Certificate issued under s 7.23(1) of the Motor Accident Injuries Act 2017

1. The Review Panel revokes the certificate of Medical Assessor Yu Tang Shen dated

2 February 2024 and issues a new certificate determining that the following injuries caused by the accident give rise to a WPI of 5%: * post-traumatic stress disorder, and * persistent major depressive episode.

1. On 13 March 2022 Ms Chanmany Siyavong (the claimant) sustained injury in a motor vehicle accident (the accident).
2. Ms Siyavong has brought a claim for common law damages under the Motor Accident Injuries Act 2017 (the MAI Act).
3. AAI Limited trading as GIO (the insurer) is the relevant insurer with liability to pay any damages to Ms Siyavong under the MAI Act.

1. Section 4.11 of the MAI Act provides that there is no entitlement to damages for

non-economic loss unless the degree of permanent impairment of the injured person as a result of the injury caused by the accident is greater than 10%. 2. This dispute is in relation to whether the degree of permanent impairment sustained by Ms Siyavong as a result of the injury caused by the accident is greater than 10%. This constitutes a medical assessment matter pursuant to Schedule 2, cl 2 of the MAI Act. 3. A medical assessment matter is determined in accordance with Division 7.5 of the MAI Act by a Medical Assessor.[1] 4. Ms Siyavong filed an application in the Personal Injury Commission (Commission) in respect of the permanent impairment dispute. 5. The dispute as to permanent impairment in respect of the claimant's psychological injury was referred to Medical Assessor Yu Tang Shen. He issued a certificate dated 2 February 2024.

1. The Review Panel issued a Direction to the parties on 21 May 2025 (the Direction) requiring each party to file an indexed, paginated bundle of documents.
2. On or about 13 June 2025 the solicitor for the claimant uploaded to the portal a bundle of documents paginated from page 1 to 97 (claimant's documents).
3. On or about 25 June 2025 the solicitor for the insurer advised it relied upon the bundle of documents previously uploaded to the portal on 22 March 2024 paginated from page 1 to 44 (insurer's documents).
4. The Panel has also had regard to a Medical Assessment Certificate of Medical Assessor Barrett dated 2 May 2023 in respect of a threshold dispute.

1. Medical Assessor Yu Tang Shen issued a certificate dated 2 February 2024 in which he certified the following injuries caused by the accident caused a whole person impairment (WPI) of 8%:
   • Major depressive disorder, and
   • Post-traumatic stress disorder.[2]
2. The injury referred for assessment was "post-traumatic stress disorder".
3. Medical Assessor Shen reported the claimant lived with her daughter, her sister, her mother, her brother-in-law and her nephew. She was born in Laos and moved to Australia as a refugee in 1987. She had a poor childhood but denies any adverse childhood experiences. She finished year 10 in Australia and worked in the beauty industry for five to six years, then in a bakery and a take-away restaurant. She also worked as a picker-packer and at Telstra and now as a carer for her mother.
4. The accident occurred on 13 March 2022 when another vehicle collided with the passenger side of the claimant's vehicle. The next day she woke up with pain in her neck and aback. She reported developing psychiatric symptoms about six months after the accident, losing her appetite, having disturbed sleep and thinking she doesn't want to live anymore. She has been under the care of a psychologist and has been on medications.
5. Medical Assessor Shen diagnosed a major depressive disorder and post-traumatic stress disorder caused by the accident having regard to the temporal and thematic association between the accident and the claimant's symptoms.
6. Medical Assessor Shen assessed class 1 for self-care and personal hygiene. The claimant showers once a day without assistance. She had been cooking every day and buys food from restaurants at other times. She does cleaning but requires frequent breaks due to pain.
7. Medical Assessor Shen assessed class 2 for social and recreational activities. The claimant has a few friends whom she is in contact with regularly. They go out to lunch and dinner about once a month.
8. Medical Assessor Shen assessed class 2 for travel. The claimant can drive but not for long distances and she is limited to the local area and not at night.
9. Medical Assessor Shen assessed class 2 for social functioning. The claimant has been arguing frequently with her younger daughter, worse since the accident. Her relationship with her mother has been on and off. Her relationship with her sister has been good overall. Due to the strained relationship with her daughter and some withdrawal from friends he found a mild impairment.
10. Medical Assessor Shen assessed class 3 for concentration, persistence and pace. He reported the claimant struggles to concentrate when reading and generally only reads up to five minutes. He assessed a moderate impairment on the basis of poor concentration although he noted he was not observable in a brief conversation.
11. Medical Assessor Shen assessed class 2 for adaption. He reported the claimant was able to continue her function as carer for her mother albeit with reduced pace and needing assistance, mostly due to pain which is not assessable. He undertook an assessment of the pre-existing condition which he assessed at 0% WPI. His assessed a 6% WPI but added a further 2% for the effect of treatment giving rise to a total 8% WPI.

1. The claimant has sought a review of the medical assessment of Medical Assessor Shen.
2. The application was lodged on 1 March 2024 within 28 days of the date on which the certificate of Medical Assessor Shen was made available to the parties.[3]
3. On 24 September 2024 the delegate of the President being satisfied there was reasonable cause to suspect that the medical assessment was incorrect in a material respect referred the medical assessment to the Review Panel (the Panel).
4. Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5 of the Personal Injury Commission Act 2020 (PIC Act). A review panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application.[4]
5. The review is by way of a new assessment of all matters with which the medical assessment is concerned.
6. On 14 August 2025 the Panel agreed an examination was necessary.

1. Section 7.21 of the MAI Act provides that the degree of permanent impairment of an injured person is to be assessed in accordance with the Motor Accident Guidelines (the Guidelines).
2. The Guidelines were issued pursuant to Division 10.2 of the MAI Act. Clause 6.213 of the Guidelines requires the impairment to be attributable to a psychiatric diagnosis recognised by the current edition of the Diagnostic and Statistical Manual of Mental Disorders, that is, the Diagnostic and Statistical Manual of Mental Disorders 5th Edition Text Revision (DSM-5) or the current edition of the International Statistical Classification of Diseases & Related Health Problems (ICD). The assessment of mental and behavioural disorders must be undertaken in accordance with the psychiatric impairment rating scale (PIRS) as set out in the Guidelines.
3. Causation of injury is addressed under Part 6 of the Guidelines dealing with permanent impairment:

"6.6 Causation is defined in the Glossary at page 316 of the AMA4 Guides as follows:

'Causation means that a physical, chemical or biologic factor contributed to the occurrence of a medical condition. To decide that a factor alleged to have caused or contributed to the occurrence or worsening of a medical condition has, in fact, done so, it is necessary to verify both of the following:

1. The alleged factor could have caused or contributed to worsening of the impairment, which is a medical determination.
2. The alleged factor did cause or contribute to worsening of the impairment, which is a non-medical determination.'

This, therefore, involves a medical decision and a non-medical informed judgement.

6.7 There is no simple common test of causation that is applicable to all cases, but the accepted approach involves determining whether the injury (and the associated impairment) was caused or materially contributed to by the motor accident. The motor accident does not have to be a sole cause as long as it is a contributing cause, which is more than negligible. Considering the question 'Would this injury (or impairment) have occurred if not for the accident?' may be useful in some cases, although this is not a definitive test and may be inapplicable in circumstances where there are multiple contributing causes."

1. In the application dated 16 March 2022 the claimant described the accident as follows:

"I was driving along Hoxton Park Rd on my right hand lane, I was singnaling [sic] to my left lane whilst I was merging. The car from behind hit my left side of the car. The impact caused my car to force it to end up on the Tway."[5]

1. The claimant reported: "I sustained whip lash, both lower arm was in pain, Lower back, shoulder".

1. In a Certificate of capacity/certificate of fitness dated 16 March 2022 Dr Tom Lieng, general practitioner (GP) provided the following diagnosis:

"WAD, Lumbar spine lig sprain, adjustment disorder".[6]

1. The management plan included physiotherapy and counselling.
2. In an email dated 9 May 2022 Dr Lieng noted:

back pain ongoing R sided, no radicular pain in leg...".[7]

1. In an email dated 25 January 2023 Dr Lieng noted:

has referral under epc for physio - extend further 5 visits today

has referral for Saima/psychologist under mental health plan - to book in..."

1. In a report dated 8 May 2022 Ms Saima Khan, psychologist reported the claimant attended an initial appointment on 6 May 2022.[9] She reported the claimant did not disclose any

pre-existing mental health conditions. She reported the onset of symptoms of depression and anxiety after the accident. Ms Khan reported prior to the accident Ms Siyavong described herself as a happy and active person. However, since the accident her mood has been deflated. Ms Siyavong reported her deflated mood is due to her ongoing pain, not having a car, not being able to drive and feeling trapped. She feels anxious when travelling in a motor vehicle, even as a passenger and sometimes she also experiences symptoms of anxiety when she goes out in the community, for example, grocery shopping. 2. In her report dated 18 July 2022 Ms Khan reported Ms Siyavong had attended nine sessions.[10] She diagnosed post-traumatic stress disorder. She reported a DASS 21 showed depression in the severe range, anxiety in the moderate range and stress in the mild range. Ms Khan administered the Post-Traumatic Check list (PCL), a self-screening tool to help in the diagnosis of post-traumatic stress disorder. Ms Siyavong scored a score of 45, noting a score of 22 and above usually indicates ongoing symptoms of post-traumatic stress disorder. 3. Ms Khan reported Ms Siyavong reported improvement in her mood, although it fluctuated depending on her pain symptomology. She reported she continued to experience anxiety when driving although she now barely experiences anxiety when out in the community. She reported Ms Siyavong had not increased her social engagement. She noted Ms Siyavong continued to complete ADL (activities of daily living) independently and daily showers. She reported broken sleep during the night due to pain symptomology. She was continuing to experience nightmares on average two to three times a week and continued to wake up with panic attacks. Ms Khan recommended further counselling to learn behavioural pain management strategies. In an Allied Health Recovery Request (AHRR) dated 18 July 2022 Ms Khan reported "decreased memory, emotional lability, difficulty sleeping, difficulty making decisions, generalised sadness and loss of interest in usual activities, heightened anxiety in crowded situations (getting better)".[11] Ms Khan also reported the claimant continued to lack motivation and energy to complete household chores, however, she was completing activities of daily living. She reported Ms Siyavong felt lethargic most of the time.

1. In an AHRR dated 23 May 2022 Mr Matthew Do, physiotherapist reported worsening neck and lumbar symptoms resulting from the accident.[12]
2. An AHRR dated 11 July 2022 reported the claimant continued to complain of persisting neck and low back symptoms with occasional numbness and tingling extending down he left leg.[13] She was also attending a psychologist for anxiety related issues arising out of the accident. Her sister and niece were still assisting with care for the claimant's mother including cooking, cleaning and personal ADL's. She was driving 10 to 15 minutes.
3. An AHRR dated 29 August 2022 reported ongoing low back symptoms, which were worse recently and activity dependent, most noticeable with household chores and shopping.[14] It was reported her neck had improved. Household duties were completed slowly with assistance from family occasionally. She was driving 20 to 25 minutes.
4. In an AHRR dated 31 August 2022 Jenny Nguyen exercise physiologist reported the claimant was certified fit for light duties 20 hours per week but she was assisted in household chores by her niece and sister.[15]She was independent with driving.

1. The claimant was assessed by Dr Lee on 1 September 2022 in respect of her neck, back and right sided upper limb pain.[16] Dr Lee reviewed the available imaging. She concluded the accident had caused the pain symptoms, noting Ms Siyavong stated she was pain free prior to the accident and was the carer of her mother. At that time, she was having trouble doing simple household chores. Dr Lee recommended physiotherapy, exercise physiology, ongoing psychology support, Panadol osteo and the use of Allegron. She also recommended nerve conduction studies.

Certificate of Medical Assessor Melissa Barrett

1. Medical Assessor Barrett issued a certificate dated 2 May 2023. She certified the following injury caused by the accident was not a threshold injury for the purposes of the Act:
   • post-traumatic stress disorder.
2. Medical Assessor Barrett stated:

"PTSD was caused by the subject accident. She denies any past psychiatric history and there is no evidence before me of any previous psychiatric history.

Her early developmental experiences, exposure to civil war in Laos, 2½ years detention in a refugee camp between 9 and 11-years-old and then the stress of migration, would have been background factors that would have increased her lifetime risk of developing a psychiatric condition. However, there is no history of psychiatric symptoms up until the subject accident.

There is a clear temporal relationship between the subject accident and the onset of her symptoms. I accept that the accident would have fulfilled DSM-V Criteria A as she states she thought she was going to die and noting the high speed of the accident. Furthermore, she states her car was written off. She describes shaking and crying at the scene which is again consistent with her having experienced the accident as traumatic.

She does not report any other DSM-V Criteria A stressors in the period prior to the accident or subsequently."

1. Medical Assessor Woo issued a certificate dated 19 September 2023. He certified the claimant had sustained a 0% WPI in respect of the following injuries caused by the accident:
   • Cervical spine - soft tissue injury;
   • Lumbar spine - soft tissue injury;
   • Both arms and shoulders - soft tissue injury..."

1. Dr Smith assessed the claimant and provided a report dated 14 October 2024.[17]
2. He described the accident on 13 March 2022 as follows:

"I was about to change lanes, from the right lane to the left lane, I looked and there were no cars, I got hit at a very fast speed, my car flew to the T-way, the other side of the road, I thought, I'm going to die, the tyre just popped". There were no airbags deployed. She stated that a car in front of her was also hit by the car ('a turbo Volkswagen') that had collided with her vehicle. Ms Siyavong stated, "I went blank, I couldn't hear anything, I got so scared". She was worried that the car might "burst into flames" and she exited the car quickly and she "was shaking in shock, I was crying". She stated that bystanders came to assist her and told her to call Police. ... "

1. Dr Smith reported the claimant's car was written off. The next day she had neck and back pains and saw her general practitioner. He did not see patients under CTP claims, and she was referred to Dr Lieng. Ms Siyavong did not drive for six months due to anxiety and fear. Her psychologist assisted her with graded exposure to driving.
2. Dr Smith reported after the accident, Ms Siyavong has suffered from post-traumatic anxiety with avoidance of driving and recurrent intrusive distressing memories and nightmares of the motor accident. She has felt depressed with reduced interest in activities, feelings of worthlessness, difficulties with thinking and concentration and suicidal ideation. She has received psychological therapy and low dose antidepressant medication, but she has remained anxious and depressed.
3. She was studying for a certificate in aged care and since the accident had found study difficult.
4. Dr Smith reported the claimant showers most days, she skips meals due to reduced motivation and her sister now assists with cooking meals. She performs some cleaning duties, but her daughters assist. He reported restriction in social and recreational activities and avoids socialising in crowds. Before she used to go out more often, every week but now it is every few months. She drives along but only in the local area. She does not drive at night. She reported some strain in family relationships and described being isolated from friends due to her anxiety and avoidance. She finds it hard to focus on reading and watching movies. Since the accident her sister had assisted with care for her mother including cleaning and cooking and taking her to medical specialists.
5. Dr Smith diagnosed:
   • Persistent depressive disorder with intermittent major depressive episodes with current major depressive episode with anxious distress; and
   • Post-traumatic stress disorder.
6. Dr Smith assessed a 19% WPI. He assessed class 2 for self-care and personal hygiene, class 3 for social and recreational activities; class 2 for travel, class 2 for social functioning, class 3 for concentration, persistence and pace, and class 5 for adaption.

1. The claimant provided submissions in respect of the permanent impairment dispute.[18]
2. The claimant notes Ms Khan, psychologist in her report dated 18 July 2022 diagnosed post-traumatic stress disorder.
3. Dr Lieng reported that the claimant presented with psychological symptoms following the accident. In his Certificates of Fitness Dr Lieng diagnosed an adjustment disorder and in his email to the insurer dated 9 May he noted the claimant reported having nightmares following the accident and that she was scared when driving. In his email to the insurer dated 28 July 2022, Dr Lieng recorded that the claimant was experiencing panic attacks. It is submitted that these symptoms are consistent with Ms Khan's diagnosis of post-traumatic stress disorder.
4. The claimant provided submissions dated 1 March 2024. The claimant submits Medical Assessor Shen erred in assessing the claimant under class 1 for self-care and personal hygiene and that the claimant has a class 2 mild impairment. It is noted the Assessor recorded:

"She said her appetite has remained low, and sometimes she only has a cup of coffee in a day, and she has lost 6-10 kg since the subject accident"; and

"She has seen a psychologist to help manage her appetite as well as buying food from restaurants."

1. The insurer provided submissions dated 20 March 2024 in response to the application for review.[19]
2. The insurer refers to the claimant's submissions that Medical Assessor Shen erred in assessing class 1 impairment instead of class 2 for self-care and personal hygiene. The insurer notes that Medical Assessor Shen reported:

"She said she showers herself once a day, without needing assistance or reminders, and she said she changes her clothes every day, and she denied needing assistance or reminders to change. She said she has been cooking every day, and she buys food from restaurants other times. She said she has been cooking less to avoid cleaning compared to the subject accident, as it puts some strain on her back. She said she does cleaning, but she has to have frequent breaks due to her pain. She said she does the shopping, approximately once or twice a week. She said she had no issues with self-care or domestic tasks prior to the accident".

1. The insurer also notes even if the rating of class 1 was changed to class 2 for self-care and personal hygiene it would still result in a median class value of 2 and an aggregate score of 13 which would produce a WPI of 7%.
2. The insurer provided submissions dated 28 December 2022 in respect of the permanent impairment dispute.[20]
3. The insurer notes that the reports of Ms Khan show significant improvement in the claimant's psychological status as a result of treatment between early May and late July 2022 and submitted her reports do not support the contention that as a result of the injuries sustained in the accident the claimant has sustained a WPI greater than 10%.
4. The insurer also notes that a number of the restrictions identified in May 2022 were more related to physical rather than psychological problems.

1. Ms Siyavong was assessed by Medical Assessor Doris and Senior Medical Assessor Mason by videoconference on 8 September 2025.

1. Ms Siyavong is a 48-year-old single woman. She lives in Prestons, Sydney, with her two daughters, her mother, sister, brother-in-law and their children. She has been a carer for her mother since 2016 and not worked outside of the home since that time.
2. Ms Siyavong was born in Laos. She grew up with her parents and five siblings. She is not aware of any family history of mental health problems. Her family came as refugees to Australia in 1987 having spent the previous two years in a camp in Thailand. Ms Siyavong's father passed away in 2019. Her mother had a stroke in 2016 requiring considerable care and support. Ms Siyavong's siblings and their families all live in the Sydney area.
3. Ms Siyavong's family left Laos as refugees, and she witnessed violence when there and in Thailand. She denied being subjected to violence, abuse, or assault directly. Her education was limited until arriving in Sydney around age 11. Ms Siyavong described finding it difficult initially in Sydney as she could not speak English and there was financial hardship for her family. She commenced high school after a six-month language course. She socialised with her family and the wider migrant community. Ms Siyavong denied having any serious health problems during her childhood or adolescence.
4. After completing school Ms Siyavong commenced a hairdressing apprenticeship. She did not continue this after being threatened and racially abused when travelling on public transport to the course. Ms Siyavong went on to work with her sister as a "pick and packer" for different organisations including Australia Post. She has worked in restaurants, takeaway food establishments, in a nail salon and in a bakery. In 2016 Ms Siyavong became a full-time carer for her mother after she suffered a stroke.

1. Ms Siyavong has had two long term relationships and has two daughters from these relationships. Her first partner returned to Thailand, and she lost touch with him several years ago. The relationship with the father of her younger daughter ended over 10 years ago. She has had no long-term partnerships since that time. Ms Siyavong's daughters are now aged 26 and 18 years.
2. Ms Siyavong has had two minor operations over twenty years ago. Otherwise, her health was good, and she has not required hospital treatment. She denied any chronic health problems before the accident.
3. Ms Siyavong denied consulting with a health professional about a mental health problem before the accident.
4. Ms Siyavong is a non-smoker. She occasionally drinks modest amounts of alcohol at social functions. She denied use of any illicit substances. Ms Siyavong said that she will put some money into "pokie" machines when socialising with her family, though this has never been excessive or led to financial or relationship problems.
5. Ms Siyavong is currently prescribed Paroxetine 20mg daily, Nortriptyline 25mg at night, Amitriptyline 10mg at night, and Temazepam 10mg to assist sleep. She occasionally takes Oxycodone for pain.
6. Before the accident Ms Siyavong was the principal carer for her mother after she suffered a stroke in 2016. She would help her mother with personal care such as combing her hair and supervising her medication. Ms Siyavong would cook, mop the floor, clean and do the laundry. Ms Siyavong was also bringing up her younger daughter who was born in 2007. Ms Siyavong said that she socialised with friends occasionally by going to pubs and into the city. She enjoyed shopping and going to restaurants.

1. On the afternoon of Sunday 13 March 2022 Ms Siyavong was driving her car at approximately 70km/h when she decided to change lane. She was struck from behind by another vehicle travelling at excessive speed. Her car was struck on the passenger side, a tyre burst, and she was pushed onto the other side of the road. She recalled fearing that she was going to die. Ms Siyavong was able to get out of her car. She was shaking and scared. The Police attended the scene though not the ambulance service. Ms Siyavong's brother came to the scene and drove her home. The car was beyond repair.

History of symptoms and treatment following the accident

1. Ms Siyavong attended her GP surgery the following day due to back and neck pain. She was referred to have X-ray imaging done and to physiotherapy for treatment.
2. Ms Siyavong developed disturbed sleep with initial and middle insomnia, she lost her appetite for food and was fearful of driving. Dr Tom Lieng referred Ms Siyavong to psychologist Saima Khan. Ms Khan found Ms Siyavong to have psychological symptoms of trauma and anxiety and made a diagnosis of post-traumatic stress disorder. Ms Siyavong proceeded to have psychological treatment with Ms Khan until approximately one year ago. After approximately six months Ms Siyavong returned to driving.

1. There have been no subsequent injuries sustained, or conditions developed since the accident.

1. Ms Siyavong describes her predominant mood state as one of irritability. This affects her relationship with her 18-year-old daughter. She said that she finds it difficult to communicate with her daughter and they often fight.
2. Ms Siyavong has a disturbed sleep pattern with middle insomnia. She notices that she is breathless when she wakes during the night and may have recollections of the accident which cause her distress. She is fatigued during the day and sometimes sleeps. Her level of motivation for activity is generally reduced.
3. Ms Siyavong said she enjoys gardening and spends time doing this most days. She can get enjoyment from watching documentaries on YouTube.
4. Ms Siyavong's appetite for food is reduced. She is not aware of significant change in her weight. Ms Siyavong said that often she will order food deliveries rather than cook.
5. Ms Siyavong describes increased anxiety when driving and she drives less often than she did before the accident. She experiences typical physiological symptoms of anxiety if she is close to the scene of the accident.
6. Ms Siyavong has chronic back pain which is present most of the time. This is exacerbated by activity and can disturb her sleep. She does exercises at home to try to ease the discomfort. She said that pain restricts her in the range of activities that she can do both at home and in the community. She cannot walk for extended periods or lift heavy items.

1. Ms Siyavong is currently prescribed Paroxetine 20mg, Nortriptyline 25mg, Amitriptyline 10mg and Temazepam 20mg. She occasionally takes Oxycodone for pain.

1. Ms Siyavong joined the video assessment from her home. She was alone. Laotian interpreter Sak Phoumirath (96432) assisted the interview throughout. Ms Siyavong managed the interview situation well and communicated effectively with normal speech and using the interpreter as needed. Her self-care appeared adequate and there were no abnormal movements or behaviours. Her affect was reduced in range and reactivity. Her mood was objectively and subjectively moderately low and anxious in keeping with her affect. She was future focussed. Ms Siyavong's thought form was normal. There were no abnormal beliefs in the form of delusions or over-valued ideas, and no abnormal perceptions. Ms Siyavong was fully alert and orientated. She appeared cognitively normal though a formal cognitive assessment was not carried out.

1. Ms Siyavong lives with her mother, daughters, sister, brother-in-law and niece. She has lived in the same accommodation for approximately 20 years. Most days Ms Siyavong gets out of bed around 7.30am. She will have a coffee then assist her mother with tasks such as laundry and cleaning. Ms Siyavong will help her mother prepare food. She said that her mother's health has improved over the last few years, and she requires less assistance from Ms Siyavong compared to before the accident.
2. Ms Siyavong typically has a shower every day or every second day, and she attends to her appearance if she is leaving home. She goes for a walk in her local area most days and does exercises at home to ease her back pain.
3. Ms Siyavong said she enjoys gardening and spends time doing this most days. She can get enjoyment from watching documentaries on YouTube. She may also sleep during the day.
4. Ms Siyavong said that approximately every two months she will go out with her sisters to a restaurant or pub. She has a few friends that she meets with occasionally for events such as birthday celebrations.
5. Ms Siyavong is able to drive in her local area, though does this less frequently compared to before the accident.
6. Ms Siyavong reports a reduction in her concentration and persistence on tasks. She was able to complete a Certificate III in Aged Care during 2024 and gained her certification in January 2025. She required some additional assistance to successfully complete the course.

1. Ms Siyavong's history and presentation at examination was internally consistent. There were no significant inconsistencies between the presentation and material in the documents provided.

1. Ms Siyavong is a 48-year-old woman who lives with her family in Prestons, Sydney. She had no mental health problems before the accident on 13 March 2022. Following the accident Ms Siyavong developed mood, anxiety and post-trauma symptoms, and these have persisted despite treatment. She has some functional impairment due to her psychological condition.

1. The Panel finds Ms Siyavong has developed post-traumatic stress disorder and persistent depressive disorder with persistent major depressive episode, moderate, due to the accident.
2. The Panel finds Ms Siyavong meets the DSM 5TR diagnostic criteria for post-traumatic stress disorder as follows:
   • Ms Siyavong was exposed to a motor accident in which she was exposed to serious injury and feared that she would die (criterion A);
   • Ms Siyavong has recurrent, involuntary, and intrusive distressing memories of the traumatic event, such as when she wakes during the night. She experiences marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event such as when she is close to the site of the accident (criterion B);
   • Ms Siyavong avoids driving if she can and avoids the scene of the accident (criterion C);
   • Ms Siyavong has a persistent negative emotional state with irritability and lowered mood much of the time. She has decreased interest and participation in social activities with family and friends (criterion D);
   • Ms Siyavong is hypervigilant for threat when in a vehicle and has an exaggerated startle response. She has sleep disturbance and reduced concentration (criterion E);
   • the disturbance has been present for more than one month (criterion F);
   • there is significant distress and impairment in function (criterion G), and
   • the disturbance is not attributable to the physiological effects of a substance or another medical condition (criterion H).
3. The Panel finds Ms Siyavong meets the DSM 5TR diagnostic criteria for persistent depressive disorder as follows:
   • Ms Siyavong describes her mood as low or irritable most of the time (criterion A);
   • Ms Siyavong has reduced appetite, sleep disturbance, low motivation, and reduced concentration. (criterion B);
   • Ms Siyavong has never been without the symptoms in Criteria A and B for more than 2 months at a time (criterion C);
   • Criteria for a major depressive disorder have been continuously present for two years (criterion D);
   • There has never been a manic episode or a hypomanic episode (criterion E).
   • the disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder (criterion F);
   • the symptoms are not attributable to the physiological effects of a substance or another medical condition (criterion G), and
   • the symptoms cause clinically significant distress and impairment in social functioning (criterion H).
4. Ms Siyavong has a persistent major depressive episode. Full criteria for a major depressive episode have been met throughout the preceding two-year period. Ms Siyavong's condition is of moderate severity.

1. In accordance with clauses 6.5 to 6.7 of the Guidelines the question is whether the accident could have caused or contributed to the claimant's psychological injury and whether, in fact, it did so.
2. Before the accident Ms Siyavong had not experienced a significant mental health problem or impairment due to a psychological condition. She developed symptoms in the weeks following the accident and these have persisted. There have been no subsequent accidents or development of any relevant condition. The Panel is satisfied the accident could and did cause the diagnosed psychological injury.

1. Ms Siyavong has had ongoing symptoms for over three years despite psychological treatment. The Panel considers it is unlikely that her condition will change substantially by more than 3% over the ensuing year. The Panel finds maximal medical improvement has been reached and the impairment is permanent.

2. Persistent depressive disorder with persistent major depressive episode, moderate

Paroxetine 20mg, Nortriptyline 25mg, Amitriptyline 10mg Temazepam 20mg

Ms Siyavong typically has a shower every day or every second day, and she attends to her appearance if she is leaving home. She goes for a walk in her local area most days and does exercises at home to ease her back pain. She does some food preparation though sometimes relies on takeaway food.

Ms Siyavong said that approximately every two months she will go out with her sisters to a restaurant or pub. She has a few friends that she meets with occasionally for events such as birthday celebrations. She frequently walks in her local area on her own for exercise.

Ms Siyavong is able to drive for up to 30 minutes in her car. She is able to use public transport such as trains and buses.

Ms Siyavong continues to live in the same family group she was in before the accident. There are tensions and arguments between Ms Siyavong and her 18-year-old daughter, though other relationships are good.

Ms Siyavong successfully completed a Certificate III course in Aged Care at the end of 2024. She required some extra assistance to complete the course, although she completed it in the expected time.

Ms Siyavong was the principal carer for her mother before the accident. She was also bringing up her younger daughter. She continues in these roles with no change to her adaptive function.

List Classes in Ascending Order Median Class Value

Pre-existing Impairment (If yes, determine % as above) Median Class Value

Apportionment - pre-existing/subsequent impairment

1. There is no pre-existing or subsequent impairment.

1. The effects of treatment have been minor. Psychological treatment ended approximately one year ago. There is no adjustment due to the effects of treatment.

1. The Panel revokes the certificate of Medical Assessor Yu Tang Shen dated 2 February 2024 and issues a new certificate determining that the following injuries caused by the accident give rise to a WPI of 5%:
   • post-traumatic stress disorder; and
   • persistent major depressive episode.