7 Dr Fry made a diagnosis of "RSD/Causalgia". The certificate contains, inter alia, the following:-
9. My reasons for my opinion and assessment of whole person impairment, including my objective comments regarding the other medical opinions submitted by the parties and the reasons why my opinion differs are:
Answer : My reasons are based on the assessment of the complication of RSD/Causalgia and the clinical signs. The following clinical signs are present:
1. Skin colour mottled, the history of being cyanotic;
2. Skin temperature, a gradient present along 3 fingers of the left hand, cooler distally,
3. Atrophic changes,
4. Skin texture loss of the pulps of little finger, ring finger and middle finger;
5. Soft tissue atrophy marked in the left ring and little fingers,
6. Joint stiffness greater on left that on right,
7. Nail changers are present in the fingers of the left hand; hair growth changes, a little more on the left side that the right, in either instance heavy growth.
This gives 7 items of change to which one adds slow movement of the joints consistent complaint of pain with burning quality and complaint of alteration in the quality of sensation.
Under the circumstances I believe the diagnosis is appropriate.
Precise range of motion measurement was not possible because of complaint of pain when he flexed his fingers and when this was carried out slowly. This can therefore only be approximate for the assessment. Approximately 20% loss of each finger joint (proximo-distally 11%, 12% and 10%) combine to 30% of each finger using clinical judgement to assess sensory deficit and pain he is assessed at Grade 2, Table 16-10 at a maximum of 80% sensory deficit for each finger, which is 86% impairment of each finger, which adds up to 52% impairment of the hand, equating to 47% of the left upper extremity which equates to 28% whole person impairment.
For this takes on board any discolouration and all the features of RSD/Causalgia.
The right side, which is much less affected, is assessed to be 50% of that of the left upper extremity, which is 14% whole person impairment. The two combined equal 38% whole person impairment.
In my view this is consistent with his loss of activities of daily living, inability to work and the loss of function of the hand.