Hinds v A Class Door Services Pty Ltd

CERTIFICATE OF DETERMINATION OF MEMBER
CITATION:	Hinds v A Class Door Services Pty Ltd [2025] NSWPIC 544
APPLICANT:	Russell Hinds
RESPONDENT:	A Class Door Services Pty Ltd
MEMBER:	John Turner
DATE OF DECISION:	13 October 2025
CATCHWORDS:	WORKERS COMPENSATION - Workers Compensation Act 1987; section 4(b)(ii) and section 60; disease injury; as a result of an injury; main contributing factor; Kooragang Cement Pty Ltd v Bates, Briginshaw v Briginshaw, AV v AW, Ariton Mitic v Rail Corporation of NSW, and Taxis Combined Services (Victoria) Pty Ltd v Schokman cited and applied; Held – the applicant has suffered injury as defined by section 4(b)(ii) to both his knees; the proposed bilateral total knee replacement surgery is reasonably necessary as a result of the injury; pursuant to section 60 the respondent is to pay the costs of and ancillary to bilateral total knee replacement surgery as proposed.
DETERMINATIONS MADE:	The Personal Injury Commission (Commission) determines: 1. That the applicant has suffered injury as defined by s 4(b)(ii) of the Workers Compensation Act 1987 to both his knees. 2. That the proposed bilateral total knee replacement surgery is reasonably necessary as a result the injury. 3. Pursuant to s 60 of the Workers Compensation Act 1987 the respondent is to pay the costs of and ancillary to bilateral total knee replacement surgery as proposed by Dr Ed Bateman. A brief statement is attached setting out the Commission’s reasons for the determination.

STATEMENT OF REASONS

BACKGROUND

Russell Hinds (applicant) has brought proceedings in the Personal Injury Commission (Commission) in which he pleads that he sustained injury to both his knees on the deemed date of 17 March 2014 as a result of the nature and conditions of his employment installing heavy garage doors for A Class Door Services Pty Ltd (respondent).
The relief sought by the applicant is the payment of the costs of and ancillary to bilateral total knee replacement surgery pursuant to s 60 of the Workers Compensation Act 1987 (the 1987 Act).

ISSUES FOR DETERMINATION

The parties agree that the following issues remain in dispute:
(a) whether the applicant sustained a disease injury to both his knees as alleged: s 4 of the 1987 Act, and
(b) whether the bilateral knee replacement surgery is reasonably necessary as a result of the alleged knee injuries: s 60 of the 1987 Act.
The respondent does not dispute that the surgery is reasonably necessary treatment but rather that it is required “as a result of an injury.”

PROCEDURE BEFORE THE PERSONAL INJURY COMMISSION

The matter was listed for conciliation conference/arbitration hearing before me on
17 September 2025. Mr Ty Hickey, counsel, instructed by Ms Milena Cugalj, appeared for the applicant, who was present. Mr Jayden Krieg, counsel, instructed by Mr Dane Twohill, appeared for the respondent. The proceedings were conducted via MS Teams. 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.

EVIDENCE

Documentary evidence

The following documents were in evidence before the Commission and considered in making this determination:
(a)    Application to Resolve a Dispute and attached documents (ARD);
(b)    Reply and attached documents;
(c)    documents attached to Application to Lodge Additional Documents lodged on behalf of the applicant dated 9 September 2025 (AALAD), and
(d)    documents attached to Application to Lodge Additional Documents lodged on behalf of the respondent dated 15 September 2025 (RALAD).
The following is a brief summary of the evidence. Further evidence will be referred to in the findings and reasons when relevant.
Dr Ed Bateman, the applicant’s current treating orthopaedic surgeon, sought approval from the respondent on 11 October 2018 and 25 May 2023 for bilateral knee replacement surgery.[1]
[1] ARD pp. 75, 77.
On 15 March 2010 the applicant consulted his general practitioner (GP), Dr Rodney Beckwith, complaining of left knee pain which he had experienced previously but which had resolved. The clinical record of the consultation records that the pain seemed to be related to the amount of work which he did. The applicant was given a steroid inject to the knee.[2]
[2] ARD p. 233.
On 17 March 2010 Dr Gary Geier reported on an X-ray of the left knee.[3]
[3] ARD p. 89.
On 27 March 2010 the applicant consulted Dr Beckwith who noted that the left knee improved with the injection however there was still an underlying ache.[4]
[4] ARD p. 234
On 5 July 2011 the applicant consulted Dr Beckwith. The clinical record of the consultation records that the applicant had a steroid injection to the right knee three months prior and that the applicant “finds it lasts several months.” The doctor injected the left knee during the consultation.[5]
[5] ARD p. 236.
On 28 November 2011 X-rays of both knees were performed.[6]
[6] ARD p. 90.
On 29 November 2011 the applicant consulted Dr Beckwith who noted moderate chronic bilateral osteoarthritis of the knee.[7]
[7] ARD pp. 236-237.
On 20 December 2011 the GP, Dr Anthea Charalambous noted that the applicant needed pain relief for ongoing pain from osteoarthritis. Tramadol was prescribed.[8]
[8] ARD p. 237.
On 6 November 2013 the applicant consulted the GP, Dr Rachel Lee, requesting stronger pain relief for pain sites including the knees.[9]
[9] ARD p. 251.
On 31 December 2013 the applicant consulted the GP, Dr Jeremy Bramston. The applicant’s complaints included pain in his knees.[10]
[10] ARD p. 252.
On 3 January 2014 X-rays of both knees were performed.[11]
[11] ARD p. 91.
On 20 January 2014 the applicant attended on Dr Bramston who performed injections to both of the applicant’s knees.[12]
[12] ARD p. 253.
A Discharge Referral from Gosford Hospital records that the applicant presented to the Emergency Department on 12 April 2014 with ongoing left knee pain. On examination a reduced range of motion as well as effusion was observed. The applicant was diagnosed with disorder of the meniscus and osteoarthritis.[13]
[13] ARD p. 87.
On 16 April 2014 an MRI scan was performed of the left knee.[14]
[14] ARD p. 92.
On 28 April 2014 Dr Peter Gray reported to Dr Beckwith that the applicant reported experiencing increasing left knee pain over the previous month. The knee tended to swell at the end of the day, and this was associated with an inability to comfortably flex the knee such that climbing stairs and ladders was becoming increasingly uncomfortable. The applicant was also having difficulty walking up and down hills.
Dr Gray reported that there was no obvious precipitating event for the recent exacerbation of pain. However, the doctor noted that the applicant worked installing garage doors which involved a lot of squatting, kneeling, lifting and stair and ladder climbing.
Dr Gray observed that the radiology suggested increased wear in the lateral compartment of the left knee compared to the medial compartment, was suggestive of a long-standing tear of the anterior cruciate ligament, that there appeared to be a tear involving the anterior horn of the lateral meniscus as well as evidence of anterior cartilage loss over the medial and lateral femoral condyles.
In the opinion of Dr Gray, the flare in the pain could relate to a further breakdown of articular cartilage, causing swelling, and which in turn caused inhibition of the quadriceps and pain. The doctor observed that the swelling appeared to have settled with the use of a brace.[15]
[15] ARD p. 78.
On 21 May 2014 the applicant consulted Dr Beckwith who noted that the left knee was going well with the use of a brace and physiotherapy. The doctor noted that an arthroscopy would probably be performed in a month. The applicant was prescribed Endone[16]
[16] ARD p. 256.
On 16 February 2016 Dr Bateman reported to Dr Mythily Ramanathan noting that the applicant’s left knee was arthritic and painful.[17]
[17] ARD p. 81.
On 30 August 2016 X-rays were performed of both knees.[18]
[18] ARD p. 93.
On 30 September 2016 ultrasounds were performed of both knees.[19]
[19] ARD p. 94.
On 30 September 2016 the applicant attended on the GP, Dr Mario Fam having suffered trauma to the proximal head of the tibia four weeks prior. The applicant had persistent swelling and pain.[20]
[20] ARD pp. 277-278.
On 4 October 2016 an X-ray was performed of the right knee and proximal tibia. Dr Denis Gradinscak reported on the X-ray observing trauma to the proximal tibia medially with swelling since injury four weeks prior.[21]
[21] ARD p. 95.
On 6 October 2016 an injection was performed to the left knee to a popliteal cyst.[22]
[22] ARD p. 96.
On 21 October 2016 an injection was performed to the right knee.[23]
[23] ARD p. 97.
On 4 November 2016 an injection was performed to the left knee.[24]
[24] ARD p. 98
On 14 November 2016 an MRI scan was performed of the right knee.[25]
[25] ARD p. 99.
On 28 June 2017 X-rays were performed of both knees.[26]
[26] ARD p. 176.
On 30 June 2017 Dr Charlie Lin, the then treating orthopaedic surgeon, reported to the GP, Dr Ban Abdukabas, noting that the applicant had suffered from knee pain for many years and had recently felt that both knees were worsening. Dr Lin noted that the applicant had gained 20kg in weight which was worsening his knee symptoms. Dr Lin diagnosed bilateral arthritis of the knees.[27]
[27] Reply pp. 34-35.
On 15 August 2018 Dr Lin again reported to Dr Abdukabas with a diagnosis of osteoarthritis of both knees. Dr Lin is of the opinion that the osteoarthritis of the left knee is mostly contributed to by genetics and general wear and tear. Dr Lin did not think that the applicant’s employment made any contribution to the applicant developing the disease and therefore did not think that the workplace has any liability for the left knee condition.[28]
[28] Reply p. 38.
On 15 November 2018 X-rays were performed of both knees.[29]
[29] ARD p. 187.
On 12 February 2019 Dr Bateman reported to the respondent that it:
“is a bit of a stretch to think that his work has resulted in osteoarthritis of the knee but certainly weight is one of the biggest factors that contributes to premature deterioration of the joints. The two factors involved, one would be his weight with a BMI of 40, which is considered excessive, and two would be lifting heavy roller doors over many years. To say that his workplace has a substantial contributing factor to his deterioration is unlikely. It is however co-contributory but I would only put it at 20% or less.”
Dr Bateman agreed with Dr Lin and Dr Diebold that the knee condition was contributed to by genetics and general wear and tear phenomenon and that employment was not the main contributing factor to the bilateral knee injuries. Dr Bateman believed that the work as a garage door installer contributed approximately 20% to the requirement for surgery. In the opinion of Dr Bateman, it is likely that surgery would have been required within the applicant’s lifetime if the workplace injury had not occurred.[30]
[30] Reply pp. 43-44.
On 26 June 2019 Dr Beckwith reported to the respondent that he was not prepared to remove the applicant’s knees from a workers compensation certificate. Dr Beckwith reported that the workers compensation certificate contains the injuries which the doctor felt exist even though that conflicts with some statements made by the specialists. The doctor disagreed with the specialists.[31]
[31] ARD p. 86.
On 24 August 2020 X-rays were performed of both knees.[32]
[32] ARD p. 196.
On 2 September 2020 an injection was performed to the left knee.[33]
[33] ARD pp. 196-197.
On 8 September 2020 an injection was performed to the right knee.[34]
[34] ARD p. 197.
On 9 December 2020 Dr Anthony Maher, an orthopaedic fellow of Dr Bateman, reported to the GP, Dr Anusnka Rajapaksha that the applicant had bilateral knee arthritis which is very likely related to his heavy work in his previous job. The doctor diagnosed osteoarthritis of the knees.[35]
[35] ARD pp. 79-80.
On 20 April 2021 an injection was performed to the left knee.[36]
[36] ARD p. 201.
On 14 September 2021 an injection was performed to the left knee.[37]
[37] ARD p. 204.
On 17 September 2021 an injection was performed to the right knee.[38]
[38] ARD p. 205.
On 9 November 2022 an MRI scan was performed of the left knee.[39]
[39] ARD pp. 101-102.
On 3 January 2023 Dr Bateman reported that he agreed with Dr Bodel that the nature of the applicant’s problem is an exacerbation caused by his workplace. Dr Bateman therefore believed that the respondent has a liability for the ongoing care of the applicant’s knee problems.[40]
[40] ARD p. 84.
On 5 August 2025 Dr Bateman reported to the applicant’s solicitors that the applicant felt that the type of work that he had done since 2008 carrying heavy roller doors which weighted between 40-80kg had put a lot of excess force on his body. Dr Bateman agreed that this excessive weight does result in degenerative joint disease which may not have otherwise occurred in the timeline that the applicant has experienced.
Dr Bateman suggests that if the applicant had not had a long period of time where he was carrying heavy roller doors there is a possibility that his knees may not have worn out in the same timeframe requiring knee replacement surgery.[41]
[41] AALAD.
Dr James Bodel, orthopaedic surgeon, provided a forensic report to the applicant dated
[42] ARD pp. 46-54.
21 June 2019.[42] Dr Bodel records that the applicant experienced a gradual onset of knee pain associated with the nature and conditions of his work.
Dr Bodel accepts that the osteoarthritic process affecting the applicant’s knees is not caused by the applicant’s work activities. In the opinion of Dr Bodel, the work activities have however aggravated, accelerated, exacerbated and caused deterioration of the underlying disease process which is largely constitutional. In the opinion of Dr Bodel, the reported progress in the degenerative changes in the knees also confirms that there has been a likely acceleration of the rate of impairment in the circumstances.
Dr Bodel agreed with Dr Bateman’s recommendation of bilateral total knee replacements.
Dr Bodel provided a further forensic medical report to the applicant dated 4 May 2023.[43]
[43] ARD pp. 55-60.
Dr Bodel took a history of the applicant sustaining injury on 17 March 2014 to his neck, back and relevantly both knees whilst lifting and installing heavy garage doors. The doctor diagnosed post-traumatic osteoarthritis of both knees. The doctor is of the opinion that an element of the injury was an aggravation, acceleration, exacerbation and deterioration of underlying disease process being post-traumatic osteoarthritis in the knees.
Dr Bodel provided a further forensic medical report to the applicant dated 28 August 2023.[44] Dr Bodel again relevantly recorded a history that the applicant suffered injury to his knees on 17 March 2014 whilst in the course of his employment installing a heavy garage door. The doctor diagnosed bilateral osteoarthritis in the knees. In the opinion of Dr Bodel, the total knee replacements are reasonably necessary for the management of the injury sustained on 17 March 2014. In the opinion of Dr Bodel at the very least the injuries are due to the aggravation, acceleration, exacerbation and deterioration of an underlying disease process in the knees.
[44] ARD pp. 63-67.
Dr Bodel provided a further forensic medical report to the applicant dated 1 October 2024.[45] In the opinion of Dr Bodel the nature and conditions of the applicant’s work has caused aggravation, acceleration, exacerbation and deterioration to the underlying degenerative disease process affecting the knees warranting the total knee replacements.
[45] ARD pp. 68-74.
Dr Bodel concedes that the underlying pathology in the knees is primarily constitutional and determined by genetics. However, Dr Bodel is of the opinion that the work installing garage doors is the main contributing factor to an aggravation, acceleration, exacerbation and deterioration of that disease process with there being no other contributing factors.
Dr Robin Diebold, orthopaedic surgeon, provided a forensic medical report to the respondent dated 6 December 2018.[46] Dr Diebold diagnosed osteoarthritis of both knees.
[46] Reply pp. 27-33.
In the opinion of Dr Diebold, the applicant’s employment is not a substantial contributing factor to the bilateral knee osteoarthritis. In support of his opinion Dr Diebold observed that there is clear evidence that the incidence of osteoarthritis of the knees is not increased in those involved in occupations that involve prolonged standing, walking, squatting, kneeling or heavy lifting. It is rather associated with a history of significant trauma to the soft tissues or bones of the knee, including intra-articular fracture, meniscal tear, partial medial meniscectomy and anterior cruciate ligament rupture. Therefore, it can be related to a history of significant injury to the knee from either sport or other trauma. Dr Diebold observed that was not the history in the applicant’s case. Dr Diebold observed that other factors include family history and obesity.
Dr Diebold provided a supplementary forensic medical report to the respondent dated
[47] RALAD.
15 September 2025[47] in which he reported after conducting a file review that his opinion remained unchanged.
Dr Diebold observed that there are two mechanisms whereby the workers compensation legislation would consider that the nature and conditions of his work duties are liable for the condition. Firstly, through being a substantial contributing factor to causing the condition. The second by being the main cause of an aggravation, acceleration, exacerbation, or deterioration of the condition.
Dr Diebold observed that it has been proposed that the physical nature of his duties have fulfilled one of these two mechanisms. In the opinion of the doctor whilst this is biologically plausible, it remains only a theoretical potential mechanism. The doctor observed that numerous scientific studies have examined the prevalence of osteoarthritis of the knees in workers in heavy physical occupations and those studies have not established an increased prevalence of knee osteoarthritis with heavy physical occupations.
In the opinion of Dr Diebold if either of the proposed mechanisms were valid, then this would result in an increased prevalence of osteoarthritis of the knees in workers involved in heavy physical occupations. As this had not been shown to be the case, the doctor is of the view that this proves that this potential relationship (between heavy physical duties and knee osteoarthritis) is not present.
Therefore, in the opinion of Dr Diebold, the nature and conditions of the applicant’s work duties have not been a substantial contributing factor to causing the condition of osteoarthritis of both knees, nor has it been the main contributing factor to an acceleration, aggravation, exacerbation, or deterioration of osteoarthritis of the knees.

Oral evidence

No oral evidence was adduced.

FINDINGS AND REASONS

Injury

The applicant alleges that he has sustained a disease injury to both his knees on the deemed date of 17 March 2014 as a result of the nature and conditions of his employment with the respondent installing heavy garage doors.
Issues of causation are determined on the facts in each case through a commonsense evaluation of the causal chain.[48] The applicant bears the onus of establishing injury on the balance of probabilities. To be satisfied on the balance of probabilities of the existence of a fact, I must feel an actual persuasion of the existence of that fact.[49]
[48] Kooragang Cement Pty Ltd v Bates (1994) 35 NSWLR 452; (1994) 10 NSWCCR 796 (Kooragang).
[49] Briginshaw v Briginshaw [1938] HCA 34; (1938) 60 CLR 336 (Briginshaw).

Section 4(b) of the 1987 Act defines injury to include 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”
There is no dispute on the evidence that the applicant suffers from osteoarthritis in both knees. The diagnosis is accepted by the treating orthopaedic surgeons Dr Lin and
Dr Bateman as well as Dr Bodel and Dr Diebold who have provided forensic medical reports.
The applicant has a long history of knee complaints. That history dates back to the applicant’s time working for the respondent installing and servicing garage doors.
It is the applicant’s evidence that he commenced employment with the respondent in about 2008 when he started the company. It is his evidence that with the respondent he worked about 80 hours per week as a garage door installer.[50] His duties involved constant lifting and carrying of garage doors weighing between 40 to 80kg, loading and unloading the doors onto/from vehicles, carrying the doors onto job sites, lifting of doors onto mounting brackets, repetitive climbing of ladders whilst holding the doors, squatting on step ladders to lift the doors during installation and constant kneeling and squatting on the ground to perform tasks such as the drilling of holes. It is the applicant’s evidence that he worked alone.[51]
[50] ARD p. 3.
[51] ARD p. 4.
The applicant’s evidence as to the nature of his work duties with the respondent is not challenged or disputed. I accept the applicant’s evidence.
The applicant’s knee problems appear to have commenced prior to March 2010 however on 15 March 2010 the applicant consulted his GP, Dr Beckwith, complaining of left knee pain which he had experienced previously but which had resolved. This appears to be, and on the applicant’s evidence is, the first time that the applicant sought medical treatment in respect to his knee condition.
It is the applicant’s evidence that on or about 17 March 2014 he lodged a workers compensation claim and that by this stage his knees, particularly his left, were constantly swelling and he could barely walk due to the pain. Climbing stairs and ladders at work was particularly uncomfortable due to the inability to comfortably flex his knee.[52]
[52] ARD p. 5.
I accept the applicant’s evidence however his capacity to walk may have been slightly better than his evidence implies in circumstances where he continued to work on with the respondent. However, by the time the applicant lodges the workers compensation claim the applicant had been diagnosed with chronic bilateral knee arthritis, undergone multiple injections to his knees, been prescribed powerful pain-relieving medications and had multiple radiological scans performed of his knees.
On 12 April 2014 the condition of the left knee was such that he presented to the Emergency Department at Gosford Hospital. Also consistent with the applicant’s evidence Dr Gray reported on 28 April 2014 that the applicant reported experiencing increasing left knee pain over the previous month. That the knee tended to swell at the end of the day, which was associated with an inability to comfortably flex the knee such that climbing stairs and ladders was becoming increasingly uncomfortable. Dr Gray also reported that the applicant was having difficulty walking up and down hills.
The contemporaneous medical records support that the applicant had ongoing and increasing problems with his knees from 15 March 2010.
It is not the applicant’s case that his employment with the respondent caused the degenerative osteoarthritic condition that affects both knees but rather that his employment has aggravated, accelerated, exacerbated and/or caused a deterioration of the disease condition. In this respect the applicant relies on s 4(b)(ii) of the 1987 Act.
In support of his case the applicant relies on the opinion of Dr Bodel that the applicant’s work activities have aggravated, accelerated, exacerbated and caused deterioration of the underlying disease process warranting the total knee replacements. In the opinion of
Dr Bodel, the reported progress in the degenerative changes in the knees confirms that there has been a likely acceleration of the rate of impairment in the circumstances.
It is not the opinion of Dr Bodel that the applicant’s work duties caused the osteoarthritis in the knees. In the opinion of Dr Bodel, the osteoarthritic condition is primarily constitutional in nature and determined by genetics.
In the respondent’s submission the opinion of Dr Bodel should not be accepted. Whilst the reports of Dr Bodel dated 21 June 2019, and 1 October 2024 provide the opinion relied upon by the applicant, Dr Bodel also provided reports dated 4 May 2023 and 28 August 2023.
Dr Bodel in his reports of 4 May 2023 and 28 August 2023 took a history of the applicant sustaining a frank injury on 17 March 2014 to both his knees whilst lifting and installing heavy garage doors rather than the injury being caused by the nature and conditions of the applicant’s employment. Relevantly the doctor diagnosed post-traumatic osteoarthritis of both knees and was of the opinion that an element of the injury was an aggravation, acceleration, exacerbation and deterioration of underlying disease process being post- traumatic osteoarthritis in the knees.
In the respondent’s submission the opinion of Dr Bodel should not be accepted when
Dr Bodel does not seem to know what caused the injury.
The reports of Dr Bodel dated 4 May 2023, and 28 August 2023 are somewhat inconsistent with his earlier report of 21 June 2019 and the doctors final report of 1 October 2024. The two different opinions which the doctor has provided are of concern, however as with any opinion it is necessary to assess, consider and weigh the opinion or opinions against all the evidence in the matter. The opinion that the nature and conditions has caused injury is the doctors last opinion in time.
The diagnosis of post-traumatic osteoarthritis which Dr Bodel provides in his reports of
4 May 2023 and 28 August 2023 is in my view not applicable as the applicant had been diagnosed with osteoarthritis of both knees prior to any event occurring on 17 March 2014. Furthermore, Dr Gray reported to Dr Beckwith on 28 April 2014 that the applicant reported experiencing increasing left knee pain over the previous month with no obvious precipitating event for the recent exacerbation of pain. The diagnosis of post-traumatic osteoarthritis is also not supported by the opinions of Dr Diebold, Dr Lin and Dr Bateman.
In support of the opinion of Dr Bodel that the applicant has sustained injury as a result of the nature and conditions of his employment, Mr Hickey drew attention to the applicant’s initial complaints of left knee pain to Dr Beckwith on 15 March 2010, at which time Dr Beckwith recoded that the pain seemed to be related to the amount of work which the applicant did.
The nature and conditions opinion of Dr Bodel is also supported by the opinion of
Dr Beckwith, the applicant’s longtime GP, who reported to the respondent on 26 June 2019 that he was not prepared to remove the knees from a workers compensation certificate as the certificate contained the injuries which the doctor felt existed even though that conflicted with some statements made by the specialists with which he disagreed. Presumably the expert opinions being referred to are those of Dr Diebold and Dr Lin who provided opinions as to whether injury had been sustained due to the nature and conditions of employment, not on the basis of a frank injury.
That the applicant’s work duties aggravated the condition of the applicant’s knees also seems to be supported by the history taken by Dr Gray who reported on 28 April 2014 that his left knee tended to swell at the end of the day and that this was associated with an inability to comfortably flex the knee such that climbing stairs and ladders was becoming increasingly uncomfortable. Dr Gray noted that the applicant’s work installing garage doors involved a lot of squatting, kneeling, lifting and stair and ladder climbing.
Dr Bateman, the applicant’s current treating orthopaedic surgeon, is also of a similar opinion that the nature and conditions of the applicant’s employment has caused injury to the knees as defined by s 4(b)(ii) of the 1987 Act stating in his report of 12 February 2019 that it:
“is a bit of a stretch to think that his work has resulted in osteoarthritis of the knee but certainly weight is one of the biggest factors that contributes to premature deterioration of the joints. The two factors involved, one would be his weight with a BMI of 40, which is considered excessive, and two would be lifting heavy roller doors over many years.”
Dr Bateman maintained his opinion in his report of 3 January 2023 stating that he agreed with Dr Bodel that the nature of the applicant’s problem is an exacerbation caused by his workplace.[53]
[53] ARD p. 84.
Dr Bateman again confirmed his opinion in his most recent report of 5 August 2025 agreeing that the excessive weights which the applicant carried in the course of his employment does result in degenerative joint disease which may not have otherwise occurred in the timeline that the applicant has experienced. Dr Bateman suggests that if the applicant had not had a long period of time where he was carrying heavy roller doors there is a possibility that his knees may not have worn out in the same timeframe requiring knee replacement surgery.[54]
[54] AALAD.
Mr Kreig submitted on behalf of the respondent that the opinion of Dr Bateman should not be accepted arguing that Dr Bateman “backflips” in his opinion having agreed with the opinions of Dr Lin in his report of 12 February 2019. I do not accept the respondent’s submission.
Dr Bateman in his report of 12 February 2019 agrees with Dr Lin and Dr Diebold that the diagnosis of osteoarthritis of his knee's was contributed to by genetics and general wear and tear phenomenon and that employment is not the main contributing factor to the bilateral knee injuries.
The opinion that the diagnosis of osteoarthritis of the knees was contributed to by genetics and general wear and tear phenomenon is not inconsistent with the doctor’s opinion.
Dr Bateman at no time expresses the opinion that the osteoarthritic condition has been caused by the nature and conditions of the applicant’s employment. Rather it is the doctor’s opinion that his work duties have caused aggravation, exacerbation, acceleration and/or deterioration. It has also at no time been Dr Bateman’s opinion that the nature of the work duties has been the main contributing factor to the knee condition. The issue of main contributing factor will be considered below.
Mr Kreig also submitted on behalf of the respondent that Dr Bodel does not deal with the reference in the treating material to an acute right knee injury occurring sometime in
mid-2016.
The applicant on 30 September 2016 consulted the GP, Dr Mario Fam, with persistent swelling and pain having suffered trauma to the proximal head of the tibia four weeks prior.[55] The applicant was referred for an X-ray of the right knee and proximal tibia which was performed on 4 October 2016. Dr Denis Gradinscak reported on the X-ray noting trauma to the proximal tibia medially with swelling since injury four weeks ago.
[55] ARD pp. 277-278.
There is however no evidence that there were any ongoing effects as a result of the injury. The injury is not mentioned in the subsequent GP clinical records. Also, by the time this injury occurs the applicant had already been complaining of knee pain since at least 2010 with the aggravation and exacerbation from work already occurring and the diagnosis of bilateral osteoarthritis of the knees having already been made as well as the claim for workers compensation.
I accept the applicant’s submission that this event was a single passing event which seems to have no ongoing issue and raises its head on a background of bilateral knee pain which flows up to that point and continues to flow after that event.
The respondent relies on the opinion of Dr Diebold. In the opinion of Dr Diebold, the applicant’s work duties have not caused, aggravated, accelerated, exacerbated and/or caused deterioration of the osteoarthritic condition of the knees.
Dr Diebold came to his opinion on the basis that studies show that the incidence of osteoarthritis of the knees is not increased in those involved in heavy physical occupations that involve prolonged standing, walking, squatting, kneeling or heavy lifting. Dr Diebold observed that the factors such as obesity and family history are associated with increased rates of osteoarthritis of the knees.
In the opinion of Dr Diebold if heavy physical work is a substantial contributing factor to causing osteoarthritis of the knees or the main contributing factor to an acceleration, aggravation, exacerbation, or deterioration of osteoarthritis of the knees then this would result in an increased prevalence of osteoarthritis of the knees in workers involved in heavy physical occupations, which is not the case.
I do not accept the opinion of Dr Diebold. It is not the applicant’s case that his work duties with the respondent have caused the osteoarthritis in his knees. It is also not the opinion of Dr Bodel and Dr Bateman that his work duties have caused the osteoarthritis. It is the applicant’s case and the opinions of Dr Bodel and Dr Bateman that the work duties caused an aggravation, acceleration, exacerbation and/or deterioration in the underlying osteoarthritic condition.
With the greatest respect to Dr Diebold, I am of the view that the doctor’s logic is flawed. The conclusion that there would be an increase in the prevalence in osteoarthritis in the knees of those who perform heavy work, if heavy physical work caused acceleration, aggravation, exacerbation, or deterioration of osteoarthritis of the knees does not inherently follow. It is not alleged that the work caused the condition. For a work aggravation, exacerbation, acceleration and/or deterioration to occur the condition must already be present for other reasons, not cause it.
In the opinion of Dr Lin, who was the applicant’s previous treating orthopaedic surgeon, the osteoarthritis of the left knee is mostly contributed to by genetics and general wear and tear. Dr Lin did not think that the applicant’s employment made any contribution to the applicant developing the disease and therefore did not think that the workplace has any liability for the left knee condition.
The opinion of Dr Lin is consistent with the view of Dr Bodel and Dr Bateman in that the applicant’s work duties did not cause the osteoarthritis which as previously discussed is not the applicant’s case.
In the respondent’s submission Dr Lin in the second last paragraph of his report dated
15 August 2018 gives his ultimate opinion where he states:
“In conclusion I do not think Russell’s employment has contributed to Russell’s clinical predicament regarding his left knee.”
In the respondent’s submission Dr Lin’s ultimate opinion is that the applicant’s employment has not contributed to the applicant’s knee condition be it by way of causing it, or causing aggravation, exacerbation, acceleration and/or deterioration. I do not accept the respondent’s submission. The report needs to be read as a whole and nowhere in the report is there any indication that Dr Lin considered whether the applicant’s employment had caused an aggravation, exacerbation, acceleration and/or deterioration of the osteoarthritic condition of the knees rather than causing the condition. It is also unclear what Dr Lin means by “clinical predicament” and whether that relates to the pathological condition only and does not include the associated symptomatology. For there to be an injury as defined by s 4(b)(ii) of the 1987 Act an aggravation of the symptomatology is all that is required. An actual change in the pathology is not required.
For the above reasons I prefer the opinion of Dr Bodel that the applicant’s employment with the respondent caused an aggravation, exacerbation, acceleration and/or deterioration of the condition of the applicant’s knees. Such an opinion is supported by the contemporaneous clinical records and is also the opinion of the treating surgeon, Dr Bateman, and the applicant’s long time GP, Dr Beckwith, who has had the opportunity to review the applicant over a number of years including whilst the applicant was continuing to perform duties with the respondent.
For there to be an injury in accordance with s 4(b)(ii) of the 1987 Act employment has to be the “main contributing factor” to the aggravation, acceleration, exacerbation or deterioration of the disease.
Deputy President Snell considered “main contributing factor” in AV v AW [2020] NSWWCCPD 9 stating at [77]-[78]:
“It follows that the test of ‘main contributing factor’ involves consideration of whether there were competing causal factors (both work and non-work related) of the aggravation, and whether on a consideration of relevant causal factors the employment represented the main contributing factor.
The following may be taken from the above:
(a) The test of ‘main contributing factor’ in s 4(b)(ii) is more stringent than that in s 4(b)(ii) in its previous form, which applied in conjunction with the test in s 9A. There will be one ‘main contributing factor’ to an alleged aggravation injury.
(b) The test of ‘main contributing factor’ is one of causation. It involves consideration of the evidence overall, it is not purely a medical question. It involves an evaluative process, considering the causal factors to the aggravation, both work and non-work related. Medical evidence to address the ultimate question of whether the test of ‘main contributing factor’ is satisfied is both relevant and desirable. Its absence is not necessarily fatal, as satisfaction of the test is to be considered on the whole of the evidence.
(c) In a matter involving s 4(b)(ii) it is necessary that the employment be the main contributing factor to the aggravation, not to the underlying disease process as a whole.”
Arbitrator Harris also considered “main contributing factor” in Ariton Mitic v Rail Corporation of NSW (Matter No 008497/2013 8 April 2014) (Mitic) stating:
“The opening words of the amended s. 4(b)(ii) relate to the aggravation, acceleration, exacerbation or deterioration ‘in the course of employment of any disease’. In my view, those opening words therefore direct attention to the work-related component of the ‘aggravation, acceleration, exacerbation or deterioration’. The following words of clause (ii) then state ‘but only if the employment was the main contributing factor to the aggravation, acceleration, exacerbation or deterioration of the disease’. The concluding words of clause (ii) requires an examination of whether the employment was the main contributing factor ‘to the aggravation, acceleration, exacerbation or deterioration of that disease’ and not to the overall pathology or the overall disease process…
In my view, the amendment to s 4(b)(ii) does not require the applicant to establish that the employment must be the main contributing factor to the overall disease process or pathology within his left knee but simply that the employment must be the main contributing factor to the injury, that is, the aggravation, acceleration, exacerbation or deterioration of such disease.”
In the applicant’s submission employment is the main contributing factor to the aggravation or exacerbation with there being no other contributing factors. I accept the applicant’s submission.
The applicant’s submission is supported by Dr Bodel who is of the opinion that the work installing garage doors is the main contributing factor to an aggravation, acceleration, exacerbation and deterioration of that disease process with there being no other contributing factors.

As considered above the applicant did on 30 September 2016 attended on Dr Fam with persistent swelling and pain having suffered trauma to the proximal head of the tibia four weeks prior. For reasons previously given I am of the view that there have been no ongoing effects from this injury. As previously discussed by the time this injury occurs the applicant had already been complaining of knee pain since at least 2010 with the aggravation and exacerbation from work already occurring.
Whilst Dr Lin states that the applicant’s weight gain of 20kg is a factor in the worsening of the applicant’s symptoms that weight gain does not occur until after the applicant sustained injury involving his right shoulder in November 2016. By this time the applicant had already suffered the work-related aggravation and/or exacerbation and lodged the workers compensation claim.
The respondent submits that Dr Bateman is of the opinion that the contribution from employment is minor. In the opinion of Dr Bateman, the contribution from employment is 20%.
In the applicant’s submission when Dr Bateman assess 20% contribution, he is considering attribution to the condition opposed to the aggravation. I accept the applicant’s submission. When Dr Bateman assesses the 20% contribution he considers the contribution of weight to the premature deterioration of the joints. In doing so he considers two factors the applicant’s body weight as well as the weights which the applicant carried in the course of his work duties. The doctor also considers the contribution from genetics and general wear and tear phenomenon. The doctor in assessing the 20% contribution has therefore not only taken into consideration the work aggravation but also those factors which have caused the osteoarthritic condition. This is not the relevant test.
In the respondent’s submission the clinical records contain repeated references to fibromyalgia as well as references to rheumatism, seronegative arthropathy and the applicant being referred to rheumatologists. In the respondent’s submission there is no evidence as to the impacts of any of these conditions on the applicant’s knees.
In my view any such conditions are not relevant to present considerations. There is no evidence that these conditions have any impact on the applicant’s knees. There are reports in evidence from the applicant’s treating orthopaedic surgeons as well as the medico-legal reports from Dr Bodel and Dr Diebold. If the doctors had considered these conditions to be relevant it is reasonable to assume that those conditions would have been raised in the doctors reports especially those of the treating orthopaedic surgeons. The treating orthopaedic surgeons would have presumably needed to consider those conditions if they were contributing to the condition of the applicant’s knees when providing treatment and considering future treatment.
For the above reasons I am of the view that the applicant’s employment with the respondent is the main contributing factor to the aggravation and exacerbation of the applicant’s bilateral knee condition.
I therefore find that the applicant has suffered injury as defined by s 4(b)(ii) to both his knees.

As a result of an injury

For the costs of the proposed bilateral knee replacements to be payable by the respondent pursuant to s 60 of the 1987 Act the proposed surgeries must be reasonably necessary “as a result of the injury.”
An injury can be a material cause of the need for proposed treatment even if other factors are present that may also contribute to the need.[56]
[56] Taxis Combined Services (Victoria) Pty Ltd v Schokman [2014] NSWWCCPD 18 (Schokman).
In the opinion of Dr Bodel, the reported progress in the degenerative changes in the knees confirms that there has been a likely acceleration of the rate of impairment in the circumstances. In the opinion of Dr Bodel, the nature and conditions of the applicant’s work have caused aggravation, acceleration, exacerbation and deterioration to the underlying degenerative disease process affecting the knees warranting the total knee replacements.
In the opinion of Dr Bateman if the applicant had not had a long period of time where he was carrying heavy roller doors there is a possibility that his knees may not have worn out in the same timeframe requiring knee replacement surgery.
Whilst Dr Bateman states that it is a “possibility” and does not state that it is a probability that the knees may not have worn out in the same timeframe requiring knee replacement it is not necessary for an aggravation and/or exacerbation to contribute to the pathological condition requiring the treatment for it to materially contribute to the need for the surgery. A symptomatic increase can materially contribute to the need for surgery as it is the nature of the symptoms which causes the need. Severe osteoarthritic can be present in a joint which whilst asymptomatic does not require surgical treatment. It is the presence of symptoms and the impact of those symptoms that causes the needed for the treatment. It is common in this jurisdiction to see reference to osteoarthritic joint’s which at the time of the diagnosis being made are asymptomatic and for which surgery is only recommended when the osteoarthritis becomes significantly symptomatic.
Mr Kreig submitted on behalf of the respondent that the radiological scans reveal multiple pathologies within the applicant’s knee and Dr Bodel does not state what pathology has been aggravated. In my view this is irrelevant. It is the opinion of Dr Bodel that the osteoarthritis has been aggravated. The surgery which is being proposed by Dr Bateman is clearly being proposed to treat the osteoarthritic condition. It is irrelevant therefore whether the work has aggravated part, or all of that condition.
For the above reasons I find that the injury to the knees caused by the applicant’s work duties materially contributes to the need for the proposed bilateral total knee replacement surgery.
There is no dispute that the proposed bilateral total knee replacement surgery is reasonably necessary treatment. I therefore find that the proposed bilateral total knee replacement surgery is reasonably necessary as a result of the previously found injury as defined by
s 4(b)(ii) of the 1987 Act.

[2025] NSWPIC 544

13 October 2025