Woolveridge v Secretary, Department of Education

[2022] NSWPICMP 78

DETERMINATION OF APPEAL PANEL
CITATION:	Woolveridge v Secretary, Department of Education [2022] NSWPICMP 78
APPELLANT:	Jane Woolveridge
RESPONDENT:	Secretary, Department of Education
APPEAL PANEL:	Member Jane Peacock Professor Nicholas Glozier Dr Michael Hong
DATE OF DECISION:	1 April 2022
CATCHWORDS:	WORKERS COMPENSATION- Psychological Injury; appellant alleged error in the assessment of five categories under the Permanent Impairment Rating Scale (PIRS) namely Self-Care and Personal Hygiene, Social and Recreation Activities, Travel, Social Functioning and Concentration, Persistence and Pace; the Panel could discern no error in the assessments for which clear reasons were given and the ratings accorded with the criteria in the NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment; Held- Medical Assessment Certificate confirmed.

BACKGROUND TO THE APPLICATION TO APPEAL

1. On 16 September 2021 Ms Jane Woolveridge (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr P Morris, a Medical Assessor (MA), who issued a Medical Assessment Certificate (MAC) on 16 September 2021.

2. The appellant relies on the following grounds of appeal under s 327(3) of the Workplace Injury Management and Workers Compensation Act 1998 (1998 Act):

   ·        the assessment was made on the basis of incorrect criteria, and

   ·        the MAC contains a demonstrable error.

3. 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.

4. 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.

5. 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).

PRELIMINARY REVIEW

1. 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.

2. The appellant did not request a re-examination. As a result of it’s preliminary review, the Appeal Panel determined that it was not necessary for the worker to undergo a further medical examination because the Appeal Panel could not find error for the reasons set out further below. Absent error, the Appeal Panel has no power to require the appellant to undergo a further examination: see New South Wales Police Force v Registrar of the Personal Injury Commission of New South Wales [2013] NSWSC 1792.

EVIDENCE

Documentary evidence

1. 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. 

Medical Assessment Certificate

1. 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

1. Both parties made written submissions. They are not repeated in full, but have been considered by the Appeal Panel.

FINDINGS AND REASONS

1. 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.

2. 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.

3. 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):

   §  the degree of permanent impairment of the worker as a result of an injury (s319(c))

   §  whether any proportion of permanent impairment is due to any previous injury or pre-existing condition or abnormality, and the extent of that proportion (s319(d))

   §  whether impairment is permanent (s319(f))

   §  whether the degree of permanent impairment of the injured worker is fully ascertainable (s319(g))

   ·    Date of injury:  21 June 2016

   ·    Body parts/systems referred: Psychiatric/psychological disorder

   ·    Method of assessment:          Whole Person Impairment”

4. The MA issued a MAC certifying as follows:

Body Part or system	Date of Injury	Chapter, page and paragraph number in NSW workers compensation 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)
1.Psychiatric/    Psychological	21 June 2016	Chapter 11, Work Cover Guides	n/a	9%	nil		9%
Total % WPI (the Combined Table values of all sub-totals)						9%

1. The assessment was based on his assessment under the Permanent Impairment rating Scale (PIRS) as required by the Guides as follows:

Table 11.8: PIRS Rating Form

Name	Jane Woolveridge	Claim reference number (if known)	W2287/21
DOB	16 May 1962	Age at time of injury	54 years old
Date of Injury	21 June 2016	Occupation at time of injury	Teaching Principal
Date of Assessment	8 September 2021	Marital Status before injury	Married

Psychiatric diagnosis	Persistent Depressive Disorder with anxious distress.
Psychiatric treatment	Takes medication Efexor-XR 150mg daily.
Is impairment permanent?	Yes

PIRS Category

Class

Reason for Decision

Self care and personal hygiene

2

Mild impairment. Ms Woolveridge is able to live independently.  She does all the cooking for herself and her husband.  She shares the other household chores with her husband.  Her appetite varies from day to day.  She showers and changes her clothes daily.  She is less interested in her personal grooming than previously.

Social and recreational activities

2

Mild impairment. Ms Woolveridge reports being less socially active than previously.  She has lost contact with her teaching friends.  She still attends a craft group for four hours every week and a tai chi and coffee group for one and a half hours every week.  She enjoys attending these groups and socialising with the other women who attend.  She also enjoys looking after a number of animals on her small farm.

Travel

2

Mild impairment.  Ms Woolveridge said she is able to drive by herself to the local village to attend her tai chi and craft groups and to pick up mail.  For longer distances she relies on her husband to drive her because of her anxiety.

Social functioning

2

Mild impairment.  Ms Woolveridge’s relationship with her husband is strained by her symptoms but they remain together with no separations or episodes of domestic violence.  She keeps in regular contact with her brother who lives in Newcastle by telephone.  She said she has lost a number of friendships due to her social withdrawal.

Concentration, persistence and pace

2

Mild impairment. Ms Woolveridge reports reduced concentration. She can concentrate on knitting, crocheting or cross stitching at the craft group for about 30 minutes at a time.  There were no short-term memory or concentration impairments present on testing at the assessment.

Employability

4

Severe impairment.  Ms Woolveridge is working around her farm for two hours on each day of the week, which amounts to 14 hours per week.  However, this is a non-stressful work environment where she can manage at her own pace and is not subject to any external pressures.  I believe that in a normal work environment she would only be able to work one or two days at a time, less than 20 hours per fortnight, with likely reduced pace and erratic attendance as a result of her symptoms of anxiety and depression.

Score class             Median

2 2 2 2 2 4 =2

Aggregate score         Total %

+2 +2 +2 +2 +2 +4 =14

Impairment Percentage WPI from table 11.8:	7%
Adjustments for effects of treatment:	2%
Final Impairment % WPI:	9%

1. The worker appealed.

2. In summary the appellant submitted that the Medical Assessor erred in his assessment under five of the six categories of PIRS as follows:

   (a)    Self-care and Personal Hygiene when he assessed a Class 2 and a Class 3 should have been assessed;

   (b)    Social and Recreational activities when he assessed a class 2 and a Class 3 should have been assessed;

   (c)    Social Functioning when he assessed a Class 2 and a Class 3 should have been assessed;

   (d)    Travel when he assessed a class 2 and a class 3 or class 4 should have been assessed, and

   (e)    Concentration, persistence and pace when he assessed a class 2 and at least a class 3 should have been assessed.

3. There was no complaint on appeal about the assessment by the MA of Class 4 for employability.

4. In summary, the appellant submitted that these errors occurred because the MA has not made assessments in accordance with the Guidelines and in particular the MA has:

   (a)    failed to consider the worker’s cultural background (clause 11.12);

   (b)    failed to consider activities that are usual for the worker’s age, sex and cultural norms (cluse 11.12);

   (c)    failed to take into account all of the information about the worker’s functioning and limitation (clause 11.6);

   (d)    rigidly applied the examples contained in the PIRS as a type of checklist without considering the whole of the evidence before him (clause 11.6 and 11.12);

   (e)    failed to exercise clinical judgment (clause 1.6b);

   (f)    failed to take into account variations in the level of functioning over time (cluse 11.6), and

   (g)    failed to consider all elements of the scale “concentration, persistence and pace”.

5. In summary, the respondent submitted that the MA did not err or make an assessment on the basis of incorrect criteria and the MAC should be confirmed.

6. The role of the MA is to conduct an independent assessment on the day of examination. The MA is required to take a history, conduct a mental state examination, make a psychiatric diagnosis and have due regard to other evidence and other medical opinion that is before the MA. The MA must bring his clinical expertise to bear and exercise his clinical judgement when making an assessment of impairment under the PIRS categories. The assessment is not to be based upon self-report alone. An appeal panel cannot disturb ratings under the PIRS scale for mere difference of opinion but must be satisfied as to error.

7. The MA took a history which was broadly consistent with the other evidence before him. He recorded in detail the appellant’s reporting of present symptoms and impact on activities of daily living (ADLs) as follows:

   “Present symptoms:

   Ms Woolveridge said she still often feels depressed and sad and “blue”.  At times she feels like bursting into tears.  She said that some days she does not feel like eating.  Her sleep is good now.  She said her energy level fluctuates.  She said her sense of self-esteem varies a lot.  She reports reduced concentration and finds it difficult to make decisions.  She still feels hopeless at times.  She describes feeling restless and edgy most of the time and frequently worries about many things.  She experiences frequent headaches due to her anxiety and stress.

   She reports her symptoms having been relatively stable for the past 12 months since her Efexor-XR dosage was increased back to 150mg daily.  She rated herself as a 7 out of 10 where zero was the worst she could imagine feeling and 10 is how she was feeling before her work problems began in 2016.

   ·    Social activities/ADL:

   ·    Ms Woolveridge lives with her husband on a 25-acre hobby farm near Candelo on the South Coast of NSW.  The farm has 10 sheep, a horse, a dog, a cockatoo, ducks and chickens.  She does the shopping with her husband at Bega.  She does all the cooking.  She shares the house cleaning with her husband and she does the clothes washing.  She showers and changes her underwear every day and changes her outer clothing every second day.  She does all the caring for the animals on the farm.  She said this takes her about two hours a day, for seven days a week.  These activities include feeding the animals, cleaning out the cages, watering the animals and also taking the dog for a walk.

   ·     Ms Woolveridge attends a craft group at Candelo on a weekly basis on Monday from 10am to 2pm.  This craft group involves activities such as quilting, knitting, crocheting and tapestry.  There are 15 or 20 people in the group.  The group also has morning tea and lunch together.  Ms Woolveridge also attends a tai chi group on a weekly basis on a Wednesday morning for an hour and a half. After tai chi the group has coffee together.  This is a group of about 30 people.  She said she enjoys socialising with people at both these groups.  She said she occasionally goes out with her husband on a boating excursion as he belongs to a boating group.  She said she talks to her brother who lives in Newcastle over the phone about once a week.  She said she has lost contact with her friends who were teachers since she stopped working.”

8. The MA conducted a mental state examination and recorded his findings.

9. He made a diagnosis as follows:

   “In my opinion Ms Woolveridge has the psychiatric condition of Persistent Depressive Disorder with anxious distress according to DSM-5 diagnostic criteria. This condition emerged as a result of work-related stressors that began in 2016 in her work as a teaching principal at Wyndham Public School.  At times her symptoms have worsened to the point where she has had suicidal thoughts and attempts, and she would have fitted diagnostic criteria for a Major Depressive Episode at those times.  She has had appropriate psychiatric and psychological treatment, and her condition appears to have stabilised on the dose of Efexor-XR 150mg daily.

   ·    consistency of presentation

   Ms Woolveridge was consistent in her presentation of her history and symptoms.  She did not appear to be exaggerating or minimising her clinical condition.”

10. The MA explained his reasons for assessment under each of the PIRS categories as set out in the Table above.

11. The MA specifically addressed where his opinion differed from that of other experts whose opinions were in evidence.

12. The appellant complains that the MA has erred in respect of the assessments for Self-Care and Personal Hygiene, Social and Recreational Activities, Travel, Social Functioning and Concentration, Persistence and Pace.

13. The panel, after careful review of the evidence, can discern no error in the ratings ascribed by the MA in respect of the categories of Self-Care and Personal Hygiene, Social and Recreational Activities, Social Functioning, Travel, Concentration, Persistence and Pace complained about on appeal. There was no application of incorrect criteria. Each of the ratings were open to the MA in accordance with the correct application of the criteria in the Guides. The MA has given reasons for each of his ratings. He has given a clear and reasoned explanation, that is based on the application of his clinical expertise and accords with the criteria set out in the Guidelines. The MA has to rate according to the criteria in the Guides and provide the best fit in each category. He has done so without discernible error. The MA must rate impairment that results from injury. The ratings ascribed by the MA in the five categories under complaint accord with the criteria for each class. The MA cannot ascribe rating on the basis of self report alone, he must exercise his clinical judgment and have regard to all of the evidence before him. It is not an assessment based primarily on what the level of functioning was prior to injury in comparison to what a worker is able to do post injury, an ipsative comparison of “capacity”. Rather ratings are ascribed according to the guide criteria in each class against a normative measure of “impairment”. As such a person may demonstrate a loss of their previously held very high capacity for some areas of function but still have no impairment. For example, a theoretical physicist may lose the capacity to formulate string theories but still have no impairment in concentration, persistence and pace using these criteria. The MA has made assessments in each of the classes complained about on appeal without discernible error and has taken into account cultural, age and gender norms as required by paragraph 11.12. The Panel cannot interfere with these ratings absent error by the MA.

14. In respect of Self Care and Personal Hygiene, Table 11.1 of the Guides provides as follows:

    Table 11.1: Psychiatric impairment rating scale – self care and personal hygiene

Class 1	No deficit, or minor deficit attributable to the normal variation in the general population
Class 2	Mild impairment: able to live independently; looks after self adequately, although may look unkempt occasionally; sometimes misses a meal or relies on take-away food.
Class 3	Moderate impairment: Can’t live independently without regular support. Needs prompting to shower daily and wear clean clothes. Does not prepare own meals, frequently misses meals. Family member or community nurse visits (or should visit) 2–3 times per week to ensure minimum level of hygiene and nutrition.
Class 4	Severe impairment: Needs supervised residential care. If unsupervised, may accidentally or purposefully hurt self.
Class 5	Totally impaired: Needs assistance with basic functions, such as feeding and toileting.

1. The MA rated a mild impairment at Class 2 with the following reasoning:

   “Mild impairment. Ms Woolveridge is able to live independently.  She does all the cooking for herself and her husband.  She shares the other household chores with her husband.  Her appetite varies from day to day.  She showers and changes her clothes daily.  She is less interested in her personal grooming than previously.”

2. The MA explained why he did not consider that she should be rated Class 3 which was the rating ascribed by Dr Chow, the IME qualified on behalf of the appellant. The MA explained:

   “Where Dr Chow differed from me were in his ratings for Self-Care and Personal Hygiene where he rated Ms Woolveridge a Class 3, whereas I rated Ms Woolveridge a Class 2 as she does all the cooking and clothes washing for herself and her husband; shares the other household chores with her husband; showers and changes her underclothes every day but is less interested in her personal grooming than previously.”

3. The appellant is clearly on the evidence able to look after herself adequately. The appellant complains that the MA has failed to take into account her approach to grooming prior to injury and that is somehow a failure to take into account cultural norms for this particular worker. The MA has made an assessment using his clinical judgment and expertise and has correctly based his assessment on the criteria examples in the PIRS. The assessment is not solely based on a comparison between how the appellant functioned prior to injury and how she functions post injury. The assessment must be conducted on the evidence using the MA’s clinical judgment and in accordance with the criteria laid out in the PIRS scale. The panel can discern no error in the rating of a mild impairment which is the best fit in this category. The rating of a mild impairment accords with the criteria in that Class. The Panel can discern no error.

1. In respect of Social and Recreational Activities, Table 11.2 of the Guides provides as follows:

   Table 11.2: Psychiatric impairment rating scale – social and recreational activities

Class 1	No deficit, or minor deficit attributable to the normal variation in the general population: regularly participates in social activities that are age, sex and culturally appropriate. May belong to clubs or associations and is actively involved with these.
Class 2	Mild impairment: occasionally goes out to such events eg without needing a support person, but does not become actively involved (eg dancing, cheering favourite team).
Class 3	Moderate impairment: rarely goes out to such events, and mostly when prompted by family or close friend. Will not go out without a support person. Not actively involved, remains quiet and withdrawn.
Class 4	Severe impairment: never leaves place of residence. Tolerates the company of family member or close friend, but will go to a different room or garden when others come to visit family or flat mate.
Class 5	Totally impaired: Cannot tolerate living with anybody, extremely uncomfortable when visited by close family member.

1. The MA assessed a mild impairment at Class 2 with the following reasoning:

   “Mild impairment. Ms Woolveridge reports being less socially active than previously.  She has lost contact with her teaching friends.  She still attends a craft group for four hours every week and a tai chi and coffee group for one and a half hours every week.  She enjoys attending these groups and socialising with the other women who attend.  She also enjoys looking after a number of animals on her small farm.”

2. The appellant submitted that a Class 3 should have been assessed. This submission was made notwithstanding that there is no expert opinion which assessed a moderate impairment in this Class. Dr Chow, the IME qualified on behalf of the appellant assessed a mild impairment at Class 2 as the MA has done.

3. The appeal panel can discern no error in the assessment of a mild impairment. The appellant has maintained a level of social and recreational activities which whilst not to the extent that she undertook prior to injury is nonetheless to a degree that allows regular social contact. This very clearly best fits the class 2 criteria.  Again, it is not entirely based on comparison between what she was able to do before injury and what she can do now. It is an assessment of her psychiatric impairment according to a scale. The Appeal Panel can discern no error in the assessment of Class 2.          

4. In respect of Travel. Table 11.3 of the Guides provides as follows:

   Table 11.3: Psychiatric impairment rating scale – travel

Class 1	No deficit, or minor deficit attributable to the normal variation in the general population: Can travel to new environments without supervision.
Class 2	Mild impairment: can travel without support person, but only in a familiar area such as local shops, visiting a neighbour.
Class 3	Moderate impairment: cannot travel away from own residence without support person. Problems may be due to excessive anxiety or cognitive impairment.
Class 4	Severe impairment: finds it extremely uncomfortable to leave own residence even with trusted person.
Class 5	Totally impaired: may require two or more persons to supervise when travelling.

1. The MA assessed Class 2 with the following reasoning:

   “Mild impairment.  Ms Woolveridge said she is able to drive by herself to the local village to attend her tai chi and craft groups and to pick up mail.  For longer distances she relies on her husband to drive her because of her anxiety.”

2. The appellant submitted that the MA should have assessed a moderate impairment at Class 3 or a severe impairment at Class 4. The Panel notes that there is no expert opinion that would support the submission that a Class 4 should have been assessed for travel.

3. The MA specifically explained why his assessment differed from that of Dr Chow, the IME qualified on behalf of the appellant who assessed Class 3 as follows:

   “Dr Chow rated Ms Woolveridge a Class 3 for Travel whereas I rated her a Class 2.  I rated her a Class 2 as she is able to drive by herself into the local village to attend craft groups and tai chi groups and to pick up mail from the post office.”

4. The assessment by the MA accords clearly with Class 2. A Class 3 assessment would have required that the appellant never be able to leave home without a support person. This is very clearly not the case. A mild impairment as assessed by the MA is the best fit and the appeal panel can discern no error.

5. In respect of social functioning, Table 11.4 of the Guides provides as follows:

   Table 11.4: Psychiatric impairment rating scale – social functioning

Class 1	No deficit, or minor deficit attributable to the normal variation in the general population: No difficulty in forming and sustaining relationships (eg a partner, close friendships lasting years).
Class 2	Mild impairment: existing relationships strained. Tension and arguments with partner or close family member, loss of some friendships.
Class 3	Moderate impairment: previously established relationships severely strained, evidenced by periods of separation or domestic violence. Spouse, relatives or community services looking after children.
Class 4	Severe impairment: unable to form or sustain long term relationships. Pre-existing relationships ended (eg lost partner, close friends). Unable to care for dependants (eg own children, elderly parent).
Class 5	Totally impaired: unable to function within society. Living away from populated areas, actively avoiding social contact.

1. The MA assessed a mild impairment at Class 2 with the following reasoning:

   “Mild impairment.  Ms Woolveridge’s relationship with her husband is strained by her symptoms but they remain together with no separations or episodes of domestic violence.  She keeps in regular contact with her brother who lives in Newcastle by telephone.  She said she has lost a number of friendships due to her social withdrawal.”

2. The appellant complained on appeal that the assessment should have been one of moderate impairment at Class 3. The appellant was assessed at Class 3 by Dr Chow, the IME qualified on the appellant’s behalf. The MA specifically addressed why his assessment differed from Dr Chow as follows:

   “Dr Chow rated Ms Woolveridge a Class 3 for Social Functioning, whereas I rated her a Class 2. I rated her a Class 2 as her marital relationship, although strained, remains intact and they are still living together. She remains in regular contact by phone with her brother but has lost a number of friendships due to her social withdrawal.”

3. It is clear that the appellant has lost some friendships and this is taken into account in the rating of Class 2. Her relationship with her husband has suffered strain but is still intact and there have been no periods of separation. The criteria that has been used by the MA to assess a Class 2 mild impairment is the correct criteria and the best fit is a mild impairment. The Panel can discern no error.

4. In respect of Concentration, Persistence and Pace, Table 11.5 of the Guides provides as follows:

   Table 11.5: Psychiatric impairment rating scale – concentration, persistence and pace

Class 1	No deficit, or minor deficit attributable to the normal variation in the general population. Able to pass a TAFE or university course within normal time frame.
Class 2	Mild impairment: can undertake a basic retraining course, or a standard course at a slower pace. Can focus on intellectually demanding tasks for periods of up to 30 minutes, then feels fatigued or develops headache.
Class 3	Moderate impairment: unable to read more than newspaper articles. Finds it difficult to follow complex instructions (eg operating manuals, building plans), make significant repairs to motor vehicle, type long documents, follow a pattern for making clothes, tapestry or knitting.
Class 4	Severe impairment: can only read a few lines before losing concentration. Difficulties following simple instructions. Concentration deficits obvious even during brief conversation. Unable to live alone, or needs regular assistance from relatives or community services.
Class 5	Totally impaired: needs constant supervision and assistance within institutional setting.

1. The MA rated a mild impairment at Class 2 with the following explanation:

   “Mild impairment. Ms Woolveridge reports reduced concentration. She can concentrate on knitting, crocheting or cross stitching at the craft group for about 30 minutes at a time.  There were no short-term memory or concentration impairments present on testing at the assessment.”

2. The MA has to make an assessment using his clinical judgment and expertise on the day of assessment. He conducted a mental state examination of the appellant of which he recorded as follows:

   “Ms Woolveridge was a well-groomed, casually dressed woman of stated age with styled hair.  She was pleasant and cooperative in the interview.  Her speech was of normal rate and flow.  Her mood was mildly anxious and depressed.  Her affect was appropriate to her mood and reactive.  There was no formal thought disorder and no psychotic symptoms.

   Ms Woolveridge was alert and orientated.  There were no impairments in immediate or short-term memory or attention, concentration or general knowledge on testing at the assessment.  She scored 3 out of 3 at two-minute recall of three items.  She could spell the word WORLD backwards correctly, her serial 3 subtractions were accurate, and her general knowledge was adequate.”

3. The appellant says the rating should have been a moderate impairment at Class 3 and that the MA has ignored the requirement to assess persistence and pace and has just focused on concentration.

4. The appellant says a moderate impairment at Class 3 should have been assessed by
   Dr Chow, the IME qualified on behalf of the appellant assessed a moderate impairment at Class 3.

5. The MA has to make an assessment on the day of examination, he has the benefit of conducting a mental state examination on that day and is required to use his clinical expertise in making the assessment. The assessment process itself enables an evaluation of the worker’s impairment in persistence and pace with cognitive demands. The MA is specifically precluded by the Guides from relying on self-report alone. He must have due regard to the other evidence before him. The MA explained why his assessment differed from that of Dr Chow as follows:

   “Dr Chow rated Ms Woolveridge a Class 3 for Concentration Persistence and Pace, whereas I rated her a Class 2. I rated Ms Woolveridge a Class 2 as she reports being able to concentrate on craft activities such as knitting, crocheting and cross-stitching for 30 minutes at a time.  There were no cognitive impairments on testing at the assessment.”

6. The Appeal Panel can discern no error in this assessment of Class 2 as the MA’s findings clearly accord with the criteria for that Class.

7. For these reasons, the Appeal Panel has determined that the MAC issued on 16 September 2021 should be confirmed.