Thew and Comcare - [2002] AATA 606

DECISION AND REASONS FOR DECISION [2002] AATA 606

ADMINISTRATIVE APPEALS TRIBUNAL        Nº N2001/28; N2002/372
GENERAL ADMINISTRATIVE DIVISION
  Re:         Michelle Thew
  Applicant
  And:       Comcare
  Respondent

DECISION

Tribunal:       Mr P.J. Lindsay, Senior Member; Dr P. Lynch, Member
Date:             24 July 2002
Place:            Sydney

Decision:The Tribunal affirms the decisions under review.

[SGD] Mr P.J. Lindsay
Senior Member
CATCHWORDS
Compensation – ganglion – whether respondent liable for ongoing compensation -epicondylitis – whether injury arose out of or in the course of employment - permanent impairment claimed in respect of upper limb conditions - whether degree of "whole person impairment" ten per cent or more under Tables 9.4 and 9.6 in approved Guide – decisions affirmed.

Administrative Appeals Tribunal Act 1975
Safety, Rehabilitation and Compensation Act 1988 ss.4, 14, 16,19, 24 and 27.
Comcare Guide to the Assessment of the Degree of Permanent Impairment, Australian Government Publishing Service, Canberra, 1989.

REASONS FOR DECISION

Mr P.J. Lindsay, Senior Member

The decisions under review before the Tribunal concerning the applicant, Ms Michelle Thew, are as follows:

Matter No N2001/28: a reviewable decision made on 11 December 2000 under the Safety, Rehabilitation and Compensation Act 1988 (the Act) by an Independent Review Officer of Comcare (T71). The decision affirmed a determination made on 11 October 2000. The determination stated that (T67):
The medical evidence is stating that your current condition is lateral epicondylitis, however, the accepted condition on your claim is for aggravation of ganglion (right) as a result of writing and typing for extended periods of time….
Given the above evidence I am unable on the balance of probabilities as opposed to possibilities to establish a relationship between your current condition and the injury of 27 July 1998.
In summary, after having regard to the provisions of the Act, I determine that you have no entitlements under any provision of the Safety, Rehabilitation and Compensation Act 1988 including Section 14(1), 16 and 19.

Matter No N2002/372: a reviewable decision made on 8 March 2002 under the Act by an Independent Review Officer for Comcare, the reasons for which were amended in part on 13 March 2002. The reviewable decision stated that:
In light of the above I hereby affirm the decision of 29 October 2001 which rejected your client's claim for permanent impairment, however the reasons are varied, on the basis that for a payment of compensation under section 24 of the Act to be made for her current condition, "lateral epicondylitis", there must be in existence a prior determination pursuant to s.14 of the Act accepting liability.
In relation to the accepted claim of 'aggravation of ganglion', I have preferred the opinion of Dr Deshpande, the treating surgeon, who has indicated that the condition has resolved. As a result I am not satisfied that she has any impairment under section 24 in relation to the ganglion condition.

At the hearing Ms Gillies of Counsel appeared for Ms Thew and Mr Johnson of Counsel appeared for Comcare, the respondent. Ms Thew gave evidence. Dr McGill, consultant rheumatologist, gave evidence for the respondent. The Tribunal had before it the exhibits taken into evidence during the hearing and documents ("the T documents") lodged under s.37 of the Administrative Appeals Tribunal Act 1975 in matter number N2001/28. There were no T documents provided in respect of matter number N2002/372.
issues
On 18 February 1999 Comcare accepted liability for Ms Thew's injury of 27 July 1998, being the aggravation of a ganglion on her right wrist. The first issue for the Tribunal's consideration in matter No N2001/28 is whether Ms Thew continued to suffer from an injury, as defined in s.4 of the Act, to her right wrist, forearm and elbow on and after 11 October 2000 arising out of or in the course of her employment. If so, two other issues become relevant. The first is whether she is entitled to compensation for the cost of medical treatment obtained in relation to the injury. The second is whether there is incapacity for work as a result of that injury.
The first issue for the Tribunal's consideration in matter No N2002/372 is whether Ms Thew's injury, being aggravation of her right ganglion, has resulted in a permanent impairment entitling her to compensation. If the Tribunal decides that her right lateral epicondylitis or her chronic right wrist pain is a work related injury for which Comcare is liable to pay compensation, the remaining issue will be whether such injury has resulted in a permanent impairment.
background
On 27 July 1998 Ms Thew completed a report of an accident, injury or illness (T3) that she gave to her employer the Department of Social Security. Ms Thew provided the following information in the report:

Date and time when the accident/injury occurred or when the disease was reported – 27 July 1998 at 8.30am.
Describe the task you were doing – At home.
Nature of accident/injury/disease (what injury did you receive) – Tendonitis right wrist.
Part of body affected – Right wrist/hand/elbow.
Describe how the accident/injury occurred – Every few months wrist goes & can't key, write etc. properly.
Describe the object, substance involved in the accident/illness/injury – Writing, keying, using mouse aggravates injury.
How much time did you take off as a result? – Two days so far.

Ms Thew completed another accident, injury or illness report on 4 December 1998 (T6). The report contained the following:

Date and time when the accident/injury occurred or when the disease was reported – 27 November 1998 at 8.30am.
Describe the task you were doing – Customer service duties.
Nature of accident/injury/disease (what injury did you receive) – Ganglion of right wrist.
Part of body affected (be specific) – Right wrist.
Describe how the accident/injury occurred – Keying aggravates the ganglion on my wrist.
Describe the object, substance involved in the accident/illness/injury – Keyboard/writing.

Ms Thew completed a Claim for Rehabilitation and Compensation on 9 December 1998 (T10). The following information was set out in the injury/illness section of the claim:

What is the precise diagnosis as stated on your medical certificate? – Chronic right wrist pain with a ganglion.
When did your injury happen or when did you notice the illness? – First time 1997. Second time 27/28 July 1998?
In your own words, describe the injury or illness as fully as you can (there is no need to use medical terminology). – Typing, writing etc; makes my right wrist so painful I can't use it to lift things etc. I need it strapped up.
In your own words, describe how this injury now affects you (eg. 'I am unable to drive a motor vehicle, 'I cannot sit for longer than 15 minutes') – Can't type, write for more than few minutes. Can't lift things with my right hand (I am right handed).
Have you ever had a similar injury before, work related or otherwise (even if you think it is unrelated to this injury or illness)? – No.

On 18 February 1999 Comcare allowed her claim "relating to aggravation of ganglion (Right) sustained on 27 July 1998" and determined that the respondent was liable to pay compensation under the Act (T21). Liability was accepted up to and including 12 March 1999. Ms Thew was informed that if she needed to claim compensation beyond that date, she would have to provide further supporting medical evidence from her doctor or specialist.
Subsequently, Comcare approved (T28) compensation for payment of physiotherapy treatment that Ms Thew received from Ms Wunsch of the Warrawong Physiotherapy Centre and consultation with Dr Deshpande, orthopaedic surgeon. Dr Deshpande excised a ganglion from the dorsal aspect of Ms Thew's right wrist on 30 April 1999. Comcare accepted liability for post operative physiotherapy treatment up to 31 July 1999.
Ms Thew accepted her employer's offer of voluntary redundancy and left Centrelink's employ on 12 November 1999.
In the months after her leaving her job with Centrelink, Ms Thew applied to the respondent for payment of medical and physiotherapy accounts. On 12 January 2000 Ms Thew wrote to Comcare as follows (T53):
… I am having trouble with my wrist (right) again where I had my operation. I am also having trouble with my right elbow, which I reported originally when I made my claim for compensation … so far I have had 1 cortisone shot in my elbow and I would like to know if it will also be covered if physio is necessary at a later date.

Her general practitioner, Dr Vesey, stated in a workers compensation medical certificate (T55), also dated 12 January 2000, that Ms Thew had had a recurrence of right wrist pain in the region of the excised ganglion and that physiotherapy treatment was required.

On 19 July 2000 Ms Thew enquired by telephone about payment of further medical expenses and whether her elbow could be included as part of her claim. Comcare replied on 21 July 2000 (T59) and informed Ms Thew that certain information would have to be provided by her doctors so that her requests in relation to the ganglion and her elbow could be given due consideration. By letter dated 3 August 2000 (T63) Ms Thew informed Comcare that she was to be examined by Dr Deshpande and that she would pay for the appointment and continuing physiotherapy until finding out whether Comcare would agree to reimburse her. She attached Dr Vesey's workers compensation medical certificate of 31 July 2000 (T61) that diagnosed chronic right wrist pain and right lateral epicondylitis. Dr Vesey noted that his diagnosis had changed since previously examining Ms Thew in that he had now diagnosed a second condition, right lateral epicondylitis (T61).
Dr Deshpande provided Comcare with a surgical report on 10 August 2000. He noted that Ms Thew had pain in the right elbow over the lateral aspect of the elbow and that the treatment to date had consisted of three cortisone injections over the lateral epicondyle and physiotherapy. Dr Deshpande reported (T64):
Clinically she has evidence of lateral epicondylitis. The right wrist demonstrates no recurrence of a ganglion. … She has been trying to work but finds it difficult to type because of lateral epicondylitis. I feel that she should continue with some non-steroidal anti-inflammatory medication and physiotherapy to her right elbow hoping this will improve her condition. A tennis elbow guard may also be of some benefit.
If this fails then release of the lateral group of muscles from the lateral epicondyle may be beneficial but this does not always help. It is likely that on balance her problem is caused due to the constant typing but one cannot be absolutely sure about that.
In considering Ms Thew's request to re-open her claim, an officer in Comcare's Claims Management Centre noted the following when responding to Ms Thew on 11 October 2000 (T67):
The medical evidence is stating that your current condition is lateral epicondylitis, however the accepted condition on your claim is for aggravation of ganglion (right) as a result of writing and typing for extended periods of time.

After referring to Dr Vesey's diagnosis of right lateral epicondylitis and chronic wrist pain in his certificate of 31 July 2000 (T61) and to Dr Deshpande's diagnosis in his recent report (T64), the officer's determination was that "Given the above evidence I am unable on the balance of probabilities as opposed to possibilities to establish a relationship between your current condition and the injury of 27 July 1998. In summary, after having regard to the provisions of the Act, I determine that you have no entitlements under any provision of the Safety, Rehabilitation Act 1988 [sic] including Section 14(1), 16 and 19." Ms Thew's solicitors requested that the determination be reconsidered.

On 11 December 2000 one of Comcare's Independent Review Officers reconsidered the determination, and in a reviewable decision under s.62 of Act, affirmed the determination. The Independent Review Officer noted that Comcare had treated Ms Thew's ganglion as an injury, on the basis that it had been aggravated by her typing and other duties. Further, the officer noted that, based on Dr Deshpande's report of 10 August 2000, there was no evidence of the ganglion having recurred since it was surgically excised in April 1999. Ms Thew's current condition, as diagnosed by Dr Deshpande and Dr Vesey was right lateral epicondylitis. The Independent Review Officer, in giving reasons for her decision, stated that (T71):
I accept the employee's submission that she did refer to a problem with her elbow in the accident report dated 28 July 1998 but this is the only reference to the elbow despite all the medical reports and certificates which were obtained between December 1998 and August 1999. I note that in a statement dated 9 December 1998 the employee advised that she had first had time off work when her wrist became sore in July and it had become sore again in November. There was no reference to her elbow. I am therefore of the view that whilst there must have been some discomfort in the elbow in July for the employee to refer to it in the accident report, it did not recur with the wrist pain in November or the employee would have referred to it in documentation completed at that time. The employee obtained a number of witness statements in December 1998 but they refer only to wrist problems being evident at work.
It also appears that the condition has either appeared or worsened since the employee took a voluntary redundancy from Centrelink. Therefore, I am unable to establish the relationship of the employee's current condition and her employment with Centrelink, as the employee ceased employment on 12 November 1999 and first advised Comcare of a problem with her elbow two months later. Therefore in summary, I am satisfied from Dr Deshpande's most recent report that the right ganglion has resolved however I am not satisfied that the lateral epicondylitis is related to the employee's employment.
Ms Thew applied to the Tribunal for review of the Independent Review Officer's decision of 11 December 2000 to affirm the primary determination. The Tribunal's reference for the application is N2001/28.
On 18 June 2001 Ms Thew completed a claim with the respondent for compensation for permanent impairment and completed a non-economic loss questionnaire. Ms Thew provided the following information in the claim:

What permanent injury/impairment(s) of the body do you suffer from as a result of your condition? – Wrist weakness and pain (chronic). Epicondylitis. Overuse right wrist.
Has the impairment stabilised? – Yes.

Dr Vesey completed a section of the claim as follows:

Diagnosis of current condition – Lateral epicondylitis right elbow. Chronic right wrist pain – occupational overuse syndrome.
Is this related to accepted condition? – Yes.
If YES, what impairments to bodily parts, bodily functions, bodily systems have resulted from the condition? – Reduced strength in right hand and wrist, reduced ability to perform repetitive tasks.
Has active treatment of the condition been completed? – No.
If NO, what further treatment is required? – Intermittent physiotherapy. May require further steroid injections or ESWL.
Please describe extent of the impairment(s) listed above. – Grip strength in right (dominant) hand approximately 75% of pre-injury. Repetitive task duration (eg. typing) reduced from approximately 60 minutes to approximately 10 minutes.

By determination dated 29 October 2001 Comcare decided that there was no liability to pay compensation for permanent impairment in respect of lateral epicondylitis in the right elbow and chronic right wrist pain. The determination reiterated what was said in the reviewable decision of 11 December 2000: that Comcare had not accepted liability for right lateral epicondylitis, and that the compensable condition of "aggravation of ganglion (Right)" had resolved. When the determination was reconsidered, it was affirmed by Comcare's reviewable decision of 8 March 2002. By letter dated 13 March 2002 Comcare informed Ms Thew's solicitors that it was amending its decision of 8 March 2002, but only in relation to its reasons for affirming the determination.
On 14 March 2002 Ms Thew lodged an application with the Tribunal for review of the decisions of 8 March and 13 March 2002. However, the reviewable decision under s.62 of the Act is the decision dated 8 March 2002 affirming the primary determination of 29 October 2001. The respondent's letter dated 13 March 2002 served merely to amend in part the reasons for the decision of 8 March. The Tribunal's reference for the application is N2002/372.
evidence
Ms Thew is 36 years of age and the single mother of a son aged 15.For the last two years she has suffered from depression and has taken anti-depressants with some success.
On being awarded her Year 10 School Certificate, Ms Thew left school at age 16 and entered the workforce. Her first job was as a receptionist with a firm called Jack Primer. Ms Thew left there to take a position as a trainee bookkeeper and worked in that capacity for some years. Following the birth of her son, Ms Thew did not work for a number of years until she commenced full time employment with the Department of Social Security (later with Centrelink) in June 1991 at the Dapto office, graded as an ASO1. Her duties included writing, typing, data entry and processing applications for unemployment relief. There was a lot of filing to be done since, at this time, the junior officers were responsible for the office's filing. She also worked some overtime.
Ms Thew transferred as an ASO3 to the Department's Warilla Teleservice Centre in December 1992 where she worked as a call centre operator at a desk with a phone and headset, and a computer. Her work involved taking telephone enquiries, generally over 100 calls a day, and looking up information for the callers on the computer's data base. Every call required her to do some keyboard work. There were three breaks during the day: 30 minutes for lunch and two 15-minute breaks in the morning and afternoon. Ms Thew recalled that, after being in the position for about 12 months, the Department introduced a weekly, 2½ hour break from taking calls.
Ms Thew said that it was around 1994 that she felt aching in her right wrist and along a muscle up to the elbow. She did not take any time off work at this stage.
Early in 1995 Ms Thew returned to the Dapto office, as a counter assessor handling enquiries from people presenting themselves at the office. Her work in the reception area involved handing out information guides and booklets, and receiving and stamping forms for lodgment. She would the use number pad on the computer to key in any earnings information that was missing from unemployment forms, a task that would not have involved keying had the Dapto office's wand scanner operated properly. Answering enquiries would usually require her looking up the individual's particulars in the computer's file, as well as the relevant advice to be provided. The remainder of her duties included the processing of new claims, which required her to type into the computer the information contained in the six to eight page forms and to ask for any necessary additional information, and then photocopy documents to be returned to claimants. In addition, she did filing because all officers, regardless of seniority, were now responsible for their own filing.
About twelve months before Ms Thew left Centrelink, some new office systems were introduced. The new procedures required claimants for certain benefits to attend at Centrelink, produce their documents such as identification and separation certificate, and then answer a series of questions that were prompted by the computer, the answers to which the officer would immediately key into the file. Ms Thew said that she had a lot of trouble with her wrist and arm after the change in procedures because she had to type in all the relevant information.

Ms Thew said that it was after the transfer back to Dapto that her right wrist and arm became really sore. There was no single accident or discrete incident that brought on the pain.
She first sought treatment in July 1998 because her wrist, hand and elbow were aching. At home, she was dropping plates, glasses, anything heavy. It was around this time that Ms Thew noticed that the lump from a ganglion that she had had on her right wrist since about 1994 or 1995 had gone away. Although she no longer had the lump, in fact she described it as having become like a crater in her wrist, the area of her wrist where the lump had been was tender and sore. Her general practitioner Dr Vesey was not available, so Ms Thew consulted Dr John who provided her with a medical certificate dated 27 July 1998 for two days absence from work. The certificate referred to Ms Thew's condition as tendonitis of the right wrist. Ms Thew filled in the report of an accident, injury or illness, part of which is set out above (T3), on 27 July 1998.
Towards the end of 1998 Ms Thew's wrist was very painful. At the end of a working day, she said she could hardly lift her right arm due to pain in the muscle running along the top of her right arm from the wrist to the elbow. On 27 November 1998 Ms Thew consulted Dr Vesey. Dr Vesey's report of 2 March 2001 (Exhibit A1) referred to the history he had taken in November 1998, that Ms Thew said the pain was a recurring problem over several years, with pain in the dorsum of her wrist aggravated by keyboarding, writing and using a computer mouse. Dr Vesey referred to an ultrasound taken earlier in 1998, requested by Dr John, which demonstrated a ganglion overlying the posterior surface of Ms Thew's wrist. Dr Vesey's examination on 27 November 1998 revealed tenderness over the mid dorsum of the wrist. Wrist extension was restricted and caused pain and although wrist flexion was in the normal range, it resulted in pain into the forearm. Dr Vesey diagnosed chronic wrist pain with a ganglion. Dr Vesey provided a medical certificate on 30 November 1998 (T5) noting that Ms Thew needed to take regular breaks from keyboarding such as five minutes in every 30 minutes, on account of the ganglion of her right wrist. Dr Vesey's proposed treatment was physiotherapy with possible splinting.
Ms Thew's claim for compensation dated 9 December 1998 referred only to her right wrist as being affected by pain. Work colleagues provided statements in early December 1998 (T11, 12 and 14). Each mentioned observing Ms Thew experiencing pain in her wrist only and did not refer to any other part of her upper limb. Moreover, in her own statement of 9 December 1998 Ms Thew said nothing about pain in her elbow or arm noting only that "When my wrist became sore again in November I had a workplace assessment…" (T13).
Centrelink referred Ms Thew to a firm of rehabilitation consultants, IOH Rehabilitation, who provided a workplace assessment report on 9 December 1998 (T9). Their report noted that "Ms Thew described her pain as an ache in her wrist and occasionally up her right upper limb to her shoulder. She also stated that she felt weak in her hand and upper limb eg. Having difficulties lifting saucepans off the stove with her right hand or lifting 3 plates from the cupboard." They recommended changes to reduce the keying through the use of a wand scanner, to assist her upper limb muscles by re-positioning her desk and computer, and to lessen the jarring impact on stamping forms by employing a rocking motion.
Early in 1999 Ms Thew was referred by Dr Vesey to Ms Wunsch, a physiotherapist and hand therapist. Ms Wunsch's goals, which she estimated would require up to twelve weeks of treatment, were to reduce the pain, restore wrist motion and reduce inflammation in the wrist dorsal capsule (T16). Dr Vesey also referred Ms Thew to Dr Deshpande for a surgical opinion. Dr Deshpande submitted a surgical report to the respondent on 8 March 1999 (T23) seeking permission to excise the ganglion. The report noted that on examination there was evidence of a large ganglion arising from the radio-carpal joint. Dr Deshpande observed that "The range of movement in the wrist is normal. Circulation and sensation distally is also normal. All tendons are functioning well." Following Ms Wunsch's pre-operative treatment to settle inflammation, Dr Deshpande operated to remove the ganglion on 30 April 1999.
Dr Deshpande saw Ms Thew on 24 May 1999 and in his report to Comcare wrote "Following removal of the ganglion, she experiences significant improvement in relation to her right wrist" (T41). Dr Deshpande advised her to return to work the following week. She continued with physiotherapy twice a week. On 30 July 1999 Ms Wunsch informed Dr Vesey that "Michelle reports the recent onset of mild diffuse right upper arm pain which I feel is related to unaccustomed usage as she gradually upgrades her function. I have advised her to perform extension stretches for her right arm and have provided her with a hand exerciser to assist grip strengthening." (Exhibit R4)
When Ms Thew returned to work in customer services, she could not do keyboarding without pain, her wrist was sore from the operation, her arm ached and she was tired at the end of the day. At home she still had difficulty picking up and holding plates, glasses and similar items. The area around the ganglion was sore to touch.
Ms Thew said she accepted Centrelink's voluntary redundancy package for a number of reasons. In the months prior to her leaving Centrelink in November 1999 she was experiencing particularly difficult relations with her former de facto. As a result, she was seeing Dr Vesey quite frequently for treatment for loss of appetite, stress and sleeping problems. The pain she still had in her arm was another reason for leaving Centrelink. She said she could have continued with her work at Centrelink only if she wanted to keep working in pain.
From the time that she returned to work following the operation to excise the ganglion until she left Centrelink, Ms Thew did not take any sick leave due to problems with her wrist or arm. She finished at Centrelink on 12 November 1999, when she accepted voluntary redundancy. Ms Thew said she and the other officers who also accepted voluntary redundancy were told not to use up their sick leave before leaving Centrelink.
Dr Vesey saw Ms Thew on 6 December 1999 and noted that Ms Thew was " … complaining of a two month history of pain in her right forearm, worse over the preceding two weeks" (Exhibit A1). On examination, Dr Vesey found tenderness over the extensor aspect of Ms Thew's forearm and over the lateral epicondyle of her elbow. Dr Vesey diagnosed lateral epicondylitis and recommended treatment by injection of corticosteroid into the region of the lateral epicondyle. Ms Thew had her first injection on 5 January 2000. On 12 January 2000 Dr Vesey saw Ms Thew who " … reported that her elbow had improved, but that her right wrist was sore again." Physiotherapy continued. Dr Vesey saw Ms Thew on 13 May 2000 when she reported a recurrence of the pain in her right proximal forearm and elbow region. Two more steroid injections were administered into this region on 27 May and 10 June and they provided relief for a few days. On 31 July 2000 Dr Vesey considered her to have full range of wrist movement, but her right grip strength was approximately 75 per cent of the left. He suggested she have regular work breaks of five minutes every hour to stretch and exercise her wrist and forearm regularly. In Dr Vesey's opinion of 2 March 2001 (Exhibit A1), the ganglion is unlikely to recur.
After leaving Centrelink in November 1999, Ms Thew did not look for a new job straight away. In March 2000 she started in the customer service call centre of the Government Employees Health Fund answering telephone enquiries. She said that, as her arm was still causing her trouble, she could not have managed more than the 30 hours a week she worked. She left that job and was unemployed between August and October 2000 despite applying for work through agencies specialising in temporary assignments.
In October 2000 she commenced part time work, four hours on five days a week, as a directory assistant operator with the Stella Call Centre. She completed a job application form as follows (Exhibit R3): Previous job: Main tasks & Duties: Customer service – face to face, problem solving. Computer, typing etc. Call centre work 3 years. What were your likes & dislikes in this job? Loved customer service, dealing with people. Reasons for leaving? Voluntary redundancy – excellent offer. Ms Thew acknowledged in the application form, that she possessed the required core competencies that included good keyboard skills and the ability to complete repetitive tasks on a constant and consistent basis.She said she could not work longer hours because of the volume of typing required, but said there was less keying involved than at Centrelink. Ms Thew remained at this job until March 2001 when she commenced her current job, as a full time telephone customer service agent with Yellow Pages Connect. In this position Ms Thew responds to calls from people asking for information about telephone listings. She said that, while the job involves typing and the use of a computer and mouse, the simplified processes for retrieving the requested information cut down the volume of keying and she definitely does less keying than she did at Centrelink. Ms Thew said that although the pay is quite a lot less than at Centrelink, she could not return to the kind of work she did there because she cannot cope with the amount of typing. However, unlike her job at Centrelink, the duties of her current position do not include filing, acting as a receptionist, or making or attending appointments with members of the public. She agreed that her current duties are restricted to taking telephone enquiries, using the keyboard and connecting the parties, but she said she has breaks and also spends time training new staff.
Ms Thew said that she experiences pain every day between the bones of her right elbow, down her arm below the elbow and in her right wrist. She told the Tribunal that her right arm aches, from the elbow down. The painful areas are always sore but on bad days, which occur about fifty per cent of the time, the pain gets much worse and is sharp. She told the Tribunal that she takes Celebrex, an anti-inflammatory, which takes the edge off the pain. At work on a good day, Ms Thew said she would be able to type for half an hour to an hour before the pain increased, while on a bad day she would start in pain. She could still type, and would still type, because she must. On a good day at home she could clean the house but on bad days she could vacuum only one room. Ms Thew said that her ability to perform a number of activities is affected, for example, she cannot draw and can drive only if the car has power steering as she does not have the strength to turn the wheel without suffering pain. She has trouble peeling vegetables, mashing potatoes, opening screw-top bottles, and turning taps off tightly. The pushing of the lawn mower also causes pain in her wrist and arm, she cannot manage fine work such as threading needles and sewing as it hurts her wrist. Similarly, Ms Thew has difficulty applying make-up. There is a computer at home that Ms Thew uses daily for about five minutes to check her email communications. She pays her bills over the internet and also uses it for investigating genealogy, a hobby she enjoys.
Under cross-examination, Ms Thew said that after she left school but before she commenced with the Department, she recalled having a ganglion on her left wrist. She may have had other ganglions as a child but was not certain. She agreed there was no explanation for their occurrence. Ms Thew also agreed that, prior to the operation in April 1999 when the right ganglion was excised, she was not involved in constant keyboarding, since she also had to perform a number of other tasks such as interview appointments, receptionist work and filing. She agreed that, on returning to work at Centrelink after the operation, she was physically able to do her job, albeit in pain, without having any time off. Mr Johnson referred to Dr McGill's report dated 25 May 2001 (Exhibit R5) that recorded her reasons for leaving Centrelink as follows: "She reported that she ceased work because of personal problems (related to her former de facto) and her decision to cease work was not influenced by her upper limb symptoms."
Ms Thew agreed with Mr Johnson that it was not until 6 December 1999, after she had left work with Centrelink, that she first complained to Dr Vesey about any pain in her right forearm and that the pain she experienced was from driving, lifting and cleaning. Dr Vesey's note of that consultation recorded Ms Thew having had pain in the forearm for some two months and that it had been worse over the past two weeks. Ms Thew also agreed in cross-examination that that two week period was subsequent to her leaving Centrelink and at a time when she was not working. Ms Thew agreed that she had consulted Dr Vesey on six occasions after 4 August 1999 and prior to the consultation on 6 December, yet did not mention pain in her right arm. She maintained that the pain in her right arm and elbow would flare up from time to time and the pain would be due to a range of activities. Ms Thew acknowledged that her application for employment at the Stella Call Centre referred to her ability to handle inbound and outbound calls and have good keyboarding skills, a minimum 25 words a minute with a ten per cent error rate. She also acknowledged that, since starting at the Yellow Pages Connect, she has not had any time off work due to problems with her right wrist or arm. She explained that she is entitled to a bonus for good attendance and that on her wage, she needs to get the bonus. She said she has no choice but to do the work.
Dr Browne examined Ms Thew on 12 March 2001. He reported to her solicitors on 20 April 2001 (Exhibit A2) about her having developed recurrent aching over the dorsal aspect of the right wrist, with radiation to the elbow and forearm in 1997. She later developed swelling over the dorsal aspect of her right wrist. On examination, Dr Browne found tenderness over the right lateral epicondyle and proximal extensor tendon. While the range of movement of Ms Thew's right wrist was full, Dr Browne reported pain over the lateral aspect of the right elbow with resisted wrist extension. Dr Browne diagnosed two conditions: right lateral epicondylitis, and capsulitis and ganglion formation of the right wrist. He thought the lateral epicondylitis appeared to have followed the development of right wrist capsulitis and ganglion formation, and may have resulted from altered use of the right upper limb to compensate for the wrist disorder. Dr Browne considered Ms Thew's employment with Centrelink was largely responsible for the development of her right wrist and elbow disorders, there being no evidence of predisposing conditions. Dr Browne has assessed Ms Thew's degree of permanent impairment of her right upper limb at ten per cent in accordance with table 9.4 of Comcare's Guide to the Assessment of the Degree of Permanent Impairment (the Comcare Guide).
42.      Dr Vesey has been Ms Thew's general practitioner since 1991. In his report of 14 November 2001 (Exhibit A1), Dr Vesey diagnosed two conditions. There is chronic right wrist pain and weakness, associated with the ganglion now excised, which he considered to be directly related to her employment with Centrelink. In his opinion the condition had now stabilised but was likely to flare with increased use. Secondly, he diagnosed lateral epicondylitis of her right elbow, which had not yet stabilised and which was related directly to her work involving typing and computer operation. In his opinion the epicondylitis is likely to be aggravated by repetitive use of the right arm, such as by typing.
43.      Dr McGill, consultant rheumatologist, examined Ms Thew on 25 May 2001 and provided Comcare with a report of the same date (Exhibit R5). Dr McGill noted that when Ms Thew's right elbow and proximal forearm pain flared early in 2000 she was not working. Dr McGill's physical examination found a full range of wrist movement bilaterally in all directions, and full movements of the fingers, elbows and shoulders. He reported some tenderness in the region of the right elbow but unlike people who have epicondylitis, Dr McGill said there was no focal tenderness and provocative movements for epicondylitis were negative. Ms Thew demonstrated full power in all muscle groups in both upper limbs, and resisted wrist movements did not cause elbow pain. Dr McGill diagnosed Ms Thew's right wrist ganglion as an idiopathic condition, that was probably aggravated by her work activities at the time and he considered there was no indication for any further treatment of the wrist. In relation to Ms Thew's right lateral epicondylitis, which he thought had developed in late 1999/early 2000, Dr McGill stated "In light of the fact that her symptoms were most troublesome after she had ceased work, I think it is unlikely that her work duties played any significant role in the development of her lateral epicondylitis. In any event, her lateral epicondylitis has now settled. She is currently fit for the full duties of a yellow pages operator that she is performing and she is also fit for the full duties of her previous job with Centrelink."
44.      Under cross-examination Dr McGill said that he did not think protracted periods of keyboard work would cause capsulitis of the wrist. He went on to say that capsulitis affects ball and socket joints, he found no evidence of capsulitis and that capsulitis of the wrist is a condition that does not exist. Dr McGill said that lifting and pushing files would not lead to lateral epicondylitis, but agreed that intense keyboard activities could temporarily aggravate symptoms from epicondylitis.   If the work activities were even a minor factor affecting her level of symptoms, Dr McGill would expect improvement upon those activities coming to an end. Dr McGill said the concept that Ms Thew's work activities played a role either in the development or aggravation of the epicondylitis was not supported by the facts. It was only after she left Centrelink, that her symptoms became more troublesome, to the extent that she required treatment.
consideration and findings
45.      Ms Gillies submitted that Ms Thew suffers from an overuse type injury to her right wrist and elbow. The injury is a consequence of her work for Centrelink and Ms Thew has not been capable of performing suitable employment since at least November 1999. She submitted that Ms Thew initially took part time work after leaving Centrelink because she was not capable of longer hours due to the level of pain she was then experiencing. It was further submitted that Ms Thew's work related injury that had caused her incapacity at the time of her departure from Centrelink, still incapacitates her as she cannot perform the type of work she carried out at Centrelink, which in Ms Gillies' submission results in continuing loss of wages.
46.      Mr Johnson put Comcare's case rather broadly in terms of the injury in question. He submitted that, by 11 October 2000, the date of the determination, that Ms Thew had no entitlements under the Act as she was no longer suffering from an injury being the aggravation to the ganglion on her right wrist. He further submitted that on and after that date, she was not suffering from a compensable injury to her right upper limb, specifically her right wrist, elbow or forearm. Mr Johnson contended that any injury to those parts of her right upper limb was not caused by her work at Centrelink or aggravated by that work. He referred to her complaint to Dr Vesey that her pain in that region came from driving, lifting and cleaning, not her work activities. Mr Johnson said that the history Ms Thew gave her general practitioner on 6 December 1999 was that she had had pain in her right forearm for two months previously but worse in the preceding two weeks, which was the period immediately following her departure from Centrelink. He said that Ms Thew's work at Yellow Pages Connect, which Mr Johnson submitted involved greater use of the keyboard than her duties at Centrelink, demonstrated that keyboard work does not have more than a temporary effect on Ms Thew's condition. It was submitted that Ms Thew's evidence be approached with caution.
47.      Mr Johnson submitted that the Tribunal should prefer the specialist opinion of Dr McGill to that of the general practitioner Dr Vesey and also to that of Dr Browne. He said that Dr Browne appeared not to be aware that Ms Thew had a ganglion on her left wrist years before commencing with Centrelink, and that Dr Browne's opinion (Exhibit A2) that her work at Centrelink "was largely responsible for the development of her right wrist and elbow disorders with no evidence of any pre-disposing condition" should be considered in light of his incomplete history. Finally, Mr Johnson submitted that the evidence did not support a finding of permanent impairment of an upper limb. Both Dr McGill and Dr Browne, he contended, were in agreement that there is no loss of movement in the elbow and that Dr McGill found no loss of grip strength in her right wrist.

The following provisions in the Act are relevant:
Section 4
Interpretation
(1) In this Act, unless the contrary intention appears:
injury means:
(a) a disease suffered by an employee; or
(b) an injury (other than a disease) suffered by an employee, being a physical or mental injury arising out of, or in the course of, the employee's employment; or
(c) an aggravation of a physical or mental injury (other than a disease) suffered by an employee (whether or not that injury arose out of, or in the course of, the employee's employment), being an aggravation that arose out of, or in the course of, that employment;
but does not include any such disease, injury or aggravation suffered by an employee as a result of reasonable disciplinary action taken against the employee or failure by the employee to obtain a promotion, transfer or benefit in connection with his or her employment.
…
Section 14
Compensation for injuries
(1) Subject to this Part, Comcare is liable to pay compensation in accordance with this Act in respect of an injury suffered by an employee if the injury results in death, incapacity for work, or impairment.
…
Section 16
Compensation in respect of medical expenses etc.
(1) Where an employee suffers an injury, Comcare is liable to pay, in respect of the cost of medical treatment obtained in relation to the injury (being treatment that it was reasonable for the employee to obtain in the circumstances), compensation of such amount as Comcare determines is appropriate to that medical treatment.
(2) Subsection (1) applies whether or not the injury results in death, incapacity for work, or impairment.
…
Section 19
Compensation for injuries resulting in incapacity
(1) This section applies to an employee who is incapacitated for work as a result of an injury, other than an employee to whom section 20, 21, 21A or 22 applies.
…
Section 24
Compensation for injuries resulting in permanent
impairment
(1) Where an injury to an employee results in a permanent impairment, Comcare is liable to pay compensation to the employee in respect of the injury.
(2) For the purpose of determining whether an impairment is permanent, Comcare shall have regard to:
(a) the duration of the impairment;
(b) the likelihood of improvement in the employee's condition;
(c) whether the employee has undertaken all reasonable rehabilitative treatment for the impairment; and
(d) any other relevant matters.
(3) Subject to this section, the amount of compensation payable to the employee is such amount, as is assessed by Comcare under subsection (4), being an amount not exceeding the maximum amount at the date of the assessment.
(4) The amount assessed by Comcare shall be an amount that is the same percentage of the maximum amount as the percentage determined by Comcare under subsection (5).
(5) Comcare shall determine the degree of permanent impairment of the employee resulting from an injury under the provisions of the approved Guide.
…
Section 27
Compensation for non-economic loss
(1) Where an injury to an employee results in a permanent impairment and compensation is payable in respect of the injury under section 24, Comcare is liable to pay additional compensation in accordance with this section to the employee in respect of that injury for any non-economic loss suffered by the employee as a result of that injury or impairment.
…
Section 28
Approved Guide
(1) Comcare may, from time to time, prepare a written document, to be called the "Guide to the Assessment of the Degree of Permanent Impairment", setting out:
(a) criteria by reference to which the degree of the permanent impairment of an employee resulting from an injury shall be determined;
(b) criteria by reference to which the degree of non-economic loss suffered by an employee as a result of an injury or impairment shall be determined; and
(c) methods by which the degree of permanent impairment and the degree of non-economic loss, as determined under those criteria, shall be expressed as a percentage.
…

Reviewable decision made on 11 December 2000
Ms Thew's condition: aggravation of ganglion (right)

By letter dated 18 February 1999, Comcare accepted liability for Ms Thew's " … claim relating to aggravation of ganglion (Right) sustained on 27 July 1998" (T21). When seeking to re-open her claim in January 2000, Ms Thew referred to having trouble with her right wrist and her right elbow (T53).
On 24 May 1999 Dr Deshpande issued a workers compensation return to work form (T43) that stated that Ms Thew was fit to return to suitable duties provided she did not lift things weighing more than five kilograms. Dr Vesey's report of 2 March 2001 noted that Ms Thew recovered well from the surgery and was certified fit for her pre-injury duties on 15 June 1999 (Exhibit A1). Dr Deshpande's opinion of 10 August 2000 (T64) stated that there was no evidence of recurrence of the ganglion and the Tribunal so finds. Dr McGill reported, albeit in terms not restricted to the ganglion, that " … the aggravation related to her work in regard to the right wrist has resolved completely." The Tribunal prefers this medical evidence to that of Dr Browne, principally because Dr Browne has diagnosed capsulitis of the right wrist, a condition that Dr McGill in oral evidence emphatically contended does not exist in relation to this joint and, moreover, he found no evidence of capsulitis in Ms Thew's case. Further, it is apparent that Dr Browne had been given an incomplete history, as he was unaware of Ms Thew's earlier ganglions. The Tribunal finds that Ms Thew had fully recovered from the surgery that excised the ganglion while she was still working at Centrelink. Her recovery was such that she was capable of resuming her former duties. Until she accepted voluntary redundancy on 12 November 1999, she continued to perform those duties, for a period of some five months. The Tribunal finds that the effects of the compensable injury, the aggravation to the ganglion on the right wrist, had ceased by the time of her leaving Centrelink.
Now the Tribunal will address the condition diagnosed by Dr Vesey as chronic pain in the wrist. The Tribunal notes that it was not until 12 January 2000, two months after Ms Thew had left Centrelink, that Dr Vesey diagnosed what he termed a recurrence of wrist pain in the region of the ganglion. Earlier, on 6 December 1999 Dr Vesey also diagnosed her suffering from lateral epicondylitis of the right elbow. The Tribunal considers it relevant that Ms Thew returned to her pre-surgery duties on a full-time basis not long after returning to work, which was about six weeks after the operation on 30 April 1999. Apart from physiotherapy, the final treatment being on 4 August 1999, she did not seek medical advice or assistance in relation to her wrist until well after she had finished working for Centrelink. The Tribunal also considers it relevant that in the period from 4 August up to the consultation on 12 January 2000, Ms Thew consulted Dr Vesey on eight occasions. She discussed her depression, tenderness of the ears, an injury to her ankle and other conditions, but did not mention to him any problem she might have been experiencing with her wrist. The Tribunal is not satisfied on the balance of probabilities that the wrist pain arose out of, or in the course of, her employment at Centrelink.
Did the aggravation to Ms Thew's ganglion on the right wrist result in incapacity for work? Following the surgery on her wrist, Ms Thew carried out the duties expected of her, without requiring any leave or medical treatment. She is currently employed as a full-time customer service agent. The job requires her to operate a keyboard and a mouse throughout the day. The duties do not include filing, interviewing, reception duties or appointments with members of the public, all of which were duties additional to the keyboarding she performed at Centrelink. Although she suffers pain and aching in her arm, she has not taken sick leave on account of the pain since commencing with Yellow Pages Connect in March 2001. The Tribunal finds therefore that, despite some level of pain and discomfort, Ms Thew is fully capable of carrying out the duties of her current employment. The Tribunal is satisfied that Ms Thew is capable of performing the full time duties that she was carrying out at Centrelink before she accepted the voluntary redundancy. Accordingly, the Tribunal finds for these reasons and Dr McGill's opinion, that there was no incapacity for work resulting from the aggravation to the ganglion, or for that matter from the wrist pain.
The Tribunal finds that Comcare is not liable to pay Ms Thew compensation in respect of the injury, being the aggravation of the right ganglion, and has no entitlements under ss. 14, 16 and 19 of the Act. The reviewable decision of 11 December 2000 is affirmed. In addition, and for the reasons set out above, the Tribunal finds that there is no liability for compensation for chronic pain in the wrist.
Ms Thew's condition: right lateral epicondylitis
The Tribunal finds that Ms Thew has sought to present herself, whether to a prospective employer or to doctors, in the best possible light. The Tribunal finds that she has provided colourable information that is pertinent to this application. When she applied for the position at the Stella Call Centre, Ms Thew said she left her job at Centrelink because of the excellent voluntary redundancy offer (Exhibit R3). Under cross-examination she said she would tell Stella Call Centre anything to get a job. In evidence in chief she said the problem with her arm was one of the reasons for leaving Centrelink. The history she gave Dr McGill, however, referred to her leaving because of personal problems relating to her former de facto, and Dr McGill reported that her decision was not influenced by her upper limb symptoms. Under cross-examination, she eventually conceded that the reason she left Centrelink was for personal problems. Since starting with Yellow Pages Connect in March 2001, Ms Thew has not taken any time off work on account of pain in her right wrist or arm. In answer to a question from Mr Johnson, she said she does not want her employer to know about her injury.
At various times since July 1998 Ms Thew has complained of pain in her right elbow and arm. The first accident report she gave her employer, dated 27 July 1998, referred to her right wrist, hand and elbow as the specific parts of her body that were affected (T3). Although her second accident report in December 1998 mentioned only her right wrist, the report to Centrelink provided by IOH rehabilitation consultants in December 1998, included a history of her having pain and aching in her wrist and occasionally up to her right upper limb and shoulder. There is also Ms Wunsch's report of 30 July 1999 (Exhibit R4) regarding the physiotherapy treatment she had given Ms Thew. Ms Wunsch reported Ms Thew's recent onset of mild diffuse right upper arm pain, which Ms Wunsch felt was related to unaccustomed usage that Ms Thew had adopted on returning to work after the operation on her ganglion.
Ms Thew first complained of pain in her right forearm to her general practitioner, Dr Vesey, on 6 December 1999. She gave him a history of having pain for two months, but that it was worse during the two weeks immediately preceding the consultation. She said that activities such as driving, lifting and cleaning aggravated her pain. Notably, in the Tribunal's view, he did not record that her work activities within that two month period prior to her voluntary redundancy, had aggravated her pain.
Dr Deshpande did not diagnose lateral epicondylitis until August 2000. He could not be absolutely sure whether constant typing was the cause of the epicondylitis.
In Dr Browne's opinion the condition affecting Ms Thew's elbow, forearm and wrist was " … upper limb pain associated with right lateral epicondylitis and capsulitis of the right wrist." (Exhibit A2). Although not certain, Dr Browne thought it may have partly resulted from an altered use of the right upper limb in compensation for what he diagnosed as capsulitis of the wrist. There was no evidence, however, from Ms Thew about such compensatory use of the arm. In addition, the Tribunal accepts Mr Johnson's submission that, as Dr McGill commented in his evidence, if there was pain in the wrist then one would expect a reduction in use of the arm, which would make the development of epicondylitis less likely rather than more likely. In his report of 25 May 2001, Dr McGill stated that Ms Thew had developed lateral epicondylitis in late 1999 or early 2000 but she no longer suffered from the condition.
In cross-examination Dr McGill agreed that, if Ms Thew required treatment for a condition affecting her elbow while working at Centrelink, and at the time of receiving treatment she had been performing an increased keyboarding workload for a number of months, her work at the time could have aggravated the epicondylitis. Dr McGill said in such circumstances, he would expect the aggravation to settle down about three months after ceasing those work activities. Ms Thew's evidence was that, in her final year at Centrelink, she was required to do increased keyboarding as a result of changes introduced to processes for recording applicants' data. The Tribunal is not satisfied, however, that the stretching exercises Ms Wunsch suggested to relieve Ms Thew's mild diffuse pain in her right upper arm alone, indicate that Ms Thew required treatment for pain in the elbow and arm. When Ms Wunsch examined her the following week on 4 August 1999, there was no reference to pain in the upper arm or elbow. She noted that Ms Thew reported further improvement in her symptoms and discharged Ms Thew from her care. It is also relevant that Ms Thew resumed her full duties at Centrelink in mid June 1999. She performed those duties until she ceased that employment, some five months later. Although she said she was told not to use up her sick leave before receiving voluntary redundancy, the Tribunal finds that she did not take any sick leave on account of her arm during this period. The Tribunal is mindful that Ms Thew did not discuss her elbow or arm with Dr Vesey at any of six consultations from 4 August until 6 December 1999. Dr Vesey reported that, on 6 December, she had a two month history of pain in the arm and that it was "possible" she had experienced symptoms prior to that time and he could not determine when the condition began (Exhibit A1).
60. The Tribunal does not accept Ms Thew's evidence that she had symptoms relating to her arm during the last two months of her employment by Centrelink. That evidence is inconsistent with her actions. She performed her job, which she said was very busy, without having to take any sick leave and at the time, did not mention any relevant pain to her general practitioner whom she was consulting quite frequently. The pain, which she told Dr Vesey on 6 December was caused by driving, lifting and cleaning, was worse in the two weeks after she finished working. The Tribunal accepts Dr McGill's opinion that, given Ms Thew's symptoms were most troublesome in the period after having left Centrelink, the epicondylitis developed in late 1999 and early 2000. On the balance of probabilities, the Tribunal is satisfied that Ms Thew did not suffer from an injury, her epicondylitis, that arose out of or in the course of her employment at Centrelink and the Tribunal so finds.
Reviewable decision made 8 March 2002
As to whether the aggravation to the ganglion on her right wrist resulted in impairment, the Tribunal notes the following definitions:
Interpretation
4(1) In this Act, unless the contrary intention appears:
impairment means the loss, the loss of the use, or the damage or malfunction, of any part of the body or of any bodily system or function or part of such system or function.
permanent means likely to continue indefinitely.

Pursuant to s.24 of the Act, Comcare is required to determine an employee's degree of permanent impairment, expressed as a percentage, by reference to the provisions of the approved Guide. The Guide to the Assessment of the Degree of Permanent Impairment, which has been prepared by Comcare under s.28 of the Act, explains that "Impairment is measured against its effect on personal efficiency in the 'activities of daily living' in comparison with a normal healthy person." Table 9.1 of the Guide deals with upper extremity function and Table 9.4 with upper limb function. Table 9.1, which may be used to assess the impairment of overall limb function from any cause, reads:

Upper Extremity
(Percentage Whole Person Impairment)
%       Description of level of impairment
0        X-ray changes but no loss of function of shoulder, elbow or wrist
5        Any one of the following:
-         x-ray changes with minimal loss of function of shoulder, elbow or wrist
-         ankylosis of any joint of fingers 4 and/or 5

10 Any one of the following:
·loss of less than one half normal range of movement of shoulder or elbow
·loss of half normal range of movement of wrist
·ankylosis of any joints of thumb

…

Table 9.4 of the Guide reads:

Limb Function – Upper Limb
(Percentage Whole Person Impairment)

% Description of level of impairment
10 Can use limb for self care and grasping and holding but has difficulty with digital dexterity.
20 Can use limb for self care but has no digital dexterity or has difficulties grasping and holding.
…

In Dr Browne's opinion, Ms Thew has suffered 10 per cent whole person impairment under Table 9.4 of the Guide. It would appear that Dr Vesey finds 20 per cent impairment under Table 9.4 for the reason that Ms Thew has difficulty in grasping and holding. On examination, Dr Browne found a full range of movement in her right wrist but greater grip strength in the left wrist. His assessment of Ms Thew's ability to use her fingers and wrist for drawing and sewing was based on her history. Dr McGill's examination also found a full range of movement in the wrist in all directions and the wrist was normal. Different methods were employed by Dr Browne and Dr McGill to measure Ms Thew's grip strength. Dr Browne used a grip meter, whereas Dr McGill measured grip strength by having Ms Thew squeeze his finger. Dr McGill reported Ms Thew's full co-operation in the examination and he was confident that his test produced a valid result. He agreed that using a meter would be more accurate, provided the test was repeated and the patient could not see the meter's dial. The Tribunal prefers the evidence of Dr McGill because he was certain he had Ms Thew's full co-operation. Given the wide divergence in opinion between Dr Browne and Dr McGill who conducted their examinations of Ms Thew only a few weeks apart, this causes the Tribunal to doubt whether Dr Browne had her co-operation. In addition, there was no evidence concerning the manner and circumstances in which Dr Browne conducted his test as to whether the test was repeated and whether he gave Ms Thew information about how the test would be performed. In Dr McGill's opinion the aggravation to the right wrist had resolved completely.
63. Dr McGill found full power in all muscle groups in both upper limbs. In his evidence in chief Dr McGill plainly stated that there was no question of loss of digital dexterity and he referred to Ms Thew's excellent muscle strength and hand grip strength. Dr McGill found no permanent impairment and said there was no possibility at all of scoring impairment in accordance with Tables 9.1 or 9.4.
Dr McGill's assessment of full movements in the fingers, elbows and shoulders was established on examination and for that reason the Tribunal prefers his assessment to that of Dr Browne. The Tribunal gives credence to Dr McGill's objective results over the history given to Dr Browne. The Tribunal prefers Dr McGill's specialist opinion and assessments to that of Dr Vesey. Accordingly, the Tribunal finds that Ms Thew's injury, aggravation of a ganglion on her right wrist, that arose in the course of her employment with Centrelink, has not resulted in a permanent impairment. Comcare is not liable to pay compensation to Ms Thew for any permanent impairment in respect of the conditions claimed. The reviewable decision of 8 March 2002 must be affirmed.
65.    There is no entitlement to costs.
I certify that the 65 preceding paragraphs are a true copy of the reasons for the decision herein of:
Mr P.J. Lindsay, Senior Member
Dr P. Lynch, Member
Signed:         .....................................................................................
  Associate
Date/s of Hearing              3 April 2002
Date of Decision  24 July 2002
Counsel for the Applicant        Ms M Gillies
Counsel for the Respondent    Mr G Johnson