Armagan v Transport Accident Commission
[2016] VCC 287
•18 March 2016
| IN THE COUNTY COURT OF VICTORIA AT MELBOURNE COMMON LAW DIVISION | Revised Not Restricted Suitable for Publication |
SERIOUS INJURY LIST
Case No. CI-14-05567
| HAMIDE ARMAGAN | Plaintiff |
| v | |
| TRANSPORT ACCIDENT COMMISSION | Defendant |
---
JUDGE: | HIS HONOUR JUDGE O'NEILL | |
WHERE HELD: | Melbourne | |
DATE OF HEARING: | 1 March 2016 | |
DATE OF JUDGMENT: | 18 March 2016 | |
CASE MAY BE CITED AS: | Armagan v Transport Accident Commission | |
MEDIUM NEUTRAL CITATION: | [2016] VCC 287 | |
REASONS FOR JUDGMENT
---
Subject: TRANSPORT ACCIDENT
Catchwords: Serious injury application – injury to cervical spine with referred pain down the right arm – earlier transport accident – nature and extent of pre-existing degenerative problems in cervical spine – whether consequences “very considerable”
Legislation Cited: Transport Accident Act 1986
Judgment: Leave to bring proceedings refused.
---
APPEARANCES: | Counsel | Solicitors |
| For the Plaintiff | Mr V Morfuni QC with Ms A C Ryan | Nowicki Carbone |
| For the Defendant | Mr D Myers | Solicitor to the Transport Accident Commission |
HIS HONOUR:
Preliminary
1 Ms Armagan suffered an injury to her cervical spine in a transport accident on 29 May 2011 (“the subject accident”) when the vehicle she was driving was hit from behind. Prior to that time, she had pain and restriction in her neck over a considerable period, together with a range of psychological issues, in particular depression. Ms Armagan was in receipt of a Disability Support Pension from about 2009, including as at the time of the transport accident. In 2010, she started work as a carer, looking after the elderly. She kept working after the transport accident until she ceased work in 2016.
2 Ms Armagan complains that, as a result of the subject accident, she suffers ongoing significant pain in her neck and down through the right shoulder to her right arm. She claims that she cannot presently work as a carer, and a range of domestic and recreational activities have been significantly affected.
3 This is an application to bring proceedings pursuant to s93(4)(d) of the Transport Accident Act 1986 (“the Act”) for injury suffered in a transport accident on 29 May 2011. The body function said to be lost or impaired is the cervical spine. The application is thus brought under ss(a) of the definition of “serious injury” contained in s93(17) of the Act.
4
Ms Armagan was the only witness called to give evidence and be
cross-examined. In addition, several of her affidavits, an affidavit of her son, and medical and radiological reports were tendered into evidence. I shall not refer to all of that material in the course of this judgment, but rather those parts of the evidence and reports which appear to me to be most relevant and which I have relied upon in coming to the conclusions referred to later in this judgment. The statutory scheme set forth in the Act which prescribes and regulates applications of this nature, and the principal authorities of the Court of Appeal, are well known, and it is unnecessary for me to revisit the various relevant sections and those authorities.
Relevant background
5 Ms Armagan is now fifty-two. She was born in Turkey and came to Australia in about 1980. She was educated to the equivalent of Year 8. In 1980, she married her husband and they have three sons. They divorced in 2002 after an unhappy and sometimes violent relationship.
6 In Australia, Ms Armagan did some factory work for a period and then took time off to look after her children. In 2009, she applied for and was granted a Disability Support Pension. The document was tendered into evidence.[1] Although it is not completely clear, it would appear that the conditions which gave rise to the application for the Pension were depression and swollen legs/obesity.
[1]Plaintiff’s Court Book (“PCB”) 127 ff
7 In about 2010, Ms Armagan started casual employment as a personal care assistant with a company assisting elderly people of Turkish background. She would help by taking them to medical appointments and shopping. She performed some light cleaning duties for them. She would work between five and ten hours a week.
8 In August 1994, she was involved in a transport accident and suffered minor injuries, which resolved.
9 In about 1997, she was involved in another transport accident (“the first accident”) and suffered an injury to her neck. According to her affidavit:
“I have experienced intermittent pain and discomfort in my neck since the [first] accident. The pain in my neck also radiated upwards and I experience intermittent headaches at the back of my head. I also experience referred pain in my right shoulder and forearm at times. I have also experienced some swelling of my right arm. I continued to experience intermittent pain and discomfort as a result of this accident. I found that my pain was worse in the cold weather.”[2]
[2]PCB 3
10 Ms Armagan said she managed this injury well and it did not affect her ability to carry out a range of recreational, social and domestic activities.
11 Further, Ms Armagan said that she had suffered anxiety and depression since coming to Australia from Turkey in about 1980. Originally, she did not wish to leave Turkey, but came to Australia to fulfil her family’s promise in an arranged marriage. The marriage was unhappy.
12 Ms Armagan has suffered from a number of medical conditions which are not of particular significance in this application.
13 Prior to the subject accident, she enjoyed gardening and maintaining her home. She particularly enjoyed cooking and would prepare a wide range of dishes, including Turkish meals, for the benefit of friends and family. Ms Armagan enjoyed knitting and crocheting. She would go to Turkish social functions and regularly dance, and was involved in the Turkish community.
14 According to various reports of her long-term general practitioner, Dr Fiona Shaw, Ms Armagan had a long history of musculoskeletal problems going back to at least 1998, including a history of intermittent right arm swelling and discolouration.[3] Dr Shaw further noted that the injuries for which Ms Armagan sought treatment following the subject accident had existed before that time.[4]
[3] PCB 32-33
[4]PCB 37
15
According to a report of Dr David Lam of the Western General Hospital, of
7 March 2002, Ms Armagan attended in the Outpatients Clinic, complaining of swelling and discolouration of her right wrist, which had been present for approximately five years.[5] She complained of subjective weakness of the arm. On examination, swelling was noted on the right wrist.
[5]PCB 45
16 As a result of complaints of neck pain, Dr Shaw arranged for an x-ray of the neck in December 2009, which showed “Mild bilateral C3-4 and right C4-5 foraminal narrowing. No disc space narrowing.”[6] Further, in July 2000, another x-ray was ordered by Dr Ng (of the same medical clinic as Dr Shaw), which noted degenerative changes at C4-5:
“… resulting in osteophytes encroaching on the anterior aspect of the corresponding neural exit foramen. There appear to be early degenerative changes in the C3-4 neuro-central joints bilaterally, with minimal foraminal encroachment.”[7]
[6]PCB 26
[7]PCB 25
17
By reason of depressive and anxiety symptoms suffered by Ms Armagan prior to the subject accident, she was treated by Ms Tina Cocking, clinical psychologist, upon the referral of Dr Shaw. According to reports compiled before the subject accident, she complained to Ms Cocking of depression and unhappiness since she was seventeen, when she was forced to come to Australia. She reported two suicide attempts, in 1986 and 2007, separation from her husband in 1991 and difficulties with the children. She had little contact with them around 2009. She took antidepressant medication from time to time. However, by November 2009, said she was feeling more positive about her future following a trip to Turkey. According to the report of Ms Cocking,
Ms Armagan was not experiencing depressive symptoms and was feeling hopeful and positive about her future.[8]
[8]Defendant’s Court Book (“DCB”) 27
The neck injury suffered in the subject accident and the consequences
18 On 29 May 2011, the vehicle Ms Armagan was driving was struck from behind. Later that evening, she noticed pain in her neck and referred pain down her right arm. She said there was bruising and swelling across the right shoulder. The next day, she went to see Dr Shaw and, according to a report of that practitioner, complained of pain in the neck across the occipital region of the skull.[9] Muscle spasm was observed in the upper back and neck areas. Dr Shaw diagnosed a soft tissue injury to the neck. Ms Armagan noticed bruising over the joints of the left hand.
[9]PCB 31
19 Dr Shaw said:
“In view of a past history of radiological evidence of cervical spine pathology, and of right arm, neck and occiput pain documented as having occurred over the previous twenty years, a cervical spine X-ray was ordered.”[10]
[10]PCB 31
20 That x-ray of 16 September 2011 showed foraminal narrowing at C3-4 bilaterally and C4-5 on the right side.[11]
[11]PCB 27
21 On review on 26 June 2011, Dr Shaw said there was a full range of movements of the neck and commented that there did not appear to be any ongoing physical issues arising from the subject accident.
22
Ms Armagan presented again on 2 September 2011 with a painful right hand and wrist. There was discoloration and temperature change. It was noted
she had previously presented with symptoms of swelling of the right hand and forearm in 2001.
23
Dr Shaw referred her for physiotherapy treatment from time to time. This continued until about August 2013. Later in 2011, Dr Shaw referred
her for specialist treatment at the Western General Hospital.
Ms Armagan was not seen until June 2012 in the Vascular Clinic. Investigation produced no abnormal findings in relation to the right wrist or hand. She was then referred to the Neurosurgical Unit in relation to her neck problems. Cervical radiculopathy was suspected. According to a report of Dr Tissa Wijeratne of June 2012, Ms Armagan complained of significant neck pain with headaches.[12] The pain was referred along her right arm with swelling, discolouration and cramps. Dr Wijeratne suggested that the clinical symptoms indicated Complex Regional Pain Syndrome. Nerve conduction studies on
the right arm were within normal limits.
[12]PCB 48
24 A CT scan of the cervical spine of May 2012 showed:
“Posterior element hypertrophy, exit foraminal stenosis right C3-4 and especially C4-5. C5 exiting nerve root may be encroached. This corresponds to site of symptoms.”[13]
[13]PCB 28
25 Dr Shaw said that by 2014, Ms Armagan’s right hand symptoms had improved and there was no swelling nor temperature change. She complained of “electric shocks” to the right hand in cold weather. Episodic neck and head pain was managed with physiotherapy and medication. Dr Shaw noted that Endep had been prescribed in 2012 to assist in the management of pain.
26 Ms Armagan was reviewed in the Neurosurgical Outpatients Department of the Western General Hospital in March 2015.[14] She complained of neck pain and referred right arm pain since the subject accident. She said sometimes she experienced electric shooting pains down the arm to the right finger. Viewing the MRI scan of April 2014, the neurosurgical registrar, Dr Vu, said:
“In light of the fact that these lesions [as disclosed on the MRI scan] do not correspond well with her symptoms and that she has no weakness at present, I discussed this patient with my consultant, Mr Nair, and we have recommended that she pursue a course of physiotherapy and a trial of Lyrica prior to our next review.”[15]
[14]PCB 50
[15]PCB 50
27 Ms Armagan was reviewed again in the Neurosurgical Department of the Western General Hospital by Mr Nair in June 2015. On presentation, she complained of pain in her neck and both arms, worse on the right side. A further MRI scan was taken, which was said not to show any significant change from the previous scan. Mr Nair said he did not think the findings on the scan correlated with her problems. Ms Armagan was referred to a pain specialist at the Sunshine Hospital for further management. Despite her being “very keen” for surgical intervention, Mr Nair recommended against surgery.[16]
[16]PCB 52
28 Ms Armagan has remained under the care of Dr Shaw to the present time. Up until March of last year, Ms Armagan was taking Endep to assist with her sleep at night. She has subsequently been taking 75 milligrams of Lyrica per night and Panadol Forte during the day.
29 Because of ongoing pain, Ms Armagan was referred back to the psychologist, Ms Cocking, for treatment of her psychological problems. Since August 2015, she has been treated by another psychologist, Ms Kurtoglu.
30
According to the various reports of the Western General Hospital,
Ms Armagan’s last attendance was in June 2015. She was seen in the neurosurgical clinic and complained of ongoing neck pain and pain down both arms, worse on the right side.
31 According to Ms Armagan’s affidavits and evidence, she complains of the following consequences of the subject accident:
·The pre-existing pain and restriction of movement in the neck has been exacerbated. That pain is aggravated by various movements of the neck, including turning and rotating her head. Ms Armagan’s range of neck movement is restricted and she often has to move her entire body rather than her neck. She says the pain is worse in colder weather. Generally, the pain is more severe and regular since the subject accident.
·She suffers headaches now on a daily basis.
·The pain is referred from her neck down into her right shoulder and into the arm. It is difficult for Ms Armagan to lift objects with her right arm, particularly above shoulder level. She is right handed.
·There has been a worsening of the swelling and discolouration in her right arm and hand. She claims her right arm is noticeably larger than the left. Intermittently, it changes colour and is cold. Ms Armagan has developed an “electric shock” sensation down the right arm with sensitivity to touch. These symptoms are much worse since the subject accident.
·Her right arm has become weak and she often drops things.
·She is required to take a range of medications to deal with the pain in her neck and arm.
·She struggles to perform household tasks, including the heavier tasks such as vacuuming and mopping. She needs the assistance of her son in these tasks. Washing and ironing are difficult.
·She has a small garden, but is not able to garden as she did before. She has lost the enjoyment the garden used to give her.
·She still drives, but for short distances.
·She finds it difficult to complete the grocery shopping.
·She has difficulty with dressing and activities of daily living.
·She is unable to cook as she did before. In fact, over recent years, she has not been able to cook at all. Her son prepares the majority of the meals.
·She has been unable to knit or crochet since the accident.
·Fine movements of her right arm are impossible.
·She does not go out dancing nor socialises as before and her social life has deteriorated.
·She has difficulty sleeping and often wakes during the night, particularly when she rolls onto her right side.
·She has suffered a psychological reaction with Anxiety and Depression and general emotional distress. She has become frustrated and short-tempered.
·After the subject accident, she had about six weeks away from her work as a carer. She returned to work in about August 2011 and worked, on average, about six hours a day until January 2016. She says she was unable to continue to perform her duties as she had before the subject accident. She had maintained her employment as she needed the money. She was finally forced to cease work earlier this year because she could not cope with the duties.
Medical opinions
32 I have referred to the opinions of Dr Shaw and various practitioners at the Western General Hospital.
33
Ms Armagan was examined by Mr Garry Grossbard, orthopaedic surgeon, in 2013 and 2015. When she first presented, she gave a history that she had never had a neck problem before the subject accident. Subsequently, she said that she had suffered a neck injury in 1997, but had fully recovered.
Ms Armagan complained of severe pain in the neck with right pain radiating into her right shoulder and forearm. She complained of a range of difficulties as outlined in her affidavit.
34
Mr Grossbard concluded that Ms Armagan had suffered a soft tissue injury in the presence of pre-existing underlying degenerative change, particularly at
C3-4 and C4-5, in the subject accident. Mr Grossbard said there was no evidence of radiculopathy either on clinical examination or radiological investigation. He thought that there was a psychological component affecting Ms Armagan’s level of incapacity. He noted discrepancies upon physical examination.[17] Mr Grossbard saw no need for surgical intervention. He said he believed Ms Armagan would have difficulty undertaking full activities as she had done prior to the subject accident and that her condition was stable.
[17]PCB 72
35
Mr David Brownbill, neurosurgeon, examined Ms Armagan in 2012 and 2015. She complained of ongoing neck pain, made much worse than before the subject accident. She said her “main problem” was electric shocks down her right arm. She also complained of regular headaches occurring every day. On examination, Mr Brownbill said there was no objective neurological abnormality in the right hand or arm. There was, further, no signs of radiculopathy. He thought that there was an emotional reaction to her presentation. He said
Ms Armagan had suffered a soft tissue injury in the subject accident on a background of pre-existing degenerative changes without objective neurological abnormality. He thought her ongoing neck pain had been significantly contributed to by the subject accident.
36 According to reports of Associate Professor Paoletti, psychiatrist, Ms Armagan had suffered an Anxiety Disorder and Adjustment Disorder, in respect of which the subject accident was a significant contributing factor.
37 Ms Armagan was examined on behalf of the defendant by Dr Peter Boys, orthopaedic surgeon, in December 2015. Dr Boys received a past medical history of Depression and some neck pain. Ms Armagan could not recall any right upper limb problems. She complained of right neck pain and restriction of movement. Further, there was pain down the right arm, elbow and forearm. She said her right arm felt swollen. There was occasional stiffness of the neck but no neurological signs on examination. Dr Boys observed a full range of motion of both shoulders, although with a complaint of discomfort. There was some restriction of neck movement. Dr Boys thought she had suffered a musculoligamentous strain to the neck as a consequence of the subject accident in the context of pre-existing degenerative changes. He said that the symptoms in her right arm were non-specific. Despite this, Dr Boys said that there were no symptoms which would prevent her resuming her employment and that psychological factors may impact upon any work capacity. Likewise, the condition did not prevent Ms Armagan undertaking her domestic activities.
38 As stated, Ms Armagan was referred back to Ms Cocking, clinical psychologist, in 2011. She complained of ongoing neck pain and problems with her wrist after the subject accident. She denied any mood disturbance.[18] She described active engagement in a range of activities. Ms Cocking said:
“Zehra’s presentation and description of her life was in stark contrast to the hopelessness, amotivation and sadness that she described in 2009.”[19]
[18]DCB 28-30
[19]DCB 28
39 According to the report, Ms Armagan denied that the pain in the neck and arm caused her any significant distress or impairment. Ms Cocking said:
“Feedback was offered Zehra that she describes significant improvement in her lifestyle and functioning when compared with her descriptions of 2009. In particular, it was noted that she is getting out of her house and engaging in community based activity, such as social interaction and work, and that she is enjoying having her children at home as this also provides her with a sense of purpose and meaning. Her more positive attitude was also identified as different as she reported that she makes effort not to focus on problems when they arise as this contributes to low mood and hopelessness.”[20]
[20]PCB 29
Conclusions
40
It is clear, in particular from the reports of Dr Shaw, the Western General Hospital and the neck x-rays of 2000 and 2009, that Ms Armagan had a significant problem with her neck and right arm well prior to the subject accident. There is clear evidence of degenerative disease at the C3-4 levels as early as 2000, with encroachment on to the neural exit foramen. Dr Shaw said that
Ms Armagan had musculoskeletal problems going back as far as 1998 and attended for symptoms of swelling and discolouration of her right arm in 2001. Dr Shaw said that the symptoms for which she sought treatment following the subject accident had been existing before that time.
41 Ms Armagan was also treated as early as 2002 at the Western General Hospital for complaints to her right hand, right arm and wrist which are very similar in description to those of which she subsequently complained. It was noted at the hospital she had these problems for five years.
42
Mr Morfuni, for the plaintiff, said it was important to assess the nature and extent of Ms Armagan’s condition as at the date of the application. He described
Ms Armagan as a credible and honest witness, giving a frank account of her problems. He accepted there were some discrepancies in the histories, but that was not unusual in cases such as this. Those discrepancies could be explained, in part, by lack of memory going back over a long period of time.
43 He emphasised that according to the records of Dr Shaw, the last consultation prior to the subject accident was in November 2009. There was, therefore, a period of eighteen or so months where Ms Armagan was not receiving any treatment, nor medication, and was able to carry out her activities as she wished. He said that position should be compared to the present, where she is being prescribed a range of strong pain-relieving medication and receiving a raft of treatment. He said the radiology confirmed the presence of degeneration which would give rise to the pain she claimed.
44 He said this was a somewhat unusual case, in that the bulk of Ms Armagan’s treatment since the subject accident was carried out by doctors at the Western General Hospital, rather than her general practitioner, Dr Shaw. He submitted that I should accept the opinions of Messrs Brownbill and Grossbard, whose opinions were favourable to the plaintiff. He submitted, that I should reject Dr Boys’ opinion. Despite having the same clinical picture available and the same radiology, Dr Boys came to a conclusion different to Mr Grossbard and Mr Brownbill. He said it was a measure of the nature and extent of the pain in her neck that she had been forced, since the subject accident, to undergo treatment from a psychologist for depression.
45 In assessing the extent to which the aggravation in the subject accident increased the pain and restriction in Ms Armagan’s neck, it is necessary to assess her evidence. Ms Armagan was not a satisfactory witness. I have reservations as to her credibility and the extent to which I can rely upon the statements made in her affidavit and the histories to the doctors. I found her unresponsive in her answers in cross-examination.
46 Despite reference in her affidavit to the neck injury suffered in the first accident and the pain and the restriction caused as a result, to a number of doctors she provided a different history. Initially, to Mr Grossbard, she said she had never had a neck problem.[21] Her description to Mr Brownbill that after the first accident she had intermittent neck pain, particularly in cold weather and for which she did not require ongoing medication, was comprehensively inadequate. To Dr Paoletti, the consultant psychiatrist, Ms Armagan denied any serious or chronic medical problems and gave a brief and inaccurate history of her psychological problems prior to the subject accident.[22] She gave a brief description of some past neck pain to Dr Boys but, again, the history was comprehensively inadequate. To Dr Doherty, psychiatrist, Ms Armagan said there were no unrelated medical conditions and no reference to the first accident.
[21]PCB 66
[22]PCB 94
47 Likewise, in the TAC Claim Form,[23] in answer to the question: “Before the accident had you ever suffered from any of the following conditions or problems? – Neck condition or pain”, Ms Armagan answered: “No”.
[23]DCB 35
48 From these histories I conclude that Ms Armagan was intentionally underplaying the nature and extent of her pre-existing neck and arm problems clearly evident from the reports of the treating practitioners. Repeatedly, in the course of cross-examination, she denied or played down the nature and extent of her previous neck, right arm and psychological problems.[24]
[24]Transcript 10, Line 18
49 I do not accept Ms Armagan’s evidence in the course of re-examination, that after the visit to her general practitioner in November 2009, she suffered no neck pain up to the time of the subject accident. Were that the case, I would expect there to be some reference to that fact in the reports of Dr Shaw. Rather, Dr Shaw referred to a “long history of upper back and neck pain”[25] and “intermittent upper back, neck, shoulder and arm pain dating back to at least 1998”.[26]
[25]PCB 32
[26]PCB 32
50
The description by Ms Armagan of “electric shock” type pain down her right arm would appear to have commenced sometime around 2012. For that, she was prescribed medication. It is difficult to see, in the absence of any radiology, any connection between that pain and the neck injury suffered in the subject accident. In fact, the surgeons who have assessed Ms Armagan,
Mr Grossbard and Mr Brownbill, each note the lack of clinical and radiological support for the complaints of pain, paraesthesia and other symptoms in the right shoulder and arm. In particular, Mr Brownbill noted discrepancies upon clinical examination. In any event, the complaints of problems in the right arm bear strong similarity to those recorded by Dr Shaw and the Western General Hospital well prior to the subject accident. There does not appear to have been any clear diagnosis in relation to the problems in her right shoulder and arm. All the investigations of those areas have shown no abnormality.
51 In relation to Ms Armagan’s employment, she resumed work after a period of recovery from the subject accident, working similar hours to that which she worked before May 2011. Ms Armagan was taken to notes of a person from her employer, Home Instead Senior Care,[27] and it would appear there is no record of her suffering any problems in the course of her work after the subject accident. In fact, the notes suggest that Ms Armagan was interested in further shifts. I reject her evidence that there was any significant restriction in her employment after the subject accident.
[27]Transcript 21-23
52
In my view, of most significance are the reports of the treating practitioners who have known and assessed Ms Armagan over a considerable period, the general practitioner, Dr Shaw, and the psychologist, Ms Cocking. It is plain from
Dr Shaw’s reports that Ms Armagan had problems with her neck and right arm over twenty years. Dr Shaw does not record any significant increase in her symptoms after the subject accident. To the contrary, in Dr Shaw’s report of
5 February 2013, when she reviewed Ms Armagan in June 2011, she had a full range of neck movements, and Dr Shaw said there appeared to be no ongoing physical issues.
53
It is clear from the radiology, including the cervical spine x-rays taken in 2000 and 2009, that there was pre-existing degenerative change, in particular at
C3-4 and C4-5. The report of the Western General Hospital of 2002[28] noted complaints of swelling and discolouration of the right wrist persistent for five years prior to that time. The report of that hospital of September 2015,[29] despite attendances prior to the subject accident, made no reference to cervical problems before the 2011 accident. In fact, upon presentation, Ms Armagan described “a three-year history of neck pain and right-sided brachialgia which she dated to a motor vehicle accident in 2011”.[30] That is clearly an inaccurate history.
[28]PCB 45
[29]PCB 59
[30]PCB 59
54
Of further significance is the report of Ms Cocking. Ms Armagan was treated by Ms Cocking in 2009 and described a long history of depressive and anxiety symptoms, including several suicide attempts. When Ms Armagan was sent for further treatment by Ms Cocking after the accident in September 2011,
Ms Cocking noted Ms Armagan was actively engaged in a range of activities with increased energy and motivation. Ms Cocking concluded that the presentation was in “stark contrast” to the hopeless and sad situation described in 2009. Further, Ms Cocking obtained a history that the chronic pain in
Ms Armagan’s arm/wrist was not significant at that time.
55
It is necessary for me to be satisfied, the onus being with the plaintiff, that the consequences arising from the aggravation suffered in the subject accident meets the “very considerable” test. Given the matters to which I have referred, I am not satisfied that the aggravation to the underlying degenerative changes in the cervical spine caused in the subject accident significantly increased the pain and restriction to that area, or caused any major alteration to the problems
Ms Armagan had been suffering in her right arm, wrist and hand. I am not satisfied that the consequences arising from the injury suffered in the subject accident, in terms of the effect upon her domestic, recreational, social or work-related activities, achieve the level required. In those circumstances, the plaintiff’s application fails.
56 I shall make consequent Orders.
- - -
0
0
0