Gusavac v GPC Asia Pacific

[2021] NSWPICMP 112

DETERMINATION OF APPEAL PANEL
CITATION:	Gusavac v GPC Asia Pacific [2021] NSWPICMP 112
APPELLANT:	Nada Gusavac
RESPONDENT:	GPC Asia Pacific Pty Ltd
APPEAL PANEL:	Member Jane Peacock Dr James Bodel Dr Margaret Gibson
DATE OF DECISION:	2 July 2021
CATCHWORDS:	WORKERS COMPENSATION-  Injury to lumbar spine, cervical spine, right upper extremity and left upper extremity; complaint on appeal that non-verifiable radiculopathy not assessed and chronic regional pain syndrome not assessed; Medical assessor’s findings on day of examination did not allow these assessments to be made; Held- no error by Medical Assessor; MAC confirmed.

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

BACKGROUND TO THE APPLICATION TO APPEAL

1. On 25 March 2021 Ms Shaylee Morgan (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Ian Meakin, a Medical Assessor (MA), who issued a Medical Assessment Certificate (MAC) on 10 March 2021.

2. 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):

   ·        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 assessment was made on the basis of incorrect criteria, and
   
   

   ·        the MAC contains a demonstrable error.

3. 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.

4. 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.

5. The assessment of permanent impairment is conducted in accordance with the NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4^th ed 1 April 2016 (the Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5^th ed (AMA 5).

PRELIMINARY REVIEW

1. 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.

2. As a result of that preliminary review, the Appeal Panel determined that there was no error in the assessment and therefore the worker should not undergo a further medical examination. It is well settled that the Appeal Panel cannot require re-examination unless error has been found, which has not been found in this case for the reasons explained more fully below (see NSW Police Force v Registrar of the Workers Compensation Commission of NSW [2013NSWSC 1792.)
   
   

Fresh evidence

1. 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.

2. The appellant seeks to admit the following evidence:

   (a)    Discharge Summary from Liverpool Hospital dated 12 March 2021.

3. The Appeal Panel determines that the following evidence should be received on the appeal:

   (b)    Discharge Summary from Liverpool Hospital dated 12 March 2021.

EVIDENCE

Documentary evidence

1. The Appeal Panel has before it all the documents that were sent to the MA for the original medical assessment as well as the additional evidence admitted as set out above and has taken them into account in making this determination.
   
   

Medical Assessment Certificate

1. The parts of the medical certificate given by the Medical Assessor that are relevant to the appeal are set out, where relevant, in the body of this decision.

SUBMISSIONS

1. Both parties made written submissions. They are not repeated in full, but have been considered by the Appeal Panel.

FINDINGS AND REASONS

1. 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.

2. In Campbelltown City Council v Vegan [2006] NSWCA 284 the Court of Appeal held that the Appeal Panel is obliged to give reasons. Where there are disputes of fact it may be necessary to refer to evidence or other material on which findings are based, but the extent to which this is necessary will vary from case to case. Where more than one conclusion is open, it will be necessary to explain why one conclusion is preferred. On the other hand, the reasons need not be extensive or provide a detailed explanation of the criteria applied by the medical professionals in reaching a professional judgement.

3. The matter was referred to the MA as follows:

   “The following matters have been referred for assessment (s 319 of the 1998 Act):

   ·    Date of injury:   12 June 2018

   ·    Body parts/systems referred:                    Lumbar spine

   Cervical spine

   Left upper extremity

   Right upper extremity

   ·    Method of assessment:   Whole Person Impairment”

4. The MA issued a MAC certifying as follows:

Body Part or system	Date of Injury	Chapter, page and paragraph number in NSW workers compensation guidelines	Chapter, page, paragraph, figure and table numbers in AMA5 Guides	% WPI	WPI deductions pursuant to S323 for pre-existing injury, condition or abnormality (expressed as a fraction)	Sub-total/s % WPI (after any deductions in column 6)
1.Cervical Spine	12 June 2018	Chapter 4, Pages 26 - 33	Table 15.5 AMA 5	0%	N/A	0%
2. Lumbar Spine	12 June 2018	Chapter 4, Pages 26 - 33	Table 15.3 AMA 5	0%	N/A	0%
3. Left Upper Extremity – shoulder	12 June 2018	Chapter 2, Pages 13 - 15	Figures 16.40 to 16.46 AMA 5, and Table 16.3 AMA 5	4%	N/A	4%
4. Right Upper Extremity – shoulder	12 June 2018	Chapter 2, Pages 13 - 15	Figures 16.40 to 16.46 AMA 5, and Table 16.3 AMA 5	7%	N/A	7%
Total % WPI (the Combined Table values of all sub-totals)					11%

1. The worker appealed.

2. The appellant submitted in summary as follows:

   ·        Erred in his assessment of the cervical spine because he should have assessed DRE II based on non-verifiable radicular complaints.

   ·        The MA failed to specifically consider the criteria set out in Table 17.1 of the Guides for complex regional pain syndrome (CRPS).

   ·        Additional relevant information in the form of the discharge summary from Liverpool hospital dated 12 March 2021. The appellant is to undergo additional medical treatment with Professor Susan Hodgkinson.

3. GPC Asisa Pacific Pty Ltd (the respondent) submitted that the MA did not err, and the MAC should be confirmed.

4. The role of the MA is to conduct an independent assessment on the day of examination. The MA is required to take a history, conduct a physical examination, review the special investigations, make a diagnosis and have due regard to other evidence and other medical opinion that is before the MA. The MA must bring his clinical expertise to bear and exercise his clinical judgement when making an assessment of impairment and make such assessment in accordance with the criteria in the Guides.

5. The MA took a history broadly consistent with the other evidence before him as follows:

   “Ms Gusavac is a 49 year old right-handed store-person. Prior to the work incident on 12 June 2018 there was no reported history of painful or traumatic disorder associated with the axial spine or indeed her right or left shoulder.

   On the day of the injury, while at work, she tripped on a pallet and fell forward onto both outstretched hands. She noted initial pain in her posterior cervical neck, posterior lumbar back and into the pad of the right and to a lesser extent the left shoulder. She also sustained injuries to both her right and left knee, with the symptoms relating to both knees eventually resolving.

   Ms Gusavac was seen by her local practitioner, Dr Kris Tomka, of Liverpool. Treatment consisted of physiotherapy, medication and various investigations, along with a steroid injection to the right shoulder with no lasting improvement.

   There was a referral to see Dr Simon McKechnie, consultant neurosurgeon. Dr McKechnie reviewed MRI scans of the cervical spine and the brachial plexus and also a brain scan. He concluded at the time of assessment on 31 January 2019 that there was no requirement for any cervical surgical intervention.

   A further referral was undertaken by Dr Tomka for Ms Gusavac to see Professor Steve Vucic, consultant neurologist with the initial consultation occurring on 8 September 2018. He noted that Ms Gusavac did not utilise cigarettes or alcohol and had no past history to be considered. He noted at the initial consultation numbness and swelling of the left upper limb with a blue, cold appearance which has since resolved. He noted also a tremor in the lower limbs with some persistence on the right side. Professor Vucic organised nerve conduction studies and EMG studies. There was some evidence of a chronic right S1 level and a chronic right L5 radiculopathy on both sides. He noted in December of 2018 that blood tests were unremarkable. There was no electrophysiological evidence of a right cervical radiculopathy. There was a mild suggestion of a right-sided carpal tunnel syndrome but this was not consistent with the official report.

   There was a subsequent referral to Dr David Manohar, musculoskeletal physician and spinal medicine interventional specialist. He was concerned that there may be evidence of a chronic Complex Regional Pain Syndrome involving the right hand when he reviewed Ms Gusavac on 18 June 2019 and sought permission to undertake a sympathetic blockade to the C7/T1 level although this was rejected by the insurer.

   There was assessment by Dr Richard Walker relating to the right hip but no ongoing clinical treatment.

   Ms Gusavac has not been able to return to work since the day of the injury and received workers compensation payments for a period of one year after the injury.

·        Present treatment:

Ms Gusavac states that Dr Manohar recommended a series of cervical sympathetic blocks. She has had physiotherapy and massage treatment. There has been approximately 50 sessions of physiotherapy but this has now ceased.

·        Present symptoms:

She reports pain in the posterior aspect of the cervical neck with at times frontal headaches. There is a separate pain on the pad of the right shoulder and also to a lesser extent on the left shoulder. She reports intermittent paraesthesia radiating to the right and left arm affecting all fingers of the left hand and right hand, excluding the little finger. These symptoms, however, were not present today. There is continuing discomfort in the lower lumbar back.

Ms Gusavac also reports that there are intermittent periods when there is a partial numbness involving the whole of the right hand and left hand with this symptom extending up to the level of the armpit on the right and left side. She states that this sensory loss is different to the episodes of pain and paraesthesia that she describes.

There have been intermittent symptoms of discomfort radiating to the right leg and the continued shaking of the right leg, which was observed today but is not present when she is removed from the examination table and is sitting in a chair.

·        Details of any previous or subsequent accidents, injuries or condition:

Nil applicable.

·        General health:

Prior to the workplace incident, Ms Gusavac reports no major medical abnormalities. There are certainly no previous issues relating to her axial spine or indeed her upper or lower extremities. There have been intermittent symptoms radiating into the right leg.

·        Work history including previous work history if relevant:

Ms Gusavac has been working for the GPC Asia Pacific group since 2011. She was doing work which consisted of picking and packing and was employed on a fulltime basis. She has remained off work since that time. She had previously worked in a warehouse distributing sunglasses.

·        Social activities/ADL:

Ms Gusavac is married and lives with her husband, her daughter-in-law and son and some grandchildren in a home at Liverpool. She does not smoke or drink alcohol and has no allergies. She states that she is mostly independent with personal care activities but needs assistance to wash her hair. She has stopped driving a car because of ongoing symptoms and reports poor sleep.”

1. The MA’s clinical findings on the day of assessment were as follows:

   “Ms Gusavac is a woman of stated age, who states that she weighs 79 kg and stands 174 cm tall. She walks with a painful gait, although having equal leg length. She appears not to use any appliances.

   On examination of the cervical spine she has a significant restriction in all planes of movement to approximately one-fifth of normal range referencing flexion and extension and lateral flexion and rotation to the right and left with no evidence of palpable or paravertebral muscle spasm or guarding. There is significant discomfort described in all planes of movement.

   In her thoracic back there is a pain free symmetrical restriction of range of motion to two-thirds of normal range but with no evidence of palpable or paravertebral muscle spasm or guarding.

   In relation to the lumbar spine there is again a very significant restriction to approximately one-quarter of range of motion referencing all planes of movement including flexion and extension and lateral flexion and rotation to the right and left with no evidence of palpable or paravertebral muscle spasm or guarding. Again there is pain present in all ranges.

   On examination of the right and left upper and lower extremities, all deep tendon reflexes are symmetrically present and equal but they are reduced. In the upper extremities the right forearm at maximal circumference is 0.5 cm greater than the left side consistent with her right-handedness. She has equal power grip on the right and left side and there is no evidence of wasting of hand musculature. There are no abnormalities of tone in the upper extremities.

   At the time of today’s assessment there is a partial sensory loss involving the entire right and left arm from the level of the axilla to the tips of the fingers and involving all digits. This is a partial sensory loss as Ms Gusavac states that she can appreciate some touch. She states that such clinical symptoms only intermittently occur and at times she reports only discomfort and paraesthesia in the distribution from the shoulder to the hands, excluding the 5^th finger.

   On examination of range of motion of the right and left shoulder when measured with the Goniometer the following is noted:

   Shoulder Movements

Movement	Right	Left
Flexion	110º	120º
Extension	40º	50º
Abduction	100º	110º
Adduction	40º	40º
Internal rotation	70º	80º
External rotation	70º	70º

There is a full range of right and left elbow, wrist and all hand and finger movements.

On examination of the lower extremities there is a negative straight leg raising test on the right and left side in both the supine and sitting position. There are no abnormalities of tone or sensation in the lower extremities. There is symmetrically equal right and left great toe power referencing flexion and extension and subtalar joint eversion and inversion. There appears to be an involuntary tremor involving the whole of the right leg noted on the examination with such tremor disappearing when walking and sitting. There is a full range of asymptomatic right and left knee movement with no evidence of local heat, redness or effusion and no evidence of crepitus.

On examination of the skin of the upper and lower extremities there is no abnormality of colour, temperature or skin appearance. There are no abnormalities of nail or hair of the right or left upper extremities.

There are no other findings.”

1. The MA had regard to the special investigations as follows:

   “X-ray Right Shoulder – 15 June 2018 – Ingleburn Imaging Centre – Dr M Craddock – no abnormality noted.
   X-ray Cervical Spine & Lumbosacral Spine – 15 June 2018 – Ingleburn Imaging Centre – Dr A Sacks – no abnormality noted in the cervical spine – lumbar spine reveals no evidence of acute bony trauma.
   CT Scan Lumbar Spine – 21 June 2018 – Spectrum Imaging – Dr L Dawes – disc osteophyte complex at L5/S1 with mild foraminal narrowing.
   Ultrasound Right Shoulder – 21 June 2018 – Spectrum Imaging – Dr D Lam – subacromial bursitis. No evidence of rotator cuff tear.
   MRI Lumbar Spine – 29 June 2018 - Spectrum Imaging – Dr R Cuganesan – slight posterior disc protrusion with loss of disc height at the L5/S1 level without significant central canal stenosis, foraminal stenosis or neural impingement.
   MRI Scan Cervical Spine – 4 July 2018 – Spectrum Imaging – Dr J Sim – focal annular fissure/tear of the right paracentral region of C5/6 with minor disc herniation at this level – background mild disc osteophyte complex at C6/7 with a more focal 4 mm disc protrusion at its posterior central region. No other findings.
   MRI Scan Left Hip – 12 July 2018 - Spectrum Imaging – Dr S Morris – short segment free edge tear of the anterolateral acetabular labrum. Small region of low grade superolateral chondromalacia. No other findings.
   MRI Scans Right and Left Knee – 14 July 2018 – Spectrum Imaging – Dr M Wong – no evidence of medial or lateral meniscal tears with intact cruciate and collateral ligaments both knees. Possible quadriceps fat pad oedema with impingement on the right side. Small focal area of mild chondral wear involving the central weight bearing lateral femoral condyle articular cartilage of the right knee with no abnormality on the left.
   MRI Thoracic Spine – 24 August 2018 – Spectrum Imaging – Dr K Tay – no abnormality other than a small disc osteophyte complex at C6/7 causing mild canal stenosis.
   Nerve Conduction Studies – 18 August 2018 – Professor Steve Vucic – nerve conduction studies performed on the left upper and both lower limbs – no abnormalities detected.
   MRI Scan Right Shoulder – 6 September 2018 - Spectrum Imaging –
   Dr R Cuganesan – mild tendinosis of supraspinatus and subscapularis – mild to moderate subacromial/subdeltoid bursitis.
   MRI Scan Brain, Spine – 23 November 2018 – Westmead Hospital Medical Imaging – Dr S Ghattas – no intracranial mass or evidence of cerebral infarction. No significant chronic microangiopathic ischaemic changes in the brain. No evidence of spinal cord/cauda equina impingement or exiting neural impingement throughout the entire spine. Disc dehydration – moderate loss of disc space at L5/S1 with Type 1 Modic change. Small posterior disc bulge at C5/6 and C6/7 with no other findings.
   MRI Scan Left Shoulder – 27 May 2019 – Spectrum Imaging – Dr J Sim – mild degenerative capsular thickening of the acromioclavicular joint. Mild subacromial/subdeltoid bursitis. Otherwise a normal MRI scan of the left shoulder.”
   
   

2. The MA summarised the injuries and his diagnosis as follows:

“•       summary of injuries and diagnoses:

Ms Gusavac was injured in a work accident on 12 June 2018. She sustained soft tissue injuries to her cervical and lumbar spine with ongoing discomfort and significant restricted range of motion in both clinical areas. There appears to be no neurological impairment of the right or left upper or lower extremities of an objective nature at the time of today’s assessment. There is a non-anatomical partial sensory loss in both upper extremities at the time of today’s assessment which in my opinion is not supported by x-ray or scan evidence or indeed nerve conduction evidence. There has also been a soft tissue injury to the right and left shoulder joint with some terminal range restriction of range of motion symmetrically.

·        consistency of presentation

Ms Gusavac was most helpful at the time of today’s physical examination and history taking.”

1. The MA explained his assessment as follows:

   “Cervical Spine:

   At the time of today’s assessment with reference to the current Guidelines and Table 15.5 AMA 5, the Applicant demonstrates clinical symptoms and signs consistent with a DRE cervical Category I impairment – 0% whole person impairment.

   There is a symmetrical active loss of range of motion with terminal range pain in all planes symmetrically on examination.

   There were no clinical symptoms or signs in the upper extremities at the time of today’s assessment that would satisfy the full definition of radiculopathy. There is no loss or asymmetry of reflexes or evidence of muscle weakness or muscle wasting that cannot be explained by the Applicant’s right-handedness and therefore not anatomically localised to appropriate spinal nerve root distribution.

   There is a partial sensory loss today as a non-anatomical whole of limb distribution on the right and left side. There is no assistance from imaging studies. Therefore, the definition of radiculopathy in relation to the right and left upper extremities is not fulfilled at the time of today’s assessment.

   Lumbar Spine:

   At the time of today’s assessment with reference to the current Guidelines and Table 15.3 AMA 5, Ms Gusavac demonstrates clinical symptoms and signs consistent with a DRE lumbar Category I impairment – 0% whole person impairment.

   Again, there is no neurological impairment in the right or left lower extremities and there is a negative straight leg raising test on the right and left side. There is also no assistance from imaging studies or nerve conduction studies. Therefore the definition of radiculopathy as set out in Item 4.27 of the Guidelines is not met.

   The shaking of the whole right leg, which was observed at the time of formal examination of the right leg, in my opinion is non-anatomical as it is totally removed at the time of walking and when sitting in a chair at the time of history taking before and after the physical examination. It is also my opinion that there are no clinical symptoms that would satisfy the definition of non-verifiable radicular complaint in the right or left lower extremities.

   In relation to the upper extremities, the described sensory loss is totally non-anatomical and nkot supported by any scan studies or nerve conduction studies.

   Right & Left Upper Extremities – Shoulders:

   At the time of today’s assessment there is a restriction of active range of motion of the right and left shoulder due to pain and therefore with reference to Figures 16.40 to 16.46 AMA 5 the following upper extremity impairment is noted:

Shoulder Movement	Right	% Upper Extremity Impairment	Left	% Upper Extremity Impairment
Flexion	110º	5%	120º	4%
Extension	40º	1%	50º	0%
Abduction	100º	4%	110º	3%
Adduction	40º	0%	40º	0%
Internal rotation	70º	1%	80º	0%
External rotation	70º	0%	70º	0%
Total	11%	7%

With reference to Table 16.3 AMA 5, 11% upper extremity impairment equates with 7% whole person impairment right shoulder. A 7% upper extremity impairment equates with 4% whole person impairment left shoulder.”

1. The MA had regard to the other medical opinion that was before him as follows:
   
   

   “I read with interest the reports of Dr Simon McKechnie of 31 October 2018 and 31 January 2019, who concluded that in his opinion there is no surgical spinal intervention required. He noted normality of the cervical spine and right brachial plexus scans. At the time of his assessment there was only discomfort radiating into the right arm and not the left arm, as noted in the current history taking.
   
   
   I read with interest the report prepared by Dr Michael Davies on 29 April 2020. He notes a continuing history of neck, low back and shoulder pain as well as symptoms in the hips and knees. Today there were no symptoms related to the right or left hip or knee. He noted a restricted range of motion of both shoulders, particularly on the right. He noted changes in colour along with swelling of the right upper extremity throughout his examination, which was not present today. He noted at the time of examination Ms Gusavac reported impaired light touch and sharp sensation throughout the right upper limb up to the trunk. He noted marked restriction of movement of the neck in all directions and also the lumbar spine. He assessed a DRE Category II impairment for the cervical spine as well as the lumbar spine and noted that the Ms Gusavac did not fulfil the definition of radiculopathy. He noted impairment for the right and left upper extremities relating to range of motion loss in both shoulders. He assessed a 2% whole person impairment for ADL assessment referencing the spinal assessment. He therefore awarded a combined impairment of 28% whole person impairment.
   
   
   The report of 18 June 2019 by Dr David Manohar set out his clinical thoughts. At that time Dr Manohar accepted the diagnosis of Chronic Regional Pain Syndrome which was not present today.
   
   
   The report of Dr Matthew Giblin, orthopaedic surgeon, of 16 March 2020 notes that Ms Gusavac had not reached maximal medical improvement and he therefore did not assess impairment. He noted a generalised decrease in sensation, more so on the right than the left side, in the upper extremities in a non-specific dermatomal pattern with no neurological impairment of the lower extremities. He noted no abnormalities in the right or left hip or the knees. He noted no distal neurological impairment but he did note the tremor in the right leg. He opined that there was no evidence of rotator cuff pathology and that the restricted shoulder movement was due to neck pain. He suggested that there was evidence of sympathetic dystrophy of the right upper limb with an aggravation of underlying degenerative change in the lumbar spine.
   The reports of Professor Steve Vucic from 8 September 2018 through to 11 December 2018 set out his assessment. In his final report he notes that Ms Gusavac’s symptoms most likely appear to be musculoskeletal in origin although he does comment on the possibility of Complex Regional Pain Syndrome.
   
   
   Dr Ron Granot, neurologist, examined Ms Gusavac on 18 December 2018. He concludes that he does not find evidence of a significant injury as a result from the original fall at work on 12 June 2018. He suggests no ongoing liability on the part of the employer for ongoing pain. At the time of his examination he noted no neurological abnormalities in the lower extremities. He did note some discolouration and swelling of the right hand but otherwise a normal cranial nerve examination. He commented that the extensive investigations demonstrated no neurological mechanism of her symptoms. He noted the minor changes in both shoulders relating to bursitis. He noted that the EMG findings tended to exclude a neurological diagnosis.
   
   
   The report of Dr Sam Perla, occupational physician, on 9 August 2018 notes on examination a restriction of movement of the cervical neck. He noted an alteration of light touch over the entire right upper limb in a non-dermatomal fashion with no other evidence to support a diagnosis of radiculopathy. He noted significant reduction in right shoulder movement and also in the left shoulder. He noted on examining the lumbar back there was reduction in range of motion. He noted the uncontrollable shaking of the right lower limb. He could find no other positive clinical signs. He did note altered sensation over the entire right leg again in a non-dermatomal fashion. Dr Perla was non-committal at the time of diagnosis.”

2. The appellant complained on appeal that the MA should have assessed DRE II for the cervical spine on the basis of non-verifiable radiculopathy. The Panel notes that the clinical findings by the MA on the day of assessment as set out above do not allow such an assessment. This is because these complaints do not correlate to a radicular pattern. Paragraph 4.28 of the Guides defines radicular complaints as: “complaints of pain or sensory features that follow anatomical pathways but cannot be verified by neurological findings (somatic pain, non-verifiable radicular pain) do not alone constitute radiculopathy”.

3. That is, there is no verifiable or non-verifiable radiculopathy evidenced by the clinical findings of the MA on the day of assessment. The panel can therefore discern no error in the assessment of 0% whole person impairment for the cervical spine.

4. In respect of the complaint about the failure to assess CRPS, the panel notes that the findings of the MA set out above would not allow an assessment of CRPS 1 or 2 to be made under the guides. The workcover guides provide as follows:
   
   

   “Complex Regional Pain Syndrome Type 1
   For Complex Regional Pain Syndrome Type 1 (CRPS1) to be present for the purposes of assessment:

   •        the diagnosis is to be confirmed by criteria in Table 17.1

   •        the diagnosis has been present for at least one year (to ensure accuracy of the diagnosis and to permit adequate time to achieve maximum medical improvement)

   •        the diagnosis has been verified by more than one examining physician

   •        other possible diagnoses have been excluded.

   •        CRPS1 is to be assessed as follows:
   
   

   Apply the diagnostic criteria for complex regional pain syndrome type 1
   (Table 17.1).

Table 17.1 Diagnostic Criteria for Complex Regional Pain Syndrome types 1 and 2

1. Continuing pain, which is disproportionate to any causal event.

2.     Must report at least one symptom in each of the four following categories:

•        Sensory: Reports of hyperaesthesiae and/or allodynia.

•        Vasomotor: Reports of temperature asymmetry and/or skin colour changes and/or skin colour asymmetry.

•        Sudomotor/oedema: Reports of oedema and/or sweating increase or decrease and/or sweating asymmetry.

•        Motor/trophic: Reports of decreased range of joint motion and/or motor dysfunction (tremor, dystonia) and/or trophic changes (hair, nail, skin).

3.     Must display at least one sign* at time of evaluation in all of the following four categories:

•        Sensory: Evidence of hyperalgesia (to pin prick) and/or allodynia (to light touch and/or deep somatic pressure and/or joint movement).

•        Vasomotor: Evidence of temperature asymmetry and/or asymmetric skin colour changes.

•        Sudomotor/oedema: Evidence of oedema and/or sweating asymmetry.

•        Motor/trophic: Evidence of decreased active joint range of motion and/or motor dysfunction (tremor, dystonia) and/or trophic changes (hair, nail, skin).

4. There is no other diagnosis that better explains the signs and symptoms.

*A sign is included only if it is observed and documented at time of the impairment evaluation.

“

1. The appellant says that the MA failed to specifically refer to the criteria in Table17.1. However, the MA’s clinical findings on the day of assessment, which have been set out by the Panel above, do not fulfil the diagnostic criteria for CRPS types 1 and 2 to be assessed.

2. The panel can discern no error in the MA failing to diagnose CRPS because the findings on the day of assessment would not allow such a finding in accordance with the criteria set out in Table 17.1 above.

3. The appellant has filed additional evidence. The appellant has made no submissions about how that evidence, in their submission, should be interpreted. The panel has allowed the evidence and had regard to it. The additional evidence does not assist the appellant in establishing the criteria for a CRPS assessment because the findings of the physical examination as recorded in the discharge summary from Liverpool hospital also do not fulfil the diagnostic criteria in the guides for a CRPS assessment.
   
   

4. Accordingly, the Panel will confirm the MAC as the MA has not erred as submitted by the appellant.

5. For these reasons, the Appeal Panel has determined that the MAC issued on 10 March 2021 should be confirmed.