Logan Jones and Comcare (Compensation)

[2017] AATA 1736

Logan Jones and Comcare (Compensation) [2017] AATA 1736 (11 October 2017)

Division:GENERAL DIVISION

File number:           2016/0202

Patricia Logan Jones

APPLICANT

AndComcare

RESPONDENT

DECISION

Tribunal:Dr James Popple, Senior Member
Dr Bernard Hughson, Member

Date:11 October 2017

Place:Canberra

Comcare’s decision on 19 November 2015 is affirmed.

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

James Popple, Senior Member

CATCHWORDS

COMPENSATION — Commonwealth employees — Applicant injured back while travelling for work — Comcare accepted liability for injury — Applicant claimed back and neck condition, and headaches, were caused by injury — Applicant no longer suffers effects of injury — medical treatment not obtained “in relation to” Applicant’s injury — incapacity for work not “as a result of” Applicant’s injury — Comcare not liable to pay compensation for medical expenses or incapacity — decision under review affirmed.

LEGISLATION

Safety, Rehabilitation and Compensation Act 1988, ss 14, 16, 19

REASONS FOR DECISION

Dr James Popple, Senior Member
Dr Bernard Hughson, Member

11 October 2017

Summary

1. The applicant injured her back while travelling for work.  Two years later, she made a claim for workers’ compensation.  She claimed that her back and neck condition, and headaches that she was suffering, were caused by her injury.  Comcare accepted liability for her injury under the Safety, Rehabilitation and Compensation Act 1988 (the SRC Act). But Comcare declined to pay her compensation for medical expenses under s 16 of the SRC Act, or for incapacity for work under s 19, on the basis that she no longer suffered from the effects of her injury.

2. The applicant no longer suffers from the effects of the injury she suffered in 2012. So, Comcare is not liable to pay her compensation under s 16 or s 19 of the SRC Act.

   Background

3. Mrs Patricia Logan Jones was employed by the Department of Defence.  On 26 March 2012, while travelling for work, she injured her back moving and lifting a suitcase into a taxi outside her home.  She notified the Department of the incident the next day.

4. On 7 December 2013, Mrs Logan Jones suffered a severe headache.  She has suffered severe headaches intermittently since then.

5. On 25 March 2014, Mrs Logan Jones made a claim for workers’ compensation.  She said that her diagnosed condition was “active C6/7 disease, right C3/4 facet joint arthropathy, right L3/4 facet joint arthropathy”.  She said that her back and neck condition, and her headaches, were a result of her 2012 back injury.

6. On 26 May 2014, Comcare accepted liability, under s 14 of the SRC Act, for Mrs Logan Jones’s “lumbar sprain”. Comcare advised Mrs Logan Jones that it would “require a further opinion from an independent specialist regarding [her] other conditions (migraines and cervical facet joint arthropathy) and whether [her] primary condition is still related to the incident on 26 March 2012, prior to making a determination”. Comcare obtained various medical reports.

7. On 1 April 2015, Comcare advised Mrs Logan Jones that the medical evidence suggested that she no longer suffered from the effects of her compensable injury.  Comcare invited Mrs Logan Jones to provide further evidence in support of her claim, which she did.

8. On 13 August 2015, Comcare decided that Mrs Logan Jones no longer suffered from the effects of her 2012 injury, and determined that she had no present entitlement to compensation for medical expenses under s 16 of the SRC Act, and no present entitlement to compensation for incapacity under s 19.

9. On 9 October 2015, Mrs Logan Jones requested a reconsideration of that determination.  On 19 November 2015, Comcare affirmed its determination.

10. On 27 January 2016, Mrs Logan Jones applied to the Tribunal, under s 64 of the SRC Act, for review of that decision.

    Decision under review

11. The decision under review is Comcare’s decision on 19 November 2015, affirming its determination that (from 13 August 2015) Mrs Logan Jones had no entitlement to compensation under s 16 or s 19 of the SRC Act.

    Issue

12. Under s 14 of the SRC Act, Comcare is liable to pay compensation in respect of an injury suffered by an employee if the injury results in death, incapacity for work, or impairment. Section 5A(1)(b) provides that “injury” includes “a physical … injury arising out of, or in the course of, the employee’s employment”. Comcare accepts that Mrs Logan Jones suffered an injury, for the purposes of s 14, when she injured her back while travelling for work on 26 March 2012.

13. Section 16 provides for Comcare to pay compensation in respect of medical treatment obtained “in relation to” an injury. Section 19 provides for Comcare to pay compensation to an employee who is incapacitated for work “as a result of” an injury.

14. The issue in this review is whether Comcare is liable to pay compensation to Mrs Logan Jones under s 16 or s 19. That depends on whether she continues to suffer the effects of her 2012 injury. If she does, Comcare is liable to pay compensation in respect of her reasonable medical expenses, and (if she is incapacitated for work) compensation for that incapacity. If she does not continue to suffer the effects of her 2012 injury, then:

    ·any medical treatment she obtains is not obtained “in relation to” her injury, so Comcare is not liable under s 16; and

    ·she is not incapacitated for work “as a result of” her injury, so Comcare is not liable under s 19.

    Medical evidence

15. There is much evidence before us about Mrs Logan Jones’s condition at various times before and after she suffered her injury in 2012.  In addition, there are reports from:

    ·Dr Colin Andrews, a consultant neurologist, who saw Mrs Logan Jones on a number of occasions, and wrote reports on 8 and 31 January, and 29 April 2014.

    ·Associate Professor Geoffrey Boyce, a consultant neurologist, who saw her on 27 June 2014, and wrote a report that same day.

    ·Dr Tracy Johns, a general practitioner (GP), who saw her on many occasions, and wrote reports on 16 May and 10 November 2014, and 11 February 2015.

    ·Dr Anthony Cairns, a consultant orthopaedic surgeon.  He saw Mrs Logan Jones on 16 January 2015.  He wrote reports on 28 January and 24 March 2015, 24 August 2016 and 17 July 2017.

    ·Dr Stephan Rudzki, a sports and exercise physician.  He saw her on 17 occasions,[1] for the first time on 4 June 2015.  He wrote reports on 25 June and 8 September 2015, and 19 April and 14 September 2016.

    We also heard evidence from Dr Cairns and Dr Rudzki.

    [1]     As at 14 September 2016.

    Agreed facts

16. We make the findings set out in [17]–[34] below, on the balance of probabilities. These findings are based on the evidence before us, including the evidence of the people listed at [15] above. These findings are generally agreed between the parties.

17. On 26 March 2012, Mrs Logan Jones injured her lower back while travelling for work.

18. Her GP prescribed non-steroidal anti-inflammatories and analgesics.  She had physiotherapy for about a year.  The physiotherapist’s notes indicate that, on 30 March 2012, Mrs Logan Jones reported pain in her lower back on her left and right side.  The pain was recorded as being greater on the left side than on the right.  On 2 April 2012, the physiotherapist noted that she was experiencing sharp pain in her left hip.  On 4 April 2012, the physiotherapist noted that she had a “sore left side”.  On 11 May 2012, the physiotherapist again recorded Mrs Logan Jones’s pain as being greater on the left side than on the right.

19. From March 2013, her lower back pain got worse.  At her GP’s suggestion, she did yoga and Pilates.

20. On 28 March 2013, she started acupuncture treatment which would reduce her pain, but the pain would return within a day or two.

21. On 30 March 2013, she started taking medication for her back pain.

22. In April or May 2013, she experienced a “hot” sensation at the right side of her neck, associated with a sharp pain.

23. At 11:40 pm on 7 December 2013, she woke in bed with a severe headache.  Her headache was generalised, and in the upper cervical region.  She suffered vomiting, diarrhoea and nausea, and was treated in hospital.  She had never previously experienced a headache as severe.

24. On 12 December 2013, she suffered another headache while in bed, and was hospitalised again.

25. On 20 December 2013, she suffered another headache, and neck and paraspinal pain.  Her symptoms persisted throughout Christmas, after which she went back to hospital, complaining of severe back pain, headaches and vomiting.

26. In late 2013 and early 2014 she suffered increased neck pain, and intermittent severe headaches.

27. She had a computed tomography (CT) scan of her brain, which revealed a Chiari malformation.  Her Chiari malformation is unrelated to any trauma.

28. On 8 January 2014, she started taking medication for chronic severe headaches.

29. On 9 January 2014, she had single-photon emission computed tomography / CT (SPECT/CT) imaging of her cervical and lumbar spine.  This showed active C6/7 disc disease, right C3/4 facet joint arthropathy and right L3/4 facet joint arthropathy.

30. On 13 January 2014, she had corticosteroid injections to the right C3/4, C4/5 and L3/4 facet joints.  These gave her three months of relief, and she was able to resume some of her normal activities.  She later[2] had corticosteroid injections to the right L4/5 joints, but these caused pain at the injection site and in her right hip and thigh.

    [2]     These second injections were probably administered in April 2014.

31. On 4 July 2014, she started to attend a gym to perform back-strengthening exercises.

32. On 4 February 2015, she had delayed planar and SPECT/CT imaging of her cervical and lumbar spine.  This showed “[a]ctive cervical (left C2–C3 and right C3–C4) and lumbar (right L3–L4 and mildly at left L3–L4) facet arthropathy”.  It also showed “[d]iscovertebral degenerative disease with moderate uptake at C6–C7 level”.

33. On 13 March 2015, she had local anaesthetic and corticosteroid injections to the L3/4 to L5/S1 facet joints bilaterally.

34. In April 2015, she had surgery (a posterior fossa decompression) to address her Chiari malformation.

    Differences of opinion

35. The parties (and the medical experts) have different opinions about whether Mrs Logan Jones continues to suffer the effects of her 2012 injury.  Generally speaking, Dr Johns and Dr Rudzki say that she does; Dr Andrews, Associate Professor Boyce and Dr Cairns say that she does not.

36. From March 2014 until September 2015, Dr Johns provided medical certificates for Mrs Logan Jones’s compensation claim.  She certified that Mrs Logan Jones’s condition was caused by:

    Initial damage to [her] lumbar spine (now showing facet joint arthritis) in March 2012.  Persistent low back pain and increasing neck pain with active facet joint arthritis at one level and disc disease at another level—but it is not possible to tell if this was damaged in the initial injury or is the result of compensatory postures due to persistent low back pain.  There has been no other specific neck injury to account for the current symptoms.  Spasm of paracervical muscles has led to frequent muscle tension headaches with triggering of migraine headache once to twice weekly.[3]

    On 29 October 2014, Dr Johns certified that Mrs Logan Jones’s Chiari malformation “may have been contributing to her headaches”.  On 11 February 2015, Dr Johns reported that her facet joint pathology was “unrelated to her Chiari malformation which we now know led to some of the headaches she has been experiencing since Dec 2013”.

    [3]     Medical certificates, 28 March, 28 April, 30 May, 27 June and 23 July 2014.  On 27 August, 17 and 24 September and 29 October 2014, Dr Johns noted that other causes for the headaches (other than paracervical muscle spasms) were being investigated.  Certificates that Dr Johns wrote between 28 March 2014 and 28 September 2015 include similar words to those quoted here.

37. On 16 May 2014, Dr Johns reported:

    The signs of osteoarthritis are localised to a single facet joint in her lumbar spine.  This is likely to indicate that there was an injury to this joint at some stage and the resultant mal-alignment of the joint has led to osteoarthritic change.  There are no signs of osteoarthritis elsewhere in the pelvis or hips.

    …

    The injury to her right L3/4 facet joint is likely to have occurred at the time of her sudden onset of back pain on 26/03/2012.

    …

    I am quite sure that these symptoms are related to the initial injury and have been exacerbated by sub-optimal treatment over the last 2 years.

    In a later report,[4] Dr Johns explained that, in her view, Mrs Logan Jones’s treatment was initially inadequate “due to her work pressures such that she did not pursue a workers compensation claim at that time, hoping her symptoms would settle with time and exercise”.

    [4]     11 February 2015.

38. On 10 November 2014, Dr Johns reported:

    While she may have a degree of osteoarthritis as part of the aging process, she had absolutely no symptoms in her low back and only mild muscle aching in her neck prior to the work related injury in March 2012.[5]  Since that time she has had constant and worsening pain and aching in these areas despite trying physiotherapy initially and continuing with [P]ilates as suggested by her previous GP …  It is much more likely that the twisting injury she had has led to a malalignment in her back and strain on the facet joints which has led to mild to moderate arthritis developing in these areas over the following 2 years.

    [5]     Comcare disputes this, pointing to evidence that Mrs Logan Jones reported lower back pain in 2009.  We have decided that Mrs Logan Jones does not continue to suffer the effects of her 2012 injury (see [61] below), so we have not had to make any findings on this issue.

39. Dr Rudzki, who also treated Mrs Logan Jones, was also of the view that she continues to suffer the effects of her 2012 injury.  On 25 June 2015, he noted Dr Cairns’s view (discussed below)[6] that her original injury was “more likely than not of a soft tissue, musculoligamentous nature” which “would have resolved within weeks, no more than a few months”.  Dr Rudzki agreed that the “likely nature of the original injury was a soft tissue musculoligamentous injury”.  But, he reported:

    I differ with [Dr Cairns’s] view on duration, as it has been my repeated observation that untreated chronic inflammatory lesions can persist for years, not months.

    [6] Report of 28 January 2015: see [47] below.

40. Dr Rudzki explained that he had examined Mrs Logan Jones on 25 June 2015:

    … her pain was well localised to the right [ilio-lumbar ligament] and deep palpation reproduced her pain.  I assess this clinically to be a chronic inflammation of her right ilio-lumbar ligament.  This was consistent with the mechanism she described for her initial injury—a bending and rotational movement of lifting up her suitcase.

41. He expanded upon this view in his 8 September 2015 report:

    I agree that the original injury was a soft tissue musculoligamentous one, specifically a chronic inflammation of her right ilio-lumbar ligament.  I disagree with the statement that it would resolve within weeks or months.  I routinely see patients with similar injuries where symptoms have persisted for years.  The basis for this is chronic inflammation which is sustained through a process of what is termed “repetitive microtrauma”.  That is, the initially injured area never fully heals and movements in certain directions reinjure the area.

    The fact that Miss Logan Jones responded to an injection of hydrocortisone and local anaesthetic into the area of maximum point tenderness at the site of her right ilio-lumbar ligament supports both the diagnosis and the contention that this has been a long-standing condition.  She described the pain at this site as being the original pain she experienced in 2012.

    …

    The issue of Miss Logan Jones’ neck pain has been a challenging one.  She has suffered from recurrent migraine-like headaches and the diagnosis of Chiari malformation has confounded the aetiology.  I initially did not believe there was any relationship between her neck pain and her right sided lumbar pain.  However on her visit of 25 August 15, she complained of well localised pain at the base of her left occiput with referred pain to her retro-orbital region.  A trial injection of hydrocortisone and local anaesthetic into that area relieved her local pain, but that evening Miss Logan Jones reported that she experienced quite marked pain on her right hand side in the region of her ilio-lumbar ligament.  This implies there was some form of relationship between her neck muscle spasm and the ilio-lumbar ligament.  …

    …

    Ms Logan Jones is troubled by recurrent headaches which seem to also result in episodes of right sided back pain.  I believe that as a result of delayed diagnosis she has developed a number of maladaptive muscle motor patterns.  These are a direct result of her initial injury and remain unresolved because she has been unable to commence or complete a strength and reconditioning program.[7]

    [7]     Spelling errors corrected.

42. On 14 September 2016, Dr Rudzki reported that, in his opinion, Mrs Logan Jones’s ongoing neck pain is “the unfortunate consequence of trauma to the neck musculature as a result of her Chiari malformation surgery”.  At the hearing, Dr Cairns agreed that “some of her cervical pain may have been related to the Chiari malformation”.

43. On 29 April 2014, Dr Andrews reported:

    I am not sure how the condition came about.  It doesn’t appear to be anything related to her employment.

    There didn’t appear to be any pre-existing history that could have accounted for the facet joint disease which I think has been probably the main reason for the headaches reoccurring at this time.

44. On 27 June 2014, Associate Professor Boyce reported that, in his opinion, Mrs Logan Jones “suffered a soft tissue injury to her lumbar spine” on 26 March 2012:[8]

    It is also my opinion that some other process occurred in December 2013 unrelated entirely to the events of 2012 when she developed the severe headaches, projectile vomiting, diarrhoea and nausea.  She was also found to have the Chiari lesion.

    …

    … it is well known that when people with Chiari lesions do have severe vomiting, there is a raise in the intracranial pressure.  When they have a Chiari lesion the lesion would be forced further into the cervical spine and increase the problems associated with headache, and ataxia.

    …

    She may well have had a viral meningitis or meningitic-like reaction in December 2013 which exacerbated her Chiari lesion …[9]

    [8]     Associate Professor Boyce specified 21 March 2012.  This was an error.

    [9]     Spelling error corrected.

45. Associate Professor Boyce also reported:

    In my opinion [Mrs Logan Jones] suffers from a recurrent vascular headache syndrome.  This may well be exacerbated by the Chiari lesion and spinal dysraphism which needs further examination and exclusion.  In my opinion the so-called hotspots [on the SPECT/CT imaging of her cervical and lumbar spine][10] have no clinical basis and there is no relationship between these and her headaches and there is no relationship between the headache syndrome and her employment …

    [10] See [29] above.

46. On 10 November 2014, Dr Johns disagreed with Professor Boyce that there was no clinical basis for the “hotspots” on the SPECT/CT imaging:

    … the subsequent MRI [magnetic resonance imaging] scan confirmed moderate facet joint arthritis in her lower lumbar spine and in her cervical spine with disc distortion at C5/6.  Also the steroid injections to the facet joints at the “hot spots” caused significant relief of her symptoms for some months which confirms there is a clinical basis for her symptoms.

    However, Dr Johns agreed that “there is no relationship between the hot spots and her headache syndrome”:

    … her neck and back symptoms are unrelated to the headache symptoms though the onset of these did lead to her finally submitting a workers compensation claim as she could no longer cope with the chronic pain as well as the headaches.

1. On 28 January 2015, Dr Cairns reported that Mrs Logan Jones:

   … appears to have suffered a soft tissue, musculoligamentous strain to her lumbosacral spine when attempting to lift a suitcase in the course of her work-related activities on or about 26 March 2012.  Some 13 to 14 months later, in April or May 2013,[11] she suffered the spontaneous onset of cervical symptoms and headache which historically and clinically do not appear to be related in any way to the index incident.

   …

   In my opinion, it is likely that the original soft tissue, musculoligamentous injury to her lumbosacral spine has resolved, superseded by symptoms derived from the underlying degenerative pathologies as diagnosed.

   Later in his report, he said that her “initial condition has been superseded by different conditions related to the natural progression of underlying conditions of cervical and lumbar degenerative pathology”.

   [11] See [22] above.

2. On 11 February 2015, Dr Johns reported:

   I think, in view of the isolated lumbar facet joint problem that it is more likely this stemmed from the initial injury which may have damaged that facet joint—as this often occurs when there is a twisting motion under load.  It is also possible she suffered a disc injury at the time of the original injury and the facet joint arthropathy is a result of this.  If it was due to normal age-related degeneration then I would expect to see signs of arthropathy at multiple levels throughout her spine.

   … she then developed compensatory postural changes that may have led to her developing symptoms and signs in her cervical spine.  She has had no other events that may have led to her developing cervical symptoms other than postural changes as a result of her back pain.  She has also now developed symptoms and signs of arthropathy on the left facet of her L3/4 lumbar vertebrae which I believe further confirms this is ongoing damage from an insult to that level of her spine, rather than age-related degeneration.

3. Comcare asked Dr Cairns to respond to the points made by Dr Johns.  On 24 March 2015, he reported:

   At the time the injury was sustained, the mechanism suggests a soft tissue, musculoligamentous injury …

   …

   Despite Dr Johns’ expressed opinion regarding the distribution of the degenerative changes, and the reasonable observation regarding localised pathology (right L3/4 facet joint arthropathy) the nature of degenerative changes occurring within any given individual’s spine is highly variable, and when people present with mechanical low back pain, the imaging investigations may demonstrate a wide variability of age-related changes, including none, up to significant, advanced multi-segmental involvement.

   The theory that the original low back injury and postural changes resulting therefrom resulted in the onset of cervical symptoms some 13 to 14 months following the index incident, in my opinion, is extremely unlikely.

   …

   I do not agree with Dr Johns’ explanation that the lumbar facet joint injury has likely arisen from the incident of March 2012 and therefore not an underlying degenerative change.  Such a change would … not be uncommon in a person aged almost 46 years.[12]

   …

   Similarly, I do not agree with Dr Johns’ explanation for the link between a neck condition and the relationship to the incident of March 2012, namely that Ms Logan [sic] developed compensatory strategies which placed abnormal forces on her cervical spine.

   Accepting such a theory, such compensatory strategies may, arguably, induce muscular tension possibly provoking neck symptoms, but not the multi-segmental pathology (active C6/7 disc disease and right C3/4 facet joint arthropathy), which are also obviously age-related, constitutional degenerative changes occurring at the cervical level, as well as the lumbar levels.

   [12]    Mrs Logan Jones was 44 when she injured her back in March 2012.  She was 45 when she experienced symptoms in her neck in April or May 2013.  She is now 49.

4. Later, Comcare asked Dr Cairns to respond to Dr Rudzki’s first three reports.[13]  On 24 August 2016, he rejected, in detail, various aspects of Dr Rudzki’s reports as “entirely speculative”, “highly arguable”, “tenuous” and “an interesting but highly controversial and most unlikely theory”.  In summary, he reported that nothing he had seen caused him to change his earlier opinion.  He diagnosed Mrs Logan Jones’s neck condition as “[c]ervical intervertebral disc degeneration and facet arthropathy, cervical spondylosis”, caused by “[n]ormal age-related, constitutional degenerative changes”.  He continued:

   In my opinion, [Mrs Logan Jones’s] impairments are directly related to the degenerative conditions demonstrated on the relevant imaging investigations, MRI and bone scans.

   I do not agree with Dr Rudzki’s postulate that the applicant suffers from inflammatory lesions of the soft tissues of the back which can persist for years.

   …

   I do not agree with Dr Rudzki’s postulate regarding the relationship of her neck pain to her low back pain.

   This answer is based upon the fact that there is no logical rationale between said relationship, and further that the documentation as quoted above reflects the significant confusion in Dr Rudzki’s multiple shifting postulated explanations for the claimant’s pain.

   The correct diagnoses are apparent from the history and relevant imaging investigations without the need to indulge in confusing speculation.

   …

   I consider the reasonable diagnosis of chronic inflammation due to “repetitive microtrauma” to be unlikely.

   [13]    25 June and 8 September 2015 (see [39]–[41] above), and 19 April 2016.

5. Comcare also asked Dr Cairns to respond to Dr Rudzki’s fourth report.[14]  On 17 July 2017, he reported:

   In my experience, the diagnosis of injury to the iliolumbar ligament is very unusual, if not rare, to the extent that in my long professional career I cannot recall ever entertaining the diagnosis in the absence of more commonly recognised diagnoses.  Common things occur commonly.

   Nonspecific mechanical low back pain is common within the general population, and there are a number of other more commonly entertained differential diagnoses than that of “iliolumbar ligament strain”.

   …

   I would also again dispute that “direct pressure over the location of the ilio-lumbar ligament” would be likely to derive any useful, particularly diagnostic information.

   [14]    14 September 2016.

6. Significantly, Dr Cairns also noted:

   … although [Dr Rudzki] refers to “specific right-sided iliolumbar ligament pain”, review of the documentation indicates that Ms Logan Jones has, from time to time, also reported left-sided pain at that level, and I would be interested in Dr Rudzki’s explanation for that, given the specificity of his diagnosis of right ilio-lumbar strain, and his reliance on the physical sign of tenderness at the site of the injury.

   This was a reference to the left-sided pain that Mrs Logan Jones reported to her physiotherapist in March, April and May 2012.[15]  Dr Rudzki was not aware of this evidence until the hearing.  At the hearing, counsel for Comcare asked him whether that evidence affected his opinion about what had happened to Mrs Logan Jones in March 2012:

   [15] See [18] above.

   Dr Rudzki:   It would—yes, it changes it.

   Counsel:    And in what way does it change it?

   Dr Rudzki:   In that the symptoms reported at the time of the incident were predominantly left-sided, whereas … the symptoms that I identified on my initial examination were right-sided.

   …

   Counsel:    Dr Rudzki, consistently through these physiotherapy notes, the pain has been recorded as being left-sided dominant, has it not?

   Dr Rudzki:   Yes.

   Counsel:    That remains consistent?

   Dr Rudzki:   Yes.

   Counsel:    It is not consistent with the right iliolumbar ligament sprain that you have diagnosed, is it?

   Dr Rudzki:   It’s not consistent with the right iliolumbar sprain diagnosis being present at the time these notes were collected, yes.

   Counsel:    … There’s something going on in this lady’s lumbar spine region that is not medically explained by a right iliolumbar ligament sprain on 26 March 2012?

   Dr Rudzki:   I think the evidence suggests that her symptoms were left-sided, therefore, a right-sided iliolumbar ligament sprain is not consistent with that.

   Further findings

7. We must now make further findings of fact, having regard to this medical evidence—some of which is conflicting.

8. Dr Andrews is a consultant neurologist, who was treating Mrs Logan Jones’s headaches.  Accordingly, we put some weight on his view that her facet joint disease was probably the main reason for her headaches, but we put little weight on his view that her pre-existing history does not account for her facet joint disease.[16]  We give some weight to the evidence of Dr Johns.  She was Mrs Logan Jones’s GP, and saw her on many occasions over several years.  But she would appear to have no specific expertise.  We give some weight also to Associate Professor Boyce’s evidence, noting that he has neurological expertise.  We give greater weight to the evidence of Dr Cairns and Dr Rudzki.  They have relevant expertise and their evidence was tested at the hearing so that the reasons for their opinions became clear.

   [16] See [43] above.

9. As between the evidence of Dr Cairns and Dr Rudzki, we prefer that of Dr Cairns:

   ·Dr Cairns is a consultant orthopaedic surgeon; Dr Rudzki is a sports and exercise physician.  Dr Cairns’s expertise is more applicable to the condition of Mrs Logan Jones’s neck and back.

   ·Dr Rudzki conceded, at the hearing, that the evidence that Mrs Logan Jones had reported left-sided pain in the months after her injury (which he only learnt about at the hearing) was not consistent with his opinion that her condition was due to a right-sided ilio-lumbar ligament sprain.[17]

   ·This movement of the pain, from left to right, suggests that Mrs Logan Jones’s condition is degenerative (as Dr Cairns says), and not caused by the injury (as Dr Rudzki says).

   [17] See [52] above.

10. Having regard to the medical evidence, we make the findings set out in [57]–[60] below, on the balance of probabilities.  We note that these findings are consistent with the evidence of Dr Cairns; mostly consistent with the evidence of Associate Professor Boyce; and consistent with parts of the evidence of Dr Andrews, Dr Johns and Dr Rudzki.

11. On 26 March 2012, Mrs Logan Jones suffered a soft tissue, musculoligamentous strain to her lumbosacral spine.  That injury resolved within a few months.

12. She suffers from cervical intervertebral disc degeneration and facet arthropathy, and cervical spondylosis, caused by normal age-related, constitutional degenerative changes.

13. Her ongoing back pain is caused by the natural progression of underlying degenerative pathologies.  Her ongoing neck pain is caused by the natural progression of underlying degenerative pathologies, and trauma to her neck musculature suffered during her Chiari malformation surgery.  Her Chiari malformation was unrelated to these underlying degenerative pathologies, or her 2012 injury.

14. Her headaches were caused by the natural progression of underlying degenerative pathologies in her neck, and her Chiari malformation.  Her ongoing headaches are caused by the natural progression of underlying degenerative pathologies in her neck.

15. It follows from these findings that Mrs Logan Jones does not continue to suffer the effects of her 2012 injury, and ceased to suffer those effects no later than 13 August 2015.

    Conclusion

16. As at 13 August 2015, Mrs Logan Jones no longer suffered from the effects of the injury she suffered on 26 March 2012. Any medical treatment obtained after that date is not obtained “in relation to” her injury, so Comcare is not liable to pay compensation in respect of her medical expenses under s 16 of the SRC Act. And, if she is incapacitated for work, she is not incapacitated for work “as a result of” her injury, so Comcare is not liable to pay compensation for that incapacity under s 19 of the SRC Act.

I certify that the preceding 62 (sixty-two) paragraphs are a true copy of the reasons for the decision herein of Senior Member Popple and Member Hughson

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

Associate

Dated: 11 October 2017

Dates of hearing:	14–15 August 2017
Counsel and solicitor for the Applicant:	Mr Wayne Arthur
Counsel for the Respondent:	Ms Kristy Katavic
Solicitors for the Respondent:	Sparke Helmore, Lawyers