Forbes Shire Council v Young
[2022] NSWPICMP 90
•20 April 2022
| DETERMINATION OF APPEAL PANEL | |
| CITATION: | Forbes Shire Council v Young [2022] NSWPICMP 90 |
| APPELLANT: | Forbes Shire Council |
| RESPONDENT: | Dennis Young |
| APPEAL PANEL: | Member Catherine McDonald Dr Douglas Andrews Dr Patrick Morris |
| DATE OF DECISION: | 20 April 2022 |
| CATCHWORDS: | WORKERS COMPENSATION- Psychological injury; Psychiatric Impairment Rating Scale categories of travel and concentration, persistence and pace; worker resided in an isolated location and took a 500km round trip for medical treatment; assessment in class 2 for travel was appropriate in the circumstances; Ferguson v State of New South Wales and Parker v Select Civil mentioned; Held- Medical Assessment Certificate confirmed. |
BACKGROUND TO THE APPLICATION TO APPEAL
On 4 January 2022 Forbes Shire Council (the Council) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr John Baker, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 8 December 2021.
The appellant relies on the following grounds of appeal under s 327(3) of the Workplace Injury Management and Workers Compensation Act 1998 (1998 Act):
· the assessment was made on the basis of incorrect criteria,
· the MAC contains a demonstrable error.
The delegate was satisfied that, on the face of the application, at least one ground of appeal has been made out, being that the Medical Assessor made a demonstrable error. We conducted a review of the original medical assessment, limited to the grounds of appeal on which the appeal is made.
The WorkCover Medical Assessment Guidelines 2018 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 2018.
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
Mr Young was employed by the Council as the Safety and Quality Manager. He ceased work on 1 November 2017 having suffered a psychological injury as a result of his interactions with senior council officers. His employment was terminated in May 2018. Mr Young had previously worked as a police officer and as a private security consultant overseas.
Mr Young had lived with his family in the Newcastle area. As a result of the injury he became estranged from his wife and adult children. Mr Young and his wife separated in 2019 and he moved to live on a rural property owned by a friend, about two and a half hours’ drive from Newcastle and 40 minutes from Quirindi.
The Medical Assessor diagnosed major depressive disorder. He assessed 22% whole person impairment (WPI) using the Psychiatric Impairment Rating Scale (PIRS).
PRELIMINARY REVIEW
We conducted a preliminary review of the original medical assessment in the absence of the parties and in accordance with the WorkCover Medical Assessment Guidelines 2018.
As a result of that preliminary review, we determined that it was necessary that a re-examination be undertaken because the material relied on in the PIRS assessment was not supported by a detailed history set out in the report. In particular, with respect to Travel, the Medical Assessor said that Mr Young was able to travel for treatment without engaging with the distance of his doctors from his residence.
EVIDENCE
We have all the documents that were sent to the Medical Assessor for the original medical assessment and has taken them into account in making this determination.
The parts of the medical certificate given by the Medical Assessor that are relevant to the appeal are set out, where relevant, in the body of this decision.
Dr Andrews of the Appeal Panel conducted an examination of the worker on 29 March 2022 and reported to us. Dr Andrews’ report is attached to this statement of reasons and we adopt it. The assessment made by Dr Andrews was the same as that made by the Medical Assessor.
SUBMISSIONS
Both parties made written submissions. They are not repeated in full, but we have considered them.
In summary, the Council submitted that the Medical Assessor ascribed incorrect classes to the assessments of Travel and Concentration, Persistence and Pace.
With respect to Travel, the Council relied on the report of Ms Glendenning, psychologist, dated 30 September 2019 to say that Mr Young drove to all of his medical appointments in Newcastle before the pandemic, a round trip of more than five hours. The Council referred to the references in the reports of Dr Vickery, qualified for the Council, and Dr Anand, qualified for Mr Young to his ability to drive. It noted the assessment in Class 1 by Dr Vickery. The Council said that Mr Young’s ability to regularly drive up to five hours in one day and to travel alone was not “out of the range of normal variation” and did not correlate with Class 2 impairment. It contended that assessment in Class 1 was more appropriate.
With respect to Concentration, Persistence and Pace, the Council reiterated its submissions a about Mr Young’s ability to drive. It emphasised that driving a car involves control precision, problem sensitivity, information and visual processing and selective attention. Over the course of 500 km or five hours demonstrated an overall functional ability requiring considerable concentration and persistence. While acknowledging that the Medical Assessor must evaluate the worker as he presented on the day of the examination, the Council submitted that a worker with a psychological injury may exhibit a more emotionally labile presentation at the examination. It emphasised Mr Young’s ability to drive and said he was “more properly” assessed in Class 2.
In reply and in submissions prepared by his solicitor, Ms Qureshi, Mr Young submitted that the appeal should be dismissed and that the assessments were appropriate. The submissions quoted from Mr Young’s treating practitioners about his difficulties with travel and said that the Council’s submissions oversimplified Ms Glendenning’s opinion. Mr Young noted the opinion of his treating psychiatrist, Dr Bhandari, that he was unable to travel for independent medical assessments. Mr Young submitted that the Medical Assessor assessed him as he presented on the day of the assessment, as required by the Guidelines.
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[1] the Court of Appeal held that an 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.
[1] [2006] NSWCA 284.
The MAC
The Medical Assessor set out the history of the injury and summarised Mr Young’s symptoms and treatment. He set out the findings as a result of his mental state examination in detail. Most of the history he recorded appears under the heading Social activities/ADL. With respect to travel he said:
“Mr Young reported that he was able to travel to local and familiar venues alone. He was able to travel to his medical team for treatment as their locations were familiar to him. He was able to walk outside of his home alone. He remained anxious whilst outside of his home alone.”
With respect to matters relevant to the assessment of Concentration, Persistence and Pace, the Medical Assessor said:
“Mr Young reported that he becomes rapidly anxious and distressed when trying to perform well learnt tasks such as shooting. He is unable to concentrate to accurately shoot and reliably hit the target. He struggled to perform other complex tasks such as completing long documents. He had lost interest in reading about his sport of shooting and had stopped reading completely. He was unable to follow a recipe to cook meals.”
When setting out his findings arising from his mental state examination, the Medical Assessor said:
“Mr Young presented as a depressed, sullen and anxiously distressed man. He was irritable and agitated during this assessment. He became frustrated and agitated as he spoke about his work-related injury. He became angry and distressed when he spoke about being bullied and harassed in the workplace. He stated he had been targeted and scapegoated by his more senior management. His reported his mood as depressed. He stated he was anxiously distressed most days. His rate of speech was fast when agitated. His volume of speech was loud. He complained of poor concentration. His concentration was impaired with him wandering off topic frequently throughout the assessment. He stated that he felt shame and guilt as he was not able to financially support himself or his family. He stated he preferred to avoid talking about his work-related injuries as he would become anxiously distressed and was unable to stop his distressing ruminations. He felt hopeless when asked to think about his future career.”
The Medical Assessor set out his diagnosis:
“In my medical opinion Mr Young’s work-related injury is Major depressive disorder with anxious distress DSM5 Code 296.23. He had no history of psychiatric or psychological conditions prior to commencing his employment with this employer.
Mr Young developed a depressed mood with recurrent agitation, increased isolation, anxious distress and suicidal thoughts. He had not been able to recover from his work-related injury. He had not returned to work. His employer had not provided any return-to-work role in a lesser position since the onset of this work-related injury. His increased depressed mood had resulted in social isolation and loss of interest in all things. He was anhedonic at the time of this assessment. He reported nothing gave him any pleasure. He reported that his relationship with his wife and two adult children was severely strained due to the effects of this work-related injury. He reported no libido and his relationship with his wife had now ceased with him leaving the family home prior to this assessment.”
The Medical Assessor quoted at considerable length from Mr Young’s statements and the medical reports.
Principles of assessment
The Medical Assessor was required to assess Mr Young as he presented on the day of the examination[2]. He was required to prepare a report which set out the path of his reasoning, and refer only briefly to the opinions of other assessors.
[2] Guidelines paragraph 1.6.
Campbell J said in State of New South Wales (NSW Department of Education) v Kaur[3]:
“In Wingfoot Australia Partners Pty Ltd v Kocak [2013] HCA 43; 252 CLR 480, the High Court of Australia dealt with the nature of the jurisdiction exercised by a medical panel under cognate Victorian legislation. The legislation is not entirely the same but it is broadly similar in purpose. Allowing for some differences, the High Court said at page 498 [47]:
‘The material supplied to a medical panel may include the opinions of other medical practitioners, and submissions to the Medical Panel may seek to persuade the Medical Panel to adopt reasoning or conclusions expressed in those opinions. The Medical Panel may choose in a particular case to place weight on the medical opinion supplied to it in forming and giving its own opinion. It goes too far, however, to conceive of the functions of the panel as being either to decide a dispute or to make up its mind by reference to completing contentions or competing medical opinions. The function of a medical panel is neither arbitral or adjudicative: It is neither to choose between competing arguments nor to opine on the correctness of other opinions on that medical question. The function is in every case to perform and to give its own opinion on the medical question referred to it by applying its own medical experience and its own medical expertise.’
Not all of this, as I have said, is apposite in the context of the New South Wales legislation. In particular it is obvious that approved medical specialists are required to decide disputes referred to them by the process of medical assessment. Even so, it is not necessary that approved medical specialists should sit as decision makers choosing between the competing medical opinions put forward by the parties. Essentially, the function is the same as that described by the High Court in Wingfoot Australia. That is to say, their function is in every case to form and give his or her own opinion on the medical question referred by applying his or her own medical experience and his or her own medical expertise. It is sufficient, as their Honours pointed out at [55], that:
‘The statement of reasons… explain the actual path of reasoning in sufficient detail to enable the Court to see whether the opinion does or does not involve any error of law.’”
[3] [2016] NSWSC 346 at [25]-[26]..
The most important part of the description of each class in the PIRS is the level of impairment – eg no deficit, mild impairment. What follows in each class are examples which demonstrate the level of impairment - see Jenkins v Ambulance Service of NSW[4].
[4] [2015] NSWSC 633 at [57]-[65].
In Ferguson v State of New South Wales[5] (Ferguson) Campbell J said:
“The Appeal Panel accepted that intervention was only justified: if the categorisation was glaringly improbable; if it could be demonstrated that the AMS was unaware of significant factual matters; if a clear misunderstanding could be demonstrated; or if an unsupportable reasoning process could be made out. I understood that all of these matters were regarded by the Appeal Panel as interpretations of the statutory grounds of applying incorrect criteria or demonstrable error. One takes from this that the Appeal Panel understood that more than a mere difference of opinion on a subject about which reasonable minds may differ is required to establish error in the statutory sense.
The Appeal Panel also, with respect, correctly recorded that in accordance with Chapter 11.12 of the Guides ‘the assessment is to be made upon the behavioural consequences of psychiatric disorder, and that each category within the PIRS evaluates a particular area of functional impairment’: Appeal Panel reasons at [37]. The descriptors, or examples, describing each class of impairment in the various categories are ‘examples only’: see Jenkins v Ambulance Service of New South Wales [2015] NSWSC 633. The Appeal Panel said ‘they provide a guide which can be consulted as a general indicator of the level of behaviour that might generally be expected’…”[6]
[5] [2017] NSWSC 887.
[6] At [24].
Harrison AsJ cited Ferguson in Parker v Select Civil Pty Limited[7] (Parker) and said[8]:
“To find an error in the statutory sense, the Appeal Panel’s task was to determine whether the AMS had incorrectly applied the relevant Guidelines including the PIRS Guidelines issued by WorkCover. Even though the descriptors in Class 3 are examples not intended to be exclusive and are subject to variables outlined earlier, the AMS applied Class 3. The Appeal Panel determined that the AMS had erred in assessing Class 3 because the proper application of the Class 2 mild impairment is the more appropriate one on the history taken by the AMS and the available evidence.
The AMS took the history from Mr Parker and conducted a medical assessment, the significance or otherwise of matters raised in the consultation is very much a matter for his assessment. It is my view that whether the findings fell into Class 2 or Class 3 is a difference of opinion about which reasonable minds may differ. Whether Class 2 in the Appeal Panel’s opinion is more appropriate does not suggest that the AMS applied incorrect criteria contained in Class 3 of the PIRS. Nor does the AMS’s reasons disclose a demonstrable error. The material before the AMS, and his findings supports his determination that Mr Parker has a Class 3 rating assessment for impairment for self care and hygiene, that is to say, a moderate impairment of self care and hygiene…”
[7] [2018] NSWSC 140.
[8] At [70]-[71].
That caselaw requires that the Council’s submission that a different assessment was “more appropriate” for Travel and Concentration, Persistence and Pace be viewed with care.
Travel
Assessment in Class 2 for Travel denotes a mild impairment. The examples of abilities which illustrate a mild impairment are the ability to travel independently and the limitation on travel to familiar areas. The criteria for assessment in Class 1 is no deficit or a minor deficit.
There are two regular trips which are relevant to the assessment of travel for Mr Young – the trip to Quirindi about 40 minutes away for shopping and the trip to Newcastle for medical appointments. Mr Young lives in an isolated location and rarely leaves the property. The fact that he does each of those trips required the Medical Assessor to carefully consider that ability in context and by reference to his location. The statement by the Medical Assessor that he was able to travel to familiar locations was not sufficient.
Mr Young told Dr Andrews that he limited his travel to those trips that were strictly necessary. He said that he goes to Quirindi to the nearest shops. The evidence in his statements is that he goes early and will leave if there are too many people. In 2020, Dr Anand recorded that Mr Young drove to go grocery shopping once a fortnight[9].His location and circumstances means that those trips are essential and the location is familiar.
[9] ARD p 33.
The Council relied on the fact that Mr Young was able to travel to medical appointments in Newcastle which involved a 500km round trip. As Dr Andrews noted, Mr Young does travel to Newcastle to see his doctor. Mr Young told Dr Andrews that he drives to Newcastle every two months to see his general practitioner. He said:
“The trip would typically be two and half hours each way, but it will take him four and a half hours each way because he becomes anxious, loses concentration and feels distressed. He frequently has to stop his car and take time out before proceeding.
He usually will make this trip in one day, but if he is too distressed, he will stop in Wallsend in stay overnight with his family.”
The material on which the Council relies to support its argument is no longer current and Ms Glendenning’s comments are taken out of context. Ms Glendenning is a psychologist who saw Mr Young in 2019 for rehabilitation support at the request of the Counsel. In her report dated 4 June 2019 she said:
“Mr Young reported a deterioration in his emotional state when he needs to travel to Newcastle. As a result Mr Young avoids spending time in Newcastle by travelling to and from Willow Tree, a two and a half hour drive each way, in an attempt to reduce his symptom discomfort. Mr Young said he spends most of the time alone at Willow Tree and avoids engaging in activities.”[10]
[10] Application to Resolve a Dispute (ARD) p 411.
Ms Glendenning’s recommendations included:
“Mr Young reports overwhelm and distress relating to the amount of time he spends travelling to and from appointments. Psychosocial Rehabilitation has focused on assisting Mr Young to problem solve this issue. Exploration of changing some appointments to teleconference appointments have been discussed with Mr Young's Treating Psychologist, Mr Screen. Mr Screen advised that he does not find that teleconferencing is an effective therapy method. Mr Screen said that he would support Mr Young to attend a Psychologist closer to his residence in Willow Tree, however, Mr Young has said that he does not want to change his treating team.”[11]
[11] ARD p 413.
On 30 September 2019, Ms Glendenning said:
Mr Young advised that his driving behaviour has not improved.
Mr Young reports difficulty attending appointments. He reports sleep deprivation and symptom exacerbation prior to appointment attendance. Mr Young said he then struggles to drive home due to fatigue.”[12]
[12] ARD p 425.
In the same report, she said:
“Mr Young will travel to Newcastle from his home at Willow Tree for treatment. This equates to 5 hours of travel for each appointment. Mr Young is understandably exhausted following the driving and treatment appointment on each occasion. Mr Young reports significant hypervigilance and symptom discomfort when travelling and attending these appointments. It has been recommended that Mr Young attend Psychosocial Rehabilitation subsequent to his treatment appointments in Newcastle, however, Mr Young reports heightened symptoms and is observed to be hypervigilant and agitated at these times which deems social exposure to be unhelpful. Therefore, Psychosocial Rehabilitation has been focused on assisting Mr Young via phone and in person when he attends a Medical Case Conference with Dr Bhandari.”[13]
[13] ARD p 426.
Ms Glendenning was appointed the Council to assist in Mr Young’s rehabilitation. Her reports show that part of her focus was to assist him in reducing the distance he drove.
Mr Young’s treating psychiatrist is Dr P Bhandari who consults in Newcastle. Dr Bhandari’s early reports in 2018 confirmed that Mr Young drove to Newcastle fortnightly.[14] He had not then separated from his wife, which occurred in 2019.
[14] For example ARD p 174.
The evidence confirms that the travel has been difficult for Mr Young for some time and that he was asked to travel for treatment. On 12 March 2019 Dr Bhandari said:
“Mr Young failed to attend a number of scheduled appointments. Mr Young reported that he felt overwhelmed and anxious and was unable to leave Willow Tree. The importance of attending appointments has been discussed with Mr Young and he is aware of all scheduled appointments moving forward. Mr Young has agreed to attend these appointments. Mr Young's rehabilitation provider was contacted and requested to attend his next appointment and develop a psychosocial rehabilitation plan.”
Dr Bhandari’s reports show that he was seeing Mr Young by video consultation as early as 13 October 2019[15], before the pandemic. In March 2020, Dr Bhandari noted that Mr Young would arrange video consultations with his psychologist.[16]
[15] ARD p 193.
[16] ARD p 172.
The Council submits that the ability to undertake a five hour round trip in one day is “out of the range of normal variation.” That statement might be accurate for someone who lives in a city where their medical practitioners are located but is probably not correct for most people who live in remote areas and routinely drive long distances.
Mr Young’s ability to travel must be seen in that context. In the early stages of his treatment, he was pressed to travel for treatment and his rehabilitation provider encouraged him to reduce his travel. There is no evidence that Mr Young has undertaken those trips other than for treatment.
He told Dr Andrews that he finds the trips challenging and he takes a long time to undertake them because he becomes anxious and loses concentration.
The assessment in Class 2 for travel is appropriate.
Concentration, Persistence and Pace
The submissions made by the Council with respect to Concentration, Persistence and Pace were based on Mr Young’s ability to drive. The Council accepted that there was some impact from the injury relevant to this scale but submitted that Mr Young’s ability to drive a car for long distances warranted assessment in Class 2.
The Council’s submissions recited the history on which the Medical Assessor relied to assess Mr Young in Class 2 but did not make any submissions about it. That history supported the Medical Assessor’s assessment in Class 3.
The submissions which the Council made do not take account of the difficulties that Mr Young experienced while driving and which he described to Dr Andrews. The Council submitted, for example, that Mr Young’s ability to drive showed that he was able to apply “selective attention (being able to pay attention to a task without distraction)”. That is not consistent with Mr Young’s description of the need to take breaks to refocus.
The Medical Assessor set out his mental state examination in detail, noting particularly Mr Young’s complaint about poor concentration and the Medical Assessor’s own observations during the examination. Dr Andrews also observed cognitive challenges during his interview. We consider that the assessment in Class 3 was appropriate.
Some of the factors relied by the Council to impugn the Medical Assessor’s assessment for Concentration, Persistence and Pace also specifically relate to the assessment of Mr Young’s ability to travel. Based on the decision in Ballas v Department of Education (State of New South Wales)[17], those matters should only be relied on when assessing travel. Bell P and Payne JA said[18]:
“Whilst it is no doubt correct that an AMS must exercise a degree of clinical judgment in assigning a class of seriousness to each area which he or she is required to address in completing a medical assessment, the characterisation of conduct as going to ‘social and recreational activities’ on the one hand, as opposed to any of the other five scales on the other hand, is not a matter of discretion.
Even if there may, as a matter of English language, be some overlap between some of the scales or categories of functional impairment, for the purposes of the WPI assessment exercise, particular conduct will fit within one or other of the scales. This calls for the correct characterisation of the conduct, ie whether it goes to ‘self care and personal hygiene’, ‘social and recreational activities’, ‘travel’, ‘social functioning (relationships)’, ‘concentration, persistence and pace’ or ‘employability’. This does not involve an exercise of discretion. If conduct is wrongly assigned to one scale, when it should have been assigned to another, this will result in the AMS taking into account an irrelevant consideration in the context of assigning a class to each of the distinct scales. This will inevitably bear upon the calculation of the WPI which is critical for an injured worker’s entitlement to compensation.”
[17] [2020] NSWCA 86.
[18] At [93]-[94].
For these reasons, we have determined that the assessment of impairment made by the Medical Assessor was correct and that the MAC issued on 8 December 2021 should be confirmed.
PERSONAL INJURY COMMISSION
APPEAL AGAINST MEDICAL ASSESSMENT
REPORT OF THE EXAMINATION BY MEDICAL ASSESSOR
MEMBER OF THE APPEAL PANEL
Examination Conducted By: | Dr Douglas Andrews |
Date of Examination: | 29 March 2022 |
The worker's medical history where it differs from previous records
Mr Young was assessed by MA Dr John Baker for the PIC on 8 December 2021. Dr Baker diagnosed a major depressive disorder with anxious distress and determined a 22% WPI. His class ratings were as follows:
·Self-care and personal hygiene Class 2
·Social and recreational activities Class 3
·Travel Class 2
·Social functioning Class 3
·Concentration, persistence and pace Class 3
·Employability Class 5
The employer appealed, arguing that MA Baker had erred in his assessment of travel and concentration, persistence and pace.
Mr Young's medical history is as presented in previous records.
Additional history since the original Medical Assessment Certificate was performed
Mr Young stated today that he had become more distressed on hearing that an appeal had been lodged against the assessment of Dr Baker, causing deterioration in his mood and an increase in his anxiety. Reviewing his symptoms today, he continues to meet DSM-5 criteria for major depressive disorder with anxious distress.
There has been no change in his pharmacological treatment, but he has increased the frequency of his video consultations with his psychologist.
Mr Young has been married to Annette since his teen years. They have a 27-year-old son and a 23-year-old daughter. He continues to live independently in a two-bedroom worker's cottage on a rural property owned by a family friend. His wife lives in Wallsend and visits him every two weeks for the weekend.
He has poor quality sleep, disturbed by intrusive thoughts and anxious rumination.
He rises between 4:30 and 5 AM most mornings. He spends most of his day sitting on his lounge. He may do some housework, such as cleaning or dishes, but generally leaves most chores for his wife when she visits.
He eats in an irregular pattern. Some days he overeats, and, on other days, he misses meals. He prepares simple meals for himself; for example, he favours tuna pasta.
He has gained between 20 and 25 kg since leaving work. He is now about 110 kg; at 180 cm, his BMI is 33.4.
He takes no structured exercise.
He showers and wears clean clothes 2 to 3 times a week. He shaves between once a week and once a month.
Before becoming unwell, he was physically and socially active. He enjoyed going to the gym, fishing, hunting and camping. He had a strong circle of friends and was involved with his family.
He has given up these previously enjoyed activities. He now has no social outings. He attempted to go bushwalking independently but failed because of a lack of motivation. He no longer sees friends.
Mr Young rarely leaves his isolated property but will when necessary. For example, he occasionally goes shopping in Quirindi, about 35 to 40 km from his home. Every two months, he drives to Charlestown to see his general practitioner, Dr Jones. Dr Jones has agreed to video consultations alternating with face-to-face meetings. Mr Young finds these trips very challenging. The trip would typically be two and half hours each way, but it will take him four and a half hours each way because he becomes anxious, loses concentration and feels distressed. He frequently has to stop his car and take time out before proceeding.
He usually will make this trip in one day, but if he is too distressed, he will stop in Wallsend in stay overnight with his family.
Although he is separated from Annette, she remains caring and supportive. Mr Young hopes that they will live together in the future. He has little contact with his adult children, blaming himself for the estrangement. He said, "it was massively my fault, they did reach out, and I didn't respond." They have some contact by text message or telephone.
He has no friends who visit or with whom he has regular contact, except for the family friend on the property where he resides. This man will stop in to check on him when he is nearby to assess his cattle.
He continues to have text message contact from his mother but doesn't talk to his father or younger brother.
Mr Young has no active hobbies or projects. He has not been camping, fishing or shooting for several years.
He used to enjoy reading but has given this up.
He watches television, favouring outdoor, fishing and four-wheel-drive shows. He watches them without close engagement.
I have reviewed all six domains in the PIRS rating form, comparing my ratings to MA Dr Baker's.
Self-care and personal hygiene -- Class 2
Mr Young lives independently but cares for himself with a degree of impairment. He neglects exercise, misses meals and fails to attend to basic hygiene daily. He prepares simple meals for himself. Although he does some housework, he relies on his wife to assist with housework and laundry.
Social and recreational activities – Class 3
Mr Young has given up previously enjoyed activities such as attending the gym, hunting, fishing and camping, all of which were once done with a social element. He has stopped participating in family celebrations.
Travel – Class 2
Mr Young travels independently. He limits his travel to necessity; for example, he travels to the nearest town to shop for food items and to Charlestown to see his doctor. Because he lives in an isolated rural setting, these trips are relatively long. However, they are to familiar areas. He is very anxious travelling away from his home and often has to take breaks to allow for his anxiety to settle in to regain his concentration. Because of this, trips take considerably longer. He does not travel to unfamiliar areas or make any trips that are not strictly necessary.
Social functioning – Class 3
Mr Young has separated from his wife, although she remains supportive. He had increased irritability and anger and feared becoming aggressive or violent. He has strained relationships with his children, with whom he rarely speaks. This is also true of his father and brother. His mother maintains regular contact at her initiative. He has lost touch with all his friends, except for the man on the property where he resides. Although this man checks on him, they have no casual social interaction.
Concentration, persistence and pace – Class 3
Mr Young is no longer able to read, a previously enjoyed pastime. He often watches television but does so without close attention, favouring shows with no story or plotline. He has no projects or hobbies. He has problems with concentration when driving. Cognitive challenges were evident during my interview.
Employability – Class 5
He continues to have severe symptoms of depression and anxiety. He is avoidant of interaction with people and has isolated himself. He struggles with motivation to be active. He has lost confidence and trust in others. For these reasons, he is unfit to work.
My impairment assessment accords precisely with that of MA Dr Baker.
Findings on clinical examination
I assessed Mr Young by video link. He was sitting in his motor vehicle because he had poor telephone coverage at his home. The connection quality was good, allowing for a comprehensive assessment.
He presented casually attired and looked mildly unkempt.
He acknowledged depression and anxiety, emphasising how stressful the WorkCover process has been for him. At the beginning of the interview, he suggested that he may not be well enough to continue. Nonetheless, we were able to proceed and complete the assessment. His affect was restricted, consistent with his stated mood and congruent with the content of the interview. During the interview, he asked permission to leave his car and go for a short walk, which settled him.
There is no evidence of disorder of thought-form or perception.
Mr Young struggled with details of his history and sequences of events.
Results of any additional investigations since the original Medical Assessment Certificate
No additional investigations have been done.
Signed: Dr Douglas Andrews
Date: 7 April 2022
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