Sun v State of New South Wales (Sydney Local Health District)

DETERMINATION OF APPEAL PANEL
CITATION:	Sun v State of New South Wales (Sydney Local Health District) [2021] NSWPICMP 95
APPELLANT:	Yun Sun
RESPONDENT:	State of New South Wales (Sydney Local Health District)
APPEAL PANEL:	Member Carolyn Rimmer Dr John Dixon- Hughes Dr John Garvey
DATE OF DECISION:	21 June 2021
CATCHWORDS:	WORKERS COMPENSATION- Assessment of lumbar spine, right lower extremity and digestive tract by Medical Assessor (MA); Medical Assessor assessed the appellant as DRE I but found reduced sensation in the L5 Dermatome region and the clinical history and examination findings were consistent with a specific injury; Held-Panel concluded that the appellant fell into DRE II and assessed 6% WPI in respect of the lumbar spine; MAC revoked.

STATEMENT OF REASONS FOR DECISION OF THE APPEAL PANEL IN RELATION TO A MEDICAL DISPUTE

BACKGROUND TO THE APPLICATION TO APPEAL

On 8 April 2021 Yun Sun (the appellant) made an application to appeal against a medical assessment (the appeal) to the Personal Injuries Commission (the Commission). The medical assessment was made by Dr Richard Crane, Medical Assessor (the MA) and issued on 11 March 2021.
The respondent to the appeal is the State of New South Wales (Sydney Local Health District).
The matter became a matter within the Workers Compensation Division of the Personal Injury Commission by operation of the Personal Injury Commission Act 2020 (the 2020 Act), from 1 March 2021. The 2020 Act amended certain parts of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act). Relevantly, the Approved Medical Specialist in the former Workers Compensation Commission became Medical Assessors in the Personal Injury Commission. However, as at the time when the MAC was issued, Dr Crane bore the title of Medical Assessor and in this decision will be referred to by his title “Medical Assessor”.
The appellant relies on the following grounds of appeal under s 327(3) of the 1998 Act:
· the assessment was made on the basis of incorrect criteria.
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 reissued 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

In these proceedings, the appellant is claiming lump sum compensation in respect of an injury to the lumbar spine, right lower extremity (knee), and upper digestive tract as a result of the injury on 2 August 2011.
In the Certificate of Determination – Consent Orders dated 20 October 2020 Arbitrator McDonald remitted the matter to the Registrar to be placed in the Approved Medical Specialist pending list. Arbitrator McDonald ordered:
“5. The referral is in respect of:
Body parts: Lumbar spine, right lower extremity (knee), upper digestive tract.
Date of injury: 2 August 2011
Method of assessment: Whole person impairment.”

In the Referral for Assessment of Permanent Impairment to Approved Medical Specialist dated 20 November 2020, the matter was referred to the MA, Dr Richard Crane, for assessment of whole person impairment (WPI) of the lumbar spine, right lower extremity (knee) and upper digestive tract with date of the injury being 2 August 2011.
The MA examined the respondent on 18 December 2020 (telephone conference) and 8 February 2021(examination). He assessed 0% WPI of the lumbar spine, 3% WPI of the right lower extremity and 2% of the upper digestive tract. Therefore, the total assessment was 5% WPI in respect of the injury on 2 August 2011.

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 requested that he be re-examined by a MA, who is a member of the Appeal Panel.
As a result of that preliminary review, the Appeal Panel determined that it was not necessary for the worker to undergo a further medical examination because there was sufficient evidence on which to make a determination.

EVIDENCE

Documentary evidence

The Appeal Panel has before it all the documents that were sent to the Medical Assessors for the original medical assessment and has taken them into account in making this determination.

Medical Assessment Certificate

The parts of the medical certificates given by the Medical Assessors 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.
The appellant‘s submissions included the following:
·        The MA declined to or failed to correctly apply the Diagnosis-Related Estimates (DRE) categories with regard to the lumbar spine. Had the MA determined the applicant's lumbar spine condition was DRE II, a 5% WPI assessment would have applied. Further, there should be an additional 1-2% for Activities of Daily Living (ADL), resulting in no less than 6% WPI. When combined with the 3% for the right lower limb and 2 % for the upper digestive tract, the overall assessment would be greater than 10% WPI.

·        The MA during his examination of the appellant at Part 5 of the MAC recorded the following:
(a)There was no deformity but there was a complaint of slight tenderness to the right of the lumbosacral area.

(b)There was no localised tenderness and range of motion in all directions of flexion, extension, lateral bending and rotation was reduced symmetrically by approximately one-third from the expected normal.

(c)Straight leg raising was 40° on the right and 30° on the left with a negative sciatic nerve stretch test.

(d)Mid-thigh circumference was 43 cm on the right and 42 cm on the left.

(e)Maximal calf circumference was 36 cm on the right and 35 cm on the left.

(f)Sensation was described as slightly reduced below the knee on the lateral side of the leg, and the dorsum of the foot.

(g)Muscle power, tone and reflexes were normal in the lower extremities.

(h)The back showed a 9 x 6 cm rectangular patch of discolouration in the left lower region, which was described as a patch of Chinese herbal nature used for the pain.

·        The MA concluded at Part 10.A of the MAC that the examination of the lumbar spine did not show any evidence of dysmetria, muscle spasm or guarding, or suggestion of radiculopathy, for which reason it was found to be DRE I with 0% WPI.

·        The MA's conclusion was incorrect as he failed to consider his own objective findings upon examination which best fit DRE II.

·        The MA's findings on examination were noted above included a reduction in range of motion in all directions by 1/3 and a complaint of tenderness, albeit slight. Further the scans (MRI reports dated 10 March 2013 and 25 January 2015) of the appellant's lumbar spine indicated below showed clear alteration of the structural integrity of the spine.

·        The MA fell into error by failing to consider or properly consider the radiology reports.

·        The MA failed to consider the significant finding of Dr Pillemer (who assessed DRE III ) who expressed the opinion that the appellant has evidence of radiculopathy involving his left lower limb as a result of a disc lesion at the L4/5 level of his low back.

·        The MA determined the matter on incorrect criteria.
The respondent’s submissions include the following:
·        It was open to the MA to assess the appellant as DRE I based on his examination and findings. The MA clearly considered the medical evidence before him, including the various radiology reports and the report of Dr Pillemer.

·        The appellant cavils with the findings of the MA, rather than identifies any objective error in his application of the DRE categories.

·        The appellant did not identify a basis for re-examination nor is there a right of re-examination in the event that there are no errors made by the MA.

·        The criteria required to satisfy DRE I were: (a) no significant clinical findings; (b) no observed muscle guarding or spasm; (c) no documentable neurologic impairment; (d) no documented alteration in structural integrity; (e) no other indication of impairment related to injury or illness , and (f) no fractures.

·        The appellant submitted the only criteria under DRE I that he satisfied were no neurological impairment and no fractures. The respondent contests this submission.

·         At page 3 of the MAC under “Lumbar Spine”, the MA recorded his findings on examination as follows:
“There was no deformity but there was a complaint of slight tenderness to the right of the lumbosacral area. There was no localised tenderness and range of motion in all directions of flexion, extension, lateral bending and rotation was reduced symmetrically by approximately one-third from the expected normal.”

·        At page 4 of the MAC under “Summary”, the MA recorded that: “There is evidence of a soft tissue injury to the lumbar spine following the work incident on 2 August 2011…”

·        On page 5 under “Reasons for Assessment”, the MA stated that: “The examination of the lumbar spine did not show any evidence of dysmetria, muscle spasm or guarding, or suggestion of radiculopathy, for which reason it has been found to be DRE I with 0% whole person impairment.”

·        In addition to the appellant’s submission that there is no documented neurological impairment and no fractures, the respondent submitted the examination by the MA did not identify any “significant clinical findings”, “no observed muscle guarding or spasm”, and no other “indication of impairment related to the injury”.

·        It was open on the evidence, and appropriate for the MA to assess the appellant as DRE I.

·        In the example in the AMA 5 at page 385, Example 15-1, 0% WPI was assessed for a “minor lumbar strain”. The MA’s diagnosis of a “soft tissue injury” is a similar diagnosis to a “minor lumbar strain”. There were also similarities between the history, symptoms and findings on examination between Example 15-1 and the present matter.

·        The MA’s assessment of DRE I was open to him and consistent with his findings on examination.

·        The appellant did not satisfy the criteria for DRE II.

·        Table 15-3 of AMA 5 outlined the various criteria for an assessment of DRE II, including: (a) clinical history and examination findings are compatible with a specific injury; (b) findings may include significant muscle guarding or spasm observed at the time of the examination, asymmetric loss of range of motion, or non-verifiable radicular complaints, defined as complaints of radicular pain without objective findings; (c) no alteration of the structural integrity, and (d) no significant radiculopathy.

·        The appellant submitted that he satisfied each of the above criteria, other than there being no significant radiculopathy. The respondent contests this submission.

·        The MA’s findings show that the appellant has no muscle guarding or spasm. There was no clinical history or findings that were compatible with a “specific injury” as referenced in Table 15-3 of AMA 5.

·        To understand what is meant by “specific injury”, one is assisted by the example contained in Example 15-2, in relation to DRE II, at page 385 of AMA 5. That example includes a diagnosis of left posterolateral disc herniation L5-S1. The comment on the example also outlines that “this individual had a radiographically confirmed herniated disc.” When one compares the appellant’s injury with the injury in Example 15-2, it is evident that the “specific injury” referred to Table 15-3 requires something more than a “soft tissue injury”.

·        In this matter, radiological scans did not confirm any injury comparable to that in Example 15-2. The lumbar spine MRI of 25 January 2015 (page 81 of Application to Resolve a Dispoute(ARD)) only shows spondylotic change at L4/5, that is, a constitutional degenerative condition. There was no evidence of any direct injury relating to the incident on 2 August 2011 that was comparable to the diagnosis in Example 15-2 of the AMA 5.

·        Paragraph 4.7 of the Guidelines has no application to the present matter, as the MA was able to clearly distinguish between DRE I and II.

·        The MA considered the medical evidence before him, including the radiological reports and Dr Pillemer’s report, and the appellant’s submissions to the contrary were unfounded. At page 4 of the MAC, the MA lists a number of radiological reports, including the reports relating to the lumbar spine, dated 10 March 2013 and 25 January 2015. In the middle of page 6, the MA specifically commented on Dr Pillemer’s report and noted that his examination of the appellant took place about 2.5 years after that of Dr Pillemer and he was unable to confirm Dr Pillemer’s finding of radiculopathy.

·        It was evident that the MA considered the radiological reports and Dr Pillemer’s report.

·        The decision in Western Sydney Local Health District v Chan [2015] NSWSC 1968 held that an AMS is under no legal obligation to discuss any of the materials before them. The Court also held that an AMS’s lack of comment on a particular report does not amount to an inference that they failed to consider it.

·        In any event, the MA provided a reason as to why he disagreed with Dr Pillemer’s findings. As such, the MA clearly discharged his duty to provide reasons for his opinion, as held in Campbelltown City Council v Vegan [2006] NSWCA 284 (Vegan). The Court also found that those reasons need not be extensive.

·        The MAC of MA dated 11 March 2021, should be confirmed.

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 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 the case of Siddik v WorkCover Authority of NSW [2008] NSWCA 116 (Siddik). The Court held that while prima facie the Appeal Panel is confined to the grounds the Registrar has let through the gateway, it can consider other grounds capable of coming within one or other of the section 327(3) heads, if it gives the parties an opportunity to be heard. 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.
Section 327(2) was amended with the effect that while the appeal was to be by way of review, all appeals as at 1 February 2011 were limited to the ground(s) upon which the appeal was made. In New South Wales Police Force v Registrar of the Workers Compensation Commission of New South Wales [2013] SC 1792 Davies J considered that the form of the words used in s 328(2) of the 1998 Act being, ‘the grounds of appeal on which the appeal is made’ was intended to mean that the appeal is confined to those particular demonstrable errors identified by a party in its submissions.

The MAC

Under “History Relating to the Injury”, the MA wrote:
“On 2 August 2011, Mr Sun was moving the operating table in the theatre
when he fell, landing on his left buttock, and knocking his right knee on the table as he fell. He noted pain in the left hip and right knee, and was off work for about two or three months.

He had physiotherapy for six months after the incident and later attended a
gymnasium program, mainly directed towards his lower back and right knee. He was also treated with a TENS machine and prescribed Panadeine, Oxycontin, Mobic and about one month later, Nurofen. Tramadol was also prescribed at a later time.
Due to upper abdominal discomfort, a gastroscopy was carried out in August 2017.”
Under “Findings on Physical Examination” the MA noted:
“LUMBAR SPINE
There was no deformity but there was a complaint of slight tenderness to the right of the lumbosacral area. There was no localised tenderness and range of motion in all directions of flexion, extension, lateral bending and rotation was reduced symmetrically by approximately one third from the expected normal.

Straight leg raising was 40° on the right and 30° on the left with a negative sciatic nerve stretch test.

Mid-thigh circumference was 43cm on the right and 42cm on the left. Maximal calf circumference was 36cm on the right and 35cm on the left.

Sensation was described as slightly reduced below the knee on the lateral side of the leg, and the dorsum of the foot. Muscle power, tone and reflexes were normal in the lower extremities.

The back showed a 9 x 6cm rectangular patch of discolouration in the left lower region, which was described as a patch of Chinese herbal nature used for the pain”.

Under “Details and Dates of Special Investigations”, the MA referred to investigations including an MRI scan of the lumbar spine dated 15 June 2017, MRI scan of the lumbar spine dated 25 January 2015, MRI of the lumbar spine dated 10 March 2013, CT of the lumbar spine dated 19 August 2011 and x-ray of the lumbosacral spine dated 2 August 2011.
Under “Summary” the MA wrote:
“There is evidence of a soft tissue injury to the lumbar spine following the work incident on 2 August 2011 and also a soft tissue injury to the right knee. There has been some upper abdominal discomfort associated with the medications that have been taken, for which treatment has been provided with Somac and Nexium.”

Under “Reasons for Assessment ” the MA wrote:
“…The examination of the lumbar spine did not show any evidence of dysmetria, muscle spasm or guarding, or suggestion of radiculopathy, for which reason it has been found to be DRE I with 0% whole person impairment.
…”

The MA, in commenting on other medical opinion, wrote:
“Medical Report of Orthopaedic Surgeon, Dr Roger Pillemer, on behalf of the
respondent, dated 23 October 2018 finding 12% WPI for the lumbar spine based on his opinion of finding evidence of L5 radiculopathy.

My examination of the claimant took place about 2.5 years after that of Dr Pillemer and I was unable to confirm his finding of radiculopathy.”
The Appeal Panel reviewed the history recorded by the MA, his findings on examination, and the reasons for his conclusions as well as the evidence referred to above. The Appeal Panel accepts the findings on examination that the MA made in the MAC.

Assessment of the lumbar spine

Paragraph 4.18 of the NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4th edition, provides:
“DRE II is a clinical diagnosis based upon the features of the history of the injury and clinical features. Clinical features which are consistent with DRE II and which are present at the time of the assessment include radicular symptoms in the absence of clinical signs (that is non verifiable radicular complaints), muscle guarding or spasm, or asymmetrical loss of range of movement. Localised (not generalised) tenderness may be present. In the lumbar spine, additional features include a reversal of lumbosacral rhythm when straightening from the flexed position and compensatory movement for an immobile spine, such as flexion from the hips. In assigning category DRE II, the assessor must provide detailed reasons why the category was chosen.”

The criteria for lumbar spine category DRE II are set out in Table 15.3 on page 384 of AMA 5. In order to meet the criteria for lumbar category II there must be a clinical history and examination findings compatible with a specific injury. Findings “may” (emphasis added) include significant muscle guarding or spasm, asymmetric loss of range of motion or non-verifiable radicular complaints defined as complaints of radicular pain without objective findings; no alteration of the structural integrity and no significant radiculopathy. Alternatively, DRE II applies if the
“individual had a clinically significant radiculopathy and has an imaging study that demonstrates a herniated disc at the level and on the side that would be expected based on the previous radiculopathy, but no longer has the radiculopathy following conservative treatment.”
The Guidelines at paragraph 4.27 provide:
“Radiculopathy is the impairment caused by malfunction of a spinal nerve root or nerve roots. In general, in order to conclude that radiculopathy is present, two or more of the following criteria should be found, one of which must be major (major criteria in bold):
·     loss or asymmetry of reflexes
·     muscle weakness that is anatomically localised to an appropriate spinal nerve root distribution
·     reproducible impairment of sensation that is anatomically localised to an appropriate spinal nerve root distribution
·     positive nerve root tension (AMA5 Box 15-1, p 382)
·     muscle wasting – atrophy (AMA5 Box 15-1, p 382)
·     findings on an imaging study consistent with the clinical signs (AMA 5, p 382).”
The appellant submitted that the MA declined or failed to correctly apply the DRE categories with regard to the lumbar spine.
The Appeal Panel considered that the mechanism of injury was significant in this case, that being a heavy fall with the appellant landing on his left buttock (Canterbury Hospital ED Discharge Referral 2 August 2011). This injury resulted in him being off work for two to three months. The Appeal Panel considered that the clinical history and examination findings were compatible with a specific injury.
The MA in the MAC stated that the examination of the lumbar spine did not show any evidence of dysmetria, muscle spasm or guarding, or suggestion of radiculopathy and assessed the lumbar spine as DRE I with 0% WPI.
This assessment of the lumbar spine as DRE I and the statement that the examination did not show any suggestion of radiculopathy were inconsistent with the finding by the MA that sensation was described as slightly reduced below the knee on the lateral side of the leg, and the dorsum of the foot. The MA clearly described symptoms in an L5 distribution. This was a significant clinical finding. A finding of reduced sensation below the knee on the lateral side of the leg and the dorsum of the foot was a finding of reduced sensation in the L5 dermatome region which is a major criterion of radiculopathy as set out above in paragraph 4.27 of the Guidelines.
The Appeal Panel concluded that the inconsistency between the findings on examination by the MA and his statement that there was no suggestion of radiculopathy was a demonstrable error and the assessment was made on the basis of incorrect criteria.
Taking into account the finding of reduced sensation in the L5 dermatome region and the fact that the clinical history and examination findings were consistent with a specific injury, the Appeal Panel concluded that on balance the appellant fell into DRE II rather than DRE I. The Appeal Panel assessed 5% WPI in respect of the lumbar spine.
The Appeal Panel then considered the impact of the injury on ADL.
The Guidelines at paragraph 4.33 provide: "... an assessment of the effect of the injury on ADL is not solely dependent on self-reporting, but is an assessment based on all clinical findings and other reports".
The Guidelines at paragraph 4.35 provide:
“The diagram is to be interpreted as follows:

Increase base impairment by:

·3% WPI if the worker’s capacity to undertake personal care activities such as dressing, washing, toileting and shaving has been affected

·2% WPI if the worker can manage personal care, but is restricted with usual household tasks, such as cooking, vacuuming and making beds, or tasks of equal magnitude, such as shopping, climbing stairs or walking reasonable distances

·1% WPI for those able to cope with the above, but unable to get back to previous sporting or recreational activities, such as gardening, running and active hobbies etc.”
The Appeal Panel reviewed the evidence in this matter. The Appeal Panel noted the clinical findings made by the MA, Dr Pillemer and Dr Bodel, Dr Wallace and Dr Sun.
The MA noted that the appellant liked watching TV and reading and regretted that he was no longer able to play tennis or badminton since the injury.
Dr Pillemer, in his report dated 23 October 2018, noted that the appellant could do some surface cleaning and wash up but not for very long. Dr Pillemer added a loading of 2% for ADL.
Dr Bodel, in his report dated 11 January 2016, noted that the appellant struggled with all household maintenance and cleaning activities and any attempt to kneel, squat, climb or bend, twist or lift could aggravate his symptoms. Dr Bodel added a loading of 2% WPI.
The Appeal Panel was satisfied that the appellant was unable to get back to previous sporting or recreational activities and was restricted with usual household tasks.
The Appeal Panel concluded that an assessment of 2% WPI in respect of ADL was appropriate in this case. It follows that an assessment of 7% WPI is made in respect of the lumbar spine.
The next matter to consider was whether a deduction should be made for a pre-existing condition.
The MA noted the following investigations:
“2 August 2011 – X-ray lumbosacral spine reported by Dr M Carmalt noting loss of lumbar lordosis and loss of intervertebral disc height, and bony endplate sclerosis at L4/5.

19 August 2011 – CT scan lumbar spine reported by Dr Andrew Jones noting a non-specific 2cm sclerotic focal bony lesion on the iliac side of the right sacroiliac joint. Advanced degenerative disc changes were noted at the L4/5 disc level.

10 March 2013 – MRI spine reported by Dr Lynette Masters showing spondylotic changes at L4/5 characterised by disc space narrowing and peri-discal osteophyte formation with reactive endplate changes. There was a disc bulge at L4/5 and early facet joint arthrosis but no central stenosis or nerve root compressive features.”
Dr Bodel, in his report dated 11 January 2016, noted that there was no evidence of any pre-existing abnormality or condition which was causing impairment at the time of the accident and expressed the view that there was therefore no basis for a deduction for pre-existing impairment. Dr Bodel noted that the appellant was unaware of the degenerative process that has been demonstrated in the investigations.
Dr Pillemer, in his report dated 23 October 2018, noted that the appellant had a number of investigations carried out of his lumbar spine including an MRI in March 2013 showing disc pathology at the L4/5 level that was longstanding. Dr Pillemer expressed the opinion that the appellant did have longstanding disc degenerative changes at the L4/5 level but was asymptomatic prior to his injury and had worked on a full time basis in an unrestricted fashion. He wrote: “In my opinion then there is no place for making a deduction for pre-existing condition”.
The Appeal Panel concluded that a deduction of one tenth should be made for a pre-existing condition resulting in a WPI of 6.3% which is rounded down to 6% WPI. The Appeal Panel accepted that the appellant was asymptomatic before the injury on 2 August 2011 but the radiological studies showed that the appellant had longstanding degenerative changes in the lumbar spine at L4/5 level in 2011. The Appeal Panel considerd that a one tenth deduction pursuant to s 323(2) was appropriate because the extent of the deduction would be difficult to determine. The Appeal Panel did not consider that a deduction of one tenth was at odds with the evidence.
The AMS made an assessment of 3% WPI in respect of the right lower extremity (knee) and 2% WPI of the upper digestive tract. The Appeal Panel has made an assessment of 6% WPI for the lumbar spine. Therefore, the combined total assessment is 11% WPI.
In summary, the assessment of total WPI by the Appeal Panel was 11% WPI in respect of the injury on 2 August 2011.
For these reasons, the Appeal Panel has determined that the MAC issued on 11 March 2021 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

This Certificate is issued pursuant to s 328(5) of the Workplace Injury Management and Workers Compensation Act 1998.

The Appeal Panel revokes the Medical Assessment Certificate of Dr Richard Crane 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.Lumbar spine	2 August 2011	Chapter 4, Pages 24 to 29	Chapter 15, Page 384, Table 15-3	7%	One tenth	6%
2.Right lower extremity	2 August 2011	Chapter 3, Pages 13 to 23	Chapter 17, Pages 523 to 564	3%	Nil	3%
3.Upper digestive tract	2 August 2011	Chapter 16, Pages 78 to 7	Chapter 6.2, Table 6-3, Page 121	2%	Nil	2%
Total % WPI (the Combined Table values of all sub-totals)					11%

Carolyn Rimmer
Member

Dr John Dixon-Hughes
Medical Assessor

Dr John Garvey
Medical Assessor

[2021] NSWPICMP 95

21 June 2021