Delic v Kennedy Health Care Group Pty Ltd
[2021] NSWPICMP 239
•15 December 2021 (amended 11 January 2022)
| DETERMINATION OF APPEAL PANEL | |
| CITATION: | Delic v Kennedy Health Care Group Pty Ltd [2021] NSWPICMP 239 |
| APPELLANT: | Aida Delic |
| RESPONDENT: | Kennedy Health Care Group Pty Ltd |
| APPEAL PANEL: | Member Carolyn Rimmer Dr John Ashwell Dr Tommasino Mastroianni |
| DATE OF DECISION: | 15 December 2021 (amended 11 January 2022) |
| CATCHWORDS: | WORKERS COMPENSATION- Matter referred to Medical Assessor (MA) for assessment of right leg (knee) and consequential conditions in the lumbar spine and in the left Leg (knee) as a result of an injury on 23 November 2011; MA assessed 0% whole person impairment expressing an opinion as to causation when causation had been determined by the Arbitrator; Held - MA erred in determining liability for injury to the right knee and consequential condition of the lumbar spine and left knee; appellant re-examined and Panel assessed a combined total of 20% . |
AMENDED STATEMENT OF REASONS FOR DECISION OF THE APPEAL PANEL IN RELATION TO A MEDICAL DISPUTE
BACKGROUND TO THE APPLICATION TO APPEAL
On 30 March 2021 Aida Delic (the appellant) made an application to appeal against a medical assessment (the appeal) to the Personal Injuries Commission (the Commission). The medical assessment was made by Dr Roger Pillemer, Medical Assessor (the MA) and issued on 2 March 2021.
The respondent to the appeal is Kennedy Health Care Pty Ltd.
The appellant relies on the following grounds of appeal under s 327(3) of the Workplace Injury Management and Workers Compensation Act1998 (the 1998 Act):
· 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 reissued 1 March 2021 (the Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th ed (AMA 5).
RELEVANT FACTUAL BACKGROUND
In these proceedings, the appellant, who was employed by the respondent as an assistant nurse, claimed lump sum compensation in respect of an injury to the right knee on 23 November 2011.The appellant alleged that she developed consequential conditions to the left leg, lower back, digestive system and contracted Type 2 diabetes as a result of the injury to the right leg.
The matter proceeded to arbitration on 20 November 2020 before Arbitrator Wynyard. In a Certificate of Determination dated 8 January 2021 (COD), Arbitrator Wynyard determined:
“1. There is an award for the respondent in respect of the claim for compensation regarding the applicant’s gastrointestinal tract.
2. There is an award for the respondent in respect of the claim for compensation regarding the applicant’s diabetic condition.
3. I remit this matter to the registrar for referral to an Approved Medical Specialist on the following bases:
Date of injury: 23 November 2011.
Matters for assessment: Right leg (knee);
Left leg (knee);
Lumbar spine.
Evidence: Application to Resolve a Dispute and attached documents, Reply and attached documents, Application to Admit Late Documents and attached documents.”In the Referral for Assessment of Permanent Impairment to an Approved Medical Specialist dated 22 February 2021, the matter was referred to the MA, Dr Roger Pillemer, for assessment of whole person impairment (WPI) of the right leg (knee), left leg (knee) and lumbar spine as a result of the injury on 23 November 2011.
The MA examined the respondent on 22 February 2021. He assessed 0% WPI of the lumbar spine, 0% WPI of the right leg (knee) and 0% of the left leg (knee). Therefore, the total assessment was 0% WPI in respect of the injury on 23 November 2011.
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 requested that she be re-examined by a MA, who is a member of the Appeal Panel.
As a result of that preliminary review, the Appeal Panel determined that it was necessary for the appellant worker to undergo a further medical examination because there was a demonstrable error in the MAC and insufficient evidence on which to make a determination.
The Appeal Panel noted that there were no x-rays of the left knee. The Appeal Panel considered that x-rays were required as the investigations already undertaken were inadequate for the purpose of carrying out an assessment. The Appeal Panel required that the appellant undergo further investigation, namely, weight bearing Rosenberg view x-rays (film) of the left knee.
A report of x-ray left knee dated 29 September 2021 by Dr Mark Cohen, radiologist was provided to the Appeal Panel.
EVIDENCE
Documentary evidence
The Appeal Panel has before it all the documents that were sent to the MA for the original medical assessment and has taken them into account in making this determination.
Further medical examination
Dr John Ashwell of the Appeal Panel conducted an examination of the worker on 8 December 2021 and reported to the Appeal Panel.
Medical Assessment Certificate
The parts of the medical certificates 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.
The appellant’s submissions included the following:
(a) There was a demonstrable error in that the MA did not abide by the terms of the referral. The MA acted ultra vires in determining causation: Inghams Enterprises Pty Limited v Hickey [2019] NSWWCCMA.
(b) Injury to the right knee was never in dispute and therefore the MA could not decline to conduct an assessment of impairment on the basis that "the injury on 23 November 2011 was an aggravation of [an] advanced arthritic condition, which made what was until then an asymptomatic condition become symptomatic...”. The MA was offering an opinion with respect to causation, which, in addition to being wrong, was not his role.
(c) The MA opined: “... where there is an aggravation of an underlying condition, the effects of that aggravation will progressively decrease until such time as the natural history of the osteoarthritic condition and deterioration negates the effect of any aggravation...". The MA went on to conclude: "It is axiomatic to say that there is also no impairment of the left knee or lumbar spine associated with this incident."
(d) This was completely at odds with the MA's function, since the Arbitrator had already conclusively determined the issue, stating at paragraph 122 of the COD: "I am satisfied that the condition of the left knee and the lower back may be seen as being consequential upon the right knee injury."
(e) It was simply not available to the MA under the terms of the referral to either: (i) form his own opinion as to causation of the right knee injury, or (ii) form his own opinion as to causation of the consequential injuries to the left knee and lumbar spine, as those matters had been properly determined by the Arbitrator.
(f) The purpose of the referral to the AMS was for the AMS to conduct an assessment impairment under s 322 of the 1998 Act, and not to posit alternate theories as to either causation or 'injury'.
(g) This clearly constituted a demonstrable error or a factual error, or both: see Dotlic v CFMEU (NSW Branch) Construction [2019] NSWWCCMA 143 and Bandel v JM Harris & Ors [2018] NSWWCCMA 99.
(h) The MAC should be revoked, and the appellant re-examined by a member of the Appeal Panel.
The respondent’s submissions include the following:
(a) The respondent agrees with the appellant’s submission that it was not within the jurisdiction of the MA to determine liability for injury to the right knee and the
consequential conditions to the left knee and lumbar spine. This jurisdiction lay with the Member in the Personal Injury Commission.
(b) In Singh v BUPA Services Pty Ltd [2013] NSWWCCMA 79 in which it was said at paragraph 26:
“It is settled law that matters of injury are determined by Arbitrators. Once there has been a determination of injury the AMS is required to accept that injury and assess the impairment that results from it (See Wakaira v Registrar of the Workers Compensation Commission New South Wales & Anor [2005] NSWSC 954 and Elcheikh v Diamond Formwork (NSW) Pty Limited (in liquidation) [2013] NSWSC 365) ...”
(c) Accordingly, the respondent agrees with the submissions filed for the appellant with the Form 10 – Appeal Against a Decision of Medical Assessor dated 30 March 202 and that the matter be referred to a Medical Appeal Panel for further assessment.
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 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 role of the Medical Appeal Panel was considered by the Court of Appeal in the case of Siddik v WorkCover Authority of NSW [2008] NSWCA 116 (Siddik). The Court held that while prima facie the Appeal Panel is confined to the grounds the Registrar has let through the gateway, it can consider other grounds capable of coming within one or other of the s 327(3) heads, if it gives the parties an opportunity to be heard. An appeal by way of review may, depending upon the circumstances, involve either a hearing de novo or a rehearing. Such a flexible model assists the objectives of the legislation.
Section 327(2) was amended with the effect that while the appeal was to be by way of review, all appeals as at 1 February 2011 were limited to the ground(s) upon which the appeal was made. In New South Wales Police Force v Registrar of the Workers Compensation Commission of New South Wales [2013] SC 1792 Davies J considered that the form of the words used in s 328(2) of the 1998 Act being, ‘the grounds of appeal on which the appeal is made’ was intended to mean that the appeal is confined to those particular demonstrable errors identified by a party in its submissions.
The MAC
Under “History Relating to the Injury”, the MA wrote:
“Her history was confirmed of having sustained an injury to her right knee on 23 November 2011. She informs me that the injury occurred at 3:00 pm in the afternoon. She had been cleaning homes and there was something leaking and she slipped and fell, injuring her right knee and basically has had problems with her knee since then. Ms Delic informs me that her knee was ‘a little bit sore’, but that symptoms became progressively worse with time and became really bad after about three months.
On specific questioning, she feels she developed discomfort in her low back region within three to four months of the injury and she recalls developing discomfort in her left knee about one year later. These symptoms are all described below.”
Under “Summary of injuries and diagnoses” the MA wrote:
“As noted then, Ms Delic sustained an injury to her right knee on 23 November 2011 and has had ongoing problems with her right knee since then. As noted at the time of the injury, she had advanced degenerative changes present in her right knee. In my opinion, the incident on 23 November 2011 would be regarded as the aggravating factor of her underlying condition. In my opinion, as will be discussed below, the effects of the aggravation had long since settled down.
As noted, Ms Delic developed symptoms in her lumbar spine, which she feels came on within three to four months of the injury and also developed problems with her left knee, which she feels came on within a year of her injury. She has had ongoing problems at all three sites.
She obviously has advanced osteoarthritic change in her left knee as well, and degenerative changes throughout the lumbar region, particularly at the lower two lumbar levels.”Under “Reasons for Assessment” the MA wrote:
“In my opinion then the injury on 23 November 2011 was an aggravation of advanced arthritic condition, which made what was until then an asymptomatic condition become symptomatic. If Ms Delic had had her total knee replacement carried out at the time as was suggested by Dr Nabavi, she would have been entitled to impairment for a total knee replacement with a substantial deduction for her pre-existing condition, on the basis that the need for the operation had been brought on earlier than might otherwise have been the case. However, as noted, this did not occur, and Ms Delic has not as yet had a total knee replacement carried out. (The very relevant medical reports of Drs Dave and Nabavi are discussed in 10c).
It is well recognised that in this sort of situation, where there is an aggravation of an
underlying condition, the effects of the aggravation will progressively decrease until such time as the natural history of the osteoarthritic condition and deterioration negates the effect of any aggravation. This is obviously dependent on the extent of the injury which in this case was fairly mild.
I would suggest that there is no doubt that this has occurred in the present case. That is, Ms Delic would have reached her present situation even if she had not had the injury on 23 November 2011.
This is evidenced by the facts that:
• The injury was relatively minor as indicated, was not reported and noting that she was able to continue doing her normal duties.
• The extent of the changes in the knee at the time which showed advanced degenerative osteoarthritis.
• Noting that the specialist at the time recommended total knee replacement, is a reflection of the extent of the existing damage.
In my medical opinion then, the effects of the aggravation would have been negated within weeks of the incident, and certainly within 6 months.
Therefore, accepting that the aggravation to Ms Delic’s knee on 23 November 2011 for the reasons given above, the effect of that aggravation has long since ceased, and she would have reached her present level of impairment and disability irrespective of whether or not she had had the incident on that date. There is therefore no residual impairment in relation to the right lower extremity as a result of this incident.
That being the case, it is axiomatic that there is also no impairment of the left knee or lumbar spine associated with this incident. In addition, there is nothing to suggest that the onset of back symptoms in 2015, more than 3 years following the incident with the knee, could be related to the knee condition. There is no medical justification for this.
Please note that on reading through all the contemporaneous medical reports, there is no mention of low back symptoms until 2015.
Similarly the onset of symptoms in the left knee, again some 3 years after the incident in November 2011, would not be regarded as related to the original incident. It is well recognised that the only way that osteoarthritis in one knee could affect arthritis in the opposite knee would be in exceptional cases, for example where there had been an amputation of one lower limb and the prolonged use of crutches, or where there was significant leg length discrepancy, and even in those situations there is not a significant increase in the incidence of arthritis. It is certainly recognised that constitutional medial compartment osteoarthritis of the knees is very commonly bilateral. Ms Delic therefore suffers from constitutional medial compartment osteoarthritis of both knees.
Therefore, as noted in Table 2, in my opinion there is no residual impairment of the right leg (knee), left leg (knee) or lumbar spine, as a result of the injury of 23 November 2011.”
The Appeal Panel reviewed the history recorded by the MA, his findings on examination, and the reasons for his conclusions as well as the evidence referred to above.
Assessment of the right knee, left knee and lumbar spine
The appellant submitted that the MA made a demonstrable error in not abiding by the terms of the referral and acted ultra vires by determining causation.
The respondent agreed with the appellant’s submission that it was not within the jurisdiction of the MA to determine liability for injury to the right knee and the consequential conditions to the left knee and lumbar spine as this jurisdiction lies with a member in the Personal Injury Commission.
The Appeal Panel accepted the submissions of the parties and agreed that the MA made a demonstrable error in determining liability for injury to the right knee and the consequential conditions to the left knee and lumbar spine.
The Appeal Panel reviewed the evidence in this matter.
The Appeal Panel considered that re-examination was necessary as there was insufficient information on which to make a determination, particularly, in relation to the assessment of the right knee and left knee.
As noted above, Dr John Ashwell re-examined the appellant on 8 December 2021. The appellant attended unaccompanied. Ms Maida (Kulic) Vugdalic, an official interpreter, was present via telephone for the entire consultation.
Dr Ashwell provided a report to the Appeal Panel on 10 December 2021.
The Commission issued a Statement of Reasons for Decision of the Appeal Panel in relation to a Medical Dispute on 15 December 2021.
In an email to the Commission dated 24 December 2021 the respondent requested the Commission to confirm the degree of flexion contracture assessed by Dr Ashwell and adopted by the Appeal Panel for both knees.
Dr Ashwell provided the following amended report to the Appeal Panel on 4 January 2022:
“The worker’s medical history, where it differs from previous records
I read to Ms Delic, the history relating to the injury as recorded in the MAC of 2 March 2021. She stated it was generally correct but had some further points to add. She came to Australia from Bosnia in 1997. She was working full-time as an assistant in nursing (AIN) for Kennedy Health Care for fifteen years before the work injury. On 8 December 2011 she was working at night and it was raining. She had been cleaning homes and water had wet the flooring. She slipped, twisting her right knee and fell to the floor. She was able to get up and had to keep working despite the pain in her knee. She later noticed swelling in the right knee. She saw her doctor the next day and was put off work for one week. She returned on reduced hours of four days a week, later reduced to three days per week. She was seen by Dr Nabavi (Orthopaedic surgeon) on 13/12/2011 and was noted to have advanced osteoarthritis with subchondral bone collapse medially. She was recommended to undergo total knee replacement.
She stated she developed low back pain within four months of the work injury. She stopped working in 2015 when she developed increasing low back pain. She stated she developed left knee pain in 2018 though this may have been a year or two earlier according to the notes.
Additional history since the original Medical Certificate was performed.
There was no additional history.
Present symptoms.
She has constant pain in both knees and occasional swelling. She cannot walk far and always uses a shopping trolley for support around the supermarket. She would use a walking frame with wheels when out, but no support when around the house.
She has constant pain in the low back area with occasional pain radiating to her feet. She has intermittent paraesthesia in the outer two toes on her right foot but not up the calf.
She wakes frequently at night with back pain, usually up to three times.She can walk slowly for only 20 to 30 metres before resting. She can stand for a time without support.
She lies down a lot during the day. She cannot do any walking exercise and cannot cycle or attend a gym.
Over the last few nights, she has noticed pain and swelling on the outer aspect of her left ankle and this increases with standing or walking.
She denied any past history of injury or condition with her back or left knee. She confirmed having problems with her right knee in 2009 and recalled having an xray. She stated her symptoms at that time settled within a few weeks with no time off work.
She now lives with her son in a residential house. She can manage her selfcare but has difficulty with house work and cannot do yard work.Present treatment
She takes two tablets of nurofen three times a day and one to two panadeine forte at night as needed. She also has treatment for hypertension and diabetes. There is no plan for other treatment and she prefers not to have any surgery.
Findings on clinical examination.
All movements were conducted in an active manner and measured using a goniometer and repeated. She was advised to notify me of any increased pain whereupon movement would be discontinued. There were no complaints of increased discomfort. She did not require any removal of clothing to adequately examine the lumbar spine and both knees.
Her height was 169cm and weight 91Kg. She had difficulty get up out of a chair and used both arms. She also had difficulty get up and down from the examining couch.
Her gait was slow and cautious but without a limp. She could not one leg stand without support. She could not attempt a squat.There was a varus deformity of both knees on weight bearing with 9 degrees on the right and 5 degrees on the left. The right thigh was reduced 2 cm compared with the left at 10cm above the patellar. The right calf was reduced 1 ½ cm compared with the left at the maximal point. Peripheral pulses were intact with normal capillary return.
Both knees were stable with no effusion but had a fixed flexion contracture and limited flexion. The right flexed from 15 to 95 degrees and the left from 10 to 105 degrees.
On examining the thoracic and lumbar spine, there was reduced but symmetrical movement with no muscle guarding or spasm. Thoracic spine rotation was to 60 degrees to either side. The lumbar spine flexed to 45 and extended to 15 with lateral flexion of 10 degrees to each side. There was no scoliosis but loss of the lumbar lordosis. The lumbar spine was tender to palpate with a negative axial compression sign. Straight leg raising was restricted by lack of knee extension to 60 degrees on both legs with no nerve root tension. There was equal leg length. There was slight reduce sensation on the outer two toes of her right foot but this did not extend up the foot or calf. It was non-dermatomal and appeared to be due a peripheral nerve problem on the top of her foot. Reflexes and power were equal and normal in her lower limbs with no evidence of radiculopathy.
Results of any additional investigations since the original Medical Assessment.
7/2/2017 X-ray of the right knee was viewed and showed moderately severe osteoarthritis (OA) particularly the medial compartment and patella-femoral joint. Weight bearing views showed almost complete loss of the medial joint space with varus. There were calcified loose bodies in the supra-patellar pouch.
31/10/2019 MRI report of both knees: Right knee – severe OA medial compartment with full thickness cartilage loss. There was a multi-directional tear of the body and posterior horn of the medial meniscus. There was a partial tear of the PCL with a ganglion in the inter-condylar area and a small effusion. The left knee had significant OA with full thickness chondral loss medially. There was a horizontal tear of the posterior horn medial meniscus and a small effusion.
29/9/2021 X-ray of the left knee including weight-bearing views was viewed and showed moderately severe OA medial compartment and patella-femoral joint. There was complete loss of the medial joint space with varus but no erosive changes. There were osteophytes on the medial side, patella and intercondylar area. There was calcification of the medial ligament.
Opinion and WPI assessment.
On assessing the WPI I used the Guidelines and AMA 5 edition.
For the lumbar spine, AMA 5 P384 T15.3 is used and DRE1 applies as there is symmetrical movement with no muscle guarding or spasm and no radiculopathy. This equates to 0% WPI.
On assessing the knees, according to AMA 5 P526, T17.2, atrophy, arthritis and range of movement (ROM) cannot be combined.
Section 3.16 of the 4th Edition Guides states that when using Table 17.10, varus/valgus deformity and range of movement cannot be combined and only the greater value can be used.
This would only give 35% LEI for the right knee varus and 30% LEI for the left knee range of movement. Under these circumstances, the arthritis table P 544 T 17.31 gives the greater impairment figure with weightbearing Rosenberg views of both knees showing complete loss of the medial joint space (cartilage interval) and this is confirmed by MRI study 31/10/19 showing full thickness chondral loss in the medial compartment of either knee. This results in 50% LEI or 20% WPI for either knee.
A deduction for pre-existing condition of both knees should apply as there was similar advanced osteoarthritic change in both knees. This was evident on x-ray of her right knee on 30 November 2011 with reported osteochondral defect and MRI right knee on 22/12/2011. There was also a past history of right knee symptoms in 2009 but unfortunately the x-ray taken at that time was not available. A report by Dr Dave (Primary Campbelltown Medical Centre) 15/1/2010 indicated avascular necrosis of the medial femoral condyle right knee. The avascular necrosis would result in progressive osteoarthritis of the medial compartment. The left knee, being a consequential injury, did not suffer a direct or twisting injury yet has a similar degree of osteoarthritis. Therefore, a greater than 1/10th deduction is supported by the evidence and the amount of deduction should be greater for the left knee as it did not suffer any direct injury and symptoms did not occur until some years later.
It was noted that Dr Dixon 4/3/2020 deducted ¼ for the right knee but none for the left. Dr Doig 10/7/2020 stated the left knee was not injured at work and made a deduction of just less the 1/2 for the right knee”.
Following the amended report of Dr Ashwell sent to the Appeal Panel on 4 January 2022, the Appeal Panel decided that an amended statement of reasons for decision of the Appeal Panel in relation to a medical dispute should be issued.
The Appeal Panel has adopted the report and findings of Dr Ashwell as set out in his amended report as sent to the Appeal Panel on 4 January 2022.
In relation to the lumbar spine, the Appeal Panel concluded that the appellant falls into DRE Lumbar Category I (AMA 5, page 384, Table 15-3). The appellant had symmetrical movement with no muscle guarding or spasm and no radiculopathy.
In relation to the right knee, medial joint cartilage interval of 0mm equated to 20% WPI. In relation to the left knee, medial joint cartilage interval of 0mm equated to 20% WPI.
The Appeal Panel determined that a deduction should be made pursuant to s 323 of the 1998 Act for a pre-existing condition in the right knee and in the left knee. The Appeal Panel was satisfied that the appellant had advanced osteoarthritic changes in both knees and avascular necrosis of the medial femoral condyle right knee. Having reviewed the evidence, the Appeal Panel concluded that a 50% deduction was appropriate for the right knee and a 60% deduction was appropriate in respect of the consequential condition in the left knee. This resulted in an assessment of 10% WPI for the right knee and 8% WPI for the left knee and a combined total of 17% WPI as a result of the injury on 23 November 2011.
For these reasons, the Appeal Panel has determined that the MAC issued on 2 March 2021 should be revoked, and a new MAC should be issued. The new certificate dated 5 January 2022 is attached to this statement of reasons.
PERSONAL INJURY COMMISSION
APPEAL PANEL
MEDICAL ASSESSMENT CERTIFICATE
Injuries received after 1 January 2002
This Certificate is issued pursuant to s 328(5) of the Workplace Injury Management and Workers Compensation Act1998.
The Appeal Panel revokes the Medical Assessment Certificate of Dr Roger Pillemer 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) | |
| 1. Lumbar Spine | 23/11/ 2011 | Chapter 4 Page 24-29 | Chapter 15 Page 384 Table 15-3 | 0 | N/A | 0 | |
| 2. Right Leg (Knee) | 23/11/ 2011 | Chapter 3 Pages 13-23 | Chapter 17 Pages 523 to 564 | 20 | One half | 10 | |
| 3. Left Leg (Knee) | 23/11/ 2011 | Chapter 3 Pages 13-23 | Chapter 17 Pages 523 to 564 | 20 | Three-fifths | 8 | |
| Total % WPI (the Combined Table values of all sub-totals) | 17% | ||||||
Carolyn Rimmer
Member
Dr John Ashwell
Medical Assessor
Dr Tommasino Mastroianni
Medical Assessor
11 January 2022
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