DETERMINATION OF APPEAL PANEL	
	
CITATION:	Lloyd v Newcastle City Council [2023] NSWPICMP 34	
		
APPELLANT:	Sandra Lloyd	
		
RESPONDENT:	Newcastle Council	
		
Appeal Panel		
		
MEMBER:	Marshal Douglas	
		
MEDICAL ASSESSOR:	John Brian Stephenson	
		
MEDICAL ASSESSOR:	Gregory McGroder	
		
DATE OF DECISION:	3 February 2023	
		
CATCHWORDS: 	wORKERS cOMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; appellant assessed for whole person impairment from injury to right knee and consequential condition in left knee; appellant had previously had total right knee replacement and had extensive pre-existing osteoarthritis in left knee; whether deduction of 100% under section 323 with respect to left knee and deduction of 73% under section 323 of with respect to right knee was an error; Held – Appeal Panel held it was an error; Medical Assessment Certificate revoked.    	

BACKGROUND TO THE APPLICATION TO APPEAL
1.	On 17 December 2022 Sandra Lloyd, the appellant, lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Tim Anderson, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 
8 November 2022.
2.	The appellant relies on the following ground of appeal under s 327(3) of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act): 
•	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.	The WorkCover Medical Assessment Guidelines 2006 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 the WorkCover Medical Assessment Guidelines 2006.
5.	The assessment of permanent impairment is conducted in accordance with the NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4th ed 
1 April 2016 (the Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th ed (AMA 5). 
RELEVANT FACTUAL BACKGROUND
6.	The appellant was an employee of Newcastle City Council, the respondent. She worked in its “child care division”. On 4 December 2015 she stepped backwards onto a toy telephone which caused her to twist awkwardly and fall heavily. She injured her right knee. 
7.	The following day the appellant consulted her general practitioner (GP) who referred her to orthopaedic surgeon Dr Jonathan Young, whom she consulted on 10 December 2015. 
Dr Young had previously performed a total replacement of the appellant’s right knee joint in December 2013. That was to manage osteoarthritis that the appellant then had in that joint. The appellant recovered well from that surgery in that immediately preceding her injury on 
4 December 2015 she had a stable right knee, reasonable movement and no pain.
8.	Following the consultation between the appellant and Dr Young on 10 December 2015, 
Dr Young wrote to the appellant’s GP advising him that the appellant had a fracture of her right femoral epicondyle of the distal femur, which was the site of the attachment of the medial collateral ligament. Dr Young advised the GP that the appellant’s knee was now open up to valgus strain. Dr Young recommended surgery so that the appellant could achieve stability of her knee and so that “the replacement with prosthesis such as a hinge is not required”. 
9.	Dr Young undertook that surgery on 14 December 2015 when he repaired the medical collateral ligament. That involved the use of a screw to fix the avulsed medial collateral ligament to the medial femoral condyle. 
10.	In statements the appellant signed on 25 February 2020 and 14 October 2021 she described having intense physiotherapy for several months following this surgery. Notwithstanding that physiotherapy, she walked with a limp favouring her left leg and occasionally needed crutches and a walking stick to ambulate. She described having an altered gait, and having to drag her left leg. She described having a prominent waddle when walking. She described developing problems with her left leg and also pain in her back, which she attributed to her altered gait. 
11.	On 11 November 2021 the appellant’s solicitors wrote to the respondent and advised it that the appellant claimed compensation from it under s 66 of the Workers Compensation Act 1987 (the 1987 Act) for 22% whole person impairment (WPI) from her injury. They further advised that the appellant relied on reports of orthopaedic surgeon Professor Ghabrial dated 6 March 2019 and 29 September 2021, which they enclosed with their letter. 
12.	Professor Ghabrial had examined the appellant on 6 March 2019. In his report to the appellant’s solicitors on that date he advised that he had assessed the appellant had 22% WPI from her injury. He explained he assessed the appellant had 7% WPI relating to her lumbar spine but that she also had pre-existing spondylosis which warranted a deduction of 1/10th when assessing her permanent impairment from her injury, such that he assessed the appellant’s permanent impairment from her injury relating to her lumbar spine was 6% WPI. He advised that he assessed the appellant had 6% WPI for right knee patella-femoral compartment narrowing and had 4% WPI for restricted range of motion of her right knee and had 1% WPI due to the scarring of her right knee. He said that the total WPI of the appellant with respect to her right knee was 11% that he said totally related to the appellant’s injury on 4 December 2015. He further advised that he assessed the appellant had 10% WPI of her left knee due to her having 1 mm of cartilage interval at the lateral compartment. He also said that the appellant had 4% WPI of her left knee due to her having 2 mm of cartilage interval in the patella-femoral compartment. He said that the appellant’s total WPI for injury to her left knee was therefore 14% but he explained that half of that was related to pre-existing osteoarthritis of her left knee which meant that he had assessed the appellant had 7% WPI with respect to her left knee as a result of her injury on 4 December 2015. 
13.	Professor Ghabrial advised in his report of 29 September 2021, which responded to a report that the respondent’s solicitor had obtained from orthopaedic surgeon Dr Richard Powell, that the appellant’s “lumbar spine and the left knee present problems are mainly related to being consequential to the right knee injury on 4 December 2015”. He said that those problems “resulted from the altered gait as a consequence of the right knee injury and therefore contributed to the aggravation of the left knee pre-existing osteoarthritis and developed lumbar spine complaints which were not present prior to the injury”.
14.	As indicated, the respondent’s lawyers had organised for the appellant to be examined by 
Dr Richard Powell. That occurred on 6 November 2019. Dr Powell provided the respondent’s solicitors with a report on 7 November 2019 in which he advised that the appellant’s left knee condition represented a pre-existing degenerative disease process and was not the result of the injury she suffered on 4 December 2015. He said that any aggravation of that pre-existing disease would have been minor or temporary. He said that her ongoing symptoms are consistent with a natural progression of a pre-existing degenerative disease process. He also said that the appellant had long standing pre-existing multi level degenerative disc disease in her lumbar spine and that her present symptoms were consistent with that and were “accentuated by her poor level of overall fitness, markedly elevated body mass index and altered gait associated with her bilateral knee conditions”. He said that any aggravation of her lumbar spine relating to the fall and subsequent surgery and rehabilitation would have been minor or temporary. He said that he did not consider the appellant’s employment “represents the main contributing factor to the level of permanent aggravation of the pre-existing degenerative disease processing”. He advised that the appellant had 7% WPI relating to her right knee based on her having moderate medial collateral ligament laxity. He advised that she had “no assessable permanent impairment as a result of any injuries sustained in the course of her employment”. He said the same with respect to her lumbar spine. He advised that he had assessed the appellant had 0% WPI due to scarring. 
15.	Dr Powell examined the appellant again on 23 March 2022 and provided the respondent’s solicitors a report on 1 June 2022. With respect to the permanent impairment of the appellant, Dr Powell, in substance, repeated what he had advised in his earlier report of 
7 November 2019.
16.	On 10 June 2022 the respondent wrote to the appellant, care of her solicitors, and advised her that it disputed she was entitled to compensation under s 66 of the 1987 Act. It advised her that it disputed that she had “suffered a secondary or consequential left knee condition” from the injury to her right knee on 4 December 2015. It advised her that it disputed she had suffered an injury to her left knee on 4 December 2015. It advised her that it disputed that she had “suffered a secondary or consequential lumbar spine condition” as a result of her right knee injury on 4 December 2015. It advised her that it disputed that her permanent impairment from the injury to her right knee was more than 10%, which her permanent impairment had to exceed in order for her to be entitled to compensation under s 66 of the 1987 Act. It advised her that it considered that Dr Powell had “provided a thorough and well reasoned opinion” and that it preferred Dr Powell’s opinion over that of Dr Ghabrial. 
17.	Thereupon the appellant commenced proceedings in the Commission seeking determination of her disputed claim for compensation under s 66 of the 1987 Act. The matter was referred to Member Mr John Isaksen who, with the consent of the parties, made the following determination on 26 August 2022:
“1. 	Award for the respondent in regard to the claim for a consequential condition affecting the lumbar spine.
2. 	The matter is remitted to the President for referral to a Medical Assessor as follows:
Date of injury: 4 December 2015
Body Parts: Right lower extremity (knee)
Left lower extremity (knee)
Scarring (TEMSKI)
Method of Assessment: Whole Person Impairment
3. 	The following documents are to be forwarded to the Medical Assessor:
(a) ARD with attachments; and
(b) Reply with attachments.”
18.	On 2 September 2022 a delegate of the President duly referred that medical dispute between the parties to the Medical Assessor. The MAC that the Medical Assessor issued in response to that referral certified that the appellant had 9% WPI resulting from her injury, comprising 8% WPI for the right lower extremity (knee), 0% WPI for the left lower extremity (knee) and 1% WPI for scarring. 
PRELIMINARY REVIEW
19.	The Appeal Panel conducted a preliminary review of the original medical assessment in the absence of the parties and in accordance with the WorkCover Medical Assessment Guidelines 2006.
20.	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. This is because, firstly, neither party took issue with the Medical Assessor’s findings from his examination of the appellant. Secondly, neither party sought that the appellant be re-examined. Lastly, the issues raised in the appeal related to the deduction the Medical Assessor made under s 323(1) of the 1998 Act for the proportion of the appellant’s permanent impairment he considered was due to a pre-existing condition and the material before the Appeal Panel is sufficient for the Appeal Panel to deal with that issue and to determine the appeal. In other words, re-examining the appellant would not generate any additional evidence that would be useful for the Appeal Panel to consider.
EVIDENCE
21.	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. 
MEDICAL ASSESSMENT CERTIFICATE
22.	As said the issues the appellant raised in her appeal against the MAC relate to the deduction the Medical Assessor made under s 323(1) of the 1998 Act with respect to the assessment of her permanent impairment of both her right and left lower extremities. The history that the Medical Assessor obtained relevant to that included that the appellant had obtained a “technically ‘good’ result” from the replacement of her right knee that occurred in late 2013. The Medical Assessor noted that the injury the appellant suffered on 4 December 2015 caused an avulsion of the medial collateral ligament from the medial femoral condyle and that Dr Young carried out a repair procedure of the medial collateral ligament on 
14 December 2015 using a screw to fix the avulsed medial collateral ligament to the medial femoral condyle. The Medical Assessor also noted that the appellant had a long history of excessive weight and her current body mass index was in the 40s. 
23.	The Medical Assessor noted within the MAC that the appellant had a very extensive history of knee joint deterioration on the left side. 
24.	The Medical Assessor set out, in very brief fashion, the results of X-rays the appellant had done on her knees. With respect to the left knee these included an X-ray done on 
6 November 2013, 10 March 2017 and 6 March 2019. The summary the Medical Assessor provided with the earliest of those X-rays was “due for joint replacement next year, osteoarthritis”. With respect to the latter X-rays the summary the Medical Assessor provided was “extensive degenerative changes”. 
25.	The investigations done on the appellant’s right knee were an X-ray on 10 January 2012, 
22 July 2014, 7 December 2015, 12 February 2016 and 9 September 2016. The Medical Assessor’s summary of the first two of those investigations was “moderate to severe medical osteoarthritis”. His summary of the investigation on 7 December 2015 was “possible fracture at the medial femoral condyle at the MCL insertion”. His summary of the last two X-rays was “right knee joint replacement in good position. Screw fixation of the MCL in medical femoral condyle”.
26.	The Medical Assessor recorded the following findings in the MAC from his examination of the appellant:
“Ms Lloyd was of average stature with a height of 1.7m. Her current weight was 120kg.
With these parameters, she has a body mass index of 41. This is excessively overweight. The upper level of healthy BMI is 25. In order to achieve this she should be no more than 72kg. It is understood that weight control has been a difficult problem for many years.
Lower Limbs. She walked with a rather painful and almost lurching gait. Due to her morphology, it was quite impossible to measure leg lengths or effectively measure thigh or calf circumferences. She had extensive pronation of the ankles bilaterally. (She mentioned that she has a grandson who is a podiatrist who has advised that she needs to use orthotics.)

The mid-line vertical scar over the right knee from the previous knee joint replacement had healed satisfactorily. To the medial side of this was a slightly oblique longitudinal scar which would be consistent with the approach for the repair of the medial collateral ligament. This area was sore and tender.
The range of movement of the right knee was from full extension at 0° through to 80°. On the left side she also had full extension. The range of movement ceased at 90°. On the left side there was slight valgus deviation. On the right side the alignment was linear. I was unable to demonstrate any ligament laxity in either knee in either plane.”
27.	The Medical Assessor used Table 17-35 of AMA 5, as modified by the Guidelines, to assess the appellant’s permanent impairment of her right lower extremity. The tally of the points he had scored for the appellant’s right knee replacement, in accordance with that table, was 46. In accordance with Table 17-33, that was a poor result, which meant that the appellant’s overall impairment of her right lower extremity was 30% WPI. 
28.	The Appeal Panel notes that neither party challenged the Medical Assessor using Table 17-35 to rate the appellant’s permanent impairment of her right lower extremity, nor the Medical Assessor’s finding that she had a poor result from her right knee replacement. 
29.	The Medical Assessor noted in the MAC that the permanent impairment of the appellant with respect to her right lower extremity before her injury on 4 December 2015 would have been 15% WPI based on her having, at that time, a good result from her knee replacement in 2013. The Medical Assessor noted that the difference between her current permanent impairment relating to her right lower extremity and that which she had beforehand was therefore 15%. The Medical Assessor said that that difference “is therefore attributed to the effects of the fall in early December 2015 associated with the avulsion injury of the medial collateral ligament and its associated repair”. 
30.	Subsequently in the MAC the Medical Assessor explained that when assessing what impairment the appellant had relating to her right lower extremity from her injury on 
4 December 2015 he made a further deduction under s 323(1) of 50% because he considered that her pre-existing degenerative changes in her knee contributed to the permanent impairment she had from her injury. He explained himself in this way:
 “Attention is drawn to the very excessive degenerative changes which Ms Lloyd has experience with both of her knees. On the right side the whole person impairment was assessed at 15%. Half of this is deducted to account for the extensive pre-existing degenerative changes which technically reduces the whole person impairment from 15% down to 7.5%. This is rounded up in Ms Lloyd’s favour to 8%.”
31.	With respect to the appellant’s left lower extremity, the Medical Assessor considered that the appellant had “no assessable impairment of the left knee associated with the event or subsequent status of the right knee condition following the injury of early December 2015”. He explained that he held that view because of the “very extensive history of knee joint degeneration of the left side, together with a very gross excessive weight which has been in existence for many years”. He assessed the appellant had an overall permanent impairment of her left lower extremity of 4% WPI based on her having flexion of her left knee of less than 1000. When comparing his assessment to the assessments Dr Ghabrial and Dr Powell respectively made of the appellant’s permanent impairment of her left lower extremity, the Medical Assessor noted that Dr Powell had considered that the appellant’s permanent impairment of her left lower extremity was “completely due to extensive pre-existing degenerative changes and a raised BMI”. The Medical Assessor said that “I would completely agree with this analysis”.
32.	The Appeal Panel observes that neither party challenged the Medical Assessor’s assessment that the appellant’s overall permanent impairment relating to her left lower extremity was 4% WPI. 
33.	The Medical Assessor assessed that the appellant had 1% WPI due to scarring. Neither party has challenged that assessment.
34.	Hence, the Medical Assessor certified that as a result of the appellant’s injury on 
4 December 2015 she had 8% WPI relating to her right lower extremity, 0% WPI relating to her left lower extremity and 1% WPI relating to scarring, which combined to 9% WPI.
SUBMISSIONS 
35.	Both parties made written submissions. They are not repeated in full, but have been considered by the Appeal Panel. 
36.	In summary, the appellant submitted that the Medical Assessor did not apply s 323(1) of the 1998 Act correctly when assessing her permanent impairment from her injury. The appellant submitted that with respect to the left lower extremity the Medical Assessor did not follow the steps that the relevant authorities mandated a Medical Assessor adopt when determining the deduction to be made under s 323(1). With respect to the right lower extremity the appellant submitted that the Medical Assessor in effect applied s 323(1) twice which is contrary to what is required under the relevant authorities. 
37.	In reply, the respondent submitted that with respect to the left lower extremity the Medical Assessor made a deduction of 100% under s 323. The respondent submitted that the Medical Assessor was entitled to conclude that the entire impairment of the appellant’s left knee resulted from a pre-existing condition and that his conclusion does not constitute an error in the MAC. 
38.	The respondent also submitted that with respect to the appellant’s right lower extremity the Medical Assessor did not apply s 323 twice when determining what deduction was to be made under s 323(1) for the proportion of the appellant’s permanent impairment that was due to a pre-existing condition. The respondent noted that the Medical Assessor provided an overall assessment of 30% WPI and apportioned half of that to the work injury on 
4 December 2015 and half to the appellant’s earlier right knee replacement. The respondent noted that the Medical Assessor said that the condition of the appellant’s right knee at the time she had the right knee replacement “was considered more severe at that stage”. The respondent also noted that the Medical Assessor considered that the appellant’s gross excess weight was associated with her degenerative changes. The respondent submitted that the deduction the Medical Assessor made to account for the appellant’s excessive weight is not a re-application of s 323 but forms part of the deduction the Medical Assessor previously made to account for the earlier knee replacement surgery. 
FINDINGS AND REASONS 
39.	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. 
40.	In Campbelltown City Council v Vegan [2006] NSWCA 284 the Court of Appeal held that the Appeal Panel is obliged to give reasons. 
41.	The authorities relating to the requirements of s 323(1) of the 1998 Act are consistent and clear. In substance, a Medical Assessor must follow four steps. Firstly, the Medical Assessor must determine the level of a worker’s post-injury impairment, as at the time of assessment. Secondly, the Medical Assessor must identify whether a worker has suffered an earlier injury or has a pre-existing condition or abnormality. Thirdly, the Medical Assessor must determine whether a proportion of the worker’s post-injury impairment is due to that earlier injury or pre-existing condition, which requires the Medical Assessor to be satisfied that the earlier injury or pre-existing condition makes a difference to the outcome for the worker. Lastly, the extent to which a worker’s post work injury impairment is due to the earlier injury or pre-existing condition or abnormality must be determined. 
42.	The contest in this case relates to the fourth step, that is the Medical Assessor’s determination of the extent to which the appellant’s existing problems with her knees as at the time she suffered injury on 4 December 2015 contribute to her post injury impairment. 
43.	The Appeal Panel considers that the Medical Assessor erred with respect to the deduction he made under s 323(1) of the 1998 Act for both lower extremities. 
44.	The appellant’s present condition with respect to her left knee is the consequence of both her pre-existing degeneration in that joint and the manner in which she walked subsequent to her injury to her right knee on 4 December 2015. The manner in which she walked subsequent to her injury was likely to have placed great strain and force on what was an extensively degenerate knee. That worsened the condition of her knee and consequently the function of that joint. 
45.	Accordingly, the Medical Assessor’s assessment that all of the appellant’s permanent impairment relating to her left lower extremity was due to the pre-existing osteoarthritis is wrong. 
46.	It is difficult in a case such as this, where there is extensive pre-existing osteoarthritis in the appellant’s left knee, to determine with any specificity the extent to which that condition contributes to her present impairment of her left lower extremity. There is no doubt that it makes a significant difference to her present outcome, for without it she would have no impairment. Bearing in mind her evidence in her statement relating to the manner in which she walked subsequent to her injury to her right knee on 4 December 2015 and bearing in mind also the extent of the degeneration in her left knee at the time she suffered that injury, the Appeal Panel considers that the pre-existing degeneration in her left knee would have contributed half of her current impairment. The Appeal Panel observes that although it is difficult to determine with any specificity the extent to which the appellant’s pre-existing degeneration in her left knee contributes to her current impairment, s 323(2) of the 1998 Act cannot engaged because an assumption that the contribution was only 10% would clearly be at odds with the evidence relating to the extent of the degeneration she had in her left knee as at the time of injury.
47.	With respect to the appellant’s right knee, the appellant’s permanent impairment is a consequence of her having an artificial joint. The Appeal Panel repeats that neither party challenged the validity of the Medical Assessor assessing the appellant’s permanent impairment with respect to her right knee by reference to Tables 17-33 and 17-35, that is her having a total knee replacement. The Appeal Panel considers, in any event, that that was the most appropriate method by which to assess the appellant’s permanent impairment with respect to her right knee.
48.	The appellant’s need for her artificial joint was due to her having extensive osteoarthritis in that knee as at the date she had the operation, that is late December 2013. The Medical Assessor considered that as at the time she suffered injury on 4 December 2015 to her right knee she had a good result from that procedure. Neither party challenged that finding of the Medical Assessor and, in any event, the Appeal Panel considers that the evidence before it substantiates the finding. 
49.	The procedure of replacing the appellant’s degenerate right knee with an artificial joint effectively eliminated the osteoarthritis the appellant had in her right knee. It eliminated her symptoms from that disease.
50.	As a consequence of the injury the appellant suffered on 4 December 2015 she no longer had a good result from her earlier total knee replacement and, indeed, as the Medical Assessor found, she had a poor result. Again, neither party challenged that finding of the Medical Assessor, and the Appeal Panel in any event agrees with it. The injury the appellant suffered on 4 December 2015 did not revive the osteoarthritis she previously had in her right knee preceding her total knee replacement in December 2013. Rather, and to repeat, it resulted in her artificial joint, that had eliminated her osteoarthritis, not providing her with as good an outcome as it did beforehand. 
51.	In that circumstance, the Appeal Panel considers the Medical Assessor was wrong to make a deduction under s 323(1) for pre-existing osteoarthritis in her right knee. That arthritis was not existing in her right knee at the time she suffered injury. Rather, she had an artificial joint which, as a consequence of her injury, provided her with a poor outcome.
52.	The approach of the Medical Assessor with respect to the s 323(1) deduction with respect to the appellant’s right knee was flawed. The appellant’s overall permanent impairment with respect to her right knee was 30% WPI. She had a pre-existing abnormality, being an artificial joint. The artificial joint was an abnormality in that it was not a normal joint, although at the time of the appellant’s injury it was providing her with a good outcome. As a consequence of her injury the joint provided her with a poor outcome.
53.	The Appeal Panel considers that the appellant’s pre-existing abnormality and her injury equally contributed to her present impairment. In other words, the Appeal Panel considers that the deduction to be made under s 323(1) of the 1998 Act with respect to the appellant’s right lower extremity is 50%. Essentially, this is the outcome achieved by subtracting the rating for her having a poor result from her knee replacement following her injury from the rating she would have been assessed to have had immediately preceding her injury and which in all likelihood she would have continued to have had she not suffered injury.
54.	For these reasons, the Appeal Panel has determined that the MAC issued on 
8 November 2022 should be revoked, and a new MAC should be issued. The new certificate is attached to this statement of reasons.

PERSONAL INJURY COMMISSION

APPEAL PANEL
MEDICAL ASSESSMENT CERTIFICATE

Injuries received after 1 January 2002

Matter Number:	W4052/22	
Applicant:	Sandra Lloyd	
Respondent:	Newcastle City Council	

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 Dr Tim Anderson 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/s % WPI (after any deductions in column 6)	
Right lower extremity (knee)	4/12/2015	Chapter 3
Paragraph 3.29	Table 17-35	30%	1/2
	15%	
Left lower extremity (knee)		Chapter 3	Table 17-10	4%	1/2
	2%	
Scarring		Chapter 14. Table 14.1		1%	-
	1%	

Total % WPI (the Combined Table values of all sub-totals)             
	
18%