West v Simon Blackwood (Workers' Compensation Regulator)
[2015] QIRC 77
•29 April 2015
QUEENSLAND INDUSTRIAL RELATIONS COMMISSION
CITATION: | West v Simon Blackwood (Workers' Compensation Regulator) [2015] QIRC 077 |
PARTIES: | West, Toby v Simon Blackwood (Workers' Compensation Regulator) |
CASE NO: | WC/2012/496 |
PROCEEDING: | Appeal against a decision of Simon Blackwood (Workers' Compensation Regulator) |
DELIVERED ON: | 29 April 2015 |
HEARING DATES: | 12 and 13 August 2013 |
MEMBER: | Deputy President Bloomfield |
ORDERS: | 1. The Appeal is dismissed. 2. The Appellant is to pay the Respondent's costs of, and incidental to, the Appeal with recourse available to the Commission. |
| CATCHWORDS: | WORKERS' COMPENSATION - APPEAL AGAINST DECISION - whether injury arose out of or in the course of employment - whether employment was a significant contributing factor - Appellant worked as a waterproofer - Appellant also has diabetes and peripheral neuropathy - likely cause of carpal tunnel syndrome - medical evidence - different opinions as to likely cause of condition - obligation on Appellant to establish claim on the balance of probabilities - obligation not satisfied - Appeal dismissed. |
| CASES: | Workers' Compensation and Rehabilitation Act 2003, s 32 |
| APPEARANCES: | Mr M. J. Smith, Counsel instructed by Ms N. Howie of Parker Simmonds Solicitors & Lawyers for the Appellant. Mr G. Rhead, Counsel directly instructed by Simon Blackwood (Workers' Compensation Regulator), the Respondent, with Ms L. Hedges. |
Decision
Introduction
This decision relates to an Appeal by Mr Toby West against a decision of Simon Blackwood (Workers' Compensation Regulator) (the Regulator) to confirm an earlier decision of WorkCover to reject Mr West's Notice of Claim for Damages in accordance with section 32 of the Worker's Compensation and Rehabilitation Act 2003 (the Act).
The Notice of Claim for Damages sought compensation for right carpal tunnel syndrome said to have been incurred between 27 January 2009 and 4 January 2010* with Commercial Waterproofing Services (CWS) during which time Mr West was employed in the capacity of Site Supervisor/Waterproofer and (allegedly) required to undertake work involving the extensive use of a hammer drill and injection pump, amongst other tools and equipment. (*While the claim specifies this date, the period most often mentioned was January 2009 to March 2010 - the date Mr West went on stress leave (see below)).
Issue requiring determination
The issue requiring determination in this case is whether Mr West's carpal tunnel syndrome arose out of, or in the course of, his employment during the designated period and whether his employment was a significant contributing factor.
Evidence
Mr West
Mr West said he had worked in the waterproofing industry for 23 years and started working with CWS in early 2001 in New South Wales. About 18 months after he commenced he moved to Queensland and became the Construction Foreman, managing construction projects in Sydney, Newcastle, the Gold Coast, Caloundra, Cairns and Port Douglas. In the course of performing this job he was required to drive between Sydney and Caloundra on a regular basis, and his car effectively became his office. In early - mid 2009 he was required to spend more time working on the tools because CWS was reducing its staffing levels and he needed to physically work on jobs.
Working on the tools required him to use a hammer drill to drill into concrete slabs so that epoxy could be injected into the concrete to seal water leaks and the like. He was also required to use nail guns, so that waterproofing membranes could be affixed onto vertical concrete walls, and to use grinders to clear away excess epoxy after it set. The hammer drill, injection equipment and grinders each delivered significant vibration which was felt through one's hands, arms and body. "… a lot of times your whole body can just ache, but mainly your hands, because that's what you use."
After leaving CWS in March 2010 because of a stress-related condition, Mr West commenced a return to work program doing light work at Ashmore TAFE in early September 2010. After using a hedge trimmer and chainsaw for a few hours on one day, early in the return to work program, he went home and found the pain in his hands to be "unbelievable". As a result he went to see Dr Malvern Shinn who referred him to a Dr Maxwell for conduction tests to establish whether he had carpal tunnel syndrome. The test results came back positive, showing he had carpal tunnel syndrome in both wrists. At or about this time it was also established that he had peripheral neuropathy, which affects the nerve endings, mainly in his legs but also in his hands.
Under cross-examination Mr West said:
· he could not remember if he informed Dr Shinn about any concerns he might have had regarding pain in his hands during 2009 or in the period January - March 2010;
· he was diagnosed as a diabetic in approximately 2001/2002 and was prescribed medication to control his blood-sugar levels;
· he took his diabetes medication "95% of the time", in that he had odd days he forgot to take his tablets, as well as other tablets he was required to take;
· he did not dispute the accuracy of a Report from Dr Shinn to the effect that the first time he mentioned pain in his hands, after he became a patient in July 2007, was on 9 September 2010 - the day after he undertook the work mentioned above at the TAFE college;
· he did not dispute records made by Dr Shinn to the effect that he was drinking up to 20 beers a day, averaging 5 - 10 drinks a day.
Dr Malvern Shinn (called by Mr West)
In the course of his examination-in-chief Dr Shinn was asked if he had a view about the original cause of Mr West's carpal tunnel syndrome. In response he said "well, given that carpal tunnel (is) usually due to compression of the nerves within the carpal tunnel, for example the median nerve, then that would be caused by, usually, fibrosis and - and swelling of the tissues there, which is usually associated with repetitive use."
In cross-examination Dr Shinn gave the following evidence:
· he was not an expert in the field of carpal tunnel syndrome and would defer to Dr Coleman and Dr Stabler (see their evidence below);
· he had checked Mr West's medical records from July 2007 through to September 2010 and found no record of complaint by Mr West of hand or wrist pain and this was despite the fact he was doing lots of manual work over this period;
· when he saw Mr West on 9 September 2010 he had burning feet and the distal fingers were completely numb. He had not recorded any note about Mr West suffering hand or wrist pain at that time; and
· his notes contained multiple references to Mr West having poor sugar and lipid control for his diabetes, with regular references to Mr West not taking his diabetes medication.
Finally, in re-examination, Dr Shinn was taken to a workers' compensation medical certificate he issued on 24 September 2010 which recorded that Mr West had "pain, paraesthesia and numbness in the left and right hands and fingers…" as at that date.
Dr Stephen Coleman (called by Mr West)
Dr Coleman's six page Report (Exhibit 10) recorded the following information:
· he had seen Mr West on 21 June 2011 for the purpose of providing a Report to his Solicitors;
· nerve studies undertaken by Dr Maxwell on 23 September 2010 showed established, moderately severe, bilateral carpal tunnel syndrome;
· Mr West had a right open carpal tunnel decompression on 9 March 2011 and a left carpal tunnel decompression on 12 May 2011;
· the exact cause of Mr West's carpal tunnel syndrome is uncertain;
· the nerve studies undertaken on 23 September 2010 showed quite significant compression, which takes years or months to develop; and
· it is more likely that the symptoms arose over a period of time from his waterproofing work and constant hand use.
In the course of his examination-in-chief Dr Coleman gave the following response when asked what the usual background was for carpal tunnel syndrome in males: "They may have some medical conditions such as diabetes, thyroid problems, or they may be - usually they're working in an occupation which requires a lot of hand use or gripping or vibration or cold. They're all factors that can aggravate carpal tunnel."
Under cross-examination Dr Coleman gave the following evidence:
· he noted that Mr West had been engaged in waterproofing for 23 years;
· he understood that for the last nine years he had been doing more supervising work than waterproofing;
· he understood Mr West's workers' compensation claim related to the period January 2009 to January 2010;
· he did not recall, and had not included in his Report, how much time
Mr West might have spent "on the tools" over this period;· no-one knows exactly what causes carpal tunnel syndrome or why it is more common in females;
· as you age the ligaments stretch and the shape of the carpal tunnel changes, it becomes a little flatter and not as circular or elliptical in shape;
· carpal tunnel can happen acutely or it can also build up over time. It is not uncommon to see people working in an occupation for an extended period and, eventually, start to get more symptoms "and no one knows - you can't totally explain it, yet, possibly some of it is aging. It's just that it is more common in persons who have used their hands over a period of time or a number of years.";
· carpal tunnel syndrome was multi-factorial. He did not think there was one single thing that always caused it. "… the shape of your carpal tunnel, your age, your diabetes, what you've been doing with your hands, whether you have your hands hanging down, or up, whether it is in the hot or the cold, whether you spend all your day gripping…";
· driving, which involved gripping, was also a significant factor in the development of carpal tunnel syndrome;
· activities like using hammer drills, using the waterproofing injector and gripping, while driving, were factors that could see carpal tunnel develop over a period of time, but not in all persons undertaking those activities;
· "… if you do something that causes increased fluid or increased volume in there, such as using a chainsaw or just constant use, then you can get a secondary and more permanent thickening of the tissues which then leaves less room in that canal for - for the median nerve, which is the structure which gets compressed. So that's theoretically what happens. Now, I think Mr West was also diabetic. Diabetics' nerves are a little more prone to compression, more so that the normal population, or the non-diabetic population. So you need a lesser compression, if you like, to cause the symptoms.";
· alcohol was not really a cause of carpal tunnel syndrome. However, it could cause peripheral neuropathy, where the nerves are a little bit thicker. "The same sort of thing with diabetes, that's really a peripheral neuropathy, where the nerves are more susceptible to compression. I don't think you can say alcohol causes the compression, but it would make the nerve more susceptible to - to the symptoms developing, same as the diabetes.";
· the nerve studies undertaken by Dr Maxwell showed that the compression was quite severe and that "(a) it could have been there for many years or (b) it's the diabetes plus or minus the alcohol.";
· if Mr West had been working as a waterproofer and he wasn't a diabetic he would feel comfortable saying that work was a "significant contributing factor in the development of his carpal tunnel syndrome. The fact that he is diabetic puts more loading on the diabetes… the diabetes is a factor but it is not the sole factor and that's - again - comes this problem of what's significant, what's insignificant."; and
· people who have diabetes could also develop carpal tunnel syndrome without doing any of the activities he described above.
Dr David Stabler (called by the Regulator)
Dr Stabler had prepared a detailed, 17 page, Report for Mr West's Solicitor immediately following his consultation with Mr West on 17 May 2012. In the course of this Report (Exhibit 12), Dr Stabler referred to his earlier Report of 7 October 2010 (Exhibit 11) which he had completed immediately following his first assessment of Mr West. In doing so, he noted that the nerve conduction studies undertaken by
Dr Maxwell on 23 September 2010 had been performed very soon after the onset of symptoms. Dr Stabler also noted that while the initial symptoms had been unmasked by the nature of the work Mr West had undertaken at the TAFE college, in September 2010, he reported his symptoms as worsening when Dr Stabler assessed him four weeks later. This led Dr Stabler to conclude (in October 2010) that the ongoing symptoms were due to constitutional factors, which was due to a combination of
Type 2 Diabetes and ageing.After touching on his earlier Report, Dr Stabler turned his attention to Mr West's claim for right wrist carpal tunnel syndrome which Mr West alleged was sustained during the course of his employment during the period 27 January 2009 until March 2010. In the course of his written commentary about this claim, Dr Stabler made the following comments and observations:
· Mr West advised that he sustained his right carpal tunnel syndrome from hammer drilling;
· the Notice of Claim filed with WorkCover stated that after his return from the Christmas break, on or about 27 January 2009, Mr West was required to return to the tools and to perform excessive work on the hammer drill for weeks at a time and to also use an injection pump;
· the records of the employer showed that the claimant worked on the tools as follows:
o3 days in February 2009;
o9 days in March 2009;
o5 days in April 2009;
o9 days in May 2009;
o8 days in June 2009;
o4 days in July 2009;
o1 day in August 2009;
· Mr West reported that in an 8 hour day he would be using the hammer drill or the injection pump for about 2 or 3 hours;
· Mr West recalled more frequent use of the hammer drill than recorded by the employer;
· notwithstanding release of each carpal tunnel, Mr West reported that he still (i.e. at 17 May 2012) experienced burning pain and numbness and pins and needles in his hands;
· Mr West drew a pain diagram on 17 May 2012 which showed global pins and needles and severe pain on the dorsum and the palmar aspects of both hands. "This loss of sensation in both hands is in a 'glove and stocking' distribution which is more typical of peripheral neuropathy than of ongoing carpal tunnel syndrome symptoms";
· after undertaking a clinical examination of both hands and wrists (in the manner described on page 12 of his Report) Dr Stabler indicated that he did not consider there was any evidence of ongoing carpal tunnel syndrome; and
· there is no evidence in the medical records of Dr Shinn that Mr West complained of bilateral carpal tunnel syndrome prior to September 2010, a point Mr West independently confirmed during his consultation.
Towards the conclusion of his Report, Dr Stabler expressed his opinion about the likely cause of Mr West's right wrist carpal tunnel syndrome as follows:
"I note that the opinion of Dr S Coleman, Upper Limb & Orthopaedic Surgeon, was apparently given to the claimant (although I have seen no direct evidence of this) that the cause of his carpal tunnel syndrome was the waterproofing duties he previously performed.
The claimant however was asymptomatic during the period of the waterproofing duties and he apparently did not develop carpal tunnel syndrome until he had stopped performing those waterproofing duties in March 2010 and remained asymptomatic until September 2010.
The onset of symptoms therefore for carpal tunnel syndrome was at least
6 months after the cessation of work duties as a waterproofer.The claimant has medical evidence from Dr Shinn that his diabetes has been present since 2002 and has been under poor control and that the claimant has not been taking Diabetic medication all of the times he should have been.
The claimant has apparently developed evidence of peripheral neuropathy which could be considered to be due to a combination of poorly controlled Diabetes together with possible increased alcohol intake.
The claimant has undergone nerve conduction studies which have confirmed bilateral carpal tunnel syndrome but I consider that the carpal tunnel syndrome was due to constitutional factors and these constitutional factors include age, alcohol intake and diabetes.
The claimant has a complicating factor in that he has developed peripheral neuropathy which definitely confuses the symptomatic presentation and examination in relation to bilateral carpal tunnel syndrome."
…
"My recent examination and history obtained from the claimant on 17/05/12 has not changed my opinion in any way in relation to the aetiological factors.
I still consider that the claimant had sub clinical bilateral carpal tunnel syndrome due to constitutional factors and that this condition of bilateral carpal tunnel syndrome was unmasked due to the activities with the chainsaw at TAFE in early September 2010.
Were it not for that incident at TAFE in September 2010 with the chainsaw I consider that it is more likely than not that the claimant would have developed the symptoms of bilateral carpal tunnel syndrome as shown on the nerve conduction studies which confirm severe bilateral carpal tunnel syndrome.
The exact alcohol intake of the claimant is difficult to determine but at the time of most recent consultation 17/05/12 Mr West indicated that he now drinks 10 schooners per day (425 mls per schooner) and it is possible that he may have been drinking more heavily than this in the past.
This level of alcohol is certainly sufficient to cause a peripheral neuropathy which I consider to be a major cause of the ongoing symptoms of which the claimant complains.
I consider that the condition in both hands is stable and stationary and that the claimant is unlikely to benefit from any further medical or other treatment in relation to his hand symptoms.
I do not consider that the incident at TAFE caused more than a brief increase in symptoms in both hands and I consider that the effect of work at TAFE had ceased by 07/10/10 (one month after the apparent onset of symptoms).
In particular I do not consider that it is reasonable to assume that the claimant developed bilateral carpal tunnel syndrome due to the nature of his work using a hammer drill or injection pump, when the claimant remained completely asymptomatic up until September 2010 (6 months after ceasing work for Commercial Waterproofing)."
Finally, in responding to an unreferenced question from Mr West's Solicitor,
Dr Stabler wrote, inter alia:"Uncontrolled Diabetes can have an adverse effect upon the blood supply and subsequent nerve function of peripheral nerves and it is possible that the claimant may have some permanent damage to both median nerves as a result of his constitutional factors. I do not consider that there has been any permanent damage to his median nerves in relation to work duties.
Finally the claimant has apparently retrospectively claimed the period of
27th January 2009 to March 2010 as the period of development of his right carpal tunnel syndrome.All of the evidence provided to me indicates that the claimant was asymptomatic during that period and this lack of any clinical presentation of carpal tunnel syndrome during that period indicates strongly that the nature of work duties by the claimant was not the cause of right carpal tunnel syndrome."
In the course of his cross-examination, Dr Stabler gave the following evidence:
· while he had seen driving a vehicle unmask carpal tunnel syndrome he did not believe that driving was a significant contributing factor to its development;
· the cause of carpal tunnel syndrome in males was frequently unidentified. It was seen in people with diabetes and occasionally in people with conditions such as rheumatoid arthritis and rare conditions such as acromegaly. Many males with the syndrome were 50, 60, 70 years of age and it was something they just had a predisposition to develop. "They form excessive synovial tissue around the flexor tendons in the wrist and that puts pressure on the nerve.";
· excessive use of the hands and wrists could be a contributing factor but "I don't think you'll get any hand surgeon in the world to say it is caused by excessive use of the hands…". There might be 1000 workers in a factory and you might have maybe 2, 3, 4%, at the most, of those people who will develop carpal tunnel syndrome from doing exactly the same work;
· its cause was often multi-factorial - a point already made by Dr Coleman, with which he agreed;
· if Mr West was not obese, did not have excessive alcohol intake, did not have diabetes and if he were to work continuously with his hands, rather than for a few hours a day, then it would be a reasonable assumption to say that work was a significant contributing factor to the development of carpal tunnel syndrome; and
· while it was not his opinion, he could not rule out that work contributed to the development of Mr West's carpal tunnel syndrome. "… you can't rule anything out. As I said, it's multi-factorial".
In the course of re-examination Dr Stabler was asked some questions about the potential linkage between peripheral neuropathy and carpal tunnel syndrome. In responding he said "I think it's important that the Court understands that these two are so intimately related. The peripheral neuropathy means that the nerves are sick. They are less able to tolerate any pressure at all, and the - frequently there is interruption of the blood supply of the nerve from the diabetes, and so the - this is why I've said that I believe that the major contribution - or in my opinion the contribution - is that of the constitutional factors and any work that he did was only a temporary exacerbating factor, and by exacerbating I don't mean permanent change in the pathology, I mean a temporary increase in symptoms.".
In response to a further question as to what he regarded as the significant cause of
Mr West's carpal tunnel syndrome Dr Stabler responded by saying "well, I have no doubt, in my opinion, the most significant contributing factors are the diabetes and the alcohol intake … and, of course, with the obesity, which is part of those constitutional factors."Findings and conclusion
In the course of his submissions Mr M Smith of Counsel, who represented Mr West, urged me to prefer the evidence of Dr Coleman over that of Dr Stabler. This was on the basis that Dr Coleman is a Specialist engaged in surgery of the hand and upper limb. The submission is an interesting one and resulted in me comparing the curriculum vitae of each of the doctors. This revealed the following:
Dr Coleman:
· President, Queensland Hand Surgery Society: 2003 - 2008
· President, Australian Hand Surgery Society: 2010 - 2012
· Member, Editorial Board, Asia-Pacific Journal Hand Surgery
Dr Stabler:
· President, Queensland Hand Surgery Society: 2009 - 2012
· President, Australian Hand Surgery Society: 2012 - 2014
· Secretary and Board Member, Australian Hand Surgery Society: 2001 - 2005
· Newsletter Editor, Australian Hand Surgery Society: 2005 - 2012.
With great respect to Mr Smith, I cannot accept his submission that Dr Coleman's evidence should be preferred over that of Dr Stabler because of his area of speciality. The curriculum vitae of the respective doctors shows a similar level of interest in the field of hand surgery over many years and a similar standing in that area in terms of peer recognition. In addition, no hard, assessable, evidence was led to support the submission that Dr Coleman possessed a higher level of expertise or knowledge in the field of the likely origin of an individual employee's carpal tunnel syndrome than
Dr Stabler. Quite apart from that, the evidence presented would not support a decision to prefer Dr Coleman's opinion over that proffered by Dr Stabler.Dr Coleman's Report (Exhibit 10), prepared on 21 June 2011, is notable in several respects - more so for what it does not mention than what it says. Firstly, it was prepared prior to lodgement of the Notice of Claim with WorkCover for Mr West's right wrist carpal tunnel syndrome which is said to have arisen from his work during the period January 2009 - January (or March) 2010. On my reading of his Report,
Dr Coleman's opinion about the cause, or likely cause, of Mr West's carpal tunnel syndrome appears to be entirely based on his knowledge that Mr West worked as a waterproofer for 23 years. Although he indicated in cross-examination that he understood Mr West's workers' compensation claim related to the period January 2009 to January 2010, it is not clear, from his oral evidence, whether he had particularly considered the nature of the work undertaken by Mr West during this limited period in formulating his opinion about the likely cause of Mr West's carpal tunnel syndrome.Secondly, Dr Coleman's Report does not make any mention of the fact that Mr West had diabetes since 2001/2002, nor does he appear to have given any consideration as to what impact this condition - particularly the uncontrolled nature of it - might have had on the development of Mr West's carpal tunnel syndrome. In this respect, it is worth noting that while Dr Stabler's Report of 7 October 2010 (which was provided to Dr Coleman before he saw Mr West in June 2011) contained extensive reference to Mr West's diabetes, its uncontrolled nature as well as the fact that Dr Stabler considered constitutional factors to be the cause of Mr West's injury rather than his work as a waterproofer, Dr Coleman did not touch on any of these matters in his own Report.
Further, notwithstanding that he appeared to have formed an early view as to the likely cause of Mr West's carpal tunnel syndrome it was highly relevant, in my opinion, that during the course of his cross-examination Dr Coleman clearly became more open to the potential for Mr West's diabetes, his alcohol consumption and his peripheral neuropathy to be more of a feature in the development of Mr West's carpal tunnel syndrome than he might previously have contemplated (see, for example, the last five dot points in paragraph [13] above). In the end, Dr Coleman appeared to acknowledge that Mr West's diabetic condition, alcohol intake and peripheral neuropathy might all have significantly contributed to Mr West having developed carpal tunnel syndrome.
In contrast to Dr Coleman's very sparse Report, which does not record the nature of any enquiries he might have made of Mr West about his medical history or the nature of the physical examination undertaken, Dr Stabler's Report is extremely comprehensive. More importantly, for present purposes, it reveals the nature of
Dr Stabler's thought processes in relation to his consideration of the actual claim which is the subject of this Appeal and reveals exactly why it was that he came to his opinion that it was constitutional factors, rather than the nature of Mr West's duties between January 2009 and January (or March) 2010, which were the likely cause of his carpal tunnel syndrome. Of particular relevance is his line of reasoning recorded at [16] and [17] (above).
The thoroughness with which Dr Stabler went about the task of considering the potential causes of Mr West's carpal tunnel syndrome is demonstrated, for example, in his consideration of the amount of time Mr West spent, during the relevant period, working on the tools. In that respect, he did not rely solely on the employer's records (which are recorded in paragraph [15] above) but also made further enquiries of
Mr West about the same matter. In doing so, he noted Mr West's comment to the effect that he thought he had used the hammer drill more frequently than recorded by the employer and took this into account in forming his overall opinion.While Mr Smith was critical of the fact that the employer was not called to substantiate the validity of its records, I am not persuaded that this criticism is justified. The records had previously been canvassed with Mr West and while he told Dr Stabler he thought he worked more often on the hammer drill than they employer had recorded, he does not appear to have seriously disputed the number of days recorded. Equally, during the course of his cross-examination, Mr West did not seriously dispute the amount of time he is said to have worked on the tools in the relevant period.
At the end of the day, it is up to the Appellant to establish, on the balance of probabilities, that his right wrist carpal tunnel syndrome arose out of, or in the course of, his employment during the period January 2009 until January (or March) 2010 and that his employment was a significant contributing factor to the development of that condition. All things considered, my evaluation of the evidence leads me to conclude that Mr West has failed to demonstrate, on the balance of probabilities, that his Appeal should be allowed.
While there is a possibility that Mr West's employment contributed to the development of his carpal tunnel syndrome during the period January 2009 - January (or March) 2010 that falls well short of the requirement that he demonstrate that his employment was a significant contributing factor. In a similar vein, Mr Smith's general submission to the effect that I should allow the Appeal because Dr Stabler conceded under cross-examination that he could not rule out the work being performed by Mr West as causative of his carpal tunnel syndrome also falls well short of satisfying the statutory provision.
Indeed, not just has Mr West failed to demonstrate the validity of his claim, the evidence points to Ms West's diabetes, alcohol intake and obesity as not just being a significant contributing factor to the development of his carpal tunnel syndrome but, rather, the significant contributing factor.
For the foregoing reasons, I Order:
· Mr West's Appeal in Matter No. WC/2012/496 be dismissed; and
· Mr West is to pay the Regulator's costs of, and incidental to, the Appeal with recourse to the Commission if the parties are unable to agree on the amount involved.
I determine and Order accordingly.
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