Jegatheeswaran and Comcare

[2005] AATA 1096

Administrative

Appeals

Tribunal

 

DECISION AND REASONS FOR DECISION [2005] AATA 1096

ADMINISTRATIVE APPEALS TRIBUNAL      )

)          No N2004/751

GENERAL ADMINISTRATIVE  DIVISION		)
Re		SELVARANI JEGATHEESWARAN

Applicant

And COMCARE

Respondent

DECISION

Tribunal Ms N Bell, Senior Member
Dr J D Campbell, Member

Date4 November 2005

PlaceSydney

Decision The decision under review is affirmed. 

..........................................

Ms N Bell

Presiding Member

COMPENSATION –Medical Expenses - Accepted Condition – Generalised Anxiety Disorder - Applicant Suffered Myocardial Infarction – Claim that Infarction Caused or Materially Contributed to by Workplace – Claim that Generalised Anxiety Disorder Precipitated Infarcts – Tribunal Found Stress Suffered by Applicant was Significant but not Acute and so Coronary Infarcts were not Contributed to by Work Related Stress or Anxiety

Safety, Rehabilitation and Compensation Act 1988, section 16

REASONS FOR DECISION

4 November 2005 Ms N Bell, Senior Member
Dr J D Campbell, Member

1.Mrs Jegatheeswaran suffered anxiety disorder which arose out of events in the course of her employment as a compliance Field Officer with the Australian Taxation Office.  Comcare ultimately accepted liability for this condition.

2.Mrs Jegatheeswaran suffered myocardial infarctions in September and December 2003, for which she had balloon angioplasty and stenting.  She underwent coronary artery bypass grafting soon after her second infarct.

3.There is no dispute that Mrs Jegatheeswaran has a family history of coronary artery disease involving her father and brother.  Nor is there any dispute that coronary artery disease was already present at the time of her first infarct in September 2003.  However, Mrs Jegatheeswaran claims reimbursement of medical expenses for her heart condition and contends that her coronary infarcts were precipitated by her work related anxiety disorder.

4.The central issue in this application is therefore whether Mrs Jegatheeswaran’s employment caused or materially contributed to the cardiac events she suffered in September and December 2003.  This issue requires consideration of whether it is probable, medically, that the employment caused anxiety or stress she suffered precipitated her infarcts.  This, in turn, requires an examination of the level of severity of that stress or anxiety at the time of the cardiac events.  We turned to this question first and found Mrs Jegatheeswaran, while certainly suffering from substantial anxiety at the relevant times, was suffering something less than acute stress.

5.Applying this finding to the expert medical opinion we heard, in concurrent evidence, from Cardiologists Professor O’Rourke and Associate Professor Richards, we concluded that, preferring the opinion of Professor O’Rourke, Mrs Jegatheeswaran’s coronary infarcts were not precipitated by her work related anxiety disorder.

the severity of mrs jegatheeswaran’s anxiety

6.Mrs Jegatheeswaran gave evidence that the first two years of her work at the Australian Taxation office was enjoyable.  However, in 2002, an issue of harassment in the workplace arose and she was diagnosed as suffering adjustment disorder with features of anxiety and in November 2002 made a claim in respect of this condition.  A number of Mrs Jegatheeswaran’s treating medical practitioners recommended that she be relieved of contact with the alleged harasser.

7.Throughout the course of 2003 Mrs Jegatheeswaran continued to have occasional contact with the alleged harasser and she continued to attempt to have herself removed from the GST Compliance section so that this contact would cease.  She said she experienced some tightness in her chest from about May 2002.  She also continued to be distressed and disappointed by her employer’s response to her concerns.  In particular, a meeting on 18 September 2003, at which she hoped she would be moved out of the GST Compliance section, was a great disappointment to her. She said she felt panic during the meeting and an increased sensation of heartburn.

8.Mrs Jegatheeswaran described being frightened by her supervisor’s anger towards her and having difficulties starting a new job on 22 September, but still in the GST Compliance section.  She described being tearful, anxious and feeling she was being victimised.  She would eat alone at her desk at lunchtime and often cry at her desk.  She said she also felt angry.  Her husband’s evidence supported this but he also described her as optimistic that the difficulties at work would be resolved.  In addition, her heartburn-like symptoms increased and she found, on 25 September 2003, when walking with her husband, she had heaviness, chest pain and tightness, and left arm pain.  She said by then her symptoms came on with exertion and when she was frightened at work.  She saw her general practitioner at that time and was referred for a cardiological specialist opinion.

9.In addition, Mrs Jegatheeswaran had been under the care of a psychiatrist from November 2002.  In a report dated 24 October 2003, Dr T Newlyn, Mrs Jegatheeswaran’s treating Psychiatrist,  said the move on 22 September 2003 to the new work section “would have” increased her stress.  In a report dated 24 November 2003, Dr S Meagher, Mrs Jegatheeswaran’s general practitioner, described her as being under intense emotional stress.

10.Mrs Jegatheeswaran’s evidence was that on 30 September 2003, the day of her first infarct, she was anxious about another meeting coming up on 2 October.  She left work at 4.30 pm and drove home.  There she ate a meal with her husband and two sons and then sat down to watch television with her husband.  Her evidence and that of her husband was that she was talking about work, and particularly about the upcoming meeting on 2 October, and was agitated and unhappy.  She then began to experience severe chest symptoms which led to her being taken to Concord Hospital.

11.Mrs Jegatheeswaran had a stent inserted by Dr Pawsey, Senior Specialist in Cardiology at Concord Repatriation General Hospital, and was discharged on 4 October.  She remained off work until 8 December.

12.When Mrs Jegatheeswaran returned to work she started in the Small Business Section but was still in the same physical vicinity as the alleged harasser.  She said she continued to have heartburn-like symptoms and was still very anxious about work.  At about mid morning on 11 December she noticed some heaviness on her chest which settled when she used her medication.  She went home at about 4.00 pm and then to Concord Hospital at about 6.30 pm.  Her symptoms continued and she underwent further stenting on 19 December.  Very soon after that she was transferred to Royal Prince Alfred hospital where she underwent bypass surgery.

13.This evidence leads us to find that Mrs Jegatheeswaran suffered chronic stress and anxiety up to and including the last of her coronary infarcts.  We find, however, that while, at the time of her first infarct on 30 September 2003, the stress and anxiety she suffered was significant, it was not acute.  We note that she had attended work on that day until 4.00 pm and had eaten with her family and settled down to watch television with her husband.  We accept she was tearful and distressed on that day but her distress was not so severe as to prevent her from finishing her day’s work and eating and relaxing with her family in the evening.

the role of stress in the onset of cardiac events

14.In concurrent evidence, Professor M O’Rourke and Associate Professor D Richards, both Cardiologists, agreed that stress, if sufficiently severe, can cause unstable angina and even plaque rupture, which, in turn can cause an infarct.

15.The two cardiologists differed as to the severity of the stress experienced by Mrs Jegatheeswaran and the severity of the stress required to give rise to an infarct.

16.Professor O’Rourke was of the view that the type of stress required to cause an infarct was of a very high order such as fear for one’s life.  His view was that the stress experienced by Mrs Jegatheeswaran was of a considerably lesser degree.  We consider Mrs Jegatheeswaran’s level of stress was higher than the normal workplace stress described by Professor O’Rourke but we agree it was not acute.  He also considered the second event was simply a result of the progression of Mrs Jegatheeswaran’s cardiac disease.

17.Associate Professor Richards considered Mrs Jegatheeswaran experienced chronic stress but also had recurrent acute stress.  He considered she developed a pattern of unstable angina soon after the acute stress of the meeting on 18 September and that this ultimately led to the infarct on 30 September 2003.  He also considered Mrs Jegatheeswaran’s return to work caused the further progression of the disease and therefore her further infarct in December 2003.

18.Professor O’Rourke referred to a number of publications attached to his report of 23 November 2004, canvassing the relationship between stress and cardiac events.  By reference to these publications he said the temporal relationship between stress and a cardiac event must be in the order of one hour and the stress must be acute rather than chronic.  We also note the view expressed that inflammation has recently been implicated in the process of acute coronary thrombosis and that such inflammation is caused by the underlying coronary disease.

19.Although Mr Snell, for Mrs Jegatheeswaran, submitted that Dr Meagher and Dr Pawsey supported the view that Mrs Jegatheeswaran’s infarcts arose out of her stress, we note that Dr Meagher’s report of his conversation with Dr Pawsey was simply that it “could” have done so.  Dr Pawsey’s report of 31 March 2004, in which he said it is likely that stress played a role in precipitating acute closure of one of her coronary arteries, should, as submitted by Mr Kelly for Comcare, be read with his report of 8 December 2004 in which he said that stress “may” have been a contributing factor in Mrs Jegatheeswaran’s acute infarction.  Dr Pawsey also noted that he did not know the details of Mrs Jegatheeswaran’s workplace environment but did know that she complained that it was stressful.  Ultimately, neither of these doctors stated it was probable that stress contributed to her infarcts.

20.We also note that Mrs Jegatheeswaran experienced cardiac symptoms on exertion, in the week leading up to her first infarct.  This dilutes the probability of a causal relationship between her stress and the infarct further.

21.On balance we prefer the view of Dr O’Rourke because, while we consider he underestimated the severity of Mrs Jegatheeswaran’s stress to some extent, we accept his view that stress must be acute to precipitate a cardiac event and we have found that she did not suffer from acute stress.  We are also mindful of more recent views that implicate inflammation in the causation of coronary events.

conclusion

22.It follows, given our finding that Mrs Jegatheeswaran’s stress at the relevant time was not acute, and our preference for the expert opinion of Professor O’Rourke, that we are not satisfied that Mrs Jegatheeswaran’s coronary infarcts were caused or contributed to by her work related stress or anxiety.

23.For these reasons, the decision under review is affirmed.

I certify that the 23 preceding paragraphs are a true copy of the reasons for the decision herein of Ms N Bell, Senior Member and Dr J D Campbell, Member

Signed:         ....[Linda Blue]........................................
  Associate

Dates of Hearing  12 & 13 September 2005
Date of Decision  4 November 2005
Counsel for the Applicant         Mr Michael Snell
Solicitor for the Applicant          Carroll & O'Dea 
Counsel for the Respondent     Mr Brendon Kelly
Solicitor for the Respondent     Phillips Fox