(a) Application to Resolve a Dispute and attachments, and

(b) Reply and attachments.

A brief statement is attached setting out the Commission's reasons for the determination.

1. Phillip Griffiths (the applicant) sustained an injury to his left knee whilst employed by the Department of Communities and Justice (the respondent) on 26 April 2021. He underwent surgery, rehabilitation and pain management and was medically retired in 2025. He now claims lump sum compensation resulting not only for impairment arising from the left knee injury but also consequential conditions to the right knee and lumbar spine which he claims result from his left knee injury.
2. The claim was assessed by the respondent's insurer. Liability has been accepted for the left knee condition but declined for the right knee and lumbar spine on the basis that it was considered such conditions were not consequential to the left knee injury. No offers were made for the left knee as impairment was assessed below threshold.
3. Given the above, an Application to Resolve a Dispute (ARD) was filed in the Personal Injury Commission (Commission). The matter underwent the usual case management pathway and after conciliation impasse, I proceeded to determine the matter.
4. At conciliation/arbitration, Mr Hanrahan of counsel instructed by Ms Burgess represented the applicant. Mr Stockley of counsel instructed by Ms Ralph represented the respondent. Mr Rivett was the insurer representative.
5. The issues for determination is whether the claimed consequential conditions to the right knee and lumbar spine result from the accepted injury to the left knee.
6. No oral evidence was called. The documents before the Commission were limited to the ARD and Reply.

1. By way of written statement dated 17 July 2025[1] the applicant recites the injury on

26 April 2021 when he slipped and his left knee twisted resulting in pain and swelling. After a cortisone injection and conservative treatment, he proceeded to arthroscopy. Surgery "failed" and he embarked on a pain management program. 2. He states abnormal gait has resulted in an increase in pain to both knees and lumbar spine. He now relies on a walking stick and has "been overusing my right leg and overcompensating it". 3. Dr Bodel was qualified by the applicant. He physically assessed the applicant and reviewed the notes of the Windmill Practice in Tamworth and the "extensive physiotherapy treatment reports". In his report dated 10 January 2025,[2] he records the history of injury to the left knee and surgical progress noting that a left knee replacement has been suggested but deferred. 4. As regards the right knee and back he recorded "the right knee is getting worse. He is also developing some back pain because of his abnormal gait pattern and he has pain in the foot and ankle". 5. On examination he observed restriction in movement of both knees and tenderness on palpation of the lumbosacral junction. 6. His report incorrectly refers to injury to the right knee on 26 April 2021 (the injury was to the left knee). He considered the right knee was subject to injury on this date with an aggravation of degenerative change in both knees and in the lumbar spine. He reported the conditions reached maximal medical improvement and provided an impairment assessment of both knees and the lumbar spine. 7. In his supplementary report dated 5 August 2025[3] he corrects the above error. As regards causation he initially postulates in addition to the frank left knee injury, symptoms in the right knee and back are due to the "nature and conditions" of his employment "in general". He then proceeds to report "employment is a substantial contributing factor to the consequential injury to the right knee and lumbar spine for the reasons outlined above", referring to his assessment of the respondent's medico legal report, relevantly; (unedited)

"Dr Powell indicates that the right knee symptoms developed postoperatively after the operation on the left knee when he was favouring that right side because he had pain in the left knee and the lower back pain came on approximately 12-18 months later, again because of the abnormal gait pattern.

Dr Powell is quite correct in indicating that the pathology in those other areas, being the right knee and the lower back has not been caused by work but the injury has occurred because of aggravation, acceleration, exacerbation and deterioration of underlying disease processes in both areas, with the degenerative disc disease in the lower part of the back and the early arthritic change in the region of the right knee which is constitutional and predetermined pathology in both areas. The injury is the aggravation, acceleration, exacerbation and deterioration of the disease process"[4].

1. The consultation notes of the Windmill Medical Centre were attached to the ARD. They commence on 13 August 2020. The injury to the left knee on 26 April 2021 was reported on

7 May 2021.[5] 2. On 16 June 2021, it was recorded the applicant was "favouring the knee"[6] and the left knee had deteriorated. On 14 June 2022[7] "right knee and back pain as has been compensating" was recorded. On 19 September 2022[8], poor recovery from left knee surgery was documented with "rt knee and back pain from compensation for pain in the left knee". Examination on that day recorded the applicant walked with a limp, had limited extension of both knees and limited movement of the back. Similar findings were recorded at examination on 25 October 2022[9] and 18 November 2022[10] with complaints of pain with sitting and standing for prolonged periods and sciatica. 3. The records reveal ongoing complaints of back pain on 8 December 2022,[11]

19 January 2023,[12] 28 February 2023,[13] 3 April 2023,[14] 2 May 2023,[15] and 18 July 2023[16] with pain and restriction of movement in both knees. 4. Consultations on 28 March 2023, 28 August 2023 and 27 September 2023 are silent on right knee symptoms but record ongoing left knee and back pain. On 30 May 2023 back pain and left knee pain was recorded as "possibly mechanical due to exercise plan".[17] 5. Jake McManus, physiotherapist in his report 1 September 2021[18] recorded good progress with left knee injury but "R knee is aggravated at the moment". On 14 November 2022[19] ongoing bilateral knee and back pain was again documented. 6. Dr Gooden, orthopaedic surgeon, on 28 April 2022[20] in his post-operative report recorded pain with mobilising with antalgic gait and some residual swelling. He noted the complaint of pain in the right knee which he considered was "likely the result of the increased weight he has put through his right knee". 7. In his report dated 15 September 2022[21], he recorded complaints of bilateral knee pain and back pain. The right knee was noted to be "irritable". MRI investigation was sought. 8. Following review of the MRI on 14 October 2022,[22] Dr Gooden noted the findings in the lumbar spine did not demonstrate any major compression of the lumbar spinal nerves. The left knee MRI showed a stable medial meniscus but "evolving patella-femoral osteoarthritis". The right knee MRI revealed a small tear of the lateral meniscus with "early chondral wear in the medial compartment and retro-patellar region". Non-surgical management was recommended but arthroplasty was forecasted if the pain and functional profile deteriorated. He suggested intervention by a sports physician to "get his back and lower limb symptoms under control".[23] 9. Jessica Barker, exercise physiologist in her report dated 15 September 2022[24] recorded pain in the left knee but also "increasing pain and symptoms on his right hand side, including lower back and sciatic symptoms in the right leg". She reported this to be due to his "compensatory movement and stance patterns" where he is avoiding weight bearing on his left lower limb". 10. Dr Jonathan King, sports physician on 9 December 2022[25] documented dysfunctional movement in the bilateral knees and lower back as being responsible for symptoms as opposed to any specific pathology. At assessment on 24 April 2023,[26] he took a history the applicant informed him the knees were "feeling good" and that he was doing more exercise. On 22 May 2023, he discharged the applicant from his care considering that there were no further treatments he could offer as "psychosocial health appears to be more important and this will impact his physical functioning". 11. A referral to pain specialist on 21 June 2023[27] recorded ongoing left knee pain following surgery which "has now affected his rt knee and back". 12. Pain specialist, Dr Cartwright in her report dated 16 August 2023[28] took a history of the injury to the left knee but also recorded the complaints of the development of pain in the right knee and low back pain "secondary to reduced activity compared to his previous". 13. In a referral to the physiotherapist dated 24 December 2019[29] following a torn left calf muscle (the subject of a previous claim) a past history summary between 2002 and 2018 records no attendances relating to the lumbar spine or bilateral knees. An identical history is recorded in the referral to Dr Gooden dated 18 May 2021.[30]

1. In summary, on behalf of the applicant it was submitted;

(a) the applicant has been straight forward in his presentation and is credible;

(b) the medical evidence establishes a clear link to symptoms in the right knee and lumbar spine due to the antalgic gait that resulted from left knee injury, extensive rehabilitation and failed surgery, that is, the conditions are consequential;

(c) the applicant has been brief in his statement but it is consistent with the medical chronology. He has attended the same practice and been referred to multiple practitioners. There is no history of symptoms to the right knee or lumbar spine until after the left knee injury at work. There is no other cause or explanation for the symptoms. As a matter of common sense, in the absence of any other injury, the claimed consequential conditions result from the left knee injury;

(d) Dr Bodel does initially state that the symptoms are due to injury and the nature and conditions of his employment. This is not the case the applicant relies on. The applicant maintains that his conditions are consequential to the left knee injury and the respondent has acknowledged this in its s78 notice and via its qualified opinion. Dr Bodel has also referred to consequential conditions in his report, albeit probably not to precision demanded by the respondent, however this cannot be fatal to the applicant's case;

(e) the only medical opinion which disputes consequential conditions is that of Dr Powell, qualified by the respondent. Dr Powell acknowledges antalgic gait but dismisses the claim for consequential condition on the basis that such antalgic gait would not be sufficient to aggravate underlying pathology. He has failed to engage with the evidence and complaints of the applicant. The establishment of a consequential condition does not require aggravation of underlying conditions but rather a global assessment of symptoms and the evidence, and

(f) given the above, it is appropriate that the matter be referred to a medical assessor for assessment of all areas claimed.

1. The respondent qualified Dr Powell, orthopeadic surgeon. In his report dated 30 April 2025[31] he documented the left knee injury, surgical intervention and subsequent rehabilitation modalities. He reported the development of right knee symptoms following the left knee arthroscopy and low back pain about 12 to 18 months after the surgery without precipitating incident.
2. On examination he noted restriction in range of motion in the lumbar spine and "an antalgic gait reflecting contribution from both knees". He recorded marked irritability in both knees more severe on the left side. He concluded the symptoms in the right knee and lower back could not be explained on the basis of the pathology identified in the MRI scans and concluded employment did not represent the main contributing factor in the development of any injury involving the lower back or right knee. Further, any alteration in the biomechanics related to the left knee injury were insufficient to have caused "any structural pathology in the right knee".[32] As regards the lumbar spine he noted the MRI did not demonstrate any significant structural pathology and current lumbar spine symptoms could not be explained directly or consequentially by the workplace incident on 26 April 2021. He documented a possible psychosomatic component to the overall presentation.

1. In summary, on behalf of the respondent it was submitted;

(a) there is no dispute the applicant suffered injury to the left knee and it is appropriate its impairment be assessed by a medical assessor;

(b) the applicant must demonstrate a logical connection between the left knee injury and any condition in the lumbar spine and right knee. He relies on the report of Dr Bodel which attributes symptoms to the nature and conditions of employment, however this is not the claim pleaded. Dr Bodel's report does not directly support the claim of consequential conditions as pleaded. The applicant has failed to provide evidence that is logical and probative and the evidence falls short of meeting the standards required. The report of Dr Bodel fails to established a causal link or a chain of causation which passes the common sense test;

(c) further the applicant's statement fails to adequately explain how the injuries or conditions in the right knee and lumbar spine came to be. His statement says nothing about the pre injury status. In these circumstances it is impossible to assess whether the conditions as pleaded "result from" the injury to the left knee;

(d) it is reasonable to accept that left knee surgery resulted in limping which may have caused symptoms but there is insufficient evidence in the qualified evidence to support this, and

(e) given the above, there should be an award for the respondent with respect to the claims for consequential condition of the right knee and lumbar spine.

1. There is no dispute that the applicant has sustained a left knee injury on 26 April 2021 with reference to s 4 of the Workers Compensation Act 1987 (the 1987 Act).
2. The epicentre of this dispute is whether such injury has resulted in the consequential conditions of the right knee and lumbar spine as claimed by the applicant.
3. The 1987 Act does not define a consequential condition. Authorities establish the following key principles (which by no means are exhaustive):

(a) the applicant bears the onus of establishing the existence of a consequential condition on the balance of probabilities[33] (Kumar);

(b) each case must be determined on its own facts;

(c) it is unnecessary for an applicant alleging such a condition to establish that it is an 'injury' (including 'injury' based on the 'disease' provisions) within the meaning of s 4 of the 1987 Act[34] (Moon);

(d) in order to establish a condition, there is to be a 'common sense evaluation' of the causal chain, determined on the basis of the evidence, including expert opinions[35] (Kooragang);

(e) a finding of a consequential condition does not require the identification of pathology[36] (Kumar);

(f) a consequential condition occurs when an applicant experiences a new injury or condition due to the effects or consequences of their original work-related injury;

(g) reliable and contemporaneous medical evidence plays a significant role in establishing causation[37] (Ireland);

(h) there must be an unbroken chain of causation from the injury to the development of the consequential condition; (Kooragang);

(i) it is not necessary the applicant prove he suffered from 'injury' to the conditions claimed to be consequential, all he needs to demonstrate is that the symptoms arise from the accepted left knee injury;

(j) the test of causation in a claim for lump sum compensation is the same as it is in a claim for weekly compensation, namely, has the loss 'resulted from' the relevant work injury[38] (Sidiropoulos);

(k) the absence of treatment is not fatal to the applicant's claim of the presence of a consequential condition[39] (Baker), and

(l) the causal relationship must be established on the balance of probabilities from evidence in an acceptable form[40] (Munce).

1. The applicant carries the onus of establishing on the balance of probabilities that the conditions now present in the right knee and lumbar spine resulted from his accepted left knee injury. The content of the standard of proof has been the subject of much judicial discussion and consideration but, for present purposes, it is sufficient to say I must be satisfied to a sense of actual persuasion or affirmative satisfaction that such claims have been made out (Nguyen).[41] It is not necessary that I be satisfied to a degree of medical or scientific certainty but, on the other hand, it will not be sufficient if I am merely satisfied that it is possible that the condition is related to employment.
2. The respondent's criticism of the applicant's qualified evidence is a cogent one. The opinion of Dr Bodel is ambiguous and difficult to understand at first examination. He initially suggests symptoms in the right knee and lumbar spine were due to injury simpliciter, then reports they were due to nature and conditions of employment and ultimately uses the term "consequential".
3. Unfortunately, I am observing this criticism to be more frequent with 'experts' failing to properly consider and/or understand the nuances of terminology as it relates to "injury" and "consequential conditions" and legal practitioners being unable to align or clarify the medical position/opinion with the legal position and definitions.
4. When assessing expert evidence I make the following observations

(a) expert evidence is a species of opinion evidence. A common definition of the term "opinion" is "an inference drawn or to be drawn from observed and communicable data";[42] (Dasreef)

(b) the Commission is not bound by the rules of evidence;[43]

(c) although not bound by the rules of evidence, I must be satisfied the expert evidence provides a satisfactory basis upon which to make findings of fact[44], the acceptability of expert evidence will not be one of admissibility but of weight (Hancock);

(d) for expert evidence to be of any value the facts upon which it is based must be provable by admissible evidence[45] (Ramsay);

(e) Rule 73 of the Personal Injury Commission Rules 2021 requires such evidence to be logical and probative and relevant to the issues in dispute. Unqualified, speculative and unsubstantiated assumptions are unacceptable;

(f) I must draw conclusions and make findings from material that is satisfactory, in the probative sense, to ensure that conclusions reached are not capricious, arbitrary or without foundational material[46] (Onesteel);

(g) it is a question of fact whether the case supposed is sufficiently like the one under consideration to render the opinion of the expert valuable both in terms of principle and common sense[47] (Paric), and

(h) discrepancies in evidence may be fatal; in some cases even slight discrepancies may be fatal; in other cases even broad departures are not likely to affect the force of the expert opinion. It is for the tribunal of fact to assess this factual basis (Paric).

1. The respondent asserts the qualified opinion of Dr Bodel failed to demonstrate either a logical or intellectual basis for the conclusions that he reached.
2. I agree with the respondent the opinion is ambiguous and suggests causation is multifactorial. The qualified opinion is not pristine and the lack of specificity has inflamed the dispute. I so find. I have however formed the view the respondent's criticism is cushioned in an assessment and interpretation of the evidence through a narrow lens. Answers to a series of poorly worded or irrelevant questions in the report do not undermine the balance of the report or the opinions expressed therein particularly in the circumstances where the term 'consequential' is supported by the multiple medical practitioners who treated the applicant at the Windmill Medical Centre, Dr Gooden, Dr Cartwright, Dr King and Jake McManus physiotherapist and Jessica Barker, exercise physiologist. Overall, I find the case supposed is sufficiently like the one under consideration to render the opinion of the expert valuable both in terms of principle and common sense as having weight (Paric) and (Hancock). I further note that the insurer had assessed the conditions as being consequential, and so the frustration, whilst valid, is misplaced here. As indicated above, I do not consider that the entirety of the report is to be discarded. It follows that there cannot be an Award for the respondent on this ground.
3. The respondent also maintained the applicant's statement was deficient which could lead to a finding he has not established his case to the requisite standard. Again, I agree the applicant's statement is sparse but he does refer to an antalgic gait following his left knee surgery with the pronouncement of symptoms in the right knee and lumbar spine following therefrom. The applicant is not a medical specialist. He has been consistent throughout his representations to the doctors. I find his evidence credible. I find the statement which aligns with the bulk of the evidence satisfies the evidentiary onus in these circumstances.
4. The respondent advances that the opinion of its expert should be accepted. Careful review of the report of Dr Powell reveals he has not engaged with the evidence. His conclusion is that the altered biomechanics from the accepted altered gait were insufficient to have caused any structural changes or damage to either the right knee or lumbar spine. His opinion fails to consider whether the accepted altered gait has had any impact apart from structural change, for example muscle strain or pain resulting in restricted movement (as documented by those that have treated the applicant). In claims for consequential conditions, 'injury' such as structural changes, leading to aggravation, deterioration etc do not need to be established (Moon). I so find.
5. I also find the clinical notes of the treating practitioners, physiotherapist, exercise physiologist and various specialists including the orthopod and pain specialist have recorded symptoms in the right knee and lumbar spine on account of favouring and altered gait from the left knee with such symptoms reported as early as three months post injury in June 2021. I find the claim of a consequential condition is not a manufactured one but represents the sequelae of the left knee injury, given the consistent and contemporaneous complaints of pain throughout the life of this claim. (Ireland)
6. I further find there is an unbroken chain of causation (Kooragang) and that conditions in the lumbar spine and right knee have resulted from the injury to the left knee. The evidence demonstrates symptoms in the right knee and lumbar spine only commenced after the injury to the left knee and its treatment. The respondent was critical of the applicant's statement in that he was silent on any pre-existing conditions. Careful review of the past and contemporaneous medical records confirm there were no other factors recorded as being responsible for these symptoms.
7. For the reasons discussed above and with reference to a common sense evaluation, (Kooragang) which has involved scrutiny of the chronology, medical evidence (both treating and qualified) and factual statements, I find the applicant has demonstrated on the balance of probabilities, and with a degree of actual persuasion and affirmative satisfaction (Nguyen) that he has suffered a consequential condition to the right knee and lumbar spine resulting from the left knee injury.

1. I make the findings and orders set out on page 1 of this Certificate of Determination.

[33] Kumar v Royal Comfort Bedding [2012] NSWCCPD 8.

[34] Moon v Conmah Pty Limited [2009] NSWWCCPD 134 (Moon).

[35] Kooragang Cement Pty Ltd v Bates (1994) 35 NSWLR 452 (Kooragang).

[36] Kumar v Royal Comfort Bedding [2012] NSWCCPD 8.

[37] Dept of Education & Training v Ireland [NSWWCCPD 2008]

[38] Sidiropoulos v Able Placements Pty Limited [1998] NSWCC 7; (1998) 16 NSWCCR 123; Rail Services Australia v Dimovski & Anor [2004] NSWCA 267; (2004) 1 DDCR 648.

[39] As DP Roche noted in Baker v Southern Metropolitan Cemeteries Trust [2015] NSWWCCPD 56, there is no requirement for corroboration in the context of a civil case particularly where an injured worker's credibility is not an issue (see also Chanaar v Zarour [2011] NSWCA 199 at [86]).

[40] Munce v Thomson Cool Rooms Pty Ltd [2017] NSWWCCPD 39 at paragraph 101.

[41] Nguyen v Cosmopolitan Homes [2008] NSWCA 246.

[42] Dasreef [2011] HCA 21; (2011) 277 ALR 611 per Heydon J at [53] quoting from Allstate Life Insurance Co v Australia and New Zeeland Banking Group Ltd (No 5) (1996) 64 FCR 73 at 75

[43] Section 43 of the Personal Injury Commission Act 2020

[44] Hancock v East Coast Timber Products Pty Limited [2011] NSWCA11

[45] Ramsay v Watson [1961] HCA 65

[46] Onesteel Reinforcing Pty Ltd v Sutton [2012' NSWCA 282

[47] Paric v John Holland (Constructions) Pty Ltd [1985] HCA 58; (1985) 62 ALR 85)