Quintero v Osvaldo a Duarte trading as Paint n Drill

DETERMINATION OF APPEAL PANEL
CITATION:	Quintero v Osvaldo A Duarte trading as Paint n Drill [2023] NSWPICMP 640
APPELLANT:	Yonathan Quintero
RESPONDENT:	Osvaldo A Duarte t/as Paint n Drill
APPEAL PANEL
MEMBER:	Paul Sweeney
MEDICAL ASSESSOR:	Drew Dixon
MEDICAL ASSESSOR:	Mohammed Assem
DATE OF DECISION:	5 December 2023
CATCHWORDS:	WORKERS COMPENSATION - Worker alleges that Medical Assessor (MA) erred in assigning 0% whole person impairment of the cervical and lumbar spinal segments and the right lower extremity knee; and failed to give adequate reasons for his assessment of these body parts; Held – that as the MA had performed a comprehensive examination of the spinal segments and given adequate reasons for his findings, there was no proven error in respect of the spinal segments; that the brief reasons given by the MA in respect of the right knee did not enable the Panel to understand the actual path of his reasoning; Wingfoot Australia Partners Ltd v Kocak applied; after re-examination in respect of the right knee Medical Assessment Certificate revoked.

BACKGROUND TO THE APPLICATION TO APPEAL

On 7 June 2023, Yonathan Quintero (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Ross Mellick, a Medical Assessor (MA), who issued a Medical Assessment Certificate (MAC) on 10 May 2023.
The appellant relies on the following grounds of appeal under s 327(3) of the Workplace Injury Management and Workers Compensation Act 1998 (1998 Act):
· the assessment was made on the basis of incorrect criteria, 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 (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 Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5^th ed (AMA 5).

RELEVANT FACTUAL BACKGROUND

The appellant suffered multiple injuries when he fell from a ladder on 26 June 2019 in the course of his employment with Osvaldo A Duarte (the respondent).
Following the injury, he was transported to Prince of Wales Hospital where he was treated for serious facial injuries including a zygomatico-maxillary fracture and a head injury. He was discharged on 26 June 2019 for follow-up in respect of maxillofacial injuries. Subsequently, he came under the care of an orthopaedic surgeon, Dr Bernard Schick, who operated on his left scaphoid on 4 July 2019, Dr Broe, an orthopaedic surgeon, who treated an injury to the right knee, and Dr Hassan, a neurologist, in respect of his head injury.
After his discharge from hospital, the appellant also came under the care of his general practitioner, Dr Jimenez, who referred him to a facial plastic surgeon and an ear nose and throat surgeon for his facial injuries. The appellant has also been reviewed by neuropsychologists and rehabilitation physicians in respect of his injury. He has been unable to return to his employment as a painter.
On 14 June 2022, Dr Patrick, a general surgeon provided, a report to the appellant’s solicitors addressing his permanent impairment as a result of the injury for the purposes of a claim under s 66 of the Workers Compensation Act 1987 (the 1987 Act). Dr Patrick expressed the opinion that the appellant was “essentially unemployable because of his physical restrictions”. He continued:
“I do believe that Yonathan Quintero does attract an assessment whole person impairment (sic) and I do believe that his central nervous system disorder (consciousness and awareness) as well as cervical spine, thoracic spine, lumbar spine and right lower extremity (knee) are all rateable for assessment.”
Dr Patrick expressed the opinion that the appellant suffered 25% whole person impairment (WPI). He attributed 10% WPI to an injury to the central nervous system (consciousness and awareness), 2% to the right lower extremity (knee) and 5% to each of the cervical, thoracic, and lumbar spines.
On 2 June 2022, Dr Scoppa, an ear nose and throat surgeon, provided a report to the appellant’s solicitors by which he expressed the opinion that the appellant suffered 2% WPI as a result of nasal deformity.
The appellant consulted three specialist medical practitioners at the request of the respondent. Dr Raj, an ear nose and throat surgeon, provided a report of 23 August 2022 by which he expressed the opinion that the appellant had suffered no WPI as a result of nasal obstruction/deformity. On 30 August 2022, Dr Graeme Doig, an orthopaedic surgeon, expressed the opinion that the appellant suffered 10% WPI as a result of injury to the cervical and lumbar spines. On 31 August 2022, Dr Granot, a neurologist assessed 4% WPI as a result of a “very mild traumatic brain injury”.
By a supplementary report dated 27 September 2022, Dr Doig expressed the opinion that when combining the assessment of Dr Granot with his own the appellant suffered 14% WPI.
The difference of opinion between the appellant’s qualified medical practitioners and those qualified by the respondent gave rise to a medical dispute as that term is used in s 319 of the 1998 Act. Accordingly, a delegate of the President referred the dispute to Dr Mellick, a neurologist, and Dr Williams, an ear nose and throat surgeon, for assessment. It is from their MAC that the appellant brings this appeal.

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 there was prima facie error in the Dr Mellick’s assessment of the impairment of the appellant’s right knee. Accordingly, it concluded that Dr Assem, a member of the Panel, should re-examine the appellant’s right lower extremity. Conversely, the Panel was unable to find error in the MA’s assessment of the cervical spine, thoracic spine or lumbar spine.

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 in the body of this decision.

SUBMISSIONS

Both parties made written submissions. They are not repeated here in full, but have been considered by the Appeal Panel.
In summary, the appellant submitted that the MA erred in assessing the injuries to the appellant’s cervical, thoracic and lumbar spines as 0% WPI and in failing to provide any adequate reasons for assigning Diagnosis Related Estimate category 1 (DRE 1) in respect of the cervical spine, thoracic spine and lumbar spine. Secondly, the appellant alleged that the MA failed to provide adequate reasons for assigning 0% WPI in respect of the right lower extremity (knee).
The appellant emphasised aspects of the clinical examinations of Dr Patrick and Dr Doig in respect of the spine. Dr Patrick recorded that there was restriction of movement of the neck on examination. It was stiff and there was “some dysmetria”. He also recorded that there was muscular guarding at the mid-thoracic and lumbar spine “in the paravertebral musculature”.
Dr Doig also found some guarding and dysmetria in the cervical spine and “mild guarding and dysmetria in the lumbo-sacral area”.
The appellant submitted that as both doctors assessed 5% WPI in respect of the cervical and lumbar spines, the assessment of the MA was:
“so at odds with those other assessments so as to constitute a demonstrable error”.
The appellant further submitted that the MA had erred in failing to comment on why his “findings differed from that of Dr Doig”. He submitted that the MA did not “even make a brief comment” concerning Dr Doig’s opinions and “why his opinion differs”. The appellant continued:
“The medical assessor’s very brief findings on physical examination do not contain any reference at all to the presence or absence of muscle spasm in either the cervical spine, thoracic spine or lumbar spine. This is particularly important, noting that on clinical examination Dr Patrick found marked rigidity/spasm at the thoracic spine and lumbar spine.”
The appellant submitted that in view of this discrepancy there should be a re-examination by a member of Panel to determine the presence or absence of “clinical findings as were found by both Dr Patrick and Dr Doig referable to the cervical and lumbar spine”.
In respect of the right knee, the appellant submitted that it did “not appear that any specific physical examination of the right knee occurred". The medical assessor noted no abnormality of rhythm of gait of the legs and no ataxia on tandem walking. However, he made “no other comment referable to the accepted and referred lower right extremity (right knee)”.
The appellant notes that Dr Patrick found “definite patella-femoral crepitus and positive Clark test”. In these circumstances it was “incumbent upon the medical assessor to provide evidence of his findings and/for testing with respect to the right knee”.
The appellant sought a re-examination by a member of the Panel in respect of his cervical and lumbar spine and the right knee.
The respondent submitted that the MA had provided sufficient reasons for finding DRE category 1 in respect of the cervical, lumbar and thoracic spines. Contrary to the appellant’s submissions, the MA specifically noted that the movements of each of the spinal areas was “without caution or guarding”.
The respondent referred to Marina Pitsonis v Registrar of the Workers Compensation Commission & Anor[1] to support its argument that the appellant was merely cavilling with “a matter of clinical judgement”.
[1] [2008] NSWCA 88.
While the MA was required to consider all of the evidence before him, he was “not required to outline each aspect of every treating and/or expert report within the decision”. It continues:
“Both Dr Doig and Dr Patrick assessed the worker at DRE 2 and with 5% WPI of the cervical spine. Whilst the MA did not directly address Dr Doig’s report, the MA explained that his assessment differed from Dr Patrick’s as his ‘examination did not identify persisting abnormalities of spinal movement’”.
The respondent also referred to the reasoning of Hoeben J in Merza v Registrar of the Workers Compensation Commission[2] where his Honour contrasted a demonstrable error with a mere “difference of opinion”. It also referred to the reasoning of the Court of Appeal at [41]-[42] in Sydney Trains v. Batshon.[3]
[2] [2006] NSWSC 939.
[3] [2021] NSWCA 40.
It followed from the reasoning in the cases referred to above that the appellant was unable to demonstrate error as there was none which was “readily apparent in the medical assessor’s finding of fact or reasoning”.
The respondent also submitted that the MA had given sufficient reasons in respect of the appellant’s right knee when he stated that he agreed with the findings of Dr Broe, the treating orthopaedic surgeon.

FURTHER MEDICAL EXAMINATION

Dr Mohammed Assem of the panel re-examined the appellant on 10 October 2023 in respect of his right knee. Insofar as it is relevant, his report is as follows:
“On 10 October 2023, Mr. Yonathan Quintero was examined by Dr. Assem at the PIC rooms, located at 1 Oxford St., Sydney. The examination took place in the presence of his girlfriend, Ms. Carolina Silva, and Mr. Jorge Czimente, a Spanish-speaking interpreter with the CPN 7SC69K.
History of Injury:
Mr. Yonathan Quintero, a 29-year-old right-hand dominant man, was employed as a full-time painter with the company Paint and Drill for approximately four years. On 26 June 2019, he suffered a significant workplace accident while painting a large house at 51 Daunt Avenue, Matraville. At the time, he was standing on a ladder that was placed against a second-floor balcony. Despite his supervisor holding the ladder at the bottom, the ladder unexpectedly moved. This caused Mr. Quintero to lose his balance and fall a considerable distance of 7 to 8 metres to the ground. He was momentarily unconscious following the fall.
Mr. Quintero was transported by his supervisor to the Prince of Wales Hospital's Emergency Department, where a series of medical investigations were performed. The imaging studies and subsequent medical evaluation revealed multiple injuries:
1.Multiple rib fractures on his right side, accompanied by a pneumothorax that required intercostal drainage.
2.A displaced fracture of the left scaphoid bone in his non-dominant wrist, which was treated through open reduction and internal fixation.
3.Multiple dental and facial fractures that required the involvement of maxillo-facial specialists and dentists.
4.Damage to his nasal septum necessitating rhino-septoplasty.
After the accident, Mr. Quintero has also reported experiencing neck, lower back, and anterior right knee pain. He was examined by orthopaedic surgeon Dr. David Broe on 28 August 2019. The MRI scan showed bone oedema and contusions in the knee, consistent with a hyperextension injury. Surgical intervention was deemed unnecessary, but a strength and conditioning program with physiotherapy was recommended.
The management of his injuries involved various specialists. He underwent surgery for his left scaphoid fracture on 4 July 2019, performed by orthopaedic surgeon Dr. Bernard Schick. He has also been seen by facial plastic surgeon Dr. Niranjan Sritharan and ENT and facial plastic surgeon Dr. Sim Choroomi for follow-up after his rhino-septoplasty surgery.
Mr. Quintero continues to experience ongoing symptoms directly related to his injuries sustained on the day of the accident. He has recently relocated from Burwood to Homebush and has been receiving ongoing physiotherapy treatment for his injuries.
Current Status:
Mr. Quintero experienced constant discomfort in his right knee, specifically localized to the medial aspect of the patella. He reports sensations of audible crepitus along with a general feeling of weakness and instability in the joint. Attempts at jogging exacerbate the pain. In an effort to mitigate the discomfort, he has increasingly relied on his left leg, causing consequential pain in his left knee. He avoids negotiating steps whenever feasible. He has not been prescribed a knee brace or other form of supportive device. To cope with household responsibilities, his girlfriend has taken on the majority of chores. Mr. Quintero does contribute to housework in her absence, albeit cautiously, ensuring that he paces himself and takes frequent rest breaks. He has remained off work since the date of his injury.
Present Treatment:
In terms of his ongoing treatment, Mr. Quintero has independently embarked on a regimen of TheraBand strengthening exercises. For pain management, he alternates between taking Panadol, Panadeine Forte, and CBD oil as needed.
Examination
Mr. Quintero presented as well and displayed no visible signs of distress during the examination. He was cooperative throughout and seemed to answer questions and undergo tests in a forthright manner. He was advised beforehand to refrain from any manoeuvres that could potentially cause harm or discomfort. His height measured at 173 cm, and he weighed 61 kg.
In terms of mobility, Mr. Quintero demonstrated a normal gait pattern and was capable of walking on both his toes and heels. However, he encountered difficulty when attempting to squat, being unable to go beyond three-quarters of the normal range of motion.
Upon inspection of his right knee, there were no scars or deformities, and no joint swelling was evident. There were no noticeable changes in skin colour, temperature, or perspiration level. The range of motion in his right knee was within normal limits for both flexion and extension. Coarse patellofemoral crepitations were present bilaterally but were more pronounced on the right knee. Additionally, a symmetrical 5° valgus alignment and lateral tracking of the patella were observed. The patellofemoral grind test yielded a positive result, and McMurray's test was mildly positive, reproducing his symptoms along the medial joint line.
Stability assessments revealed no mediolateral or anteroposterior instability in the knee, and the patella apprehension test was negative. Measurements of his thigh and calf circumferences were taken: 42 cm for the right thigh, measured 10 cm above the superior pole of the patella, and 41.5 cm for the left. There was a 1 cm atrophy of his left calf compared to the right. Neurological examination of his lower extremities was otherwise normal.
Impairment:
According to Table 17-31 on page 544 of the AMA5, patellofemoral pain syndrome with crepitations can be assessed. The footnote in the table generally guides us that this condition warrants a lower extremity impairment rating of 5%. In addition, he has clinical features suggesting a tear to the medial meniscus giving 2% LEI AMA5, Table 17-33. The combined lower extremity impairment is 7% which converts to 3% WPI.”

FINDINGS AND REASONS

Section 328(2) of the 1998 Act provides that an 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. This subsection was considered by Davies J in New South Wales Police Force v Registrar of the Workers Compensation Commission of New South Wales [2013] SC 1792 (11 December 2013). Davies J considered that the form of the words used in s 328(2) of the 1998 Act ‘the grounds of appeal on which the appeal is made’ was intended to convey that the appeal is confined to those particular demonstrable errors identified by a party in its submissions. The Appeal Panel has only considered those grounds specifically raised by the appellant in his application.
In Campbelltown City Council v Vegan [2006] NSWCA 284 (Vegan), 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 role of the medical appeal panel was considered by the Court of Appeal in Siddik v WorkCover Authority of NSW [2008] NSWCA 116. An appeal by way of review may, depending upon the circumstances, involve either a hearing de novo or a rehearing. Such a flexible model assists the objectives of the legislation. However, in Versace vAustralia Best Tyres & Auto Pty Limited [2016] NSWSC 1540 (2 November 2016) Schmidt J, held that the 1998 Act did not permit the panel to review the determination of the Medical Assessor without first identifying error.
Though the power of review is far ranging it is nonetheless confined to the matters which can be the subject of appeal. Section 327(2) of the 1998 Act restricts those matters to the matters about which the MAC is binding. In considering the submissions of the appellant, it is necessary to bear in mind the nature of the statutory obligation of the Medical Assessor to provide reasons. It is evident from reasoning of the High Court of Australia in Wingfoot Australia Partners Pty Ltd V Kocak[4] that it is only necessary for the MAC to explain the actual path of reasoning of the Medical Assessor in sufficient detail to enable a court or an appeal panel to determine whether there is error in its findings. In Wingfoot it was said that:
“The function of a medical panel is neither arbitral nor 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 form and give its own opinion on the medical question referred to it by applying its own medical experience and its own medical expertise.”
[4] 252 CLR 480.

The reasoning in Wingfoot has been applied to medical assessments under the NSW Workers Compensation legislation: see, for example, El Masri v Woolworths Ltd.[5]
[5] [2014] NSWSC 1344 (26 September 2014).
The appellant does not criticise the certification of Dr Williams in respect of facial disfigurement or respiration or the certification of Dr Mellick in respect of the appellants nervous system. Rather, the appellant confined his grounds of appeal to Dr Mellick’s examination and conclusions in respect of the right lower extremity and the spine.
It is evident from the MAC that the MA performed a thorough physical examination of three segments appellant’s spine at the assessment consultation. The MA recorded:
“Cervical, thoracic and lumbar movements were performed over a normal range, symmetrically and without caution or muscle guarding. Forward flexion, lateral flexion and extension of the lumbar spine were performed normally and spinal movements were performed without guarding.
There was no wasting of the paracervical or shoulder girdle muscles and no abnormalities of contour, posture, tone, power production, coordination or sensation in the upper or lower extremities. The deep tendon reflexes were symmetrical and normally brisk and the plantar responses were flexor.”
The MA specifically considered the medical reports from the treating medical practitioners and from Dr Patrick. He noted that Dr Hassan did not identify “abnormalities of motor or sensory function in the trunk or limbs or the deep tendon reflexes”.
Relevantly, the MA summarised Dr Patrick’s findings in respect of the spine as follows:
“He records impairment of cervical movement on examination with associated guarding of the mid and lower thoracic spine.”
The MA continues:
“My examination did not identify persisting abnormalities of spinal movement”.
In the MAC, the MA also considered the radiological evidence. Relevantly, he stated:
“An MRI of the cervical, thoracic, lumbar spine and sacrum performed on 6 July 2021 were reported to reveal no abnormalities in the cervical region or thoracic spine. There were no disc protrusions or evidence of neural compression in the lumbar spine. There was arthropathy at L4/5 and L5/S1 and a mild facet joint disorder was noted. The sacral films were all normal. The conclusion prepared by Dr Sim and Dr Dugal was ‘no cord lesion seen. No cervical, thoracic, lumbar or sacral obvious lesion or neural compression noted’”.
In summarising his findings, the MA stated that:
“The neurological assessment does not establish an assessable injury of the cervical, thoracic or lumbar spine, nor of the right lower extremity”.
In the opinion of the panel there is considerable force in the respondent’s submission that the appellant is merely cavilling with the clinical judgement of the MA. There is no true basis for the allegation that the MA erred in assessing the appellant’s spine.
The appellant argues that the MA did not give sufficient reasons for his categorisation of the spinal segments. But it is clear from the above review that on his examination the MA found no restriction of movement, guarding or spasm of the lumbar spine. He specifically states that movements were performed “symmetrically and without caution or muscle guarding”. Taken together with his neurological findings and the radiological evidence, these examination findings were only capable of fulfilling the criteria of DRE Category 1 in respect of each spinal segment.
The appellant also argues that the MA failed to address the opinions of Dr Patrick and Dr Doig. While he did not specifically refer to the opinion of Dr Doig, the MA directly addressed the findings of Dr Patrick. He states that the abnormalities of spinal movement found on Dr Patrick’s examination were not present on his examination. It is unnecessary for the MA to canvass in his reasons the findings and opinion of every medical practitioner whose report has been received into evidence.
As several months had elapsed since the earlier examinations, difference in examination findings is not entirely surprising. The radiological evidence does not establish any significant compressive lesion at any segment of the spine and it might be expected that in a young man soft tissue injuries sustained in the accident would ameliorate with the passage of time.
The panel is of the opinion that the appellant has not proven demonstrable error in the MA’s assessment of the spine.
The position is different in respect of the right knee. The MA noted the opinion of Dr Patrick that there was patella-femoral crepitus and pain on examination of the right knee and stated that he was unable to detect any abnormalities involving the right knee or right lower extremity. The MA, however, does not specifically record his findings in respect of the right knee. He referred to no test that he performed in respect of the knee. On balance, the panel doubted that the references to the appellant’s right knee in the MAC demonstrated the actual path of his reasoning in accordance with the principles in Wingfoot.
At the preliminary conference, the panel concluded that in view of the error it was appropriate to re-examine the appellant in relation to his right knee. As there was no proven error in respect of the spine the panel concluded that it was inappropriate to carry out a further examination of those body parts. As there was neither demonstrable error in the MA’s assessment of the spine or any systemic error in the MAC, there was no appropriate factual or medical basis for an unrestricted re-examination.
Following the receipt of the report Dr Assem’s re-examination, the panel reconvened and considered his assessment of the appellant’s right lower extremity. While Dr Assem’s findings in respect of the right knee were not reproduced by all of the medical examiners in the case, they are similar to the findings of Dr Patrick. Dr Assem’s re-examination of the appellant is the most recent medical examination. It reflects a consideration of the entirety of the medical evidence in the case. The panel, therefore, determined that it should prefer Dr Assem’s certification to the other evidence in the case.
To the 9% WPI assessed by Dr Melick in respect of the nervous system and the 2% WPI assessed by Dr Williams in respect of respiration, must be added 3% WPI in respect of the right lower extremity. The total WPI is 14%.
For these reasons, the Appeal Panel has determined that the MAC issued on 10 May 2023 should be revoked, and a new MAC should be issued. The new certificate is attached to this statement of reasons.

PERSONAL INJURY COMMISSION

APPEAL PANEL

MEDICAL ASSESSMENT CERTIFICATE

Injuries received after 1 January 2002

Matter number:	W8091/22
Applicant:	Yonathan Quintero
Respondent:	Osvaldo A Duarte t/as Paint n Drill

This Certificate is issued pursuant to s 328(5) of the Workplace Injury Management and Workers Compensation Act1998.

The Appeal Panel revokes the Medical Assessment Certificate of Medical Assessor Dr Ross Mellick and issues this new Medical Assessment Certificate as to the matters set out in the table below:
Table - whole person impairment (WPI)

Body Part or system	Date of Injury	Chapter, page and paragraph number in WorkCover Guides	Chapter, page, paragraph, figure and table numbers in AMA 5 Guides	% WPI	Proportion of permanent impairment due to pre-existing injury, abnormality or condition	Sub-total/s % WPI (after any deductions in column 6)
1. Nervous system	26 June 2019	Chapter 5 Pars 5.3, 5.4, 5.5, 5.9	Chapter 13 Section 13.3(d) Tables 13-2, 13-3, 13-4, 13-5, 13-6, 13-7, 13-8	9	0	9%
2. Cervical spine	26 June 2019	Chapter 4 4.17, 4.18, 4.22, 4.23, 4.26, 4.27, 4.33, 4.37, 4.7, 4.8	Chapter 15 Page 392 Table 15-5	0	0	0%
3. Thoracic spine	26 June 2019	As above	Chapter 15 Page 389 Table 15-4	0	0	0%
4. Lumbar spine	26 June 2019	As above	Chapter 15 Page 384 Table 15-3	0	0	0%
5. Facial disfigurement 6.Respiration	26 June 2019	Chapter 6, par 6.4, Table 6.1 Chapter 6.8, Table 6.2 Chapter 1 Par 1.21.1	0 2	0 0	0% 2%
7. Right lower extremity	26 June 2019	Chapter 3 Pages 13-25	3	0	3
Total % WPI (the Combined Table values of all sub-totals)					14 %

The above assessment is made in accordance with the SIRA NSW Guidelines for the Evaluation of Permanent Impairment for injuries received after 1 January 2002

[2023] NSWPICMP 640

5 December 2023