Pravica and Comcare [2010] AATA 24 (15 January 2010)

Last Updated: 18 January 2010

Administrative Appeals Tribunal

DECISION AND REASONS FOR DECISION [2010] AATA 24

ADMINISTRATIVE APPEALS TRIBUNAL )

) No 2007/4927 &

) No 2009/0989

GENERAL ADMINISTRATIVE DIVISION		)
	Re		MILENA PRAVICA

Applicant

And

COMCARE

Respondent

DECISION

Tribunal

Dr J D Campbell, Member

Date 15 January 2010

Place Sydney

Decision

The decisions under review are affirmed.

....................[Sgd]...................
Dr J D Campbell
Member

CATCHWORDS

WORKERS’ COMPENSATION – travel claim – issues of the general work practice environment – issues of the immediate particular work environment – issue of stress – nature of the “event” – transient ischaemic attack (TIA) or development or culmination of an antecedent – morbid condition (essential hypertension) – injury simpliciter – disease – material contribution – psychiatric disorder – decisions under review affirmed.

Safety, Rehabilitation and Compensation Act 1988 ss 4, 6, 14

Comcare v Sahu-Khan [2007] FCA 15; (2007) 156 FCR 536

Kirkpatrick v Commonwealth (1985) 9 FCR 36

Treloar v Australian Telecommunications Commission [1990] FCA 511; (1990) 26 FCR 316

Wiegand v Comcare [2002] FCA 1464; (2002) 72 ALD 795

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

REASONS FOR DECISION

15 January 2010

Dr J D Campbell, Member

1. Mrs Pravica was born in Serbia in 1943. Mrs Pravica completed a degree and diploma in teaching, followed by a year of teaching experience prior to arriving in Australia in 1968. Mrs Pravica has been employed in other than teaching work since her arrival, and for 23 years had worked at Centrelink. Since 1995 and until her cessation on 31 May 2007, Mrs Pravica worked as a bilingual customer service operator in a Centrelink call centre at Liverpool.
2. Mrs Pravica completed a claim for compensation on 4 October 2006, in which she claimed that an injury/illness, namely minor stroke/hypertension, occurred at 4.20pm on 4 October 2006, as she was driving home from work. Mrs Pravica attributed her illness/injury to work pressure.
3. In a determination dated 6 March 2007, Comcare denied liability for “transient cerebral ischaemia” (TIA) and “essential hypertension” pursuant to section 14 of the Safety, Rehabilitation and Compensation Act 1988 (the Act). In a reconsideration decision dated 4 September 2007, Comcare affirmed the earlier determination of 6 March 2007.
4. Mrs Pravica lodged a further compensation claim dated 17 October 2007, in which she claimed that a psychiatric condition, namely post traumatic stress disorder (PTSD), had arisen and resulted from the incident of 4 October 2006. In a determination dated 1 October 2008, Comcare denied liability in respect of PTSD pursuant to section 14 of the Act. In a reconsideration decision dated 25 February 2009, a Comcare delegate, while accepting that Mrs Pravica was suffering from a psychiatric disorder, namely “adjustment disorder with anxiety”, affirmed the earlier determination of 1 October 2008. The delegate concluded that the psychiatric condition was neither a work-related injury nor a disease.

ISSUES

5. The relevant issues in this matter are:

(a) What general workplace issues were of a concern to Mrs Pravica and what was her response to such issues?
(b) What particular workplace issues were of a concern to Mrs Pravica on the days prior to and the day of 4 October 2006 and what was her response?
(c) Does the workplace issues analysis documented indicate that Mrs Pravica suffered workplace stress generally and/or particularly on the days prior to and the day of 4 October 2006 prior to the incident driving home?
(d) What were the particular details/circumstances of ‘the event’ of 4 October 2006, occasioned when Mrs Pravica was driving home?
(e) What is the appropriate diagnosis for the clinical symptoms experienced by Mrs Pravica surrounding the event of 4 October 2006 and occasioned when she was driving home?
(f) Did Mrs Pravica suffer an injury simpliciter?
(g) Was Mrs Pravica suffering from a pre-existing condition and, if so, was this condition aggravated as a consequence of the incident while travelling home on 4 October 2006?
(h) If the condition was so aggravated, was the aggravation one that was contributed to in a material degree by Mrs Pravica’s employment?
(i) Does Mrs Pravica suffer from a psychiatric disorder and, if so, what is the diagnosis of that disorder?
(j) Is Mrs Pravica’s psychiatric disorder a compensable injury?
(k) Is Mrs Pravica entitled to compensation in relation to the injuries/illnesses nominated in her two claims for compensation?

GENERAL WORKPLACE ISSUES

6. In a written statement dated 15 February 2008 (Exhibit A2), Mrs Pravica detailed the following comments:

About a week before 4 October 2006 I was having problems with my eye sight using the computer.
I recall that the week of 4 October 2006 was very busy and personally very stressful for me.
The reason for this is that apart from dealing with the enquiries on a day to day basis during that period, I had to deal with the installation of a new software computer system which was causing extreme stress in so far as it made my job a lot more difficult dealing with enquiries as the computer would not work at all.
I had a particularly stressful day on 4 October 2006 in so far as I began to use the new computer system completely. During that day I had a slight headache and some visual problems with the computer screen. I left work at 4.00 pm.

7. In oral evidence, Mrs Pravica detailed the following:

• Since 3 April 1995, she had worked as a bilingual customer service officer in the call centre. Working in a group of five that was undertaking work in the benefits area, she would translate documents into Serbian and explain the benefit areas to customers. Mrs Pravica stated that she had been trained and worked on various computer systems over time.
• There were monthly performance appraisals, and over time she had had 20 or more supervisors. During the appraisal process she would receive some negative feedback (‘try to stay shorter with the customer’, ‘don’t talk too much’), which made it difficult, if acted upon, to keep the customer happy.
• In relation to the statistical data feedback, Mrs Pravica stated “They were happy and I was happy”.
• From time to time, from 2005 onwards, when things were not going well, supervisors would comment that the call centre function would be either sold or sent to India. Mrs Pravica stated that she did not like such threats, because they were doing well, were human, and she did not believe that it would be possible to send a multilingual section to India because of the 26 languages involved.
• Computer entries were required for every activity, including logging off for toilet breaks. Mrs Pravica remembers being indignant when questioned about a 7 minute toilet break in 2006 by a much younger supervisor.
• When asked by her counsel “Did you ever worry about how well you were working?” Mrs Pravica replied “No. I was happy with the work that I did there.”

8. In response to questions in cross-examination, Mrs Pravica confirmed that:

• It was her belief that she was working very well there;
• Despite what others were saying, she was happy with the way she was doing things;
• That this was the position more or less up to 4 October 2006.

WORKPLACE ISSUES IN THE WEEK PRIOR TO THE INCIDENT ON 4 OCTOBER 2006

9. Mrs Pravica detailed the following during her oral evidence:

• She received training about a new computer system in late September 2006 for one and a half hours. Mrs Pravica was of the view that, while the theory concerning the new system was clear, a better learning application would have been experienced if the computer application had been demonstrated and shared as a learning experience.
• She commenced using the new system on 4 October 2006, and when contacted by a customer from Adelaide in the morning, she was unable to do anything as the computer screen was frozen. Mrs Pravica stated that she maintained the phone link for 90 minutes, was unable to secure assistance from a supervisor, and eventually advised the customer that she would enter the necessary details once she was able. Mrs Pravica stated that she felt absolutely hopeless and disappointed with all involved.
• Shortly after experiencing the difficulty with the computer, Mrs Pravica stated that a girl from the office came out and said “Oh, this is news from Canberra. New system doesn’t work. Please sign off new system. Canberra said they need another two years to work on the new system.”
• Mrs Pravica stated that she switched to the old system, which was a relief and continued to take more calls until finishing her shift.

10. In response to questions in cross-examination, Mrs Pravica stated that:

• While she may have regarded the criticisms made of her by other people in the workplace as unfair, she got on with her job and did the best she could, believing that she was competent in what she did. While at times she complained about the adequacy of training, and considered some management practices unfair, she never had any occasion to see a doctor about a psychiatric illness occurring from such. In the past, Mrs Pravica stated that she had sought medical assistance, including psychiatric consultation for emotional upset arising from death of family members and being unable to attend their funerals and depression in the mid 1990s.
• She considered her understanding of the new computer system to be similar to that of her co-workers. Mrs Pravica, while acknowledging that she was told that average call handling times with the new system would increase, stated that management expectations were the same as for the old system.
• In relation to an undated document (T16), Mrs Pravica denied that she was the author of the three page document.
• While Mrs Pravica admitted in part that she may have signed onto the new system a day or two before 4 October 2006, she did so to start, but not to work. While Mrs Pravica was advised during training of technical support assistance with the new system, no one was available until 1.00 pm on 4 October 2006.
• She handled the computer malfunction on the morning of 4 October 2006 in a competent and professional manner. Following lunch on that day Mrs Pravica, having felt under tremendous stress because of the earlier difficulties, stated that working on the old system helped relieved her stress, activities she continued until she finished work at 4.00pm.
• Mrs Pravica also detailed an event which occurred in the week or so preceding the event of 4 October 2006, in which she had difficulty with viewing her computer screen (blurring). After seeking and being given a break of 5 minutes she returned to her computer activity with no difficulties arising, although Mrs Pravica stated that she did attend an optometrist and was prescribed reading glasses.

THE EVENT OF 4 OCTOBER 2006

11. Mrs Pravica described the incident of 4 October 2006 in the following terms in her written statement of 15 February 2008 (Exhibit A2):

Whilst driving home from work on 4 October 2006 I experienced an onset of severe dizziness and severe headaches. I also experienced some visual difficulties.
I recall that I pulled over and I blacked out for about 2 to 3 minutes. When I came to I did not know where I was, what time it was or what I was doing. I came to about 5 minutes later.
When I recovered somewhat I drove to my local family doctor, Dr Milena Trajilovic ...

12. In oral evidence, Mrs Pravica described the incident in the following manner:

I was driving from my office in North Tamberlin Street to Hume Highway. Then when I enter M5, about maybe few minutes – five minutes – I felt absolutely terrible. The pain on my top of my head – it was like that machine that breaks concrete. And I couldn’t see. I throw my sunglasses. I somehow went into left and I fell unconscious.
... Then I, first thing I start seeing – I didn’t know whether it was daylight or night and I was very frightened when I couldn’t remember when I – whether I was going home or whether I was going to work. ...then I remember I am going home. ...Then I started to drive, slowly, in the left lane and I get at Maroubra about half past five, quarter to six to see my doctor.

13. In response to questions in cross-examination, Mrs Pravica conceded that she had started to relax a bit when she got in her car to drive home on 4 October 2006. Mrs Pravica stated that after 10 to 14 minutes her first symptom was that she was unable to see – this led to her discarding her sunglasses. She then described feeling a terrible pain on top of her head immediately and pulling somehow onto the left where she stopped.
14. In response to questions from the Tribunal, Mrs Pravica stated that the first thing she noticed was a sense of darkness/blackness affecting both eyes, with dizziness occurring for a few seconds beforehand. Mrs Pravica stated that she was unaware as to how long she stopped, but continued on her journey at a slow pace when the headache abated, although retaining a feeling of heaviness in both arms and legs.

ISSUES SUBSEQUENT TO THE EVENT OF 4 OCTOBER 2006

15. In her written statement dated 15 February 2008 (Exhibit A2), Mrs Pravica stated:

I have not returned to the performance of any employment activities with Centrelink. The reason I have not returned to the performance of such activities is that I am worried that if I work in an environment where I become stressed and my blood pressure becomes elevated it could lead to another stroke occurring. I am afraid that on the next occasion I will experience a major stroke which will result in substantial disability, paralysis or possibly death.

16. In oral evidence, Mrs Pravica stated that:

• She did see her general practitioner, Dr Trajilovic on 4 October 2006, who told her that she had had a minor stroke, referred her for a CT scan, gave her some blood pressure tablets and told her to return after the CT scan, which she did on 5 October 2006. On 6 October 2006, Mrs Pravica stated that she fell unconscious, went to see Dr Trajilovic and was hospitalised on 6 October 2006 at Prince of Wales Hospital feeling unwell with headaches and dizziness.
• Since the incident of 4 October 2006, she has suffered from headaches on top of her head every second day. Further she notes that her balance is affected and that about one month after the incident she noticed her memory was affected – difficulty with remembering names, events – progressively worsen and necessitating note taking when undertaking interpreting duties – an activity she did not previously need to do. Mrs Pravica also noted that she experiences difficulty with concentration, with her span of concentration now limited to an hour.

17. In response to questions in cross-examination, Mrs Pravica stated that:

• She was referred to Dr Gracey, a nephrologist, for investigation and treatment of hypertension.
• Besides memory loss, which she became aware of one month after the incident, she does not like mixing with people, but this emotional disturbance is variable. Despite feeling better when she is on her own, not having to see anyone and with a book to read, she very much enjoys her part-time work as a health interpreter, and gets enjoyment from looking after her two grandchildren.

THE MEDICAL EVIDENCE

18. In the clinical notes of the Kingsford Family Medical Centre (Exhibit R9), the following entries are noted:

9 January 1987	Past history left renal colic à Removed surgically 1977. Woke up this a.m. with right flank pain. Was noted to be in pain. BP 140/90. Treated with Pethidine.
9 August 1989	BP 110/70
14 January 1992	BP 110/70
27 April 1993	BP 140/80
17 June 1994	BP 160/90
27 June 1994	BP 150/90
11 July 1994	BP 130/85
12 August 1994	BP 145/85
21 August 1995	BP 150/90
6 January 1998	BP 135/85
1 November 2001	BP 130/82

19. In the clinical notes of the Maroubra Medical Centre (Exhibit R10), the following entries are noted:

12 July 2003	BP (sitting) 130/80
15 August 2005	BP (sitting) 150/100
17 August 2005	BP 160/100
26 August 2005	BP 140/90
3 September 2005	BP (sitting) 135/88
21 September 2005	BP 140/80
24 May 2006	BP 150/80
8 July 2006	BP (sitting) 130/80
4 October 2006	BP 170/100. Commenced Micardis (medication for hypertension). Felt very dizzy while driving home from work. Had to stop car. Dizziness lasted a few minutes with some pressure on top of the head. Had similar episodes in the past.
5 October 2006	BP 165/90. CT scan brain shows paraventricular ischaemic changes. Stressed importance to lose weight, improve cholesterol and control BP. Increase Micardis.
6 October 2006	BP 210/100. Severe headache last night, feels dizzy and has pressure on top of the head. Referred to emergency Prince of Wales Hospital.
7 October 2006	BP (sitting) 185/92
10 October 2006	BP 150/80. Referral to Professor Gracey.
13 October 2006	BP 145/78
18 October 2006	BP 160/80

DR MILENA TRAJILOVIC – GENERAL PRACTITIONER

20. In a medical report dated 30 November 2006 (T19), Dr Trajilovic, Mrs Pravica’s treating general practitioner, records that she saw Mrs Pravica at 6.00pm on 4 October 2006. She records Mrs Pravica as providing a history of sudden onset of severe dizziness and headache, while she was driving home from work. Mrs Pravica also had some visual difficulties, but was able to pull her car over to the left, stopping safely without causing an accident. Mrs Pravica is also recorded as stating that she had a very stressful day at work.
21. Dr Trajilovic considered that Mrs Pravica had suffered a TIA, which she considered to be a minor stroke. Dr Trajilovic considered that the TIA was caused by a sudden rise in blood pressure due to a stressful day at work. Dr Trajilovic acknowledged that Mrs Pravica had particular predisposing factors to cerebrovascular and cardiovascular disease, namely age, obesity and hypercholesterolaemia. Dr Trajilovic considered Mrs Pravica permanently unfit for any previous duties, unsuitable for any retraining for another job, and needed to avoid stress to prevent a major stroke.
22. In a further report dated 20 April 2008 (PT15), Dr Trajilovic confirmed comments made in her earlier report, while nominating that her efforts up until early November 2006 were concentrated on controlling Mrs Pravica’s fluctuating blood pressure through medication. However, during this period she observed that Mrs Pravica was showing a number of psychological symptoms, namely anxiety, fear of another stroke, bad dreams, fear of prolonged driving, memory and visual problems, social isolation, frequent headaches and dizzy spells.

CT SCAN OF HEAD

23. A CT scan of Mrs Pravica’s head was undertaken on 5 October 2006 (T6) and this was reported by Dr Chung as demonstrating:

No acute intracranial lesion is seen. Paranasal sinus disease. There is mild periventricular ischaemic change. There is mild age related involution.

CLINICAL NOTES – PRINCE OF WALES HOSPITAL (EXHIBIT R11)

24. The clinical notes for 6 October 2006 record a history of Mrs Pravica driving home from work (stressed) on Wednesday afternoon, when she felt strange, tight, buzzing in the top of the head, light-headed as though she was going to faint, and slight visual disturbances. The notes further record that Mrs Pravica pulled over to lay-by, with symptoms easing after 2-3 minutes, after which she drove straight to her general practitioner. The notes record the impression that the most likely diagnosis was hypertension, with a cerebrovascular accident (CVA) unlikely. On discharge the same day, the records indicate that Mrs Pravica was referred to renal outpatients.

DR DAVID GRACEY – CONSULTANT NEPHROLOGIST

25. In a report dated 30 January 2007, Dr Gracey, having detailed a limited history of Mrs Pravica’s events, concluded that Mrs Pravica suffered from uncontrolled essential (primary) hypertension, and that there was no objective evidence to support a diagnosis of a CVA. Dr Gracey noted the presence of particular risk factors for hypertension, namely sedentary lifestyle and age, against a background of vascular risk factors, including hypercholesterolaemia.
26. Dr Gracey noted that the primary physiological change was that of an elevated systolic and diastolic blood pressure, but was unable to state how long prior to the onset of the neurological symptoms the hypertension was present. Dr Gracey considered essential hypertension to be a disease, which in his opinion is likely that Mrs Pravica had asymptomatic hypertension for some time before the events in question. Dr Gracey noted that transient neurological symptoms are very common in patients with uncontrolled hypertension. Dr Gracey also noted that the role of “stress” in the pathogenesis of hypertension is unclear, and in his opinion there is little evidence to suggest that Mrs Pravica experienced a CVA, with the neurological symptoms being much more likely to have related to her underlying uncontrolled hypertension.

DR DAVID SHARPE – CONSULTANT NEUROLOGIST

27. In a medical report dated 22 November 2006 (Exhibit R2), Dr Sharpe detailed a history of Mrs Pravica experiencing a severe pain in the vertical position of the scalp accompanied by a noise and some difficulty with vision. He notes that Mrs Pravica pulled her car over to the left, and stopped, with her symptoms improving over time and allowing her to drive directly to her general practitioner. Dr Sharpe also noted a clearance in the headaches for the most part, and the development of dizziness, which sounds very postural in nature.
28. Dr Sharpe did not think that Mrs Pravica had suffered a TIA or a stroke, as her symptoms seemed to have been generalised, with the main complaint being headache and noise in the head, as well as a finding of a significantly raised blood pressure. Dr Sharpe, mindful of the CT scan findings and the absence of any local features to suggest an ischaemic event, concluded that it was more likely that the headache may have been a reflection of the uncontrolled hypertension.

DR DAVID GORMAN – CONSULTANT PHYSICIAN

29. In a medical report dated 21 February 2007 (T32), Dr Gorman detailed a history of Mrs Pravica experiencing a stressful time at work in the few days prior to the incident on 4 October 2006. Dr Gorman records Mrs Pravica as stating that after driving for a short time, she felt dizzy and had a “pressure” feeling on the top of her head, together with some visual difficulties and a feeling of being “weak all over”. Dr Gorman records that she did not remember how long she stopped, but was able to resume driving.
30. Dr Gorman concluded that Mrs Pravica’s main continuing problem was hypertension, that she is not totally incapacitated and that there are no limitations to a graduated rehabilitation program, although it is to be recognised that Mrs Pravica is of the view that she is not going to return to work for fear of a future stroke.

DR PAUL TEYCHENNE – CONSULTANT NEUROLOGIST

31. In a medical report dated 2 May 2007 (T47), Dr Teychenne recorded a history of Mrs Pravica feeling under intense pressure at work concerning the introduction of a new computer system at work. When driving home on 4 October 2006 she felt a drill like sharp headache over the top of the head and she could not see properly. She pulled over and lost her memory for 5 minutes, regained memory and sight, but felt heavy in the hands and legs. Dr Teychenne also records that since the CVA Mrs Pravica complains of memory deficit e.g. Doctor’s name, what people tell her, what she wants to say, what she has said, what she has read and that she has lost about fifty per cent of her IQ. Dr Teychenne also records Mrs Pravica as saying she now has a fear of driving, suffers from insomnia and has bad dreams and a forty per cent diminution in visual acuity in both eyes, as well as vertigo. Further, he records Mrs Pravica as suffering from headaches localised on top of the head and lasting for a day complete with nausea and decreased visual acuity. Dr Teychenne noted a history of feeling depressed, seeing a psychologist and difficulty with concentration.
32. In a further report dated 16 May 2007 (T47), Dr Teychenne reviewed the reports of Drs Sharpe, Trajilovic and Gracey and considered the comments of Dr Gracey quite reasonable, as patients with hypertension, particularly with a rapid rise in hypertension, may experience neurological symptoms. Dr Teychenne also notes that hypertensive lesions may develop acutely and if therapy results in significant reduction of blood pressure, such lesions may show rapid resolution. Dr Teychenne also observes that focal neurological signs are infrequent and if present, suggest that the patient has had infarction, haemorrhage or transient ischaemic attacks.
33. Dr Teychenne concluded by stating that it was probable that Mrs Pravica’s symptoms which she experienced when she was driving was due to acute hypertension, with her memory deficit, slow-thinking and difficulties with concentration being due to prolonged ischaemia that is the equivalent of a CVA. Dr Teychenne suggests that psychometric tests be undertaken to confirm such memory deficits.

DR KEITH LETHLEAN – CONSULTANT NEUROLOGIST

34. In a report dated 18 January 2008 (Exhibit R6), Dr Lethlean recorded the following history as described by Mrs Pravica:

• She loved her work, the people and the customers, but did find it stressful.
• One week prior to the incident of 4 October 2006, she had difficulties with reading her computer screen. She went to the bathroom and vision returned to normal within a 10 minute period.
• On 4 October 2006 there was a similar but brief episode at work.
• When driving home on the M5 after 4.00pm on 4 October 2006, she found that she was unable to see anything, managed to pull over, the top of her head felt as if drilling of concrete was going on and she lost consciousness for 2-3 minutes. She also felt her hands and legs were heavy when she began to see light. She drove straight to see her general practitioner.

35. Having reviewed the other available medical material provided to him, Dr Lethlean concluded:

• The patient’s history was consistent with his examination, with no inconsistencies in the file reports available to him in relation to her present examination.
• She reported few incidents of headaches since the incident 15 months ago.
• Her diagnosis was uncontrolled essential-primary hypertension – probably acute on chronic.
• Her episode of 4 October 2006 was one of global visual difficulties. She felt she was dying and may or may not have been unconscious. Recovery was quick from a most frightening event and the sequence is consistent with an acute rise/aggravation of her presumed pre-existing hypertension.
• It is his opinion that the neurological symptoms of 4 October 2006 were probably due to her underlying, uncontrolled hypertension.
• The substantial role of stress in the pathogenesis of hypertension remains unproven.
• It is possible that the frustration-anger-anxiety of that day could have elevated her blood pressure to a degree materially contributing to the episode that afternoon, shortly after she left her employment – although Dr Lethlean acknowledges the contrary argument engendered by her blood pressure remaining high for some days. In summary conclusion, Dr Lethlean did not consider, on the balance of probabilities, that Mrs Pravica’s conditions were caused or materially contributed to by her employment, but considered that stress, anxiety, anger on that day may have made a possible contribution.

36. In a further report dated 10 March 2009 (Exhibit R7), Dr Lethlean, having reviewed the clinical notes of Prince of Wales Hospital, Maroubra Medical Centre and Kingsford Family Medical Centre, concluded that such material did not alter his views previously expressed.
37. In oral evidence, Dr Lethlean confirmed his written opinion that Mrs Pravica’s neurological symptoms of 4 October 2006 were due to underlying hypertension for the following reasons:

• the neurological symptoms involved a widespread disturbance of brain function and there was no sufficiently localised or defined features to suggest a TIA.
• that she reported to him a previous similar episode.

38. Dr Lethlean also confirmed his earlier written opinion that the elevation of blood pressure due to work pressures was a material contributing factor to the neurological episode on 4 October 2006 was, on the basis of probability, unlikely.
39. Dr Lethlean also commented that after reviewing the various clinical records available, there was clear evidence that Mrs Pravica had had high blood pressure recordings over a period of time prior to 4 October 2006.
40. Dr Lethlean also noted that a TIA involves a temporary blockage of blood flow due to a small piece of blood, a small blood clot, with the obstruction clearing in a short period of time, with no damage to the structure of the vessel or the function of that part of the brain involved.
41. Dr Lethlean’s attention was drawn to both Mrs Pravica’s evidence concerning her memory loss (one month after the event) and Dr Teychenne’s description of her memory deficit contained within his report of 2 May 2007. In response, Dr Lethlean made the following observations:

• The account described by Dr Teychenne was not an account given to him or to other doctors, particularly Drs Sharpe and Gracey.
• It sets out a range of difficulties which are very great.
• Whether such was due to brain damage, tension, anxiety and other factors is a separate issue.
• The severity as described is not consistent with Mrs Pravica’s account to him or as evidenced by letters and her accounts to other doctors.
• Even if what is recorded by Dr Teychenne is a description of what was related to him, Dr Lethlean would be reluctant to state that the memory deficit was due to a stroke due to damage from the original episode.
• If there is a substantial memory deficit, the order of that deficit would be obvious very shortly after the originating episode.
• Dr Teychenne’s actual results on testing Mrs Pravica’s memory function is a very different performance from the difficulties recorded from her account.
• Both his and Dr Teychenne’s clinical examination in relation to memory deficit produced similar results, which in his view were not indicative of a memory problem.
• The memory deficit, as tested by Dr Teychenne, is not of the order as suggested by the nominated symptoms; that it is not established that she did have a poor memory function due to brain damage and that it is not established that she had an episode of ischaemia due to multiple small infarcts, nor was it the impression that was gained by the doctors who saw her after the initial episode.

42. In response to questions in cross-examination, Dr Lethlean stated:

• The difference between a stroke and a TIA is that in the latter recovery is full, is less severe and the time scale is defined, although damage (temporary) in a stroke does not always have to be asymmetrical.
• Reduced blood flow to the brain can cause brain damage with symptoms of memory loss and difficulty in concentration a possible consequence, while headaches are not usually related to brain damage.
• An acute rise in blood pressure with associated arterial spasm can give rise to the type of headache described by Mrs Pravica on 4 October 2006, with the earlier visual disturbances experienced by her in relation to the computer screen being of a similar nature, but less severe.
• If the situation was that Mrs Pravica was angry and stressed in relation to the events of the day when driving the car, Dr Lethlean would have to reconsider his opinion.
• It is the fluctuation in the blood pressure at the time which cause arterial spasm, although the latter may happen spontaneously.
• The changes demonstrated by the CT scan of the brain were consistent with Mrs Pravica’s age and hypertension.
• The risk of a further neurological episode arising from hypertension was very low if the hypertension was well controlled.
• The risk in such circumstances would not change, even if an individual had stressful feelings about driving.
• In light of Mrs Pravica’s experiences, it is reasonable for Mrs Pravica to hold a belief that she did not wish to drive, but there is no medical basis for such a belief, and as such not medically logical or reasonable as opposed to being psychologically logical and reasonable.

DR INGLIS HOWE SYNNOTT – CONSULTANT PSYCHIATRIST

43. In a report dated 16 February 2007 (T31), Dr Synnott detailed the work events of 4 October 2006 as related to him by Mrs Pravica, which led her to feeling stressed and tense by the end of the day. Dr Synnott noted the incident occurred when Mrs Pravica was driving home that day and the subsequent treatment and outcome, observing that she had not been back to work for four months as she did not wish to have “another stroke” and it was “so stressful”.
44. Dr Synnott noted Mrs Pravica’s psychological symptoms as:

• frightened to drive when she has a dizzy head, although she does drive to the shopping centre and to visit the doctor, but never on the M5;
• she did not want to go back to work, as it would be so stressful and she could have another stroke;
• sleep disturbance (bad dreams), feels nervous and anxious, at times unable to think clearly, and difficulty in concentration and remembering, as well as feeling depressed and having a loss of appetite;
• contact from work increasing her symptoms.

45. At examination, Dr Synnott noted no evidence of cognitive impairment. Dr Synnott diagnosed an adjustment disorder with anxiety, and concluded that it is her fear of having a stroke that prevents her from returning to employment of any kind, or undertaking any form of rehabilitative program.
46. In a second report dated 10 April 2007 (Exhibit R4), Dr Synnott concluded that Mrs Pravica had an entrenched belief that her employment at Centrelink will cause her stress and lead to a stroke, with such a belief being based on what she claims was told to her by her general practitioner. Dr Synnott believes that it is this mindset and conviction which prevents her from returning to Centrelink employment, and not her adjustment disorder. Dr Synnott was of the opinion that Mrs Pravica is unlikely to accept medical advice that is contrary to her mindset.
47. In a third report dated 19 June 2008 (PT29), Dr Synnott noted that Mrs Pravica did not return to any kind of employment until early 2008, when she began to undertake the role of an ‘on call’ interpreter for Health Care Interpreting Services – something she had done many years ago. Mrs Pravica is recorded as stating that she could not go back to work as a bilingual customer service officer because “it is far too stressful” and “I don’t want to take the risk (even if it is a small risk) of having another stroke”.
48. Dr Synnott notes Mrs Pravica as continuing to express a range of psychological symptoms:

• sleep disturbance (twice a week, bad dreams);
• impaired concentration and memory;
• moodiness, impatience;
• very depressed on occasions (some suicidal ideation);
• anxious and nervous with fluctuating appetite.

49. Dr Synnott noted that Mrs Pravica gave what appeared to be a clear, comprehensive and organised history – often going into considerable detail. Dr Synnott found no evidence of any cognitive impairment, and despite her complaint of psychological symptoms, her mental state examination showed no overt evidence of a psychiatric condition, demonstrating no evidence of psychological fragility. In summary, Dr Synnott concluded that at that time Mrs Pravica was possibly suffering from an adjustment disorder, because she described sufficient psychological symptoms to meet the diagnostic criteria. Dr Synnott stated that Mrs Pravica identified the reasons for her psychological difficulties as ‘the stroke’ experienced on 4 October 2006 and her fear of possibly having a major stroke, with the stressful employment at Centrelink contributing to the ‘mini stroke’ on 4 October 2006. Dr Synnott considered that her employment was likely to have contributed to her condition in a significant yet transient manner, with her ongoing fear of another stroke being a significant non-employment factor contributing to her condition.
50. Dr Synnott considered that Mrs Pravica has a capacity to work, but will never return to work in her former role at Centrelink. Dr Synnott considered that Mrs Pravica would not do more than one health care interpreting consultation per week because of her mindset as regards fear and stressful duties.
51. In a further report dated 2 September 2009 (Exhibit R5), Dr Synnott concluded that work had a transient yet significant impact on her psychological state – as a result of her TIA and subsequent perception of the work situation she developed an adjustment disorder. Further, Dr Synnott concluded that it is a matter of probability that her psychological response to the TIA and her perception of the work situation was materially significant in the development of the adjustment disorder.

DR ANTHONY DINNEN – CONSULTANT PSYCHIATRIST

52. In a report dated 6 April 2009 (Exhibit A3), Dr Dinnen detailed briefly the circumstances of both the workplace and the incident of 4 October 2006 as told to him by Mrs Pravica. Dr Dinnen noted that Mrs Pravica is fearful of having another episode, that she has difficulty sleeping, is afraid of falling down unconscious, that she is not friendly or sociable anymore, that she feels very sad, and most days feels unhappy.
53. Dr Dinnen, in reviewing documentation forwarded to him, noted that Mr Malone, a psychologist, in a report dated March 2007 had detailed the presence of headache, impairment of memory, anxiety symptoms and disturbed sleep.
54. Dr Dinnen considered that Mrs Pravica was suffering from an adjustment disorder with depressed mood, with the condition now chronic. Dr Dinnen was of the opinion that the stress at work as described by Mrs Pravica may have contributed to the raised blood pressure, with the psychological dysfunction being a reaction to the physical illness.

MR JOHN MALONE – PSYCHOLOGIST

55. In a report dated 18 March 2007 (PT30), Mr Malone details Mrs Pravica’s self-reporting of the following psychological symptoms:

• fear of specific travel;
• recurrent bad dreams;
• memory and vision problems;
• becoming socially isolated;
• dizziness, frequent headaches and fear of another stroke;
• anxiety symptoms.

56. In considering work-related matters, Mr Malone detailed Mrs Pravica’s concerns about returning to work because of her fear of another stroke, and issues at work which cause her stress, namely the monthly compliance audit, which has resulted in a build up of stress over 10 years.
57. Mr Malone did not, at that time, recommend that Mrs Pravica return to work until the symptoms of PTSD arising in response to the traumatic event of 4 October 2006 were effectively treated and managed.

DR ANTHONY LOWY – OCCUPATIONAL PHYSICIAN

58. In his report dated 19 March 2007 (Exhibit R3), Dr Lowy reported details of Mrs Pravica’s work, which she stated caused her stress, namely:

• the inherent stress associated with interpreting duties because of not so subtle differences in languages and their nuances when explaining the nature of benefits and an individual’s entitlement to such;
• the nature and number of bureaucratic requirements in her role;
• introduction of new systems which added complexity and further difficulties in her work.

59. After detailing a comprehensive examination of Mrs Pravica, Dr Lowy noted that Mrs Pravica had and still has no intention of returning to work at Centrelink, and such contention is based on her experience of the nature and conditions of her work and a firm conviction that she may suffer a major stroke if she does so return.

CONSIDERATION AND FINDINGS

60. In this matter I have devoted much effort to detailing Mrs Pravica’s description of both general and particular workplace activities and her response to those activities. I recognise that much, if not most, of Mrs Pravica’s history of work events have been detailed at a time and in an environment in which she has been suffering from psychological dysfunction that involved her holding a belief that her work at Centrelink was too stressful and she did not want to risk having another stroke.
61. A careful analysis of such workplace activities as described by Mrs Pravica would point, in her view, to the nature of the interpreting work (explaining to one or more people at a time the nature of, and entitlements to, benefits) as stressful, and that some of the management practices (e.g. monthly performance feedback against statistical targets, necessity to log everything into the computer including time away from the computer, constant suggestions that the work activity would be contracted out to India) were the cause of irritation and stress.
62. Further, Mrs Pravica’s description of the introduction of the new software system involving, in her view, less than adequate training and supervision, together with her experiences in using the system before it was recalled on the morning of 4 October 2006, clearly identifies a situation in the work environment where she felt stressed.
63. I note that in an acting Call Centre Manager’s report of 5 May 2008 (Exhibit A5), Ms Rodrigues noted that Mrs Pravica had talked to her team leader about lengthy travel time to work each day. More significantly, Ms Rodrigues details a coaching session (monthly performance review) on 13 June 2006 during which Ms Daniel (team leader) discussed with Mrs Pravica her need to apply duty of care and attention to detail as some of her transactions were returned due to error and a further 13 were noted with feedback.
64. Of more significance Ms Daniel, at the same coaching session, discussed with Mrs Pravica her reactions when she is provided with feedback. Ms Daniel noted that Mrs Pravica was “getting too upset once a feedback is being discussed or addressed and taking personal leave afterwards due to sickness.”
65. Further, I note the report of Ms Canivilo, dated 3 April 2009 (Exhibit R8), the office trainer at Liverpool Centrelink who conducted the training course in the introduction of the new computer system. Ms Canivilo recalls Mrs Pravica expressing some concern over the new system and requesting further assistance, with one-on-one training sessions being scheduled. In a report dated 4 January 2007 (T23), Ms Duggan (Mrs Pravica’s team leader) acknowledged that problems associated with the introduction of the new system did cause frustration for all staff.
66. I note that Mrs Pravica has stated that she much enjoyed her job at Centrelink and wished to continue working with no age-related end point. She also stated that her statistical analysis reviews were always satisfactory and not a source of concern for her and that she had not required treatment for psychiatric ailments, apart from episodes over deaths in the family and a period of depression in the mid 1990s. I observe that a review of the clinical notes of both medical practices Mrs Pravica attended over many years are silent on specific complaints of work-related stress issues raised by Mrs Pravica.
67. After considering all the material before me concerning Mrs Pravica’s workplace activities, I conclude that there is insufficient material to support a finding that, on the balance of probabilities, Mrs Pravica suffered from a stress-related condition prior to the incident on 4 October 2006. There is, however, in my view sufficient material before me which demonstrates, on the balance of probabilities, that there were particular aspects of Mrs Pravica’s workplace activities (monthly performance/coaching sessions, repeated threats to sell off the activity, particular activities relating to data entry) that caused her irritation and stress. Further I would find that the introduction of the new computer system in late September/early October 2006 did cause her frustration and stress. In relation to my earlier finding that there was an absence of material to support a finding of a stress condition, I rely upon Mrs Pravica’s own admissions and the absence of clinical notes supporting the presence of such a condition in the records of the two practices Mrs Pravica had attended over many years prior to the incident on 4 October 2006. Similarly, I recognise that my finding in relation to Mrs Pravica experiencing stress in response to some workplace activities are again reliant upon Mrs Pravica’s statements and the material outlined earlier arising from reports from particular Centrelink employees. I would also hasten to comment, that while Mrs Pravica may have experienced stress in relation to particular workplace activities, there is no evidence to suggest that such stress has arisen as a consequence of improper action by either Centrelink and/or its employees, but more as a consequence of Mrs Pravica experiencing growing concern about change and what was expected of her in the workplace.
68. In addressing the incident that Mrs Pravica experienced while driving home from work on 4 October 2006, I am satisfied that the description provided by Mrs Pravica is a competent account, in so far as it relates to a feeling of dizziness, visual disturbances, acute pain on top of the head, pulling to the side of the road, gradually recovering and proceeding for medical assessment. Whether or not there was a loss of consciousness is an issue, with all the clinical notes of her interactions with many doctors in the immediate months after the event making no mention of a period of unconsciousness. While Mrs Pravica has referred to such a period in later presentations, such a statement by her may refer to the period of obvious difficulties she experienced, when clearly she experienced an event causing her fright and distress. Furthermore, I would comment that little probably hangs upon a precise definition of each symptom within the set of neurological symptoms experienced by Mrs Pravica on 4 October 2006.
69. Before proceeding further with my consideration, I would observe and so find that Mrs Pravica was able to detail the particulars of her history, including medical symptomatology and work circumstances with both accuracy and clarity in the main. While on occasions Mrs Pravica may have seemed to provide inconsistent answers as regards statistical review and some aspects of the nature of the work, I remain satisfied that any inconsistency that may be apparent is a reflection of what Mrs Pravica perceived to be the prime purpose of the question, remembering in turn that Mrs Pravica has been suffering over a long period from various psychological symptoms since the incident on 4 October 2006 or shortly thereafter. In all the circumstances I consider Mrs Pravica a competent and reliable witness.
70. I note that subsection 6(1)(b)(ii) of the Act provides for an injury to have arisen out of, or in the course of, employment if it was sustained while the employee was travelling between his/her place of residence and place of work.
71. I also note the following definitions contained within subsection 4(1) of the Act:

Injury means:
(a) a disease suffered by an employee; or
(b) an injury (other than a disease) suffered by an employee, being a physical or mental injury arising out of, or in the course of, the employee’s employment; or
(c) an aggravation of a physical or mental injury (other than a disease) suffered by an employee (whether or not that injury arose out of, or in the course of, the employee’s employment), being an aggravation that arose out of, or in the course of, that employment;

......

Disease means:
(a) any ailment suffered by an employee; or
(b) the aggravation of any such ailment;
being an ailment or an aggravation that was contributed to in a material degree by the employee’s employment by the Commonwealth or a licensed corporation.

Ailment means any physical or mental ailment, disorder, defect or morbid condition (whether of sudden onset or gradual development).

72. I observe, from what I outlined earlier, that Mrs Pravica was involved in an incident when driving home from work on 4 October 2006, which involved her sustaining an array of neurological symptoms lasting for a short period (minutes) and then resolving, and enabling Mrs Pravica to drive to and seek attention from her general practitioner.
73. I detailed earlier the sequence of clinical events, treatments and investigations that have occurred in relation to Mrs Pravica’s subsequent clinical care. I have also detailed relevant blood pressure readings obtained from the clinical notes of the two practices Mrs Pravica frequented over many years prior to the incident.
74. In addressing the issue of the nature of the neurological symptomatology, I observe that Dr Trajilovic, Mrs Pravica’s general practitioner, considered that Mrs Pravica had suffered a TIA, which she considered to be a minor stroke, and that such symptomatology had occurred as a result of a sudden rise in blood pressure due to a stressful day at work. I note that a brain CT scan on 5 October 2006 revealed that no acute intracranial lesion was evident but there was mild periventricular ischaemic change.
75. I note that on admission to the Prince of Wales Hospital, the most likely diagnosis was recorded as hypertension. In a report dated 30 January 2007, Dr Gracey, a consultant nephrologist, considered that Mrs Pravica was suffering from essential hypertension (uncontrolled), with there being no evidence to support a diagnosis of a CVA. Dr Gracey noted that transient neurological symptoms are very common in patients with uncontrolled essential hypertension, which he considered to be a disease. Such a view was supported by Dr Sharpe (a neurologist), while Dr Teychenne (also a neurologist) considered the opinion of Dr Gracey quite reasonable, but that in his opinion such a process led to prolonged ischaemia that is the equivalent of a CVA and which would account for Mrs Pravica’s memory deficit, slow-thinking and difficulties with concentration.
76. In light of the clinical opinions referred to in the previous paragraphs and outlined in greater detail earlier on in this decision, I find on the balance of probabilities that Mrs Pravica was suffering from uncontrolled essential hypertension prior to the incident on 4 October 2006 and that neurological symptomatology reported by Mrs Pravica as occurring on the drive home from work that day was a consequence of the uncontrolled essential hypertension disease process. In so finding I am mindful that both Drs Sharpe and Lethlean detailed their reasoning for excluding the occurrence of TIA, as did Dr Gracey and essentially Dr Teychenne. I have earlier detailed Dr Teychenne’s more particular opinion in which he concludes that the uncontrolled hypertension led to both transient neurological symptoms and to permanent soft tissue brain damage as evidenced by Mrs Pravica’s memory loss and difficulties in concentration – such a condition arising from small infarcts due to prolonged ischaemia.
77. In addressing whether an injury has arisen out of or in the course of Mrs Pravica’s employment pursuant to the Act, I am left to contemplate the following scenarios:

(a) whether the neurological symptomatology, however diagnosed, that arose during Mrs Pravica’s journey to her residence was an injury simpliciter?

(b) whether there is material to support Dr Teychenne’s opinion that Mrs Pravica suffered permanent brain damage as a consequence of the hypertension episode on 4 October 2006 and, if so, does this constitute an injury simpliciter?

(c) whether Mrs Pravica suffered from a disease and/or an aggravation of her underlying disease of essential hypertension, and whether such aggravation was contributed to in a material degree by stress arising from activities in her employment?

78. In Zickar v MGH Plastic Industries Pty Ltd [1996] HCA 31; (1996) 187 CLR 310, the High Court acknowledged that there were three kinds of cases that fell for consideration within the phrase “injury by accident”, namely:
    • Cases in which a disease has been actually contracted through exposure to infection or other risk attendant on the conditions of employment. Eg. entry of harmful bacteria.
    • Cases where there is actual physical injury such as the rupture of an aneurism or of an oesophagus.
    • Cases in which death or incapacity results not from an actual physical injury, external or internal, but from the development or culmination of a pre-existing and progressive morbid physical condition, with the final occurrence commonly referred to as a “sudden physiological change”.
79. In further commentary I note that the majority in Zickar’s case were agreed upon the following in differentiating cases falling within the first two types of cases and the third type (the autogenous disease cases) referred to in the previous paragraph, with the third class of cases considered to be “disease” as opposed to “injury by accident” cases:

If the rupture is due to blood pressure, arteriosclerosis, arteriovenous malformation, or any other congenital or diagnostic aetiology, it is nonetheless a rupture – something quite distinct from the defect, disorder or morbid condition, which enables it to occur.

80. In addressing whether Mrs Pravica’s neurological symptomatology which occurred while travelling home from work on 4 October 2006 was an injury simpliciter, I have already concluded that such symptomatology was in effect the progress of the pre-existing uncontrolled essential hypertension, a morbid condition/disease. I note that the only evidence of significance before me indicates that any symptomatology was transient and there was no evidence to suggest damage to the cerebral blood vessels by way of internal injury. I conclude that the circumstances as considered in this paragraph are the consequence solely of the progression of a pre-existing morbid condition, and as such do not constitute a defined “event” and as such cannot be considered an injury simpliciter.
81. In addressing Dr Teychenne’s contention that Mrs Pravica’s memory loss and difficulties in concentration are severe, I observe that his contention relied upon her self-reporting of such symptoms as detailed in his report of 2 May 2007. I note that there have been no neurological tests to substantiate such difficulties. I further note that Dr Lethlean carried out some basic neuropsychological testing with results similar to those found at examination by Dr Teychenne, and concluded that such results were not indicative of the psychological deficits recorded. Similarly, while I note that in evidence Mrs Pravica stated that she noted difficulties with memory one month after the events of 4 October 2006, I observe that Dr Lethlean was of the opinion that such memory deficit would have occurred shortly after a few days if cerebral damage was involved. Finally I note that both psychiatrists, while referring to Mrs Pravica’s complaint of difficulties with memory and concentration, considered Mrs Pravica to be a detailed historian and that both considered her mental state at examination to show no evidence of cognitive deficit.
82. In summary I find, on the balance of probabilities and for the reasons nominated earlier, that the foundation for Dr Teychenne’s proposition that Mrs Pravica suffered cerebral damage as a consequence of the events of 4 October 2006 is not made out. Even if in the circumstances it were made out, I would consider that such was the natural progression of her pre-existing morbid condition and as such does not constitute an injury simpliciter.
83. I am mindful that I have already concluded the following in this matter:

• The incident which occurred when Mrs Pravica was driving home from work on 4 October 2006 involved Mrs Pravica experiencing a nominated set of neurological symptoms.
• That such symptomatology arose as a consequence of the progression of an underlying uncontrolled essential hypertension.
• That essential hypertension is a disease.
• That Mrs Pravica experienced stress in the workplace in response to particular nominated activities of or in the workplace.

84. Further I am mindful that:

• Mrs Pravica had experienced two earlier episodes of visual disturbance at work, one a week or so earlier and one in the morning of 4 October 2006, the latter associated with a slight headache. I note both episodes were transient, and that Dr Lethlean considered such episodes to be consistent with symptomatology arising from the underlying hypertension.
• While Mrs Pravica indicated in some written and oral statements, or at least as recorded by doctors she has attended, that she found the work day of 4 October 2006 to be stressful, in other oral evidence she stated that when she reverted to working on the old system after lunch on 4 October 2006, this helped relieve her stress from that morning’s activities which she had found stressful but nevertheless handled in a professional manner. Further, I note her comment that she started to relax when she got in her car to drive home.
• The contention being made is that stress arising in the course of Mrs Pravica’s duties both generally, and particularly surrounding the activities of the day of 4 October 2006, have contributed to an elevation of her blood pressure which led to her experiencing the symptoms when driving home on 4 October 2006. I note that Mrs Pravica’s general practitioner is in support of such a contention, as it would seem is Dr Synnott, a psychiatrist, who concluded that the stressful employment at Centrelink contributed to the minor stroke on 4 October 2006.

85. I also observe the following specialist opinions:

• Dr Gracey – the primary physical change was elevated systolic and diastolic blood pressure, but unable to state how long prior to the onset of neurological symptoms the hypertension was present.
• Dr Gracey – the role of stress in the pathogenesis of hypertension is unclear.
• Dr Lethlean – substantive role of stress in the pathogenesis of hypertension remains unproven.

86. In the circumstances where Dr Lethlean was the only consultant who provided oral evidence, I am left to finalise this case with what material I have before me. With such in mind it is difficult to define what role stress plays, if any, in the causation of essential hypertension. In so doing I rely upon the opinions of Dr Gracey, in particular, and Dr Lethlean. In addressing the issue of what role stress may have in causing an increase in blood pressure, I conclude that on the material before me, that it may cause/possibly cause a rise in blood pressure.
87. I am mindful that the term disease involves consideration of an ailment (in this case hypertension) or the aggravation of such that was contributed to in a material degree by employment. In this matter I have concluded that on the balance of probabilities Mrs Pravica did experience a stressful work situation in response to nominated work activities. One of these involved the events of the morning of 4 October 2006. While general opinion has been rendered by a general practitioner and a psychiatrist that this and other stressful events have contributed to a rise in Mrs Pravica’s blood pressure, other and more relevant specialist opinions (Drs Gracey and Lethlean) suggest that stress may have or possibly caused an increase in blood pressure for a period of time although the role of stress in the causation of hypertension is unclear or unproven. In this matter I have detailed a series of blood pressure readings over time, with the blood pressure being recorded as 170/100 in Dr Trajilovic’s surgery some 90 minutes after the event. I am left with a relatively undefined set of circumstances and consequent specialist opinion as to when, if and for how long the blood pressure was raised, and whether such circumstances were a consequence of stress and/or normal progression of the underlying hypertensive disease process, by way of a hypertensive episode.
88. I have given this matter much thought. I am mindful that “contributed to in a material degree” requires a finding on the balance of probabilities (Treloar v Australian Telecommunications Commission [1990] FCA 511; (1990) 26 FCR 316 – considered and followed). I am unable to make such a finding as the material before me would permit me, at best, to make a finding of a possible contribution. In so finding I rely upon the opinions of Drs Gracey and Lethlean, being specialists in the relevant areas involved in this matter.
89. Finally I would also conclude that on the material before me, because of its lack of definition and probative value, a positive finding cannot be made that stress arising from the workplace had made a substantial or considerable contribution to an increase in the underlying hypertension (Comcare v Sahu-Khan [2007] FCA 15; (2007) 156 FCR 536 – considered and followed). While I note that Drs Trajilovic and Synnott have made assertions to that effect, I also observe that there is little reasoning to support such assertions, leaving aside any attempt to address such issues as substantial or considerable in the context of a contribution in a medically complex but undefined scenario.
90. It is for such reasons I conclude that the decision under review in relation to Mrs Pravica’s claim for a transient cerebral ischaemia and essential hypertension is affirmed.
91. In addressing the second claim, I observe that both psychiatrists are of the view that Mrs Pravica suffers from a chronic adjustment disorder with anxiety (Dr Synnott) and depressed mood (Dr Dinnen). They both consider that the adjustment disorder has arisen as a consequence of the events of 4 October 2006 and Mrs Pravica’s fear of having another stroke. I note that Dr Synnott is also of the view that Mrs Pravica has formed a firm conviction that a return to the Centrelink workplace would induce another stroke.
92. I observe that both specialists did not confirm a diagnosis of PTSD as made by Mr Malone (psychologist). Both psychiatrists were firmly of the opinion that the adjustment disorder was contributed to in a significant manner by the “stroke” Mrs Pravica experienced on 4 October 2006, with Dr Dinnen concluding that the psychological dysfunction being a response to the physical illness.
93. In light of my findings that the physical ailments were not compensable, and as the adjustment disorder is a consequence of the physical ailments, liability for such a disease is denied.
94. In such circumstances, the decision under review concerning adjustment disorder with anxiety is affirmed.

DECISION

95. The decisions under review are affirmed.
    

I certify that the 95 preceding paragraphs are a true copy of the reasons for the decision herein of Dr J D Campbell, Member

Signed: ..........................[Sgd]..........................

Associate: Jennifer Wong

Dates of Hearing 19-20 October 2009

Date of Decision 15 January 2010

Counsel for the Applicant Mr S Brennan

Solicitor for the Applicant Ron Kramer Associates Solicitors

Counsel for the Respondent Mr G Elliott

Solicitor for the Respondent Australian Government Solicitor