1. The medical dispute was assessed by Dr Ian Meakin, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 2 November 2021. He assessed that Mark Aliprad had 8% whole person impairment (WPI) comprised of 6% WPI for the lumbar spine and 2% WPI for the right lower extremity (ankle) as a result of injury sustained during the course of his employment with the respondent on 28 February 2018.
2. On 25 November 2023 Mr Aliprad underwent a fusion from T10 to S1.
3. On 23 April 2025, Principal Member Harris issued a Certificate of Determination and Statement of Reasons determining that there has been a deterioration in Mr Aliprad's condition since the MAC of 2 November 2021. Principal Member Harris made the following orders:

(a) the Certificate of Determination dated 7 December 2021 is rescinded pursuant to section 57 of the Personal Injury Commission Act 2020;

(b) the appellant was directed to file an application to appeal the medical assessment dated 2 November 2021 within 14 days of 23 April 2025, and

(c) the appeal is limited to an assessment for all threshold purposes of the degree of permanent impairment of the lumbar spine and right lower extremity (ankle/hindfoot).

1. On 2 May 2025 Mark Aliprad (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor.
2. The appellant relies on the following grounds of appeal under s 327(3) of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act):
   • deterioration of the worker's condition that results in an increase in the degree of permanent impairment (section 327(3)(a) of the 1987 Act).
3. On 21 May 2025 the respondent, Abbey Manufacturing Group Pty Ltd, lodged a Notice of Opposition to Appeal Against the Decision of Medical Assessor. The respondent, however, conceded in their submissions that the appellant had demonstrated a deterioration of his condition and so the appeal should be allowed.
4. On 22 May 2025, the appellant lodged an Application to Lodge Additional Documents. The respondent consented to the admission of the material. In these circumstances, the Medical Appeal Panel (the Panel) finds that the additional documents can be admitted.
5. On 5 June 2025 the President's Delegate referred the matter to the Panel.
6. Rule 128 of the Personal Injury Commission Rules 2021 (the PIC Rules) and Procedural Direction PIC7 - Appeals, reviews, reconsiderations and correction of obvious errors in medical disputes 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 r 128(1) of the PIC Rules.
7. The assessment of permanent impairment is conducted in accordance with the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4th ed

1 March 2021 (the Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th ed (AMA 5).

1. The Panel conducted a preliminary review of the original medical assessment in the absence of the parties and in accordance with the Procedural Direction PIC7.
2. As a result of that preliminary review, the Panel determined that it was not necessary for the worker to undergo a further medical examination because the Panel considered it has sufficient information to assess permanent impairment.

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

1. The Medical Assessor found the appellant sustained injury to his right ankle on

28 February 2018 in the form of a long deep vertical laceration over the posterior ankle and heel area with the resultant terminal loss of subtalar joint inversion and eversion. He found 2% WPI calculated by reference to Table 17.12 AMA 5 with inversion to 10 degrees resulting in

2% lower extremity impairment and eversion to 10 degrees resulting in a 2% lower extremity impairment, making a total of 4% lower extremity impairment. With reference to Table 17.3 the 4% lower extremity impairment equated to 2% WPI. 2. The Medical Assessor summarised that the appellant complained of low lumbar back pain some six weeks after the injury due to limping, with soft tissue injury to his low back being diagnosed at that time. He found the appellant had continuing low back pain. 3. The Medical Assessor assessed permanent impairment of the lumbar spine at DRE Category II with 5% WPI and added 1% for loss of activities of daily living. The reason why he found DRE II was because he found asymmetrical active loss of range of motion with no clinical signs to satisfy the definition of radiculopathy.

1. Both parties made written submissions. They are not repeated in full but have been considered by the Panel.
2. Attached to the appellant's Application to Lodge Additional Documents dated 22 May 2025 is the appellant's submissions. It is argued that there has been deterioration of the appellant's condition coming within s 327(3)(a) of the 1998 Act because he has undergone an eight-level fusion, from T10 to the pelvis.
3. However, the Panel finds that the referral to it is only in respect of the body parts assessed by the Medical Assessor, that is the lumbar spine and right lower extremity (ankle/hindfoot). The Panel finds it cannot assess the thoracic spine or scarring.
4. The appellant does not submit that there should be increased permanent impairment of the right ankle/hindfoot. Dr Gehr in his more recent report dated 24 September 2024 did not assess the permanent impairment of the right ankle. The Medical Assessor assessed

2% WPI and neither party has identified error with that assessment. 5. The balance of the appellant's submissions are not summarised here because they are directed to the issue whether the appellant should have known his condition would deteriorate at the time he made his lump sum claim. This issue is not a matter for the Panel and has been determined by Principal Member Harris in his decision of 23 April 2025. 6. On 19 May 2025 the respondent submitted that the Panel should re-assess the appellant to determine the extent of permanent impairment resulting from the injury. It asserts that the scope of the medical dispute is limited to the lumbar spine and the right lower extremity (ankle/hindfoot) and that no other body parts or systems can be assessed. 7. The respondent at [4.1] concedes that the appellant has demonstrated a deterioration of his condition. At [1.7] the respondent states that it agreed to fund a two stage L2 to L5/S1 spinal fusion and says the operation was performed on 25 November 2023. The operation report dated 25 November 2023 confirms the operation performed was a T10- pelvis decompression and fusion at Macquarie University Hospital by Dr Bhisham Singh. 8. Despite the respondent's position for the Panel to re-assess the appellant, accepting deterioration and the resultant surgery, it has not made a submission about what the appropriate assessment of permanent impairment should be.

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. Both parties have agreed there has been deterioration in the appellant's lumbar condition. The Panel concurs this is evident because of the surgery which has been undertaken on the appellant's lumbar spine.
3. Dr Singh sets out the details of the surgery in his operation report dated 25 November 2023, a decompression and fusion from T10 to the pelvis. In his report dated 10 January 2024 Dr Singh he states that X-rays of his whole spine show that the alignment of the thoracolumbar spine is satisfactorily restored, the implants are in good position and the fusion was progressing well. In the further report dated 20 February 2024 further improvement was recorded.
4. The Panel has read all of the evidence filed by the parties but considers it is not necessary in these reasons to summarise those that pre-dating the surgery, particularly in view of the parties' common position that there has been deterioration culminating in and from the surgery.
5. Dr Gehr examined the appellant and reported on 24 September 2024. He records that the appellant still has pain in his lumbar spine with numbness going down both legs to the level of his knee, with the pain in the back averaging a 6/10. His back is also stiff. He can only sit for about two and a half hours, stand for 10 minutes and walk for 300 metres. On examination the doctor stated he walked with a wide based gait, unsteady. He is not able to stand on his toes, heels, invert or evert. Dr Gehr found loss of lordosis, forward flexion was reduced by 80%, extension 0 degrees, left lateral flexion was reduced by 80% and right lateral flexion reduced by 50%. Lumbar spine guarding and dysmetria were present. Straight leg raising in the sitting position was 70 degrees left and right. He had a negative nerve tension test and deep tendon reflexes were absent on both sides. Dr Gehr states that the surgery has helped to reduce his back pain, but not his lower limb pain. He noted that an

X-ray dated 26 July 2024 showed surgical correction of scoliotic curve with multilevel fusion. 6. Dr Gehr, using the Guidelines page 26, paragraph 4.24 found DRE IV and from AMA 5 page 384, table 15-3 and table 15-4 found WPI of 20%. He added for activities of daily living 3% using the Guidelines page 28 paragraph 4.34. These added to 23%. Dr Gehr added a further 7% for the second and further levels of fusion as per the Guidelines page 29, paragraph 4.37, Table 4-2. However, this included two levels of the thoracic spine. This meant that the modifiers included an extra 2% for the additional level of fusions at T10/11 and T11/12. Dr Gehr states that his assessment of the lumbar spine included the thoracic spine, which the Panel cannot assess for the reasons set out earlier. 7. In addition, Dr Gehr assessed scarring, which the Panel cannot assess as it is not a body system referred to the Panel. 8. The Panel agrees that DRE lV is the correct category for the lumbar spine, which does gives 20% WPI. The Panel also agrees with Dr Gehr's assessment of the ADL at 3%. These are added and equal 23%. Using the modifiers in Table 4-2 1% WPI needs to be added for each level of the fusion of the lumbar spine, totalling 6%WPI. Combining this 6% with 23% gives 28% WPI. 9. Combining 28% WPI for the lumbar spine with the 2% for the ankle gives 29% WPI as indicated in the Table below. 10. For these reasons, the Panel has determined that the MAC issued on 2 November 2021 should be revoked, and a new MAC should be issued. The new certificate is attached to this statement of reasons.

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 Medical Assessor Ian Meakin and issues this new Medical Assessment Certificate as to the matters set out in the Table below:

Chapter, page and paragraph number in NSW workers compensation guidelines

Chapter, page, paragraph, figure and table numbers in AMA 5 Guides

Proportion of permanent impairment due to pre-existing injury, abnormality or condition

Sub-total/s % WPI (after any deductions in column 6)

Total % WPI (the Combined Table values of all sub-totals)

The above assessment is made in accordance with the SIRA NSW Guidelines for the Evaluation of Permanent Impairment for injuries received after 1 January 2002.