Wednesday 6 March 2013

3. How the System Went Up In Smoke

Every organisation has its own culture. The Department of Veterans’ Affairs has a long and recognized culture of courtesy and helpfulness to their clients. While many ex-service organisations complain that it ought to be more generous in the assessment of pension claims, they are virtually unanimous in not wanting its functions transferred to another Department, such as Centrelink – which apparently has a reputation of seeing claimants as potential rorters. (Perhaps they know something.)
Originally, the department was staffed wholly by veterans, with all the advantages and disadvantages that entailed. They took a sympathetic view of claims, they could draw on the experience of their colleagues in various areas of conflict, and understand the sort of experiences the applicants had been through. They also found it easier to recognize phonies. On the debit side, there was a tendency to look after one’s own, and often staff members were given a TPI pension as a retirement present. It may well be, nevertheless, that the level of respect and sympathy received by veterans is actually greater now that most staff have never been to war. Their clients are, for the most part, a generation older than them, and actively served in the defence of their country – and that counts for a lot in most people’s eyes.
Prior to 1977, the method of dealing with pension claims was rather hit and miss. Although a different determining system prevailed, it still involved a primary decision making body and two levels of appeals, and incorporated a medical opinion. But medical examinations were often not thorough, and psychiatric reports, in particular, tended to be brief and open to question.
It also involved a peculiar interpretation of the law. Diseases and injuries can be linked to service in a variety of ways: due to an occurrence on service, or if it arose out of, or was attributable to service, or was caused by an accident going to or from service, or would not have been contracted but for service, or was aggravated by service. (I am paraphrasing the more complex wording of the legislation.) Within this broad framework, it is not necessary for a condition to be wholly due to service; any minor contribution is sufficient.
But at least from the 1920s, the terms “occurrence” and “arose out of” were considered to have been satisfied if a condition was first discovered on service. In this way, we saw such conditions as “congenital syphilis” and “horseshoe kidney”, diseases which, almost by definition, were present at birth, labelled as war-caused. Another favourite was “refractive error”, popularly known as weak eyes – something we all acquire eventually, some in middle age, others while we are still children. But if the first prescription for glasses was made on service, then the condition was deemed to have been war-caused. Not only that, but the resultant pension was calculated on the uncorrected visual acuity ie how good his vision was without the use of glasses. Thus, a significant number of people were receiving substantial pensions, even though they could see perfectly well with the free spectacles the department provided. This sort of thing does not happen any more.
Even so, on reading some of the old files, one is often at a loss to understand how some of those early decisions were made. There was no obvious connection to service – not even a temporal one – and a medical officer had specifically said so, but the determining authority accepted it anyway. On the other hand, many claims were rejected which appeared quite reasonable, even under the standards of the time. Perhaps the department handed out the right number of pensions, but to the wrong people.
In 1963 a group of Departmental Medical Officers wrote to the Medical Journal of Australia, with allegations of widespread manipulation of the system, typically by people who were the farthest from the front line, of millions of pounds being paid in pensions for diseases which were not realistically war-caused, of veterans working towards the TPI pension as their ultimate financial goal, and of departmental staff colluding in granting pensions to one another. As far as I know, the government did nothing to rectify the situation. However, it did inspire one of those doctors, John Whiting, himself a veteran, to turn it into a book, Be In It, Mate!, already mentioned in the first chapter.

The year 1977 was the turning point. The first important change in the law was a reform which applied across the board, not just to veterans’ legislation: henceforth all decision makers had to provide written reasons for their decisions. Incredible as it might seem, up till then, a veteran could be absolutely convinced his disease was due to the war, make a claim, have it rejected, submit an appeal, using the same arguments he had used before, have it rejected again, appeal, and again see it rejected, without ever knowing why.
The second change related to the standard of proof. In criminal cases, the jury has be convinced of the defendant’s guilt “beyond reasonable doubt”, but in ordinary civil proceedings, the standard is that of “balance of probabilities”. If, for example, you lodge a claim for worker’s compensation, it must be established that there is at least a 51% chance that your injury was caused by your work. Should the same apply to veterans? Not only can it be argued that they are a more deserving group of applicants, but there are special circumstances relating to war.
In the few cases when I had to deal with First World War veterans, it was surprising how meagre were their wartime medical records. There was a good reason for this. At the end of the war, the bulk of them were held by the British Museum. In 1919 they ran out of storage space, and destroyed the lot! But even in later wars, it is common to find that medical records, though very detailed while the serviceman is in Australia, suddenly become scarce once he goes overseas. Over there, the military is too busy fighting a war to worry about paperwork. If a man gets sick he is given some pills and put on light duties. Sometimes it might be recorded; at other times it may not. Or he may simply “soldier on”. If he is posted to a distant outpost or, worse still, a small ship, there may be no medical aid available – only a first aid officer.
Even when the war ends, there are difficulties. A final medical examination is performed at discharge, but if he says he has anything wrong with him, he will be held a few more weeks while they process his claim. Meanwhile, his wife is awaiting him, and other dischargees are grabbing the jobs. Even if he had a clean bill of health at discharge, it might be another couple of decades before he starts to make a connection between his increasingly bad back (for example) and what happened on service. In the interim, the civilian doctor who first treated him has retired, and his medical records have disappeared.
Good reasons therefore exist for the law having taken an increasingly lenient view of the evidence required to grant a disability pension. Decision makers are obliged to take into account the typical deficiencies of records in time of war, and the passage of time on the availability of witnesses and the preservation of records. The result is that – and this cannot be emphasized too strongly – in the majority of cases, the only evidence for a particular event is the unsupported testimony of the veteran himself, or even, indeed, merely that of his widow. No doubt, it would be unreasonable not to take their word for it under such circumstances, but the problems involved can well be imagined.
What happens if the exact cause of a disease is unclear? The RSL had always contended that such questions should be resolved by assuming the disease to be war-caused. In the 1960s they were campaigning to have all cancers be made pensionable. The government refused, but as a sop, offered free treatment for cancers – thus removing a great weight from the victims’ shoulders.
It would be tedious to both the writer and the reader to detail the gradual change in the standard of proof used by the department over the years, but it came to a head with the Toose Report of 1975. In it, Justice PB Toose recommended that :

“[A] determining authority should accept as proof of any fact favourable to the member, any credible evidence in respect thereof submitted to him that is not contradicted. This may be but another way of stating that a member shall have the benefit of all favourable inferences and of any doubt.”

In other words, he was recommending a modified civil standard of proof. The decision makers should be required to weigh all the evidence, pay due attention to the difficulties in obtaining evidence, listen to what the veteran said, and if it came down to the wire, instead of tossing a coin, they should find in the veteran’s favour. It was all quite reasonable, and not very different from the way the department was already acting. When the government got around to amending the Act in 1977, the minister indicated that that was the intention of the amendment. Unfortunately, that was not what the amendment actually said.
Departmental rumour has it that, on a wall in the Canberra office hangs a copy of the memo of the drafter of the amendment: “What about beyond reasonable doubt?” - kept as a reminder of how things can go terribly wrong. The fact is, the actual wording of the new amendment was that the determining authority:

“shall grant the claim or application or allow the appeal, as the case may be, unless it is satisfied, beyond reasonable doubt, that there are insufficient grounds for granting the claim or application or allowing the appeal.”

Little did they know that, already working its way through the appeal system, was a claim which would turn the entire Repatriation compensation system upside down.

On 15 September 1976, James Law finally succumbed to lung cancer, and one month later his widow, Nancy applied for a war widow’s pension. She remembered quite well that, when her husband had enlisted at the age of 30, he had been a non-smoker, and when he came home, emaciated and sick, he was smoking. In her mind, there was thus no doubt that the smoking habit which killed him was a result of his war experiences.
This was all very well, but the decision to smoke was still a personal choice, and the Commission rejected the claim. Thus began a long series of appeals, reconsiderations, and new appeals lasting almost three years, in the middle of which the law changed. The result was, when the last administrative avenue of appeal was exhausted, she was able to go to the court and cite the new standard of proof.
Now, we know that the law is supposed to play no favourites. Whether a veteran’s service was meritorious should, strictly speaking, make no difference to the case. Nevertheless, the court found is necessary to record that James Law had served in both the Middle East and Java, and had survived three and a half years in Japanese prisoner of war camps. He had come out a living skeleton, suffering from enteritis, bacterial dysentery, malaria, hookworm, beriberi, and middle ear infection. In later years he suffered from sarcoidosis of the liver and sigmoid diverticulitis of the colon. He had had a piece of his bowel removed.
In other words, this was one case which the Commission would definitely not have chosen to fight. But they had no choice; hard cases make bad law. They took it all the way to the High Court, and when that august body agreed with Mrs Law, the law itself had been changed.

The government should have acted to amend the legislation then and there. It was a little cloud no bigger than a hand, but everyone could see how it would soon develop. Looked at dispassionately, the court’s decision was probably right – for that specific case. If the fallout could be restricted to the very severe and deserving cases represented by James Law, not much would have been at stake. But even as the Law case was going to the Full Federal Court, another case was wending its way up to a single judge of the same court – that of the late Edward McGlynn.
Here was another prisoner of the Japanese, who had commenced smoking on service, and had died of lung cancer. Evidence was provided as to how prisoners used tobacco to deaden the gnawing pangs of hunger, how they would scrounge rank, wire-like tobacco from the local Chinese, and how the less fortunate were reduced to smoking paper, bark, even pine needles. But there was a twist. There were people still alive who could testify that Mr McGlynn had been a non-smoker on enlistment, but had taken up the habit in Australia, before he went overseas. It made no difference. It could not be disproved, beyond reasonable doubt, that he did not acquire the tobacco addiction because of the changed circumstances of service: the handing out of cigarettes to troops, the example of other soldiers, and the stress of knowing that he would shortly be posted to a war zone, nor could it be disproved that his addiction was not intensified by his POW experiences.

That did it. The floodgates were open. Soon would be swept away everything which stood in the way of disability pensions. The standard of proof was the reverse of the criminal standard. Now a veteran only had to claim that he started smoking on service to receive a pension and treatment for any disease for which smoking is a risk factor. Remember: it only needs a contribution from service for a condition to be ruled as service related.
Of course, we all know that smoking causes lung cancer. No doubt most of us are aware that tobacco harbours many other dangers. But it is a fair bet that very few people know the full extent of the tobacco peril. So, for those of you who need yet another reason to stop smoking, here is the current comprehensive list. No doubt more will be added in due course. For some of these conditions, you need to smoke heavily for most of your life before it becomes a risk factor; for others, a mere whiff of the weed is sufficient. In a few cases, the risk is only a possibility, rather than a probability. For many conditions, giving up smoking reduces the risk, or even eliminates it completely. For others, the risk remains strong for most of your life.
First of all, cancers: smoking has been linked to cancers of the lung, liver, and pancreas, the skin of the lip, the mouth, hypopharynx, and larynx, oesophagus (gullet), stomach, colon, rectum, anus, kidney, renal pelvis and ureter, bladder, the skin of the anus and genitals, the cervix, as well as Hodgkin’s disease, and acute and chronic myeloid leukaemia, not to mention squamous cell carcinoma of the skin. Thus, most of the body involved in breathing, digestion, and waste disposal is covered. However, you will be relieved to know that smoking does not cause cancer of the small intestine, the muscles, brain or nerves, or the breast. Nor, to the chagrin of the ex-service organisations, can it be blamed for prostate cancer.
Moving to non-cancerous conditions, smoking obviously enough, destroys the lung by producing bronchitis and emphysema – but not asthma, or pulmonary fibrosis.
The next major group of smoking related diseases are those involving atherosclerosis or hardening of the arteries ie ischaemic heart disease (the most common type of heart disease), carotid artery disease, aortic atherosclerotic disease, renal artery atherosclerotic disease, pulmonary thromboembolism, peripheral vascular disease of the legs, and various types of cerebrovascular disease (stroke), and well as the dementia which multiple strokes can cause. For most, but not all, of these conditions, the risk of disease gradually returns to normal after giving up smoking.
By reducing the blood supply to the back, smoking can lead to intervertebral disc prolapse (slipped disc). By reducing the blood supply to the eyes, it has been implicated in the cause of cataracts and macular degeneration, the latter of which is a major cause of blindness in elderly people. (So let that be a lesson to you smokers: stop it! or you’ll go blind.) Other effects on blood flow can result in impotence (now that’s a good reason not to smoke) and aortic aneurysm (which can kill you).
Smoking is also a risk factor for a whole host of other diseases: type 2 diabetes, osteoporosis, goitre, gastro-oesophageal reflux disease (heartburn), stomach and duodenal ulcers, Crohn’s disease, colorectal adenoma (which can lead to cancer), rheumatoid arthritis, and Buerger’s disease. It is possible, but not proven, that it can cause chronic sinusitis, myelodysplastic disorder, and motor neurone disease, which is both crippling and fatal.
Lastly, and also least, smoking does not cause ulcerative colitis, nor does it protect you from it. But giving up smoking puts you at risk.

Any of the above conditions can become a royal road to a pension for any veteran who tells the right story about smoking. Now, ask yourself: if you were sick, and needed treatment, and could do with some extra money, wouldn’t you at least be tempted to bend the truth a little? It is a well established principle that the best way to get money out of the government is to tell a lie which cannot be disproved. Veterans’ Affairs staff are long acquainted with stories bearing the ring of untruth. One professional soldier had only three weeks of service covered by the legislation: when he was seconded to Malaya, and he patrolled the backwaters without ever encountering the enemy. By then he had been in the army for nine years, and had reached the age of thirty while resisting all the peer pressure, advertisements, and temptations to smoke – until those three weeks. I contacted him by telephone to confirm it, but could not shake his story.
Sometimes veterans say the wrong thing the first time round, and then get themselves tangled up trying to counter a prior inconsistent story. But even then, it is possible to brazen it out. Yes, said one, I know there are many references on file to my being a non-smoker. I made numerous attempts to quit, and it seems every time I got involved with the Department was during one of those attempts. The prize must surely be given to the man who came out straight and said: I lied. I thought that if I admitted I was a smoker, it would harm my claim. Now that I have discovered it will actually assist me in getting a pension, I have decided to tell the truth. Did he get his pension? Ask yourself: can you be certain, beyond reasonable doubt, that he wasn’t telling the truth the second time round?
Not only does one have to deal with dishonesty from veterans (and their widows!), but also from the advocates employed by the ex-service organisations to assist them. I would not want to leave you with the wrong impression of these advocates. They are ordinary people, and most of them, I suppose, put themselves in the same position as the ethical lawyer, whose job it is to put the best spin on a client’s case, without actually telling a lie, or revealing anything which might harm the claim. Some are scrupulously honest. After I had defeated one veteran at the AAT, one advocate telephoned to congratulate me. He’d known he was a phoney from the start. Another pair of advocates asked my advice on how to “dob in” a client whom they were sure was telling lies.
Unfortunately, there remains a handful of advocates who believe that anything goes as far as getting a client a pension, and only occasionally are they found out. Once an advocate submitted a smoking questionnaire from an ex-merchant mariner indicating that he had started smoking while on a particular ship. Merchant mariners are eligible only for the specific voyages they made outside of the country, and in this case, the dates he gave did not coincide with our records. I therefore picked up the telephone, and asked him exactly when he started smoking. It was some time during the war years, he replied. Was it while he was at sea or on shore? I asked. Could he relate it to a specific voyage? “How on earth would I know?” he responded. “How can anybody remember when he started smoking?” How, indeed? After the conversation had continued in this vein for some time, it became perfectly clear that everything on the smoking questionnaire was fiction. The advocate had simply made it up, and the veteran, already sick and in hospital, had signed it without proof reading it. (This same advocate also signed a smoking questionnaire on behalf of a veteran on the day he died – of dementia.)
Another advocate was more forthright. “Some of these old fellows are too honest for their own good,” he told me. “I told Joe Blow to say that he started smoking during the war, but he refused. He kept saying he started before the war.” Presumably, some of his other clients had fewer scruples about taking his advice.

So, the system is open to abuse. What system isn’t? But, as I pointed out in Chapter 1, most people are honest. How did the decision in Law affect the average veteran? We will start off with the veterans of World War II, because they were the contemporaries of James Law, and because 99% of smokers from that war claim to have started during the war.
The first point to understand – and this will need to be reiterated many times in later chapters – is that the human brain is not a computer. It does not have perfect recall. You have no doubt had the experience of listening to a song after an absence of years, and discovering that some of the words were different from the way you remembered them. Or else you viewed a painting, a scene, or a film a second time, and realised that, not only had you forgotten some details, but your memory had also been false about some of the details, such as colour or shape. Whenever we remember something, the mind has to recreate the event from all the original perceptions of sight, sound, and smell. Every time we do so, there is the opportunity for details to be lost, or reassembled incorrectly. In matters of contention, there is also the subconscious tendency for our memory to morph into a version which supports our position – and all this for concrete events, not just vague trends over time, such as a smoking habit.
The second point is that, in those days, starting to smoke was not a memorable occasion. It was no big deal. Even if a boy’s parents disapproved of smoking – and only a few did – he would still see grown men smoking. He may even have sneaked a couple of fags as a boy, and been punished because he was “too young to smoke”. As soon as grew up, he would enter a workplace and social setting which regarded smoking as normal. Advertisements for cigarettes were everywhere, and on the silver screen he would watch glamorous stars light each other’s cigarettes as part of their courtship ritual. Smoking, in other words, was something grown ups did. It wasn’t a temptation he resisted stoutly until some extraneous pressure, like a war, was put upon him. It was something he just drifted into.
Considering how the Law decision revolutionised the legal landscape, it is remarkable that there has never been a study into whether veterans are more likely to be smokers than their contemporaries who stayed in civvies. However, there are some pointers. According to Quit Victoria, a coalition of government and private organisations set up to help people quit smoking, the first year that reliable prevalence data became available was 1945, at which date 72% of the adult male population of Australia smoked. Such a level is much too high to be explained by the sudden return of newly addicted servicemen. Although a million Australians enlisted at one time or another, twice as many stayed home. Also, many veterans remained non-smokers. Besides, as already mentioned, anyone who follows the popular culture of the interwar years – books, films, and magazines – knows that smoking was the rule rather than the exception. If there was any increase in smoking rates among veterans, it is unlikely to have been more than (say) 10%.
It is a safe bet, therefore, that most of those who started smoking on service would have done so in any case if they had remained civilians. The age at which men normally start smoking – between 18 and 21 – was also the age at which that generation enlisted. Prior to joining up, most of them were working for low teenage wages. For many, their introduction to the military was the first time they had been away from home. But, of course, those who stayed in civvies were also, at the same time, leaving home, setting themselves up independently in their own homes and careers, and joining the general community of peers where smoking was the norm, and cigarettes were almost as readily available as in the services. Therefore, I would say that the veterans are being perfectly accurate when they say that they commenced smoking on service, but for most of them, the military was not the cause of their smoking habit, but merely the setting of various pressures and enticements which applied equally to civilian life. At least, that is what I would say – except for one thing.
Any man who wanted to become an airman had to pass a medical exam a couple of months before he enlisted, at which a quite different form was completed to that required for the army, navy, or the R.A.A.F. ground staff. It was not obviously more comprehensive than other medical forms, but for some reason or other, it contained three questions about the enlistee’s habits: athletics, drinking – and smoking. Driven by curiosity, I once did a survey of a hundred such files which passed my desk. In more than half of them, the veterans were recorded as smokers before they enlisted. Admittedly, there was usually no reference to the amount smoked, so it was open to them to state that they increased their tobacco consumption on service. But that is not what they claimed. In nearly every case, they claimed to have started smoking on service. Many of them have been genuinely surprised when informed of the facts.
I have no reason to doubt their honesty or sincerity. It is just a natural transformation of the memory forty to fifty years after the event, when self-interest is at stake. As the merchant mariner quoted previously said, “How can anybody remember when he started smoking?” And since there is no obvious reason why airmen should be any different from the other members of the defence forces, I thus conclude that this memory failure is general. At least half the veterans who claimed to have taken their first cigarette on service are mistaken.
Contemporary references to smoking habits are frequently encountered on veterans’ medical and hospital files, and from these it becomes clear that there are two other areas where memories are regularly defective. The first is the date a man gives up smoking. One did so as a fiftieth birthday present to himself. Another gave up after a severe illness the year after his marriage. But without such an anchor, how does anyone remember just when he ceased smoking? As the actual date recedes into the past, the tendency is for memory to bring it closer to the present. So, for example, in 2000 a veteran might say that he gave it up in 1980. However, his admission sheet to hospital in 1995 contains the annotation, “Smoking: nil for 20 years.” That would put it back to 1975. Further research reveals that, in 1982, he told a doctor: “Gave up smoking 12 years ago.” Now we are back to 1970. Not infrequently such details are vital, because certain diseases require a certain minimal amount of tobacco consumption, or onset within certain time limits.
To be fair, it should be recorded that many smokers deny their habit to their doctors, because of the latter’s propensity to nag. However, it is hard to see why anybody would tell his doctor he smokes twenty cigarettes a day when the correct figure is thirty. This brings us to the second area where veterans’ histories are regularly false: the amount smoked. The average smoker has a pretty good idea of how many cigarettes he buys, and how often. But if it has changed over a lifetime, how can he possibly remember when it was he started buying a second packet at the end of each day because his consumption had gone up from twenty a day to thirty? Mostly, of course, the veteran’s account must be accepted on the “benefit of doubt”, but where contemporary records actually are available, time and time again they contract the official story. The tendency is to overestimate the quality smoked in the past. Sometimes a veteran provides a complex history of five or six fluctuations over the course of decades. He is no doubt telling the truth as he sees it, but you know it is about as accurate as a peak hour bus timetable.
So much for World War II veterans. What about those of later conflicts? The statements in the above two paragraphs still hold good, but the issue of commencing smoking is more complicated. For the World War, the whole of a veteran’s service, from enlistment to discharge, is covered by the legislation, but for the smaller wars, only the period outside of Australia is covered. It is a credit to most people’s basic honesty that very few actually claim to have started smoking in Vietnam – or Malaya, or Korea, as the case may be. Nearly always, they claim to have started on enlistment. The first batch of Vietnam veterans to enter the system got a raw deal. They were mostly older, professional soldiers who had been in the defence forces, and smoking, for years before they went to war, and their longtime smoking habit was unaffected by it.
However, in less than a decade a younger set of veterans was getting sick and lodging claims, and a consistent pattern began to emerge. Almost invariably they claim to have started smoking when they enlisted, usually at around five cigarettes a day. Then, a year or so later, when they were dispatched to a war zone, what with the stress of war and the ready availability of cheap cigarettes, their tobacco consumption went up to twenty or thirty a day, and remained high after the war. The only difference was how high, and whether and when they stopped smoking. On this basis, most smoking related diseases are now accepted for veterans of this era.
If you stop to think about it, however, a couple of questions should spring to mind. The first is: is it credible? Commencing smoking upon enlistment rings true, especially since the servicemen were usually quite young at the time. (However, even that is open to doubt. These days, when the services are more aware of the hazards of tobacco, the habit is often recorded on the enlistment medical form.) But, apart from that, how can anybody remember, decades after the event, the detailed progression of his smoking habit in the first couple of years? How can he remember when it went from five a day to ten a day, to twenty a day? No-one kept records at the time; no-one considered the issue important.
But even if his memory were accurate, what does it signify? The entire thrust of the claim, the logic by which they are accepted, is that, had it not been for the war, the man’s smoking habit would have remained at five cigarettes a day for the rest of his life. How many smokers do you know who smoke like that? It can be safely asserted, with a confidence close to certainty, that if a young man started smoking on enlistment, his tobacco consumption would have reached twenty or thirty a day before very long. If it took place in Vietnam, it was only because the timing of his overseas service happened to intersect with the normal progression of the habit.
In the original Law case, the courts took judicial notice of the fact that tobacco is strongly addictive, and the addiction very difficult to break – especially in an environment where the drug is readily and cheaply available and socially acceptable, and its inherent dangers little known. If the addiction is the result of war service, then every cigarette smoked from then on becomes a result of service. But there has never been any evidence provided as to how the addiction can be increased.
Under such circumstances, one might have recourse to common sense, and say that a smoker’s tobacco consumption is ultimately conditioned by his body’s need for nicotine. Despite the caveats already mentioned about official smoking histories, two definite trends are evident. In some cases, the smoker develops a greater and greater tolerance to the drug throughout life, and his smoking increases slowly but consistently over the years. The other trend is that, shortly after commencing, he reaches a plateau which satisfies his nicotine cravings. Most commonly, this is about twenty or thirty cigarettes a day – which is why they are packaged in such quantities. After that, his tobacco consumption tends to fluctuate up and down around that level, depending on such factors as finances, availability, and pressure of work. “Stress” can certainly make a person smoke more in the short term, but nobody has ever presented evidence that it can produce any long term change in the level of the addiction.
Despite all this, it is an article of faith at all levels of decision making that any increase in smoking on eligible service is a direct result of service, even if the increase is permanent. This applies even if the veteran was a confirmed smoker prior to service; increases from thirty a day to fifty a day are accepted without question. And the only evidence is the veteran’s say so.

To summarise: the change in the standard of proof, and the actions of Nancy Law completely revolutionised Veterans’ Affairs. Overnight, disability pensions turned into a massive growth industry, with smoking the main engine driving it. At a rough guess, it accounts for about two thirds of all pensions. And the premises on which it is based are essentially bogus. At least half on the successful claims are the result of faulty memories. Even when a veteran did, in fact, commence or increase smoking on service, it was due to circumstances which applied equally to civilian life. In very, very few cases did service actually “cause” the smoking habit.
Even then, we tend to forget, it was still a matter of personal choice. “Look,” one R.S.L. advocate said to me, “I always think they made a mistake in ruling smoking was due to war service. Of course, I argue it at the VRB when I’m assisting veterans, but the fact is, I served in the same battles as they did, and I don’t smoke.”

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