WORKERS COMPENSATION - accepted ankle condition - the Tribunal is not satisfied that the applicant continues to suffer from the effects of his accepted left ankle condition - no entitlement to medical treatment or incapacity benefits - decision under review affirmed.

Safety, Rehabilitation, and Compensation Act 1988 (Cth) ss 14, 16, 19

1. Mr Howard is a truck driver employed by Linfox. He is aged 60 years.
2. In December 2009, Mr Howard twisted his left ankle. He successfully lodged a claim for worker's compensation for a severe inversion sprain in March 2011. Compensation up to and including 14 April 2011 was payable under section 14 of the Safety, Rehabilitation, and Compensation Act 1988 (Cth) (the Act). Mr Howard has sought to reopen this claim.
3. In July 2023, Mr Howard was found to have no present entitlement to compensation under sections 16 and 19 of the Act arising from his accepted left ankle condition. The Delegate relied upon the evidence of Professor Peter Steadman, an orthopaedic surgeon, to be satisfied that Mr Howard's current condition is a different and unrelated condition to his accepted condition. This determination was affirmed on 15 September 2023 and is the reviewable decision.
4. The threshold issue for the Tribunal is whether Mr Howard continues to suffer from the effects of his accepted left ankle condition.
5. The evidence is that Mr Howard twisted his left ankle during a bulk newspaper delivery at night in December 2009. There was uneven ground with building rubble in a laneway, with a pothole. It is uncontroversial that Mr Howard's injury arose out of his employment.
6. On 2 July 2010, being after the injury but before surgery, a magnetic resonance imaging (MRI) scan was conducted of Mr Howard's left foot and ankle. Dr Nick Wambeek addressed a report to Mr Howard's orthopaedic surgeon, Dr Reza Sellah.
7. Dr Wambeek reported on a cystic lesion of the lateral talar dome and considerable surrounding marrow odema. The report commented on evidence of previous ankle trauma, with a large lateral cystic talar dome lesion with florid surrounding oedema. There was evidence of a healed anterior talo-fibular ligament injury with anterolateral gutter synovitis. Mr Howard's peroneus brevis tendon was split, but otherwise he had normal mid foot alignment with no evidence of Lisfranc injury.
8. Mr Howard required keyhole surgery to his ankle in March 2011. He was compensated. He returned to work and has conducted his pre-injury duties since then.
9. Mr Howard sought to reopen his claim in 2015. In an email dated 3 September 2015, Mr Howard stated that his foot was fine after his operation, that he no longer needed orthotics, but that it had niggled occasionally. Mr Howard said though that in the preceding couple of months that he had taken to wearing orthotics. Mr Howard's efforts to reopen his claim were supported by a letter dated 31 August 2015 from Dr Nima Elahi.
10. In November 2016, Mr Howard underwent an MRI of his left foot and ankle, having been referred by Dr Andrew Mattin. In his report, Dr Wambeek commented on Mr Howard's previous ankle sprains with ligamentous injuries and noted a healed lateral talar dome lesion. Dr Wambeek opined that Mr Howard's ganglion probably arose from the lateral talonavicular articulation, although it was possible that it arose from the torn anterior talofibular ligament. Dr Wambeek also commented on Mr Howard's peroneus brevis tendinopathy, and peroneal tenosynovitis.
11. There is some evidence of an incident in 2017 whilst Mr Howard was loading a truck. However, any injury arising from that incident falls outside the ambit of current proceedings.
12. In 2023, Mr Howard reported pain in his left ankle. He suffers sharp pain within the ankle joint. This pain is of a similar intensity to the pain Mr Howard suffered prior to his March 2011 surgery.
13. Mr Howard's evidence is that his ankle pain cannot be massaged or accessed from the outside of the ankle. It differs from the occasional discomfort that Mr Howard suffers in his calcaneofibular ligament. Mr Howard can use a massaging device to manage his occasional calcaneofibular ligament and tendon discomfort, but he is not able to do so to manage the pain arising from inside his ankle.
14. Mr Howard regards his ankle pain symptomology as arising out of his accepted ankle condition and has sought prescription orthotics for his work boots accordingly.
15. Mr Wesley Huck, a podiatrist, has been treating Mr Howard since his original injury. Mr Huck has examined Mr Howard. Mr Huck has assisted him with identifying movements that place stress on the site of his injury and helped him to modify his technique of climbing into and out of trucks.
16. Mr Huck's suggested techniques has helped to reduce Mr Howard's symptomatology. Mr Huck has palpated Mr Howard's calcaneofibular ligament, producing tenderness. Mr Howard says that this tenderness is of a different nature to his pain from within his ankle.
17. In a report dated 22 April 2023, Mr Huck expressed his belief that Mr Howard's symptoms are associated with the original injury and surgery. A review was then conducted by Professor Steadman.
18. Professor Steadman referred Mr Huck for a further MRI of his left ankle. A report of 31 May 2023 was produced by Dr Sam Cherian. An image from this MRI was used by Professor Steadman to explain his opinions during the hearing. In his evidence to the Tribunal, Professor Steadman noted that Mr Howard's ligament was intact on the previous scars that arose from surgery. He was therefore of the opinion that something had happened to Mr Howard since surgery.
19. In essence, the Respondent's contention is that the chain of causation since the original injury and surgery has been broken by an intervening event in Mr Howard's ankle.
20. Professor Steadman wrote a report dated 28 June 2023 following an assessment that was conducted via video conference, which Mr Huck attended. In that report, Professor Steadman expressed an opinion that the current status of Mr Howard's ankle is not a progressive consequence of his accepted left ankle condition because Mr Howard's talar dome injury has improved and healed. In summary, the keyhole surgery performed on Mr Howard was successful.
21. In his oral evidence, Professor Steadman said that there was a new odema in Mr Howard's ankle that was not present in 2016. Professor Steadman distinguished between symptoms and signs and attributed the pain and discomfort that Mr Howard suffered as arising from the odema.
22. Professor Steadman's oral evidence is consistent with supplementary medical report of 7 September 2023, which also considered the report of Mr Huck dated 16 September 2023 and compared MRIs from June 2010, November 2016 and May 2023. Professor Steadman's evidence is clear that he believes that the accepted left ankle condition is not the source of Mr Howard's pain.
23. The evidence of Dr Salleh differs from that of Professor Steadman. In a letter dated 2 February 2024, Dr Salleh opined that the irregularity of the lateral talar dome with subchondral cyst formation is the cause of Mr Howard's pain. Dr Salleh opines that chondral damage cannot heal and predisposes Mr Howard to ongoing pain. As meritorious as this opinion may be, Dr Salleh did not appear at the hearing and his opinion was unable to be tested or inquired into in further regarding the chain of causation. This lessens the weight of Dr Salleh's evidence to the extent that it is contradicted by Professor Steadman.
24. There is a wealth of medical evidence before the Tribunal, which has been considered holistically and the material parts have been repeated above. This evidence does not allow the Tribunal to be reasonably satisfied that Mr Howard continues to suffer from the effects of his accepted left ankle condition.
25. The Tribunal is satisfied that Mr Howard suffers pain within his ankle and that pain is similar in nature to that which he suffered from his accepted left ankle condition. The treatment Mr Howard receives is beneficial to him. However, the balance of the evidence does not allow the Tribunal to attribute Mr Howard's present symptomology to his accepted condition.
26. The Tribunal is satisfied from Professor Steadman's evidence that Mr Howard's surgery on his ankle was successful. The Tribunal accepts Dr Salleh's evidence that Mr Howard has a predisposition to developing ongoing pain in his ankle. However, the Tribunal places greatest weight on Professor Steadman's evidence that the accepted left ankle condition is not the source of Mr Howard's pain. There is strength to Professor Steadman's evidence that this pain is caused by Mr Howard's odema, but the Tribunal does not make a positive finding of fact in this regard and nor must it. It is sufficient that the Tribunal is reasonably satisfied that Mr Howard's current condition is a different and unrelated condition to his accepted condition.
27. Accordingly, the Tribunal is not satisfied that Mr Howard continues to suffer from the effects of his accepted left ankle condition. Accordingly, he does not require ongoing medical treatment in respect of his accepted left ankle condition under section 16 of the Act and is not entitled to incapacity benefits under section 19 of the Act. The Tribunal must therefore affirm the decision under review.

1. The Tribunal affirms the decision under review.

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