"MRI scan showed pre-existing medial compartment degeneration in the left knee. It was asymptomatic prior to the injury. It was aggravated after the injury and it has deteriorated. It will continue to deteriorate in the future."

4. Dr Lee's second report confirms that employment was the main contributing factor to the injury in the left knee, being aggravation of pre-existing degeneration.
5. Dr Lee provides a third report commenting on the report of Dr Miniter. This report is somewhat confusing in that Dr Lee states he agrees with "the body of his report". He also states:

"I agree with Dr Miniter that the need for knee replacement was the pre-existing degeneration, but the pre-existing degeneration would be related to her working at Bathurst Jail and is related to work."

6. He does, however, go on to explain the critical question in this dispute:

"It is my opinion the that work injury materially contributed to our client's need for the knee replacement surgery to the left knee. The joint space deteriorated rapidly since her injury. The pace of injury was much quicker that I would observe in a normal individual. It is logical that the injury at work caused the deterioration of her knee, leading to the need for knee replacement."

1. The respondent relies on two reports provided by Dr Miniter dated 15 May 2024 and 27 March 2025. In the first, Dr Miniter takes a consistent history of the fall that injured her left knee. He notes that two weeks after the fall she had an MRI, which Dr Miniter accessed and reviewed. He questions the arthroscopy that proceeded after this fall.
2. Dr Miniter discusses the various investigations undertaken at PRP Imaging. He describes Ms Brennan's presentation as "interesting", going on to make the following comment:

"As you know, arthritic disease waxes and wanes in terms of symptoms, and the fact that she has increasing and decreasing symptoms over that time is no more a reflection of the natural history than it is of injury. I would take issue with the fact that she underwent arthroscopic surgery for which I could see no indication."

3. Dr Miniter does not agree that there was an aggravation of a pre-existing condition, stating "there was no evidence of injury", which is curious in circumstances where injury is accepted and acknowledged as involving a direct blow to the left knee. Dr Miniter agrees that the knee replacement is appropriate treatment but does not believe that it is associated with her "alleged" fall.
4. Dr Miniter's second report comments on the pre-existing investigations into the left knee:

"I have taken a previous history relating to her left knee injury. Whilst she told me today that she had not had significant issues of her left knee, having had three arthroscopic procedures for the right knee during the course of her adult life, it remains that there are clear investigations relating to this left knee and many of these, date back over a decade. I have previously commented on this in my report to you."

5. Dr Miniter maintains his previous opinion that there was no significant aggravation caused by the fall in question. He also comments on the radiology that occurred shortly after the injury, stating "there are no features to suggest that there has been an aggravation of an objective nature".

1. Dr Kilby is the applicant's treating surgeon. He provides a report dated 9 August 2024, which is discussed above. The questions raised in requesting that report have been filed under the cover of an Application to Lodge Additional Documents.
2. He notes that "it is not my role to ascertain if work was the contributing factor" but goes on to say that Ms Brennan did not report any pre-existing problem with the knee and was functioning quite well, but after the fall she had a clear history of deterioration and pain.
3. Dr Kilby's clinical records are also in evidence. These records show the progression of Ms Brennan's left knee problems (as well as the right knee, which is unrelated to the present claim but was also treated by Dr Kilby as a private patient).
4. In a letter dated 2 April 2024, which appears to be in response to questions raised by the respondent's insurer, Dr Kilby describes a "clear deterioration in pain and dysfunction in the left knee since the fall on 19/7/22" and that she describes "mild issues only with the knee prior to the fall down the stairs at work".
5. Dr Kilby preformed an arthroscopy in December 2022. In the pos-operative report following that procedure, Dr Kilby refers to intra-operative photographs which show a "very large tear of the medial meniscus with a large displaced fragment into the joint". He also notes that "the flap tear had already caused some damage on the end of the bone".
6. There are various other clinical records and radiology reports that discuss the left knee condition.

1. The parties provided oral submissions during the hearing of this dispute, which were recorded. I will briefly summarise those submissions. In the interests of efficiency the respondent offered to provide submissions first in spite of the applicant's onus to prove.
2. The respondent acknowledged that there were no real facts in issue in this case, and you can accept the accounts Ms Brennan has given in her statements. It really comes down to an analysis of the medical and medicolegal opinions.
3. The respondent referred to the opinion of Dr Lee which was submitted was based on an assumption. The left knee was not asymptomatic as described by Dr Lee, referring to clinical notes that set out a history of left knee pain and earlier radiology. This diminishes the value of Dr Lee's report.
4. The respondent has accepted liability for a medial meniscus tear but not the surgery sought. The question is that there has been an aggravation of a degenerative condition, if so, what is that condition, and how has it been aggravated. Dr Lee does not tell us.
5. Dr Miniter couldn't understand why there was an arthroscopy in the first place, and perhaps given the outcome he was right. The applicant's need for knee replacement is due to degeneration. The claim must fail as it does not find support.
6. The applicant refers first to the opinion of Dr Miniter and reference to radiology. The applicant submits that the comments made do not reflect the report, and the earlier radiology that is available only shows the right knee with a significant degree of osteoarthritic disease.
7. The applicant then progressed through the treatment history of Dr Kilby. It was submitted that the arthroscopic surgery shows a significant tear and some other issues in the knee. At the point of the surgery the tear had caused some surface damage to the bone. Only about 14 months after that surgery Ms Brennan has progressed to a total knee replacement. It was submitted that Dr Miniter has not considered the opinions of Dr Kilby at all.
8. Dr Kilby clearly articulates that there has been an exacerbation of an underlying condition. Whilst there were some problems prior, these were minor and never stopped the applicant worker. The respondent's declinature relies on Dr Miniter, who is at odds with the objective evidence of the treating practitioner. There is clear evidence of aggravation of an underlying condition. The applicant submits that I would disregard the foundation of Dr Miniter's report. There has been a clear acceleration in the submission of the applicant, and I would make an award for the cost of the surgery and incidentals, as well as the period of incapacity following surgery.

1. The issue in this case is narrow - whether the surgery undertaken by the applicant (funded privately), a total knee replacement that took place in March 2025, was as a result of the injury she suffered on 19 July 2022. The causation question implicit in s 60 of the 1987 Act arises from the words "as a result of an injury". The question of whether the surgery was reasonably necessary does not arise and is not present in the medical evidence before me. That is, it is accepted by the respondent and clear from the evidence that the surgery was reasonably necessary, but the dispute arises as to the basis for the need for that surgery. The respondent's case is that it was unrelated to the accepted injury. The applicant's case is that the need for the total knee replacement arises from the work injury.
2. It is appropriate first to consider the state of Ms Brennan's left knee prior to her work injury. In her statement, she describes "very minor symptoms". This is consistent with what appears in the reports and clinical notes of Dr Kilby, her treating surgeon. Dr Lee records that she "did not have an issue with her left knee prior to the injury", which give a broad, fair interpretation, is largely correct. There were no significant interventions that one would consider an "issue". Later, he describes her as suffering from "pre-existing degeneration of the left knee which was asymptomatic prior to the incident". This takes things a step further and is likely incorrect. Ms Brennan was not entirely asymptomatic but had not required time off work or any significant intervention in her left knee. The extent to which reduces the weight I can place on the report of Dr Lee is minor. There is no great debate that Ms Brennan was suffering from pre-existing degenerative change prior to her injury, that was aggravated by her employment.
3. This is evidenced by radiology that was before the independent medical assessors who assessed her. Dr Miniter sets out the history of investigations in his report dated 15 May 2024. He accessed some of those through software, they were not provided to him as part of the brief. The applicant addressed this point briefly in submissions. It is not clear that the applicant was suggesting some impropriety on the part of Dr Miniter in accessing these films. Some of the reports with the corresponding radiology referred to are not before me. Dr Miniter refers to "MRI scans" which were undertaken on 19 February 2024. It is not clear what body part this was. Dr Miniter then refers to an MRI of the right knee of 2 May 2014, which he says shows "advanced arthritic change".
4. Further investigations were completed in an X-ray of both knees on 22 March 2021, showing "advanced osteoarthritic change on both knees", that was "more evidence on the right-hand side". As anyone experienced in this jurisdiction would understand, it is common to take comparative X-rays of contralateral body parts, particularly where osteoarthritic conditions are involved. It is clear that in 2021, prior to the injury, Ms Brennan's right knee was worse.
5. Dr Lee sets out the progressive history of joint space narrowing in his report of 31 May 2025:

"4 mm on 23 June 2016, > > 3 mm on 22 August 2022, > > 2 mm on 23 November 2024 > > and from Dr Miniter's report > > 0 mm on 6 May 2025."

6. It can clearly be seen that there has been slow deterioration between 2016 and 2022 (1mm in six years), with a rapid advancement from that date to May 2025 (3mm in under three years). This is precisely the rationale for Dr Lee's conclusion, where he explains that the joint space deteriorated rapidly since the injury, "much quicker than I would observe in a normal individual". Again, this report has some unfortunately unclear expressions from Dr Lee (where he agrees with the body of Dr Miniter's report) and in particular the following comment:

"I agree with Dr Miniter that the need for knee replacement was the pre-existing degeneration, but the pre-existing degeneration would be related to her working at Bathurst Jail and is related to work."

7. This was described as an "unhelpful comment" and I agree with that conclusion - it appears to be attempting to attribute Ms Brennan's overall employment to contributing to aggravating the disease process in her knee, but that is not the case brought by the applicant. Accepting these weakness, overall Dr Lee provides a reasonably coherent account supporting the connection between the need for surgery and the injury suffered by Ms Brennan. I am particularly persuaded by what Dr Lee describes as the rapid deterioration of the joint space, quicker than he would expect in a normal individual. This precisely distinguishes what is normal degenerative change from a material contribution from the work injury.
8. There are other factors of this case that are relevant to my consideration and support the applicant's contentions. Although Dr Kilby, in his report of 9 August 2024, posits that it is not his role to determine whether the injury was a material contributing factor, Ms Brennan finds support in his reports and clinical notes. Dr Kilby, in his report dated 2 April 2024, responding to questions posed by the insurer, describes a clear deterioration in pain and dysfunction in the left knee since the fall. He notes the (correct) history that she only had minor issues with the knee prior to the fall, that progressed to "constant and severe pain, swelling and stiffness".
9. Of further significance is the report of the arthroscopic surgery that took place in December 2022. The applicant referred to this in submissions. There is a significant tear of the medial meniscus, but that tear has caused some surface damage to the bone. To the extent that there is an argument that the respondent accepted liability for the meniscal tear only, and the surgery is a result of osteoarthritis only, this report seems to entirely defeat that categorisation.
10. Critically, Dr Miniter has not dealt with that medical construction at all. He questions the need for the arthroscopic surgery without any real explanation and fails to comment on that bone damage. He explains the general pathology of an arthritic condition in the following terms:

"As you know, arthritic disease waxes and wanes in terms of symptoms, and the fact that she has increasing and decreasing symptoms over that time is no more a reflection of the natural history than it is of injury. I would take issue with the fact that she underwent arthroscopic surgery for which I could see no indication."

11. This puts a real gloss on the actual condition of Ms Brennan's knee, which has not waxed and waned in terms of symptoms, but has proceeded progressively since the injury. As Dr Lee explains, this condition has progressed much quicker than one would expect in a normal individual. Dr Miniter's dismissive report is summed up by his conclusion that "there was no evidence of injury", in spite of the symptoms, radiology, and results of surgery that proceeded shortly after the fall. Later, he describes her "alleged fall". These factors really undermine Dr Miniter's opinion.
12. In his supplementary report, Dr Miniter continues down this vein. For example, he states "I have previously commented on x-rays taken in 2014 where there was already established medical compartment osteoarthritic disease". This is problematic for two reasons. Firstly, it is not claimed that Ms Brennan did not have some degree of osteoarthritis before injury, but it was well controlled and caused very minor symptoms only (in contrast with the post injury position). Secondly, Dr Miniter's own summary of the radiology (appearing in his earlier report) makes no reference to X-rays taken in 2014. The only reference is to an MRI of the right knee on 2 May 2014, which is not the injured knee in question.
13. For the above reasons, I am satisfied that the applicant's injury to the left knee materially contributed to the need for her surgery that took place in March 2025. The surgery was reasonably necessary as a result of that injury.
14. Accordingly, I will make the appropriate awards as agreed between the parties, in respect of the payment of medical expenses and weekly compensation during the applicant's recuperation from the surgery.