Certificates from approved medical specialists
16 The matters referred to Dr Blake for assessment were:
"Assessment of impairment of the back, loss of efficient use of right and left legs at or above the knee, and impairment of the pelvis, in accordance with the Table of Disabilities."
17 Dr Blake examined the plaintiff. In relation to that examination he reached the following conclusions:
"Back - pelvis level on standing, nearly flat lordosis. No deformity, no lateral tenderness or spasm, and no central tenderness over the spine identified. Mr Smith indicated that some levels of his back feel good with the application of pressure. Movement show extension absent, flexion lower than expected at forty degrees, fingertips reaching the lower thigh. Lateral flexion a normal 40º to both sides, without pain. Rotation a low 40º to both sides without pain. When attempting extension movement in particular pain occurs and his trunk twists around. …
Right lower leg - no evidence locally of the site of impact from the hose flange. A recent circular abrasion present in the lower shin area, and there was a small vein blow out evident. No abnormality found otherwise in the soft tissue. No abnormality found in the shin bone, which was not tender and in which no deformity was identified.
Mental state - sadly, Mr Smith has some difficulty in holding a normal rational conversation. He was emotionally labile, would change the conversation to another direction, and would vary between being nervous and agitated, to relaxed and laughing at the questions, to being somewhat aggressive and threatening. He could then be sad and teary, appearing distressed and somewhat tormented to find himself in his present state."
18 Dr Blake's summary of injuries and diagnoses was:
"Mr Smith describes how on 7 February 2001 he was at work as a hose maker and was fitting heavy flanges to 4" petrol hoses. He picked up a 6m role of completed hose to put it on the pallet. The flange, weighing possibly 10kg, came out of the coil and struck his right shin. In his initial statement of 20 April 2001, two and a half months following the injury, Mr Smith described how his right shin was very sore and he was helped to the first aid post and he rested and had ice supplied for about twenty minutes. He then resumed his normal work again. He makes no mention of any back problems, either Mr Smith himself or his work colleagues who have given statements made on the same date (20 April 2001). Mr Smith's work colleagues in their statements indicate that two days after the injury Mr Smith was running around the workshop trying to get things done and did not appear to have any limp or injury to his leg and Mr Smith did not appear to have any difficulties with performing his usual tasks following the alleged injury on 7 February 2001.
At the time of this assessment and history giving, just over three years six months after the injury, Mr Smith describes a somewhat different incident in which he was taking weight through his right foot and toes at the time of the incident, his right leg being pushed backwards on the toes and with something suddenly going "bang" in his left outer buttock and groin, and a tearing in his right outer pelvis and groin. The two descriptions are not compatible.
Diagnosis is of a sharp direct blow to the right shin, with bruising and local damage to the underlying bone, a bone scan showing increased activity. Recovery has been complete, there being no evidence of abnormality either on repeat x-rays or on repeat bone scan, or on physical examination of the right knee or lower leg, relating to such injury.
The lumbar spine in which degenerative changes have been demonstrated in the lower two levels, together with a small to moderate central protrusion at L4/5 and a protrusion on the right at L5/S1, was not involved in the injury to his right shin at work on 7 Feb 2001. Apparently in about April 2001 during a course of physiotherapy, he developed low back pain radiating to the right leg. These symptoms increased after the skiing injury to his left knee on 15 July 2001.
Unfortunately Mr Smith appears to have had a very disordered childhood followed by ongoing marijuana abuse and a personality disorder. A severe pain disorder and severe depression have been diagnosed. These factors considerably cloud and enlarge his musculo-skeletal presentation. His presentation was not consistent and his mood varied considerably during the assessment."
19 Dr Blake assessed the plaintiff as having suffered a 5% permanent loss of the efficient use of his back, 1.7% permanent loss of the efficient use of his right leg at or above the knee and 1.7% permanent loss of the efficient use of his left leg above the knee as a result of the incident of 7 February 2001. He set out his reasons for making that assessment as follows:
"Below are my reasons for:
a. My opinion and assessment of the percentage of permanent loss of efficient use and/or permanent impairment.
Right shin - Mr Smith describes the sharp direct blow to the middle area of his right shin, producing bruising to the soft tissues and local damage to the underlying bone. The plain x-rays have always been normal, but the first bone scan showed increased activity locally in the shin, consistent with the blow producing a reaction in the bone, as a result of the trauma. Subsequent bone scans have returned to normal. Mr Smith is unable to identify the site of the injury now, and there is no scarring or other deformity on physical examination to suggest any persisting related abnormality. The muscle compartments are soft and normal. No abnormality is found in the right knee, apart from an old unrelated scar just below the kneecap. Thus it is evident that while occasional mild discomfort may still be present, the injury has healed and no sign of abnormality is now found.
Back - the accounts of details of Mr Smith's injury and the subsequent events vary, including the two different descriptions given by Mr Smith himself in his early statement two and a half months after the event, and in his history as given now three and a half years later. There was no early mention of his back being in any way involved in the initial incident. His back appears to be first mentioned in the clinical notes of his treating physiotherapy on 21.4.01. They state that after initiating slump stretching involving his back (no reason is evident why they would start treating his back) there was a slight increase in his right leg symptoms. On 26.4.01 his symptoms are decreasing, and on 28.4.01 it is recorded there is no lower back pain. On 12.5.01 the notes record his condition is static and he is having right sided lower back pain.
Dr Stenning on page 2 of his report states Mr Smith "feels the injury to his left knee (skiing on 15.7.01) produced added pressure onto his right leg leading to problems here and shin splints again started hurting a lot". Dr Bodel records that Mr Smith complained of back pain before the skiing injury, but doesn't mention a date. Later accounts of the initial incident by Mr Smith change and include the inclusion of his back being involved. There is thus inconsistency in the initial descriptions and history, and the more recent descriptions and history. The initial descriptions and Mr Smith's own statement would appear to be the more reliable, having been recorded close to the event.
In my opinion, on the available information, Mr Smith's lower back was not involved directly in the work incident on 7.2.01. However it does appear that his back became involved secondarily, apparently during physiotherapy treatment in or about mid April. Pre-existing degenerative changes have been demonstrated in the lower two lumbar levels. On this basis, a smaller proportion of his present back symptoms are attributable to the original injury to his right shin.
An Assessment is made, in relation to a most extreme case, as he now presents, of 15% impairment of the back, and 5% permanent loss of efficient use in each leg at or above the knee. The assessments in the legs relate to the complaint of pain radiating down the back of each leg in the absence of objective neurological signs. 2/3 of his total impairment in both the back and legs is attributable to the pre-existing degenerative changes in the back, and the subsequent effects of the skiing accident. 1/3 of the impairment in both the back and legs is related to the injury to his right shin on 7.2.01.
Pelvis - there has been no injury to his pelvis. Both hip joints are normal to clinical examination. No impairment is thus found. …
c. My brief comments regarding the other medical opinions and findings submitted by the parties and, where applicable, the reasons why my opinion differs:
The opinions given in the medico-legal reports range from no back injury and no back or right leg impairment, through to significant back impairment relating to the injury, and impairment of the legs and of the pelvis. My opinion and assessments are explained under (a) above, and indicate why my opinion differs from the two extremes presented, falling more in the middle. The main decisions relate particularly to whether or not a back injury occurred at the time of the initial injury, and whether the back became secondarily involved as appears to be the case."
20 The matter referred to Dr Taylor for assessment was "sexual organs". Dr Taylor took a similar factual history to that recorded by Dr Blake.
21 In his summary of injuries and diagnoses Dr Taylor recorded:
"Mr Robert Smith suffered two injuries on 7 February 2001 and 17 July 2001. In the first he suffered an injury to the right side of his leg and in the second an injury to the left knee. Since then he has developed diffuse body pains and complains of a degree of loss of use of his sexual organs.
It is beyond my comprehension to envisage how the injuries that Mr Smith described to me as happening to him could lead to the loss of use of his sexual organs."
22 Dr Taylor assessed the plaintiff as having suffered 0% permanent loss of the efficient use of his sexual organs as a result of the injury of 7 February 2001. He set out his reasons for making that assessment as follows:
"a. My opinion and assessment of the percentage of permanent loss of efficient use and/or permanent impairment.
In my opinion the percentage of permanent loss of efficient use and/or permanent impairment of Mr Robert Garry Smith's sexual organs from the two accidents described above is nil. It is beyond my ability to conceptualise how the injuries described to me could result in the loss of sexual organs as described to me by Mr Smith.
…
c. My brief comments regarding the other medical opinions and findings submitted by the parties and, where applicable, the reason why my opinion differs:
There are two other reports giving an opinion as to the loss of use of Mr Smith's sexual organs. Dr Lowy gives a total assessment of 30% and a whole person impairment of 5%. Dr Nash gives an impairment of 40%.
I would point out that in Mr Smith's case his erectile function has been maintained and I cannot conceptualise how an injury to the right leg and the left knee would result in the widespread body pains and the testicular pains which Mr Smith told me he believed were the cause of the loss of use of sexual organs. I would point out further that there are no objective findings in Mr Smith's case which would substantiate his claim. That situation, however, is not uncommon in the loss of use of sexual organs following an injury. However, in the light of the thoroughly confusing and inconsistent history given by Mr Robert Smith it is my opinion that objective findings would be important in giving him the benefit of any doubt in the assessment of loss of use of his sexual organs. Further there is, in my opinion, no possible mechanism, either physiological or pathological by which Mr Smith's injuries of 7.2.2001 and 14.7.2001 could produce the loss of use of sexual organs that he described. Further, Mr Smith himself attributed the loss of use of his sexual organs to pains felt in his testes, back and right ribcage, not to the pain in the site of injuries. Also in assessing any loss of use of sexual organs in Mr Smith's case, that loss of use is slight reduced frequency of intercourse, and his statement that he does not enjoy it as much as he did before the injury. I disagree that this degree of loss of use of use of sexual organs is anywhere near as high as the 30% and 40% given by Drs Lowy and Nash."
The Appeals
23 The sections dealing with appeals from approved medical specialist are
ss 327 and 328: At the time these applications for appeal were brought those sections were in the following form:
" 327 Appeal against medical assessment
(1) A party to a medical dispute may appeal against a medical assessment under this Part, but only in respect of a matter that is appealable under this section and only on the grounds for appeal under this section.