State of New South Wales (Murrumbidgee Local Health District) v Tyrell (Clarke) - [2021] NSWPICMP 158

DETERMINATION OF APPEAL PANEL
CITATION:	State of New South Wales (Murrumbidgee Local Health District) v Tyrell (Clarke) [2021] NSWPICMP 158
APPELLANT:	State of New South Wales (Murrumbidgee Local Health District)
RESPONDENT:	Patricia Tyrell (Clarke)
APPEAL PANEL:	Member Paul Sweeney Dr Roger Pillemer Dr Mark Burns
DATE OF DECISION:	1 September 2021
CATCHWORDS:	WORKERS COMPENSATION- Parties refer left lower limb/left leg at or above the knee for assessment resulting from an 1996 injury without identifying site of injury; employer appeals from certification by Medical Assessor (MA) of WPI and loss of efficient use of the leg at or above the knee resulting from hip injury; applicant’s statement and medical evidence contain no reference to left hip injury; previous medical examinations of the hip exclude injury; Skates v Hills Industries Ltd considered; Held - there will generally be no error by an MA when his findings and certification are consistent with the Referral; in the circumstances of this case, there was compelling evidence that the applicant’s hip impairment did not result from the 1996 injury; certification of WPI for left hip set aside; certification of loss of efficient use of left leg at or above the knee confirmed; new MAC issued.

BACKGROUND TO THE APPLICATION TO APPEAL

On 6 April 2021, the State of New South Wales (Murrumbidgee Local Health District) (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor (MA, formerly an Approved Medical Specialist). The medical dispute was assessed by Dr Tim Anderson, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on11 March 2021.
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,
· 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, 4^th ed 1 April 2016 (the Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5^th ed (AMA 5).

RELEVANT FACTUAL BACKGROUND

Rose Tyrrell (the respondent) suffered injury in the course of her employment as a nurse with the appellant at the Griffith Base Hospital on 19 September 1996. On that day, she slipped on a concrete pathway and fell on her left side. She made a claim for compensation on the appellant and was paid weekly compensation and medical expenses during her absences from work.
In 2002, the respondent made a claim for lump sum compensation pursuant to s 66 of the Workers Compensation Act 1987 (the 1987 Act). That claim was settled on 15 October 2003.The Short Minutes of Order in Matter No 11128/02 in the former Compensation Court provide that the appellant pay the respondent the sum of $3,000 for 5% permanent impairment of her back, $3,200 for 8% permanent impairment of her neck, $3,750 for 5% loss of use of her left leg at or above the knee, $1,500 for 2% loss of use of her right leg at or above the knee, and $3,750 for 5% loss of efficient use of her left dominant arm at or above the elbow. The respondent worker was also paid compensation for pain and suffering pursuant to the former s 67.
On 15 October 2019, the respondent’s solicitors advised the appellant’s insurer that her condition had deteriorated and that she wished to make a further claim for lump sum compensation pursuant to s 66. That letter enclosed a report of Dr Giblin, an orthopaedic surgeon, dated 24 September 2018 on which the claim for further compensation was founded.
Dr Giblin assessed the respondent’s losses and impairments pursuant to the Table of Disabilities in respect of injuries prior to 1 January 2002 and also assessed permanent impairment for the purposes of a threshold dispute. In respect of losses and impairments pursuant to the Table of Disabilities, he assessed the following:
(a)    20% permanent impairment of her neck;
(b)    20% permanent impairment of the back;
(c)    12.5% permanent loss of efficient use of the left leg above the knee taking into account all symptoms in the left leg as a whole;
(d)    10% permanent loss of efficient use of her right leg above the knee taking into account all symptoms in her right leg as a whole; and
(e)    15% loss of efficient use of the left arm at or above the elbow taking into account all symptoms in the left arm as a whole.
In respect of permanent impairment, he assessed the following:
(a)    Right and left lower extremities (knees) 2% whole person impairment (WPI).
(b)    Left upper extremity 5% WPI (in respect of an injury to her shoulder).
(c)    Lumbar spine 5% WPI.
(d)    Cervical spine 8%WPI.
On the combined tables these gave rise to a total of 21% WPI.
Dr Doig, an orthopaedic surgeon, saw the respondent at the request of the appellant’s solicitors on 13 December 2019 and prepared a report of 7 January 2020. Dr Doig commented that he was not provided with medical evidence relating to the respondent’s treatment over the years. However, he diagnosed:
“Soft tissue injuries to the neck, lower back and left shoulder on a background of very early degenerative changes in her neck and lower back on the initial imaging in 2007”.
He assessed permanent loss and loss of efficient use pursuant to the Table of Disabilities as follows:
(a)    Neck: 20%
(b)    Back: 20%
(c)    Left leg: 10%
(d)    Right leg: 5%
(e)    Left arm: 15%
In respect of permanent impairment, he assessed 7% WPI of the cervical spine, 5% of the lumbar spine and 10% of the left upper extremity as a result of the injury to her left shoulder. That gave rise to a combined figure of 20% WPI.
The presumed difference of opinion as to WPI between Dr Giblin and Dr Doig gave rise to a medical dispute as that term is defined in s 319 of the 1998 Act. Accordingly, the Registrar of the former Workers Compensation Commission referred the dispute to a MA.
The Amended Referral, which is dated 28 January 2021, referred the dispute for assessment in respect of an entitlement under the Table of Disabilities and for a threshold dispute in accordance with the permanent impairment regime in force for injuries after 31 December 2002. In respect of the Table of Disabilities, the referral was made as follows:
“Neck, Back, Left leg at or above the knee, Right leg at or above the knee, Left arm at or above the elbow.”
In respect of WPI, the referral was made as follows:
“Cervical Spine, Lumbar spine, Left Upper Extremity, Right Lower extremity, Left Lower extremity.”
On 11 March 2021, Dr Anderson issued a MAC in which he found that the respondent had the following losses and impairments pursuant to the Table of Disabilities:
Neck: 20%;
Back: 20%;
Left leg at or above the knee: 15%;
Right leg at or above the knee: 5%, and
Left arm at or above the elbow: 15%.
In respect of WPI, he assessed the respondent as follows:
Cervical spine 7% WPI;
Lumbar spine 5% WPI;
Left upper extremity 5% WPI, and
Left lower extremity 8% WPI.
It is from the assessment of the respondent’s left lower extremity, insofar as it was based on an injury to her hip that the appellant appeals.

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.
As a result of the preliminary review, the panel determined that it was unnecessary for the worker to undergo a further medical examination. Neither party sought a further examination by a medical practitioner who was a member of the panel. The appellant’s submissions did not criticise the manner in which the MA carried out his physical examination. Rather, it contended that the medical dispute between the parties did not extend to the respondent’s left hip.
As the panel considered that the recent decision of the Court of Appeal in Skates v. Hills Industries Ltd [2021] NSWCA 142 (14 July 2021) (Skates) was relevant to the issues on the appeal, it issued a Direction inviting both parties to make submissions as to the application of the reasoning in Skates to the circumstances of this case.

EVIDENCE

The appeal panel has before it all the documents which were sent to the MA 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 MA which are relevant to the appeal are set out in the body of this report.

SUBMISSIONS

Both parties made written submissions. They are not repeated in full but have been considered by the panel.
In summary, the appellant submitted that the MA erred in assessing loss of efficient use of the respondent’s left leg at or above the knee and WPI of her left lower extremity on the basis of an injury to her left hip in 1996. The submission continued:
“The respondent (appellant) submits that the applicant’s (respondent’s) injuries to her bilateral lower extremities pertain to her knees, not her hips.
That is the body part that was assessed by Dr Giblin for the Worker and Dr Doig for the employer when they assessed the worker. The Appellant Employer submits there simply has never been a claim for a hip injury. The prior compensation payable in respect of the lower extremities was in respect of the knees, not the hips.”
The appellant argued that the respondent’s statement was “silent” in respect of an injury to the left hip and that complaints in respect of her left leg were “limited to her left knee”. It also argued that Dr Giblin found a “normal” range of movement of her left hip on 24 September 2018, which suggested that the restriction of movement found by the MA at the left hip was unrelated to the subject injury. The submission continues:
“There is no report of, or evidence of any injury to the hips arising out of the claimed injury in 1996 that was before the AMS. It is therefore submitted that Dr Anderson applied incorrect criteria in assessing impairment arising from the left hip in relation to the claimed injury.”
In the alternative, the appellant submitted that Dr Anderson erred in failing to make a deduction pursuant to s 323 of the 1998 Act in respect of a pre-existing medical condition of the left hip.
Several aspects of the respondent’s submissions are difficult to relate to the circumstances of this case. Nonetheless, she submitted that the MA was required to “undertake a clinical assessment in accordance with her presentation on the day”. This, “evidently included reduced movement in the hip”. That was sufficient to permit the MA to assess impairment/loss of efficient use of the left leg/left lower limb arising from a hip injury without falling into error.
The respondent then dealt with the appellant’s submission that the MA erred in failing to make a deduction pursuant to s 323 of the 1998 Act. She argued that:
“The report provides no indication of any other factor in the claimant’s presentation and symptoms and therefore affords no basis of a deduction in accordance with s 323 of the Workplace Injury Management and Workers Compensation Act.”
By its further submissions in respect of the applicability of Skates, the appellant argued that the nature and extent of a “medical dispute” as that term is defined in s 319 of the 1998 Act can be ascertained from the correspondence between the parties setting out their respective positions in respect of impairment and the medical evidence underlying that correspondence. After quoting extensively from the decision, the appellant submitted that:
“The decision in Skates supports its primary submission, in that the AMS, (as he then was) fell into error in including the left hip in his assessment of the Worker’s whole person impairment.”
By her submission, the respondent sought to distinguish the facts in Skates from those in the instant case. In Skates, the parties had sought to confine the claim to certain body parts and this was reflected in the Referral. The MA had assessed body parts which were clearly outside the scope of the referral. The respondent continued:
“By contrast the terms of the referral of the worker’s injuries are as set out in the MAS (sic) report. Importantly the body parts nominated to be referred are “neck, back, left arm at or above the elbow, right leg at or above the knee, left leg at or above the knee” and “cervical spine, lumbar spine, left upper extremity, right lower extremity, left lower extremity.”
As can be seen from the above, the Referral in this case did not seek to confine the assessment in a manner similar to the referral in Skates.
The respondent also submitted that Dr Giblin had provided an assessment in respect of each leg, for the purposes of the Table of Disabilities, “taking into account all symptoms of the leg as a whole”. The respondent continued:
“The terms of the referral were known to the appellant. The appellant had the opportunity at the time of making the referral, and indeed afterwards to the Registrar to seek to confine the body parts being referred. It did not do so.”
The failure to confine the claim was “inexplicable” and to now seek to appeal the determination of the MA was equally “inexplicable”.
Finally, the respondent reiterates that the body parts referred in this case were “unconfined”. Moreover, the referral, unlike Skates, contained no error and the MA made findings in accordance with the referral.

FINDINGS AND REASONS

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.
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 panel has only considered those grounds specifically raised by the appellant in her application.
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 MA 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 medical assessment certificate is binding.

In considering the submissions of the appellant, it is necessary to bear in mind the nature of the statutory obligation of the MA to provide reasons. It is evident from reasoning of the High Court of Australia in Wingfoot Australia Partners Pty Limited v Kocak 88 ALJR 52 (Kocak) that it is only necessary for the MAC to explain the actual path of reasoning of the MA in sufficient detail to enable a court or an appeal panel to determine whether there is error in its findings. In Kocak, 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.”

The reasoning in Kocak has been applied to medical assessments under the NSW Workers Compensation legislation: see, for example El Masri v Woolworths Ltd [2014] NSWSC 1344 (26 September 2014).
The MA summarised the respondent’s injuries and diagnoses as follows:
“Mrs Clarke sustained a severe fall just after mid-September 1996. This resulted in a multiplicity of mild to moderate injuries at that stage. There were no fractures, although she sustained severe bruising and jarring affecting her neck, back, both legs and her left shoulder complex.”
The MA did not specifically record that the respondent suffered an injury to her hip at the time of the fall or specify the nature of such an injury. However, on his examination, he recorded that she had reduced flexion, internal and external rotation of the hip which gave rise to an 8% WPI. He referred to the reports of Dr Patrick of 15 August 2003, Dr Giblin of 24 September 2018 and Dr Doig of 7 January 2020, but did not comment as to why his opinion in relation to an impairment at the hip was different to the findings and opinions expressed in those reports.
It has been accepted by medical appeal panels that the nature of the medical dispute referred to an MA for assessment is to be determined by the Referral and not by the Application to Resolve a Dispute or any antecedent document related to the litigation between the parties. This approach is of ancient lineage. On 6 February 2006, in Denny Collins Wholesalers Pty Ltd v Anastasia Papstamatakis [2006] NSWWCCMA 016, the appeal panel stated the following:
“we feel that we should point out that the Appellant’s submissions seem to be based upon a misapprehension that matters referred to the AMS are done so upon what appears in the Application to Resolve a Dispute. That is not the case at all. The practice has been in the Commission for matters which claim benefits pursuant to s 66 and/or s 67 of the 1987 Act to be referred for a telephone conference prior to them being referred. It is at the telephone conference where the matters to be decided by the AMS are finalised. In this case the referral was made on 8 March 2005 by an arbitrator following a telephone conference in which both parties were represented and at which no application was made to have the matter referred for arbitral decision as to injury causation, s 9A or any other preliminary matter which is in the province of the arbitral jurisdiction.
The appellant complains that the AMS has made decisions as to injury dates and body parts that are not consonant with the pleadings in the application to resolve a dispute. However, a perusal of the terms of the arbitral referral demonstrate that the AMS has confined herself to the dates therein referred to and the body parts therein referred to as well. The respondent was represented as appears from the face of the referral and any objection as to the relevant date or part of the body to be examined should then have been raised.”

In this case, as far as the panel is aware, there was no telephone conference conducted by a Member of the Commission prior to the referral of the matter for medical assessment. The parties, however, were able to view the Referral document and request that it be amended if it failed to reflect the medical dispute between them. In the event of a disagreement, the Commission could refer the matter to a Member to resolve the dispute and determine the terms of the referral of the matter to an MA.
It is true as the respondent argues that the MAP in Skates held that the medical dispute must be determined by the MA in accordance with the Referral. In going outside the referral in that case, the MA erred. Both the trial judge and the Court of Appeal, by majority, upheld this aspect of the determination of the MAC. Nonetheless, aspects of the reasoning in Skates are inconsistent with the previous approach to the status of Referrals. At [48], Leeming JA said this:
“The paperwork associated with the administration of the legislation seems to have led to a tendency to give to the document comprising the ‘referral” to an approved medical specialist a greater status than it warrants.”
And at [50], he stated:
“The foregoing substantially corresponds with the first explanation given by Basten JA for confirming the correctness of the result reached by the Appeal Panel and the primary judge, with a heavier emphasis upon the purpose of the statutory regime being to resolve a medical dispute and that a dispute is identified by the disputants’ competing claims.”
While the ratio of Skates is elusive, the case does emphasise the importance of the claim for compensation and the pleadings in determining the “medical dispute” between the parties. Patently, in this case the parties did not intend to refer to the Commission or to the MA a medical dispute concerning the respondent’s left hip. A review of the evidence does not leave open any other conclusion. It is also doubtful whether the respondent suffered an injury to her left hip in the subject accident. It is necessary to briefly review some aspects of the evidence.
Dr Patrick, a general surgeon, saw her on 15 August 2003 for the purpose of the previous lump sum claim. He expressed the following opinion in respect of her injuries:
“It is likely that at this time she has sustained a disc injury at the upper lumbar spine and L1/2 and also causation or aggravation/acceleration of low lumbar facet arthropathy. There has also been some neck strain injury with aggravation of spondylosis/uncovertebral arthrosis, and she probably also sustained left knee injury, probably with lateral meniscus injury, probably some twisting at the time and probably lateral compartment articular cartilage damage. On plain x-ray a year ago changes are more medial at the knee.”
Dr Patrick assessed 15% permanent loss of efficient use of the left leg at or above the knee, presumably to reflect his finding of knee injury. Dr Patrick did not assess an injury to the left hip and no claim was made for such an injury
The present claim is based upon an assessment pursuant to the Table of Disabilities and in respect of WPI by Dr Giblin. While the appellant asserts that Dr Giblin found that the respondent’s left hip was normal when he examined her for the purposes of his report of 24 September 2018, that report is not in evidence in these proceedings. However, it is clear from the report that is in evidence that Dr Giblin did not opine that the respondent suffered impairment of her left lower extremity at the hip. Rather, he assesses 2% WPI resulting from an injury to her knee. There is no other assessment of the left leg.
When Dr Doig examined the respondent on 13 December 2019 for the purposes of the present claim, he found that her hip examination “was satisfactory”. He did not assess an injury to the left hip.
Thus, the medical dispute between the parties crystalised on the basis of two medical reports, neither of which asserted that the respondent had an injury to the left hip or WPI resulting from such an injury. This is consistent with the injury description under the heading “Injury Details” in the Application to Resolve a Dispute. It records injuries to the respondent’s:
“back, neck, R shoulder, L knee”
It is not alleged that the respondent suffered an injury to her left hip.
Similarly, as the appellant argued, the respondent worker’s statement makes no reference to an injury to her left hip. By her undated statement, the respondent said:
“In 1996 I had a fall at the Griffith base hospital landing heavily on concrete and injured my back, neck, right shoulder and left knee.”
The respondent relates that she was involved in a motor vehicle accident which aggravated her injuries and that the work which she has been performing since 2003 aggravated her “back and neck conditions primarily as well as my left and right knees.”
Irrespective of the true ratio in Skates, a MA who certifies WPI or impairments and losses pursuant to the Table of Disabilities will generally not fall into error if his findings and assessments are within the body parts set out in the Referral document. In Merza v
Registrar of the Workers Compensation Commission and Anor Anor [2006] NSWSC 939 (14 September 2006), Hoeben J said:

“it is sufficient for the purposes of this matter that I conclude that ‘demonstrable error’ is readily apparent from an examination of the medical assessment certificate and the document referring the matter to the AMS for assessment.”

It must follow from this reasoning that it if an MA correctly certifies WPI for the body parts referred there can be no demonstrable error or the application of incorrect criteria. That is so even if the body parts referred are not those in dispute between the parties. It remains necessary, however, for the MA to determine the matter on the basis of the evidence before him.
The respondent’s evidentiary statement does not assert that she suffered an injury to the left hip in her fall in 1996. There is no other evidence in the material put into evidence that she suffered a hip injury. Neither Dr Patrick nor Dr Giblin, whose evidence is discussed above, find an injury to the hip or assess permanent impairment of the left hip. The MA does not explicitly record that the respondent told him at the consultation that she sustained an injury to the left hip in the fall. If there is no evidence of a hip injury a finding that hip impairment resulted from that injury must constitute an error.
If the MA took a history of a left hip injury it would be necessary for him to reconcile that history with the other conflicting evidence including the respondent’s statement. In the circumstances of the case, some explanation would have to be given of why the injury had not been previously addressed in the evidence gave rise to an impairment. In the absence of some explanation, the MA has not explained the actual part of the reasoning by which he concluded that there was, contrary to the other evidence, a left hip injury and an impairment resulting from that injury. That, of course, is an error in accordance with the reasoning in Kocak.
Obviously, it is common for persons of the respondent’s age to experience hip symptoms. The previous examinations of the hip referred to in the evidence and the radiological evidence, however, are not consistent with a conclusion that the respondent’s hip symptoms result from injury in 1996. The examination of Dr Doig, an orthopaedic surgeon, in 2020 did not reveal hip symptoms. It seems likely that the examination of Dr Giblin was to the same effect. It seems highly improbable that hip symptoms which arose between these examinations and the date of the MAC had any causal connection with the applicant’s injury in 1996.
In the circumstances, the panel is of the opinion that the MA erred in certifying that there was impairment of the left hip resulting from injury. Either there was no evidence to support such a finding or the MA gave no reasons as to why his finding was so dramatically different to all the other evidence.
It follows that the finding of the MA in respect of WPI of the left hip must be set aside. The finding of loss of efficient use of the left leg at or above the knee, however, involves different considerations. The respondent suffered an injury to her left knee which all of the specialist medical practitioners accept causes loss of efficient use of that leg. The respondent also has a back injury which may interfere with the efficient use of left leg. In those circumstances, it is impossible to ascertain what part of the percentage loss of efficient use of the leg the MA attributed to her hip injury. It follows that the panel is unable to identify error in his determination of loss of efficient use of the left leg.
For these reasons, the appeal panel has determined that the MAC issued on 22 February 2021 in respect of injuries received after 1 January 2002 should be revoked, and a new MAC should be issued. The new certificate is attached to this statement of reasons. The MAC issued on 22 February 2021 for injuries received before 1 January 2002 is confirmed.

PERSONAL INJURY COMMISSION

APPEAL PANEL
MEDICAL ASSESSMENT CERTIFICATE

Injuries received after 1 January 2002

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 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)
Cervical spine	19/09/96	Chap 4 P24	P392 T15-05	7%	0	7%
Lumbar Spine	Chap 4 P24	P384 T15-03	5%	0	5%
Left Upper Extremity	Chap 2 P10	P 476 F16-40 P 477 F16-43 P 479 F16-46 P 439 F16-03	5%	0	5%
Right Lower Extremity	0%	n/a	0%
Left Lower Extremity	0%	n/a	0%
Total % WPI (the Combined Table values of all sub-totals)					16%

Paul Sweeney
Member
Dr Roger Pillemer

Medical Assessor

Dr Mark Burns
Medical Assessor

1 September 2021