WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; Medical Assessor (MA) found that the appellant was not at maximum medical improvement (MMI) and required a neurological assessment yet assessed whole person impairment in the body of the Medical Assessment Certificate (MAC); MA erred in not providing adequate reasons for his conclusion that MMI had been reached; MA erred in calling for a neurological assessment as no power to do so; worker re-examined; Held - MAC revoked.

1. On 24 March 2025 Peter Sirijovski (the appellant) lodged an Application to Appeal Against the decision of a Medical Assessor. The medical dispute was assessed by Dr Roger Pillemer, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on

27 February 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 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 appellant was employed as a team member with Coles Supermarkets Australia Pty Ltd (the respondent) from 2014 until July 2022. He claims lump sum compensation for whole person impairment (WPI) arising out of an injury with the respondent, due to the nature and conditions of his employment.
2. The appellant lodged an Application to Resolve a Dispute in the Personal Injury Commission (Commission) on 25 June 2024 in which he claimed lump sum compensation in respect of the injury to his right and left lower extremities deemed to have occurred on

16 February 2023. 3. In a Certificate of Determination - consent orders dated 6 September 2024, Member Parnel McAdam made orders including the following:

"1. The applicant suffered injuries to his left and right lower extremities (hip, ankle, and foot) due to the nature and conditions of his employment with the respondent.

1. The matter is remitted to the President for referral to a Medical Assessor pursuant to s 321 of the Workplace Injury Management and Workers Compensation Act 1998 for assessment as follows:

(a) Date of injury: 16 February 2023 (deemed).

(b) Body systems/parts: left lower extremity (hip, ankle, foot), and right lower extremity (hip, ankle, foot), and

(c) Method of assessment: whole person impairment.

1. The documents to be referred to the Medical Assessor are:

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

(b) the Reply and attached documents, and

(c) the Application to Admit Late Documents dated 13 August 2024."

1. The Medical Assessor examined the appellant on 10 February 2025 and made no assessment of WPI noting in respect of each lower extremity "not able to assess WPI as a firm diagnosis has not been reached or possible treatment carried out".

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 he be re-examined by a medical member of the Appeal Panel.
3. As a result of that preliminary review, the Appeal Panel determined that there was a demonstrable error in the MAC and that the appellant should undergo a further medical examination because there was insufficient evidence on which to make a determination.

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 Drew Dixon of the Appeal Panel conducted an examination of the appellant on 22 August 2025 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.
2. The appellant's submissions include the following:

(a) Ground 1 - at paragraph 8 of the MAC the Medical Assessor stated that the appellant was claiming for a body part/system outside his area of expertise. The body parts/systems referred were well within his field of exercise. To find otherwise was a demonstrable error.

(b) Ground 2 - the same error led the Medical Assessor to his conclusion (at 8b) that the body systems referred had not reached maximum medical improvement (MMI) because of (at 8c) the neurological involvement of both lower limbs. The detected neurological signs played no part in the claim and were not part of body systems referred.

(c) Ground 3 - at paragraph 8d the Medical Assessor suggested discomfort in movement of the hip joints was not related to the hip joints themselves. There had been no suggestion by either party that the cause of hip discomfort was anything but the result of degenerative changes/osteoarthritis of the hips. To deny the diagnosis was to embark on a medico-legal departure from what was required of him which constitutes a demonstrable error.

(d) At paragraph 10c the Medical Assessor reviewed the other medical opinions and disagreed with the diagnoses of Dr Guirgis. This is a further manifestation of the Medical Assessor's failure to acknowledge and perform the statutory task required of him; to assess the impairments subject of the referral and injuries determined by Member Parnel.

(e) Ground 4 - the Medical Assessor then expressed the view that the appellant required a neurological assessment. The appellant does not accept that the foundation for this opinion was available to the Medical Assessor for the reasons advanced above. This constitutes a demonstrable error. If this was truly the impediment to completing his statutory task, the Medical Assessor had the power pursuant to s 324(1) (a) of the 1998 Act to consult treating medical practitioners and under s 324(1) (b) to call for production of medical records and other information as he considered necessary. There is no evidence that he did either.

(f) Consistent with the Medical Assessor's power pursuant to s 324(1), the Guidelines provide guidance for the ordering of additional investigations. Not only did the Medical Assessor fail to order additional investigations, he did not identify what additional investigations he required in order to discharge his statutory task, other than to refer to neurological assessment.

(g) Ground 5 - despite all of the qualifications that he expressed referred to above, the Medical Assessor assessed a 14% WPI for left and right lower extremities (at 10a), before saying in the same paragraph that he could not assess impairment.

(h) Had he concluded that MMI had not been achieved as contemplated by paragraph 1.15 of the Guidelines he should have said so and not embarked on the assessment.

(i) The MAC should be revoked and the appellant re-examined.

1. The respondent's submissions include the following:

(a) The MAC does not contain any demonstrable errors. The referral to the Medical Assessor was with regard to the right lower extremity and left lower extremity. There was no limitation as to method of assessment be it orthopaedic of neurological.

(b) The Medical Assessor's role is to obtain history from the appellant, perform an extensive examination, on the basis of the examination provide a diagnosis, and assess if his condition has stabilised to assess WPI and if so to provide that assessment.

(c) The examination of the Medical Assessor was not in any way materially defective. The Medical Assessor's examination amounted to a proper medical examination. The Medical Assessor is entitled to rely upon the Medical Assessor's own history, examination and diagnosis in providing the MAC. There is no error in the diagnosis as reached based upon the Medical Assessor's examination and the finding of peripheral neuropathy.

(d) The Medical Assessor's diagnosis was different to that of Dr Guirgis and it was on that basis that the Medical Assessor could not provide an assessment of WPI. The diagnosis reached by the Medical Assessor was based on his examination and observation of neurological signs that had not been investigated. On that basis, the Medical Assessor was not able to assess permanent impairment. On examination, the Medical Assessor found evidence of significant peripheral neuropathy as evidenced by the very distinct sensory loss and absence of reflexes. This was not picked up on examination of the appellant by Dr Guirgis.

(e) The observed neurological signs (peripheral neuropathy) during the examination, were outside the Medical Assessor's expertise to enable him to determine permanent impairment or if MMI had been reached.

(f) The Medical Assessor does not need to accept the diagnosis of the qualified doctors where his diagnosis is different based on his own examination of the appellant.

(g) On the basis of the Medical Assessor's examination a neurological opinion/assessment is required prior to any assessment of permanent impairment is ascertainable. This is in accordance with the Guidelines.

(h) The MAC does not contain any demonstrable errors and should be confirmed.

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 Appeal Panel reviewed the MAC and the evidence in this matter.

Ground 1 -Claim outside Medical Assessor's area of expertise

1. The appellant submits that the Medical Assessor erred at paragraph 8 of the MAC where he stated that the appellant was claiming for a body part/system outside his area of expertise because he had detected significant neurological involvement of both legs. The appellant argues that the referral had not asked him to perform assessment of any neurological condition other than the peripheral nerve injuries assessed in each foot by Dr Guirgis. The appellant submits that the body parts/systems referred were well within his field of expertise and to find otherwise was a demonstrable error.
2. The Medical Assessor at paragraph 7 of the MAC wrote:

As noted, Mr Sirijovski developed problems with both hips in approximately mid-2021, noting that x-rays at the time were reported as being normal and subsequent x-rays within a year suggested osteoarthritic change in both hips, but this could not have been significant for the reasons suggested above.

He does, however, present with significant ongoing restriction of movement of both hips at this stage and with genuine discomfort when testing range of movement, although, as noted above, the fact that he was easily able to touch his toes with his fingertips on flexing his back without any symptoms certainly indicates that the osteoarthritic change in his hips is unlikely to be the cause of his severe discomfort.

As far as his lower limbs are concerned, Mr Sirijovski has evidence of very significant peripheral neuropathy as evidenced by the very distinct sensory loss and the absence of reflexes. As noted, the pain in both legs below the knees is described as being "20/10" and worse than his hip pain. In my opinion this is likely to be very significant.

Mr Sirijovski presented in a straightforward and open fashion, but I am unable to explain the severe discomfort on direct examination of his hips while noting his normal gait and the ability to touch his toes with no discomfort".

1. The Medical Assessor at paragraph 8 of the MAC wrote:

My answers to the following questions regarding the assessment of impairment and or whole person impairment in accordance with the NSW workers compensation guidelines for the evaluation of permanent impairment with respect to the injury suffered in the accident are:

(a) Is the worker claiming for any body part/system outside your field of expertise? If so, please indicate the body part/system: Yes. As noted Mr Sirijovski has significant neurological involvement of both legs which has not been noted previously and seems to be his main cause of pain at the present time.

(b) Have all body parts/systems stabilized/reached maximum medical improvement? No

(c) If not, please list those injuries not yet stable/at maximum medical improvement: Neurological involvement of both lower limbs.

(d) If stabilisation/maximum medical improvement, of any or all injuries has not been reached, when, in your opinion, will this occur? Unable to say without a neurological assessment. It is certainly possible, and I think likely, that the discomfort experienced of movement of his hips is not related to the hip joints themselves, for the reasons suggested above.

(e) Is any proportion of loss of efficient use or impairment or whole person impairment, due to a previous injury, pre-existing condition or abnormality? Unable to say without neurological assessment.

(f) If so, please indicate which body part/system is affected by the previous injury, pre­ existing condition or abnormality. As I e**.** above."

1. The appellant argues that the referral had not asked him to perform assessment of any neurological condition other than the peripheral nerve injuries assessed in each foot by

Dr Guirgis and that the body parts/systems referred were well within his field of expertise. 2. The Medical Assessor formed the view after his clinical examination of the appellant that there was evidence of very significant peripheral neuropathy in the lower limbs. He considered that assessment of this peripheral neuropathy in the lower limbs was outside his expertise and he was therefore unable to determine permanent impairment or whether MMI had been reached. 3. The Appeal Panel notes that Guidelines at "Chapter 3 Lower Extremity" provide at 3.2 that:

"Assessment of the lower extremity involves physical evaluation, which can use a variety of methods. In general, the method should be used that most specifically addresses the impairment present. For example, impairment due to a peripheral nerve injury in the lower extremity should be assessed with reference to that nerve rather than by its effect on gait."

1. The Appeal Panel notes that AMA 5 at page 550 provides for assessment of peripheral nerve injuries and contains various figures (Figures 17.8 and 17.9) and Tables (Table 17-36, Table 16-10 and 16-11) used for such assessments.
2. The Appeal Panel was satisfied that the assessment of the peripheral neuropathy was not outside the expertise of the Medical Assessor. Assessment of the peripheral nerves is regularly undertaken by assessors as part of the assessment of the lower extremities.
3. This ground of appeal is made out.

1. The appellant submits that the same error led him to his conclusion that the body systems referred had not reached MMI because of the neurological involvement of both lower limbs. The appellant submits that the detected neurological signs played no part in the claim and were not part of body systems referred.
2. Although there was no referral of the nervous system, the Appeal Panel accepts that neurological signs were part of the assessment. Dr Guirgis made an assessment of peripheral nerve injuries. The appellant's claim is based on Dr Guirgis' report of

8 November 2022 and his assessment. Dr Guirgis assessed the right lower extremity as including:

"According to Chapter 17 Table 17-37(page 552) Impairments due to Nerve Deficits, BY ANALOGY: Sural nerve sensory 2 + dysthaesiae 5 = 7 % Lower Extremity Impairment."

1. Similarly, Dr Guirgis assessed the left lower extremity as including:

"According to Chapter 17 Table 17-37(page 552) Impairments due to Nerve Deficits, BY ANALOGY sensory 2 + dysthaesiae 5 = 7 % Lower Extremity Impairment."

1. The Guidelines at paragraphs 1.15 and 1.16 provide:

"1.15 Assessments are only to be conducted when the medical assessor considers that the degree of permanent impairment of the claimant is unlikely to improve further and has attained maximum medical improvement. This is considered to occur when the worker's condition is well stabilised and is unlikely to change substantially in the next year with or without medical treatment.

1.16 If the medical assessor considers that the claimant's treatment has been inadequate and maximum medical improvement has not been achieved, the assessment should be deferred and comment made on the value of additional or different treatment and/or rehabilitation - subject to paragraph 1.34 in the Guidelines."

1. The Medical Assessor did not comment on whether the degree of permanent impairment of the claimant is unlikely or likely to improve further or whether the appellant's condition is well stabilised and unlikely to change substantially in the next year with or without medical treatment. The Medical Assessor did not comment on whether treatment had been inadequate so that MMI has not been achieved apart from noting in Table 2 that he was

"not able to assess WPI as a firm diagnosis has not been reached or possible treatment carried out". 2. The failure by the Medical Assessor to give adequate reasons for the conclusion that MMI has not been achieved by reference to the requirements in the Guidelines was a demonstrable error. 3. This ground is made out.

Ground 3 - speculation about any otherwise undiagnosed condition

1. The appellant submits that the Medical Assessor suggested discomfort in movement of the hip joints was not related to the hip joints themselves. The appellant argues that there had been no suggestion by either party that the cause of hip discomfort was anything but the result of degenerative changes/osteoarthritis of the hips. The appellant submits that to deny the diagnosis constituted a demonstrable error.
2. The Medical Assessor at paragraph 8d of the MAC wrote:

"If stabilisation/maximum medical improvement, of any or all injuries has not been reached, when, in your opinion, will this occur? Unable to say without a neurological assessment. It is certainly possible, and I think likely, that the discomfort experienced of movement of his hips is not related to the hip joints themselves, for the reasons suggested above."

a. My opinion and assessment of Whole Person Impairment

As noted, Mr Sirijovski has 35% Lower Extremity Impairment on each side for the reduced range of hip movements, which equates with 14% WPI on each side.

However, as noted, the hip symptoms only came on in approximately 2021 and x-rays at that time were reported as being within normal limits. He continued working till July 2022 and has not worked since then. As noted, in my opinion, it is more likely than not that his discomfort on hip movements is not due to osteoarthrosis of his hips.

At this stage I am not able to assess Mr Sirijovski's impairment, as in my opinion a firm diagnosis has not been reached, and his condition may well be neurological as evidenced by his severe leg symptoms with absent reflexes and sensory loss.

In my opinion he requires a neurological assessment at this stage to determine the cause of his sensory and reflex loss, and also to determine of his severe discomfort of moving his hips is possibly also due to an underlying neurological condition.

Depending on the findings of a neurologist, I may well be able to suggests figures of impairment on an orthopaedic basis, without the need of a further examination."

"In calculating the final level of impairment, the assessor needs to clarify the degree of impairment that results from the compensable injury/condition. Any deductions for pre-existing injuries/conditions are to be clearly identified in the report and calculated. If, in an unusual situation, a related injury/condition has not previously been identified, an assessor should record the nature of any previously unidentified injury/ condition in their report and specify the causal connection to the relevant compensable injury or medical condition."

1. In Merza v Registrar of the Workers Compensation Commission and Anor [2006] NSWSC 939 Hoeben J found that where an injury has been defined in general terms an Approved Medical Specialist was entitled to identify the precise pathological process falling within the general description of injury referred to him. In Merza the referral was of an undefined injury to the left upper extremity (shoulder and wrist) and Hoeben J held that in those circumstances the Approved Medical Specialist was entitled to form his own view as to the nature of the injury to the left wrist.
2. The Appeal Panel accepts that the Medical Assessor could identify the precise pathological process, however, that is not what occurred in this matter. The Medical Assessor expressed the opinion that there might be a neurological condition affecting the hips and causing discomfort in hip movement. The Appeal Panel accepts that the Medical Assessor had difficulty with identifying precise pathological process regarding the appellant's hips. The Medical Assessor was not able to make any diagnosis in respect of any such possible neurological condition. The Appeal Panel also accepts that the Medical Assessor is not bound to accept opinions of other doctors.
3. At paragraph 10c the Medical Assessor reviewed the opinions of the three medico legal doctors referred to above. He disagreed with the diagnoses of Dr Guirgis. The Appeal Panel does not accept that this is a further manifestation of the Medical Assessor's failure to acknowledge and perform the statutory task required of him.
4. This ground of appeal is not made out.

1. The appellant submits that following the findings made, the Medical Assessor expressed the view that the appellant required a neurological assessment and this constituted a demonstrable error. The appellant argues that the Medical Assessor had the power pursuant to s 324(1) (a) 1998 Act to consult treating medical practitioners and under s 324(1)(b) to call for production of medical records and other information as he considered necessary but there is no evidence that he did either.
   1. Section 324 of the 1998 Act provides:

"(1) the Medical Assessor assessing a medical dispute may:

(a) consult with any medical practitioner or other health care professional who is treating or has treated the worker;

(b) call for the production of such medical records (including X-rays and the results of other tests) and other information as the Medical Assessor considers necessary or desirable for the purposes of assessing a medical dispute referred to him or her, and

(c) require the worker to submit himself or herself for examination by the Medical Assessor.

(2) If a worker refuses to submit himself or herself for examination by the Medical Assessor if required to do so, or in any way obstructs the examination:

(a) the worker's right to recover compensation with respect to the injury, or

(b) the worker's right to weekly payments, is suspended until the examination has taken place.

(3) This section extends to the assessment of a medical dispute in the course of an appeal or further assessment under this part.

(4) A Medical Assessor hearing the appeal or who is assessing the matter by way of further a medical dispute."

"1.37 As a general principle, the assessor should not order additional radiographic or other investigations purely for the purpose of conducting an assessment of permanent impairment.

1.38 However, if the investigations previously undertaken are not as required by the Guidelines, or are inadequate for a proper assessment to be made, the medical assessor should consider the value of proceeding with the evaluation of permanent impairment without adequate investigations.

1.39 In circumstances where the assessor considers that further investigation is essential for a comprehensive evaluation to be undertaken, and deferral of the evaluation would considerably inconvenience the claimant (eg when the claimant has travelled from a country region specifically for the assessment), the assessor may proceed to order the appropriate investigations provided that there is no undue risk to the claimant. The approval of the referring body for the additional investigation will be required to ensure that the costs of the test are met promptly."

1. The Appeal Panel accept that a Medical Assessor can consult with treating medical practitioners or other health care professionals and call for the production of medical records (including X-rays and the results of other tests) and other information, However,

s 324 does not provide for the Medical Assessor to call for a neurological assessment to take place. 2. The Guidelines provide that where the Medical Assessor considers that further investigation is essential for a comprehensive evaluation to be undertaken, and deferral of the evaluation would considerably inconvenience the claimant, the assessor may proceed to order the appropriate investigations. The Appeal Panel does not accept that a neurological assessment is an investigation although such assessment may possibly involve investigations. The Appeal Panel is not persuaded that the Medical Assessor has the power under the Guidelines to call for a neurological assessment to take place.

Ground 5 - assessment of 14% WPI for left and right lower extremities

1. The appellant submits that despite the qualifications that he expressed, the Medical Assessor nevertheless assessed a 14% WPI for left and right lower extremities, before saying in the same paragraph that he could not assess impairment. The appellant argues that if the Medical Assessor concluded that MMI had not been achieved as contemplated by paragraph 1.15 of the Guidelines, he should have said so and not embarked on the assessment. Section 327(4) 1998 Act.
2. The Appeal Panel accepts that there is an inconsistency in the MAC in that the Medical Assessor stated that the appellant was not at MMI but made an assessment of the impairment in each lower extremity. error. In the view of the Appeal Panel, if a worker is not at MMI, no assessment of impairment can be made.
3. This ground is made out.
4. The Appeal Panel, having found error, concludes that it is necessary for the appellant to undergo a further medical examination because there is insufficient evidence on which to make a determination.
5. As noted above, Medical Assessor Drew Dixon of the Appeal Panel examined the appellant on 22 August 2025. Dr Dixon provided the following report:

This 65 year old claimant sustained injuries to his hips, ankles and feet while working as a night filler for Coles at Corrimal on the South Coast for nine years. He was working as a night filler and had to do prolonged standing and walking, stand up on his toes and use steps to replenish shelves, doing evening shifts working an average of 23 hours a week.

He developed pain in his lateral hip region as well as some stiffness of the hips with mild groin pain and developed metatarsalgia in both feet with burning pain after prolonged walking and stiffness of his ankles.

The pain in his feet first started in 2015 with some swelling of the feet and some paraesthesia with dysthesia on prolonged standing and walking.

In April 2015 he had an x-ray of his left heel which showed plantar fasciitis and an x-ray in 2017 showed osteoarthritic change but he continued with his work duties.

By 2019 he still had pain in his feet radiating to the toes with dysthesia, mainly to the middle three toes but continued to work and in November 2011 he saw his GP, Dr Emilija Sokolovska, who arranged for an ultrasound of the left foot which showed a Morton's neuroma. Around that time, he developed pain in both hips.

He was referred to a podiatrist but could not afford the treatment.

In July 2023 his pain was so painful that he could hardly walk with a burning sensation, dysthesia and lateral pain at his hips. His GP gave him a Certificate of Capacity for restricted hours which he lodged with his employer but was subsequently terminated from Coles and in August 2022 he received a note from the insurer that liability for his claim had been declined.

He did have a psychological injury while working at Coles due to the manner in which his employment was terminated and this matter was dealt with by the Commission and he was compensated for it.

He first contacted his lawyers in mid 2022 for his psychological claim and then because he complained of persisting pain and stiffness in his hips and left ankle and feet with dysthesia in the toes of both feet and clicking of his hips with aggravation by extended periods of standing or walking, he lodged a claim for physical injuries in relation to his work at Coles as a night filler.

It is noted that he worked for many years as a labourer at the Steelworks for Bluescope fand finished in May 2013. During the course of employment, he sustained various injuries which included his left knee, lumbar spine, cervical spine but did not have any issues with his feet while working at Bluescope and did not report any hip complaint.

He lives in a two level house on the South Coast with two adult sons, one of whom is a lawyer and the other is a doctor, working as a neurophysiologist.

He has difficulty doing heavy household cleaning chores and difficulty with prolonged standing and walking to do heavy grocery shopping and has difficulty doing the garden and lawns and cleaning his car and with prolonged driving of an automatic vehicle.

One of his main difficulties has also been toileting, which he finds difficult due to hip pain.

He has a pacemaker inserted. He does not have a history of diabetes.

He did have osteomyelitis when younger in his right femur which was drained as a child.

He has always had wasting of the right thigh since that time.

He has a history of hypothyroidism for which he takes Oroxine.

He has had a cortisone injection to each hip without sustained benefit.

He takes Mobic as an anti-inflammatory and Panadol for analgesia as required.

He is not using an assistive device such as a walking pole or stick.

He reports pain and stiffness in both hips particularly on prolonged weight bearing. He has difficulty standing on his toes. He has difficulty climbing steps and ladders and he has a walking tolerance on level ground of 15 to 20 minutes and a sitting tolerance of half an hour, after which his hips begin to ache and a standing tolerance of 15 minutes, after which he needs to move about. He reports he can drive an automatic car for up to half an hour before the hips become painful. He tends to only do local driving.

He has burning pain in both feet radiating to the middle three toes which is quite marked after walking. He also has recurrent fasciculation in his lower legs.

He is unable to jog or run and has difficulty with crouching or squatting due to hip pain and ankle stiffness and has difficulty walking on uneven terrain and difficulty sleeping on either hip due to lateral hip pain in the region of the trochanteric bursae.

He has no recreations at present and has no hobbies.

On examination at PIC on 22 August 2025 he was 180cm tall and weighed 84kg.

His normal gait was slow but he was unable to toe walk because of metatarsalgia and heel walking was associated with bilateral hip pain and his squat test was restricted due to painful stiffness of both ankles.

His Trendelenburg test was positive on the right and equivocal on the left. There was tenderness of the trochanteric bursae more marked on the left today. The range of motion of both hips was restricted with active abduction 30 degrees, adduction 20 degrees, external rotation 30 degrees and internal rotation 20 degrees. Flexion on the right was 120 degrees and that on left 110 degrees and there were no flexion contractions. There was mild restriction of the hips in flexion in abduction.

He had a good range of motion of both knees which were stable.

He had a satisfactory range of motion of his lumbar spine with flexion and extension decreased by one by one third and lateral flexion decreased by one quarter bilaterally. His straight leg raise was 70 degrees bilaterally and there was no tenderness of sciatic nerves on compression and his knee jerks and medial hamstring jerks were present with reinforcement; His ankle jerks were difficult to elicit. His power was grade 5 out of 5. There was wasting of his right thigh measuring 45cm 15cm above the knee due to his old osteomyelitis and on the left 47cm.

There was an old 14cm scar where they drained osteomyelitis at the age of 10. There was no wasting of either calf below the knee measuring 32cm bilaterally.

There was stiffness of both ankles with dorsi flexion 10 degrees and plantar flexion 30 degrees. In the subtalar joint there was stiffness on eversion at 10 degrees and inversion at 25 degrees bilaterally. The movement of toes was satisfactory. He did have a positive compression test for metatarsalgia. The plantar fascia was non-tender today and the windlass phenomenon was negative and there was no tenderness over the plantar fascia insertion into either heel.

He did indicate burning pain into the middle three digits of his toes after walking and standing. This appears consistent with his described Morton's Neuroma.

The pedal pulses were difficult to palpate on the left and just palpable on the right. Capillary refill was good on both feet.

His investigations include the bone scan with spec CT on 7 September 2022 which showed some increased uptake at L5/S1 and discovertebral joint in the right L4 facet joint and uptake of the hips was relatively unremarkable and there was bilateral tuberosity uptake more prominent on the left and the right in keeping with enthesopathic change. Uptake in the ankles was relatively unremarkable and there was no abnormal focal uptake within the feet.

X-ray of the left ankle on 2 October 2017 showed a moderate plantar calcaneal spur with prominent spurring of the dorsal calcaneum and an ossicle at the tip of each malleolus but no acute malleolar fracture seen. The position of the talar dome within the ankle mortise was satisfactory and the dome contour was preserved. There was minor dgeneraiv4e lipping of the ankle joint without significant joint space narrowing. The conclusion was there was mild AO changes to the left ankle joint with calcaneal spurs.

Weight bearing X-rays of the left ankle showed joint space medially of the mortise at 3mm and in the central tibiotalar 3cm and 2cm at the fibula-talar joint.

Ultrasound of the right hip on 24 August 2022 showed right trochanteric bursitis.

Ultrasound of the left foot on 10 November 2021 showed two small Morton's neuromas between the 2nd and 3rd and 3rd and 4th inter metatarsal web spaces.

X-ray of pelvis and left hip on 9 November 2021 showed the hip joint spaces were preserved and the SI joints were unremarkable.

Ultrasound of the left hip on 25 August 2022 showed probable trochanteric bursitis. The anterior and posterior hip joint spaces were unremarkable.

X-ray of both hips and pelvis on 8 July 2023 showed mild narrowing of the hip joint spaces with sclerotic bone changes in the acetabular rims. The humeral head cortices were intact and the SI joints appeared normal.

Ultrasound of right hip on 10 July 2025 showed no abnormalities were identified.

Ultrasound of the left hip on 14 July 2025 showed mild trochanteric bursitis.

Ultrasound of the left ankle on 5 July 2022 showed insertional tendonosis of the tibialis anterior. The deltoid and spring ligaments appeared normal.

Ultrasound of the left foot on 5 July 2022 showed a Morton's neuroma between the second and third interspace.

Ultrasound of the right foot on 29 June 2022 showed small pockets of complex fluid in the dorsal aspect of the foot at the second and third and third/fourth intermetatarsal web spaces. This may be due to intermetatarsal bursitis.

X-ray of the left heel and ultrasound on 22 April 2015 showed plantar fasciitis with an intrasubstance tear and a plantar fibroma. Summary

In summary, during the course of his duties as a night filler at Coles over 9 years, the claimant has developed pain at both hips, both ankles and subtalar joints and developed metatarsalgia with dysaesthesia extending to the middle three toes, particularly after prolonged standing and walking consistent with Morton's neuromas.

1. Aggravation of OA of both hips with post-traumatic stiffness;
2. Trochanteric bursitis of his hips more marked on the left;
3. Post traumatic stiffness of both ankles and subtalar joints;
4. Metatarsalgia of both feet with burning pain to the middle three digits, consistent with Morton's neuromas;
5. Previous plantar fasciitis. The arch has settled today and the windlass effect on the plantar fascia was negative on both feet and the plantar fascias were non tender.

That for the post traumatic stiffness of his left hip is from Table 17-9, Page 537, AMA 5, 10% lower extremity impairment less one-tenth for pre-existing condition, giving 9% lower extremity impairment. That for the post traumatic stiffness of the left ankle and subtalar joint is 7% + 2% giving 9% lower extremity impairment from Tables 17-11 and 17-12. That for the dysaesthesia in the distribution of the medial plantar nerves is from Table 17-11, 5% lower extremity impairment for the left foot. This gives a total of 21% lower extremity impairment which equates to 8% whole person impairment for the left lower extremity.

That for the post-traumatic stiffness of the right hip is from Table 17-9, Page 537,

AMA 5, 10% lower extremity impairment less one-tenth for pre-existing condition, giving 9% upper extremity impairment. That for the post traumatic stiffness of the right ankle and subtalar joint is 9% lower extremity impairment from Tables 17-11 and 17-12. That for the dysaesthesia in the distribution of the medial plantar nerves in the right foot is from Table 17-11, 5% lower extremity impairment. This gives a total of 21% lower extremity impairment which equates to 8% WPI for the right lower extremity.

This gives a total from the Combined Values Chart of 15% whole person impairment."

1. The Appeal Panel adopts the report and findings of Medical Assessor Dixon.
2. The Appeal Panel therefore assesses 8% WPI in respect of the left lower extremity and 8% WPI for the right lower extremity. This gives a total from the Combined Values Chart of 15% WPI.
3. For these reasons, the Appeal Panel has determined that the MAC issued on

27 February 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 Roger Pillemer 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)