Corfield and Australian Postal Corporation - [2000] AATA 533

DECISION AND REASONS FOR DECISION [2000] AATA 533

ADMINISTRATIVE APPEALS TRIBUNAL      )
  )           No N1998/1250
GENERAL ADMINISTRATIVE DIVISION          )                N1998/1251
           Re      PAUL PETER CORFIELD
  Applicant
           And    AUSTRALIAN POSTAL CORPORATION
  Respondent

DECISION

Tribunal Ms G Ettinger, Senior Member

Date30 June 2000
PlaceSydney

Decision      The Administrative Appeals Tribunal ("the Tribunal") affirms the decision of the Reconsideration Officer, Australian Postal Corporation dated 18 August 1998 which affirmed the decision of the Australian Postal Corporation dated 1 July 1998 to decline liability to pay further compensation to the Applicant Mr Paul Peter Corfield on and from 1 July 1998 with regard to his left knee injury sustained at work on 2 March 1993. The Tribunal affirms the decision of the Reconsideration Section, Australian Postal Corporation (undated) which affirmed the decision of the Australian Postal Corporation dated 11 March 1998 to refuse payment to the Applicant for the travel expenses incurred in attending physiotherapy at the McConnell practice on and from 13 March 1998.
  ..............................................
   Ms G Ettinger
  Senior Member
CATCHWORDS
Compensation - soft tissue knee injury at work - causation - extent of disability not commensurate with level of impact sustained - aggravation raised but not argued –costs of attending specialist knee physiotherapy program held not to be reasonable costs (s16) - decisions affirmed

LEGISLATION
Safety Rehabilitation and Compensation Act 1988 ss 4, 14, 16 and 19

REASONS FOR DECISION

30 June 2000 Ms G Ettinger, Senior Member

There were two decisions under review before the Administrative Appeals Tribunal ("the Tribunal").

In the matter N1998/1250, the decision under review was the decision of the Reconsideration Officer of the Australian Postal Corporation dated 18 August 1998 which affirmed the decision of the Australian Postal Corporation dated 1 July 1998 denying liability to pay further compensation to the Applicant Mr Paul Peter Corfield on and from 1 July 1998 with regard to his left knee injured at work on 2 March 1993.
In the matter N1998/1251 the decision under review was the decision of the Reconsideration Section of the Australian Postal Corporation (undated), which affirmed the decision of the Australian Postal Corporation dated 11 March 1998 to refuse payment for the travel expenses incurred in attending physiotherapy at the McConnell practice on and from 13 March 1998.

The Applicant, Mr Paul Peter Corfield, was represented by Mr J Graham of counsel and the Respondent, Australian Postal Corporation, by Ms R Henderson of counsel. Oral evidence was given by the Applicant, Mr Corfield, Dr S Dalton, rehabilitation physician and Dr S Sorrenti, orthopaedic surgeon. Dr B Casey, consultant orthopaedic surgeon, gave evidence by telephone.
ISSUES BEFORE THE TRIBUNAL
The issues before the Tribunal were:
(a) whether the Applicant continued to suffer from a compensable injury within the terms of section 4 of the Safety Rehabilitation and Compensation Act 1988 ("the Act"), on or after 1 July 1998 in respect of his left knee injury arising out of and in the course of his employment with the Respondent Australian Postal Corporation on 2 March 1993; and
(b) whether the Respondent was responsible for travel expenses pursuant to section 16 of the Act for Mr Corfield to attend physiotherapy at the McConnell practice in Mosman in connection with his left knee injury on or after 13 March 1998.

LEGISLATIVE FRAMEWORK

The relevant legislation in this matter was the Safety Rehabilitation and Compensation Act 1988, ("the Act"), in particular sections 4, 14, 16 and 19.
Section 4 of the Act defines "disease" and "injury" and follows as relevant:
"4. (1) In this Act, unless the contrary intention appears:
...
"disease" means:
  (a)       any ailment suffered by an employee; or
  (b)       the aggravation of any such ailment;
being an ailment or an aggravation that was contributed to in a material degree by the employee's employment by the Commonwealth or a licensed corporation;
...
"injury" means:
(a)      a disease suffered by an employee; or
(b)an injury (other than a disease) suffered by an employee, being 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), being an aggravation that arose out of, or in the course of, that employment;
but does not include any such disease, injury or aggravation suffered by an employee as a result of reasonable disciplinary action taken against the employee or failure by the employee to obtain a promotion, transfer or benefit in connection with his or her employment;
..."

Section 14(1) of the Act provides that:
"Compensation for injuries
14. (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."
Section 16 of the Act provides for compensation in respect of medical expenses.
"16 (1) Where an employee suffers an injury, Comcare is liable to pay, in respect of the cost of medical treatment obtained in relation to the injury (being treatment that it was reasonable for the employee to obtain in the circumstances), compensation of such amount as Comcare determines is appropriate to that medical treatment.
(6) Subject to subsection (7), if:
(a)   compensation in respect of the cost of medical treatment is payable; and
(b) the employee reasonably incurs expenditure in doing either or both of the following:
(i) making a necessary journey for the purpose of obtaining that medical treatment;
(ii)remaining, for the purpose of obtaining that medical treatment, at a place to which the employee has made a journey for that purpose;
Comcare is liable to pay compensation to the employee:
        …
(7) Comcare is not liable to pay compensation under subsection (6) unless:
(a) the reasonable length of such a journey as it was necessary for the employee to make (including the return part of the journey) exceeded 50 kilometres; or
(b)   if the journey made by the employee involved the use of public transport or ambulance services—the employee's injury reasonably required the use of such transport or services regardless of the distance involved.

(8) The matters to which Comcare shall have regard in deciding questions arising under subsections (6) and (7) include:
(a) the place or places where appropriate medical treatment was available to the employee;
(b) the means of transport available to the employee for the journey;
(c) the route or routes by which the employee could have travelled; and
(d) the accommodation available to the employee."

Section 19 of the Act provides that:
"19. (1) This section applies to an employee who is incapacitated for work as a result of an injury, other than an employee to whom section 20, 21, 21A or 22 applies."

EVIDENCE BEFORE THE TRIBUNAL

The Tribunal had before it documents lodged pursuant to section 37 of the Administrative Appeals Tribunal Act 1975 ("the T-documents") and the following other exhibits:
ITEM DATE NAME
Medical report of Dr S Sorrenti     6 October 1998       Exhibit A1
Medical Report of Dr S Sorrenti    8 December 1999    Exhibit A2
Operation report of Dr D Dickison           10 September 1996 Exhibit R1
Clinical Notes of Drs Spicer and Aziz      21 January 1986 – 14 April 1999 Exhibit R2
Medical report of Dr S Dalton       15 October 1999     Exhibit R3
Operation report of Dr D Dickison 25 July 1995 Exhibit R4
Diagram of the longitudinal section through the middle of the right knee-joint  Exhibit R5

EVIDENCE OF MR PAUL PETER CORFIELD THE APPLICANT

Mr Corfield, whose date of birth was 1 November 1964, and who is single, gave oral evidence that he joined the Australian Postal Corporation at the end of 1990 or in early 1991 as a mail sorter. He said he had been a picture framer for the previous ten years, and had not suffered any injuries. He had played golf and tennis and enjoyed good general health.
In cross-examination, Mr Corfield was asked about his hobby of riding motor cycles. He indicated that he had ridden motorcycles for many years and still owned a Triumph, but that he could barely bend his left knee and now barely get onto it. In this respect, I noted the comments of Dr Dickison at T53 regarding the Applicant's desire to be reassigned from a mail sorter to a postman. Dr Dickison recommended that Mr Corfield
"would be best suited for the motor bike type runs rather than the full walking runs … obviously in the starting phase it would have to be in a controlled manner to see if the knee does hold up, but I feel confident that he should do well."
When cross examined about Dr Spicer's record regarding a motorcycle landing on his left leg in June 1986 which documented that he had pain in his tibia and a swollen calf, Mr Corfield agreed reluctantly, and replied "yeah probably". The bike had been a Ducati 500. Mr Corfield said he did not recall whether his leg was bent or straight when he fell off the motorcycle.
When asked whether he felt he should have disclosed that accident to doctors in connection with his claim, Mr Corfield said that the fall had no connection with what he was suffering with regard to his left knee.
Mr Corfield was also asked why he had not disclosed to doctors with regard to the claim the fact he had hurt his left ankle, and had been on crutches after falling from a bar stool at an RSL Club. He was also questioned with regard to a fall from a motorcycle on 18 April 1993 which he said he did not recall. The Applicant said that he last rode a motorcycle in November of the previous year to get it registered.
Mr Corfield said that before the incident of 2 March 1993, he used to sit at a steel table to sort mail. He said that he had no previous injuries and his general health was good. He said that on 2 March 1993, at approximately 2:00 or 3:00 am, while on night shift, he turned around on his swivel chair and struck his knee-cap, (patella), on the table at which he was sitting. He said that he felt pain around the knee-cap which swelled, so he finished his shift, filled in an incident report and attended the surgery of his general practitioner, Dr Spicer, where he was seen by Dr Aziz. He said he could not remember ever having bumped his knee before. Mr Corfield said that he was paid for his time off work.
In cross-examination, Mr Corfield was reminded that his doctor did not record any swelling in his knee with regard to the incident in March 1993. He answered that "it puffed up as soon as I hit it."
I noted that Dr Aziz (of Dr Spicer's practice) had recorded as follows on 2 March 1993:
"nil effusion … limping gait but full movements … m/c… crepe bandages"

The medical certificate was to give Mr Corfield time off work for two days, until 5 March 1993.

When cross-examined about why he did not say anything about his left knee between 1993 and 1995 to doctors he consulted for other problems, Mr Corfield replied that "I just put up with the pain." I noted that the first visit in those years where any record was made with regard to the left knee was Dr Spicer on 30 May 1995.
Mr Corfield said that for the next couple of years he worked full hours but was always conscious of the pain, which became worse. He said that he could not play golf during that period, and found walking painful. Dr Spicer referred him to Dr Dickison, orthopaedic surgeon, in mid-1995. The Applicant said that he had an arthroscopy in July 1995, and had a month off work. On his return he again worked full time and had a further arthroscopy carried out by Dr Dickison in October 1996 – I noted that Mr Corfield did not have a good recollection of dates and events and that the second arthroscopy was, in fact, conducted by Dr Dickison on 10 September 1996. Mr Corfield described this as a "lateral release". He was off on compensation for a month and a half he said. He said that his left knee was tender and had never been the same since.
In mid-1997, Dr Dickison arranged for an MRI scan. Mr Corfield said that he "put up with the pain", worked and had some time off. He said that in 1997 he was working six hours a day.
Mr Corfield said that between 1995 and 1999 he was sore, and attended a physiotherapist, Peter Ho, which helped in the short term. Mr Corfield also said that he attended physiotherapy with Nicole Clements at Mosman, which involved four hours of travelling per session and that he had, since March 1998, been paying his own bills. He agreed that he had been taught strapping of the knee and the McConnell exercises, the full routine taking 10 to 15 minutes. He said he did the exercises now and then.
On 2 February 1998, Mr Corfield underwent a further arthroscopy and chondroplasty and had further treatment. He said that he was off work on compensation for one to one and a half months. In April 1998 he resumed sorting duties on restricted hours (four hours) on a return to work program which had increased to six hours a day by 15 October 1998. Mr Corfield said that he stood the whole time during the time of the four hour shift, and that by the end of the shift his leg "swells – blows up like a balloon." Mr Corfield said that his sorting table had been raised so that he could sort mail standing up. The Applicant said that he could no longer do things he could before like walking down the street.
When questioned about the 1998 operation, the third on his knee, Mr Corfield said that it gave him some relief but he had pain and throbbing and could not bend his knee. The Applicant said that he could just manage a six hour shift but that he still suffered pain and saw his general practitioner for painkillers although he did try to stay off those. He said that he consulted Dr Sorrenti six monthly and attended the physiotherapist at Mosman. Mr Corfield said that this afforded temporary relief but that the Respondent had not paid for medical expenses since March 1998.
When questioned about whether the area of the pain had changed over the years, Mr Corfield said that his patella was sore and that he had numbness and pain over the whole leg, the top and front of the leg, more so on the "outside." He said that he had always felt the numbness.
When questioned about the mode of transport he used to attend work, Mr Corfield said that he could drive three, or at times, five kilometres, and that he had used a motorcycle in the past. He said that he had had a few different cars, and had owned a four wheel drive for the past eight or nine months. The Applicant said that although he suffered pain driving a manual car, his present car was a manual, and had a light clutch.
When questioned about leisure activities, Mr Corfield said that he went fishing every two to four weeks in rivers and from pontoons. He had had a runabout in the past. He said whilst fishing he sat with his leg straight, and needed to move after about half an hour.
EVIDENCE OF DR B CASEY CONSULTANT ORTHOPAEDIC SURGEON
Dr Casey, whose report of 15 May 1998 was before the Tribunal at T100, gave oral evidence by telephone link. The second arthroscopy report of Dr Dickison was read to him (Exhibit R1).
"With the arthroscope the patella seems to have Grade I change with softening. There appeared to be some significant lateral overhang of the patella. The medial compartment, lateral compartment, medial meniscus and lateral meniscus were normal. The lateral femoral condyle tibial plateau did demonstrate some Grade II changes. Anterior cruciate ligament normal.
Lateral release performed using Glycine fluid. Tourniquet released, haemostasis checked. Drain inserted."

Dr Casey said that Dr Dickison had released the patella which was tight due to a constitutional condition, and therefore "maltracking."
A history of Mr Corfield's accidents was put to Dr Casey who opined from what he had heard, that the injury the Applicant had suffered on 2 March 1993 had not been severe, and he said, relying on the record of Dr Aziz, had settled within approximately five days. He noted that the motorcycle accident in 1993 had been with regard to the right leg.
When cross-examined about Dr Aziz's record dated 7 March 1993, Dr Casey said that he understood Mr Corfield had taken time off work after the incident of 2 March 1993, and had improved after five days. He said that Dr Aziz had recorded no effusion had occurred.
Dr Casey opined that there was a lack of correlation between the CT and MRI scan results relating to Mr Corfield, and the physical examination.
Dr Casey then told the Tribunal about chondromalacia patellae, which may occur if the patella maltracks. Maltracking he said was constitutional, inherent in the anatomy of an individual. He did concede that it could be precipitated by injury, remarking that in Mr Corfield's case, the claimed trauma had been minor. He said that he expected the Applicant to be able to cope with standing and doing his job if there was not a lot of lifting and twisting involved.
Dr Casey remarked on the physiotherapy program in which Mr Corfield was involved, the McConnell program, and said that it was widely available, and that many people did the exercises themselves. He remarked that in any case, the Applicant was not being treated by Ms McConnell but by one of the other people there. He opined that "any competent physiotherapist should be able to do it."
Remarking on the numbness experienced by Mr Corfield, Dr Casey said that this was referred from the back, probably the low lumbar spine.
Dr Casey concluded in his written report (PT100/127), that "I would regard the effects of the compensable condition as having ceased at the end of April 1993." He opined further:
"On the balance of probabilities, I would regard Mr Corfield's current condition as not attributable to the incident of 2.3.93."

EVIDENCE OF DR S DALTON REHABILITATION PHYSICIAN

Dr Dalton, whose report of 15 October 1999 was Exhibit R3 before the Tribunal, also gave oral evidence. Referring to the Applicant's incident on 2 March 1993, Dr Dalton noted from the report of Dr Aziz that there had been a mild swelling in the front of the kneecap, a lack of effusion which he said indicated that there was no swelling in the joint, and that the Applicant had improved between 2 and 7 March 1993. He said that this indicated there had been a mild blow to the front of the kneecap and a mild soft tissue injury which had responded with little intervention.
Dr Dalton echoed Dr Casey's comment that it was difficult to obtain an accurate history from Mr Corfield. Dr Dalton said that although Mr Corfield had told him the symptoms in his left knee had continued between 1993 and 1995, the details of these were not clear. Dr Dalton commented in his report (Exhibit R3), that Mr Corfield did not see Dr Dickison, the orthopaedic surgeon who performed the first two arthroscopies on his knee until 25 July 1995.
Dr Dalton opined that Dr Dickison, in his report of 25 July 1995, had reported a softening of the cartilage at the back of the knee cap. He said that this suggested degeneration and was not the result of direct impact. He opined that fourteen months later, the second arthroscopy indicated there had been progression of the degenerate condition, with Dr Sorrenti's operation in February 1998 (the third arthroscopy), indicating there had been further change. He noted Mr Corfield had a partial tear of the anterior cruciate ligament and that the incident of 2 March 1993 had not caused the tear or any joint effusion.

Dr Dalton opined in his report of 15 October 1999 that:
"Plain X-rays and a CT scan of this man's left knee dated 31.5.95 were essentially normal. A further CT scan of his knees dated 25.6.96 shows no significant patellar maltracking….
An MRI scan of his left knee dated 24.6.97 shows no evidence of chondromalacia patellae. There are changes of mild patellar tendonitis but no cystic degeneration and there is a suggestion of an old anterior cruciate ligament injury….
….this man has chondromalacia patellae which has been demonstrated at arthroscopy but such changes are unlikely to have resulted from the injury in question…
It is also my opinion that there is likely to be a considerable degree of functional overlay in this case."

Dr Dalton also opined that anterior knee pain was common in the population. It could occur spontaneously he said, and young adults suffered it without necessarily having a history of trauma. He said that there were people who had chondromalacia patellae and experienced no pain.
He said that he observed minimal muscle wasting in Mr Corfield, and that there were differences in tolerance towards pain between people. However, he opined that the Applicant exhibited functional overlay, pain behaviour, and was exaggerating his disability. He commented at Exhibit R3 about the Applicant's continuing complaints of anterior knee pain that limited his ability to squat, kneel and ascend and descend stairs. He opined:
"Reasons for this are complex but I do not believe that they can be adequately explained on the basis of the underlying pathology which has been demonstrated to date. The inconsistencies in his clinical examinations and other aspects of his history suggest that his prognosis may be dependent on factors not directly related to his medical condition."
Dr Dalton described Mr Corfield's disabilities as limited to squatting and stair climbing. He said that whether six hours of work a day was reasonable depended on the level of pain reported by the Applicant.
Dr Dalton said that his opinions on aggravation in his report of 15 October 1999 (Exhibit R3) were no longer valid in the light of the report of Dr Aziz, which he had not been shown until after he had written his report.
EVIDENCE OF DR D DICKISON ORTHOPAEDIC SURGEON
There were many reports of Dr Dickison, Mr Corfield's treating surgeon, in the T-documents before the Tribunal. The first of these was at T15 dated 1 June 1995. I have reviewed them all and quoted those which are most relevant to summarise the history of Dr Dickison's involvement with the Applicant.
It is clear that Dr Dickison was given a history which has now been shown to be inaccurate. He first saw Mr Corfield two years after the incident on 2 March 1993 and recorded:
"At that time he had quite a deal of swelling which was treated with NSAIDs and general exercises. Since that time he has had intermittent anterior knee pain which he finds is made worse by sitting…."
Clearly Dr Dickison did not have the benefit of the report of Dr Aziz before him as the Tribunal had had, because Dr Aziz recorded that the Applicant had presented with a limping gait but demonstrated a full range of movements and treated him by allowing two days off work and prescribing a crepe bandage. Dr Aziz had also recorded that there was no effusion.
Dr Dickison then operated on Mr Corfield on 25 July 1995. He recorded at T18:
"He had quite marked softening of the articular surface particularly affecting the medial half of the patella…. He also had an interesting tear affecting a small proportion of the anterior cruciate ligament anteromedial bundle."
On 18 June 1996, Dr Dickison wrote that he had arranged a bone scan and a CT scan, and due to continuing patellofemoral pain, he thought Mr Corfield may require an arthroscopic lateral release.
On 10 September 1996, Dr Dickison performed a further arthroscopy on the Applicant and he noted at T35 "there was a little scuffing on the lateral tibial plateau". He also said that the arthroscopy he performed involved a lateral release.
On 19 December 1996, Dr Dickison reviewed the Applicant and documented at T47 that the Applicant was:
"…having some problems with pain in the inferior pole area … he has occasional giving way of his knee and seizing consistent with patellofemoral type symptoms still. Clinically the patella is still tracking a little towards the lateral when he initiates flexion."
On 18 March 1997, (T48), Dr Dickison examined the Applicant and noted that he "has a near full range of motion but is tender along the lateral border of his patella."
Dr Dickison opined on 10 June 1997 (T50) that in "view of the patellar tenderness … it is important to exclude the possibilities of degenerative meniscal tears" and recommended that the Applicant undergo an MRI scan.
At T52, on 1 July 1997, Dr Dickison noted that the results of the MRI scan indicated:
"some mild patellar tendinitis (sic) possibly even an old anterior cruciate ligament tear … at the first arthroscopy he did have some scuffing around the anterior cruciate ligament but certainly no obvious instability … my clinical examination today demonstrates possibly a Grade I Lachman's compared with that of the right knee but not major laxity .. the patellar tendon is actually slightly tender and appears thickened around it compared with that of the right."
Dr Dickison, in his treatment of the Applicant during the period 1995 to 1997, recorded a history from Mr Corfield of tenderness over the patellar region together with limitation in walking, sitting and standing. I noted that after 1997, the Applicant was treated by Dr Sorrenti for his knee complaint.
EVIDENCE OF DR S SORRENTI ORTHOPAEDIC SURGEON
Dr Sorrenti, whose reports of 6 October 1998 (Exhibit A1) and 8 December 1999 (Exhibit A2) were before the Tribunal, gave oral evidence. Dr Sorrenti was one of Mr Corfield's treating surgeons and there were many other reports of Dr Sorrenti dating between 1997 and 1998 in the T-documents.
Dr Sorrenti had initially seen the Applicant on 25 September 1997. He reported on that day (T58):
"A history was obtained that in 1993, whilst working for Australia Post, he sustained an injury to his left knee. It was a simple matter of trauma, direct impact to his prepatella…. The reason for Paul seeing me, is that he has problems with his left knee. The major problem is pain and swelling with activity. He has difficulty going up and down stairs, kneeling and squatting."

I noted there was no mention of any difficulty with walking.

Dr Sorrenti also reported:
"He had the correspondence which was available from the treating doctor and also the latest MRI scan, which was done on the 24th June, 1997.
The MRI scan demonstrates no specific pathology in the knee. However, both clinically and historically the problems seem to be still one of chondromalacia patellae…. most likely Grade I-II."

Dr Sorrenti noted that Mr Corfield had undergone two operations before being referred to him. In his oral evidence he described the various "Grades" of chondromalacia patellae, opining that Mr Corfield had now reached Grade IV which was a progression from the time of the original injury.
Dr Sorrenti who had referred Mr Corfield to the McConnell physiotherapy program said that it was an internationally recognised program and described it as the "anterior knee pain centre of the world."
He said that in spite of the operations, Mr Corfield had not reported great improvement. He agreed in cross-examination that the trauma Mr Corfield suffered on 2 March 1993 may have been minor and did not necessarily lead to his chondromalacia patellae.
SUBMISSIONS AND CONCLUSIONS
Having heard and read all the evidence, I had to take into account the case law and legislation as well as the submissions of both parties to make the correct and preferable decision regarding Mr Corfield's compensation entitlements (section 4, 14, 19 of the Act), and the accompanying claim for travelling expenses to attend physiotherapy (section 16 of the Act).
I am mindful that the medical evidence before me indicated that Mr Corfield suffers chondromalacia patellae of the left knee. It was undisputed that he has undergone three arthroscopy operations in this regard, two performed by Dr Dickison, orthopaedic surgeon, which took place on 25 July 1995 and 10 September 1996, and a further operation by Dr Sorrenti, orthopaedic surgeon, on 2 February 1998. These were well documented and the doctors' reports were before the Tribunal.
The Applicant's evidence was that his knee pain and disability were the result of an incident on night shift during his work as a mail sorter on 2 March 1993. He gave evidence that he had swivelled around on his chair while sorting mail and struck his kneecap (patella) on the steel sorting frame at which he sat. The injury had occurred at work, and, during Mr Corfield's working hours. Liability had been accepted pursuant to the Act which had ceased on and from 1 July 1998 for the knee injury and 13 March 1998 for travel expenses incurred in connection with attendance at physiotherapy. My task was to consider whether the disability claimed could on and from 1 July 1998 still be held to be an injury within the terms of section 4 of the Act, and whether Mr Corfield could therefore be compensated for his loss of wages due to his shorter working hours. As discussed later in these reasons, I also considered whether Mr Corfield's claim for travel expenses to attend physiotherapy was compensable pursuant to section 16 of the Act on and from 13 March 1998.
Mr Graham submitted that Mr Corfield has suffered pain ever since the incident of 2 March 1993, with swelling of the knee area and numbness on his left side and that he continues to suffer that pain. He said that Mr Corfield had for the past year and a half had been working six hours per day five days per week.
Mr Graham emphasised that the Applicant had given evidence to the effect that he had suffered no other accidents implicating his left knee, and that his evidence in that regard had not been rebutted. From the evidence before me of the motorcycle accident the Applicant suffered in June 1986 which was raised at the Tribunal, and despite the Applicant's vague recollection of it, I accept from the medical evidence of Dr Sorrenti dated 6 October 1998 that this fall was not the cause of the problems Mr Corfield suffers in relation to his left knee.
Ms Henderson referred to the medical records of Dr Spicer's practice, a practice which Mr Corfield attended over a period of years. She indicated that Dr Aziz of that practice had recorded on 3 (sic) March 1993 (Exhibit R2), the day after Mr Corfield's encounter with his sorting frame:
"Dr Aziz w/c 2960 lst consult
sitting on a swivel chair – piece of metal hit (L) knee – o/e mildly swollen with tenderness femoral patella area - Nil effusion – Limping gait but full movements - m/c - crepe bandage"

I was mindful that the first visit to the surgery was followed by another on 7 March 1993 when Mr Corfield again saw Dr Aziz who recorded:
"Dr Aziz w/c 2960 REVISIT A/Hours
better – residual tenderness - Nil effusion"
I noted that from the evidence before me, Dr Aziz, in his initial consultation with the Applicant following the injury (2 March 1993), certified in a medical certificate (T7) that Mr Corfield would be fit to return to work on 5 March 1993. This was followed by a second medical certificate (T8) from Dr Aziz to certify that the Applicant was suffering from "residual soft tissue injury" and would be unfit for work for a further two days from 8 March 1993 until 9 March 1993. There was no further evidence before the Tribunal regarding mention to any medical practitioner of problems with his left knee until Mr Corfield consulted Dr Spicer about the knee on 30 May 1995.
I noted also from Exhibit R2, the notes of the Spicer practice which first recorded a visit by Mr Corfield on 21 January 1986, that he had attended every year over a number of years, the last entry before me being April 1999. There was, however, no further evidence regarding complaints about Mr Corfield's left knee to medical practitioners between 7 March 1993 until his visit to Dr Spicer and referral by Dr Spicer to Dr Dickison in mid-1995.
Mr Graham submitted that no significance should be attached to the fact that Mr Corfield did not seek medical treatment for his knee for two years between 1993 and 1995, and emphasised that when asked why he had not reported his continuing pain to his doctors when consulting them for other problems, the Applicant had replied: "I decided to put up with it."
Ms Henderson on the other hand, submitted that Mr Corfield had not been backward in consulting medical practitioners over the years 1993 to 1995. She submitted, and I agreed, that it seemed remarkable that if the Applicant had suffered continuous pain in his left knee, he had not mentioned this pain in visits to his medical practitioners over the two year period from 1993 to 1995. I noted from the records of Mr Corfield's general practitioner that he attended on 18 April 1993 for injuries sustained to his right leg when he fell off his motorcycle. In July 1993, Mr Corfield sought treatment for a cough. On 1 September 1993, Mr Corfield presented at the surgery because he felt unwell. In August 1994, his doctor had recorded a visit for ear and throat problems, and in February 1995, he sought treatment for sunburn. I noted Ms Henderson's submission which I accepted, that none of the other visits recorded any troubles with Mr Corfield's left knee.
What then was the nature of the injury sustained on 2 March 1993? Mr Corfield gave oral evidence that he attributed his present condition to the injury to his left knee on 2 March 1993. He said that since that time, it had been painful and tender and that now he has difficulties walking, driving, sitting or standing for prolonged periods. However, there was a view amongst some doctors including Dr Casey and Dr Dalton whose evidence was before the Tribunal that as the injury sustained was a soft tissue injury without any resulting effusion, the effects of it would have ceased within weeks or months. Dr Dalton, when shown the notes of Dr Aziz, considered the trauma suffered by the Applicant on 2 March 1993, as minor. Dr Casey commented at T100 that:
"On the information of the history of injury and time off work, I find it difficult to relate any ongoing problems in 1995 to the episode of 1993. Unless there is a history of a greater problem in 1993, I would regard the episode of 1993 as having settled within a two month period of 2.3.93."
Dr Sorrenti also agreed in cross-examination that the trauma Mr Corfield suffered on 2 March 1993 may have been minor and did not necessarily lead to his chondromalacia patellae.
Mr Graham submitted that Dr Casey's view that the injury on 2 March 1993 was minor, was questionable. Mr Graham emphasised this having particular regard to the fact that Dr Casey had misread Dr Aziz' notes of 7 March 1993 to understand that there had been no residual tenderness five days after the incident of 2 March 1993, whereas it was clear Dr Aziz had recorded the presence of residual tenderness five days after the incident on 2 March 1993. Mr Graham also questioned whether the injury could have been minor given that Mr Corfield had not suffered a previous injury to his left knee and has suffered pain in that region ever since 2 March 1993.
Ms Henderson submitted that Dr Casey had told the Tribunal that to suffer chondromalacia patellae resulting from the incident on 2 March 1993, the Applicant would have to have been subjected to severe trauma. She submitted that the Tribunal should be satisfied that the trauma suffered by Mr Corfield on 2 March 1993 was minor. I was mindful of Ms Henderson's submission and the evidence of Dr Dalton that the condition could occur spontaneously, particularly in a young person. I was also mindful of Mr Graham's submission regarding Dr Casey's misreading of the notes of Dr Aziz, but did not find that this error impacted negatively on the rest of his written and oral evidence. I noted that Dr Casey considered that the compensable condition would have ceased by the end of April 1993, and that he regarded Mr Corfield's current condition as not attributable to the incident of 2 March 1993.
I noted the considerable discussion at the Tribunal regarding the lack of effusion recorded on both the visits to Dr Aziz (2 & 7 March 1993), in connection with the incident of 2 March 1993. I was satisfied that the lack of effusion at the time of the incident and in the days which followed indicated the incident of 2 March 1993 had been minor and accepted the opinion of Dr Dalton dated 15 October 1999 (R3) and Dr Casey dated 15 May 1998 that the intensity and duration of pain described by Mr Corfield was out of proportion with the severity of the incident.
Mr Graham submitted that Mr Corfield had undergone three operations with regard to his left knee. Dr Dickison had performed two arthroscopies, (1995 and 1996), and Dr Sorrenti had performed a further arthroscopy on 2 February 1998. He submitted that the incident of 2 March 1993 had set off a progression of damage to Mr Corfield's knee who initially had a Grade I or II chondromalacia patellae which was, by the time of Dr Sorrenti's operation in February 1998, a Grade IV. I relied on the opinion of Dr Dalton who, when commenting on this progression, referred to it as degenerative.
Dr Dalton, who clearly considered that the Applicant was exaggerating his condition, opined in his report of 15 October 1999 that:
"Plain X-rays and a CT scan of this man's left knee dated 31.5.95 were essentially normal. A further CT scan of his knees dated 25.6.96 shows no significant patellar maltracking….
An MRI scan of his left knee dated 24.6.97 shows no evidence of chondromalacia patellae. There are changes of mild patellar tendonitis but no cystic degeneration and there is a suggestion of an old anterior cruciate ligament injury….
….this man has chondromalacia patellae which has been demonstrated at arthroscopy but such changes are unlikely to have resulted from the injury in question…
It is also my opinion that there is likely to be a considerable degree of functional overlay in this case."
Ms Henderson submitted that the Applicant's evidence, when weighed against contemporaneous records of the time of the incident, showed a number of inaccuracies. She submitted that she did not wish to press that the Applicant was untruthful, but simply to point out problems the Applicant had with certain recollections.

She pointed out that Dr Casey's report indicated Mr Corfield had told him he had had a month off work after the incident of 2 March 1993, whereas the leave records (T135), indicated Mr Corfield had taken six days. This was not rebutted.
She also indicated that at T15/20, Dr Dickison had recorded that the Applicant told him Dr Aziz had prescribed anti-inflammatories, general exercises and that there had been swelling of the knee after the incident. Again, she submitted correctly, that the records at Exhibit R2 indicated Dr Aziz had prescribed only a crepe bandage and recorded no effusion.
In connection with the Applicant's evidence to the Tribunal that he has suffered pain continuously since the incident on 2 March 1993, Ms Henderson drew to my attention the report of Dr Dickison of 1 June 1995 at T15/20 where he had recorded the Applicant's report of suffering intermittent pain:
"… At that time [2 March 1993] he had quite a deal of swelling which was treated with NSAIDs and general exercises. Since that time he has had intermittent anterior knee pain which he finds is made worse by sitting for extended periods of time. He has also noted his knee seems to click and crack intermittently…"

Ms Henderson also submitted that there were inconsistencies in the evidence regarding whether walking was a problem for Mr Corfield. Whilst he gave evidence about problems with walking to the Tribunal, it appeared he had not reported such problems to Dr Sorrenti, his current treating orthopaedic surgeon, who had recorded problems only with stairs, kneeling and squatting.

Ms Henderson submitted that the injury had been minor as Dr Aziz had recorded the knee as "better" five days after the first visit.

There is no doubt there were inconsistencies in Mr Corfield's evidence. Mr Corfield demonstrated this on several occasions in his answers before the Tribunal, indicating he could not remember events, even to the extent of saying he did not recall that his motorcycle had fallen on his right leg in 1993. I did find that curious considering his long and allegedly painful situation with regard to his left leg, and his love of motorcycles.
I noted further that Dr Dalton, in his report dated 15 October 1999 (Exhibit R3), and Dr Casey, in his report dated 15 May 1998 (T100), documented that they found it difficult to obtain an accurate history from the Applicant.
Ms Henderson submitted that the opinion of Dr Dalton that Mr Corfield's chondromalacia patellae was a spontaneously arising condition which progressed with degenerative change, be preferred to that of the other doctors.
Ms Henderson submitted, and I accepted, that there appeared to be little to correlate the findings of disability with any objective findings on radiological or physical examination. In particular, I noted that Dr Casey, in his report dated 15 May 1998 (T100), opined:
"There has not been enough pathology found in the knee to explain the current level of knee pain complaint and there has been very poor response to prolonged physiotherapy and surgical procedures. There is definite possibility of conscious or subconscious exacerbation of symptoms."

Dr Dalton, in his medical report dated 15 October 1999 (Exhibit R3), opined that the reasons for the Applicant's present complaints:
"… are complex but I do not believe that they can be adequately explained on the basis of the underlying pathology which has been demonstrated to date. The inconsistencies in his clinical examinations and other aspects of his history suggest that his prognosis may be dependent on factors not directly related to his medical condition."

Ms Henderson submitted that the Applicant's doctors shared the concerns of Dr Casey regarding the level of his ongoing disability. I was mindful that Dr Sorrenti agreed in cross-examination that the injury of 2 March 1993 may have been minor and did not necessarily lead to the Applicant's chondromalacia patellae.
Dr Sorrenti, at T110, also indicated his concerns regarding the Applicant's ability to return to work on his previous duties:
"If he fails to cope with that work I do agree with Brian Casey that it is difficult to understand to why he is having that problem."

In closing, Ms Henderson submitted that the Tribunal note Mr Corfield's constant riding of motorcycles although his evidence was that in recent times he rode only once a year for registration purposes. She emphasised he had owned four motor vehicles in recent times, two of which were manual transmission, including the present one. She submitted that this militated against the claimed level of disability regarding the left knee.
In considering all the evidence, I preferred the submissions of the Respondent and found that whilst Mr Corfield suffers chondromalacia patellae of the left knee, on the medical evidence of Dr Dalton and Dr Casey available before the Tribunal, it is more likely than not that it arose spontaneously or as a result of some other injury to the knee and has degenerated, and did not arise as result of the incident the Applicant suffered at work on 2 March 1993. I was also mindful of the findings of Dr A. Walker, nuclear physician, in respect of the bone scan conducted on the Applicant on or about 24 June 1996 (T24):
"Mild arthritic changes are noted in the medial compartment and to a lesser extent the lateral compartment of the left knee. Similar appearances are noted in the right knee particularly in the patello-femoral joint but these are less marked than on the left side. Mild arthritis of both ankle joints and posterior tarsal regions is evident".
Ms Henderson submitted that there was no satisfactory explanation before the Tribunal to explain why the Applicant had been working only six hours a day for the past year and a half, and no explanation why he could not work full-time in his normal position of mail sorter. She submitted that the Respondent considered Mr Corfield had suffered a soft tissue injury on 2 March 1993 for which liability should not have been accepted in 1995. She added that although liability had ceased on 1 July 1998 the Respondent did not intend to seek recovery of the compensation paid between 1995 and 1998.
I find from the evidence before me that any disability Mr Corfield suffers with regard to his chondromalacia patellae is not compensable, and prefer the evidence of Dr Casey and Dr Dalton who opined that his presentation of pain and disability was exaggerated. I am mindful further that the objective investigations such as x-rays, CT scans and MRI scans, which Mr Corfield has undergone, do not accord with the degree of disability exhibited by the Applicant in evidence and upon medical examination. I find also from consideration of the objective radiological and other evidence that the Applicant's level of disability is exaggerated.
I have noted Ms Henderson's submission with regard to compensation paid to the Applicant between 1995 and 1998. I do not intend to investigate the situation of Mr Corfield's compensation payments up to and including 1 July 1998. I agree they should not be disturbed.
My finding on the evidence before me is that the injury of 2 March 1993 was a minor soft tissue injury which would have resolved within a period of weeks and that there is no compensation for that injury available to Mr Corfield on and from 1 July 1998. The reviewable decision of 18 August 1998 must be affirmed.
THE SITUATION REGARDING CLAIM N98/1251
As noted above, a second claim N98/1251 before the Tribunal related to travel expenses to attend physiotherapy. Mr Corfield had been referred by Dr Sorrenti to the McConnell practice, which was described by him as a specialist in patello-femoral problems. The distance travelled by Mr Corfield on each occasion was approximately 70 kilometres to get from his home in Baulkham Hills to the McConnell practice in Mosman and back again.
Section 16 of the Act provides for a person suffering a compensable injury to be reimbursed the reasonable cost of travel to attend treatment.
"16. (6) Subject to subsection (7), if:
(a)   compensation in respect of the cost of medical treatment is payable; and
(b) the employee reasonably incurs expenditure in doing either or both of the following:
(i) making a necessary journey for the purpose of obtaining that medical treatment;
(ii)remaining, for the purpose of obtaining that medical treatment, at a place to which the employee has made a journey for that purpose;
Comcare is liable to pay compensation to the employee:
…
     (7) Comcare is not liable to pay compensation under subsection (6) unless:
(a) the reasonable length of such a journey as it was necessary for the employee to make (including the return part of the journey) exceeded 50 kilometres; or
(b)   if the journey made by the employee involved the use of public transport or ambulance services—the employee's injury reasonably required the use of such transport or services regardless of the distance involved.

(8) The matters to which Comcare shall have regard in deciding questions arising under subsections (6) and (7) include:
(a) the place or places where appropriate medical treatment was available to the employee;
(b) the means of transport available to the employee for the journey;
(c) the route or routes by which the employee could have travelled; and
(d) the accommodation available to the employee."

Pursuant to relevant parts of section 16(6) of the Act, Comcare is liable for compensation where the employee reasonably incurs expenditure in making a necessary journey for medical treatment. In the instant case, Mr Corfield was advised by Dr Sorrenti in September 1997 to undergo a course of physiotherapy at the McConnell physiotherapy practice in Mosman for treatment of what Dr Sorrenti described as the patello-femoral irritation in his left knee.
In his oral evidence, Dr Sorrenti stated that he recommended Mr Corfield seek specialised physiotherapy treatment at the McConnell practice because it was the "anterior knee pain centre of the world".Notwithstanding, I am mindful from his own evidence that Mr Corfield had attended the McConnell practice for long enough to learn the techniques (strapping and exercises), said to have been developed by Ms McConnell. In addition, the evidence before me was that a large number of physiotherapists now use the well recognised technique in their work, and are able to provide it to their clients.
Mr Graham submitted that Dr Casey had said it was not uncommon for a specialist to refer a person to a specific physiotherapist, and that Dr Sorrenti had done just that. While I accepted that Dr Sorrenti had referred Mr Corfield to the McConnell practice, I was mindful that he had not, of course, specified the length of time Mr Corfield should attend, nor the frequency of visits. I further noted that Mr Corfield was not seeing Ms McConnell, who developed the treatment technique, but a Ms Nicole Clements.
Subsection 16(7) of the Act provides that Comcare is not liable for compensation unless the reasonable length of the necessary journey exceeds 50 kilometres and the employee's injury reasonably requires the use of public transport/ambulance to attend such treatment regardless of the distance. The evidence was that Mr Corfield travelled by public transport from Baulkham Hills to the McConnell clinic in Mosman each session, which was approximately 70 kilometres for each round trip which took approximately four hours to complete.
The matters to be considered in respect of sections 16(6) and (7) of the Act as relevant included the availability of appropriate medical treatment and means of transport available for the journey. I noted that Mr Corfield gave oral evidence that he could only drive three to five kilometres at a time, and that he required the use of public transport to avail himself of the treatment at the Mosman practice.
As noted above, the evidence before me was that the McConnell technique is a well recognised technique and is now used by a number of physiotherapists outside of the McConnell practice in Mosman. I conclude, therefore, that not only has Mr Corfield learnt the techniques of exercise and strapping which the McConnell clinic employs, but he can obtain McConnell treatment much closer to home.
Taking into account the legislation, particularly sections 16(6), 16(7) and 16(8) of the Act, I find that it was not reasonable in the circumstances for Mr Corfield to be travelling some 70 kilometres to obtain physiotherapy treatment which was able to be provided much closer to home and the techniques of which, he had become skilled.
I therefore affirm that compensation is not available to Mr Corfield in relation to his left knee as a result of an injury he says resulted from striking his patella at work on 2 March 1993, and I also find that the Respondent is not liable for the costs of travelling to physiotherapy on and from 13 March 1998.
DECISION
The Tribunal affirms the decision of the Reconsideration Section, Australian Postal Corporation dated 18 August 1998 which affirmed the decision of the Australian Postal Corporation dated 1 July 1998 to decline liability to pay further compensation to the Applicant Mr Paul Peter Corfield on and from 1 July 1998 with regard to his left knee injury sustained at work on 2 March 1993.
The Tribunal affirms the decision of the Reconsideration Officer, Australian Postal Corporation (undated) which affirmed the decision of the Australian Postal Corporation dated 11 March 1998 to refuse payment to the Applicant for the travel expenses incurred in attending physiotherapy at the McConnell practice on and from 13 March 1998.
No costs may be awarded pursuant to section 67(8) of the Safety Rehabilitation and Compensation Act 1988.
I certify that the 105 preceding paragraphs are a true copy of
the reasons for the decision herein of Ms G Ettinger, Senior Member
Signed:         .....................................................................................
  Associate
Date/s of Hearing  10 & 11 April 2000
Date of Decision  30 June 2000
Counsel for the Applicant        Mr J Graham
Solicitor for the Applicant         Mr W Neal
Counsel for the Respondent    Ms R Henderson
Solicitor for the Respondent    Ms E O'Connor