Agnihotri and Australian Postal Corporation
[2006] AATA 963
•9 November 2006
Administrative
Appeals
Tribunal
DECISION AND REASONS FOR DECISION [2006] AATA 963
ADMINISTRATIVE APPEALS TRIBUNAL )
) No N2005/1518
DIVISION ) Re MIRIDULA AGNIHOTRI Applicant
And
AUSTRALIA POSTAL CORPORATION
Respondent
DECISION
Tribunal Senior Member Robin Hunt and Member Dr Max Thorpe Date 9 November 2006
Place Sydney
Decision The decision under review is affirmed. ..............................................
Ms Robin Hunt
Senior Member
CATCHWORDS
COMPENSATION – soft tissue injury – medical treatment – cessation of effects of injury – no continuing injury – no incapacity.
legislation
Safety Rehabilitation and Compensation Act 1988 (Cth) – ss 16 & 19
9 November 2006
REASONS FOR DECISION
SUMMARY
1. Ms Miridula Agnihotri, the applicant, applied to the Administrative Appeals Tribunal (the tribunal) for review of a decision of the respondent, the Australia Postal Corporation (Australia Post). The decision determined that, pursuant to the provisions set out in ss 16 and 19 of the Safety Rehabilitation and Compensation Act 1988 (the Act), Australia Post was under no present liability to pay Ms Agnihotri compensation for incapacity and medical expenses.
2. The tribunal, after careful consideration of the evidence before it, has decided that there is no significant pathology to explain Ms Agnihotri’s symptomology. As there is no evidence of any pathology explaining Ms Agnihotri’s symptoms there can be no basis for finding continuing effects from her compensable condition. She is therefore not entitled to any compensation at the date of the decision under review for compensation pursuant to ss 16 and 19 of the Act.
BACKGROUND
3. Ms Agnihotri commenced work as a postal sorting officer with Australia Post on 5 June 2000. At various times since commencing work as a postal sorting officer Ms Agnihotri’s duties have included:
§dock set up, including use of BT – a hand operated forklilft;
§loading of trays onto the tray management system (TMS); and
§administrative duties, including revenue checking, “meet and greet” and labellilng ULDs.
In her position as a postal sorting officer Ms Agnihotri would normally work 25 hours per week, that is, 5 hours per day for 5 days per week.
4. Ms Agnihotri has a long history of pain arising from the carrying out of her tasks for Australia Post. On 14 August 2001 Ms Agnihotri was loading the TMS when she developed pain in her back and right shoulder. Australia Post accepted liability for this condition and Ms Agnhotri was subsequently placed on restricted duties.
5. On 3 February 2004 Ms Agnihotri lodged a claim for compensation in relation to an aggravation of her previous right upper limb condition. She also complained of pain in her right knee and down to her foot. On 4 March Australia Post accepted liability for this, describing Ms Agnihotri’s condition as “muscular pain in right upper limb and knee”. Liability was accepted pursuant to s 14 of the Act.
6. On 8 April 2004 Australia Post advised Ms Agnihotri that it intended to cease paying compensation for her condition. Shortly after, on 30 April 2004, Ms Agnihotri informed Australia Post that she was pregnant and as such unable to undergo further testing in relation to her physical condition. Ms Agnihotri requested that the matter be left open until after she had given birth.
7. On 12 May 2004 Australia Post determined that, pursuant to the provisions set out in ss 14, 16, 19, 24 and 27 of the Act, there was no present liability for it to pay Ms Agnihotri compensation. On 17 June 2004 Ms Agnihotri, by way of her solicitors, requested a reconsideration of the 12 May determination. On 6 July 2004 Australia Post varied the 12 May determination and found that there was no present liability for it to pay compensation to Ms Agnihotri pursuant to ss 16, 19, 24, 27 and 29 of the Act.
8. On 19 July 2004 Ms Agnihotri lodged an application for review of the 6 July determination with the Administrative Appeals Tribunal (the tribunal). On 5 November 2004, however, Australia Post issued a reconsideration of its own motion and varied the determination dated 12 May 2004. The reconsideration found that Ms Agnihotri was entitled to time off work and medical treatment expenses up to and including 28 September 2004. Subsequently, on 10 November 2004 Ms Agnihotri withdrew her application for review with the tribunal.
9. On 10 February 2005 Ms Agnihotri returned to work from maternity leave. Eighteen days later, that is on 28 February 2005, she lodged an incident report in relation to an aggravation of her previous injury, namely her right upper limb and neck condition. Next, Ms Agnihotri lodged a claim for compensation in relation to her right upper limb and neck condition on 13 March 2005 and on 21 April 2005 Australia Post accepted liability for “soft tissue injury, neck & upper arm” pursuant to s 14 of the Act.
10. On 8 September 2005 Dr McGill, Consultant Rheumatologist, provided a report on Ms Agnihotri at the request of Australia Post. In the report Dr McGill stated that he did not consider that Ms Agnihotri suffered from a physical disorder. He stated that the investigations demonstrated minor cervical spondylosis but stated that he considered that this was constitutional in nature and unlikely to account for Ms Agnhotri’s symptoms. Dr McGill also noted that the changes in Ms Agnhotri’s cervical spine could account for her intermittent neck discomfort. In the report Dr McGill stated that he considered the minor polphasia noted on the EMG as unlikely to reflect genuine radiculopathy. Subsequently on 16 September 2005 Australia Post informed Ms Agnihotri of its intention to cease payments of compensation.
11. On 17 October 2005 Australia Post determined that as at 17 October 2005 Ms Agnihotri had no present entitlement to compensation pursuant to ss 16 and 19 of the Act. On 2 November, by way of her solicitors, Ms Agnihotri requested a reconsideration of the determination of 17 October. On 24 November the respondent affirmed the determination. Subsequently, on 30 November Ms Agnihotri, by way of her solicitors, applied to the tribunal for review of the decision of 24 November 2005.
ISSUES
12. The issues before the tribunal are:
§Whether Ms Agnihotri, as at 17 October 2005, continued to suffer from the effects of the compensable condition, that is soft tissue injury to the neck and upper arm, that was sustained on 28 February 2004; and if so
§Whether Ms Agnihotri is therefore entitled to compensation, pursuant to ss 16 and 19 of the Act, from 17 October 2005.
MEDICAL EVIDENCE
13. Several medical reports are before the tribunal and express differing views about Mrs Agnihotri’s health problems. Dr Najeet was Ms Agnihotri’s General Practitioner and recorded that Mrs Agnihotri had been expressing symptoms since 14 August 2001. A series of investigations commenced in 2001 and have continued. Some early investigations were carried out by Dr Blundell and Dr Larcos.
14. Dr Jim Blundell conducted imaging tests on Ms Agnihotri’s cervical spine and right shoulder. He provided a report of 10 September 2001. In regards to Ms Agnihotri’s cervical spine, he stated:
There is slight scoliosis convex to the left. Alignments are otherwise normal apart from reversal of the lordotic curve at the C4/5 level.
There is normal degenerative narrowing of the C5/6 disc space. The facet joints are normal.
15. In relation to Ms Agnihotri’s right shoulder, Dr Blundell stated that “no bone or joint lesion can be seen”.
16. Dr George Larcos conducted a bone scan on Ms Agnihotri and provided a report, dated 31 May 2002. In this report he stated that:
There is a focus of mildly increased radiopharmaceutical uptake in the posterolateral aspect of the fight fourth rib. The distribution of radiopharmaceutical elsewhere in the cervical spine and thorax is physiologic. Blood pool images of the chest are normal.
17. Dr Larcos commented that Ms Agnihotri had a subacute fracture involving the right fourth rib with no other skeletal abnormality.
18. Mrs Agnihotri first saw Dr Neil McGill in 2002. His opinions are discussed further in the consideration below.
DR ROBYN CHASE
19. Dr Robyn Chase, an occupational physician and injury management consultant, provided a letter to the tribunal and a report, both dated 1 April 2004. In her report Dr Chase stated:
Physical examination reveals a short stout woman with no evidence of pain behaviours. She had full range of movement in the right shoulder with tenderness over the supraspinatus and long head of biceps. The maximal area of tenderness was in fact over the right medial scapular region, rhomboids and thoracic spine.
In her right knee there was some mild medial femoral condyle and medial joint line tenderness without any other abnormality.
20. In relation to Ms Agnihotri’s upper limb complaint Dr Chase stated that Ms Agnihotri suffered “difuse tenderness” with “’few ‘hard’ clinical signs”. Dr Chase stated that despite extensive investigations the only clear findings were a reported tear in the right supraspinatus tendon in the ultrasound, and a bone scan which revealed a fracture in the 4th rib. Dr Chase concluded that:
The maximal area of tenderness is Ms Agnihotri’s upper limb is indeed contiguous with the hot spot on the bone scan. This argues that in fact many of her upper limb symptoms are related to that previous rib fracture… The remainder of her upper limb symptoms appear to be diffuse and non-specific.
21. Likewise, Dr Chase stated that in regards to Ms Agnihotri’s right knee:
I can find little in the way of clinical abnormality. She may have some diffuse pains from patellar mal tracking.
22. Dr Chase stated that it was difficult to ascribe any work causality to Ms Agnihotri’s symptoms. On this point Dr Chase commented that if Ms Agnihotri does have a rib fracture which is the cause of her symptoms, then “there is no clear relationship whatsoever” between Ms Agnihotri’s injury and her position with Australia Post. Dr chase stated:
There does not appear to be any history of trauma sufficient to explain a rib fracture. Similarly, if her knee problems are due to patellar mal tracking then this is due to her intrinsic anatomy rather than any work injury.
23. In relation to the attributably of Ms Agnihotri’s injuries to the incident of 3 February 2004, Dr Chase said:
There does not appear to be any clear incident and therefore they are not attributable.
DR DAVID HO
24. Dr David Ho conducted a MRI on Ms Agnihotri’s cervical spine at the request of Dr Chandra Najeeb, Mrs Agnihotri’s General Practictioner. Dr Ho sent a copy of his report to Dr Medhat Guirgis, consultant orthopaedic physician. He provided a report dated 3 June 2005. In this report Dr Ho stated:
There is a fixed flexion deformity of the cervical spine centred at the C5/6 level. The disc is narrowed and degenerate. A broadbased posterior disc protusion has occurred, mild cervical uncodisc arthrosis has also developed.
The remaining cervical disc spaces are maintained. Signal intensity is within normal limits. A slight anterolisthesis of C3 and C4 is also evident.
The central canal dimensions remain adequate, the intevertebral foramina are not narrowed.
The cervical cord is of normal size and signal.
25. Dr Ho concluded that the C5/6 disc is narrowed and degenerate. He stated that a mild broadbased posterior disc protrusion has occurred and that mild cervical uncodisc arthrosis is also present.
DR MARK WATERLAND
26. Dr Mark Waterland conducted an ultrasound on Ms Agnihotri’s right shoulder and a C.T. scan on her cervical spine. He provided a report dated 5 June 2002. In his report of 5 June Dr Waterland stated:
Anteriorly in the supraspinatus tendon there is a small partial thickness partial width tear extending from the bursal surface. It extends down for approximately 60% of the width of the tendon. There is no significant retraction of the tendon ends with stress. There is no dipping of the superior surface tendon.
27. Dr Waterland stated that Ms Agnihotri’s remaining rotator cuff tendons define normally and that there was no joint effusion. He stated that the biceps tendon defines normally and lies in the normal position. He stated that with abduction there was pain but no tendon blocking.
28. Dr Waterland performed the CT scan from C3 to T1 and displayed in bone and soft tissue windows. He stated that:
There is minimal disc buldge at C4/5. There is associated end plate osteophytes. This is slightly indenting the anterior aspect of the thecal sac causing slight canal stenosis.
29. Dr Waterland stated that the remaining discs define normally and that the remaining canal was of normal diameter. He stated that the foramina are patent and the nerve roots extend normally. He said that there were slight bony degenerative changes.
DR NEIL MCGILL
30. Dr Neil McGill, a Consultant Rheumatologist, provided a report dated 6 June 2002 and gave concurrent evidence with Professor Sambrook at the hearing. In his report of 6 June Dr McGill stated that Ms Agnihotri’s imaging studies demonstrate:
minor cervical spondylosis (constitutional and of relatively little significance), a focal area of increased uptake in the right 4th rib posterolaterally (I think that is very unlikely to relate to her work activities and she specifically denied any trauma to that region but further investigation is warranted. A begnin or malilgnant bone lesion could account for that abnormality and although a serious disorder is unlikely, imaging is warranted) and although an initial ultrasound study was thought to be normal, a repeat study in June 2002 suggested she may have a small partial thickness rotator cuff tear. If that finding is correct I think her work duties could have aggravated some symptoms related to that tear although I think it is unlikely that her work duties were primarily responsible as there was no history of an event at work that one might expect to cause a tear.
31. In his report Dr McGill stated that he believed that Ms Agnihotri suffered difuse aches and pains which are best labelled fibromyalgia. Dr McGill opined that:
these relate to unhappiness for reasons unrelated to the physical aspect of her work.
32. In giving evidence Dr McGill told the tribunal that he agreed with Professor Sambrook that there was no relevant pathology in the shoulder with respect to Ms Agnihotri’s symptoms. He pointed out, however, that the MRI on Ms Agnihotri’s shoulder pain did not, as Professor Sambrook told the tribunal, demonstrate a tear. Rather, Dr McGill told the tribunal that there were one or two ultrasounds which showed a small patial tear.
33. Dr McGill told the tribunal that Ms Agnihotri does have cervical disc changes, but stated that these were mild and “more than you would expect at her age”.
34. Dr McGill told the tribunal that Ms Agnihotri’s X-ray indicated that her spine was already abnormal at the time her symptoms commenced. He said that disc narrowing takes years to develop. He said that he didn’t believe “that there is any possibility” that Ms Agnihotri’s work with Australia Post over the 13 months influenced the changes to her spine shown in her plain X-ray results.
35. Dr McGill told the tribunal that Ms Agnihotri’s MRI of her cervical spine showed degeneration of the C5/6 disc. He said that he thought that he and Dr Sambrook were both agreed that Ms Agnihotri doesn’t have any features of nerve compression.
36. Dr McGill told the tribunal that he thought that it was possible that some of Ms Agnihotri’s symptoms in her right upper limb have been referred from her cervical spine on the basis of somatic referred pain, and not on the basis of nerve compression. He said:
I think if her activities had influenced those symptoms, which activities can influence symptoms for cervical spondylosis, the nature of her work activities were such that it could have influenced the symptoms while she was doing those work activities and possibly for hours or maybe even a day or two afterwards. But I don't believe that those work activities would have had any influence on the pathology. I think her current capacity to perform work would need minor changes on her energy... I think she is fit for normal duties.
37. Under cross-examination Dr McGill stated that he did not believe that it would be wise for a woman of Ms Agnihotri’s size and stature to be repetitively lifting a 25 kilogram weight. When asked if he thought that this could cause permanent aggravation, he said:
It would depend on the history. I mean someone who has lifted a 25 kilogram weight in a fashion and experienced an acute episode of pain, you know, I would ..... would think that that could cause a permanent exacerbation. On the other hand, if someone had been lifting a 25 kilogram weight and had not noticed any acute episodes, ..... just gradually developed soreness, then I would not think it was likely to have made any permanent change.
38. When asked his opinion on whether someone with Ms Agnihotri’s disc pathology should have any weight lifting restrictions, specifically lifting weights of 16 kilograms or more, Dr McGill stated that he did not. He explained to the tribunal:
the changes we are talking about here are extremely common. If one did an MRI, in fact it has been done MRIs on normal asymptomatic people, you find these changes very commonly. And there is no reason to restrict those people's activities.
39. Under cross-examination Dr McGill told the tribunal that he wouldn’t put Ms Agnihotri or another person with her disc pathology on any restrictions with regard to twisting or movement on the basis that Ms Agnihotri’s cervical disease is very mild.
PROFESSOR PHILLIP N. SAMBROOK
40. Professor Phillip N. Sambrook, a Professor of Rheumatology at the Royal North Shore Hospital, provided a report to the tribunal dated 6 February 2006 and gave concurrent evidence to the tribunal with Dr McGill.
41. In his report Professor Sambrook assessed Ms Agnihotri thus:
Mrs Agnihotri suffers from cervical spondylosis and C5/6 disc protrusion with probably referred pain into her right upper limb. This is presumably somatic referred pain from facet and uncontrovertral osteoarthritis rather than due to frank nerve compression, although the nerve conduction suggested an abnormality at C6/7. The association between her symptoms and head rotation is strongly suggestive of this. There are also some neuropathic features, which may be aggravated by the issue of the vibrating nature of the BT power equipment.
42. In his report Professor Sambrook stated that cervical spondylosis and disc degeneration are often constitutional in nature. He said that Mrs Agnihotri was 33 when her symptoms first occurred, which is at the young end of the spectrum for age related degeneration. He said that Ms Agnihotri’s definite history of the onset of her shoulder and upper back symptoms could be significant. Mrs Agnihotri had described approximately 5 weeks of heavy lifting and loading of trays onto the TMS machine. These trays could weigh between 8 and 16 kilograms. Professor Sambrook said:
There is a known relationship between heavy lifting and intervertebral disc disease and so this may be relevant to her case. As noted, some contribution from age related degeneration could also be present but this is generally less likely in some one who was 33 when [her] symptoms first occurred. The fact that she gets certain symptoms when turning her neck frequently whilst operating the BT machine also suggests a cervical origin aggravated by work activity.
43. In giving evidence Professor Sambrook expanded on this, saying that it was not possible to say whether Ms Agnihotri’s disc degeneration was age related or primarily related to her work. He stated:
Certainly if it occurred within this period [13 months at Australia Post], that’s a bit quick. But then on the other hand to have disc degeneration at that age is a little unusual. But even if there is some component of age related degeneration, the nature of the activities that she described to me, namely quite frequent – well, heavy lifting at times as well as the requirement to turn her head and neck obviously when using some of the equipment, which often seem to cause the symptoms she described to me, I felt was consistent with a cervical origin for the pain which is not primarily caused by her work but at least would be exacerbated by her work whilst performing those activities…
44. At the hearing Professor Sambrook told the tribunal that he disagreed with Dr McGill’s opinion that a person with Ms Agnihotri’s disc pathology could lift weights of up to 16 kilograms. To this Professor Sambrook said:
I think it is generally agreed that if you have got significant disc pathology you advise the patient to avoid heavy lifting. The question becomes what is heavy. For someone of her stature 16 kilos sounds a bit heavy. Certainly 25 kilos I think is too heavy. I think you have got to [look]. to the patient and the stature and the pathology. So I think in general most people would think that if you have got disc pathology the restrictions on weight would be appropriate. It becomes a matter of how heavy the weight could be. 16 kilos is probably a bit much for her and her stature, I would have thought. Certainly 25 is. ..... although, as it goes over, the more it goes over 10 the more of an issue I think it becomes.
45. Professor Sambrook told the tribunal that he thought that it was appropriate that restrictions were put on Ms Agnihotri regarding heavy lifting. He stated:
I think it is pretty well accepted in medical practive that if someone has significant disc pathology, then there are certain things that can exacerbate this. These include heavy lifting and twisting movements. So it was on this that I thought there would be some appropriate restrictions placed upon her in terms of avoiding heavy lifting. It seems to me that the management – or the equipment she had to operate did lead to quite a lot of twisting activity which is probably again not a good idea in the longer term for someone with cervical pathology. I agree that it is very quick for these changes to develop and 13 or 14 months from her work at Australia Post. Then again, I think Mr (sic, Dr) McGill said the changes on the X-ray were more than expected for her age. So if they were expected for her age it would be fine but if they are more than expected, well, there is something else operating there.
DR MEDHAT GUIRGIS
46. Dr Medhat Guirgis, a Consultant Orthopaedic Surgeon, gave oral evidence and provided three reports dated 26 April 2004, 5 September 2005 and 29 September 2005. In his report of 5 September Dr Guirgis diagnosed Ms Agnihotri with:
§Post-traumatic mechanical derangement of the cervical and lumbar areas of the spine.
§Tendonitis/subacromial bursitis in the right shoulder.
§Chondromalacia patellae in the right knee.
47. Under cross-examination Dr Guirgis explained post-traumatic mechanical derangement, and how it was caused in Ms Agnihotri, thus:
It is… [a] traumatic stress disorder. It is some sort of trauma that happens from everyday activity and gradually builds up until the person is exposed to the traumatic stress… If you have a wire and you keep bending that wire at a certain point, at a particular point, after some time you will find that the wire will snap in the middle.
48. Dr Guirgis said that post-traumatic mechanical derangement was caused by everyday work activity that was “stressfull activity”. He said that he did not believe that it could have been caused by activity in the home. On this point he told the tribunal:
I would imagine she…[has] a maximum three or four bedroom house and she would clean that house twice a week or something like that. So there is nothing at home that would require her to be overloading her spine to the extent that it would snap. When we are talking about traumatic stress disorder we are talking about an activity that is done, that is repeatedly done say every minute or so and..one hour, two hours and then to repeat that cycle several times a day…
49. When asked if picking up her baby could have caused Ms Agnihotri’s post-traumatic mechanical derangement, Dr Guirgis told the tribunal that he did not believe that this could be so. He explained:
If she picks up her baby every second from the floor and puts it back on the floor…every second for one hour or for 24 hours a day, yes. But if she picks up the baby once every two hours and feeds the baby and then carries the baby, that would not cause that stress. We are talking about something repetitive that would…make the head go forward in front of the neck and act as a weight. The normal daily living activities would not cause such a strain. Our bodies build up to accommodate that stress.
50. In evidence Dr Guirgis told the tribunal that he would agree with Dr McGill and Professor Sambrook’s opinion that Ms Agnihotri suffers from disc pathology and that this is the mechanism for the somatic referred pain to her right arm. Dr Guirgis concurred with Dr McGill and Professor Sambrook and told the tribunal that Ms Agnihotri’s symptoms of neck pain were aggravated by the duties she was performing in August 2001. He went on to state that he would describe Ms Agnihotri’s disc pathology in relation to her sponylosis as chronic. He said he would use this term as the affected spinal limit where Ms Agnihotri’s disc protrudes is not functioning to its full capacity.
51. Dr Guirgis told the tribunal that he believed that Ms Agnihotri’s disc protrusion occurred when she started complaining about her right cervical back symptoms. He disagreed that Ms Agnihotri has degenerative constitutional change that was responsible for her symptoms. He said:
We all have degenerative changes, all of us. Actually, we start our aging process at the age of 13. … [S]omebody called Puschen…says that we first start to dry up at the age of 13 but these changes are supposed to be completely asymptomatic. Symptoms appear when you expose the spine to stress that it cannot handle.
52. In cross-examination counsel for the respondent asked whether operating a BT lifter machine could be a traumatic activity that would result in disc protrusion. The BT lifer machine slips prongs underneath a load and then lifts and moves it. It requires that the operator look over their right shoulder and sometimes their left. Dr Guirgis stated that if such activity was performed repeatedly over a long time, it could be the traumatic activity that resulted in the protrusion. Dr Guirgis stated that he would define a long time as “a few months”.
53. Dr Gurigis agreed that Ms Agnihotri was suffering from a somatic pain mechanism. He explained his reasons for this to the tribunal thus:
Normally any acute pain or any pain of acute origin is supposed to settle down within weeks or maximum months. When the pain persists in the body more than six months then we are talking about chronic pain. And if the pain produces changes in the central nervous system then it becomes a chronic pain syndrome
54. Dr Guirgis told the tribunal that Ms Agnihotri’s somatic referred pain would produce diffuse symptoms in her right arm. He said:
In cervical disc problems the demarcation between the various… [points] is not as marked as in the lumbar area but the chronic pain syndrome as well has got an element in producing this sensation of diffuse pain in the arm.
55. Dr Guirgis concurred with Dr Sambrook and disagreed with Dr McGill and said that, in his opinion, Ms Agnihotri’s pathology and symptoms made it such that she should have some form of restriction as to lifting at work. He stated that he would limit her to lifting 10 kilograms and then, restrict this to only occasional lifting. Dr Guirgis stated that lifting up to 16 kilograms on a repetitive basis would aggravate the pain in Ms Agnihotri’s neck and arm. Such lifting, Dr Guirgis said, would increase the intensity of the pain Ms Agnihotri experienced.
56. He stated that he would advise Ms Agnihotri to avoid prolonged bending of the neck, explaining that such action:
Will narrow… the root by twisting the neck to one side you are approximating the… joints on one side and restricting them on the other. These can cause narrowing of the nerve root... on the oblique side and stretching of the neve roots across the… of the other side.
DR TONY PEDUTO
57. Dr Tony Peduto, MT, conducted an MRI scan of Ms Agnihotri’s right shoulder on 3 June 2005. He provided a report of that date in which he stated:
The AC joint is normally located with no evidence of oedema or bony spurring. The rotator cuff is intact with no evidence of partial or full thickness tear. Some minor fluid/signal is noted in the anterior portion of this subdeltoid/subacromial bursa in keeping with mild bursitis. More posteriorly, the bursa is normal. The subsapularis, infraspinatus and teres minor components of the rotator cuff are intact. The muscle bellies of the rotator cuff elements are normal. The long head of biceps tendon and the bicipto-labral anchor are normal. The fibrocartilaginous glenoid labrum and bony articular surfaces of the gleno-humeral joint area are intact and have normal appearance. No marror bedema is noted. No soft tissue masses or fluid collection are seen.
58. Dr Peduto concluded that there was minor bursal/flulid at the anterior portion of the subdeltoid/subacromial bursa in keeping with mild bursitis. In his report he stated that there was no significant cuff ligament or labral abnormality.
DR CHANDRA NAJEEB
59. Dr Chandra Najeeb, Ms Agnihotri’s treating doctor, provided a report dated 13 March 2006 in which she set out that she had been seeing Ms Agnihotri periodicially since 7 September 2001.
60. In her report Dr Najeeb diagnosed Ms Agnihotri thus:
§Cervical spondylosis and C5/6 disc protrusion, with minor polphasia of C6/7 inneverated muscles right arm.
§Bursitis right shoulder and teno synovitis right elbow and wrist.
§Mild median neuropathy right hand.
DR MICHAEL CARR
61. Dr Michael Carr conducted a right shoulder ultrasound on Ms Agnihotri and provided a report, dated 18 October 2001. In this report Dr Carr stated:
The biceps tendon defines normally and lies in its normal anatomical position.
The components of the rotator cuff are normal.
No tear is evident within the supraspinatus tendon and there is normal mobility.
There is no fluid in the bi9ceps tendon sheath or in the subdeltoid bursa.
62. Dr Carr commented that Ms Agnihotri’s shoulder was sonographically normal.
consideration
63. We have considered the medical opinions before us and found that, on balance, the experts were of the opinion that there was no significant pathology to explain Ms Agnihotri’s symptomology. Indeed, Dr McGill found underlying mild cervical spondylosis and no underlying physical disorder. He found no physical disorder in the right limb and reported that the MRI of Ms Agnihotri’s shoulder was normal although there was a minor amount of fluid in the subdeltoid bursa. He reported that this was in keeping with “mild bursitis”. Dr McGill reported that the MRI of Ms Agnihotri’s lumbar spine was normal.
64. Additional medical opinions referred to the following features. Dr Guirgis found post traumatic mechanical derangement of the lumbar area of the spine. He reported tendonitis/subacromial bursitis in the right shoulder with chandro malava palillar of the right limb. Dr Najeeb found symptoms relating to Ms Agnihotri’s right upper limbs since 14 October 2001. Dr Chase reported non-specific neck and upper limb pain combination of much fatigue, postural pain and possibly a component due to a specific muscular strain. Dr Chase reported that there may be a contribution from degenerative disease of the cervical spine.
65. On the whole, the doctors who treated or examined Mrs Agnihotri reported no physical basis for Ms Agnihotri’s widespread symptoms. We have therefore reached the conclusion on the material before us that there is no significant pathology to explain her symptomology.
66. It follows that, as there is no evidence of any pathology, there can be no basis for finding continuing effects from her compensable condition. She is therefore not entitled to any compensation at the date of the decision under review for compensation pursuant to ss 16 and 19 of the Act.
67. The decision under review is affirmed.
I certify that the 67 preceding paragraphs are a true copy of the reasons for the decision herein of
Signed: Rhonda Pietrini Associate
Date/s of Hearing 4 - 7 August 2006
Date of Decision 9 November 2006
Counsel for the Applicant David Richards
Solicitor for the Applicant Hamad Zreika
Counsel for the Respondent Rhonda Henderson
Solicitor for the Respondent Cameron Hutchins
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