Woolworths Group Limited v Jonmarie Gray
[2021] NSWPICMP 77
•26 May 2021
| DETERMINATION OF APPEAL PANEL | |
| CITATION: | Woolworths Group Limited v Jonmarie Gray [2021] NSWPICMP 77 |
| APPELLANT: | Woolworths Group Limited |
| RESPONDENT: | Jonmarie Gray |
| APPEAL PANEL: | Member Carolyn Rimmer Dr James Bodel Dr David Crocker |
| DATE OF DECISION: | 26 May 2021 |
| CATCHWORDS: | WORKERS COMPENSATION- Respondent employer appealed on the basis that the Medical Assessor (MA) erred in assessing the right elbow when the claim related solely to the right wrist and left shoulder; MA assessed pronation and supination in the right elbow caused by restriction of movement in the forearm caused by the wrist injury; AMA 5 provides that the restriction in pronation and supination is measured by reference to Figure 16-36 which is set out under 16.4 “Elbow Motion Impairment”; Held- MAC confirmed. |
STATEMENT OF REASONS FOR DECISION OF THE APPEAL PANEL IN RELATION TO A MEDICAL DISPUTE
BACKGROUND TO THE APPLICATION TO APPEAL
On 23 February 2021 Woolworths Group Limited (the appellant) lodged an Application to Appeal Against the Decision of Approved Medical Specialist. The medical dispute was assessed by Dr Mohammed Assem, a Medical Assessor (MA), who issued a Medical Assessment Certificate (MAC) on 8 February 2021.
The respondent to the appeal is Jonmarie Gray (the respondent).
The appellant relies on the following grounds of appeal under s 327(3) of the Workplace Injury Management and Workers Compensation Act 1998 (1998 Act):
· the assessment was made on the basis of incorrect criteria, and
· the MAC contains a demonstrable error.
The delegate is satisfied that, on the face of the application, at least one ground of appeal has been made out. The Appeal Panel has conducted a review of the original medical assessment but limited to the ground(s) of appeal on which the appeal is made.
The WorkCover Medical Assessment Guidelines 2006 set out the practice and procedure in relation to the medical appeal process under s 328 of the 1998 Act. An Appeal Panel determines its own procedures in accordance with the WorkCover Medical Assessment Guidelines 2006.
The assessment of permanent impairment is conducted in accordance with the NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4th ed 1 April 2016 (the Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th ed (AMA 5).
RELEVANT FACTUAL BACKGROUND
In these proceedings, the respondent is claiming lump sum compensation in respect of an injury to the left upper extremity and right upper extremity on 29 September 2016. The respondent alleged that she was injured while employed by the appellant at the Bonnyrigg store on 29 September 2016 when she was “splitting a pallet” and slipped and fell landing on her outstretched right arm and wrist. The respondent returned to work on 15 November 2016 with the use of her left arm only and was pulling a pallet when she injured her left shoulder.
In the Referral for Assessment of Permanent Impairment to Approved Medical Specialist dated 23 December 2020, the matter was referred to the AMS, Dr Mohammed Assem, for assessment of whole person impairment (WPI) of the right upper extremity and left upper extremity as a result of the injury on 29 September 2016.
The AMS examined the respondent on 27 January 2021. He assessed 5% WPI of the left upper extremity and 10% WPI of the right upper extremity. Therefore, the total assessment was 15% WPI in respect of the injury deemed on 29 September 2016.
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 did not request that that the respondent be re-examined by a Medical Assessor, who is a member of the Appeal Panel.
Neither party requested that they be given an opportunity to make oral submissions to the Appeal Panel.
As a result of that preliminary review, the Appeal Panel determined that it was unnecessary for the respondent to undergo a further medical examination because there was sufficient evidence by way of medical reports and clinical investigations in relation to assessment of the right upper extremity on which to make a determination.
EVIDENCE
Documentary evidence
The Appeal Panel has before it all the documents that were sent to the AMS 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 AMS 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 include the following:
(a) The AMS erred in assessing the right elbow, when this body part was not the subject of the referral. The claim related solely to the right wrist and left shoulder. At no stage during the matter had a claim been made for injury to the right elbow. The AMS has gone beyond the scope of his powers, by providing an opinion on injury and causation.
(b) The parties had agreed that the right wrist and consequential left shoulder condition formed the entirety of the claim for lump sum compensation as a result of the injury on 29 September 2016.
(c) The respondent in her statement dated 12 November 2020 outlined the history of injury to her right wrist and left shoulder and made no reference to the right elbow.
(d) In the Injured Worker Initial Interview (at page 6 of the Application to Resolve a Dispute (ARD)), the injury was noted as "left shoulder cannot lift arm" and it also listed a prior right-sided wrist injury under the heading of 'Other relevant medical information'. This was reiterated in subsequent Claim Forms.
(e) Dr Endrey-Walder, in his report dated 24 March 2020 (page 21 of ARD), noted the respondent suffered a soft tissue injury to the right wrist and a traction-type injury to the left shoulder. Under heading of 'Present Condition and Complaint', there was no report any right elbow symptoms. Similarly, his assessment of whole person impairment did not include the right elbow. The only reference to the right elbow in his report was to clarify there were no functional deficits in relation to same as a result of the original injuries. He stated she “had full flexion and extension at the elbows”.
(f) Dr Breit, in his report dated 1 July 2020 (page 10 of Reply), recounted the history of injury as it appeared in his earlier reports, pertaining to a right wrist and left shoulder injury. Under heading of 'Present Complaints' there was no mention of the right elbow. He did not offer a diagnosis or provide any reasoning with respect to causation for same.
(g) Dr Duckworth (treating specialist) provided a report dated 20 October 2020 (page 35 of ARD). His reports of injury were limited to the right wrist and left shoulder. In an earlier report from Dr Duckworth dated 11 April 2017 (page 51 of ARD), the respondent received an opinion on her left shoulder symptoms. The elbow did not form part of his review over the many years whilst under his care.
(h) Associate Professor Gumley (treating specialist) provided a report dated 14 August 2020 (page 38 of ARD). At no stage in this report was there any reference to the right elbow.
(i) All radiological investigations relied upon in the ARD exclusively relate to the right wrist and left shoulder pathology.
(j) Dr Dalton (rehabilitation specialist) provided an initial report dated 24 April 2017 (page 52 of ARD). On review, he outlined the symptoms suffered by the respondent. There was no reference to the right elbow.
(k) The various Certificates of Capacity in this claim (page 98 of ARD) made a diagnosis of injuries to the right wrist and left shoulder. There was reference to the left elbow (page 107 of ARD), however no diagnosis was given.
(l) The parties proceeded to the AMS on the basis the worker would be assessed for the accepted injuries to the right wrist and left shoulder. The appellant takes no issue with the AMS’s assessment of the right wrist or of the left shoulder. The only issue relates to the inclusion of the right elbow, as this constitutes a separate region of impairment.
(m) The AMS assessed 2% Upper Extremity Impairment in relation to the right elbow. There was no reference in the body of his report to any history, pathology or symptoms pertaining to the right elbow. On page 2 of the MAC the AMS outlined the history relating to the frank injuries occurring on 29 September 2016 and 15 November 2016. These did not reference any resultant elbow symptoms. On page 3 of the MAC, the AMS recorded the worker's present symptoms. He noted complaints of "intermittent discomfort at the lateral aspect of the left shoulder .... the dorsal aspect of her right wrist and right forearm". The AMS then outlined his findings on physical examination under headings of 'Left Shoulder' and 'Right Upper Extremity'. The examination was confined to the intended body part on the left side, but not the right. At page 4 of the MAC, the AMS noted there was "normal range of motion to the right elbow in flexion and extension. Pronation was 70° and supination was 60°". The AMS did not provide adequate rationale as to how this range of motion is attributable to the right wrist pathology. At page 5 of the MAC, the AMS summarised the injuries sustained by the respondent. These were limited to the right wrist and left shoulder.
(n) The AMS has erred in assessing the right elbow. This body part never formed any part of the claim. All contemporaneous evidence, namely the treating specialist reports, support the worker's symptoms were localised to her right wrist and left shoulder following the workplace injuries.
(o) The AMS referral dated 23 December 2020 listed the body parts as 'Right Upper Extremity, Left Upper Extremity'.
(p) In Toll Holdings Pty ltd v Williamson [2020] NSWWCCMA 24 which involves a similar factual matrix. In this matter the parties agreed the claimed body parts were the right shoulder and neck. The AMS referral was listed as the "Right Upper extremity". The AMS then went on to assess the right shoulder, wrist and elbow. In Williamson the appellant made a similar submission in that the wrist and elbow were not referred to the AMS. Whilst the referral broadly related to the right upper extremity, this "did not properly frame the nature of the injury referred". The appellant further submitted "it should be "considered in the context of the medical evidence before the Arbitrator who referred the matter". The appellant concluded there was no "material to support the finding" made by the AMS which amounted to a demonstrable error as considered by the Court of Appeal in Vannini v Worldwide Demolitions Pty Ltd [2018] NSWCA 324 at [77]-[80]. It was ultimately held that as no claim was made and no medical dispute existed for the wrist and elbow, the AMS erred in assessing these body parts.
(q) In the current matter, the AMS was not entitled to assess the right elbow. There have been no liability determinations with respect to this body part. It was beyond the scope of the powers ascribed to an AMS to make determinations on injury and causation. In this regard the appellant relies on the decisions of Trustees for the Roman Catholic Church for the Diocese of Bathurst v Hine [2016] NSWCA 213 and Bindah v Carter Holt Harvey Wood Products Australia Pty Ltd [2014] NSWCA 264.
(r) The appellant has not been afforded any opportunity to respond to a claim for injury to the right elbow, as it has never before been alleged.
(s) The assessment by the AMS should be limited to the right wrist and left shoulder. The final assessment should be 13% WPI and not 15% WPI. The MAC should be amended to reflect same.
The respondent’s submissions include the following:
(a) The Appellant asserts specifically that:
“27. At page 5 of the AMS report, Dr Assem summarised the injuries sustained by the worker. These were limited to the right wrist and left shoulder.
28. The Appellant submits the AMS has erred in assessing the right elbow. This body part never formed any part of the claim.”(b) The appellant went on to draw a parallel between the present case and Toll Holdings Pty Ltd v Williamson [2020] NSWWCCMA 24, suggesting a ‘similar factual matrix’ and therefore contending for the same result.
(c) The appellant has misunderstood what the assessment of supination and pronation of the forearm is, and has neglected to observe that all of the medico-legal assessors (including its own) did the same assessment.
(d) The basis of the appeal is that the respondent did not (on its reckoning) make a claim regarding the elbow, and that it was erroneous of the AMS to assess any impairment of the elbow under the AMA5 Guides.
(e) The AMS, in actual fact, did not err at all. His method of assessment was identical to that of both IMEs. He has simply used the word ‘elbow’ where the others have not.
(f) Dr Endrey-Walder set out the history of injury, complaint and treatment across pages 1 to 4 (inclusive) and referred to scans and treatment directed at both the shoulder and the wrist specifically, culminating in essentially the last historical note, being: “On 18.11.2019 “continued multifocal wrist pain” wrote the Professor [Gumley]. An MRI scan (25.11.2019) was requested, subsequently showing no particular cause for your client’s chronic pain.” On page 8 of the report,
Dr Endrey-Walder set out his assessment under the Guidelines. Under what appears to be a heading of “Right Wrist”, Dr Endrey-Walder steps through the various measurements required under the Guidelines, and includes in his assessment: “Thus, she has 18% Right UEI (Upper Extremity Impairment) at the wrist. 30 degree deficit in supination right forearm: 1% UEI. 30% deficit in pronation: 2% UEI.” (emphasis added)”(g) The supination and pronation of the forearm is, according to Figure 16-37 of AMA5, technically an assessment of the “elbow”, although the movements of supinating and pronating the forearm quite readily lend themselves to being imagined as assessments of a wrist (easily seen if one simply holds out one’s arm and performs a supination and then a pronation of the forearm).
(h) The AMS has quite appropriately performed the same assessment at page 7 of the MAC, in which he set out a table wherein he noted the degree of tested pronation and supination.
(i) The assessment of supination and pronation was performed also by the appellant’s own doctor, Dr Breit. When he examined the worker he recorded the following: “There was 60 degrees pronation and 70 degrees supination. (emphasis added)”
(j) The AMS, in fact, recorded 70 degrees of pronation and 60 degrees of supination.
(k) The appellant did not appreciate the implications of an assessment of supination and pronation of the forearm as being one, technically, of the elbow, that does not transmogrify the AMS’s assessment of the same into a ‘demonstrable error’. The AMS was charged with assessing the Right Upper Extremity, and of assessing any impairment consequential on the injury agreed to have occurred on 29 September 2016. This was the basis of the referral with which the appellant took no issue.
(l) The Guidelines make quite clear at part 1.6 that an assessor is to perform a “clinical assessment of the claimant as they present on the day of assessment taking account the claimant’s relevant medical history”. Further, part 1.6(c) specifically directs the assessor to clarify the “degree of impairment that results from the compensable injury/condition”.
(m) In the present case, each of the assessing examiners had tested the supination and pronation of the respondent’s forearm and included the result as part of their assessment of impairment.
(n) The restriction of the respondent’s forearm rotational movement was a relevant part of the impairment that results from the compensable injury to her wrist. There was medical consensus on the fact of impairment of pronation and supination of the forearm.
(o) The appeal was a misunderstanding of the assessment process of the upper extremity (perhaps caused by the inclusion by the AMS of the word ‘elbow’ in the table on page 8 of his MAC, a body part not named in the other reports directly).
(p) The AMS did not make an error in the assessment of pronation and supination. In the circumstances of the case, it made it a medical consensus, and confirmation that the AMS has provided a robust, careful assessment of impairment which should not be disturbed.
(q) There is no demonstrable error on the face of the MAC, and the appeal should be dismissed.
(r) The MAC should be confirmed and orders entered with respect to 15% WPI as assessed.
FINDINGS AND REASONS
The procedures on appeal are contained in s 328 of the 1998 Act. The appeal is to be by way of review of the original medical assessment but the review is limited to the grounds of appeal on which the appeal is made.
In Campbelltown City Council v Vegan [2006] NSWCA 284 the Court of Appeal held that the Appeal Panel is obliged to give reasons. Where there are disputes of fact it may be necessary to refer to evidence or other material on which findings are based, but the extent to which this is necessary will vary from case to case. Where more than one conclusion is open, it will be necessary to explain why one conclusion is preferred. On the other hand, the reasons need not be extensive or provide a detailed explanation of the criteria applied by the medical professionals in reaching a professional judgement.
The 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 delegate has let through the gateway, it can consider other grounds capable of coming within one or other of the s 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.
In this matter, the delegate has determined that she is satisfied that there is an arguable case of error under s 327(3)(d) of the 1998 Act in relation to the AMS’s assessment of permanent impairment to the right upper extremity.
The Appeal Panel reviewed the history recorded by the AMS, his findings on examination, and the reasons for his conclusions as well as the evidence referred to above.
Medical Assessment Certificate
Under “Present symptoms” the AMS wrote:
“Present symptoms: Mrs Gray complains of intermittent discomfort at the lateral aspect of her left shoulder associated with restriction of movement. She also experiences intermittent discomfort involving the dorsal aspect of her right wrist and right forearm. She has a restriction in forearm and wrist movements. There are occasional pins and needles at the ulnar border of her hand. Her right hand gives way at times, causing her to drop objects.”
Under “Findings on physical examination” the AMS wrote:
“Right Upper Extremity
She was wearing a static wrist-hand orthosis that was removed for the purpose of this assessment. There was a fine, healed, longitudinal surgical scar at the dorsal aspect of her wrist. She reported tenderness on distal radioulnar joint compression and the ulnar border of her wrist. There were no joint crepitations and no instability. Active range of wrist motion was consistently restricted in flexion 20°, extension 40°, ulnar deviation 20°, and radial deviation 15°. She had a normal range of motion to her right elbow in flexion and extension. Pronation was 70° and supination was 60°. Her grip strength was markedly reduced on the right compared to the left. Sensation was normal. Tinel’s sign at the cubital tunnel was positive.”
Under “Summary of injuries and diagnoses” the AMS wrote:
“Mrs Gray is a 42-year-old right-hand dominant lady who fell onto her outstretched right hand. As a result, she sustained a tear to the fibrocartilage complex. She underwent surgery on 23 January 2018 and 3 December 2018 with some improvement in her condition.
She has continued to have pain and stiffness in her right wrist.
She also sustained an injury to her left shoulder while pulling a pallet causing a SLAP tear.
She was given a cortisone injection to her left shoulder followed by hydrodilatation without any significant benefit. She continues to have pain and stiffness involving her left shoulder.”
Under “Reasons for Assessment”, the AMS wrote:
“R) Wrist
Permanent impairment evaluation is based on Section 16.4g, Wrist Motion Impairment (5th ed, pp 466-470). According to Figure 16-28, Pie Chart of Upper Extremity Impairments due to Lack of Flexion and Extension of Wrist Joint (5th ed, p 467), Ms Gray has 11% R) upper impairment.
Due to Abnormal Radial and Ulnar Deviation of Wrist Joint (5th ed, p 469), she has 3% right upper extremity impairment. Elbow movements were slightly reduced in pronation and supination giving 2% RUEI (AMA5, Figure 16-37, page 474).”
In commenting on other medical opinions and findings, the AMS wrote:
“Dr Endrey-Walder (Surgeon) completed a report on 24 March 2020 and 5 August 2020. He obtained a better range of shoulder motion but greater restriction in wrist motion and elbow motion to obtain 16% whole person impairment..”
Assessment of the right upper extremity
The appellant submitted that the AMS erred in assessing the right elbow, when this body part was not the subject of the referral. The appellant argued that claim related solely to the right wrist and left shoulder and that at no stage during the matter had a claim been made for injury to the right elbow. The appellant submitted that the AMS has gone beyond the scope of his powers, by providing an opinion on injury and causation.
The Appeal Panel reviewed the evidence in this matter.
The respondent filed an ARD in the Workers Compensation Commission (WCC) dated 19 November 2020 in relation to the disputed claim for permanent impairment. The section for “Permanent Impairment” on page 7 of the ARD listed date of injury as 29 September 2016, and under Systems Claimed, the respondent listed:
• Right upper extremity; and
• Left upper extremity.
On 23 December 2020, the Appellant filed its Reply to ARD.
On 23 December 2020, the Delegate of the Registrar of the WCC referred the matter to the AMS for assessment, in the following terms:
Date of injury: 29 September 2016
Body part/s referred: Right Upper Extremity, Left Upper Extremity
Method of assessment: Whole Person Impairment.
The AMS issued his MAC on 8 February 2021, following an assessment of the respondent on 27 January 2021. The AMS assessed 5% WPI of the left upper extremity and 10% WPI of the right upper extremity, which combined to give a total WPI of 15%.
The AMS assessed 10% WPI in respect of the right upper extremity. In assessing the right wrist, a careful reading of the MAC indicates that the AMS relied on Figure 16-28, page 467, Figure 16-31, p469 and Figure 16-37, page 474 of AMA5 in making the assessment. Permanent impairment evaluation was based on Section 16.4g, Wrist Motion Impairment (pp 466-470). Under Figure 16-28, “Pie Chart of Upper Extremity Impairments due to Lack of Flexion and Extension of Wrist Joint” (p 467), the AMS assessed the respondent as having 11% right upper impairment. Under Figure 16-31 “Pie Chart of Upper Extremity Motion Impairments Due to Abnormal Radial and Ulnar Deviation of Wrist Joint (p 469), the AMS assessed the respondent as having 3% right upper extremity impairment. The AMS then noted that elbow movements were slightly reduced in pronation and supination and assessed 2% right upper extremity impairment under Figure 16-37 “Pie Chart of Upper Extremity Motion Impairment Due to Lack of Pronation and Supination”(page 474).
AMA 5 at page 472 under the heading “Pronation and Supination” provides:
“The normal range of motion is from 80 °supination to 80° pronation. …
Impairments of pronation and supination are ascribed to the elbow because the major muscle for this function are inserted about the elbow. This applies even if the loss of forearm rotation results primarily from wrist involvement in the presence of an intact elbow.”
In Example 16-78 on page 514 of AMA5, the patient had a Colles’ Fracture with physical findings of some limitation of wrist movement, some deformity of the wrist, moderate pain with heavy activity and 40% grip strength loss index. The factors to be rated were the loss of motion of the wrist and forearm rotation. The example proceeded to add to the assessment for wrist motion impairment upper extremity impairment an additional impairment for loss of pronation and supination which was assessed under Elbow Motion (Figure 16-36).
The AMS found an injury to the left shoulder and right wrist. The Appeal Panel considered that it was clear that the AMS did not find that there was an injury to the right elbow. What the AMS did find was a reduction in pronation and supination and the Appeal Panel was satisfied that this resulted primarily from the wrist injury. The wrist injury in this case caused restriction in movement in the forearm including pronation and supination. AMA 5 provides that the restriction in pronation and supination is measured by reference to Figure 16-36 which is set out under 16.4h “Elbow Motion Impairment.”
The Appeal Panel noted that other doctors had measured pronation and supination and taken this into their account in the assessment of impairment.
Dr Endrey-Walder, in his report dated 24 March 2020, wrote:
“She had a full range of symptom-free arc movement at the right shoulder.
She had full flexion and extension at the elbows.
There was irritability to the ulnar nerve at the back of each elbow.
Pronation/supination of the right forearm each lacked 30 degrees at the limitof movement compared to the normal left side.
….
Right Wrist
Flexion to 10 degrees: 8% UEI.
Radial deviation to 10 degrees: 2% UEI.
Ulnar deviation to 25 degrees: 1 % UEI.
Thus, she has 18% Right UEI at the wrist.
30 degree deficit in supination right forearm: 1 % UEI.
30% deficit in pronation: 2% UEI.
Thus, she has 21 % Right UEI, which is equivalent to 13% WPI.”Dr Breit, in his report dated 1 July 2020, wrote:
“This lady is at ease, she removed the splint from her right wrist. There was
tenderness particularly over the distal radioulnar joint and movements were 40'
extension, 20' flexion, 20' radial and 20' ulnar deviation. There was 60° pronation
and 70' supination. There was said to be slight diminution of sensation in the right
thumb. Tinel's sign over the carpal tunnel was negative, and I was unable to carryout provocation testing because of pain.”
Dr Breit concluded that the respondent was not at maximum medical improvement, however, proceeded to provide an assessment of impairment based on the respondent’s current state. He wrote:
“ii. Right Wrist - 29 September 2016.
“SIRA Guides Chapter 2, AMA Guides Chapter 16, paragraph 16.4g for the wrist and
16.4h for the elbow.
That results in 13% upper extremity impairment.
16.4h for the elbow and lack of rotation results in 1% upper extremity impairment.
The total is 14% of the upper extremity and that converts to 8% WPI.”The Appeal Panel considered that the AMS did assess the body parts set out in the Referral and found that there had been injuries to the right wrist and left shoulder. The AMS in assessing the restriction of motion in pronation and supination was in fact assessing part of the right wrist condition, which had resulted in the loss of forearm rotation. Both
Dr Endrey-Walder and Dr Breit made assessments that included an assessment in respect of lack of rotation in the elbow, that is, restriction in pronation and supination in the right forearm.The appellant submitted that the AMS did not provided adequate rationale as to how this range of motion (pronation and supination) was attributable to the right wrist pathology. The Appal Panel does not consider that the AMS was required to provide further reasons for including an assessment in relation to pronation and supination in view of the assessments made by Dr Endrey-Walder and Dr Breit.
The Appeal Panel found no error in the MAC nor any application of incorrect criteria.
For these reasons, the Appeal Panel has determined that the MAC issued on 18 December 2020 should be confirmed.
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