1. The documents to be reviewed by the Medical Assessor are:

(a) application to Resolve a Dispute and attached documents;

(b) Reply and attached documents, and

(c) respondent's Application to Lodge Additional Documents dated 8 December 2025 and attached documents.

1. The matter is to be listed before me for a preliminary conference following the completion of the Medical Assessment process to deal with the balance of the claim.

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

1. The applicant, Ms Mahmoud, was employed by the respondent, Momentum Consulting Group Pty Ltd from 2019 as a part time pick packer.
2. In about May 2022 the applicant had right shoulder pain that flared up and worsened. On 26 October 2022 liability was accepted for her right shoulder injury. She experienced increasing neck and left shoulder pain over time, and in about February 2024 the applicant also developed pain and swelling in both feet.
3. A work capacity decision issued by the respondent on 15 September 2023 under s 78 of the Workplace Injury Management and Workers Compensation Act 1998 (1998 Act) brought the applicant's weekly payments to an end on 8 January 2024.
4. On 3 June 2024 the respondent issued a s 78 notice disputing liability for the applicant's right shoulder injury. Following internal review a notice was issued on 19 June 2024 withdrawing the dispute but maintaining there was no entitlement to compensation resulting from the right shoulder injury.
5. The applicant brought a claim for lump sum compensation for 16% whole person impairment (WPI) of her cervical spine, right upper extremity and left upper extremity on 5 June 2024.
6. Liability was re-disputed for the applicant's right shoulder injury as well as for the left shoulder and cervical spine injuries in a further s 78 notice on 24 September 2024. The right shoulder dispute was withdrawn in a review decision issued on 23 October 2024.
7. The s 78 notice of 11 November 2024 disputed the applicant is entitled to permanent impairment lump sum compensation as a result of the 7% WPI assessment for the right shoulder made by Dr Ron Haig, independent orthopaedic surgeon. This was maintained on 28 November 2024 following internal review.
8. The applicant lodged an Application to Resolve a Dispute (ARD) with the Personal Injury Commission (Commission) on 24 September 2025 claiming weekly payments from 8 January 2024 to date and continuing pursuant to ss 37 and 38 of the Workers Compensation Act 1987 (1987 Act), future medical expenses estimated at $30,000 and lump sum compensation for 21% WPI of the cervical spine, left and right upper extremities and left and right lower extremities.
9. At a preliminary conference held on 30 October 2025 the parties agreed the applicant's pre-injury average weekly earnings rate is $604.
10. The dispute was listed for conciliation conference and arbitration hearing on

1. The parties agree the following issues remain in dispute:

(a) whether the applicant sustained left shoulder, cervical spine and/or bilateral feet-ankle injuries on 7 July 2022 pursuant to ss 4 and 9A and/or 4(b) of the 1987 Act;

(b) whether the applicant sustained consequential injuries to the left shoulder, cervical spine and/or bilateral feet-ankles as a result of the accepted right shoulder injury on 7 July 2022;

(c) the extent and quantification of the applicant's entitlement to weekly compensation in the period 3 June 2024 to date and continuing pursuant to ss 37 and 38 of the 1987 Act, and

(d) whether the applicant is entitled to the payment of medical expenses pursuant to s 60 of the 1987 Act.

1. The parties appeared for conciliation conference and arbitration hearing on

12 December 2025 in Sydney. Mr Boris Necovski of counsel appeared for the applicant instructed by Mr Andy Deng, legal practitioner. Mr Jarryd Malouf of counsel appeared for the respondent instructed by Ms Jamie Coleman, legal practitioner. Ms Jenkins was present as was Mr Bazzi, interpreter. 2. During conciliation the parties agreed the question of injury should be determined first and if appropriate referred for medical assessment, and the remaining claims for weekly payments and medical expenses are to be deferred until the medical assessment process is completed. 3. The respondent's Application to Lodge Additional Documents dated 8 December 2025 was admitted during conciliation. 4. I am satisfied the parties to the dispute understand the nature of the application and the legal implications of any assertion made in the information supplied. I have used my best endeavours in attempting to bring the parties to the dispute to a settlement acceptable to all of them. I am satisfied the parties have had sufficient opportunity to explore settlement and that they have been unable to reach an agreed resolution of the dispute.

1. The following documents were in evidence before the Commission and considered in making this determination:

(a) ARD and attached documents;

(b) Reply and attached documents, and

(c) respondent's Application to Lodge Additional Documents (ALAD) dated 8 December 2025 and attached documents.

1. No application was made to call oral evidence or to cross examine the applicant.

1. The applicant relies on her statement of 7 July 2025. She describes previously working in physical jobs including as a pick packer before starting work as a part time pick packer with the respondent in 2019.
2. Her work included standing for various periods of time, heavy lifting, handling boxes and moving them from a trolley to a table, wrapping boxes with tape, twisting and pulling. She worked around eight hours a day over five or six days a week.
3. In around March 2021 the applicant started feeling discomfort in her right shoulder and saw her general practitioner, however no specific interventional treatment was offered. Her symptoms remained but had improved and she returned to work with the respondent.
4. Right shoulder pain flared up and worsened in about May 2022, deteriorating over time. The applicant was subject to intense work conditions as her place of employment was understaffed. When other staff members were not available at times to assist her the applicant lifted heavy loads by herself.
5. The applicant describes consulting her general practitioner Dr Mervat Akladious, a shoulder surgeon Dr Manish Gupta, and having a cortisone injection into her right shoulder in July 2022 which helped for a few months. Her condition improved with rest but never completely recovered.
6. When she returned to work for the respondent she took a role in the office which she found difficult. This was discontinued when there was no further work available for her.
7. Over time the applicant developed increasing neck and left shoulder pain. From around February 2024 she developed pain and swelling in both her feet without any further accident or injury.
8. The applicant describes having no capacity for work, being unable to undertake household maintenance, cleaning and shopping as she used to before the injury, her shoulder pain disrupts her sleep, she struggles with driving, pushing, pulling, lifting or using her arms overhead, and she is unable to be emotionally present with her children in the way she was before the injury. The whole ordeal has been stressful, negatively affecting her mental health.

1. The right shoulder ultrasound report of 7 July 2022 concludes with long head of biceps tendinosis, supraspinatus tendinopathy without tear, and subacromial/subdeltoid bursitis with evidence of impingement.
2. The Auburn Hospital Emergency Department Summary of 28 August 2022 notes the applicant presented as feeling unwell since the day before with generalised body pains, headache and fever.
3. The lumbar spine X-ray report of 31 January 2023 shows mild degenerative changes with disc height reduction and marginal osteophytes.
4. The right shoulder MRI report of 3 February 2023 finds moderate tendinosis.
5. Dr Manish Gupta, treating orthopaedic surgeon, diagnoses right shoulder subacromial pain syndrome related to heavy pick pack work on 13 March 2023, and notes the plan to continue physiotherapy and review the applicant in two months.
6. The left ankle and/or hindfoot ultrasound report of 28 February 2024 finds peroneus brevis and longus tendinosis and tendon sheath thickening. The comment is there is peroneus tenosynovitis with no other abnormality seen at the lateral ankle.
7. The left ankle and/or hindfoot ultrasound report of 13 December 2024 includes the impression of persistent peroneus longus and brevis tendinopathy with associated tenosynovitis. There is no evidence of plantar fasciitis, tear or fibroma.

Dr James Bodel, independent orthopaedic surgeon

1. On 30 January 2024 Dr Bodel reports the applicant presents with neck and bilateral shoulder pain as a result of her work for the respondent. Dr Bodel diagnoses rotator cuff bursitis and tendinitis in each shoulder and soft tissue injury to the neck.
2. There is a causal link between the nature of the work in general and the ongoing rateable impairment in the neck and both shoulders. The applicant is currently unfit for her pre-injury work and theoretically may be able to do some part time light duty work, although poor command of the English language will make that difficult.
3. In part her injury is the aggravation, acceleration, exacerbation and deterioration of the disease process and her work is the main contributing factor to that. All injuries are associated with the nature of her work in general.
4. Dr Bodel makes an impairment assessment of 7% WPI of the cervical spine, 6% WPI of the right shoulder and 4% WPI of the left shoulder, totalling 16% WPI.
5. In a supplementary report on 29 June 2024 Dr Bodel confirms the diagnosis of rotator cuff pathology in both shoulders, the right worse than the left, and early degenerative disc disease in the cervical spine.
6. Employment is the main contributing factor as work has caused aggravation, acceleration, exacerbation and deterioration in the neck and both shoulders. The pathology has come on gradually over time.
7. Dr Bodel disagrees with Dr Haig's opinion that he suspects there is not a diagnosis for the applicant's current complaints, as she has evidence of aggravated degenerative disc disease in the cervical spine and rotator cuff pathology in both shoulders.
8. On 21 February 2025 Dr Bodel records the history of the injury as the applicant developing swelling in the feet about eight to twelve months ago, in addition to the cervical spine and shoulder injuries, which came on gradually over time without further accident or injury.
9. The applicant's current complaints are pain in the neck and shoulders for which she takes analgesic medication.
10. Dr Bodel notes the reports of X-rays and ultrasounds of both feet confirm no specific bone or joint abnormality is identified. Dr Bodel diagnoses non-specific swelling, pain and stiffness in the feet in addition to a soft tissue injury to the neck and rotator cuff injury to both shoulders.
11. The injury is a frank injury to the neck, shoulders and the feet with an element of aggravation, acceleration, exacerbation and deterioration of a disease process, being the rotator cuff pathology and the degenerative disc disease caused by the injury on 7 July 2022.
12. The applicant's employment is the only contributing factor to the injuries that occurred as there are no other contributing factors.
13. The feet injuries are a late onset of symptoms which appear to be consequential. Dr Bodel finds it difficult to make any causal link between the feet and the injuries to the neck and shoulders, and notes the feet complaint is not listed on the original certificate of capacity.
14. The impairment assessment is of 5% WPI of the cervicothoracic spine, 6% WPI of each shoulder and 3% WPI of each ankle, totalling 21% WPI.

1. Dr Akladious provides a referral to Dr Gupta on 10 February 2023. The presenting problem is right shoulder pain due to repetitive movement at work since June 2022. The past history includes neck pain in 2015, left cervical radiculopathy in 2016 and right shoulder pain in 2022.

1. Payslips for the period 7 June 2022 to 19 January 2023 are with the ARD.
2. These appear to show the applicant's normal hours were 7.5 hours a day usually five days a week between 10 May 2022 and 19 January 2023, she received workers compensation payments between 4 August 2022 and 25 August 2022, 5 January 2023 and 19 May 2023, and 21 September 2023 and 28 September 2023.

1. On 5 April 2024 Dr Haig reports that he does not have a diagnosis for the applicant's current complaints and he suspects there is not one. An MRI, preferable to an ultrasound, would be helpful in this regard.
2. Dr Haig's impression from reading the documentation is that the applicant was quite adverse to working in the area of pick-packing.
3. Dr Haig does not believe the applicant sustained any injury arising out of or during the course of her employment, and the employment is not considered to be a substantial contributing factor to any current symptoms the applicant alleges.
4. The applicant does not require any treatment and she has current work capacity for her original employment as a pick packer.
5. Dr Haig carries out a further examination of the applicant on 31 August 2024.
6. On 4 September 2024 Dr Haig notes the right shoulder radiology shows "moderate subacromial/subdeltoid bursitis". He does not have a diagnosis for the left shoulder as no radiology has been performed.
7. Dr Haig remains of the view that the applicant did not suffer any injury arising out of or in the course of her employment and the employment was not therefore the main contributing factor to injury. There is no pre-existing disease of the shoulders or the cervical spine as far as Dr Haig is aware.
8. Dr Haig disagrees with Dr Bodel's opinion that the nature of the applicant's work was responsible for her symptoms and Dr Bodel's diagnosis of a soft tissue injury to the neck.
9. Dr Haig also disagrees with Dr Bodel's opinion that there is a causal link between the nature of the applicant's work in general and an ongoing rateable impairment in the neck and both shoulders, and that the applicant is unfit for her pre-injury work.
10. Dr Haig notes the applicant's pre-injury work did not appear to include any overhead use of the upper extremities and he does not believe she suffered a workplace injury or that she is incapacitated for work.
11. Dr Haig noted no signs of exaggeration or inconsistent responses to examination or malingering but he does believe there are non-organic factors affecting the clinical presentation.
12. Setting aside the matter of her cervical spine condition not being work-related, Dr Haig assesses impairment of 0% WPI of the cervical spine.
13. Any permanent impairment in the shoulders, as there is a reduction in range of motion, is not as a result of any injury in Dr Haig's opinion. Dr Haig nevertheless assesses 7% WPI of the right upper extremity and 6% WPI of the left upper extremity.
14. Having no reason to believe the applicant sustained any work-related injuries, when asked to comment on Dr Bodel's impairment assessment, Dr Haig notes he found no asymmetry of movement or guarding in the cervical spine and rated her as Category I and not Category II. Dr Haig is in general agreement with Dr Bodel's quantitative assessment of the right shoulder but differs considerably on the left side due to difference in measured ranges of motion.
15. In a supplementary report of 4 November 2024 Dr Haig opines that shoulder symptoms are very common, there was no incident that caused the applicant's right shoulder pain and no radiology performed of the left shoulder. Such pathology and complaints are common and Dr Haig notes again there was no workplace injury.
16. Dr Haig believes there are no complaints arising from the applicant's cervical spine but rather the pain in her trapezius area was emanating from her neck. Dr Haig quotes from the AMA Guides to the Evaluation of Disease and Injury Causation (2nd Edition) that in the general population self-reported shoulder pain varies from 16% to 26%, and shoulder symptoms are prone to recur or become chronic.
17. Under the heading "Occupational Risk Factors for Shoulder Tendinopathy, Impingement and Rotation Cuff Tears" the only factor is where there is some evidence of a combination of risk factors such as force and repetition or force and posture. Under the heading "Non Occupational Risk Factors for Shoulder Tendinopathy, Impingement and Rotator Cuff Tears" for age there is very strong evidence and similarly strong evidence for "biopsychosocial factors".
18. On 28 August 2025 Dr Haig reports following his examination of the applicant that she has relatively minor complaints in both shoulders and both ankles and she did not specifically mention any neck complaints. The applicant complains of intermittent pain in either the left or right ankle with symptoms beginning in 2024, and as such Dr Haig has no reason to attribute any complaints in that area to her work.
19. Dr Haig has no reason to believe any shoulder complaints now are related to work some two years after discontinuing her work, or that any ankle complaints are related to work, which she discontinued at least a year before the onset of those symptoms.
20. Dr Haig maintains his view that the applicant did not suffer any injury to the left shoulder or cervical spine arising out of or in the course of her employment, or that any ankle complaint was related to work.
21. Asked to comment on Dr Bodel's report of 21 February 2025, Dr Haig notes there is no history of injury on 7 July 2022, the applicant made no complaint of neck pain, she does not require assistance with shopping, and he agrees the applicant has significant psychological disturbance. Dr Bodel's measurement of shoulder movements are considerably greater than Dr Haig's estimated ranges. Dr Haig also found full and pain-free range of motion in both ankles.
22. Dr Haig agrees with Dr Bodel that it is difficult to make any causal link between the feet and the injuries to the neck and shoulders.
23. Dr Haig confirms his opinion that the applicant has not sustained permanent impairment due to the nature of her employment with regard to the cervical spine, shoulders or ankles.

Strategic Industry Solutions Functional Capacity Evaluation Reports

1. On 8 February 2023 the applicant is found to have current demonstrated functional capacity to perform sedentary work for six hours a day and three days per week. She would benefit from a graded return to work plan increasing her capacity to full time.
2. On 9 June 2023 a vocational assessment concluded three vocational options for the applicant are general clerk, light pick packer and light product assembler. It is anticipated the applicant is capable of obtaining suitable full time employment and she was agreeable or open to the three options.

1. Dr Akladious approved three vocational options of general clerk, call centre operator and front desk attendant on 3 March 2023 provided the applicant has a job with Arabic, the language that she can understand well.
2. Dr Akladious approved the vocational options of general clerk - Arabic speaking, light pick packer and product assembler on 1 June 2023.
3. Dr Akladious approved the vocational options of general clerk - Arabic speaking, light pick packer and product assembler on 22 August 2023 for six hours per day and five days per week.
4. Dr Catherine Field, independent physician in occupational and environment medicine, provides an injury management consultation file review to the respondent's insurer on 7 September 2022. Dr Field recommends alternative, lighter work for the applicant for the long term may need to be explored, and she does not believe aiming for upgrades of work capacity towards pre-injury duties is a realistic and achievable goal.
5. Dr Field reviewed the applicant's work capacity and reports on 5 January 2023 the applicant has chronic right shoulder pain, her work seems to have been too heavy for her and she is also a petite woman and would need to reach above shoulder height more often than a taller person to reach higher items, increasing the risk of developing shoulder overuse injuries. It is medically appropriate that she be redeployed into a lighter work role in the future. Referral for a vocational assessment is required to assist in job-seeking for appropriate longer-term roles.
6. Mr Gateano Milazzo, physiotherapist, reports to the respondent's insurer on 10 January 2023. In the absence of measured improvements, ongoing physiotherapy is not reasonably necessary or in agreement with the conditions of the Clinical Framework. A further four sessions to transition to independent self-management is reasonable.
7. Dr Gupta reports to Dr Akladious on 13 March 2023 the applicant is suffering from subacromial pain syndrome with an intact rotator cuff along with some secondary glenohumeral capsulitis, and more aggressive intervention does not need to be considered at this time. Dr Gupta will review her in two months.
8. Dr Bikram Karmakar, treating sports and exercise physician, reports to Dr Akladious on 27 April 2023 following an assessment of the applicant. She localises pain to her right shoulder, worse with overhead and reaching movements, and performs all of her lifting on the left side in her largely paperwork light duties role. A customised and supervised home exercise rehabilitation program is recommended and a short course of anti-inflammatory tablets. He is happy for her to continue with her admin-based duties and she can look to progress to full time hours over the next six weeks keeping a two kilogram below right shoulder range lifting restriction.
9. Dr Karmakar reports on 25 May 2023 the applicant has demonstrated some functional improvements but requires ongoing rehabilitation and encouragement. He recommends she continue with her exercise program and increase her work initially to six hours five days a week in a mainly admin-based role with a two kilogram lifting restriction. Once tolerated she can look to progress gradually towards full time hours.
10. Dr Karmakar reports on 3 August 2023 the applicant's right shoulder symptoms have plateaued and she has also noted discomfort in the left shoulder which may be related to overuse. He would be happy for her to work full time hours in a desk-based capacity with limited lifting and frequent breaks. The applicant was discharged from their program.
11. Dr Sugeesh Pathirana, consultant occupational physician, provides an injury management consultant report to the respondent's insurer on 16 November 2023. The applicant reports more pain in her left shoulder than in her right shoulder which she attributes to overuse of her left arm due to the right shoulder problem. She also has intermittent left leg pain and on examination her neck was pain free with normal range of movement. The applicant is likely to have some capacity for part time work however several psychosocial factors appear to be impacting her return to work.
12. Dr Pathirana's supplementary report of 19 January 2024 clarifies the vocational options of general clerk (Arabic speaking), product assembler and light pick packer are likely to be medically suitable provided she has regular breaks. She is likely to find it difficult to sustain full time work in the long term if the work involves repetitive upper limb work even if it is relatively light. The applicant is likely to require permanent part time work with permanently modified duties.
13. The ALAD includes a s 78 notice issued on 3 June 2024 that disputes liability for the applicant's right shoulder injury. A List of Payments, the applicant's financial records and Certificates of capacity, and the clinical notes of Akladious Associates and Active Recovery Clinics are with the ALAD.
14. The Akladious Associates notes include;

(a) left shoulder and forearm two weeks "using it to avoid R shoulder pain"[1] on 13 July 2023,

(b) bilateral shoulder pain, she is doing exercises for both shoulders on 21 July 2023;

(c) still pain both shoulders especially above shoulder level on 22 August 2023, and

(d) Ankle Brachial Index (ABI) Reports, regarding testing of both ankles for peripheral artery disease, between November 2014 and June 2021.

1. The Active Recovery Clinics notes include that the applicant advised the left side has started to become sore on 3 August 2023 and she wakes up during the night due to pain in the left side now.

1. The applicant made oral submissions which have been recorded and form part of the Commission's record. These are set out below.
2. The applicant referred to cases she says are instructive on the issues; Mason v Demasi[2] that clinical notes are simply a transcript of what was said during consultations and the absence of records is not fatal to workers, Chanaa v Zarour[3] that stands for the proposition that corroboration is not necessary in relation to the worker's statement evidence_, Proops v MSS Security Pty Limited_[4] reflects the critical importance of the worker's statement, Finney Pty Limited t/as Cut Price Car Rentals v Chequer[5] that stands for the proposition that evidence should not be rejected without a proper basis, and cases on injury and cases such as Semlitch[6] in relation to the development and worsening of symptoms.
3. This is a claim for lump sum compensation and a primary issue for determination is injury, as the balance of the dispute will be deferred until after medical assessment takes place if the applicant succeeds. The right shoulder is accepted and that leaves the left shoulder, neck and bilateral feet injuries in dispute.
4. The applicant's statement gives a history of her duties and responsibilities as a pick-packer for the respondent, including standing for various periods of time, of some importance where bilateral feet and ankle injuries are concerned, and lifting and handling heavy boxes. She moved boxes from a trolley to a table and wrapped them, twisting and pulling. She did this eight hours a day and five to six days a week.
5. She began to develop discomfort in her right shoulder which gets worse and deteriorates over time. Her place of employment was understaffed and she was subject to intense work conditions lifting heavy loads by herself.
6. Due to the work she then developed neck and left shoulder pain over time. The evidence as to the work environment is uncontradicted and there is no reason not to accept that evidence.
7. She goes on to say that around February 2024 she began developing pain and swelling in both feet, with the backdrop of continuing to work and standing at various times.
8. Dealing with the left shoulder the applicant is again consistent in her evidence reporting left shoulder symptoms. The certificate of capacity dated 11 October 2023 notes she was reporting new pain in the left shoulder that was due to overuse or over compensation due to avoidance. That is how it is described by her general practitioner. She has injured her right shoulder in the course of her duties and she has started preferring and abusing the left side. This is not unusual in circumstances such as these.
9. The applicant says that evidence could equally be taken to represent or support the conclusion that the nature and conditions of her employment were such that she would be using that arm more in the context of the right side being injured, which would lead to injury.
10. The applicant describes her left sided symptoms to her psychologist on 3 August 2023 and says the left side has started to become sore and the pain has remained the same.[7] The applicant submits that is contemporaneous reporting of symptoms at that time.
11. There is a coherent nexus between the repetitive duties, keeping in mind she is grappling with the right sided injury at the same time. That only serves to increase the risk that she would suffer widespread injuries which she then did to her neck and left shoulder, as Dr Bodel says.
12. The applicant's statement evidence is that over time she developed increasing neck and left shoulder pain. Dr Bodel says while her injuries are mainly on the right side she developed discomfort in the neck and left shoulder. He refers to the nature and conditions of her employment causing a flare up in pain in May 2022 which is consistent with her statement. Dr Bodel also refers to staff shortages as the applicant says in her statement.
13. There was an increase in exertion on the part of the applicant and over time that lead to increasing pain as Dr Bodel says. Dr Bodel says it increased pain in her left shoulder girdle and in the neck.
14. The general practitioner says the applicant overused that side because of her existing right sided injury. The applicant submits the nexus is made out on the evidence.
15. There is a stark difference between what Dr Bodel says and what Dr Haig says.
16. Dr Bodel also refers to the applicant having intermittent neck pain and refers to her head being postured down and that using her arms overhead aggravates her pain. That is all part and parcel of the nature and conditions claim.
17. It is well understood in cases such as this that those sort of movements will cause injuries that the applicant went on to suffer.
18. On examination Dr Bodel noted her neck and shoulders were stiff, she had tenderness in the trapezius muscles along the base of the neck, with a reduced range importantly of neck flexion extension and rotation in all directions, most restricted on the left.
19. Dr Bodel notes there is impingement in both shoulders and he is in no doubt whatsoever that the applicant's injuries are caused by the nature and conditions of her duties which she has elaborated on in her statement.
20. Dr Bodel diagnoses bursitis and tendinitis in each shoulder and a soft tissue injury to the neck. He also says that at least in part her injuries consist of aggravations which is not an uncommon finding in people of the age of the applicant but also in people who have largely worked in physical jobs their entire lives.
21. Dr Bodel elaborates on the aggravation of the neck and says that there is pathology which is degenerative disc disease that was aggravated by her employment. At least in part in his opinion there is an aggravation to the neck and that gives rise to the injury because of her degenerative disease.
22. Turning to the feet, there is not a whole lot of evidence. The applicant says she was standing for long periods in the eight hours a day, five to six days a week presumably on a hard floor which is to be expected in warehouses, and she is most likely not standing on grass for example.
23. The evidence the applicant gives in her statement is entirely consistent with the causal theory of the long standing coupled with her duties in carrying, lifting and bending. To link all of that in combination leads to the development of disease in her ankles. That disease is made clear in the radiology of the left ankle on 28 February 2024, consistent with when the applicant says there was an onset of symptoms. The radiologist says she has tenosynovitis in her left ankle.
24. Dr Bodel addresses the onset of the ankle symptoms in his report. Dr Bodel is somewhat at a loss to explain whether the feet are consequential to the neck and shoulders and one would not necessarily expect that, but what he does say is that the feet injuries are consistent with being developed gradually over time which is characteristic of a nature and conditions type injury. That coupled with long periods of standing on a hard floor presumably for eight hours a day for five or six days a week can only lead to the conclusion that she has suffered nature and conditions injuries to her ankles.
25. The applicant has also provided that exact history to Dr Haig. Dr Haig is quite dismissive of her symptoms. What she tells Dr Haig is that she complains of pain that she indicates across the front of both ankles, which occurs sometimes, and sometimes on the left and sometimes on the right. She says this complaint began last year but attributes it to the fact that she was standing at work although that work was two to three years before her complaints began.
26. There is a real issue about whether the applicant was still working. When you look at Dr Bodel's and the applicant's statement evidence there sems to be no doubt she continued working although she was being sent from place to place.
27. In Proops Deputy President Parker found that the applicant's statement coupled with the nature of the injuries described could only lead to the conclusion that she did in fact suffer injury. In Mason v Demasi the lack of some contemporaneous reporting in the transcript of what is said at some medical appointment is not determinative whatsoever in cases such as this.
28. The applicant's submission is that in a case like this where the nature and conditions of the applicant's employment, the repetitive duties according to her in her statement and the evidence of Dr Bodel result in injury, and we say that that provides a sufficient link to explain the development of those conditions, confirmed on the radiology.
29. In terms of the aggravation of the neck Dr Bodel has given a separate explanation however it all forms part of the nature and conditions of her employment resulting in that aggravation.
30. It follows that there should be an award for the applicant and a referral of the neck, bilateral shoulders and bilateral ankles for a medical assessment.

1. The respondent made oral submissions which have been recorded and form part of the Commission's record. These are set out below.
2. The respondent notes the applicant refers to some clinical notes that refer to overuse and over compensation per se of the left shoulder however no submissions were made that any of the other injuries were consequential.
3. This is an important consideration in determining injury in this case in circumstances where the applicant's evidence is in no way consistent about how it is alleged these injuries occurred.
4. The applicant's statement is heavily relied upon and it is important to determine what her work was. She was doing pick-packing in a part time role, whilst on the disability pension. It included standing for various periods of time and heavy lifting, handling boxes, and at no stage anywhere in the evidence is there an explanation of what heavy lifting means in terms of weights, regularity and so on. The applicant is moving boxes from a trolley to a table, wrapping boxes with tape, twisting and pulling, eight hours a day, five to six days a week.
5. There is no doubt the applicant has a right shoulder injury from work but whilst working in the pick-packing work she does not provide any evidence of any symptoms in any other body part.
6. What we know is that from around May 2022 and onwards, or July 2022, it is not clear, the applicant did not return to any pick-packing work and it ends in the middle of 2022 without any report or any complaint of symptoms by her own statement evidence. The only issue she had was the right shoulder.
7. The applicant returned to work in a role within the office but there were no heavy duties, there is no evidence of that, and she says it was difficult to do that work with her right shoulder. She was then advised no further work was available and it was discontinued.
8. In her statement the applicant says over time she developed increasing neck and left shoulder pain. The context of that is since she ceased doing pick-packing work. The only case presented by the applicant is that that the pick-packing work has caused injury to her neck and left shoulder. She had no symptoms while she was doing that work and it developed after that by her own evidence.
9. The applicant then tells us that it is not until February 2024, so almost two years since she has done pick-packing work, that she develops pain in her feet.
10. The respondent's case is there is simply insufficient evidence to convince the Commission of injuries to the feet, the neck as well, and the left shoulder, where although there is some evidence of a consequential injury the way the applicant has framed her case the evidence does not get anywhere near satisfying the question of injury.
11. This is compounded in terms of the feet. In the permanent impairment claim form in June 2024 the only injuries claimed are the cervical spine, right and left upper extremities. The applicant says she has symptoms in February so why is it not mentioned as being part of the claim? We know she had already seen Dr Bodel twice and had never mentioned the feet. The first time was 30 January 2024.
12. The applicant made some submissions about the reliability of clinical records and Mason v Demasi but there is a history of what has actually been said where the applicant is very clear that there are no issues outside of the right shoulder. Dr Gupta on 13 March 2023 asked her about her shoulder and she says she is otherwise medically of good health. She does not offer that she has any issues with her neck, left shoulder or feet. That is not a criticism because by her own admission the feet did not start until 2024 but there is a positive history that she is otherwise medically of good health.
13. The functional capacity assessor for the insurer despite a very significant assessment makes no mention of symptoms outside of the right shoulder. In the vocational assessment on 9 June 2024 not only is there no mention of any of these other body parts, but the applicant gave a history of having no restrictions twisting from the neck and that her left arm is unaffected by reaching.
14. There is some description of non-compensable injury to the applicant's left leg when climbing stairs and in the context of a foot injury that no one has covered. Dr Field's reports are consistent with the treating practitioners in that there is no mention of left shoulder complaints.
15. Similarly with Dr Karmakar who on 27 April 2023 reports on present symptoms and other medical/injury history with nothing besides the right shoulder. Dr Karmakar only talks about the right shoulder in his report of 25 May 2023. On 3 August 2023 Dr Karmakar refers to left shoulder issues which may be related to overuse, as does Dr Pathirana on 16 November 2023.
16. With the feet there is no complaint until February 2024 when she had not been working in the warehouse pick-packing for almost two years.
17. It is also impossible because of these factual matters and the evidence referred to to find that there is a nature and conditions injury anywhere. There were no symptoms whilst working and the work changed for some period and then she ceases working and the symptoms appear.
18. At its height the applicant's case supports potentially a consequential injury to the left shoulder. On the medical evidence you would still have to be satisfied that occurred, and in the context of Dr Bodel who rules that out. This leaves the Commission in a difficult position to identify how it is that there is a consequential injury.
19. The psychologist notes on 3 August 2023 the applicant's work is good and she is working on a laptop two days for five hours, so there is no pick-packing work on the evidence since the middle of 2022, and it is not the applicant's case that there is any injury from this administrative work.
20. Dr Bodel's first report of 30 June 2024 has no history of any feet issues at this stage, although the respondent notes the history taken is very limited. Dr Bodel does not necessarily take a detailed history of what exactly was heavy or arduous about this work. He takes a history of pick-packing work and then says there is a flare up of pain in May 2022 and the right shoulder was getting worse as a result of the nature and conditions of her work in general.
21. Dr Bodel then says there were staffing shortages and she was working very intensely and the right shoulder steadily deteriorated. He says over time she developed increasing neck and left shoulder girdle pain and today presents with neck and bilateral shoulder pain. We know from the evidence that did not happen until after she ceases the pick-packing work and she never told any doctor outside of this case of neck pain.
22. There is a reference to a report Dr Dias on 5 June 2023 who only made an assessment of the right shoulder according to Dr Bodel. That would be consistent with all the other evidence in this case that there is no mention of any other injuries until August 2023 with the left shoulder, more than a year after she ceases pick-packing work.
23. Dr Bodel gives an opinion that this is a s 4(b)(ii) injury of the left shoulder and neck at this stage. He initially says that recurring problems in the neck are associated with nature and conditions and he says in part her injury is the aggravation, acceleration, exacerbation and deterioration of the disease.
24. Dr Bodel makes this more plain in his next report where he says the injury is not a frank injury, the pathology has come on gradually over time and work is the main contributing factor to that by way of aggravation. It is very clear that his opinion is this is a s 4 (b)(ii) injury of the left shoulder and the neck.
25. In Dr Bodel's next report he takes a history that without additional accident or injury the applicant developed swelling in the feet about eight to twelve months ago. Curiously under the heading current complaints Dr Bodel does not mention the feet, and only mentions pain in the neck and shoulders. He then says the reports of X-rays and ultrasound of both feet confirmed no specific bone or joint abnormality, although there is no radiology of the right foot, but importantly Dr Bodel does not give an opinion on anything about the ankles, only the feet. No one says the ankles are related and Dr Bodel does not have this radiology anyway.
26. In terms of linking the feet to work he says there was an injury at work on 7 July 2022 and the applicant had an injury to the neck, both shoulders and has developed pain and swelling in the feet. It is non-specific in terms of a diagnosis, with non-specific swelling, pain and stiffness in the feet. This is completely insufficient for the purposes of determining what the applicant's injury is.
27. Dr Bodel says the nature of the injuries are a frank injury to the neck, shoulders and feet which is very confusing because he has already given a very clear, unequivocal opinion that it is a s4(b)(ii) aggravation of the disease injury. Dr Bodel then says there is an element of aggravation etc. This cuts it both ways and the respondent's submission is that in terms of the applicant discharging her burden it does not assist you.
28. Dr Bodel says the feet injuries are a late onset of symptoms which appear to be consequential as she developed discomfort gradually over time. He is not sure how her clinical condition caused by the earlier accident has led to the foot complaint but she indicates it has come on gradually over time. Dr Bodel finds it difficult to make any causal link between the feet injuries and the neck and the shoulders.
29. The applicant has presented a case without any support in terms of forensic medical opinion that these are anything other than s 4 arguably but primarily 4(b)(ii) injuries. No one has provided any medical support for these being consequential injuries. Indeed the height of it is that the applicant says maybe it is from overuse but no experts give that opinion.
30. Dr Haig is of the medical opinion that there is no right shoulder injury either but of course that has been admitted and his reasoning on that is not pressed.
31. Dr Haig takes a history on 5 April 2024 that the applicant says she started to use her left shoulder a lot, but what he does say is he does not have a diagnosis for her current complaints. Dr Haig has only been told about on his examination of the shoulders and there is no reference to the neck and he says there is no injury.
32. In his next report on 4 September 2024 Dr Haig records some history about complaints of the shoulders, but crucially and in the context of zero complaints made to any treating medical practitioner, when questioned about the neck she appears to have no complaints in the neck but rather indicates some pain in the inner trapezius area.
33. Dr Haig examines the cervical spine and finds her posture to be normal, there was a full range of motion with equal left and right rotation and lateral flexion. In the upper extremities there was normal power and reflexes and he could not draw any conclusions testing for sensation.
34. Dr Haig says there is no injury, there are no complaints outside of some trapezius symptoms, there are no complaints to doctors and there is a completely normal clinical assessment, which is a compelling argument to say there is no neck injury to speak of.
35. Dr Haig's next report on 4 November 2024 confirms his opinion.
36. On 28 August 2025 Dr Haig deals with the foot injury, with complaints of pain sometimes in the left and sometimes in the right, and the complaint began last year. This is very clear and consistent with the medical records that there was no pain until 2024, and he makes the obvious point that she was standing at work although that was two to three years before her complaints.
37. The respondent submits there is an insurmountable hurdle to find there was an injury caused by work where there were no symptoms for two to three years. This is not a consequential case and he says he has no reason to attribute any complaint to that area of the feet to her work. Dr Haig notes the applicant was not working since late 2022 or early 2023, and if she was working it was in office duty for five hours a day two days a week.
38. There are a number of authorities that talk about exactly what is required of the applicant in terms of proving injury.
39. In Tudor Capital Australia Pty Limited v Christensen[8] what is required is precise consideration on a fact by fact basis of the evidence and the identification of a physiological change or disturbance of the workers normal physiological state.
40. In Kempsey Shire Council v Kirkman[9] Deputy President Roche says that although it is often preferable, it is not essential as a matter of law for the precise nature of the injury to be determined, but it does depend on a case by case basis.
41. Here there are no radiological investigations of the neck. There is a soft tissue injury according to Dr Bodel but all arising arguably for the first time when she saw Dr Bodel on 30 January 2024, the first time she made any complaints of the neck.
42. Similarly for the feet there is a scan of the left ankle and nothing for the right ankle, and the left ankle was talked about as ankle issues as opposed to foot issues.
43. In terms of s 4 and consequential injury the Commission could not be satisfied that there is a s 4(b)(ii) injury for any of those body parts because of the conflicting nature of the evidence.
44. On the question of when the applicant ceased work, she was definitely doing pick-packing work until 2022 and she was then performing office duties.
45. The respondent's submission is the applicant has not discharged her onus of proving any kind of injury let alone a s 4(b)(ii) injury to the left shoulder, the cervical spine and both feet.

1. One of the respondent's submissions was that the worker was not working in pick-packing work the entire way through. The applicant says that does not carry any weight in circumstances where the applicant has been exposed over the course of some years to pick-packing work which is repetitive and heavy in nature.
2. In her statement the applicant explains that she has a low level of English and requires an Arabic interpreter. She had previously worked in labour heavy jobs. The clinical records on 17 September 2021 refer to pain in the legs and limping.
3. There is no doubt the applicant was on restricted duties and so her activity level has changed. Whether she is in an office job or not she has still been exposed to these heavy, demanding tasks and ultimately gives evidence that over time she developed neck and left shoulder pain.
4. The applicant's return to office duties does not mean she is completely inactive. She is still going to work and she is still on her feet while she may be sitting at times, but ultimately the injuries were sustained in the course of her pick-packing duties and subsequent employment.
5. The evidence in the applicant's statement is that she had symptoms in the right shoulder in March 2021. She appears to have returned to work for the respondent in an office role after about July 2022 and continued to work until 2023.
6. There is no doubt the applicant suffered the injury, she had restricted capacity thereafter and activity levels dropped, however that does not matter the applicant submits, because she has been exposed to these repetitive tasks the whole way through for years on end, and she has developed these injuries and symptoms which increased.
7. The state of the evidence is that examining the applicant's statement taken against the background of the duties she undertook, which were repetitive, arduous duties she did for eight hours a day, five to six days a week, the respondent's argument is rather technical in the sense that she has gone into office duties and therefore did not sustain these injuries.
8. The respondent's argument holds no water as she has been doing these duties for years on end. She may transition to a role which is less active but that does not discount the fact that she has suffered these injuries.
9. It is not suggested the applicant is a liar, she has not been cross examined, and that can only mean her evidence is uncontradicted. Her statement reflects a gradual increase in symptoms to the left shoulder, to the neck and to the feet.
10. The reason they come on at that time is a medical question. Dr Bodel provides the only assistance in this case because Dr Haig just gives a completely dismissive opinion that he cannot figure it out. Dr Bodel has no doubt that she suffered these injuries as a result of the nature and conditions of her employment. He refers to there being an aggravation to the neck.
11. The general practitioner records in relation to the left shoulder suggests there was overuse and the applicant submits that is sufficient to apply the test in Kooragang v Bates[10] test in relation to the left shoulder for a finding of either consequential injury to the left shoulder or a s 4(b)(i) or (ii) injury.
12. In terms of the lower extremities, what is demonstrated on the evidence is that after a passage of time, after she has gone on reduced duties, she is still suffering from the consequences of the pick-packing work years before, and all the while she is receiving treatment for the right shoulder and she is unsuccessfully trying to get nursed back to working health.
13. The evidence paints a picture of a woman who on her own doctor's evidence is described as petite and she was doing arduous, heavy repetitive work in nature, and ultimately she suffered widespread injuries in the course of that employment.
14. Whilst the evidence may not be perfect, for which it has been heavily criticised, it does not have to be. The fact that her lower limb symptoms are reported at a later stage does not mean that they were not suffered as a result of the nature and conditions of her heavy employment.
15. While the notes are extremely difficult to read, the clinical records of Akladious Associates show on 28 April 2021 a reference to lower limb pain, on 17 September 2021 to legs pain, on 31 January 2023 to lower limb pain on the left, and again on the left on 17 February 2023.
16. The applicant refers to the reports regarding the ankle testing in the clinical notes between 2014 and 2021.
17. The respondent refers to a reference in the clinical notes on 6 November 2020 to distal leg trauma, and on 9 June 2021 bilateral hand pain, right knee pain and low back pain. There are a lot of complaints noted that are not referable to work.
18. The respondent submits that lower limb injuries have not been pleaded and that while the applicant was doing pick-packing work there is no complaint of any symptoms outside of the right shoulder, and the other symptoms took a very long time to come on.

Did the applicant sustain left shoulder, cervical spine and/or bilateral feet-ankle injuries on 7 July 2022

1. The applicant has the onus to prove on the balance of probabilities she sustained injuries to her left shoulder, neck and/or both feet or ankles on 7 July 2022.
2. The relevant principles to discharge that onus were discussed in Nguyen v Cosmopolitan Homes,[11] including that the Commission must feel actual persuasion of the occurrence or existence of a fact that is found, and where the probability of it having occurred is less than it not having occurred, it is to be treated as not having occurred.[12]
3. In s 4 of the 1987 Act an 'injury';

"(a) means personal injury arising out of or in the course of employment,

(i) a disease that is contracted by a worker in the course of employment but only if the employment was the main contributing factor to contracting the disease, and

(ii) the aggravation, acceleration, exacerbation or deterioration in the course of employment of any disease, but only if the employment was the main contributing factor to the aggravation, acceleration, exacerbation or deterioration of the disease, and..."

1. What is required to constitute a personal 'injury' is "a sudden and ascertainable or dramatic physiological change or disturbance of the normal physiological state."[13] While suddenness is not necessary for there to be an injury, it may be relevant in distinguishing a physiological change from the natural progression of an underlying disease.[14]
2. The evidence does not support a finding that the applicant's left shoulder, cervical spine or feet or ankle conditions are personal injuries in accordance with s 4(a) of the 1987 Act.
3. The applicant's statement evidence is that she developed increasing neck and left shoulder pain over time, and she developed pain and swelling in her feet in February 2024 without any further accident or injury. There is no evidence of sudden identifiable physiological change.
4. Turning to a 'disease injury' in s 4(b), the three necessary components are the existence of a 'disease', that the disease was contracted or aggravated, accelerated, exacerbated or deteriorated (hereafter referred to only as aggravation) in the course of employment, and that employment was the main contributing factor to the contraction or aggravation of the disease.[15]
5. 'Disease' is a word of very wide import and includes any form of illness.[16]
6. If the above three components are demonstrated on the evidence, the applicant will have established she has suffered a 'disease injury' and is entitled to the workers compensation benefits that may flow.[17]
7. The aggravation of a disease occurs where "the experience of the disease by the patient is increased or intensified by an increase or intensifying of symptoms."[18] In Cant v Catholic Schools Office [2000] 2000 NSWCC 37 Burke J said:

"...irrespective of whether the pathology has been accelerated there is a relevant aggravation or exacerbation of the disease if the symptoms and restrictions emanating from it have increased and become more serious to the injured worker."[19]

1. I accept the applicant has sustained disease injuries to her left shoulder and cervical spine for which the employment was the main contributing factor in accordance with s 4(b) for the reasons below.

1. An examination of the nature of the work performed by the applicant is required to determine whether it was capable of causing her claimed injuries, that is, whether the contribution of the employment is real and of substance.[20]
2. The applicant's statement evidence is that she previously worked in several physical jobs before her employment with the respondent. She was employed by the respondent on a part time basis in 2019 and at some later time worked eight hours a day, five to six days a week.
3. Dr Bodel notes the applicant worked on a part time basis from 2019 for 15 to 20 hours a week and later did full time work for about 12 to 18 months.[21]
4. The applicant's statement evidence is that her duties as a pick-packer included heavy lifting, handling boxes, moving them from a trolley to a table, wrapping them with tape, and twisting and pulling.
5. Dr Field records on 5 January 2023 the applicant had two main tasks. The first was packing large boxes by filling them with smaller boxes, taping them closed, labelling them and carrying them to tables. The products being packed were for Bunnings and could include lights and tools and some of the items and boxes were very heavy. One particular long box was very heavy and she could not lift it. When a job was too heavy a colleague occasionally came to help her. Her second task was picking products from racks using a trolley and scanner.[22]
6. In March 2023 Dr Gupta takes a history of the applicant's work involving a lot of repetitive heavy lifting.[23]
7. Following the flare up of her right shoulder pain in May 2022 the applicant ceased work on about 18 July 2022. Her attempt to return presumably to pick-packing work in about October 2022 was unsuccessful, as indicated in the certificates of capacity.
8. Dr Field records the applicant performed suitable duties from November 2022. The applicant then worked part time with restrictions in office-based administrative work in city locations and at Parramatta for about 11 months until 4 October 2023, when suitable duties were no longer available with the respondent.[24]
9. Considering the above I do not accept Dr Haig's opinion that there is no reason to believe the nature of her work was responsible for her symptoms, or that there does not appear to be any overhead use of the upper arms.[25]
10. Dr Field notes the applicant's work seems to have been too heavy for her and she is petite and would need to reach above her shoulder height more often than a taller person to reach higher items, increasing the risk of developing shoulder overuse injuries.[26]
11. I am satisfied the evidence establishes the nature of the work the applicant performed for the respondent was capable of causing her claimed injuries.

1. The applicant's statement evidence, the evidence of the nature of the work she performed and the weight of medical evidence supports a finding that she contracted a left shoulder disease which was also aggravated in the course of her employment with the respondent, and the employment was the main contributing factor.
2. Dr Field notes on 3 January 2023, while the applicant is working part time on suitable duties, that due to right shoulder pain and an inability to lift objects with her right arm she primarily uses her left hand.[27] Dr Karmakar records on 27 April 2023 the applicant performs all of her lifting on the left side in her largely paperwork light duties role.
3. As the respondent submits, Ms Hughes, the functional assessor, notes on 9 June 2023 the applicant's left arm is unaffected by reaching,[28] however the records of the applicant's complaints of left shoulder pain commence in July 2023.
4. A left shoulder complaint is recorded in the clinical notes of Akladious Associates on 13 July 2023, followed by complaints of bilateral shoulder pain on 21 July 2023 and 22 August 2023. In August 2023 Dr Karmakar says her left shoulder discomfort may be related to overuse. The applicant reports to Ms Kotevski, psychologist, on 3 August 2023 that the left side has started to become sore.[29] The applicant reports left shoulder pain to Dr Alsayed, general practitioner, on 26 October 2023.[30]
5. Dr Pathirana notes she has more pain in the left shoulder than the right on 16 November 2023. Dr Pathirana examines the applicant's left shoulder and records reduced active shoulder range of movement of the left shoulder as compared to the right, with impingement testing positive in both shoulders. The recent onset of left shoulder pain is awaiting further evaluation and treatment the doctor notes.
6. Dr Bodel diagnoses rotator cuff pathology in the left shoulder associated with the nature and conditions of work with the respondent,[31] which has come on gradually over time and with aggravation of the disease process.[32] The employment is the main contributing factor in Dr Bodel's opinion.
7. Confusingly on 21 February 2025 Dr Bodel says the applicant suffered frank injuries to the neck, shoulders and feet with an element of aggravation of a disease process, being the disease of rotator cuff pathology and the degenerative disc disease.
8. I note the applicant is able to rely on injury simpliciter despite the existence of a disease.[33] A sudden identifiable physiological change can be caused by a personal injury, and the fact that the change is connected to an underlying disease process does not prevent the injury from being a personal injury. The change may be as simple as a soft tissue strain.[34]
9. The history of the injury however in Dr Bodel's first two reports and in his report of 21 February 2025 is of the gradual development of neck and shoulder pain.
10. I afford less weight to Dr Haig's opinion that he has no reason to believe her employment aggravated any pathology in her shoulders for the reasons below.
11. I have accepted the nature of the duties performed by the applicant were capable of causing the applicant's left shoulder disease injury.
12. Dr Haig's reference to the "AMA Guides to the Evaluation of Disease and Injury Causation" does not appear to assist the respondent's case. The evidence of the nature of the duties performed by the applicant referred to above includes the only relevant risk factor where there is some evidence of shoulder tendinopathy, impingement and rotation cuff repairs, being a "combination of risk factors (e.g. force and repetition, force and posture)".[35]
13. Dr Haig makes no diagnosis of the applicant's left shoulder condition as no radiology has been performed, and he refers to shoulder symptoms generally being very common. Dr Haig initially found no diagnosis of the applicant's right shoulder complaints, although he considered the right shoulder MRI report of 3 March 2023 that showed moderate subacromial/subdeltoid bursitis. This opinion altered in his report of 4 September 2024.
14. The evidence of the reason why no left shoulder radiology is available is found in Dr Alsayed note on 8 November 2023 that the applicant is referred for a left shoulder ultrasound [36] which was not approved by the insurer.
15. Any inconsistencies between the applicant's statement evidence and the clinical notes should in general be treated with caution.[37]
16. The respondent submits Dr Gupta's report of 13 March 2023 states that other than her right shoulder pain she is medically of good health, and Dr Dias in June 2023 does not assess the applicant's left shoulder. This is consistent however with records of the applicant's complaint of left shoulder pain dating from July 2023.
17. I do not agree with the respondent's submission that as the applicant ceased pick-packing work before she reports left shoulder pain the employment could not have caused her disease injury. The nature of diseases of gradual onset is that they may become apparent after the work ceases.[38]
18. I find on the basis of the applicant's statement evidence, the evidence of the nature of the work performed by her and the weight of the medical evidence that the applicant has sustained a left shoulder disease injury for which the employment was the main contributing factor.

1. The applicant's statement evidence, the evidence of the nature of the work performed by her and the weight of medical evidence also supports a finding that she aggravated early degenerative disc disease in her cervical spine in the course of her employment with the respondent, and the employment was the main contributing factor.
2. Existing cervical spine disease is noted with the history of left cervical radiculopathy in 2016 in Dr Akladious' referral to Dr Gupta on 10 February 2023 for his opinion and management of the applicant's right shoulder injury.[39]
3. The applicant's uncontradicted statement evidence is that over time she developed increasing neck pain.
4. On 30 January 2024 Dr Bodel notes injury to the applicant's neck, her current complaint of intermittent neck pain and that head down posture or use of arms overhead can aggravate pain. Dr Bodel notes tenderness in the trapezius muscle at the base of the neck with guarding, and reduced range of neck flexion extension and rotation in all directions with asymmetry of movement.
5. Dr Bodel diagnoses early degenerative disc disease and a soft tissue injury of the cervical spine, in part the aggravation of the disease process. There is a causal link between the nature of her work in general and the ongoing rateable impairment in the neck in Dr Bodel's opinion.
6. As the respondent submits, there is no record taken of the applicant's cervical spine symptoms until January 2024. Dr Gupta notes on 13 March 2023 the applicant is in good health aside from the right shoulder injury, and Ms Hughes records on 9 June 2023 the applicant has no restrictions twisting from the neck. Dr Pathirana notes on 16 November 2023 the applicant's neck is pain-free and she had normal range of movement.
7. As the neck pain is increasing over time and is intermittent, this may explain why it may not have been recorded in clinical notes, and I note inconsistencies between the applicant's evidence and clinical notes should in general be treated with caution.[40]
8. Dr Haig records no complaint of neck pain in his report of 5 April 2024. In his report of 4 September 2024 Dr Haig notes the applicant has physiotherapy therapy including massage of the neck. Dr Haig's examination of the applicant's cervical spine showed her posture to be normal with full range of motion and no diagnosis is made.
9. Dr Haig records the applicant appears to have no complaints in the neck itself but rather pain in the trapezius area emanating from the neck, he notes no radiology is available and he has no reason to believe her employment aggravated any pathology in her cervical spine. Dr Haig does not provide any further reasoning as to why the applicant's pain is not related to her employment with the respondent.
10. Dr Haig's conclusion is that the applicant did not suffer any injury in the course of her employment. I note however the right shoulder injury is accepted by the respondent and I have found above the applicant contracted and aggravated a left shoulder disease.
11. I afford less weight to Dr Haig's opinion also with respect to the applicant's cervical spine injury for these reasons.
12. I note the applicant's statement evidence with respect to her cervical spine pain, that the nature of the work she was performing was capable of causing that condition, and that Dr Bodel provides expert medical evidence that it did so. There is no evidence of any other contributing factor to the applicant's increasing neck pain.
13. On a consideration of the evidence on balance I find the applicant's cervical spine disease was aggravated or made worse by her employment with the respondent, and the employment was the main contributing factor.

1. I do not find the applicant has sustained an injury in accordance with s 4(b) with respect to her feet or ankles for which the employment was the main contributing factor.
2. The applicant's evidence is that in February 2024 she developed pain and swelling in both feet without any further accident or injury. I accept her uncontradicted evidence that she stood for various periods of time carrying out pick-packing work for the respondent, and the inference that she was standing on a hard floor.
3. The left ankle and/or hind foot ultrasound report of 13 December 2024, with a history of chronic swelling over the left ankle, refers to tendinopathy with associated tenosynovitis.
4. I do not accept the applicant's submission that her uncontradicted statement evidence coupled with the nature of the injuries leads to a conclusion they were caused by the employment in the absence of medical evidence of a causal relationship.[41]
5. The diagnosis made by Dr Bodel is of pain and swelling in the feet. Dr Bodel notes in January 2025 the reports of X-rays and ultrasounds confirm no specific bone or joint abnormality of the feet. Even were the applicant's ankle or feet conditions accepted as disease injuries, there is insufficient evidence the condition was causally related to her employment.
6. The available evidence is insufficient to justify an inference of probable connection.[42] The probability of pain and swelling in the applicant's feet or ankles in February 2024 being a disease contracted or aggravated in the course of her employment which ceased in October 2023 is less in my view than of it not having occurred.
7. The available evidence is unpersuasive on a common-sense evaluation of the causation chain[43] and I accept the respondent's submissions in this regard.

Did the applicant sustain consequential injuries to the left shoulder, cervical spine and/or bilateral feet-ankles as a result of the accepted right shoulder injury on 7 July 2022

1. The respondent submits and I agree there is no evidence aside from reference in some clinical notes or the submissions made by the applicant that her left shoulder or neck injuries were sustained as a consequence of the accepted right shoulder injury. The applicant has not framed her case on that basis and there is no expert medical opinion in support.
2. As I have found the applicant did not sustain feet or ankle conditions as a result of the employment, and that she has sustained disease injuries to her left shoulder and cervical spine for which the employment with the respondent is the main contributing factor, a consideration of consequential injuries is not necessary.

1. The applicant sustained left shoulder and cervical spine injuries on 7 July 2022 pursuant to s 4(b) of the 1987 Act6.
2. There will be an award for the respondent with respect to claimed injuries to the bilateral feet-ankles.
3. I remit this matter to the President for referral to a Medical Assessor for assessment of the applicant's right upper extremity (shoulder), left upper extremity (shoulder) and cervical spine.
4. The matter is to be listed before me for a preliminary conference following the completion of the Medical Assessment process to deal with the balance of the claim.

[2] [2009] NSWCA 227.

[3] [2011] NSWCA 199.

[4] [2024] NSWPICPD 45 (Proops).

[5] [2021] NSWPICPD 13.

[6] Federal Broom Co Pty Ltd v Semlitch [1964] HCA 34; (1964) 110 CLR 626.

[8] [2017] NSWCA 260.

[9] [2010] NSWWCCPD 104.

[10] Kooragang Cement Pty Ltd v Bates (1994) 35 NSWLR 452; (1994) 10 NSWCCR 796 (Kooragang).

[11] [2008] NSWCA 246 (Nguyen).

[13] Trustees of the Society of St Vincent de Paul (NSW) v Maxwell James Kear as administrator of the estate of Anthony John Kear [2014] NSWWCCPD 47.

[14] Ky v Blue Leaf Food Group Pty Ltd [2016] NSWWCCPD 55 at [55].

[15] Taylor v J & D Stephens Pty Ltd [2018] NSWCA 287.

[16] Federal Broom Co Pty Ltd v Semlitch [1964] HCA 34; (1964) 110 CLR 626.

[17] Taylor v J & D Stephens Pty Ltd [2018] NSWCA 287.

[18] Kelly v Western Institute NSW TAFE Commission [2010] NSWWCCPD 71 at [66]; Federal Broom Co Pty Ltd v Semlitch [1964] HCA 34; (1964) 110 CLR 626.

[19] Cant v Catholic Schools Office [2000] NSWCC 37; (2000) 20 NSWCCR 88 at [17].

[20] Ghilagabar v Kmart Australia Pty Ltd [2022] NSWPIC 25 at [97], Badawi v Nexon Asia Pacific Pty Limited trading as Commander Australia Pty Limited [2009] NSWCA 324.

[33] Zickar v MGH Plastic Industries Pty Ltd [1996] HCA 31; 187 CLR 310.

[34] North Coast Area Health Service v Felstead [2011] NSWWCCPD 51 at [77].

[37] Mason v Demasi [2009] NSWCA 227.

[38] Smith v Mann [1932] HCA 30; (1932) 47 CLR 426, Qantas Airways v Phegan [2025] NSWPICPD 80.

[40] Mason v Demasi [2009] NSWCA 227.

[42] Seltsam Pty Limited v McGuiness; James Hardie & Coy Pty Limited v McGuiness [2000] NSWCA 29.

[43] Kooragang Cement Pty Ltd v Bates (1994) 35 NSWLR 452; (1994) 10 NSWCCR 796 (Kooragang).