DETERMINATION OF APPEAL PANEL	
	
CITATION:	Yoogalu Pty Limited ATF Harvey Norman Discounts No 1 Trust v Quinn [2024] NSWPICMP 2	
		
APPELLANT:	Yoogalu Pty Limited ATF Harvey Norman Discounts No 1 Trust	
		
RESPONDENT:	Alan Quinn	
		
Appeal Panel		
		
MEMBER:	Catherine McDonald 	
		
MEDICAL ASSESSOR:	Nicholas Glozier	
		
MEDICAL ASSESSOR:	Michael Hong	
		
DATE OF DECISION:	8 January 2024	
		
CATCHWORDS: 	wORKERS cOMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; psychological injury; Medical Assessor did not make any section 323 deduction; diagnosis of condition included alcohol use disorder; extensive history of alcohol use with adverse consequences in general practitioner’s notes; section 323 deduction of one-tenth appropriate; Held – Medical Assessment Certificate revoked.

BACKGROUND TO THE APPLICATION TO APPEAL
1.	On 9 October 2023 Yoogalu Pty Limited ATF Harvey Norman Discounts No 1 Trust (Yoogalu) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr John Lam-Po-Tang, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 11 September 2023.
2.	Yoogalu 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 was satisfied that, on the face of the application, at least one ground of appeal was made out. We conducted a review of the original medical assessment, limited to the grounds 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).
RELEVANT FACTUAL BACKGROUND
6.	Mr Quinn worked for Yoogalu for more than 30 years as a warehouse manager and warehouse trainer. He alleged that he suffered a psychological injury as a result of interpersonal conflicts with his manager in the period between September 2019 and March 2021. He reported his manager’s behaviour to Human Resources on 14 May 2021 and that it is the deemed date of injury.
7.	The Medical Assessor assessed Mr Quinn under the Psychiatric Impairment Rating Scale (PIRS) in the Guidelines. He assessed 19% whole person impairment (WPI) and did not make any deduction under s 323 of the 1998 Act.
PRELIMINARY REVIEW
8.	We conducted a preliminary review of the original medical assessment in the absence of the parties and in accordance with the Procedural Direction PIC7.
9.	As a result of that preliminary review, we determined that it was not necessary for Mr Quinn to undergo a further medical examination because there is enough material in the file to determine the appeal.
EVIDENCE
10.	We have all the documents that were sent to the Medical Assessor for the original medical assessment and have taken them into account in making our determination.
11.	The parts of the MAC that are relevant to the appeal are set out in the body of this decision.
SUBMISSIONS 
12.	Both parties made written submissions. They are not repeated in full, but we have considered them.
13.	In summary, and in submissions prepared by its solicitor, Ms Tancred, Yoogalu submitted that the Medical Assessor was in error in failing to take Mr Quinn’s longstanding psychological condition into account. It referred to the notes from his general practitioner, Dr Houwing in 2019 and January 2021.
14.	Yoogalu said that the Medical Assessor made a second error in failing to consider Mr Quinn’s pre-existing issues with alcohol abuse, referring to notes from Dr Houwing, in 2017 and 2019 and to Dr Kumar, qualified on its behalf. It submitted that the Medical Assessor’s third error was in failing to consider Mr Quinn’s inconsistent assertions as to a pre-existing condition, in particular concerning when he first saw his psychologist, Mr McShane.
15.	Yoogalu submitted that there should be a deduction under s 323 of at least 25%.
16.	In submissions prepared by Mr Joseph of counsel, Mr Quinn said that there was no basis to say that the Medical Assessor’s decision was based on incorrect criteria because he had considered the application of s 323 and assessed him under the PIRS.
17.	Mr Quinn said that it is important to acknowledge that the injury is in the nature of a psychiatric disease or condition, which developed over a period of time, or was caused by his employment over an extended period. It was not consistent with the findings in the MAC to say that Mr Quinn was symptomatic before 14 May 2021 because it was not the case of a single incident on that date causing injury. Mr McShane’s records showed that he had been treated from 2019, as a result of the problems at work.
18.	Mr Quinn said that the assessment was of permanent impairment rather than of an alcohol use disorder and that references to alcohol use in the notes do not, without more, denote mental health issues. Mr Quinn said that a mistake in the MAC as to the date on which he consulted Mr McShane does not mean that there was an inconsistency and Mr McShane’s note as to his history is consistent with his narrative. He said that if the appeal is upheld that a re-examination was appropriate and, if there was a re-examination, that the s 323 deduction should be one-tenth.
FINDINGS AND REASONS 
19.	The procedures on appeal are contained in s 328 of the 1998 Act. The appeal is 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.
20.	In Campbelltown City Council v Vegan the Court of Appeal held that an 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.
The MAC
21.	The grounds of the appeal relate solely to the extent of the appropriate s 323 deduction and there is no issue as to the Medical Assessor’s assessment of 19% WPI under the PIRS.
22.	The Medical Assessor set out the history that Mr Quinn provided, noting that he relied on a number of incidents that he felt contributed to his mental state. They included incidents in September 2019, when the manager raised the question of his age, and in a Teams meeting on 14 August 2020. In early 2021, after being hospitalised for a suspected transient ischemic attack (TIA). On his return, the manager asked Mr Quinn to go to a meeting where he was asked if he proposed to retire. When he declined, he was offered a more senior position, reporting directly to the manager. He left work and sought treatment.
23.	The Medical Assessor summarised Mr Quinn’s treatment, recording that he first saw his psychologist, Mr McShane in 2021. He described Mr Quinn’s present symptoms.
24.	With respect to past psychiatric history, the Medical Assessor wrote:
“Mr Quinn reported no consultations with psychologists or psychiatrists as a child or adolescent. He advised he had never been assessed by a psychiatrist for treatment until 2021, and had never seen a psychologist prior to Mr McShane in 2021. He advised he had never been prescribed psychotropic medications until 2021.
Mr Quinn reported no episodes of deliberate self-harm or suicide attempts, but did refer to urges to undertake impulsive actions, such as jumping over a railing.”
25.	The Medical Assessor said that Mr Quinn reported “an extensive and complex medical history” including:
“Mr Quinn advised he was admitted to RNSH in 2019 with a suspected cerebrovascular event. This is consistent with a letter from RNSH to Dr Houwing, dated 5 July 2019. He stated he had neuroimaging studies whilst in hospital, but has not had any neuroimaging studies since that time.”
26.	With respect to alcohol and substance use, the Medical Assessor wrote:
“Mr Quinn does not smoke cigarettes or use nicotine products such as vaping devices. He drinks one cup of weak coffee in the morning. He estimated he drinks alcohol four times per week, consuming at least a bottle of wine on these days. He stated that one or two days per week he will drink more than a bottle of wine, stating this would involve one bottle of wine and one glass of wine. When asked about complications of alcohol consumption, Mr Quinn replied, ‘They said my liver count was a little bit high… about a year ago’. He recounted how he sometimes undertakes impulsive actions whilst intoxicated, such as calling his estranged son. He reported occasionally forgetting where he placed his wallet or keys. He said that his GP and hospital staff have advised him to reduce his alcohol consumption. He advised he had not sustained any physical injuries as a result of alcohol intoxication. He reported no illicit substance use.”
27.	When describing Mr Quinn’s current level of function, the Medical Assessor said:
“Mr Quinn advised that he does not attend restaurants, cafes or go to the movies, but later described going to a local Chinese restaurant, and behaving in a way that got himself thrown out. He also advised that he had been attending a local licensed club, but was also thrown out.
Mr Quinn reported a pattern of conflicted interactions with other people. By way of example, he commented that people including strangers were ‘disrespecting me’. He alleged that on one occasion he was asked to move out of a senior seat on the bus by a young woman, whom he alleges took a photo of him and he thought this occurred a year ago. Another example was Mr Quinn advising he ‘got into trouble walking on the street’, recounting a scenario where he was walking in one direction, when a young person was walking with their dog in the other direction. Somehow a verbal disagreement occurred, but the details were unclear.
Mr Quinn advised he can focus on matters for about five minutes, and then, ‘I just get distracted… I've got no concentration span’.”
28.	The Medical Assessor described his mental state examination. He said:
“Mr Quinn's psychiatric symptoms are consistent with a chronic Adjustment Disorder. His description of his alcohol consumption, and the consequences thereof are consistent with Alcohol Use Disorder.”
29.	The Medical Assessor assessed 19% WPI and set out the reasons in the PIRS rating sheet. Neither party has taken issue with that assessment. The Medical Assessor assessed Mr Quinn in class 3 for concentration, persistence and pace, because that he reported subjective impairment in concentration, but observing that he was able to maintain focus throughout the 90 minute consultation.
30.	The Medical Assessor considered a small number of the other reports in the very large file including Dr Khan, qualified for Mr Quinn, his treating psychiatrist, Dr Hartshorn. He summarised the report of Dr Kumar, qualified for Yoogalu. The Medical Assessor said that there was no deductible proportion for a pre-existing condition. He did not explain his reason for failing to make a deduction and did not engage with that aspect of Dr Kumar’s report.
31.	The MAC is based primarily on the history which Mr Quinn provided without detailed reference to Dr Houwing’s notes.
Medical evidence
32.	Dr Khan saw Mr Quinn at the request of his solicitors and reported on 29 June 2022. He recorded that Mr Quinn’s alcohol use had escalated since the injury. He diagnosed major depressive disorder with anxious distress and alcohol use disorder and attributed both to the work related injury. Dr Khan assessed 19% WPI and did not make any deduction under s 323.
33.	Dr Kumar saw Mr Quinn at the request of Yoogalu and reported on 29 October 2022. Dr Kumar obtained a history of the injury and noted that Mr Quinn drank a bottle of wine each day. Mr Quinn denied any past history of a mental illness. Dr Kumar diagnosed chronic adjustment disorder, generalised anxiety disorder and alcohol use disorder. He said:
“The chronic adjustment disorder is in context of work related interactions as described above. The generalised anxiety disorder and alcohol use disorders are pre-existing and were continuing when he was seen by his doctor in 2019.”
34.	Dr Kumar referred to an entry in the general practitioner’s notes from 3 September 2019 to which we refer below and said that indicated that anxiety and the alcohol use disorder had been present since two years before 2019. He assessed 7% WPI and deducted one-tenth under s 323.
Medical history
35.	The determination of this appeal turns on a review of the historical medical evidence in the file.
36.	Mr Quinn said in his statement that the conduct which led to his injury occurred in the period between September 2019 to March 2021. He said that after a suspected stroke in September 2019 he was harassed by email, phone and text about his return to work and, on his return, was asked if he was going to retire. He said that he was ridiculed at training sessions in October 2019 and reported the condition to Dr Houwing. He was referred to Mr McShane. He said that he saw Mr McShane for the first time in September 2020.
37.	Mr Quinn’s general practitioner is Dr Houwing and the notes from her practice date back to 1997. The notes in the Application to Resolve a Dispute are incomplete, starting in 2003 and ceasing in 2016, apart from a few medical certificates. An almost complete copy of the notes appears in the Reply.
38.	An incomplete letter from Westmead Neurological Centre dated 25 March 1997 noted that Mr Quinn had been referred for pupillary inequality and that his problems had arisen after a wine tasting at which he had indulged “rather heavily” and work on the following morning, aware that this left side of his body was hyper-sensitive. He noticed a drooping of the eyelid on the right, and his right pupil was smaller than the left. He felt off balance. The doctor diagnosed a combination of rights sided Horner’s syndrome, and left-sided sensory syndrome, suggesting a small vascular lesion affecting the right side of his brain stem. Mr Quinn also attended hospital on 30 August 1999, when he was reassured they had been no new ischaemic event, and on 11 June 2003 for dizziness.
39.	In 2007 Prof Anderson, neurologist, saw Mr Quinn for his “long-standing problem of left-sided ‘hypersensitivity’ or dysaesthesia, believed to be due to a pure motor ‘lacunar’ cerebral ischaemic stroke in 1997, following excessive consumption of alcohol at a wine festival.” Mr Quinn had been maintained on blood pressure lowering therapy, and anti- thrombotic treatment, and had generally limited his alcohol to one to two glasses of wine at dinner. The sensory symptoms fluctuated in severity, but never disappeared, and Prof Anderson reassured Mr Quinn that the features were consistent with long-standing central thalmic pain syndrome presumed related to the old ischaemic lesion.
40.	There are a number of references to drinking wine in the handwritten notes – on 18 April 2007 Mr Quinn reported pain in his left groin and leg causing him to limp for a few minutes when he started walking which was “worse with a few glasses of wine.” On 5 May 2008 when blood clotting time was tested for another condition the doctor noted “had been drinking wine.”
41.	On 21 March 2015 Dr Houwing noted that Mr Quinn was feeling depressed as a result of separation from his wife a year before and estrangement from his son. He had other health issues and was looking after his mother. There is no record of treatment prescribed, though a medical certificate for three days off work was provided.
42.	The handwritten notes end in April 2016 and the computer notes for the last months of that year do not appear in the file. We therefore do not know what led to the entries which follow but we presume that Mr Quinn had undergone a gamma-glutamyl transferase (GGT) test. On 13 January 2017 Dr Houwing noted that Mr Quinn had nearly ceased alcohol and had lost weight. It was hoped that his “next test will be much improved”. On 14 March 2017 Dr Malhotra recorded that Mr Quinn’s GGT was better though he was still drinking two glasses of wine six days per week and “was drinking two bottles a day”.
43.	On 5 November 2017 in the early hours of the morning, Mr Quinn presented to St Vincent’s Hospital with a head injury because he “was found by ambulance staff to be wandering within an ataxic gait and bleeding head laceration. He was intoxicated and amnesic to the events precipitating his injury.… His blood alcohol level was 0.26.”
44.	A chronic disease management plan dated 23 March 2018 noted a past history of cerebrovascular accident in 1987 for which it was recommended that Mr Quinn limit his alcohol intake. The same advice was repeated in a plan dated 3 July 2019.
45.	On 1 July 2019, Mr Quinn presented to Ryde Hospital after experiencing an unsteady gait on early morning waking. On Friday, 5 July 2019 he was reviewed in the TIA Clinic by A/Prof Krause and Dr Sutherland and it was recorded that he drank approximately one bottle of wine per night. It was recommended that he significantly reduce or completely cease his alcohol intake.
46.	On 12 August 2019 Mr Quinn was discharged from Royal North Shore Hospital after an admission for a suspected stroke. The discharge summary noted chronic alcohol abuse with consumption of one to two bottles of wine a day and that his liver function tests showed derangement throughout the admission. Mr Quinn was to be followed up in the Liver Clinic and Dr Houwing was asked to provide a referral.
47.	The first references to work stress in the general practitioners’ notes appear on 14 August 2019 when Mr Quinn had been to hospital with a likely transient ischaemic attack thought to be caused by stress at work and being asked to train higher management. Mr Quinn had a period off work and a Mental Health Care Plan was made. The plan noted that Mr Quinn’s current mental health issues were not limited to the issues at work. Dr Houwing noted:
“Anxiety - worse over the past couple of years
Anxious about heights (Started past couple of years) – escalaters [sic], Looking out windows, says he won't fly again.
Not able to go back to work currently - Worked Harvey Norman 30 yrs - he is anxious they want him to perform at a higher level - and he can't go currently.”
48.	Dr Houwing noted that Mr Quinn had “had a recent health scare – possible stroke – Probably worse anxiety since then”. The reference to stress in Dr Houwing’s notes is a result of Mr Quinn feeling inadequate to undertake a task he was requested to perform. It does not form part of the factual matrix of his claim, which relates only to the way he was treated by his manager.
49.	The notes do not support Mr Quinn’s contention that he told Dr Houwing about bullying and harassment at work in October 2019.
50.	Dr Chang of the Hepatology Unit at Royal North Shore Hospital reported on 7 November 2019 and said:
“We saw Mr Alan Quinn today in the Liver Clinic at Royal North Shore Hospital. Alan was referred to us by his Neurology Team during a recent admission earlier this year for likely TIA This is on a background of haemochromatosis for which he is getting regular venesections at Ryde Hospital as well as a history of chronic alcohol excess. Alan states that his liver function tests have been elevated for some time. He has not had any formal investigations of this as far as he is aware. He does consume at least a bottle of wine a night although since the recent admission this has decreased remarkably.”
51.	Dr Chang diagnosed alcohol-induced steatohepatitis on a background of haemochromoatosis (a chronic, unrelated condition which Mr Quinn suffers). Further investigations and treatment were proposed.
52.	A Chronic Disease Management Plan dated 26 August 2020 noted a diagnosis of anxiety for which general practitioner review was proposed. On 30 September 2020 Dr Houwing again referred Mr Quinn to the Liver Clinic at Royal North Shore Hospital.
53.	On 12 January 2021 Dr Houwing diagnosed generalised, anxiety, disorder and panic disorder with when Mr Quinn reported that he had to stop driving on a trip as he was very anxious. On 30 January 2021, Mr Quinn told Dr Houwing that he was no longer drinking alcohol.
54.	Mr Quinn told Dr Houwing that he wished to claim compensation on 15 June 2021.
55.	In 2021 Dr Houwing referred Mr Quinn to Dr Smith and he was reviewed by Dr Verma at St John of God Hospital in a telehealth consultation on 6 December 2021. Mr Quinn said that he usually had four to five glasses of wine a night which he said he had reduced and that he had not had any for a few months. The only history provided was that Mr Quinn’s issues related to work. Dr Verma diagnosed an “adjustment disorder in the context of subjective work-related difficulties and Cluster C personality traits”.
56.	On 23 August 2023 Dr Hartshorn, psychiatrist, reported to Dr Houwing, noting that Mr Quinn had been referred for a “single, cross-sectional assessment”. Dr Hartshorn recorded a history of difficult interactions between Mr Quinn and his manager in the two or so years before May 2021. The difficulties came to a head at that time and Mr Quinn reported the onset of anxiety from that time. Dr Hartshorn described the symptoms reported to him, which included panic and ate more “background” type anxiety resulting in avoidance, particularly of heights and some locations, including escalators and airports. He told Dr Hartshorn that his “alcohol has escalated overtime, that he’s now drinking a bottle of wine per day from 4 pm onwards.” Mr Quinn denied a previous psychiatric history. Dr Hartshorn said:
“I do have concerns regarding his alcohol intake which seems to have escalated over this period. Although I suspect this reflects a way of managing his difficulties, the level of consumption is likely to adversely effect his prognosis over the longer term.”
Mr McShane
57.	Mr McShane, psychologist, saw Mr Quinn at the request of Dr Houwing on 1 September 2020, before he claimed compensation. The referral was initially in respect of the underlying conditions and progressed so that Mr McShane treated Mr Quinn in respect of the injury.
58.	After session 1 Mr McShane noted:
“Assessment and supportive counselling under dated MHCP
Alan reports he has an increase in anxiety due to workplace issues and other health anxiety (potential strokes, hernia, hip pain and replacement) with increased alcohol consumption over the last few years. Alan reports some inappropriate comments, behaviour and pressure from his manager (GB) at Harvey Norman led to increased stress and anxiety about his ongoing employment after hospital admission for a suspected TIA. Alan reports more recent sexualized remarks in a team video conference. Alan reports he has been employed at Harvey Norman for 30 years with no performance or conduct issues. Alan reports he has increased his dependency on alcohol to manage same. Alan experiencing nightmares waking screaming some nights. Alan has some specific fears of heights and closed spaced (claustrophobia) which has recently impacted his ease of driving. Alan has hemochromatosis previous history of DVT & CVA following pedestrian MVA earlier in his life (30’s) and long-term left leg and related nerve pain, hip pain and abdominal hernia, which gives a basis for his health anxiety…”
59.	On 10 November 2020 he reported on his seventh to tenth sessions and said:
“Alan has engaged well and has responded to supportive counselling, psychoeducation and CBT/ACT strategies to manage his anxiety and mood and gain better insight and clarity into his mental health issues. Alan was unsettled by the need for a hip operation and regressed for a week or two but is now starting to come forward again and has reduced his drinking and working 4 days per week.
Alan would benefit from regular ongoing session to support and manage his condition.”
60.	The Medical Assessor’s reference to Mr Quinn being treated by Mr McShane for the first time in 2021 is an error, possibly arising from the fact that the history he recorded was that provided by Mr Quinn, rather than that disclosed by the medical reports in the file. It is clear from Mr McShane’s notes that the treatment was originally for non-work related conditions.
Section 323
61.	Section 323 provides:
“323 Deduction for previous injury or pre-existing condition or abnormality
(1)	In assessing the degree of permanent impairment resulting from an injury, there is to be a deduction for any proportion of the impairment that is due to any previous injury (whether or not it is an injury for which compensation has been paid or is payable under Division 4 of Part 3 of the 1987 Act) or that is due to any pre-existing condition or abnormality.
(2)	If the extent of a deduction under this section (or a part of it) will be difficult or costly to determine (because, for example, of the absence of medical evidence), it is to be assumed (for the purpose of avoiding disputation) that the deduction (or the relevant part of it) is 10% of the impairment, unless this assumption is at odds with the available evidence.
…”
62.	The Medical Assessor was directed by the referral to consider whether any proportion of the impairment assessed was due to any pre-existing condition or abnormality. He commented only a small amount of the material in a very large file and while he said that he had regard to information in the supplied documents, he did not show that he had done so to the extent necessary. Paragraph 1.6 of the Guidelines sets out some key principles of permanent impairment assessments, including 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:
•	whether the condition has reached Maximum Medical Improvement (MMI)
•	whether the claimant’s compensable injury/condition has resulted in an impairment
•	whether the resultant impairment is permanent
•	the degree of permanent impairment that results from the injury
•	the proportion of permanent impairment due to any previous injury, pre-existing condition or abnormality, if any, in accordance with diagnostic and other objective criteria as outlined in these Guidelines.”
63.	The Guidelines provide additional guidance to a medical examiner in paragraphs 1.27 and 1.28 which provide:
“1.27 The degree of permanent impairment resulting from pre-existing impairments should not be included in the final calculation of permanent impairment if those impairments are not related to the compensable injury. The assessor needs to take account of all available evidence to calculate the degree of permanent impairment that pre-existed the injury.
1.28 	In assessing the degree of permanent impairment resulting from the compensable injury/condition, the assessor is to indicate the degree of impairment due to any previous injury, pre-existing condition or abnormality. This proportion is known as ‘the deductible proportion’ and should be deducted from the degree of permanent impairment determined by the assessor. For the injury being assessed, the deduction is 1/10th of the assessed impairment, unless that is at odds with the available evidence.”
64.	Those paragraphs alert the examiner to consider the medical history and available relevant information and to take them into account in assessing impairment and in assessing any s 323 deduction. 
65.	Paragraph 11.6 of the Guidelines also directs the Medical Assessor’s attention to consider more than the worker’s history and the reports of independent medical examiners. Paragraph 11.6 reads:
“It is expected that the psychiatrist will provide a rationale for the rating based on the injured worker’s psychiatric symptoms. The diagnosis is among the factors to be considered in assessing the severity and possible duration of the impairment, but is not the sole criterion to be used. 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. 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. Evaluation of impairment will need to take into account variations in the level of functioning over time. ...”
66.	While the standard MAC template only asks the assessor to comment on the opinions offered by the parties, the principles under which the assessment is to be conducted required him to engage with the history.
67.	In Secretary, Department of Communities and Justice v Lewandowski Griffiths AJ highlighted the need to analyse the available medical evidence relating to the issue of contribution to determine if a pre-existing condition contributed to impairment.
68.	The extent of the s 323 deduction turns on a review of the medical history. A re-examination is not required to undertake that review. Our summary of Dr Houwing’s notes set out above shows that the history Mr Quinn provided to the Medical Assessor as to the onset of his symptoms is not accurate. Our review of the medical evidence shows that Mr Quinn did have a pre-existing condition in the form of alcohol use disorder and anxiety and that those conditions warranted a deduction under s 323.
69.	While we agree that the work-related condition developed over a period before the deemed date of injury, Mr Quinn did not make any complaint to Dr Houwing that could be construed as work related until after he had been released from Royal North Shore Hospital in August 2019 after a suspected stroke. In his statement, the first conduct Mr Quinn relied on was the extensive contact from his manager in the period after his release from hospital.
70.	The criteria for the diagnosis of alcohol use disorder in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), are:
“A. A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:
1. Alcohol is often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
4. Craving, or a strong desire or urge to use alcohol.
5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
8. Recurrent alcohol use in situations in which it is physically hazardous.
9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
10. Tolerance, as defined by either of the following:
a.	A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
b.	A markedly diminished effect with continued use of the same amount of alcohol.
11. Withdrawal, as manifested by either of the following:
a.	The characteristic withdrawal syndrome for alcohol (refer to Criteria A and B of
the criteria set for alcohol withdrawal, pp. 499–500).
b.	Alcohol (or a closely related substance, such as a benzodiazepine) is taken to
relieve or avoid withdrawal symptoms.”
71.	Mr Quinn did not take issue with the Medical Assessor’s diagnosis of alcohol use disorder, though submitted that it did not necessarily contribute to permanent impairment and did not, on its own, denote mental health issues. 
72.	The notes show that Mr Quinn had consumed alcohol heavily for many years and that there was evidence of adverse consequences of his alcohol use. The references to heavy alcohol consumption and the need for Mr Quinn to reduced it to avoid those adverse health consequences date back to at least 1997. There are examples of significant consequences of that consumption - including, for example, treatment at St Vincent’s Hospital in 2017 for a head laceration.
73.	Because of the longevity of the alcohol use disorder condition as disclosed by the notes, it is likely to have had an impact on Mr Quinn’s ability to concentrate and to be partly responsible for the assessment of a moderate impairment for concentration, persistence and pace which the Medical Assessor made.
74.	In addition, Dr Houwing noted significant features of anxiety in 2019 which dated back about two years. At his first session, Mr McShane noted an increase in anxiety partly related to work issues but also relating to health issues over a period of a few years.
75.	However, neither alcohol use disorder nor the anxiety symptoms, impacted on Mr Quinn’s ability to perform his role. They contributed to a vulnerability to suffering the injury but that injury was significant. It caused Mr Quinn to stop working and led to other significant impairments in his functioning. The extent of the contribution from the pre-existing conditions is therefore difficult to determine and the appropriate deduction is one-tenth.
76.	For these reasons, we have determined that the MAC issued on 11 September 2023 should be revoked, and a new MAC should be issued.  The new certificate is attached to this statement of reasons.

WORKERS COMPENSATION DIVISION
APPEAL PANEL
MEDICAL ASSESSMENT CERTIFICATE
Injuries received after 1 January 2002

Matter number:	W3650/23	
Applicant:	Alan Quinn	
Respondent:	Yoogalu Pty Limited ATF Harvey Norman Discounts No 1 Trust	

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 John Lam-Po-Tang and issues this new Medical Assessment Certificate as to the matters set out in the Table below:
Table - whole person impairment (WPI) 
Body Part or system	Date of Injury	Chapter,
page and paragraph number in WorkCover Guides 	Chapter, page, paragraph, figure and table numbers in AMA 5 Guides	% WPI 	Proportion of permanent impairment due to pre-existing injury, abnormality or condition	Sub-total % WPI (after any deductions in column 6)	
Psychological injury	14 May 2021	Chapter 11	N/A	19%	One-tenth	17%	
Total % WPI (the Combined Table values of all sub-total 	17%