Secretary (Department of Communities and Justice) v Hammond
[2022] NSWPICMP 474
•22 November 2022
| DETERMINATION OF APPEAL PANEL | |
| CITATION: | Secretary (Department of Communities and Justice) v Hammond [2022] NSWPICMP 474 |
| APPELLANT: | Kylie Hammond |
| RESPONDENT: | Secretary, Department of Communities and Justice |
| Appeal Panel | |
| MEMBER: | Jane Peacock |
| MEDICAL ASSESSOR: | James Bodel |
| MEDICAL ASSESSOR: | Brian John Stephenson |
| DATE OF DECISION: | 22 November 2022 |
| CATCHWORDS: | wORKERS cOMPENSATION - Left lower extremity injury; Chronic Regional Pain Syndrome (CRPS) referred for assessment; appeals by both the worker and the employer; the worker alleged error by the Medical Assessor (MA) in the assessment because CRPS not assessed; employer alleged error in the assessment of the lower extremity; Held – Appeal Panel found error and considered a re-examination was necessary; CRPS assessed; Medical Assessment Certificate revoked. |
BACKGROUND TO THE APPLICATION TO APPEAL
On 17 June 2022 Ms Kylie Hammond (the appellant worker) and on 15 June 2022 the Secretary, Department of Communities and Justice (the respondent employer) respectively lodged Applications to Appeal Against the Decision of a Medical Assessor Tim Anderson, a Medical Assessor (MA), issued a Medical Assessment Certificate (MAC) on 20 May 2022. The appeals are heard together and for ease of reference the worker will be referred to as the appellant worker and the employer will be referred to as the respondent employer.
The appellant worker relied 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 respondent employer relied on the following grounds of appeal under s 327(3) of 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.
The WorkCover Medical Assessment Guidelines 2006 set out the practice and procedure in relation to the medical appeal process under s 328 of the 1998 Act. An Appeal Panel determines its own procedures in accordance with the WorkCover Medical Assessment Guidelines 2006.
The assessment of permanent impairment is conducted in accordance with the NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4th ed
1 April 2016 (the Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th ed (AMA 5).
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 WorkCover Medical Assessment Guidelines 2006.
The appellant worker requested a re-examination. As a result of its preliminary review, the Appeal Panel determined that it was necessary for the worker to undergo a further medical examination because the Appeal Panel found error and in the circumstances considered that a re-examination was necessary.
EVIDENCE
Documentary evidence
The Appeal Panel has before it all the documents that were sent to the MA for the original medical assessment and has taken them into account in making this determination.
Further medical examination
Dr Brian Stephenson of the Appeal Panel conducted an examination of the worker on 26 October 2022 and reported to the Appeal Panel.
The MAC
The parts of the medical certificate given by the MA 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.
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 matter was referred to the MA for assessment as follows:
“The following matters have been referred for assessment (s 319 of the 1998 Act):
•
Date of injury:
03/02/15
•
Body parts / systems referred:
Left lower extremity (ankle – CRPS)
Scarring
Lumbar spine (consequential)
•
Method of assessment:
Whole Person Impairment”
The MA issued a MAC certifying as follows:
Body Part or system
Date of Injury
Chapter,
page and paragraph number in SIRA guidelines
Chapter, page, paragraph, figure and table numbers in AMA5 Guides
% WPI
WPI deductions pursuant to S323 for pre-existing injury, condition or abnormality (expressed as a fraction)
Sub-total/s % WPI (after any deductions in column 6)
Left lower extremity (ankle – CRPS)
03/02/15
Chap 3 P 13
P 81 T 17.1
P 527
T 17-03P 537
T 17-11 and 17-1210
0
10
Scarring
P 74
T 14.10
0
0
Lumbar spine (con-sequential)
Chap 4
P 24P 384
T 15-035
0
5
Total % WPI (the Combined Table values of all sub-totals)
15
Both the worker and the employer appealed. There was no complaint on appeal by other party about the assessment of 5% whole person impairment (WPI) for the lumbar spine.
In summary, the worker appealed against the assessment on the basis that the MA had made a demonstrable error or made an assessment on the basis of incorrect criteria because he failed to rate an impairment in respect of the appellant’s workers diagnosed Chronic Regional Pain Syndrome (CRPS). The appellant worker sought that she be re-examined.
In summary, the employer appealed against the assessment of the left lower extremity on the basis of demonstrable error or assessment on the basis of incorrect criteria. The respondent employer sought the MAC be revoked.
The MA took a history which included symptomology being experienced in the left ankle as follows:
“Brief history of the incident/onset of symptoms and of subsequent related events, including treatment:
Ms Hammond related that on 03/02/15, she was getting out of her car at a client’s home and rolled her left ankle with an inversion injury. This resulted in ligament injury on the lateral side.
She was initially seen by Specialist Orthopaedic Surgeon, Dr Todd Gothelf who recommended at that stage that she should continue with conservative management.
Unfortunately, the condition of her left ankle never settled down and in mid-year 2016 it deteriorated badly. It was later identified that there had been a tear to the anterior tibio-fibular ligament. She was seen again by Dr Todd Gothelf who recommended a surgical repair procedure. This went ahead in early May 2017. Unfortunately she did not get a good result and developed a chronic pain condition. She then came under the care of Specialist Pain Management Physician, Dr Tim Ho. A diagnosis of CRPS was made. Her clinical management included cortisone injections and also a spinal block. Unfortunately none of this treatment helped her.
She started developing pain in her lower back somewhere around 2019. She advised that in order to take the loading off her left foot and ankle, she was bent sideways towards her right. She started experiencing pain in her lower back and right hip area. Unfortunately this situation never seems to have been fully addressed, largely due to the Code 19 restrictions. This condition has grumbled on without much change.
· Present treatment:
She takes sleeping tablets.
· Present symptoms:
She has severe pain in her left ankle with very unpleasant boiling hot or ice cold sensations. She described that there is a change of colour to red and sometimes blue with associated pins and needles and sometimes increased sweating of the lower left foot and ankle. This area is also extremely sensitive, such that she can hardly touch it.
She continues to have aches and pains in her lower back. This is mostly focused towards the right of the mid-line.
· Details of any previous or subsequent accidents, injuries or conditions:
There is no previous or subsequent condition associated with her lower back or her left hindquarter.
· General health:
This is not so good. She has developed a mental health condition for which she has psychological support. She described that in 2017 she was literally at her wits’ end and cut herself on the volar side of the left wrist with a knife. She realises that this was not the right sort of thing to do, especially since she has a young family to care for. This condition was satisfactorily managed, and she has subsequently had some tattoos to the area of the left wrist to cover up the scarred area, which has been fairly successful. Other than this, her physical health has previously been good if.
· Work history including previous work history:
Ms Hammond worked in home care, assisting elderly and disabled people with their housework. She very much enjoyed the work and enjoyed meeting her clients. She has been unable to continue with this since this event.
· Social activities/ADL:
Ms Hammond importunely comes from an unenviable background. She had a tough upbringing with various family splits. Her education was not particularly good and even now, she mentioned that she has difficulty with reading and writing.
She has five children, all of whom are fit and well. She has daughters of 20 and 18 who have left home. The 18 year old lives nearby and comes around and gives her a great deal of assistance. There is a son of 13 and two further daughters of 12 and 10, who live with her. The children apparently are doing quite well at school. Ms Hammond related that she had been a single mum for about ten years or so. She lives in a two storey dwelling. The children sleep upstairs but she cannot easily go up and down the stairs and sleeps downstairs on the lounge.
She smokes. She realises this is unwise and has dropped down to five cigarettes a day. She is hoping to reduce further and cease. Occasionally she enjoys a modest drink.
She was physically fit and active. At the moment her only hobby is listening to music.
She can drive her car for short local trips, for example to and from the local school.
She has great difficulty with her housework. Her 18 year old daughter usually comes around on a daily basis and gives her a lot of help with the housework and also general support.”
The MA conducted a physical examination and recorded his findings as follows:
“Ms Hammond was of average stature and build. With her current height of 1.67m and weight of 62kg, she currently has a body mass index of 22, which is in the middle of the healthy weight range. She was in a great deal of discomfort, particularly with her left foot and ankle.
Back. Pain was located to the right of the mid-line at the lumbar area. There was associated tenderness.
On forward flexion she could reach her lower thighs with a McRae-Wright movement of only 2cm. This is very stiff in this direction. The lower limit of normal is 5cm. Extension and lateral flexion and rotation to each side were very nearly normal.
Lower Limbs. She walked with a left sided limp. She was unable to stand or walk on her heels and toes and could not squat.
The legs were equivalent in length and in circumference at the calves. The right thigh was 1cm less in circumference than the left.
No significant features were identified with the hips or the knees. She had the following ankle movements:
MOVEMENT
RIGHT
LEFT
Dorsi-flexion
20°
0°
Plantar flexion
60°
50°
Inversion
40°
10°
Eversion
30°
10°
The area of her left lower limb was hyper-sensitive from the toes in a stocking distribution to just above the ankle. Sensation to pinprick in this area was dull. There was a very fine demarcation line all around the lower leg identifying this change.
There was no swelling, alteration of temperature, colour or sweating.
Reflexes were present and equivalent at the knees (L4) and at the ankles (carried out most cautiously) (S1).
The straight leg raise test was conducted sitting on the edge of the couch. She could fully extend each knee.”
The MA had regard to the special investigations as follows:
DATE
INVESTIGATION
RESULTS
09/02/15
Plain x-ray
Normal.
23/02/15
Ultrasound scan
Full thickness tear of the anterior tibio-fibular ligament.
13/03/15
MRI scan
Partial thickness tear anterior tibio-fibular ligament and calcaneo-fibular ligament.
30/06/16
Plain x-ray and ultrasound scan
Tears of the anterior tibio-fibular ligament, if deltoid ligament and calcaneo-fibular ligament sprain.
The MA summarised the injury and his diagnosis as follows:
“Ms Hammond sustained an injury to her left ankle in early February 2015. This resulted in tears and sprains to a series of ligaments on the lateral side of the left ankle complex. Eventually this was diagnosed and was managed by a surgical repair procedure. Unfortunately this did not give her a good result and ever since then she has experienced a chronic pain condition.
It has previously been suggested that she had complex regional pain syndrome. At this assessment, she did not have the definitive hallmarks to confirm such a diagnosis, although it was fairly obvious that she had developed quite a severe chronic pain condition. This has been grumbling on now for about five years.
The situation is further complicated by the development of mental health issues which continue to need extensive support. There are yet further complexities with Ms Hammond being a single mum and currently having to care for three young children. This is made even more difficult by her own lack of capacity for fully effective reading and writing.”
The MA considered that the appellant worker’s “presentation was completely consistent”.
The Appeal Panel notes that the MA stated it has previously been suggested that she had complex regional pain syndrome. At this assessment, she did not have the definitive hallmarks to confirm such a diagnosis, although it was fairly obvious that she had developed quite a severe chronic pain condition. This has been grumbling on now for about five years.
The MA assessed 10% WPI for the left lower extremity and 0% WPI for the scarring and explained his assessment as follows:
“Left Lower Extremity.
AMA 5 REFS
MOVEMENT
RIGHT
% RIGHT LEI
LEFT
% LEFT LEI
P 537
T 17-11
Dorsi-flexion
20°
0
0°
7
Plantar flexion
60°
0
50°
0
P 537
T 17-12
Inversion
40°
0
10°
2
Eversion
30°
0
10°
2
Subtotals
0
11
Neurological. There is significant neurological dysfunction in the left lower leg in a stocking distribution to just above the ankle. This affects three nerves identified from Page 551 Figure 17-08:
(i)Lateral sural cutaneous
(ii)Saphenous
(iii)Superficial peroneal
From Page 552, Table 17-37 dysaesthesia for the lateral sural cutaneous and superficial peroneal nerves carries a lower extremity impairment of 5% each. Strictly speaking, the saphenous nerve does not feature in this table, although by analogy from either of these nerves, it is reasonable to conclude that this nerve also would carry 5% LEI for dysaesthesia. This therefore gives her 15% LEI for this neurological condition.
This is combined with the 11% for the reduced range of movement, giving 24% lower extremity impairment.
From Page 527, Table 17-03, this converts to 10% WPI.
Scarring. The surgical scar over the lateral side of her left ankle is very small and has healed extremely well and is really quite difficult to see. This is an uncomplicated scar for a defined elective procedure and carries a whole person impairment of 0%.”
The MA made brief comment as required on the other expert medical opinions that were before him as follows:
“Specialist Rheumatologist, Dr Denise Tong in her four reports of 08/10/19, 03/08/20, 15/03/21 and 16/09/21 has diagnosed complex regional pain syndrome with a whole person impairment of 23% and scarring 1%. With the greatest of respect, I am unable to replicate these findings confirming CRPS. Also, I believe that 0% WPI for the scarring is more accurate.
Specialist Orthopaedic Surgeon, Dr Richard Powell in his four reports of 03/08/18, 06/02/19, 02/01/20 and 12/07/21 advises quite strongly that there are no definitive features of CRPS. I agree with this clinical view. Nevertheless, he does not identify a chronic pain condition which I believe does exist. The range of movement which I assessed at this assessment gave a considerably greater impairment than that described by Dr Richard Powell.”
The appellant worker submitted that the MA was in error when he noted that there was merely a suggestion that the appellant had CRPS when in fact a diagnosis had been made. He accepts she has a chronic pain condition of some five years duration.
The respondent employer submitted that the MA erred in his assessment of the left lower extremity because he failed to undertake his assessment in accordance with the criteria in the Guides which provide that the MA undertake a three-step process when assessing impairment of the lower extremity nerves as follows:
“• The first step is to identify the amount which is applicable for complete loss of each particular nerve. The amounts are found in Table 17-37.
• The second step is to identify the ‘grade’ or severity of the loss for each nerve. The grades are set out in table 16-10.
• The third step is to multiply the percentage applicable for the relevant grade by the estimate provided for complete loss.”
The Appeal Panel considered that the MA had erred in respect of the assessments of the left lower extremity and in respect of CRPS.
In the circumstances, the Appeal Panel considered that a re-examination was required and Dr Brian Stephenson, a member of the Appeal Panel conducted the re-examination and reported to the Appeal Panel as follows:
“REPORT OF THE EXAMINATION BY MEDICAL ASSESSOR
MEMBER OF THE APPEAL PANEL
Matter No: M1&M2-W6102/21
Appellant/Respondent: Kylie HAMMOND
Age: 39 years
Respondent/Appellant: Secretary, Department of Communities & Justice
Appeal Panel Member: Jane Peacock
Medical Assessor: Dr James Bodel
Medical Assessor: Dr John Brian Stephenson
Examination Conducted By: Dr J Brian Stephenson and member of the Appeal Panel
Date of Examination: 26 October 2022
Time of Examination: 12 noon through 1 pm
I have noted with the documents there was an ultrasound-guided right knee steroid injection (for superolateral fat pad impingement).
The report of Dr Hitchen noted the procedure was targeting the medial posterior fibular joint, adjacent to the remnant plica, the radiologist injected 1 mL of Celestone Chronodose and 8 mL of 1% Lignocaine tolerated well by the patient. It is noted at the MA, on ultrasound of 23 February 2015 and 30 June 2016 found on ultrasound of 2015 the full-thickness tear of the anterior tibiofibular ligament at the ankle and on 30 June 2016, tears of the anterior tibiofibular ligament, deltoid ligament, and calcaneofibular ligament sprain.
The appellant wished re-examination based on concern that a diagnosis of complex regional pain syndrome was not made by the MA. At Page 5 of the MAC, the MA opined, ‘At this assessment, she did not have the definitive hallmarks to confirm such a diagnosis, although it was fairly obvious that she had developed quite a severe chronic pain condition. This has been grumbling on now for about five years’.
In the summary table, Dr Anderson found for left lower extremity, ankle, 10% WPI, for scarring 0% WPI and for lumbar spine 5% WPI. The appellant did not refer in the appeal to scarring or lumbar spine. Dr Anderson found 0% WPI for scarring for the lumbar spine (consequentially found 5% WPI).
Therefore this current re-examination should include that 5% WPI for the lumbar spine to be combined with the value for CRPS-1.
1. The worker's medical history, where it differs from previous records
Kylie Hammond attended the consultation. At the time of the clinical examination, chaperone was Aeriel, a lady member of staff of this office.
As a home care disability support worker, she joined the employer in September 2014 and worked until date of injury of 3 February 2015.
History of Injury
On 3 February 2015 she was about to enter a client’s residence. She was on the driveway and as she stepped off the footpath, her left foot sustained a severe inversion sprain injury. This was initially treated with a few months of physiotherapy interrupted by the COVID pandemic. She was treated conservatively for left knee injury by Dr Gavin Soo, Orthopaedic Surgeon. She came under the care of Dr Todd Gothelf, Orthopaedic Surgeon, and there was a surgical repair procedure at left ankle.
Operation report Dr Todd Gothelf, date 2 May 2017. Operation: Left ankle arthroscopy, open stabilisation. Diagnosis: Left ankle instability indicated for left ankle arthroscopy and open stabilisation. Since then she has been under the care of Western Sydney Pain Centre, namely Dr Tim Ho who has reported in his previous reports on pain issues with a diagnosis CRPS-1 left foot, for example the report of Tuesday, 10 October 2017. Dr Tim Ho noted the diagnostic sequence:
1.CRPS left foot triggered by workplace injury.
2.Background of left ankle inversion injury at work with large collateral ligament damage.
The report of Dr Tim Ho which I have referred to is the report of 16 May 2018.
Dr Denise Tong, Rheumatologist, report 16 September 2021 noted findings consistent with CRPS 1. She found a 14% lower extremity range of motion loss left lower extremity which she combined with the value from Table 16-10A, Page 482 AMA-5 Grade 3 Diagnostic Classification. Dr Denise Tong should have used that maximum of 60% sensory deficit to combine with range of motion loss. The combination of 50 with 14 gained 57% lower extremity impairment which converted to 23% WPI. She rated the scarring at 1% WPI, gaining therefore 24% WPI. For the lumbar spine she found DRE Category II at 5% WPI plus 2% for ADLs. However, the appellant did not appeal against the MA assessment of 5% WPI for lumbar spine.
With reference to WorkCover Guides Fourth Edition, the strict requirements in terms of Table 17.1 at Page 81, at 2 and 3 there must be at least one symptom in each of four categories and must apply at least one sign of each of those four categories namely:
·Sensory.
·Vasomotor.
·Sudomotor.
·Motor/trophic.
However, that method is governed by the last main paragraph on page 80 as follows, for CRPS type 1 to be present for the purpose 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 CRPS type 1 table 17.1.
In that regard the condition has been diagnosed by in fact three clinicians:
Dr Tim Ho, for example, report of 17 October 2017.
Dr Todd Gothelf on the left ankle arthroscopy and open stabilisation 2 May 2017.
At page 2 of his report of 21 October 2015, Dr Gothelf reported ‘If after seeing her she seems to have developed more signs of complex regional pain syndrome, then it is inconsistent with my findings and as such it would require a re-evaluation to assess for any change prior to proceeding with any surgery. Without surgery, she can persist with non-operative management or physiotherapy’.
However, Dr Gothelf eventually did operate on 2 May 2017. By 8 November 2017 Dr Gothelf reported, ‘Kylie is now 6.5 months since left ankle arthroscopy and open stabilisation. The ankle is stable but she still has ongoing pain, related to CRPS. She is under pain management for this. She feels the knots from the surgery in her lateral ankle. These can be removed with surgery easily, but I would be hesitant to do so now with the CRPS’.
Finally 8 May 2018 Dr Gothelf noted there was pain management and physiotherapy continuing. Assessment of CRPS-1. This affects the left lower extremity. There is full range of motion of all the joints of the right lower extremity.
Once an assessment has been completed in the left lower extremity, the combined range of motion loss of all the joints in the left lower extremity are combined with the value for sensory deficit or pain where I found a category 3 which is described at Table 16-10 Page 22 ‘distorted superficial tactile sensibility (diminished light touch and two-point discrimination) with some abnormal sensations or slight pain that interferes with some activities. Sensory deficit range is 26% to 60% and here the maximum is 60% lower extremity is the value for sensory deficit in this instance. For range of motion loss in the joints of the left lower extremity, refer AMA 5 Page 537 Table 17-9 hip motion impairment.
Table 17-10 knee impairment.
Table 17-11 and table 17-12 for ankle and hind foot and finally table 17-14 for toe impairments.
| Left Hip | Range of Motion | Percentage Impairment |
| Internal Rotation | 20° | 5% Lower Extremity |
| External Rotation | 30° | 5% Lower Extremity |
| Abduction | 20° | 5% Lower Extremity |
| Adduction | 10° | 5% Lower Extremity |
| Flexion | 50° | 10% Lower Extremity |
| Extension | 10° | 5% Lower Extremity |
Total Left Hip: 35% lower extremity.
Left Knee
Flexion 80° equals 10% lower extremity.
Left Ankle/Hind Foot
Dorsiflexion 0 equals 7% lower extremity.
Plantar flexion 20 degrees, 7% lower extremity.
Hind foot eversion 0 equals 2% lower extremity.
Hind foot inversion 10 degrees equals 2% lower extremity.
By addition there is an 18% lower extremity.
Ankle and hind foot values are added due to the complex nature of the joint, total 18% lower extremity left ankle and hind foot.
I consider scarring at the left ankle as routine non-complicated surgical scarring, not therefore carrying an impairment rating under TEMSKI table.
Reference Table 17-14 toe impairment, left great toe metatarsophalangeal joint extension 45 degrees equals 0% lower extremity.
Left great toe interphalangeal joint flexion 10 degrees equals 2% lower extremity. Lesser toes metatarsophalangeal joint extension 30 degrees equals 0% lower extremity. The values are now combined for all the joints of the left lower extremity from the relevant impairment tables at page 537. The combination is that of 35 with 18 with 10 with 2 for hip, ankle, knee and foot expressed as lower extremity. The combination gains 53% lower extremity which then combines with 60% lower extremity for sensory deficit and pain, that gains 81% lower extremity which converts to 32% WPI. The 32% WPI combines with 5% WPI for the lumbar spine gaining a 35% WPI total value.
The above paragraph is repeated again at the conclusion of this report.
Assessment of CRPS-1 left lower extremity, reference Table 17.1 at Page 81, it is noted from Page 80 that the criteria met that is:
1.Continuing pain which is disproportionate to any causal event.
2.The claimant reports at least one symptom in each of the following categories:
·Sensory: Reports hyperaesthesia and also allodynia. She dislikes the examiner touching the sensitive limb and also reports hyperaesthesia to touch.
·Vasomotor: Reports coolness left foot in contrast to coldness right foot.
·Sudomotor/oedema: Reports oedema left foot and toes with swelling. She reports temperature increase in the left foot.
·Motor/trophic: Reports decreased range of joint motion in the joints of the left lower extremity. Reports tremor left foot and leg, reports decreased range of joint motion.
3.The claimant does display at least one sign at time of evaluation in all of the following four categories.
·Sensory: There is evidence of hyperalgesia to pinprick. This is seen when using the Neurotip pinprick device around the left lower leg including around the ankle and foot. There is hypersensitivity to the pinprick, that is hyperalgesia. There is also allodynia to light touch to the leg.
There is also deep somatic pressure and joint movement sensitivity. With deep somatic pressure to the left calf, there is a pain reaction and evident marked discomfort at left calf.
·Vasomotor: There is evidence of temperature asymmetry and also asymmetric skin colour changes. A purplish blotchy appearance occurs in the skin colour left lower leg. The left foot is cool compared with the cold right foot.
·Sudomotor/oedema: There is evidence of sweating asymmetry with sweating on the sole of the left foot with dampness of the white cotton socks worn on the left foot. There are blotchy asymmetric skin colour changes left lower leg and foot.
·Motor/trophic: There is the evidence of decreased active range of joint motion found on the clinical examination of all the joints of the left lower extremity. There is also motor dysfunction, namely a tremor which developed as the left lower limb is lifted from the floor and flexed forwards.
4.There is no other diagnosis that better explains the signs and symptoms.
Then consider following the assessment CRPS:
·If the criteria in each of the sections 1, 2, 3 and 4 and table 17.1 above are satisfied, the diagnosis of CRPS may be made and it is made on this occasion as the criteria are all satisfied.
·I have rated the extremity impairment for loss of motion in each individual joint involved and that is a combination of hip 35% lower extremity, ankle and hind foot 18% lower extremity, knee 10% lower extremity and toes 2% lower extremity. The total combined value for range of motion loss is 53% lower extremity. That is combined with 60% lower extremity for sensory deficit and pain and the combination of 60 with 53 gains 81% lower extremity. This 81% lower extremity gains 32% WPI; 32% WPI combines with 5% for lumbar spine gains 35% WPI.
2. Additional history since the original medical assessment certificate was performed.
This is referred to above.
3. Findings on clinical examination.
Findings are detailed above.
4. Results of any additional investigations since the original medical assessment certificate.
There were no additional investigations.”
The Appeal Panel adopted the report and findings of Dr Stephenson.
Accordingly, the Appeal Panel will revoke the MAC and issue a new certificate certifying 35% WPI as a result of the injury on 3 February 2015.
For these reasons, the Appeal Panel has determined that the MAC issued on 17 May 2022 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: | W6102/21 |
Applicant: | Kylie Hammond |
Respondent: | Secretary, Department of Communities and Justice |
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 Dr Tim Anderson 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. Left Lower Extremity | 3/2/15 | Ch 17, | Ch 8 | 32 | 0 | 32 |
| 2.Lumbar Spine | 3/2/15 | Ch 4, | Ch 15, | 5 | 0 | 5 |
| Total % WPI (the Combined Table values of all sub-totals) | 35% WPI | |||||
0