1. On 16 April 2025 Luke Tindall (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Ankur Gupta, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 18 March 2025.
2. The appellant relies on the following grounds of appeal under s 327(3) of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act):
   • the assessment was made on the basis of incorrect criteria, and
   • the MAC contains a demonstrable error.
3. The delegate is satisfied that, on the face of the application, at least one ground of appeal has been made out. The Appeal Panel has conducted a review of the original medical assessment but limited to the 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 suffered a psychological injury in the course of his employment with the State of New South Wales (NSW Police Force) (the respondent) deemed to have occurred on

30 November 2021. The appellant alleged he had suffered a psychological injury as a result of the nature and conditions of his employment with the respondent. 2. The appellant commenced proceedings in the Personal Injury Commission (Commission) claiming 19% whole person impairment (WPI) pursuant to s 66 of the Workers Compensation Act 1987 (the 1987 Act) in respect of a psychiatric and psychological disorder deemed to have occurred on 30 November 2021. 3. The Medical Assessor examined the appellant on 3 March 2025. The Medical Assessor assessed 7% WPI. The total WPI was 7% as a result of the injury deemed to have occurred on 30 November 2021.

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 it was not necessary for the appellant to undergo a further medical examination because there was sufficient information on which to make a decision.

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. 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 -There was a demonstrable error in failing to address the evidence submitted by both the appellant and respondent in the Application to Resolve a Dispute (ARD) and Reply in respect to the Psychiatric Impairment Rating Scale (PIRS).

(b) Clause 1.6(a) of the Guidelines provides that assessing permanent impairment involves clinical assessment of the claimant as they present on the day of assessment taking account the claimant's relevant medical history and all available relevant medical information.

(c) Clause 11.6 of the Guidelines makes various provision including clinical assessment of the person may include information from the injured worker's own description of his or her functioning and limitations, and from family members and others who may have knowledge of the person. Cl 11.6 also provides that medical reports, feedback from treating professionals and the results of standardised tests, including appropriate psychometric testing performed by a qualified clinical psychologist and work evaluations, may provide useful information to assist with the assessment. Appropriate tests were not performed, and proper consideration of the evidence was not considered.

(d) An unsupportable reasoning process can be made out (Ferguson v State of New South Wales [2017] NSWSC 887), and there is more than a mere difference of opinion.

(e) Ground 2 - self care and personal hygiene - the Medical Assessor assessed the appellant in the Class 1 category in accordance with the PIRS scale.

(f) Dr Graham George in his report dated 19 April 2023 assessed a Class 2 impairment for self care and personal hygiene, as did Dr Judith Clarke in her report dated 18 October 2024. The Medical Assessor provided no detailed reasons as to why his assessment in this category differed from those assessors.

(g) There is no indication by the Medical Assessor as to what is meant by 'regularly' when he described the appellant as "cleaning his teeth and showering regularly".

(h) At point 10 of his Reasons for Assessment, the Medical Assessor in reciting the documents taken into account in making the assessment at pages 4 and 5, did not make any reference to the appellant's signed statement dated 17 December 2024 and his evidence concerning self care and personal hygiene.

(i) Despite making indications of varying deficits that would align with a Class 2 category, the Medical Assessor assessed Class 1 citing that there is "a minor deficit attributable to the normal variation in the general population". He did not provide any reasoning or explanation as to how the appellant's deficits in this category align with the general population.

(j) The medical and lay evidence available suggests that the appellant has decreased self care and hygiene. It is unclear how his deficits are the same of the general population to render a Class 1 category in the area of self care and personal hygiene.

(k) It is clear from all of the evidence, including that of the Medical Assessor, that there is at least some deficit in his personal hygiene. As per the Guidelines, there is an expectation that the assessor will provide a rationale for the rating which is assigned. Further, the Guidelines indicate that assessing permanent impairment involves clinical assessment of the claimant as they present on the day of assessment taking account the claimant's relevant medical history and all available relevant medical information to determine impairment.

(l) This matter is one where there is more than a mere difference of opinion. Whilst the Medical Assessor's opinion does differ to those of the assessors, he does not clarify the difference. Further, the Class 1 category has not been indicated in a reasoned way. There has been no explanation put forward as to how the appellant's class aligns with the general population.

(m) The evidence suggests, and as confirmed by the Medical Assessor, that there is some deficit. The Medical Assessor assesses a minor deficit attributable to the normal variation in the general population. Where there is evidence of some deficit, the Medical Assessor ought to have provided reasoning as to how such deficit aligns with the normal variation in the general population.

(n) The Medical Assessor has made a demonstrable error/applied incorrect criteria in applying the Guidelines by failing to class the appellant's self care and personal hygiene as a Class 2 impairment where the Medical Assessor's findings together with the medical evidence is consistent with a Class 2 impairment of the PIRS.

(o) Ground 3 - travel. Dr George, in his report dated 19 April 2023, assessed a Class 2 impairment for travel. Dr Clarke, in her report dated 18 October 2024, assessed a Class 2 impairment for travel. The Medical Assessor assessed a Class 1 category, without any comparison to the reports of Dr George and Dr Clarke in relation to this category, both of whom assessed a Class 2 for travel.

(p) On page 8 the Medical Assessor reports that 'he could follow the GPS and get to a new place if needed'. The Medical Assessor does not indicate that the appellant actually has or does follow a GPS to a new place but rather that 'he could'. This is merely speculation.

(q) In coming to a categorisation of Class 1 the Medical Assessor does not indicate that there is no deficit but specifies 'a minor deficit attributable to the normal variation in the general population' in accordance with the guidelines. There is no explanation as to how the appellant's circumstances could be categorised such as to fit in the "a minor deficit to the normal variation in the general population". An individual who drives his car 'in emergency situations' who goes to the shops accompanied by his wife, is 'triggered' whilst driving and has to take 'the back way' to the shops would not be akin to a travel deficit attributable to general population. It is clear from all of the evidence, including that of the Medical Assessor, that there is at least some deficit in his ability to travel.

(r) Applying the Medical Assessor's findings on examination on 18 March 2025 to the Guidelines, the Medical Assessor made a demonstrable error/applied incorrect criteria in applying the Guidelines by failing to categorise the appellant's travel as a Class 1 impairment where the Medical Assessor's findings together with the medical evidence is consistent with a Class 2 impairment of the PIRS.

(s) Ground 4 - concentration, persistence and pace. The Medical Assessor assessed the appellant in the Class 2 category in accordance with the PIRS scale.

(t) Dr George in his report dated 19 April 2023, assessed a Class 3 impairment for concentration while Dr Clarke in a report dated 18 October 2024 assessed a Class 2 impairment.

(u) As previously noted, the Medical Assessor does not appear to have given any consideration to the statement of the appellant and his evidence relevant to the concentration, persistence and pace class.

(v) Despite the Medical Assessor's findings on the appellant's difficulty with concentration, the Medical Assessor did not say in his mental state examination findings that he had undertaken concentration tests with the appellant. Concentration can be assessed by objective tests and the failure of the Medical Assessor to undertake these tests - such as 'serial sevens' (counting down from 100 by sevens) or the Trial Making test, or to record the results of those tests was in error and requires a re-assessment of the appellant.

(w) The Medical Assessor's reasons in support of rating Class 2 are inconsistent with Class 2. Based on his examination, the Medical Assessor considered that the appellant had difficulties with concentration and had memory issues. The difficulties the appellant reports with reading, instruction and memory connote a class 3 impairment. Applying the Guidelines to the Medical Assessor's findings on examination, the medical evidence and the appellant's statement, the Medical Assessor made a demonstrable error and/or applied incorrect criteria in assessing a Class 2 impairment and it is appropriate that this category be rated as a Class 3 impairment.

(x) The MAC contains demonstrable errors and application of incorrect assessment criteria and should be set aside.

1. The respondent's submissions include the following:

(a) Ground 1 - self care and personal hygiene. At point 10 under "Reasons for assessment", the Medical Assessor he had taken account of the" following matters" and at pages 4 and 5 he then went on to make reference to a number of medical reports and documents considered when making in his assessment.

(b) The appellant's criticisms reflect more a question of weight as opposed to a failure to consider relevant material. In terms of the appellant's statement, this is likely to have been regarded as self-serving evidence with limited probative value, particularly given that it was prepared with a view to challenging the respondent's determination of WPI. It was open for the Medical Assessor to assign that evidence limited weight.

(c) Further, having examined the worker, the Medical Assessor was in a position to obtain a history directly from the appellant relevant to the PIRS categories.

(d) In terms of the assertion that the Medical Assessor did not account for the assessments of Dr Clarke and Dr George, this is without merit as he clearly refers to both assessments in his reasoning. He was not required to do a side-by-side comparison of both reports. It is sufficient that he considered the material and arrived at an assessment of his own based on the history and his own examination of the worker.

(e) As to the reasoning process, the Medical Assessor has provided a clear basis for assessing Class 1 asset out in the reasons for Decision in Table 11.8.

(f) A key criticism is the fact that the Medical Assessor ignored the appellant's comment that he did not pay much attention to his appearance. This is not the same as suggesting that he looks unkempt on occasions. Further, the Medical Assessor took a history that the appellant's physical health was maintained. Indeed, the omission to clip his beard regularly would amount to a minor deficit attributable to normal variation in the general population. The appellant did not provide a history of meticulous grooming pre-dating the subject injury.

(g) In assessing the appellant into the various PIRS Classes, clinical judgment is very important. Further the Medical Assessor does not have to be satisfied of every nuance of the descriptor categorisation for each PIRS Class to place the appellant in that Class, as these descriptors are examples only. In other words, a Medical Assessor is not bound by the examples contained in the Guidelines (although they do provide assistance in making an assessment). The Medical Assessor's assessment under the category of self care and personal hygiene should stand.

(h) Concentration, Persistence and Pace - in relation to the Medical Assessor not undertaking a concentration test, this was not required in order for the assessment to have been valid. It was sufficient that upon examining the worker and reviewing his history, the Medical Assessor arrived at the assessment he provided.

(i) In relation to the rationale being inconsistent with Class 2, the Medical Assessor took a history of the appellant being able to repair his bikes and do gardening, and Class 2 is appropriate. The ability to repair bikes is inconsistent with Class 3.

(j) There was also clinical evidence (with which the Medical Assessor was briefed) to support the appellant being able to continue restoring his motorbike and having increased motivation and concentration so this class does seem appropriate.

(k) Ground 4 - travel. As already noted under self care and personal hygiene, the appellant's criticisms reflect more a question of weight as opposed to a failure to consider relevant material. In terms of the appellant's statement, this is likely to have been regarded as self-serving evidence with limited probative value. Further, having examined the worker, the Medical Assessor was in a position to obtain a history directly from the appellant relevant to the PIRS categories which would be more current evidence than the statement, which is somewhat outdated.

(l) In terms of the Medical Assessor not accounting for the assessments of Dr Clarke and Dr George, he clearly refers to both assessments in his reasoning. He was not required to do a side-by-side comparison of both reports. It is sufficient that he considered the material and arrived at an assessment of his own based on the history and examination.

(m) The appellant misconstrued the language of the Guidelines which are expressed in terms of what the appellant 'can' do as opposed to what he actually does. For example, Class 1 states "No deficit, or minor deficit attributable to the normal variation in the general population: Can travel to new environments without supervision".

(n) The MAC 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 history recorded by the Medical Assessor, his findings on examination, and the reasons for his conclusions as well as the evidence in this matter.

1. The appellant submits that appropriate tests referred to in cl 11.6 of the Guidelines were not performed, and there was not a proper consideration of the evidence.
2. The Appeal Panel accepts that cl 11.6 requires that that the Medical Assessor take into account all available relevant medical information.
3. Clause 11.6 provides that medical reports, feedback from treating professionals and the results of standardised tests, including "appropriate psychometric testing performed by a qualified clinical psychologist and work evaluations", may provide useful information to assist with the assessment.
4. The appropriate psychometric tests referred to in cl 11.6 are tests performed by a clinical psychologist. The documents attached to the ARD include the clinical notes and records of Olga Tanevska, registered psychologist, of Uniquely You Psychology and include DASS 21 assessments (a self-reported symptom questionnaire). It appears that no psychometric testing was recommended by any treating doctor.

1. The Appeal Panel agrees with the respondent that a concentration test was not required in order for the assessment to have been valid. It was sufficient that upon examining the worker and reviewing his history, the Medical Assessor arrived at the assessment he provided with adequate reasons
2. The appellant does not identify specifically what documents the Medical Assessor failed to properly consider.
3. It is not necessary that the Medical Assessor refer to every document submitted or explain in detail the criteria applied to reach his professional judgment (Campbelltown City Council v Vegan [2006] NSWCA 284.)
4. The Appeal Panel is satisfied that although the Medical Assessor may not have referred specifically to some documents, such documents would have been considered by him in his assessment.
5. This ground of appeal is not made out.

1. The appellant submits that the Medical Assessor has made a demonstrable error/applied incorrect criteria in applying the Guidelines by failing to class the appellant's self care and personal hygiene is a Class 1 impairment where the Medical Assessor's findings together with the medical evidence is consistent with a Class 2 impairment of the PIRS
2. The examples under Table 11.1 for "self care and personal hygiene" in the Guidelines are:

"Class 1: No deficit, or minor deficit attributable to the normal variation in the general population.

Class 2 Mild impairment: Able to live independently; looks after self adequately, although may look unkempt occasionally; sometimes misses a meal or relies on take-away food.

Class 3 Moderate impairment: Can't live independently without regular support. Needs prompting to shower daily and wear clean clothes. Does not prepare own meals, frequently misses meals. Family member or community nurse visits (or should visit) 2-3 times per week to ensure minimum level of hygiene and nutrition".

1. The Medical Assessor assessed the appellant as Class 1 for self care and personal hygiene. In the PIRS Rating Form, the Medical Assessor wrote:

As described in the main body of the report, there is a minor deficit attributable to the normal variation in the general population. He describes cleaning his teeth and showering regularly. He also contributes to household chores. However, he does not pay much attention to his appearance. He has lost some weight since the injury but does not require prompting to eat."

1. Under "Present symptoms" the Medical Assessor noted: "He says his appetite is reduced and he does not feel overtly hungry. He says that he has lost weight but 'not dramatic'."
2. Under "Social activities/ADL" the Medical Assessor wrote:

"He says that he keeps himself clean "most days". He showers and cleans his teeth regularly. He says that he contributes his fair share in managing household chores. He does not think about his appearance or clip his beard regularly. He says that he is doing everything that he can for his mental health, including going for rides, yoga and breathing exercises. ...He takes his medications regularly, but his wife reminds him sometimes.".

1. Under Findings on Physical Examination on page 4 of the MAC the Medical Assessor noted "not applicable".
2. In his statement dated 17 December 2024, the appellant stated:

"5. I only usually eat one meal a day, usually late in the afternoon and a majority of the time it is takeaway. I just drink coffee during the day.

6. I never prepare meals for myself, If I have to get my own food it'll be takeaway or a large drink of milk.

7. A lot of the time I have to be reminded to take my medication.

8. I wear the same clothes for several days in a row all the time".

1. Dr Graham George consultant psychiatrist, in a report dated 19 April 2023, assessed a Class 2 for self care and personal hygiene providing the following reasons:

"He said that he does shower regularly and put on fresh clothes as required. If his wife asks him to do some household tasks, he said he would do his best to help out. His sleep hygiene has been disturbed for, possibly, two years. His diet is poor and he might only have one meal a day. It appears that, often, he feels too agitated to eat or to sit down to have a meal."

1. Dr Judith Clarke, consultant psychiatrist, in a report dated 26 September 2023 described the appellant as casually dressed and well groomed.
2. Dr Judith Clarke, consultant psychiatrist, in a report dated I July 2024 described the appellant as casually dressed and tidily groomed. Dr Clarke assessed a Class 2 for self care and personal hygiene providing the following reasons:

"Reported decreased self-care but maintaining general hygiene. "Potters around" doing some housework."

1. The appellant submits that the Medical Assessor incorrectly applied the Guidelines and Table 11.1 by failing to take into account the appellant's evidence and specifically the available evidence relating to the failure to shower and shave regularly, failure to change into clean clothes, failure to take pride in one's appearance and failure to eat properly.
2. The Appeal Panel was satisfied that the reasons given by the Medical Assessor for a Class 1 rating for self care and personal hygiene were inconsistent with descriptors for Class 1 rating. In particular, the loss of weight, reduced appetite and failure to take medication without prompting were deficits in this Class and not minor deficit attributable to the normal variation in the general population. The Appeal Panel noted that Dr George reported that the appellant often felt too agitated to eat or sit down to have a meal.
3. The Appeal Panel accepts that a Class 1 impairment does not adequately reflect the appellant's impairment and is unsupported by the available evidence. Both Dr George and Dr Clarke assessed class 2 for self care and personal hygiene. However, the Medical Assessor failed to provide any opinion as to his difference in opinion in this rating this Class.
4. The Appeal Panel is satisfied that there was a demonstrable error in the MAC in relation to the ratings in the PIRS category of self care and personal hygiene and the assessment in this class is made on the basis of incorrect criteria. This ground of appeal is made out.
5. The Appeal Panel considers that there is evidence to support an assessment of Class 2 for self care and personal hygiene. The appellant has lost weight, needs reminding to take medication, and often felt too agitated to sit down or eat a meal. The Appeal Panel assesses the appellant as Class 2 for self care and personal hygiene.

1. The appellant submits that applying the Medical Assessor's findings on examination on

18 March 2025 in respect of travel to the Guidelines, the Medical Assessor has made a demonstrable error/applied incorrect criteria in applying the Guidelines by failing to categorise the appellant's travel as a Class 2 impairment where the Medical Assessor's findings together with the medical evidence is consistent with a Class 2 impairment of the PIRS. 2. The examples under Table 11. 3 for "Travel" in the Guidelines are:

"Class 1: No deficit, or minor deficit attributable to the normal variation in the general population.

Class 2: Mild impairment: can travel without support person, but only in a familiar area such as local shops, visiting a neighbour.

Class 3: Moderate impairment: cannot travel away from own residence without support person. Problems may be due to excessive anxiety or cognitive impairment."

1. The Medical Assessor assessed the appellant as Class 1 for travel. In the PIRS Rating Form, the MA wrote:

As described in the main body of the report, there is a minor deficit attributable to the normal variation in the general population. He rides his bike to the bush and can drive a car. He becomes anxious if triggered by places but could follow GPS and visit new places."

1. Under "present symptoms", the Medical Assessor noted:

"He says that he is unable to relax when he goes out. He can go to the shops but not alone. He waits for his wife to finish work and goes with her.

He says that there are times when he is able to go to the shops, but takes the back way and says that "it is quick". He likes motorbikes and rides his in the bush. He says he drives a car in an emergency, but it is a chore. He says he "hates it" because he gets triggered with places. He says he could follow the GPS and get to a new place if needed".

1. Under "Social activities/ADL" the Medical Assessor noted:

"Mr Tindall is close to his parents and brothers. They live four hours away from him. He visited them over Christmas.

He says that he is doing everything that he can for his mental health, including going for rides, yoga and breathing exercises..."

1. In his statement dated 12 December 2024 the appellant wrote:

"12. I only leave the house every 3-4 days and that is usually just to go to the local shop for bread and milk. Most times I will wait for my wife to finish work so she can come with me. I hate going alone for fear of meeting someone associated with my past in the police such as crooks, victims or other police officers. I get a butterfly feeling in my stomach at the thought of such encounters.

13. I can't even remember the last time I was out socially with my wife and kids in the same setting. My kids actually make remarks such as 'ah you won't want to go anyway, will you?" when discussing their intentions to go out.

14. The only places I will go alone is the local shops, Bunnings or a ride in the bush. I will wait for my wife to be available to come with me if I need to go to an unfamiliar place".

1. Dr Graham George consultant psychiatrist, in a report dated 19 April 2023 assessed a Class 2 for travel. He provided the following reasons:

"He indicated that when he is driving his wife normally would accompany

him on a longer trip. He indicated that, normally, he drives short distances. He indicated that there are constant triggers provoking dissociative flashbacks for him when he drives a vehicle and it is worse for him because he has lived and worked in his local area".

1. Dr Judith Clarke, consultant psychiatrist, in a report dated I July 2024 assessed a Class 2 for travel. She provided the following reasons:

"Drives independently to familiar places, including to Sydney for psychiatry appointments. Prefers to be accompanied by wife if not in familiar places."

1. The appellant submits that that the evidence supports an assessment of Class 2 for travel.
2. Dr Graham George in his report dated 19 April 2023, assessed a Class 2 impairment for travel. Dr Judith Clarke, in her report dated 18 October 2024, assessed a Class 2 impairment for travel. The Appeal Panel accepts that the Medical Assessor assessed a Class 1 category, without providing an opinion as to his difference in this rating in this class from the assessments of Dr George and Dr Clarke.
3. The appellant submits that the Medical Assessor incorrectly applied the Guidelines and Table 11.1 by failing to take into account the appellant's evidence and specifically the available evidence. The Medical Assessor notes that the appellant waits to go to the shops with his wife although he is able to make a quick trip to the shops using the "back way" and is able to drive in an emergency.
4. The Appeal Panel was satisfied that the reasons given by the Medical Assessor for a Class 1 rating for travel were inconsistent with descriptors for Class 1 rating. In particular, the history that he normally went to the shops with his wife. This is a deficit in this Class and not minor deficit attributable to the normal variation in the general population. The Appeal Panel noted the appellant stated that the only places he would go alone is the local shops, Bunnings hardware store or a ride in the bush. He stated that he would wait for his wife to be available to come with him if he needed to go to an unfamiliar place.
5. The Appeal Panel accepts that a Class 1 impairment does not adequately reflect the appellant's impairment in travel and is not supported by the available evidence.
6. The Appeal Panel is satisfied that there was a demonstrable error in the MAC in relation to the ratings in the PIRS category of travel and the assessment in this class is made on the basis of incorrect criteria. This ground of appeal is made out.
7. The Appeal Panel considers that there is evidence to support an assessment of Class 2 for travel. The appellant normally waits for his wife in order to go to the shops and waits for his wife to be available as a support person, if he goes to an unfamiliar place. The appellant has a mild impairment in this category caused by anxiety limiting his ability to travel to places. The Appeal Panel assesses the appellant as Class 2 for travel.

1. The appellant submits the difficulties which the appellant reports with reading, instruction and memory connotes a Class 3 moderate impairment. The appellant argues that applying the Guidelines to the Medical Assessor's reporting findings on examination, medical evidence and appellant's statement the Medical Assessor made a demonstrable error and/or applied incorrect criteria in assessing a Class 2 impairment. Relying on the Guidelines, the Medical Assessor's reporting findings on examination, medical evidence and the appellant's statement dated 17 December 2024, it is appropriate that the category for concentration be rated as a Class 3 impairment.
2. The examples under Table 11.5 for "Concentration, persistence and pace" in the Guidelines are:

"Class 2: Mild impairment: can undertake a basic retraining course, or a standard course at a slower pace. Can focus on intellectually demanding tasks for periods of up to 30 minutes, then feels fatigued or develops headache.

Class 3: Moderate impairment: unable to read more than newspaper articles. Finds it difficult to follow complex instructions (e.g. operating manuals, building plans), make significant repairs to motor vehicle, type long documents, follow a pattern for making clothes, tapestry or knitting."

1. The Medical Assessor assessed the appellant as Class 2 for concentration, persistence and pace. In the PIRS Rating Form, the Medical Assessor wrote:

As described in the main body of the report, there is mild impairment. He describes reduced memory and concentration. He has become forgetful and needs

reminders from his wife to take his medication. He was able to focus well throughout the assessment."

1. Under "Present symptoms" the Medical Assessor noted: "Mr Tindall says that he finds involvement in anything very hard".
2. Under "Social Activities /ADL" the Medical Assessor wrote:

"He says that he likes fixing his bike as well. He says he likes rose gardening but has not looked after his plants well over the last season. He watches motorbike videos on YouTube. He says that he does not read because of lack of concentration. He says that he gets "fumbled up in the sentence". He has to reread sentences to understand. ...

He has never been involved in managing the family's finances.

He says that his memory is "horrible". He says his wife works from home but travels to Sydney on Fridays. However, he always forgets that. He forgets tasks such as taking their daughter somewhere..."

1. In his statement dated 17 December 2024, the appellant stated:

"23. I now struggle to complete the simplest of forms and documents in my day to day living. I get frustrated at having to think about and answer simple questions on documents. While attempting to understand a document either a bill or application I find myself having to read the same line of text numerous times before understanding its context. I also find myself not reading sentences from the start, starting off half way through the sentence or paragraph and getting lost in the text. I have reported this condition to my treaters on numerous occasions. After a few minutes I throw it down or give it to my wife to look at. A recent example of this is when my daughter asked me to help her with her drivers licence application form and drivers log book the other day. A basic form became a tedious task when I couldn't work out amount of hours, how to carry them over and where to write them down on the page. It turned into an argument and awkward situation with me my daughter and wife.

24. I used to refer to my owners manuals when performing maintenance on my motorbikes. I now hate having to read for an answer or method no matter how simple, I prefer to YouTube it.

25. I have so many unfinished jobs around the house to do. When I'm met with the slightest inconvenience in completing a task, I become highly agitated and frustrated and usually give up on it leaving it for another time. In recent rains the stormwater drain out the back became blocked. I dug down to find the pipes not aligned and blocked with mud. When the dirt in the hole kept falling down around the sides hampering me getting to the pipes, I got extremely agitated and left it. I just wanted to dig it out to expose the pipe so I could rejoin it. The back area floods every time it rains now and that small task remains incomplete for about a month.

26. Prior to my PTSD I was a highly accomplished investigator and able to complete the most complex of affidavits, warrant applications, risk assessments etc. I completed these documents within a couple of hours usually and to a standard accepted by senior police and magistrates. It has taken me five days to complete this simple statement".

1. Dr Howard Napper, treating psychiatrist, in a report dated 18 April 2024 noted that the appellant continued to experience problems with attention, focus and concentration. He noted that the appellant had reduced his alcohol intake to four beers on weekends and alcohol-free days during the week.
2. Dr Graham George consultant psychiatrist, in a report dated 19 April 2023 assessed Class 3 for concentration, persistence and pace providing the following reasons:

"He can look at something on YouTube and take in some information. He cannot read information and retain it. He has to reread material to try to understand something. When he was at work, he could not comprehend what he was reading towards the end of his time at work."

1. Dr George noted that the appellant was consuming four to six standard drinks a day and considered that would impact on his mental health. He made a diagnosis of chronic post-traumatic stress disorder, persistent depressive disorder and alcohol use disorder.
2. Dr Judith Clarke, consultant psychiatrist, in a report dated 26 September 2023 noted under "mental state examination" that the appellant was observed to maintain attention and concentration throughout the examination.
3. Dr Clarke in a report dated 18 October 2024 assessed Class 2 for concentration, persistence and pace providing the following reasons:

"Reports decreased focus. Observed to maintain concentration and attention during examination. Able to concentrate to drive safely".

1. Dr Clarke noted that the appellant stated he had "cut out" consuming alcohol late last year and consumed one to two drinks on his birthday this year. She noted that Dr Napper in his report noted the appellant had reduced his alcohol consumption and this was consistent with Dr Vishnoi's comments in his most recent medical certificate of capacity (6 May 2024), where he stated the appellant "has reduced and stopped alcohol Nov 2023." Dr Clarke wrote: "Mr Tindall stated that these improvements occurred soon after my initial examination. He attributed his improvement to medication and his psychological treatment, especially distress tolerance skills".
2. Dr Clarke wrote:

"Alcohol misuse is established as an exacerbator of psychiatric problems, and whilst

Mr Tindall does not endorse this being his experience, the timing of his quite significant improvement at the time of ceasing regular alcohol consumption and in the absence of any other changes in his care or his life, endorse this as the case for him".

1. Dr Clarke noted that the appellant would spend most of the day in the garage, restoring and building old motorbikes. She noted that after dinner, the applicant would watch "footy" on television or watch a YouTube video instructing him on how to execute the next repair for his bike.
2. In a report dated 21 March 2024, Ms Tanevska, treating psychologist, noted that the appellant continued to improve mood and anxiety symptoms. She wrote: "It is anticipated that with continued progress with the above goals, there will be an improvement in executive functioning of his cognitive capacity."
3. In her clinical notes dated 18 July 2024, Ms Tanevska wrote:

"Reported cont. to work on restoring/repairing his motor bike and also attempted to do his personal tax return (not all the way through). Although reported he struggled to deal with dealing with a repairer he was able to collect himself and return to the place. Discussed the positives of both situations including increased motivation to do things, increased concentration and emotion regulation".

1. The Appeal Panel accept that the Medical Assessor did not appear to have given any consideration to the statement of the appellant and his evidence relevant to this class.
2. The appellant submits that despite the Medical Assessor's findings on the appellant's difficulty with concentration, the Medical Assessor did not say in his mental state examination findings that he had undertaken concentration tests with the appellant. This submission was made under Ground 1 above.
3. The Appeal Panel notes that cl 11.6 provides that medical reports, feedback from treating professionals and the results of standardised tests, including "appropriate psychometric testing performed by a qualified clinical psychologist and work evaluations", may provide useful information to assist with the assessment. However, there is no requirement that a Medical Assessor should undertake concentration tests of a worker in the assessment.
4. Further, the appropriate tests referred to in cl 11.6 are tests performed by a clinical psychologist, not by a psychiatrist such as the Medical Assessor. The documents attached to the ARD include the clinical notes and records of Olga Tanevska, registered psychologist, of Uniquely You Psychology and include DASS 21 assessments. It appears that no treating doctors or IMEs, including Dr George, have recommended that the appellant undergo such testing.
5. The Appeal Panel agrees with the respondent that a concentration test was not required for the assessment to have been valid. It was sufficient that upon examining the appellant and reviewing his history, the Medical Assessor arrived at the assessment he did.
6. The appellant submits that the Medical Assessor based on his examination, considered that the appellant had difficulties with concentration and had memory issues. The appellant argues that the difficulties the appellant reports with reading, instruction and memory connote a Class 3 impairment. The appellant submits that applying the Guidelines to the Medical Assessor's findings on examination, the medical evidence and the appellant's statement, the Medical Assessor made a demonstrable error and/or applied incorrect criteria in assessing a Class 2 impairment and it is appropriate that this category be rated as a Class 3 impairment.
7. The Appeal Panel notes that Dr Clarke assessed Class 2 in this category while Dr George assesses Class 3.
8. The Appeal Panel notes that the appellant had significantly reduced his alcohol intake by the end of 2023, after Dr George had assessed the applicant, and that there had been some improvement in his condition.
9. The Appeal Panel notes that the Medical Assessor found that the appellant was able to focus and concentrate well throughout the assessment. The Medical Assessor described in some detail that the appellant liked fixing bikes and watched motorbike videos on YouTube. The appellant, in his statement, said that he watched the YouTube videos in order to work out how he can repair bikes rather than looking at a manual.
10. The Appeal Panel considers after considering the evidence, particularly that of Dr Clarke and Ms Tanevska, that there has been some improvement in the appellant's condition after he reduced his alcohol use and since his examination by Dr George. The Appeal Panel has placed less weight on the appellant's evidence as this is subjective and he omitted to refer to activities such as restoring and repairing old motorbikes, and watching YouTube at night to provide himself with guides on how to do so later, indicative that he had sufficient cognitive capacity to concentrate and retain this information.
11. The Appeal Panel accepts that the appellant has some problems with memory and concentration, however, he is able to fix and restore motor bikes and watch YouTube videos in order to work out how to repair and restore the motor bikes. Both Dr Clarke and the Medical Assessor observed that the appellant remained focused throughout the respective examinations. The Appeal Panel infers from this report that the Medical Assessor was satisfied that the appellant was able to attend, persist, understand and comprehend and engage in the interview is such a manner to suggest a mild impairment in this scale. The Appeal Panel accept this report as clear evidence of the appellant's ability to focus on an intellectually demanding task for more than 30 minutes, and certainly up to 30 minutes. The assessment of Class 2 in this category is consistent with the assessment of Dr Clarke.
12. The Appeal Panel finds no error in the rating of a mild impairment. The Medical Assessor is entitled to form his own clinical judgment on the day of assessment and having had due regard to the other medical opinions before him. The assessment of Class 2 is in accordance with the criteria in the Guidelines. The Medical Assessor has assessed in accordance with the correct criteria.
13. This ground of appeal is not made out.
14. Therefore, the Appeal Panel finds that the PIRS scales score 2 3 2 2 2 5, ascending order 2 2 2 2 3 5, median class 2, aggregate 16 so that the WPI = 9%.
15. For these reasons, the Appeal Panel has determined that the MAC issued on 18 March 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 Ankur Gupta 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)

The above assessment is made in accordance with the SIRA NSW Guidelines for the Evaluation of Permanent Impairment for injuries received after 1 January 2002.