1. The worker Jan Gramza (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by a Medical Assessor Danielle Wadley, who issued a Medical Assessment Certificate (MAC) on 21 November 2025.
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 Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th ed (AMA 5).

1. The Appeal Panel conducted a preliminary review of the original medical assessment in the absence of the parties and in accordance with the Procedural Direction PIC7.
2. The appellant did not request that they be re-examined by a Medical Assessor who was also a member of the Appeal Panel.
3. As a result of its preliminary review, the Appeal Panel determined that the worker did not need to undergo a further medical examination because the Appeal Panel even though the Appeal Panel found error, there was sufficient material before the Appeal Panel to enable it to make a determination in the matter.

1. The Appeal Panel has before it all the documents that were sent to the Medical Assessor for the original medical assessment and has taken them into account in making this determination.

1. The parts of the medical certificate given by the Medical Assessor that are relevant to the appeal are set out, where relevant, in the body of this decision.

1. Both parties made written submissions. They are not repeated in full, but have been considered by the Appeal Panel.

1. The procedures on appeal are contained in s 328 of the 1998 Act. The appeal is to be by way of review of the original medical assessment but the review is limited to the grounds of appeal on which the appeal is made.
2. In Campbelltown City Council v Vegan [2006] NSWCA 284 the Court of Appeal held that the Appeal Panel is obliged to give reasons. Where there are disputes of fact it may be necessary to refer to evidence or other material on which findings are based, but the extent to which this is necessary will vary from case to case. Where more than one conclusion is open, it will be necessary to explain why one conclusion is preferred. On the other hand, the reasons need not be extensive or provide a detailed explanation of the criteria applied by the medical professionals in reaching a professional judgement.
3. The matter was referred by the Personal Injury Commission (Commission) to the Medical Assessor as follows:

"The following matters have been referred for assessment (s 319 of the 1998 Act):

• Date of injury: 1 October 2019
• Body parts/systems referred: Lumbar spine
• Method of assessment: WPI"

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)

Total % WPI (the Combined Table values of all sub-totals)

1. The worker appealed.
2. There is no complaint on appeal about the assessments of the overall level of impairment of the lumbar spine at 14% whole person impairment (WPI). The complaint of appeal concerns the extent of the s 323 deduction made by the Medical Assessor at one-half.
3. In summary, the appellant submitted on appeal that the Medical Assessor made an assessment on the basis of incorrect criteria and/or made demonstrable errors for reasons which included the following:
   • the evidence was not properly engaged with including the evidence in the general practitioner's (GP's) clinical notes that there were no back symptoms prior to injury for some two years;
   • the appellant was able to engage in heavy manual work prior to the subject injury. and
   • a deduction of one-tenth is consistent with the available evidence and a deduction of one-half is not.
4. In summary, the employer Jakane Constructions Pty Ltd (the respondent) submitted that the Medical Assessor did not make an assessment on the basis of incorrect criteria and did not make demonstrable errors and that the MAC should be confirmed on the basis that the Medical Assessor has given adequate reasons for making a deduction of one-half which is not inconsistent with the available evidence and represents the proper exercise of her clinical judgment.
5. The role of the Medical Assessor is to conduct an independent assessment on the day of examination. The Medical Assessor is required to take a history, conduct a physical examination, make a diagnosis and have due regard to other evidence and other medical opinion that is before the Medical Assessor. The Medical Assessor must bring her clinical expertise to bear and exercise her clinical judgement when making an independent assessment of impairment including the assessment of the extent of any deduction under s 323 and must apply the correct criteria for assessment under the Guidelines. The path of reasoning disclosed by the Medical Assessor must be adequate.
6. The Medical Assessor recorded the following history:

"• Brief history of the incident/onset of symptoms and of subsequent related events, including treatment:

The subject incident occurred on 01/10/2019 whilst at work, whereby he describes twisting to pick up a hammer at work weighing less than 1 kg. The twisting motion resulted in acute, severe lower back pain radiating to his left leg and predominantly left thigh and buttock, but not past his knee. At some point, he developed numbness in the forefoot. He denies right thigh or leg radiculopathy at this time. However, had experienced minor tingling in the past.

Mr Gramza confirmed it was a similar pain to his preexisting lower back symptoms but significantly more intense. He was treated with nonsurgical methods, including physiotherapy. However, given his persistent symptoms, came to surgical treatment by Dr Yang, neurosurgeon on 10/10/2020. He underwent a left L2-3, 3-4 and 4-5 discectomy and L3-4-5 nerve root decompression. The surgery resolved the radiculopathy, significantly improved the lower back pain, and he reports persistent numbness in the forefoot. However, this is now bilateral.

Additionally, Mr Gramza later suffered an injury on 15/09/2022 requiring T1 to T5 fusion for a T3 fracture, and a left rotator cuff repair.

• Present symptoms: Mr Gramza reports intermittent left paraspinal lumbar pain, generally rated 4 out of 10 with exacerbations caused by certain movements such as rapid movements, which occur during activities such as vacuuming, bending, or getting up and down from the floor. He avoids moderate or heavy lifting and exacerbations can increase pain up to 7 out of 10. Walking on uneven ground exacerbates his symptoms and leaning on a shopping trolley relieves his pain. Very occasionally, he has left leg pain. The numbness in both feet have persisted. He has no symptoms consistent with a foot drop.
• No current treatment for lower back. He has no current treatment and undertakes self-directed swimming at home.
• He has had no further injuries to his lumbar spine.
• Details of any previous or subsequent accidents, injuries or condition:

Motorbike accident 1980: Suffered a fractured mandible, rib fractures and left clavicle fracture.

17 April 1990: L2, L3, L4 transverse process fractures following an incident when the wall framing fell onto him. Treated non surgically. Fully recovered and denies residual symptoms.

11 November 2014: While self-employed as a carpenter, he lost his footing after he was stepping off the ladder onto the barbecue, resulting in a lower back injury. He reportedly suffered a disc prolapse and nerve root impingement causing radicular pain to the left legs. He continued to experience lower back pain rated generally at 3/10 with intermittent left thigh pain. However he returned to work.

2017: He jarred his lower back when he stepped awkwardly off the bottom rung of a ladder resulting in intense pain. Symptoms did not resolve and remained intermittent with certain movements and activities.

• General health: Mr Gramza suffered an acute myocardial infarction in 2007 requiring stents. Atrial fibrillation. Hypertension. Hypercholesterolaemia. He denies diabetes. He takes Pradaxa, Diazide, metoprolol, amlodipine, perindopril, rosuvastatin, ezetimibe, moxonidine.
• Work history including previous work history if relevant: Mr Gramza has been involved in a variety of occupations since 1975 ranging from working as an aluminium welder/fabricator, crane driver, completion of his carpentry apprenticeship, and then owning his own business in both the taxi trucks and Atlas awnings and span line. In between 2013 to 2022, he has worked as a subcontractor for True Line Home Improvements. Mr Gramza retired when his work cover claim was finalised, and once he reached the age of 67 years.
• Social activities/ADL: Mr Gramza lives alone in a house. He has independent children living outside the family home. He's generally independent in his household duties. However, these take longer than previously, and he takes more frequent breaks. He continues to manage the gardening and lawn mowing. He is a nonsmoker, denies the use of recreational drugs or medicinal marijuana and drinks no alcohol.
• Mr Gramza reports the general home maintenance activities can result in pain lasting for several days afterwards, and he takes longer to recover. He has altered his ergonomics to manage his symptoms. He is more comfortable when frequently changing positions, can manage driving for approximately one hour and sitting for approximately one hour. He has discomfort sleeping, and his symptoms gradually worsen throughout the day."

1. The Medical Assessor noted the following special investigations:

"• 30 December 2014, CT Lumbosacral spine, North Coast Radiology

• Grade 1 spondylitic spondylolisthesis L5 on S1. Generalised degenerative disc disease throughout the lumbar spine. L3/4 developmentally narrow canal with moderate disc bulge and mild/moderate facet joint arthropathy. L4/5 central and right paracentral disc protrusion.
• 6 May 2020, MRI spine, North Coast Radiology:
• Disc desiccation and posterior disc protrusion at L2-3, L3-4, L4-5 with canal stenosis and flattening of the exiting right L4 nerve root within the foramen. Bilateral spondylolysis at L5 with 7 mm anterior displacement of L5 on S1 and flattening of the L5 nerve roots within the neural foramina. Bulging disc contacts the traversing right S1 nerve root.

19 May 2020. CT, lumbosacral spine, North Coast Radiology:

• Loss of disc height throughout the whole lumbar spine. Moderate canal narrowing at L3-4. No convincing nerve root compression at this level. Right sided L4 foraminal narrowing, but no convincing nerve root compression. Severe bilateral foraminal narrowing with compression of both exiting L5 nerve roots."

1. The Medical Assessor recorded her examination findings which were not the subject of complaint on appeal. The Appeal Panel notes that there is no complaint about the assessment of overall impairment for the lumbar spine.
2. The Medical Assessor summarised the injury and diagnosis as follows:

Aggravation of preexisting spondylitic spondylolisthesis L5 on S1 with generalised lumbar disc degenerative changes, facet joint degeneration and canal stenosis. Disc bulge and nerve root compression left L3/4/5 requiring discectomy and nerve root decompression.

Consistent with presentation and radiological findings. There was no indication Mr Gramza was exaggerating his presentation."

1. The Medical Assessor set out reasons for her assessment as follows:

"My opinion and assessment of whole person impairment 7% WPI

In making that assessment I have taken account of the following matters:-

Radiological and clinical evidence of symptomatic preexisting lumbar spine pathology"

1. The Medical Assessor explained her calculations as follows:

Table 15-3 Croteria for rating impairment lumbar spine page 384

DRE III 10-13% given previous surgery for radiculopathy.10% allocated on this basis.

Given effect on household duties, a further 2% allocated on this basis.

4.27 page 27 criteria for radiculopathy. The presentation did not fit the cirteria for radiculopathy given symmetrical reflexes, no muscle atrophy or weakness, sensory distrubance inconsistent with a spinal cause and negative nerve root tension signs.

Table 4.2 page 29 Modifiers for spinal surgery - 1% for each additional level. Therefore additional 2% given there was three surgical levels.

The first onset of lower back symptoms was dated 11 November 2014: While self-employed as a carpenter, he lost his footing after he was stepping off the ladder onto the barbecue, he suffered a disc prolapse and nerve root impingement causing radicular pain to the left legs. He continued to experience lower back pain rated generally at 3/10 with intermittent left thigh pain.

Prior to this incident he sustained transverse process fractures which resolved without ongoing symptoms.

The incident in question, namely a minor twisting motion to lift an object <1 kg in weight resulted in further aggravation of the underlying lumbar spine degenerative changes. Therefore a 50% deduction for preexisting appears to be a more accurate representation of the presentation in question, rather than a 1/10th deduction.

1. The Medical Assessor set out further her reasoning in respect of the deduction as follows:

"DEDUCTION (IF ANY) FOR THE PROPORTION OF THE IMPAIRMENT THAT IS DUE TO PREVIOUS INJURY OR PRE-EXISTING CONDITION OR ABNORMALITY

1. In my opinion the worker suffers from the following relevant previous injuries, pre-existing conditions or abnormalities:

17 April 1990: L2, L3, L4 transverse process fractures following an incident when the wall framing fell onto him. Treated non surgically. Fully recovered and denies residual symptoms.

11 November 2014: While self-employed as a carpenter, he lost his footing after he was stepping off the ladder onto the barbecue, resulting in a lower back injury. He reportedly suffered a disc prolapse and nerve root impingement causing radicular pain to the left legs. He continued to experience lower back pain rated generally at 3/10 with intermittent left thigh pain. However he returned to work.

2017: He jarred his lower back when he stepped awkwardly off the bottom rung of a ladder resulting in intense pain. Symptoms did not resolve and remained intermittent with certain movements and activities.

1. The previous injury, pre-existing condition or abnormality directly contributes to the following matters that were taken into account when assessing the whole person impairment that results from the injury, being the matters taken into account in 10a, and in the following ways:

Whilst the extent of the deduction is difficult or costly to determine the available evidence is that the deductible proportion is large and a deduction of one tenth is at odds with the available evidence. In my opinion the deductible proportion is X for the following reasons:

The first onset of lower back symptoms was dated 11 November 2014: While self-employed as a carpenter, he lost his footing after he was stepping off the ladder onto the barbecue, he suffered a disc prolapse and nerve root impingement causing radicular pain to the left legs. He continued to experience lower back pain rated generally at 3/10 with intermittent left thigh pain.

Prior to this incident he sustained transverse process fractures which resolved without ongoing symptoms.

The incident in question, namely a minor twisting motion to lift an object <1 kg in weight resulted in further aggravation of the underlying lumbar spine degenerative changes. Therefore a 50% deduction for preexisting appears to be a more accurate representation of the presentation in question, rather than a 1/10th deduction."

1. The Medical Assessor made brief comments on the other medical opinions as follows:

"The incident in question, namely a minor twisting motion to lift an object <1 kg in weight resulted in further aggravation of the underlying lumbar spine degenerative changes. Therefore a 50% deduction for preexisting appears to be a more accurate representation of the presentation in question, rather than a 1/10th deduction."

1. A deduction under s 323 can only be made if the pre-existing condition, abnormality or injury has contributed to the level of permanent impairment assessed. There is no cavilling by the appellant that a deduction should have been made to take account of the contribution to the overall level of permanent impairment assessed in respect of the lumbar spine but the appellant says it should have been assessed at one-tenth.
2. A deduction of one-tenth can be made if the deduction is too difficult or costly to assess and the Medical Assessor says that it is difficult or costly to determine but considers that a one-tenth deduction is inconsistent with the available evidence and she reasoned that a deduction of one-half was consistent with the available evidence. This reasoning fails to take adequate account that the appellant returned to heavy manual work after the prior injury and it was only after the subject injury that he proceeded to multi-level surgery. Taking adequate account of all of the available evidence a one-tenth deduction was not inconsistent with the available evidence in circumstances where the deduction was difficult or costly to determine as stated by the medical assessor and a one-tenth deduction should have been made. This means the calculations become 14% WPI as assessed for the overall impairment and not complained about on appeal less 1.4 gives 12.6 or 13% WPI after rounding. This means the MAC will be revoked.
3. For these reasons, the Appeal Panel has determined that the MAC issued on 21 November 2025 should be revoked. A new Medical Assessment 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 Pane revokes the Medical Assessment Certificate of Medical Assessor Danielle Wadley 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 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)

Total % WPI (the Combined Table values of all sub-totals)

The above assessment is made in accordance with the SIRA NSW Guidelines for the Evaluation of Permanent Impairment for injuries received after 1 January 2002.