Loveday v Crookwell Taralga Aged Care Ltd

DETERMINATION OF APPEAL PANEL
CITATION:	Loveday v Crookwell Taralga Aged Care Ltd [2025] NSWPICMP 283
APPELLANT:	Rebecca Loveday
RESPONDENT:	Crookwell Taralga Aged Care Ltd
APPEAL PANEL
MEMBER:	John Wynyard
MEDICAL ASSESSOR:	Greg McGroder
MEDICAL ASSESSOR:	James Bodel
DATE OF DECISION:	24 April 2025
CATCHWORDS:	WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); appeal against 0% finding for injury to right wrist; whether additional evidence admissible; whether Medical Assessor (MA) applied incorrect criteria in finding no CRPS pursuant to Table 17.1 of the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th ed (AMA 5); whether MA required to adopt a longitudinal holistic approach in applying Table 17.1 criteria of the AMA 5; whether reasons inadequate; Held – additional evidence application dismissed as having no relevance to the dispute; criteria in Table 17.1 to be strictly applied; Elsworthy v Forgacs Engineering Pty Ltd, and Warwick Campbell v Star Electric Co Pty Ltd applied; MA explanation adequate although grammatically incorrect and containing spelling mistakes; MAC confirmed.

BACKGROUND TO THE APPLICATION TO APPEAL

On 10 October 2024 Rebecca Loveday, the appellant lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by
Dr Yiu-Key Ho, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 17 September 2024.
The appellant 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, 4^th ed
1 March 2021 (the Guides) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5^th ed (AMA 5). “WPI” is reference to whole person impairment.

RELEVANT FACTUAL BACKGROUND

On 9 August 2024 this matter was referred to the Medical Assessor for an assessment of WPI caused by injury to the right upper extremity (wrist) on 1 March 2021.
Ms Loveday was employed as a cook where she had been working for Crookwell Taralga Aged Care Ltd (the respondent) since 2008. On 1 March 2021 as she lifted a pot of heavy potatoes, she noticed pain on the dorsum of the right wrist. She suffered a burn on the left forearm on the ulna aspect as she pushed the pot back to prevent it from falling.
She kept working for three days but as the problem did not resolve she went to the Emergency Department of a regional hospital where X-rays were done on 6 March 2021. No fracture was detected.
She came to an ultrasound on 16 March 2021 which demonstrated a small 4 x 3 mm dorsal wrist ganglion.
An MRI was performed on 29 March 2021 which found only some ligament problem and she was recommended to continue with conservative treatment.
Ms Loveday came to a further X-ray on 11 May 2021, a CT on 17 August 2021 and was then referred for pain management to Dr Mazyar Danesh in September 2021.
She was diagnosed with chronic regional pain syndrome (CRPS) at that time and the Medical Assessor commented that she probably did then demonstrate all the features necessary to satisfy that diagnosis.
She was treated with a Ketamine infusion, nerve block and radio frequency treatments.
In April 2022 that treatment was helpful and the second round on August 2023 gave initial help for a couple of months.
The Medical Assessor could not confirm that Ms Loveday was suffering from chronic regional pain syndrome as defined in the guides and gave a 0% assessment.

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.
Ms Loveday requested that she be re-examined by a Medical Assessor who is a member of the Appeal Panel but no re-examination was required as no error was found in the MAC.

Fresh evidence

The Application to Appeal Against a Decision of a Medical Assessor stated (by virtue of ticking the appropriate box) that leave was not sought to rely on the availability of additional relevant information that was available before the medical assessment or that could not reasonably have been obtained before then.
No further evidence was attached to the Application, but in a separate document lodged with the Personal Injury Commission (Commission), submissions were made supporting the admission of two reports of Dr Danesh dated 12 May 2024 and 10 February 2025 respectively. (We note that seven reports from Dr Danesh were also lodged with the Application to Resolve a Dispute[1]).
[1] Appeal Papers page 45.

Additional reports of Dr Danesh

In his report of 12 May 2024 Dr Mazya Danesh, specialist pain medicine physician, wrote to Ms Loveday’s general practitioner (GP), Dr Lisa Opie, “responding to a questionnaire sent to my office”. Dr Danesh indicated Ms Loveday's right upper limb symptoms were “tremors, shooting pain triggered physically by touching vibrating objects e.g. food grinder, mixer, etc. and twisting force around the wrist e.g. opening jar caps.”
She reported occasional skin discolouration but less frequent than the previous two years.
Dr Danesh was asked about what response Ms Loveday had to treatment, and he stated that:
“It is quite important to note the main reason behind the vasomotor and sympathetically mediated signs including skin discoloration, swelling and sweating discrepancy to be less prominent currently is the fact that she has had the Stellate Ganglion Pulsed Radio frequency to modulate the excessive sympathetic outflow to the CRPS limb and gradual transition from warm to cold."
Dr Danesh also said that the therapy, (Ketamine infusion and Stellate Ganglion PRF) had helped Ms Loveday to control most of her symptoms.
Dr Danesh thought that this treatment had avoided escalation to further advanced therapies such as spinal cord stimulation which was more invasive and expensive.
This treatment, Dr Danesh advised, was the “Gold Standard” treatment for CRPS but was considered as a last resort due to its expense and also the fact that it was invasive.
Dr Danesh's second report of 10 February 2025 followed a telehealth consultation with Ms Loveday on the same date. He recorded her symptoms and recommended a trial of cervical spinal cord stimulation.

SUBMISSIONS

Ms Loveday submitted that the provisions of “Rule 10.3 of the Workers Compensation Act” was relevant and we were also referred to “Section 367 of the Workplace Injury Management Act.”
The respondent sent a message to the Panel through the Commission advising that it objected to the inclusion of the two reports as they were not relied on in the substantive proceedings and the Medical Assessor did not have access to these reports.

DECISION

The application is rejected. The submissions in support were, with respect, misconceived.
There is no “Rule 10.3 of the Workers Compensation Act,” and s 367 of the Workplace Injury Management and Workers Compensation Act 1998 also does not exist.
The relevant provision is s 328(3) of the 1998 Act which provides:
Section 328(3) of the 1998 Act provides:
“(3) Evidence that is fresh evidence or evidence in addition to or in substitution for the evidence received in relation to the medical assessment appealed against may not be given on an appeal by a party to the appeal unless the evidence was not available to the party before that medical assessment and could not reasonably have been obtained by the party before that medical assessment.”
The reports of Dr Danesh are not relevant to the task to be performed by the Medical Assessor. This is a case involving injury to the right upper extremity (wrist) and whether the condition of chronic regional pain syndrome has been established. The criteria for its establishment, as will be seen below, is set out in Chapter 17 of the Guides. Issues regarding continuing treatment and symptoms are not relevant to the Medical Assessor’s enquiry which was concerned, amongst other things, with the signs of CRPS as they were present on the day of assessment.
The application is accordingly rejected.

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.

Medical Assessment Certificate

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

Both parties made written submissions which have been considered by the Appeal Panel.

FINDINGS AND REASONS

The procedures on appeal are contained in s 328 of the 1998 Act. The appeal is to be by way of review of the original medical assessment but the review is limited to the grounds of appeal on which the appeal is made.
In Campbelltown City Council v Vegan [2006] NSWCA 284 the Court of Appeal held that the Appeal Panel is obliged to give reasons. Where there are disputes of fact it may be necessary to refer to evidence or other material on which findings are based, but the extent to which this is necessary will vary from case to case. Where more than one conclusion is open, it will be necessary to explain why one conclusion is preferred. On the other hand, the reasons need not be extensive or provide a detailed explanation of the criteria applied by the medical professionals in reaching a professional judgement.

The MAC

The Medical Assessor recorded Ms Loveday’s complaints. He said:
“She still complains of pain in the right hand. The pain is in the dorsum of the wrist and she says the pain can go all the way up to the forearm and even to the neck. She claims to have pins and needles in the whole right hand and it also goes up all the way even involving the right side of the face. She says the two arms are different in colours, she can see either purplish or reddish colour in the right forearm and claims to have more sweating on the right hand than on the left. The nails seem to be more brittle and grow faster. She does not describe any obvious stiffness in the joint movement of the whole right upper limb but the hand is weak in grip.”
On physical examination the Medical Assessor’s findings were that he could not see any signs of “chronic regional pain syndrome’. He said:
“…. There is no difference in colour between the two arms. I cannot see any oedema or swelling of the right upper limb. There is no difference in temperature between the two upper limbs. There is no difference in sweating pattern. All the joints enjoy good range of movement and symmetrical to the other side. There is no stiffness that I can notice in the hand certainly the hand grip is weaker on the right than on the left probably relating to the pain factor. All the other joints including the wrist, elbow and shoulder demonstrate full and symmetrical movement. No atrophic change that I can notice in terms of skin texture, hair growth and the nail growth. Neurological examination in terms of motor powers and reflex jerks remains symmetrical and equal on two hands in relation to all the peripheral nerves and various joints.”
The Medical Assessor noted the investigations before him as mentioned in his history. In his summary the Medical Assessor noted that Ms Loveday had a lifting injury which caused pain in the right wrist:
“…probably corresponding to ligament and capsular damage with a small ganglion cyst develop on the first MRI. She presented with clinical diagnosis of Chronic Regional Pain Syndrome initially which now has settled down.”
At [10a] the Medical Assessor noted that the injury had been for over three years. He thought Ms Loveday’s condition was static and she was suitable for an assessment for permanent impairment.
His explanation of his calculations stated:
“Although in her history and symptoms she described, has features of pain and symptoms suggestive of Complex Regional Pain Syndrome as she report symptoms of sensory, vasomotor, sudomotor and oedema, trophic change with weakness in the grip of the right hand. However on clinical examination on the 5 September, 2024, I cannot really find any signs in terms of sensory. She mentioned numbness which is even including the right side of the face and I cannot find any vasomotor sign, colour, temperature everything the same. I could not find any sedumotor signs there is no oedema, no sweating asymetry. Finally active range of movement are full and symmetrical and I could not find any atropic change. So even though there are no other diagnosis that can explain the signs and symptoms but if we base it on WorkCover Guide 4th Edition. Table 17-1 page 81 she does not fit into the criteria for Chronic Regional Pain Syndrome.” (As written).
In dealing with the other medical opinions the Medical Assessor said at [10c]:
“My opinion concur with the opinion of the Dr Gronow. He did an assessment on her twice in 2022 and in 2024, both assessments could not fit all the criteria and I agree with. I cannot agree with Dr Lai. She probably describes all the symptoms but I cannot find any sign of that and hence I cannot support Dr Lai’s opinion. I agree she is a case of Chronic Neuropathic pain probably quite a bit of psychosomatic overlay and will need further treatment on the psychological aspect but from physical point of view I do not think she justify as a case of Chronic Regional Pain Syndrome and I have to say that the permanent impairment remains 0%.” (As written).

SUBMISSIONS

Ms Loveday first of all set out a “comparison of medical evidence,” comparing Dr Min Fee Lai’s assessment on 27 November 2023 of 28% WPI, based on a diagnosis of chronic regional pain syndrome.
References were then made to two reports by Dr David Gronow dated 6 September 2022 and 13 March 2024. It was noted that the initial assessment did not support a CRPS diagnosis. The follow-up assessment in 2024, Ms Loveday said, included findings that there was “no evidence of CRPS according to the Budapest criteria” and other findings on examination which included that there was “no voluntary exaggeration of symptoms or conscious guarding”.
Ms Loveday had noted that Dr Gronow had not provided a WPI assessment but disagreed with the 28% WPI assessment by Dr Lai.
Ms Loveday then referred to the findings by the Medical Assessor noting that he had stated that she did not fit the criteria within the Guides.
We were referred to what was described as “relevant legal principles”.
A Medical Panel decision of Ingram v State of New South Wales (NSW Police Force)[2] was relied on.
[2] [2022] NSWPICMP 35.
We were also referred to NSW Police Force v Derek Fleming[3].
[3] [2010] NSWSC 216.
The principles enunciated in those cases, it was submitted, supported Ms Loveday’s submission that the Medical Assessor did not fully comply with the requirements set out in the Guides and in established case law.
Ms Loveday submitted that the Medical Assessor erred by applying incorrect criteria in the following ways:
·        the Medical Assessor “did not adequately demonstrate the application of the diagnostic criteria for CRPS as outlined in Table 17.1 of the [Guides]”;
·        the Medical Assessor over emphasised “on physical signs at the time of examination”. The Medical Assessor had erred in that he had placed undue weight on the absence of physical signs during the examination and disregarded the requirement that the diagnosis but have been present for at least one year and verified by more than one physician;
·        the Medical Assessor further applied incorrect criteria because Table 17.1 required that “the patient ‘must report at least one symptom in each of the four following categories”. It was submitted that Ms Loveday’s reported symptoms were noted but that the Medical Assessor “seems to dismiss them entirely due to the lack of observable signs during the examination”;
·         the Medical Assessor had not considered the criteria for CRPS diagnosis “holistically”. It was submitted the Guidelines provided a comprehensive set of criteria for diagnosis CRPS which included both symptoms and signs. Ms Loveday submitted that the Medical Assessor did not demonstrate “a thorough consideration of all its criteria” regarding her condition “over time”;
·        the Medical Assessor did not provide a detailed analysis of why Ms Loveday’s condition failed to meet the criteria set out in table 17-1. This was especially so in the light of her reported symptoms and the findings of other medical professionals “over time”;
·        incorrect criteria had been applied through a “failure to consider the longitudinal history”. Ms Loveday referred again to Ingram in this regard, as the Medical Assessor had not adequately considered Ms Loveday’s condition “over time.”;
·        Ms Loveday alleged that the Medical Assessor did not adequately consider the progression of her condition over time. That approach was inconsistent with “the principle” that the overall history of the condition should be taken into account not just the presentation on the day of examination, and
·        the final allegation regarding incorrect criterial was that the Medical Assessor had not demonstrated a strict application of the “diagnostic criteria” of the Guides.      This was particularly so in relation to consideration of both reported symptoms and observed symptoms “over time”.
As to there being a demonstrable error, Ms Loveday submitted the Medical Assessor failed to consider the proper guidelines. It was submitted that if the criteria for CRPS were met, then the Medical Assessor was required to take a four steps approach, which Ms Loveday then set out. It was submitted that the Medical Assessor had not done so “even if he believed the CRPS criteria were not fully met”.
Demonstrable error had also been shown, it was submitted, because the Medical Assessor failed to explain why, having found some symptoms, that Ms Loveday did not fit the criteria when the guidelines required both reported symptoms and signs.
A further demonstrable error was that the Medical Assessor had failed to address conflicting evidence and give adequate reasons to explain why his assessment differed “so significantly” from that of Dr Lai, particularly that Dr Lai observed colour changes and sweating asymmetry, but the Medical Assessor did not. Ms Loveday said the “the SIRA Guidelines emphasized that the diagnosis should be verified by more than one examining physician.”
In finding maximum medical improvement the Medical Assessor had also fallen into error, as Ms Loveday’s condition had not stabilised and the Medical Assessor’s conclusion “may have been premature.”
A further demonstrable error was alleged that the Medical Assessor had misapplied both the SIRA guidelines and AMA 5. The Medical Assessor’s 0% assessment was erroneous because he had failed to consider the impact of Ms Loveday’s reported pain and functional limitations, which should have been assessed, as we understood the submission. It was submitted that the guidelines provide methods for assessing impairment due to pain and sensory deficits “which do not appear to have been applied in this case”.

We were referred again to Fleming as authority for the proposition that the Medical Assessor had not demonstrated a comprehensive approach that considered all available medical evidence and its impact on Ms Loveday. It was submitted that Ingram emphasised the importance of considering both reported symptoms and observed signs.
The Medical Assessor’s dismissal of the reported symptoms due to lack of observable signs during a single examination, was erroneous, Ms Loveday said..
Ms Loveday submitted that Dr Lai’s assessment should be preferred. This was because:
·        Dr Lai had demonstrated a more thorough application of the diagnostic criteria;
·        Dr Lai had taken into account the progression of Ms Loveday’s condition over time not just her presentation on the day of her examination;
·        the quantification of impairment by Dr Lai was appropriate and followed the methodology required by the guidelines;
·        Dr Lai’s findings were consistent with reported symptoms of the medical history;
·        Dr Lai’s approach aligned with the guidelines;
·        Ms Loveday acknowledged that the Guides excluded chronic pain as a separate condition but said that they did provide specific criteria and assessment methods for CRPS;
·        Dr Lai’s approach was more consistent than the Medical Assessor’s;
·        Dr Lai’s approach aligned with case law principles as set out in Ingram and Fleming;
·        Dr Lai had demonstrated a proper application of the guides in accordance with the above authority;
·        it was submitted that the discrepancy between Dr Lai and the Medical Assessor had significant implications for Ms Loveday and we were referred to the five different ways in which that discrepancy affected her, and
·        in conclusion it was submitted that the MAC should be set aside and a new assessment should be conducted.

Respondent

The respondent did not accept that the cases of Ingram and Fleming contained relevant legal principles. In relation to the submission that criteria had been relied on incorrectly, the respondent submitted that the Medical Assessor had correctly applied the Guidelines and found that Ms Loveday did not fit the criteria therein set out.
It was submitted that Medical Assessor explained his findings, although it conceded that the Medical Assessor interchanged the words “chronic” and “complex” in nominating the regional pain syndrome. It was submitted that such a semantic error did not have any bearing on legitimacy of the Medical Assessor’s findings.
The Medical Assessor addressed each of the relevant criteria that needed to be satisfied, the respondent said. He explained sufficiently why Ms Loveday did not meet those diagnostic criteria.
The respondent submitted:
·        the Medical Assessor correctly applied Table 17-1;
·        no error had been identified by Ms Loveday and sufficient reasoning in support of his decision was given by the Medical Assessor. He explained that he agreed with the opinion of Dr Gronow and noted the inconsistencies in the report from Dr Lai;
·        the respondent rejected Ms Loveday’s submissions as to whether a demonstrable error had been made. It submitted that the Medical Assessor applied the proper Guidelines and gave sufficient reasons in support of its decision in both his physical examination and his reasoning at paragraph 10b and 10c of the MAC;
·        the respondent submitted that the opinion of Dr Lai, who examined Ms Loveday on 15 November 2023, prior to the assessment with the Medical Assessor “whereby it is submitted that the Medical Assessor correctly applied the guidelines…” on the date of examination, 5 September 2024, and
·        the respondent submitted that no error had been established and the MAC should be confirmed.

DISCUSSION

Chapter 17 of the Guides is entitled “Evaluation of Permanent Impairment arising from chronic pain,” and the title also explains that the condition of chronic pain as described in Chapter 18 of AMA5 is excluded.
Chapter 17 sets out the criterion for finding Complex Regional Pain Syndrome:
“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…”
The criteria relating to a diagnosis of CRPS are thus contained in paragraph 17.5 of the Guides. They are demanding and must be strictly applied.[4]
[4] Elsworthy v Forgacs Engineering Pty Ltd [2018] NSWSC 1638 at [41], cited with approval in Windley v Workers Compensation Nominal Insurer [2021] NSWSC 1125 (Windley) and Turner v Truss-T-Frame Timbers Pty Ltd [2021] NSWSC 1088. See also Warwick Campbell v Star Electric Co Pty Ltd [2024] NSWSC 1341.
It can be seen that Ms Loveday’s submissions run into trouble when item 3 of Table 17.1 is considered. This provides that a claimant “must display at least one sign *at time of evaluation in all of the following four categories:”. The asterisk defines the sign as “*A sign is included only if it is observed and documented at time of the impairment evaluation.”
The appellant was accordingly incorrect when she relied in general terms on the two authorities she cited. We note that Ms Loveday purported to summarise the “relevant legal principles” that arose therefrom. She did not refer to any passage within either Ingram or Fleming that supported such summaries, and we were unable to locate any such references. Ingram was a decision regarding psychological injury, and whilst the Medical Panel impeccably summarised the relevant authorities, they had very little bearing on Ms Loveday’s matter. Similarly, the decision in Fleming did not reflect the principles alleged in Ms Loveday’s summary thereof. Fleming was concerned mainly with the principles concerning the admission of additional evidence pursuant to s 328(3), which we have discussed above. There have been many authorities since 2010 that deal with the general principles of appeal to a Medical Appeal Panel, and Fleming is now somewhat dated.
The thrust of the appellant’s case is that there was a requirement for the assessor to consider Ms Loveday’s condition “over time”. However, contrary to Ms Loveday’s submission, a longitudinal history of Ms Loveday’s condition does not assist her, as
Table 17.1.3 does indeed rely solely on a single examination.
The reliance on the report of Dr Lai was similarly misplaced, with respect, and Ms Loveday’s submission that Dr Lai assessed 28% “based on the CRPS diagnosis” must be queried.
[5] Dr Lai’s report was dated 27 November 2023; appeal papers page 195.
Dr Lai did not find that Ms Loveday satisfied Table 17.1, but rather used an analogous diagnosis on which to assess WPI. He found that Ms Loveday displayed the symptoms required by Table 17.1.2, but not the signs listed in Table 17.1.3.[5] No submissions were addressed to this opinion.
Ms Loveday’s reference to the requirement that the diagnosis had to be verified by one examining physician and that it had been present for at least one year, we had difficulty in relating to the requirement in Table 17.1.3 that the sign had to be observed and documented at the time of the evaluation.
Similarly it was submitted that the Medical Assessor had dismissed Ms Loveday’s symptoms due to the lack of observable signs. How that approach was said to be inconsistent with Table 17.1.3 was not explained by Ms Loveday. Neither was it explained how the precise criteria in Table 17.1 should be applied “holistically” when a sign was missing on examination, as it was here.
The assertion that the Medical Assessor gave inadequate reasons must also be dismissed. We have reproduced his explanation above (paragraphs [42] and [43]). Whilst some grammatical and spelling errors were evident, they did not detract from the sense of his reasoning. There was no other explanation for Ms Loveday’s symptoms but CRPS, as active range of movement was full and symmetrical. He found that Ms Loveday was “a case of Chronic Neuropathic pain” but noted a psychological overlay and advised further psychological treatment. He said that from a physical point of view he did not think she justified a diagnosis of “Chronic Regional Pain Syndrome” which, whilst being an inaccurate description of “Complex” Regional Pain Syndrome, was no more than a semantic error, as was submitted by the respondent.
For these reasons, the Appeal Panel has determined that the MAC issued on 17 September 2024 should be confirmed.

[2025] NSWPICMP 283

24 April 2025