CCA v Koskela Pty Ltd
[2023] NSWPICMP 418
•28 August 2023
| DETERMINATION OF APPEAL PANEL | |
| CITATION: | CCA v Koskela Pty Ltd [2023] NSWPICMP 418 |
| APPELLANT: | CCA |
| RESPONDENT: | Koskela Pty Ltd |
| APPEAL PANEL | |
| MEMBER: | Marshal Douglas |
| MEDICAL ASSESSOR: | Chris Oates |
| MEDICAL ASSESSOR: | Neil Berry |
| DATE OF DECISION: | 28 August 2023 |
| CATCHWORDS: | WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; appellant suffered injury to lumbar spine and consequential condition to urinary and reproductive system; approved Medical Specialist certified in Medical Assessment Certificate (MAC) that was issued on 25 February 2020 that appellant had 7% WPI relating to his lumbar spine and 0% WPI relating to his consequential condition; appellant subsequently had L3/4 anterior body fusion; parties agreed that grounds for appeal provided in section 327(3)(a) & (b) established; Held – MAC revoked. |
BACKGROUND TO THE APPLICATION TO APPEAL
This matter involves an appeal CCA, the appellant, has made against Approved Medical Specialist (AMS) Dr Ross Mellick’s assessment of a medical dispute that arose between the appellant and his employer, Koskela Pty Ltd. The appellant relies on the grounds for appeal enumerated at s 327(3)(a) and s 327(3)(b) of the Workplace Injury Management and Workers Compensation Act 1998 (1998 Act), being:
·deterioration of the worker’s condition that results in an increase in the degree of permanent impairment, and
·availability of additional relevant information (being additional information that was not available to, and that could not reasonably have been obtained by, the appellant before the medical assessment appealed against).
The medical dispute the former Workers Compensation Commission referred to the AMS
Dr Mellick to assess related to the degree of permanent impairment of the appellant from an injury the appellant suffered to his lumbar spine on 21 July 2017. The referral, which was dated 17 January 2020, specified the body parts being referred for assessment were “lumbar spine” and “urinary and reproductive system (consequential condition)”.In a Medical Assessment Certificate (MAC) dated 25 February 2020, the AMS certified he had assessed the appellant had 7% whole person impairment (WPI) relating to his lumbar spine and 0% WPI relating to his urinary and reproductive system (consequential condition). He thus certified the total permanent impairment he assessed the appellant had from his injury was 7% WPI. An Appeal Panel confirmed that MAC on 11 May 2020.
Following that, in all likelihood on 15 June 2020,[1] the Workers Compensation Commission issued a Certificate of Determination in the following terms:
“The Commission determines:
1. The applicant suffers 7% permanent impairment resulting from injury on 21 July 2017.
2. The applicant has no entitlement to lump sum compensation resulting from injury on 27 July 2017.
Brief statement of reasons
3. This Certificate of Determination is issued in accordance with the Medical Assessment Certificate issued under Part 7 of Chapter 7 of the Workplace Injury Management and Workers Compensation Act 1998.
4. The claim for compensation was made on or after 19 June 2012. The applicant did not reach the threshold for entitlement to compensation, as required by s66(1) of the Workers Compensation Act 1987.
5. The proceedings were commenced after 2 April 2013 and therefore no order is made as to costs.”
[1] There is confusion within the material before the Appeal Panel regarding the exact date on which the Certificate of Determination issued. The copy of the certificate within the Appeal Panel’s brief is dated 13 January 2020, but that is unlikely to be the correct date given the earlier Appeal Panel did not determine the prior appeal until 11 May 2020. A Certificate of Determination the Personal Injury Commission issued on 23 April 2023 records an order revoking that earlier certificate, and records the date of that earlier certificate as 15 June 2023, but in the statement of reasons published for that order the date of the earlier certificate is variously noted as being 15 June 2020 and 15 July 2020. Nothing hinges on this in the Appeal Panel’s consideration of the appeal before, and the Appeal Panel merely notes this for completeness and to ensure clarity.
On 9 November 2020 neurosurgeon and spinal surgeon Dr Renata Abraszko conducted surgery on the appellant in which she performed an L3/4 anterior interbody fusion. Following that Dr Abraszko issued a report in which she advised she had assessed the appellant had 33% WPI from his injury, comprising 24% WPI of the lumbar spine, 5% WPI of the cervical spine, 1% WPI for scarring and 5% WPI for the bladder.
On 6 February 2023 the appellant’s then solicitors lodged with Personal Injury Commission
(Commission) the appellant’s appeal against the MAC. On 30 March 2023 the appellant, now seemingly self-represented, forwarded correspondence to the Commission titled “the application to seek a deliver on revocation of certificate dated 15 June 2020”. It was apparent that by that correspondence the appellant sought the Certificate of Determination dated 15 July 2020 be revoked.The matter was referred to Member Mr John Isaksen who on 20 April 2023 revoked the Certificate of Determination dated 15 June 2020 pursuant to s 57(1) of the Personal Injury Commission Act 2020. The Member remitted the matter to the President of the Commission for the purpose of determining:
“(a) if at least one of the grounds for appeal specified in s327(3) of the Workplace Injury Management and Workers Compensation Act 1998 has been made out; and, if so
(b) whether this matter can be referred for a further assessment of permanent
impairment as an alternative to an appeal as provided for by s329 (1) of the Workplace Injury Management and Workers Compensation Act 1998.”
On 19 June 2023 a delegate of the President found that the ground for appeal as specified in s 327(3)(a) is capable of being made out and directed that the matter be referred to a Medical Appeal Panel. It is implicit from that, and also from the short reasons the delegate published for her decision, that she was of the view that the matter ought not to be referred for further assessment of permanent impairment as an alternative to an appeal pursuant to
s 323(1) of the 1998 Act.Rule 128 of the Personal Injury Commission Rules 2021 (PIC Rules) and Procedural Direction PIC7 - Appeals, reviews, reconsiderations and correction of obvious errors in medical disputes set out the practice and procedure in relation to the medical appeal process under s328 of the 1998 Act. An Appeal Panel determines its own procedures in accordance with r 128(1) of the PIC Rules.
The assessment of permanent impairment is conducted in accordance with the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4th ed
1 March 2021 (the Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th ed (AMA 5).
SUBMISSIONS
The appellant’s former solicitor provided written submissions attached to the appellant’s application to appeal dated 6 February 2023. With respect to the ground for appeal found in s 327(3)(a) of the 1998 Act the appellant’s submissions were, in substance, that as a consequence of the surgery Dr Abraszko performed on 9 November 2020 there had been a deterioration in the appellant’s condition after AMS Dr Mellick had assessed the appellant’s permanent impairment from his injury.
With respect to the appellant’s appeal relying on the ground for appeal specified in
s 327(3)(b) of the 1998 Act, the appellant relied on numerous documents listed in an index attached to the appellant’s application to appeal. Those documents included a statement of the appellant dated 29 September 2022, medical records and medical reports dated both before and after the MAC issued by AMS Dr Mellick, the MAC, and certificates of determination the Workers Compensation had issued. The appellant submitted that this additional relevant information:“[I]s information about the worker’s medical condition and surgery that was undertaken after the Medical Assessment Certificate of Dr Mellick. Logically that information did not exist prior to the Medical Assessment Certificate and as such could not have been obtained before the Medical Assessment Certificate”.
The respondent filed submissions attached to its Notice of Opposition to the appellant’s appeal against the MAC, which are dated 27 February 2023. These related to the competency of the appellant’s appeal. In further submissions made dated 3 May 2023, which the respondent lodged in accordance with directions the Commission made on
26 April 2023, following the Certificate of Determination that Member Isaksen issued on
20 April 2023, which required the parties to make further submissions regarding the appellant’s appeal against the MAC, the respondent conceded that the appellant had suffered a deterioration of his condition subsequent to the MAC and further conceded that “the additional information and/or evidence” supporting the deterioration of the appellant’s condition was not available to the AMS at the time of the original assessment. The respondent conceded that the matter could proceed by way of appeal pursuant “to section 327(3)(a) and/or (b) of the 1998 Act”. The respondent submitted that one of the Medical Assessors constituting this Appeal Panel would need to conduct an examination of the appellant to assess his permanent impairment.The appellant also lodged further submissions dated 3 May 2023 in response to the directions made on 26 April 2023. It is apparent from those that, as at that date he was not represented. The submissions the appellant made are hard to comprehend. The gist of them seems to be that the only body part the subject of his current appeal is his lumbar spine and that the Commission should adopt the 24% WPI that Dr Abraszko assessed he had relating to his lumbar spine.
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 Procedural Direction PIC7.
At its preliminary review, the Appeal Panel determined that there had been a material deterioration in the appellant’s condition as a consequence of the surgery he had on
9 November 2020 in the form of an L3/4 anterior interbody fusion. The occurrence of that surgery necessarily meant that the degree of the appellant’s permanent impairment from his injury had increased from that which AMS Dr Mellick assessed it to be. This is because, in accordance with clause 4.37 of the Guidelines the appellant’s impairment must be considered as falling within DRE Lumbar Category IV of Table 15-3 of AMA5. That provides for an assessment of between 20% and 23% WPI, depending upon the extent to which the appellant’s impairment affects his activities of daily living. Further, potentially the appellant may be entitled to a further 3% WPI if he has residual symptoms and radiculopathy.The Appeal Panel would therefore need to revoke the MAC and assess the degree of permanent impairment the appellant now has from his injury consequent upon there being a deterioration of his condition relating to his lumbar spine. The Appeal Panel appointed Medical Assessor Chris Oates to conduct that examination. Medical Assessor Oates’ report to the Appeal Panel is set out below under Findings and Reasons.
With respect to the appellant’s appeal relying on the ground for appeal found in s 327(3)(b) of the 1998 Act, the Appeal Panel also considered during its preliminary review whether the documents listed in the index to the appellant’s application to appeal should be received into evidence, pursuant to s 328(3), in support of this ground for appeal.
Section 328(3) of the 1998 Act provides that evidence that is fresh evidence or evidence in additional to or in substitution for the evidence received in relation to a medical assessment appealed against may not be given on an appeal by a party unless the evidence was not available to the party before the medical assessment and could not reasonably have been obtained by the party before that medical assessment.
The Appeal Panel has determined that it shall receive into evidence all the reports of
Dr Abraszko dated after the MAC and the report of Dr Bentivoglio dated 2 March 2022. This evidence was not available to the appellant before the medical assessment AMS Dr Mellick carried out and could not reasonably have been obtained by the appellant before that assessment. It is relevant to the grounds for appeal upon which the appellant relies. The respondent does not indicate in its submissions that it objects to the Appeal Panel receiving this material into evidence.The Appeal Panel has also decided to receive into evidence paragraphs 41 and 42 of the appellant’s statement dated 29 September 2022. The Appeal Panel considers that all other paragraphs of the appellant’s statement consist of either information that was available at the time AMS Dr Mellick conducted his assessment or information that has no probative value as it just repeats what is contained within the reports of Dr Abraszko that the Appeal Panel has decided to receive into evidence or it just sets out the procedural history of the proceedings before the Commission.
The Appeal Panel also has decided not to receive any of the other of the documents listed in the index to the appellant’s appeal as it only has marginal or no relevance to what the Appeal Panel has to consider.
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.
The additional material that the Appeal Panel has allowed into evidence establishes that the appellant has, subsequent to the MAC, undergone surgery in the form of an L3/4 anterior interbody fusion. As a consequence of that material there has been a deterioration of the appellant’s condition. That is uncontroversial.
Further, and as stated above, due to that surgery there has been an increase in the degree of the appellant’s permanent impairment from that which Dr Mellick assessed it to be.
Consequently, both the grounds for appeal on which the appellant has relied are established, and indeed, as the Appeal Panel has indicated, the respondent conceded that.
Given that, the Appeal Panel must revoke the MAC. As said above, in order to enable the Appeal Panel to assess the degree of permanent impairment of the appellant, the Appeal Panel had Medical Assessor Chris Oates examine the appellant. His report on his examination to the appellant is this:
“CCA
DOB: [redacted]
DOI: 21 July 2017
Details of who attended the examination
CCA attended the PIC medical examination suite on 3 August 2023 for re-examination by Medical Assessor Oates as arranged.
He was accompanied by Mr Unensaikhan Bolovson, who provides some care and transport for CCA. No interpreter was required because CCA spoke excellent English.
HISTORY RELATING TO THE INJURY
Brief history of the incident, onset of symptoms and subsequent related events including treatment
CCA had been placed at Koskela Pty Ltd three months before the accident, through the Newtown JobSeeker Support Centre. He was a warehouse storeman in a furniture and interiors company, and controlled the inbound and outbound receipt and dispatch of furniture.
He had help to lift heavier objects but on the day of injury, there was no-one to assist him and he was asked to prepare an area for a conference beginning at 8.00am, thus he was under some time pressure. He had to move a large table on his own and on doing so, he experienced severe pain in his lower back. Thereafter, a co-worker came to help.
He was advised to go to a pharmacy and get some analgesics. He was limping whilst at work during the day but only doing paperwork because of back pain.
He saw a GP on the day of injury, adjacent to the pharmacy, and was told to stop work, was given strong painkillers and advised to see his own GP.
Overnight, the back pain increased and radiated into the posterior right thigh. He saw his usual GP, Dr Vaswan, Liverpool, and was referred to Dr Van Gelder, neurosurgeon, and also attended physiotherapy. He tried different physiotherapists. Most of them recommended that he should be having surgery, but he was not ready to accept that advice.
He saw Dr Van Gelder around 26 September 2017 and MRI scans were done showing an internal disc herniation with probable endplate disc fracture. Dr Van Gelder discussed the possibility of L3/4 anterior fusion but CCA was unwilling to accept surgery, so Dr Van Gelder advised referral to a multi-disciplinary pain clinic consisting of a pain psychological, pain medicine specialist and Dr Van Gelder as a team member. He was treated with Endone.
CCA told me that he psychologist, after various assessments, decided that his back pain condition was not psychogenic and there was concern expressed about the dangers of opioid addiction should he continue this intake.
He saw Dr Abraszko, neurosurgeon, Liverpool, for second opinion and at first she thought that surgery should be avoided if possible. CCA was agreeable to that.
He developed bladder problems, diagnosed as detrusor hyperactivity, and also erectile dysfunction. He was referred to Dr Mancuso, urologist, and advised annual Botox injection to the bladder, which he commenced.
He has had annual Botox injections at his own expense since then, the last being approximately 12 months ago. Liability was declined for the urological symptoms on account of the work injury.
Physiotherapy and analgesics have not been successful in relieving his continuing low back pain and severe right leg pain, particularly noticed when stepping out, and weakness in both legs, right greater than left. The symptoms in the legs are worse with prolonged sitting or standing longer than 20 minutes, and radiate from the right buttock, through the lateral right thigh to the anteromedial right leg to the hallux, and lateral left thigh to the level of the knee. Because of weakness, he had to use an orthopaedic bed because he had difficulty getting up from a conventional bed.
In view of failure of progress, he was reviewed by Dr Abraszko on 5 June 2020, 12 months after she had previously seen him in October 2019. At that stage, he was wheelchair fast. She noticed that power in the legs was difficult to assess because of pain inhibition, that the knee reflexes were present but the ankle reflexes although also present, were of reduced amplitude.
She noted that Dr Van Gelder had advised L3/4 fusion and the urologist, Dr Mancuso, had also advised spinal canal decompression, and that he had had pain management under the team lead by Dr Nazha, pain physician. She noted that pain management had failed. She ordered an EMG nerve conduction study, MRI scan of the brain, C-spine and thoracic spine, all of which yielded normal results. She noted significant psychological overlay to his presentation. She recommended L3/L4 CT discogram and that he should see a vascular surgeon to look at the prospects of access for anterior fusion.
In the meantime, he saw Dr Vanessa Sammons, neurosurgeon, who had advised conservative treatment.
At specialist review with Dr Abraszko on 26 August 2020, she noted that the discogram revealed L3/4 as the origin of back pain. She then advised L3/4 anterior discectomy and fusion, and at that stage CCA accepted surgery. After a process, it was approved by the Workers Compensation Commission.
He had the surgery at Norwest Hospital on 9 November 2020, performed by Dr Abraszko, and then was an inpatient in the Hills Rehabilitation Unit for one or two weeks, and discharged in a wheelchair.
Dr Abraszko opined that because of incomplete anterior fusion at L3/4, which became evident in the months following surgery, that he may require future revision decompression and posterior fusion with pedicle screws at the posterior L3/4 level.
She did an IME assessment report dated 7 February 2022, assessing the lumbar spine as DRE Category IV giving 22% WPI, including 2% loading for activities of daily living, with a 3% loading for persistent L4 radiculopathy, and 1% WPI under the TEMSKI table for the abdominal surgical scar. At the date of assessment on 7 December 2022, she noted spasm of the thoracic and lumbar paraspinal muscles with Lasegue test to 80° bilaterally, with numbness in both thighs in an L3/4 distribution, and that knee jerks and ankle jerks were present, and that there was a visible scar after the anterior interbody fusion.
The last specialist review was in February 2023.
Present Treatment
He has Targin or Endone. His treating psychiatrist put him on duloxetine to try and assist with sleep, but it has not been successful. He also takes Panadol or Maxigesic as required. He tries to minimise opioids.
Dr Abraszko is waiting for him to contact her office regarding having the revision fusion, but he is not keen to go ahead with further surgery.
He was provided with an orthopaedic bed with a good supporting mattress.
Present Symptoms
His main concern is numbness in the right lower extremity and weakness in both legs. The symptoms in the legs are worse with prolonged sitting and he is concerned that he might fall when he is walking, so his carer walks behind him whilst he mobilises on a walking stick or else he uses a wheelchair.
Concerning his bladder symptoms, he says Botox is given to try and help him hold his urine but he still has to wear incontinence diapers, as the treatment is not 100% effective.
Details of any previous or subsequent accidents, injury or condition
He stated to have had no previous problems with the back, and has had no subsequent injury or relevant condition develop.
General health
Very good.
Work history including previous work history if relevant
He worked in his native Kenya for seven years with Opus Dei doing community support work in various countries around the world.
He came to Australia as an asylum seeker because one of his projects was politically sensitive in Kenya.
He attended the asylum seeker support centre in Newtown and they placed him in various temporary employment situations, including in a cosmetics factory and elsewhere, up until he worked for Koskela Pty Ltd three months before the subject accident.
He has not worked since the accident.
Social activities/ADL
He separated from his wife in 2019. She is a support worker with NDIS in Liverpool. They have a daughter aged five.
He lives in a townhouse with other Kenyan single men. He is feeling very housebound. A carer stays with him at his home during the day. The carer and the other flatmates do the housework. There is no yard work to do.
He tries to accomplish personal care ADLs independently, however after the anterior fusion where bone did not properly fuse, Dr Abraszko told him he is at risk of falls causing complications to his spine, so she has advised him to receive care when walking and when performing activities of daily living of personal care.
He doesn’t smoke or drink alcohol.
EXAMINATION
He was of indigenous African appearance with an average to muscular build with height 178cm and weight 93.2kg. He ambulated using a walking stick in the right hand but said he has a wheelchair to use for longer distances. They were able to park in the disability parking space close to the building. When he is walking, the carer walks behind him to support him in case he accidentally starts to fall.
He sat in discomfort and shifted weight in his seat. He transferred with back discomfort out of a chair and on and off the examination couch, and needed assistance with removing and replacing his track pants. He wore slip-on slide shoes.
Lumbar spine
Lordosis was reduced. Flexion was one-quarter normal range, extension nil with pain inhibition. Lateral flexion one-half bilaterally. Thoracic rotation two-thirds bilaterally. All movements were tentative.
Squatting, heel and toe and tandem walking were not tested because of his complaint of lower limb weakness. Supine straight leg raising was resisted at 10° on the left with complaint of low back pain, and resisted at 20° on the right with complaint of low back pain. The reflexes were symmetrical with plantar responses both flexor.
Range of movement testing was partly affected by giving way because of pain, but appeared grossly intact in both lower extremities, without myotomal weakness. Sensation in the left lower extremity was intact and in the right lower extremity was reported to be reduced in the entire right foot, lower leg and right medial thigh in a non-dermatomal distribution. He was able to clarify that his complaint of numbness in the left leg actually referred to weakness, not loss of sensation.
Thigh girth; right 49.5cm, left 49cm at 10cm above the superior patellar pole. Leg girth; right 39cm, left 37cm at 14cm below the inferior patellar pole (maximal circumference).
Scarring
There was a 12cm midline longitudinal scar in the anterior abdomen, skirting around to the right of the umbilicus and between 5-10mm wide, with extensive keloid and darkening compared with his surrounding pigmented skin. There was no adherence, no contour defect and sensation was intact around the scar.
IMAGING
No imaging was brought to the examination.
DIAGNOSIS
Lumbar spine soft tissue injury – intravertebral L3/L4 disc herniation, without radiculopathy.
The Appeal Panel considers that Medical Assessor Oates conducted a thorough examination of the appellant and obtained a detailed history. The Appeal Panel adopts the history that Medical Assessor Oates obtained and his findings from his examination.
As mentioned earlier, because the appellant has had an L3/4 anterior lumbar discectomy and fusion his impairment must be assessed by reference to DRE Lumbar Category IV which allows for a base assessment of 20% WPI. That can be increased by up to 3% WPI depending upon the effect that the appellant’s lumbar spine impairment has on his activities of daily living. With respect to that, the Appeal Panel considers that the base 20% WPI for DRE Lumbar Category IV should be increased by 2% given that the appellant is limited, due to his lumbar spine impairment, with respect to his capacity to undertake housework and sport and recreation.
The Appeal Panel observes that based upon Medical Assessor Oates’ findings from his examination of the appellant, the appellant does not meet the requirements of clause 4.27 of the Guidelines for a finding to be made that the appellant has radiculopathy. The appellant’s reflexes are symmetrical, his power is intact and there is non-dermatomal sensory loss complaint in the right leg but intact sensation in the left leg. The Appeal Panel notes that the appellant had a negative sciatic nerve stretch test that could not be successfully completed because of pain inhibition and that he did not exhibit any lower extremity atrophy that is concordant with the L3/4 disc herniation diagnoses.
Therefore, as at the date of examination, the appellant did not have residual symptoms and radiculopathy following his spinal surgery. Because of both that and the fact that he has only had one operation involving only one level of his spine, table 4.2 of the Guidelines is not engaged.
The Appeal Panel considers that the appellant has 1% WPI due to the abdominal scarring from the appellant’s surgery. The scarring has extensive keloid and darkening compared with the appellant’s surrounded pigmented skin. The appellant’s scar would not be visible with normal clothing but would be so when the appellant is wearing swimming attire. The appellant is conscious of his scar. His scar has no contour defect or adherence. The Appeal Panel considers that, consequently, the appellant’s scar best fits with the criteria listed in table 14.1 of the Guidelines for 1% WPI.
The Appeal Panel observes that the medical dispute that was referred to AMS Mellick did not include any impairment due to scarring, nor did the appellant make a claim for permanent impairment with respect to scarring. To state the obvious, that was due to the appellant not having undergone surgery at that time. However, a ground for appeal on which the appellant has succeeded relates to the deterioration of his condition subsequent to the medical assessment AMS Mellick conducted and that deterioration includes the scar that the appellant has from his surgery. It is, in the Appeal Panel’s view, therefore appropriate that the impairment he has from his scarring be assessed because it is part of the deterioration the appellant has experienced of his condition.
Consequently, the Appeal Panel assesses the appellant to have 23% WPI from his injury.
For these reasons, the Appeal Panel has determined that the MAC issued on
25 February 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
Matter number: | 5679/19 |
Applicant: | CCA |
Respondent: | Koskela Pty Ltd |
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 Approved Medical Specialist
Dr Ross Mellick and issues this new Medical Assessment Certificate as to the matters set out in the Table below:
Table - whole person impairment (WPI)
| 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) |
| Lumbar spine | 21 July 2017 | Chapter 4, Paragraph 4.27 to 4.30 | Chapter 15, Table 15-3, page 384 | 22 | 0 | 22 |
| Scarring | 21 July 2017 | TEMSKI table | Not appliable | 1 | 0 | 1 |
| Urinary and reproductive system (consequential condition) | 21 July 2017 | Chapter 4, paragraphs 4.22, 4.23, 4.26, 4.27 | Chapter 15 Table 15-6(d) Table 15-6(f) | 0 | - | 0 |
| Total % WPI (the Combined Table values of all sub-totals) | 23% | |||||
0