WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; psychological injury; appellant worker alleged assessment on the basis of incorrect criteria and demonstrable error in the making of assessments under two of the psychiatric impairment rating scale categories (PIRS), namely social and recreational activities, and concentration, persistence and pace; Appeal Panel considered that the Medical Assessor's path of reasoning was inadequate, and it was not clearly discernible from the reasons given in the Medical Assessment Certificate (MAC) that the assessments under the contested PIRS categories were based upon the correct criteria; re-examination was considered necessary in the circumstances of a finding of error; Held - MAC revoked.

1. On 2 June 2025 the worker Claudia Medina (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by

Dr Surabhi Verma, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 15 May 2025. 2. The appellant relies on the following ground 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 grounds 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 requested that she undergo a re-examination by a Medical Assessor who is also a member of the Appeal Panel. As a result of its preliminary review, the Appeal Panel determined that it was necessary for the worker to undergo a further medical examination because the Appeal Panel found error.

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. Medical Assessor Ash Takyar of the Appeal Panel conducted an examination of the worker and reported to the Appeal Panel.

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 to the Medical Assessor for assessment as follows:

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

• Date of injury: 1 March 2021
• Body parts/systems referred: Psychiatric/ Psychological / disorder
• Method of assessment: whole person impairment."

1. The Medical Assessor issued a MAC certifying 9% whole person impairment (WPI) as a result of the injury as follows:

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 assessment was based on his assessment under psychiatric impairment rating scale (PIRS) as required by the Guidelines as follows:

Child protection Case Worker and Child Protection Case Manager

1. Major depressive disorder with anxious distress.

Ms Medina showers 2-3 times a week. She showers, brushes her teeth and changes into clothes 2-3 times a week. She is able to do all the household chores including washing her plates, cooking once a week, doing laundry, vacuuming and mopping. She is able to live independently and manage her household.

She previously did not have any significant hobbies as she was not able to think about anything else apart from work. She said that she used to sleep during the daytime and work during the night shifts which meant that she did not have much time left for other activities. Her daughter now comes over once every fortnight to once every week but does not come more often as she works full-time. Ms Medina has been able to attend her grandchildren's party at the ice-skating rink about a year back but did not stay long. She tries to meet up with her 10-year-old grandson on Friday and attend his school chapel. She said that she sits at back and looks at "well-cared children which generates some hope." She added that some of her friends ended friendships with her as she is on "Workers' Compensation."

Her friends generally have negative attitude and perception of being on Workers' Compensation. She said that she is trying to go for an exercise date with an acquaintance, but they did not work out as she got sick. She is a Buddhist and maintains and does daily chants which she enjoys doing. She has found a Tai Chi lesson but has been unable to attend as it is on the same day as on the chapel, but she has written to New South Wales if the class could be subsidised on other days. Her brother who lives in Sydney has met her once when he came to borrow a trailer.

Ms Medina drives locally to the shopping centre. She has not driven interstate or gone for any vacations or overseas travel. She said that they went to a campsite for holidays in Foster for a couple of days. She mostly attends her appointments with psychologists and doctors over telehealth.

Ms Medina said that her a 12-year long-term relationship ended because of her mental health. She reflected that she had trouble with coping with her mental health. They initially lived together for about eight years and then started living separately from 2022. She is now estranged from one of her daughters which she reflected was a result because of her symptoms.

Ms Medina reported that she is able to read about half a chapter of a book and is able to remember. She is able to watch the whole episode on TV and is engaged. With regards to her finances, she reported that she manages her finances on her own and is able to budget and save for her groceries. Objectively, she was able to pay attention and focus during the assessment. She was also able to subtract 7 from 100 up to five steps and spell the word, world backwards and name of months in both forward and backward manner.

Ms Medina continues to experience significant symptoms of low mood, anhedonia, lack of interest in activities and anxiety attacks. I believe that these ongoing symptoms will impact her ability to return to work in any capacity. She has earlier tried volunteering at OzHarvest but was not doing that regularly as well. I believe that she has no capacity to work.

1. The worker appealed.
2. In summary, the appellant submitted that the Medical Assessor made assessments on the basis of incorrect criteria and demonstrable errors in the assessments she made under two of the six PIRS categories, namely social and recreational activities, and concentration, persistence and pace causing her to make an error in the assessments in these domains as follows:

(a) in assessing Class 2 for social and recreational activities when she should have assessed Class 3, and

(b) in assessing Class 2 for concentration, persistence and pace.

1. In summary it was submitted that these errors arose because the Medical Assessor did not provide an adequate path of reasoning for her findings in the contested domains and it could not be discerned on a fair reading of the MAC whether the assessments had been made on the basis of correct criteria.
2. In summary, the employer Secretary, Department of Communities and Justice (the respondent) submitted that the Medical Assessor neither erred nor made an assessment on the basis of incorrect criteria and the MAC should be confirmed. It was submitted that the MAC was adequately reasoned when read as a whole and the findings were open to the Medical Assessor applying her clinical expertise to the assessment.
3. 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 mental state examination, make a psychiatric 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 under the PIRS categories. The assessment is not to be based upon self-report alone. An appeal panel cannot disturb ratings under the PIRS for mere difference of opinion but must be satisfied as to error.
4. The path of reasoning disclosed by the Medical Assessor must be adequate. This is also dependent on the extent of the history taken and a thorough examination of the worker so that self-report can be properly evaluated in the context of other evidence before the Medical Assessor. The Appeal Panel considered that the path of reasoning was inadequate, and it was not clearly discernible from the reasons given that the assessments under the contested PIRS categories were based upon the correct criteria, and in the case of Social and Recreational Activities was not based upon the quality of her relationships with friends and family that should be rated under Social Functioning.
5. In these circumstances of the above finding of error, the Appeal Panel considered that a re-examination by a Medical Assessor member of the Appeal Panel was necessary. Medical Assessor Ash Takyar was appointed to conduct the re-examination, and he reported to the Appeal Panel as follows (emphasis in original):

Secretary, Department of Communities and Justice

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

• Date of injury: 1 March 2021
• Body parts/systems referred: Psychiatric / Psychological disorder
• Method of assessment: Whole person impairment

The following documents were referred by the Commission for this assessment:

The following information was obtained in accordance with Section 324(1) of the 1998 Act:

• List any imaging studies provided by the worker which were not listed in the documentation provided: N/A

1. WORKER'S DETAILS INCLUDING
   • Date of examination:
   • Date of birth and age at examination: 29 January 1964, 61 years
   • Hand dominance: Right-handed
   • Details of who attended the examination: Examinee _ TEAMS
   • Date of injury: 1 March 2021

• Employer and occupation: Child Protection Case Worker and Case Manager

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

Ms Medina said she began working at the Department in 2002, and confirmed that she ceased in February 2021, and that while she had tried to return to work twice - lasting two weeks and two months respectively, and she was medically retired at the end of 2023 by her work. She then volunteered OzHarvest until around six months ago.

She reported that workplace bullying and harassment "was ongoing for quite a while", and she began discussing her current symptoms and mental state. It took some time to establish that these issues began around "five years after I started work". Resource limitation in terms of what could be given to family worsened in the last ten years of her work, as she said the criteria at work changed, "and we changed from being people-focussed to statistics, opening and closing cases... with work pressures, people left". She described a significant cultural change, adding, "It became more like a referral agency rather than actually doing casework. When I started, I could have a case for five years, and now you have to open and shut a case within 30 days", with managerial pressure to maintain monthly statistics.

Other aspects of the injury in the MAC were also described, including exposure to situations where children were victims of violence and abuse, including deaths which she witnessed via photographic evidence, video footage and written material, along with violence from clients (and families, from what was understood) towards her, which impacted her psychological state.

Over the course of her employment, Ms Medina felt her mental state changes began when she asked for a work adjustment prior to a critical incident; due to loss of focus, she was redirected - due to memory problems she struggled to clearly recall, though she said she had physical symptoms she had not associated with anxiety three months before finishing and later, looking back, she realised she had depressive and anxiety symptoms which she had not seen at the time, earlier than that. Trauma re-experiencing nightmares and flashbacks commenced "After the incident, after I was safe". The incident took place on 1 March 2021.

Of this incident, she recalled that she had a female client who was ultimately admitted to hospital - she was firstly assessed after a suicide attempt but was discharged, and the foster care parents did not want to have her back. Ms Medina said the manager would not pay for a hotel, and this meant she had to put pressure on the Nurse Unit Manager to let the patient remain in hospital despite not having a mental illness. This was contingent on the female being picked up at 7am on the Monday, and on the day prior, "a new manager came on board, and they said we're not doing it, we're not sending anyone out", and Ms Medina raised concerns as she saw the health service as partners in care - and as the plan was an approved one. She reported that she had to ring the hospital, and she described a furious response. She felt unable to cope after this incident, ceasing "within a day", or so.

She sees general practitioner, Dr Nam Phan once a month at Myhealth Medical Centre in Parramatta. She is prescribed sertraline since 2021, at variable doses. She is currently prescribed 50mg (the usual maximal dose), and she reported that although she had tried to maintain 100mg "for about three months", she experienced nausea and had to reduce back. Ms Medina felt this was "a couple of years ago". While she reported that her GP has not discussed a medication change, she said her psychologist had suggested this more recently (she could not remember when).

Psychologist, Dr Charlotte Morgan has been seeing her since 2022, and appointments have been around fortnightly in the last six months. She reported that they have been doing CBT (cognitive behavioural therapy), but she added, "We have a plan to do some more EDMR [sic]", stating that they have used it before for other aspects of the injury.

She had seen psychiatrist, Dr Mark Ryan in March 2021, and she recalled having several sessions - on exploring this, she reported that she self-funded as "there was a problem with his approval or something", and she said he recommended neurofeedback but she could not fund it.

This history was obtained with respect to a period of the last two months, as an average, unless otherwise stated.

On enquiring about sleep prior to the pre-injury work injuries, she reported that she used to work shifts - at the Department; prior to that role when she worked in Community Housing she slept for "seven, eight hours a night... solid", with no delay in falling asleep. Even on shiftwork, before the work injury itself happened while at the Department, she would sleep "roughly about six".

This has reduced to "four to five hours" a night in the last two months, and it takes her "hours" to fall asleep, tossing and turning, and sometimes she gets out of bed three times having still not had any sleep, "finding that it's dawn". It takes "at least three hours", but on discussing this she estimated that it actually takes her "about six hours" to fall asleep, and usually two hours into being in bed she has to get up for an hour then "if I am lucky I will go to sleep after two hours", because of rumination and anxiety, with palpitations and elevated heartrate. Once asleep, "I can sleep up to four hours", and she might be up for "at least an hour, sometimes two" on waking, due to rumination and the cardiac physiologic symptoms. She also reported, "I will be dreaming a lot and it's almost hard to fall asleep", referring to fear of further nightmares.

Disruption in Ms Medina's focus was fairly prominent throughout the assessment of an hour and 46 minutes; history had to be refocussed often due to lapses in her concentration. When she described memory issues, she reported, "I can read a page, but then my mind wanders, I can't concentrate", with this limited to around five minutes of solid focus after which lapsing occurs, and comprehension is fair for this brief period. If she watches a show she likes, the duration of continuous focus is less than a full episode (a half-hour one, it was clarified), estimated at "maybe 20 minutes... sometimes I am watching something and I lose focus and I come back and a couple of episodes have gone, and I haven't noticed" (of how often that occurs, she reported, "I wouldn't say it's that often but in the last two months, it's happened once"). In the 20 minutes of focus she can follow the plot. Later, she described losing focus due to rumination during conversations. In history further on, she reported playing a game on her phone - for around 15 minutes before she has to break; she sometimes does well but if not she is more distractable, she stated.

Ms Medina had difficulty remembering dates and providing details, and at times she needed prompting to try and help memory. She finds it now "Not the best", and said she forgets names of shows she wants to watch and she mentioned that once she reads a page she cannot recall what she has read. After she watches a show for 20 minutes, she can remember the plot afterwards "probably 70% of the time". On exploring if she misplaces or loses things, she thought for some time before reporting, "Not that often, because I am pretty OCD where I put things", but the history revealed she did not have to do this in such a rigid manner pre-injury, only doing so after the injury to compensate for and to manage memory problems. She added, "I never had to write myself notes, I never had to do any of that pre-injury, those things are a coping strategies", and she makes a shopping list now to prevent her forgetting things (for online orders), which was not required before the injury.

She reported, "I feel like I have nothing to contribute... that I have nothing to give, I feel pretty empty and then I go into a headspace of not trying to... like, project that onto anybody, so I listen and nod" - she described distraction in conversation from rumination. Mood was described as always lower than before her injury, and she described lowered enjoyment: "Some of the things I do, I'm just ticking the boxes". She rated her mood at 3/10 (where 1-2 reflect severe depression, 3-4 moderate depression, 5-6 mild depression, 7-8 normal mood and 9-10 elated mood) and she finds she cries more often nowadays. Hope of improvement is present still, but diminished, and along with lowered self-worth she reported feeling helpless.

Ms Medina reported having enjoyment of eating with her granddaughter, and overall enjoyment has reduced to "maybe 20%". Energy has reduced to 20% as well, and added, "I find it very hard to motivate myself to do anything". She denied napping these days.

Ms Medina denied having thoughts of self-harm or active suicidal ideation, intent or plans though she reported passive thoughts "that if I don't wake up, I'd be thankful", which occurs "a couple times a month", which her general practitioner and psychologist are aware of.

She used to consume "two or three meals", prior to the work injury, which has reduced to "once, sometimes once a day, and occasionally, once every two days" - the latter has occurred in the last two months on three occasions, she felt. Meals are normally-sized but she feels enjoyment is lacking, and she felt that is why she eats less often; since the injury, Ms Medina has had weight fluctuation - loss at first but overall is the same weight now.

In the last two months, anxiety has been enduring, and of the severity, she reported that it is high-to-severe (8-9/10, where 1-3 reflect low anxiety, 4-6 moderate anxiety, 7-8 high anxiety, and 9-10 severe anxiety) which has been the case in the last six months (slightly better at 7-8/10 before that, due to being reminded of the injury when she volunteered with AusHarvest once a fortnight in the early morning to avoid others - other volunteers did not like the head of the section and they agitated against them, which reminded her of her own circumstances at the pre-injury employer, and she said there had been other reminders, so she eventually stopped there).

Along with degradative effects on sleep, focus and fatigue, Ms Medina described some irritability ("Not always"), and on discussing this she described being internally irritable and more easily annoyed but she does not express this others, which she confirmed on rechecking. Anxious muscle tension occurs in her shoulders, neck and via tension headaches, and less often in the jaw. She was not restless during the examination within the video field but she spoke of sometimes feeling agitated and irritable at herself, so she paces.

In her work, Ms Medina reported that she was exposed to critical incidents involving at times violence or injury or deaths of children, with exposure through photographs, video evidence and written material. She said nightmares of the actual circumstances occurred "earlier on", which was treated with EMDR. This occurred "initially, after the injury. So I had that ongoing for I don't know, close to a year, and I think we did about eight - and they were specific around the child deaths and then we did about maybe, six, I don't know, seven sessions of EDMR [sic] and it settled down, those nightmares. And then this round, they have been ongoing and again that's the issue we're gonna address. This time it has been the violence - the violence from clients". Nightmares of violence to her and witnessed trauma events via work in the last two months have occurred "at least twice a week". Intrusive visual flashbacks currently occur "a couple of times a week", of "the violence that was directed towards me", in which she reported fearing for her life.

Along with hyperarousal changes to sleep, focus and irritability, she described exaggerated startling to sudden or loud noises - such as if her dog barks (she checks around the house for threat) or bangs, and hypervigilance about risks, about bumping into clients and about bumping into staff. Negative cognitive and emotional changes include loss of interest, feeling "fearful a lot", having difficulty with positive mood and a general loss in trust that others.

Trauma avoidance includes having no contact with anyone from work (she got a text four months from a colleague and she did not reply), and she avoids watching or reading the news to prevent trauma recall, and she avoids routes that take her past the office, and she refused to go to Liverpool when someone offered to take her there (where her previous office was) for a funeral four or five months ago.

Details of any previous or subsequent accidents, injuries or condition:

Ms Medina did not describe and was not aware of any unrelated stressors or contributing factors outside of the injury events and their impacts. She denied being involved in any other accidents or injuries.

She denied any significant new general medical history in terms of new conditions unrelated to the injury.

• Cerebral aneurysm, operated "20 years ago".
• Hyperthyroidism, treated.
• Hypertension - now in remission.

Before the work injury events, Ms Medina had no history of mental illness, including any anxiety or mood disorder, and she had not been treated by a psychiatrist or psychologist (here she began discussing post-injury treatment twice, in the context of anxiety). She was not previously prescribed sleep inductive medicine or antidepressant therapy.

Ms Medina reported rolling her own cigarettes, and she currently has about "ten a day", but before the injury she was smoking "maybe ten a week", which she attributed to finding it helps quell anxiety.

Before the injury, she consumed around "two drinks a week", which she said had reduced to "two drinks every couple of months", due to reduced socialisation. She does not use recreational substances, gamble or have any forensic history.

Work history including previous work history if relevant:

After finishing Year 10, Ms Medina worked "for a couple years, just odd jobs. Then I went to TAFE and did a Diploma in Social Science", over six years part time. During this time, she was employed in family support work at Anglicare (from what could recall, she was unsure at one point), followed by working at a Community Centre as a childcare assistant for a period of "maybe three years, I had a couple of roles", and she left as a Teacher's Aide. Following this, she felt she was at Western Suburbs Housing as a Housing Manager, where she remained for "about seven years. I left that to go to Ryde-Hunters Hill Community Housing, as a Housing Manager for seven years".

She reported that she then commenced work at the Department of Communities and Justice - in 2002 (from the previous MAC, which she felt was correct). Her last day of work was in February 2021.

Ms Medina lives alone, and has her pet dog, Coco. She gets up around 11am and her routine is to have coffee, she might play a game on her phone for about an hour, watch the television, then adding "Not a lot, really". She eats meals "any time between 7pm and 3am", and she goes to bed at 10pm but she needs five or so hours to fall asleep, as noted. In the last two months, she has been leaving the home once a week, taking her daughter to an afterschool activity - last term she "only made four out of ten classes", and she is trying "to be more consistent". Groceries are mostly ordered online but she might go to the supermarket about monthly. She has two daughters, in their mid-40s - she has contact with the daughter in Newcastle; her relationship with the daughter in Parramatta deteriorated after following her injury due to her depression, which her daughter "couldn't understand". Ms Medina described her as active and positive, and she felt her daughter could not relate to her as well in her depressed state.

Before the injury, Ms Medina used to garden "a lot", most days for half an hour. She continues this - other than in the winter - monthly now. She used to garden in the winter, pre-injury. While she wanted to commence Tai Chi, she said she had not ultimately done so. She also said she had not attended the chapel in some time - around "about maybe seven months" or so.

She enjoyed socialising before the injury and saw friends "on a weekly basis. I had a lot of contact with my family before the injury, so Christmases and stuff were always at my place". Ms Medina then stated that she would see friends once or twice a week pre-injury, which continues at a reduced "once every six weeks". She see them and "meet out", within a ten-minute drive of where she lives. She has made some new social contacts via an elderly friend of a long-distance friend, though she said her circle is still smaller than before the injury, as she said she no longer sees her old friends from the Department. Her social circle now consists of

"four people, from south America, and I go out for lunch with them".

Ms Medina used to see family members "at least twice a week" in-person, along with other family gatherings she organised once a month which have ceased. She has missed family events such as the celebration her daughter organised when her grandson started high school, at her home. She also missed her nephew's birthday party, and an event when her sister visited from Perth. Ms Medina said she sees her daughter in Newcastle fortnightly for a coffee.

Ms Medina presented as a female of 61 years in neat attire, and she sat for the one hour and 46 minute long assessment via Teams, with a good-quality, clear connection throughout. She was not restless, she was polite in manner and eye contact was reduced, appropriate to her mood. Speech was reduced in rate and volume, while thought stream and form were unremarkable. Mood was low, affective range was limited and in quality affect was anxious and well-communicated. She denied current self-harm or suicidal ideation, intent plans though passive thoughts that if she were not to wake she would feel thankful. Thought content was of depressive and anxious themes. Concentration was fairly substantially limited, with lapsing often during the assessment and memory deficits were prominently present through the history. Insight and judgement were intact.

Ms Medina presents with a history of trauma re-experiencing, hyperarousal and negative cognitive emotional changes with avoidance phenomena in the context of violence from clients towards her, though she had re-experiencing of traumatic incidents to clients earlier on, which responded to trauma therapy. Depressive symptoms were described, which are ongoing and impact energy, enjoyment, motivation, self-esteem, appetite, sense of hope and memory. Both affect her sleep and concentration.

On the basis of her history, the material in the brief and her mental state examinations, Ms Medina presents with symptoms reflecting under DSM-5-TR diagnoses of post-traumatic stress disorder (PTSD) and major depressive disorder; while MA, Dr Verma in May 2025 diagnosed the latter with anxious distress, the history obtained at this examination allowed for diagnosis of a PTSD. These diagnoses are consistent with the opinion of psychiatrist, Dr Frank Chow from his 2022 and 2024 reports, and with the view of Dr Sivarubin from 2024. Treating psychologist, Dr Morgan has also diagnosed PTSD.

There was consistency across the history over and hour and 46 minutes, the mental state examination features observed and the material in the brief, including treatment records and medicolegal reports.

In the domain of Social and Recreational activities, a Class 2 score was determined, congruent with the assessment of the MA; while this is higher than the Class 3 determined by Dr Chow in May 2024 and Dr Sivaruban in July 2024, both of these assessments are over a year old and do not reflect present functioning.

Both Dr Sivarubin and Dr Chow found a moderate impairment in Concentration, Persistence and Pace, consistent with my findings - the degree of disturbance of concentration and memory was substantial and a focus on understanding the duration and limits to concentration in this examination shed light on the degree of impairment.

1. The Appeal Panel considers that the examination undertaken by Medical Assessor Ash Takyar was conducted in a thorough manner. The Appeal Panel notes the history Medical Assessor Ash Takyar has provided in his report to the Appeal Panel, including the history as to the appellant's ability to function in the PIRS categories that has been challenged on appeal, namely social and recreational activities, and concentration, persistence and pace. The Appeal Panel notes that Medical Assessor Ash Takyar had clear regard to the other evidence before him, has not relied on self -report alone and has used his clinical expertise on the day of assessment to make recommendations to the Appeal Panel about the assessments of the contested PIRS categories. The Appeal Panel notes Medical Assessor Ash Takyar's findings on clinical examination of the appellant and his diagnosis made after clinical examination of the appellant as follows:

"On the basis of her history, the material in the brief and her mental state examinations, Ms Medina presents with symptoms reflecting under DSM-5-TR diagnoses of post-traumatic stress disorder (PTSD) and major depressive disorder; while MA, Dr Verma in May 2025 diagnosed the latter with anxious distress, the history obtained at this examination allowed for diagnosis of a PTSD. These diagnoses are consistent with the opinion of psychiatrist, Dr Frank Chow from his 2022 and 2024 reports, and with the view of Dr Sivarubin from 2024. Treating psychologist, Dr Morgan has also diagnosed PTSD."

1. The Appeal Panel agrees with and adopts the findings of Medical Assessor Ash Takyar.
2. In respect of social and recreation activities, Table 11.2 of the Guides provides as follows:

Table 11.2: Psychiatric impairment rating scale - social and recreational activities

No deficit, or minor deficit attributable to the normal variation in the general population: regularly participates in social activities that are age, sex and culturally appropriate. May belong to clubs or associations and is actively involved with these.

Mild impairment: occasionally goes out to such events eg without needing a support person, but does not become actively involved (eg dancing, cheering favourite team).

Moderate impairment: rarely goes out to such events, and mostly when prompted by family or close friend. Will not go out without a support person. Not actively involved, remains quiet and withdrawn.

Severe impairment: never leaves place of residence. Tolerates the company of family member or close friend, but will go to a different room or garden when others come to visit family or flat mate.

Totally impaired: Cannot tolerate living with anybody, extremely uncomfortable when visited by close family member.

1. The Appeal Panel adopts the findings of Medical Assessor Takyar on re-examination as follows:

"Before the injury, Ms Medina used to garden 'a lot', most days for half an hour. She continues this - other than in the winter - monthy now. She used to garden in the winter, pre-injury. While she wanted to commence Tai Chi, she said she had not ultimately done so. She also said she had not attended the chapel in some time - around 'about maybe seven months' or so.

She enjoyed socialising before the injury and saw friends 'on a weekly basis. I had a lot of contact with my family before the injury, so Christmases and stuff were always at my place'. Ms Medina then stated that she would see friends once or twice a week pre-injury, which continues at a reduced 'once every six weeks'. She see them and 'meet out', within a ten-minute drive of where she lives. She has made some new social contacts via an elderly friend of a long-distance friend, though she said her circle is still smaller than before the injury, as she said she no longer sees her old friends from the Department. Her social circle now consists of

"four people, from south America, and I go out for lunch with them".

Ms Medina said she sees her daughter in Newcastle fortnightly for a coffee."

1. The Appeal Panel agrees that based on the findings on re-examination, the best fit is a mild impairment or Class 2 for social and recreational activities. She has made new friends with whom she has regular social contact more frequently than 'rarely'. There is no evidence she needs prompting or a support person for this.
2. In respect of concentration, persistence and pace, Table 11.5 of the Guides provides as follows:

No deficit, or minor deficit attributable to the normal variation in the general population. Able to pass a TAFE or university course within normal time frame.

Mild impairment: can undertake a basic retraining course, or a standard course at a slower pace. Can focus on intellectually demanding tasks for periods of up to 30 minutes, then feels fatigued or develops headache.

Moderate impairment: unable to read more than newspaper articles. Finds it difficult to follow complex instructions (eg operating manuals, building plans), make significant repairs to motor vehicle, type long documents, follow a pattern for making clothes, tapestry or knitting.

Severe impairment: can only read a few lines before losing concentration. Difficulties following simple instructions. Concentration deficits obvious even during brief conversation. Unable to live alone, or needs regular assistance from relatives or community services.

Totally impaired: needs constant supervision and assistance within institutional setting.

1. The Appeal Panel adopts the findings of Medical Assessor Takyar on re-examination as follows with the following directly relevant to the ascertainment of this rating during the assessment,

"Disruption in Ms Medina's focus was fairly prominent throughout the assessment of an hour and 46 minutes; history had to be refocussed often due to lapses in her concentration.

'Ms Medina had difficulty remembering dates and providing details, and at times she needed prompting to try and help memory.'

Concentration was fairly substantially limited, with lapsing often during the assessment and memory deficits were prominently present through the history. Insight and judgement were intact."

1. Dr Takyar identified that she is unable to read extensively or even focus on TV shows she likes for 30 minutes,

"- 'I can read a page, but then my mind wanders, I can't concentrate', with this limited to around five minutes of solid focus after which lapsing occurs, and comprehension is fair for this brief period. If she watches a show she likes, the duration of continuous focus is less than a full episode (a half-hour one, it was clarified), estimated at 'maybe 20 minutes... sometimes I am watching something and I lose focus and I come back and a couple of episodes have gone, and I haven't noticed' (of how often that occurs, she reported, "I wouldn't say it's that often but in the last two months, it's happened once"). In the 20 minutes of focus she can follow the plot.

• - She forgets names of shows she wants to watch and she mentioned that once she reads a page she cannot recall what she has read. After she watches a show for 20 minutes, she can remember the plot afterwards 'probably 70% of the time'.

She identified difficulties concentrating and persisting with complex tasks

• - She reported playing a game on her phone - for around 15 minutes before she has to break; she sometimes does well but if not she is more distractable, she stated.
• - she makes a shopping list now to prevent her forgetting things (for online orders), which was not required before the injury."

1. The Appeal Panel agrees that based on these findings, the only fit is a moderate impairment or Class 3 for concentration, persistence and pace.
2. What this means is that the classes assessed by the Appeal Panel are higher than those assessed by the Medical Assessor for the contested PIRS category of concentration, persistence and pace where there is moderate impairment at Class 3 and the rating for social and recreational activities remains a mild impairment at Class 2 as assessed by the medical assessor.
3. This means the calculations become as follows:

1. For these reasons, the Appeal Panel has determined that the MAC issued on

15 May 2025 should be revoked and a new MAC issued. The new certificate is attached to this statement of reasons.

Secretary, Department of Communities and Justice

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 Michael Hong and issues this new Medical Assessment Certificate as to the matters set out in the table below:

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.