Antonina Hubertz and Australian Postal Corporation

[2014] AATA 280

[2014] AATA 280

Division	General Administrative Division
File Number	2013/2884
Re	Antonina Hubertz
APPLICANT
And	Australian Postal Corporation
RESPONDENT

DECISION

Tribunal	Deputy President S D Hotop
Date	9 May 2014
Place	Perth

The decision under review is affirmed.

....................[sgd]..........................................

S D Hotop

Deputy President

CATCHWORDS

COMPENSATION – employee of licensed corporation – applicant suffered right shoulder injury in May 2011 and left shoulder and neck injury in June 2011 in performance of employment duties – respondent accepted responsibility to pay compensation for injuries – respondent ceased payment of compensation for injuries in April 2013 – as at April 2013 applicant’s ongoing pain symptoms not causally related to compensable injuries – from April 2013, and presently, respondent not liable to pay compensation to applicant for compensable injuries – decision under review affirmed 

LEGISLATION

Safety, Rehabilitation and Compensation Act 1988 (Cth), s 4, s 5A, s 5B, s 14, s 16 and s 19

REASONS FOR DECISION

Deputy President S D Hotop

9 May 2014

Introduction

1. Antonina Hubertz (“the applicant”) who, at all material times, has been employed by Australian Postal Corporation (“the respondent”) as a mail officer, has applied to the Tribunal for review of a “reviewable decision”, dated 16 May 2013, made by a delegate of the respondent under s 62 of the Safety, Rehabilitation and Compensation Act 1988 (Cth) (“SRC Act”).

2. That reviewable decision affirmed a determination, made by another delegate of the respondent on 12 April 2013, that the respondent was not presently liable to pay compensation to the applicant, in accordance with the SRC Act, in respect of an accepted compensable injury previously suffered by her, namely, “right upper trapezius rotator cuff muscle strain with subsequent development of left shoulder and neck strain”.

   The Evidence

3. The evidence before the Tribunal comprised the “T Documents” (T1–T234, pp 1–441) lodged on behalf of the respondent in accordance with s 37 of the Administrative Appeals Tribunal Act 1975 (Cth), and:

   ·Exhibits A1–A4 tendered by the applicant;

   ·Exhibit R1 tendered by the respondent; and

   ·the oral evidence of the applicant and Mr Michael Alexeeff.

   The Relevant Legislation

4. The SRC Act relevantly provides as follows:

   “4     Interpretation

   (1)   In this Act, unless the contrary intention appears:

   …

   impairment means the loss, the loss of the use, or the damage or malfunction, of any part of the body or of any bodily system or function or part of such system or function.

   …

   licensed corporation means a corporation that is the holder of a licence that is in force under Part VIII.

   licensee means a Commonwealth authority or a corporation that is licensed, or that is taken to be licensed, under Part VIII.

   …

   (9)     A reference in this Act to an incapacity for work is a reference to an incapacity suffered by an employee as a result of an injury, being:

   (a)an incapacity to engage in any work; or

   (b)an incapacity to engage in work at the same level at which he or she was engaged by the Commonwealth or a licensed corporation in that work or any other work immediately before the injury happened.

   …

   (10A) For the purposes of the application of this Act in relation to an employee employed by a licensed corporation, or a dependant of such a person, a reference in this Act (except in section 28 or Part III, V, VI, VII or VIII) to Comcare is, unless the contrary intention appears, a reference to that corporation.

   …

   5ADefinition of injury

   (1)     In this Act:

   injury means:

   (a)   a disease suffered by an employee; or

   (b)an injury (other than a disease) suffered by an employee, that is a physical or mental injury arising out of, or in the course of, the employee’s employment; or

   (c)an aggravation of a physical or mental injury (other than a disease) suffered by an employee (whether or not that injury arose out of, or in the course of, the employee’s employment), that is an aggravation that arose out of, or in the course of, that employment;

   but does not include a disease, injury or aggravation suffered as a result of reasonable administrative action taken in a reasonable manner in respect of the employee’s employment.

   …

   5BDefinition of disease

   (1)     In this Act:

   disease means:

   (a)   an ailment suffered by an employee; or

   (b)   an aggravation of such ailment;

   that was contributed to, to a significant degree, by the employee’s employment by the Commonwealth or a licensee.

   …

   (2)     In this Act:

   significant degree means a degree that is substantially more than material.

   …

   14Compensation for injuries

   (1)     Subject to this Part, Comcare is liable to pay compensation in accordance with this Act in respect of an injury suffered by an employee if the injury results in death, incapacity for work, or impairment.

   …”

5. Section 16 of the SRC provides for the payment of compensation in respect of the cost of reasonable medical treatment obtained in relation to an “injury” (as defined in s 5A(1)), and s 19 of the SRC Act provides for the payment of compensation for “incapacity for work” (as defined in s 4(9)) resulting from an “injury” (as defined).

   The Factual Background

6. The following factual background appears from the T Documents and is not in dispute.

7. On or about 10 May 2011 the applicant made a report to the respondent regarding an incident on 10 May 2011 at 11:15 am at the Perth Mail Centre which caused her to suffer a “sore right shoulder”.  The applicant’s description of that incident is recorded in an Incident Form as follows:

   “ Was moving lids/sleeves from cardboard trays at Checkpoint Charlie and the sleeves were tight.  Felt pain in right shoulder.  Periodically the lid becomes jammed and excessive force is required to remove sleeve from tray.”  (T4, p 11)

8. On 11 May 2011 Dr David Evans issued a medical certificate in respect of an injury described as “right upper trapesius/rotator cuff muscle strain”, suffered by the applicant on 10 May 2011.  Dr Evans certified that the applicant was fit for work on “full hours (including overtime)” with the following work restrictions:

   ·lifting restricted to 5 kg with both hands

   ·no use of right hand at shoulder height or above

   ·avoid repetitive use of the right arm alone

   ·to report if experiencing pain.

   Treatment was described as “physiotherapy”, “anti-inflammatories” and “heat packs”. (T8)

9. On 17 May 2011 and 24 May 2011 Dr Evans issued similar medical certificates regarding the applicant’s ongoing fitness for work in which the applicant’s work restrictions were specified as follows:

   ·lifting restricted to 10 kg with both hands

   ·no use of the right hand at shoulder height or above

   ·avoid repetitive use of the right arm alone

   ·5 minute stretch periods each hour

   ·to alternate between sorting and frame duties.  (T9, T10)

10. On 26 May 2011 the applicant lodged with the respondent a completed “Claim for Rehabilitation and Compensation” form, signed by her and dated 26 May 2011, whereby she claimed compensation in respect of an injury described by her as “right upper trapesius/rotator cuff muscle strain” which happened on 10 May 2011 at 11:15 am and for which she first had medical treatment on 11 May 2011. (T7)

11. On 3 June 2011 a delegate of the respondent made a determination accepting liability under s 14 of the SRC Act to pay compensation to the applicant in respect of an injury described as “right upper trapezius rotator cuff muscle strain” sustained on 10 May 2011. (T12)

12. On or about 7 June 2011 the applicant made a report to the respondent regarding an incident on 7 June 2011 at 11:15 am at the Perth Mail Centre involving an injury to her left shoulder which was described in the relevant Incident Form as an “aggravation from a previous injury” suffered on 10 May 2011. (T14)

13. On 7 June 2011 Dr Richard Kain issued a medical certificate in respect of an injury suffered by the applicant, described as “right upper trapesius/rotator cuff muscle strain – settling rapidly but unfortunately left shoulder and neck has flare up with increase amount of work on that side [sic]”.  Dr Kain certified that the applicant was fit for work on “full hours”, but “no overtime”, with the following work restrictions:

    ·lifting restricted to 5 kg with both hands

    ·no above shoulder height duties with both arms

    ·lifting up to 5 kg both hands from knee to chest height only (elbows at side)

    ·avoid repetitive use of both arms.

    Treatment was described as “physiotherapy”, “anti-inflammatories” and “heat packs”. (T17)

14. On 1 July 2011 Dr Kain issued a medical certificate in which his previous description of the applicant’s injury was amended by the addition of the following:

    “Ongoing left sided neck and arm (referred) symptoms”.

    Dr Kain certified that the applicant was fit for work on “full hours”, but “no overtime”, with the following work restrictions:

    ·lifting restricted to 5 kg with both hands

    ·no use of the right/left hands at shoulder height or above

    ·avoid repetitive use of both arms

    ·avoid upward gazing prolonged

    ·current best to remain seated with standing for short periods.

    Treatment was as previously described. (T19)

15. On 12 July 2011 Dr Kain issued a medical certificate in which the applicant’s injury was described as:

    “ Right upper trapesius/rotator cuff muscle strain – settled but ongoing left shoulder and neck strain.  Ongoing left sided neck and arm (referred) symptoms.”

    Dr Kain certified that the applicant was fit for work on “full hours” with the following work restrictions:

    ·lifting restricted to 5 kg with both hands

    ·right hand lifting to 3 kg

    ·left hand lifting only to 1 kg (use right hand predominantly) – to keep left elbow at side at all times

    ·above shoulder lifting – right hand only.

    Treatment was described as “physiotherapy” and “anti-inflammatories Brufen”. (T20)

16. On 14 July 2011 Dr David Collis issued a medical certificate in which Dr Kain’s previous description of the applicant’s injury was amended by the addition of the following:

    “ Left shoulder symptoms worsening -  ? rotator cuff tear/bursitis.  Symptoms and pains worsening in last 6 weeks.”

    Dr Collis certified that the applicant was fit for work on “part hours”, namely “3.5 hours per day only until left shoulder investigations completed”, with the following work restrictions:

    ·lifting restricted to 5 kg with both hands

    ·right hand lifting to 3 kg

    ·left hand lifting only to 1 kg (use right hand predominantly) – to keep left elbow at side at all times

    ·above shoulder lifting – right hand only.

    Treatment was described as “physiotherapy”, “anti-inflammatories Brufen” and “referral for U/Sound of left shoulder to assess rotator cuff”. (T23)

17. On 14 July 2011 the applicant lodged with the respondent a completed “Claim for Rehabilitation and Compensation” form, signed by her and dated 14 July 2011, whereby she claimed compensation for an injury described by her as:

    “ Right upper trapesius/rotator cuff muscle strain – settled but ongoing left shoulder & neck strain.  Ongoing left side neck and arm (referred) symptoms.  Left shoulder symptom [sic] worsening – rotator cuff tear/bursitis.”

    The applicant indicated that that injury happened on 7 June 2011 at 11:15 am. (T15)

18. A report of an ultrasound of the applicant’s left shoulder by Dr Dirk Sweeney, dated 21 July 2011, addressed to Dr Collis, referred to a clinical history of “left shoulder soreness for six weeks” and concluded as follows:

    “ Comment

    1.Small intrasubstance tear of the distal subscapularis tendon

    2.Supraspinatus tendinopathy.

    3.Very significant subacromial bursal thickening with impingement.  The symptoms may respond to ultrasound guided corticosteroid injection into the bursal space.” (T26)

19. On 3 August 2011 Dr Collis issued a medical certificate in which he described the applicant’s injury as follows:

    “ Left Subacromial bursitis with minor rotator cuff tendinopathy.

    Inflamed bursa on ultrasound

    No improvement in symptoms over last fortnight

    Appointment for steroid injection in shoulder booked for next week.

    No changes to working conditions in meantime.”

    Dr Collis certified the applicant as fit for work and specified the following work restrictions and treatment:

    “ Lifting restricted to 5 kg with both hands

    Right hand lifting to 3 kg

    Left hand lifting only to 1 kg (use right hand predominantly) – to keep left elbow at side at all time

    Above shoulder lifting – right hand only

    3.5 hours per day only

    Referral for Subacromial steroid injection in left shoulder.

    Physiotherapy

    Anti-inflammatories Voltaren”.  (T30)

20. By letter dated 9 August 2011, a delegate of the respondent notified the applicant as follows:

    “ SAFETY, REHABILITATION AND COMPENSATION ACT 1988 (the Act)

    I am writing to you regarding your claim for compensation for ‘left shoulder symptom worsening rotator cuff tear/bursitis’ with a date of injury reported as 7 June 2011.

    I also refer to your accepted claim for compensation for ‘RIGHT UPPER TRAPEZIUS ROTATOR CUFF MUSCLE STRAIN’ with date of injury of 10 May 2011.

    On the incident report dated 7 June 2011 you have stated the nature of the condition as ‘left shoulder’.  I note that the on [sic] Incident Report supplied the cause of the condition is indicated as being from favouring your left should [sic] as a result of your right shoulder condition.

    Dr Richard Kain has from 7 June 2011 indicated that your left shoulder has flared up as a result of the increased work on that side.

    Therefore, in accordance with Section 14 of the Act and from the evidence available, I have determined that the incident report supplied and the subsequent claim for Rehabilitation and Compensation, form part of your original claim dated 10 May 2011.

    The merging of these claims will not affect any entitlements previously paid.

    I also determine in accordance with Section 62(1) of the above Act, that the injury, which your claim is accepted for, be amended to ‘RIGHT UPPER TRAPEZIUS ROTATOR CUFF MUSCLE STRAIN WITH SUBSEQUENT DEVELOPMENT OF LEFT SHOULDER AND NECK STRAIN’.

    …” (T31)

    Subsequent Medical Evidence Included in the T Documents and Exhibits

    Dr Mary Cameron/Dr Melanie Waters

21. Dr Cameron, who has been one of the applicant’s treating general practitioners at her local medical centre, has issued regular workers’ compensation progress medical certificates in respect of the relevant compensable injury, covering the period from August 2011 to May 2013, which are included in the T Documents.  Dr Cameron’s clinical notes regarding consultations with the applicant in the period from 26 November 2009 to 14 May 2012 are also in evidence (Exhibit R1).

22. The most recent workers’ compensation progress medical certificate in respect of the relevant compensable injury which is in evidence was issued by Dr Waters (a general practitioner at the same local medical centre) on 11 June 2013 (T233).  Dr Waters then certified the applicant as totally unfit for work from 10 June 2013 to 14 June 2013 and as fit for work, with restricted hours and restricted duties, from 17 June to 1 August 2013.

    Mr Allan Wang

23. Mr Wang, Orthopaedic Surgeon, saw the applicant on two occasions following a referral from Dr Cameron, and he subsequently provided two reports to Dr Cameron which are in evidence.

24. Mr Wang’s first report, dated 23 September 2011, states as follows:

    “ Thank you for sending Antonina along.  She is a 53 year old right hand dominant mail officer at Australia Post, and her work is very repetitive.  She developed right shoulder pain in May of this year, and favouring of [sic] the right arm, has subsequently developed left shoulder pain.  The left shoulder and arm symptoms are the presenting concern, there is pain on overhead movement of the left arm.  She has paraesthesiae in the hand, though symptoms have not improved with subacromial cortisone injection physiotherapy anti-inflammatory treatment.

    In past history, Antonina has had a left open carpal tunnel release many years ago. She does get some neck pain, and a CT scan of the cervical spine dated 7 September 2011 shows some minor degenerative changes, with no obvious disc protrusion or nerve impingement at the C6/7 level.

    On examination, the left shoulder has active forward flexion and abduction to 150°, the impingement sign seems negative. She has good power on stress testing the various components of the rotator cuff.

    Lateral flexion of the neck to the left side causes some pain,  but there is no radicular pain down the arm with neck movements.  There is a well healed carpal tunnel scar with normal sensation and motor function in the median nerve.

    I have arranged an MRI scan of the left shoulder looking for any rotator cuff damage.  At Antonina’s request, I have arranged some nerve conduction studies looking for radiculopathy or recurrent carpal tunnel.

    I will review Antonina in the next week or two with the results.” (T50)

25. Mr Wang’s second report, dated 21 October 2011, states as follows:

    “ I reviewed Antonina today.  The MRI scan left shoulder shows mild tendinopathy of the rotator cuff but no tendon tear.  The biceps are intact.  The acromion is benign.  There is some residual subacromial bursitis.

    Antonina had an EMG of the left arm and this shows no evidence of residual carpal tunnel syndrome.  There are very mild chronic left C6 or C7 radiculopathy changes.

    Antonina is doing part time light duties, but she reports significant pain on the left side of her neck and pain down into the forearm and hand.  Range of left shoulder movements is well preserved with a negative impingement sign.

    My overall impression is that Antonina’s symptoms are related to her cervical spondylosis.  She may have some minor bursal impingement, and at Antonina’s request I referred her for a second subacromial cortisone injection.  I do not think any arthroscopic surgery to the left shoulder is indicated and Antonina agrees with this.  I have referred Antonina to the work physiotherapist for treatment to both the left shoulder and neck, and I have asked her to pop by and see you for further review.”  (T58)

    Mr Soni Narula

26. Mr Narula, Neurosurgeon, saw the applicant following a referral from Dr Cameron and he subsequently provided 3 reports to Dr Cameron which are in evidence.

27. Mr Narula’s report of 15 February 2012 states as follows:

    “Thank you for asking me to see this pleasant 53 year old lady who describes a work related injury to the right shoulder for which she had physiotherapy and found improvement.  Gradually she started noticing symptoms on the left side as she was compensating by using her left hand and arm more than the right.  She also reported an ache in the left side of the neck with paraesthesia coming down the arm and going into the hand.  She describes difficulty in her sleep and difficulty to lift.  She has had two injections into the left shoulder but these have provided only temporary relief.

    She is using Tramadol but has GI symptoms.

    Since July 2011 she has been working 3.5 hours a day.

    On examination she is relatively slim in build.  She has a thin neck with normal lordosis and absence of spasms.  Her spinal movements were reasonably normal in their range.  She was mild to moderately tender at C4/5/6 with pressure in the midline causing a cold sensation to go down the left arm.  Neurologically she was intact.

    She had a CT scan of September 2011 which did not show any significant findings.  I have suggested she an [sic] MRI scan and x-rays and come back for review thereafter.” (T84)

28. Mr Narula’s report of 13 March 2012 states as follows:

    “ I saw Mrs Hubertz at follow up today.  Her MRI scan is quite bland.  The x-rays are also unremarkable.  The bone scan shows occipitocervical increased uptake and T1 costovertebral uptake.

    I note that she has had an EMG which shows mild carpal tunnel involvement and mild chronic C6 or C7 radiculopathy.

    Currently, I am of the opinion that we should manage conservatively.  I have prescribed Lyrica to see the response.  I have also asked her to see Dr Berrigan.  Hopefully with injections her symptoms will improve.” (T100)

1. Mr Narula’s report of 12 March 2013 states as follows:

   “ I saw this lady today.  She has similar symptoms in her arm as before and her shoulder.  Now she also describes pain and paresthesia into the left lower limb.  Her sleep is disturbed.  She has tried TENS machine and also has had multiple injections.

   The only positive findings were that of tenderness to the C5/6 to the left side.  There was otherwise full range of movements and in her lumbar spine I noted reduction in her movement but no evidence of nerve tension or positive neurology.

   I have an [sic] arranged a MRI scan of the cervical and lumbar but I think her problems are mainly mechanical and I think she will likely benefit from hydrotherapy.  Surgery certainly has nothing to offer if her scans are unremarkable.” (T213)

   Dr Thomas Berrigan

2. Five reports of Dr Berrigan, Consultant in Pain Medicine and Anaesthesia, addressed to Mr Narula, are in evidence.

3. Dr Berrigan’s report of 11 June 2012 states as follows:

   “ Many thanks for asking me to see Antonina whom I saw on 08 June with her problem of neck and left arm pain.

   Antonina told me this problem started with a work incident on 10 May 2011.  She was in her usual occupation, working for Australia Post, and was pulling lids off mail trays.  She pulled them off and threw them to one side and experienced acute onset of pain which is [sic] felt initially in the right shoulder.  This became unbearable and then soon after that she developed pain in the left side of her neck and shoulder and this has now become the worst problem.

   The pain is felt all down the left side of her neck, radiating out towards the left shoulder and down the right [sic] arm with a feeling of pins and needles.  She also experiences constant left occipital headaches.  She also has pain the interscapular region.

   The pain is always present though the intensity varies.  She rates her usual level of pain in the last week as 8/10.

   She has a great deal of trouble sleeping at night because of the pain and has to take drugs to help her sleep.

   She has been treated with physiotherapy and massage.  She has had two left subacrominal bursa injections which have not made any difference.

   With regards to her work, she has continued to work on light duties - 2½ hrs/day, 5 days/week.

   Currently she is taking Amitriptyline, Voltaren, Lyrica and Stilnox.

   She denies having any of this pain prior to the above accident.  She did have bilateral carpal tunnel releases 7 years ago.

   On examination she is of slim build.  There was some limitation of forward flexion with a three-finger-breadth gap from chin to sternum;  range of movement was satisfactory.  She was extremely tender all down the facet joints on the left side and palpation of the facet joints caused a cold, agonising feeling down the left arm.

   On examination of her left shoulder she had a good range of movements but there was some mild tenderness there.  Deep tendon reflexes and power in the upper limbs were normal and Phalen’s test was negative.

   Plain x-rays, CT and MRI are all fairly normal for her age.  Nerve conduction studies show perhaps some mild changes affecting C6 and C7 nerve roots.  Nuclear bone scan highlights the atlanto-occipital joint.

   My feeling is that most likely her pain is arising from the facet joints and atlanto-axial joint.  I plan to inject all of these joints with local anaesthetic and cortisone on 21 June to see if we can settle down this problem.

   I will review her post procedure on 27 July 2012.” (T123)

4. Dr Berrigan’s report of 30 July 2012 states as follows:

   “ I reviewed Antonina on 27 July 2012.  On 21 June 2012 I performed left atlanto-axial and left C2/3, C3/4, C4/5, C5/6 facet joint injections without any benefit at all.

   I think at this stage we should obtain an MRI of her cervical spine.  I have now made arrangements for this to be done the evening of this consultation (27 July) and will review her on 03 August 2012.” (T140)

5. Dr Berrigan’s report of 7 August 2012 states as follows:

   “ I reviewed Antonina on 03 August 2012.  The repeat MRI does show that the disc annulus tear at C5/6 is perhaps a little larger than before.  I think this is quite possible this is where her problem is coming from [sic].

   At this stage she might be helped by a cervical epidural and I have now discussed this with Antonina.

   However, when I explained all the possible complications she was reluctant, at this stage, to make a decision about whether to proceed.

   I have given her some information on this and, if she wishes to proceed, she will give my rooms a call.  Otherwise, I shall review her in 2 months.” (T146)

6. Dr Berrigan’s report of 6 November 2012 states as follows:

   “ On 02 October 2012 I performed a cervical epidural with the catheter passed  up to the left at C5.

   On review on 02 November she said that since the procedure she has obtained relief of the pain around the scapula but not in the shoulder or down the arm.

   It could be that her remaining pain is coming from her shoulder joint area.  She has not obtained relief in the past with subacromial bursa injections but I plan to perform a left suprascapular nerve block with a view to cryolesioning of this nerve if it is positive.” (T173)

7. Dr Berrigan’s report of 14 January 2013 states as follows:

   “ On 20 November 2012 I performed left suprascapular nerve block.  This was totally negative and I would assume therefore that her pain is not arising from the shoulder joints.

   I feel that the best course of action here would be for her to be fitted with a TENS machine and have made arrangements for that in the near future with Dr Hamzah.

   I do not think she is going to be helped by a nerve root sleeve injection.

   I feel it would be a good idea for her to see a psychologist.  Cymbalta is also worthwhile trying but, if she has too many side-effects from that, we could try Amitriptyline.  Lyrica is another possibility and has not been tried already.” (T194)

8. Dr Berrigan also provided a letter to the respondent, dated 2 July 2013, which states as follows:

   “ I have been treating Mrs Hubertz with a TENS machine since January this year.  She has found this to be very helpful.  This is, at the moment, rented out to her but I request that you authorise purchase of this machine for her continued use.

   The unit can be obtained from my rooms at a cost of $190 plus associated accessories.” (Exhibit A1)

   Dr Hamid Hamzah

9. On 23 January 2013 Dr Hamzah, Consultant in Anaesthesia and Pain Management, reported to Dr Berrigan as follows:

   “Thank you very much for asking me to see Antonina whom I saw on 22 January 2013.  As you stated, she has been having problems with her left shoulder and you have trialled various injections on her without success.

   Currently she has pain in the left trapezius and latissimus dorsi areas and I therefore fitted her with a TENS machine and instructed her on its use.  She is to trial this for 4-6 weeks and will return to you for further review.” (T202)

   Mr Hari Goonatillake

10. On 14 December 2012 Mr Goonatillake, Orthopaedic Surgeon, reported to Dr Cameron as follows:

    “ Thank you for asking me to see Ms Hubertz for a further opinion regarding her left upper limb symptoms.  She is 54 years old and right-handed.  She presents with pain involving her neck with radiation about her shoulder, and more distally to the level of her hand with associated pins and needles involving her upper arm.  Her symptoms have been present since 10 May 2011.  Whilst she feels a sense of stiffness about the shoulder, her movements are not restricted.  I note that two subacromial injections have not made any difference to her symptoms.

    On examination today she had a full range of movement about the shoulder with very mild impingement signs.  I note that EMG has confirmed cervical pathology.

    I do not think her current symptoms are related to her shoulder and in particular I do not think any surgery of her shoulder is likely to improve her symptoms.  I would suggest her treatment be directed to her cervical spine with a possible neurosurgical review.

    …” (T187)

    Mr Michael Alexeeff

11. Mr Alexeeff, Consultant Orthopaedic Surgeon, provided a report, dated 8 March 2013, regarding the applicant to the respondent (T212).  As Mr Alexeeff gave oral evidence in this proceeding, his report and his oral evidence are referred to below (see paragraphs 44-46).

    The Applicant’s Evidence

12. On the first day of the hearing the applicant (who was unrepresented) gave brief oral evidence-in-chief and was then cross-examined by the respondent.  On the second day of the hearing the applicant sought to tender a written statement.  The Tribunal indicated that it was prepared to grant leave to the applicant to tender that statement on the basis that the respondent be given leave to cross-examine her on the contents of that statement.  The respondent did not seek leave further to cross-examine the applicant, and the Tribunal granted leave to the applicant to tender that statement.  Having regard to the contents of that statement, it is convenient to set out those contents before referring to the applicant’s oral evidence.

13. The contents of the applicant’s statement, tendered on 18 March 2014, are as follows:

    “1.    This statement made by me accurately sets out the evidence which I would be prepared, if necessary, to give in Court as a witness.  The statement is true to the best of my knowledge and belief, and I make it knowing that if it is tendered in evidence, I shall be liable to prosecution if I have wilfully stated in it anything which I know to be false or do not believe to be true.

    2.This statement is made regarding the circumstances of my injury that occurred on 10 May 2011, whilst employed by Australia Post at their Mail Sorting Centre, Boud Avenue, Perth Airport.

    3.I am a divorced woman aged 55 years born on … May 1958.  I have 3 children aged, 21, 29 and 32.  They do not live with me.

    4.I have been employed by Australia Post as a Mail officer since 1998.  I had various labouring type occupations before starting with Australia Post. From 15 March 2010 till 2 March 2011, I was on annual leave and ‘career break’ which I spent resting at home and engaged in normal household duties.

    5.From about 2007 to 11 May 2011 I was employed in the outside area of the mail sorting centre at Perth Airport,  that is known as ‘Checkpoint Charlie’.  This is the term used to describe the outside team that unloads mail from ULD containers that arrive from overseas and interstate as airfreight.  This mail is sorted within the Perth Mail Centre by others within the building, for eventual delivery within Perth and surrounds. 

    6.Checkpoint Charlie’ operates from 10 am to 6 pm Sunday to Friday.  At the time of my injury these were the hours of my shift.

    7.Mail arrives in a large, aluminium  containers known as a Unit Load Device or ULD,  which is the commonly accepted term used in the air freight cargo business.  They are also known as ‘cans’ or ‘Canisters’.  In general terms a ULD is a container used to load luggage, freight, or mail onto aircraft. It allows a large quantity of cargo to be bundled into a single unit.  Since this leads to fewer units to load, it saves ground crews time and effort and helps prevent delayed flights.  Each ULD has its own packing list (or manifest) so that its contents can be tracked.

    8.The ULD’s for the mail varies in measurement as follows:

    a.  4.90 sqm   -  156/234 x 153 x 163 cm

    b.  3.40 sqm   -  119 / 156 × 153 × 163 cm

    c.  4.50 sqm  - 156 / 201 × 153 × 163 cm

    d.  8.95 sqm  -  318 / 407 × 153 × 163 cm

    e.  6.88 sqm  -  244 / 318 × 153 × 163 cm

    f.  7.16  sqm  -  318 × 153 × 163 cm

    9.A can would hold from ½ to 3 tonnes of mail. The ULD’s  arrive by cargo plane and offloaded from the plane in a secure area by Airline Freight handlers and is towed to the secure mail sorting centre where it is unloaded by Australia Post staff. A photograph of the ULD’s that arrive is attached as photograph 1 & 2.

    10.During the course of the shift, there would be 5 to 20 ULD’s arriving.  In total there would be about 10 – 20 tonnes of mail arriving on any one day.

    11.Inside the cans there are cardboard - of what we call - ‘small letter trays’ measuring 51 cm x 25 cms x 16 cms.  (See photograph  4). The maximum weight they should hold is 16 kgs but it is normal for them to weigh from 6 to 12 kgs.  Inside each can there would be about 120 to 240 trays. If a can is full with trays only, they are stacked in 3 rows of 8 and 10 high.

    12.There are also plastic - what we call – ‘large letter tubs’ measuring 60 cms x 30 cms x 30 cms.  The maximum weight for these tubs is 16 kgs, but it is normal for them to weigh from 10-20 kgs. (see photographs 5 & 6).  Inside each can there could be from 90 to 112 tubs, depending on whether they had lids.  If the can is full with tubs only, they would be stacked in 3 rows of 6 and stacked 5 high. Sometimes, because tubs have no lids they become stuck, so more effort is needed to prize them apart.   

    13.There are also canvas bags of mail each weighing a maximum of 16 kgs.  

    14.Inside each can there would either be all small letter trays or large letter tubs or a mix of both.  

    15.It takes about 10-15 minutes to empty a can.  One person is inside the can passing the trays or tubs to about 2-3 others who walk about 2-3 metres and place the tubs or trays on the conveyor.  These other workers could also be taking trays and tubs directly from the cans as they can be accessed from the ground.

    16.Working in this area can be 5-8 employees.  Their duties would be as follows;

    a.    tug driver  - driver who tows the ULD and cans of mail from the unload point on the tarmac of the cargo plane.

    b.    strap cutting – one person cuts the blue nylon straps securing the tops of the mail trays  (See Photograph 4).  The trays are stacked on the conveyor after being removed from the cans.  The straps are cut with a pair of scissors or a Stanley Knife, while standing.  You cut, then pull the strap from under the box.  The strap is roughly rolled up and thrown in the rubbish bin which is next to where you are working.  Time is important because others are waiting to de-lid.

    c.    De-lidding.  Is standing at the conveyor (see photograph 3) taking the lids off cardboard trays. The trays are stacked on the conveyor that is about 900 cm high.  The trays have been placed there by others.  Someone else has cut and removed the straps.   The trays have an outer cardboard casing.  Inside this casing is the removable cardboard tray that holds the mail.  At each end of the removable tray there is a cut out carry-handle. 

    When de-lidding, the tray is facing longways on the conveyor as shown in  photograph 4, I firstly slightly lift one end of the tray to get a grip, then grab the closest end of the cut out handle with the left hand and the right hand I grab hold of the edge of the outer tray at the opposite end of the outer casing.  Sometimes when the tray is full or has large mail it becomes stuck and you have to pull harder than normal.  I do this job for up to half an hour and in this time I would de-lid about 100 trays.  There are 2 people de-lidding. You have to work fast to keep up with the person loading the trays onto the conveyor and those taking them off. 

    After de-lidding the empty outer cardboard casing is thrown into a wire caged ULD with the right hand which is located about 2-3 metres opposite to where I am standing on the conveyor. (See photograph 5)  The tray of mail is placed in another row of the wire caged ULD’s that are located behind where I am standing and about 1 metre away so I have to turn and place them into the ULD. (See photograph 3)

    d.    unloading  - there are up to 6 people unloading a ULD. The ULD’S are wheeled as close as possible to 2 conveyors – one for the trays and the other for the tubs.  The bags are put directly into the steel cage ULD’S.   I could be standing on the edge of the inside of the can.  I would be reaching up to the height of the can lifting the trays off and as the stack went down would be bending down, to get the trays. I would be passing out the trays, bags and cardboard letter trays to about 2 people who are standing on the ground.  They walk about 2-3 metres and put the trays and tubs onto the conveyor and the bags into the steel caged ULD’s. 

    e.    After de-lidding the trays and tubs are lifted from the conveyor and placed into wire ULD’S.  We then have to use a pallet lifter and push the full ULD’s to another  station about 5-6 metres to be picked up by the forklift crew and taken inside to be processed.

    17.Staff are rotated on each of these duties about every 20 minutes.

    18.On 10 May 2011, I had started work at 10 am …  I was to finish at 6 pm.  I normally work from 11.45  am to 7.30 pm.  I was feeling good and was not suffering from any injury. 

    19.I was designated to work as normal at ‘Checkpoint Charlie’.  Also working with me was my normal crew members.  Their details can be obtained from Australia Post.  For the first hour and 15 minutes when I started I had been unloading, then went onto cutting the straps, then de-lidding.

    20.At about 11.45 am I was ‘de-lidding’ a cardboard mail container.  I was removing the lid in the manner as described in paragraph 17c above.  The lid of the tray had become stuck because it was too full of mail. To open it I had to pull extra hard with both hands.  It was then that I felt extreme pain in the right upper arm and under the arm and through the shoulder blade up to the nape of my neck.  Both arms were sore but the right was worse as I couldn’t not raise my right arm.  I couldn’t exactly pin-point where the pain was as the whole of my upper body was sore.  I only knew that I could not move the right arm.  I reported immediately to my process leader … but he just nodded.  I then spoke to the supervisor … and she said, ‘Lets go and fill out a form and report it.’  This I did.  I carried on working till the end of shift on light duties sitting sorting mail, stamping and culling from time to time, because I could not lift up my right arm and the left arm was tingling.

    21.When I got home I showered, changed and went out for a pre-arranged … dinner with friends.

    22.The following day I saw the works Doctor, Dr Evans and was I given a medical certificate. Dr Evans diagnosed a ‘right upper trapesius/rotator cuff muscle strain.’ He said that I was capable of returning to work on normal hours, but with lifting restrictions of 5 kgs and not use the right hand at shoulder height or above.  When I took this into work I was placed on a Rehabilitation programme and reduced hours.

    23.When I went back to work I was placed in sorting mail.  I was sitting in a ‘cage’  on a wheeled swivel chair with arms on either side at a desk at about .900 cm from the floor.  In front of me and to each side are pigeonholes into which mail is placed.  Tubs of mail is brought to me by the process leader in about 98% of the time, otherwise get up and walk about 3 steps and back to get them to enable me to stretch.  When my pigeonhole is full of mail, I bundle them and put them into the tray.  I am supposed to put a rubber band around them but because of the pain I can’t.  When sorting a handful of mail is in either hand – whichever is comfortable and with the other hand the mail is placed into the pigeonholes that are in front, up, or to the side of where I am sitting.

    24.The strain in the right hand recovered after 2 months but the neck was still tight.  The pain then started to get worse gradually in the left shoulder as the right started to get better.  The neck head and were tingling with pins and needles.  It  got worse in the left hand and neck region.  This has continued until now. 

    25.I then saw another works Doctor, Dr Kain at the same practice on 7 June 2011. Because now the left arm was becoming very painful.  I don’t know how this occurred.  Whether it was because I was using the left hand more that the right I don’t know, or it happened when I was de-lidding – again I don’t know.

    26.I carried on working but the pain gradually increased and all treatment that I was getting was not helping, so as from 17 August 2011 I was placed on reduced hours only working from 4 pm to 7.30 pm Monday to Friday sorting mail as previously described.

    27.The treatment I have had is detailed in the medical certificates.

    28.I have been prescribed the following medicines:   Voltaren, Lyrica, Nurofen, Panadol, Digesic, norspan patch, Tramadol, Amitriptyine , Sillnox, Endep.  I am allegic to codeine.

    29.I went back to work on light duties with work hour restrictions until I was formally notified on 12 April 2013 that my claim for Workers’ Compensation had been denied.” [sic]  (Original emphasis) (Exhibit A4 – photographs included).

1. In her oral evidence-in-chief the applicant said that, since her injury in May 2011, the symptoms have continued in her neck and shoulder and include “pins and needles”.  She added that, whenever she does her work duties with Australia Post, those symptoms are “aggravated badly”.  She has been, and is presently, working full-time hours but with “light duties”.

2. In cross-examination the applicant gave evidence to the following effect:

   ·her present symptoms are located at the nape of her neck and above her left shoulder and down her arm;

   ·she experiences a “dull pain” above her left shoulder that is “always there” – on some days it is “bad”, on other days it is “mild”;

   ·she had taken time off work for about 10 months, and had returned to work shortly before suffering the relevant injury on 10 May 2011;

   ·when she suffered her work injury on 10 May 2011 she experienced pain in her right shoulder – she had not previously had right shoulder pain;

   ·when she saw Dr Evans on 11 May 2011 she only told him about the pain in her right shoulder because that is where she was experiencing the pain;

   ·at that time she had no complaints about her neck or left arm;

   ·when she saw Dr Evans on 17 May and 24 May 2011 she again only told him about the pain in her right shoulder;

   ·as stated by her in her second compensation claim on 14 July 2011, the first time she noticed a problem with her left shoulder and neck was on 7 June 2011 at 11.15  am;

   ·she had an ultrasound of her left shoulder on 21 July 2011 and at that time her work-related symptoms were neck and left shoulder pain going down into her arm.

   The Evidence of Mr Michael Alexeeff

3. Mr Alexeeff, Consultant Orthopaedic Surgeon, confirmed that he had examined the applicant at the request of the respondent on 26 February 2013 and that he had prepared a report, dated 8 March 2013, in respect of that examination.  Mr Alexeeff confirmed that he adhered to the contents of that report.

4. Mr Alexeeff’s report commences with a summary of the background medical material regarding the applicant’s compensation claim provided to him by the respondent, and continues:

   “ HISTORY 

   This fifty four (54) year old divorced woman with three (3) adult children (ages 22, 29 & 32 years) and two (2) grandchildren, presented with a male friend … whom she advised was acting as an interpreter.  The abovenamed provided vocational history of employment as a mail officer, with Australia Post, working at Perth Airport.  She advised she had been so employed for the preceding twelve (12) years.

   Prior to this, the abovenamed advised of employment with Buttercup (1994-1995) and Tiptop (1994), working as a casual.

   I obtained history that the abovenamed was originally from the Philippines but had been in Australia for twenty five (25) years.  Her command of the English language appeared satisfactory.

   The abovenamed advised that she was right hand dominant.

   The abovenamed provided past surgical history of bilateral carpal tunnel decompression (2006), undertaken by Mr Hari Goonatillake, whom I know to be a Consultant Orthopaedic Surgeon, laparoscopy (2010), colonoscopy for bowel polyps (2012) and a kidney stone requiring a stent (2012).

   I did not obtain past or present history of any medical co-morbidity.  The abovenamed denied being a diabetic.

   The abovenamed did provide history of a work injury involving both shoulders on the 10 May 2011 (date of injury).  Specifically, the abovenamed stated that whilst working , she was removing the lid of a cardboard tray which became stuck and she had to use force to open it.  She described pain in her left shoulder.  The abovenamed advised that pain here also occurred as she had been favouring her right hand.  The abovenamed reported that pain was felt about the front and back of the shoulder and involved the ‘shoulder blade’.  She described it as trying to ‘lift bricks’.  She stated that she ‘couldn’t lift’.  She advised her supervisor.  I did note the advice presented in your case summary which indicated that initially, the right shoulder was the source of pain.  Left shoulder symptoms were described as developing as the abovenamed was favouring her right hand side.

   Comment: The medical literature is quite clear in regard to contra-lateral symptoms following ipsi-lateral injury.  There is no evidence in the medical literature to support this notion.

   I obtained history that the abovenamed then saw a Dr Kain and was referred for investigations of the left shoulder.  She subsequently underwent an injection.  She found the injection ‘very painful’.  Subsequent to the injection, the abovenamed advised that she was involved in a motor vehicle accident afterwards.  Because of ongoing symptoms, the abovenamed advised that her hours were reduced.  Because of ongoing symptoms, the abovenamed was referred to a Dr Allan Wang, who investigated her further.  I am aware of Clinical Professor Wang, who practises as a Consultant Orthopaedic Surgeon.  The abovenamed advised that a further injection was performed but this ‘didn’t help’.  She was told by Clinical Professor Wang that the neck was the source of her symptoms and referred her to a Neurosurgeon, Mr Soni Narula.  I obtained history of further neck investigations.  Subsequent to this, the abovenamed advised that she was referred to a Dr Berrigan, who undertook a number of injections.  These did not provide any particular benefit.  The abovenamed was advised to undergo an epidural injection following which, the abovenamed  reported ‘pins and needles’ in the legs.  She then sought the opinion of Mr Goonatillake, another Orthopaedic Surgeon, who had treated her previously.  Mr Goonatillake apparently advised her that he did not think the shoulder was the problem and did not offer her any other treatment.  During this period, the abovenamed advised that she remained at work, albeit at reduced hours.

   ...

   Currently, the abovenamed advised that she remained on lighter duties, working three and a half (3½) hours per day, as advised in your preamble.

   The abovenamed advised of ongoing symptoms.  Pain was a feature.  Pain level was said to be ‘remaining the same’.  Pain was said to be present ‘most of the time’, with the abovenamed advising that at times, pain was ‘severe’.

   Specifically, the abovenamed advised of right shoulder pain.  She advised that she ‘put up with it’.  I did not obtain history of difficulty lifting right handed.  The abovenamed denied right upper limb paraesthesia.  Hand symptoms were not described.

   The abovenamed advised of left shoulder and neck pain.  She advised of some restriction in lifting.  Pain was described as emanating from the left cervical outline and extending down the left upper limb.  I did not obtain history of specific paraesthesia in the left upper limb.  I did obtain history of left leg ‘pins and needles’ following the undertaking of the cervical epidural injection.

   The only pattern to symptoms advised was that there was an increase in symptoms when the abovenamed had to use either hand.

   Morning stiffness was not a feature with the abovenamed advising of occasional stiffness only.  It remained with her throughout the day.

   The abovenamed did advise of having to lay down during the day occasionally.  She would rest for three to four (3 – 4) hours.  On some days, the abovenamed advised staying in bed for a prolonged period.

   Good and bad periods were denied.

   As the abovenamed was working, I enquired as to her work activities.  The abovenamed advised sitting and sorting mail.  She advised of an issue with this.  If she sat for a prolonged period, she advised that her neck and both shoulders could become painful.

   As she worked minimal hours, I enquired as to her domestic capacity.  The abovenamed advised living alone.  Her friend, a son and daughter, assisted with house chores.  The impression gained was that the abovenamed was restricted in her house chore [sic] activities but she did provide history of washing clothes once a fortnight and some meal preparation.  I also obtained history of washing dishes.  There was no advice provided of driving.

   The abovenamed did provide history of headache.  Headache reportedly commenced after her work injury.  Headache occurred on a daily basis.  Duration varied dependent on her taking medication.  She found relief with Panadol and Nurofen medication.  Migrainous features were not prominent.

   I obtained history of bowel disturbance (constipation).  There was no cause proposed.

   Otherwise, the abovenamed denied other constitutional symptoms including bladder disturbance, night sweats, fevers, malaise or weight loss.

   On a Visual Analogue Pain (VAS) score of 0 – 10, the abovenamed provided an average pain score of 8 – 9.  Variance of pain was said to be 5 → 9.  The abovenamed advised of pain beyond 7 on a regular basis.  Sitting in the rooms providing history, the abovenamed advised of right sided neck ache (VAS = 5), left sided neck ache with referral of pain in the left upper limb to the level of the elbow (VAS = 9), with advice that she had no right upper limb pain.

   The abovenamed’s Pain Drawing was marked anteriorly and posteriorly.  Anteriorly, I found crosses about the left neck outline, the left anterior aspect of the pectoral girdle, the right neck outline, the left forearm, the left antero-lateral  proximal thigh, the mid antero-lateral thigh and the antero-lateral distal leg. Posteriorly, the abovenamed placed crosses about the sub-occipital region bilaterally, the left neck outline, the right neck outline, the postero-lateral aspect of the right shoulder, the posterior aspect of the left shoulder, the lateral aspect of the mid arm, about the left olecranon, a cross about the iliac crest in the posterior axial line, a cross about the proximal right antero-lateral thigh, a cross about the lateral aspect of the mid thigh and a cross about the antero-lateral region of the right hindfoot.

   The abovenamed was currently medicated.  She described taking Lyrica (75mg noctė), prescribed by Mr Narula, Digesic analgesia (2 bd), Stilnox, Diazepam (3 per month), prescribed by her general practitioner, Panadol Osteo (2 bd) and Ostelin (Vitamin D).  The abovenamed did provide history of an allergy to Penicillin, Codeine and Panadeine Forte.  She had previously taken Panadeine Forte but had now stopped this medication.  She did provide history of an allergic reaction where she was unable to breathe and had to be rushed to Royal Perth Hospital in the mid 1990’s.

   Allied health treatment was reviewed.  The abovenamed did advise attending for physical therapy [sic] with this commencing in 2011.  The impression gained was that she no longer attended.  She provided no history of benefit from physiotherapy treatment.  She did advise of rehabilitation (2011–2013), with this perhaps the physiotherapy performed [sic].  Again, this was said to be unhelpful.  It was unclear whether this related to her medical management or vocationally.  I had previously advised of previous subacromial space injection, without benefit.  I had also advised of subsequent facetal joint injections and a cervical epidural, also without benefit.  The abovenamed had been provided with a TENS machine which she found unhelpful.

   Otherwise, I did not obtain history of chiropractic, a home based exercise programme, a water based exercise programme, acupuncture, psychological counselling, magnetic treatment or other more esoteric treatments.

   The abovenamed did not provide history of previous neck or upper limb injury, previous compensable claims or any motor vehicle related trauma.  The motor accident referred to in history, was reportedly quite minor.

   The abovenamed’s Oswestry Disability Index advised of mild to moderate ongoing encumbrance.  Personal care was said to be independently undertaken but causative of an increase in symptoms.  Pain prevented her walking more than a mile.  Pain prevented her standing for more than an hour.  Sexual activity was said to be normal although causative of an increase in symptoms.  Travel was unrestricted but increased her symptoms.  It was unclear to me whether she drove a motor vehicle.  Pain affected the more energetic social pursuits.  I did obtain history of mild sleep disturbance (< 6 hours sleep per night).  Pain prevented her from sitting for more than an hour yet she sat through an extended consultation, without obvious distress, but did stand and walk around the consultation room on one (1) occasion.  Lifting was said to be limited to light weights.  This may have been a medical restriction.  Analgesia, when taken, provided moderate relief from pain.

   EXAMINATION

   The abovenamed presented neatly attired.  She sat throughout historytaking except for one (1) occasion where she stood and walked around the consultation room, ‘friend’ [sic] and who also acted as an interpreter.  Her command of the English language was such that she didn’t really require an interpreter.  I found the abovenamed vague historian with history having to be extracted rather than provided.  Obvious embellishment of symptoms was therefore not a feature.  At the conclusion of historytaking, when asked, the abovenamed stood and moved to the examination room, walking unremarkably.  She undressed for examination purposes unaided.  Minimal undressing was required as she was attired in a sleeveless black dress which exposed the neck and shoulders generously.  My secretary was present throughout the examination.

   The abovenamed advised height as 161cm and weight as 55 kg.  Body mass index (BMI) was 21.

   When standing, the abovenamed displayed a minor right cervical hemi-asymmetry, an unremarkable thoracic kyphos with a seemingly preserved lumbar lordosis.  She stood displaying flat feet (pes planus).  She was able to stand on her toes demonstrating restoration of the medial longitudinal arch.  She was able to heel walk.  Trendelenburg’s test appeared unremarkable bilaterally.

   Given the presence of mobile flat feet, I did check the abovenamed for further evidence of persistent generalised joint laxity, notwithstanding her age.  I found that both elbows hyper-extended, there was evidence of increased thumb hyper-mobility, both wrists retained almost a 180° arc of motion and both shoulders externally rotated to 90°.  This suggested to me that the abovenamed retained features of persistent generalised joint laxity.

   The cervical spine was formally assessed.  Aside from a mild right cervical hemi-asymmetry, I found the abovenamed with soft neck musculature.  The abovenamed displayed mid line focal tenderness extending from approximately the C3 spine to the vertebra prominens (C7), in the mid line.  She was mildly tender to the right of mid line at about the C5/6 level.  She was more tender to the left of mid line, corresponding to the C4/5, C5/6 and C6/7 level.  This tenderness extended laterally along the left cervical outline to the supraspinous fossa region.  I found the abovenamed focally tender over the base of the left anterior triangle.  Tinel’s sign here was negative however.  Active cervical spine range of motion was assessed formally.  The abovenamed forward flexed to within two (2) finger breadths of the sternum.  Rhythm appeared preserved both flexing and returning to the neutral position.  I did find the abovenamed with minor loss of hyper-extension, at the extreme.  Lateral rotation and lateral flexion appeared entirely normal.  There were no referred symptoms into the upper limbs with active cervical spine range of motion.

   The thoracic spine was non tender.

   Given the absence of lumbar symptoms and indeed, aside from the history of ‘pins and needles’ involving the left lower limb, I did not examine the lumbar spine or lower limb major joints.

   The right pectoral region was initially assessed.  I found no evidence of muscle wasting about the pectoral girdle.  There was no particular focal tenderness nor swelling about the acromio-clavicular joint, the antero-lateral corner of the acromion or within the bicipital groove.  Active right shoulder motion was assessed.  Elevation was normal (180°).  Abduction was normal (90°).  With the arm by the side, the abovenamed achieved 90° of external rotation.  She was however only able to place the right hand to the thoraco-dorsal spine junction.  With the shoulder maximally abducted, I confirmed an unremarkable rotation arc, effectively excluding any suggestion of shoulder capsulitis.  The lift-off test was unremarkable.  There was no pain or weakness to resisted external rotation. Impingement signs were unimpressive.  The abovenamed retained her Bicipital muscle contour.  There was no pain to resisted elbow flexion, resisted elbow hyper-extension and O’Brien’s test was unremarkable.

   The right elbow joint appeared anatomically aligned.  I did note that the right elbow hyper-extended.  Furthermore, the abovenamed displayed a hyper-mobile ulna nerve at the medial epicondyle.  There were however no clinical signs of ulna neuritis.  Elbow motion appeared entirely normal including pronation/supination.

   There was no forearm muscle wasting evident.  The right wrist joint appeared anatomically aligned.  I found no evidence of de Quervain’s disease.  The abovenamed had to show me the surgical scar from her carpal tunnel decompression as it was difficult to define.  There were no clinical signs of recurrent carpal tunnel syndrome.  The palmar surface of the hands was clean.  There was no evidence of intrinsic muscle wasting.  I noted swan necking of the 2^nd and 3^rdrays (physiological).  Long flexor/extensor tendon function appeared entirely preserved.  There were no obvious features of sympathetic over-activity.

   The left pectoral girdle was assessed.  Again, I found no evidence of pectoral girdle muscle wasting, no focal swelling nor tenderness about the acromio-clavicular joint, the antero-lateral corner of the acromion or within the bicipital groove.  Active left shoulder motion was assessed.  Ostensibly, the abovenamed retained normal elevation (180°), normal abduction (90°) and normal external rotation, certainly synonymous with the right shoulder.  In contrast to the right shoulder, the abovenamed was only able to place the left hand to the lumbar region.  With the left shoulder maximally abducted, rotation arc appeared entirely preserved and I could therefore not exclude the inability to internally rotate the left shoulder no further than the lumbar region, as being perhaps voluntary.  As for the right shoulder, provocation signs for impingement, cuff pathology, AC joint pathology and instability, were unimpressive.

   The left elbow appeared entirely normal although again I found evidence of hyper-mobility of the left ulna nerve at the medial epicondyle.  The abovementioned did not display signs of neural irritability.  Motion appeared preserved.

   The left upper limb distal extremity appeared unremarkable.  In particular, there was no evidence of de Quervain’s disease,  recurrence of carpal tunnel syndrome or intrinsic muscle wasting.  I again noted swan necking of the 2^nd and 3^rd rays.  Long flexor/extensor tendon function appeared entirely normal.  There were no obvious features of sympathetic over-activity.

   Neurological examination was undertaken formally.  I found motor power preserved through all myotomes.  Tone appeared unremarkable.   Reflexes were symmetrically brisk at the Biceps, Brachio-radialis and Triceps tendon.  Lower limb reflexes were equally present and symmetrical.  The abovenamed did advise of a heightened sensitivity to both light touch and pin prick in both the right upper limb and lower limb.  Given that this involved multiple dermatomes, the significance of same appeared controversial.  I noted no sensory disturbance involving the trunk.  Long tract signs were not found.

   ELECTROPHYSIOLOGICAL REVIEW

   The abovenamed had undergone EMG and nerve conduction studies undertaken by Dr Peter L Silbert, whom I know to be a Consultant Neurologist, on the 11th October 2011.  Dr Silbert did advise of prolonged latency involving the left median nerve in comparison to the left ulna nerve which he advised was a common finding following previous median nerve entrapment at the wrist, such that it is commonly seen following carpal tunnel decompression.  Interestingly, Dr Silbert also advised of EMG changes involving the left lateral head of the Triceps muscle, reporting this as:  ‘Very mild neurogenic changes in the left Triceps muscle consistent with a very mild chronic left C6 or C7 radiculopathy’.

   RADIOLOGICAL REVIEW

   The abovenamed presented with a collection of radiographic investigations including a left shoulder ultrasound (21/07/2011), left shoulder subacromial space injection films (10/08/2011, 24/11/2011), a CT scan of the cervical spine (07/09/2011), an MRI scan of the left shoulder (30/09/2011), plain xrays of the cervical spine (17/02/2012), a technetium bone scan of the neck and upper limbs (17/02/2012) and MRI scans of the cervical spine (28/02/2012, 02/08/2012),  You enclosed all the related radiologists’ reports in your correspondence.

   I viewed the index investigation being that of a left shoulder ultrasound examination (21/07/2011).  This study displayed a mildly tendinopathic supraspinatus tendon, without a cuff tear.  The infraspinatus tendon appeared unremarkable.  There was minor subscapularis tendinopathy evident. The long head of Biceps tendon appeared intact.  There was no effusion around the long head of Biceps tendon.  The subacromial bursa was said to be thickened with the reporting radiologist advising of impingement with shoulder abduction.  A treatment recommendation of injecting the subacromial space was made.

   I viewed subacromial space injection films (10/08/2011, 24/11/2011).  On the index film, needle placement was evident and appeared appropriate.  There was however no post-injection effect evident.  The abovenamed advised that this injection was ‘painful’.  A subsequent injection film again displayed needle placement and on this occasion, a post-injection effect.  The abovenamed did not think that this injection assisted her symptoms.

   I viewed a CT examination of the cervical spine (07/09/2011).  Although cervical alignment was said to be ‘normal’, I did feel that there was perhaps some loss of the normal cervical lordosis seen, with the neck appearing ostensibly straight.  There was no obvious evidence of bony injury.  There was no evidence of a disc protrusion.  There was no gross evidence of facetal joint arthropathy.  Overall, the study was unimpressive.

   I viewed an MRI scan of the left shoulder (30/09/2011).  This non contrast study displayed a mildly tendinopathic cuff without evidence of a rotator cuff tear.  The tendinopathy affected all the cuff tendons.  The gleno-humeral joint appeared preserved.  There was no gross evidence of AC joint arthropathy.  Acromial morphology appeared Type II in nature, as reported.  The subacromial bursa was mildly thickened, as reported.  There did appear to be some undercutting of the superior labrum but within the confines of a non contrast study, no further comment could be made.

   I viewed plain xrays of the cervical spine (17/02/2012).  A full cervical series including dynamic views, was available.  As previously advised in the radiologist’s report of the CT examination, there was evidence of significant dental work.  Cervical spine alignment appeared unremarkable and was reported as such.  There was no gross evidence of cervical spondylopathy.  Disc height appeared maintained.  There was no gross evidence of facetal joint arthropathy.  The atlanto-axial articulation appeared unremarkable.  The dynamic views suggested no restriction of cervical spine range and no evidence of instability, as reported.

   I viewed a technetium bone scan of the neck and upper limbs (17/02/2012).  The blood pool images appeared unremarkable.  The delayed images did display some minor increased uptake at the cervico-occipital junction and again, at the costo-vertebral articulation of the 1^st rib.  Overall, this study was unimpressive and should have reassured the abovenamed’s clinical carers of no active pathology.

   I viewed the MRI scans of the cervical spine (28/02/2012, 02/08/2012).  Again, the neck appeared to be a little straighter than one is normally used to seeing.  I did note alignment generally however preserved.  There was no evidence of bony injury.  T2 signal appeared largely preserved except perhaps for the C5/6 and possibly, C4/5 segment.  There was no evidence of a discrete disc lesion.  The posterior elements appeared unremarkable.  The cervical cord appeared unremarkable.  I did note the reporting of a nodule about the right lobe of the thyroid, which should be further investigated.  Otherwise, the study was unimpressive.  A subsequent MRI scan of the cervical spine (02/08/2012) ostensibly revealed unchanged findings although on this occasion, a different reporting radiologist did advise of ‘some reversal of the upper to mid cervical lordosis in the position of scanning’.  T2 signal was unchanged.  At the C5/6 level, disc height was said to be ‘minimally reduced’ with the reporting of ‘an annular fissure which has become slightly more prominent since the previous study’.  There was said to be a ‘shallow central posterior disc protrusion’ associated with the annulus fissure but within the confines of a capacious cervical canal, without effacing of the cervical sac, I would have thought this was a physiological finding.

   DIAGNOSIS

   1.Chronic neck pain without radicular features.

   2.Hypothyroidism – treated.

   3.Bilateral carpal tunnel syndrome.  Status – following bilateral carpal tunnel decompression.

   4.A pain syndrome could not be excluded.

   PROGNOSIS

   The abovenamed presented advising of initial right cervico-pectoral symptoms with these reportedly settling.  Because of having to use her left upper limb, it was said that left upper limb and neck symptoms developed.  This supposition is disproven in the medical literature.  The abovenamed has been extensively investigated with investigations depicting minor degenerative change in the neck only.  She reports unchanged symptoms despite the passage of time.

   Because a pain syndrome could not be excluded, I would offer a guarded prognosis.

   SPECIFIC QUESTIONS

   Question 1.

   From what conditions of the left upper limb/neck does Ms Hubertz currently suffer?

   Based upon my assessment of the abovenamed, I would advise that the abovenamed suffers from chronic neck pain.

   A pain syndrome could not be excluded.

   There is no clinical evidence of radicular involvement.

   By and large, the imaging is reassuring although it does depict early degenerative change in the mid cervical spine consistent with mild cervical spondylopathy.

   Question 2.

   Having regard to the radiographic evidence of degeneration in Ms Hubertz’ neck and left shoulder, is there any connection at all between her current left upper limb/neck symptoms and her employment with Australia Post as a Mail Officer?  Please explain.

   Based upon my assessment of the abovenamed, notwithstanding that the abovenamed claims neck and left shoulder symptoms, advising that these are related to her work at Australia Post, the imaging changes display evidence of mild degenerative mid cervical spondylopathy, with this frequently seen in the asymptomatic population.

   I cannot reconcile her ongoing symptoms over a period now approaching two (2) years with the imaged pathology.

   For this reason, a pain syndrome has been proposed.

   Any connection between the symptoms reported, the imaging findings and current status appears extremely tenuous.

   Question 3.

   Do you agree with the premise put forward by Dr Kain on 7/6/11 that the increased amount of work Ms Hubertz was doing on the left side at the time was the cause of a flare up of symptoms in her left shoulder and neck?  Please explain.

   The medical literature clearly advises that contra-lateral symptoms following ipsi-lateral injury simply does not occur.  There is clinical [sic] no basis for advising of the development of left sided symptoms as a consequence of favouring the right upper limb.

   Question 4.

   Having regard to the fact that (i) Ms Hubertz has only been working approximately half her normal weekly hours since 17/8/11, (ii) her right upper limb symptoms have resolved, and (iii) she no longer needs to favour one side, do you feel that Ms Hubertz’ current left upper limb/neck symptoms are still related to the extra work she was doing on the left side over a year and a half ago, or are they now related solely to her underlying degeneration?

   As I have previously advised, I have extreme difficulty in reconciling the abovenamed’s ongoing symptoms with her employment and more specifically, the injury reported on the date of injury (10/05/2011).

   Whilst the abovenamed does have imaging evidence of mild mid cervical degenerative spondylopathy, this can be found in the asymptomatic population and does not necessarily indicate that this is the source of symptoms.

   To answer your question directly, I do not believe the current left upper limb/neck symptoms are still related to her employment.

   Question 5.

   Does Ms Hubertz currently have the capacity to increase her hours of work?  If so, please specify:

   Based upon my assessment of the abovenamed, the abovenamed does currently retain the capacity to increase her hours of work.

   (a)the type of work she should be able to perform;

   I would expect that the type of work would not significantly alter, given the abovenamed remains with the same employer.

   (b)the number of hours per week she should be able to perform; and

   I have previously advised that the hours per week worked can be incremented.

   (c)details of any work restrictions.

   I do not believe, on the basis of clinical assessment, that the abovenamed requires any work restrictions.

   Question 6.

   Are there any aspects of the clinical examination which tend to suggest that Ms Hubertz is:

   ·Voluntarily exaggerating her symptoms?

   ·Consciously guarding restriction of movement?

   ·Displaying symptoms and examination findings inconsistent with the claimed conditions?

   ·Demonstrating a range of movement during your passive observation which were not replicated during clinical examination?

   The abovenamed did display some non organic signs.  Whether or not this is part of what I have described as a pain syndrome, is controversial.  What one can confidently state on the basis of clinical assessment, is that the abovenamed does not appear to be suffering from any functional incapacity.

   Question 7.

   Is there any treatment other than that already provided, that you feel will be of benefit to Ms Hubertz?  If so, what would you suggest?

   Based upon my assessment of the abovenamed, in my opinion, the abovenamed should be treated symptomatically.

   It could be argued that the abovenamed is currently being over-treated.  I do not see any indication for continuance of Lyrica anti-neuropathic medication nor Diazepam (Benzodiazepine) medication.  I would further simplify the abovenamed’s analgesic regime.  My recommendation would be to take either Digesic or Panadol Osteo but not both.

   I have said to the abovenamed that it would be pertinent that she re-present to her general practitioner to have the thyroid nodule depicted on MRI imaging further investigated but this is unrelated to any work claim.  As part of that investigation, she should be assessed for hyperparathyroidism given her history.

   I would agree with my colleagues that there is no basis for consideration of surgery to either shoulder.

   I am surprised that you have approved the number of injections that have been performed.  Presumably, your approval was sought prior to the undertaking of these injections.  Given that history was provided of no benefit [sic], I do not see a place for further injection treatment.

   The abovenamed should continue to see her general practitioner for primary health care needs.

   Question 8.

   What is the prognosis for Ms Hubertz’ left upper limb/neck conditions?

   In an overall sense, the abovenamed’s prognosis is benign.  There is no major musculo-skeletal pathology affecting the neck or upper limbs.

   However, because the abovenamed may well be suffering from a pain syndrome, I have provided a mildly guarded prognosis.  Until such time as her claim is resolved, that will likely remain the status quo.

   …”  (original emphasis) (T212)

1. In response to questions from the applicant, Mr Alexeeff gave evidence as follows:

   ·as regards his answer to Question 3 in his report, he added that there is no evidence that having an injury on one side of the body causes symptoms to develop on the other side;

   ·as regards his reference to a “pain syndrome” in his answers to Question 1 and Question 2, he described a “pain syndrome” as a “disconectivity between symptoms and objective findings”, or “pain which cannot be explained on the basis of known paraphysiology”;

   ·as regards his answer to Question 6, he opined that “pain syndrome” is the “most likely diagnosis” to describe the applicant’s pain symptoms, and he confirmed that his statement that the applicant “does not appear to be suffering from any functional incapacity” was based on his clinical assessment of her.

   Additional Evidence Tendered by the Applicant

2. The applicant tendered in evidence a letter, dated 14 March 2014, from Mr Narula, Neurosurgeon, addressed “To Whom it May Concern”, which  states as follows:

   “ I have seen this lady at the behest of her GP Dr Cameron.  She presented with a work related injury to her cervical spine with pain in her right shoulder and subsequently left arm and neck.

   The mechanisms involved at her work do suggest a role in reproduction of her pain.

   Her MRI scan of the cervical spine does not show significant pathology.

   Her continued ergonomics at work place a stress on her neck and result in ongoing symptoms.

   She has requested a medico-legal report for which I have not been able to find time in the given time-frame.  Should further time be available, I will endeavour to provide a report.”  (Exhibit A3)

3. The applicant also tendered in evidence a report of Mathew Judd, Physiotherapist, dated 13 August 2013, addressed to Dr Cameron, which states as follows:

   “ Thank you for referring Antonina for physiotherapy assessment of her left sided shoulder, cervical and thoracic pain which has been longstanding.

   Antonina reported flaring up her symptoms at work last week when she was performing a task involving cutting strips of plastic.  However, she states that she has had a constant level of pain since her initial injury almost 2 years ago, although her pain levels following this work task are dramatically worst [sic].  Her symptoms involved painful restriction of cervical movement, along with pain along the arm from the shoulder down to the hand.  Her symptoms have remained quite severe and are significantly impacting on her mood and sleep.

   On assessment Antonina was painfully restricted with cervical motion palpation, and her arm symptoms were strongly reproduced on Neural-tissue provocation.  This eased somewhat with gentle manual therapy and muscle release, and I have provided Antonina with some exercises to complete at home.

   It appears that Antonina’s flare up on this occasion involves an element of nerve sensitisation however this is clouded by her complex injury history.  As she is a new patient for the clinic it is difficult to determine which symptoms are from her recent flare up and which are long standing.  However we will endeavour to settle down her symptoms as much as possible while she is attending Mercy Physiotherapy.

   …”  (Exhibit A2)

   The Issue

4. As previously mentioned, the respondent, on 3 June 2011, accepted liability under s 14 of the SRC Act to pay compensation to the applicant in respect of an injury described as “right upper trapezius rotator cuff muscle strain” sustained on 10 May 2011, and subsequently, on 9 August 2011, amended the description of the relevant compensable injury to “right upper trapezius rotator cuff muscle strain with subsequent development of left shoulder and neck strain” (“the compensable injury”). In this proceeding the respondent did not seek to agitate the correctness of either of those decisions.

5. Accordingly, the issue for the Tribunal’s consideration and determination is whether the respondent has continued, with effect from 12 April 2013, to be liable to pay compensation to the applicant, in accordance with s 16 and/or s 19 of the SRC Act, in respect of the compensable injury.

   Consideration

6. The Tribunal accepts the applicant’s evidence that, for the period from 12 April 2013 to date (“the relevant period”), she has experienced pain symptoms in her neck and left shoulder.  The question whether those ongoing pain symptoms are resulting from the compensable injury is, however, a medical question and is to be determined by the Tribunal on the basis of the medical evidence before it.

7. There is much medical evidence before the Tribunal regarding pain symptoms experienced by the applicant in her neck and left shoulder in the period since the respondent’s acceptance of liability to pay compensation to her in respect of the compensable injury (see paragraphs 21–38, 44–48 above).  That medical evidence may be briefly summarised as follows:

   ·Dr Cameron and Dr Waters, General Practitioners, have, in the relevant period, continued to issue workers’ compensation progress medical certificates in respect of the compensable injury (paragraphs 21-22);

   ·Mr Wang, Orthopaedic Surgeon, saw the applicant in September and October 2011 and opined that her “symptoms are related to her cervical spondylosis but he did not express an opinion regarding the existence of a causal relationship between her symptoms and the compensable injury, and he has not seen her since 21 October 2011 (some 18 months before the commencement of the relevant period) (paragraphs 24-25);

   ·Mr Narula, Neurosurgeon, saw the applicant in February and March 2012 and, following the results of radiological investigations, he referred her to Dr Berrigan;  he saw her again in March 2013 and commented on her symptoms and treatment but did not express an opinion regarding the existence of a causal relationship between her symptoms and the compensable injury (paragraphs 27-29);

   ·Dr Berrigan, Consultant in Pain Medicine and Anaesthesia, saw the applicant in June, July, August, October and November 2012 and described her symptoms and various treatments which he had administered (without significant success) and then opined that it would be “a good idea for her to see a psychologist”; he reported in July 2013, however, that he had been treating her with a TENS machine since January 2013 which she had found to be “very helpful” (paragraphs 31–36);

   ·Dr Hamzah saw the applicant in January 2013, following a referral from Dr Berrigan, and fitted her with a TENS machine (paragraph 37);

   ·Mr Goonatillake, Orthopaedic Surgeon, saw the applicant in December 2012 and opined that her symptoms were not related to her shoulder and suggested that “treatment be directed to her cervical spine” but he did not express an opinion regarding the existence of a causal relationship between her symptoms and the compensable injury (paragraph 38);

   ·Mr Alexeeff saw the applicant in February 2013 for the purpose of a medico-legal consultation and provided a very comprehensive report in which he:

   -summarised the voluminous background medical material regarding the applicant’s compensation claim;

   -set out in detail the history of the applicant’s employment and the compensable injury and her subsequent symptoms;

   -provided a detailed description of his examination of the applicant and his findings;

   -opined that the applicant was suffering from (relevantly) “chronic neck pain without radicular features”;

   -stated that he did “not believe the current left upper limb/neck symptoms are still related to her employment”; and

   -    proposed that the applicant’s pain symptoms were instead the result of a “pain syndrome” (paragraph 45);

   ·Mr Judd, Physiotherapist, saw the applicant in August 2013 for a “physiotherapy assessment of her left sided shoulder, cervical and thoracic pain which has been longstanding” but did not express an opinion regarding the existence of a causal relationship between her symptoms and the compensable injury (paragraph 48);

   ·Mr Narula provided a letter, dated 14 March 2014, the contents of which are set out in paragraph 47 above.

8. In the Tribunal’s opinion, only some of the abovementioned medical evidence directly bears on the issue which the Tribunal is required to determine in this proceeding, namely, whether, in the period from 12 April 2013 to date, the applicant has continued to suffer pain symptoms resulting from the compensable injury such that the respondent continues to be liable to pay compensation to the applicant, in accordance with s 19 and/or s 16 of the SRC Act, in respect of that injury. That evidence comprises:

   ·the workers’ compensation progress medical certificates issued by Dr Cameron and Dr Waters in the relevant period;

   ·the medico-legal report of Mr Alexeeff; and

   ·the letter from Mr Narula, dated 14 March 2014.

9. The Tribunal attaches the greatest weight to the report and evidence of Mr Alexeeff.  As previously mentioned, Mr Alexeeff provided a comprehensive report in which he unequivocally expressed an opinion to the effect that the applicant’s left upper limb/neck symptoms were no longer related to her employment with the respondent and, in particular, the compensable injury, and he gave oral evidence and was available for questioning, and was questioned, by the applicant.

10. The Tribunal attaches relatively little weight to the medical certificates issued by Dr Cameron and Dr Waters because neither Dr Cameron nor Dr Waters provided a detailed medical report in support of those medical certificates, addressing the issue of the existence of a causal relationship between the applicant’s ongoing symptoms and incapacity for work and the compensable injury, and neither of them was called as a witness by the applicant or was available for cross-examination by the respondent.

11. The Tribunal likewise attaches relatively little weight to Mr Narula’s letter of 14 March 2014 which was presumably provided at the request of the applicant, whom (the Tribunal understands on the basis of the evidence before it) Mr Narula has not examined since March 2013.  Mr Narula’s letter, in the Tribunal’s opinion, is brief and somewhat vague and does not contain a clear and unequivocal expression of opinion to the effect that the applicant’s ongoing symptoms are causally related to the compensable injury.  The Tribunal also notes that Mr Narula was not called as a witness by the applicant and was not available for cross-examination by the respondent.

12. As regards the reference in the last paragraph of Mr Narula’s letter of 14 March 2014 to his not having been “able to find time in the given time-frame” to prepare a medico-legal report as requested by the applicant, the Tribunal notes that the applicant’s application for review was lodged on 18 June 2013 and the parties were formally notified on 14 November 2013 that this proceeding had been listed for a hearing on 17 and 18 March 2014 and, on 28 November 2013, a Conference Registrar made directions for each party to file and serve, prior to the hearing, evidence on which it was proposed to rely at the hearing.  In those circumstances, the applicant, in the Tribunal’s opinion, cannot reasonably claim that she had insufficient time in which to obtain a medico-legal report from Mr Narula, or from any of her other treating medical practitioners, prior to the hearing of this proceeding.    

    Finding

13. Having considered the whole of the medical evidence before it, the Tribunal accepts the evidence of Mr Alexeeff and, on the basis of that evidence, it finds that, in the period from 12 April 2013 to the present date, and as at the present date, the pain symptoms suffered by the applicant in her neck, left shoulder and left arm were, and are, not causally related to the compensable injury.  Although it is unnecessary for the Tribunal to make a finding as to a precise cause – other than compensable injury – of the applicant’s ongoing pain symptoms, the Tribunal is attracted to the proposition of Mr Alexeeff that it is most likely that those symptoms are attributable to a “pain syndrome” unrelated to the compensable injury and to her employment by the respondent.

    Conclusion

14. Accordingly, the Tribunal concludes that, for the period from 12 April 2013 to the present date, and as at the present date, the respondent is not liable to pay compensation to the applicant, pursuant to s 16 or s 19 of the SRC Act, in respect of the compensable injury.

    Decision       

15. For the above reasons, the decision under review is affirmed.

I certify that the preceding 60 (sixty) paragraphs are a true copy of the reasons for the decision herein of Deputy President S D Hotop

............[sgd D Brodie]................................................

Administrative Assistant

Dated 9 May 2014

Dates of hearing	17, 18 March 2014
Applicant	In person (unrepresented)
Counsel for the Respondent	Mr M Gollan
Solicitors for the Respondent	Corporate Legal Australia Post