTC/html/directive 5.

[104] www.ostp.gov.NSTC/html/directive 5.

[105] See Chapter 4, paragraphs 4.3, 4.344.44.

[106] See Brigadier Paul Buckley, The Defence Health Serviceformative steps, ADF Health, 1 (November 1999), p. 8.

[107] Budget estimates, FADT, 4 June 2003, p. 363. Submission 9, Defence Organisation, p. 1, paragraph 3.

[108] Submission 9B, Defence Organisation, p. 4, Q2 (d): The current ADF medical screening processes are heavily focussed on preventive health and lifestyle issues. A working group has recently been formed to review our current health examination processes and determine if a change in emphasis towards a more occupational focus is warranted. This will involve extensive consultation and the development of a business case to support any move away from the current system.

[109] Committee Hansard, p. 8. See also Submission 5, Regular Defence Force Welfare Association Inc, p. 5, paragraph 29: Knowledge of the unique environmental exposures associated with ADF service and deployments is not as widespread within the ADF health system as it should be or used to be and this is compounded by the increasing outsourcing of Defence health services to a civilian health population that has had no experience of Defence service.

[110] In addition, some specialist services may not be approved as either not necessary for deployment/operational purposes or as making personnel unfit for these purposes: see DJHSA Directive 07/03, 30 July 2003, Non Standard Health Care Procedures in the ADF, p. 1: It should also be noted that, should it be undertaken at the members cost,the outcome may not be compatible with the maintenance of a deployable profile IAW references A and B.

[111] Submission 9B, Defence Organisation, p. 4, Q2(e).

[112] Committee Hansard, p. 72 and see above, paragraphs 2.7, 2.9.

[113] Some familiarity with the work of ADF personnel was to be obtained through all CHPs being given the opportunity to attend at least one field day annually with a major unit from the establishment in their normal working and training area, DJHSA Directive 10/04, 7 April 2004, Orientation of Contract Health Practitioners Working on Australian Defence Force Bases, p. 2.

[114] Area Health Services may fund attendance of contract health practitioners on selected ADF health courses, and on those professional body health conferences which have a military component, DJHSA Directive 10/02, 17 September 2002, Contract Health Practitioner Attendance at ADF Medical Courses.

[115] See Submission 5, Regular Defence Force Welfare Association Inc, p. 5, paragraph 29.

[116] Committee Hansard, p.8. See also Submission 5, Regular Defence Force Welfare Association Inc, p. 2, paragraphs 810.

[117] See Submission 5, Regular Defence Force Welfare Association Inc, p. 2, paragraph 4.

[118] See especially Appendix 3, below, and also Submission 9, Defence Organisation, Appendix D, ADFP 1.2.2.1 paragraph 1.10.

[119] Submission 5, Regular Defence Force Welfare Association Inc, p. 4, paragraph 25.

[120] See Appendix 3.

[121] See Appendix 3.

[122] See Appendix 3

[123] Submission 9B, Defence Organisation, p. 3, Q 2(b).

[124] See Brigadier Paul Buckley, The Defence Health Serviceformative steps, ADF Health, 1 (November 1999), pp. 56.

[125] Budget estimates, FADT, 4 June 2003, p.363. Submission 9, Defence Organisation, p. 1, paragraph 3.

[126] Submission 9, Defence Organisation, p. 2, paragraph 9 and p.4, paragraph 21.

[127] Committee Hansard, p. 72.

[128] See Redress of Grievance, Attachment to Submission 10, Mrs Screaton, paragraph 34, see also Appendix 3.

[129] Joint Health Support Agency, DJHSA Directive 07/03, 30 July 2003, Non Standard Health Care Procedures in the ADF.

[130] Submission 9, Defence Organisation, p. 1, paragraphs 24, p. 2, paragraphs 69, pp. 23, paragraphs 1013.

[131] Submission 9, Defence Organisation, p. 3, paragraph 12.

[132] Submission 9, Defence Organisation, p. 3, paragraph 12.

[133] Submission 9A, Defence Organisation, p. 3, Q2(b).

[134] Submission 9, Defence Organisation, p. 2, paragraphs 67.

[135] Submission 5, Regular Defence Force Welfare Association Inc, p. 2, paragraphs 4, 5.

[136] Submission 3, Armed Forces Federation of Australia, p. 1.

[137] Committee Hansard, p. 89.

[138] Submission 9, Defence Organisation, p. 1, paragraph 8. See also chapter 3.The US in particular has collected some exposure data, but this may have limited value unless it can be matched to individuals through HealthKEYS, see below, paragraphs 2.642.66.

[139] See Appendix 3.

[140] Committee Hansard, p. 30, Australian Peacekeepers & Peacemakers Association.

[141] Committee Hansard, pp. 8889.

[142] Committee Hansard, p. 8: doxycycline is a registered drug in Australia and it is widely used, so we do not spend a lot of time telling people about it, nor do we require a signed consent from them.

[143] Committee Hansard, p. 76. Doxycycline is an antibiotic (tetracycline) which is used for several health problems, including as an anti-malarial and antianthrax drug. It is used as an anti-malarial in areas which have become mefloquine resistant (Mefloquine is an older anti-malarial which no loner provides adequate coverage against malaria in some areas) and this includes the Pacific region. It does have side effects including gastrointestinal upset and esophagitis. It can also be photo sensitizing, and therefore adequate sunscreen protection is required. It is contraindicated in pregnant women, Stephen J. Gluckman, Prevention of malaria in travellers, American Family Physician, 1 August 2003, pp. 34, www.findarticles.com/doxycycline). Although one source indicated that long term use of tetracyclines was tolerated well, another stated that some sources do not recommend taking it for more than three months (Australian College of Tropical Medicine, Faculty of Travel Medicine, Travel Medicine Briefcase, 2 (December 2001) p. 1). The Australian College of Tropical Medicine refers to the fact that there are no long-term antimalarials, and mentions doxycycline as a short term drug. If this information was available, it does not appear to have been transmitted to the individual who had been taking it for 14 months.

[144] Submission 9, Defence Organisation, p.3, paragraph 13.

[145] Committee Hansard, p. 64. See also Submission 9B, Defence Organisation, p. 1, Q1(c): ADF personnel receive detailed health threat assessment briefings prior to deployment that provide sufficient information about the risks and possible consequences of different hazards.

[146] Committee Hansard, p. 61.

[147] Submission 9, Defence Organisation, p.5, paragraph 23.

[148] Submission 9B, Defence Organisation, p. 1, Q1(a).

[149] Submission 6, Australian Peacekeepers & Peacemakers Association, pp. 23, paragraphs 914.

[150] Budget supplementary estimates, FADT, 5 November 2003, p. 104.

[151] See Committee Hansard, Australian Peacekeepers & Peacemakers Association, p. 36: 'There is psychological suitability testing, psychometric testing, that is completed prior to entry into the service to identify people who are suitable and not suitable. The repeat of that as a tool before deployment may be an idea; I am not too sure'.

[152] See John Ellard, 'Principles of Military Psychology', ADF Health, 1, 2000, p.83.

[153] Submission 9B, Defence Organisation, p. 8, Q5(h).

[154] Improving the Delivery of Cross Departmental Support and Services for VeteransA Joint Report of the Department of War Studies and the Institute of Psychiatry, Kings College London, July 2003, p. 45, paragraph 5.3.1.3, at

http://news.mod.uk/news_press_notice.asp?newsItem_id=2616.

[155] Submission 6, Australian Peacekeepers & Peacemakers Association, pp. 23, paragraph 11.

[156] Committee Hansard, p. 33, Australian Peacekeepers & Peacemakers Association, and see also below, paragraph 2.89, and Chapter 4, paragraph 4.64.

[157] Budget estimates, FADT, 4 June 2003, p. 367.

[158] Budget estimates, FADT, 4 June 2003, p. 361.

[159] See below, paragraphs 2.692.71.

[160] Submission 9, Defence Organisation, p. 1, paragraphs 4, p. 2, paragraph 10.

[161] Submission 9, Defence Organisation, p. 4, paragraph 17.

[162] Submission 9, Defence Organisation, p. 3, paragraph 13.

[163] Submission 9, Defence Organisation, pp. 45, paragraph 21.

[164] Submission 9, Defence Organisation, p. 5, paragraph 21; see also p. 3, paragraph 11, which notes that the medical and dental examinations are conducted by JHSA staff.

[165] At the time of writing its submission (January 2004) the ADF had not yet incorporated into the annual assessment any information relating to compensation claims or acceptance of claims, which left the responsibility of identifying any problems to individual personnel. This was a matter which the ADF expected to rectify (Submission 9, Defence Organisation, p. 5, paragraph 21), although some crosschecking of responses with compensation claims may be necessary in order to determine the exact nature of such claims or conditions for which the individual is being compensated (because the proposed incorporation of this issue into the annual assessment takes the form only of an indication (p. 5, paragraph 21) that may not elicit sufficient detail)see Submission 9, Defence Organisation, p. 5, paragraph 29.

[166] Submission 9, Defence Organisation, p. 5, paragraph 21.

[167] See Submission 9, Defence Organisation, p. 2, paragraph 9. These standard inoculations were ADT (adult diphtheria and tetanus; measles, mumps, rubella; polio; hepatitis A and B; and typhoid (Estimates, FADT, 4 June 2003, p. 365).

[168] Submission 9, Defence Organisation, p. 5, paragraph 22.

[169] Submission 7, Major Laboo, p. 3.

[170] Submission 5, Regular Defence Force Welfare Association Inc., p. 4, paragraphs 2021.

[171] See Appendix 3.

[172] Submission 9B, Defence Organisation, p. 4, Q2(i).

[173] Department of Defence, Media Release, First ADF health status report supports white paper aims, 2000.

[174] Budget estimates, FADT, 4 June 2003, p. 358, Senator Evans: There seem to have been reports of nothing more than cuts and abrasions which seem quite remarkable given the large number of people and the potential for industrial accidents let alone anything involving a conflict.

[175] Budget estimates, FADT, 4 June 2003, p. 383.

[176] Additional estimates, FADT, 18 February 2004, Answers to Questions on Notice, Defence, part 2, p. 68.

[177] Submission 9B, Defence Organisation, p. 3, Q2(b): As a general principle, and in line with United Nations policy, as a Troop Contributing Nation, the ADF provides its own primary health care.

[178] United Nations, Office of Mission Support, Department of Peacekeeping Operations, Medical Guidelines for Peacekeeping Operations, Medical Support Unit/ OSD/LMS Hospital Level Medical Care (2003) outlines the standards of equipment and staff to be provided. See www.un.org/Depts/dpko/medical/pdfs/472 hospital care.

[179] In Timor, the original UN hospital at Comoro was established by Australia in 1999 and closed at the end of August 2002. It was replaced by the UN hospital in Dili. Medical staff for the hospital were provided by Australia, Egypt and Singapore. (See www.un.org/peace/timor 040902). However, under the system set up by the UN, hospital care is the responsibility of the UN (United Nations, Office of Mission Support, Department of Peacekeeping Operations, Medical Guidelines for Peacekeeping Operations, Medical Support Unit/ OSD/LMS Hospital Level Medical Care (2003), Introduction, p. 6) even though the facility in which the care is provided and the staff who provide it, may be contracted. This may account for the UN retaining medical records.

[180] See Chapter 3, paragraphs 3.393.40.

[181] Submission 9B, Defence Organisation, p. 3, Q2(b).

[182] Budget estimates, 4 June 2003, p. 359.

[183] See Correction of evidenceconcerning medical examinations for ADF personnel returning from active duty in the Middle East, Material provided following Budget estimates of June 4, 2003 at www.aph.gov.au/committees/Senate/Foreign Affairs, Defence and Trade, Budget estimates 20032004.

[184] See Correction of evidenceconcerning medical examinations for ADF personnel returning from active duty in the Middle East, Material provided following Budget estimates of June 4, 2003 at www.aph.gov.au/committees/Senate/Foreign Affairs, Defence and Trade, Budget estimates 20032004.

[185] Submission 9, Defence Organisation, p. 5, paragraph 24. This card is apparently meant as a prompt for personnel during the post-deployment period, presumably by listing issues they may wish to raise with medical staff.

[186] All personnel are medically examined three months after returning to Australia and provided with appropriate treatment if required(Budget estimates, FADT, 4 June 2003, p. 359).

[187] Submission 9, Defence Organisation, p. 1, paragraph 3.

[188] Defence Health Service, Health Directive 222, Health requirements for deployed Australian Defence Force Personnel, p.3 paragraph 20, at www.defence.gov.au/dpe/dhs/infocentre/publications/directives/HD222.

[189] Budget estimates, FADT, 4 June 2003, p. 360.

[190] See Budget supplementary estimates, FADT, 5 November 2003, p. 30.

[191] See History of Plasmodium Paragraph sites, www. wehi.edu.au MalDB.

[192] However, prevalence rates of HIV/AIDS are very low in Afghanistan and Iraqsee World Health Organisation (WHO), Epidemiological fact sheets in HIV/AIDS and sexually transmitted infection, 2000 at www.who.int/emc_hiv/fact_sheets 2000.

[193] The initial infection with M. tuberculosis often goes unnoticed; 95% of those infected enter a latent phase from which there is a lifelong risk of reactivation. The other 5% progress directly to pulmonary tuberculosis or by lymphohaematogenous dissemination of TB bacilli to miliary, meningeal or other extrapulmonary involvement. Infants, young children, older people and the immunocompromised are more likely to progress rapidly to severe generalized infection with poorer outcome. It is common for the initial infection to result in a characteristic nodular lesion in the middle or lower lungs, and this lesion acts as the source of disease during reactivation. Asia Pacific Vaccination Council, Tuberculosis: General Information on the Disease and the Vaccine, www.vaccinenews.net/default.asp? articleID=209&Topic_ID+65.

[194] National Health and Medical Research Council, The Australian Immunisation Handbook, 8th edition Canberra 2003, Part 2, p. 81: The incubation period for inhalational anthrax is thought to range from 1 to 43 days after exposure. The initial phase consists of flulike symptoms such as sore throat, mild fever, chest pain, cough and myalgia. Within 2 to 3 days, a second phase begins with the abrupt onset of high fever, dyspnoea and hypoxia, rapidly progressing to shock and death within 24 to 36 hours.

[195] www.nevdgp.org.au/genin f/lung_f/tuberculosis.

[196] People with poor health status, and limited access to food and medicine, are more vulnerable to TB.

[197] See National Health and Medical Research Council, The Australian Immunisation Handbook, 8th edition, Canberra 2003, pp. 60, 61.

[198] Stephen J Gluckman, Prevention of malaria in travellers, American Family Physician, 1 August 2003, p. 3.

[199] See Submission 9, Defence Organisation, Attachment D, ADFP 1.2.2.1, Immunisation Procedures, paragraph 5.80.

[200] Committee Hansard, p. 63. See also Appendix 3.

[201] See Submission 8, Repatriation Commission, p.15, paragraph 73.

[202] Committee Hansard, p. 42 Australian Peacekeepers & Peacemakers Association.

[203] Submission 8A Repatriation Commission/Department of Veterans Affairs, p. 7. DVA understands that for a brief period in the 1980s, certain Australian close-in air defence systems used on Royal Australian Navy ships used depleted uranium. Depleted uranium is also used in a wide variety of industrial applications such as in drills in engineering and in early Boeing 747 aircraft. Given this, Australia has been broadly aware of the potential for exposure to DU since the early 70s, although it has not been seen as a matter of particular concern until the years after the 199091 Gulf War.

[204] Budget estimates, FADT, 4 June 2003, p. 369. See also Chapter 4.

[205] Submission 8A, Repatriation Commission/Department of Veterans Affairs, p. 6.

[206] See Budget estimates, FADT, 4 June 2003, p. 369, Budget Supplementary Estimates, FADT, 5 November 2003, p. 27, Additional Estimates, FADT, 18 February 2004, pp. 99100.

[207] Submission 9B, Defence Organisation, p. 4, Q2(h), Submission 8A, Repatriation Commission/Department of Veterans Affairs, p. 7: It should be noted that the levels of uranium in exposed persons decreased with the passage of time, thus with so many years since the Gulf War, it may be that urine testing has limited or even no value.

[208] Budget estimates, FADT, 4 June 2003, p.369.

[209] Budget estimates, FADT, 4 June 2003, p. 371.

[210] See also above, Chapter 1, paragraphs 1.46 and 1.751.77

[211] Budget estimates, FADT, 4 June 2003, p. 368.

[212] Budget estimates, FADT, 4 June 2003, p. 368.

[213] See above, paragraphs 2.32.5.

[214] See below, Chapter 3, paragraphs 3.323.34 and Chapter 4, paragraphs 4.5, 4.34, 4.35, 4.45, 4.514.54.

[215] Budget estimates, FADT, 4 June, 2003, p. 359, General Cosgrove: Prior to departure from the Middle East all ADF members were examined by a medical officer and debriefed by a military psychologist. See also p. 362.

[216] Submission 6, Australian Peacekeepers & Peacemakers Association, p. 3, paragraph 13.

[217] Submission 6, Australian Peacekeepers & Peacemakers Association, p. 3, paragraph 12.

[218] Submission 9B, Defence Organisation, p. 8, Q5(a).

[219] Budget estimates, FADT, 4 June 2003, p. 360.

[220] Budget estimates, FADT, 4 June 2003, p.361.

[221] Budget estimates, FADT, 4 June 2003, pp. 360361, see also Committee Hansard, p. 81: The issue is then reinforced when we do the post deployment medical screening: the medical officers are invited to ask open ended questions such as, Are there any of the above or is there anything else you would like to share with me? Other than that, unless the person presented to a health care provider whilst they were deployed and said, I am here to see you because I have just had a near death experience, or, I am upset because I witnessed such an event, the only way we have to do that is through more formal things such as patrol logs or contact logs or that sort of thing. But I freely admit that there are many possible scenarios where someone may be exposed to a significant event and that event may not be recorded in real time. I can think of examples from Rwanda that I was made aware of.

[222] Budget estimates, FADT, 4 June 2003, p. 362.

[223] Budget estimates, FADT, 4 June 2003, p. 361.

[224] Karl L Haas, 'Stress and mental health support to Australian Defence Health Service personnel on deployment: a pilot study', ADF Health, 4 (1) 2003, pp. 1922.

[225] Budget estimates, FADT, 4 June 2003 p. 361: they are encouraged to provide that document to their spouses or partners or family members.

[226] Budget estimates, FADT, 4 June 2003, p. 363.

[227] See also below, Chapter 4, paragraphs 4.644.68.

[228] Submission 8A, Repatriation Commission/ Department of Veterans Affairs, p. 12.

[229] Joint Health Support Agency, DJHSA Directive 04/02, 17 May 2004, Collection of Key Performance Indicators, pp. 23.

[230] Submission 9B, Defence Organisation, p.4, Q2(e) and (f).

[231] Budget estimates, FADT, 4 June 2003, p. 363.

[232] Budget supplementary estimates, FADT, 5 November 2003, pp. 104105.

[233] See below, Chapter 3, paragraphs 3.63.21.

[234] Submission 9, Defence Organisation, pp. 45, paragraph 21.

[235] Budget estimates, FADT, 4 June 2003, p. 367.

[236] Australian National Audit Office, Report No. 51, 20002001, Australian Defence Force Health Services Follow-up Audit, Department of Defence, 2001, paragraph 3.14.

[237] Australian National Audit Office, Report No. 51, 20002001, Australian Defence Force Health Services Follow-up Audit, Department of Defence, 2001, paragraph 3.24: Overall, the ANAO found that progress on Recommendation No.7 had been slow but that Defence has examined the medical officer structure. The proposed salary and career structures, once implemented, should provide greater flexibility, improve operational effectiveness and assist in retaining ADF medical officers.

[238] Committee Hansard, p.87level 2 and 3 health care is in patient care.

[239] Australian National Audit Office, Report No. 51, 20002001, Australian Defence Force Health Services Followup Audit, Department of Defence, paragraph 4.15.

[240] Australian National Audit Office, Report No. 51, 2000-2001, Australian Defence Force Health Services Followup Audit, Department of Defence, paragraph 4.16: The situation has not changed significantly since the original audit. Although a strategic alliance between 1st Health Support Battalion (1HSB) and Liverpool Hospital has been in operation since 1998, there are no alliances between other ADF health units and civilian hospitals. Defence advised that strategic alliance proposals were being discussed with a number of civilian hospitals including, a major Brisbane hospital, Royal North Shore Hospital and Westmead Hospital. The ANAO was advised that progress in making such agreements with civilian health authorities had been slow due to health personnel shortages and the high number of recent ADF operations in which the DHS has been involved. See also Submission 5, Regular Defence Force Welfare Association Inc, p. 2.

[241] Joint Health Support Agency, DJHSA Directive 03/03, 25 March 2003, Guidelines for Accurate and Legible Clinical Records. See also DJHSA Directive 10/04, 7 April 2004, Orientation of Contract Health Practitioners Working on Australian Defence Force Bases

[242] Additional estimates, FADT, 18 February 2004, Answers to Questions on Notice, Defence, part 2, p. 69: Assistant Dental/Dental Assistant, Dental Hygienist, Dental Technician/ Technician Dental, Dentist, Doctor, Environmental Health Surveyor, Environmental Health Officer, Examiner Psychological, Laboratory Officer, Laboratory Technician/Tech Lab, Medic/Medical Assistant, Medical Administrator, Medical Scientific Officer, Nurse, Pharmacist, Physical Training Instructor, Radiographer (Officer), Radiographer (Soldier), Technician Operating Theatre, Technician Preventive Medicine, Therapeutic Officer (Physio).

[243] Additional estimates, FADT, 18 February 2004, Answers to questions on notice, Defence, part 2, p. 69.

[244] Additional estimates, FADT, 18 February 2004, Answers to questions on notice, Defence, part 2, p. 69.

[245] See above, paragraph 2.7 where Defence notes the difficulties experienced in obtaining sufficient numbers of qualified staff.

[246] 'A major limitation in the delivery of mental health services to the ADF identified in the ADF Health Status Report (2000) was the lack of integration between service providers. There are a number of organisations within Defence that deliver comprehensive mental health services, but due to a lack of integration they sometimes work at best in parallel and have the potential to work in opposition,' www.defence.gov.au/dpe/dhs/mental health. Mental health teams which have been established as part of the ADF Mental Health Strategy include doctors, psychologists, social workers and nurses, see www.defence.gov.au/dpe/dhs/mental health/publications

[247] See Appendix 3. Details of this alleged persuasion are not provided, and therefore it cannot be discussed further.

[248] Submission 9, Defence Organisation, p. 3, paragraph 11.

[249] Submission 9, Defence Organisation, p. 5, paragraph 24.

[250] Submission 9, Defence Organisation, p. 5, paragraph 24.

[251] Committee Hansard, pp. 3233, Australian Peacekeepers & Peacemakers Association.

[252] Submission 9B, Defence Organisation, p. 8, Q5(e).

[253] Submission 9B, Defence Organisation, p. 4, Q2(g).

[254] Submission 9B, Defence Organisation, pp. 67, Q4.

[255] Australian National Audit Office, Report No. 51, 20002001, Australian Defence Force Health Services Followup Audit, Department of Defence, paragraph 7.1.

[256] Australian National Audit Office, Report No. 51, Australian Defence Force Health Services Followup Audit, Department of Defence, paragraph 7.9.

[257] See also Peter S Wilkins, Occupational Health and Safety Challenges for the ADF, ADF Health, 5:1, 2004, pp. 12: By 2000, Defences annual OH&S cost per uniformed member was almost 3 times that for comparable civilian employee groups. Commanders and supervisors at all levels are greatly concerned for the health and safety of their subordinates, but there is an obvious lack of means to give effect to their good intentions.

[258] Department of Defence, Annual Report 20022003, Chapter 5, Section: Performance Against People Matter Priorities for 200203, p. 424.

[259] Committee Hansard, Australian Peacekeepers & Peacemakers Association, p. 43.

[260] Committee Hansard, Regular Defence Force Welfare Association Inc, p. 12.

[261] See above, paragraph 2.37, and see also Karl L. Haas, 'Stress and mental health support to Australian Defence Health Service personnel on deployment: a pilot study', ADF Health, 4 (1) 2003, pp. 1922.

[262] See above, paragraph 2.97.

[263] Committee Hansard, Australian Peacekeepers & Peacemakers Association, p. 43.

[264] Committee Hansard, Australian Peacekeepers & Peacemakers Association, p. 43.

[265] Department of Defence Annual Report 20022003, p. 432.

[266] Department of Defence Annual Report 20022003, pp. 426, 430.

[267] Committee Hansard, Regular Defence Force Welfare Association Inc, p. 5.

[268] Committee Hansard, Australian Peacekeepers & Peacemakers Association, p. 28.

[269] Submission 8A, Repatriation Commission/Department of Veterans' Affairs, p. 2: 'Where a reservist is eligible for health care from DVA, they have access to the arrangements pertaining to DVAs White or Gold Card, as appropriate'.

[270] Submission 8A, Repatriation Commission/Department of Veterans Affairs, p. 2.

[271] Submission 9, Defence Organisation, p. 3, paragraph 15.

[272] Committee Hansard, pp. 7576.

[273] See Committee Hansard, p. 79.

[274] Committee Hansard, pp. 7778.

[275] Submission 5, Regular Defence Force Welfare Association Inc, p. 3, paragraph 17.

[276] Submission 9, Defence Organisation, p. 4, paragraph 18.

[277] Submission 9, Defence Organisation, p. 4, paragraph 19.

[278] Committee Hansard, p. 77.

[279] See Department of Defence, Joint Health Support Agency, DJHSA Directive 07/04, Implementation of HealthKEYS, 18 March 2004, www.defence.gov.au/dpe/dhs/jhsa/publications/djhsadirectives.

[280] Somewhere between three to five years from early 2004, Committee Hansard, p. 77. Another source refers to 2009, Additional Estimates, FADT, 18 February 2004, Answers to Questions on Notice, Defence, part 2, p. 68.

[281] Committee Hansard, p. 67.

[282] Some of the key elements in the database will obviously be biographical data, but they may include things like height, weight, BMI, vaccination status, medical employment classification and history of previous injuries, Committee Hansard, p. 70.

[283] www.ibatech.

[284] Committee Hansard, p. 70.

[285] Committee Hansard, p. 73.

[286] Committee Hansard, p. 73.

[287] Committee Hansard, p. 70.

[288] Committee Hansard, p. 73

[289] Submission 8, Repatriation Commission, p. 18, paragraph 90.

[290] Committee Hansard, Repatriation Commission, p. 66.

[291] Committee Hansard, p. 77. See also p. 70 on the likely contents of individual data: Some of the key elements in the database will obviously be biographical data, but they may include things like height, weight, BMI, vaccination status, medical employment classification and history of previous injuries. All of those things, hopefully, will be coming from that one central database. I do not wish to go into the technical jargon, but what we can do is set up data cubes, Cognos cubes, which allow you to extract data from your master database, move it aside and, if need be, de-identify it so that it can then be used by a research facility, be that the Centre for Military and Veterans Health or one of our existing research organisations. They can do work on the data, and if need be it can be reinjected back into the database.

[292] Committee Hansard, p. 77.

[293] Committee Hansard, p. 3.

[294] Submission 5, Regular Defence Force Welfare Association, p. 3.

[295] See above, Chapter 2, paragraphs 2.922.97.

[296] See Additional Estimates, FADT, 18 February 2004, p. 70.

[297] Committee Hansard, p. 66.

[298] A separate system is commercially available to track vaccinations and reactions/adverse events arising from these. However, it is more logical to have this type of event on HealthKEYS to ensure such information was readily available to medical officers treating a patient especially during deployments.

[299] It is described as a real-time system for tracking the spread of infectious diseases, see www.ovistech.com/indexnsf/373d, Several solutions, many industries. See also Submission 9, Defence Organisation, Attachment C, Department of Defence, DirectorGeneral Defence Health Service, Health Directive No 128, Health Surveillance in the Australian Defence Force, 2003, paragraph 4, which refers to EpiTrack being based on the United Kingdom Army Health Surveillance System, J97 EPINATO.

[300] Submission 9, Defence Organisation, Attachment C, Department of Defence, DirectorGeneral Defence Health Service, Health Directive No 128, Health Surveillance in the Australian Defence Force, 2003, paragraphs 4, 5, 7 and 9.

[301] Submission 9, Defence Organisation, Attachment C, Department of Defence, DirectorGeneral Defence Health Service, Health Directive No 128, Health Surveillance in the Australian Defence Force, 2003, paragraph 3.

[302] Submission 9, Defence Organisation, Attachment C, Department of Defence, DirectorGeneral Defence Health Service, Health Directive No 128, Health Surveillance in the Australian Defence Force, 2003, paragraph 3.

[303] Committee Hansard, p. 70.

[304] HealthKEYS is also expected to be linked with the Defence personnel data system so that issues such as discharge through injury can also be monitoredsee Additional Estimates, FADT, 18 February 2004, p. 70.

[305] Submission 8, Repatriation Commission, p. 11, paragraph 52.

[306] Submission 8, Repatriation Commission, p. 11, paragraph 53.

[307] Committee Hansard, pp. 82, 83.

[308] Committee Hansard, p. 82. See also comment on the HealthKEYS system in respect of non current members, Committee Hansard, p. 73: we cannot construct historic data. If the data does not exist, I have no way of generating that

[309] Committee Hansard, p. 77.

[310] Submission 5, Regular Defence Force Welfare Association Inc, p. 3, paragraph 16.

[311] Submission 8A, Repatriation Commission/Department of Veterans Affairs, p. 2.

[312] Submission 8A, Repatriation Commission/Department of Veterans Affairs, p. 3.

[313] Submission 6, Australian Peacekeepers & Peacemakers Association, pp.12, paragraphs 67.

[314] Submission 6, Australian Peacekeepers & Peacemakers Association, p. 2, paragraph 11. See also below, Chapter 4, paragraphs 4.764.79.

[315] Submission 8A, Repatriation Commission, Department of Veterans Affairs, p. 13.

[316] Submission 8A, Repatriation Commission/Department of Veterans Affairs, p. 12. See also: The amount of information available to veterans and health providers on mental health and related problems and coping strategies has improved with the implementation of their respective mental health and alcohol management strategies. However, as with the general community, the problem of poor mental health literacy and concern about the stigma of mental health disorders remain significant barriers for young veterans. Continued work is required to improve awareness and understanding of the nature of mental health problems experienced by veterans and ways to access assistance and treatment (p.12).

[317] Submission 8A, Repatriation Commission/Department of Veterans Affairs, p. 1.

[318] Submission 8A, Repatriation Commission/Department of Veterans Affairs, p. 1.

[319] Submission 8A, Repatriation Commission/Department of Veteran Affairs, pp. 12.

[320] Submission 8A, Department of Veterans Affairs, p. 13.

[321] See below, Chapter 4, paragraph 4.10.

[322] Budget supplementary estimates, FADT, 5 November 2003, p. 7.

[323] BCOF, British Commonwealth Occupying Forces, who occupied Japan and other areas after the end of the War; some were also present at the British series of tests at Maralinga and other sites.

[324] Committee Hansard, pp. 4647.

[325] See also below, Chapter 4, paragraphs 4.44.5, 4.10, 4.18, 4.20, 4.26, 4.344.35, 4.384.39, 4.404.43, 4.734.82.

[326] Similar work has also been undertaken in the United States, including civilian exposure to radiation arising from testing.

[327] Committee Hansard, p. 68.

[328] Committee Hansard, p. 81.

[329] Chapter 2, paragraph 2.49.

[330] Chapter 4, paragraphs 4.8, 4.9

[331] Submission 4, British Commonwealth Occupation Force, p. 1.

[332] Submission 8A, Repatriation Commission/Department of Veterans Affairs, p. 4.

[333] See Chapter 4, paragraphs 4.464.47, 4.484.54.

[334] Budget supplementary estimates, FADT, 5 November 2003, p. 4, see also www.dva.gov.au: The objectives of the Links Project are to: improve service delivery and costeffectiveness to ADF members and ex-members within existing resources; improve the costeffectiveness of the services provided; and to take opportunities where appropriate to move functions, particularly transition, postdischarge and closely associated services, to DVA. Some possible options to achieve these objectives include: elimination of duplication; and increased coordination'. See also Submission 9B, Defence Organisation, p. 8, Q5(d).

[335] See www.dva.gov.au/adf/dlp/medadvisory.

[336] The DHS and DVA have very strong links through the Defence/DVA Links Program and the Mental Health Focus Group that is part of this program, Submission 9B, Defence, p. 8, Q5(d)

[337] See www.dva.gov.au/

[338] Committee Hansard, p. 90.

[339] Submission 8ARepatriation Commission/Department of Veterans Affairs, p. 3.

[340] Submission 8A, Repatriation Commission/Department of Veterans Affairs, p. 5.

[341] Submission 5A, Regular Defence Force Welfare Association, p. 1.

[342] Submission 5A, Regular Defence Force Welfare Association, p. 2.

[343] These are both issues also raised by Submission 5A, Regular Defence Welfare Association Inc, p. 2.

[344] This form is also used for claims relating to injuries by those still in the ADF.

[345] See www.dva.gov.au/forms.

[346] See above, Chapter 1, paragraphs 1.26, 1.28.

[347] www.rma.gov.au.

[348] See above, Chapter 1, paragraphs 1.29, 1.31.

[349] United States, Department of Veterans Affairs, Federal Benefits for Veterans and Dependants, 2004.

[350] Submission 5A, Regular Defence Force Welfare Association Inc., p. 2.

[351] See Chapter 1, paragraphs 1.40, 1.44.

[352] Submission 4, British Commonwealth Occupation Force, p. 2.

[353] Submission 8A, Repatriation Commission/Department of Veterans Affairs, p. 4.

[354] Committee Hansard, p. 14: There is much greater awareness within Defence and the defence community on mental health strategies. I think a lot of very good work has been done within Defence on providing information pre and post deployment and on lots of available resources through their mental health strategy. In that way, I think there has been a big improvement. I have not seen any difficulties associated with it.

[355] Submission 5, Regular Defence Force Welfare Association Inc, p. 5, paragraph 29.

[356] Submission 3, Armed Forces Federation of Australia, p. 1.

[357] Submission 5, Regular Defence Force Welfare Association Inc, p. 4, paragraphs 20, 21. See also Committee Hansard, p. 3 Our experience, and that of servicemen who took part in the 1990 Gulf War, has been one of inadequate record keeping. The department seemed confused about who received preventative vaccinations and at what time they were given, and there are deficiencies in individual records. This led to justified concerns among those who were deployednot so much at the time but later when they were trying to reconstruct a medical historywhich may explain the symptoms that they reported in later years. We therefore believe that the department should be required to implement a record keeping system that combines an individuals health record with accurate details of his or her exposure to environmental threats and that is capable of receiving continual updating on the nature and extent of environmental exposure.

One submission also noted that when there was an absence of information on a particular issue, it might be suggested that the individual seeking to make a claim relied in other factors instead (Submission 2, Confidential, p. 3). It is not possible to assess the accuracy of this statement, which reflects that there is no formal recognition as yet by the RMA of any ill health resulting from combined effects of biological and environmental exposures with other factors, whereas there is recognition of PTSD. Insofar as the individual suffers from PTSD it is appropriate for DVA to advise him to make such a claim.

[358] Committee Hansard, p. 68.

[359] See Submission 8, Repatriation Commission, p. 16, paragraph 81 on the difficulty of determining the validity of some syndromes (Gulf War syndrome as opposed to others (e.g. chronic fatigue syndrome, CFS). However, the Commission does not note that CFS itself was once perceived as a collection of symptoms rather than a syndrome, i.e. it is often more a matter of time and an increase in the number of reports, than a change in the nature of a disorder, that allows it to be seen as a causal factor which is evidence based.

[360] Submission 9, Defence Organisation, p. 4, paragraph 17.

[361] Committee Hansard, p. 74.

[362] See Chapter 4, paragraph 4.80.

[363] Budget Supplementary Estimates, FADT, 5 November 2003, p. 27.

[364] Department of Defence, DirectorGeneral Defence Health Service, Australian Defence Force Policy on Depleted Uranium Health Screening (6 August,2003), Annex B, paragraph 5.

[365] Department of Defence, DirectorGeneral Defence Health Service, Australian Defence Force Policy on Depleted Uranium Health Screening (6 August, 2003), Annex A, p. 2, last dot point. Nonetheless, the Health Bulletin also notes that the risks from du are less likely to be from radiation than from chemical toxicity. This is in line with overseas research which places little emphasis on the radiation problems and hence on urinary screening. See also Additional estimates, FADT, 18 February 2003, Answers to questions on notice, Defence, part 2, Question W22, p. 53, where further information is provided on Australian input into the level of du in the Balkans.

[366] With respect in particular to information issues, it was considered the RMA might contribute to the more proactive assessment of issues relevant to future deploymentssomething akin perhaps to the provision of data required for the development of health plans: A substantial amount of their work involves assessment of environmental factors. At present the information which is gained, in the form of Statements of Principles (SOPs), is used in a retrospective way to determine the acceptability of claims for compensationThere might therefore be scope for using their considerable expertise in monitoring, and anticipating, environmental hazards both for ongoing peacetime service in Australia and for overseas deployments. However, this is not a suitable role for the RMA. Some of the issues raised about the role of the RMA may be overcome by the fact that the RMA is an observer of the Medical Advisory Panel (Submission 8, Repatriation Commission, p. 12, paragraph 59) which, among other things, reviews patterns of injury, disease and compensation.

[367] See below, paragraphs 4.344.44.

[368] See paragraphs 4.454.46.

[369] See below, paragraphs 4.514.54.

[370] See paragraphs 4.454.50.

[371] Submission 8, Repatriation Commission, pp. 56, paragraphs 24, 2526. See also Improving the Delivery of Cross Departmental Support and Services for VeteransA Joint Report of the Department of War Studies and the Institute of Psychiatry, Kings College London, July 2003, at http://news.mod.uk/news_press_notice.asp?newsItem_id=2616, p. 32, paragraph 4.3.1.1 which notes the limited research undertaken on world war 2 veterans in the UK.

[372] Including a reluctance to discuss recent conflict. See Improving the Delivery of Cross Departmental Support and Services for VeteransA Joint Report of the Department of War Studies and the Institute of Psychiatry, Kings College London, July 2003, at http://news.mod.uk/news_press_notice.asp?newsItem_id=2616, p. 95, paragraph 6.5.1 which notes the difference between past attitudes and current ones where personnel are less inclined to tolerate a lack of response to issues.

[373] Submission 8A, Repatriation Commission/Department of Veterans Affairs, p. 5.

[374] See Improving the Delivery of Cross Departmental Support and Services for VeteransA Joint Report of the Department of War Studies and the Institute of Psychiatry, Kings College London, July 2003, at http://news.mod.uk/news_press_notice.asp?newsItem_id=2616, p. 46, paragraph 5.3.1.2 which notes that in the UK there was originally a reluctance to pay a war pension for psychiatric illness after world war 2, although this policy was changed.

[375] Submission 8, Repatriation Commission, p.6, paragraphs 2729.

[376] Submission 8, Repatriation Commission, pp. 67, paragraphs 3032.

[377] Adelaide Advertiser, 3 August 2001: 'Industry Science and Resources Minister Nick Minchin has revealed 79 court cases have been started since the program finished in SA in the early 1960s but only four have gone to trial. The remaining cases either had been withdrawn or confidentially settled out of court, with only one resulting in a $867,100 payout ordered by a judge in 1989'.

[378] Submission 8, Repatriation Commission, p. 10, paragraph 47.

[379] The Hon. John Clarke QC et al, Report of the Review of Veterans' Entitlements (January 2003), volume 2, paragraph 16.8.

[380] The Hon John Clarke QC et al, Report of the Review of Veterans' Entitlements (January 2003), volume 2, paragraph 16.10.

[381] The roll is available at www.dva.gov.au

[382] The Hon. John Clarke QC et al, Report of the Review of Veterans' Entitlements (January 2003), volume 2, paragraph 16.37.

[383] Submission 1, Returned and Services League of Australia Ltd, p. 2: claimants would have great difficulty in obtaining specialist medical evidence to meet the appropriate SOP. Additionally, some of the SOPs which refer to si evert levels also require that a cancer become evident within 40 years of claimed exposure. Thus, those veterans who have not developed some form of cancer connected with radiation before this 40 year limit (19861992 for BCOF forces in Japan) would not be eligible even if they could demonstrate the required si evert or mili si evert levels. On the other hand, SOP 18/2003 malignant neoplasm of the brain, requires a si evert dose of 0.1, and for this to have been given/received at least 5 years prior to onset of the disease (section 5(b)).

[384] Budget supplementary estimates, FADT, 5 November 2003, pp. 67. This was described by the Clarke report as a very complex, but achievable, task, Hon John Clarke QC et al, Report of the Review of Veterans' Entitlements (January 2003),volume 2, paragraph 16.22.

[385] The Hon John Clarke QC et al, Report of the Review of Veterans' Entitlements (January 2003), volume 2, chapter 16.

[386] The Hon John Clarke QC et al, Report of the Review of Veterans' Entitlements (January 2003), volume 2, chapter 16.

[387] Minister for Veterans Affairs Press Release, Response to the Clarke Committee Report on Veterans' Entitlements, 2 March 2004, p. 2.

[388] The Hon John Clarke QC et al, Report of the Review of Veterans' Entitlements (January 2003), volume 2, chapter 15.

[389] Minister for Veterans Affairs Press Release, Response to the Clarke Committee Report on Veterans' Entitlements, 2 March 2004, p. 2.

[390] New Zealand, Ministry for Social Development, War Veterans Entitlements (April 2004) at www.workandincome.govt.nz/get-financial-assistance,war-veterans-pensions/war-disablement.html#wars-and-emergencies.

[391] New Zealand, Ministry for Social Development, War Veterans Entitlements (April 2004) at www.workandincome.govt.nz/get-financial-assistance,war-veterans-pensions/war-disablement.html#wars-and-emergencies.

[392] Wars and Emergencies recognised for a war pension: Operation Grapple at Christmas and Malden Islands on the ships: Rotoiti 15 May 19578 Nov 1957, Pukaki 15 May 19578 Nov 1957 and 28 Apr 195823 Sept 1958, New Zealand, Ministry for Social Development, War Veterans Entitlements (April 2004) at www.workandincome.govt.nz/get-financial-assistance,war-veterans-pensions/war-disablement.html#wars-and-emergencies.

[393] Apart from sailors, there were five officers from New Zealand who were involved in ground tests.

[394] Inquiry into the Health Status of the Children of Vietnam and Operation Grapple Veterans, at www.executivegovt.nz/96-99/minister/shipley/vietnam/01, paragraph 8. 5.

[395] Inquiry into the Health Status of the Children of Vietnam and Operation Grapple Veterans, at www.executivegovt.nz/96-99/minister/shipley/vietnam/01, paragraph 18.9.

[396] June Beckett, Forgotten Veterans Still Waiting for Justice, The Issue Dec/Jan 2001, p. 1, www.theissue.com.au/maralinga.

[397] Committee Hansard, p. 21. See also US Department of Veterans Affairs, VA Proposes New Aid For 'Atomic Veterans', 27 December 2000, www. va.gov. In 1988, Congress established a presumption of service connection for 13 different cancers in veterans exposed to "ionizing radiation", with later changes bringing the number to 16. Under provisions of the Radiation-Exposed Veterans Compensation Act (Pub. L. 100321), veterans are presumed to be service connected if they participated in a radiation-risk activity: The proposed changes apply to those veterans who participated in "radiation-risk activities" while on active duty, during active service for training or inactive duty training as a member of a reserve component. Those activities include the occupation of Hiroshima or Nagasaki, internment as a POW in Japan, or onsite involvement in atmospheric nuclear weapons tests. People in this group are frequently called "atomic veterans". The number of conditions was eventually increased to 21 in 2002.

[398] See for example the comments by Congress relating to extension of benefits to energy workers in 2000: Congress finds that The Congress finds the following: (1) Since World War II, Federal nuclear activities have been explicitly recognised under Federal law as activities that are ultrahazardous. Nuclear weapons production and testing have involved unique dangers, including potential catastrophic nuclear accidents that private insurance carriers have not covered and recurring exposures to radioactive substances and beryllium that, even in small amounts, can cause medical harm....(4) scientific data resulting from the enactment of the Radiation Exposed Veterans Compensation Act of 1988 (38 U.S.C. 101 note), and obtained from the Committee on the Biological Effects of Ionizing Radiation, and the President's Advisory Committee on Human Radiation Experiments provide medical validation for the extension of compensable radiogenic pathologies, www.acranet.com/pdxavets/broudy

[399] Since 1981, these veterans have been eligible for care for all conditions except those that VA affirmatively determines have causes other than radiation exposure. As a result of legislation enacted in 1996, special eligibility for care now is limited to those exposed veterans with an illness that VA has recognised as potentially radiogenic through statute or regulation. Health care also is available to veterans determined to have service-connected diseases related to radiation exposure they suffered anytime during their military service. VA also pays compensation to veterans and their survivors if the veteran is determined to have a disability due to radiation exposure while in service, US Department of Veterans Affairs, VA Programs for Veterans Exposed to Radiation, VA Fact Sheet January 1997, www.va.gov/ooa/pocketcard/

[400] Radiation Exposed Veterans Compensation Act of 1988 (38 U.S.C. 101 note); see also US Department of Veterans Affairs, VA Proposes New Aid For 'Atomic Veterans', 27 December 2000, www.va.gov.

[401] Other legislation also provided compensation to persons involved in tests at the Marshall Islands, etc.

[402] www.acranet.com/pdxavets/broudy, referring to the amendments made in 1999.

[403] www.acranet.com/pdxavets/broudy, referring to the amendments made in 1999.

[404] www.acranet.com/ @pdxavets/broudy, referring to the amendments made in 1999; www.acranet.com/ pdxavets/broudy9 (106TH Session of the US Congress, January 2000.

[405] www.acranet.com/pdxavets/broudy6

[406] US Department of Veterans Affairs, VA Programs for Veterans Exposed to Radiation, VA Fact Sheet January 1997, www.va.gov/ooa/pocketcard/

[407] US Department of Veterans Affairs, Fact Sheet, September 2002, Attachment C.

[408] The 21 types of cancer covered under the presumptive program are: all forms of leukaemia except chronic lymphocytic leukaemia; cancer of the thyroid, bone, brain, breast, colon, lung, ovary, pharynx, esophageus, stomach, small intestine, pancreas, bile ducts, gall bladder, salivary gland and urinary tract (kidneys, renal pelvis, ureter, urinary bladder and urethra); lymphomas (except Hodgkin's disease);multiple myeloma; primary liver cancer; and bronchioalveolar carcinoma (a rare lung cancer).

[409] See www.va.gov/vetapp02files 01/0202427.

[410] The Radiation Exposure Compensation Act Amendments of 2000 provided for further changes to categories and also to the amount of exposure.

[411] Inquiry into the Health Status of the Children of Vietnam and Operation Grapple Veterans, at www.executivegovt.nz/96-99/minister/shipley/vietnam/01, paragraph 16.2.

[412] See above, Chapter 1, paragraphs 1.161.25.

[413] See above, Chapter 1, paragraphs 1.231.29.

[414] As is indicated in the governments response to the Clarke reports recommendations concerning BCOF service in Japan, see above, paragraph 4.13.

[415] Submission 8, Repatriation Commission, p. 5, paragraph 23, p.6, paragraphs 2731.

[416] See Submission 8A, Repatriation Commission/Department of Veterans Affairs, p. 5.

[417] Submission 8A, Repatriation Commission/Department of Veterans Affairs, p. 9.

[418] See above, Chapter 1, paragraph 1.40.

[419] Submission 8A, Repatriation Commission/Department of Veterans Affairs, p. 9.

[420] United States, Institute of Medicine, Report, Health of Former Prisoners of WarFindings (1992) at www.veterans.iom.edu/conflict.asp?id= 6149 (Korea/Reports).

[421] Submission 8, Repatriation Commission, pp.7, 910, paragraphs 3435, 4546.

[422] Older veterans also served in World War 2 or BCOF forces. The DVA client database indicates that at least 30% of Korean War veterans participated in World War 11, Australian Veterans of the Korean War Mortality Study 2003, Executive Summary, Effect of Nature of Service, at www.dva.gov.au/publications

[423] See for example Korean War Health Issues Readings and other resources, www.va.gov/ ooaa/pocketcard/korea.asp, and also: 'It is pertinent to examine veteran mortality studies which relate to all recent conflicts whilst, additionally, addressing those facts and situations peculiar to the Korean conflict, Australian Veterans of the Korean War Mortality Study 2003, Executive Summary, at www.dva.gov.au/publications.

[424] That is, less familiar with terminology and literature, although likely also to be affected by PTSDsee Submission 8A, Repatriation Commission/Department of Veterans Affairs, p. 13.

[425] Submission 8A, Repatriation Commission/Department of Veterans Affairs, p. 5.

[426] Australian Veterans of the Korean War Mortality Study 2003, Executive Summary, at www.dva.gov.au/publications

[427] Although there was a higher rate of suicides among those who served between 19531956, this may not be significant; Australian Veterans of the Korean War Mortality Study 2003, Executive Summary, at www.dva.gov.au/publications. The more detailed Health Status study may provide more information on mental health issues. However, the higher rate of accidents in Gulf War veterans (see above, Chapter 2 paragraph 2.5 may indicate similar problems).

[428] Australian Veterans of the Korean War Mortality Study 2003, Executive Summary, Strengths and Weaknesses of the Study, at www.dva.gov.au/publications

[429] Australian Veterans of the Korean War Mortality Study 2003, Executive Summary, Conclusion, at www.dva.gov.au/publications. Another important factor may be the distinction between those who served in both World War 2 and Korea and those who served only in the formerif the comparison is between men of the same age group, a percentage of that cohort would have been World War 2 veterans. The Cancer Incidence Study (Australian Veterans of the Korean War Cancer Incidence Study 2003, at www.aihw.gov.au/publications/index/cfm) compared deaths from cancer 19821999 between Korean veterans and those of the same age who did not serve in Korea. Mortality from 13 causes of death of a priori interest were elevated They included mortality from all causes, chronic obstructive pulmonary disease, ischaemic heart disease, stroke, alcoholic liver disease and external causes, such as suicide and motor vehicle accidents. Among the cancers of interest, mortality rates for cancer of the oesophagus, gastrointestinal and colorectal cancers, head and neck, lung, genitourinary and prostate cancers were elevated. Mortality rates from two a priori diseases (tuberculosis and peptic ulcer disease) and four cancers (liver and gallbladder, mesothelioma, melanoma and leukaemia) did not differ from that of Australian males.

[430] Korean War Health Issues Readings and other resources, www.va.gov/oaa/pocketcard/korea.asp

[431] Cirrhosis of the Liver A Presumptive Medical Condition in Former Prisoners of War, Press Release Secretary of [US[Veterans Affairs Department, at www.vba.va.gov/bln/21/Benefits/POW/docs/cirrhosis.doc

[432] www.iom.edu/topic

[433] See United States, Institute of Medicine, Report, Health of Former Prisoners of WarFindings (1992) at www.veterans.iom.edu/conflict.asp?id=6149

[434] Cirrhosis of the Liver A Presumptive Medical Condition in Former Prisoners of War, Press Release Secretary of Veterans Affairs Department, www.vba.va.gov/bln/21/Benefits/POW/docs/cirrhosis.doc.

The Australian research referred to in this quote is presumably that mentioned by the Repatriation Commission at Submission 8, Repatriation Commission, p. 6, paragraph 28. By 2004, the US recognised the following diseases for Prisoners of War (United States, Department of Veterans Affairs, Federal Benefits for Veterans and Dependants, 2004): Former prisoners of war (POW) are eligible for disability compensation if they are rated at least 10 percent disabled from conditions presumed to be related to the POW experience. The following presumptive conditions apply to former POWs who were imprisoned for any length of time: psychosis, any of the anxiety states, dysthymic disorder, organic residuals of frostbite, and post-traumatic osteoarthritis. Former POWs who were imprisoned for at least 30 days are also eligible for the following additional presumptive conditions: avitaminosis, beriberi (including beriberi heart disease), chronic dysentery, helminthiasis, malnutrition (including optic atrophy), pellagra and/or other nutritional deficiencies, irritable bowel syndrome, peptic ulcer disease, peripheral neuropathy and cirrhosis of the liver. www1.va.gov/opa/vadocs/Fedben, pp.1920.

[435] Submission 8, Repatriation Commission, p. 10, paragraphs 4950.

[436] See Improving the Delivery of Cross Departmental Support and Services for VeteransA Joint Report of the Department of War Studies and the Institute of Psychiatry, Kings College London, July 2003, at http://news.mod.uk/news_press_notice.asp?newsItem_id=2616, p. 52, paragraph 5.3.2.6 which refers to a particular 'culture' growing up around the Vietnam war experience. PTSD was recognised in 1980, although a wide range of effects of war had been studied long before that date (p. 60).

[437] Submission 8, Repatriation Commission, p. 7, paragraph 36.

[438] Submission 8, Repatriation Commission, pp.78, paragraphs 3738.

[439] The establishment of agent orange and depleted uranium registries by the US Veterans Affairs department will not guarantee full enrolment of all those who believe they have been exposed but will allow for the collection of at least a percentage of these, thus reducing later need for reconstruction of rolls.

[440] United States, Institute of Medicine, Health of Veterans and Deployed Forces, Vietnam, at www.veterans.iom.edu/conflict asp?id=6139.

[441] United States, Institute of Medicine, Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam (1994), see www.veterans.iom.edu/subpage.asp?id=10316. Summaries of the 1994 report and of subsequent updates are available at this address.

[442] See also the additional reports produced by the IOM: Veterans and Agent Orange: Length of Presumptive Period for Association Between Exposure and Respiratory Cancer(2004);Characterising Exposure of Veterans and Agent Orange and Other Herbicides Used in Vietnam: Interim Findings and Recommendations (2003); Veterans and Agent Orange: Herbicide/Dioxin Exposure and Acute Myelogenous Leukaemia in the Children of Vietnam Veterans(2002); Veterans and Agent Orange: Herbicide/Dioxin Exposure and Type 2 Diabetes (2000).

[443] www.va.gov.gov/ooa/pocketcard/vietnam_summary asp. In 2001, diabetes mellitus was added to the list of compensable diseases, United States, Department of Veterans Affairs, Vietnam Veterans Benefit From Agent Orange Rules (2001) at www.vba.va.gov/bln/21/Benefits/Herbicide/AOno1.

By 2004, one form of leukaemia was also listed, chronic lymphocytic leukaemia: see Agent Orange and Other Herbicides, in United States, Department of Veterans Affairs, Benefits for Veterans and Dependants, 2004: Eleven diseases are presumed by VA to be servicerelated for compensation purposes for veterans exposed to Agent Orange and other herbicides used in support of military operations in the Republic of Vietnam between January 9, 1962, and May 7, 1975. The diseases presumed are chloracne or other acneform disease similar to chloracne, porphyria cutanea tarda, softtissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposis sarcoma or mesothelioma), Hodgkins disease, multiple myeloma, respiratory cancers (lung, bronchus, larynx, trachea), nonHodgkins lymphoma, prostate cancer, acute and subacute peripheral neuropathy, diabetes mellitus, (Type 2) and chronic lymphocytic leukaemia, www1.va.gov/opa/vadocs/Fedben, p. 20. The US Department of Veterans Affairs is able to make independent assessments of research and add compensable diseases.

[444] See paragraphs 4.28, 4.29, 4.42 and also Chapter 1, paragraphs 1.301.31.

[445] United States, Department of Veterans Affairs, Vietnam Veterans Benefit From Agent Orange Rules (2001)at www.vba.va.gov/bln/21/Benefits/Herbicide/AOno1.

[446] M. Friedman, Current Trends in PTSD Research, NCP Clinical Quarterly 2(1): Fall 1991 at www.ncptsd.org/publications/cq

[447] See, for example, B.Engdahl and R.Eberly, Assessing PTSD Among Veterans Exposed to War Trauma 4050 Years Ago, NCP Clinical Quarterly 4(1): Winter 1994, at www.ncptsd.org/publications/cq/v4/n1/engdahl

[448] See J. Hamblen, PTSD in Children and Adolescents, at www.ncptsd.org/facts/specific/fs_children

[449] Submission 8, Repatriation Commission, p. 7, paragraph 37.

[450] The latter, which is the responsibility of the Commonwealth Department of Health and Ageing, is concerned to identify the mental health needs of all Australians. In so doing it has developed greater awareness of a range of community needs in this field and, with other programs, can help to overcome some of the stigma that remains associated with psychiatric health.

[451] However, the extent to which Congress has initiated policy reform is difficult to assess, since the role of lobby groups has been important.

[452] See M Friedman, About the National Centre for PTSD, NCP at www.ncptsd.org/about/index.

See also www.ncptsd.org The National Centre for PostTraumatic Stress Disorder (PTSD) was created within the Department of Veterans Affairs in 1989, in response to a Congressional mandate to address the needs of veterans with militaryrelated PTSD. Its mission was, and remains: To advance the clinical care and social welfare of America's veterans through research, education, and training in the science, diagnosis, and treatment of PTSD and stress-related disorders.

[453] The United States considers the Gulf War to have been ongoing since 1990, distinguishing between the two Gulf Wars by names of battles, eg Iraqi Freedom.

[454] Gulf War veterans who suffer from chronic disabilities resulting from undiagnosed illnesses, medically unexplained chronic multisymptom illnesses (such as chronic fatigue syndrome, fibro myalgia, or irritable bowel syndrome) that are defined by a cluster of signs or symptoms, and any diagnosed illness that the Secretary of Veterans Affairs determines warrants a presumption of service-connection may receive disability compensation. The undiagnosed illnesses must have appeared either during active duty in the Southwest Asia Theatre of Operations during the Gulf War or to a degree of at least 10 percent at any time since then through December 31, 2006. The following symptoms are among the manifestations of an undiagnosed illness: fatigue, skin disorders, headache, muscle pain, joint pain, neurologic symptoms, neuropsychological symptoms, symptoms involving the respiratory system, sleep disturbances, gastrointestinal symptoms, cardiovascular symptoms, abnormal weight loss and menstrual disorders. A disability is considered chronic if it has existed for at least six months. Amyotrophic Lateral Sclerosis (ALS) may also be serviceconnected if the veteran served in the Southwest Asia Theatre of Operations, United States, Department of Veterans Affairs, Benefits for Veterans and Dependants, 2004, pp. 2021.

[455] See United States, Department of Veterans Affairs, Guide to Gulf War Veterans Health, 2002 (originally published 1998), www.va.gov/gulfwar/docs/VHIgulfwar, p. 3.

[456] United States, Department of Veterans Affairs, Guide to Gulf War Veterans Health, 2002, p. 3: Since 1992, about 130,000 of the 750,000 Gulf War veterans from the US, Great Britain and Canada have received a systematic clinical registry examination conducted by the US Departments of Veterans Affairs (VA) and Defence (DoD), or comparable examination programs in other countries, www.va.gov/gulfwar/docs/VHIgulfwar

[457] in April 2001, VA announced the establishment of two new Centres for the Study of WarRelated Illnesses, with the goal of serving not just for Gulf War veterans, but all veterans of past and future combat and peacekeeping missions, United States, Department of Veterans Affairs, Guide to Gulf War Veterans Health, 2002, p. 2, at www.va.gov/gulfwar/docs/VHIgulfwar

[458] See above, paragraph 4.26 and see also above, Chapter 2, paragraphs 2.32.5.

[459] See United States, Department of Veterans Affairs, Guide to Gulf War Veterans Health, 2002, p. 2.

[460] United States, Department of Veterans Affairs, Guide to Gulf War Veterans Health, 2002, p. 5: 'poorly understood war syndromes characterised by multiple physical symptoms have been reported since at least the U.S. Civil War. Consistent with this observation, unexplained syndromes have been reported among troops involved in more recent hazardous military deployments to the Balkans and other areas around the world. Unexplained illnesses appear to be one inevitable health consequence associated with any hazardous military or peacekeeping deployment. See also Submission 8, Repatriation Commission, p. 9, paragraph 44.

[461] See www.dva.gov.au/media/publicat/2003/gulfwarhs

[462] www.dva.gov.au/media/publicat/2003/gulfwarhs, paragraph 19.1.

[463] See www.dva.gov.au/media/publicat/2003/gulfwarhs, paragraph 19.2.

[464] www.dva.gov.au/media/publicat/2003/gulfwarhs, paragraph 19.2.

[465] See Chapter 2, paragraphs 2.222.30. See also Submission 9, Defence Organisation, pp. 89, paragraphs 4345 on health and medical intelligence work.

[466] Submission 9, Defence Organisation, p. 7, paragraphs 3435, although see also the limitations involved in undertaking research on particular deployments, pp. 78, paragraph 37.

[467] Submission 9, Defence Organisation, p. 8, paragraph 38.

[468] See Chapter 2, paragraphs 2.922.97.

[469] Submission 9, Defence Organisation, p.8, paragraph 41.

[470] Submission 8, Repatriation Commission, p. 13, paragraphs 6667.

[471] Submission 9, Defence Organisation, p. 7, paragraph 35.

[472] Submission 9, Defence Organisation, p. 7, paragraph 35.

[473] Karl L Haas, Stress and mental health support to Australian Defence Health Service personnel on deployment: a pilot study, ADF Health, 4 (1) 2003, pp. 1922.

[474] Submission 8A, Repatriation Commission/Department of Veterans Affairs, p. 12.

[475] See www.defence.gov.au/dfe/dhs/mental healthsee ADF Mental Health Strategy; Suicide Fact Sheet; and Post Traumatic Stress Disorder.

[476] www.defence.gov.au/dfe/dhs/mental health, Enhanced Mental Health Service Delivery ADF Model of Critical Incident Mental Health Support.

[477] www.defence.gov.au/dfe/dhs/mental health, Integration of Mental Health Services in Defence.

[478] Submission 8, Repatriation Commission, p. 12, paragraphs 5961.

[479] Submission 8, Repatriation Commission, p. 12, paragraph 60.

[480] Submission 9B, Defence Organisation, p. 9.

[481] Submission 9, Defence, Attachment G, ADFP Personnel Series 1.2.5.3, Health and Human Performance Research in DefenceManual for Researchers.

[482] Submission 9, Defence Organisation, Attachment G, ADFP Personnel Series 1.2.5.3, Health and Human Performance Research in DefenceManual for Researchers, Chapter 1, sections 1.4, 1.5.

[483] Submission 8, Repatriation Commission, pp. 5-19, Paragraphs 2388.

[484] Submission 8B, Department of Veterans Affairs, p. 13.

[485] See above, Chapter 3, paragraphs 3.313.34.

[486] Professor Mark Creamer and Professor Bruce Singh, The Australian Centre for Posttraumatic Mental Health, An integrated approach to veteran and military mental health, ADF Health, 5(1) 2004, pp. 3639.

[487] Professor Mark Creamer and Professor Bruce Singh, The Australian Centre for Posttraumatic Mental Health, An integrated approach to veteran and military mental health, ADF Health, 5(1) 2004, pp. 3639.

[488] Submission 8A, Repatriation Commission/Department of Veterans Affairs, p. 5.

[489] Submission 8A, Repatriation Commission/Department of Veterans Affairs, p. 4.

[490] Submission 6, Australian Peacekeepers & Peacemakers Association, p. 2, paragraphs 914.

[491] Submission 5, Regular Defence Force Welfare Association, p. 2, paragraph 11; Submission 6, Australian Peacekeepers & Peacemakers Association, pp. 34, paragraphs 1415.

[492] Submission 4, British Commonwealth Occupation Force Executive Council of Australia,
pp. 12.

[493] Submission 8A, Repatriation Commission/Department of Veterans Affairs, p. 6.

[494] Department of Veterans Affairs, Towards Better Mental Health for the Veteran Community, pp. 12, at www.dva.gov.au/health/younger/mhealth/policy

[495] Department of Veterans Affairs, Mental Health Disorders in the Veteran Community and their Impact on DVAs Programs, at www.dva.gov.au/health/younger/mhealth/data

[496] Mental Health Disorders in the Veteran Community and their Impact on DVAs Programs, p. 4 at www.dva.gov.au/health/younger/mhdata

[497] Submission 6, Australian Peacekeepers & Peacemakers Association, p. 2, paragraph 11.

[498] Karl L Haas, Stress and mental health support to Australian Defence Health Service personnel on deployment: a pilot study, ADF Health, 4 (1) 2003, pp.1922.

[499] Submission 8A, Repatriation Commission/Department of Veterans Affairs, p. 5.

[500] Submission 8, Repatriation Commission, p. 11, paragraph 52.

[501] Submission 8, Repatriation Commission, p. 9, paragraph 43; pp.1415, paragraphs 6970, 72.

[502] Submission 8, Repatriation Commission, p. 14, paragraphs 6970.

[503] Submission 8A, Repatriation Commission/Department of Veterans Affairs, p. 14.

[504] See above, Chapter 2, paragraphs 2.982.101.

[505] Australian Gulf War Veterans Health Study 2003, www.dva.gov.au/media/publicat/gulfwar paragraph 19.219.

[506] These standard vaccinations are listed at Budget Estimates, FADT, 4 June 2003, p. 365.

[507] It was suggested that mencevax ACWY vaccinationsagainst meningococcal disease A, C, W135 and Ywere given at the same time as the anti-anthrax vaccine (Budget Estimates, FADT, 4 June 2003, p. 365), but in fact were given before the Kanimbla left Australia. There was no consent form used: (We did not require a signed consent form for the mencevax. Mencevax has been a routine immunisation for operationally deployed personnel for quite some time, Additional Estimates, FADT, 4 June 2003, p. 372) but General Cosgrove stated that anyone who had not agreed to this vaccination would not have been able to deploy (Budget Estimates, FADT, 4 June 2003, p. 364).

[508] It is stated that there were also Air Force and Army personnel on board the Kanimbla who would have received information about the vaccination at the same time as naval personnel (Additional Estimates, FADT, 12 February 2003, p. 71). For simplicitys sake, the discussion refers to naval personnel insofar as the relevant actions were taken by the navy and it appears that only naval personnel made a decision not to accept the vaccination.

[509] Committee Hansard, p. 51. See also Additional Estimates, FADT, 12 February 2003, p. 40:Within Defence Health, we obviously treat our men and women we serve in exactly the same way as other citizens of Australia. Implicit in that is that, when they receive any health care, there is informed consent on their behalf so they understand what is being put forward to them, what the ramifications of that may be and they always retain the right to decide whether they will or will not proceed.

[510] Senate Estimates, FADT, 12 February 2003, p. 41.

[511] Submission 9, Defence Organisation, p. 6, paragraph 25. One of the reasons perhaps for concerns is that different standards may apply in deployments where Australia is not in command of its own forces, Submission 5, Regular Defence Force Welfare Association Inc., p. 3, paragraphs 12, 17. Consent was not an option for US forces in respect of anthrax vaccinations, Senate Estimates, FADT, 12 February 2003, pp. 3738.

[512] Submission 9, Defence Organisation, p.6, paragraph 26.

[513] Committee Hansard, pp 5152.

[514] For example, the refusal to have a child vaccinated has led to non-payment of various benefits. This consequence was openly stated and known to those who choose not to proceed, see www. health.gov.au/pubhlth/strateg/immunis/7point.htm, The Seven Point Plan.

[515] Submission 10, Mrs Screaton, p. 6. This is taken from the document Redress of Grievance, part of Submission 10.

[516] Submission 10, Mrs Screaton, p. 3.

[517] Submission 10, Mrs Screaton, p. 4.

[518] See below, Attachment A, document 1.

[519] Redress of Grievance, p. 4, paragraphs 1516.

[520] Submission 10, Mrs Screaton, p. 6; I am satisfied that there was no need to provide an advance explanation of the possibility of medical recategorisation to the ships company.

[521] The information on the websitesee www.defence.gov.au/dps/dhs/infocentre as at mid July 2004 was dated August 2003, well after the date by which documents concerning the effect of not agreeing to the anti-anthrax vaccine were supposed to have been changed.

[522] www.defence.gov.au/dpe/dhs/infoline/anthrax, FAQ, Q 11, Q 12, emphasis added.

[523] Submission 10, Mrs Screaton, p. 5.

[524] See Submission 9, Defence Organisation, Attachment D.

[525] Submission 9, Defence Organisation, Attachment D, Chapter 1, paragraph 1.4.

[526] Submission 9, Defence Organisation, Attachment D, Chapter 2, paragraph 2.9.

[527] Submission 9, Defence Organisation, Attachment D, Chapter 2, paragraph 2.10.

[528] Submission 9, Defence Organisation, Attachment D, Chapter 5, paragraph 5.10 (c). See also Redress of Grievance Determination, p. 9, paragraph 47 which quotes the relevant paragraph, 5.11.c.

[529] Redress of Grievance Determination, p. 9, paragraph 47.

[530] Additional Estimates, FADT, 12 February 2003, p. 36, emphasis added; see also p. 37.

[531] Submission 10, Mrs Screaton, pp. 5-6 MEC 207 is defined as fit for deployment or sea going service except in geographic areas as defined, Redress of Grievance Determination, p. 8, paragraph 42.

[532] Additional Estimates, FADT, 12 February 2003, p. 24.

[533] Committee Hansard, p. 52.

[534] Approximately 10 nonNavy personnel did not agree to the vaccination.

[535] Additional Estimates, FADT, 4 June 2003, p. 365.

[536] There was some discussion in Senate Estimates about whether personnel on ships would have had access to public information available in January that anti-anthrax shots would be providedsee Additional Estimates FADT, 12 February 2003, pp. 3435. Even if they had, they may not have considered it further since nothing was formalised until later.

[537] Committee Hansard, p. 65: Clearly we are also talking about the issue of when the members were advised of the program, and that does not have to be linked directly to when the vaccine is administered. They are actually two parts of the process.

[538] Additional Estimates, FADT, 18 February 2004, p. 65; however, see also Committee Hansard, p. 57, Senator Bishopthe information that militarised anthrax could be used in the 2^nd Gulf War was known by approximately 11 January 2003.

[539] Submission 9A, Defence Organisation, Q2, part (j). The order to vaccinate was given on 3 February 2003, and implemented on the Kanimbla on 5 February 2003 (Submission 10, Mrs Screaton, pp. 34)

[540] Submission 9A, Defence Organisation, Q2(j). However, according to one submission, the greater part of these tasks had been completed prior to leaving Darwin for the second timesee Submission 10, Mrs Screaton, pp. 23.

[541] 20 January 2003see Additional Estimates, FADT, 18 February 2004, p. 65.

[542] Submission 10, Mrs Screaton, pp. 13.

[543] See also www.defence.gov.audpe/dhs/infoline/Anthrax FAQ: Almost all medical personnel who deploy with you will have undergone specialist NBC training. The ADF runs an intensive two week course that teaches medical personnel about recognising and treating NBC injuries, including Anthrax.

[544] Committee Hansard, p. 52.

[545] See Committee Hansard, p. 52 where it is stated that one naval officer at least had the opportunity to discuss possible long term effects with an external source.

[546] It was stated that although policy did not require that information on the vaccine and its date of expiry be on the consent form, this was in fact done at least for the Navy (Kanimbla and Darwin), Committee Hansard, p. 60. However, other information in the Redress of Grievance (p. 4, paragraphs 10(d), (e), and (f)) states that required information was not listed at all, but this was apparently an error.

[547] Submission 10, Mrs Screaton, p. 7.

[548] Submission 10, Mrs Screaton, p. 7. However, the information provided on the UK Ministry of Defence website about the UK vaccine is detailed, and does provide the information referred to above.

[549] Additional Estimates, FADT, 12 February 2003, p.32.

[550] Additional Estimates, FADT, 12 February 2003, p. 35.

[551] Additional Estimates, FADT, 12 February 2003, p. 31.

[552] Additional Estimates, FADT, 12 February 2003, p.31.

[553] Additional Estimates, FADT, 12 February 2003, p. 31: the ships captain was aware that he would have to have an education program once he announced that he was going to do this and he sought extra material to enable him, the medical officer and the psychologist who was on board that ship to explain that to individuals collectively and then individually as each one talked through the business.

[554] Submission 10, Mrs Screaton, pp. 67.

[555] Although the likelihood of this was limited, as there is no live anthrax in the US or UK vaccines.

[556] See Attachment A, document 1, paragraph 21.

[557] See United Kingdom, Ministry of Defence, Anthrax, Voluntary Immunisation Programme, A Guide for Medical Staff, 2000.

[558] As noted above at footnote 41, the Australian Defence website also notes that a special course was available on the anthrax vaccine for medical officers, although this may not have been known to the deployed MOs.

[559] Additional Estimates, FADT, 12 February 2003, p. 32.

[560] Submission 10, Mrs Screaton, p. 7. Material available by 18 March 2003 in fact provides some detail on the components of the vaccine and its media, although how easily this information was understood is unknown, as the language used is quite technical, www.defence.gov.au/dpe/dhs/infocentre/anthrax/FAQ, Q5 and Q6.

[561] Committee Hansard, p .53: The lessons learnt report highlights that as being a failure on our part because it could certainly be construed that it was taking away peoples freedom of choice and that there was an unintended but potential degree of coercion being exercised on these people by the very fact that they had already embarked onboard ship heading towards an area of operations.

[562] Other Navy personnel on the Darwin and the Anzac who refused the anti-anthrax vaccine were already in the Gulf; those on the Kanimbla landed on Christmas Island and were flown home from there, Senate Estimates, FADT, 3 June 2003, pp. 374375.

[563] Senate Estimates, FADT, 3 June 2003, p. 373, General Cosgrove.

[564] See above, Chapter 2.

[565] The ADF has stated that some personnel believe they received antianthrax vaccinations during Gulf War 1, and that this has led to a belief that various illnesses are linked to such vaccinations (Committee Hansard, p. 61). Because the anthrax vaccine is used only when circumstances require, some of the terminology used (unlicensed, unregistered) may have suggested to personnel that it was unsafe.

[566] Committee Hansard, p. 53.

[567] Major reactions are registered with the Adverse Drug Reaction Unit, Therapeutic Goods Administration, see www.tga.health.gov.au/adr

[568] Committee Hansard, p. 65.

[569] Committee Hansard, p. 54.

[570] Additional Estimates, FADT, 4 June 2003, p. 378.

[571] Additionl Estimates, FADT, 4 June 2003, pp. 365,372, 378379.

[572] in general, anthrax and mencevax may well be administered on the same day at two different locations [ie, vaccination sites on the body], Additional Estimates, FADT, 4 June 2003, p. 365.

[573] Interactions with other Medicaments and other forms of Interaction. The vaccine should be used alone. There is no evidence for the safe use in combination with other vaccines or medicinal products. See United Kingdom Ministry of Defence, Anthrax, Voluntary Immunisation Programme, A Guide for Medical Staff, p. 26,
at www.mod.uk/ linked_files/mod_vip_mo_guide

[574] Submission 9, Defence Organisation, Attachment D, Immunisation Procedures, Chapter 5, Section 5.12.

[575] See www.avn.org.au/Vaccinations%20/Information/Meningococcal_mencevax

[576] See National Health and Medical Research Council, Australian Immunisation Handbook, p.167. In this context, simultaneously presumably means on the same day as or at the same time as (although not at the same site, or mixed in with other vaccines).

[577] AVA was initially administered on a limited basis, primarily to protect veterinarians and workers processing animal products such as hair or hides that could be contaminated with anthrax spores. The Institute of Medicine, National Academy of Science ran two projects on anthrax, with the following reports: Committee to Review the CDC Anthrax Vaccine Safety and Efficacy Research Program, CDC Anthrax Vaccine Safety & Efficacy Research Program: Interim Report, 2001, and Committee to Assess the Safety and Efficacy of the Anthrax Vaccine, The Anthrax Vaccine: Is It Safe? Does It Work?, Washington,2002, see The Anthrax Vaccine: Is It Safe? Does It Work?, Executive Summary, p.1.

[578] United Kingdom, Ministry of Defence, Anthrax Vaccine, see www.mod.uk/issues/anthrax/vaccine.htm

[579] Additional Estimates, FADT, 12 February 2003, p. 37.

[580] Committee Hansard, p. 61.

[581] Committee Hansard, p. 62.

[582] See Additional Estimates 2002-2003, FADT, Answers to Questions on Notice, Question 3, p. 50.

[583] Budget Estimates 20032004, FADT, 3 June 2003, pp. 376 and 377.

[584] Submission 9A, Defence Organisation, Q2(b).

[585] Committee Hansard, p. 56 (Air Commodore Austin).

[586] Submission 9A, Defence, Q2.

[587] Committee Hansard, p. 59.

[588] Submission 9A, Defence Organisation, Q2which means the date of manufacture would have been 4 years previously if the same process was used in post 1998 manufacturesee Committee Hansard, p. 60. However, if it had been decanted, the shelf life would have been one year, Committee Hansard, p. 58

[589] The Anthrax Vaccine: Is It Safe? Does It Work?, Executive Summary, p. 1.

[590] None of the adverse effects noted from the US vaccine was considered serious, although it is not entirely clear if testing included batches made prior to the review of the manufacturing facility:

After examining data from numerous case reports and especially epidemiologic studies (see The Anthrax Vaccine: Is It Safe? Does It Work? Chapters 5 and 6), the committee also concluded that AVA is reasonably safe. Within hours or days following vaccination, it is fairly common for recipients to experience some local events (e.g., redness, itching, swelling, or tenderness at the injection site), while a smaller number of vaccine recipients experience some systemic events (e.g., fever and malaise). But these immediate reactions, and the rates at which they occur, are comparable to those observed with other vaccines regularly administered to adults, The Anthrax Vaccine: Is It Safe? Does It Work?, Executive Summary, p. 2.

[591] The study was also to address the issue of validation of the manufacturing process, with a consideration of discrepancies identified by the US Food and Drug Administration (FDA) in February 1998, the definition of vaccine components, and identification of gaps in existing research (The Anthrax Vaccine: Is It Safe? Does It Work?, Executive Summary, p. 2).

[592] The Anthrax Vaccine: Is It Safe? Does It Work?, Executive Summary, p. 2.

[593] Finding: The currently licensed subcutaneous route of administration of AVA and the six-dose vaccination schedule appear to be associated with a higher incidence of immediateonset, local effects than is intramuscular administration or a vaccination schedule with fewer doses of AVA. The frequencies of immediate-onset, systemic events were low and were not affected by the route of administration. Recommendation: DoD [Department of Defense] should continue to support the efforts of CDC [Centers for Disease Control] to study the reactogenicity and immunogenicity of an alternative route of AVA administration and of a reduced number of vaccine doses, The Anthrax Vaccine: Is It Safe? Does It Work?, Executive Summary p. 13.

[594] Budget Estimates, FADT, 4 June 2003, p. 377.

[595] National Health and Medical Research Council, The Australian Immunisation Handbook, 8^th edition, Canberra 2003, p. 41, emphasis in text.

[596] There is also a reference to another storage incident when material was returned to the manufacturer for checking because of a minor deviation in temperature (Senate Estimates, FADT, 3 June 2003, p. 377). Reference to a lower side effect profile (Senate Estimates, FADT, 3 June 2003, p. 378) in this particular case might in fact indicate a reduced efficacy, although the vaccine was found to be both effective and safe. Possibly the deviation in temperature was not beyond the limits recommended.

[597] Submission 7, Mr Laboo, p. 1.

[598] Submission 7, Mr Laboo, p. 2reference is made to the vaccine being carried from Sydney to Brisbane in a small styrofoam esky. For information on the use of such itemsalthough within a larger fridgesee Australian Immunisation Handbook, pp.42, 46.

[599] Submission 7, Mr Laboo, p. 2-3

[600] The ADF should therefore check the medical file of the relevant personnel to see if the batch is recorded and determine if this batch would be deemed ineffective.

[601] National Health and Medical Research Council, The Australian Immunisation Handbook, 8^th edition, Canberra 2003, p. 41. See also Submission 9, Defence Organisation, Attachment ADFP, 1.2.2.1, Immunisation Procedures, Chapter 7, p. 71, paragraphs 7.17.5.

[602] See www.defence.gov.au/dpe/dhs/infocentre/anthrax vaccine.

[603] Submission 7, Mr Laboo, p. 1.

[604] The US vaccine manufacturer was the subject of an adverse FDA notice, also followed up by the US General Accounting Office (GAO) on vaccine manufactured up to and including 1998.

[605] Additional Estimates, FADT, 12 February 2003, pp. 2930, 4748.

[606] Additional Estimates, FADT, 12 February 2003, p. 30.

[607] Additional Estimates, FADT, 12 February 2003, pp. 4748.

[608] See also Commonwealth Department of Health and Ageing, Population Health Division, Q and A on Anthrax , www.health.gov.au, where information relates only to the US vaccine: The vaccination itself involves six doses, three given two weeks apart followed by three additional injections given at 6, 12, and 18 months, after the first dose. An annual booster is required to maintain ongoing immunity.

[609] The first three doses are given 2 weeks apart, and the following doses are given 6, 12, and 18 months after administration of the first dose. Annual booster doses are required, Committee to Assess the Safety and Efficacy of the Anthrax Vaccine, The Anthrax Vaccine: Is It Safe? Does It Work?, Washington,2002, Executive Summary, p. 5.

[610] United Kingdom Ministry of Defence, at www.mod.uk/issues/anthrax/faqs

[611] US Defense Department Report, 22 May 1998, Anthrax vaccination, Partnership for Peace exercises, (1040), [Secretary of Defense] Cohen Orders Total Military Force Anthrax Vaccination to Proceed, www. defenselink.mil/otherinfo/protection.html

[612] www.defence.gov.au/dpe/dhs/infocentre/anthrax . The consent form dated 29 January 2003, which refers to both the UK and the US vaccines, is misleading when it states primary schedules are complete at 18 months, which is true only of the US vaccine (Attachment A, document 1, p. 3, paragraph 14).

[613] National Health and Medical Research Council, The Australian Immunisation Handbook ,8^th edition, Canberra 2003, Part 2, p. 82. The reference immediately before was to the US vaccine.

[614] Senate Estimates, FADT, 4 June 2003, p. 382.

[615] Submission 9A, Defence Organisation, Q5.

[616] See above, Chapter 2, paragraph 2.58.

[617] Submission 9, Defence Organisation, Attachment D,

[618] www.defence.gov.au/dpe/dhs/infocentre/anthrax vaccine.

[619] Submission 9, Defence Organisation, p.3, paragraph 11.

[620] Submission 9, Defence Organisation, p. 5, paragraph 22.

[621] Submission 9, Defence Organisation, p. 6, paragraph 26.

[622] Committee Hansard, p. 60.

[623] Committee Hansard, p. 61. See also Submission 9, Defence Organisation, Attachment D, Chapter 2, Sections 2.242.26.

[624] Submission 7, Mr. Laboo, p. 2.

[625] Submission 5, Regular Defence Force Welfare Association, p. 3, paragraph 17.

[626] Committee Hansard, p. 62.

[627] Redress of Grievance, p. 3, paragraphs 10 (d), (e) and (f).

[628] United Kingdom, Ministry of Defence, Background to the use of Medical Countermeasures to protect British forces during the Gulf War (Operation Granby), at www.mod.uk/issues/gulfwar/info/medical/mcm. It had been decided that use of pertussis as an adjuvant could significantly reduce the numbers and severity of casualties in the event of an anthrax-based BW attack, paragraph 51.

[629] Additional Estimates, FADT, 18 February 2004, p. 62.

[630] The Anthrax Vaccine: Is It Safe? Does It Work?, Washington,2002, Executive Summary, pp.910.

[631] See www.defence.gov.au/dpe/dhs/infocentre/anthrax: As a biological weapon, anthrax bacteria would be released into the air in invisible clouds that when inhaled by personnel would infect them with anthrax. The first symptoms of this type of inhalational anthrax would generally appear within a week (typically 23 days) and include flulike symptoms, general lethargy and mild fever. Without treatment, these would quickly progress to serious breathing difficulties, collapse, shock, and, in almost all cases, death.

[632] Committee Hansard, p.75. See also interview with then AMA President Kerryn Phelps, 14 February 2003, at www. abc.net.au/am/s784207.htm, see Attachment A, document 2.

[633] Committee Hansard, p. 75.

[634] www.abc.net.au/am/s784207.htm

[635] Committee to Assess the Safety and Efficacy of the Anthrax Vaccine, The Anthrax Vaccine: Is It Safe? Does It Work?, Washington,2002, Executive Summary, p. 2.