1. It was Mrs Nolan's evidence that she had not derived any benefit from the naturopathic products in the form of emu oil, anti-snooze and ultra glucosamine which she had ceased taking some time ago. Mrs Nolan further accepted that the claimed expenses with respect to these products were not related to her compensable injury. The consultation fees for Dr Ghali were associated with the anti-snore medication and those for Dr Hall were related to problems she had experienced with her jaw and ear. Dr Hall reported on 8 July 2005 that after examining Mrs Nolan "there appears to be a stress-related temporomandibular joint pain dysfunction". After counselling Mrs Nolan and requesting an OPG x-ray it was his advice that the vertical dimension of her upper denture be increased and after further review he would consider "lower dentures or appliance". Whilst Dr Hall stated that the dysfunction appeared to be stress-related his recommended treatment included denture adjustment which subsequently improved Mrs Nolan's condition.
2. Although Dr Stillger suggested that these problems were related to Mrs Nolan's compensable condition, there was no evidence from the specialists consulted. The claims were not strenously pursued by the applicant at the appeal hearing. There is an absence of evidence upon which the Tribunal could be satisfied that these treatments were reasonable for Mrs Nolan to obtain in the circumstances as required by section 16(1) of the SRC Act.
3. The issues therefore for determination are whether the claimed expenses with respect to massage and chiropractic treatment constitute reasonable medical treatment for Mrs Nolan's accepted condition of adjustment reaction with anxious mood.

1. Mrs Nolan gave evidence in relation to her employment with Centrelink and the circumstances leading to her stress-related condition. Mrs Nolan referred to unfair treatment and the lack of constructive assistance in meeting her job performance targets. She felt that she was under scrutiny and was treated differently than the other members of staff. She felt intimidated and bullied and was concerned that her employment may be terminated. As the respondent had accepted liability for Mrs Nolan's condition, it is not necessary to refer to this evidence in any detail.
2. Mrs Nolan said that it was in approximately 2003 that she first experienced anxiety symptoms. Mrs Nolan first consulted her general practitioner on 2 September 2003 and submitted a claim for compensation on 23 October 2003. Her claim was accepted on 4 December 2003 as adjustment reaction and anxious mood disorder. Comcare paid for associated expenses between 4 December 2003 and November 2005.
3. Mrs Nolan was originally treated by Dr Debra Scott at the Burnie City Medical Practice and subsequently by Dr Stillger when Dr Scott left the state in early 2004. Mrs Nolan was referred to Bernadette Smith, a psychologist who on 14 June 2005 diagnosed a chronic adjustment disorder with anxiety which she considered was precipitated by perceived harassment within the workplace. Ms Smith reported that her treatment plan was focused on utilising cognitive behavioural therapy. In July 2005 Dr Stillger noted that Mrs Nolan was having regular psychologist sessions as well as massage therapy and had been referred for chiropractic help for her headaches and neck pain. Investigation of her jaw and ear pain and headaches had been undertaken by Mr Earles and a neurologist physician, Dr Bruce Watson. However no pathological organic cause was found for her persisting pain symptoms. Whilst Mrs Nolan had trialled antidepressant medication this had ceased and Dr Stillger reported that she was having beneficial relief from a massage therapist, regular physiotherapy and a naturopath.
4. Mrs Nolan has been referred for various types of treatment for physical ailments that some doctors had informed her were stress-related. In July 2004 Mrs Nolan was referred to Dr Earles, a Ear Nose and Throat Surgeon regarding ear pain and Dr Haybittel, an ophthalmologist with respect to headaches. Dr Earles referred Mrs Nolan to Dr Hall, oral surgeon, after diagnosing tempro-mandibular joint arthralgia. In his report to Mrs Nolan's treating general practitioner, Dr Stillger of 27 April 2005, Mr Earles states:

"As you are probably aware she is a rather rambling historian and has evidently had treatment from alternative medical practitioners who have clouded her thinking substantially".

1. On 10 August 2005, a report was prepared by Dr Jeffrey Swift, consultant psychiatrist for Centrelink, who referred Mrs Nolan for psychiatric assessment and report. Dr Swift considered that Mrs Nolan's mental state at examination and psychological testing was suggestive of conversion disorder DSMIV 300.11. Whilst he considered that she had been well managed by her general practitioner he recommended that Mrs Nolan be referred to a psychiatrist for treatment.
2. It was apparent during the course of giving her evidence that Mrs Nolan still suffers from the symptoms of her compensable condition. This was confirmed by the various specialists who gave evidence. There have been periods of time however when Mrs Nolan's symptoms were significantly relieved. In early 2005 she undertook a rehabilitation program with Commonwealth Rehabilitation Services when she worked four and a half days per week. Mrs Nolan also undertook a Teachers' Aide course through TAFE Tasmania and worked as a volunteer teachers' aide at a local primary school for a period. In October 2007 she commenced work at TAFE as an administrative assistant. More recently she has been employed in a part-time capacity for two days a week with Guaranteeing Futures. Mrs Nolan said however that she feels that her condition is not improving and agreed that her on-going dispute with Comcare could be a contributing factor.
3. Mrs Nolan said that she now accepted that her physical ailments are related to her stress condition although she had not initially accepted this fact. It is not clear from the various medical reports whether the practitioners who treated Mrs Nolan also believed that her physical ailments were related to her stress condition.

1. Mrs Nolan was receiving weekly massage treatments on the recommendation of Dr Stillger until Comcare determined to cease payment from November 2005.
2. Mrs Nolan first presented for treatment with Dr Stanton on 22 August 2006. Dr Stanton reported that between this period and 19 December 2006, Mrs Nolan was also having a weekly massage with Ms Roberts, taking her prescribed medication (Mirtazapine) and nutritional supplements of emu oil, glucosamine, magnesium and vitamin B5.
3. In her report of 15 April 2008, Dr Stillger states that Mrs Nolan:

"... was recommended weekly massage therapy for her main analgesic effect, chiropractor with acupuncture for her neck and jaw pain every 2 weeks. Mrs Nolan had undergone extensive various treatment plans and the above regime seemed to keep her at a functioning level. She was able to participate to her return to work plan as long as this therapy continued.

...

In my opinion the massage treatment was her main form of therapy for her severe headaches and helping her return to work plan. When this was ceased suddenly she deteriorated markedly in her work capacity and was reluctant to go backwards. She was forced to pay for the massage herself and to find her own retraining in another area. ..."

1. It was Mrs Nolan's evidence that she considered the treatment that she received from Dr Stanton consisted of massage rather than chiropractic treatment. She did not understand the claim for chiropractic treatment. It was Dr Stanton's evidence however that the treatment that he administered was in the form of chiropractic and acupuncture treatment comprising the following:
   • Nimmo Trigger Point Therapy
   • Chiropractic Soft-tissue Manipulation
   • Chiropractic Activator Technique
   • Acupuncture
   • Stretching - Muscle Energy Techniques
   • Nutrition Supplements: Magnesium, Calcium pantothenate (Vitamin B5)

2. Dr Stanton reported that Mrs Nolan was suffering from chronic stress as a direct result of her work at Centrelink and diagnosed Fibromyalgia Syndrome precipitated by chronic stress. He recommended a holistic approach to her on-going treatment to include:
   • counselling for her anxiety disorder
   • anti-depressant medication (prescription and/or herbal)
   • massage for her fibromyalgia, acupuncture for her fibromyalgia
   • nutritional supplements for her fibromyalgia,
   • gainful employment in a suitable area
   • acknowledgement by Comcare of her physical distress and its relationship to her compensable claim of anxiety disorder.

3. Dr Stanton considered that fibromyalgia is a direct consequence of prolonged chronic stress/anxiety disorder. It was his opinion that the chiropractic/acupuncture/massage is the treatment of choice for somatic pain when the patient cannot tolerate analgesia. He recommended massage to her hypertonic muscles at 2 weekly intervals; acupuncture to assist with achieving a holistic balance and correct function of the hypothalamic-pituitary-adrenal systems, at a frequency of once a month and the use of nutritional supplements.
4. Dr Stanton suggested that massage would be beneficial to ease muscle tension provided the other issues relating to Mrs Nolan's adrenal exhaustion, fibromyalgia and stress coping mechanisms are also addressed.
5. Dr Stanton detailed how he had diagnosed fibromyalgia by the history given and a physical examination. He considered that his treatment of soft tissue manipulation, acupuncture and nutritional supplements assisted Mrs Nolan and enabled her to get on with her life. Dr Stanton said that Mrs Nolan ceased her treatment with him for financial reasons.
6. Dr Stillger maintained that massage treatment had provided Mrs Nolan with pain relief and kept her at a functioning level. Dr Stillger said that Mrs Nolan was unable to tolerate oral medication and that in her view she is entitled to whatever reasonable treatment enables her to continue to function. Dr Stillger agreed that she had approved Mrs Nolan's cessation of the medication prescribed by Dr Ratcliff as Mrs Nolan felt that the side-effects outweighed any benefits. Dr Stillger noted that only a small dose had been prescribed.
7. Dr Stillger agreed under cross-examination that massage treatment would not cure Mrs Nolan's condition but provide a temporary relief of her symptoms. Whilst Dr Stillger agreed that Mrs Nolan may have developed a form of dependency on the massage treatments which she had been undergoing for several years, she considered that it has been beneficial. Dr Stillger stated that Mrs Nolan had been "functioning beautifully" until March of this year when this appeal was listed for hearing. Dr Stillger agreed that the primary stressor for Mrs Nolan which is maintaining her current condition is the dispute with Comcare.
8. Dr Stillger confirmed that Mrs Nolan's physical complaints have been extensively investigated by specialists over a number of years. In many cases the specialists were unable to find an organic cause for the physical symptoms, some of which were assessed as being stress-related.
9. Mrs Nolan was referred to Dr Eric Ratcliff by Dr Hudson, general practitioner, in November 2005. However Dr Ratcliff was not able to see Mrs Nolan until January 2006. He saw her again on 23 February 2006, 30 March 2006 and 27 April 2006. The referral by Dr Hudson was made following a recommendation by Dr Swift who undertook a psychiatric assessment of Mrs Nolan in August 2005 at the request of Centrelink. Dr Swift had assessed Mrs Nolan as totally incapacitated for her role as a personnel pay processing officer and considered that unless she received treatment for her psychiatric syndrome she would probably never be fit for any form of work. Dr Swift did not believe that Mrs Nolan was malingering but believed that the nature of her past work experience and personality traits had hampered the return to work program established by Centrelink.
10. Dr Ratcliff diagnosed Mrs Nolan with adjustment disorder, unspecified (DSM IV 309.9) characterised by physical complaints, work inhibition, anxiety and depression. He noted that Mrs Nolan's somatic symptoms had been extensively investigated and considered that no further physical investigations were necessary. In his report dated 1 May 2006, Dr Ratcliff stated:

"Somatic symptoms are recognised as an expression of anxiety and depression in some people, who by reason of their personality structure cannot readily recognise and accept symptoms involving mood and emotion. They can, and do occur in Adjustment Disorders, as recognised by DSM IV".

1. In his medical notes Dr Ratcliff reported on 6 July 2006 that massage produced "transient relief of her discomforts, but has not been prescribed". On 7 December 2006 Dr Ratcliff reported that Mrs Nolan was seeing a chiropractor but that "he's not chiropracting me (her words)". Further that she was paying for the treatment herself on a two weekly basis but claimed that it only helped if it was "done regularly weekly".
2. In his oral evidence to the Tribunal Dr Ratcliff stated that the benefits of massage treatment are transient and of limited value in the long term. He agreed that the preferred and long term treatment is intensive psychotherapy and medication. He did not consider that massage therapy constitutes reasonable treatment in that it does not treat the condition. Dr Ratcliff agreed that the provision of on-going massage as appropriate treatment could indeed foster a patient's sick role mentality and encourage dependence on such treatment rather than seek appropriate beneficial treatment for the condition.
3. Dr Ratcliff had recommended that Mrs Nolan persevere with the medication that he had prescribed despite her complaints of its side-effects. He believed that during the time that he had treated Mrs Nolan, she had made significant progress. He is optimistic that recent advancements in medical science are producing medications with reduced side-effects. He agreed that Dr Kostas' recommendation of a self-managed exercise program could be beneficial in treating Mrs Nolan's condition but said that he would defer to the experts in this field.
4. Mrs Nolan was referred to Dr Tony Kostas, rheumatologist, by the Australian Government Solicitor who examined her on 5 September 2008 and provided a written report dated 8 September 2008 which was tendered in evidence. Also tendered in evidence were letters from Dr Kostas to Ms Richards, Senior Lawyer with AGS of 19 March 2009 and 30 March 2009.
5. Dr Kostas' diagnosis was a chronic pain syndrome. His physical examination of Mrs Nolan did not produce results that were suggestive of fibromyalgia. Dr Kostas explained how he had followed the diagnostic criteria formulated by the American College of Rheumatology for fibromyalgia which refers to tenderness to digital palpitation in 11 out of 18 identified tender points on the body.
6. It was Dr Kostas' evidence that during his examination of Mrs Nolan he found no tender points. He agreed that it is possible that on other occasions tender points may have been present. He explained however that there can be other reasons why patients experience tender points. He remarked that patient's with fibromyalgia complain of chronic pain in certain locations and that in his opinion Mrs Nolan did not present with the clinical signs that need to be present before a diagnosis of fibromyalgia can be made.
7. In his report of 8 September 2008 Dr Kostas questioned Dr Stanton's diagnosis of fibromyalgia and noted that Dr Stanton did not describe the clinical findings that led him to his conclusion. He also commented that Dr Stanton's suggested treatment program is inappropriate for this condition and that long term chiropractic treatment has not been subjected to randomised clinical studies in fibromyalgia. He further stated that none of the supplements proposed by Dr Stanton are appropriate either.
8. Dr Kostas was asked by me to comment on the methodology adopted by Dr Stanton in his physical examination of Mrs Nolan as described in his evidence at the hearing. Dr Kostas remarked that some of the areas examined by Dr Stanton are not the tender points referred to in the American College of Rheumatology diagnostic criteria for fibromyalgia.
9. In his report Dr Kostas recorded that Mrs Nolan had found that a weekly massage provided her with temporary benefit. Dr Kostas disagreed that massage is an appropriate form of treatment for fibromyalgia or to treat Mrs Nolan's chronic pain syndrome. He stated that it should be explained to Mrs Nolan that she is not injured and there is no physical basis for her symptoms. She should avoid passive treatments and embark on a graded exercise program. He considered that there is no physical reason why Mrs Nolan could not be pursuing an exercise program. Despite her contention that past exercise has caused her problems, Dr Kostas maintained that there is always a level of exercise that a patient can undertake which can be started at a low level and gradually built up. He agreed with Dr Sale's recommendation of swimming but suggested that some form of aerobic exercise to increase the heart rate would also be beneficial.
10. It was pointed out to Dr Kostas that there is evidence that Mrs Nolan has received pain relief from massage treatment. He agreed that massage treatment can be beneficial in the short term for between 6-8 weeks to break a pain cycle but suggested that it should last no longer than a couple of months. Beyond that point in time Dr Kostas said it is counter productive in that it diverts a patients attention from treatment than can be of real long term benefit by making a patient reliant on passive modalities and fostering "the sick role". Nor did Dr Kostas believe that any form of chiropractic treatment is appropriate in patients with chronic pain syndrome because they do not have any objective musculoskeletal lesion that can be treated in this way.
11. Dr Sale agreed with the diagnosis of chronic adjustment disorder with anxiety symptoms. He also doubted whether any of the naturopathic products have a role to play in the treatment of a psychiatric condition. It was Dr Sale's view that passive treatment such as massages foster a patients dependence and are in fact counter productive to long term treatment. Massage will only provide short term relief and is appropriate for a short term acute condition such as a sport injury. In his view, massage is not a reasonable treatment modality for a psychiatric condition. Dr Sale advocated a more active fitness based program such as swimming or general running to tackle the problem of muscle tone and pain.

1. The respondent, Comcare, had accepted liability to pay compensation for Mrs Nolan's "injury" pursuant to section 14 of the SRC Act in December 2003. The definition of "injury" as contained in section 5A of the SRC Act has since been amended by excluding "injury or aggravation suffered as a result of reasonable administrative action taken in a reasonable manner in respect of the employee's employment". Reasonable administrative action is further defined in sub-section 2. The amendment is not applicable to this case as it became effective after the date of the injury. (Section 42 of the Safety, Rehabilitation and Compensation and Other Legislation Amendment Act 2007). It was accepted by the respondent that Mrs Nolan continues to be entitled generally to compensation under the legislation whilst she is able to satisfy Comcare that her illness is work-related.
2. Mrs Nolan's claim is made pursuant to section 16 of the SRC Act. Section 16(1) reads as follows:

"(1) Where an employee suffers an injury, Comcare is liable to pay, in respect of the cost of medical treatment obtained in relation to the injury (being treatment that it was reasonable for the employee to obtain in the circumstances), compensation of such amount as Comcare determines is appropriate to that medical treatment

(2) Subsection (1) applies whether or not the injury results in death, incapacity for work, or impairment".

1. The issues for the Tribunal to determine are firstly, whether the treatment constitutes medical treatment as defined in section 4(1) of the SRC Act and secondly, if so, whether the treatment is reasonable for the applicant to obtain in the circumstances.
2. Medical treatment is relevantly defined in section 4(1) as follows:

(a) medical or surgical treatment by, or under the supervision of, a legally qualified medical practitioner; or

(b) therapeutic treatment obtained at the direction of a legally qualified medical practitioner; or

(d) therapeutic treatment by, or under the supervision of, a physiotherapist, osteopath, masseur or chiropractor registered under the law of a State or Territory providing for the registration of physiotherapists, osteopaths, masseurs or chiropractors, as the case may be; or

(e) an examination, test or analysis carried out on, or in relation to, an employee at the request or direction of a legally qualified medical practitioner or dentist and the provision of a report in respect of such an examination, test or analysis; or

(h) nursing care, and the provision of medicines, medical and surgical supplies and curative apparatus, whether in a hospital or otherwise; or

(i) any other form of treatment that is prescribed for the purposes of this definition".

1. As is evident from paragraph (d) of the above definition, treatment by registered masseurs and chiropractors constitutes medical treatment. The next issue for the Tribunal to determine whether it was reasonable for Mrs Nolan to obtain such treatment in the circumstances.

1. A useful summary of previously decided cases with respect to the issue of "reasonable treatment" is contained in the decision of the Tribunal in Mikic v Comcare [2002] AATA 125 which involved a claim for the cost of massage therapy:

"13. Counsel for both parties referred the Tribunal to a number of earlier Tribunal decisions dealing with the issue of "reasonable" treatment. One of these was the decision of Gray J in Re Jorgensen and Commonwealth (1990) 23 ALD 321; 11 AAR 543 and in particular the following passage (at 325/547):

In my view, the question of reasonableness in the circumstances is intended to raise issues as to whether some kind of medical treatment other than that undertaken, or in some cases no medical treatment at all, would have been better for a person suffering from the particular injury. The idea of reasonableness involves objectivity. A reference to the circumstances raises subjective factors, but they are intended to be subjective factors related to the nature of the injury, and not to details of the personal life of an applicant for compensation.

...

14. Reference was made to ... Re Popovic and Comcare [2000] AATA 264; (2000) 64 ALD 171...:

In relation to the applicant's claim for physiotherapy treatment expenses, in our view there is no role for passive physiotherapy in the applicant's current treatment regime. The physiotherapy he was having could not improve him in the long term, has limited, if any, short term benefit, and may in fact be contra-indicated. Any therapeutic benefit he received was small and short- lived. We accept that pain relief, even short-term relief or reduction in pain, can be therapeutic: Comcare v Watson (1997) 73 FCR 273 at 276; [1997] FCA 149; 46 ALD 481 at 484; [1997] FCA 149; 154 ALR 173 at 176 per Finn J. However, in this case any benefit is outweighed by the counter-productive effect of it leading the applicant to a dependent state, inhibiting his ability to learn to cope, and to embark on pain management programs to assist him with that object. Taking into account the whole of the evidence before us, we consider that in the applicant's case it was not in his best interests for passive physiotherapy modalities to have continued beyond 16 September 1997 ...

Even if we found that the short-term therapeutic benefit derived by the applicant was therapeutic for the purposes of the Act, in our opinion it is not reasonable treatment in the circumstances for the reasons mentioned above. To the extent the applicant derives some therapeutic value from the psychological effect of receiving the treatment, psychologists could better provide this in an appropriately devised pain management plan..."

1. In Lovrinovic and Comcare [1998] AATA 1038 the Tribunal concluded that the applicant's claim for the cost of therapeutic massage and chiropractic treatment providing short-term relief for a pain condition arising from psychological rather than physical causes was not reasonable medical treatment within the meaning of section 16. The following paragraphs are relevant to the circumstances of this appeal:

"22. The treating and examining doctors agree that the applicant's relevant symptoms are headaches, generalised widespread pain over her neck, shoulders, arms, thoracic and lumbar spine, and thighs, and depression. Examination by the treating and examining doctors reveals essentially full and free movement of upper and lower limbs, neck and lumbar spine. On some occasions mild pain was reported at the limits of passive movement (movements made with the assistance of the doctor). All relevant scans and tests report essentially normal results. Thus there is no detectable organic source of the reported pain ...

53. From all the foregoing it is clear that there is substantial medical agreement that Mrs Lovrinovic suffers a fibromyalgic-type constellation of symptoms which have no underlying organic basis. Further, it seems agreed that, whatever the etiology, Mrs Lovrinovic's pain condition is largely a result of psycho-social factors. It is also clear that there is no adequate, widely accepted explanation of the mechanism by which psychological factors can reflect in chronic pain; nor even how a physical trauma can lead to such pain. Yet such cases are apparently relatively common. In short, the medical world does not yet understand this problem. There are obviously many doctors who, in the absence of a demonstrable explanation, remain sceptical that a minor injury could lead to a major pain syndrome. Nevertheless, there are those who see these cases frequently and accept their reality without having a good understanding of the physical and psychological factors at work ...

63 ... In Comcare v Watson (1997) 22 AAR 516 at 519, Justice Finn noted that Comcare submitted that treatment:

can only be 'therapeutic' if its object is to cure a disease or injury.

Justice Finn went on to say:

Though some dictionary definitions do emphasise the 'healing or curative' connotation of the words 'therapy and therapeutic', the latters' use in this context encompasses the alleviation of the pain of an injury. This view is consistent with the section 4 definition of 'therapeutic treatment' which includes 'treatment given for the purpose of alleviating an injury.'

Justice Finn therefore found that treatment designed to alleviate, or aimed at alleviating pain arising from an injury or a disease is properly to be regarded as therapeutic treatment.

64. It is our task to objectively assess whether therapeutic massage and chiropractic treatment is reasonable given the nature of the applicant's injury for the purposes of section 16(1) ...

Deputy President Forrest in Tiranti-Valenti and Comcare (1996) 45 ALD 478 at 480 also noted that "[t]he reasonableness of the treatment is a matter of judgment to be assessed by reference to the relevant circumstances" ....

67. In recommending that the applicant have chiropractic care every 2 to 6 weeks Dr Rosendahl states that it has proved to be of substantial benefit (Exhibit 5). On the other hand, Dr McGill said 'the benefit she receives is likely to be via psychological support rather than any physical aspect of the massage treatment' (T99), and that 'further therapy along physical lines is likely to be counter productive by reinforcing an inappropriate sick role' ...

68. Given that the applicant's pain condition is psychologically rather than physiologically produced, we agree with Dr McGill's opinion that physical therapy is inappropriate. The treatment produces temporary relief from pain with no curative effect ... All suggest anti-depressant therapy is a reasonable treatment option at this stage. We accept this view".

1. The Tribunal in Lonsdale and Comcare [2004] AATA 555 determined that Comcare was liable to pay for the cost of massage treatment. In that case the Tribunal accepted that the applicant had a genuine physical injury and that massage treatment helped her cope with the pain she experienced from her back injury. The Tribunal noted that a number of medical experts had expressed views that massage is a passive therapy which can encourage on-going passive therapies at the expense of more active therapy such as exercise. Some of the specialists considered massage to have a transitory effect with little long term value.

1. Mrs Nolan was initially receiving massage treatment from a masseur which was compensated by Comcare until November 2005. Dr Stanton reports that Mrs Nolan was having weekly massage treatment with Ms Yvonne Roberts between 22 August 2006 and 19 December 2006, the cost of which she would have met herself following Comcare's cessation of payment in November 2005. Mrs Nolan's masseur, Ms Roberts, subsequently moved to Hobart.
2. At the recommendation of Dr Stillger Mrs Nolan commenced massage/chiropractic treatment with Dr Stanton. Dr Stanton reported that he last administered chiropractic treatment to Mrs Nolan on 15 January 2008. Mrs Nolan's massage/chiropractic treatment has effectively been administered over a period of some three years. The question for the Tribunal to determine is whether the evidence supports a continuation of the massage/chiropractic treatment beyond November 2005 on the basis that it was reasonable for it to be continued in treatment of Mrs Nolan's compensable condition.
3. It was Dr Kostas' opinion that although massage treatment may provide some short-term pain relief, it should not be continued for longer than six to eight weeks. Dr Sale opined that massage was not an appropriate medical treatment for a psychiatric condition. Mrs Nolan's own treating psychiatrist, Dr Ratcliff, said that the benefits of massage treatment are transient and of limited value in the long term. In his opinion massage therapy does not treat the condition and therefore could not be considered reasonable medical treatment. These specialists all agreed that on-going massage treatment can induce dependence, fostering the sick role thereby deferring appropriate medical treatment of the underlying condition.
4. On the other hand Dr Stillger maintained that Mrs Nolan is entitled to seek whatever treatment provides her with some relief. She accepted Mrs Nolan's claims that massage treatment had been beneficial in the past. Dr Stanton supported this view. Dr Stanton however had diagnosed that Mrs Nolan was suffering from fibromyalgia. He stated in his report of 25 February 2008 that Mrs Nolan was receiving massage to help with her condition of fibromyalgia and not her anxiety disorder as such, although he noted that it was the anxiety disorder that had led to her suffering fibromyalgia.
5. Dr Kostas, a specialist in musculo-skeletal medication disagreed with Dr Stanton's diagnosis of fibromyalgia after his assessment of Mrs Nolan using the accepted diagnostic criteria of the American College of Rheumatology. Dr Stanton had not referred to this criteria but had used "naturopathic criteria". Under cross-examination Dr Stanton said that he was not aware that fibromyalgia was generally regarded as a medical condition. Although he had not, Dr Stanton accepted that it would be a reasonable starting point to adopt the criteria as published by the American College of Rheumatology. Dr Kostas was critical of Dr Stanton's assessment methodology and the treatment modalities proposed by him.
6. Dr Stanton is not a qualified medical practitioner, his qualifications are cited as B. App.Sci (Chemistry); B. App.Sci (Nursing); B. AppSci (Chiropractic); Diploma of Herbal Medicine; Diploma of Acupuncture and Member of the Chiropractors Association of Australia. In the Tribunal's opinion Dr Kostas, a specialist rheumatologist in musculo-skeletal medicine is best qualified to diagnose fibromyalgia, a condition which is generally treated by specialist rheumatologists. On balance the Tribunal prefers and accepts the evidence of Dr Kostas over that of Dr Stanton. Similarly the Tribunal prefers the evidence of Drs Ratcliff and Sale to those opinions expressed by Dr Stillger who does not hold specialist qualifications in psychiatry.
7. The treatment proffered and recommended by Dr Stillger and Dr Stanton is not supported by the specialist medical experts called by the respondent. In their view the administration of on-going massage treatment has no long-term benefit and may in fact be contra-indicated by fostering dependence on this type of treatment at the expense of undergoing beneficial long-term treatment in the form of medication, psychotherapy and an active exercise program. Drs Ratcliff, Sale and Kostas all agree that the latter form of treatment would constitute reasonable medical treatment for Mrs Nolan's compensable condition, which is psychiatric rather than physical. The Tribunal accepts that these medical practitioners are best qualified to proffer opinions as to the most appropriate and reasonable medical treatment in the circumstances of this case.
8. For these reasons the Tribunal is unable to accept that it was reasonable for Mrs Nolan to continue to receive massage and chiropractic treatment beyond November 2005. The evidence was that such treatment should only be offered in the short-term. Dr Kostas suggested for a period of up to a maximum of two months beyond the date of injury. Whilst such treatment may have provided temporary relief, it cannot constitute reasonable treatment for Mrs Nolan's condition in that such treatment has no long-term benefit in actually treating a psychiatric condition such as Mrs Nolan's. The treatment(s) therefore cannot be considered reasonable treatment(s) within the meaning of section 16(1). The Tribunal accordingly affirms the decisions under review.
9. During the course of her evidence to the Tribunal, Mrs Nolan maintained that she had at all times followed the guidance and directives of her medical practitioners. It is apparent to the Tribunal that these medical practitioners were dedicated in their attempts to help Mrs Nolan source treatment for the various ailments of which she complained from time to time. Mrs Nolan has only recently accepted that her somatic symptoms are stress-related. It was unfortunate that Mrs Nolan was not able to attend the balance of the appeal hearing after giving her own evidence to hear the evidence of the medical specialists. It is hoped that Mrs Nolan will heed the advice of the specialists whose evidence the Tribunal has accepted, namely Drs Sale, Ratcliff and Kostas and pursue their recommended treatment in the form of psychotherapy, medication and a graded self-managed exercise program.

I certify that the 56 preceding paragraphs are a true copy of the reasons for the decision herein of Ms A F Cunningham (Senior Member)

Solicitor for the Respondent Ms N Richards, Australian Government Solicitor