1. Ms Hartikainen enlisted in the Australian Army in 1984. By the time she enlisted at the age of 19 she already had issues with her knee. She underwent a left lateral meniscectomy in 1980, arthroscopies on the left knee in 1980 and 1981 and an arthroscopy scar revision in 1982.[10]
2. In August 1986 Ms Hartikainen experienced pain in her left knee whilst playing netball.[11] She reported the pain on 22 September 1986.[12] After an arthroscopy a surgeon recommended that she undergo a patellectomy of the left knee. The procedure involved the removal of the left knee cap. It was a common enough procedure at the time. It is not a procedure that is performed anymore. It alters the mechanics of the knee joint and leads to adverse consequences in the short and long term. She underwent the surgery on 10 April 1987.[13] The results of the surgery for Ms Hartikainen were not good.[14] From 1987 onwards she complained that the knee collapsed unexpectedly was very painful. She was prevented from engaging in a range of activities as a result of symptoms.
3. Ms Hartikainen left the Army in 1989. Despite her left knee symptoms, she continued to work.
4. In 2004 Ms Hartikainen was experiencing lower back pain and was referred for scans.
5. In 2011 Ms Hartikainen submitted a claimant report to the Department of Veterans Affairs in relation to lumbar spondylosis said to have originated from an incident in September 1984 when she bent down to pick up a blanket.[15]
6. On 27 November 2012 Ms Hartikainen was assessed for the purpose of preparing a rehabilitation report. It reports that Ms Hartikainen:
   • walked with a significant limp;
   • required a walking stick;
   • experienced knee collapse; and
   • reported that her back pain resulted from her altered gait and posture.[16]
7. A Home Assessment dated 26 November 2014 reported:
   • Ms Hartikainen had permanent knee dysfunction following patellectomy;
   • her walking was limited to approximately 50 metres;
   • she was in constant use of a cane; and
   • she was experiencing chronic low back pain.[17]
8. In support of a subsequent claim Ms Hartikainen gave a statement in 2013. She noted as follows:

I had to struggle with the effects of the eventual removal of my left knee cap, which in turn due to the way I walked with a limp put more pressure on my back injury. In turn, I began to rely heavily on my right knee which has since developed similar symptoms to the left knee due to the twisting type motion that I have developed due to the chronic pain in my lower back and left knee.[18]

9. A claim for compensation was submitted in relation to lumbar spondylosis on 8 September 2014. Liability for the injury was accepted on 23 September 2014, but the claim for permanent impairment compensation was rejected on 13 October 2014. The claim was rejected on the basis that the impairment had to be assessed under the Compensation (Commonwealth Government Employees) Act 1971 (the 1971 Act) and no lump sum compensation in relation to lumbar spondylosis was provided for under the 1971 Act.
10. Ms Hartikainen sought review of that decision. In the context of that review reports were sought from Associate Professor Outerbridge. In a report dated 17 February 2015 Associate Professor Outerbridge concluded:

It is my opinion that Ms Hartikainen's current problem is unrelated to the incident on 13 September 1984. It is also my opinion that Ms Hartikainen's current problem is most likely related to her post-military employment.[19]

11. In a reviewable decision dated 25 February 2015 a delegate determined that Ms Hartikainen was not entitled to compensation as there was no impairment due to the injury suffered on 13 November 1984.
12. Ms Hartikainen lodged a further claim for permanent impairment on 7 November 2020.
13. On 5 October 2021 a reconsideration on own motion was undertaken by a delegate of the decision accepting liability dated 23 September 2014. The date of injury was amended to 3 July 2004. On 19 October 2021 the applicant was advised that if it made an election to accept compensation under s 24 the delegate would determine a degree of impairment at 10%. On 5 January 2022 that assessment was formally determined. The applicant sought review. The decision under review was affirmed on 27 January 2022. The applicant then applied to the Administrative Appeals Tribunal for review.
14. Both parties sought further medical evidence in relation to Ms Hartikainen's condition. Reports were prepared based on the documents briefed.

1. Dr Bell prepared two reports dated 19 November 2025. He concluded that Ms Hartikainen suffered from severe lower back pain, progressively worsening, most likely form 2003 or 2004. The date of first onset was noted as 2003. He expressed the view that over a period of time 'multiple discs have degenerated which is largely a genetic aetiology combined with smoking history, which has become symptomatic in approximately 2003. When asked about the connection to military service, Dr Bell concluded:

Given the onset in 2003 at age 35 and the multiple discs that deteriorated over time, it is my opinion that her disc degeneration was driven by genetics. I am also of the understanding Ms Hartikainen was a cigarette smoker and this would have also contributed. I do not consider there is any evidence to suggest it was secondary to her strain as a 19-year-old in 1984. Of note, in her employment history, it is possible repetitive bending and lifting required of a Nurse could have contributed to progression of lumbar spondylosis. This job would be more physically demanding than what was required of her when serving in the Australian Army.[20]

1. In response to the question 'How does the removal of the patella alter knee biomechanics and gait mechanics, and how would this predictably affect other joints over time?' Dr Bell said:

Patellectomy generally leads to loss of extensor strength, leading to persistent knee flexion. This places excessive load through both the knee joint and adjacent soft tissues, predisposing them to degenerative change. It also creates a functional leg length difference, tilting the pelvis and placing increased strain through the spine...[21]

...in my opinion the asymmetric load could have contributed as described [to degenerative changes in the lumbar spine caused by compensatory weight-bearing]...From the documentation it is difficult for me to determine the relationship of the right knee, hips, and lumbar spine. Gait, not doubt, was altered due to the function of the left knee, but her decreased mobility would likely place less force through the right knee and thus, an argument for it being due to compensating for the left cannot clearly be made. For the lumbar spine, the altered gait would aggravate any degenerate condition due to asymmetric load going through the spine. I consider it is therefore reasonable to correlate these two.[22]

1. In a supplementary report dated 3 December 2025 Dr Bell commented on the service contribution to the altered gait and to lumbar deterioration in the following terms:

As noted previously, there is actually a complete absence of documented lower back pain from 1984 through to 2004. With respect to the altered gait and the left patellectomy, this was adequately covered in my original report where I did note lower back pain could be exacerbated or aggravated by altered gait. This is distinct from the musculoligamentous injury to the sacroiliac joint region in 1984.[23]

1. Dr Journeaux prepared a report in relation to Ms Hartikainen's lumbar spondylosis dated 24 May 2023. He concluded that the date of onset in relation to the lumbar spondylosis was 5 July 2004. His view was that the condition arose because of constitutional degenerative change. It was Dr Journeaux's view that there were no employment related factors either military or non-military that contributed to Ms Hartikainen's lumbar spondylosis.
2. Dr Journeaux prepared a supplementary report dated 9 May 2024 which is not presently relevant.
3. Dr Journeaux prepared a further report dated 12 January 2026. The report clarified his assessment of Ms Hartikainen's degree of impairment under Table 9.6 of the Guide to the assessment of the degree of permanent impairment 2.1.

1. Mr Bridges also gave evidence concerning Ms Hartikainen's gait.

1. As the respondent submits, the overwhelming weight of the evidence supports the conclusion that Ms Hartikainen's lumbar spondylosis was not materially contributed to by her service in the Army. The theory that the alteration to Ms Hartikainen's gait caused by her left knee injury was responsible for the development of her back pain and that her lumbar spondylosis is a sequelae to her accepted left knee injury was considered by both the applicant's and the respondent's independent medical specialists.
2. Dr Bell, the applicant's independent medical examiner in his report dated 19 November 2025 concluded:

(a) The lower back injury Ms Hartikainen sustained in 1984 was likely a muscle or ligamentous strain and was unlikely to have resulted in any disc injury; > > (b) There is no evidence to suggest that Ms Hartikainen's lumbar spondylosis was secondary to the 1984 strain; > > (c) The degeneration of Ms Hartikainen's discs in the lumbar spine observable on scans is caused by a genetic predisposition rather anything related to military service.

3. In relation to the possibility that the altered gait caused by Ms Hartikainen's left knee injury was responsible for impairment arising from her lumbar spondylosis, Dr Bell indicates that he does not think that the altered gait caused the lumbar spondylosis. He is clear that genetic factors and smoking are the fundamental causes. He is however prepared to accept that it is reasonable to correlate the gait with increased pain in the degenerate spine. This is at best weak evidence of an aggravation of Ms Hartikainen's spine condition that is contributed to some degree by the altered gait. I could not be reasonably satisfied on the basis of this evidence that the applicant's military service through the mechanism of the left knee injury, contributed to a material degree to an aggravation of lumbar spondylosis.
4. Dr Journeaux, the respondent's independent medical examiner was clear that there was no contribution to Ms Hartikainen's lumbar spondylosis from her service. He concluded after a review of documents relating to Ms Hartikainen's medical history that:

(a) He was unable to identify a significant injurious event that occurred to Ms Hartikainen's lumbar spine; > > (b) Ms Hartikainen likely fully recovered from the musculoskeletal sprain/strain she sustained in September 1984 (i.e. the event which the respondent previously accepted was causative of her lumbar spondylosis); > > (c) Ms Hartikainen's lumbar spondylosis has arisen because of constitutional degenerative change; and > > (d) There are no employment related factors either military or non-military that have contributed to the condition.

5. Dr Journeaux was cross examined on the effect of Ms Hartikainen's gait alteration arising from her left knee issues. His evidence was that an abnormal gait doesn't generally cause an injury.
6. The applicant also raised various briefing issues concerning Dr Journeaux. The applicant raises the possibility that Dr Journeaux did not have access to Ms Hartikainen's treating orthopaedic surgeon, Dr Lawrie's reports. Based on his answers in the hearing I am satisfied that he did have access to those reports. Even if he did not, having reviewed those reports I cannot find anything recorded in them that would support a conclusion that Dr Lawrie accepted that the applicant's left knee condition led her lumbar spondylosis.
7. I am also satisfied that Dr Journeaux had access to the Army Medical History Questionnaire dated 8 June 1989.
8. Even if I accepted that Dr Journeaux's briefing was inadequate or deficient (which I do not) that still leaves the difficulty of the applicant's own doctor not providing sufficient evidence to support a conclusion that there was contribution from the applicant's gait to a material degree.
9. In addition, when Ms Hartikainen was examined by an Associate Professor Outerbridge in 2015 he did not posit the applicant's gait as the likely cause of her back pain. He identified Ms Hartikainen's post-service work as the likely cause.
10. In these circumstances I am satisfied that Ms Hartikainen's lumbar spondylosis does not meet the necessary statutory threshold to be classified as an injury. I am not satisfied that the ailment she suffered from, lumbar spondylosis, was materially contributed to by her service. Satisfaction that an 'injury' results in permanent impairment is an essential element for a payment of compensation under sections 24 and 25. Notwithstanding the earlier findings of delegates that Ms Hartikainen's lumbar spondylosis did amount to an injury, on the evidence before me that conclusion is not sustainable and must be revisited consistently with the principles set out in Telstra Corporation v Hannaford[24].
11. In light of that finding, the applicant's claim for compensation under ss 24 and 25 of the DRCA cannot succeed.

1. The decision under review is set aside and in substitution I decide that no compensation is payable under ss 24 and 25 of the DRCA in relation to Ms Hartikainen's lumbar spondylosis as I am not satisfied that her ailment was contributed to to a material degree by her employment.

Dates of Hearing 27 January 2026 and 6 February 2026

Respondent's solicitor Australian Government Solicitor

[1] T Documents (2022/4696), T15, 75-82.

[7] The date of disease for the purpose of s 7(4) of the DRCA is when Ms Hartikainen first sought medical treatment for a lower back condition. That was on or around 5 July 2004.

[8] Report of Dr Simon Jorneaux dated 24 May 2023 (Hearing Book, 173). Report of Dr Christopher Bell concerning lumbar spondylosis dated 19 November 2025 (Hearing Book, 68).

[9] This document was not exhibited during the hearing but relied upon in the applicant's written submissions that were handed up during the hearing.

[10] T Documents (2022/2106), T5, 71; T11, 89.

[14] Report of Dr Christopher Bell concerning left knee condition dated 19 November 2025 [6], [14].

[16] Extract of s 26 documents (2022/2106), 5.

[17] Section 29 Home Asessement Summary Report dated 4 December 2026.

[20] Report of Dr Christopher Bell, orthopaedic surgeon concerning lumbar spondylosis, including letter of instruction dated 19 November 2025 (Hearing book, 68).

[21] Report of Dr Christopher Bell, orthopaedic surgeon concerning left knee condition, including letter of instruction dated 19 November 2025 (Hearing book, 86).

[23] Supplementary report of Dr Christopher Bell, orthopaedic surgeon including email requesting clarification dated 3 December 2025.

[24] Telstra Corporation Ltd v Hannaford (2006) 151 FCR 253.