Boys v Western Earthmoving Pty Limited

DETERMINATION OF APPEAL PANEL
CITATION:	Boys v Western Earthmoving Pty Limited [2021] NSWPICMP 44
APPELLANT:	Lisa Boys
RESPONDENT:	Western Earthmoving Pty Limited
APPEAL PANEL:	Member John Wynyard Dr John Dixon-Hughes Dr Philippa Harvey-Sutton
DATE OF DECISION:	13 April 2021
CATCHWORDS:	WORKERS COMPENSATION- Appeal against finding of 11% WPI urinary and reproductive system by non-lead assessor; 26% WPI found for injury, but 15% (58%) deducted pursuant to section 323; Held- methodology used by Medical Assessor (MA) of assessing pre-injury condition by reference to Table 7.1 of the Guides inappropriate; MA failed to give adequate explanation as to why evidence referred to justified maximum discretionary assessment for class 1 of the Table; evidence relied on did not support conclusions reached; deduction too difficult to determine; section 323(2) applied; MAC revoked and 23% WPI MAC issued.

STATEMENT OF REASONS FOR DECISION OF THE APPEAL PANEL IN RELATION TO A MEDICAL DISPUTE

BACKGROUND TO THE APPLICATION TO APPEAL

On 7 January 2021 Lisa Boys, the appellant, lodged an Application to Appeal Against the Decision of a Non Lead Medical Assessor. The medical dispute was assessed by Dr John Garvey, a Medical Assessor (MA), who issued a Medical Assessment Certificate (MAC) on 10 December 2020.
The appellant relies on the following grounds of appeal under s 327(3) of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act):
· the assessment was made on the basis of incorrect criteria,
· the MAC contains a demonstrable error.
The delegate is satisfied that, on the face of the application, at least one ground of appeal has been made out. The Appeal Panel has conducted a review of the original medical assessment but limited to the ground(s) of appeal on which the appeal is made.
The WorkCover Medical Assessment Guidelines 2006 set out the practice and procedure in relation to the medical appeal process under s 328 of the 1998 Act. An Appeal Panel determines its own procedures in accordance with the WorkCover Medical Assessment Guidelines 2006.
The assessment of permanent impairment is conducted in accordance with the NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4^th ed 1 April 2016 (the Guides) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5^th ed (AMA 5). “WPI” is reference to whole person impairment.

RELEVANT FACTUAL BACKGROUND

On 2 October 2020 the delegate referred this matter to Dr Tim Anderson for assessment of WPI to the thoracic spine and lumbar spine and to Dr John Garvey in respect of WPI caused to the urinary and reproductive system. The WPI assessment was made on the basis of an injury occurring to the claimed areas of the body on 22 November 2015.
Ms Boys was employed as a carer for the father of an officer of the respondent company. She sustained her physical injuries whilst looking after this gentleman at Bupa Hospital at Baulkham Hills on 22 November 2015. She experienced bladder problems in May 2016 which settled following a spinal facet injection in September 2018, but which returned when she was being managed by an Exercise Physiologist. She was unable to tell how much urine she needed to pass, and experienced dribbling if she stood too soon after passing urine. She had not been sexually active since her husband became ill and could not remember the last occasion of sexual activity. She experienced occasional faecal incontinence.
The MA found there to be a 26% WPI from which he deducted 15% leaving an entitlement of 11% WPI.

PRELIMINARY REVIEW

The Appeal Panel conducted a preliminary review of the original medical assessment in the absence of the parties and in accordance with the WorkCover Medical Assessment Guidelines 2006.
The appellant did not seek a re-examination by an MA of the Appeal Panel. The issue raised on appeal related to the evidence of past history, so that a re-examination was not necessary.

EVIDENCE

Documentary evidence

The Appeal Panel has before it all the documents that were sent to the Medical Assessor for the original medical assessment and has taken them into account in making this determination.

Medical Assessment Certificate

The parts of the medical certificate given by the Medical Assessor that are relevant to the appeal are set out, where relevant, in the body of this decision.

SUBMISSIONS

Both parties made written submissions which have been considered by the Appeal Panel.

FINDINGS AND REASONS

The procedures on appeal are contained in s 328 of the 1998 Act. The appeal is to be by way of review of the original medical assessment but the review is limited to the grounds of appeal on which the appeal is made.
In Campbelltown City Council v Vegan [2006] NSWCA 284 (Vegan) the Court of Appeal held that the Appeal Panel is obliged to give reasons. Where there are disputes of fact it may be necessary to refer to evidence or other material on which findings are based, but the extent to which this is necessary will vary from case to case. Where more than one conclusion is open, it will be necessary to explain why one conclusion is preferred. On the other hand, the reasons need not be extensive or provide a detailed explanation of the criteria applied by the medical professionals in reaching a professional judgement.
The appeal was from the MAC issued by Dr Garvey. It challenged the assessment made regarding the appropriate deduction pursuant to s 323 of the 1998 Act.

Dr Garvey’s MAC

Dr Garvey (the MA) took a general history regarding the injury and, when considering details of past history did not record any bladder problems, whilst noting several other previous injuries and conditions. However, in considering the opinions of the other medical specialists, the MA noted histories taken by the qualified urologists, Dr Edward Korbel for the appellant, and Dr Robert Wines for the respondent. It is necessary to consider the evidence referred to the MA regarding the appellant’s prior bladder problems.

Referred evidence

The clinical notes produced from Ms Boys’ GP, Dr Zaid Ali, show on 1 September 2011[1] a complaint of frequency with painful urination for a few days with “smelly vaginal discharge,”[2] but by 15 November 2011 the entry noted “passing urine normal”[3].
[1] Clinical notes appeal papers page 247.
[2] Appeal papers page 243.
[3] Appeal papers page 241.
A further entry was on 16 May 2014 when the notes referred to “frequency of urination”[4] and no further entries regarding urinary problems appear in the clinical notes before the date of injury of 22 November 2015.
[4] Appeal papers page 227.
On 11 March 2009 Dr John Cummine, Orthopaedic Surgeon reported to Dr Ali. Dr Cummine was treating Ms Boys’ back condition, and reported that whilst she was pursuing an exercise regime of Pilates twice daily in November 2008, she had a couple of weeks off, followed by more exercise, and there was a question of how vigorously to push her exercise program. He said:[5]
“There have been a couple of other things that she has noticed which I think warrant an updated MRI scan:
• Her bladder still feels weak, and it has been an issue for as long as I have known her.
• She said that at night she will get up twice per night, and through the day, probably ten times, although there certainly has been no incontinence.”
[5] Appeal papers page 987.
Dr Gordon Dandie, Neurosurgeon, reported to Dr Ali on 1 December 2014. Dr Dandie took a history that Ms Boys had injured her lower back in the late 1990s when she was assisting her sister who was suffering from MS. Dr Dandie reported that Ms Boys had several episodes of low back pain over the years, which was managed by conservative treatment and would tend to settle after rest and physiotherapy. Dr Dandie was reporting on an episode that occurred four weeks prior to the consultation. He noted:[6]
“…The pain tends to radiate down the posterolateral aspect of the thigh and calf to the level of the ankle and can be associated with paraesthesia affecting the middle digits of the foot. The patient hasn’t noticed any specific weakness in the lower limbs. She does however quite frequently experience urinary incontinence when she has her back pain. At other times however the incontinence is not an issue…”
[6] Appeal papers page 961.
In a further report dated 2 February 2015 Dr Dandie did not mention Ms Boys’ incontinence, saying that whilst there was some improvement in her symptoms over January, “things seem to have regressed back to her usual level of back and leg discomfort.”[7]
[7] Appeal papers page 960.
On 30 July 2019 Dr Korbel took the following history as to Ms Boys previous problems[8]:
“Her bladder problems started when lifting and straining and this had been ongoing over the years although it settled once her back pain improved. From November 2014, she had no bladder problems until 22/11/2015.”
[8] Appeal papers page 125.
Dr Korbel also reported:[9]
“As far as her history of bladder problem is concerned, she states that she had no bladder problems until 1999 when she had back pain and urinary leakage. This settled once the back pain settled. The bladder problem was intermittent and related to her back pain…”
[9] Ibid.
Dr Thierry Vancaillie, Clinical Professor University of NSW and Member of the Women’s Health and Research Institution of Australia, examined Ms Boys on 11 October 2019 and did not take a history of past bladder problems.[10]
[10] Appeal papers page 1015
Dr Korbel reported again on 29 October 2019[11]. Dr Korbel confirmed his assessment of 16% and made no reference to Ms Boys’ pre-existing condition.
[11] Appeal papers page 160.
On 28 January 2020 Dr Wines reported. He said that he had considerable difficulty in obtaining a coherent history. He said:[12]
“…12 months prior to the alleged injury she admitted to an episode of urinary incontinence but this is was of short duration. She voided infrequently offer [sic] lasting 12 hours between voids. There had been no documented urinary tract infections. There has been no sexual activity for many years.”
[12] Appeal papers page 381.
In his opinion Dr Wines noted[13]:
“…… it is clear that she had an abnormal pattern of micturition present for some years prior to the alleged injury. I could not detect any evidence clinically or in the investigations documented in the notes that she has any neurological or orthopaedic pathology that would account for her alleged symptoms. I suspect she has suffered from a long-standing chronic retention of urine probably as a consequence of delayed voiding probably on a psychological background.”
[13] Appeal papers page 382.
We note Ms Boys in a supplementary statement stated that she had read Dr Wines’ report and did not believe “it” to be a result of her psychiatric injury, which she described in her statement of 4 August 2016 as occurring as a result of the bullying and harassment she endured at the hands of her managers in the course of her employment whilst looking after her patient.

MA reasons re s 323

At [10b] of the MAC, the MA found that the appellant qualified for a rating of 26% WPI, applying Table 7.2 of the Guides. At [10c] he concluded that Dr Korbel had found that:
“No bladder problems until 1999 when she had back pain and urinary leakage On November 22, 2015, she injured her back in the nursing home where her care charge resided. Bladder problems started when lifting and Straining and had been ongoing over the years but settled and from November 2014 until November 2015 she had no bladder problems.”
Similarly he noted the opinion of Dr Robert Wines, as to the history of an abnormal pattern of micturition for some years before the injury.
The MA considered the application of s 323 at [11]. He said[14]:
“Dr John Cummine in his report of March 11, 2009 noted the following: The bladder still feels weak and it has been an issue for as long as I have known her. She said that at night she will get up twice per night and through the day probably 10 times but without incontinence. In his report of March 2012, he noted some urinary incontinence which took several days to settle.
Dr Gordon Dandie in his report of December 1, 2014 noted that the patient does however quite frequently experience urinary incontinence when she has of back pain but at other times the incontinence is not an issue. There was no history of perineal sensory changes.
So, there was evidence of pre-existing urinary frequency and nocturia and incontinence between 2009 and 2012, without perineal sensory changes, 3 years before the subject injury. So, the Worker has gone from being a high Class 1 impairment (0-15%) to a midrange class 2 impairment being frequency, nocturia and incontinence with nocturnal enuresis 3 times a week, and now with perineal sensory changes of saddle anaesthesia. Therefore, the deductible portion of 15% WPI (equivalent to the fraction to 6/10) is deducted from the Class 2 impairment of 26% to arrive at a final whole person impairment assessment for bladder function of 11% WPI following her injury of November 22, 2015.”

SUBMISSIONS
Appellant
[14] Appeal papers page 29.

The appellant noted the assessment of 26% WPI and did not challenge it. With regard to the s 323 assessment however the appellant noted that the MA had consulted reports of Dr Cummine in 2009 and 2012 and of Dr Dandie in 2014, noting that the evidence demonstrated that she had suffered bladder problems such as urinary frequency since the 1990s and urinary incontinence from about 2012.
The appellant noted that the deduction constituted 58% of the amount assessed. She submitted that the error was that the MA had not exposed his process of reasoning in reaching the conclusion that Ms Boys’ prior condition rated 15% WPI under Table 7.2, class 1 of the Guides[15]. It was submitted that the MA simply made a “conclusory” statement and the reader was unable to understand why, out of the range of 1% - 15% that constitutes class 1, he had selected the highest rating, 15%.
[15] Guides page 38.
This was particularly difficult to understand, the appellant submitted, when the evidence showed that there were no perineal sensory changes prior to the work injury and there had been almost one year without any recorded problems of urinary frequency, incontinence or treatment.
The criteria for a class 1 assessment, it was submitted, required not only symptoms and signs of bladder disorder but intermittent treatment, neither of which had been present for the 12 months prior to the subject injury.
We were referred to Vegan, which we discussed earlier, as to the reasons required to be given by law to enable the interested party to understand the conclusion reached. Failure to give an adequate explanation was a demonstrable error, the appellant contended.
The appellant concluded by submitting that the deduction was excessive in all the circumstances and it ought to be limited to the statutory 1/10^th.

Respondent

The respondent submitted that no grounds had been argued as to the alleged error of the application of incorrect criteria. With regard to the allegation that adequate reasons had not been given, the respondent submitted that the MA had made his assessment on his clinical findings, and on the appellant’s presentation during the examination.
The respondent submitted that the MA had given consideration to the other medical reports particularly Dr Cummine, Dr Dandie, Dr Zaid Ali, Dr Coughlin, Dr Stephenson and Dr Vancaillie.
The respondent referred to the MA’s discussion of the pre-existing condition noted by the other medical specialists, noting the MA’s comment that the pre-existing condition was of pre-existing urinary frequency, nocturia and incontinence between 2009 and 2012 without there being perineal sensory changes.
The respondent submitted that a perusal of the criteria for a class 1 finding at Table 7.2 of the Guides provided an adequate explanation for the deduction made by the MA.
The MA had referred to Dr Cummine’s report, which reported that the appellant in 2009 would get up twice a night, and throughout the day probably urinate about 10 times during the day. These symptoms and signs of bladder disorder set out by Table 7.2 were equivalent to a class 2 assessment, it was argued.
Similarly Dr Cummine and Dr Dandie had reported urinary incontinence by Ms Boys between 2009 and 2012, the respondent said, which also was a criterion for a class 2 rating, as was the criterion of continuous treatment, which the respondent also submitted the evidence had demonstrated since 2009.
As we understood the respondent’s submission, it followed that many of the criteria described by contemporaneous reports prior to the occurrence of the subject injury indicated that Ms Boys’ rating could have been in the class 2 field, that is to say 16-40%, which would make the 15% assessed by the MA both reasonable and adequately explained.
We were referred to Cole v Wenaline Pty Ltd[16] and Ryder v Sundance Bakehouse[17] with regard to the application of s 323, the respondent submitting that in the light of the evidence the MA had decided that Ms Boys’ pre-existing bladder condition contributed to the overall impairment caused by the subject injury.
[16] [2010] NSWSC 78 (Cole).
[17] [2015] NSWSC 526 (Ryder).
The respondent then submitted that the appellant was doing no more than “merely cavil” with the findings of the MA and we were referred to Marina Pitsonis v Registrar of the Workers Compensation Commission[18] in that regard.
[18] [2008] NSWCA 88 (Pitsonis).
The respondent concluded by saying that the MA had adequately “recoded” the history of Ms Boys symptomatology and provided an extensive commentary on the evidence before him. This included reasons as to why he differed from the opinions of Dr Korbel and Dr Wines, the two medico-legal experts.

DISCUSSION

Section 323 of the 1998 Act provides relevantly:
“323 Deduction for previous injury or pre-existing condition or abnormality
(1) In assessing the degree of permanent impairment resulting from an injury, there is to be a deduction for any proportion of the impairment that is due to any previous injury(whether or not it is an injury for which compensation has been paid or is payable under Division 4 of Part 3 of the 1987 Act) or that is due to any pre-existing condition or abnormality.
(2) If the extent of a deduction under this section (or a part of it) will be difficult or costly to determine (because, for example, of the absence of medical evidence), it is to be assumed (for the purpose of avoiding disputation) that the deduction (or the relevant part of it) is 10% of the impairment, unless this assumption is at odds with the available evidence.”
Table 7.2 of the Guides provides criteria for rating permanent impairment due to bladder disease.
The criteria set out for class 1 give a discretion between 0-15% WPI. They are:
·        Symptoms and signs of bladder disorder
and
·        Requires intermittent treatment
and
·        Normal functioning between malfunctioning episodes
For a class 2 the discretion is between 16-40% WPI. The criteria are:
· Symptoms and signs of bladder disorder, eg urinary frequency (urinating more than every 2 hours), severe nocturia (urinating more than 3 times a night), urgent incontinence more than one a week
and
· Requires continuous treatment
As indicated, the MA found there to be a 26% WPI applying that criteria.
We note that the appellant has not submitted that Ms Boys’ prior condition should not attract a deduction, but rather that the amount was excessive.
In Ryder Campbell J said at [54]:
“Section 323 as I have already said, requires there to be a deduction for any proportion of the impairment that is due to any pre-existing condition. This is an essential element of the section; indeed it is the pith of it. It is not enough to simply identify that there is a pre-existing condition and that there has been a subsequent impairment and therefore make a deduction under this section because of the existence of the pre-existing condition. Such reasoning fails to consider a necessary condition of the operation of the section; that a proportion of the permanent impairment is due to the pre-existing condition.”

It is in this respect that the Panel has strong reservations as to the deduction. In considering what proportion of the impairment was due to Ms Boys’ pre-existing condition, the MA did not, with respect, give proper consideration to the facts that he referred to. His assessment failed to explain adequately why he applied the maximum discretionary deduction. Such explanation as was given did not expose the path of his reasoning, and an examination of the evidence he relied on does not support the extent of the deduction he made.
The basis for the reasoning by the MA was that there was evidence of pre-existing urinary frequency, nocturia and incontinence between 2009 and 2012. That summary was accurate as far as it went. However in assessing what part of that condition contributed to the impairment caused by the subject injury, the MA applied the provisions of Table 7.2 regarding a class 1 bladder disorder. Class I provides a range between 0 and 15% WPI. In choosing the highest rating the MA indicated that he thought Ms Boys’ pre-existing condition had been so serious that only the maximum WPI in that class could apply. This in turn indicates that the MA was satisfied that Ms Boys had suffered (in accordance with the class 1 criteria indicated above) symptoms and signs of bladder disorder that were severe, and that there had been intermittent treatment of such frequency as to persuade the MA that the maximum WPI assessment should be given.
We note in passing that the respondent’s submission that Ms Boys’ pre-existing condition should have warranted a deduction pursuant to class 2 of Table 7.2 cannot be accepted. One criteria for a class 2 rating is that the bowel disorder required continuous treatment, and the evidence falls far short of that proposition.
An analysis of the evidence relied on by the MA also demonstrates that the assumptions inherent in the allocation of the maximum rating for a class 1 assessment were not supported by the reports to which he referred.
Firstly, the summary by the MA of Dr Korbel’s findings at [10c] was not correct. The MA‘s conclusion that Ms Boys’ bladder problems had been “ongoing over the years” was a finding of such generality that it gave no indication of the actual periods such problems had occurred. In the exercise of the discretion as to the level of impairment warranted by a class I classification, the actual period during which a person actually suffered his/her bladder problems was a relevant factor. For the same reason, the report of Dr Wines that there had been an abnormal pattern of micturition “for some years” did not have that specificity that would allow any judgement as to the applicable degree of a class 1 impairment.
Dr Korbel’s report simply noted the onset of bladder problems in 1999, which settled once the back pain settled, and that the bladder condition was intermittent and related to the back pain. Without more, however, such evidence of past bladder problems did not warrant a finding of a 15% WPI.
Secondly, in justifying his 6/10th deduction at [11], the MA referred to three reports. The two reports of Dr Cummine noted bladder problems in 2009 and 2012, and Dr Dandie reported problems in 2014.
The MA then concluded that there had been pre-existing urinary frequency, and nocturia, and incontinence, between 2009 and 2012 without perineal sensory changes. He further concluded that Ms Boys had “gone from” a 15% WPI pursuant to class I to a class 2 impairment of 26%.
An analysis of the reports upon which he relied does not support the conclusions to which he came.
In his first report of 11 March 2009, Dr Cummine recommended an updated MRI for two reasons, which he used bullet points to indicate. The first bullet point was that Ms Boys’ bladder felt weak, which had been an issue as long as he had known her.
The second bullet point was that at night Ms Boys was getting up twice, and through the day probably 10 times, but with no incontinence.
How long Dr Cummine had known Ms Boys was not clarified. Ms Boys first injured herself lifting her disabled sister in 1999 and it is difficult to determine when Dr Cummine became involved in her management, beyond speculating that it might have been within a few years of his first report.
Further, it is not clear whether Dr Cummine’s reference to Ms Boys’ bladder as feeling ‘weak’ was intended to encompass the symptoms and signs he described in the second bullet point. The distinction evidenced by the bullet points might indicate that the reference to Ms Boys’ weak bladder was separate to the symptoms described. Dr Cummine may have been motivated to order a fresh MRI because the symptoms he described in his second bullet point were of recent origin.
If that were the case, then it could not be said that the symptoms and signs of bladder disorder had been severe for as long as Dr Cummine had known her, however long that might have been. Moreover, Dr Cummine did not mention whether Ms Boys was receiving any treatment for the difficulties he referred to in the second bullet point, nor as to when those symptoms began.
Similarly in his report of 8 March 2012, Dr Cummine referred to one instance only of urinary incontinence, which took several days to settle, some two weeks prior to his consultation on 6 March 2012. He had written a further report on 6 October 2009, which was not before us, and had seen her the time before in February 2011. Dr Cummine appeared to suggest that she had not suffered any further signs or symptoms of bladder disorder over that two year period, and again there was no evidence as to whether Ms Boys had required treatment over that time, although it seemed improbable that she would have. This evidence too would tend to negate the suggestion by the MA that the disorder was recurring between 2009 and 2012 on such a scale that it warranted a maximum class1 finding.
Dr Dandie located the beginning of Ms Boys’ troubles in the “late 90s”, and noted that she came under the care of Dr Charles New, and then “eventually” with Dr Cummine, which is further evidence of the difficulty in dealing with the actual dates involved. The urinary incontinence Dr Dandie described as occurring “quite frequently” when Ms Boys experienced back pain. There had been “several” episodes of back pain over the years, which would settle after rest. This evidence too is of a general nature, and would indicate that since the late 1990s – probably 1999 in the light of other evidence – Ms Boys experienced some episodes of back pain which quite frequently involved incontinence. How many back episodes were involved it is impossible to know, and how many of those episodes involved urinary incontinence is also unclear. Again, Dr Dandie’s evidence forms no basis for a conclusion that there was pre-existing urinary frequency, nocturia and incontinence regularly occurring between 2009 and 2012.
Ms Boys’ GP, Dr Ali, noted urinary problems between 1 September and 15 September 2011, and only one further entry relating to bladder problems of 16 May 2014. His notes began in May 2009 and no relevant entry was made therein until 1 September 2011. This evidence too does not suggest a regular pattern of symptoms and signs occurring between 2009 and 2012 – quite the contrary. Ms Boys appeared to be functioning normally from that point of view although the notes showed that she had a plethora of medical conditions that were being treated between 2009 and the date of injury.
It is common ground that Ms Boys was symptom free for a year prior to the subject injury. Dr Korbel recorded the last date as being symptomatic being November 2014, whilst the last entry in Dr Ali’s notes is May 2014 as indicated.
Thus the assumption that Ms Boys had “gone from” a class 1 15% WPI is not sustainable. There is no suggestion that she had any symptoms or signs over the year before the subject injury. Whilst that fact does not necessarily mean that no class 1 assessment can be made, it is a strong indication that Ms Boys’ symptoms and signs were not so pervasive that the maximum assessment was called for.
It is also significant that the criterion in class 1 regarding intermittent treatment was not addressed by the MA at all. Whether Ms Boys required intermittent treatment for her condition is unclear, although we are of the view that it may be assumed that she had some treatment from time to time. Just how often that treatment was required was also too difficult to determine on the evidence.
That Ms Boys suffered from a pre-existing bladder disorder is not in question, but the evidence does not permit a determination of how often her symptoms occurred, and it does not form a basis on which to speculate that they occurred so frequently, or that they were so severe, that a maximum class I rating was appropriate. Accordingly, it is dangerous to apply the discretionary scale in Table 7.2 when the evidence lacks the precision required to make an informed decision. The extent of the deduction is simply too difficult to determine and accordingly the provisions of s 323(2) should be applied.
We are satisfied that the reasons given by the MA were not adequate. As we noted in Vegan, the extent of the necessity to refer to evidence or other material varies from case to case. We note further that no other medical expert made any deduction pursuant to s 323 (although Dr Wines did not support an acceptance of liability).
For these reasons, the Appeal Panel has determined that the MAC issued on 10 December 2020 should be revoked, and a new MAC should be issued. The new certificate is attached to this statement of reasons.

PERSONAL INJURY COMMISSION

APPEAL PANEL
MEDICAL ASSESSMENT CERTIFICATE

Injuries received after 1 January 2002

This Certificate is issued pursuant to s 328(5) of the Workplace Injury Management and Workers Compensation Act 1998.

The Appeal Panel revokes the Medical Assessment Certificate of Dr John Garvey and issues this new Medical Assessment Certificate as to the matters set out in the Table below:

Table - Whole Person Impairment (WPI)

Name of approved Medical Specialist	Body Part or system	Date of Injury	Chapter, page and paragraph number in WorkCover Guides	Chapter, page, paragraph, figure and table numbers in AMA 5 Guides	% WPI	Proportion of permanent impairment due to pre-existing injury, abnormality or condition	Sub-total/s % WPI (after any deductions in column 6)
Tim Anderson	Thoracic spine	22/11/15	Chap 4 P 24	P 384 T 15-03	5%	1/10^th	5%
Tim Anderson	Lumbar spine	22/11/15	Chap 4 P 24	P 389 T 15-04	7%	1/10^th	6%
John Garvey	Urinary and reproductive system	22/11/15	Table 7.2, page 38 Clause 4.23, page 26	Table 15-6d, Page 397	26%	1/10^th	23%
Total % WPI (the Combined Table values of all sub-totals)					32%

John Wynyard
Member
Dr John Dixon-Hughes

Medical Assessor

Dr Philippa Harvey-Sutton

Medical Assessor

[2021] NSWPICMP 44

13 April 2021