The medical assessment
35The medical assessor in this case found left arm sensory disturbance in the left index and thumb presumably related to nerve root but no other neurological abnormalities.
36I take it as being common ground between the parties that this finding satisfies one of the requirements of guideline 4.28 and in particular the fifth sign, but the statement about no other neurological abnormalities is taken as an exclusion of any of the others.
37In applying to have the matter referred to a review panel, the plaintiff criticised, if I may put it that way, these findings. Effectively the argument was, and is, that the reasons provided by the assessor in fact disclosed at least two and perhaps more of the clinical signs referred to in guideline 4.28.
38There is some argument about aspects of the assessor's reasons which on their face may seem inconsistent and I interpolate that the proper officer was satisfied about at least one of those inconsistencies, a topic to which I shall return.
39In recording his findings on clinical examination of the neck the assessor, at p 6 of his report stated that there was some diminished sensation in the left thumb and index finger which did not extend up the forearm. He did not regard this as dermatomal. Reflexes and power were equal in both upper limbs on repeated testing. There was some generalised reduced power in the whole of the left arm but, again, the assessor did not consider this was relevant as it was non-dermatomal and power was in a "good range at grade 5".
40On examination of the upper extremity he recorded so far as is relevant for present purposes "the right forearm and the upper forearm are one centimetre larger in circumference than the left side consistent with hand dominance but possibly indicating some mild lack of use of the left arm."(P 6.)
41During his review of the medical reports he had been provided with by the parties the medical assessor recorded that other independent specialists had found more than one clinical sign of radiculopathy. They were Dr Licina and Dr J Bodel. Each of those doctors recorded a diminish left biceps reflex and Dr Bodel, although the assessor did not refer to this, also found an altered sensation in the C6 distribution in the left upper limb particularly along the radial border of the index finger and ulnar border of the thumb.
42The assessor said there was "no clinical evidence of radiculopathy present on examination today"(p9). But having made that statement he also said at p 9:
The altered sensation in the left index and thumb were non-dermatomal. It did not fit specifically into a peripheral nerve. It could be part of an area supplied by C6 nerve root and there was indeed neuroforaminal narrowing at that level at C5/6 on the MRI study. However there was no other neurological finding to satisfy the criteria of radiculopathy. I therefore disagree with DRE III as an assessment of the cervical spine and it should be DRE II.
43On reading of the assessor's reasons, and reading them as a whole and not with an eye keenly attuned to the detection of error, there is, I think, a clear inconsistency between the statement that there is no clinical evidence of radiculopathy and the statement that there were no other neurological findings to satisfy the criteria of radiculopathy.
44At the top of p 11 the assessor said the altered sensation in the left hand, which was consistent with the C6 nerve root distribution (p9), was "presumably related to the nerve root". These matters are inconsistent with the specific finding of no clinical evidence of radiculopathy I have already referred to, recorded at p6.
45The sense of inconsistency is somewhat enhanced when one considers that at p 10 when giving his reasons for his assessment of the degree of impairment, the assessor said "he has DRE category II with asymmetrical loss of movement but no clinical evidence of ongoing true radiculopathy." (My emphasis.) Here there is no mention of his finding of sensory disturbance.
46It seems to me that the assessor found some clinical evidence of true ongoing radiculopathy, being the alteration in sensation. That is the only way one can understand the finding he made.
47Another aspect relied on by the plaintiff relates to the question of atrophy. As I have quoted the medical assessor posited two possible causes. One was that the difference was consistent with right hand dominance but the other, which he described as a "possibility" is lack of the use of the left arm. I note further from the context of that statement that the second possibility is capable of being a clinical sign of radiculopathy.
48I emphasise that one clinical sign called for by cl 4.28 of the guidelines is "muscle atrophy and/or decreased limb circumference." In express language the doctor found decreased limb circumference. The only question then, in accordance with the definition of atrophy, is which explanation was correct, at least so far as the doctor's opinion was concerned. If the difference was explicable by reference to "extremity dominance" then it was not a clinical sign of radiculopathy. On the other hand if that explanation was excluded, as it may well have been at least having regard to the terms of the guidelines as I have set them out, decreased limb circumference as found may well have been the second necessary clinical sign for DRE III
49I think in the end, reading the assessor's report as a whole, there is much to be said for Mr Catsanos' argument that it is tolerably clear that the assessor opted for extremity dominance as the relevant explanation although he does not resolve the issue expressly anywhere in his report. This lack of clarity is not helped by the other inconsistencies in relation to what might be called the doctor's vacillation about the significance of the altered sensation in the left hand.
50I point out in passing that Mr Perry relied upon what was said about the adequacy of reasons provided by the experts in the position of the medical assessor in Campbelltown City Council v Vegan [2006] NSWCA 284; 67 NSWLR 372 at 397. As the validity of the assessment certificate is not in question it is unnecessary for me to make any decision about that in terms.
51Mr Perry also relied upon the question of the doctor's finding about reflexes in the upper arms. The doctor said that he checked them more than once and they were not diminished, notwithstanding the earlier findings of other doctors.