1. There are competing medicolegal opinions in this case. Mr Denshire relies on the opinion of Dr Mark Hardy, a physician with subspecialities in addiction medicine, dual diagnosis and acquired brain injury. The respondent relies on the opinion of Dr David Gorman, a physician and pain medicine specialist. I would observe here (and discuss later) that neither doctor who has provided an opinion in this case is a psychiatrist.
2. Dr Hardy provides a report dated 27 February 2025. He takes a history of present complaint including the various traumas Mr Denshire was exposed to. He sets out Mr Denshire's medications, which at the time of report were Pristiq 100mg daily and medicinal cannabis oil. He takes a history of Mr Denshire first trying cannabis at the age of 21 as "experimental use only" and that it was "never a problem", and that he began using medicinal cannabis 18 months ago (in approximately July 2023). He provides the diagnosis of post-traumatic stress disorder, although it is not clear whether that diagnosis was reached on his own opinion, or based on that of others with relevant qualifications in psychiatry.
3. He notes that the nature of post-traumatic stress disorder in first responders and military tends to be resistant to traditional treatments, and where that is the case, medicinal cannabis may be a very favourable treatment, supported by a growing body of evidence. Dr Hardy systematically addresses the Diab v NRMA Ltd [2014] NSWWCCPD 72 (Diab) criteria. He discusses the opinion of Dr Gorman and particularly addresses the potential for cannabis use disorder.
4. Dr Gorman provides a report dated 20 November 2024. He sets out a similar history of injury and onset of psychological symptoms in 2016. He takes a history of Mr Denshire having been smoking cannabis for at least 12 months, but trying to use oil instead. He notes that Mr Denshire "vapes" the oil if he needs faster relief. He provides a diagnosis of post-traumatic stress disorder, but notes that "I am not a consultant psychiatrist or psychologist and I have based this on documentation and history". Dr Gorman does not believe that medicinal cannabis is standard treatment and the Royal ANZ College of Psychiatrists do not support the use of medicinal cannabis for any psychiatric illnesses. He also addresses (to some extent) the Diab criteria.
5. The applicant also attaches a report of Dr David Kumagaya dated 2 February 2024. Dr Kumagaya is a psychiatrist but the report does not address the issue in dispute. The report notes that "Mr Denshire smokes medicinal cannabis". He recommends treatment, including ongoing treatment through his general practitioner and psychologist. He recommends that antidepressant medication be continued, for at least two years. He does not recommend (although was not specifically asked) medicinal cannabis, and does not comment on its use, although he was aware Mr Denshire had used it.
6. The MAC of A/Prof Glozier takes a history of the use of medicinal cannabis "for some time now".

1. The applicant's treating general practitioner is Dr Peter Cooke. He is not the prescriber of the medicinal cannabis that Mr Denshire has previously received, who is a Dr Chiranjal Saikia (based on the invoices attached to the Application). It appears that Dr Saikia practices out of Victoria.
2. Dr Cooke provides a report dated 5 November 2024. He answers three questions, which are not before me, but appear to be about Mr Denshire's last visit, causation, and whether the treatment of medicinal cannabis is reasonably necessary.
3. Dr Cooke notes the background to Mr Denshire being prescribed medicinal cannabis, which he declined to do and suggested he "consult someone with more experience". He notes that he has had no communication from the online prescriber of Mr Denshire's medicinal cannabis. He acknowledges his limited experience but suggests there is potential to help "chronic pain and anxiety (plus nausea and epilepsy)". There are a few specific clinical records relating to Mr Denshire's use of cannabis in the clinical records that I will discuss below.
4. On the reasonably necessary question, Dr Cooke acknowledges that it is "difficult to answer", but that he "thought it a reasonable option to trial". He does address the Diab criteria systematically, which I will discuss below. Dr Cooke also earlier provided a medical certificate dated 17 May 2024 which states "In my opinion, he will benefit frome [sic] medical cannabis (CBD/THC oil)".
5. There is an Allied Health Treatment Request of 20 September 2024, for psychological therapy. There are notes from Mr Denshire's psychologist that don't particularly assist on the issue.

1. The parties provided oral submissions during the hearing of this matter on 19 June 2025. Those submissions were recorded and I do not intend to recite them at length. The parties' submissions were systematic and thorough and I found them helpful in determining this dispute.

1. The applicant commenced by acknowledging that the law in respect of s 60 is settled, with reference to Diab. The applicant's submissions then went through the relevant criteria set out in Diab in a systematic way with reference to the relevant evidence. I will deal with those submissions in more detail under each of the Diab headings, below. The applicant submits that ultimately when you consider the various headings in Diab, I would be satisfied that it is reasonably necessary. The fact that there is a risk is not decisive, and the alternative is that the applicant goes without or self medicates, which is not an ideal situation.

1. The respondent also addressed the relevant criteria as set out in Diab. The respondent submits that it is important to consider Dr Gorman's opinion in respect of the use of illicit cannabis, in the context of the opinion of Dr Cooke. He does not believe it is a standard treatment and is familiar with the position taken by the body of psychiatrists, which does not support it for any illness.
2. The respondent notes that Dr Cooke's support is very unenthusiastic. It is noted that there are no dosages attached to the recommendation and it is not clear who is going to be supervising the use of cannabis. Dr Cooke gives it a "token" tick of approval, but I would not be persuaded that he really supports it. On the present state of the medicine, I would not be satisfied that the orders should be made.

1. The applicant first addressed a question I raised about the qualifications of the experts in this case. The applicant submits that Dr Hardy is a physician, which is over and above a general practitioner. The tenor of Dr Hardy's report is that he has a high degree of expertise, and on the basis of his qualifications he's entitled to provide the opinion that he does. There is sufficient evidence to answer the question of the past medicals.
2. In respect of the future claim, that was described as a more vexing problem. If I accepted the applicant's position, that order should be couched in terms of a referral and supervision from a general practitioner.
3. I would be cautious of accepting the general position of the college of psychiatrists in respect of medicinal cannabis as each case turns on its own facts. Whilst Dr Cooke's opinion blows both ways, he does support medicinal cannabis.
4. The applicant submits that the respondent's case has been totally focussed on what the doctors say, no attempt has been made to deal with the applicant's statement that describes symptomatic benefit. This is power support that the treatment should be allowed, but in the form recommended by the general practitioner, that is oil only.

1. The parties approached this issue on the basis of the principles set out in Diab. Those, consistent with Rose v Health Commission (NSW) [1986] NSWCC 2; (1986) 2 NSWCCR 32, are:

"(a) the appropriateness of the particular treatment;

(b) the availability of alternative treatment, and its potential effectiveness;

(c) the cost of the treatment;

(d) the actual or potential effectiveness of the treatment, and

(e) the acceptance by medical experts of the treatment as being appropriate and likely to be effective." (at [88])

1. Of course the above heads for consideration do not represent the scope of the test in a statutory sense, they do provide useful guidance. As much was said in Diab at [90]:

"While the above matters are 'useful heads for consideration', the 'essential question remains whether the treatment was reasonably necessary' (Margaroff v Cordon Bleu Cookware Pty Ltd [1997] NSWCC 13; (1997) 15 NSWCCR 204 at 208C). Thus, it is not simply a matter of asking, as was suggested in Bartolo, is it better that the worker have the treatment or not. As noted by French CJ and Gummow J at [58] in Spencer v Commonwealth of Australia [2010] HCA 28, when dealing with how the expression 'no reasonable prospect' should be understood, '[n]o paraphrase of the expression can be adopted as a sufficient explanation of its operation, let alone definition of its content'."

2. I will deal with each of those criteria under separate headings below. I would first, however, make some general comments about this case.
3. The first concerns my general reservation about the qualifications of the independent medical experts that both parties have relied on. I raised this issue at the preliminary conference in this matter and during the conciliation, before the hearing commenced. Both doctors are physicians. I have no medical opinion available, concerning the issue in dispute, from a psychiatrist. Dr Kumagaya's report is attached but doesn't provide any opinion, only notes the use of medicinal cannabis. The only other psychiatric opinion is contained in the MAC and that has been appealed and again only notes the history of use of medicinal cannabis.
4. The above is not to question the experience of both Dr Hardy and Dr Gorman. Both have clearly detailed their knowledge and experience in the space, as physicians. Dr Hardy has some specialised knowledge relevant here in terms of being an addiction medicine specialist. That was a specific issue canvassed. Dr Gorman has some experience with the use of medicinal cannabis as a pain specialist.
5. However, in my view neither are qualified to comment on psychiatric issues. Dr Gorman, of the two, was quick to express this, at least in terms of the diagnosis. When providing a diagnosis of post-traumatic stress disorder, he comments that he is not a consultant psychiatrist and the diagnosis was based on documentation and history. That is, he has proceeded on the basis of the diagnosis provided by other experts, which is appropriate. Whilst diagnosis does not have a great deal of relevance in this case (perhaps absence the opinion that medicinal cannabis may assist with anxiety), it is in my view still relevant that I do not have a psychiatrist commenting on this treatment, either as an independent medical expert or as a treater. The applicant must prove his case, and this gives me great reservation about whether I could be satisfied he has met his onus.
6. I would also note that whilst there appears to be growing acceptance of the appropriateness of medicinal cannabis in the treatment of chronic pain, this does not necessarily extend to the applicant's injury and diagnosis, which is psychiatric. Dr Gorman expresses as much. I have also reviewed other decisions of the Commission and have been unable to find any authority with a similar factual background (that is for a psychological injury). There are a number of cases where medicinal cannabis has been held to be reasonably necessary for the treatment of chronic pain (Faint v Elam Communications Pty Ltd [2024] NSWPIC 377; White v Gilda Fabrics Pty Ltd [2025] NSWPIC 192 as two such examples). Whilst I acknowledge that facts do not make law, and each case must be determined on its own facts, I found this somewhat surprising (although perhaps not so, given the apparent blanket rejection of it as a treatment modality by the Royal ANZ College of Psychiatrists).
7. I am also concerned by the lack of oversight of the previous provision of medicinal cannabis and the absence of any commentary from the prescribing doctor (Dr Saikia). Dr Cooke, who is the applicant's treating general practitioner, apparently shares my concerns in a general way.
8. Given the way the matter proceeded through submissions, I will deal with the Diab headings, although my concern about the lack of qualified expert evidence is still relevant.

1. Dr Hardy's opinion on appropriateness is of a general nature. He refers to the USA National Academics research for use in anxiety disorders and suggests Mr Denshire is a reasonable candidate for a trial. He suggests that medicinal cannabis is a new treatment, and is not considered absolutely necessary, it should be borne in mind that traditional treatments have been trialled without success.
2. Dr Gorman does not specifically address this issue under the heading "appropriateness" as Dr Hardy does, but opinions that it is not a standard treatment, and it is not in fact supported for any psychiatric illness. Specifically for present circumstances, Dr Gorman does not support it on the basis that Mr Denshire is at a risk of cannabis use disorder, based on a history of alcohol overuse and illicit cannabis use.
3. I note here that there is some inconsistent history of Mr Denshire's previous cannabis use. Dr Gorman's history of use commences in about November 2023. This is fairly consistent with the history recorded by Dr Hardy. However the clinical records include much earlier use of cannabis, including as prescribed by Dr Cooke. In a record dated 18 September 2020, Dr Cooke records:

"use THC - to help anxiety > > - smokes backy in cigs x1/nigh 3-7/7/wk > > wants med THC for court"

4. On 2 September 2022, Dr Cooke records "insomnia needs THC", although no prescription was provided on that date. On 10 November 2022, Dr Cooke records "THC for PTSD via cookies Ubuntu" and provides a specific prescription for "Cannabidiol 100mg/ml Oral Solution (Cannabidiol) 6 drops daily plus cookies ¼ per day Ubuntu".
5. On his next attendance at Dr Cooke, on 28 September 2023, he records a reason for visit as "cannabis use" with the record "PTSD Rx THC to mx stress - cook eat smoke and vape". This is broad usage. Although there is no evidence of addiction, this does lend some support to Dr Gorman's concerns. It is also somewhat inconsistent with Dr Cooke's report that says "he was taking cannabis before I met him" and a suggestion of a referral to someone with more expertise. This is on the background of Dr Cooke having specifically prescribed medicinal cannabis to Mr Denshire in the past, or at least spoken to him about it, for multiple reasons (anxiety, insomnia, and for post-traumatic stress disorder).
6. Dr Cooke's opinion on medicinal cannabis is "reasonable to trial". In circumstances where Mr Denshire has self-funded medicinal cannabis, including prior to the provision of the report, it must be interpreted that it has been subject to a trial, so it is not clear why Dr Cooke recommends a further trial. On the other hand, Mr Denshire's lay evidence is that his use of it on a self-funded basis (roughly equivalent to a trial) has been "highly valuable".

1. The applicant, in submissions, suggested he does not want to undertake alternative treatments. There was also reference to the ongoing issues Mr Denshire has had with Sertraline, including where his condition deteriorates when he comes off it.
2. Dr Gorman recommends that Mr Denshire needs to continue with his psychologist and have at least one session with a consultant psychiatrist. This recommendation goes to my earlier concern about the lack of evidence from a psychiatrist in this case, and is where the issue really comes to the front. Neither doctor briefed is appropriately qualified to comment on or recommend alternative psychiatric treatments. Dr Gorman's recommendation is well made - it is a matter for a psychiatrist.
3. Whilst Dr Hardy suggests that "most available and potentially helpful alternative treatments have been tried or earnestly considered", there is no commentary on what those alternatives are. Dr Hardy has not commented on the lack of attendance with a psychiatrist. The applicant's issues with Sertraline do not support the use of medicinal cannabis (as suggested in submissions) - if anything, given his ongoing issues when he comes of that medication, suggest that he should remain on it. However, I am not a psychiatrist and it is not appropriate that I make a conclusion on that basis. Other treatment modalities may exist, including specific in or out-patient post-traumatic stress disorder treatment. Given the applicant has the onus to prove, this absence of evidence does not favour that the treatment is reasonably necessary.

1. Cost is not prohibitive in this case. It is described as "expensive" at $300 per month, but were the other relevant criteria satisfied, I do not think that would be an impediment to me finding in favour of the applicant.

1. Here there is some lay evidence of the effectiveness of the treatment for Mr Denshire. He finds it very helpful, as set out in his third statement. It improves his sleep and helps regulate his emotions during the day, and is helpful for the ongoing management of post-traumatic stress disorder symptoms. I have given significant weight to Mr Denshire's experience in that regard.
2. Dr Hardy acknowledges this in his opinion and suggests that whilst the side effects are a potential concern, research has shown that those are minor. He suggests that "a trial with medicinal cannabis thus is not an unreasonable next step in treatment". Again, I would suggest a trial has already been undertaken with reasonable success, although as Dr Cooke suggests, without a great deal of supervision.
3. Dr Cooke expresses some concern about Mr Denshire's status as a prior user, the lack of supervision, and the inadequate dose supervision. The applicant, in submissions, attempted to address this through the way I would express any order (through the supervision of a general practitioner), but that is not a matter that I would be able to comment on. I accept that I could order treatment on a supervised basis but absent a specific recommendation, could no go further.
4. Dr Gorman does not believe that it would be helpful, but more for concerns with addiction. He also suggests that the sedation may reduce his psychological stress initially but it means he cannot drive which will limit improvement in functioning. I do not find this aspect of Dr Gorman's opinion particularly persuasive. It is not clear how an ability to drive is a contraindicator for the treatment or counter to its effectiveness.

1. This is the aspect of the applicant's case that is potentially the least satisfactory. Dr Gorman opines that medicinal cannabis is accepted by the TGA (Therapeutic Goods Australia) for chronic pain but not accepted for post-traumatic stress disorder, and that it is not supported by the Faculty of Pain Medicine or the Royal ANZ College of Psychiatrists.
2. Whilst in general terms I accept the applicant's submission that each case turns on its own facts, there is some force in the opinion of Dr Gorman with reference to the blanket lack of support of medicinal cannabis for post-traumatic stress disorder. This is exaggerated in present circumstances where I do not have the opinion of a psychiatrist to comment on the specific aspects of Mr Denshire's case that would place it outside of the general recommendation of the college.
3. In terms of the medical evidence before me, there are competing opinions as to whether it is accepted. I have outlined Dr Gorman's opinion above, who does not support it. In spite of his reliance on the general position taken by the college of psychiatrists, I am satisfied that a fair reading of his report shows that he has considered Mr Denshire's specific factual circumstances. He takes a fair history of injury and functioning that does not undermine his opinion.
4. Dr Hardy is of a different opinion. He states that the treatment has been accepted by medical experts across a broad range of disciplines, and references research that suggests a third of scripts written for medicinal cannabis were for mental health reasons.
5. Dr Cooke describes acceptance as "an evolving area", including for anxiety and psychosis, but this opinion is based on "personal communications with Professor Pat McGorry". He does note the potential for psychosis. It is hardly an unequivocal voice of support for the treatment, particularly in circumstances where the potential for abuse is noted, and Dr Cooke's concerns about supervision and dosage.

1. Although I have dealt with the Diab criteria in a systematic way, consistent with how the case was presented by the parties, the essential question is whether the treatment is reasonably necessary. The applicant must prove his case on the balance of probabilities.
2. The applicant provides evidence, from a lay perspective, that medicinal cannabis has been useful to him in the treatment of his ongoing post-traumatic stress disorder symptoms. This lay evidence is just one piece of the puzzle, and the case must be considered on all of the evidence. Otherwise every dispute where the applicant achieves some benefit for treatment would be necessarily decided in favour of the worker. It is not simply enough to say that it is better that the worker have it than not.
3. The applicant finds some support in the medical evidence. Dr Hardy supports it, largely unequivocally. Dr Cooke, his treating general practitioner, provides somewhat more circumspect report. Dr Gorman, for the respondent, does not support the treatment as being reasonably necessary.
4. As I expressed earlier, my greatest concern in this case is the lack of evidence from a psychiatrist. This weighs heavily against the applicant. I am being asked to make conclusions without a sufficient medical, or medico-legal expert opinion in support. Whilst I don't doubt that Dr Hardy has a great deal of expertise, as do Dr Cooke and Dr Gorman, they are not psychiatrists. In fact it appears that Mr Denshire has not seen a psychiatrist on a treatment-related basis. He has not undertaken any specific post-traumatic stress disorder related treatment or attended any specific programs designed to treat the post-traumatic stress disorder he suffers with. I find it difficult to accept that most available treatments have been tried, as concluded by Dr Hardy, in the absence of such evidence. Dr Hardy goes further to suggest other potential treatments including Psilocybin and MDMA for "treatment-resistant PTSD". There is insufficient evidence to conclude in present circumstances that Mr Denshire's post-traumatic stress disorder is "treatment-resistant", particularly in the absence of psychiatric opinion in support.
5. There is also the concern around misuse of cannabis. It is not the Commission's role, once treatment has been determined as reasonably necessary, to determine how that treatment is to be used by the applicant. There may be many cases where proposed treatment, that has been approved, is not undertaken. There are certainly cases where there is the potential for misuse, such as matters that involve strong narcotics.
6. However, Dr Cooke notes that there is inadequate supervision and Dr Gorman notes the potential addictive nature of the treatment modality. I must give some weight to that issue. It was addressed as a "risk" issue which may be appropriate, but that does not mean that I can ignore it.
7. Further absent from the medical evidence in this case is the actual prescriber of the past treatments claimed and undertaken by Mr Denshire, that were obtained through an online system. Dr Saikia (understandably) has provided no evidence in this case, other than the receipts attached to the Application. His views on the treatment are unknown.
8. In all of the circumstances, and for the reasons outlined above, I am not satisfied that the treatment claimed, on a past and future basis, is reasonably necessary. Accordingly, I will make an award for the respondent.