austlii:nsw/NSWPICMP/2025/512
General information, not legal advice.
NSWPICMP
2025-08-13
Original judgment source is linked above.
BUO v State of New South Wales (NSW Police Force) [2025] NSWPICMP 512
WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); appeal by claimant against 14% whole person impairment (WPI); error conceded in Medical Assessor (MA) miscalculating WPI; whether MA erred in finding 1% for activities of daily living (ADLs) regarding the lumbar spine; whether the MA erred in finding cervical DRE 1; - MA failed to give adequate reasons as to classification of cervical assessment; re-examination conducted; MA failed to take into account restrictions in activities of domestic duties; non-verifiable radiculopathy present in cervical spine; MAC revoked; 15% WPI found.
17 December 2024. 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): * the assessment was made on the basis of incorrect criteria, and * the MAC contains a demonstrable error. 3. 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. 4. 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. 5. 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 Guides) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th ed (AMA 5). "WPI" is reference to whole person impairment.
"He has neck pain that goes down to his left arm, burning. He notices that positions of his neck particularly turning to the left result in tingling and symptoms that require sometimes up to a week to settle. He has problems with sleep. He finds driving difficult because his left arm has to be held in particular positions to avoid irritation.
He has low back pain with shooting pain that goes into his left buttock. His left leg has pins and needles, and he feels that his whole back pops out of alignment."
"He is married with 2 children aged 8 and 6 years. His wife works so he does some child minding, getting kids to and from school and spends time with them. He says he does some home maintenance but in the main finds he cannot use a mower and uses a whipper snipper.
Leisure activities was regular fishing, and he has his own boat. He finds that it is very difficult to manage a boat and so this is greatly diminished. He was physically active running and exercising before the injury and now says that most of these activities have stopped. A lot of what stops him he says is motivation to get out and do things which is related probably to the PTSD.
He has a house cleaner come in about once a fortnight and only does a certain amount of light work as he finds other aggravates his back."
"On examination, he is well built. He stood and sat through the interview consistently. He was without pain behaviours but his speech and his gaze suggested some difficulty with communicating. Speech was in short sentences.
Examination of the cervical spine showed normal curvatures, however movement of the neck in all directions was extremely limited but observed to be equal. I uncovered no muscle spasm.
Examination of the mid back showed no muscle spasm and normal kyphosis.
Examination of the lumbar spine showed normal lumbar curves. Movement of flexion and extension was full but he moved less to the left. There was no spasm."
"There were no objective findings to supports (sic) radiculopathy, although he has ongoing symptoms."
"The lumbar spine is assessed by the DRE method, as set out in T15-3 p 384. He has ongoing pain. He has dysmetria. This is DRE category 2 with 10% WPI.
The thoracic spine is assessed by the DRE method, as set out in T15-4 p 389. He has ongoing pain, but no findings. This is DRE category 1 with 0% WPI.
The cervical spine is assessed by the DRE method, as set out in T15-5 p 392. He has ongoing pain, but no findings. This is DRE category 1 with 0% WPI.
A further rating is added from interruptions to ADLs as per 4.34 P 28 NSW guides. He has lost recreational activities and yard care ability, which adds 1% WPI.
The left shoulder is assessed by loss of ROM, as set out in the table below. This is 5% UEI, which converts to 3% WPI."
"Dr Hopcroft had an earlier examination in which he found more physical finding about the spine.
Dr Haig did not find these. Both found no evidence of radiculopathy.
•• 3% WPI if the worker's capacity to undertake personal care activities such as dressing, washing, toileting and shaving has been affected
•• 2% WPI if the worker can manage personal care, but is restricted with usual household tasks, such as cooking, vacuuming and making beds, or tasks of equal magnitude, such as shopping, climbing stairs or
•• 1% WPI for those able to cope with the above, but unable to get back to previous sporting or recreational activities, such as gardening, running and active hobbies etc."
DRE Cervical Category II 5%-8% Impairment of the Whole Person
No significant clinical findings, no muscular guarding, no documentable neurologic impairment, no significant loss of motion segment integrity, and no other indication of impairment related to injury or illness; no fractures
Clinical history and examination findings are compatible with a specific injury; findings may include muscle guarding or spasm observed at the time of the examination by a physician, asymmetric loss of range of motion or non verifiable radicular complaints, defined as complaints of radicular pain without objective findings; no alteration of the structural integrity
individual had clinically significant radiculopathy and an imaging study that demonstrated a herniated disk at the level and on the side that would be expected based on the radiculopathy, but has improved following nonoperative treatment
fractures: (1) less than 25% compression of one vertebral body; (2) posterior element fracture with- out dislocation that has healed without loss of structural integrity or radiculopathy; (3) a spinous or transverse process fracture with displacement
"... There were no objective findings to support[s] radiculopathy though he has ongoing symptoms."
"[BUO] was accompanied to the assessment by his wife, Mrs Kia Wall. The history was obtained directly from the worker.
[BUO] states that he sustained injuries during the course of his work as a Police Officer, working as a Senior Constable, general duties police officer out of Forster, New South Wales.
On or about 11 April 2021, he says that he was involved in a violent arrest incorporating the use of tasers. There was violent wrestling involved.
He recalls the onset of neck and back pain immediately after the event. Symptoms increased, such that he eventually sought medical attention from his general practitioner, Dr Arreza in Forster.
He confirms that he experienced symptoms of neck pain, upper back pain, lower back pain and left shoulder pain. There were early symptoms of referred pain to the right arm.
He reports more recent symptoms of burning pain and paraesthesia in the left upper extremity.
After medical imaging was performed, he was referred for physical therapy.
Imaging included CT scan of the cervical spine on 8 May 2021. MRI scans of the cervical spine were performed on 14 July 2021.
[BUO] confirmed treatment under the care of Dr Robert Kuru, orthopaedic spinal surgeon from 24 August 2021. He confirms that although he was offered cervical and lumbar spine fusion surgery, he declined that path of treatment.
He also received a further opinion from Dr Peter Spittaler, neurosurgeon.
He confirms a period of treatment under the care of Dr Simon Tame, pain specialist commencing in September 2021 and adjustments were made to his medication. He also received advice regarding management of his mental health concerns.
He received a period of supervised exercise under the supervision of an exercise physiologist.
With regards to his left shoulder condition, he had previously undergone treatment under the care of Dre Ed Bateman, orthopaedic surgeon. He also suffered a left shoulder injury in June 2019 whilst tackling an offender, falling onto his outstretched arm.
Subsequently, he underwent surgical management under the care of Dr Stewart Kennedy at Port Macquarie Private Hospital on 7 August 2019 consisting of a left shoulder labral repair and rotator cuff repair and biceps tenodesis. There was partial recovery from his injuries, and he recalls persisting mild left shoulder stiffness.
In the subject accident he suffered an aggravation of his left shoulder condition. However, there has been no further surgical management. He received a period of physical treatment directed towards this left shoulder condition.
[BUO] attends a chiropractor at fortnightly intervals. He receives massage treatment between 4 and 6-week intervals.
[BUO] reports current symptoms of constant neck pain, average intensity 6-7 out of 10 on a VAS. Pain is more severe on the left side. He describes greater stiffness with left-sided motion.
There is associated left-sided occipoto-frontal headache occurring several days weekly. This can be associated with nausea and photophobia.
In the left upper limb, he described intermittent burning pain occurring for several minutes, once or twice weekly. There is intermittent tingling in the thumb and index fingers of his left hand that occurs up to half a day once or twice weekly.
There is intermittent sharp pain in the interscapular region. He is aware of upper back stiffness.
There is sometimes pain with coughing and sneezing.
He reports constant low back pain, of average intensity 8-9 out of 10 on a VAS. Pain is worse on the left side. There is sometimes associated sharp pain in the buttock and intermittent pain in the back of the left thigh.
He reports intermittent numbness in the anterior left thigh. There is sometimes paraesthesia in the left foot.
He reports activity-related pain at the left shoulder exacerbated by attempted overhead reaching and loading of the left arm.
He cannot sleep comfortably over his left side at night.
He limits lifting to a small bag with his left hand. Between two hands, he is able to lift up to 10 kilograms.
He reports a sitting tolerance of up to 30 minutes, a similar tolerance for driving. He limits walking for 15 minutes due to back pain.
There is difficulty with deep forward bending at the waist, and he avoids repetitive deep forward bending.
There is no major difficulty with crouching, kneeling or stair climbing.
[BUO] is married with children aged 6 and 8 years.
His wife performs most of the domestic chores presently.
He sometimes helps out with bench height cleaning. He cannot cope with the heavier chores himself.
They also have the services of a cleaner who attends 3 hours fortnightly.
He primarily performs click and collect grocery shopping.
He has not resumed previous active hobbies of fishing, 4WD driving and camping.
He suffered a car accident in 2014 causing injury to the left shoulder. He suffered further injuries to the left shoulder. He has previously undergone a left shoulder cuff repair in 2019.
Examination reveals normal spinal curvature without muscle spasm. Cervical spine flexion is performed to half normal range, extension half normal range. Right rotation three quarters normal range, left rotation half normal range. Right and left lateral flexion symmetrically performed to one third normal range. Pain is declared during extreme left-sided roation.
Neurological examination of the upper extremities reveals normal moyotmal power in all muscle groups with reinforcement. There is no muscle wasting. There is normal sensibility declared in the right uper extremity.
In the left upper extremity there is reduced sensibility along the radial border of the left forearm extending to the thumb and index fingers conforming to a C6 dermatomal pattern. The deep tendon reflexes are symmetrically preserved. Spurling's test is negative.
There is normal spinal curvature. There is no muscle spasm. Active lumbar flexion is performed to two thirds normal range. Lateral flexion to the right is full, Left lateral flexion is three quarters normal range with reported left-sided low back pain. Extension is performed to two thirds normal range. Lateral flexion is symmetrically performed to three quarters normal range. There is no muscle guarding evident. Straight leg raise is performed to 60 degrees bilaterally.
Neurological examination of the lower extremities reveals normal lower limb power in all muscle groups. There is non-dermatomal reduced sensibility declared from the left hip to the toes of the left foot in a non-dermatomal pattern. The deep tendon reflexes are symmetrically preserved. There is no calf muscle wasting.
The circumference of the calves are 39 centimetres bilaterally.
The claimant, [BUO] was involved in a workplace assault after which he suffered aggravation of a pre-existing left shoulder condition. This was in addition to injury to the cervical spine.
The facts on which I have based the whole person impairment:
The determination as to permanent impairment is made in accordance with the American Medical Association's Guides to the Evaluation of Permanent Impairment (5TH Edition) and the Workers Compensation Guidelines for the Evaluation of Permanent Impairment 4th Edition, as follows:
The clincial presentation is consistent with a DRE Cervical Spine Category 2 impairment rating in accordance with Table 15-5, AMA5 Page 392.
There are non-verifiable radicular complaints in a C6 dermatomal pattern in the left upper extremity. There are symptoms of burning and intermittent paraesthesia in the left hand.
The clinical findings required for a diagnosis of cervical radiculopathy in accordance with Section 4.27 of the Workers Compensation Guidelines are not met.
Radiculopathy is the impairment caused by malfunction of a spinal nerve root or nerve roots. In general, in order to conclude that radiculopathy is present, two or more of the following criteria should be found, one of which must be major (major criteria in bold):
• muscle weakness that is anatomically localised to an appropriate spinal nerve root distribution
• reproducible impairment of sensation that is anatomically localised to an appropriate spinal nerve root distribution
• positive nerve root tension (AMA5 Box 15-1, p 382)
• findings on an imaging study consistent with the clinical signs (AMA5, p 382).
There is a reduction of sensibility in the left C6 dermatomal pattern. No other criteria required for a diagnosis of radiculopathy are met.
Whilst the previous MRI scan demonstrated possible right C6 root impingement, there were no corresponding findings on the left side. The deep tendon reflexes are symmetrical. There is no muscle wasting. There is no moyotomal weakness. A positive nerve root tension sign is absent.
The clincial presentation is consistent with a DRE Lumbar Spine Category 2 impairment rating in accordance with Table 15-3, AMA5 Page 384.
There is spinal dysmetria. A 5% WPI rating impairment arises.
The clinical findings required for a diagnosis of lumbar radiculopathy in accordance with Section 4.27 of the Workers' Compensation Guidelines are not met.
I have assessed additional lumbar spine impairment due to the impact of the workers injuries upon his capacity for activities for daily living.
I find that a 2% WPI impairment rating arises in accordance with Sections 4.33 to 4.35 of the NSW Guidelines.
His capacity for heavy domestic chores, gardening activities, sporting and recreational activities are curtailed. The worker is independent for activities of personal care.
The total whole person impairment rating for the lumbar spine conditon is 7%.
There is no evidence of a pre-existing lumbar spine condition. Therefore no deduction is made.
The combined whole person impairment rating is 7% WPI (lumbar spine), combined with 5% WPI (cervical spine), combined with 3% WPI (left shoulder) providing a Combined Whole Person Impairment Rating which equals 15%."
This Certificate is issued pursuant to section 325 of the Workplace Injury Management and Workers Compensation Act 1998.
Table 2 - Assessment in accordance with AMA5 and NSW workers compensation guidelines for the evaluation of permanent impairment for injuries received after 1 January 2002
page and paragraph number in NSW workers compensation guidelines
Chapter, page, paragraph, figure and table numbers in AMA5 Guides
WPI deductions pursuant to S323 for pre-existing injury, condition or abnormality (expressed as a fraction)
Sub-total/s % WPI (after any deductions in column 6)
Chapter 15, Table 15-5 Page 392
Chapter 15, Table 15-3, Page 384
Chapter 16, Figs 16-40, 16-43, 16-46, Pages 476-479
Total % WPI (the Combined Table values of all sub-totals)
BUO
State of New South Wales