A brief statement is attached setting out the Commission's reasons for the determination.

1. Ian Edward Felsch, the applicant in these proceedings, makes a claim for a lump sum payment for 20% whole person impairment (WPI) pursuant to s 66 of the Workers Compensation Act 1987 (the 1987 Act) as a result of an injury he sustained on 9 June 2016 while employed as a labourer with the respondent, NPV international Pty Ltd.
2. Mr Felsch claims that he sustained an injury to the right hand and wrist, and an injury and/or consequential condition to the right elbow and shoulder, and a consequential condition affecting the left wrist, left elbow and left shoulder, as a result of the injury sustained on

9 June 2016. Mr Felsch also claims that he has the condition of complex regional pain syndrome (CRPS) as a result of the injury sustained on 9 June 2016. 3. Mr Felsch has undergone two operations as a result of the injury sustained on 9 June 2016:

(a) a right ECU tendon debridement/synovectomy plus ECU excision performed by Dr Myers on 26 April 2017, and

(b) a right de Quervain's release performed by Dr Dowd on 24 October 2018.

1. The claim for 20% WPI is based upon an assessment made by Dr Dryson, occupational physician, in a report dated 29 January 2024. Dr Dryson makes an assessment of 10% upper extremity impairment (UEI) of the right wrist, 4% UEI of the right elbow, 9% UEI of the right shoulder, 2% UEI of the left wrist, 2% UEI of the left elbow, and 9% UEI of the left shoulder.
2. The claim for a lump sum payment for WPI made by the lawyers for Mr Felsch on

9 May 2024 also claims that Mr Felsch had "probable Complex Regional Pain Syndrome", although no assessment of WPI is made by Dr Dryson for CRPS. 3. The respondent admits liability for an injury to the right wrist and hand. However, the respondent disputes liability for the claims made by Mr Felsch that he has sustained an injury and/or consequential condition to the right elbow and shoulder, and a consequential condition affecting the left wrist, left elbow and left shoulder. The respondent also rejects an application made by Mr Felsch that any referral for assessment of WPI should include CRPS affecting the right upper limb.

1. The parties agree that the following issues remain in dispute:

(a) whether the applicant sustained an injury and/or consequential condition to the right elbow and shoulder as result of the incident on 9 June 2016;

(b) whether the applicant has suffered a consequential condition affecting the left wrist, left elbow and left shoulder as a result of the injury sustained on

9 June 2016, and

(c) whether the condition of CRPS affecting the right upper limb can be included in any referral to a Medical Assessor for the assessment of WPI.

PROCEDURE BEFORE THE PERSONAL INJURY COMMISSION

1. The parties attended a conference and hearing on 15 October 2025. I have used my best endeavours in attempting to bring the parties to the dispute to a settlement acceptable to all of them. I am satisfied that the parties have had sufficient opportunity to explore settlement and that they have been unable to reach an agreed resolution of the dispute.
2. Mr Pecelj appeared for the applicant, instructed by Mr Sparke. Mr Hanrahan appeared for the respondent, instructed by Mr Orr.

1. The following documents were in evidence before the Personal Injury Commission (Commission) and considered in making this determination:

(a) Application to Resolve a Dispute and attached documents;

(b) Reply with attached documents, and

(c) Application to Lodge Additional Documents filed by the applicant on

15 September 2025, which annexed copies of clinical notes from St Clair Medical Practice.

1. There was no application to adduce oral evidence or to cross examine the applicant in these proceedings.

Whether the applicant sustained an injury and/or consequential condition to his right elbow and right shoulder as a result of the incident on 9 June 2016

1. Mr Felsch has provided statements dated 20 November 2020 and 25 November 2024.
2. Mr Felsch states that on 9 June 2016 he was trying to unload some wooden doors when he felt a snapping and popping sensation in his right wrist, and his right hand then swelled up and "virtually locked". Mr Felsch does not describe any symptoms affecting his right elbow or right shoulder following this incident.
3. Mr Felsch provides a summary of medical treatment which he underwent following the incident on 9 June 2016, including two operations to the right wrist and hand in April 2017 and October 2018. Mr Felsch states his general practitioner was initially Dr Owen Green, but he changed to Dr Gupta at St Clair Medical Practice in January 2018.
4. Mr Felsch states that he was continually told by his doctors not to use his right hand for any lifting, gripping or pushing. He states that he avoided using his right hand due to the significant amount of pain that he was experiencing.
5. Mr Felsch provides details of the development of pain in his left wrist, left elbow and left shoulder following the incident on 9 June 2016, but does not provide any details of the development of any symptoms in his right elbow or right shoulder. He does state that he has pain in his right arm, and constant pain, discomfort and restriction of movement in the right elbow.

1. There are no clinical records in evidence from Dr Owen Green, who was the first doctor that Mr Felsch said he attended upon following the incident on 9 June 2016.
2. Dr Myers initially sees Mr Felsch on 27 September 2016 and records that Mr Felsch felt a snapping, popping sensation in his right wrist on 9 June 2016. Dr Myers diagnoses a right wrist injury with ECU subluxation instability. There is no mention in this report of any injury to, or symptoms affecting, the right elbow or right shoulder from the incident on 9 June 2016.
3. The clinical notes from St Clair Medical Practice cover a period from 9 January 2018 to

23 August 2023. I could not locate, nor was I directed to, any reference to treatment required for symptoms experienced by Mr Felsch in the right elbow or right shoulder. There is no reference to any problems with the right elbow or right shoulder in a report from Dr Gupta dated 17 February 2020. 4. Dr Dryson records that on 9 January 2016 Mr Felsch was unloading objects weighing approximately 15-20 kg when he felt a "pop" in his right wrist. Dr Dryson does not record any symptoms affecting the right elbow or right shoulder at that time. 5. Dr Dryson records that Mr Felsch reports pain radiating up the arm from the right wrist, to about 5 cm below the elbow. He records from Mr Felsch that the right shoulder is "okay". 6. Dr Dryson makes no diagnosis of any condition affecting the right elbow. He diagnoses painful restricted range of movement of both shoulders. 7. Dr Dryson assesses 4% UEI of the right elbow and 9% UEI of the right shoulder. Those assessments of impairment are based upon range of motion. 8. Dr Dryson states that he records details from Mr Felsch of symptoms which are consistent with a diagnosis of CRPS, but he could find no clinical evidence of CRPS on the day of his assessment. 9. Dr Dryson in a supplementary report dated 17 February 2025 concedes that there are no radiological investigations of the right shoulder, but states: "Mr Felsch has developed symptoms suggestive of a complex regional pain syndrome involving the right upper extremity and this will, in my opinion, be affecting his right shoulder function." 10. A/Prof Kleinman, orthopaedic surgeon, has provided reports at the request of the respondent dated 5 December 2019, 19 September 2024 and 22 December 2024. 11. In his first report dated 5 December 2019, A/Prof Kleinman records details of the injury on

9 June 2016 which are consistent with the details recorded by Dr Dryson, namely that

Mr Felsch felt something "pop" in his right wrist when he was undertaking some lifting. A/Prof Kleinman does not record Mr Felsch experiencing any symptoms in his right elbow or right shoulder, either at the time of the incident on 9 June 2016 or up until this examination. 12. The report from A/Prof Kleinman dated 19 September 2024 is produced after Mr Felsch makes his claim for a lump sum payment for WPI. A/Prof Kleinman does not record

Mr Felsch complaining of any symptoms in his right elbow or right shoulder. He finds a full range of movement in the right elbow and stiffness in the right shoulder, but states that

Mr Felsch made no complaints of pain or injury to the right shoulder. 13. A/Prof Kleinman provides a further report dated 22 December 2024. He writes in regard to the right shoulder:

"In my opinion the pain in Mr Felsch's right shoulder is not related to his right wrist injury as if he had severe pain in his right wrist, he would not have been using his right arm excessively."

1. A/Prof Kleinman writes in regard to the right elbow:

"I can find no mention in his report of how Dr Dryson relates his right elbow condition to the incident on 9/6/16 and Dr Dryson does not supply the evidence of which he relies to support his views."

1. In Trustees of the Society of St Vincent de Paul (NSW) v Maxwell James Kear as administrator of the estate of Anthony John Kear [2014] NSWWCCPD 47 (Kear), DP Roche said at [38]:

"The authorities establish that a "personal injury" is "a sudden and ascertainable or dramatic physiological change or disturbance of the normal physiological state" (Gleeson CJ and Kirby J in Petkoska at [39]). In other words, as stated at [81] in Felstead, it is "a sudden identifiable pathological change."

1. There is simply no evidence provided in this dispute which would allow me to be satisfied that Mr Felsch suffered a sudden identifiable pathological change to either his right elbow or right shoulder in the incident on 9 June 2016.
2. Firstly, and most significantly, Mr Felsch does not provide any evidence of symptoms immediately following the incident which would suggest some pathological change to the right elbow or right shoulder, and which would allow a medical expert to opine as to whether an injury had been sustained to either or both of those two body parts.
3. Secondly, there is no medical evidence which supports a finding that Mr Felsch sustained an injury to his right elbow or right shoulder as a result of the incident on 9 June 2016. There is no material from soon after the incident, in particular from Dr Green, to confirm any symptoms affecting those parts of the body. The first medical report which I could locate following the incident is from Dr Myers on 27 September 2016, and that report does not refer to any injury to the right elbow or right shoulder.
4. Neither Dr Dryson nor A/Prof Kleinman record details of symptoms experienced by Mr Felsch in the right elbow or right shoulder immediately following the incident on 9 June 2016.
5. There will therefore be an award for the respondent on the claim for an injury to the right elbow and right shoulder on 9 June 2016.
6. The determination of whether a condition suffered by a worker is as a consequence of a work injury was considered by DP Roche in Moon v Conmah Pty Limited [2009] NSWWCCPD 134 (Moon). In that matter the worker claimed WPI from symptoms experienced in the left shoulder as a consequence of an accepted injury to the right shoulder. DP Roche said at [45]-[46]:

"It is therefore not necessary for Mr Moon to establish that he suffered an 'injury' to his left shoulder within the meaning of that term in section 4 of the 1987 Act. All he has to establish is that the symptoms and restrictions in his left shoulder have resulted from his right shoulder injury. Therefore, to the extent that the Arbitrator and Dr Huntsdale approached the matter on the basis that Mr Moon had to establish that he sustained an 'injury' to his left shoulder in the course of his employment with Conmah they asked the wrong question.

The test of causation in a claim for lump sum compensation is the same as it is in a claim for weekly compensation, namely, has the loss 'resulted from' the relevant work injury (see Sidiropoulos v Able Placements Pty Limited [1998] NSWCC 7; (1998) 16 NSWCCR 123; Rail Services Australia v Dimovski & Anor [2004] NSWCA 267; (2004) 1 DDCR 648)."

1. Deputy President Roche then proceeded to state that the expression "results from" should be applied using the principles set out by Kirby P in Kooragang Cement v Bates (1994) 35 NSWLR 452 (Kooragang). President Kirby said in Kooragang at [462]:

"It has been well recognised in this jurisdiction that an injury can set in train a series of events. If the chain is unbroken and provides the relevant causative explanation of the incapacity or death from which the claim comes, it will be open to the Compensation Court to award compensation under the Act."

"...What is required is a common sense evaluation of the causal chain. As the early cases demonstrate, the mere passage of time between a work incident and subsequent incapacity or death, is not determinative of the entitlement to compensation. In each case, the question whether the incapacity or death 'results from' the impugned work injury... Is a question of fact to be determined on the basis of the evidence, including, where applicable, expert opinions."

1. Dr Dryson finds restriction of movement of the right elbow and right shoulder and accordingly makes assessments of impairment. However, he does not explain how those restrictions are as a result of the injury on 9 June 2016 and thereby satisfy the test in Moon. In Hevi Lift (PNG) Ltd v Etherington [2005] NSWCA 42 (Hevi Lift), McColl JA (Mason P and Beazley JA agreeing) said at [84]:

"It has long been the case that a court cannot be expected to, and should not, act upon an expert opinion the basis for which is not explained by the witness expressing it."

1. There is no causal link identified at all by Dr Dryson between the injury to the right wrist and the restriction of movement in the right elbow.
2. Dr Dryson does opine that symptoms suggestive of CRPS involving the right upper extremity would be affecting his right shoulder function. However, he does not explain the mechanism or rationale for this given that those doctors who have identified Mr Felsch as having symptoms of CRPS, and whose reports will be addressed elsewhere in this decision, limit those findings to the right hand. Dr Dryson does not explain how symptoms of CRPS in the right wrist and hand can extend to restricted movement in the shoulder.
3. There is no other medical support for the claim made by Mr Felsch that he has conditions affecting his right wrist and right shoulder as a result of the injury to his right wrist and hand.
4. It is otherwise difficult to understand as a matter of logic how Mr Felsch can have restrictions and symptoms in his right elbow and right shoulder when, on his own evidence, he has been limiting the use of his right arm.
5. There will therefore be an award for the respondent on the claim of a consequential condition affecting the right elbow and right shoulder as a result of the injury sustained on 9 June 2016.

Whether the applicant has suffered a consequential condition affecting his left wrist, left elbow and left shoulder as a result of the injury sustained on 9 June 2016

1. In addition to the two operations which he underwent, Mr Felsch describes having several injections to treat the condition of his right wrist and hand, and periods when he has had his right wrist in a splint. Mr Felsch states:

"I was continually told by my doctors not to use my right hand for any lifting, gripping or pushing. I avoided using my right hand due to the significant amount of pain it was causing me. I was relying on my left arm to do any day-to-day lifting, including eating, using my phone, getting in and out of chairs, toileting and anything else I would be doing."

1. Mr Felsch states that he began to develop significant pain in his left elbow and forearm towards the end of 2018. He states that he was on a cruise when he had to use his left hand to arise from his bed and his left hand locked and twisted, which caused tenderness to his left wrist.
2. Mr Felsch states that he has constant pain, discomfort and restriction in his left arm. He complains of muscle spasms in his left shoulder. He states that he now relies upon his left arm to perform basic household tasks or self care tasks.

1. The first reference in the clinical notes from St Clair Medical Practice in regard to problems with the left upper limb appears to be on 13 December 2018 when Dr Gupta records:

using left hand most of the time as rt and is quiet sore

1. Thereafter there are multiple entries in those notes in regard to treatment for various parts of the left upper limb, some of which were referred to by Mr Pecelj and include the following:

(a) on 15 January 2019: "left wrist also sore" and "left hand sore on picking things";

(b) on 31 January 2019: "left hand is still sore";

(c) on 4 March 2019: "left elbow sore", and a referral is given for an ultrasound of the left elbow;

(d) on 18 July 2019: "sore left elbow"; "has been using left side more";

(e) on 30 December 2019: "left elbow gets sore depending on usage";

(f) on 28 May 2020: "did half lawn mowing with left hand and left elbow got sore", and

(g) on 25 February 2021: "flare up of left elbow as well".

1. Dr Gupta writes in a report dated 17 February 2020:

"I think restrictive of rt hand could have contributed in overuse of left side but I can't comment on causal factor for left elbow lateral epicondylitis."

1. There is a referral for an X-ray and ultrasound recorded by Dr Gupta on 5 May 2022, with a note of "pain in left shoulder, no injury".
2. Dr Dryson records that Mr Felsch is unable to do the cleaning or laundry at home, and that his daughters are doing the lawns. Dr Dryson records that Mr Felsch goes shopping with his wife, but he does not do any of the lifting.
3. Dr Dryson finds restriction of movement of the left wrist, left elbow and left shoulder on examination. He diagnoses Mr Felsch as having left lateral epicondylitis and restricted range of movement of the left shoulder.
4. Dr Dryson concludes in his report dated 29 January 2024:

"Subsequently, because of Mr Felsch's efforts to protect his right wrist, he has developed symptoms on the left wrist, left elbow and left shoulder, all of which can be considered overuse injuries."

1. In his supplementary report dated 17 February 2025, Dr Dryson adds to his opinion on the cause of the restrictions he found in the left upper limb as follows:

"The reason why I consider the left arm symptoms to be due to overuse is because Mr Felsch was clearly relying heavily on his left upper limb because of the development of the complex regional pain syndrome in the right upper limb. Although Associate Professor Kleinman points out that he was not working since 2016 and was "inactive", the fact remains that during normal activities of daily living, including dressing and undressing, showering, and light household duties, he was preferentially using the left arm. There were no new injuries to explain onset of symptoms in the left arm."

1. In his first report dated 5 December 2019, A/Prof Kleinman records that Mr Felsch strained his left wrist when trying to get up from his lounge because he could not use his right hand to do so.
2. A/Prof Kleinman finds Mr Felsch to be slightly tender to palpation of the lateral epicondyle of the left elbow. However, he concludes that Mr Felsch does not meet the clinical requirements for a diagnosis of tennis elbow.
3. A/Prof Kleinman concludes that the left upper extremity is not causally related to the original injury because the left wrist condition was caused by the incident at home. A/Prof Kleinman then writes: "His left tennis elbow is consequent to this but not due to his right wrist condition."
4. A/Prof Kleinman records in his report dated 19 September 2024 that Mr Felsch has developed pain in his left shoulder since the previous examination in 2019. He finds the left shoulder to be stiff. He also states that Mr Felsch has signs consistent with lateral epicondylitis of the left elbow.
5. A/Prof Kleinman records that Mr Felsch is unable to do the vacuuming, lawn mowing or gardening, and that he spends the day watching television.
6. A/Prof Kleinman does not consider that the lateral epicondylitis of the left elbow is due to overuse because Mr Felsch has been inactive. He considers that the pain complained of by Mr Felsch in the left shoulder is due to constitutional degenerative changes and not due to overuse.
7. A/Prof Kleinman confirms his opinion that Mr Felsch's complaints of pain in the left shoulder, left elbow and left wrist are not due to overuse because Mr Felsch has not worked and has been inactive since the work injury in 2016.

1. I accept that Mr Felsch sustained a serious injury to his right wrist and hand on 9 June 2016. He has undergone two operations to the right wrist. He has had multiple injections in the right wrist. He has had to wear a splint on several occasions. He has sought treatment from pain specialists and tried different types of medication to relieve the ongoing pain which he experiences.
2. It is therefore entirely understandable that Mr Felsch would limit as much as possible the use of his dominant right hand and use his left hand and arm for his activities of daily living.
3. However, the amount of use required by the left hand and arm is questionable having regard to the available evidence. Mr Felsch has not worked at all since the injury of 9 June 2016. Both Dr Dryson and A/Prof Kleinman record that Mr Felsch does not undertake household tasks. That information leads A/Prof Kleinman to conclude Mr Felsch's complaints of pain in the left shoulder, left elbow and left wrist cannot be due to overuse because Mr Felsch has not worked and has been "inactive" since the work injury in 2016.
4. Nevertheless, I accept that Mr Felsch has had to mostly use his left hand and arm for his normal activities of daily living. Mr Felsch refers to reliance upon his left arm for activities such as eating, getting in and out of chairs, and toileting. Dr Dryson refers to the preferential use of the left arm dressing and undressing, showering and light household duties. These activities have been undertaken by Mr Felsch for almost 10 years now.
5. Furthermore, the clinical notes from St Clair Medical Practice include attendances which record the treatment of the left upper limb coinciding with the use of that body part. It is recorded that "left hand sore on picking things" on 15 January 2019. A sore left elbow is recorded on 18 July 2019 when "using left side more". It is recorded that the "left elbow gets sore depending on usage" on 30 December 2019.
6. I consider that Dr Gupta is even handed in the observation which he makes in his report dated 5 May 2022 that restrictive use of the right hand could have contributed to overuse of the left upper limb but defers to others to provide a definitive conclusion on this issue.
7. Having regard to the applicant's evidence of undertaking basic activities of daily living with the use of the left arm since the work injury in 2016, the references in the clinical notes from St Clair Medical Practice regarding symptoms of pain from use of the left arm, and

Dr Dryson's understanding that the normal activities of daily living have required preferential use of the left arm, I prefer the opinion reached by Dr Dryson that the development of symptoms in the left wrist, left elbow and left shoulder have been caused by overuse of the left hand and arm. 8. That conclusion is consistent with the path of reasoning adopted by DP Wood when she accepted the expert opinion on causation of a consequential condition in Arquero v Shannons Anti Corrosion Engineers P/L [2019] NSWWCCPD 3 (Arquero) at [143]:

"...the evidence was consistent with the historical medical evidence and Mr Arquero's statement evidence. It was not inherently incredible, and provided a logical basis on which the necessary causal connection could be established."

1. I prefer the opinion of Dr Dryson over that provided by A/Prof Kleinman because I accept from the evidence I have just referred to that Mr Felsch has not been as inactive as suggested by A/Prof Kleinman. I accept that Dr Dryson has provided a logical basis for the necessary causal connection to be established.
2. The contemporaneous medical records indicate that the symptoms complained of by

Mr Felsch in the left wrist, left elbow and left shoulder have developed at different times. Symptoms in the left wrist and elbow are recorded by Dr Gupta in early 2019, whereas a referral for scans for the left shoulder is not made until May 2022. 3. Nevertheless, Dr Dryson concludes that the restriction of movement he finds in the three joints of the left upper limb is due to overuse of that limb because of the injury to the right hand and wrist, and this satisfies the test set out in Moon. 4. Mr Hanrahan submits that the record made by Dr Gupta on 13 December 2018 of Mr Felsch falling on his left hand while on a cruise and injuring his left hand and wrist is evidence of a separate injury to the left wrist and casts doubt on the contention that symptoms in the left wrist are due to overuse. 5. The evidence regarding the onset of symptoms in the left wrist at around this time is unclear. Mr Felsch states that he was on a cruise, but that he injured his left wrist when he was using his left arm to get out of bed. The brief entry made by Dr Gupta is: "fell on hand on cruise". A/Prof Kleinman records that Mr Felsch strained his left wrist when trying to get up from his lounge. 6. Whether Mr Felsch did sustain an injury to the left wrist in the form of a strain or sprain to the left wrist does not preclude the finding that I have made on a review of the available evidence that Mr Felsch has also suffered a consequential condition to his left wrist as a result of the work injury. The contribution of that incident to any permanent impairment of the left wrist can be determined by a Medical Assessor, and this was quite fairly conceded by Mr Hanrahan in his submissions. 7. There will therefore be a finding that Mr Felsch has suffered a consequential condition affecting his left wrist, left elbow and left shoulder as a result of the injury he sustained to his right wrist and right hand in the course of his employment on 9 June 2016. 8. There will be a referral to a Medical Assessor for assessment of WPI of the left upper limb (wrist, elbow and shoulder).

Whether the condition of CRPS affecting the right upper limb can be included in a referral to a Medical Assessor for the assessment of WPI

1. The pages of a report from Dr Russo, pain medicine physician, dated 22 November 2017, is broken up in the attachments to the ARD. The first page of the report is at ARD 223.

Dr Russo writes that Mr Felsch reports symptoms of CRPS in terms of swelling of the hand, intermittent red discolouration of the hand, sweating coming from the palm, and abnormal hot sensation coming from the hand. 2. There is another page of that report at ARD 151 wherein Dr Russo writes that on examination there was marked sweat coming from the palmar surface of the hand and diffuse swelling through the fingers and hand, although colour change and temperature change was within normal limits. Dr Russo found the right wrist, right shoulder and cervical spine to be unremarkable. Dr Russo concludes that Mr Felsch has CRPS. 3. There is a report from Dr Wallace, interventional pain specialist, in the attachments to the ARD (166-167) which is incomplete, and the date of the report cannot be verified. Dr Wallace does write:

"Ian exhibits allodynia, hypoalgesia, swelling of the right hand and decreased strength. Therefore he fits the Budapest criteria for diagnosis of complex regional pain syndrome. This diagnosis was also made by Dr Russo as far as I can understand."

1. There is another report from Dr Wallace dated 12 November 2018 in the Application to Lodge Additional Documents at page 32 wherein there is confirmation of a diagnosis of "CRPS right hand".
2. Dr Dowd, plastic, reconstructive and hand surgeon, initially sees Mr Felsch on 9 March 2018 and finds the whole of the right hand to be moderately swollen and there is reddish discolouration to the hand. Dr Dowd writes: "I have no doubt he has complex regional pain syndrome and has had for a number of months".
3. There are multiple occasions in the clinical notes from St Clair Medical Practice wherein a diagnosis of CRPS is recorded, commencing on 19 January 2018, which is soon after

Mr Felsch begins to attend that practice. 4. Both Dr Dryson and A/Prof Kleinman could not identify clinical evidence of CRPS during their examinations of Mr Felsch. However, Dr Dryson still diagnoses "Probable Complex Regional Pain Syndrome" as one of the injuries or conditions sustained by Mr Felsch.

1. I accept from a review of the medical evidence that Mr Felsch has had symptoms of CRPS in the right hand. There are three treating specialists who have found symptoms referable to CRPS in the right hand and have concluded that Mr Felsch has had CRPS.
2. I have given particular weight and preference to the opinion of Dr Dowd because he carries the additional burden of deciding on whether surgery should be performed when the patient is also suffering symptoms of CRPS. Dr Dowd ultimately performed a right de Quervain's release in October 2018.
3. However, the question is whether the referral for WPI should include an assessment of CRPS.
4. Mr Pecelj submits that so long as there is an injury to the right upper limb there can be a referral for assessment of that limb which includes an assessment for CRPS.
5. Mr Hanrahan submits that there has been no assessment of WPI for the condition of CRPS, and therefore there is no dispute, and thus there can be no referral for assessment of CRPS.
6. The claim for lump sum compensation made on behalf of Mr Felsch which is made by letter dated 9 May 2024 claims: "due to our client's efforts to protect his right wrist, he began to develop consequential injuries in the left wrist, left elbow and left shoulder as well as complex regional pain syndrome". The letter includes a copy of the report of Dr Dryson dated

29 January 2024 wherein Dr Dryson includes a diagnosis of "Probable Complex Regional Pain Syndrome". 7. The respondent has therefore been put on notice of a claim made by Mr Felsch that he has CRPS as a result of the work injury, and A/Prof Kleinman has had the opportunity in his reports to address this condition and whether it has been caused by the work injury. 8. The dispute notices issued by GIO on behalf of the respondent dated 6 December 2024,

13 January 2025 and 12 March 2025 subsequent to the claim made by Mr Felsch make no reference to CRPS but dispute injury or consequential conditions to both upper limbs other than to the right wrist. 9. In Greater Taree City Council v Moore [2010] NSWWCCPD 49 (Moore), DP Roche said at [141]:

"... where an employer admits that a worker received an injury and the only compensation claimed is lump sum compensation, the assessment of the degree of permanent impairment is a matter for an AMS."

1. In this matter, the respondent accepts that Mr Felsch has sustained an injury to his right hand and wrist, and I have provided reasons as to why I accept that Mr Felsch has had symptoms of CRPS in the right hand. It is now for a Medical Assessor to assess WPI of the right hand and wrist, which includes an assessment for CRPS, given that it is established that Mr Felsch has sustained an injury to the right wrist and hand and has suffered CRPS as a result of the injury to the right wrist and hand.
2. This was an approach taken by Arbitrator Egan in Elsworthy v Forgacs Engineering Pty Ltd [2017] NSWWCC 64 (Elsworthy) at [166]:

"Accordingly, while it is clear from Bindah, Bishop, and Jaffarie v Quality Castings Pty Ltd [2014] NSWWCCPD 79, that the Commission must determine the liability before a matter may be referred to an AMS impairment, if the condition referred for assessment is CRPS, once it is so referred the AMS is bound to diagnose the existence of the condition by application of the prescriptive definition in cl 17.5 and Table 17-1. This is it so regardless of any determination of the Commission. Additionally, that diagnosis by the AMS must be made on the day of assessment applying Chapter 17, and the AMS is not concerned with, or at least not bound by, whether it may have been diagnosable in the past."

1. The reference to Bindah is the Court of Appeal decision of Bindah v Carter Holt Harvey Wood Products Australia Pty Ltd [2014] NSWCA 264, wherein Emmett J said at [119]:

"Consequently, Order 3 of the Certificate of Determination on 21 November 2011 simply recorded the arbitrator's determination that Mr Bindah had incurred an injury. That determination involved a conclusion on a matter of causation, being that Mr Bindah's employment was a substantial contributing factor to his injury. The arbitrator did not need to make a determination about the precise nature of the injury, because that matter fell within the province of a medical dispute, which was for the approved medical specialist, and, if necessary, the Appeal Panel, to determine. The arbitrator's determination that Mr Bindah had suffered an injury meant that he had suffered an injury according to the definition of that term in s 4 of the Compensation Act. That definition includes both a personal injury and an aggravation, acceleration, exacerbation or deterioration of a disease. It was then for the approved medical specialist to determine the degree of permanent impairment that resulted from the injury. That determination involved a conclusion on a matter of causation, as indicated by the words in bold. (emphasis in [118] and [119] in Bindah)."

1. In accordance with those observations in Bindah, there has been a finding of injury to the right wrist and hand, and the precise nature of that injury, including CRPS, now falls within the province of the Medical Assessor.
2. That there has not been an assessment of WPI for CRPS does not preclude such an assessment being made by the Medical Assessor. I find support for this conclusion in Klement v Bull-N-Bush Nurseries Pty Ltd [2024] NSWSC 466 (Klement) wherein Schmidt AJ said at [73-73]:

"The fact that neither Dr Lai nor Dr Doig had concluded that Mr Klement's shoulder injury had resulted in an impairment, could not confine the medical dispute. The assessor was not bound by those conclusions. He had to make his own assessment, having regard to their reports and the other material which he had to consider because of the way the claim had been advanced and resisted, based on opinions which he formed, having undertaken the examination of Mr Klement which he explained.

This statutory scheme accepts that injuries can improve or worsen over time and so an assessor must base his conclusions on his own findings and opinions, formed at the time of the assessment, while taking into account what earlier examinations have established."

1. That neither Dr Dryson nor A/Prof Kleinman found impairment from CRPS of the right hand does not confine this medical dispute. The Medical Assessor will make his or her own assessment based on a finding that Mr Felsch has sustained an injury to the right hand and wrist and has been diagnosed by three treating specialists as having had CRPS. CRPS is a condition which can improve or worsen over time and, as observed in Elsworthy, it is the diagnosis on the day of assessment which is critical as to whether there will be a finding of WPI for CRPS.
2. The referral for assessment of WPI to the Medical Assessor will include CRPS in the right hand (if verified by the Medical Assessor).