DMQM and Comcare (Compensation)

[2021] AATA 4438

DMQM and Comcare (Compensation) [2021] AATA 4438 (26 November 2021)

Division:GENERAL DIVISION

File Number(s):      2020/5350 & 2020/7554

Re:DMQM

APPLICANT

AndComcare

RESPONDENT

DECISION

Tribunal:Senior Member J Rau SC

Date:26 November 2021

Place:Adelaide

The decision under review is affirmed.

...........................[Sgnd]..............................

Senior Member J Rau SC

Catchwords

COMPENSATION – whether the injury occurred in the course of employment – herpes simplex virus – whether Applicant included injury on the claim form – whether the Applicant suffers from a disease or a mental injury – whether an injury arises out of or in the course of employment – decision under review affirmed

Legislation

Safety, Rehabilitation and Compensation Act 1988 (Cth)

Cases

Comcare v Canute [2006] 226 CLR 535

Kelso and Telstra Corporation Ltd [2015] AATA 403

Miller and Minister for Immigration, Citizenship, Migrant Services and Multicultural Affairs (Migration) [2021] AATA 1623

MZAIC v Minister for Immigration and Border Protection [2016] FCAFC 25

Secondary Materials

World Health Organization, Herpes simplex virus fact sheet, 1 May 2020

REASONS FOR DECISION

Senior Member J Rau SC

26 November 2021

The Applications

1. The Applicant has two applications for review involving two decisions made by Comcare.

2. 2020/5350:

   (a)This application relates to a reviewable decision which was made on 7 July 2020. That decision affirmed a determination dated 9 April 2020. In that determination, Comcare denied liability to pay compensation to the Applicant in relation to her acquisition of “Herpes Simplex Virus (HSV–1)” (HSV) on 12 April 2019, under section 14 of the Safety Rehabilitation and Compensation Act 1988 (Cth) (the SRC Act).

3. 2020/7554:

   (a)This application relates to a reviewable decision made on 16 October 2020. That decision affirmed a determination dated 10 August 2020. In that determination, Comcare denied liability to pay compensation to the Applicant in respect of a “psychological injury” claim to have been sustained on 12 April 2019, under section 14 of the SRC Act.

4. The Hearing for the above two matters was conducted on 8 & 9 November 2021. The Applicant was self-represented, and the Respondent was represented by Sarah Wright of Counsel, Australian Government Solicitor. The Applicant appeared in person at the Tribunal, the Respondent appearing by video-link via Microsoft Teams. The documents that were received by this Tribunal are listed under “Annexure A”.

   Background Facts

5. The Applicant is 41 years of age.

6. Since 7 January 2000, the Applicant has been employed by Department [A] (the Department).

7. The Applicant has for some years suffered from Crohn’s disease. She was first diagnosed in 2013. As a result of this, she was on medication which had an immunosuppressive effect from 2013, until late 2019.

8. On 12 April 2019, the Applicant was involved in helping to prepare food for morning tea at her workplace, when she cut her left index finger with a knife, whilst cutting sausage rolls. Two of her colleagues, Mr X and Ms Y were with her at the time. Mr X took hold of the Applicant’s cut finger and put it in his mouth. At this time, he had a visible cold sore (HSV-1) around his mouth. This action was not requested by the Applicant and was unwelcome. The Applicant removed her finger from Mr X’s mouth and proceeded to the sink when she ran warm water over her finger. Ms Y then assisted the Applicant to administer a band aid. There is no dispute about these events (the Incident).

9. On 15 April 2019, the Applicant advised her supervisor, Mr Z of the Incident. She expressed to him her concern about the possibility of her having acquired an infection during the Incident.

10. On 16 April 2019, a workplace incident report was prepared by Mr Z.[1]

    [1] Exhibit 3, p 157.

11. On 17 April 2019, the Applicant consulted a Dr NR at Practice A. Practice A was the health service used by the Department to provide medical services to its employees. It was not the Applicant’s usual general practitioner service. The Applicant invited her supervisor Mr Z to accompany her. The Applicant described the Incident and her concerns about the possibility of having acquired an HSV-1 infection. The Applicant was seen by Dr NR and she specifically drew Dr NR’s attention to her concern about Mr X having an active and obvious cold sore at the time of the Incident. The Applicant requested a blood test to see whether she had acquired such an infection. Dr NR did arrange a blood test, however, this was to test for the presence of HIV and Hepatitis B or C. There was no test for HSV-1. In her subsequent response to a complaint by the Applicant about this, Dr NR said:

    “By way of explanation for [the Applicant] I can advise that my concern at the time was to exclude any infection by diseases such as HIV and Hepatitis B or C, because the presence of these conditions will require involvement of an infectious disease physician and immediate treatment, and because the conditions are serious and can have a very adverse effect on a patient… I acknowledge that having immunosuppressant treatment for Crohn’s disease may indicate a different approach…”[2]

    [2] Exhibit 4, email of 13 February 2020 from [Practice A] to Applicant.

12. The failure by Dr NR to arrange for an HSV-1 test at this point, notwithstanding the fact that this was obviously stated to be the Applicant’s major point of concern when she attended the surgery, has made the determination of the Applicant’s claim much more difficult than it might otherwise have been. A negative or positive test, a few days after the Incident, may have been of great assistance to medical experts in piecing together the likely origin of the Applicant’s HSV-1 infection. It may have enabled the Applicant’s claim to have been amicably resolved with Comcare, one way or the other, some time ago.

13. Pending the outcome of the blood test, the Applicant took care to ensure that she had no contact with her husband of the kind that might transmit the infection to him, should she turn out to have acquired it.

14. On 23 April 2019, the Applicant returned to Practice A to obtain blood results. Dr NR was overseas, and she spoke to Dr TV who advised her that the blood tests had all come back negative. The Applicant was given a one-page document which she does not recall reading at the time. She explained in her evidence that she did not read the document at that time because she was just relieved to hear the oral advice from Dr TV that the tests were negative. It seems probable that she gave a copy of this to her supervisor Mr Z, as the results subsequently appeared in a document prepared by him on 12 November 2019.[3] The Applicant incorrectly, though perhaps quite reasonably, given her original request for an HSV-1 test, assumed that these tests had included an HSV-1 test and that she was not infected. She did not read the document that she was given and relied on what she had been told. As a result of this, she did not believe that she had any reason to be cautious about passing on the virus to her husband.

    [3] Exhibit 3, p 130.

15. The wound to the Applicant’s finger healed normally and there was no further obvious cause for the Applicant to be concerned about the Incident. There were no lesions at the site of the wound and the Applicant did not become otherwise unwell.

16. Between 17 August 2019 and 22 February 2020, the Applicant was required to work in Singapore. Between 14 and 27 October 2019, the Applicant’s husband visited her in Singapore. The Applicant and her husband were intimate during the period of his visit. Just before her husband left, the Applicant noticed symptoms that she thought might be caused by a thrush infection. Her discomfort increased.

17. Starting on about 26 October 2019, the Applicant had “severe itch and pain at vulva… She shaved her pubic area on 28 October 2019 and redness developed at pubic area after shaving”.[4] On 30 October 2019, the Applicant sought medical help from Dr CYT in Singapore. Dr CYT reported “The vulva was swollen and red and pubic area was warm and erythematous and had well defined margins. A tentative diagnosis of staphylococcus cellulitis and fungal infection was made”.[5]

    [4] Exhibit 4, Medical report of Dr CY Tien – 10.12.2019.

    [5] Ibid.

18. The Applicant saw Dr CYT again on 31 October. Dr CYT reports “there was decreased swelling but multiple small shallow ulcers appeared over the affected area of perineum and mons pubis. A clinical diagnosis of herpes simplex was made…”.[6]

    [6] Ibid.

19. Dr CYT saw the Applicant again on 2 November and 4 November. Dr CYT records that “culture report confirmed herpes simplex type 1”.[7]

    [7] Ibid.

20. Shortly after his return to Australia, the Applicant’s husband reported developing symptoms of an HSV-1 infection. Given that this infection was the same infection that the Applicant had and that it post-dated her symptomatic presentation, the Applicant and her husband drew the logical conclusion, that she had infected him with the virus during his stay in Singapore. Dr RW in his evidence, agreed that this was the most likely explanation, on the known facts.

21. On 7 November 2019, the Applicant contacted Mr Z to advise him that she and her husband had HSV-1. She was understandably upset, shocked, angry, and sad at receiving this news. This placed stress on her relationship with her husband. It continues to do so.

22. Both the Applicant and her husband have been taking medication since this time to prevent any further outbreaks of the infection.

23. The World Health Organisation website has the following material published on 1 May 2020:

    “Infection with herpes simplex virus, commonly known as herpes, can be due to either herpes simplex virus type 1 (HSV-1) or herpes simplex virus type 2 (HSV-2). HSV-1 is mainly transmitted by oral-to-oral contact to cause infection in or around the mouth (oral herpes). However, HSV-1 can also be transmitted through oral-genital contact to cause infection in or around the genital area (genital herpes). HSV-2 is almost exclusively transmitted through genital-to-genital contact during sex, causing infection in the genital or anal area (genital herpes).

    Both oral herpes infections and genital herpes infections are mostly asymptomatic or unrecognized but can cause symptoms of painful blisters or ulcers at the site of infection, ranging from mild to severe.

    Herpes simplex virus type 1 (HSV-1)

    HSV-1 is a highly contagious infection, that is common and endemic throughout the world. Most HSV-1 infections are acquired during childhood, and infection is lifelong. The vast majority of HSV-1 infections are oral herpes (infections in or around the mouth, sometimes called orolabial, oral-labial or oral-facial herpes), but a proportion of HSV-1 infections are genital herpes (infections in the genital or anal area).

    Scope of the problem

    In 2016, an estimated 3.7 billion people under the age of 50, or 67% of the population, had HSV-1 infection (oral or genital). Estimated prevalence of the infection was highest in Africa (88%) and lowest in the Americas (45%).

    With respect to genital HSV-1 infection, between 122 million to 192 million people aged 15-49-years were estimated to have genital HSV-1 infection worldwide in 2016, but prevalence varied substantially by region. Most genital HSV-1 infections are estimated to occur in the Americas, Europe and Western Pacific, where HSV-1 continues to be acquired well into adulthood.

    Signs and symptoms

    Oral herpes infection is mostly asymptomatic, and most people with HSV-1 infection are unaware they are infected. Symptoms of oral herpes include painful blisters or open sores called ulcers in or around the mouth. Sores on the lips are commonly referred to as “cold sores.” Infected persons will often experience a tingling, itching or burning sensation around their mouth, before the appearance of sores. After initial infection, the blisters or ulcers can periodically recur. The frequency of recurrences varies from person to person.

    Genital herpes caused by HSV-1 can be asymptomatic or can have mild symptoms that go unrecognized. When symptoms do occur, genital herpes is characterised by 1 one or more genital or anal blisters or ulcers. After an initial genital herpes episode, which can be severe, symptoms may recur. However, genital herpes caused by HSV-1 typically does not recur frequently, unlike genital herpes caused by herpes simplex virus type 2 (HSV-2; see below).

    Transmission

    HSV-1 is mainly transmitted by oral-to-oral contact to cause oral herpes infection, via contact with the HSV-1 virus in sores, saliva, and surfaces in or around the mouth. However, HSV-1 can also be transmitted to the genital area through oral-genital contact to cause genital herpes.

    HSV-1 can be transmitted from oral or skin surfaces that appear normal and when there are no symptoms present. However, the greatest risk of transmission is when there are active sores.

    Individuals who already have HSV-1 oral herpes infection are unlikely to be subsequently infected with HSV-1 in the genital area.

    In rare circumstances, HSV-1 infection can be transmitted from a mother with genital HSV-1 infection to her infant during delivery to cause neonatal herpes (see below).

    Possible complications

    Prevention

    HSV-1 is most contagious during an outbreak of symptomatic oral herpes, but can also be transmitted when no symptoms are felt or visible. People with active symptoms of oral herpes should avoid oral contact with others and sharing objects that have contact with saliva. They should also abstain from oral sex, to avoid transmitting herpes to the genitals of a sexual partner. Individuals with symptoms of genital herpes should abstain from sexual activity whilst experiencing any of the symptoms.

    People who already have HSV-1 infection are not at risk of getting it again, but they are still at risk of acquiring herpes simplex virus type 2 (HSV-2) genital infection (see below).

    The consistent and correct use of condoms can help to prevent the spread of genital herpes. However, condoms can only reduce the risk of infection, as outbreaks of genital herpes can occur in areas not covered by a condom.

    People who already have HSV-1 infection are not at risk of getting it again, but they are still at risk of acquiring HSV-2 genital infection (see below).

    Pregnant women with symptoms of genital herpes should inform their health care providers. Preventing acquisition of a new genital herpes infection is particularly important for women in late pregnancy, as this is when the risk for neonatal herpes is greatest.

    Additional research is underway to develop more effective prevention methods against HSV infection, such as vaccines. Several candidate HSV vaccines are currently being studied.

    Herpes simplex virus type 2 (HSV-2)

    HSV-2 infection is widespread throughout the world and is almost exclusively sexually transmitted, causing genital herpes. HSV-2 is the main cause of genital herpes, which can also be caused by herpes simplex virus type 1 (HSV-1). Infection with HSV-2 is lifelong and incurable.

    Scope of the problem

    Genital herpes caused by HSV-2 is a global issue, and an estimated 491 million (13%) people aged 15 to 49 years worldwide were living with the infection in 2016.

    More women are infected with HSV-2 than men; in 2016 it was estimated that 313 million women and 178 million men were living with the infection. This is because sexual transmission of HSV is more efficient from men to women than from women to men.

    Prevalence of HSV-2 infection was estimated to be highest in Africa (44% in women and 25% in men), followed by the Americas (24% in women and 12% in men). Prevalence was also shown to increase with age, though the highest numbers of people newly-infected were adolescents.

    Signs and symptoms

    Genital herpes infections often have no symptoms, or mild symptoms that go unrecognised. Most infected people are unaware that they have the infection. Typically, about 10-20% of people with HSV-2 infection report a prior diagnosis of genital herpes. However, clinical studies following people closely for new infection demonstrate that up to a third of people with new infections may have symptoms.

    When symptoms do occur, genital herpes is characterised by one or more genital or anal blisters or open sores called ulcers. In addition to genital ulcers, symptoms of new genital herpes infections often include fever, body aches, and swollen lymph nodes.

    After an initial genital herpes infection with HSV-2, recurrent symptoms are common but often less severe than the first outbreak. The frequency of outbreaks tends to decrease over time but can occur for many years. People infected with HSV-2 may experience sensations of mild tingling or shooting pain in the legs, hips, and buttocks before the appearance of genital ulcers.

    Transmission

    HSV-2 is mainly transmitted during sex, through contact with genital surfaces, skin, sores or fluids of someone infected with the virus. HSV-2 can be transmitted from skin in the genital or anal area that looks normal and is often transmitted in the absence of symptoms.” (Footnote WHO fact sheet 1 May 2020)”[8]

    [8] World Health Organization, Herpes Simplex Fact Sheet, 1 May 2020.

24. The evidence suggests that the Applicant had never had a test for HSV-1 prior to the culture test arranged by Dr CYT in Singapore. The Applicant has maintained that she had never suffered from HSV symptoms at any time in her past. Her medical records reveal no complaints to doctors of any sort, relating to this type of infection.[9]

    [9] Exhibit 3, pp 228-230.

25. The Applicant obtained a report from Dr SW dated 27 February 2020. This report relevantly states as follows:

    “Regarding the case involving, [DMQM] I have made the following assumptions:

    ·     That the history as told to me by the patient is factual.

    ·     That there is truthfulness on the patient’s behalf in expression of her subjective symptoms such as pain and discomfort.

    ·     That the patient is fully motivated for complete recovery if possible.

    In answer to your specific questions:

    Question 1

    [DMQM] confirmed diagnosis is herpes Simplex Virus type 1 infection.

    A)   [DMQM] presented to a medical practitioner in Singapore at the time of initial onset of signs in keeping with a HSV type 1 infection.

    B)   [DMQM] will have a life long presence of a positive HSV Type 1 serology. This may result in symptoms periodically when she has an outbreak due to an altered immune status. That is [DMQM] may exhibit signs of HSV Type 1 if she becomes run down or ill.

    Question 2

    [DMQM] reports accidentally cutting her left index finger on 12/04/2019 while cutting food in the kitchen at work. A male colleague, Mr [X], grabbed her hand and placed her left index finger in his mouth. As a result of this, [DMQM’s] open wound on her left index finger came into contact with Mr [X]’s lips. She quickly retracted her finger out of his mouth and noted that he had a cold core on his lip at the time of the incident. [DMQM] reported another colleague (Ms [Y]) was in the kitchen at the time of the incident. She immediately ran her finger under warm water to attempt to avoid being infected with the HSV 1 from Mr [X]. [DMQM] placed a band aid on her finger and sought medical intervention in Singapore on 17/04/2019.

    Question 3

    [DMQM] sought medical intervention on 17/04/2019. She requested being tested for HSV serology but the doctor she consulted with did not arrange for this test to be done. [DMQM] suffered from identifiable symptoms of HSV 1 infection on 31/10/2019. She was examined by a doctor in Singapore. Examination exhibited ulcers in her perineum and mons pubis regions. Viral culture of swabs taken from the ulcers in question confirmed the presence of HSV type 1 infection. She was closely followed up by a doctor in Singapore on 31/10/2019, 02/11/2019 and 04/11/2019. I first consulted with [DMQM] on 24/02/2020 in relation to her condition.

    Question 4

    It is my opinion that there is a significant causal connection between the claimed condition and [DMQM’s] employment with the Department. The connection has been described in my responses to the first 3 questions.

    Question 5

    It is my opinion that [DMQM’s] claimed condition is not attributable to factors other than her employment.

    Question 6

    The conventional course for a HSV 1 infection is to remain dormant and for periodic flare ups with expression of the virus in the pubic or perioral regions.

    Question 7

    The incident in question appears to be the clear cause for [DMQM] to become HSV 1 positive and for her confirmed positive HSV 1 swab culture taken from her genital region.

    Question 8

    [DMQM] has been prescribed long term use of an antiviral medication in order to avoid any viral related flare ups in the future.

    Question 9

    Treatment of this condition for [DMQM] will be life long.

    Question 10

    There are no anticipated risks associated with her current anti viral medication treatment to avoid flare ups of HSV 1 related episodes.

    Question 11

    [DMQM may suffer from HSV related episodes should her Crohn’s disease condition become unstable or if she becomes immuno comprised in the future.”[10]

    [10] Exhibit 3, pp 188-190.

1. The Applicant obtained a report from Dr PCL dated 8 March 2021. This report relevantly states as follows:

   “Thank you for asking me to review [DMQM] who apparently contracted genital Herpes Simplex Virus for which she has been given maintenance Famciclovir suppressive therapy. There was no documented history for recurrence following her first episode of symptomatic infection.

   This episode occurred in October 2019 while she was in Singapore. At that time, she experienced localising discomfort and pain in urination. There was no associated fever and no herpetic lesion in the other parts of her body. A swab from the shallow ulcers taken by her doctor on 31/10/2019 and subsequently being cultured at the Singapore General Hospital confirmed Herpes Simplex Type 1 infection.

   In November 2019 her husband… developed a groin wash and a swab taken on 4/11/2019 at your surgery detected Herpes Simplex Virus type 1 DNA. Since then, her husband has also been taking famciclovir regularly for suppression treatment.

   [DMQM] would like to seek proof that she contracted the genital herpes infection from an incident on 12/4/2019 while she was preparing morning tea in the kitchen at work. In that incident she was cutting food in the kitchen and accidentally cut her left index finger. A male colleague standing next to her quickly grabbed her hand and put her left index finger in his mouth. She retracted her finger quickly and, in the process, she noticed… a cold sore lesion on his lip. She saw Dr [NR] at [Practice A] on 17 April 2019 and a blood sample for post exposure screen was taken.

   Following the incident, the finger wound healed quickly without complications and she had no herpetic whitlows developing on her hands as a consequence of the exposure.

   Assessment

   Herpes Simplex Virus Type 1 is a common type associating with cold sores, while Herpes Simplex Virus Type 2 is commonly associated with genital infection. From the history presented by [DMQM] it is quite plausible that she could have contracted the Herpes infection during the incident when the cut wound of her index finger was contaminated by the cold sore on the lip of her male colleague.

   However, I am unable to explain how the infection on her index finger, if any, could have transferred to her genital region given that the cut wound did heal quickly without sign of infection and there was no herpetic whitlow developing on her hands to act as a source of transfer, after the incident.

   I have contacted the Clinpath Laboratory in Adelaide trying to retrieve her blood sample collected on 17 April 2019, as an attempt to find out her herpes serological status at that time. Unfortunately, the Laboratory informed me that the blood sample has been discarded after testing for HIV and Hepatitis B/C. Thus, I am not able to pinpoint the timing for her acquisition of the herpes infection. That is to distinguish a true primary infection from a first symptomatic attack of the infection being acquired for quite some time prior to the incident at work.”[11]

   [11] Exhibit 8.1.

2. The Respondent obtained a report from sexual health physician Dr RW dated 13 March 2020. This report relevantly states as follows:

   “[DMQM] is suffering from HSV-1 genital infection. She was seen on 30 October 2019 by Dr [CYT], Gynaecologist, in Singapore. She presented with vulval pain and a skin rash diagnosed as cellulitis. She has developed some symptoms on 26 October and subsequently shaved her pubic hair to see more clearly whether there were any lesions present. Dr [CYT] saw her again on 31 October, 2 November and 4 November 2019. She had a swab collected which grew herpes simplex virus type 1… Her presentation is completely consistent with herpes type 1 infection. Subsequent to her husband’s visit, in October 2019 and sexual activity, her husband was diagnosed with a herpes simplex infection on 8 November 2019. I do not have access to his test results. I am told that he had cultured HSV-1. Her story is completely consistent with having genital herpes due to HSV-1 infection.

   ……

   The presentation I would expect from the history, cut finger on 12 April 2019… would the development a lesion at the site of the inoculation. This would often be accompanied by a fever and occur about 7-10 days after inoculation… I think it is highly unlikely that this genital infection is a result of the cut finger.

   ……

   [DMQM] does not give a history of any illness in the week following the cut… if herpes serology was performed for HSV-1… It is my belief that [DMQM] probably had asymptomatic genital herpes at the time of the workplace episode… and asymptomatic first infections are well documented and can be demonstrated by correct interpretation of serology at presentation… At the time of her attendance with Dr [NR], herpes serology would have been able to tell us whether or not she had had previous exposure to HSV-1 or HSV-2… it would not tell us what site was infected, but would confirm previous exposure prior to the incident… Because of the lack of serology there is a great deal of uncertainty surrounding the importance of the workplace incident to her subsequent presentation with herpes. [DMQM] was concerned about acquiring herpes after the incident and when she developed genital herpes she associated the workplace incident as the cause.

   ……

   Her clinical presentation was of irritation in her vulval area, followed by vulval pain and a description of red “cellulitis” for 2 to 3 days prior to consulting a doctor on the 30 October 2019. She shaved the area to better see the lesions. Her presentation is typical of genital herpes and this was confirmed by Dr [CYT]… In much of the documentation I have provided with, it refers to primary first episode. In fact, there is no evidence to suggest that this was a primary infection. For a herpes infection to be primary, a patient has to be serologically negative for herpes simplex type 1 and type 2 when the lesions are present. However, no serology was ever performed and so all I can say is that this was a first clinical episode of genital herpes.

   ……

   As stated above, I believe that if the infection had been caused by the workplace, she would have had lesions develop at the site of the cut and would have experienced recurrences in the distribution of the brachial plexus… I do not believe that there is a significant causal connection between the claim condition (genital herpes) and [DMQM’s] employment.

   ……

   She has experienced a genital infection and transferred it to her husband. She has experience considerable psychological trauma because of this and the uncertainty of whether this was caused by her workplace incident, due to a lack of HSV serological testing at the time of presentation, does maker it all the more difficult for her. Clinically, herpes simplex infections are generally minor and easily managed. The major problem with herpes is a psychological issue about guilt, over acquisition of a sexually transmitted infection that is life long and transmitting the infection to a partner, a partner’s resentment for this. I believe that [DMQM] is experiencing significant symptoms, because the initial assessment did not take into account herpes serology. I think it is well documented that herpes can be exaggerated by physical and psychological stressors and consequently this may exacerbate symptoms.

   ……

   I believe [DMQM] had pre-existing asymptomatic herpes genital infection and the trauma of the cut finger has, in her mind, raised the issue that she has acquired herpes from that incident.”[12]

   [12] Exhibit 3, pp 204-209.

3. Dr RW gave his oral evidence at the hearing by video-link via Microsoft Teams. Dr SW and Dr PCL were not called.

4. The Respondent also obtained a psychiatric report from Dr SG dated 20 April 2021. This report relevantly states as follows:

   “I noted [DMQM] states that HSV1 is highly likely caused by the workplace incident and she stated that she has never been diagnosed, treated or prescribed medications for HSV1 in the past.

   ……

   …her being deployed between 17 August 2019 and 23 February 2020, wherein she was deployed with work in Singapore.

   ……

   It is also noted that her husband visited her in Singapore for a short period in October on Friday 8 November 2019. After his brief visit, her husband was also diagnosed with HSV1 primary outbreak shortly after his return to Australia. She expressed her difficulties in the relationship and how her husband is upset and angry and how that has brought a change in her marriage and that psychologically, it was taking a toll.

   ……

   It explained that psychological injury is secondary to HSV-1 injury and they cannot accept a secondary condition where it does not have the liability for the primary condition.

   ……

   Expanding on events soon after the accident, she reported the manager at that time was helpful.

   ……

   There was no evidence of her having mental status, in symptoms, of significant anxiety or depressive symptoms or any characteristics of a disproportionate level of worry. Nor were there the presence of biological, psychological or social dysfunction emerging out of this. She appeared to be performing well at work and also adapting to her deployment, even when on holidays prior to that she indicated that she has intact recreational functioning.

   I also further explored how she was in Singapore, when she arrived. She stated that there were no concerns in relation to her infection at that point in time. She stated that her husband visited her for two weeks in October and she stated that she was not aware of any infection status and she was not aware that she had to take any precautions at that time. Therefore, she took part of sexual activity with her husband, which subsequently may have been the reason for her husband acquiring the infection as well.

   ……

   Anticipatory anxiety, worry, frustration, and guilt are normative human experiences, which usually resolve once there is a conclusive negative test or diagnosis, however, when the  diagnosis is confirmed positive, then how individuals deal with this situation varies from person to person.

   [DMQM] has no previous psychiatric condition and presented with what appears to be an expected level of anticipation, worry and apprehension about possible acquiring a HSV infection after her colleague inappropriately sucked on her finger, when she cut it whilst preparing food at the workplace. She stated she noticed cold sores on her colleague’s lip, which caused concern at that time. There was no mental illness at this time. The level of symptoms cannot be labelled as mental illness at that point in time, given that her experience of emotion was appropriate and expected and with a degree of normal anticipation.

   There is no evidence of any psychological condition and her psychiatric condition as per DSM-5, that being a disease state of mind and illness of any form, was not until she had an HSV infection in a quite dramatic presentation at a Singapore Hospital and then subsequently her husband receiving the same infection (this contributed to her emotions and complicated their relationship).

   ……

   The critical issue here was one of her resentment, anger and frustration that [Practice A] did not order a HSV infection test, which would have established whether she was HSV negative at that point in time.

   ……

   One would not have diagnosed her with anything at that stage. Assuming she had positive symptoms at that point in time, the normative emotional experience may have progressed to something else; however, that was quickly relieved by the negative test (at that time she presumed that the test had been done as part of the battery of tests). This also put her husband’s concerns at ease (according to her) and she felt the immediate matter had been resolved, although she was uncomfortable about seeing the colleague at the workplace.

   Her manager was supportive. She went on a holiday to Europe at that time for approximately a month during annual leave. Thereafter, she came back to Australia and briefly worked for a couple of weeks and she was busy preparing for a Singapore deployment.

   Thereafter, she did not see her colleague and reported that she was in a good mental state in Singapore until she acquired the infection in Singapore (the genital infection) and subsequently the matters became more complicated and the couple’s relationship dynamics changed significantly once her husband also acquired the infection.

   At that time, her mental health symptoms escalated to stress, guilt, anger, resentment and further confusion once she discovered that a HSV test had not been done. Her mind went back to the original incident and also on [Practice A], when she asked about the missed opportunity with testing her HSV at that time. This gradually built to a crescendo when liability for her claim was declined and then she apparently pursued other means to prove that she has not had a symptomatic HSV in the past and this has been unsuccessful so far.

   In this time when she returned to Australia, she found it difficult to work with her colleague (now she suspected that he had given her the infection), and she could not work with him. She was placed in another unit and has been working successfully with this modification in place.

   More recently and subjectively, she reports some general intolerance, some fluctuating motivation issues, and continued relationship difficulty because of having given the infection to her husband. Apparently, there is some communication between both the partners which she finds it difficulty to address. 

   ……

   The diagnosis of the psychiatric condition suffered by [DMQM] is one adjustment disorder with mixed anxiety and depressed mood based on her presentation of preoccupation, feelings of shame, guilty, burden, which accompanied the diagnosis of HSV-1 infection.

   ……

   The psychiatric condition emerges from the diagnosis HSV-1. On analysis of the symptoms and presentation, her general functioning and the level of symptomatology, one can state that her symptoms have been present since she was diagnosed with HSV-1 in a Singapore hospital. Therefore, if the HSV-1 infection (genital herpes infection) has emerged from the work-related incident, then her psychiatric conditions is a secondary reaction to that; otherwise, it is not.

   ……

   The diagnosis is one of adjustment disorder with mixed anxiety and depressed mood.

   ……

   In short, one can state that her symptoms have been present since she was diagnosed with HSV-1 in the Singapore hospital.

   ……

   In or around November 2019 when she became aware that Dr [NR] had not requested testing for HSV-1 following her attendance for such testing on 17 April 2019.

   Yes, there would have been a level of contribution from this issue as once she became aware HSV testing had not been requested she became upset as she thought the doctor had missed an opportunity to undertake testing.

   ……

   The psychiatric diagnosis is the flow-on impact of a proven positive genital herpes diagnosis. The diagnosis of adjustment disorder is secondary to the diagnosis of genital herpes in October 2019. The symptoms of adjustment disorder occurred after this period.

   Therefore is one assumes the herpes infection is work related then the psychiatric condition is work-related.

   ……

   There is no impact on her capacity because of the variable nature of symptoms.

   ……

   There is no need for using psychotropic medications at this time as the nature of the condition is mild and would be amenable to both couples counselling and individual counselling.”[13]

   [13] Exhibit 10.2.

5. Dr SG gave his oral evidence at the hearing by video-link via Microsoft Teams.

   Summary of the facts

6. Prior to the Incident, there is no evidence to suggest that the Applicant ever suffered from an HSV infection. Dr RW gave evidence that this fact alone does not totally exclude the possibility of a long standing, unrecognised infection. The only way to have been totally sure about this would have been to have performed blood tests shortly after the Incident. This, however, was not done.

7. At the time of the Incident, it appears that Mr X was suffering from a symptomatic HSV-1 infection and that he placed his active HSV-1 infection in immediate contact with an open wound on the Applicant’s left index finger.

8. The Applicant immediately reported the Incident. There is no dispute between the Applicant and Respondent that this event did occur. The Applicant was anxious about the possibility of being infected with HSV-1 and sought medical attention from Dr NR on 17 April 2019. She was accompanied by Z, her supervisor. She requested that blood tests be taken to establish whether she had acquired an infection. She understood, and in fact was most concerned to ensure, that these tests include a test for HSV-1. The test that were undertaken at this time did not, however, include a test for HSV-1.

9. On 23 April 2019, Dr TV advised the Applicant that she did not have any positive results from her blood tests. The Applicant understandably, but incorrectly, assumed this to include a test for HSV-1.

10. On or about 26 October 2019, the Applicant began to experience painful symptoms in her groin area, she sought medical advice on 30 October 2019 whilst she was in Singapore. On 4 November 2019, tests conducted by Dr CYT confirmed that she was suffering from a symptomatic outbreak of HSV-1.

11. Within a few days, in early November, her husband also came down with symptoms subsequently confirmed to be an HSV-1 genital infection. Dr RW accepted, that given the history, this was most likely to have been an infection transmitted to him, by the Applicant, in October 2019.

12. There is no obvious explanation as to how an exposure to the virus on a wound to the Applicant’s left index finger could have resulted in the transmission of the infection to her genitals. The Applicant was cross-examined about whether she was using sanitary products at the time of the Incident. Unsurprisingly, she was unable to recall specifically. The Applicant was invited to agree that if she were using sanitary products at the time, she would have been unlikely to have used her left hand to apply them, in particular if it had a band aid on it. The Applicant did not agree with this proposition and did not accept that she would necessarily have used only her right hand.

13. There is nothing in the history to support a finding that the Applicant did acquire an HSV-1 infection in the Incident. There were no symptoms such as the subsequent development of lesions at the site of the wound, or other symptoms of general illness.

14. Even if this had occurred, there is no evidence of any later lesion on the Applicant’s finger that might have enabled an inadvertent infection of her genital area some six months later in late October 2021. It is highly unlikely that an infection in her finger, if it had occurred, could have made its way via the nervous system from the brachial plexus to the Applicant’s genital area.

15. The Applicant has been understandably distressed by this turn of events, in particular her feelings of responsibility and guilt for transmitting the infection to her husband.

16. As a result of all of the foregoing, the Applicant has been diagnosed as having suffered a psychiatric condition namely “adjustment disorder with mixed anxiety and depressed mood based on her presentation of preoccupation, feelings of shame, guilt, burden, which accompanied the diagnosis of HSV-1 infection”.[14]

    [14] Exhibit 10.2, p 13.

17. In his evidence, Dr SG slightly modified the position that he had taken in his report. He agreed that the circumstances surrounding the Applicant’s initial visit to Dr NR and the confusion caused by the failure to obtain the proper blood tests at that time was a factor contributing to the Applicant’s psychiatric condition, however the “most significant contributing factor” was the outbreak of the infection in late October 2019 and its consequences.

18. Given the course of events, it is understandable that the Applicant should have come to the conclusion that there was a causal connection between the Incident and her presentation with an HSV-1 infection in late October 2019. That was exactly the concern that she had on 17 April 2019 when she went to see Dr NR. Unfortunately, the weight of expert evidence does not support such a finding. It also provides no answer to the question of the true origin of the infection. This underscores the uncertainty that has been created by Dr NR’s failure to obtain the appropriate HVS-1 blood tests on 17 April 2019. This may have established the objective fact of the Applicant’s previous exposure, (or not), to HSV. As it is, that opportunity was lost.

    Application to the law

1. The Applicant suffered an “injury” for the purposes of section 5A(1)(b) of the SRC Act in the Incident. She cut her finger at work. It arose “out of or in the course of” her employment. The Respondent contended in submissions that the cut to the Applicant’s finger was too trivial to constitute an “injury”. I do not accept this submission. Such an injury could have provided an opportunity for a secondary infection as the Applicant feared or otherwise resulted in serious, if improbable, complications. It is clear that not all “injuries” will give rise to a claim for compensation under section 14(1) of the SRC Act. An “injury” that does not give rise to a claim for compensation, is still an “injury”. Section 5A does not exclude trivial injuries. Section 14 of the SRC Act limits payment of compensation in respect of an injury suffered by an employee. Such compensation may be for death, incapacity for work, permanent impairment. The occurrence of an “injury” is not determinative of a claim for compensation, it is a condition precedent to it. Such a claim, if made, may or may not fail for other unconnected reasons, for example a failure to demonstrate an incapacity for work.

2. Section 16 of the SRC Act provides that:

   “Compensation in respect of medical expenses etc.

   (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.

   Note: Compensation is not payable under this subsection in relation to certain claims (see section 119A).

   (2) Subsection (1) applies whether or not the injury results in death, incapacity for work, or impairment.

   (3) For the purposes of subsection (1), the cost of medical treatment shall, in a case where the treatment involves the supply, replacement or repair of property used by the employee, be deemed to include any fees or charges paid or payable by the employee to a legally qualified medical practitioner or dentist or other qualified person for a consultation, examination, prescription or other service reasonably required in connection with that supply, replacement or repair.

   (4) An amount of compensation payable by Comcare under subsection (1) is payable:

   (a) if the employee has paid the cost of the medical treatment--to, or in accordance with the directions of, the employee; or

   (b) if the employee dies before the compensation is paid and without having paid the cost referred to in subsection (1) and another person, not being the legal personal representative of the employee, has paid that cost--to that other person; or

   (c) in any other case--to the person to whom the cost is payable.

   (5) Where a person is liable to pay any cost referred to in subsection (1), any amount paid under subsection (4) to the person to whom that cost is payable is, to the extent of the payment, a discharge of the liability of the first-mentioned person.

   (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 us liable to pay compensation to the employee:

   (c) in respect of the journey--of an amount worked out using the formula:

   Specified rate per kilometre x Number of kilometres travelled

   where:

   specified rate per kilometre means such rate per kilometre as the Minister specifies, by legislative instrument, under this subsection in respect of journeys to which this subsection applies.

   numbers of kilometres travelled means the number of whole kilometres Comcare determines to have been the reasonable length of such a journey as it was necessary for the employee to make (including the return part of the journey).

   (d) in respect of the employee remaining for the purpose of obtaining the treatment--of an amount equal to the expenditure so reasonably incurred in remaining for that purpose.

   (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.

   (9) Where:

   (a) an employee suffers an injury;

   (b) a person has reasonably incurred expenditure in connection with the transportation of the employee, or, if the employee has died, of his or her body, from the place where the injury was sustained to a hospital or similar place, or to a mortuary; and

   (c)  the employee, or the legal personal representative of the employee, does not make a claim for compensation in respect of that expenditure;

   Comcare is liable to pay compensation to the person who incurred the expenditure of an amount equal to the amount of that expenditure.”

3. An injury may result in compensation in respect of medical expenses irrespective of whether there is a claim for compensation under section 14.

4. In this case the Applicant was taken to the employer’s preferred medical provider to receive medical attention as a result of the injury. The cost of these medical services was not paid by the Applicant. (These appear to have been costs paid pursuant to section 16, or at very least, by the employer).

5. Section 6 of the SRC Act operates to deem a range of circumstances that might otherwise arguably have not arisen “out of, or in the course of” a person’s employment, to have so arisen. Section 6(1)(f) specifically extends this deeming provision to circumstances where an employee is at a place for the purposes of, amongst other things, receiving medical treatment. In this instance, the Applicant was attending a medical service arranged by the Department to obtain medical services consequent upon a work injury. The Applicant was not required to pay for this medical service. To the extent that there is any force in the argument raised by the Respondent about there being no “compensation” paid for this “injury”, (and I do not believe that to be so), the Department’s payment for these services would appear to cloud that issue.

6. It follows that the Applicant’s attendances for medical treatment in April 2019 are deemed to have “arisen out of, or in the course of” her employment. Any “injury” caused by these attendances may likewise be a work injury for the purposes of section 5A.

7. The Applicant’s claim form submitted on 17 February 2020[15], makes a claim for HSV-1 and a psychological injury. The Respondent has taken the point that the cut that was sustained to the Applicant’s left index finger is not mentioned immediately next to the question on the form asking “what is the condition that you are claiming for?”. The Respondent argues that notwithstanding the fact that the exact circumstances of the Incident have never been in dispute and the fact that the very same form contains a detailed description as to how the injury to the left index finger occurred, it is not formally before the Tribunal and cannot constitute an “injury” for the purposes of these proceedings. I note that the very same form poses the question “what tasks were you doing when you were injured?” To which the Applicant responds, “whilst on duty I cut my left index finger with a knife while cutting food…”.

   [15] Exhibit 3, pp 25-32.

8. In MZAIC v Minister for Immigration and Border Protection[16], the Full Court in the Federal Court of Australia considered the question of whether there had been substantial compliance with the provisions of an application made to the Refugee Review Tribunal. The applicant in that case had used a superseded form. In considering whether this made the application invalid, the court made the following observation:

   “In our opinion, it would be counter to the scheme of the legislation to hold that the mere use of a superseded form, subject to the question of substantial compliance with the current form, rendered ineffective an application to the Tribunal which had been made.”[17]

   [16] [2016] FCAFC 25.

   [17] Ibid, at [50].

9. In the case of Miller and Minister for Immigration, Citizenship, Migrant Services and Multicultural Affairs[18], the Tribunal said at [55]:

   “Construing the whole of such Act, it is plain that it could not have been intended that a technical issue of the kind which has been raised by the Respondent could defeat an application which is otherwise valid, or to facilitate use of a technicality to deny an applicant an opportunity for independent review of a decision, especially one which might compromise is very right to liberty. The construction of the relevant statute will provide a guide to its interpretation...”

   [18] (Migration) [2021] AATA 1623.

10. The legislation that is being dealt with in this instance is remedial in its nature. It would be totally contrary to an appropriate interpretation of this legislation that a technical argument of this kind should be permitted to deny the Applicant an opportunity to have properly reviewed, a decision regarding her entitlement to compensation under the SRC Act. I reject the Respondent’s submission to this end.

11. It is clear that the Applicant suffered a physical injury in the course of the Incident namely, a cut to her left index finger. The more difficult questions concern whether she also contracted HSV-1 at the time of the Incident or suffers from psychological sequela that are causally connected to the Incident.

    Has the Applicant been able to establish that she contracted HSV-1 in the course of the Incident?

12. Having regard to all of the evidence set out above, despite the strong apparent coincidence of the April 2019 Incident and the Applicant’s presentation of HSV-1 in October 2019, the weight of the medical evidence does not support this connection being made. There appears to be nothing more than a remote possibility on the known medical evidence, that there is any causal nexus between the Incident in April 2019 and the Applicant suffering an outbreak of an HSV-1 infection in October 2019. In these circumstances, the correct or preferable decision is that the Applicant cannot succeed in this aspect of her claim. This may not have necessarily been the case, if the requested HSV-1 blood test had been undertaken, as requested by the Applicant, in April 2019.

    Has the Applicant been able to establish that she has suffered a psychological injury as a result of the Incident?

13. The evidence of Dr SG is that the “most significant contributing factor” of Applicant’s psychological condition is the onset of HSV-1 symptoms in October 2019, and the consequences of that infection being passed on to her husband. The circumstances surrounding the medical treatment that the Applicant received immediately following the Incident in April 2019 are also a contributing factor, but not of the same magnitude.

14. For the Applicant to succeed in her claim in respect of her psychological condition, she must establish that she has either suffered an “injury” as defined in section 5A of the SRC Act or a “disease” as defined in section 5B of the SRC Act.

15. Both section 5A and section 5B refer to a “disease”.

16. Section 5A says:

    “Definition of injury

    (1) In this Act:

    “injury” means:

    (a) a disease suffered by an employee; or

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

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

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

    (2) For the purposes of subsection (1) and without limiting that subsection, reasonable administrative action is taken to include the following:

    (a) a reasonable appraisal of the employee's performance;

    (b) a reasonable counselling action (whether formal or informal) taken in respect of the employee's employment;

    (c) a reasonable suspension action in respect of the employee's employment;

    (d) a reasonable disciplinary action (whether formal or informal) taken in respect of the employee's employment;

    (e) anything reasonable done in connection with an action mentioned in paragraph (a), (b), (c) or (d);

    (f) anything reasonable done in connection with the employee's failure to obtain a promotion, reclassification, transfer or benefit, or to retain a benefit, in connection with his or her employment.”

17. Section 5B(1) says:

    “Definition of disease

    (1) In this Act:

    “disease” means:

    (a) an ailment suffered by an employee; or

    (b) an aggravation of such an ailment;

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

18. Section 4(1) defines "ailment” as:

    “…means any physical or mental ailment, disorder, defect or morbid condition (whether of sudden onset or gradual development)”.

19. It is notable that the causal test for a “disease” is that employment contributed to “a significant degree”. This is not the case with an “injury” under section 5A. In the case of a mental “injury”, it need only arise “out of or in the course of” the employment.

20. This means that it may be important to determine whether the Applicant suffers from a “disease” (section 5B) or a “mental injury” (section 5A).

21. The term “injury” as used in section 5A has been interpreted as requiring a sudden, identifiable, psychological change. Such a sudden change might, for example, occur in the case of a sudden onset Post-Traumatic Stress Disorder. In this instance, there is no such “injury” at any point in April 2019, including the related medical treatment.[19]

    [19] Comcare v Canute [2006] 226 CLR 535 & Kelso and Telstra Corporation Ltd [2015] AATA 403.

22. This means that the Applicant can only succeed if she can bring herself within section 5B. Whatever psychological consequences may be attributable to the April 2019 Incident and the immediate treatment of it, the evidence does not support a finding that this Incident contributed to a “significant degree” the Applicant’s diagnosed condition of “adjustment disorder with mixed anxiety and depressed mood”.

23. The Applicant has been diagnosed as having suffered a psychiatric condition namely “adjustment disorder with mixed anxiety and depressed mood based on her presentation of preoccupation, feelings of shame, guilt, burden, which accompanied the diagnosis of HSV-1 infection”.[20] This is an “ailment”. It arose in October 2019. Dr SG says of this condition:

    “The psychiatric diagnosis is the flow-on impact of a proven positive genital herpes diagnosis. The diagnosis of adjustment disorder is secondary to the diagnosis of genital herpes in October 2019. The symptoms of adjustment disorder occurred after this period.

    Therefore is one assumes the herpes infection is work related then the psychiatric condition is work-related.”[21]

    [20] Exhibit 10.2, p 13.

    [21] Ibid, p 16.

    Conclusion

24. For the reasons set out above, I have come to the view, based on the weight of expert medical evidence, that there is only a remote and unexplained possibility that the Applicant’s HSV-1 infection is work related. It follows that as there can be no finding of a primary work-related injury or disease in this case, there can also be no secondary, or consequential mental injury. The Applicant’s medical treatment in April 2019 did not contribute to a “significant degree”, the Applicant’s mental ailment as required by section 5B of the SRC Act.

25. It follows that neither the Applicant’s HSV-1 infection or the Applicant’s mental ailment are compensable under the SRC Act.

    Decision

26. The decision under review is affirmed.

I certify that the preceding sixty-nine (69) paragraphs are a true copy of the reasons for the decision herein of Senior Member J Rau SC.

...........................[Sgnd]...............................

Legal Administrative Assistant

Dated:   26 November 2021

Date of hearing:

8 & 9 November 2021

Applicant:

Self-Represented

Advocate for the Respondent:

Sarah Wright,

Australian Government Solicitor

Annexure A – List of Exhibits

Exhibit no.	Lodged by	Document
1	Respondent	Statement of Facts, Issues and Contentions
2	Applicant	Outline of Argument
3	Respondent	T-Documents (2020/5350)
3A	Respondent	T-Documents (2020/7554)
4	Applicant	Applicant’s material for Dr RW
5	Applicant	Letter – Dr SW to Comcare – 10.07.2020
6.1	Applicant	Email – Applicant – further information to be considered – 05.02.2021
6.2	Applicant	Workers Compensation Claim Form – 27.11.2019
6.3	Applicant	Best You Appointment Confirmation – 20.11.2019
7	Applicant	Statement (Email) – [Ms Y] – 11.08.2020
8.1	Applicant	Dr PCL – Medical Report – 08.03.2021
8.2	Applicant	Dr PCL – Invoice – 09.01.2021
8.3	Applicant	Dr PCL – Invoice – 30.01.2021
9	Applicant	Screenshots – leave taken – as of 07.05.2021
10.1	Respondent	Dr SG – Briefing Letter – 11.03.2021
10.2	Respondent	Dr SG – Medical Report – 20.04.2021
10.3	Respondent	Dr SG – AAT Expert Witness Declaration Form – 20.04.2021
10.4	Respondent	Dr SG – Curriculum Vitae
10.5	Respondent	Dr SG – Letter – Applicant to Dr SG – 18.03.2021
11	Respondent	Bundle of Authorities