No liability of the military insurance for PTSD following voluntary SKH deployments due to lack of adequate causal connection

Facts

The respondent [A.] (born 1974, freight forwarding clerk) was sole shareholder and managing director of [B. GmbH] , which was deleted from the commercial register in 2020 following bankruptcy. Between 2005 and 2015 he completed fifteen voluntary deployments for the Swiss Corps for Humanitarian Aid (SKH), including 142 days in the first half of 2005 in Indonesia after the tsunami of 26 December 2004. From December 2006 to June 2007 he received psychotherapeutic treatment at the External Psychiatric Services [C.] (thirteen consultations, concluded with good improvement). The last SKH deployment ended on 6 June 2015.

On 11 January 2018 the respondent registered with Suva, Military Insurance Division (Suva-MV), due to post-traumatic stress disorder (PTSD) and a moderate depressive episode. By decision of 26 October 2018 and opposition decision of 29 August 2019, Suva-MV denied liability but assumed the therapies incurred until August 2018 as investigative measures.

The Insurance Court of the Canton of Aargau upheld the appeal on 25 August 2020, affirmed liability under Art. 6 MilIA (adequate causal connection), set aside the opposition decision and remitted the matter for a new decision. Based on the assessments of the military insurance psychiatrist Dr. med. [D.] , it proceeded on the assumption of sequential traumatisation during the SKH deployments.

Suva-MV lodged an appeal in public law matters and requested that liability be denied or, alternatively, that the matter be remitted for a new assessment (partial liability). The respondent requested non-admission or, alternatively, dismissal. The FOPH waived submission of a response.

The question in dispute was whether the lower court violated federal law by affirming the adequate causal connection between PTSD or the atypical depressive clinical picture and the fifteen SKH deployments.

Considerations

The Federal Supreme Court applies the law of its own motion (Art. 106 para. 1 FSCA) and is not bound by the lower court's findings of fact (Art. 105 para. 3 FSCA) where cash benefits of military or accident insurance are at issue. The liability under Art. 6 MilIA for late sequelae and relapses was correctly set out by the lower court.

In the absence of contemporaneous documentation of psychological complaints during the deployments, the lower court relied on subsequent anamnestic statements. The Federal Supreme Court confirms the anticipatory assessment of evidence, by which supplementary factual investigations were omitted. Accordingly, only liability under Art. 6 MilIA is under consideration.

The adequacy of a shock event without physical injury is to be assessed according to the general formula (ordinary course of events and general life experience) and must be examined separately for each event (BGE 129 V 177). The usual reaction to shock events is that the traumatisation is generally overcome within a few weeks or months. Whether a natural (partial) causal connection exists may be left open if adequacy is to be denied.

The lower court did not comprehensively examine the legal question of adequacy. The deployments in Banda Aceh and Kathmandu (aftershocks 2015) did not expose the respondent to…