She was flung forward into the classroom, landing on her hands and knees on the floor. She was not knocked out but was shocked. The student then acted aggressively towards her, throwing the ball towards her face. He then left the scene and other students came to her aid. She felt a sense of tingling down the right arm from the shoulder, into the right ring and little fingers.

She contacted the Deputy Principal of the school and then she left work early to go home. As the adrenalin settled down, she became more aware of pain in the upper back, radiating to the lower back, and in the neck and right scapula on day four after the assault, similar to a whiplash condition, and also ongoing right shoulder joint pain. She developed presyncope with the neck pain and stiffness.

She saw a GP, Dr Ryan Horn, Canterbury on 9/5/2023 and was referred for MRI scan of the cervical spine and right shoulder performed on 25/5/2023. She had MRI scan of brachial plexus on 22/7/2023 which showed no radiological abnormality of the plexus.

She had a nerve conduction study on 30/8/2023 of the right upper limb which was normal. An MRI scan thoracic spine on 18/12/2023 showed a small central T6/7 protrusion without neural compression.

She had physiotherapy twice a week with treatment directed to the neck and thoracic and right shoulder for about two years, and this therapy is continuing. She recently had to undertake a re-assessment review.

She finds that physiotherapy has been very effective, both short-term in managing pain and also over the longer term in terms of improving muscle strength and reduction of muscle atrophy, which was visible early on after the incident. Nevertheless, she can still only work with 500gm weights when doing exercise with the right arm.

She was treated with Pregabalin (Lyrica) for about seven months, but this had side-effects. She was also taking Mobic, an anti-inflammatory.

She was referred to Dr A Weiss, pain physician, at North Shore Private Hospital. She had a right stellate ganglion block in December 2024, followed by one week off work, and then a further stellate ganglion block in March 2025.

The blocks reduced the cold and hot nerve pain radiating down the right arm and improved the sense of weakness in the right wrist and reduced pain in the right scapula and thoracic area which radiated to the posterior right upper arm and helped to a lesser extent with right-sided neck pain. She notices the effect of the second block has been wearing off over the last two months, but she is delaying having a further stellate block whilst she is trying to fall pregnant.

After the accident, she was off work for a couple of weeks and then tried to return to work full-time, but needed to have further time off because of the injury. She moved to a different school and attempted a further three weeks of work, but needed days off and was down-graded to three days a week at Hunters Hill High School in Term 4 of 2023.

In Term 1 of 2024, she again resumed full-time duties but still would have sick days with migraine headaches, neck pain and right shoulder joint pain radiating to the right scapula and upper thoracic, and also for undergoing procedures and attending appointments related to her injury.

She saw A/Professor Raymond Schwartz, neurologist, Kogarah regarding headaches. He recommended Botox injections and she has had had two treatments of Botox so far with good result.

She has had the third stellate ganglion block injection pre-approved and has done a multi-disciplinary pain program through her rehabilitation case manager over a 12-week period in 2024.

Her last Botox injection was two weeks ago for cervicogenic C1/C2 pain and migraines. These headaches used to last up to three days and severe for a week overall, and consisted of eye pain and also TMJ dysfunction. She has had Botox in both TMJs, along with the base of the skull, neck and trapezii.

She is due to have another stellate ganglion block, but this is postponed at the moment, and also further Botox injections.

She is still attending physiotherapy on a regular basis and her current GP is Dr Zan, whom she sees every couple of months.

Details of any previous or subsequent accidents, injuries or condition

She had a right knee arthroscopy in 2018 after her knee suffered a meniscal injury when she was running in a cross country race at aged 13.

She had a fractured right forearm treated with plaster immobilisation at eight years old.

She was diagnosed with an under-active thyroid when she was three and has taken Thyroxine since and thyroid function is well controlled.

She had a workers compensation claim for a psychological injury in 2022 and received psychological therapy for this, and this continued until June 2025.

She has had no previous problems relating to the neck, thoracic or right shoulder, and no subsequent accidents or injuries.

She has a debilitating migraine headache about once a week on a background of constant tension headache and intense bilateral jaw pain radiating to the soft palate, with stabbing pain in the right ear and tinnitus. She also gets visual auras in the right eye.

There was constant neck stiffness and bilateral upper cervical sharp pain radiating to the base of the skull, and she will wake up with a rigid neck spasm at times.

She gets a lot of pain in the upper half of the thoracic spine, radiating to under the right scapula and around into the right upper arm.

When the thoracic area is flared up, she also feels some discomfort in the lower back as well. Sometimes the thoracic pain is worse than the cervical pain.

She will get a hot throbbing sensation in the right shoulder joint which wakes her up from sleep and in conjunction with soreness in the neck.

She has a presyncope feeling which affects her ability to drive and she has to stay home until this feeling wears off.

The symptoms return quickly when the effect of the Botox has worn off.

She has a 50-minute drive to work and is sore when she arrives. She can't drive long distances unless she takes frequent stops. This was required when she was visiting family members in Coffs Harbour.

She lives in a house with her husband, who works full-time, and he does most of the shopping. She can only carry a small bag of a few groceries and unpacks the trolley at the car.

Her work consumes all her energy. She has nothing left at the end of the day.

She can only do light housework mid-week. She can do short stints on the weekend.

She did have a gardener and housekeeper after the accident, but before this she did the gardening and her husband did the mowing. Now she just does small jobs like watering the plants, but can't do vacuuming or high reaching tasks such as hanging clothes on the line. She can vacuum now for about 10 minutes at a time. She was given a light steam mop and a stick vacuum after an occupational therapy assessment.

She is independent with personal care, although pain and exhaustion cause difficulty brushing teeth and washing her face some days, and she has to sit on the floor of the shower. She has difficulty tilting her head back to wash her hair and nearly faints.

She can no longer practise her yoga or teach yoga to adults. This was a second source of income for her. Now she just teaches chair yoga to school students.

She has difficulty with making artworks now because she has less physical endurance. She used to run four times a week, but now finds that running and jumping jolts her spine. She is limited in terms of physical activities.

She has a lifting restriction of 2kg in the right hand and 5kg for two-handed lifts, and this makes things difficult for her.

She has Panadeine Forte as required for a flare-up of pain and last used this a week ago, but will take them about once a month. She has Thyroxine and a medication for ADHD which was diagnosed in 2021. She has ceased this medication whilst trying to conceive in early 2025.

She is worried about her future career in teaching and ability to continue in this. She is going to sell her property on the South Coast to have some financial certainty. She and her husband rent their current house at Kenthurst.

She was of average build with height 166cm and weight 70.2kg.

Active range of movement was undertaken tentatively with flexion one-third, extension one-half, lateral flexion one-half bilaterally and rotation one-half bilaterally.

Upper limb reflexes were symmetrical. Power testing was affected by pain inhibition in the right arm at the shoulder and there was slight weakness of the right hand intrinsic muscles.

Sensation was decreased to light touch in the inner right upper arm and forearm to the ulnar half of the hand.

Upper arm girth; right equals left equals 30cm at 10cm above the elbow.

Forearm girth; right 24.5cm, left 24cm at 5cm below the elbow.

This was tested in the seated position. Rotation was two-thirds of normal bilaterally. Sensation over the trunk was normal. There was no spasm or guarding and no focal tenderness.

Lateral flexion two-thirds bilaterally. Flexion and extension both two-thirds of normal range. No spasm or guarding.

Reflexes in the lower limbs were symmetrical, with plantar responses both flexor. Power and sensation in the lower limbs were normal.

Straight leg raising was 80° bilaterally with negative stretch test.

Positive impingement on the right and negative on the left. There was no instability in the glenohumeral or acromioclavicular joints. There was no undue prominence of the acromioclavicular joints.

There was some crepitus in the AC joint on the right.

I brought to the worker's attention that she was able to move her right shoulder better previously according to the results recorded by Medical Assessor Truskett, and she stated that her stellate ganglion block was fresh at the time of that examination and was working well, hence the better range of movement at that stage.

There was asymmetry present placing her in DRE Category II giving 5% whole person impairment, with an addition of 2% whole person impairment for the effects on activities of daily living.

There was no dysmetria, no guarding, no spasm and no radiculopathy, placing her in DRE Category I giving 0% whole person impairment.

Although there was positive impingement, there was also restricted range of movement which is considered to be a more specific method of assessing impairment when it is present.

The loss of range of movement in various planes produced a total of 7% upper extremity impairment, which converts to 4% whole person impairment.

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The combined whole person impairment of 7 by 4 by 0 is 11% whole person impairment."

1. The Appeal Panel, having reviewed the assessment and findings on examination of

Medical Assessor Oates is satisfied that it appropriately determines the medical dispute between the parties with respect to the degree of permanent impairment to the thoracic spine and right shoulder as a result of injury on 8 May 2023 being the extent of the dispute (subject to appeal). No complaint has been made by the parties on appeal nor any submissions provided raising issue with the assessment of the cervical spine by the Medical Assessor and this finding is not disturbed by the Appeal Panel. 2. The Appeal Panel accepts that in reaching the assessment regarding the right shoulder and thoracic spine, Medical Assessor Oates has used his clinical judgment and explained the assessment with reference to the Guides and Guidelines. 3. In Coca-Cola Europacific Partners API Pty Ltd v Pombinho [2024] NSWCA 191, Ward P considered at [88]:

"The statutory provisions assume power on the part of a medical member of the Appeal Panel to carry out a re-examination and assessment of the worker. It may be inferred that the Appeal Panel, in adopting the report and findings, was endorsing the reasoning in that report since that is where the reasons are to be found. I do not accept that the Appeal Panel was required to deliver separate or distinct reasons as to why the Appeal Panel (or two of the three members of it, perhaps) accepted Medical Assessor Glozier's assessment in preference to the assessment of, say, the Medical Assessor. In my opinion, it was sufficient for the Appeal Panel to adopt Medical Assessor Glozier's assessment (for the reasons contained therein)."

1. The Appeal Panel considers the findings and assessments of Medical Assessor Oates to be reliable, and the Appeal Panel adopts those findings and assessments.
2. For these reasons, the Appeal Panel has determined that the MAC issued on 2 April 2025 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 Truskett 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)