Holden v Lake Macquarie City Council
[2025] NSWPICMP 242
•4 April 2025
| DETERMINATION OF APPEAL PANEL | |
| CITATION: | Holden v Lake Macquarie City Council [2025] NSWPICMP 242 |
| APPELLANT: | Warren Holden |
| RESPONDENT: | Lake Macquarie City Council |
| APPEAL PANEL | |
| MEMBER: | Jacqueline Snell |
| MEDICAL ASSESSOR: | James Bodel |
| MEDICAL ASSESSOR: | Roger Pillemer |
| DATE OF DECISION: | 4 April 2025 |
CATCHWORDS: | WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); whether Medical Assessor (MA) misapplied section 323; Appeal Panel did not accept the MA misapplied section 323 or failed to provide a clear path of reasoning in making a one-third deduction under section 323; Appeal Panel determined it was not necessary for the appellant to undergo a further medical examination as the Appeal Panel did not consider the MA’s assessment was made on the basis of incorrect criteria; Held – MAC confirmed. |
BACKGROUND TO THE APPLICATION TO APPEAL
On 20 January 2025 the appellant, Warren Holden (Mr Holden) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Rob Kuru, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on
8 January 2025.Mr Holden relies on the following grounds of appeal under s 327(3) of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act):
· the assessment was made on the basis of incorrect criteria, and
· 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.
Rule 128 of the Personal Injury Commission Rules 2021 (the PIC Rules) and Procedural Direction PIC7 - Appeals, reviews, reconsiderations, and correction of obvious errors in medical disputes set out the practice and procedure in relation to the medical appeal process under s 328 of the 1998 Act. An Appeal Panel determines its own procedures in accordance with r 128(1) of the PIC Rules.
The assessment of permanent impairment is conducted in accordance with the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4th ed
1 March 2021 (the Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th ed (AMA 5).
RELEVANT FACTUAL BACKGROUND
Mr Holden relevantly made a claim for permanent impairment compensation resulting injury sustained to his left lower extremity (hip) in the course of his employment with Council, with date of injury of 3 December 2020. An Application to Resolve a Dispute was lodged with the Personal Injury Commission (Commission) on 4 November 2024 and a Reply was lodged with the Commission in response on 7 November 2024.
The Commission subsequently referred Mr Holden’s claim to the Medical Assessor.
The Medical Assessor examined Mr Holden on 17 December 2024 and the MAC in which the Medical Assessor assessed 10% whole person impairment (WPI) resulting from injury
Mr Holden sustained to his left lower extremity (left hip) with date of injury of 3 December 2020 issued on 8 January 2025. The Medical Assessor’s assessment of 10% WPI included a one third deduction under s 323 of the 1998 Act.
PRELIMINARY REVIEW
The Appeal Panel conducted a preliminary review of the original medical assessment in the absence of the parties and in accordance with the Procedural Direction PIC7.
As a result of that preliminary review, the Appeal Panel determined that it was not necessary for Mr Holden to undergo a further medical examination because the Appeal Panel did not consider the Medical Assessor’s assessment was made on the basis of incorrect criteria and the Appeal Panel did not consider the MAC contains demonstrable error.
EVIDENCE
Documentary evidence
The Appeal Panel has before it 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.
MAC
The parts of the MAC 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 Appeal Panel notes Mr Holden’s appeal against the decision of the Medical Assessor is limited to the Medical Assessor’s assessment of permanent impairment resulting from injury sustained by Mr Holden to his left lower extremity with date of injury of 3 December 2020 in the course of his employment with Council. Mr Holden does not quibble with the Medical Assessor’s assessment of permanent impairment resulting from injury sustained by Mr Holden to his right lower extremity on 2 December 2015.
Mr Holden submits:
(a) the Medical Assessor erred in that he misapplied s 323 of the 1998 Act;
(b) the Medical Assessor failed to provide a clear path of reasoning in making one third deduction under s 323 of the 1998 Act, and
(c) there is no basis for any deduction under s 323 of the 1998 Act; alternatively, a one tenth deduction should be applied, or Mr Holden should undergo further medical examination.
Council submits in reply:
(a) the Medical Assessor’s decision to apply a one third deduction under s 323 of the 1998 Act was based on his review of the evidence provided in the referral and his clinical assessment of Mr Holden, and the Medical Assessor did not err in his application of s 323 of the 1998 Act;
(b) the Medical Assessor provided sufficient detail in his actual path of reasoning, and
(c) Mr Holden’s appeal should be dismissed and the MAC confirmed.
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.
Review of the MAC
The Medical Assessor relevantly records the date of injury of 3 December 2020. While the Medical Assessor confirmed he had not been provided with any imaging studies not listed in the documents provided, it is evident the Medical Assessor had available to him the following diagnostic imaging reports:
(a) an X-ray left hip report dated 11 November 2019;
(b) an X-ray pelvis, left hip report dated 19 October 2020;
(c) a CT left hip report dated 9 November 2020;
(d) an X-ray pelvis report dated 2 December 2020, and
(e) an X-ray left hip report dated 14 January 2021.
The Medical Assessor recorded the brief history of injury to Mr Holden’s left lower extremity:
“Mr Holden started having problems with pain in his left hip after he had surgery to his right knee. He had worsening pain in his buttock and his groin. He went on to have a left total hip replacement on 2 December 2020. Unfortunately, he still has some intermittent pain in his groin and over the lateral aspect of his hip, particularly following golf but noting that he walks the golf course and does not use a cart.”
The Medical Assessor noted Mr Holden took no medication for his left hip injury and neither is he receiving rehabilitation. The Medical Assessor described Mr Holden as having achieved a good result from his left hip replacement, with Mr Holden being “able to return to golf.”
In response to specific questioning, the Medical Assessor provided opinion Mr Holden suffered “previous injury, pre-existing condition or abnormality” in his left lower extremity and confirmed he based his assessment of WPI resulting from the injury on the following:
“A thorough history, a comprehensive physical examination, a review of the documentation made available by the Personal Injury Commission with reference to the SIRA Guidelines (2021) and AMA-5.”
Following “review of the material provided and detailed examination of the claimant” and according to AMA 5 page 548, Table 17.34, the Medical Assessor assessed Mr Holden with 15% WPI resulting from injury to his left lower extremity The Medical Assessor explained his calculations:
Factor
Points
Pain
40
Function
33
Activities
13
Deformity
5
Range of Motion
5
The Medical Assessor further explained:
“This gives a total of 96 points for the right (sic) total hip replacement. According to AMA 5 page 546, Table 17.33, this is assessed as a good result (15% whole person impairment).”
Relevant to the report dated 5 May 2021 prepared by Dr Stephenson in his capacity as independent medical examiner, the Medical Assessor relevantly noted Dr Stephenson had assessed Mr Holden’s left hip replacement as having had a fair result rather than a good result and said of Dr Stephenson’s assessment “the assessment is just below the threshold for a good result and is within margins for error.”
Relevant to the report dated 17 October 2023 prepared by Dr Powell in his capacity as independent medical examiner the Medical Assessor agreed with Dr Powell having assessed Mr Holden’s left hip replacement as a good result. The Medical Assessor also said of the one third deduction made by Dr Powell under s 323 of the 1998 Act, that the deduction was made “on the basis of pre-existing osteoarthritis which I also agree is reasonable in the absence of injury.”
Relevant to any deduction to be made under s 323 of the 1998 Act, the Medical Assessor provided opinion Mr Holden suffered a pre-existing condition in the nature of “osteoarthritis left hip” and said that the requirement for Mr Holden’s left hip replacement was “on the basis of work-related aggravation of a pre-existing constitutional condition”. The Medical Assessor provided reasoning for his deduction made under s 323 of the 1998 Act:
“Whilst the extent of the deduction is difficult or costly to determine the available evidence is that the deductible proportion is large and a deduction of one tenth is at odds with the available evidence. In my opinion the deductible proportion is one-third for the following reasons:
(i) Osteoarthritis of the left hip is a constitutional condition which, in itself, has not been injured or aggravated at work.”
Review of Mr Holden’s statements
Mr Holden is currently 65 years old. Mr Holden worked with the Council as a beach lifeguard for over 31 years.
Mr Holden provided an initial statement dated 30 June 2022. Mr Holden said he sustained significant injury to his right knee in the course of his employment with Council, coming to total right knee replacement under the care of Dr Young on 22 November 2019. Mr Holden said that both before and subsequent to his total right knee replacement, he was guarding his right knee and placing weight on his left side.
Mr Holden could not recall having any prior problems with his left hip and said, “any degenerative changes that have been identified were not known to myself or my treating doctors.”
Mr Holden said that following his total right knee replacement he developed an altered gait and limp and with his left hip discomfort intensifying to the point it became “unbearable”, he came to total left hip replacement under the care of Dr Young on 3 December 2020. Mr Holden said of his total left hip replacement “I had an excellent outcome following surgery and the restrictions with my left hip are minimal.”
Mr Holden provided a subsequent statement dated 10 October 2024. On this occasion
Mr Holden said that despite his total left hip replacement “I continue to suffer from ongoing symptoms and restrictions.” Mr Holden particularised the difficulties he experienced due the pain he suffered in his left hip, including a restriction in his recreational activities. Mr Holden confirmed he “self-managed” his pain with walking and stretching and did not take medication or receive physiotherapy.
Review of the independent medical evidence
Dr Posel
Mr Holden was orthopaedically assessed by Dr Posel on 31 March 2021 in his capacity as independent medical examiner. Dr Posel relevantly provided reports dated 31 March 2021 and 11 June 2022.
Following his assessment of Mr Holden, Dr Posel relevantly noted Mr Holden came to total left hip replacement on 3 December 2020 with Mr Holden reporting “120% function” and no pain and no limp. Dr Posel reported Mr Holden was taking no medication.
Dr Posel provided opinion Mr Holden had sustained no particular injury to his left hip and had “developed symptomatic degenerative change in his left hip requiring a left total hip replacement.”
Dr Posel provided diagnosis in terms of a successful total left hip replacement on the basis of constitutional osteoarthritis. In response to specific questioning, Dr Posel provided opinion there was no causal link between Mr Holden’s left hip osteoarthritis and his employment with Council. He said:
“This osteoarthritis is a disease of gradual progression and would deteriorate with time, irrespective of his employment with the Lake Macquarie City Council.”
Relevant to the medical management of Mr Holden’s left hip osteoarthritis, Dr Posel accepted this had been appropriate and said:
“His left hip replacement was not performed on an urgent basis. Dr Young had informed him already on 16 January 2020 that his left hip was “arthritic enough to replace” and it took 11 months before surgery transpired. With already Grade 4 (bone-on-bone) degenerative change of hip joint, there are not many treatment options.”
Dr Stephenson
Mr Holden was orthopaedically assessed by Dr Stephenson on 5 May 2021 and
8 February 2023, in his capacity as independent medical examiner. Dr Stephenson provided reports dated 5 May 2021, 18 April 2022, 13 February 2023, and 23 April 2024.Following his initial assessment of Mr Holden, Dr Stephenson described Mr Holden as having “what could be regarded as a very satisfactory result from the total hip replacement, certainly a fair result.”
Following his subsequent assessment of Mr Holden, Dr Stephenson noted Mr Holden had recently ceased working. Dr Stephenson again described Mr Holden as having had a fair result from his left hip replacement, with explanation as to why he did not accept Mr Holden had not had a good result from his total left hip replacement.
Dr Stephenson assessed Mr Holden with 20% WPI resulting from injury sustained to his left hip and made no deduction under s 323 of the 1998 Act with explanation there was no indication Mr Holden was unable to work during his 31 plus years employment with Council until he was obliged to retire in recent times.
Dr Powell
Mr Holden was orthopaedically assessed by Dr Powell on 12 July 2023, with Dr Powell relevantly providing a report dated 17 October 2023. Mr Holden had previously been assessed by Dr Powell on 14 August 2019, with this earlier assessment relevant to his right knee injury only.
Following his assessment of Mr Holden on 12 July 2023, Dr Powell noted Mr Holden had ceased working with Council. Dr Powell noted Mr Holden had come to total left hip replacement on 3 December 2020 with “excellent outcome with significant improvement in symptoms and function”. Dr Powell reported Mr Holden suffered occasional discomfort of the lateral aspect of his left hip though no significant stiffness or restriction in range of motion.
Dr Powell described Mr Holden’s current treatment as being “limited to regular walks.”Dr Powell provided diagnosis in the following terms:
“Left hip osteoarthritis was diagnosed in 2020 with a deemed date of injury of 3/12/20 attributed to the nature and conditions of his employment. This was treated surgically by Dr Jonathan Young with a total hip replacement on 3/12/20. An excellent result has been obtained.”
With reference to the Tables 17-33 and 17-34 on page 548 of the Guides Dr Powell considered Mr Holden had had a good result from his total left hip replacement and assessed him with 15% WPI resulting from his left hip injury. Dr Powell then proceeded to make a one third deduction under s 323 of the 1998 Act “to reflect the extent of the pre-existing pathology”, which consequently resulted in 10% WPI. Dr Powell noted Dr Stephenson had made no deduction for pre-existing pathology.
Review of the diagnostic imaging
An X-ray report dated 11 November 2019 relevant to Mr Holden’s left hip concluded gross osteoarthritis with spurring and sclerosis. This X-ray report pre-dates Mr Holden’s right knee replacement surgery undertaken on 22 November 2019.
An X-ray of the pelvis and left hip dated 19 October 2020 concluded advanced left hip osteoarthritis noted with complete loss of superior joint space.
A planning CT scan dated 9 November 2020 demonstrated marked degenerative change in left hip; complete superiorly and anteriorly.
An X-ray report dated 2 December 2020 relevant to Mr Holden’s pelvis concluded a total hip replacement has been performed using a cemented prosthesis. The position is good with no sign of complication.
An X-ray report dated 14 January 2021 relevant to Mr Holden’s left hip concluded the total hip replacement is well positioned with no periprosthetic lucency.
Review of specialist treating evidence
Mr Holden came under the orthopaedic specialist care of Dr Young, coming to total right knee replacement on 22 November 2019 under his care.
Prior to Mr Holden’s right knee replacement, on review on 24 June 2019, with Mr Holden making complaint of pain in the left groin and left superolateral thigh Dr Young formed the view that Mr Holden’s left hip was arthritic. This review of Mr Holden by Dr Young is of course some months prior to Mr Holden coming to total right knee replacement under Dr Young’s care. On review on 16 January 2020, which is some months after Mr Holden came to total right knee replacement under Dr Young’s care, Dr Young described Mr Holden’s left hip as “giving him more and more trouble” and provided opinion Mr Holden’s left hip was “arthritic enough to replace”. Mr Holden came to total left hip replacement on 2 December 2020 under Dr Young’s care.
In his report dated 3 March 2022, Dr Young provided opinion:
“Hip osteoarthritis is common in men of Mr Holden’s age. Given the hip was already arthritic and not consequent from an injury at work, I believe the conditions of his employment played no role in the causation of his left hip osteoarthritis.
It is possible the left hip symptoms may have increased (been aggravated) for a period after the knee replacement but there is no evidence to suggest an acceleration of the disease process. It is likely the aggravation, if any, was short lived.
It is therefore implausible to suggest that the onset of the left hip symptoms is related to the right knee injury.”
Legal considerations
Legislation and Guidelines
Section 323 of the 1998 Act relevantly provides:
“(1) In assessing the degree of permanent impairment resulting from an injury, there is to be a deduction for any proportion of the impairment that is due to any previous injury … or that is due to any pre-existing condition.
(2) If the extent of a deduction under this section (or part of it) will be difficult or costly to determine (because, for example, of the absence of medical evidence), it is to be assumed (for the purpose of avoiding disputation) that the deduction (or the relevant part of it) is 10% of the impairment, unless this assumption is at odds with the available evidence.
…
(3) The reference in subsection (2) to medical evidence is reference to medical evidence accepted or preferred by the medical assessor in connection with the medical assessment of the matter.”
Chapter 1 of the Guidelines provides for deductions for pre-existing condition or injuries.
Clause 1.27 provides:
“The degree of permanent impairment resulting from pre-existing impairments should not be included in the final calculation of permanent impairment if those impairments are not related to the compensable injury.”
Clause 1.28 provides:
“In assessing the degree of permanent impairment resulting from the compensable injury/condition, the assessor is to indicate the degree of impairment due to any previous injury, pre-existing condition, or abnormality. The proportion is known as ‘the deductible proportion’ and should be deducted from the degree of permanent impairment determined by the assessor. For the injury being assessed, the deduction is 1/10th of the assessed impairment, unless that is at odds with the available evidence.”
Authorities
At this point it is useful to note authority the Appeal Panel considers to be central to complaint made by Mr Holden.
In Ferguson v State of New South Wales[1] the court cited with approval NSW Police Force v Daniel Wark[2] where the court said:
“The pre-eminence of the clinical observations cannot be underrated. The judgment as to the significant or otherwise of the matters raised in the consultation is very much a matter for assessment by the clinician with the responsibility of conducting his/her enquiries with the applicant face to face.”
[1] [2017] NSWSC 140 (Ferguson).
[2] [2012] NSWCCMA 36.
The task of the Medical Assessor was described by the court in State of New South Wales 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…”
[3] [2016] NSWSC 346.
Justification of intervention by an Appeal Panel such as ours was also discussed by the court in Ferguson:[4]
“The Appeal Panel accepted that intervention was only justified: if the categorization 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.”
[4] [2017] NSWSC 140 (Ferguson).
The matter of Ferguson was cited with approval by the court in Parker v Select Civil Pty Limited.[5]
[5] [2018] NSWSC 140.
In determining Mr Holden’s appeal, we are mindful that in Campbelltown City Council v Vegan[6] the Court of Appeal held 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. However, the reasons need not be extensive or provide a detailed explanation of the criteria applied by the medical professionals in reaching a professional judgement.
[6] [2006] NSWCA 284.
Discussion
It is evident the task of the Medical Assessor was to assess Mr Holden as he presented on the day of the examination and to apply his own clinical judgment in the application of the Guidelines. It is also evident the Medical Assessor was not bound to agree with findings of other assessors and nor was he required to choose between their assessment.
The Appeal Panel is not of the view the Medical Assessor’s assessment was made on the basis of incorrect criteria, and neither is the Appeal Panel of the view the MAC contains demonstrable error. The Appeal Panel does not accept Mr Holden’s submission the Medical Assessor erred in that he misapplied s 323 of the 1998 Act and neither does the Appeal Panel accept Mr Holden’s submission the Medical Assessor failed to provide a clear path of reasoning in making one third deduction under s 323 of the 1998 Act.
The Appeal Panel has carefully reviewed the history recorded by the Medical Assessor, his findings on examination, and the reasons for his conclusion. The Appeal Panel has carefully reviewed Mr Holden’s evidence and that provided by the independent medical examiners who were provided with the opportunity to clinically assess Mr Holden. The Appeal Panel has also carefully reviewed the diagnostic imaging reports and the medical evidence of Mr Holden’s treating orthopaedic surgeon, Dr Young, under whose care
Mr Holden came to both total right knee replacement and total left hip replacement.While Mr Holden said he could not recall having any prior problems with his left hip and
Dr Stephenson who had the opportunity to orthopaedically assess Mr Holden on 5 May 2021 made no deduction under s 323 of the 1998 Act with explanation there was no evidence to suggest Mr Holden had been unable to work during his longtime employment with Council, both Dr Posel who had the opportunity to orthopaedically assess Mr Holden on
31 March 2021 and Dr Powell who had the opportunity to orthopaedically assess Mr Holden on 12 July 2023 considered Mr Holden suffered pre-existing left hip osteoarthritis, with
Dr Posel providing opinion Mr Holden’s pre-existing left hip osteoarthritis would deteriorate with time irrespective of his employment with Council and Dr Powell making a one third deduction under s 323 of the 1998 Act “to reflect the extent of the pre-existing pathology”.The Appeal Panel considers it of significance that on orthopaedic review on 24 June 2019,
Mr Holden’s long-term treating surgeon, Dr Young, formed the view that Mr Holden’s left hip was arthritic, which was confirmed by diagnostic imaging on 11 November 2019. The Appeal Panel also considers it of significance that Dr Young provided opinion Mr Holden’s employment with Council “played no role in the causation of his left hip osteoarthritis” and while he conceded it was possible Mr Holden’s left hip symptoms may have been aggravated for a period after his total right knee replacement, he said such aggravation, if any “was short lived”.The Appeal Panel accepts that prior to Mr Holden coming to total right knee replacement surgery on 22 November 2019 Mr Holden suffered pre-existing left hip osteoarthritis (which is demonstrated on diagnostic imaging and accepted by the Medical Assessor, Drs Posel and Powell and by Dr Young under whose orthopaedic care Mr Holden came to total right knee replacement and total left hip replace).
The Appeal Panel accepts the Medical Assessor considered the question of deduction for the proportion of impairment that is due to the pre-existing left hip osteoarthritis suffered by
Mr Holden against a back drop of diagnostic imaging dated 11 November 2019 relevant to Mr Holden’s left hip which concluded gross osteoarthritis with spurring and sclerosis, the independent and treating medical evidence available to him and the Medical Assessor’s own clinical examination of Mr Holden on the day of assessment. The Appeal Panel accepts the Medical Assessor’s conclusion, in agreement with Dr Powell, that the making of a one third deduction under s 323 of the 1998 Act was appropriate in all of the circumstances.The Appeal Panel also accepts the Medical Assessor has adequately explained his reasons for making a one third deduction under s 323 of the 1987 Act. The Appeal Panel accepts Vegan requires that where more than one conclusion is open, it is necessary for a Medical Assessor to explain why one conclusion is preferred but notes reasons need not be extensive.
It is evident from opinion provided by Dr Young on 24 June 2019 and diagnostic imaging undertaken on 11 November 2019 that Mr Holden suffered pre-existing osteoarthritis. In addition, Drs Young, Posel, and Powell have all indicated that Mr Holden’s employment with Council played little, if any, part in the aggravation of the long-standing, advanced osteoarthritis he suffered in his left hip. The Appeal Panel considers the Medical Assessor’s reasoning for the making of a one third deduction under s 323 of the 1987 Act is clearly in keeping with the opinions expressed by these specialists, in particular the opinion clearly expressed by Mr Holden’s long-term treating orthopaedic surgeon, Dr Young.
CONCLUSION
For the reasons canvassed above, the Appeal Panel has determined that the MAC issued on 8 January 2025 should be confirmed.
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