DETERMINATION OF REVIEW PANEL	
	
CITATION:	Seydler v Allianz Australia Insurance Limited [2024] NSWPICMP 447	
		
CLAIMANT:	Jett Seydler	
		
INSURER:	Allianz	
		
REVIEW Panel	 	
		
MEMBER:	Gary Victor Patterson	
		
MEDICAL ASSESSOR:	Michael Couch 	
		
MEDICAL ASSESSOR:	Thomas Rosenthal	
		
DATE OF DECISION:	8 July 2024	
		
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of medical assessment; medical dispute about permanent impairment; claimant injured while working as a tree trimmer; claimant’s legs run over by work truck when the truck was mistakenly put into motion causing bilateral leg crush injuries with micro fractures; claimant developed bilateral knee bone oedema; claimant also alleges injury to right ankle, both hips and lumbar spine; Medical Assessor assessed permanent impairment at 9% and found complex regional pain syndrome was not caused by accident; Mandoukos v Allianz Australia Insurance Limited cited in respect of a nerve injury found but which was not referred for assessment; Held – Medical Review Panel assessed permanent impairment at 18%; complex regional pain syndrome not caused by motor accident; Medical Assessment Certificate revoked. 
	
DETERMINATIONS MADE:  	CERTIFICATE
REVIEW PANEL ASSESSMENT OF DEGREE OF PERMANENT IMPAIRMENT
Certificate issued under s 7.26(7) of the Motor Accident Injuries Act 2017 (the Act)
1.	The Review Panel revokes the certificate dated 29 November 2023 and issues a new certificate determining that:
(a)	The following injuries caused by the motor accident give rise to a permanent impairment of 18% and IS GREATER THAN 10%:
(i)	right ankle injury;
(ii)	bilateral hip injury;
(iii)	bilateral knee oedema; 
(iv)	bilateral leg injury with micro fractures, and
(v)	lumbar spine injury.
(b)	The following injury referred for assessment has been assesed and determined not caused by the motor accident:
(i)	left leg – Complex Regional Pain Syndrome.
2.	The claimant does have a peripheral nerve dysaesthesia represented by the femoral nerve according to Table 68 of the AMA 4 Guides to the Evaluation of Permanent Impairment.	

STATEMENT OF REASONS
introduction
1.	Jett Seydler (the claimant) was injured on 18 December 2020 when he was working as a tree trimmer with one colleague. Whilst the claimant was standing near the left rear wheel of the work truck, his colleague mistakenly put the truck into motion, causing the claimant to fall under the left rear wheel of the truck trailer. Both his legs were runover, his left leg trapped beneath his right, causing bilateral leg crush injuries with micro fractures. These remained undetected for two weeks. The claimant developed bilateral knee bone oedema. The claimant says that he also suffered injury to his right ankle, both hips and lumbar spine.
2.	Allianz (the insurer) insured the owner and/or the driver of the at-fault vehicle for liability to pay to the claimant damages under the Motor Accident Injuries Act 2017 (the MAI Act). 
3.	The issue in dispute is the degree of permanent impairment of the claimant that has resulted from injuries caused by the motor accident.
ASSESSMENT UNDER REVIEW
4.	The present application is a review of a medical assessment pursuant to s 7.26 of the MAI Act. The medical assessment the subject of the review was conducted by Medical Assessor Mohammed Assem who certified on 29 November 2023 as follows:
The following injuries caused by the motor accident give rise to a permanent impairment of 9% and IS GREATER THAN 10%:
•	Right ankle injury
•	Bilateral hip injury
•	Bilateral knee oedema
•	Bilateral leg injury with micro fractures
•	Lumbar spine injury	
Medical Assessor Assem did not say whether or not he made adjustments for pre-existing conditions and/or subsequent injury or treatment effects. Medical Assessor Assem did not view any radiological investigations.
5.	Medical Assessor Assem found that the following injuries were not caused by the motor accident:
(a)	leg – Complex Regional Pain Syndrome.
However, he did not so certify.
THE REVIEW
6.	The claimant sought a review of Medical Assessor Assem’s certificate on the basis that the assessment was incorrect, within the meaning of s 7.26 of the MAI Act, in a number of material respects. The claimant brought the application within the time prescribed by s 7.26(10) of the MAI Act and cl 34 of Procedural Direction PIC 7 (28 days). 
7.	The claimant submitted that Medical Assessor Assem erred in his assessment on the following bases:
(a)	the Medical Assessor did not provide sufficient reasoning to explain why he did not diagnose the claimant with Complex Regional Pain Syndrome (CRPS) in his assessment. It was submitted that the medical assessor did not provide any real explanation for why the claimant does not meet the diagnostic criteria for CRPS as per the AMA 4 Guidelines (3/56).
(b)	The Medical Assessor fell into clear error when referring to AMA 4 Guidelines 3/56 which, it is submitted, must not be used. Rather, it was submitted, when CRPS occurs in the lower extremity, it must be evaluated as for the upper extremity, using clauses 6.61 to 6.64 within this part of the Motor Accident Guidelines.
It was submitted that the errors contained in the medical assessor’s report/certificate are more than trivial, insignificant or immaterial and that, if those errors had not occurred, the claimant’s permanent impairment may have been assessed greater than 10%.
8.	The claimant’s application for review was opposed by the insurer. The insurer submitted that Medical Assessor Assem did not make a material error because:
(a)	his finding that the claimant did not sustain CRPS is consistent with the Motor Accident Guidelinesand the available medical evidence; 
(b)	Medical Assessor Assem discharged his duty to provide reasoning to the standard required at law, and
(c)	in any event, any such error is not material, because the correction sought by the claimant would be inconsequential.
The insurer acknowledges the claimant’s submission that Medical Assessor Assem was in error because he referred to page 3/56 of AMA 4 Guidelines, when the Guidelines supply the applicable criteria for assessment of CRPS. However, the insurer submitted that such an error does not mean that the clinical finding, that the claimant has not sustained CRPS, was itself in error. 
9.	The insurer further submitted that the finding that the claimant did not sustain CRPS is plainly consistent with the AMA 4 Motor Accident Guidelines and the available medical evidence. The insurer referred to clause 6.108 of the AMA 4 Motor Accident Guidelines.
10.	The insurer submitted that Medical Assessor Assem’s path of reasoning is logical and adequate and that any error was not material.
11.	President’s delegate Jeremy Lum issued a Determination of an Application for Review of a Medical Assessment on 9 February 2024 which stated the satisfaction of the President’s delegate that there is a reasonable cause to suspect that Medical Assessor Assem’s assessment was incorrect in a material respect. The basis of that decision was stated to be Medical Assessor Assem’s failure to reference the correct methodology when providing his diagnosis. Whilst acknowledging the insurer’s submission that the claimant “has provided ‘no such explanation as to why he has sustained CRPS contrary to Assessor Assem’s finding”, the President’s delegate did not find that submission to be persuasive.
12.	Accordingly, the application was accepted and was referred to the Review Panel, which is to assess the following injuries:
(a)	right ankle;
(b)	bilateral hip injury;
(c)	bilateral knee oedema;
(d)	bilateral leg injury with micro fractures;
(e)	leg injury – CRPS, and
(f)	lumbar spine.
13.	The Review Panel notes that, for a finding of CRPS to be made, 9 of 11 diagnostic criteria must be present, according to the AMA 4 Motor Accident Guidelines.
STATUTORY PROVISIONS
14.	A medical assessment matter is determined in accordance with Division 7.5 of the MAI Act. The matter is determined at first instance by a Medical Assessor pursuant to s 7.20 of the MAI Act and on review, by a Review Panel consisting of two Medical Assessors and a Member assigned to the Motor Accidents Division of the Personal Injury Commission (Commission).
15.	Part 5 of the Personal Injury Commission Act 2020 (the PIC Act) enables the Commission to make rules with respect to the practice and procedure before the Commission, including proceedings before a Review Panel, reviewing a decision of a Medical Assessor. 
16.	Rules 127 to 130 of the Personal Injury Commission Rules 2021 (the PIC Rules) are made pursuant to Part 5 of the PIC Act. A Review Panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written Application.
17.	The review of the medical assessment is by way of new assessment of all the matters with which the medical assessment is concerned, unless the parties otherwise agree, or the Review Panel otherwise decides.
18.	All members of the Review Panel had no previous involvement with the claimant or with this matter.
CAUSATION OF INJURY
19.	Sections 5D and 5E of the Civil Liability Act 2002 apply to the MAI Act. See s 3B(2) of that Act.
20.	In Briggs v IAG Limited t/a NRMA Insurance his Honour Justice Wright stated at [35]: 
“…the question of causation of injuries was not dealt with in Part 5 of the Guidelines but causation was addressed in Part 6, which related to assessment of permanent impairment. There is no reason to think that different principles were intended to be applied when a medical assessment was being made in relation to causation of minor injuries. Clauses 6.5 to 6.7 provided:
Causation of injury
6.5	An assessment of the degree of permanent impairment is a medical assessment matter under cl 2(a) of Schedule 2 of the Act. The assessment must determine the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident. A determination as to whether the injured person’s impairment is related to the accident in question is therefore implied in all such assessments. Medical assessors must be aware of the relevant provisions of the American Medical Association Guides (AMA 4) Guides, as well as the common law principles that would be applied by a Court (or claims assessor) in considering such issues.
6.6	Causation is defined in the Glossary at page 316 of the American Medical Association Guides (AMA 4) Guides as follows:
‘Causation means that a physical, chemical or biological factor contributed to the occurrence of a medical condition. To decide that a factor alleged to have caused or contributed to the occurrence or worsening of a medical condition has, in fact, done so, it is necessary to verify both of the following:
1.The alleged factor could have caused or contributed to worsening of the impairment which is a medical determination.
2. The alleged factor did cause or contribute to worsening of the impairment, which is a non-medical determination.’
This, therefore, involves a medical decision and a non-medical informed judgment.
6.7	There is no simple common test of causation that is applicable to all cases, but the accepted approach involves determining whether the injury (and the associated impairment) was caused or materially contributed to by the motor accident. The motor accident does not have to be a sole cause, as long as it is a contributing cause, which is more than negligible. Considering the question ‘Would this injury (or impairment) have occurred if not for the accident?’ may be useful in some cases, although this is not a definitive test and may be inapplicable in circumstances where there are multiple contributing causes.”
MATERIAL BEFORE THE REVIEW PANEL
21.	The claimant relied upon the following material which the Review Panel has considered:
(a)	claimant’s statement dated 28 March 2022.
(b)	Report dated 17 April 2022 by Dr Simon Coffey, orthopaedic surgeon, to the claimant’s lawyers.
Clinical examination revealed marked hypersensitivity around the infra patella branch of the saphenous nerve of both knees with the right knee being worse. Range of motion of the knees at last review on 13 May 2021 was from 0 to 100 degrees due to periarticular sensitivity. Imaging confirmed evidence of crush injury but no intra articular lesions requiring surgical management.
(c)	Physiotherapists’ report dated 20 June 2022 to Dr Hillman.
(d)	Report dated 18 July 2022 by Dr Uthum Dias, occupational physician, to the claimant’s lawyers.
Dr Dias noted a previous minor injury around May 2019 to the claimant’s right knee which resolved within a few days. The claimant could not recall any other significant pre-existing injuries or conditions affecting his lower back, hips, knees, legs or ankles, prior to the motor accident. Dr Dias records a detailed history of the accident and the claimant’s subsequent treatment. MRI scans revealed significant crush injuries and micro fracturing to both knees. Dr Dias records that the claimant was dependant on crutches for approximately two months, following the accident, before being able to mobilise independently. The claimant informed Dr Dias that he has continued to suffer with ongoing symptoms of pain, stiffness and discomfort affecting both knees and both ankles, as well as pain and patchy sensory loss, affecting both legs. The claimant said he also began to experience consequential symptoms of pain and discomfort affecting his right hip and lumbar spine, within four to six months of the accident, due to prolonged altered gait pattern. He continues to suffer with lower back and right hip pain.
After a detailed description of his examination, Dr Dias gives the following diagnosis:
(a)	chronic right knee pain, stiffness and discomfort, with associated patellofemoral dysfunction, secondary to an acute right knee crush injury.
(b)	Chronic right leg pain and discomfort, with an associated traumatic tibialis anterior muscle belly herniation, and associated non-specific sensory symptomology, secondary to an acute right leg crush injury.
(c)	Chronic mild right ankle pain, stiffness and discomfort, secondary to an acute right ankle crush injury, with associated trabecular micro fracturing affecting the calcaneus bone.
(d)	Chronic left knee pain, stiffness and discomfort, with associated patellofemoral dysfunction, secondary to an acute left knee crush injury with associated trabecular micro fracturing affecting the medial femoral condyle.
(e)	Chronic left leg pain and sensory symptomology, secondary to an acute left leg crush injury.
(f)	Chronic mild left ankle pain, stiffness and discomfort, secondary to an acute left ankle crush injury.
(g)	Consequential chronic non-specific lumbar spine pain, secondary to prolonged altered gait mechanics, as a result of his lower limb injuries.
(h)	Consequential right hip pain, stiffness and discomfort, secondary to prolonged overcompensation for altered gait patterns, as a result of his bilateral lower limb injuries.
Dr Dias was asked to provide a separate report assessing whole person impairment arising from injuries caused by the accident. No such report is in evidence.
(e)	Reports dated 10 October 2022 and 10 November 2022 by Dr Eric Lim, treating general practitioner (GP), to the claimant’s lawyers.
This records the history of treatment, symptomatology, management plan and referrals, as at the reporting date. Included is a report of MRI lumbar spine dated 24 October 2022 which shows mild degenerative spondylosis of the lumbar spine. Also included are Dr Lim’s progress notes dated 10 November 2022.
(f)	Supplementary report dated 17 November 2022 by Dr Dias to the claimant’s lawyers.
Dr Dias reviews a report dated 18 October 2022 by Dr Paul Robinson, orthopaedic surgeon, to the insurer’s lawyers. Dr Dias disagrees significantly with Dr Robinson’s assessment of whole person impairment.
(g)	Certificates of capacity and clinical notes comprising some 450 pages which it is not necessary to summarise.
(h)	Report dated 22 February 2023 by Dr Boesel, pain medicine physician, to Dr Hillman.
Dr Boesel records that the claimant’s condition has not changed physically and that mental health support from the psychiatrist is helping. Dr Boesel records allodynia and hypersensitivity with associated sensory reduction to some modalities on the inside of the right knee to a greater extent than on the left. He describes some CRPS features. Dr Boesel opines that the claimant sustained bilateral crush injuries to the inferior medial patellar branch of the saphenous nerve with consequent significant neuropathic pain, complex regional pain syndrome type 2, particularly on the right, consequent lower back and hip pain related to gait disturbance, as well as significant post-traumatic stress disorder.
(i)	Report dated 29 November 2022 by Dr Matthew Tait, neurosurgeon, to Dr Lim.
Dr Tait states that, upon examination, the claimant was overweight, with reduced range of movement in the lumbar spine. He reviewed a MRI scan of the lumbar spine (24 October 2022) and recommended against lumbar surgery.
(j)	Report dated 10 November 2022 by Dr Lim to the claimant’s lawyers.
This essentially repeats material previously summarised.
22.	The insurer relied upon the following material which the Review Panel has considered:
(a)	NSW Police report dated 23 March 2022.
(b)	Report dated 11 February 2021 by Dr Simon Coffey, orthopaedic surgeon, to Dr Mansouri.
Dr Coffey opined that the claimant sustained quite significant crush injuries to his lower limbs as a result of a four-tonne trailer driving over his legs. Dr Coffey recommended physiotherapy, lower limb rehabilitation and possible pain management strategies.
(c)	Report dated 11 March 2021 by Dr Coffey to Dr Mansouri.
The claimant was making satisfactory progress. Dr Coffey opined that the claimant had a regional pain syndrome following the crush injury to his right leg.
(d)	Report dated 13 May 2021 by Dr Coffey to Dr Mansouri.
Dr Coffey diagnosed crush injury to both legs with secondary post-traumatic stress disorder and saphenous neuritis. He recommended multi-disciplinary pain management and referred the claimant to Professor Tillman Boesel for management.
(e)	Report dated 22 June 2022 by Associate Professor Paul Miniter, orthopaedic surgeon, to the worker’s compensation insurer.
Dr Miniter observed that the claimant “is in poor physical shape”. Upon examination, he could see no evidence of any ligamentous instability at the ankles or knees. There was no feature of wasting. The claimant was unable to stand on his right foot “for no obvious reason”. Professor Miniter found no localised areas of tenderness and “there are definitely no features of CRPS”. Professor Miniter described the workplace injury “as reasonably mild, it is not a major injury”. He expected that the injury should have recovered completely by the date of his examination. There were no other obvious injuries, nor pre-existing conditions of relevance. Professor Miniter said that the claimant is not incapacitated and should return to normal duties with no restrictions. He did not think that the claimant required any further treatment. Professor Miniter opined that “there is definite exaggeration of this matter”. He said there is no clear underlaying pathology and there are marked inconsistencies. Professor Miniter did not think that the MRI scan evidence of minor injury to the lower limbs was consistent with a 4-tonne trailer running over his legs.
(f)	Report dated 18 October 2022 by Dr Paul Robinson, orthopaedic surgeon, to the worker’s compensation insurer.
Dr Robinson opined that the claimant suffered soft tissue injuries to the lumbar spine and both lower limbs in the accident. He found no evidence of any radiculopathy in the lumbar spine. He opined that the right lower limb symptoms are related to a herniation of muscle due to a rupture of some fascia. He found knee symptoms not associated with any instability of internal derangement. Dr Robinson stated that the injury was significant but the symptoms should have settled by the time of his examination. He could not determine any abnormal illness behaviour but thought that psychological problems are contributing to the claimant’s presentation.
With respect to the lumbar spine, Dr Robinson assessed a diagnosis-related estimate (DRE) Lumbar Category I from the AMA Guides 5th Edition (0% whole person impairment (WPI)). He found no assessable WPI for either knee or the right lower limb. Dr Robinson was not able to rationalise the variance in his assessment from that made by Dr Dias.
(g)	Report dated 9 December 2022 by Dr Margaret Gibson, occupational health and safety specialist, to the insurer’s lawyers.
Dr Gibson observed that the treating orthopaedic surgeon, Dr Coffey, found no evidence of any treatable surgical condition (such as any internal derangement of either knee of frank fractures) and so recommended physical therapy and interventions to manage the claimant’s pain. Dr Gibson diagnosed crush injuries to both lower limbs, comprising soft tissue injuries with bone swelling and micro fractures (which would now have healed) and possible minor superficial nerve involvement. Dr Gibson attributed those injuries to the accident and found no relevant prior injuries, nor subsequent injuries or impairments. Dr Gibson thought that the claimant should be able to resume normal activities. Based on her assessment, Dr Gibson assessed WPI as follows:
both hips – there was 0% impairment as there was normal range of motion, and no other ratable criteria.
Right knee – there was 2% impairment due to patellofemoral crepitus. There was no ratable impairment based on range of motion.
Left knee – there was 0% impairment based on range of motion due to patellofemoral crepitus. There were no other ratable criteria.
Both ankles – there was 0% impairment based on range of motion due to patellofemoral crepitus. There were no other ratable criteria.
Lumbosacral spine – DRE Lumbosacral Category I based on Table 72 Chapter 3 AMA 4 Guidelines. This was because there was no muscle guarding, asymmetry of movement and no non-verifiable radicular complaints. There was no radiculopathy.
Dr Gibson found 2% WPI arising from the subject accident.
(h)	Report dated 8 February 2023 by Dr Graham Vickery, consultant psychiatrist, to the insurer’s lawyers.
Dr Vickery found no assessable psychiatric impairment. This is not of direct relevance to the Review Panel’s deliberations.
(i)	Report dated 22 May 2023 by Associate Professor Tillman Boesel (previously summarised).
(j)	Clinical notes and certificates of capacity comprising some 455 pages which it is not necessary to summarise.
RE-EXAMINATION
23.	The claimant was assessed on 28 May 2024 by Medical Assessor Thomas Rosenthal and Medical Assessor Michael Couch whose report is as follows:
“Mr Seydler attended for re-examination in regards to an appeal of Assessor Mohammed Assem’s certificate dated 29 November 2023. He attended the PIC rooms, 1 Oxford Street, Darlinghurst on 28 May 2024. In attendance were Assessors Thomas Rosenthal and Mike Couch.
HISTORY 
Mr Seydler re-confirmed the history of his accident which occurred on 18 December 2020. He was working as a tree lopper at the time. He was working with a colleague. They had lopped a tree and chopped it up. He went to grab a rake to rake the ground as the driver pulled forward and the trailer ran over both his legs. He estimated the weight of the trailer to be 3-4 tonnes. His right leg was struck first. He had tyre marks throughout his right leg. His left leg was also run over-he explained that it lay under his right leg. He ended up with significant bruises over both his legs.
An ambulance came and took him to Campbelltown Hospital. He had various scans there. He was observed for a couple of days and then discharged home on crutches. They found no particular fractures and only found soft tissue damage.
He was subsequently treated by his GP. He required crutches for eight weeks, took painkillers and had physiotherapy. Because of ongoing symptoms, further MRI scans were performed which revealed microfractures and bony oedema in both knees.
He came under the care of Dr Simon Coffey, orthopaedic surgeon. He developed a hypersensitivity around both his knees and he continued to have significant pain in both his legs, hips and also his back. He was suspected of having a complex regional pain syndrome (CRPS).
He was referred to Professor Tillman Bosel who thought he had some elements of CRPS and he was treated with radiofrequency nerve ablation.
Mr Seydler noted ongoing symptoms in both his legs, hips, knees and ankles. At times his skin was discoloured and became sweaty. There were temperature changes and patches of numbness. He noted brittle toenails and ended up with split skin on his heels and was also later diagnosed with plantar fasciitis. His right leg symptoms always appeared to be worse than his left.
No surgical procedures occurred but he has been left with ongoing chronic pain. Professor Bosel still treats him and he has now been given THC medication. He also continues to see a psychologist.
CURRENT SYMPTOMS
He has constant pain in both legs, back and hips. There is a muscle hernia in the front of his right shin. His legs regularly get fatigued. He gets a lot of right calf pain. Ongoing sensitivity exists in both legs, more to the inside. He gets electric shock feelings in his feet and constant knee pain in both knees. He is restricted with up to one hour of walking. He gets fidgety. He has trouble walking up and down steps. He has trouble with downhill walking and he avoids running.
He has not worked since the accident. He is getting workers’ compensation insurance payments and his workers’ compensation claim is still open.
He is restricted with many activities including bending, lifting and squatting. 
His low back pain persists. It gets stiff and locks up. He rates the pain at 7½ on a scale of 0-10, with 10 being maximal pain.
He can sleep now up to six hours-he said that it was very disturbed before, being prescribed medicinal THC. 
His bowels are OK. He has some hesitancy passing water when urinating.
SOCIAL HISTORY
He continues to live in the Penrith district with his partner and two children, aged 4 and 3.
He is restricted with many household chores.
PHYSICAL EXAMINATION 
On examination, he walked with an antalgic gait favouring his right leg. 
He weighed 98kg. He was 179cm tall. 
At the lumbar spine, there was initially some spasm but he was restricted with forward flexion to approximately half. Extension was to normal range with complaint of pain. Lateral flexion appeared to be symmetrical as was rotation and they were of normal range.
He developed a muscle spasm in his back whilst lying on his stomach in the prone position. 
Straight leg raise was 70° on both sides. Lasegue’s signs were negative. 
Thigh measurements were 56cm on the right and 55cm on the left, 10cm above the superior patellar pole. Calf measurements were 41cm on the right and 40.5cm on the left, 10cm below the inferior patellar pole.
He was hypersensitive with dysaesthesia over the femoral distribution of a peripheral nerve prominent on both sides in the inner thigh, inner knee and also inner calf areas. (When lightly touched with a tissue in these areas while his eyes were closed, he spontaneously withdrew and described a very unpleasant sensation.) He added the information that he tries to avoid contact with clothing or bed-clothes to these areas.
His lower limb reflexes were normal. 
He could not walk on his heels or toes and he could only do a partial squat. He walked flatfooted failing to spring off his feet.
An approximately 3cm diameter muscle hernia was noted over his anterior shin in the standing position.
At the hips, range of motion was measured with a goniometer:
Hip Movements	Active ROM Measured
RIGHT	Active ROM Measured
LEFT	
Flexion	80°	90°	
Extension	normal°	normal°	
Abduction	40°	40°	
Adduction	20°	30°	
External rotation	30°	50°	
Internal rotation	30°	20°	
His hips did flex to 90° in the sitting position. Pain appeared to be a limiting factor in hip flexion in the supine position.
The knees had a range of motion of 0° extension to 100° of flexion on both sides. Alignment was normal and ligaments were intact. There was mild retropatellar crepitus in both knees.
The ankles measured normally in flexion and extension but inversion was 15° on the right and 20° on the left. Eversion was 15° on the right and 15° on the left. 
Muscle power in the lower limbs was normal. There was no evidence of radiculopathy in his lower extremities. Lower limb reflexes were all present and equal.
In terms of CRPS, there was no obvious swelling of the joints. There was no evidence of temperature differential, no obvious discoloration of the skin and no obvious sweating of the skin on either leg. Some loss of hair was noted and the toenails did appear slightly brittle.
OPINION
The Panel noted some different clinical findings to that found by Assessor Assem. However, there appears to have been no intervening incident. He was assessed for whole person impairment based on his presentation at today’s examination. 
Range of motion of the hips is assessed under Table 40. There is 5% LEI for the right hip and 5% LEI for the left hip.
For the reduced range of motion at both knees there is 10% LEI for the right knee and 10% LEI for the left knee under Table 41. Each knee could be assessed as 5% LEI from the footnote to Table 62 AMA4, because of patellofemoral crepitus following direct trauma. However, the arthritis method may not be combined with range of motion. Assessors are instructed to use the method or combination of methods giving the highest impairment rating. This is 10% LEI for each knee.
Both hindfeet showed slight restriction of inversion, giving 2% LEI each. 
The above LEI ratings are combined to give 17% LEI. This converts to 7% WPI for each lower limb.
The lumbar spine is assessed under lumbosacral spine Table 72, page 110. He has asymmetry of lumbar movement. He gets DRE II and 5% whole person impairment.
The total whole person impairment for the right lower extremity is 7%.
The total whole person impairment for the left lower extremity is 7%.
The combined whole person impairment is 18%.”
FINDINGS
24.	The Review Panel conducts a new assessment of all the matters with which the medical assessment is concerned. The Review Panel adopts the examination findings and reasons of the Medical Assessors.
25.	The Review Panel is not required to choose between competing medical opinions and is required to form its own opinion. The Medical Assessors have explained the bases of their assessment which is different to that provided by Medical Assessor Assem and some of the other qualified medical experts.
26.	The Review Panel is aware that peripheral nerve dysaesthesia was not an injury referred to the Review Panel for assessment. Notwithstanding that it may fall within the referral of bilateral leg injury, the parties have not had an opportunity to make submissions in relation to that condition, notwithstanding that possible nerve involvement has been identified by a number of the qualified reporting specialists. Having regard to what was said by the Court of Appeal in Mandoukos, the Review Panel has not included in the certificate its assessment of WPI arising from that condition. Notwithstanding, the Review Panel’s assessment of WPI, arising from the referred injuries caused by the accident, exceeds the 10% threshold.
27.	The Review Panel is not satisfied that the motor accident caused the claimant to suffer a CRPS in either of his lower limbs, as a matter of medical determination, and as a matter of factual non-medical determination, for the reasons stated.
CONCLUSIONS
28.	For the above reasons, the Review Panel concludes that the certificate issued by Medical Assessor Mohammed Assem on 29 November 2023 should be revoked. The new certificate appears at the commencement of these reasons.