Else and Australia Postal Corporation

[2006] AATA 1092

Administrative

Appeals

Tribunal

 

DECISION AND REASONS FOR DECISION [2006] AATA 1092

ADMINISTRATIVE APPEALS TRIBUNAL      )

)          No Q2004/654; Q2005/2

GENERAL ADMINISTRATIVE DIVISION		)
Re		MERYL ELSE

Applicant

And AUSTRALIA POSTAL CORPORATION

Respondent

DECISION

Tribunal

Senior Member B J McCabe

Dr Maynard, Member

Date19 December 2006

PlaceBrisbane

Decision The decisions under review are affirmed.

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SENIOR MEMBER

CATCHWORDS

COMPENSATION – applicant says she suffered injuries arising from her employment – postal sorting officer – left hip injury – right wrist condition – discussion of medical evidence – decisions affirmed

Safety Rehabilitation and Compensation Act 1988

REASONS FOR DECISION

19 December 2006

Senior Member B J McCabe

Dr Maynard, Member

introduction

1.      Ms Meryl Else claims to have suffered injuries arising out of her employment as a Postal Delivery Officer with the respondent. She seeks compensation under the Safety Rehabilitation and Compensation Act 1988 (the SRCA) for two injuries: a soft tissue injury to the left hip which she says was sustained after an incident on 16 January 2003 (Q2004/654) and a right wrist condition (Q2005/2).

2.      The respondent accepted liability in respect of the soft tissue injury to the left hip for the period from 16 January 2003 to 24 December 2003. The original decision mistakenly describes the condition as a “soft tissue injury to the right hip region”. It was agreed that was an error: the claim relates to the left hip. Ms Else says the condition has persisted. The respondent also accepted liability for the right wrist condition until 8 June 2004. Ms Else says that condition has also persisted. She has asked the Tribunal to reconsider the decisions and provide her with compensation under the provisions of the SRCA.

3.      We have decided to affirm the two decisions under review. We are not satisfied that the medical evidence establishes a link between the applicant’s work and her current conditions. We explain our reasons below.

the material before the tribunal

4. The Tribunal was provided with the material required pursuant to s 37 of the Administrative Appeals TribunalAct 1975. A number of medical reports and other documents were also admitted into evidence. The following medical experts were also called to give evidence:

·     Dr Howe;

·     Dr MacFarlane;

·     Dr Cameron;

·     Dr Ganter;

·     Dr Martin; and

·     Dr Rowan.

5.      The hearing was held in Gladstone. Mr Press of counsel represented the applicant. The respondent was represented by Mr Clark of counsel.

factual background

6.      The applicant was 45 years of age at the time of the hearing. She is currently employed by the respondent as a Postal Delivery Officer (Night Sorting) at the Gladstone Delivery Centre.

7.      On 16 January 2003 the applicant says she suffered an injury to her left knee. She describes the incident in her statement (exhibit 9) as follows:

At approximately 4.30am I was opening a gate on a ULD. The ULD is a metal crate used to hold mail and parcels… I was pulling on the gate, because the left side of the gate was stuck, attempting to open the gate. The gate suddenly sprang open and hit me in the left knee. I twisted and jumped away trying to get out of the way of the gate but was unsuccessful.

8.      The applicant’s oral testimony was not as precise as her written statement. She was uncertain which part of her body was struck by the gate. In any event, Ms Else reported the injury to her supervisor and was taken to hospital where she was referred for an X-ray. She was seen the following morning by the Australia Post appointed Medical Officer, Dr Ganter. She was placed on reduced duties, undertook physiotherapy and was scheduled for a review the following week.

9.      In the months that followed, Ms Else was seen by a number of clinical specialists, had a number of investigations and was managed at work with reduced duties that conformed to recommended rehabilitation program. She says her symptoms did not improve. She says she now suffers from pain in the left hip, the groin, crotch, bottom and leg. Her upper thigh, buttocks and hip on the left side appear to cause her the most trouble. She experiences “clicking” in the left hip region but it is not painful. She says the pain in her lower left extremity is aggravated by sitting, standing, housework and other activities. She says treatments like physiotherapy and hydrotherapy also make the pain worse.

10.     The applicant says she became aware of a problem with her wrist while she was undergoing a return to work program in 2003. She made a claim in respect of tenosynovitis of the right wrist on 4 November 2003. She underwent treatment and was placed on modified duties. A number of the experts who examined her said the condition had resolved but the applicant insists she suffers from work-related carpal tunnel syndrome.

the medical evidence in relation to the left knee and hip

11.     The Tribunal was provided with evidence from a number of medical experts who had seen the applicant and provided reports on her condition. We were also provided with the clinical notes taken by the treating doctor at Gladstone hospital on the day of the accident (exhibit 10). The notes describe a severely bruised left knee but make no mention of a hip or thigh injury. The records refer to patella pain and note the applicant was provided with crutches. The applicant claims her leg had “let go” several times before arriving at the hospital, and said it had “locked up”. There is no reference to these symptoms in the notes although there is a reference to clicking in the knee.

12.     The applicant was sent to see Dr Ganter, a doctor approved by Australia Post. Ms Else saw Dr Ganter on 16 January 2003. His notes (exhibit 11) refer to left knee pain. They do not describe pain anywhere else. The notes of a further examination conducted on 17 January 2003 do not record complaints of pain in the thigh although he observed a lump in the middle of her thigh. He arranged for an ultra-sound investigation on 22 January 2003 which identified a subtotal tear of the left rectus femoris muscle. He wrote to the respondent the same day and reported a significant tear of the quadriceps muscle of her thigh.  From the tone of the letter it seemed Dr Ganter thought this was an acute injury. He suggested in a medical certificate dated 28 January 2003 that the condition was properly described as “injury to left thigh, torn muscle”.

13.     The diagnosis on the medical certificate must be reconciled with the applicant’s evidence before the Tribunal that the lump in her thigh was actually the product of a sporting injury dating back to 1994. Dr Ganter was also in possession of a report from Dr Delaney, an orthopaedic surgeon, dated 23 January 2003. That report confirmed the tear to the thigh muscle was an old injury. Dr Delaney found very little abnormality in his examination other than some tenderness in the upper medial thigh and on stretching the adductus. He was also able to reproduce the clicking over the hip joint during flexion and extension. Dr Delaney reported there was no evidence of recent bleeding, substantial inflammation or oedema in the T2 studies or the MRI performed on 23 January 2003 (exhibit 1, page 30). He noted the ultrasound investigation did not reveal any abnormality in the left thigh other than the earlier tear. He offered a differential diagnosis of a blow-type injury or a musculo ligamentous strain type injury to the soft tissues in the upper medial thigh including the adductor muscles.

14.     The provisional diagnoses were made notwithstanding the history of a blow to the knee rather than the thigh and the negative findings of the ultrasound and the MRI T2 studies. While the T2 studies do not always reveal soft tissue injuries it was the opinion of Dr Martin that it was more probable than not that they would show evidence of trauma and there is no evidence in the ultrasound scan nor the history to support a thigh injury.  Dr Cameron was also of the view that the oedema or soft tissue injury would be visible on scans. We note the applicant says she complained of thigh pain almost immediately after the accident – which one would expect to find if she sustained a musculo-ligamentous strain caused by taking avoidance action. But the contemporaneous medical records of Dr Ganter and the records from the Gladstone hospital do not bear this out.

15.     Dr MacFarlane’s examination detected few abnormal physical signs. He considered the report of an X ray of the left hip which did not disclose any abnormality or evidence of degeneration. He suggested it was possible the applicant suffered from a snapping tendon that might have been caused by trauma. He agreed in cross-examination that this was only a possibility. He also agreed the trauma would have to occur in the hip region rather than in the knee. Dr Cameron, a neurologist, took a similar view: he said he could not see how a blow to the knee would result in hip problems. He added that he did not detect any abnormality in the hip during his examination. He agreed that a soft tissue injury might occur as a result of avoidance action but said it should have resolved quickly. He pointed out the MRI did not detect any evidence of soft tissue injury.

16.     Dr Martin did not discover any abnormality. He noted the MRI and ultrasound investigations did not suggest any problems. He accepted the tests were not always accurate but said they were more likely than not to detect evidence of soft tissue injury.

17.     Dr Martin’s evidence in relation to the snapping tendon was unhelpful. He admitted during the cross-examination that he had not read all of the reports of other experts (including that of Dr MacFarlane) supplied to him. He said he had not heard of the condition.

18.     Dr Blue was unable to attend the hearing because of illness but his report was tendered. Dr Blue was unable to identify any specific problem with the knee. He noted the clicking or snapping tendon but suggested that was a common problem for female patients. He said it was unrelated to the workplace accident.

19.     The specialist medical evidence does not support a finding that the hip symptoms described by the applicant can be attributed to the incident at work on 16 January 2003. We are satisfied the applicant suffered a blow to the knee. It is possible she sustained a soft tissue injury at the time of the accident in an attempt to avoid impact but the absence of a record of complaints of pain and the MRI and ultrasound results suggest that injury resolved quickly if it occurred at all. We prefer Dr Blue’s explanation for the snapping tendon condition: it accords with the experience of the medical member of the Tribunal. We acknowledge Dr MacFarlane’s view that trauma could have caused the snapping tendon but note the trauma would have to occur in the hip region. We accept that did not occur here.

the medical evidence in relation to the right wrist condition

20.     The applicant was diagnosed with tenosynovitis on 4 November 2003 following an ultrasound. She was treated with a cortisone injection. The condition was showing steady improvement in the months that followed, according to reports from Drs Ganter, Soon Young and Rohan.  Drs Blue and MacFarlane also produced reports suggesting the tenosynovitis settled by March – May 2004.

21.     Dr Howe described evidence of mild carpal tunnel syndrome in his report of 6 September 2004. He subsequently recommended decompression surgery. That was performed on 15 March 2005. All but one of the specialists accepted the applicant’s tenosynovitis had settled after treatment. Dr Cameron said carpal tunnel syndrome is not produced by occupational activity. He said it arises from constitutional conditions. He said occupational activity could aggravate the symptoms but it would require heavy loads and intense activity. Drs Howe and Rohan broadly agreed. While Dr Howe was more inclined to accept repetitive activity might have aggravated the condition, Dr Rohan pointed out the applicant was on a reduced workload when she began to experience problems.

22.     We are unable to accept the applicant’s carpal tunnel syndrome is attributable to her work. The medical evidence suggests it is constitutional in nature. We are not persuaded the applicant’s activities when she returned to the workplace contributed to an aggravation of the condition: she was on a reduced work-load after all, and the doctors appeared to agree that only particularly intense activity would have any effect. We do not accept that tenosynovitis has persisted beyond early 2004.

conclusion

23.     The respondent initially accepted liability for both conditions under s 14 of the SRCA. The reviewable decisions in relation to the left hip and right wrist concluded the applicant was not entitled to any further compensation under the SRCA in respect of those injuries. Given we found the applicant’s current symptoms are unrelated to events in the workplace, we must affirm those decisions.

I certify that the 23 preceding paragraphs are a true copy of the reasons for the decision herein of Senior Member B J McCabe and Dr Maynard, Member.

Signed:         .....................................................................................
  Associate      Adam Ryan

Dates of Hearing  9-10 October 2006
Date of Decision  19 December 2006
The applicant was represented by Mr Press of Counsel.
The respondent was represented by Mr Clark of Counsel.