50 It is necessary to exercise extreme caution in the use of this material. It is logically possible that it might rationally affect the decision of an issue of the case, and therefore must be considered and is admissible, but the weight to be attributed to such a certificate is a matter to be considered in the light of all the other evidence, after the exercise of extreme caution. Smiths rely primarily on the certificate issued by the review panel. This certificate was issued only on the basis of documentary evidence. The panel did not physically examine or interview Mr Baker, and it relied materially on a number of certificates, which were prepared for the purpose of determination of a whole person impairment, rather than the issues that I have to consider in this case. Further, neither the review panel nor the medical assessors had the benefit of Dr Kirsh's oral evidence, particularly his cross-examination, to which I attach significant weight. In the circumstances, while I have considered the certificates issued by the Medical Assessment Service, and particularly by the review panel, I cannot accept the conclusion that the review panel reached in relation to causation, in particular the conclusion that the injury in the warehouse had no more than a negligible effect on Mr Baker's overall condition. For the reasons I have given, and in particular, because of the marked changes in that condition which were present, as I conclude from the evidence after, but not before, the warehouse incident, I find, on the evidence before me, that that incident was a significant cause of Mr Baker's condition.