Culhana v State of New South Wales (NSW Police Force)

CERTIFICATE OF DETERMINATION OF MEMBER
CITATION:	Culhana v State of New South Wales (NSW Police Force) & Ors [2024] NSWPIC 257
APPLICANT:	Danielle Culhana
FIRST RESPONDENT:	State of New South Wales (NSW Police Force)
SECOND RESPONDENT:	Maddison Louise Stockwell
THIRD RESPONDENT:	Archie JD Stockwell
FOURTH RESPONDENT:	Liam Michael Stockwell
FIFTH RESPONDENT:	Belinda Sultana
PRINCIPAL MEMBER:	Rachel Homan
DATE OF DECISION:	17 May 2024
CATCHWORDS:	WORKERS COMPENSATION - Workers Compensation Act 1987; application for compensation in respect of death of worker; deceased worker had an accepted psychological injury; whether Barrett’s oesophagus, adenocarcinoma and subsequent death resulted from the psychological injury; Kooragang Cement Pty Ltd v Bates referred to; material contribution; Held – deceased worker died as a result of injury for the purposes of sections 25(1) and 26.
DETERMINATIONS MADE:	The Commission determines: 1. Craig Stockwell died on 27 November 2022 as a result of injury for the purposes of ss 25(1) and 26 of the Workers Compensation Act 1987. The Commission directs: 2. The matter to be listed for further preliminary conference to deal with the outstanding matters.

STATEMENT OF REASONS

BACKGROUND

Mr Craig Stockwell (the deceased worker) was employed as a police officer by the State of New South Wales (NSW Police Force) (the first respondent). In the course of his employment with the first respondent, the deceased worker sustained a psychological injury, liability for which was accepted by the first respondent’s insurer.
The deceased worker was subsequently diagnosed with Barrett's oesophagus and adenocarcinoma, liability for which was disputed in a notice issued pursuant to s 78 of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act) on
9 July 2021.
The deceased worker died on 27 November 2022 as a result of metastatic gastroesophageal functional carcinoma.
Solicitors acting on behalf of the deceased worker’s de facto partner, Ms Danielle Culhana (the applicant), made a claim for compensation in respect of the death on 22 May 2023.
Following an exchange of correspondence, the applicant commenced the current proceedings in the Personal Injury Commission (Commission) by lodgement of an Application in Respect of Death of Worker on 11 October 2023. The Application named the deceased worker’s three children (the second, third and fourth respondents) as dependants. The Application was subsequently amended to include the deceased worker’s former spouse, Ms Belinda Sultana, as fifth respondent.
Liability to pay compensation in respect of the death was disputed in a notice issued pursuant to s 78 of the 1998 Act on 31 October 2023.

PROCEDURE BEFORE THE PERSONAL INJURY COMMISSION

The parties appeared for conciliation conference and arbitration hearing via Microsoft Teams on 21 March 2024.
The applicant was represented by Ms Eraine Grotte, of counsel, instructed by Ms Lara Karam.
The first respondent was represented by Ms Kavita Balendra, of counsel, instructed by
Ms Serena Bentley.
The second respondent was represented by Mr Jon Trainor, of counsel, instructed by
Ms Gueri Kim.
The third respondent was represented by Mr Michael Dababneh, legal practitioner.
The fourth respondent was represented by Mr Dewashish Adhikary, of counsel, instructed by Mr Jamie Nemme.
The fifth respondent was represented by Mr Sean Brennan, of counsel, instructed by
Ms Emma Robey.
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.

ISSUES FOR DETERMINATION

A number of issues potentially requiring determination arise in these proceedings. The parties agreed, however, that the following liability disputes ought to be determined before submissions were made in respect of the other matters:
(a) whether the deceased worker’s Barrett's oesophagus and adenocarcinoma resulted from the psychological injury deemed to have occurred on
3 November 2019, and
(b) whether the deceased worker’s death resulted from the psychological injury deemed to have occurred on 3 November 2019 pursuant to s 25(1) of the Workers Compensation Act 1987 (the 1987 Act).

EVIDENCE

Documentary evidence

The following documents were in evidence before the Commission and considered in making this determination:
(a)    Application in Respect of Death of Worker and attached documents;
(b)    Reply lodged by the first respondent;
(c)    Reply lodged by the second respondent;
(d)    Reply lodged by the third respondent;
(e)    Reply lodged by the fourth respondent;
(f)    Reply lodged by the fifth respondent;
(g)    documents attached to an Application to Admit Late Documents lodged by the applicant on 11 January 2024;
(h)    documents attached to an Application to Admit Late Documents lodged by the first respondent on 6 March 2024, and
(i)    documents attached to an Application to Admit Late Documents lodged by the second respondent on 18 March 2024.
No application was made to adduce oral evidence or cross-examine any witness.

Deceased worker’s statement evidence

The deceased worker provided a statement to an investigator procured by the first respondent on 30 June 2020.
The deceased worker stated that he had been a police officer for 16 years. He first raised issues relating to his mental health with his supervisors in mid-2019. The deceased worker said he had been struggling in relation to recent jobs involving suicides. The deceased worker was provided with the number for the Employee Assistance Program (EAP) but continued to work and attempted to self-manage his mental health until November 2019, when he consulted his doctor as he was no longer able to cope.
The deceased worker said events at work over the course of his 16 years of service were the catalyst for his condition. He saw the worst of society and dealt with crime and death.
A number of incidents were described, including the murder of an Asian male who had been shot in the head and chest; the suicide of a Middle Eastern man; the suicide of an Indian lady; and the death of an Irish national whose vehicle was struck by a truck. The deceased worker said there were about 20 or 30 jobs like this but he did not want to think about them. The deceased worker could see their faces and the scenes and sometimes woke up in the middle of the night and could not go back to sleep.
In an unsigned supplementary statement, the deceased worker said he began having difficulty swallowing food and experiencing excessive heartburn in or around November 2020. The deceased worker resorted to liquid foods and experienced intensifying pain in his chest and abdomen.
On 1 March 2021, the deceased worker consulted with Dr Damodoran Kumar who advised that prolonged periods of stress and anxiety could cause physical symptoms. Dr Kumar recommended an endoscopy which was performed on 4 March 2021. The findings revealed a condition called Barrett’s oesophagus.
As the deceased worker’s symptoms were worsening, he underwent a further endoscopy on 10 June 2021, which revealed Grade 4 ulcerative oesophagitis and adenocarcinoma.
Dr Kumar explained that post-traumatic stress disorder (PTSD) symptoms increased stomach acid and reflux, which commonly caused Barrett’s oesophagus. The deceased worker was referred to A/Prof Talbot.
A PET scan later showed multiple tumours in the deceased worker’s body and he was referred to Dr Hruby for radiation treatment. The deceased worker started seeing another oncologist, Prof Pavlakis, on 26 June 2021.
With regard to his diet, the deceased worker stated,
“…my diet remained consistent, until the onset of my PTSD symptoms in 2019, when my appetite reduced as I had no motivation to cook meals. However, from November 2020, my oesophagus symptoms commenced, making it even more difficult to eat. This is why I told Dr Neale in April 2021 that I only consumed one meal per day.”
With regard to the consumption of alcohol and tobacco, the deceased worker stated,
“I confirm prior to my cancer diagnosis, I turned to heavy drinking and smoking to numb the intrusive thoughts. My treating Psychologist, Mr Smith, is mistaken in his report as I expressed reliance on these substances to cope with the crippling anxiety and depression. My other practitioners and colleagues were aware of the increase of my alcohol and tobacco consumption and can verify this account. I ceased drinking and smoking following my cancer diagnosis in June 2021.”
With regard to previous gastric symptoms, the deceased worker stated,
“I confirm any gastric symptoms prior to 2019, were for minor stomach bugs or contagious gastro. These symptoms can be distinguished to what I am currently experiencing. I confirm these symptoms had nothing to do with my current condition.”

Applicant’s evidence

The applicant prepared a written statement on 24 November 2022.
The applicant first met the deceased worker in 2006 and worked with him in the Mounted Police Unit for three years. At that time, the deceased worker would occasionally have a drink socially and sometimes smoke at the same time but this was not a regular occurrence.
The applicant and the deceased worker kept in touch over the years. In October 2020, they caught up in person. The deceased worker told the applicant about his post-traumatic stress disorder and said that during the worst period he was drinking a bottle of bourbon per night. By this stage, the deceased worker had been accessing psychological treatment and was able to speak about things without it triggering him extensively. The applicant noticed that the deceased worker was smoking heavily which he had not done previously.
The applicant and the deceased worker began dating in March 2021. By this time, the deceased worker had lost weight and was smoking a packet of cigarettes over a couple of days.
The deceased worker told the applicant he was having problems swallowing in March or April 2021 and was diagnosed with Barrett’s oesophagus after an endoscopy. His swallowing problems became progressively worse and, in May or June 2021, the deceased worker was referred for a second endoscopy which confirmed Stage 4 cancer which had metastasized. The deceased worker then quit drinking and smoking ‘cold turkey’.
The deceased worker moved to live with the applicant in Hornsby and changed oncologists to Prof Nick Pavlakis at Royal North Shore Hospital as his rooms were closer.
The applicant stated,
“I believe if Craig had either never worked for NSW Police, or had continued working in the Mounties Police unit, he would not have been exposed to so many traumatic incidents and would not have developed PTSD. His chain smoking and increased drinking only started after his psychological injury and if he had not suffered from this, he would have remained a social drinker only, who had the occasional cigarette here and there.”

Other witness evidence

The deceased worker’s older brother, Andrew Stockwell, prepared a written statement on
21 November 2022.
Mr Stockwell said that before joining the New South Wales Police Force, the deceased worker did not have any health issues and was in prime condition, both psychologically and physically. The deceased worker rarely consumed alcohol or smoked cigarettes but did sometimes have a few whilst socialising.
Mr Stockwell stated,
“After Craig started working as a Police Officer with NSW Police Force, I noticed our phone calls were not upbeat as usual and after some time, he told me that he was having a tough time at work. I recall early in his policing career, Craig told me about an incident he attended, where a female had committed suicide by jumping in front of a train. This incident really affected his mental health and took him a long time to get past.
I recall within the first couple of years that Craig started working for NSW Police, he began to smoke cigarettes and consume alcohol more regularly, both in and out of social settings.
Over the years, Craig had mentioned various other incidents that he had attended during his employment, which typically involved deceased persons, including children. I could tell this began to affect him as he became withdrawn and just did not seem himself.
Approximately 5 years ago, I noticed Craig’s consumption of alcohol and cigarettes increased significantly and it became clear that he had begun relying on these as a coping mechanism for dealing with the traumatic incidents he was forced to attend during his employment. At this stage, we would visit each other often, several times per year and during those visits, I would rarely see Craig without a cigarette in his hand. He would also binge drink alcohol several days/nights of each visit that would typically last around one week at a time.
Around this time, in addition to his apparent reliance on alcohol and tobacco, Craig had also become even more withdrawn and was extremely jittery. He always seemed to be constantly on edge and could never relax. Compared to his usual happy-go-lucky, outgoing self, he was a shell of who he used to be.”
A friend and former work colleague of the deceased worker, Mr Stephen De Jong, prepared a statement on 22 November 2022. Mr De Jong met the deceased worker in approximately 2003 or 2004. Around this time, Mr De Jong had no recollection of seeing the deceased worker smoke cigarettes and he would only consume alcohol socially on the weekend. Mr De Jong stated,
“I do not recall exactly when exactly this took place, however after Craig was transferred to the Electronic Surveillance unit, I noticed immediately that his consumption of alcohol had increased significantly. His work within this unit placed an extreme amount of stress and pressure on him including fearing for his own safety, as he was working as a high stress environment. He was an operator that performed extremely high-risk security work which required him to have different false identities at any given time. This work entailed him breaking into houses and installing listening devices (both audio and visual), after a warrant had been secured by various units including Counter Terrorism Australia.”
Mr De Jong recalled a particular incident involving the death of a child following which he noticed the deceased worker had become extremely withdrawn and on edge.
Mr De Jong recalled a trip to Dubbo during which he noticed a significant change in the deceased worker’s demeanour. The deceased worker spent an entire night in the pokies section of a pub, smoking and drinking and did not spend any time socialising with his mates.
Mr De Jong recalled having a conversation with the deceased worker about four to five years earlier about how much he was smoking. The deceased worker acknowledged that it had become a problem and that he was smoking 1 ½ packs of cigarettes per day.
Around three to four years earlier, the deceased worker had come over to Mr De Jong’s house for dinner. He was smoking so much that they moved the kitchen table outside to the balcony so they could have dinner whilst he still smoked. The deceased worker drank so much that he passed out at around 10pm and had smoked an entire packet of cigarettes since arriving at 3-4pm. Mr De Jong recalled a conversation that night about how much his work had affected him mentally.
Another colleague, Mr Adam Skelton, prepared a statement on 25 November 2022.
Mr Skelton commenced working with the deceased worker in 2016. By mid-2017 Mr Skelton noticed the deceased worker was not just smoking in social settings. In 2018, Mr Skelton noticed an exponential increase in the deceased worker’s consumption of alcohol.
Mr Skelton stated,
“Instead of just having a couple beers with the boys, he was drinking to the point of being completely drunk. Around this time, I stayed at his house a few times and noticed he would do the same at home. He had also increased smoking significantly at this time.”
Mr Skelton said the deceased worker’s excessive alcohol and cigarette consumption continued during 2019, during which period they were catching up every few months.
Mr Skelton stated,
“From this point onwards, I noted he would linger outside more and sometimes stay outside for the entire evening, so that he could continue smoking. There were many occasions where he would smoke an entire packet of cigarettes, over the space of 2-3 hours. In addition to an entire pack of cigarettes, he would also drink a lot of alcohol, sometimes an entire bottle of scotch in one night. It was clear that the excessive drinking and smoking had become his coping mechanism because I know he really couldn’t afford the cost of cigarettes that he was chain smoking through.”

Injury notification

An incident notification form completed by the deceased worker on 4 November 2019 reported a psychological injury occurring in the following circumstances:
“Over an extended period of time in regard to attending to critical incidents involving murder/suicide/self harm/motor vehicle accidents I have suffered from psychological issues. It was originally reported to Inspector, Stone, Sgt Sommerville, Mary Koksal which was documented as a conversation date unknown.”

Treating evidence

The Hills Medical & Dental Centre

Clinical notes from The Hills Medical & Dental Centre, record a consultation with Dr Maisie Dong on 29 November 2019 as follows:
“A police officer for 16 yrs
had a complaint at work
stated it was a rubbish complaint
having anxiety for 6 months
seek legal advise yesterday
getting no support from work
they transferred to a different station this Monday
handling trauma cases as well
works becomes very stressful
lives with partner and 4 kids
tried Dr Selwyn Smith / St John's of God
does not take any new pt
MHCP done
if crisis to go to hospital /ED
counselled”
On 14 December 2019, Dr Anne Pollard recorded:
“w comp
one trauma after another
indian female hung herself 4-5 mths ago
had to cut her down but long dead
prior to that was a shooting ( in head , chest )
8-12 mths prior accident on m4 truck hit car
did an arrest oct 2019 , common assault charges against him, restrictions to front desk and transfered to a different suburb
currently under investigation coroners re a hanging, dealing with family
went to work next day to complete forms , was struggling , current boss of 1 year said you'll be right , next h e told day 2 sergeants and inspector he didnt want to do any suicides for now
straw that broke the camels back is that he was not supported after arest of a person in possession who laid charges against him about the arrest
no suport from superintendant
and he will not have court hearing for perhaps a year
flashbacks
waks with nightmares
hyper vigilant
he is easily angrered than ever before and easily upet now even at home
depressed
not want to get out of bed
ptsd needs psychiatrist ?? minipress re ptsd”
Dr Pollard prepared a report for the deceased worker’s solicitors on 4 September 2022.
Dr Pollard noted that she had not documented the deceased worker’s smoking but had documented that he used alcohol as a crutch when his post-traumatic stress disorder was bad. The deceased worker was disinclined to take prescribed medication for his poor sleep, nightmares, anxiety and post-traumatic stress disorder symptoms, preferring to use alcohol.
Dr Pollard expressed the opinion that increased alcohol consumption and binge drinking in order to cope with symptoms of post-traumatic stress disorder was a widely recognised occurrence. Alcohol was an aggravating factor for gastro-oesophageal reflux disease (GORD) due to relaxation of the lower oesophageal sphincter and mucosal damage. In some patients, this progressed to Barrett’s oesophagus and oesophageal cancer. This pathway from post-traumatic stress disorder to alcohol abuse to GORD to Barrett’s to oesophageal cancer appeared to have occurred very rapidly in the deceased worker’s case. Dr Pollard expressed the view that work was the main contributing factor in the pathway to Barrett’s and finally adenocarcinoma.

Dr Pollard also commented that her records indicated that the deceased worker intermittently used alcohol as a crutch with episodes where he tried not to be heavily reliant on alcohol. His use of alcohol may have been very heavy then reduced again as he felt shame at his coping mechanism. If, on one day, he said I am not drinking now, that would not imply that he did not have a history of prolonged alcohol abuse.

Dr Smith

The deceased worker’s treating psychiatrist, Dr Selwyn Smith, prepared a report for his general practitioner on 6 February 2020. It was noted that during his lengthy police career, the deceased worker had been exposed to a significant number of distressing and traumatic incidents, including fatal motor vehicle accidents, murders and suicides. The deceased worker had been confronted by violent offenders. He had attempted in the past to maintain a stoic stance.
Dr Smith reported,
“Craig has not resorted to alcohol to any extent. He no longer smokes and does not indulge in drugs of addiction.”
Dr Smith also prepared a medicolegal report for the deceased worker’s solicitors on
8 February 2021. That report took a history of the deceased worker joining the police force in 2003 and working in a number of different locations. He served in the Mounted Unit for a period of five years between 2006 and 2011 and was subsequently transferred to the State Technical Investigations Branch (STIB) where he served between 2011 and 2015.
During his employment with the first respondent, the deceased worker had attended a significant number of distressing and traumatic incidents, many of which would satisfy the severe stressor A criterion for the diagnosis of post-traumatic stress disorder. These included murders and suicides as well as motor vehicle accidents.
The deceased worker noted a gradual alteration in his state in 2019 with heightened levels of anxiety with agitation. He became fearful of being confronted by individuals who had suicided. His sleep patterns became interrupted with troubling dreams and nightmares. He reported dissociative flashback episodes of the traumatic incidents, hypervigilance and startle responses. He was increasingly irritable and aggressive.
Dr Smith noted,
“Mr Stockwell reported that he did not resort to alcohol, cigarettes nor drugs of addiction as a method of coping with his symptoms.”
Dr Smith diagnosed post-traumatic stress disorder and major depressive disorder, both of which were “chronic in duration” as a result of the deceased worker’s exposure to significant distressing and traumatic incidents. He assessed a 24% whole person impairment resulting from the injury.

Dr Cameron

Consultant psychologist, Dr Ian Cameron, prepared a report for the insurer on
19 February 2020. Asked for a history of the psychological injury, Dr Cameron said the deceased worker reported hundreds if not thousands of incidents commencing with his general duties at Hurstville in 2003, including his involvement in the Cronulla riots. While at the Technical Investigations Branch, the deceased worker began experiencing intrusive memories and avoided reading affidavits involving alleged paedophiles and child neglect. Several other specific incidents were described and, in the latter part of 2019, the deceased worker had told two sergeants and an inspector that he was not coping. The deceased worker was given the number for the EAP but was told by the counsellor that there was nothing further the counsellor could offer.
Dr Cameron said,
“From my three interviews with Mr Stockwell I believe the recurrent high exposure to potentially life threatening situations, witnessing multiple deaths and delivering the news of deaths to families during his policing career, has resulted in Mr Stockwell developing Post-Traumatic Stress Disorder (PTSD).”
In a report prepared for Dr Pollard on 24 February 2020, Dr Cameron said he had detected that the deceased worker had been avoiding the distressing aspects of his police work as far back as three years earlier.

Dr Kumar

Consultant surgeon and endoscopist, Dr Damodoran Kumar prepared a report for the insurer on 3 March 2021. Dr Kumar noted that the deceased worker required an urgent gastroscopy to diagnose a swallowing problem which was most likely GORD secondary to increased acid secretion. Dr Kumar observed that post-traumatic stress disorder was associated with increased acid secretions in the stomach which could lead to GORD. Dr Kumar expressed the view that the GORD due to post-traumatic stress disorder was a workers compensation liability.
On 24 March 2021, Dr Kumar wrote again to the insurer reporting that histopathology had confirmed the diagnosis of GORD and Barrett’s oesophagitis. Dr Kumar reiterated his view that the condition was secondary to excessive gastric secretion caused by post-traumatic stress disorder.
In a further report for the insurer on 30 June 2021 Dr Kumar confirmed that the deceased worker had a Barrett’s oesophagus with grade 4 ulcerative oesophagitis and now confirmed adenocarcinoma.
Dr Kumar stated,
“He is known to suffer from post-traumatic stress disorder (PTSD). This is known to cause increased acid secretion by the stomach due to the anxiety and worrying associated with PTSD. He has also been smoking heavily and drinking. I believe both these habits are also attributable to PTSD as it is used to relieve the symptoms of PTSD, as well as to relieve his anxiety. Increased and repeated continuous secretion of acid in the stomach, with reflux, is known to cause Barrett’s oesophagus in which there is a double change in the lining of the oesophageal mucosa in such a way that it is unable to defend the organ against the erosive nature of hydrochloric acid secretions from the pyloric antrum of the stomach. These are known causes of Barrett’s oesophagus which he was confirmed to have on the gastroscopy and histological findings of 4/3/21. Barrett’s oesophagus itself is a known cause of adenocarcinoma of the oesophagus. With uncontrolled and continued gastric acid reflux he has since progressed the Barrett’s into an adenocarcinoma of the oesophagus.
…
I consider his adenocarcinoma to be directly caused by the Barrett’s oesophagus which he was confirmed to have on 4/3/21. The Barrett’s oesophagus itself is caused through excess acid secretion which I feel is related to the anxiety and stress associated with his diagnosed PTSD.”
Dr Kumar said that the deceased worker’s post-traumatic stress disorder would have been the cause for his anxiety and the increased consumption of cigarettes and alcohol which in turn would cause increased acidity in the stomach. Dr Kumar was not aware of any non-work related factors which would have created the conditions for increased acidity in the stomach. Such factors might have included skipping meals, delaying meals, hurried consumption of food without chewing adequately or congenital weakening of the oesophagus sphincter.
Further,
“I consider Mr Stockwell’s employment with the NSW Police as being the main contributing factor [to] the adenocarcinoma of the oesophagus. As explained earlier this caused PTSD which in turn resulted in him increasing his intake of alcohol and cigarettes. Together with the increased anxiety and stress, this would be considered that these aggravating factors caused increased acidity in the stomach. This in turn has led on to Barrett’s, which in turn has eventuated in an adenocarcinoma of the oesophagus.”

Associate Professor Talbot

A/Prof Michael Talbot, a consultant surgeon and specialist in upper gastrointestinal and bariatric surgery prepared a report for Dr Kumar on 16 June 2021.
A/Prof Talbot noted an endoscopy performed three months earlier had showed some Barrett’s. Subsequently, the deceased worker had had progressive difficulty maintaining his weight.
In terms of risks, of A/Prof Talbot noted the deceased worker had been a heavy smoker until recently and a regular drinker as well. A/Prof Talbot recommended a PET scan and multimodality therapy and said he would arrange an appointment with Dr George Hruby in North Sydney closer to where the deceased worker had support.
In a report to Dr Clifton Brookes at Miranda Medical Centre, dated 7 September 2022, A/Prof Talbot noted that his specialist practice included management of Barrett’s and surgical therapies for Barrett’s dysplasia and cancer.
A/Prof Talbot recorded that when he met the deceased worker on 16 June 2021 he had a previous history of obesity at 108kg and had been a heavy smoker with regular consumption of alcohol. The deceased worker had been diagnosed with adenocarcinoma and subsequent investigations showed Stage 4 metastatic disease.
A/Prof Talbot reported that Barrett’s oesophagus was a condition driven predominantly by a history of gastro-oesophageal reflux. The burden of risk appeared to fall on patients who smoked and Barrett’s adenocarcinoma could be viewed as a smoking related cancer. Obesity was also a risk factor for the development of reflux and Barrett’s oesophagus.
A/Prof Talbot said,
“The time taken for reflux to lead to the development of Barrett’s oesophagus and then for Barrett’s oesophagus to lead to the development of Barrett’s dysplasia and then on to adenocarcinoma happens over years or decades. Stress is a probable modifying risk factor for the development of gastro-oesophageal reflux or acid related diseases but it is only a modifier of the condition not a cause of the condition. Reflux is predominantly caused, not by an increase of gastric acid secretion but by factors that allow gastric contents to escape out of the stomach up into the oesophagus. These risk factors are predominantly related to structural failings in the lower oesophageal valve, and dietary -related and lifestyle related especially with regards to weight. The majority of patients with significant reflux also have anatomic abnormalities of the lower oesophageal sphincter valve related to the development of a hiatus hernia. Hiatal hernias are more common in older or overweight individuals. Mr Stockwell’s reflux would most probably have started developing many years previously and the risk of then developing Barrett’s and then the Barrett’s developing or transforming into carcinoma is predominantly based on smoking, his diet, his weight and possibly alcohol consumption as well.”
With regard to the effect of anxiety, A/Prof Talbot said,
“Anxiety may certainly increase the number of transient lower oesophageal sphincter relaxation’s and increase somebody’s predisposition to develop reflux symptoms or reflux per se however it is unlikely that this is anywhere near as significant a risk factor for development of Barrett’s or cancer as the other factors discussed.”
With regard to the effect of cigarettes and alcohol, A/Prof Talbot said,
“Cigarettes and alcohol significantly increase your risk of virtually all cancers. While they probably increase the risk of reflux as well the effect is more likely to be due to a direct carcinogenic effect of these agents rather than through some secondary mechanisms such as increasing transient lower oesophageal sphincter relaxations and subsequent reflux events.”
A/Prof Talbot said the deceased worker’s grade 4 ulcerative oesophagitis was due to well-established gastro-oesophageal reflux disease which had likely been present for many years (5 to 10 years plus). With regard to the effect of the deceased worker’s psychological injury, A/Prof Talbot stated,
“As I do not know when Mr Stockwell suffered a psychological injury which is part of his claim it is hard to me to have an opinion on this matter. Nevertheless, the balance of probabilities was that he had significant reflux plus other risk factors contributing to the development of cancer that had existed for at least 10 years prior to his cancer diagnosis.
It is highly likely that Mr Stockwell developed adenocarcinoma as a result of the Barrett’s oesophagus which was a result of his well-established reflux oesophagitis combined with smoking, alcohol and obesity.”

Associate Professor Hruby

Oncologist, A/Prof George Hruby prepared a report for A/Prof Talbot on 19 June 2021. A/Prof Hruby noted that the deceased worker had been formally diagnosed with post-traumatic stress disorder for 18 months.
A/Prof Hruby indicated that he had discussed the case with his colleague Nick Pavlakis who was well respected in the gastrointestinal sphere.

Professor Pavlakis

Senior consultant medical oncologist, Prof Nick Pavlakis, prepared a report for the deceased worker’s solicitor on 20 November 2022. Prof Pavlakis stated that he was an expert in the management of gastrointestinal and lung malignancies, with relevant clinical research experience in upper gastrointestinal malignancies, in particular oesophageal/oesophago-gastric cancers. Prof Pavlakis stated,
“My experience and training includes a broad understanding of tumour biology and pathogenesis across lung and gastrointestinal malignancies, with expertise in critical appraisal and interpretation of the literature. However, I am not an expert in the specific epidemiology and pathogenesis of oesophageal/gastric cancers nor post-traumatic stress disorder and its consequences. As such I have focused my responses to my field of expertise and provided relevant literature support of my responses where appropriate.”
Prof Pavlakis recorded that at the time of his first consultation with the deceased worker he was an ex-smoker, having quit just prior to his diagnosis, and was not consuming alcohol but reported doing so to excess in the past. The history of post-traumatic stress disorder was noted.
Prof Pavlakis noted that the deceased worker was diagnosed with stage IV Her2 negative distal oesophageal adenocarcinoma at age 41. The median age for that diagnosis was 68-69 years of age, with a mean age of approximately 66.5 years. For men, the peak decade for oesophageal cancer incidence was 70-79.
With regard to causation, Prof Pavlakis gave the opinion,
“Given the fact Mr Stockwell has no clear genetic susceptibility to oesophageal cancer, besides the play of chance inducing sporadic carcinogenesis, the development of oesophageal cancer in Mr Stockwell must be related to gastroesophageal reflux disease (GERD), considered the main aetiologic factor for oesophageal adenocarcinoma, diagnosed on endoscopy on March 4, 2021. The known leading lifestyle risk factors for oesophageal adenocarcinoma are dietary, obesity, cigarette smoking and possibly alcohol through causing chronic inflammation. These latter two factors act synergistically to elevate the risk of GERD, with cigarette smoking a more certain causal link. Alcohol itself is considered a risk factor for GERD, as is psychologic stress, with the severity of reflux corelating with the degree of stress, however the relationship of alcohol to Barretts’ oesophagus and oesophageal adenocarcinoma per se is less clear in the literature.”
Prof Pavlakis was asked whether employment was the main contributing factor to the consequential condition and need for treatment and responded,
“From my own notes and corroborated by the notes of Drs Kumar, Talbot and Neal,
Mr Stockwell had significant work-related stress, resorting to drinking heavily and smoking. While the report of Dr Smith does include a statement to contradict the latter, the consistency with the other reports and my own observations lead me to believe Mr Stockwell mostly did have these lifestyle behaviours. It is consistently clear that he had significant work-related stress and was independently confirmed to have PTSD.
His diagnosis of advanced oesophageal adenocarcinoma following severe ulcerative oesophagitis, GERD with Barrett’s oesophagus only a year earlier, suggest to me that he must have had significant chronic stress while stress alone to cause such rapid development of stage IV malignancy in such a short time interval, but more likely other aetiologic factors contributed to its development, such as smoking and possibly excessive alcohol. Acknowledging that the majority of patients with Barrett’s oesophagus will not develop cancer, in Mr Stockwell I believe the severe GERD/reflux oesophagitis and its causes are the most likely factors contributing to the pathogenesis of his cancer. And I believe that his significant work stress leading to PTSD contributed to his GERD and the cigarette smoking and possibly excessive alcohol, which collectively led to his diagnosis of cancer.”

Medicolegal evidence

Professor Richard Fox

The applicant relies upon a medicolegal report prepared by oncologist, Professor Richard Fox, dated 4 January 2023.
Prof Fox took a medical history that was consistent with the other evidence. Prof Fox noted the history of work-related emotional stress in the deceased worker’s written statement and the diagnosis of post-traumatic stress disorder.
Prof Fox noted there was a series of research publications going well back into the 1990s regarding the relationship between stress and GORD.
In a 2007 publication, Soderholm JD, concluded that psychological stress had a major impact on gut mucosal function and affected the course of gastrointestinal disorders. Stress caused barrier dysfunction of the gastrointestinal mucosa. The increased permeability was a pathogenic factor in GORD.
A further publication was cited, which noted that reflux oesophagitis was significantly associated with psychological stress and the severity of reflux oesophagitis correlated with the degree of stress.
Prof Fox said that Barrett’s oesophagus was a condition which developed as a consequence of chronic GORD and predisposed patients to the development of adenocarcinoma of the oesophagus. Other risk factors included central abdominal obesity and smoking although there was no clear-cut relationship between alcohol ingestion and the condition.
Prof Fox noted,
“Causes of oesophageal injury is chronic reflux oesophagitis caused by gastric reflux of acid and other noxious substances from the stomach into the lower end of the oesophagus.
This leads to oxidative DNA damage and induces double strand DNA breaks in Barrett’s epithelial cells. This is a precursor of malignant change leading to Oesophageal carcinoma.
The risk of Adenocarcinoma of the oesophagus with these risk factors has been documented to be of the order of some 8 fold min a review paper by Drahos J et al (2016), from several US centres, including DC Whiteman from Brisbane.”
Prof Fox was asked whether the deceased worker’s employment was the main contributing factor to his consequential injuries and need for treatment. Prof Fox responded:
“I have described above the relationship between stress and gastroesophageal reflux disease (GORD), the relationship of that to Barrett’s oesophagus and hence to an adenocarcinoma in the Barrett’s mucosa of the lower end of the oesophagus.
There is, hence, a clear-cut chain of events between his post-traumatic stress disorder related to his work and the sequential development of the cancer as noted above. i.e., it would in my opinion be that his employment was the main contributing factor to the development of his cancer.”
Prof Fox referred to studies which noted that individuals with post-traumatic stress disorder presented with high levels of nicotine dependence and excessive use of alcohol. There was a connection between post-traumatic stress disorder, smoking and increased acid secretion in the stomach causing ulcerative oesophagitis. Alcohol did not appear to be critical to the development of Barrett’s oesophagus or subsequent adenocarcinoma.
Asked to comment on the first respondent’s dispute notice, Prof Fox noted the differing histories recorded by Dr Smith on the one hand and Dr Kumar on the other regarding the deceased worker’s use of alcohol and tobacco. Prof Fox responded,
“I believe the insurer has relied in their opinion on that there may not be links to smoking and alcohol and meals, etc. This is an incorrect assumption.
I note the literature is inconclusive regarding any link between alcohol and the development of Barrett's oesophagus.
The issue is well reviewed in the Runge TM paper et al Epidemiology of Barrett's oesophagus of oesophageal adenocarcinoma. They note the gastroesophageal reflux disease is the strongest risk factor and the risk is more pronounced with longstanding GERD.
They note that risk factors include GERD, tobacco smoking and obesity.
I note that Mr Stockwell’s has had evidence of obesity at the time he was diagnosed with Barrett's oesophagus.
I believe the insurer has not considered the relationship between PTSD, GORD and Barrett's oesophagus and hence the adenocarcinoma. The issues involved are appropriately described by Pro N Pavlakis.”

Prof Fox observed that there appeared to be no relevant pre-existing conditions or abnormality.

Dr Alice Neale

The first respondent relies on a medicolegal report prepared by consultant psychiatrist,
Dr Alice Neale dated 30 April 2021.
Dr Neale noted that the deceased worker last worked in early November 2019 as a Senior Constable in General Duties. Dr Neale summarised the deceased worker’s employment history and recorded:
“Mr Stockwell said that, upon reflection, he noticed he began to experience some difficulties with his mood approximately six to eight months prior to transferring from STIB to Rosehill. He said he noticed he was unable to read certain affidavits about jobs as ‘they made me feel sick’. He said the attitude in his workplace was ‘get in and get it done’ so he noticed that he began to increase his alcohol in order to ‘drown my sorrows’. He reports he had good colleagues and very much enjoyed the workplace, though found that there was limited debrief about jobs as ‘what happens at STIB stays at STIB’. Looking back, Mr Stockwell said that around that time his mental health ‘fell apart’. He reports recalling feeling anxious travelling to jobs, as he was wanting the best outcome for the victims. He also said that he would often look up newspaper articles about jobs after they were finished. At that time, Mr Stockwell said he began to experience intermittent flashbacks about previous traumatic jobs. On reflection, Mr Stockwell said that the flashbacks and nightmares that he has experienced have mostly been from his work in STIB and Rosehill, with no particularly traumatic incidents prior to that.”
After being transferred to Rosehill in 2015, the deceased worker reported that his alcohol and avoidance behaviours increased. He described an increase in flashbacks, nightmares and noticed he was hypervigilant. Around that time, he also began experiencing panic attacks, and felt unable to control his mental health symptoms.
The deceased worker reported that he said that he has experienced a reduced appetite and has lost approximately 16kg since going off work. The deceased worker was consuming one meal per day.
The deceased worker reported that he was currently consuming one to two standard drinks every two days, smoking half a packet of cigarettes per day and consuming three to four serves of caffeine per day.
Dr Neale concluded that the deceased worker presented with symptoms consistent with a DSM-V diagnosis of post-traumatic stress disorder. With respect to causation Dr Neale opined:
“It is my opinion that the main contributing factor to Mr Stockwell developing his Post-Traumatic Stress Disorder was the exposure to traumatic incidents during the course of his duties as a police officer, most notably during his time with the State Technical Investigations Branch and at the Rosehill station.”
Dr Neale made an assessment of 22% whole person impairment.

Dr David Gorman

The first respondent also relies on medicolegal reports from Dr David Gorman, a physician in general medicine, medical oncology and pain medicine specialist, dated 24 October 2023 and 6 March 2024.
In his first report, Dr Gorman took a history of psychological injury as a result of his exposure to traumatic events over the course of the deceased worker’s employment. A gastroscopy performed on 4 March 2021 confirmed Barrett’s oesophagitis and grade 4 ulcerative oesophagitis. With ongoing symptoms, he had a further gastroscopy and biopsy in June 2021 which identified a circumferential adenocarcinoma in combination with the Barrett’s oesophagitis.
Dr Gorman noted that the deceased worker was a heavy smoker and regular drinker but said there was question over this given Dr Smith’s history.
Dr Gorman noted the reports of Prof Fox, Dr Kumar and Prof Pavlakis, which outlined a relationship between stress and the development of GORD. Prof Pavlakis also identified smoking (and to a lesser extent alcohol) as a causative factor in the pathogenesis of reflux oesophagitis, Barrett’s oesophagitis and oesophageal carcinoma.
Dr Gorman said he nonetheless considered that A/Prof Talbot had offered a more accurate analysis of the clinical situation in his report of 7 September 2022.
Dr Gorman quoted from A/Prof Talbot’s report, in particular his observation that it would take years or decades for reflux to lead to Barrett’s oesophagitis and then adenocarcinoma.
Dr Gorman also highlighted A/Prof Talbot’s view that structural issues and lifestyle factors, particularly obesity, were the predominant risk factors.
Dr Gorman expressed the view,
“While Mr Stockwell had stressful incidents during his time in the Police Force, these only reached a crescendo around two years prior to his diagnosis. He had been a long term smoker from at least around 2006 and while his smoking may have increased as a result of work stress from 2018 onwards, as Associate Professor Talbot states, that would not be long enough to develop the adenocarcinoma.
I agree completely with the statements of Associate Professor Talbot as outlined above and believe that they are more directly related to Mr Stockwell’s case than the opinions of Professor Fox, Professor Pavlakis or Dr Kumar who note only generally the relationship of stress, alcohol and smoking to the development of adenocarcinoma rather than considering the length of time that these factors need to act.”
In response to specific questions from the insurer, Dr Gorman expressed disagreement with Dr Kumar’s opinion that the deceased workers GORD was secondary to his post-traumatic stress disorder, reiterating that structural abnormalities at the gastroesophageal junction were more significant than an increase in acid itself.
Dr Gorman noted that the deceased worker was overweight prior to his cancer diagnosis and reiterated his view, in reliance on A/Prof Talbot’s report, that the more significant or “predominant” risk factors to the development of Barrett’s or cancer were structural failings in the lower oesophageal valve as well as dietary and weight related.
Dr Gorman said Dr Kumar, Prof Pavlakis and Prof Fox did not consider the long period of exposure to risk factors required and stated,
“I believe the fact that he was a smoker from at least 2006 would have given him very sufficient and much more exposure to the carcinogenic effects of cigarette smoke than the much shorter period after 2018, even if he was smoking more during that later period.”
Asked about the “primary cause” of the development of Barrett’s oesophagus, Dr Gorman responded:
“As I have outlined above, I believe that the predominant cause is structural abnormality of the gastroesophageal valve. This is the primary cause of reflux of acid which, over a long period, leads to the histopathological change and the development of Barrett’s oesophagus.
The smoking and psychological distress are not the primary cause of the development of Barrett’s oesophagus.”
Asked whether the deceased worker’s psychological injury was caused or materially contributed to the development of cancer, Dr Gorman responded:
“No, I do not believe that the psychological injury (PTSD) caused or materially contributed to the development of oesophageal cancer.
I believe that the major causes were structural at the gastroesophageal junction leading to longstanding reflux of acid into the oesophagus and the subsequent development of severe gastroesophageal reflux, Barrett’s oesophagitis and eventually adenocarcinoma. Added to this was the carcinogenic effect of the smoking and alcohol. In addition, his reflux was likely worsened by being overweight and this may have also led to increased episodes of reflux in association with the structurally deficient gastroesophageal valve.”
Dr Gorman concluded that the deceased worker was likely to have developed Barrett’s oesophagus and/or oesophageal cancer irrespective of his employment with the first respondent:
“He was overweight, had longstanding alcohol use and was smoking since 2006. These in conjunction with his deficient gastroesophageal valve contributed to the reflux and contributed to the eventual development of Barrett’s oesophagus and oesophageal cancer. While stress from time to time would have increased his level of smoking and possibly increased the amount of reflux, this was a minimal causative factor compared with the other factors discussed and, therefore, I believe that whatever his employment he would have developed Barrett’s oesophagus and oesophageal cancer.”
In his supplementary report of 6 March 2023, Dr Gorman confirmed that he did not believe that post-traumatic stress disorder caused or materially contributed to the deceased worker’s oesophageal adenocarcinoma.
Dr Gorman explained,
“As noted in my report, the development of reflux and later Barrett’s oesophagus was related to the anatomy of the gastro-oesophageal junction. The Barrett’s oesophagus was a precursor to the oesophageal carcinoma. While factors such as obesity and distress may contribute to an intermittent extent to the amount of acid reflux, they are not “material causes” I consider. Smoking not only contributes to reflux but may also be a carcinogen – as discussed however in the report, this preceded the development of work related stress I understand.
Again I must emphasise however, in someone who had such severe reflux as to develop Barrett’s oesophagus, the structural issues at the oesophageal junction far outweigh other contributing factors.”

Applicant’s submissions

The applicant submitted that the deceased worker’s Barrett’s oesophagus and adenocarcinoma were consequential conditions that had resulted from his psychological injury.
The psychological injury had set in train a series of events which culminated in the deceased worker’s death. The injury materially contributed to the deceased worker’s GORD, which led to the Barrett’s oesophagus, which led to the adenocarcinoma and ultimately the deceased worker’s death.
The applicant’s case was neatly summarised by Prof Pavlakis, who expressed the view that psychological stress was a risk factor for GORD and the severity of symptoms increased with the severity of the stress. The deceased worker had experienced significant stress for a very long period of time.
The relevant test was that set out in Kooragang Cement Pty Ltd v Bates[1] and was one of “material contribution”. Although other factors may have contributed to the death, the correct question was whether the psychological injury had materially contributed to the development of the other conditions and ultimately the deceased worker’s death.
[1] (1994) 10 NSWCCR 796 at [810].
The applicant referred to the authorities in Strong v Woolworths Ltd;[2] Bonnington Castings Ltd v Wardlaw[3] and Amaca Pty Ltd v Ellis[4]on the test of “material contribution” and submitted that any contribution other than a minimal contribution would be regarded as “material”. The applicant submitted that the Commission would have no doubt that the psychological injury was a material cause of the deceased worker’s death.
[2] [2012] HCA 5.
[3] [1956] AC 613.
[4] [2010] HCA 5.
The applicant referred to the statements of the deceased worker and the reports of Dr Smith with regard to the nature of the psychological injury. The deceased worker had attended a significant number of distressing and traumatic incidents over the course of his career. His emotional state gradually altered leading to a diagnosis of PTSD and major depressive disorder, both of which were said to be “chronic” in duration. The deceased worker’s condition did not commence on the date of injury. Rather, that was the date on which the deceased worker was no longer able to cope with his employment duties.
The applicant submitted that the Commission would place great weight on the opinion of Prof Pavlakis. As the treating oncologist, he was in an excellent position to assess the deceased worker’s conditions and how they came about.
Prof Pavlakis noted that the deceased worker had no clear genetic susceptibility to oesophageal cancer. Besides the play of chance, the oesophageal cancer was related to GORD.
Prof Pavlakis noted that the deceased worker quit smoking around the time of the Barrett’s oesophagus diagnosis and had drunk alcohol to excess in the past. Smoking was clearly identified as a risk factor. Alcohol and psychological stress were also identified as risk factors with the severity of reflux corelating with the degree of stress. Even on Prof Pavlakis’ evidence alone, the Commission would find that the chain of causation was made out.
The applicant noted that Dr Smith recorded that the deceased worker told him that he did not resort to alcohol or cigarettes to cope with his psychological symptoms. However, Dr Neale, Dr Talbot and Dr Kumar all referred to the deceased worker smoking and drinking heavily to manage his stress. Dr Smith’s history was in contrast to all of the other evidence and ought to be put to one side.
Leaving aside the increase in drinking and smoking, an increase in psychological stress was independently confirmed to be a risk factor. Prof Pavlakis referred to independent medical literature confirming the link between stress, GORD and Barrett’s oesophagus.
The applicant submitted that little weight would be placed on Dr Gorman’s opinion. There was no evidence that the deceased worker had pre-existing reflux or GORD. Any pre-existing vulnerability was irrelevant.
The applicant referred the Commission to the evidence of the treating practitioners,
Dr Cameron, Dr Pollard and Dr Kumar. Dr Kumar gave the opinion that the deceased worker’s post-traumatic stress disorder was the cause of his anxiety, as well as the increased consumption of cigarettes and alcohol which in turn would have caused increased acidity in the stomach. This in turn led to Barrett’s oesophagus, which eventuated in an adenocarcinoma of the oesophagus.
The applicant noted that the evidence from Dr Kumar linking the post-traumatic stress disorder to the deceased worker’s oesophageal condition was provided to the insurer contemporaneously to the diagnosis.
There was no evidence of other non-work factors contributing to the condition.
The applicant referred to the report of Prof Fox and noted that the published articles on which he relied were not addressed by Dr Gorman. Prof Fox expressed a clear and unequivocal opinion on the causal relationship between stress and gastroesophageal reflux. The chain of causation resulting in the deceased worker’s death was explained. The chronic GORD led to oxidative DNA damage and induced double strand DNA breaks in Barrett’s epithelial cells. This was a precursor of malignant change leading to oesophageal carcinoma.
Although Prof Fox found employment was the “main contributing factor” to the condition, a lesser test applied.
The applicant submitted that the deceased worker was very young and there was no evidence that the adenocarcinoma would have occurred without the post-traumatic stress disorder. Other lifestyle risk factors such as poor diet and lack of exercise could have resulted from the post-traumatic stress disorder but it was not necessary to make any findings in that regard.
In contrast to the strong and clear opinion from Prof Fox, backed up by the treating evidence, Dr Gorman recorded a truncated history of the deceased worker’s experiences. He skipped to 2019 without taking a history of stress over an extended period of time. He did not refer to Prof Pavlakis’ unequivocal opinion on the connection between post-traumatic stress disorder and the condition. Dr Gorman did not engage properly with the post-traumatic stress disorder diagnosis, referring only to “work stress” or “distress”.
In expressing the view that structural or anatomical factors were more significant, Dr Gorman did not refer to any medical literature or studies weighing the risk factors. His use of the expression, “primary cause” was not the correct test.
While the first respondent sought to remedy that error in Dr Gorman’s supplementary report, his reasoning was not adequately explained.
The applicant submitted that it was not clear that A/Prof Talbot understood the correct test of causation. There was no evidence the deceased worker had experienced reflux for 10 years in the clinical notes. A/Prof Talbot conceded that stress was relevant.
The applicant submitted that the Commission would be satisfied on the balance of probabilities that the death resulted from the deceased worker’s post-traumatic stress disorder. There was no break in the chain of causation. The contribution was material and not de minimis. The language used by the deceased worker’s doctors suggested that it had contributed to a significant or “material” degree.

Second respondent’s submissions

The second respondent adopted the applicant’s submissions.
In addition, the second respondent submitted that various authorities had established that the test of materiality required something more than a de minimis contribution. It was a low bar that had to be satisfied.
There was no dispute that post-traumatic stress disorder could theoretically give rise to gastritis and that gastritis was the primary driver to Barrett’s oesophagus and in turn adenocarcinoma. In considering the contribution of the deceased worker’s post-traumatic stress disorder, the degree of stress was relevant. The greater the stress, the greater the risk factor. Prof Pavlakis and Prof Fox both referred to academic literature in support of that proposition.
The first respondent failed to acknowledge the severity of the stress to which the deceased worker was exposed. The stressors to which the deceased worker was exposed were not de rigueur. He did not simply have an adjustment disorder. The deceased worker witnessed truly awful things and, as a consequence, developed post-traumatic stress disorder.
The second respondent submitted that the accumulation of events gave rise to a diagnosable condition as early as 2014. Referring to the history given to Dr Neale, things really became bad when the deceased worker joined the State Technical Investigations Branch in 2011. Around that time, the deceased worker began to increase his alcohol intake. By 2014, the stressors had probably given rise to an extant condition. The disorder eventually diagnosed was of considerable magnitude and was a profound psychological illness.
Although A/Prof Talbot took a consistent history, he did not know when the applicant sustained a psychological condition. A/Prof Talbot’s report, which was not prepared for the purpose of legal proceedings, did not negative the proposition that the psychological condition contributed materially to the evolution of the cancer.
Dr Gorman essentially adopted A/Prof Talbot’s opinion, however, that opinion had been given in ignorance of the extent of the psychological condition. Dr Gorman’s report suggested that symptoms only became significant in 2018. In fact, the deceased worker was experiencing profound illness as far back as 2014. The second respondent referred in this regard to the deceased worker’s consultation with his treating doctor Dr Pollard on
14 December 2019.
On the basis that there was an onset of injury in 2014, the duration of the injury was consistent with what A/Prof Talbot said would be required for the injury to have an impact.
The applicant was only required to prove a material contribution. The presence of other significant factors did not negative the proposition that post-traumatic stress disorder played a material role.

Third respondent’s submissions

The third respondent adopted and relied upon the submissions of the other family members.

Fourth respondent’s submissions

The fourth respondent adopted and relied upon the submissions of the other family members.
In addition, it was submitted that the dispute was misconceived in its reliance upon
Dr Smith’s history regarding cigarette and alcohol consumption. Dr Neale obtained a history of increased cigarette and alcohol consumption in the context of psychological symptoms prior to the diagnosis of post-traumatic stress disorder. The deceased worker was also noted to be consuming only one meal per day due to lack of motivation and lack of appetite.

Dr Gorman failed to grapple with the evidence that the deceased worker’s issues commenced from time he was attested as a police officer in 2003. Dr Gorman misread A/Prof Talbot’s report and did not offer an independent opinion.
From the time the deceased worker commenced working as a police officer there was a notable change. The lay evidence from the deceased worker’s brother was that he did not seem himself. He began to consume alcohol and cigarettes more regularly from the time he became a police officer. Dr Gorman had that history but ignored it.
Dr Gorman also applied an incorrect test in giving his opinion.

Fifth respondent’s submissions

The fifth respondent adopted and relied upon the submissions of the other family members and submitted that even if the deceased worker had a predisposition, the effects of the psychological injury brought forward the Barrett’s oesophagus and adenocarcinoma. The stress and increased cigarette and alcohol intake sped up the development of the condition. The contribution from the injury was not de minimis.

First respondent’s submissions

The first respondent submitted that in weighing the competing medical opinions, the Commission ought to look to the doctors’ areas of specialisation. Prof Pavlakis, although a treating oncologist conceded that he was not an expert in the field of oesophageal cancers. In contrast, A/Prof Talbot specialised in Barrett’s oesophagus and cancer. A/Prof Talbot’s opinion ought to hold the greatest weight on causation. A/Prof Talbot gave the opinion that stress was not a cause of the condition.
The experience of stress was not itself an “injury”. Although it had been suggested that the deceased worker had a diagnosable condition from an earlier date in around 2014, the deceased worker’s evidence only suggested the development of symptoms from that period. The deceased worker first raised issues in 2018 and referred to more recent incidents causing flashbacks to earlier incidents. It was not until the end of 2019 that the deceased worker ceased working.
Referring to the notes of Dr Pollard, the first respondent submitted that the incidents the deceased worker was most concerned with occurred in 2018 or 2019.
The first respondent submitted that the lay evidence ought to be treated with caution. The applicant first met the deceased in 2006 and did not see him for a lengthy period until October 2020 after he had already ceased employment.
The other witnesses placed the increase in the deceased worker’s drinking and smoking in around 2017 and 2018 and predominantly addressed his behaviour in social settings.
Dr Gorman had extracted A/Prof Talbot’s report because he agreed with the contents of it.
The first respondent observed that three oncologists had given evidence that alcohol intake was the lowest risk factor. Smoking and obesity were far greater risk factors. The deceased worker had been smoking for 12 years prior to 2018. There was no suggestion in the evidence that the deceased worker’s increased weight was caused by post-traumatic stress disorder or stress symptoms.
The period of increased stress leading to the post-traumatic stress disorder diagnosis was comparatively brief. The medical evidence suggested that stress alone was a de minimis factor. Dr Gorman gave a clear opinion that the deceased worker’s post-traumatic stress disorder did not cause the adenocarcinoma.
The first respondent referred to the evidence of Dr Neale. Dr Neale recorded that the deceased worker increased his alcohol intake in response to his earlier symptoms but did not record that the deceased worker’s smoking increased.
The major events reported to Dr Neale occurred between 2018 and 2019. At best, the Commission would be satisfied of an increase in alcohol intake but that had the smallest effect on the development of cancer. The Commission would not be satisfied that the adenocarcinoma resulted from the post-traumatic stress disorder.

Submissions in reply

In responding to the first respondent’s submission that the relevant stressful events occurred only recently, the applicant submitted that the Commission would look at the context in which the deceased worker’s statement was prepared. At that stage, a claim was being made for weekly payments from 3 November 2019. The deceased worker’s focus was the events that put him off work.
The psychological injury was a disease process that was cumulative in nature after being exposed to many traumatic events over a period of time.
The applicant submitted that the lay evidence would be accepted. The deceased worker had begun relying on alcohol to deal with traumatic incidents.
Dr Gorman’s weighing of the causative factors was deficient with regard to the deceased worker’s psychological stress. The symptoms were only brought to his supervisors when the deceased worker could no longer cope. The deceased worker did not merely experience stress “from time to time”, he experienced significant trauma that led to a chronic condition.
With regard to the criticism of Prof Pavlakis’ qualifications, the applicant submitted that she did not just rely on one expert. She also relied upon on Dr Kumar who was an endoscopist. The whole of the evidence ought to be evaluated.
The second respondent submitted that the first respondent’s submissions suggested that between 2003 and 2019 the deceased worker was in good health then suddenly some events occurred in 2019 that tipped him over the edge. The sole basis for that submission was the general practitioner’s clinical notes.
That submission stood in contrast to the history recorded by Dr Neale, which would be preferred. Clinical notes were shorthand records prepared with a view to implementing treatment. In contrast, Dr Neale was a psychiatrist asked to prepare a medicolegal report. Her evidence was far more detailed and more accurate.
The second respondent submitted that the deceased worker’s injury was a cumulative psychological condition that built and evolved into something that could be diagnosed.
Dr Neale considered that exposure to traumatic incidents during the course of his duties as a police officer, most notably during his time with the STIB and at the Rosehill station was the cause of the deceased worker’s injury.
While the lay evidence was not proof of a diagnosable condition, it was consistent with a condition that was present well before 2019.
The relevant test was that of material contribution. Although Dr Gorman said the major contributing factor to the adenocarcinoma was structural issues involving the gastroesophageal valve, that did not mean that the psychological injury was not a material contributing factor. The fact that the injury may not be a primary or major cause did not negative that it was a material cause.
Dr Gorman’s opinion was fundamentally flawed.
The fourth respondent noted the first respondent’s suggestion that the deceased worker’s stress had to be at the severity of post-traumatic stress disorder the whole time to be relevant. The medical evidence indicated stress alone was sufficient to increase stomach acidity. The evidence established that the deceased worker experienced significant stress from the early stages of his employment.
With respect to the challenge to Prof Pavlakis’ expertise, the fourth respondent observed that he was a treating doctor who provided a well-reasoned opinion that was in fact broadly consistent with that of A/Prof Talbot. The difference between the two was the history of stress and consumption of alcohol and cigarettes pre-dating the post-traumatic stress disorder diagnosis that was before Prof Pavlakis.
The reports of Dr Cameron and Dr Smith were not addressed by the first respondent. It was clear that deceased worker traumatised by many traumatic incidents that pre-dated the events in 2018 and 2019. This was said to be consistent with the incident notification form.
The fourth respondent submitted that the Commission would accept the lay evidence with regard to the deceased worker’s consumption of alcohol and cigarettes.
The fifth respondent submitted that the deceased worker was stoic and underplayed his condition only seeking assistance as a last resort.

FINDINGS AND REASONS

Section 25 (1) of the 1987 Act provides for the payment of compensation “if death results from an injury”.
The term “injury” is defined in s 4 of the 1987 Act as follows:
“4 Definition of ‘injury’
In this Act:
injury:
(a)     means personal injury arising out of or in the course of employment,
(b)     includes a disease injury, which means:
(i) a disease that is contracted by a worker in the course of employment but only if the employment was the main contributing factor to contracting the disease, and
(ii) the aggravation, acceleration, exacerbation or deterioration in the course of employment of any disease, but only if the employment was the main contributing factor to the aggravation, acceleration, exacerbation or deterioration of the disease, and
(c)     does not include (except in the case of a worker employed in or about a mine) a dust disease, as defined by the Workers’ Compensation (Dust Diseases) Act 1942, or the aggravation, acceleration, exacerbation or deterioration of a dust disease, as so defined.”
It is accepted that the deceased worker sustained an “injury” for the purposes of s 4 of the 1987 Act in the nature of post-traumatic stress disorder. What is in dispute is whether the conditions which caused the deceased worker’s death “resulted from” that injury.
In Bouchmouni v Bakhos Matta t/as Western Red Services[5], Roche DP commented,
“The Commission has considered and explained the difference between an ‘injury’ and a condition that has resulted from an injury in several recent decisions (Moon v Conmah Pty Ltd [2009] NSWWCCPD 134 at [43], [45] and [50] (Moon); Superior Formwork Pty Ltd v Livaja [2009] NSWWCCPD 158 at [122]; Cadbury Schweppes Pty Ltd v Davis [2011] NSWWCCPD 4 at [28]–[32] and [39]–[42] (Davis); North Coast Area Health Service v Felstead [2011] NSWWCCPD 51 at [84]; Australian Traineeship System v Turner [2012] NSWWCCPD 4 at [28] and [29] (Turner); Kumar v Royal Comfort Bedding Pty Ltd [2012] NSWWCCPD 8 at [35]–[49] and [61]). …
The injury to Mr Bouchmouni’s right knee caused him to seek treatment in the form of surgery and physiotherapy. The evidence suggests that it was in the course of receiving that treatment, and/or as a result of an altered gait because of his knee symptoms, Mr Bouchmouni developed back symptoms. If that is accepted, and no reason has been advanced why it should not be, it is clear beyond doubt that his back condition has resulted from the treatment he received for his accepted knee injury and his altered gait. That does not, however, make the back condition an ‘injury’.”
[5] [2013] NSWWCCPD 4.
A commonsense evaluation of the causal chain is required. The applicable test of causation is that discussed by the Court of Appeal in Kooragang Cement Pty Ltd v Bates,[6] where Kirby P said at [461] (Sheller and Powell JJA agreeing):
“From the earliest days of compensation legislation, it has been recognised that causation is not always direct and immediate…
Since that time, it has been well recognised in this jurisdiction that an injury can set in train a series of events. If the chain is unbroken and provides the relevant causative explanation of the incapacity or death from which the claim comes, it will be open to the Compensation Court to award compensation under the Act.”
[6] (1994) 10 NSWCCR 796 at [810].
His Honour said at [463]-[464]:
“The result of the cases is that each case where causation is in issue in a workers’ compensation claim, must be determined on its own facts. Whether death or incapacity results from a relevant work injury is a question of fact. The importation of notions of proximate cause by the use of the phrase ‘results from’, is not now accepted. By the same token, the mere proof that certain events occurred which predisposed a worker to subsequent injury or death, will not, of itself, be sufficient to establish that such incapacity or death ‘results from’ a work injury. What is required is a commonsense evaluation of the causal chain. As the early cases demonstrate, the mere passage of time between a work incident and subsequent incapacity or death, is not determinative of the entitlement to compensation. In each case, the question whether the incapacity or death ‘results from’ the impugned work injury (or in the event of a disease, the relevant aggravation of the disease), is a question of fact to be determined on the basis of the evidence, including, where applicable, expert opinions. Applying the second principle which Hart and Honoré identify, a point will sometimes be reached where the link in the chain of causation becomes so attenuated that, for legal purposes, it will be held that the causative connection has been snapped. This may be explained in terms of the happening of a novus actus. Or it may be explained in terms of want of sufficient connection. But in each case, the judge deciding the matter, will do well to return, as McHugh JA advised, to the statutory formula and to ask the question whether the disputed incapacity or death ‘resulted from’ the work injury which is impugned.”
It is the applicant who bears the onus of establishing that the death resulted from the accepted psychological injury on the balance of probabilities. In Nguyen v Cosmopolitan Homes (NSW) Pty Limited[7] McDougall J stated at [44]:
“A number of cases, of high authority, insist that for a tribunal of fact to be satisfied, on the balance of probabilities, of the existence of a fact, it must feel an actual persuasion of the existence of that fact. See Dixon J in Briginshaw v Briginshaw [1938] HCA 34; (1938) 60 CLR 336. His Honour’s statement was approved by the majority (Dixon, Evatt and McTiernan JJ) in Helton v Allen [1940] HCA 20; (1940) 63 CLR 691 at 712.”
[7] [2008] NSWCA 246.
The deceased worker’s psychological injury is well documented in the evidence before the Commission.
Although he first raised mental health issues with his supervisors in mid-2019 and ceased work due to being unable to cope in November 2019, the deceased worker’s own evidence was that events over the course of his 16 years of service with the first respondent were the catalyst for his psychological injury. Similarly, in his incident notification form, the deceased worker described his attendance at critical incidents over an extended period of time as causative of his injury.
The deceased worker’s evidence in this regard was consistent with the clinical note recorded by Dr Pollard on 14 December 2019 which referred to “one trauma after another”. Although the deceased worker described some particular incidents occurring over the previous 12 months, the most recent workplace event was described as “the straw that broke the camel’s back”.
Treating psychologist, Dr Cameron recorded a history of “hundreds if not thousands” of traumatic incidents commencing with the deceased worker’s general duties at Hurstville in 2003. Dr Cameron noted a particular onset of symptoms such as intrusive memories and avoidant behaviours during the period of the deceased worker’s employment at the STIB, which Dr Smith, in his reports, confirmed was between 2011 and 2015. Dr Smith similarly recorded that the deceased worker had been exposed to a significant number of distressing and traumatic incidents during the course of his lengthy police career.
The period during which the deceased worker served in the STIB was also identified as significant in the history recorded by Dr Neale. Dr Neale recorded that the deceased worker began to experience difficulties with his mood approximately six to eight months prior to transferring from the STIB to Rosehill. Those symptoms included anxiety and intermittent flashbacks. The deceased worker told Dr Neale that his flashbacks and nightmares were mostly from his work at the STIB and Rosehill. After his transfer to Rosehill, the deceased worker reported an increase in flashbacks, nightmares and hypervigilance.
The histories recorded in the medical evidence align with the body of lay evidence before the Commission. The deceased worker’s brother, Mr Stockwell, gave evidence as to his own observations of a change in the deceased worker’s demeanour within the first couple of years of his service with the first respondent. By approximately 2017, the deceased worker was observed to be “withdrawn”, “extremely jittery” and “on edge”.
The deceased worker’s friend and former colleague, Mr De Jong, described the deceased worker being placed under an “extreme amount of stress and pressure” while working at the STIB.
Mr Stockwell, Mr De Jong and Mr Skelton all also described a significant increase in the deceased worker’s tobacco and alcohol consumption, particularly from around mid to late 2017.
Mr Stockwell said it became clear that the deceased worker had begun relying on these as a coping mechanism for dealing with the traumatic incidents he was forced to attend during his employment. From approximately 2017 onwards, Mr Stockwell said he would “rarely” see the deceased worker without a cigarette in his hand and he was regularly binge drinking.
Mr De Jong gave evidence that around this time the deceased worker had disclosed that his smoking had become a problem and he was consuming 1 ½ packets of cigarettes a day.
Mr Skelton also described excessive cigarette and alcohol consumption from this period. By 2019, Mr Skelton had observed the deceased worker smoking an entire packet of cigarettes over the course of 2-3 hours and sometimes an entire bottle of scotch in one night.
A significant change in the deceased worker’s pattern of tobacco and alcohol consumption in the interval between 2006 and 2020 was also described in the applicant’s evidence.
While the first respondent’s submissions suggested that the Commission ought to approach the lay evidence with caution, amongst other reasons because it only recorded the deceased worker’s behaviour in social settings, the deceased worker, in his own statements, confirmed that he turned to heavy drinking and smoking to numb his intrusive thoughts.
The deceased worker also said that he had expressed his reliance on these substances to cope with his crippling anxiety and depression to Dr Smith.
Dr Smith’s account, that the deceased worker had not resorted to alcohol or cigarettes as a coping mechanism, is therefore inconsistent with all of the lay evidence, including the deceased worker’s own evidence. It is also inconsistent with the histories recorded by
Dr Pollard and Dr Neale.
Upon careful consideration of the evidence, I am satisfied on the balance of probabilities that the deceased worker began experiencing psychological symptoms, later diagnosed as symptoms of post-traumatic stress disorder, at least from a period towards the end of his service in the STIB, with a particular deterioration between approximately mid-2017 and late 2019.
While I accept the first respondent’s submission that there is no basis on which to find that the deceased worker experienced symptoms sufficient to warrant a diagnosis of post-traumatic stress disorder during the time of his service with the STIB, I do accept that the symptoms which later formed the basis for that diagnosis were experienced from that time onwards.
I am further satisfied that the deceased worker’s consumption of tobacco and alcohol significantly and materially increased as a result of these psychological symptoms. There is evidence of the deceased worker smoking and drinking alcohol prior to the commencement of his employment with the respondent and prior to him reporting work-related stress. I am satisfied, however, that his intake of both substances increased from occasional to excessive levels due to the deceased worker using them to cope with his worsening psychological symptoms.
Having made the findings above with regard to the nature and duration of the deceased worker’s psychological injury it is necessary to consider whether the physical conditions which lead to the deceased worker’s death “resulted from” that injury.

There is little dispute on the medical evidence as to the pathological sequence of events that lead to the deceased worker’s death. The medical experts all agreed that the deceased worker experienced reflux of acid into the oesophagus and the subsequent development of GORD, leading to Barrett’s oesophagus and eventually adenocarcinoma.
The medical evidence also consistently indicated that the development of those conditions was multifactorial.
The first respondent’s medicolegal expert, Dr Gorman, expressed the opinion that structural abnormality of the gastroesophageal valve was the primary or predominant cause of reflux which, over a long period, lead to histopathological change and the development of Barrett’s oesophagus and eventually the adenocarcinoma.
Dr Gorman did, however, agree that other factors such as obesity, smoking, alcohol and stress contributed to the reflux and the eventual development of Barrett’s oesophagus and oesophageal cancer.
Dr Gorman considered that obesity, alcohol and stress were only minimal causative factors and not “material causes”. While Dr Gorman accepted that smoking had a more significant impact upon the deceased worker’s reflux and also had a carcinogenic effect, he did not accept that this was a result of the injury, based on a history of the deceased worker’s smoking preceding the development of work-related stress.
Dr Gorman drew support for his conclusions from the report of A/Prof Talbot dated
7 September 2022.
I am not satisfied, however, that either Dr Gorman or A/Prof Talbot gave adequate consideration to the extent of the deceased worker’s psychological symptoms and use of tobacco and alcohol.
Dr Gorman appears to have understood that the deceased worker’s psychological symptoms only reached a crescendo or impacted upon the extent of the deceased worker’s smoking from 2018 onwards. Dr Gorman described the psychological symptoms as “stress” or “distress” without expressly identifying the nature or severity of the deceased worker’s symptoms as described, for example, in Dr Smith’s and Dr Neale’s reports.
A/Prof Talbot conceded that he did not know when the deceased worker suffered a psychological injury. It is not clear what history was provided to A/Prof Talbot with regard to the extent and nature of the psychological injury or whether he understood the extent of the deceased worker’s tobacco and alcohol consumption from 2015 onwards.
As noted by Dr Gorman, A/Prof Talbot found that reflux was “predominantly” caused by structural failings in the lower oesophageal valve. However, A/Prof Talbot, like Dr Gorman, also accepted that stress, smoking and alcohol were probable “modifying” or “aggravating” factors to an increase in gastric acid secretion and transient lower oesophageal sphincter relaxations. In addition, A/Prof Talbot noted the carcinogenic effects of cigarettes and alcohol.
The legal principles to be applied in determining the question in issue have been traversed above. In addition, the applicant referred the Commission to common law authorities in Strong v Woolworths Ltd;[8] Bonnington Castings Ltd v Wardlaw[9] and Amaca Pty Ltd v Ellis.[10] The authorities confirm that it is not necessary for the applicant to establish that the injury was the “primary” or “predominant” cause of the conditions resulting in death. It is sufficient that the injury materially contributed to the death. What constitutes a “material contribution” was described by Lord Reid in Bonnington Castings v Wardlaw:[11]
“What is a material contribution must be a question of degree. A contribution which comes within the exception de minimis non curat lex is not material, but I think that any contribution which does not fall within that exception must be material. I do not see how there can be something too large to come within the de minimis principle but yet too small to be material.”
[8] [2012] HCA 5.
[9] [1956] AC 613.
[10] [2010] HCA 5.
[11] [1956] AC 613.
In considering the expression, “as a result of” in the context of s 60 of the 1987 Act, Deputy President Roche in Taxis Combined Services (Victoria) Pty Ltd v Schokman[12] found:
“The Arbitrator was correct to observe that the presence of a pre-existing condition did not mean that the need for treatment did not “result from” the injury in the sense discussed in Kooragang. The appellant’s submissions have ignored the fundamental principle that employers must take workers as they find them (Spigelman CJ (Bryson AJA agreeing) in State Transit Authority (NSW) v Chemler[2007] NSWCA 249 at [40]; [2007] NSWCA 249; 5 DDCR 286).
…
It is trite law that a condition can have multiple causes (ACQ Pty Ltd v Cook [2009] HCA 28 at [25] and [27]; [2009] HCA 28; 237 CLR 656). More importantly, the injury does not have to be the only, or even a substantial, cause of the need for the proposed treatment before the cost of that treatment is recoverable under s 60 of the 1987 Act. As the section states, and the Arbitrator acknowledged (at [55] and other places), Mr Schokman only has to establish that the proposed treatment is reasonably necessary “as a result of” the injury. On the evidence called from Dr Roessler, he easily met that test.”
[12] [2014] NSWWCCPD 18 at [54].
The evidence on which the applicant relies is, in my view, capable of satisfying the relevant test of causation.
The deceased worker’s endoscopist, Dr Kumar, expressed the view that there was a causal relationship between the deceased worker’s post-traumatic stress disorder and increased acid secretions in his stomach leading to GORD and consequently Barrett’s oesophagus.
Dr Kumar explained that the excessive acid secretion was due to anxiety associated with post-traumatic stress disorder and the heavy drinking and smoking adopted by the deceased worker to relieve his symptoms of anxiety and post-traumatic stress disorder. With uncontrolled and continued gastric acid reflux, the Barrett’s had progressed into an adenocarcinoma of the oesophagus. Dr Kumar went so far as to say that the post-traumatic stress disorder was “the main contributing factor” to the adenocarcinoma of the oesophagus.
Prof Pavlakis expressed a similar view. Prof Pavlakis noted, in particular, the relatively young age at which the deceased worker was diagnosed with adenocarcinoma and the rapid development of Stage 4 malignancy. In the absence of any clear genetic susceptibility, besides the play of chance, it was more probable that the deceased worker’s significant work stress, excessive cigarette smoking and possibly his excessive alcohol intake collectively led to the cancer diagnosis.
In giving his opinion, Prof Pavlakis relied on relevant literature which was consistent with that relied on by Prof Fox. Prof Fox identified research going back into the 1990s supporting a relationship between stress and GORD. The severity of reflux correlated with the degree of stress. Smoking was another relevant risk factor. Like Dr Kumar and Prof Pavlakis, Prof Fox found a clear-cut chain of events between the post-traumatic stress disorder and the sequential development of cancer. Prof Fox also considered employment to be the main contributing factor to the cancer diagnosis.
The deceased worker’s general practitioner, Dr Pollard also expressed a view consistent with the specialist opinions described above.
Considering the medical evidence as a whole, it is clear that a number of factors potentially contributed to the deceased worker’s adenocarcinoma. Several of those are unrelated to the injury, including structural abnormalities of the oesophagus, obesity and idiopathic carcinogenesis. Even if the Commission were to accept that these non-work factors were the main or predominant contributing factors, all of the doctors, including Dr Gorman and A/Prof Talbot, agree that stress, cigarette smoking and possibly alcohol were also contributing factors, through their effect on gastric secretions and, in the case of smoking, the separate carcinogenic effect.
The difference between the doctors’ conclusions as to the extent to which stress and smoking contributed to the adenocarcinoma can be explained by their different understanding of the extent and duration of the deceased worker’s post-traumatic stress disorder symptoms and use of tobacco.
I have found above that the deceased worker experienced significant symptoms of post-traumatic stress disorder that went beyond mere stress or distress and changed his smoking pattern to one of excess as a result of those symptoms, from approximately 2015. I am not satisfied that Dr Gorman and A/Prof Talbot gave adequate consideration to that history in expressing a view that the injury had not been present long enough to have a “material” effect.
I prefer the opinions of Prof Fox, Prof Pavlakis, Dr Kumar and Dr Pollard. Contrary to the suggestion in the first respondent’s submissions, I am satisfied that those doctors possessed appropriate qualifications and a proper history for the expression of their opinions.
Noting, in particular, the comparatively young age at which the deceased worker was diagnosed with cancer and the rapid development of malignancy in his case, I am satisfied on the balance of probabilities, that the contribution of the deceased worker’s injury to the adenocarcinoma and consequently, his death, was material.
I am satisfied that the deceased worker’s death resulted from the injury. The first respondent is liable to pay compensation in respect of the death pursuant to ss 25 and 26 of the 1987 Act.

Resolution of the proceedings

Before orders can be made resolving the claim in these proceedings, it is necessary to provide the parties with a further opportunity to make submissions in relation to the outstanding issues of the identification of dependent family members, apportionment, discretionary interest, funeral expenses and payment of compensation.
As no submissions have been made in respect of those matters, the appropriate course is for the matter to be listed for further preliminary conference.

[2024] NSWPIC 257

17 May 2024