Huynh v Primo Smallgoods Pty Ltd
[2022] NSWPIC 193
•2 May 2022
| CERTIFICATE OF DETERMINATION OF MEMBER | |
CITATION: | Huynh v Primo Smallgoods Pty Ltd [2022] NSWPIC 193 |
| APPLICANT: | My Huyen Huynh |
| RESPONDENT: | Primo Smallgoods Pty Ltd |
| MEMBER: | Brett Batchelor |
| DATE OF DECISION: | 2 May 2022 |
| CATCHWORDS: | WORKERS COMPENSATION - Claim for compensation for permanent impairment for undisputed injury to cervical spine, left upper extremity (shoulder), right upper extremity (wrist), scarring (TEMSKI), and to the lumbar spine, disputed by the respondent; applicant relies on the ‘nature and conditions’ of her employment; the respondent asserts that such employment, whilst sufficient to be causative of the undisputed injuries, was not such as to cause injury to the lumbar spine; Held- finding that the arduous, strenuous and repetitive nature of the applicant’s employment causative of the aggravation of the applicant’s pre-existing degenerative condition in the lumbar spine; applicant’s employment was the main contributing factor to injury; award for the applicant in respect of injury to the lumbar spine; matter referred to Medical Assessor for assessment of permanent of all body parts claimed by the applicant. |
| DETERMINATIONS MADE: | 1. The applicant suffered injury to the lumbar spine, in the form of the aggravation of the pre-existing degenerative lumbar spondylolisthesis at the L5/S1 level with associated chronic non-specific left lower limb symptomatology, arising out of or in the course of her employment with the respondent, deemed to have occurred on 20 August 2018. 2. The applicant’s employment with the respondent was the main contributing factor to such injury. 3. The matter is remitted to the President for referral to a Medical Assessor for assessment of permanent impairment as a result of injury to: (a) the cervical spine; (b) the lumbar spine; (c) the left upper extremity (shoulder): (d) the right upper extremity (wrist), and (e) scarring (TEMSKI). deemed to have occurred on 20 August 2018. 4. The documents to be referred to the Medical Assessor are: (a) Application to Resolve a Dispute and attachments; (b) Reply and attachments; (c) Application to Admit Late Documents dated 21 March 2021 with supplementary report of Dr Powell dated 21 March 2021 attached, and (d) this Certificate of Determination and Statement of Reasons. |
STATEMENT OF REASONS
BACKGROUND
Ms Huyen Huynh (the applicant/Ms Huynh ) claims compensation for permanent impairment pursuant to s 66 of the Workers Compensation Act 1987 (the 1987 Act) as a result of injury deemed to have occurred on 20 August 2018 arising out of or in the course of her employment as a process worker with Primo Smallgoods Pty Ltd (the respondent). Injury to the cervical spine, left upper extremity (shoulder), and lumbar spine, and condition in the right upper extremity (wrist) consequent upon injury to her left upper extremity is claimed. Ms Huynh relies on the repetitive nature of her employment, which involves stretching, bending and prolonged standing, as the cause of her injury and condition. The applicant ceased work for the respondent in June 2019.
The applicant ceased work in June 2019. On 1 August 2019 Dr Richard Powell, orthopaedic surgeon, independently medically examined the applicant on behalf of the respondent’s insurer/scheme agent, Employers Mutual NSW Limited (EML), and produced a report to EML dated 26 August 2019[1]. Dr Powell expressed the belief that the applicant’s employment represented a substantial contributing factor in the aggravation of pre-existing pathology involving the cervical spine, left shoulder, and the development of right wrist de Quervain’s tenosynovitis. He did not however believe that there was sufficient evidence to conclude that the recent onset of lumbar spine symptoms were the result of injury sustained in the course of employment.
[1] Reply p 41, noting that page references in this Statement of Reasons are to those in the electronic records of the Personal Injury Commission (the Commission).
On 20 January 2020 the applicant was independently medically examined by Dr Uthum Dias at the request of his solicitor, who produced a report of that date.[2] Dr Dias assessed the applicant as having sustained whole person impairment (WPI) totalling 32% as a result of injury to the cervical spine, lumbar spine, left shoulder and right wrist.
[2] Application to Resolve a Dispute (ARD) p 36.
In a supplementary report dated 17 February 2020[3] Dr Powell noted that Ms Huynh’s self-reported lower back symptoms developed around February 2019 after periods of prolonged sitting. Investigations at that stage identified the presence of well established pre-existing multilevel degenerative pathology, and he said he did not believe there was sufficient evidence to conclude that the applicant’s employment in itself through its nature and conditions represents the main contributing factor in either the development or aggravation of the underlying degenerative disease process.
[3] Reply p 51.
In a further supplementary report dated 18 March 2020[4] Dr Powell expressed his belief that it was reasonable to conclude that the nature and conditions of employment had resulted in permanent aggravation of the underlying degenerative disease process (in the cervical spine) and brought forward the time frame for surgical intervention.
[4] Reply p 54.
In a notice issued to the applicant on 1 April 2020[5] pursuant to s 78 of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act) the respondent accepted that the applicant suffered injury to her cervical spine, left shoulder and right wrist as a result of the nature and conditions of the applicant’s employment with the respondent, but denied that she suffered injury to the lumbar spine.
[5] ARD p 12.
The applicant was further independently medically examined by Dr Powell on 2 April 2020 who produced a report to EML dated 13 May 2020[6]. In that report Dr Powell noted that as a result of the nature and conditions of her employment, Ms Huynh described the gradual onset of symptoms involving the cervical spine, left shoulder and right wrist. Symptoms were reported in 2018, though appear to have developed a year or two prior to that, without any specific precipitating incident. Dr Powell diagnosed:
(a) cervical spondylosis maximal at C5/6 with persisting features of left sided radiculopathy. It was noted that the treating specialist, Dr Khong, had recommended cervical fusion;
(b) left shoulder rotator cuff tendinopathy and AC joint degeneration, characterised clinically by restricted range of motion and some irritability and cuff weakness;
(c) right wrist de Quervain’s tenosynovitis, and
(d) lumbar spondylosis.
[6] Reply p 57.
Dr Powell discussed treatment of the applicant’s injuries and noted that Ms Huynh informed him that she proposed to proceed with the cervical spine surgery proposed by Dr Khong.
On 12 August 2020 Dr Khong carried out a C5/6 anterior cervical discectomy and fusion.
Following a further independent medical examination of the applicant on 22 March 2021 Dr Dias produced a report of that date containing assessments of WPI totalling 38% as a result of injury to the cervical spine, lumbar spine, left upper extremity (shoulder), right upper extremity (wrist) and skin (scarring – TEMSKI)[7]. The applicant’s claim for permanent loss compensation for 38% WPI was rejected by the respondent, which maintained its denial in respect of the claimed injury to the lumbar spine in s 78 notice dated 13 August 2021.
[7] ARD p 56.
ISSUES IN DISPUTE
The parties agree that the following issues remain in dispute:
(a) Did the applicant sustain injury to her lumbar spine arising out of or in the course of her employment, deemed to have occurred on 20 August 2018?
PROCEDURE BEFORE THE COMMISSION
I am satisfied that the parties to the dispute understand the nature of the application and the legal implications of any assertion made in the information supplied. I have used my best endeavours in attempting to bring the parties to the dispute to a settlement acceptable to all of them. I am satisfied that the parties have had sufficient opportunity to explore settlement and that they have been unable to reach an agreed resolution of the dispute.
The parties attended a conciliation conference/arbitration hearing on 20 April 2022 conducted via video conference. Mr Gaitanis of counsel appeared for the applicant briefed by Mr DePasquale. The applicant also attended with a Vietnamese interpreter. Mr Hanrahan of counsel appeared for the respondent briefed by Mr Hodges. A representative of EML also attended.
EVIDENCE
Documentary evidence
The following documents were in evidence before the Commission and considered in making this determination:
(a) ARD and attached documents;
(b) Reply and attached documents, and
(c) Application to Admit Late Documents (AALD) dated 21 March 2021 with supplementary report of Dr Powell dated 21 March 2021 attached.
Oral evidence
There was no application to adduce oral evidence or to cross-examine the applicant.
SUBMISSIONS
The submissions of the parties are recorded, a copy of which can be obtained on request. I will not repeat the submissions in full. In summary, they are as follows.
Applicant
The applicant emphasises the arduous nature of the applicant’s duties in her employ with the respondent, as set out in detail in her statement dated 28 January 2022[8], and notes that such duties would have been onerous, particularly as the applicant was 50 years old when she commenced her employment with the respondent in 2009. The applicant’s description of her duties is at odds with the history recorded by Dr Powell in his report dated 26 August 2019, where the doctor describes Ms Huynh as “...not a good historian despite the best efforts of the interpreter and it was difficult to obtain a detailed history.” The applicant also submits that Dr Dias obtained and recorded a detailed history from Ms Huynh of her duties at work, and had no trouble in determining the cause of the injury she suffered in her neck as a result of the nature and conditions of her work.
[8] ARD p 3.
The applicant notes that she started experiencing symptoms of pain in her left wrist and shoulder in about 2016, and on 14 August 2018 began to experience symptoms of pain in her cervical spine and lumbar spine while performing duties at work. There is contemporaneous evidence of complaints of pain in the cervical spine and lumbar spine provided by the X-rays of these two parts of the spine taken on 17 August 2018 at the request of Dr Vu[9]. Dr Vu issued a Certificate of Capacity dated 17 August 2018 containing a recorded diagnosis, inter alia, of back pain, and a recommendation for X-ray of the cervical and lumbar spine[10]. A clinical note of Dr Vu dated 18 August 2018 is also in evidence which records a consultation on the previous day[11]. Whilst there is no specific reference to the back in that note, the reference to “...no previous neck, back, shoulder problem” infers that some problem with the back was discussed on that day.
[9] ARD pp 73 & 198.
[10] ARD p 204.
[11] ARD p 196.
The applicant also refers to the CT scan on the lumbar spine dated 14 May 2019[12] and MRI scan of the lumbar spine dated 9 July 2019[13], noting that while Dr Powell had access to these investigations or reports thereon, he does not refer to the X-rays of 17 August 2018 in his reports. The applicant submits that for the above reasons, caution should be exercised when the reports of Dr Powell are considered.
[12] ARD p 84.
[13] ARD p 98.
The applicant submits that Dr Dias in his report dated 20 January 2020 at [6][14] quite clearly refutes the opinion of Dr Powell, noting that the applicant’s symptoms in her lower back developed long before February 2019 as stated by Dr Powell, but as far back as in 2018, noting Dr Vu’s referral for X-rays of the lumbar spine on 17 August 2018. Dr Powell does not deal with the clinical notes in respect of the applicant’s complaints of back pain in 2018, and no other doctor had trouble with the applicant as a difficult or poor historian.
[14] ARD p 67.
Respondent
In opening submissions, the respondent notes that it is not the case that Dr Powell says that there has been no aggravation of the degenerative condition in the lumbar spine, but that the onus is on the applicant to prove that her employment with the respondent was the main contributing factor to the aggravation of the condition in the lumbar spine. Further, the respondent submits that use of the term “poor historian” by medical practitioners is to enable them to satisfy themselves that they are obtaining correct information on which to base their diagnosis. The respondent submits that each of the doctors in this case have had to depend on the history provided by the applicant as a basis for their opinion.
The respondent emphasises that, on the history provided by the applicant, her overtime was reduced in 2016, and that thereafter her duties became very much less onerous. The respondent submits that there is a lack of detail in the applicant’s evidence as to the precise nature of her duties, the weights she had to deal with, conveyors used, and also daily activities of life outside work. The respondent submits that there is no mention of pain after 2016 by the applicant in her statement, yet it is mentioned in the history recorded by Dr Dias. In this regard, the respondent draws attention to the “HISTORY OF INJURIES” in the report of Dr Dias dated 20 January 2020[15]
[15] ARD p 41.
The respondent submits that there is no record of complaint in respect of the lower back recorded by Dr Lim when he saw the applicant on 19 July 2019, apart from reference to “midline lumbar spine.”[16] Dr Lim records that it is the neck pain that bothers the applicant the most, and that this is consistent with long sitting, when the doctor records that it is worse in the sitting position. The respondent notes that when Dr Lim saw the applicant on 19 July 2019 and recorded complaints of neck and shoulder pain, she had been on light duties since February 2019, so that any injury could not have been as a result of injury on 20 August 2018 as claimed by the applicant.
[16] ARD p 521
The respondent notes that when the applicant saw Dr Tom Lieng on 20 August 2018[17] she complained only of ongoing left shoulder and neck pain, no back pain. In the report of the
X-ray of the lumbar spine on 17 August 2018 , the respondent submits that there is no recorded complaint of pain in the lumbar spine. The respondent notes that the applicant is of short stature, which is consistent with the response of the respondent to the applicant’s claim. The respondent submits that the first genuine complaint of pain by the applicant recorded is in February 2019, after the claimed date of injury.[17] ARD p 140.
The respondent submits that the result of the CT scan of the lumbar spine on 14 May 2019 is consistent with the respondent’s diagnosis that the cause of the applicant’s symptoms in the lumbar spine is pre-existing degenerative change in the lumbar spine and not aggravated by the applicant’s work for the respondent. The respondent also submits that there is no change in pathology demonstrated in the radiological investigations of the lumbar spine in 2018 and 2019.
The respondent submits that the complaints in the lumbar spine commenced well after the applicant was placed on light duties work, and that therefore the applicant’s employment cannot be shown to be the main contributing factor to the aggravation of the pre-existing degenerative condition in the lumbar spine. In this regard the respondent notes the entry in the clinical notes of Dr Lieng of 5 June 2019[18] where the doctor records doubt if the applicant’s lumbar spine and radicular pain is a work-related condition because her duties are mostly waist to chest height, with no repetitive bending or heavy lifting.
[18] ARD p 169.
The respondent submits that although Dr Powell discusses the point as to whether the applicant’s employment with the respondent was a substantial contributing factor to injury in terms of s 9A of the 1987 Act, nevertheless s 9A factors are relevant in considering work has been the main contributing factor to the aggravation of the applicant’s condition in her back.
The respondent notes that the applicant lives alone, and that many activities that the applicant performs outside the work environment could contribute to the symptomatology the applicant is experiencing in her lumbar spine. The respondent submits that Dr Dias, in giving his opinion of the causation of the applicant’s back condition, couples all injuries together, and does not explain the pathology said to be causative of the applicant’s complaints of pain in the lower back.
The respondent submits that the applicant has not produced sufficient evidence to demonstrate the nature and conditions of her employment were the main contributing factor to the aggravation of the degenerative condition in the lumbar spine.
Applicant in response
The applicant submits that the respondent’s submissions in respect of complaints of pain after the notional date of injury, 20 August 2018, are not to the point having regard to the fact that it is a ‘nature and conditions’ claim brought by her. Dr Powell’s assertion that there is insufficient evidence to find causation of injury attributable to employment takes no account of the complaints of symptoms in the back as far back as 2018, and the referral for radiological investigation at that time. The applicant told Dr Vu in 2018 of problems in her lower back which were related to work.
The applicant submits that Dr Dias has taken a history of activity, consistent with what she says in her statement, that would explain the reasons for pain experienced in the lumbar spine. The applicant was required to engage in her duties at a fast pace, and that even though she worked less overtime after 2016, she nevertheless was obliged to continue her duties during normal work hours.
The applicant rejects the respondent’s submission that Dr Dias has ‘lumped together’ the assessments of the different body parts for the purpose of drawing a causative link between employment and injury. It is difficult to find any other factors which would give rise to the conditions now suffered by the applicant. It is a fallacious argument to say the back condition is caused by something else.
FINDINGS AND REASONS
Injury to the lumbar spine
Dr Powell had difficulty in obtaining a detailed history from the applicant, who he described as a difficult historian. This was notwithstanding the best efforts of the interpreter who attended.
In her statement dated 28 January 2022 the applicant has provided a detailed history of her duties at work from the time when she commenced with the respondent at age 50 in 2009. I accept that her duties were varied and strenuous, involving the left shoulder, cervical spine and right wrist, in respect of which liability for injury has been accepted by the respondent as being due to the nature and conditions of the applicant’s employment. The respondent, relying on the opinion of Dr Powell, does not accept that such conditions caused injury also to the lumbar spine, citing:
(a) the fact that the applicant’s duties became less onerous after 2016 because of the reduction in overtime that was offered by the respondent;
(b) the lack of detail in the applicant’s evidence as to the precise nature of her duties, and a description of her non-work activities;
(c) the observation of Dr Lieng in his clinical note of 5 June 2019 that he doubts if the applicant’s lumbar spine and radicular pain is a work-related condition because her duties are mostly waist to chest height, with no repetitive bending or heavy lifting;
(d) the lack of complaint of low back pain to Dr Lim on 19 July 2019, apart from reference to “midline lumbar spine”, and the fact that the applicant was more concerned about her neck pain at that time;
(e) no change in pathology demonstrated in the radiological investigations of the lumbar spine in 2018 and 2019, and
(f) the manner in which Dr Dias diagnosed injury to the lower back, along with the other injuries, liability for which has been accepted by the respondent.
In my view Dr Dias in his report dated 20 January 2020 has recorded a comprehensive outline of the applicant’s duties which accords with the description given by Ms Huynh in her statement. Those duties are not restricted to above the waist activity, and do involve repetitive work performed at a rate which was above the applicant’s own pace, in order to keep up with the speed of the conveyor line. The applicant was on occasions obliged to twist her body to the left and right, pick up cuts of bacon from the conveyor line and, with the assistance of another worker, lift tubs weighing up to 30 kilograms and swap them for another tub. She was also occasionally required to wheel three or four tubs filled with bacon to the next process.
I accept that Ms Huynh started having symptoms in her left wrist and shoulder, as she says, in about 2016. She began to experience symptoms in her cervical spine and lumbar spine, whilst performing the work duties she describes, in August 2018. This is confirmed by her attendance on Dr Vu 17 August 2018 who ordered an X-ray of the cervical and lumbar spine. This showed degenerative spondylolisthesis at L5/S1 due to severe facet joint arthrosis and severe facet joint arthrosis at L4/L5. Although Dr Vu does not record complaint of back pain in her clinical note of 18 August 2018 when she reviewed the X-ray result, I think that it is reasonable to infer that the lumbar spine was discussed at the consultations in view of the reference to “no previous neck, back, shoulder problem” coupled with the fact that an X-ray of the lumbar spine was ordered.
Dr Dias had access to the relevant radiological investigations of the lumbar spine when he prepared his report of 20 January 2020, namely the X-rays of the cervical spine and lumbar spine dated 17 August 2018, the CT scan of the lumbar spine dated 14 May 2019 and the MRI scan of the lumbosacral spine dated 9 July 2019. He also had access to the whole body scan with SPECT/CT dated 11 November 2019 which showed moderately severe arthritis at the facet joints at the L3/4, L4/5 and L5/S1 levels of the lumbar spine.
Dr Dias in his report dated 20 January 2020 diagnosed a persistent aggravation of degenerative lumbar spondylolisthesis at the L5/S1 level with associated chronic non-specific left lower limb symptomatology, secondary to the nature and conditions of employment. He repeated this diagnosis in his supplementary report dated 23 March 2021n noting therein that Ms Huynh did not suffer from any significant symptoms of pain, stiffness and discomfort in her lumbar spine “...prior to the development [sic, commencement] of her employment with Primo Small Goode in February 2009.” He said:
“In my opinion the nature and conditions of Ms Huynh’s employment which involved prolonged walking, prolonged standing, repetitive lifting of heavy items, repetitive bending and twisting of the lower back and repetitive heavy pulling and pushing are sufficient over a period of nine and a half years of employment, to result in the persistent aggravation of Ms Huynh’s underlying condition of degenerative lumbar spondylolisthesis at the L4/L5 level which was asymptomatic prior to Ms Huynh’s employment with Primo Small Goods. In my opinion clear evidence that Ms Huynh’s lumbar spine condition results from a persistent work-related aggravation of previously asymptomatic degenerative changes in her lumbar spine region, as a result of the nature and conditions of heavily manual and repetitive employment with Primo Small Goods, similar to that of her excepted [sic, accepted] cervical spine condition. Therefore for these reasons I disagree with Dr Powell’s opinion espoused in his report dated 17th February 2020.”
In his report dated 17 February 2020 Dr Powell says that the self-reported lower back symptoms developed around February 2019 after periods of prolonged sitting, and that investigations at that stage clearly identified the presence of well established pre-existing multilevel degenerative pathology. Dr Powell goes on to say:
“Although I acknowledge that Ms Huynh’s work did have a physical component, merely performing these activities does not establish a causal link between a disease process and her employment. These activities are well within the physiological capabilities of a normal spine. The majority of workers are able to perform these duties without establishing a widespread degenerative disease process affecting multiple joints and areas including the cervical and lumbar spine.”
A number of observations may be made about this opinion of Dr Powell. Firstly, my finding is that symptoms in the lumbar spine developed in August 2018 resulting in the consultations with Dr Vu on 17 and 18 August 2018 and the X-rays of the cervical and lumbar spine on 17 August 2018. Dr Powell did not have access to that radiological investigation. I note from the applicant’s statement that she says that she first consulted Dr Vu on 16 August 2018, however the first clinical note in evidence is that of 17 August 2018[19]. Nothing turns on this discrepancy. More relevantly, Ms Huynh says that she was placed on light duties, weighing pieces of bacon of 1 kilogram, and she did not have to lift tubs to change them as another person would do this for her. She does not indicate whether she was sitting or standing.
[19] ARD p 197.
Ms Huynh worked on light duties until 14 June 2019 when she was certified to have no capacity for work by Dr Lim. Prior to that date, Ms Huynh had complained to Dr Lieng about worsening lower back pain, resulting in a reduction in her hours to six per day. This complaint to Dr Lieng is confirmed by his clinical note dated 22 May 2019[20] when he reviewed the CT scan of the lumbar spine that he had previously ordered[21]. On 5 June 2019 Dr Lieng expressed the view, when commenting on Ms Huynh’s lumbar spine and radicular leg pain, that he was not sure if it was going to be a work-related condition. He said this because:
“...but I think if her duties is [sic] mostly waist to chest height with no heavy lifting and repetitive bending then it’s not really fair to consider the problem work-related.”
[20] ARD p 125.
[21] ARD p 145.
Secondly, in respect of Dr Powell’s opinion, there was a significant physical component in Ms Huynh’s work leading up her complaint about her back to Dr Vu on 17/18 August 2018, and as is evident from the X-ray, Ms Huynh’s spine was not a normal spine. Dr Powell says that the majority of workers are able to perform “...these duties without establishing a widespread degenerative disease process affecting multiple joints and areas including the cervical and lumbar spine.” The widespread degenerative disease was established when the applicant first experienced symptoms in the lumbar spine in August 2018 and consulted Dr Vu. What the applicant is claiming is that the nature and conditions of her work was the main contributing factor to the aggravation of the pre-existing asymptomatic degenerative changes in the lumbar spine.
Dr Lieng places a qualification on his opinion as to whether or not the applicant’s lumbar spine and radicular leg pain can be considered a work-related problem (“…if her duties...”). My finding is that the applicant’s duties were such as to cause persistent aggravation of the degenerative lumbar spondylolisthesis at the L5/S1 level, in accordance with the opinion of Dr Dias. These duties were the main contributing factor to the persistent aggravation diagnosed by Dr Dias.
For completeness, I do not place any weight on the fact that, from 2016 onwards, the applicant’s overtime hours were reduced. Thereafter she was still working a 40 hour week plus 8 to 10 hours overtime, performing the strenuous duties that I have found gave rise to the aggravation of the condition in her lumbar spine, as well as the accepted condition in the cervical spine. Further, I do not accept the respondent’s submission that the fact that there is no apparent change in pathology demonstrated in the radiological investigations of the lumbar spine in 2018 and 2019 means that the applicant has not suffered an aggravation of her condition. There may be an exacerbation or aggravation of a condition, notwithstanding that there is no change in the underlying pathology[22]. Whether there is such an exacerbation or aggravation is a question of fact in each case[23].
SUMMARY
[22] Commonwealth of Australia v Beattie [1981] FCA 88; 35 ALR 369.
[23] Mellor v Australian Postal Corporation [2009] FCA 504 at [23].
The applicant suffered injury to the lumbar spine, in the form of the aggravation of the pre-existing degenerative lumbar spondylolisthesis at the L5/S1 with associated chronic non-specific left lower limb symptomatology level, arising out of or in the course of her employment with the respondent, deemed to have occurred on 20 August 2018
The applicant’s employment with the respondent was the main contributing factor to such injury.
The matter is remitted to the President for referral to a Medical Assessor for assessment of permanent impairment of injury to:
(a) the cervical spine;
(b) the lumbar spine;
(c) the left upper extremity (shoulder);
(d) the right upper extremity (wrist), and
(e) scarring (TEMSKI),
deemed to have occurred on 20 August 2018:
The documents to be referred to the Medical Assessor are:
(a) ARD and attachments;
(b) Reply and attachments;
(c) AALD and attachments, and
(d) this Statement of Reasons and Certificate of Determination.
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