1. Amanda Butfield, the respondent, commenced employment as a primary school teacher in 2016 with the New South Wales Government. The Secretary of the Department of Education, the appellant, is in accordance with ss 21 and 26(1) and Part 1 Schedule 1 of the Government Sector Employment Act 2013 the employer of the respondent.
2. On 22 June 2020 the respondent was working at the Barrack Heights Public School when a student grabbed her left arm and pulled down on it forcefully causing the respondent to fall to the ground. The respondent felt pain in her left shoulder and pins and needles down her left arm. She was diagnosed with capsulitis with impingement syndrome and acromioclavicular (AC) joint sinusitis. She had prolonged conservative treatment and an operation on

17 June 2021 where her AC joint was excised and labral degeneration in her shoulder was debrided. 3. The respondent claimed compensation from the appellant's insurer for permanent impairment resulting from the injuries she suffered on 22 June 2020. She relied on a report her solicitors obtained from orthopaedic surgeon Dr Frank Machart dated 16 April 2024. In his report Dr Machart advised that based on the respondent's physical signs he diagnosed she had a brachial plexus traction injury. He advised that that injury was consistent with the mechanism by which the respondent suffered her injury. He advised that he assessed the degree of the respondent's permanent impairment from her injury is 15% whole person impairment (WPI). That assessment was a combination of 14% WPI he assessed the respondent had relating to her left upper extremity and 1% WPI he assessed she had relating to scarring from her surgery. 4. With respect to his report of the respondent's impairment relating to her left shoulder, he advised that he assessed she had 5% upper extremity impairment relating to the excision of the outer end of her clavicle and 15% upper extremity impairment due to a partial motor brachial plexus injury with no sensory deficit. 5. With respect to her brachial plexus injury, Dr Machart considered the respondent's muscle function was such that it warranted a grade 4 rating pursuant to Table 16-11 of the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th ed (AMA 5). Noting that the maximum for a motor deficit of a brachial plexus injury allowed in Table 16-14 is 75% upper extremity impairment, he calculated that based on his findings the respondent's impairment relating to her brachial plexus injury is 15% upper extremity impairment. 6. Dr Machart noted that 15% upper extremity impairment when combined with 5% upper extremity impairment, for the excision of the outer end of the respondent's clavicle, comes to 23% upper extremity impairment, which in turn converts to 14% WPI. 7. To respond to the respondent's claim, the appellant's insurer organised for the respondent to be examined by orthopaedic surgeon Dr Yiu Key Ho. He provided a report to the insurer on 1 August 2024 relating to that examination. In that he advised the respondent had residual stiffness of her left shoulder that was probably related to post-traumatic and post-surgical frozen shoulder as well as brachialgia from a traction injury to the brachial plexus. He advised that he assessed the degree of the respondent's permanent impairment is 11% WPI. That was a combination of his assessing the appellant having 6% upper extremity impairment because of restricted range of movement of her shoulder, 5% upper extremity impairment because of the resection arthroplasty and 8% upper extremity impairment due to the motor deficit from upper tract brachial plexus damage. With respect to his assessment of the respondent's brachial plexus damage, he also considered that the damage of the respondent's muscle function was such that she warranted a classification of grade 4 in accordance with Table 16-11 but, in contrast to Dr Machart, he considered that the severity of her impairment was such that he assessed only 10% of the maximum impairment allowed under Table 16-14 and hence he assessed she had 8% upper extremity impairment due to her motor deficit from her brachial plexus injury. He noted when all those were combined the result came to 18% upper extremity impairment which equates to 11% WPI. He did not assess the respondent had any impairment due to scarring. 8. The appellant's insurer made an offer to the respondent to pay compensation to her based on Dr Ho's assessment. That offer was not accepted and on 23 May 2025 the respondent instituted proceedings in the Personal Injury Commission (Commission) seeking the Commission determine her claim for compensation for permanent impairment. 9. On 18 June 2025 a delegate of the President of the Commission referred the respondent's claim to Medical Assessor Peter Honeyman to assess the medical dispute between the parties arising from the respondent's claim. The Medical Assessor issued a Medical Assessment Certificate (MAC) on 5 August 2025 in which he certified he assessed the degree of the respondent's permanent impairment from her injury is 12% WPI. That assessment was a combination of the Medical Assessor assessing the respondent having 11% upper extremity impairment due to her restricted range of movement of her left shoulder, and 10% upper extremity impairment for the distal clavicle resection. The Medical Assessor noted this combined to 20% upper extremity impairment, which converted to 12% WPI. 10. The Medical Assessor noted in the MAC that the respondent had suffered a traction injury to her left shoulder that was initially diagnosed as capsulitis which did not settle and progressed to an AC joint synovitis that also did not settle with conservative treatment including repeated injections. The Medical Assessor noted that the respondent's AC joint was surgically removed and that the respondent initially experienced a resolution of symptoms and renewed function of her shoulder but her shoulder deteriorated with increased use. 11. The Medical Assessor recorded in the MAC that he found from his examination of the respondent that she did not exhibit pain behaviours and that she did not have any obvious wasting of either shoulder. He detailed in the MAC the movement he found the respondent had in both shoulders. He recorded that "there were no neurological findings". He recorded that "weakness is subjective". He noted that Dr Ho had rated the respondent had an impairment relating to a brachial plexus traction injury based on the respondent's subjective arm weakness. 12. The Medical Assessor noted that "a brachial traction injury was suggested but not followed by investigations". He said that "the proposal of a traction injury has no objective findings". He did not assess the respondent had any impairment by reference to the criteria of Tables 16-11 and 16-14 of AMA 5. 13. Both the appellant and the respondent have appealed the Medical Assessor's assessment. Both rely on the grounds for appeal provided in s 327(3)(c) and (d) of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act), being: * the assessment was made on the basis of incorrect criteria, and * the MAC contains a demonstrable error. 14. A delegate of the President is satisfied that, on the face of the application, at least one ground for appeal has been made out. The Appeal Panel has conducted a review of the original medical assessment but limited to the ground(s) for appeal on which the appeal is made. 15. Rule 128 of the Personal Injury Commission Rules (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. 16. 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. 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. As a result of that preliminary review, the Appeal Panel determined that the respondent should undergo a further medical examination. This is because the Appeal Panel found, for reasons it explains below, the MAC contained a demonstrable error that the Appeal Panel would need to correct. In order to do that, the Appeal Panel needed to examine the respondent. The Appeal Panel appointed one of its members, namely Medical Assessor Drew Dixon, to conduct that examination. His report to the Appeal Panel is copied below.

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. Both parties made written submissions. They are not repeated in full, but have been considered by the Appeal Panel.
2. With respect to its appeal against the medical assessment, the appellant submitted that the Medical Assessor erred by assessing the degree of the respondent's permanent impairment relating to the resection arthroplasty as 10% upper extremity impairment rather than 5%. The appellant further submitted that the Medical Assessor applied incorrect criteria by doing that in that the Medical Assessor did not abide the instructions within paragraph 2.14 of the Guidelines which amended Table 16-27 of AMA 5.
3. The respondent agreed with the appellant's submission on this issue. With respect to her appeal against the medical assessment, the respondent submitted that the Medical Assessor erred by failing to make any assessment of her impairment from her motor brachial plexus injury. The respondent referred to the assessments that both Dr Machart and Dr Ho had made of her permanent impairment from her injury, both of whom included an impairment for the motor deficit from her brachial plexus traction injury. The appellant submitted that there is nothing within the Guidelines that requires objective findings of such an injury before impairment can be assessed from the injury. The appellant submitted that it is not clear from the findings the Medical Assessor recorded in the MAC whether he examined her for any weakness regarding a motor brachial plexus injury.
4. It is implicit from the respondent's submissions that she contends that the Medical Assessor was wrong not to assess her as having any impairment from a brachial plexus injury on the basis that there were no objective findings to confirm the injury.
5. The appellant submitted that the Medical Assessor was required to assess the respondent as she presented at the time of examination. The appellant submitted that the Medical Assessor had acknowledged a brachial traction injury had been suggested and that this had not been followed up with investigations and that the diagnosis of such an injury had not been confirmed. The appellant submitted that it was open to the Medical Assessor to find that the respondent did not have a brachial traction injury on the basis that there were no objective findings to support the diagnosis. The appellant submitted it was open to the Medical Assessor not to make an assessment of impairment from a brachial traction injury.

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.
3. Consistent with what both parties submitted, the Medical Assessor erred by assessing the respondent has 10% upper extremity impairment, rather than 5% upper extremity impairment, for the excision of her left AC joint. The Guidelines clearly stipulate in paragraph 2.14 that the figure for resection arthroplasty of the distal clavicle (isolated) in Table 16-27 of AMA 5 is amended to 5% upper extremity impairment.
4. The Appeal Panel also considers, consistent with the respondent's submissions, that the Medical Assessor erred by not assessing what if any impairment the respondent has relating to a brachial plexus injury. Both Dr Machart and Dr Ho diagnosed the respondent suffered such an injury. It is apparent that their respective diagnoses of the respondent having such an injury was based on clinical grounds from how the respondent presented at their respective examinations. Given that Dr Machart, on whose report the respondent relied to support her claim and Dr Ho, on whose report the appellant relied to make an offer of compromise in response to the respondent's claim, both diagnosed the respondent suffered a brachial plexus injury, there is consequently no dispute between the parties that in the event on 22 June 2020 the respondent indeed suffered such an injury. As the respondent submitted, there is nothing within the Guidelines or AMA 5 that requires the diagnosis of such an injury be confirmed through objective investigations, such as nerve conduction studies, before an impairment can be assessed from such an injury.
5. Simply put, the Medical Assessor erred by not considering whether the respondent had any impairment relating to her brachial plexus injury. The findings the Medical Assessor recorded in the MAC from his examination of the respondent are not sufficient to enable the Appeal Panel to determine whether the respondent has any impairment from such an injury. For that reason, the Appeal Panel decided to examine the respondent, and as said it appointed Medical Assessor Dixon to conduct that examination on its behalf. His report to the Appeal Panel follows:

This 48 year old claimant was working as a primary school teacher and special needs teacher at Young North Primary school when a child came from the floor and grabbed her outstretched left arm and dropped to the floor again, causing a traction injury of her left shoulder. She had review by her local doctor and subsequently had review by Dr Jansen, orthopaedic surgeon, and was diagnosed with capsulitis with impingement syndrome with AC joint sinusitis.

After a prolonged period of conservative management including physiotherapy and five cortisone injections, she had operative intervention at Wollongong Private Hospital on 17 June 2021 where she had the AC joint excised with good decompression and debridement of labral degeneration. The operative findings at the time showed the rotator cuff was intact with subacromial bursitis and there was an anterolateral spur at the acromion. The biceps anchor was intact.

She had physiotherapy treatment in the convalescent period but had ongoing pain and weakness of the shoulder girdle and was referred to Dr Craig Vonhoff, neurosurgeon, who reviewed her on 10 August 2023. He noted that she had left sided neck pain radiating to the shoulder and into the region of the scapula with episodic numbness and paraesthesia in the left hand with pain at times radiating to the medial aspect of her arm to the elbow. She did feel there was weakness of the shoulder, for example, when carrying a bag. He found that the pain radiated from the neck down to her shoulder and that it had been relieved by heat and soaking in a spa and that she was, at that stage, having difficulty driving a manual car. She had been having physiotherapy regularly.

He found that she had decreased power, grade 4 plus out of 5 on the left shoulder in abduction and the elbow flexion.

He noted the MRI scan had shown minor disc bulge at C5/6 and C6/7 with minor left C5 foraminal stenosis without impingement on the exiting nerve root. He felt the claimant's symptoms did not fit with C6 radiculopathy and felt the brachial plexus traction injury was the cause for her brachalgia. He reports it could be confirmed with nerve conduction studies but these have not been done.

He thought an additional component of her neck could be facet arthropathy and recommended ongoing conservative treatment with physiotherapy and simple analgesia.

She takes Celebrex as an anti-inflammatory as well as Ibuprofen and takes Panadeine Forte and Tramal for pain relief.

She takes medication for raised blood pressure, Keppra to prevent seizures and Oroxine as she has had thyroidectomy in the past.

She has physiotherapy and does her own exercises at home.

She sees her local doctor regularly and will see her orthopaedic surgeon as referred.

She reports persisting pain and weakness in the shoulder with difficulty with heavy lifting and carrying such as heavy groceries and difficulty with repetitive tasks such as word processing. She is careful when working as a teacher of special needs at the primary school to avoid injury to her left arm.

She has a history of asthma and high blood pressure.

She has some depressive disorder with pain but is not taking any anti-depressants.

She reports no significant motor vehicle accidents or whiplash injuries in the past and no past history of neck or shoulder complaints.

She has been a primary school teacher for 21 years and spent the last 10 years as a special needs teacher at Young South Primary School. She is currently doing 6 hours a day, four days a week but avoids heavy lifting at work and picking up children.

She is a single lady who lives in her own house. She has difficulty with cleaning, particularly the bathroom and high dusting and has a girlfriend that helps her with tasks such as vacuuming, mopping and changing the bed linen and she has difficulty with repetitive tasks such as ironing, meal preparation and cooking. She regularly uses an air fryer and avoids lifting heavy baking dishes. She is unable to do the garden or lawns and she pays someone to do the yard work for her.

She does not play team sports. She used to be an active participant in going to the gym, which she no longer goes but enjoys recreational walking.

She does have difficulty at times doing her toenails, doing her hair and dressing, bathing and showering.

On examination on 20 February 2026 at PIC she was 181cm tall and weighed 92.5kg. She presented in a straightforward manner without embellishment.

There was no gross deformity of either shoulder. There was mild wasting of the supraspinatus. There was some elevation of both scapulae on resisted protraction.

The range of motion of her left shoulder was restricted. She reports it has deteriorated over the last six months. Forward flexion was 80 degrees, active abduction 90 degrees, extension 40 degrees, adduction 40 degrees, external rotation 70 degrees and internal rotation 50 degrees. Her shoulder girdle power was grade 4 plus out of 5.

There was a full range of motion of her other shoulder where power was grade 5 out of 5.

She had a symmetrical range of motion of her cervical spine with flexion, extension and lateral rotation decreased by one quarter and lateral flexion decreased by one third bilaterally, with that to the right producing some pain in the left trapezius muscle. There was tenderness of the deltoid muscle down to its insertion. There was a surgical scar across her shoulder, where her AC joint was surgically removed. She finds the scar is tender and she reports her clothing can irritate the scar, such as a bra strap and she prefers to keep the scar covered by wearing t-shirts. There was mild colour contrast and no visible suture marks and claimant was readily able to localise the scar and remains conscious of it and it would be visible if she wore a strappy top or swimming costume.

Her cervical foraminal compression test was equivocal and her brachial plexus stretch test was positive and she had tenderness of the left supraclavicular brachial plexus. Her reflexes were equal and brisk in both upper extremities. While there was no objective sensory change in her hand today, she does have periods where the left index finger goes quite numb. Her thenar power, intrinsic power and grip strength was grade 5 out of 5 bilaterally.

There was no wasting of either upper arm measuring 35cm, 10cm above the elbow crease. There was 1cm of wasting of her left forearm measuring 28cm, 10cm below the elbow crease and 29cm on the right.

Her investigations include an MRI of the left shoulder on 13 July 2020 which showed supraspinatus tendonosis with decrease in tendon thickening and the previously documented capsulitis and subacromial bursitis had resolved.

CT of the cervical spine on 18 January 2023 showed a left sided disc osteophyte complex at C5/6 causing left subarticular recess stenosis and compression of the left C5 nerve.

MRI of the cervical spine on 23 March 2023 showed cervical spondylosis with left sided mild to moderate C5/6 foraminal narrowing with potential irritation of left C6 nerve root.

She was consistent presentation and was consistent on repeat range of motion testing of her shoulders.

In summary this claimant sustained an injury to her left shoulder following a traction injury in the manner described while working as a primary school teacher for children with special needs.

She was initially diagnosed with capsulitis and supraspinatus tendonosis (with AC joint synovitis) but when the condition did not resolve with conservative measures, she had AC joint resection which helped with shoulder symptoms, however, the shoulder has deteriorated subsequently.

Her condition has reached maximum medical improvement and no further treatments are proposed.

Her diagnosis is post traumatic stiffness of her left shoulder plus resection arthroplasty of the AC joint and grade 4 plus out of 5 brachial plexus motor injury, that is 0.5 out of 5.

The impairment for the restricted range of motion of the left shoulder is from Pie Charts 16-40, 16-43 and 16-46, Pages 476-9, AMA V, 14% upper extremity impairment.

That for resection arthroplasty is from SIRA Guidelines 4th Edition page11-12 Sect. 2.14, 5% upper extremity impairment.

The combined impairment for the shoulder is 14+5 which equates to 18% UEI.

That for the brachial plexus at C5/6 weakness grade 4 plus out of 5 is one-tenth of 75% from Table 16-14, Page 490, is one-tenth of 75%, giving 7.5% upper extremity impairment which rounds to 8% upper extremity impairment.

This gives a total from the Combined Values Chart of 25% upper extremity impairment."

1. The Appeal Panel accepts and adopts Medical Assessor Dixon's report. It considers his history relating to the mechanism by which the respondent suffered her injury and the history he otherwise obtained relating to the respondent's treatment and symptoms is accurate. It considers his examination of the respondent was thorough and that his findings from his examination are reliable. There is no point served in repeating all that.[1]
2. The Appeal Panel considers that the mechanism by which the respondent suffered her injury was likely to have caused her to suffer a brachial plexus injury. In the Appeal Panel's view the respondent suffering such an injury is confirmed the Medical Assessor Dixon's finding from his examination of her that she had a positive brachial plexus stretch test and had tenderness of her left supraclavicular brachial plexus.
3. The Appeal Panel also accepts Medical Assessor Dixon's ratings of the respondent's impairment based on his findings from his examination of her. The Appeal Panel has checked those figures and confirmed they are correct. The Appeal Panel notes that 25% upper extremity impairment converts to 15%WPI. The Appeal Panel assesses that is the degree of the respondent's permanent impairment from her injury.
4. For these reasons, the Appeal Panel has determined that the MAC issued on 5 August 2025 should be revoked, and a new MAC should be issued. The new 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 Panel revokes the Medical Assessment Certificate of Medical Assessor Peter Honeyman 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 AMA 5 Guides

Proportion of permanent impairment due to pre-existing injury, abnormality or condition

Sub-total/s % WPI (after any deductions in column 6)

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

[1] Coco Cola Europacific Partners API Pty Ltd v Pombinho [2024] NSWCA 191 at [88].