Cadden v Prestige Racehorse Transport Pty Ltd

CERTIFICATE OF DETERMINATION OF MEMBER
CITATION:	Cadden v Prestige Racehorse Transport Pty Ltd [2025] NSWPIC 255
APPLICANT:	Phillip Mark Cadden
RESPONDENT:	Prestige Racehorse Transport Pty Ltd
MEMBER:	Cameron Burge
DATE OF DECISION:	5 June 2025
CATCHWORDS:	WORKERS COMPENSATION - Permanent impairment compensation; whether applicant suffered injury to his sciatic nerve in addition to accepted work-related injuries to his right upper and right lower extremities; whether applicant also suffered complex regional pain syndrome (CRPS); whether an injury to the applicant’s right sciatic nerve forms part of the injury to the right lower extremity; Held – applicant suffered injury to his right sciatic nerve which will therefore form part of the referral for medical assessment of the right lower extremity; (by consent) the question of whether the applicant meets the criteria for CRPS is properly a matter for a Medical Assessor (MA) to consider; matter remitted to the President for referral to a MA to determine the permanent impairment of the applicant’s right lower extremity and right upper extremity.
DETERMINATIONS MADE:	The Commission determines: 1. Leave is granted to the applicant to discontinue the claims in respect of the left lower extremity, left upper extremity and lumbar spine. 2. The matter is remitted to the President for referral to a Medical Assessor to determine the permanent impairment arising from the following: Date of injury: 16 August 2016. Body system preferred: right lower extremity including sciatic nerve and complex regional pain syndrome (if clinically found), and consequential condition to the right upper extremity including complex regional pain syndrome (if clinically found). Method of assessment: whole person impairment. 3. The documents to be referred to the Medical Assessor to assist with their determination are to include the following: (a) this Certificate of Determination and Statement of Reasons; (b) Application to Resolve a Dispute and attachments, and (c) Reply and attachments. A brief statement is attached setting out the Commission’s reasons for the determination.

STATEMENT OF REASONS

BACKGROUND

On 16 August 2016, Phillip Mark Cadden (the applicant) suffered an injury in the course of his employment as a stable hand with the respondent, Prestige Racehorse Transport Pty Ltd.
On that occasion, the applicant slipped and fell while walking down the ramp of a horse float.
There is no question the applicant suffered an injury to his right lower extremity (ankle) in the fall at issue. He also suffered a consequential condition to his right upper extremity. As a subset of the injury to his right lower extremity, the applicant also claims injury to his right sciatic nerve. That alleged injury is disputed.
The applicant also alleges injury in the nature of complex regional pain syndrome (CRPS) in his right lower extremity and right upper extremity. The parties agree the question of whether the applicant's injury satisfy the clinical requirements for CRPS is a question for a Medical Assessor, not the Personal Injury Commission (Commission) constituted by a Member.
Accordingly, regardless of the outcome of the liability dispute concerning the right sciatic nerve, the right lower extremity and right upper extremity will be referred for medical assessment, including an assessment of whether the applicant's injuries to those body systems also fit within the clinical guidelines for CRPS.

ISSUES FOR DETERMINATION

The only issue for determination is whether the applicant suffered an injury to his right sciatic nerve in the incident at issue.
If that question is resolved in the affirmative, the sciatic nerve will be included in the referral of the right lower extremity.
As noted, regardless of the outcome of this dispute, each of the right lower extremity and right upper extremity will in any event be the subject of medical assessment, including a determination by a Medical Assessor as to whether the applicant suffers from CRPS.

PROCEDURE BEFORE THE PERSONAL INJURY COMMISSION

I am satisfied that the parties to the dispute understand the nature of the application and the legal implications of any assertion made in the information supplied. I have used my best endeavours in attempting to bring the parties to the dispute to a settlement acceptable to all of them. I am satisfied that the parties have had sufficient opportunity to explore settlement and that they have been unable to reach an agreed resolution of the dispute.
The parties attended a hearing before me on 3 June 2025. The applicant was represented by Mr Adhikari of counsel instructed by Mr Tucker. The respondent was represented by
Mr Stiles of counsel instructed by Ms Hales.
At the hearing, the applicant discontinued the pleaded claims in relation to the left lower extremity, left upper extremity and lumbar spine. The parties agreed that this being the case, the only issue for determination by the Commission was whether the applicant suffered an injury to his sciatic nerve in the fall at issue.

EVIDENCE

Documentary evidence

The following documents were in evidence before the Commission and considered in making this determination:
(a) Application to Resolve a Dispute (the Application) and attachments, and
(b) Reply and attachments.

Oral evidence

There was no oral evidence called at the hearing.

FINDINGS AND REASONS

Whether the applicant suffered an injury to his right sciatic nerve in the fall at issue

By way of background, there is no issue the applicant suffered an injury to his lumbar spine whilst working with a previous employer in 2008. That injury was the subject of proceedings in the then Workers Compensation Commission where, on 22 July 2009, a Medical Assessment Certificate (MAC) was issued, assessing the applicant as suffering a 16% whole person impairment to his lumbar spine.
In his statement, the applicant gives the following uncontested evidence in relation to that injury:
“20. I sustained an injury in 2008 at a previous workplace when I was working for Peter Snowden at Darley. During this incident, another horse ran into the horse I was mounted on, and I fell off and landed on my back. Due to this, I underwent a laminectomy at L4 and L5 on 29 February 2008. I lodged a workers compensation claim with Racing NSW and the claim number was 0800242. I instructed Law Partners to resolve a personal injury claim and in 2012, I received lump sum compensation at 16% for this injury.”
The applicant further stated that he fully recovered from the 2008 injury and had no ongoing issues before the incident at issue.
At the time of the injury at issue, the applicant was working as a yard hand for the respondent approximately 30 to 36 hours per week. His evidence is he was able to attend to those duties pain free and without any issues.
There is little issue the applicant had prior problems in the nature of sciatica after the 2008 fall. In a referral to Dr Dubenec, the applicant's general practitioner (GP) Dr Patel provided a history of sciatica against the background of L4/L5 disc prolapse on the right-hand side as a result of the previous fall. In 2013, the applicant suffered left-sided disc prolapse at L5/S1 with associated sciatica. It is noted the left sciatic nerve is not the subject of these proceedings.
Mr Adhikari submitted, and I accept, there is no suggestion of right-sided sciatica beyond the comparatively immediate aftermath of the 2008 fall. I accept there is no issue the applicant was able to carry on work once he had recovered from his laminectomy, and that at the time of the injury at issue he was carrying out normal duties without any difficulties related to his lumbar spine.
On 16 August 2016, the applicant was working as a stable hand with the respondent when he suffered an injury in circumstances which he describes as follows:
“24    [The] truck had to be moved so that the interstate driver could put his truck there to get it washed. I was going to move Holgate's truck; but it had all the internal partitions opened from the night before, with the door ramp left open. I went to close the partitions so I could move the horse truck (float). When I was walking down the flight ramp, I slipped and fell down the ramp. I almost felt like a slippery dip. And my right ankle twisted, and I ended up with the top of my right foot on the ground whilst my left foot was still inside the back of the float. I had done the splits. I could not bring my left leg underneath me to stop the fall in time and I fell towards the right side, sliding down the door until I was laying on my back.
25.    I felt a crack in the right foot when I fell, I then tried to get my left foot and right foot back together to sit up. I was screaming in pain, trying to yell out to the interstate truck drivers until they were able to come and help me out…
28.    At first the pain was sharp, I think because the crack and the adrenaline were going through me. But after we had waited for the ambulance and I was able to take my boot off, the pain became crushing and unbearable. It felt like it was in a vice, it was swelling and continuously throbbing.
29.    John Holgate reported my injury straight after it happened just after 12 noon on 16 August 2016. He was the second person to help me.
30.    John Holgate then drove me to the Bligh Park Family Medical Centre and left me there. I called my wife, Linda, and she took me to the doctors. I saw my GP, Dr Snehal Patel and he sent me for an x-ray and ultrasound to look at the right ankle, foot and from the knee down at Castlereagh Imaging at Windsor.
31.    Their scans revealed that I suffered from a fractured right ankle because of a stretched sciatic nerve that caused damage to the common peroneal branch at the right sciatic nerve and the distal tibial branch…
33.    My foot felt like it had been crushed, and my spine ached but when I spoke of this no one listened to me except Dr Patel. He had realised that the spine was the point of impact whilst my right leg had twisted as I fell.”
The applicant relies on both treating and independent medical examiner (IME) evidence in support of his claim of an injured sciatic nerve. Mr Adhikari noted there had been a marked deterioration in the applicant's condition since the injury at issue, which he submitted was due to not only the fractured ankle, but to the sciatic nerve injury and CRPS.
It is timely to note the alleged nerve injury is referred in the medical evidence almost interchangeably as having occurred to the peroneal nerve and/or sciatic nerve. It should be noted that in his report dated 28 June 2024, the applicant's IME A/Prof Boesel stated the applicant suffered “a distal fibular fracture with the development of an injury to the peroneal branch of the sciatic nerve.” It therefore appears, and the point was not challenged when the issue was raised, that the peroneal nerve is in fact a subset of the sciatic nerve structure, and accordingly if there is a finding of injury to the peroneal nerve branch, it would satisfy a finding of injury to the sciatic nerve.
There is no issue that at a point following the injury at issue, the applicant began to develop foot drop. There is also no question the development of such condition is consistent with sciatic/peroneal nerve damage. However, such damage is not the exclusive cause of a condition in the nature of foot drop, which can also be brought about by trauma to the foot or ankle, spinal cord injuries, tumours or cysts or inflammatory conditions, to name but a few sources of aetiology.
Mr Stiles attacked A/Prof Boesel's opinion as failing to point to objective evidence of sciatic nerve damage in support of his diagnosis. Mr Adhikari submitted the objective evidence was A/Prof Boesel's examination of the applicant, together with the history taken of injury which was accurate.
When he examined the applicant, A/Prof Boesel noted he was wearing a foot drop support; dorsiflexion of the foot and dorsiflexion of the hallux was 2/5 with sensory impairment in the superficial peroneal distribution. It was this finding which led to A/Prof Boesel's diagnosis of injury to the peroneal branch of the sciatic nerve.
In his report, A/Prof Boesel indicated the sciatic nerve injury led to the development of CRPS.
Mr Stiles submitted that absent a definitive radiological finding from, for example, an MRI of the sciatic nerve or some other radiological investigation, A/Prof Boesel's diagnosis was not reliable.
However, this is not necessarily the case, and in this matter, there are a number of clinical entries which support A/Prof Boesel's diagnosis.
The applicant's evidence, uncontested as it is, concerning his right lower extremity and any ongoing effects on it is as follows:
“121. My right foot drop/sciatic nerve injury occurred from the incident on 16 August 2016. My foot has always been the same since this incident. It has always felt like it has been in a vice, being squashed. From the time of my injury, I was unable to put any weight on my foot and when I walk, I drag my foot throwing it to the side all the time. This caused me to become unbalanced. My toes would scrape along the ground. My left foot started to compensate for my right foot but once I got my prosthesis, it helped until the left leg started to mimic the right leg.”
Among the practitioners to whom the applicant was referred for treatment was Dr Mohabbati, pain specialist. In a clinical entry dated 30 October 2023, he noted the applicant suffered from chronic low back pain, bilateral leg pain greater on the right together with right leg CRPS.
In a later entry, Dr Mohabbati indicated the applicant had had good outcomes from a spinal cord stimulator trial.
Dr Mohabbati provided a report to the applicant's general practitioner on 7 June 2023, in which examination results showed multilevel degenerative changes, facet arthrosis, disc bulges and foraminal stenosis throughout the applicant's lumbar spine. Mr Adhikari submitted that the findings in relation to the applicant's lumbar spine were consistent with sciatic nerve injury.
The applicant was admitted to Kempsey Hospital on 22 February 2023, having relocated from Sydney. The applicant was complaining of a dull ache and cramping in his chest. The clinical records noted the applicant as allegedly suffering from CRPS “due to injured peroneal nerve secondary to broken foot in accident many years ago.” At the time of his examination in hospital, the applicant had his spinal cord stimulator in situ.
Mr Adhikari also relied on nerve conduction studies which were carried out following the injury at issue, on 3 March 2017.
The conclusions of those nerve conduction studies are as follows:
“The lower limb nerve conduction and EMG studies show:
·Mild right sural nerve dysfunction which may be related to the ankle fracture.
·Although there is no evidence of common peroneal nerve lesion across the fibular neck on nerve conduction study, EMG did show chronic neurogenic changes in the muscles innervated by that nerve; suggest MRI scan of the common peroneal nerve around the fibular neck if clinically indicated.
·Bilateral superficial peroneal sensory nerve dysfunction may be due to technical reasons; however, a superimposed mild sensory axonal peripheral neuropathy cannot be fully excluded; therefore, a repeat lower limb nerve conduction study in 12 months’ time is recommended.”
Mr Stiles submitted this study, referring as it did to a possible peroneal nerve lesion was not definitive evidence of injury. Mr Adhikari, by contrast, submitted it was strongly indicative of such an injury.
The nerve conduction studies also point to sural nerve dysfunction possibly related to the fracture injury. Relevantly, the sural nerve is also a sensory branch of the sciatic nerve. As such, if there is an injury to this nerve, it would also satisfy the requirements of injury to the sciatic nerve.
For the respondent, pain specialist Dr Gorman, provided two reports, in January 2023 and January 2025 respectively. In his first report, Dr Gorman agreed with the findings of Dr Russo, also an IME of the respondent, who diagnosed “widespread central sensitisation” without the clinical signs of CRPS. In his second report, Dr Gorman maintained that diagnosis. In that report, Dr Gorman opined as follows:
“While he has some sensory change over L5 and S1 distributions on the right there is no weakness, wasting nor definite reflex change – a sciatic nerve injury cannot be diagnosed now and, if diagnosed, it is more likely related to the previous lumbar injury.
He has restricted movement in the right ankle likely due to neuropathic pain caused by both the superficial peroneal and sural neuropathic pain on movement as well as calf muscle contraction which has developed.”
I do not accept Dr Gorman's view that the 2008 injury was causative of any ongoing sciatic injury as at the date of Dr Gorman’s examination. The uncontested evidence of the applicant is he was able to carry out his duties without lumbar spine pain until the injurious event at issue, from which time he has clearly had a serious and ongoing decline in his condition.
As for the central question, as to whether there is or there was a sciatic injury, in my view the preponderance of the evidence supports a finding that there was.
As noted, both the sural nerve and peroneal nerves are subsets of the broader sciatic nerve structure. Taking into account the totality of the evidence, when one examines the clinical records from Kempsey Hospital, the nerve conduction studies, the views of the applicant's GP and his IME A/Prof Boesel, the applicant has discharged on the balance of probabilities the evidentiary onus of establishing an injury to his sciatic nerve.
Such a finding is also consistent with the applicant's evidence of the mechanism of his fall, and the longstanding symptoms which he has suffered ever since the accident at issue.
In my view, the evidence in this matter is clear. The applicant has suffered an injury to his sciatic nerve. Accordingly, that injury will form part of the referral of the applicant's right lower extremity to a Medical Assessor for determination of the applicant’s whole person impairment.
As noted, the question of whether the applicant satisfies the clinical requirements for CRPS is within the providence of a Medical Assessor rather than a Member of the Commission. Accordingly, I make no finding as to whether that is the case.

SUMMARY

For the above reasons, the Commission will make the findings and orders set out on page 1 of the Certificate of Determination.

[2025] NSWPIC 255

5 June 2025