Canterbury Bankstown Council v Hantke - [2021] NSWPICMP 209

DETERMINATION OF APPEAL PANEL
CITATION:	Canterbury Bankstown Council v Hantke [2021] NSWPICMP 209
APPELLANT:	Canterbury Bankstown Council
RESPONDENT:	Thomasz Hantke
APPEAL PANEL:	Member R J Perrignon Dr Douglas Andrews Professor Nicholas Glozier
DATE OF DECISION:	5 November 2021
CATCHWORDS:	WORKERS COMPENSATION- Appeal from assessment of whole person impairment (psychological); finding by arbitrator that worker had suffered both primary and secondary psychological injury; whether assessor erred in failing to identify permanent impairment resulting from secondary psychological injury and excluding it from assessment; whether a deduction was available for pre-existing Adjustment Disorder; Held – Medical Assessment Certificate set aside and replaced.

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

BACKGROUND TO THE APPLICATION TO APPEAL

The appellant Council appeals from the Medical Assessment Certificate of Medical Assessor Dr Baker dated 6 May 2021. Dr Baker had assessed a 22% whole person impairment (psychological) as a result of injury on 3 June 2016.
The respondent worker, Mr Hantke, suffered serious injury to his right ankle while working as a leading hand gardener for the Council on 3 June 2016. By a Certificate of Determination dated 4 February 2020, Arbitrator Harris in the Workers Compensation Commission determined that Mr Hantke had suffered both a primary psychological injury on 3 June 2016, and a secondary psychological injury as a result of injury to the right ankle.
In his oral reasons delivered on 2 February 2020, he found that, ‘most of the applicant’s [psychological] problems relate to his pain syndrome resulting from his injury to his right ankle’.
He noted that psychiatrist Dr Khan had diagnosed post traumatic stress disorder (a primary psychological injury). He also noted that psychiatrist Dr Rastogi had diagnosed both primary and secondary psychological injuries. He interpreted Dr Rastogi’s diagnosis of Major Depressive Disorder with generalised (or chronic) anxiety as indicating a secondary psychological injury, but he interpreted a later report of that doctor, referring to symptoms of flashback to the right ankle injury, as suggesting a primary psychological disorder.
The arbitrator concluded that Mr Hantke had suffered both a primary and secondary psychological injury as a result of injury to his right ankle.
He found that the secondary psychological injury resulted from a pain syndrome resulting from injury to the right ankle. It was neither argued before him, nor pleaded in the Application to Resolve a Dispute, that the secondary psychological injury resulted from bullying and harassment at work.
The Registrar referred the matter to Dr Baker for assessment. Dr Baker assessed a 24% whole person impairment (psychological), from which he deducted 1/10^th to account for a pre-existing Adjustment Disorder, yielding a 22% whole person impairment (psychological).
Section 65A of the Workers Compensation Act 1987 provides:
(a) no compensation is payable under section 66 in respect of permanent impairment that results from a secondary psychological injury, and
(b) in assessing the degree of permanent impairment that results from a primary psychological injury, no regard is to be had to any impairment resulting from a secondary psychological injury.
The Council says that the Medical Assessor erred by failing to consider the Arbitrator’s finding that there was a secondary psychological injury, failing to consider whether any part of the permanent impairment assessed resulted from secondary psychological injury and, if it did, failing to deduct that part from the total permanent impairment assessed.
In its submissions, the Council described the error in these terms:
“ … the M[edical] A[ssessor] should have identified, separated and excluded any permanent impairment resulting from the secondary psychological condition the worker was found to have sustained by the Arbitrator.
The appellant submits the M[edical] A[ssessor] has, in the assessment of permanent impairment, based [his] assessment on the worker’s entire psychiatric disorder which comprises both a primary psychological injury and a secondary psychological condition as found by the arbitrator.
The appellant further submits the M[edical] A[ssessor] has erroneously included permanent impairment resulting from the secondary psychological condition which is not compensable by reason of section 65A(1) of the Workers Compensation Act 1987 or guidelines referred to below.”
On 8 July 2021, the delegate was satisfied that demonstrable error was capable of being made out, and referred the matter to this Appeal Panel for determination.

PRELIMINARY REVIEW

On 4 August 2021 and 12 October 2021, the Appeal Panel conducted preliminary reviews of the original medical assessments in the absence of the parties and in accordance with the NSW workers compensation guidelines for the the evaluation of permanent impairent.

SUBMISSIONS

Both parties made written submissions. They are not repeated in full, but have been considered by the Appeal Panel.
The appellant Council’s submissions are summarised above.
In summary, the respondent worker submits that the Medical Assessor confined his assessment to impairment resulting from the primary psychological injury, for the following reasons:
(a)    the Registrar’s referral is to be interpreted as a referral for the assessment of impairment resulting from primary psychological injury only, because it makes no reference to secondary psychological injury;
(b)    the Medical Assessor confined his assessment to impairment resulting from primary psychological injury, in accordance with the referral;
(c)    he did not assess permanent impairment resulting from secondary psychological injury, and was not required to do so, and
(d)    where there has been a finding of both primary and secondary psychological injury, a Medical Assessor is entitled to diagnose only the primary psychological injury and assess impairment resulting from it, as occurred here: Secretary, Department of Communities and Justice v Topic [2020] NSWSC 1824.
At the direction of the Panel, the parties filed further written submissions as to whether a deduction for a pre-existing condition was appropriate, in the event that the Panel discerned error in the Medical Assessment Certificate.
The Council submitted that a 1/10^th deduction was appropriate, on the basis that the pre-existing condition had rendered the appellant more vulnerable to developing a psychiatric disorder, relying on Marks v Secretary, Department of Communities and Justice (No 2) [2021] NSWSC 616.
The respondent worker submitted that no deduction should be made, because:
(a) there is no evidence from which a conclusion can be drawn that the previous episode (Adjustment Disorder) contributes to the current impairment or that the current impairment is greater than it would otherwise have been in the absence of the previous episode; and
(b) the issue of a deduction does not arise on appeal, as it forms no part of the grounds of appeal relied on by the Council.

REASONING OF THE MEDICAL ASSESSOR

The Medical Assessor examined the worker on 21 April 2021 by video. He took a history at [4] of injury to the right ankle on 3 June 2016, with the subsequent development of infection and a limp, and diagnosis of complex regional pain syndrome. He noted a history of bullying and harassment during the return to work period.
Dr Baker continued: ‘Mr Hantke also developed a primary psychological injury’. We interpret this to mean that he developed symptoms of a primary psychological injury, in addition to the physical injury described. The primary psychological injury led, he said, to the breakdown of his relationship with his second partner, and ultimately to homelessness due to financial distress.
He noted Mr Hantke’s psychological symptoms, including suicidal ideation, and treatment by his GP, a psychologist, and psychiatrist Dr Rastogi.
He also noted complaints of chronic pain and numbness in the right foot which interfered with walking. He noted a prior Adjustment Disorder in 1998, from which the worker had recovered.
At [7], Dr Baker diagnosed a work-related Persistent Depressive Disorder with persistent major depressive episode, noting that ‘Mr Hantke had been exposed to traumatic incidents during his employment with Canterbury Bankstown City Council’. - emphasis added.
He concluded that symptoms of this disorder had persisted from 2016.
He said at [7] -emphasis added:
“In my medical opinion Mr Hantke’s work-related injury is Persistent Depressive Disorder with persistent major depressive episode DSM5 Code 300.4. Mr Hantke had been exposed to traumatic incidents during his employment with Canterbury Bankstown City Council. He remained symptomatic with persistent symptoms caused by his Persistent Depressive Disorder with persistent major depressive episode DSM5 Code 300.4. Mr Hantke had first suffered from symptoms caused by this work-related injury commencing in 2016. He continued to suffer from his permanent psychiatric injury at the time of this assessment.”
At [9], he added:
“He commenced work in about 2014. He was physically injured in a gardening accident. He had suffered bullying and harassment during his return-to-work plan. He had not suffered from a psychological injury prior to his employment at Canterbury Bankstown City Council. He reported that his right foot injury became re-infected. He last worked in 2017. He was no longer employed with Canterbury Bankstown City Council, at the time of this assessment. He was not rehabilitated to any employable role after the onset of his psychological injury. His mental state continued to remain impaired with depressed mood, anhedonia and loss of hope.”

Dr Baker quoted extensively from the worker’s statement and from various medical reports.
As indicated, he assessed a 24% whole person impairment as a result of psychological injury on 3 June 2016, from which he deducted 1/10^th for the pre-existing Adjustment Disorder. In support of the deduction, he reasoned at [11b] as follows:
“(i) Mr Hantke had demonstrated increased vulnerability to suffering psychiatric conditions in association with personal loss.
(ii) Mr Hantke was able to function in his role as a gardener prior to the onset of this work related injury.”

FINDINGS AND REASONS

Primary and secondary psychological injury

As the Commission had found that the worker had suffered both primary and secondary psychological injury, section 65A operated to oblige the medical assessor to assess only permanent impairment resulting from primary psychological injury, and to have no regard to any impairment resulting from secondary psychological injury.
As the respondent worker submits, the Registrar’s referral is properly interpreted as a referral for the assessment of impairment resulting from primary psychological injury only. What the Medical Assessor actually assessed, however, can only be gleaned from the reasoning expressed in the Medical Assessment Certificate itself.
As indicated, the Medical Assessor diagnosed Persistent Depressive Disorder with persistent major depressive episode. He said at [7] - emphasis added:
“Mr Hantke’s work-related injury is Persistent Depressive Disorder with persistent major depressive episode DSM5 Code 300.4”

We interpret this to mean that he suffered an injury by way of disease - namely, Persistent Depressive Disorder with persistent major depressive episode.
He did not say expressly whether the diagnosed condition resulted from primary psychological injury, or secondary psychological injury, or both. However, he noted in the same paragraph - emphasis added:
“Mr Hantke had been exposed to traumatic incidents during his employment with Canterbury Bankstown City Council.”
Doing our best, we interpret this to mean that the diagnosed condition resulted from, not one, but a number of traumatic incidents at work. The only incidents described by the Medical Assessor in the Medical Assessment Certificate prior to that passage were the traumatic incident on 3 June 2016 when he injured his ankle, and the bullying and harassment of which he complained in the return to work process. His use of the plural (‘incidents’) suggests that he was referring to both.
The worker did not allege psychological injury as a result of bullying and harassment. In his Application to Resolve a Dispute, he alleged only psychological injury resulting from an insult to the right ankle on 3 June 2016, and which the Arbitrator found had caused both primary and secondary psychiatric injuries. The Registrar’s referral for assessment is to be interpreted accordingly. It formed no part of the Medical Assessor’s function to assess permanent impairment resulting from bullying and harassment. Nothing turns on this, however, as there is no doubt that impairment assessed by Dr Baker was psychological impairment resulting from injury to the right ankle. Even if bullying and harassment contributed to that impairment, as Dr Baker appears to have considered, it did not sever the chain of causation between the assessed impairment and injury to the right ankle.
Dr Baker noted that symptoms of the diagnosed disorder had persisted since 2016. He assessed permanent impairment according to the Psychiatric Impairment Rating Scales. As the respondent worker correctly submitted, ‘The assessment appears in the PIRS rating form. That form identifies the diagnoses [sic] as Persistent Depressive Disorder with persistent major depressive episode DSM5 Code 300.4’.
In that form, Dr Baker assessed impairment on the basis of the various symptoms and consequences of Persistent Depressive Disorder.
It follows that, so far as we can tell from the reasons expressed by the Medical Assessor:
(a) the permanent impairment assessed was permanent impairment resulting from the symptoms and effects of Persistent Depressive Disorder, and
(b) that condition was found by the Medical Assessor to have resulted from injury to the right ankle.
Neither Dr Khan nor Dr Rastogi, whose reports were considered by the Arbitrator, had diagnosed Persistent Depressive Disorder. Dr Baker did not say expressly whether the Persistent Depressive Disorder was, or resulted from, a primary or secondary psychological injury, or both. His reasons do not disclose it. There is no consideration at all given in the reasons to whether the diagnosed disorder, or the impairment assessed as a result of it, constituted or resulted from primary or secondary psychological injury.
The failure to indicate whether the diagnosed disorder and consequent impairment resulted from primary or secondary psychological injury, or both, makes it unclear whether or not the assessment related solely to a primary psychological injury, as required by the referral.
That Mr Hantke suffered emotional trauma as a direct result of his physical injury - that is, a primary psychological injury - was no longer in dispute by the time of the referral. Such a determination had already been made by the arbitrator. It remained for the assessor to determine what impairment resulted from the primary psychological injury, as distinct from the secondary psychological injury.
There was ample evidence contained in records from treating and assessing clinicians to show that, for some years, Mr Hantke had suffered significant symptoms as a result of secondary psychological injury. It was that evidence, together with other evidence, that led the Arbitrator to conclude there had been secondary psychological injury in addition to primary psychological injury. In the circumstances, it was incumbent on the medical assessor to explain whether the diagnosis he made, and the impairment he assessed, resulted from primary or secondary psychological injury, or both. He did not do so.
His failure to do so puts te Panel in a position where it is unable “to see whether the opinion does or does not involve any error of law”: State of New South Wales (NSW Department of Education) v Kaur [2016] NSWSC 346 at [26], quoting and applying Wingfoot Australia Partners Pty Ltd v Kocak [2013] HCA 43. That failure amounts to error, necessitating that the certificate be set aside.
The respondent worker relies on Topic to show that an assessor is entitled simply to assess impairment resulting from a primary psychological injury, without indicating or assessing impairment resulting from a secondary psychological injury. Topic was not a case where, as here, the Medical Assessor diagnosed a condition resulting from both primary and psychological injury, and assessed whole person impairment greater than 0% on the basis of the signs and symptoms of that condition.
In Topic, the Commission had found, by consent, that both primary and secondary psychological injury had resulted from physical injuries which occurred on 31 October 2004. It also found that the worker suffered psychological injury due to the nature and conditions of employment from 2004 to 2006, during which time she had been the subject of a distressing complaint. The Medical Assessor was instructed to assess, separately:
(a) whole person impairment (psychological) as a result of injury on 31 October 2004, and
(b) whole person impairment (psychological) due to the nature and conditions of employment from 2004 to 2006.
In respect of the first injury, he was instructed to exclude any impairment resulting from secondary psychological injury. There was no need to issue such an instruction in respect of the second injury.
The Medical Assessor assessed 0% whole permanent impairment resulting from the physical injury on 31 October 2004. He assessed 15% whole person impairment resulting from injury due to the subsequent nature and conditions.
The employer appealed, alleging error in the failure to consider whether any part of the 15% whole person impairment resulted from secondary psychological injury on 31 October 2004. Noting that the Medical Assessor had assessed 0% whole person impairment resulting from that injury, the Registrar’s delegate was not satisfied that there was an arguable case of error, declined to refer the matter to an appeal panel, and later refused to reconsider his decision. The employer applied for review to the Supreme Court. The application was dismissed.
In contrast, in this case Dr Baker has assessed whole person impairment by reference to the effects of a particular diagnosed disorder, without indicating whether that disorder results from primary psychological injury, secondary psychological injury, or both.
The Panel considers that the error identified in this case can be corrected without a further examination of the worker because, for the reasons which follow, the existing evidence supports a finding that one third of the 24% whole person impairment assessed by Dr Baker results from secondary psychological injury.
In our view, it is likely that the primary and secondary injuries together resulted in the diagnosed condition of a persistent depressive disorder with a persistent major depressive episode. As indicated, the assessed impairment resulted from this condition.
It is impossible to say that some symptoms or some impairment resulted from the primary injury and some others resulted from the secondary injury. The symptoms of the diagnosed disease are not able to be so apportioned with precision.
However, having regard to the following evidence, we consider that the effects of the secondary psychological injury have been severe, and continue to contribute significantly to the total assessed impairment.
Treating psychiatrist, Dr Rastogi, offers several insights in her reports:
(a)    on 13 May 2017: “The last two months he was unable to cope and his pain worsened with depressive worsening and feeling miserable and relationships strained”;
(b)    on 23 January 2018: “Pain ongoing and unbearable”;
(c)    on 21 August 2018: “He had a physical injury and developed adjustment disorder associated with lots [sic, loss] of functioning, being a burden on his partner, loss of self-esteem and confidence, social isolation, and severe pain that has preceded to major depressive disorder with chronic anxiety and avoidance with treatment resistance”, and
(d)    on 30 April 2019: “His pain continues despite treatment and this is perpetuating his functional impairment is and mood disorder given the complex interaction between pain and mood disorders”.

IME psychiatrist Dr Graham George, 18 April 2017, wrote, “[Mr Hantke] said because of his constant pain, he stopped work recently”. Also, “The diagnosis appears to be one of a chronic adjustment disorder with depressed mood related to ongoing pain”.
Pain specialist Dr Alan Nazha, 22 April 2017, noted,
“I understand from Tomasz that he is doing his best to decrease his distress levels associated with his pain. Throughout the consultation, however, Tomasz did constantly reflect on his distress associated with his pain as well as his depressive symptoms.”
Pain management specialist Dr John Ditton, 2 May 2017, offered this opinion, “The issues generating his depression are the injury, the pain from the injury, the sleep deprivation and the disruption to his life”.
Clinical psychologist Sava Tsolis, 30 August 2017, noted,
“As a result of his current nerve pain, Mr Hantke reportedly experiences a number of symptoms associated with anxiety including breathing difficulties, racing heart, nausea, sweating and trembling. He stated that he has had several panic attacks in the past. The most recent one occurred a week or so prior to his assessment, when he attended the emergency department at the local hospital following a panic attack had after he stopped taking his antidepressants.”
Further,
“Mr Hantke stated that the situations that currently trigger his anxiety include: not experiencing relief in his symptoms (as in his pain and psychological distress), not being able to return to a fully functioning state and his partner leaving him due to his current state and an increase in conflict.”
Psychologist Graham Hiscox, senior rehabilitation consultant, 9 April 2018, wrote,
“Mr Hantke stated that he has developed a secondary psychological illness in response to the original physical injury. He attributed this psychological illness to the foot injury impeding him from participating in his usual active lifestyle. He also stated that at the time of the injury he was in the process of establishing a small business and that the injury has impeded his capacity to fulfil this project.”
Orthopaedic surgeon Dr E Gehr, 28 November 2019, wrote, “throughout the consultation, however, Tomasz did constantly reflect on his distress associated with his pain as well as his depressive symptoms”.
There is no evidence that persuades us that the effects of the secondary psychological injury, evidenced by these reports, have abated. It is highly likely that they continue to contribute to permanent impairment, and that the effects of the Persistent Depressive Disorder are seriously greater now than they would have been, but for the secondary psychological injury.
Though it is not possible to calculate with precision the degree of that contribution, doing our best and having regard to the evidence above, and to the other evidence considered by the assessor, we consider that evidence to be at odds with a finding that one-tenth of the impairment results from secondary psychological injury. In our view, the likely contribution of the secondary psychological injury to current permanent impairment is about one third.
For those reasons, we consider that, of the 24% whole person impairment assessed, 16% results from primary psychological injury, and 8% from secondary psychological injury.

Deduction for pre-existing Adjustment Disorder

Having determined that the Medical Assessment Certificate must be set aside and replaced, we turn to consider whether a deduction for the pre-existing Adjustment Disorder is required pursuant to section 323 of the Workplace Injury Management and Workers Compensation Act 1998.
The fact that the deduction was not raised on appeal does not, in our view, excuse the Panel from considering the issue. It could not have formed a ground of appeal, because the appellant Council did not allege error in that respect.
After setting aside the Medical Assessment Certificate for other reasons, it falls to the Panel to make its own assessment. That includes a determination as to whether any deduction ought be made to take account of a pre-existing condition. The parties have been given an opportunity to address the issue in written submissions, and have taken advantage of that opportunity.
Before making a deduction, an Assessor must find that there was a pre-existing condition, which currently contributes to the assessed impairment. To make the latter finding, the Medical Assessor must be satisfied that, because of the pre-existing condition, the assessed impairment is greater than it would otherwise have been: Ryderv Sundance Bakehouse [2015] NSWSC 526. It might satisfy that test, for instance, if the pre-existing condition has rendered the worker vulnerable to psychological injury and that it merits a deduction: Marks.
In this case, the evidence establishes that the worker suffered an Adjustment Disorder in 1998, from which he had fully recovered well prior to injury in 2016. There is no evidence, as there was in Marks, of multiple psychiatric episodes between the suffering of that condition and psychological injury. By the time of injury in 2016, the worker had fully recovered from his Adjustment Disorder without further episodes, and worked without restriction for many years.
In the circumstances, we are not satisfied that any symptoms of the prior Adjustment Disorder had persisted or, contrary to the opinion of Dr Baker, that it resulted in an increased vulnerability to developing Persistent Depressive Disorder.
Accordingly we are not satisfied that the pre-existing condition, having resolved, currently contributes to permanent impairment in any way. There are no proper grounds for a deduction.
For the reasons given, the Medical Assessment Certificate of Medical Assessor Dr Baker is set aside and replaced with the attached Medical Assessment Certificate.

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 Act1998.

The Appeal Panel revokes the Medical Assessment Certificate of Dr Baker with respect to the assessment of whole person impairment and issues this new Medical Assessment Certificate as to the matters set out in the Table below:

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)
Psychological	3 June 2016	Chapter 11, pages 60-68	Chapter 14	16%	nil	16%
Total % WPI (the Combined Table values of all sub-totals)					16%

R J Perrignon
Member
Dr Douglas Andrews

Medical Assessor

Prof Nicholas Glozier

Medical Assessor

5 November 2021

PERSONAL INJURY COMMISSION

Table 11.8: PIRS Rating Form

Name	Tomasz Hantke	Claim reference number (if known)
DOB	18 October 1979	Age at time of injury	38 years
Date of Injury	3 June 2016	Occupation at time of injury	Gardener Leading Hand
Date of Assessment	21 April 2021	Marital Status before injury	defacto

Psychiatric diagnoses	Persistent Depressive Disorder with persistent major depressive episode DSM5 Code 300.4
Psychiatric treatment	Mr Hantke was treated by his local medical practitioner, clinical psychologist and his consultant psychiatrist. He was treated with evidenced pharmacotherapy and evidence based psychological therapy. He had been treated as an emergency patient of a general Hospital and referred to the local community mental health team for persistent suicidal thoughts. He had not been admitted to psychiatric hospital as an inpatient.
Is impairment permanent?	Yes

PIRS Category	Class	Reason for Decision
Self-Care and personal hygiene	3	Mr Hantke reported that at the time of this assessment he was reliant on his friend’s mother. He lived in his van that was parked in the backyard. He was permitted to enter the house 2-3 times each week when prompted by his friend’s mother to shower. His friend’s mother provides him with cooked food. He also ate food delivered to his car. He would not eat regularly. He had lost interest in caring for his personal hygiene. He was not interested in his nutrition. He had not laundered any clothes for about 3 months. He did not wash or shower unless prompted by his friend’s mother. He preferred to spend his time alone, in his car wrapped in blankets. He was dishevelled, unshaven and had long uncared for hair.
Social and recreational activities	3	Mr Hantke did not socialise. He did not ride his BMX bike. He had lost all his friends except one. She organised for him to live in his van in the backyard of her mother’s house. He had a “smart telephone.” He had stopped participating or celebrating Christmas, New Years and Easter. He did not socialise with his friend in public. He did not socialise with his friend’s mother. He had lost interest in BMX or planning his travelling around Australia.
Travel	2	Mr Hantke had been able to walk locally. He becomes anxious and easily angry when driving. He suffered from panic attacks in heavy traffic. His van was out of registration and fuel. He could not use public transport, due to anxiety. He relied on his smart telephone to avoid having to leave his van when talking to government agencies or his medical team. He could walk to his nearest chemist for his medications.
Social functioning	3	Mr Hantke reported his relationship with his partner had ceased prior to the assessment. He reported she took the pets and left for Queensland. He said there was no prospect of reconciliation or reunion. He was estranged from his mother in New Zealand. She had told him that she was unable to accept him to her new home. He stated that he had no contact with his stepsister. He reported that there were no members of his immediate family in Australia. He reported being a burden to his friend and her mother. He was not in an intimate relationship with his friend.
Concentration, persistence and pace	3	Mr Hantke had difficulty following simple instructions. He would fail to complete simple tasks as he lacked motivation. His concentration deficits were obvious after a brief conversation. He struggled to remain on task and would become frustrated and agitated by intrusive depressive thoughts involving death and suicide. He could not read more than a few lines. He was slow in his pace and lacked persistence in following through on essential tasks of living. His van was out of registration as he had forgotten to renew the registration and perform all the pre-registration checks. He had abandoned all reading due to his reduced pace and loss of interest in news.
Employability	5	Mr Hantke could not work in his primary substantive role as a gardener. He had failed re-training. He was totally impaired due to the severity of his assessable psychiatric symptoms alone.

Score							Median Class
2	3	3	3	3	5	3

Aggregate Score Impairment							Total 24%
2+	3+	3+	3+	3+	5=	19

Aggregate Score Impairment	Total 24%
Impairment resulting from primary psychological injury alone (less 1/3^rd resulting from secondary psychological injury):	16%

R J Perrignon
Member
Dr Douglas Andrews

Medical Assessor

Professor Nicholas Glozier

Medical Assessor

5 November 2021