Bradford v Clinical Laboratories Pty Ltd
[2021] NSWPICMP 141
•3 August 2021
| DETERMINATION OF APPEAL PANEL | |
| CITATION: | Bradford v Clinical Laboratories Pty Ltd [2021] NSWPICMP 141 |
| APPELLANT: | Bernadette Bradford |
| RESPONDENT: | Clinical Laboratories Pty Ltd |
| APPEAL PANEL: | Member Jane Peacock Dr Julian Parmegiani Dr Michael Hong |
| DATE OF DECISION: | 3 August 2021 |
| CATCHWORDS: | WORKERS COMPENSATION- Psychological Injury; appellant alleged error in the assessment under three categories under the Permanent Impairment Rating Scale (PIRS) namely Social and Recreational Activities, Travel and Social Functioning; Held- the Panel could discern no error in the assessments for which clear reasons were given and the ratings accorded with the criteria in the Guidelines; MAC confirmed. |
STATEMENT OF REASONS FOR DECISION OF THE APPEAL PANEL IN RELATION TO A MEDICAL DISPUTE
BACKGROUND TO THE APPLICATION TO APPEAL
On 4 March 2021 Ms Bernadette Bradford (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Patrick Morris, a Medical Assessor (MA), who issued a Medical Assessment Certificate (MAC) on4 February 2021.
The appellant relies on the following grounds of appeal under s 327(3) of the Workplace Injury Management and Workers Compensation Act 1998 (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, 4th ed 1 April 2016 (the Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th ed (AMA 5).
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 worker did not request that she be re-examined by a MA who is a member of the Appeal Panel. The appellant submitted that “there is no need for a re-examination as the evidence has been comprehensively recorded by the MA in the MAC”. As a result of that preliminary review, the Appeal Panel determined that it was not necessary for the worker to undergo a further medical examination because the Appeal Panel was not satisfied as to error for the reasons explained below and absent a finding of error the Appeal Panel has no power to require a further medical examination.
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. They are not repeated in full, but 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 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 matter was referred to the MA for assessment (s 319 of the 1998 Act) as follows:
“The following matters have been referred for assessment (s 319 of the 1998 Act):
§ the degree of permanent impairment of the worker as a result of an injury (s319(c))
§ whether any proportion of permanent impairment is due to any previous injury or pre-existing condition or abnormality, and the extent of that proportion (s319(d))
§ whether impairment is permanent (s319(f))
§ whether the degree of permanent impairment of the injured worker is fully ascertainable (s319(g))
· Date of injury: 5 March 2019 (deemed)
· Body parts/systems referred: Psychological
Method of assessment: Whole Person Impairment”
The MA issued a MAC certifying as follows:
| Body Part or system | Date of Injury | Chapter, page and paragraph number in NSW workers compensation guidelines | Chapter, page, paragraph, figure and table numbers in AMA5 Guides | % WPI | WPI deductions pursuant to S323 for pre-existing injury, condition or abnormality (expressed as a fraction) | Sub-total/s % WPI (after any deductions in column 6) | |
| 1. Psychological /Psychiatric | 5 March 2019 (deemed) | Chapter 11, Work Cover Guides | n/a | 10% | 1% | 9% | |
| Total % WPI (the Combined Table values of all sub-totals) | 9% | ||||||
The assessment was based on an assessment by the MA conducted under the permanent impairment ratings scale (PIRS), as set out in the following table:
Table 11.8: PIRS Rating Form
| Name | Bernadette Bradford | Claim reference number (if known) | 6213/20 |
| DOB | 19 January 1966 | Age at time of injury | 53 years old |
| Date of Injury | 5 March 2019 (deemed) | Occupation at time of injury | Pathology Collector |
| Date of Assessment | 29 January 2021 | Marital Status before injury | Divorced |
| Psychiatric diagnoses | 1.Major Depressive Disorder with anxious distress. | ||
| 2.Alcohol Use Disorder, in early remission. | |||
| Psychiatric treatment | Consults treating psychologist three to four weekly; consults treating psychiatrist monthly; takes medications Mirtazapine 45mg at night, Lovan 20mg two tablets in the morning, Melatonin SR 2mg two tablets at night and Seroquel 25mg when required to help with sleep and for severe anxiety. | ||
| Is impairment permanent? | Yes | ||
| PIRS Category | Class | Reason for Decision | |||
| Self Care and personal hygiene | 2 | Mild impairment. Ms Bradford is able to live independently. She shops on-line and does the cooking, house cleaning and clothes washing for herself. She showers and changes her clothes daily without prompting. She is less interested in personal grooming than previously and is less interested in cooking than previously. | |||
| Social and recreational activities | 2 | Mild impairment. I note that Ms Bradford has started a new relationship in the last five months. She goes out with her partner for meals and coffee and to visit his parents. She has coffee out with friends about every fortnight. She visits her mother who lives nearby about two to three times per week. She is less socially active than before her work problems began. | |||
| Travel | 2 | Mild impairment. Ms Bradford said she is able to drive short distances such as to the local shops or to visit her mother who lives about 10 minutes’ drive away from her home. However she is generally more anxious now when driving. She will not use public transport because of her anxiety. | |||
| Social functioning | 2 | Mild impairment. Ms Bradford has started a new relationship in the last five months but there is some tension in her relationship with her partner. She has lost some friendships through her social withdrawal. She reports having a very good relationship with her mother and children. | |||
| Concentration, persistence and pace | 3 | Moderate Impairment. Ms Bradford reports finding it difficult to concentrate and complains of poor memory. She is not able to follow complex cooking recipes anymore. There were short-term memory impairments present on testing at the assessment. | |||
| Employability | 4 | Severe impairment. Ms Bradford’s depressive symptoms, particularly her reduced concentration, reduced motivation and energy would limit her to working less than one or two days at a time for less than 20 hours per fortnight with likely reduced pace and erratic attendance. | |||
| Score | Median Class | ||||
| 2 | 2 | 2 | 2 | 3 | 4 | =2 |
| Aggregate Score Impairment | Total |
| +2 | +2 | +2 | +2 | +3 | +4 | =15 |
| Impairment Percentage WPI from table 11.8: | 8% |
| Adjustment for the effects of treatment: | 2% |
Less pre-existing impairment: | 1% |
Final Impairment % WPI: | 9% |
The worker appealed.
In summary, the complaints on appeal by the appellant are that the MA erred as follows:
· in his assessment of a Class 2 impairment, rather than a Class 3 impairment, in relation to the PIRS category of Social and Recreational Activities.
· In his assessment of a Class 2 impairment, rather than a Class 3 impairment, in relation to the PIRS category of Travel.
· In his assessment of a Class 2 impairment, rather than a Class 3 impairment, in relation to the PIRS category of Social Functioning.
In summary, Clinical Laboratories Pty Ltd (the respondent) submitted that the MA did not apply incorrect criteria nor did he make a demonstrable error and that the MAC should be confirmed.
The role of the MA is to conduct an independent assessment on the day of examination. The MA is required to take a history, conduct a mental state examination, make a psychiatric diagnosis and have due regard to other evidence and other medical opinion that is before the MA. The MA must bring his clinical expertise to bear and exercise his clinical judgement when making an assessment of impairment under the PIRS categories. The assessment is not to be based upon self-report alone. An appeal panel cannot disturb ratings under the PIRS scale for mere difference of opinion but must be satisfied as to error.
The Panel notes that the MA has taken a detailed history which is broadly consistent with the other evidence that was before him as follows:
“• Brief history of the incident/onset of symptoms and of subsequent related events, including treatment:
Ms Bradford said she commenced working for Clinical Laboratories as a pathology collector in April 2018. She said she only had a short two-day training period which led to some anxiety for her. She said that she had to take bloods from patients in their homes. She said that she had one patient who made very sexually harassing comments towards her which made her very anxious. She spoke about this to the booking department at Clinical Laboratories, but they did not change her bookings for this man. She was also sexually harassed by another male patient in his home. She felt very uncomfortable and anxious as a result of these incidents. She told the booking department that she would refuse to go to this man’s home. She said she was using a work car and the engine light would come on but she was told by the booking department not to worry about it. She was told by the booking department to move all her equipment to another car in which the engine light also came on. She felt very anxious and fearful when the engine light came on. She said that she was treated ‘like a piece of garbage’ by management with no concern for her safety. She said her supervisor, Chris Durling called her to a meeting in September 2019 to tell her that she was going to be taken “off the road”. This occurred without notice and she felt increased anxiety. She was told she would have to work in a collection room at Norwest Private Hospital. When she arrived there a worker told her ‘not to trust anyone in the room’. She said that her shifts were frequently changed and cancelled. She believed the other workers working there thought that she was employed as a ‘spy’ and they also questioned her qualifications. She said that she was bullied by the other staff. She felt increasingly stressed and depressed. Over this time her alcohol consumption increased to the point where she was drinking a bottle of vodka over two nights or a bottle of wine per night. She was spending most of her evenings drinking. She said that she was more moody and her drinking was affecting her relationship with her mother and her children. She exhibited tolerance and she was needing more and more alcohol to achieve the same effect.
She stopped working on October 2019 on a medical certificate. She said that she saw her GP in October 2019 who referred her to a psychologist, named Neil and to a psychiatrist, Dr Khan. She has continued to see Neil by phone or video consultation every three to four weeks and she sees Dr Khan by phone or video consultation every month.She said that she was already taking the medication Mirtazapine 30mg daily when she was referred to Dr Khan and he had increased the dose to 45mg daily. Dr Khan also added Lovan 20mg daily and the dose was increased to 40mg daily. He also commenced her on Seroquel 25mg at night to help with her sleep. He also prescribed her Melatonin SR 2mg two tablets at night to help with her sleep. She has been on this treatment regime for many months.
· Present treatment:
Ms Bradford sees her treating psychologist, Neil every three to four weeks. She consults her treating psychiatrist Dr Khan every month. She takes the medications Mirtazapine 45mg at night, Lovan 20mg two tablets in the morning, Melatonin SR 2mg two tablets at night and Seroquel 25mg one tablet at night about twice a week to help her sleep and occasionally during the day for anxiety.
· Present symptoms:
Ms Bradford feels sad and depressed most of the time. She reports little pleasure or enjoyment in life except being with her dog and her partner. She said that she experiences nightmares relating to what happened to her at work and also unpleasant memories of her work experiences during the day. She is socially withdrawn. She is very anxious when she drives her car. She is generally more irritable and finds it difficult to trust people. She has gained 25kg in weight since stopping work. She reports poor self-esteem and said that she ‘hates’ the way she looks. She has poor sleep. She said she grinds her teeth at night. She has lost interest in socialising with people, going to the beach, crocheting or walking her dog. She reports reduced energy levels and feels tired through the day. She reports reduced motivation. She reports reduced concentration and a poor memory and said that she cannot multitask anymore. She reports having no sex drive. She feels hopeless and that life is not worth living but has not had suicidal thoughts recently. She feels anxious and stressed most of the time. She worries about many things. She worries that something awful will happen to her such as her car blowing up or someone attacking her. She has been able to reduce her alcohol consumption on the advice of her therapist and now drinks a bottle of wine over three nights and the occasional vodka or bourbon.
She said that her psychological symptoms have been stable for the past six months.
· Details of any previous or subsequent accidents, injuries or condition:
Ms Bradford said she suffered with postnatal depression after the birth of her three children. She is not sure if she took medication and she said she did not have psychological therapy. She said she made a full recovery after each depressive episode. Her last episode occurred in the year 2000.
In 2009 Ms Bradford was working as a blood collector at the Children’s’ Hospital at Westmead when she was attacked by an autistic child. She tore tendons in her left wrist which required eight operations to repair, and she also required two operations in her right wrist as well. She felt depressed at the time because of the chronic pain, frequent operations and her concerns about her work security. She said her GP commenced her on the medication Mirtazapine 30mg daily in 2009. She also had three or four sessions with a psychologist. She said she remained depressed for a significant period but her symptoms gradually improved. She returned to work on restricted duties. She was working at Children’s Hospital Westmead as a pathology collector for 20 hours per week. She remained taking Mirtazapine 30mg up until her work problems at Clinical Laboratories began in 2018.
· General health:
Ms Bradford had a vaginal prolapse surgery in August 2018.
Ms Bradford is taking Champix medication to help her stop smoking. She has been on this medication for the past two months and only has an occasional cigarette now. She said she does not use illicit drugs.
Ms Bradford takes Voltaren medication for the chronic pain in her hands.
· Work history including previous work history if relevant:
Ms Bradford was born in Sydney. She completed year 10 at school and the School Certificate. She then completed a beauty therapist course. She then worked in a supermarket and also worked as a singer. She then worked in Westmead Hospital as a ward clerk for nine years before training to become a pathology collector. She worked at Westmead Hospital as a pathology collector for six to eight months before transferring to the Children’s Hospital Westmead as a blood collector. She worked in a part-time capacity for
20 hours per week from 1996 to 2018 when she changed to working as a pathology collector for Clinical Laboratories Pty Ltd as she thought the work would be less physically demanding as she still had chronic pain in both her wrists. She has not worked since she stopped working with Clinical Laboratories in October 2019.
Ms Bradford married in 1998 and divorced in 2014. She has three children, a daughter aged 26, a son aged 22 and another son aged 20. She has been in a relationship with a new partner for the past five months. He works as a cabinet maker. They are not living together.
· Social activities/ADL:
Ms Bradford said she is living in her own home in Blacktown with her youngest son. She shops on-line. She shares the cooking with her son. She does the clothes washing and house cleaning. She showers and changes her clothes on a daily basis. She is less socially active than previously. She will go out on the prompting of her partner to visit his parents or go out for a coffee or meal. She occasionally goes out for coffee with some friends. She visits her mother two or three times a week at her mother’s home which is about 10 minutes drive away from her home. She spends more time at home than previously. She is able to drive to the local shops and to drive the short distance to see her mother. She is generally more anxious when driving now and is uncomfortable in and avoids using public transport.”
The MA conducted a mental state examination and recorded his findings as follows:
“Ms Bradford was a well-groomed, bespectacled, appropriately dressed woman with neatly combed hair and wearing appropriate jewellery. She was pleasant and cooperative in the interview. Her speech was of normal rate and flow. Her mood was both depressed and anxious and her affect was appropriate to her mood with little reactivity. There was no formal thought disorder and no psychotic symptoms.
Ms Bradford was alert and orientated. She had no impairments in concentration but her short-term memory was impaired as she could only recall 2 out of 3 items at two minute recall. Her general knowledge was less than expected as she could not name the NSW Premier.”
The MA summarised the injury and his diagnosis as follows:
“• summary of injuries and diagnoses:
In my opinion Ms Bradford has the psychiatric condition of Major Depressive Disorder with anxious distress according to DSM-5 diagnostic criteria. This condition appeared to have emerged as a result of work-related stressors she experienced in the period working as a pathology collector for Clinical Laboratories Pty Ltd between April 2018 and October 2019. Despite stopping work and having appropriate psychiatric and psychological therapy her psychiatric condition remains clinically significant. I have also diagnosed Ms Bradford with Alcohol Use Disorder in early remission, as she was drinking alcohol at excessive levels as a result of her work-related stressors, but she has been able to significantly reduce her alcohol consumption in the last 12 months.
· consistency of presentation
Ms Bradford was consistent in her presentation of her history and symptoms. She did not appear to be exaggerating or minimising her clinical condition.”
The MA has had regard to the other evidence that was before him. He specifically notes where his opinion differs from the opinion of the Independent Medical Expert (IME) qualified on behalf of the appellant Rastogi whose reports were in evidence before him in respect of the assessments under the PIRS categories. He notes that since the assessment with Dr Rastogi that the appellant has been able to form and continue a new relationship and this has effected an improvement in her whole person impairment. The MA makes comments as follows:
“I note a report on Ms Bradford by Dr Rastogi, psychiatrist dated 2 June 2020. Dr Rastogi made diagnoses of Major Depressive Disorder persistent, and Alcohol Abuse Disorder in Ms Bradford. Dr Rastogi recommended further psychiatric and psychological treatment. She also wrote that Ms Bradford had the diagnosis of ‘major depressive disorder on a background of pre-existing adjustment disorder with depressed mood’. Dr Rastogi also wrote, ‘…your client has a pre-existing psychological injury (adjustment disorder) in 2009 associated with chronic pain however it did not impede her functioning and did not impair her vocational functioning’.
I note another report on Ms Bradford by Dr Rastogi, psychiatrist dated 9 September 2020. In this report Dr Rastogi gave Ms Bradford diagnoses of Posttraumatic Stress Disorder and Alcohol Abuse Disorder in recovery. I have made diagnoses of Major Depressive Disorder with anxious distress and Alcohol Use Disorder in partial remission. I do not believe that the work stressors that Ms Bradford experienced, whilst objectively unpleasant, fulfil criterion A required for the DSM-5 diagnosis of Posttraumatic Stress Disorder.
Dr Rastogi gave Ms Bradford a whole person impairment rating of 22%. Where Dr Rastogi differed from me was in her ratings for Social and Recreational Activities where she rated Ms Bradford a Class 3 whereas I rated Ms Bradford a Class 2. I rated Ms Bradford a Class 2 as she goes out at times for coffees and meals and to visit her partner’s parents. Two or three times per week she will go by herself to visit her mother who lives about a 10 minutes drive away. Dr Rastogi rated Ms Bradford a Class 3 for Travel whereas I rated her a Class 2. I rated Ms Bradford a Class 2 for Travel as she is able to drive by herself short distances such as to the shops, and two or three times a week to visit her mother who lives about a 10 minutes drive from her home. Dr Rastogi rated Ms Bradford a Class 5 for Employability (Adaptation) whereas I rated her a Class 4. I believe that Ms Bradford would have some potential for work from home, but would be likely to be severely impaired as a result of her psychiatric condition. I made a one-tenth deduction for a pre-existing impairment to take into consideration the depressive condition for which she was still taking antidepressant medication at the time her work-related problems began. I have also made a 2% adjustment for the effects of treatment in reducing Ms Bradford’s level of whole person impairment.
I note that in the last five months Ms Bradford has started a new relationship with a man. She told me she had not yet started this relationship when she was last assessed by Dr Rastogi on 9 September 2020. The formation and continuation of this new relationship is reflected in Ms Bradford’s lower level of whole person impairment, particularly improvement in her Social and Recreational Activities, since the start of her new relationship.
I note a report on Ms Bradford by Dr Newlyn, psychiatrist dated 18 December 2019. Dr Newlyn gave Ms Bradford the diagnosis of Persistent Depressive Disorder. Dr Newlyn wrote, ‘…symptoms began at the birth of her eldest child and have waxed and waned since…the depressive disorder began as a postnatal disorder and then recurred in relation to a 2009 workplace injury and has been present since then’. I have made a diagnosis of Major Depressive Disorder with anxious distress in Ms Bradford which I believe was the result of the work-related stressors she experienced in the period whilst working for Clinical Laboratories Pty Ltd from 2018 to 2019. I have made a one-tenth deduction in her level of impairment to take into consideration the fact that she was taking antidepressant medication for a period of 9 to 10 years before her work problems began.
I note a number of letters from Ms Bradford’s treating psychiatrist Dr Abdal Khan to her treating psychiatrist Dr Eric Lim.
The first of these letters was dated 4 October 2019. Dr Khan made diagnoses of Post-traumatic Stress Disorder and Major Depressive Disorder perpetuating Tobacco Use Disorder and Alcohol Use Disorder in Ms Bradford. I have made the diagnoses of Major Depressive Disorder with anxious distress and Alcohol Use Disorder in partial remission, for the reasons I have outlined above. In this letter Dr Khan noted that he would be continuing the Mirtazapine 45mg at night that Ms Bradford was already taking, commencing Fluoxetine 20mg in the morning, Quetiapine 12.5 to 25mg when required daily, Thiamine 300mg in the morning and recommending engagement in psychological therapy for Ms Bradford.
The most recent letter from Ms Bradford’s treating psychiatrist, Dr Khan, to her GP Dr Lim was dated 23 October 2020. Dr Khan made diagnoses of Major Depressive Disorder, perpetuating Tobacco Use Disorder and Alcohol Use Disorder, and aggravating pre-existing Posttraumatic Stress Disorder. Dr Khan noted Ms Bradford’s medications at the time as being Fluoxetine 40mg in the morning, Mirtazapine 45mg at night, Melatonin SR 2 to 4mg at night, Quetiapine 12.5 to 25mg when required at night and Thiamine 300mg in the morning.
Dr Khan’s letters to the GP corroborated the history given to me by Ms Bradford.”
The appellant complains that the MA has erred in respect of the assessments for Social and Recreational Activities, Travel and Social Functioning.
The panel, after careful review of the evidence, can discern no error in the ratings ascribed by the MA in respect of the categories of Social and Recreational Activities, Travel and Social Functioning complained about on appeal. There was no application of incorrect criteria. Each of the ratings were open to the MA in accordance with the correct application of the criteria in the Guides. The MA has given reasons for each of his ratings. He has given a clear and reasoned explanation, that is based on the application of his clinical expertise and accords with the criteria set out in the Guidelines. The MA has to rate according to the criteria in the Guides and provide the best fit in each category. He has done so without discernible error. The MA must rate impairment that results from injury. The ratings ascribed by the MA in the two categories under complaint accord with the criteria for each class. The Panel cannot interfere with these ratings absent error by the MA.
In respect of Social and Recreational Activities, Table 11.2 of the Guidelines provides as follows:
Table 11.2: Psychiatric impairment rating scale – social and recreational activities
Class 1 No deficit, or minor deficit attributable to the normal variation in the general population: regularly participates in social activities that are age, sex and culturally appropriate. May belong to clubs or associations and is actively involved with these. Class 2 Mild impairment: occasionally goes out to such events eg without needing a support person, but does not become actively involved (eg dancing, cheering favourite team). Class 3 Moderate impairment: rarely goes out to such events, and mostly when prompted by family or close friend. Will not go out without a support person. Not actively involved, remains quiet and withdrawn. Class 4 Severe impairment: never leaves place of residence. Tolerates the company of family member or close friend, but will go to a different room or garden when others come to visit family or flat mate. Class 5 Totally impaired: Cannot tolerate living with anybody, extremely uncomfortable when visited by close family member.
The MA rated a Mild Impairment Class 2 with the following explanation:
“Mild impairment. I note that Ms Bradford has started a new relationship in the last five months. She goes out with her partner for meals and coffee and to visit his parents. She has coffee out with friends about every fortnight. She visits her mother who lives nearby about two to three times per week. She is less socially active than before her work problems began.”
The MA explained very clearly why his assessment differed from that of Dr Rastogi, the IME qualified on behalf of the appellant who had rated a Class 3. The MA explained his reasoning in this regard as follows:
“Where Dr Rastogi differed from me was in her ratings for Social and Recreational Activities where she rated Ms Bradford a Class 3 whereas I rated Ms Bradford a Class 2. I rated Ms Bradford a Class 2 as she goes out at times for coffees and meals and to visit her partner’s parents. Two or three times per week she will go by herself to visit her mother who lives about a 10 minutes drive away.”
The MA explains clearly his reasons for assessment of Class 2 for Social and Recreational Activities having exercised his clinical judgment in respect of his findings on the day of assessment, and having due regard to the other evidence that was before him. The assessment of Class 2 in this category accords with the criteria in the Guides and the Panel can discern no error. The Panel also notes that the frequency of the appellant’s social activities reinforces the MA’s rating of a mild impairment at Class 2.
In respect of Travel Table 11.3 of the Guidelines provides as follows:
Table 11.3: Psychiatric impairment rating scale – travel
Class 1 No deficit, or minor deficit attributable to the normal variation in the general population: Can travel to new environments without supervision. Class 2 Mild impairment: can travel without support person, but only in a familiar area such as local shops, visiting a neighbour. Class 3 Moderate impairment: cannot travel away from own residence without support person. Problems may be due to excessive anxiety or cognitive impairment. Class 4 Severe impairment: finds it extremely uncomfortable to leave own residence even with trusted person. Class 5 Totally impaired: may require two or more persons to supervise when travelling.
The MA has rated the appellant at Class 2 Mild Impairment explaining his reasoning as follows:
“Mild impairment. Ms Bradford said she is able to drive short distances such as to the local shops or to visit her mother who lives about 10 minutes’ drive away from her home. However she is generally more anxious now when driving. She will not use public transport because of her anxiety.”
The MA has provided appropriate reasons which are evidence based and accord with the criteria for a mild impairment for travel. In addition, the MA explained very clearly why his assessment differed from that of Dr Rastogi the IME qualified on behalf of the appellant who had rated a class 3. The MA explained his reasoning in this regard as follows:
“Dr Rastogi rated Ms Bradford a Class 3 for Travel whereas I rated her a Class 2. I rated Ms Bradford a Class 2 for Travel as she is able to drive by herself short distances such as to the shops, and two or three times a week to visit her mother who lives about a 10 minutes drive from her home.”
In respect of Social Functioning Table 11. 4 of the Guides provides as follows:
Table 11.4: Psychiatric impairment rating scale – social functioning
Class 1 No deficit, or minor deficit attributable to the normal variation in the general population: No difficulty in forming and sustaining relationships (eg a partner, close friendships lasting years). Class 2 Mild impairment: existing relationships strained. Tension and arguments with partner or close family member, loss of some friendships. Class 3 Moderate impairment: previously established relationships severely strained, evidenced by periods of separation or domestic violence. Spouse, relatives or community services looking after children. Class 4 Severe impairment: unable to form or sustain long term relationships. Pre-existing relationships ended (eg lost partner, close friends). Unable to care for dependants (eg own children, elderly parent). Class 5 Totally impaired: unable to function within society. Living away from populated areas, actively avoiding social contact.
The MA rated a mild impairment at Class 2 and provided the following reasoning:
“Mild impairment. Ms Bradford has started a new relationship in the last five months but there is some tension in her relationship with her partner. She has lost some friendships through her social withdrawal. She reports having a very good relationship with her mother and children.”
The Panel notes that the criteria upon which the MA has based his assessment clearly accord with the criteria for a mild impairment in the category of Social Functioning.
The MA noted that the appellant’s new relationship commenced after the assessment by Dr Rastogi and the formation and continuation of the relationship is reflected in a lower level of whole person impairment. The Panel considers that the ability to form and continue a new relationship reinforces the rating of a mild impairment for Social Functioning.
The ratings the MA has ascribed in the classes of Social and Recreational Activities, Travel and Social Functioning accord with the criteria in the Guides. The Panel cannot disturb these ratings absent error by the MA which the Panel cannot discern. The ratings for each of these categories are well-reasoned, not based on self-report alone and have had due regard to the history taken by the MA, the mental state examination conducted by him, and having due regard to the other evidence that was before him. The MA has exercised his clinical judgment on the day of examination and the Panel can discern no error.
For these reasons, the Appeal Panel has determined that the MAC issued on 4 February 2021 should be confirmed.
0