|Campbell v. Banman, claims damages for personal injuries sustained in two motor vehicle accidents caused by the negligence of the defendants|
IN THE SUPREME COURT OF BRITISH COLUMBIA
Mary Alice Campbell, also knows as Alison Campbell
Sonja lee Banman, Rose Deanna Bouchard and
Akberet Embaye Tesfasion
Before: The Honourable Mr. Justice Pearlman
Reasons for Judgment
 The plaintiff claims damages for personal injuries sustained in two motor vehicle accidents caused by the negligence of the defendants. Liability is admitted for both accidents.
 The first accident occurred on September 29, 2002. Ms. Campbell was a passenger in a vehicle driven by her common-law husband that had stopped at a stop sign shortly before it was struck from behind by another vehicle. The plaintiff described her injuries from this accident as involving stiffness more than pain in her mid-back, extending to her upper shoulders and neck. Her symptoms had fully resolved within one month of the accident. Ms. Campbell lost no time from work. She only saw her family physician once in connection with this accident, during a previously scheduled appointment for an unrelated medical condition. In cross-examination, Ms. Campbell acknowledged that the injuries she sustained in the first motor vehicle accident were “trifling”.
 The second motor vehicle accident occurred on January 31, 2003. Ms. Campbell was the seat-belted driver of her vehicle, a Jeep Cherokee, at the time of the collision. The defendant Tesfasion’s vehicle went through a stop sign. The plaintiff, in attempting to avoid the defendant’s vehicle, veered to the right, causing the left side of her body to strike the driver’s side of her vehicle. Despite the plaintiff’s efforts to avoid a collision, her vehicle struck the defendant’s vehicle and the curb before coming to rest. The parties agree that, as a result of the collision, the plaintiff’s vehicle sustained damage totalling $2,572.12.
 The plaintiff claims that, as a result of the second accident, she has suffered physical injuries, particularly to her left shoulder and scapula, that have dramatically reduced her enjoyment of life. As a result of these injuries, the plaintiff also claims she has suffered past wage loss, loss of future earning capacity, past and future loss of housekeeping capacity, special damages for expenses incurred as a result of her injuries, and costs of future care.
 The defendants submit that the plaintiff has exaggerated the extent and severity of the injuries she sustained in the second accident. Further, the defendants argue that the plaintiff has failed to acknowledge the extent to which her pre-existing, unrelated, but recurrent medical conditions, including hyperthyroidism and kidney infections, have limited her activities or interfered with her enjoyment of life since the second accident. The defendants submit that the plaintiff has failed to prove any loss of future earning capacity, loss of past or future housekeeping capacity, cost of future care, or any other special damages.
(II) ISSUES TO BE DECIDED
 The issues to be decided are:
1. The nature, extent and severity of the injuries sustained by the plaintiff in the first accident of September 29, 2002 and the amount of non-pecuniary damages attributable to that accident;
2. (a) The nature, extent and severity of the injuries sustained by the plaintiff in the second accident of January 31, 2003;
(b) To what extent the plaintiff had unrelated physical injuries or medical conditions that existed prior to the second accident, and the role that such injuries or conditions played in her post accident symptoms;
3. The amount of damages, if any, payable to the plaintiff for injuries or other losses attributable to the second accident for:
(a) non-pecuniary damages;
(b) past wage loss;
(c) loss of future earning capacity;
(d) past and future loss of housekeeping capacity;
(e) future costs of care;
(f) special damages.
4. Cost for the attendance for cross-examination of the defendants’ medical expert, Dr. Andrew Hepburn.
(III) THE PLAINTIFF’S EVIDENCE
 The plaintiff is 48 years old. She resides in New Westminster with her common-law husband of 15 years, Randy Stuber. The plaintiff has two adult children – a 28-year old daughter, and a 22-year old son, Ian, who also lives in the family home in New Westminster.
 The plaintiff has a grade 12 education and has been employed by Telus for 27 years. At the time of the second accident, she was a dispatcher. She currently works in Telus’s engineering department as a technician assistant. She earns an hourly wage of $25.50. Her total annual income for each year since 2002 has been about $50,000.00.
 The plaintiff testified that, prior to the second accident, she was healthy and that her only problem was a hyperthyroid condition. In 1996, she underwent thoracic outlet surgery to relieve pain she was then experiencing through her left shoulder and down her left arm. The surgery was successful and her symptoms were completely resolved. The plaintiff claimed that, before the second accident, she had no difficulty with her mood, and that for five years before the accident she had not seen a chiropractor or a physiotherapist for her shoulder, or any back problem.
 During bouts of hyperthyroidism, the plaintiff suffered symptoms including an increase of heart rate, poor energy, a feeling of weakness and fatigue, a lack of concentration or focus, loss of sleep and tremors in the arm and hands.
 The plaintiff testified that her first bout of hyperthyroidism was in 2001. At that time, as she acknowledged in cross-examination, she was diagnosed with a form of hyperthyroidism known as Grave's disease. She also acknowledged that the symptoms of heart palpations and dizzy spells went back to 1992. The plaintiff agreed that she suffered from panic attacks due to Grave's disease, and that she had anxiety problems before she was diagnosed with Grave's disease. According to the plaintiff, the symptoms associated with her first bout of hyperthyroidism had all resolved well over a year prior to the second accident.
 The plaintiff suffered another attack of hyperthyroidism in March of 2004, about 14 months after the second accident. The plaintiff blames the second accident, and the stress she associates with it, for a “relapse into hyperthyroidism”.
 The plaintiff suffered yet another bout of hyperthyroidism in 2006. She testified that she probably lost a couple of weeks from work on that occasion. In chief, the plaintiff testified that it takes about two months of treatment to get the condition under control. However, when her examination for discovery testimony was put to her, she agreed that it takes about a year from the time thyroid levels return to the normal range to recover from any re-occurrence of Grave's disease.
 In cross-examination, the plaintiff also acknowledged that she had a history of bladder and kidney infections and that she was diagnosed in 2004 with pyelonephritis, an ascending infection which spreads from the bladder to the kidney. When she suffers from this condition, the most prevalent complaint is left flank pain. The plaintiff confirmed that she was treated in 2004, 2005 and 2006 for her kidney infections and that, in 2005, she was physically limited by severe kidney and flank pain. The plaintiff was off work for about six months in 2005 while she took antibiotics to treat recurrent left side pyelonephritis. She testified that she did not lose any time from work as a result of her kidney condition in 2006 or 2007.
 The plaintiff described how, during the second accident, she veered sharply to the right and slammed on her brakes in an unsuccessful attempt to avoid striking the defendant Tesfasion’s vehicle, which had suddenly cut into her path from a side street. She recalled that, immediately following the second accident, she experienced pain in her left shoulder, arm and right knee. The plaintiff said that, emotionally, she was “a wreck”, and could not stop shaking.
 The plaintiff testified that in the week following the accident, she experienced a lot of pain. Her whole body felt sore and she had pain in the area of the left scapula and upper left arm, with pain shooting down her left arm into her fingers and thumb. The plaintiff described experiencing a constant tingling and found it difficult to hold objects in her left hand. Her knee injury seemed to get better within a week.
 According to the plaintiff, for the first two months following the accident, she had chronic pain in the left scapula. Picking up a bag of groceries, or any heavy object, caused a tingling sensation in her left hand. The plaintiff gave evidence that she still experiences the tingling sensation in her fingers, arm and shoulder, and is aware of a loss of strength in her left side when she lifts heavy objects. Lifting objects above shoulder level, and particularly any repetitious activity involving such lifting, will produce pain and the tingling sensation.
 According to the plaintiff, on a scale of one to ten, where ten is the most extreme pain, during the two months following the accident she experienced pain at the level of eight. That has improved with time, so that now she would rate the pain at between two and four. When it goes up to four, she takes an anti-inflammatory, Advil.
 The plaintiff was referred by her family physician for eighteen physiotherapy and ten acupuncture treatments. She was also referred to Dr. Hill, an orthopaedic surgeon, who recommended trigger point injections in the area of the scapula. The plaintiff recalls receiving four trigger point injections, each of which provided some temporary relief.
 Again, on her physician’s recommendation, the plaintiff received massage therapy. She took Tylenol extra strength and Advil for pain relief following the second accident. She testified that she continues to take Advil, and occasionally Tylenol.
 The plaintiff testified that the shooting pain down her left arm has improved over the last five years. She gave evidence that she now experiences very mild pain on a daily basis. She attempts to avoid repetitive activities which will induce more pain or the tingling sensation, including vacuuming, lifting heavy weights or doing push-ups.
 In her direct examination, the plaintiff testified that, prior to the second accident, she had taught physical fitness classes and enjoyed running, but that since the second accident she has been unable to do so.
 She described physical fitness as her passion. She now tries to walk every day and does lighter exercises in a home gym. She testified that before the second accident, she taught up to five fitness classes a week at Telus, participated in other classes, and ran three to five times a week. Her fitness classes included boxercise and other intensive programs, which she says that she is no longer able to perform.
 In cross-examination, the plaintiff admitted that she ceased to be a fitness instructor in 2001 due to her hyperthyroidism. She lost her qualifications as a fitness instructor. The plaintiff took no steps to re-qualify as a fitness instructor prior to the second accident on January 31, 2003.
 The plaintiff testified that one of the main reasons why she does not run recreationally now is because of the injury to her shoulder sustained during the second accident. However, on cross-examination, she admitted that she stopped running in 2001, when she was diagnosed with hyperthyroidism, and that her kidney condition was also a factor because the “jarring effect” of running was not good for the kidneys.
 The plaintiff testified that her injuries have negatively affected her family life. She and her common-law husband, Randy Stuber, both testified that when they met in 1991 they shared a common interest in physical fitness. The plaintiff testified that the couple ran together and swam together, but that since the second accident, she no longer engages in these activities. Mr. Stuber testified that after that accident, the plaintiff was unable to lift weights or do aerobics. She guarded her left shoulder and continues to avoid activities which involve lifting her left arm above her shoulder because such activities seem to aggravate her injuries.
 The plaintiff testified that the injuries she suffered in the second accident and the limitations on her activities have affected her mood. She is no longer interested in socializing with friends. Whereas before the accident she and her husband would take a tropical vacation every year, she no longer takes vacations with her husband.
 The plaintiff testified that she gained weight as a result of the second accident, going from 130 lbs to 153 lbs, that she is self-conscious about her size and weight, and that this has adversely affected her relationship with her husband.
 Mr. Stuber also gave evidence that the plaintiff, since the second motor vehicle accident, had become somewhat withdrawn, was subject to mood changes, had put on weight and had a reduced energy level. He testified that the second accident had a negative effect on their relationship, and that since that accident, he and the plaintiff have not taken a holiday together.
 Before the accident the plaintiff did most of the vacuuming, cleaning and cooking at home. She maintained that her hyperthyroidism made no difference to the amount of housekeeping or cooking she could perform. She said that, with the kidney condition, as long as she was taking her medication, she could perform housework.
 The plaintiff testified that, following the second accident, Mr. Stuber does the vacuuming, and any lifting of heavy objects, or work that involves reaching above shoulder level. The plaintiff testified that before the accident she did 90% of the cooking and that now Mr. Stuber does 75% of the cooking, while she does 25%. With regard to her housework, the plaintiff estimates that prior to the accident she did 90% of the household chores. After the accident, Mr. Stuber did about 80% of the housework. The plaintiff said that over time, her ability to do housework has improved. Now, the plaintiff and Mr. Stuber each do about 50% of the housework.
 The plaintiff’s testimony with respect to the division of household chores was confirmed (with minor variations) by Mr. Stuber. Mr. Stuber further testified that he did about 10 to 12 hours a week of cooking and housekeeping work in the year immediately following the accident, in lieu of housekeeping that his wife performed prior to the accident. Now, he estimates that he does between 8 and 10 hours a week of housework which he did not do before the accident.
 The plaintiff and Mr. Stuber did not pay anyone to do the housework after the second accident.
 Before the second accident, the plaintiff enjoyed home decorating and painting. Mr. Stuber testified that he and the plaintiff moved into their present home in New Westminster in October 2002, and that he started painting the new home immediately, and did most of that work. Mr. Stuber began this work four months prior to the second accident.
 The plaintiff’s son, Ian Campbell, also testified. He described his mother as happy and very social before the second motor vehicle accident. According to Mr. Campbell, her mood changed after that accident. He described her as “always on edge, very irritable and depressed in general”. Mr. Campbell’s evidence about the impact of the second accident on the plaintiff’s ability to perform housework and the extent to which his step-father, Randy Stuber, has assumed cooking and housekeeping duties, was generally consistent with that of his mother and Mr. Stuber. On cross examination, Mr. Campbell denied that he had ever seen his mother stressed prior to the second motor vehicle accident.
 Following the second accident, the plaintiff was off work for three months due to shoulder pain. The plaintiff testified that she wanted to go back to work as soon as she could and that she was in pain when she returned, but persevered with a graduated return to work program, assuming full-time duties in October 2003.
 The plaintiff also testified that in November 2005, following the strike at Telus and a corporate re-organization, she received notice that her job had been eliminated. The plaintiff grieved the notice of termination of her employment. She was successful, and obtained her present position with Telus without losing any time from work. She testified that while she hopes to remain with Telus until she retires, she believes that her residual physical difficulties limit her options for alternative employment.
 The plaintiff would have liked to apply for a position in Telus’s installation and repair department, which she described as one of the highest paid bargaining unit positions. Although training was available to her for installation and repair work, she concluded that her injuries would prevent her from becoming an installer. That position involves carrying ladders and pulling electrical lines through walls, work that she believes it would be difficult, if not impossible, for her to perform as a result of her injuries.
 The plaintiff testified that in her current position at Telus she is an assistant to eight engineers. From time to time she has to work with large documents. If she extends her arms for too long, she experiences the tingling sensation in her left arm. Again, repetition is a factor. She is able to vary her duties at work in order to avoid undue repetition of the activities which induce pain or the tingling sensation in her left shoulder and arm.
 The plaintiff’s concern is that if she were to lose her present position at Telus, alternative employment as an installer would not be available to her, nor would she be able to teach fitness classes.
 The plaintiff acknowledged that she only saw her family physician once in 2004, on January 29, in connection with complaints relating to the second accident. The remainder of her visits to her physician that year related to her kidney problem, left flank pain and hyperthyroidism. In 2005, the plaintiff consulted with her physician regarding symptoms relating to the second accident on January 24, when Dr. Dresselhuis examined her in connection with the preparation of his report dated March 31, 2005. Throughout that year she sought treatment from her physician for pain from the kidney infection and for hyperthyroidism. In 2006, she received treatment for ongoing flank pain, urinary tract problems and a flare-up of hyperthyroidism. She saw Dr. Dresselhuis, her family physician, on one occasion that year, on October 23, 2006, for a review of her motor vehicle accident injuries so that he could prepare an updated medical legal report.
 No clinical records were produced for 2007.
(IV) MEDICAL EVIDENCE
 The plaintiff relies on two expert reports provided by her family physician, Dr. Dresselhuis.
 In his first report, dated March 31, 2005, Dr. Dresselhuis notes that because the plaintiff had been under investigation and treatment for other significant medical issues (her hyperthyroidism and kidney infections), an objective assessment of her motor vehicle accident injuries was somewhat difficult. He noted that on February 1, 2003, the day following the second accident, the plaintiff, when first examined, reported that she had experienced an almost immediate sense of disorientation, headache, left shoulder and neck pain and tingling into the thumb. On examination, she was found to have decreased left rotation and right lateral flexion of her cervical spine, associated with significant pain. There was tenderness over the medial aspect of the right knee, and she was felt to have sustained a cervical and left shoulder strain, possibly with a flare-up of her previous thoracic outlet nerve irritation.
 Between February 4 and June 30, 2003, the plaintiff continued to report pain and soreness, primarily in the left shoulder and scapular areas with flare-ups from lifting, or attempts to increase her physical activities. During this period, the range of motion in her left shoulder fluctuated, and on examination, she was found to have tenderness and spasm in the left shoulder area. Dr. Dresselhuis notes that on July 10, 2003, the plaintiff reported pain in her left third and fourth digits, and refers to the plaintiff experiencing tingling in the third and fourth digits of her left hand on August 9, 2003. By August 19, 2003, the plaintiff was reporting a slow improvement in her shoulder symptoms. On October 1, 2003, the plaintiff reported that although her symptoms had initially worsened after the cessation of acupuncture therapy, they had now stabilized. On examination, the plaintiff was still tight over her left paracervicals, trapezius and medial scapular musculature, but had preserved range of motion of the neck and left shoulder. Dr. Dresselhuis assessed resolving neck strain and suggested that the plaintiff now focus on a strengthening program.
 In January 2004, the plaintiff experienced a flare-up of her left shoulder pain. At that time she was working six, and even seven days a week.
 When Dr. Dresselhuis examined the plaintiff on January 24, 2005, he reported that her shoulder and neck symptoms were still present and tended to be increased at the end of the work day. Heat and exercises helped, and she was able to modify her work schedule to permit her to work despite pain. On examination, she demonstrated tenderness over the left trapezius and deltoid areas.
 In his report of March 31, 2005, Dr. Dresselhuis summarized the plaintiff’s injuries from the second accident as follows:
Whiplash Associated Disorder Grade II
This descriptor refers to a strain of the muscular and ligamentous support structures of the cervical spine, as would be expected in a torsional mechanism MVA such as Ms. Campbell was involved in. She received appropriate physiotherapy and adjunctive massage therapy for this, and although her symptoms are not fully improved, the balance of probabilities favours full resolution of these symptoms, as well as unlikelihood of any permanent disability referable to the same. She was off work from the time of the MVA of January 31, 2003 up to approximately late April 2003. This represented a full-time disability, with a subsequent partial disability from work extending to April of 2003. Subsequent to this, her symptoms flared in late May resulting in a period of full-time disability from then until late July. She was further partially disabled, with only part-time hours undertaken from late July to the end of August 2003. Causation of her whiplash injury by the accident in question is inferred due to lack of any symptoms previous to its occurrence.
This is the less significant of her injuries, and although she had intermittent low back symptoms, it was not felt to add to any disability issues, nor require her to miss time from work.
Left Shoulder Strain, with Subscapularis Weakness and Myofascial Symptoms
This is the more perplexing of her injuries. As has been alluded to already, Ms. Campbell had undergone surgery to remove a cervical rib on the left side, in 1998. This fully resolved the pain syndrome, called Thoracic Outlet Syndrome, in which some nerves of the brachial plexus, which supplies the arm, are compressed by an extraneous vestigial rib structure and fibrous band in the area deep in the left chest and armpit. Nonetheless, her symptoms were fully resolved in the four years intervening up until her accidents. As such, causation of her current shoulder difficulties can be attributed to the accident in question. The mechanism of this is likely in one of two ways:
(a) A direct injurious effect of the MVA impact on the structures involved;
(b) An injurious effect of the MVA on any residual scarring in the region of the brachial plexus nerves or other structures subsequent to the operation.
It is impossible to tease out with any accuracy a percentage split as to which of these mechanisms is responsible for a given proportion of her symptoms. Suffice it to say, however, that she has been very diligent in applying her therapies, which have been outlined in #1 above, and for which she received injection therapy, as well as acupuncture. The shoulder symptoms still preclude her from returning to the level of fitness activities such as gym workouts and swimming, that she may have enjoyed prior to the MVA’s; however, it is hoped that she will be able to return to some of these over the next one to two years. I would estimate that she has a 10-20% residual disability for recreational and other pursuits, referable to the shoulder injury in question. Future costs to her relate to those of gym membership, possible need for future physiotherapy or kinesiologist assistance, medication use and medical investigations. A period of approximately four months full disability and three to four months of partial disability can be accrued to her shoulder injury, overlapping with the effect of the whiplash symptoms. Parenthetically, I would note that x-ray of her lumbar spine on September 21, 2004, revealed mild degenerative changes and scoliosis, likely pre-existent to the MVA. Similarly, the previously alluded to CT of her cervical spine which showed foraminal narrowing at C5-C6 contralateral to the side of her symptoms, likely relates to chronic degenerative changes which cannot be directly attributed to the accident in question.
Overall, Ms. Campbell is a highly motivated individual, who has struggled to maintain her work attendance, despite her symptoms. In fact, her absence from work may have been greater were it not for the flexibility she was able to achieve in adapting her work hours to allow her to compensate for symptom flare-ups. Although she has experienced a slight increase of her symptoms concomitant to a lack of recent exercise and conditioning therapy, this relates unavoidably to her recent medical problems. It is hoped that once these are settling, we will be able to re-enroll her in an active and self-paced rehabilitation and lifestyle management approach, which should diminish the likelihood of future flare-ups. I would estimate her prognosis for functional recovery both in terms or recreational and occupational pursuits, as good.
 In his second report, dated April 9, 2007, Dr. Dresselhuis said this:
Ms. Campbell was seen in the office on October 23, 2006 relating to review of her ongoing residual symptoms. She still tended to experience tingling in her left hand, even to the point of waking up at times. This discomfort was slightly relieved by avoiding sleeping on the left side. Left-sided neck pain tended to be worsened by household chores and gym workouts, which she was nonetheless attempting to continue with. Generally, walking, sit-ups and a light gym and weight program was tolerated (with some symptoms); however, her left had still not returned to the level of strength that the right was capable of. She tended to avoid running due to a combination of her left-sided neck and shoulder symptoms as well as the ongoing left-sided kidney difficulties. She had never returned to teaching fitness.
On examination October 23, 2006, I found her to have preserved neck range of motion with the exception of left shoulder and trapezius pain reported with right lateral flexion. There were tender spasm nodules palpable over the left trapezius area as well as a patch of skin subjectively numb over the posterior shoulder and arm pit, likely related to her previous surgery. There was full shoulder range of motion, albeit with pain beyond 120 degrees in abduction. Examination of the remainder of her upper extremities and lumbar spine was normal.
 Dr. Dresselhuis also noted that the plaintiff had experienced a small flare-up of left-sided neck and shoulder symptoms with reduced range of motion in early January 2007.
 Dr. Dresselhuis states the following conclusions in his report of April 9, 2007:
… It is clear that Ms. Campbell continues to experience residual symptoms relating to the January 31, 2003 MVA. Specifically, she continues to curtail certain household activities as well as fitness pursuits at times, due to flare-ups of symptoms which are not always activity-related. It is a testimony to her high level of motivation that she has been able to continue with work on a more or less full time basis since my last report … I would estimate that approximately 50% of her current symptomatic limitation relates to the MVA in question, the remainder being aggravated by her other medical issues. The severity of her symptoms, predictably, continues to decrease, as it becomes more distant from the time of her MVA, and I expect that her symptoms should continue to gradually wane over the next few years. Certainly, they are not vocationally disabling at present, nor do I believe that they will be in the future … I believe that she will continue to require periodic massage and acupuncture therapy as well as gym program attendance, in order to minimize her symptoms and maximize her functional recovery. Nonetheless, some activities, such as swimming and certain other household chores, continue to be inadvisable on a regular basis for her due to the injuries which she has sustained. Overall, my prognosis for her remains guardedly good, largely on account of her high level of motivation and cooperation with the prescribed programs.
 Dr. Dresselhuis also referred the plaintiff to an orthopaedic surgeon, Dr. Hill, who examined the plaintiff on May 22, 2003. Dr. Hill notes in his consultation report that at the time of his examination, the plaintiff reported persistent pain in the left scapular region. He noted that on forcible rotation of her scapula, the plaintiff experienced pain in that area. Dr. Hill diagnosed “myofascial strain, left scapula”. He recommended that the plaintiff be referred to a pain clinic for local trigger point injections and scapular exercises.
 On May 21, 2003, the plaintiff was examined by Dr. Andrew Hepburn, an orthopaedic surgeon, at the request of the defendants. In his report dated June 6, 2003, Dr. Hepburn noted that the plaintiff’s symptoms, at the time of his examination, seemed to mainly relate to her left upper quadrant. Her dominant symptoms included a focused area of pain to the outer left shoulder and in the shoulder blade area. The plaintiff also complained to Dr. Hepburn of an intermittent tingling in and around the left shoulder blade, and left arm pain that at times radiated down the side of her arm, and sometimes included a shooting pain in the ulnar two fingers of her left hand.
 Dr. Hepburn summarized his findings with respect to the injuries sustained by the plaintiff in the second accident as follows:
In summary, therefore, Allison Campbell is a 43-year old woman who has been involved in a vehicular collision as outlined above. It seems that following the accident she likely has jarred and contused the muscles of the shoulder girdle area and probably has had muscle or traction headache/neck ache.
Currently her symptoms probably relate to a degree of tendonitis developing in the left shoulder as she has become less active over the past few months. She also had some pain in the right knee initially which subsided, and in the lower back which has also subsided. These may have been muscular related symptoms also. She describes periscapular symptoms of numbness and tingling which I have difficulty in identifying as they don’t seem to localize to a definable neurological pattern. She has a past history of successful treatment of a thoracic outlet syndrome fives [sic] years ago, and as far as I could determine today there is no indication that she has a thoracic outlet syndrome currently.
 The defendant’s medical expert concluded that the prognosis for mild tendonitis should be good with strengthening and stretching exercises. In Dr. Hepburn’s opinion, the plaintiff’s symptoms of neck and shoulder girdle pain, headache and knee pain were likely related to the motor vehicle accident. He thought her current symptoms in the shoulder area might relate to her relative inactivity resulting from the motor vehicle accident. Dr. Hepburn did not believe that the plaintiff was then disabled, or that she was suffering permanent disability. He recommended that the plaintiff continue to use Advil and Tylenol, as necessary, and that she be shown a stretching and strengthening program for the rotator cuff muscles of the shoulder.
(V) DISCUSSION AND ANALYSIS
(a) The nature, extent and severity of the injuries sustained by the
plaintiff in the accident of September 29, 2002
 The only injury the plaintiff sustained in the first motor vehicle accident was stiffness, rather than pain, in the mid-back area. As the plaintiff testified, it was gone within a month. The plaintiff lost no time from work as a result of the first accident. Aside from taking Advil, she required no treatment or medication. I find, on the evidence of both the plaintiff and Dr. Dresselhuis, that the plaintiff had fully recovered from the first accident well before the second motor vehicle accident. The first accident did not interfere with the plaintiff’s activities in any significant way.
 In Surette v Tull et al, 2006 BCSC 1461,  B.C.J. No. 2204 (QL), a 40-year old plaintiff who suffered a minor soft tissue injury to his mid-back, from which he recovered within a week or two, received non pecuniary damages of $1,000.00. Counsel for the defendants also referred me to Cook v. Webb and Webb, 2004 BCSC 453  B.C.J. No. 663 (QL), add. reasons at 2004 BCSC 715,  B.C.J. No. 1108 (QL), and Lanctot v. Root,  B.C.J. No. 1226 (QL). In each of these cases, a plaintiff who sustained minor soft tissue injuries which resolved within a month without any residual disability received non-pecuniary damages of $1,000.00.
 I find that the appropriate award for non-pecuniary damages, for the very minor injury sustained by the plaintiff in the first accident, is $1,000.00.
(b) The nature, extent and severity of the injuries sustained by the
by the plaintiff in the accident of January 31, 2003
 After carefully considering all of the evidence heard at trial, I make the following findings of fact based on my assessment of the reliability and credibility of the evidence presented, including the evidence contained in the medical reports.
 The plaintiff did some damage to her own credibility by claiming in her direct examination that she had taught physical fitness classes and had been a runner until the second accident. In cross-examination, the plaintiff admitted that she had ceased teaching physical fitness as a result of a bout of hyperthyroidism in 2001, that she had stopped running at that time, and that she had taken no steps to re-qualify as a physical fitness instructor prior to January 21, 2003. The plaintiff also tended to down-play the extent to which hyperthyroidism and pyelonephritis had affected her health, particularly during the period 2004 through 2006. At the same time, the plaintiff also urged the court to find that the stress resulting from the motor vehicle accident and the limitations it imposed on her ability to engage in physical fitness activities, caused or contributed to her bout of hyperthyroidism commencing in March 2004. Although Dr. Dresselhuis suggested in his report of March 31, 2005, that the plaintiff’s attack of hyperthyroidism in the spring of 2004 was, perhaps, triggered by the flare-up of the plaintiff’s left shoulder symptoms connected with an accelerated work load at Telus, this is entirely speculative, and is not supported by any cogent medical evidence.
 The plaintiff also attributed her mood changes, lack of energy and anxiety to the second motor vehicle accident. However, as she acknowledged in cross-examination, and as Dr. Dresselhuis’s medical reports reflect, changes in mood, panic attacks and anxiety are also symptoms of hyperthyroidism. Furthermore, subsequent to the second motor vehicle accident, the plaintiff was also subjected to a number of unrelated sources of stress, including notification of the elimination of her position at Telus, the loss of three brothers, and repeated and protracted bouts of pyelonephritis.
 Although the plaintiff was not an entirely reliable witness regarding her medical condition prior to the second accident, or the extent to which unrelated pre-existing conditions affected her health and limited her activities after the second accident, she did acknowledge that her knee injury had resolved promptly and that the pain and discomfort in her left shoulder and scapula had steadily improved with the passage of time since the second motor vehicle accident. I accept the plaintiff’s evidence, which is supported by Dr. Dresselhuis’s reports, that she made a determined effort to return to work and that she followed all of the recommendations for treatment from her medical advisors, which included physiotherapy, acupuncture, massage therapy, trigger point injections and strengthening exercises.
 Counsel for the defendants characterizes Dr. Dresselhuis as an advocate for the plaintiff. He invites me to find that Dr. Dresselhuis’s report and testimony is not reliable. Counsel for the defendants takes issue with Dr. Dresselhuis’s statement in his first report, that the plaintiff had “enjoyed generally good health … and worked as a fitness instructor” prior to the second motor vehicle accident. Defence counsel also takes issue with Dr. Dresselhuis’s comment in his report of April 9, 2007, that approximately 50% of the plaintiff’s current symptomatic limitation relates to the motor vehicle accident of January 31, 2003, while the remainder relates to other medical issues. He points out that since 2004, the plaintiff received extensive treatment for hyperthyroidism and pyelonephritis. In addition, the plaintiff suffered from migraines and positional vertigo. Defendant’s counsel also notes that the plaintiff’s physician interpreted Dr. Hill’s consultation report as diagnosing “myofascial pain/strain”, whereas the actual words of Dr. Hill’s report read: “myofascial strain, left scapula”.
 I accept Dr. Dresselhuis’s evidence that he was unaware when he prepared his reports that the plaintiff had discontinued working as a fitness instructor in 2001 as a result of the hyperthyroidism that she was then experiencing.
 Dr. Dresselhuis’s statement that Ms. Campbell enjoyed generally good heath before the second motor vehicle accident, viewed in isolation, arguably understates the impact of hyperthyroidism and the plaintiff’s prior history of bladder infections preceding the diagnosis of pyelonephritis in 2004. However his report of March 31, 2005 also describes the plaintiff’s 2001 flare-up of Grave's disease, the recurrence of Grave's disease in March 2004, and the nature and extent of the treatment the plaintiff received for pyelonephritis in 2004. Dr. Dresselhuis’s report of April 9, 2007 reviews all of the plaintiff’s significant medical problems since the previous report, including the reoccurrences of hyperthyroidism and pyelonephritis. He candidly identifies symptoms not attributable to the motor vehicle accident. His report provides a guarded but positive prognosis, including his opinion that the plaintiff’s symptoms are not, and will not be, vocationally disabling.
 Although the defendant takes issue with Dr. Dresselhuis’s characterization of Dr. Hill’s report, I attach little significance to his use of the terms “myofascial pain/strain” as opposed to Dr. Hill’s own terminology of “myofascial strain, left scapula”. Both Dr. Hill and the defendants’ expert, Dr. Hepburn, examined the plaintiff in late May 2003, less than four months after the motor vehicle accident of January 31, 2003. Dr. Hepburn, after conducting a very thorough examination, concluded that the plaintiff had pain in relation to movements of the left shoulder, which he expected to resolve in time, without any permanent disability to the plaintiff. In short, “myofascial pain/strain” was probably a fair characterization of the plaintiff’s condition at the time that she was examined by both Dr. Hill and Dr. Hepburn.
 Although I find Dr. Dresselhuis’s statement that the plaintiff “enjoyed generally good health” prior to the second motor vehicle accident is not an entirely apt description of her condition at that time, I reject the defendants’ submission that he was an advocate for the plaintiff.
 I accept his opinion that the plaintiff, as a result of the second motor vehicle accident, sustained a whiplash disorder, grade 2, a mild lumbar strain and significant left shoulder strain with residual myofascial pain symptoms. I also find that the plaintiff’s left shoulder and left scapula injury had largely resolved itself within one year of the accident, although the plaintiff has from time to time since then experienced flare-ups of symptoms of pain in the left shoulder area. The fact that the plaintiff has only seen her physician occasionally since early 2004 with respect to the shoulder-related symptoms is consistent with her own evidence and that of Dr. Dresselhuis, that her condition has improved, and the severity of her symptoms has decreased with the passage of time since the motor vehicle accident.
 I accept Dr. Dresselhuis’s opinion that as of March 31, 2005, the plaintiff had a 10-20% residual disability for recreational and other pursuits referable to the shoulder injury. The plaintiff avoided intense physical recreational activities. She refrained then, as she continues to do, from lifting above shoulder level, or other forms of repetitive activity which tend to induce either shoulder pain or the tingling sensation of which she intermittently complains.
 I also accept Dr. Dresselhuis’s opinion that the severity of the plaintiff’s residual symptoms will continue to decrease, and that the second motor vehicle accident has not resulted in any vocational disability for the plaintiff.
 With the following qualification, I also accept Dr. Dresselhuis’s opinion, that approximately 50% of the plaintiff’s current symptomatic limitation relates to the second accident. Dr. Dresselhuis gave that opinion at a time when the plaintiff had not suffered any recent recurrence of her pyelonephritis or flare-up of her Grave’s disease. In stating that 50% of the plaintiff’s current symptomatic limitation relates to the second accident, I understand Dr. Dresselhuis to be referring to the plaintiff’s left shoulder-related physical limitations and related left side lack of strength. Her mood changes, anxiety and panic attacks were acknowledged by both the plaintiff and Dr. Dresselhuis in cross-examination to be symptomatic of Grave's disease. The plaintiff suffered those conditions and Grave’s disease prior to the second accident. I find that the plaintiff failed to establish that the second accident caused or contributed to her mood changes, anxiety and panic attacks.
 I also find on the basis of Dr. Dresselhuis’s reports and the plaintiff’s confirmation of the clinical records put to her in cross-examination, that in 2004, 2005 and for at least part of 2006, the plaintiff suffered from repeated bouts of pyelonephritis which involved severe left flank pain. As a result of the most severe of those bouts, the plaintiff was off work for six months in 2005. Simply as a matter of common sense, this must have contributed substantially to the plaintiff’s stress and anxiety during that period. Furthermore, the severe left side flank pain that prevented the plaintiff from working would also have impaired her ability to perform housekeeping chores.
(VI) AMOUNT OF DAMAGES ATTRIBUTABLE TO THE MOTOR VEHICLE ACCIDENT OF JANUARY 31, 2003
(a) Non-pecuniary damages
 The plaintiff seeks an award of non-pecuniary damages in the range of $55,000 to $60,000. The plaintiff referred to the following cases, each of which involved claims by plaintiffs whose ability to participate in sports or other leisure activities central to their lives was curtailed or terminated by soft tissue injuries to the neck, back or shoulders: Jervis v. Holland Landscapers Ltd.,  B.C.J. No. 2938 (BCSC) (QL); Kerr v. Macklin, 2004 BCSC 318,  B.C.J. No. 455 (QL); Mawji v. Hendry, 2007 BCSC 1880,  B.C.J. No. 2759 (QL), and Jackman v. All Season Labour Supplies Ltd., 2006 BCSC 2053,  B.C.J. No. 3559 (QL).
 The defendants submit that the plaintiff’s non-pecuniary damages fall within the range of $20,000 to $25,000. They rely upon Caleta v. Honaizer, 2001 BCSC 1726,  B.C.J. No. 2712 (QL), Campbell v. Makela and Mundy, 2003 BCSC 643,  B.C.J. No. 943 (QL), Collingridge v. Henry et al, 2006 BCSC 697,  B.C.J. No. 965 (QL), Lacey v. Flatley,  B.C.J. No. 2787 (BCSC) (QL), Marcelino v. Francesutti & Others, 2002 BCSC 1711,  B.C.J. No. 2810 (QL), Moore v. Cabral et al, 2006 BCSC 920,  B.C.J. No. 1365 (QL), Stevanovic v. Sin, 2007 BCSC 1797,  B.C.J. No. 2679 (QL), White v. Stonestreet, 2006 BCSC 801,  B.C.J. No. 1150 (QL), and Olshanoski and Fox v. Clemenson, 2006 BCSC 483,  B.C.J. No. 653 (QL).
 I am mindful that in each of these cases, the assessment of non-pecuniary damages was unique to the circumstances, and the nature, extent and severity of the particular injuries sustained by each plaintiff. I also bear in mind the requirement for care in assessing damages where there is little or no objective evidence of continuing injury, and where the plaintiff’s subjective complaints persist beyond the normal or usual recovery period: Price v. Kostryba (1982), 70 BCLR 397  B.C.J. No. 1518 (QL).
 In Olshanoski, the plaintiff suffered neck and back strain resulting from a motor vehicle collision. Her symptoms improved over the four years preceding the trial. However, she continued to experience episodes of pain and stiffness of her neck and back, particularly in times of stress and increased work load. The plaintiff had been very physically active prior to the accident. She reduced her level of physical activity following the accident and also suffered pain in attempting to perform housework. The court found that the plaintiff’s symptoms could be minimized by exercise and prescription medications, and that she had full range of motion of her neck and back. In assessing non-pecuniary damages in the amount of $35,000, the court took into account the fact that the plaintiff was formerly very active in a number of physical activities which were an important part of her life. Her involvement in those activities had been substantially diminished since the accident. Similarly, in Stenavonovic, where the plaintiff was in considerable pain post-accident, off work for four months before returning to work full-time, and suffered pain in his neck and shoulder attributable to the accident for two years, the court assessed non-pecuniary damages in the amount of $35,000.
 Taking into account the injuries sustained by the plaintiff in this case, her loss of enjoyment of life, the limitations of the plaintiff arising from her unrelated hyperthyroidism and kidney problems, and the cases mentioned above, I assess the plaintiff’s non-pecuniary damages arising from the second motor vehicle accident in the amount of $35,000.
(b) Past Income Loss
 The parties agree that the plaintiff’s net wage loss resulting from the second motor vehicle accident is $8,800. I award that amount to the plaintiff.
(c) Loss of Future Earning Capacity
 The plaintiff seeks an award of $25,000 under this heading. She relies on McCartney v. Rawlins, 2000 BCSC 1031,  B.C.J. No. 1340 (QL). There, the plaintiff sustained permanent injury to his lower back, but continued in his employment with Telus. His claim that he would be unable to pursue management positions at Telus as a result of his back injury was rejected by the court. However, the court found that the plaintiff had lost some capacity in respect of his ability to undertake all types of employment as a result of his permanent disability. On that basis, the court awarded $25,000 for loss of future earning capacity.
 The issue here is the same as arose in Chamberlain v. Giles, 2008 BCSC 171,  B.C.J. No. 228, in which it was articulated by Sinclair Prowse J. as follows: “whether the Plaintiff’s injuries have resulted in a reduction of her capacity to earn income and, if so, the quantum of the award that constitute a fair and reasonable assessment of that loss” (para. 116). The assessment of whether there has been a loss of the plaintiff’s capacity to earn income includes whether:
1. The plaintiff has been rendered less capable overall from earning income from all types of employment;
2. The plaintiff is less marketable or attractive as an employee to potential employers;
3. The plaintiff has lost the ability to take advantage of all job opportunities which might otherwise have been open [to that plaintiff] had he [or she] not been injured; and
4. The plaintiff is less valuable to himself [or herself] as a person capable of earning income in a competitive labour market.
Kwei v. Boisclair (1991), 60 B.C.L.R. (2d) 393 at para. 25, 6 B.C.A.C. 314 (BCCA), quoting with approval from Brown v. Golaiy (1985), 26 B.C.L.R. (3d) 353,  B.C.J. No. 31 (QL) (BCSC).
 In this case, unlike McCartney, the plaintiff has suffered no permanent vocational disability. Indeed, the medical evidence from Dr. Dresselhuis is that the plaintiff’s symptoms should continue to gradually wane over the next few years, and that she is not now vocationally disabled. In Dr. Dresselhuis’s opinion, she will not be disabled in the future.
 Since returning to work at Telus in 2003, the plaintiff has not lost time from work as a result of the injuries she sustained in the motor vehicle accident of January 31, 2003.
 There must be some cogent evidence to trigger the considerations set out in Brown: Moore, supra, at para. 77; Marcelino, supra at para. 57. There is no cogent evidence in this case to establish that the plaintiff has been rendered less capable overall from earning income from all types of employment, or that she is less marketable, or that she has lost the ability to take advantage of all job opportunities, or is less valuable to herself in a competitive labour market. The plaintiff did testify that she had decided not to apply for an installer’s position because she believed her left shoulder injury would prevent her from performing some of the duties of that position. However, in light of Dr. Dresselhuis’s prognosis that her symptoms will continue to gradually wane over the next few years, and his opinion that periodic massage and acupuncture therapy and gym program attendance should maximize the plaintiff’s functional recovery, I am not persuaded that the plaintiff has lost the ability to take advantage of that work in the future as a result of the second accident. I, therefore find that the plaintiff has failed to establish on a balance of probabilities that an employment asset previously enjoyed by her has been either impaired or lost as a result of the second accident.
(d) Past and Future Loss of Housekeeping Capacity
 The plaintiff seeks an award of $50,052 for this loss. This includes one and-a-half hours per day for the first year following the second accident at an hourly rate of $15.00, for a total of $8,212.00 for that year. The plaintiff also claims and additional $21,840.00 for past loss of housekeeping capacity for the next four years from February 1, 2004 to the date of trial based on the loss of one hour per day for that period. In addition, the plaintiff seeks $20,000.00 for future loss of housekeeping capacity for a period of four years after the date of trial.
 The defendants submit that if the plaintiff is able to perform her job, which involves some use of her arms above shoulder level, there is no medical or functional reason why she cannot perform housekeeping activities. Counsel for the defendants argues that the plaintiff’s failure to adduce a functional capacity evaluation, or other cogent evidence of her functional limits, is fatal to this claim. The defendants submit that from 2004 onward, the plaintiff’s hyperthyroidism and kidney problems are the reason s why the plaintiff was unable to engage in housekeeping activities.
 The plaintiff is entitled to be compensated for the loss of housekeeping capacity suffered by her as a result of the injury to her full pre-accident housekeeping capacity, attributable to the second accident: Chamberlain, supra, at para. 126.
 I do accept the evidence of the plaintiff and Mr. Stuber that, during the year following the motor vehicle accident, and as a result of the injury to the plaintiff’s left shoulder and scapula, the plaintiff’s ability to perform cooking and other housekeeping work which involved lifting and repetitive actions engaging the left shoulder, was reduced. I find that Mr. Stuber increased his share of the housekeeping duties by approximately one and-a-half hours per day. I also accept that $15.00 is a reasonable hourly rate for household assistance. I therefore award the plaintiff $8,212.00 for past loss of housekeeping capacity for the year following the motor vehicle accident.
 However, I am not satisfied that the plaintiff’s claim for loss of housekeeping capacity for 2004 through 2007 is as high as the plaintiff claims, or that the plaintiff is entitled to the amount claimed for future loss of housekeeping capacity. The evidence is that the plaintiff’s symptoms of left shoulder and scapula pain have diminished with the passage of time and that they should continue to gradually wane over the next few years. Furthermore, the plaintiff suffered from episodes of hyperthyroidism in 2004, 2005 and 2006. Her kidney condition was a significant cause of disability in 2005, resulting in six months absence from work. Dr. Dresselhuis estimated that about 50% of her current symptomatic limitation relates to the second motor vehicle accident, the remainder being aggravated by her other medical issues, most notably her hyperthyroidism and kidney condition. From 2004 through 2007, I award the plaintiff one-half of the amount claimed, that is $10,920.
 In light of Dr. Dresselhuis’s prognosis for continued improvement, it is reasonable to expect that the household assistance the plaintiff requires will continue to diminish steadily over the next very few years. I assess $3,000.00 as a reasonable amount to compensate for loss of future housekeeping capacity.
 In making an award for loss of future housekeeping capacity, while denying the plaintiff’s claim for loss of future earning capacity, I find that there is a significant difference between the plaintiff’s ability to perform the duties of her employment, and the impact of the second accident on her capacity to perform heavier housekeeping duties. The plaintiff’s work, as she described it, involves limited repetitive activities engaging her left shoulder. She is able to vary her duties so as to avoid repetition of particular tasks, such as working with large documents which require her to extend her arms and shoulders. However, some household chores, such as vacuuming, consist entirely of repetitive action. I find that the plaintiff, while failing to establish that the injury she sustained in the motor vehicle accident has impaired her future earning capacity, has established that it did cause some impairment of both past and future housekeeping capacity.
(e) Special Damages
 The plaintiff claims special damages in the amount of $863.76. This amount includes $90.40 for over the counter Tylenol medication, $400.00 for acupuncture treatments not reimbursed by MSA, $46.20 for medical forms, $327.16 for mileage at 30 cents per kilometre for the plaintiff’s attendances at her family physicians and the orthopaedic surgeons Dr. Hill and Dr. Hepburn, and for her physiotherapy, massage therapy and acupuncture visits.
 The plaintiff is entitled to recover all reasonable expenses incurred as a result of her injuries. Medical evidence adduced at trial established that the plaintiff’s physicians referred her for physiotherapy, massage and acupuncture, and that she received treatments recommended by her doctors.
 Because some of the visits to the plaintiff’s family physicians for which mileage is claimed were for matters unrelated to the motor vehicle accidents, I reduce that portion of her special damages claim by $150.00. I am satisfied that the remaining expenses were incurred as a result of the injuries the plaintiff sustained in the motor vehicle accident of January 31, 2003 and that those expenses are reasonable. I, therefore, award the plaintiff $713.76 in special damages.
(f) Cost of Future Care
 The plaintiff seeks an award of $3,000.00 to pay for periodic massage and acupuncture therapy, Advil or Tylenol medication as required, and one year’s attendance at a Weight Watcher’s program (at a cost of $780.00) to assist the plaintiff in losing the weight she has gained since the second accident as a result of her diminished physical activity. The defendants argue that the plaintiff has not taken physiotherapy, acupuncture or massage since 2003, and has been able to resume some fitness activities either in her home or at the Telus gym at no cost.
 The plaintiff must establish that the proposed expenses are medically justified and reasonably necessary to help promote the plaintiff’s mental or physical health: Chamberlain, supra at para. 107; Milina v. Bartsch (1985), 49 B.C.L.R. (2d) 33 at 84,  B.C.J. No. 2762 (QL) (BCSC), aff’d (1987), 49 B.C.L.R. (2d) 99,  B.C.J. No. 1833 (QL) (BCCA).
 Dr. Dresselhuis, in his report of April 9, 2007, found that the plaintiff will continue to require periodic massage and acupuncture therapy, as well as gym program attendance, in order to minimize her symptoms and maximize her functional recovery. The defendants, in their closing submissions, did not seriously dispute that the Weight Watcher’s program would be beneficial to the plaintiff. I am also satisfied that the plaintiff continues, occasionally, to require Advil or Tylenol for the relief of intermittent flare-ups of her left shoulder and scapula symptoms. I note again that the amount claimed by the plaintiff for non-prescription pain relief medication since the accident is only $90.40.
 I find that the proposed expenses for future care are medically justified and reasonably necessary to promote the plaintiff’s health. I award the plaintiff the $3,000.00 claimed under this heading.
 The defendants seek the costs of Dr. Hepburn’s attendance for cross-examination by the plaintiff. They argue that plaintiff’s cross-examination of the defendants’ medical expert did not assist the court. I do not accept that submission. In cross-examination, Dr. Hepburn acknowledged that the plaintiff presented as an honest patient, that she displayed no exaggerated pain behaviour, and that she passed the test aimed at exposing malingerers.
 If the parties cannot reach agreement on the costs of the action, they are at liberty to bring on an application before me at a mutually convenient time.
Pearlman , J.