Slayman v Accident Compensation Corporation
The Court preferred Dr Waite's assessment over Dr Berry's on the substantive issue of the physical demands of the jobs; on the evidence (including the appellant's domestic capacities) the generic roles of car park attendant and ticket seller/lotto counter are sedentary/light and can be performed without normal use...
Source-derived case information.
- Citation
- [2013] NZACC 236
- Parties
- Appellant: Ahmad Slayman; Respondent: Accident Compensation Corporation
- Court
- District Court
- Jurisdiction
- New Zealand
- Judgment Date
- 6 August 2013
- Procedural Posture
- Appeal Under Accident Compensation Act 2001 / District Court Appeal From ACC Review (reserved Decision)
- Outcome
- Appeal dismissed in part; ACC decision upheld in relation to two job types and rejected in relation to sales assistant
- Legal Topics
- Vocational Independence, VIMA, VIOA, Expert Medical Evidence, Statutory Review and Appeal
Source-derived case record
Summary, issues, holding and outcome
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Parties
Ahmad Slayman
Appellant
Accident Compensation Corporation
Respondent
Procedural Posture
Appeal Under Accident Compensation Act 2001 / District Court Appeal From ACC Review (reserved Decision)
Legal Issues
- 1 Whether the appellant achieved vocational independence under s6 read with ss107 and 108 of the Accident Compensation Act 2001
- 2 Whether the VIMA/VIOA medical assessments were flawed or should be preferred
- 3 Whether the identified jobs require normal use of the right shoulder or can be done within appellant's restrictions
Ratio Decidendi
The Court preferred Dr Waite's assessment over Dr Berry's on the substantive issue of the physical demands of the jobs; on the evidence (including the appellant's domestic capacities) the generic roles of car park attendant and ticket seller/lotto counter are sedentary/light and can be performed without normal use of the right shoulder (or by use of the left arm) for 30 hours per week, but the sales assistant role may require stretching and lifting and is unsuitable; accordingly the Reviewer was not shown to be wrong and the ACC decision of vocational independence is upheld in relation to two roles.
Court Disposition
Appeal dismissed in part; ACC decision upheld in relation to two job types and rejected in relation to sales assistant
Orders
- Appeal dismissed insofar as it challenges vocational independence for car park attendant
- Appeal dismissed insofar as it challenges vocational independence for ticket seller/lotto counter
Full Case Text
Judgment text and source record
1 paragraphs
[ 2 013 ] NZACC 236 IN THE DISTRICT COURT AT WELLINGTON ACR 408/12 UNDER The Accident Compensation Act 2001 BETWEEN AHMAD SLAYMAN Appellant AND ACCIDENT COMPENSATION CORPORATION Respondent Appearances: B Thompson for Appellant J Eng for Respondent Judgment: 6 August 2013 RESERVED DECISION OF JUDGE NICOLA MATHERS [1] This is an appeal against a decision of the respondent (ACC) of 8 February 2012 that the appellant (Mr Slayman) had achieved vocational independence. Mr Slayman applied for a review of the ACC's decision. The review, which was heard on 30 May 2012, upheld the decision of the ACC. Background [2] Mr Slayman is a Cambodian refugee now aged 60. He worked as a product assembler for Precision Engineering from 1985. His work involved heavy lifting in addition to twisting and reaching. He made a claim to the ACC on 11 August 1995 as a result of experiencing pain and loss of function in his dominant right shoulder. Cover was granted for right subacromil bursitis and supraspinatus tendonitis. [3] Mr Slayman initially took some time off work and received acupuncture and physiotherapy. He returned to work but suffered pain and loss of function in his shoulder. His employment was terminated in November 1996 due to his physical inability to carry out his work. [4] On 13 May 1997 Mr Rao carried out an acromioplasty. Post-surgical complications involving infection ensued, and the surgery did not provide the relief that was sought. Mr Slayman saw Mr Hopkins who noted in a report of 2 October 1997 that he had a restricted range of movement in his shoulder. That finding was repeated in a report from Mr Rao of 19 November 1997. [5] In 1998 Mr Slayman saw Mr Stronach, a psychologist, who reported that Mr Slayman was concerned that the ACC was attempting to force him back to full time work too quickly. Mr Stronach was of the opinion that Mr Slayman displayed a genuine willingness to return to work. [6] On 15 April 1998 Mr Horne saw Mr Slayman and reported that his shoulder pain was exacerbated by shoulder abduction and adduction, and at this stage he was experiencing pain in both his shoulders. [7] On 23 October 1998 Mr Slayman was seen by the Wellington Regional Pain Evaluation and Rehabilitation Service, and it was recommended that he avoid activities which require loaded or a large range of movements for his arms. Medical hypnosis was attempted, but language difficulties prevented this. [8] On 23 November 1998 Mr Slayman's employment ceased as a result of his inability to return to normal full time duties. Over the next few years Mr Slayman saw various doctors and orthopaedic surgeons in relation to his ongoing pain and impairment. [9] In 2002 Dr Antoniadis carried out an initial medical assessment in relation to vocational independence. He reported: The history and examinations now are consistent with him having a chronic regional pain syndrome ... His condition ... is currently stable, having made no improvement at all with the physical rehabilitation and strengthening programme, nor with attempts at pain management." Dr Antoniadis was of the view that Mr Slayman could work as a parking attendant, toll booth attendant, or security officer. [10] In January and February 2003 Mr Slayman underwent a work trial as a car park attendant and over a period of four weeks he built up to five hours per day, five days per week, but was unable to increase his hours due to pain. [11] The workplace manager suggested that the appellant's "employment success would be greatly improved with tuition in spoken English", and also noted the difficulties Mr Slayman had with pain management. [12] On 9 April 2004 Dr Kerr conducted a VIMA. He diagnosed a chronic regional pain syndrome affecting both shoulders, but predominantly the right. He recorded that abduction in the right shoulder was limited to 45 degrees and he should avoid heavy lifting, repetitive stretching, or reaching particularly above chest height. He considered that Mr Slayman could work as a ticket seller, forecourt attendant, electrical and electronic equipment assembler. [13] Mr Slayman reviewed that decision, obtaining a report from Dr Robinson of 6 November 2004. Dr Robinson was of the view that the assembler role and forecourt attendant roles involved stretching and lifting, and were therefore medically unsuitable. In relation to the ticket seller role, he ruled that out because the 2003 work trial had shown that Mr Slayman could only work 25 hours per week at the most. Dr Robinson also raised the concern that the role would involve stretching. [14] At the review hearing Dr Robinson's opinion was preferred, and the Reviewer noted that the forecourt attendant and assembler positions both involved lifting, stretching and reaching. Although those functions were variable or limited, they were requirements of the job. The ACC's decision that Mr Slayman was vocationally independent was therefore overturned. [15] During 2007 Mr Slayman saw Mr Welsh, who reported a continued lack of movement in the shoulder with abduction limited to 70 degrees. After reviewing an MRI image, he described Mr Slayman's condition as chronic regional pain syndrome. Mr Slayman was referred to the pain clinic and on 26 March 2008 Ms Walker, a psychologist, reported there was no indication for psychological intervention as the appellant "has a very effective coping strategy in his faith which provides a buffer for his psychological wellbeing". She also reported that: There is a large element of de-conditioning and fear/avoidant behaviour at play here, and as such I would recommend a Functional Reactivation Programme to address these behaviours and increase the functional tolerance levels, as well as providing education and a greater understanding surrounding his injury and ongoing pain". A physiotherapist, Ms Hitchcock, reported that Mr Slayman, as a result of car sickness, could only drive short distances. [16] Mr Slayman underwent a Functional Reactivation Programme but this unfortunately did not result in any benefit to him. [17] In March 2010 Mr Hurnen, a clinical psychologist, confirmed that Mr Slayman's Islamic faith had helped him in coming to terms with the effects of his injury. [18] In December 2010 Mr Slayman underwent a work trial as a car park attendant in a parking building pay booth. The work trial only lasted one week and one day, and the report from Sue Paterson Consulting Lid in respect of the trial reported: "The work trial only lasted one week and one day rather than the scheduled four weeks because the employer decided to end the work trial because Ahmad was showing a "lack of commitment" and "clearly did not want to work. "?" [19] The difficulties that Mr Slayman encountered were that on the first day of the work trial he rang his ACC case manager to say he would not be attending the work trial because his asthma had been triggered by a colleague smoking. It was suggested that Mr Slayman should wear a mask but he did not wish to. On an assessment of the workplace it was found that the person who was smoking was smoking in an outdoor area several metres away from where Mr Slayman was working, and that he did not appear to be affected by the smoke when he was seen. [20] On the last day of the work trial Mr Slayman left after completing two of the scheduled three hours because his inner ear problem had been aggravated by driving to and from work, and he would not be able to continue. [21] On 30 May 2011 Dr Waite carried out an initial occupational assessment. That assessment was based on his examination of Mr Slayman, and the various medical reports provided to him. Dr Waite made the following recommendations: I do not see the immediate need for any further specialist referrals or assessments. I believe the current level of pain could be approached by his own General Practitioner. He has clearly been intolerant to medications in the past and with a weight of 50 kg the dosage would have to be considered carefully. Nevertheless I believe to overcome some of the present pain and help with sleep a small dose of a tricyclic may assist. We would need to be very cautious here even using half a 10 mg tablet initially. This could be arranged through his own General Practitioner. I do not see any present value in any further activation programmes. Ahmad should be advised to walk regularly for up to 45 minutes five days a week. He clearly faces formidable barriers in looking towards vocational rehabilitation. He would clearly be unable to undertake any form of heavy manual activity. Heavy lifting and carrying would not be possible. He would have trouble climbing. He would have difficulty undertaking any activities that involved elevating his arm above shoulder height. He would however, in my opinion, be fit for a range of light to sedentary duties. I discussed the recent Initial Occupational Assessment report with Ahmad and his support person. Unfortunately I believe there were some communication problems when he was reviewed by Sue Patterson, employment consultant. Sue Patterson has prepared an extensive report but in discussion today I think Ahmad may have given a false impression with some of his answers. [22] Dr Waite concluded that Mr Slayman was vocationally independent in relation to seven of the 14 work types considered, namely car park attendant, gate keeper, office cashier, alarm, security and surveillance manager, radio dispatcher, stock clerk, sales assistant - cleaning, safety and protective equipment. [23] In January 2012 Dr Waite conducted a VIMA. He noted that little had changed since the previous year. On examination Dr Waite noted that Mr Slayman's shoulder abduction was limited to 45 degrees, whereas forward elevation was limited to 40 degrees, showing no improvement since Dr Kerr's examination in April 2004. Dr Waite also noted that in summer Mr Slayman rises around 3.30 am to prepare himself to go to the mosque, while in winter he would rise later. He comments: Ahmad has mentioned that fatigue is an ongoing issue here. While not wishing to recommend changes to his routine I note the very early rising required as he goes to Kilbirnie to take the call to prayer. As mentioned, in summer months he is getting up as early as 3.30 am. Were Ahmad able to establish a better sleep pattern and not rise so early I am sure the fatigue would be much less of a problem. He goes on further to say I do not believe there are any non accident conditions that prevent Ahmad from having vocational independence ... I should add however that given the long history here and language issues Ahmad does face significant barriers in returning to work. Ahmad reports that fatigue is an issue here. I believe through his own doctor he should discuss his current sleep pattern along with the early rising he undertakes as part of his duties at the mosque. [24] Dr Waite also noted that in terms of daily activities Mr Slayman was able to wash and dress himself, that he can put washing in the washing machine, wash dishes, and undertake some light gardening. He was of the opinion that Mr Slayman could work for 30 hours per week in three separate roles. Those roles were as a car park attendant, a ticket seller / lotto counter and sales assistant / cleaning, safety and protective equipment. In respect of each of those roles, Dr Waite commented that the activities involved would be no more onerous than the appellant's day to day activities, that his restriction in shoulder movement and pain would not prevent him from undertaking the relevant activities, and the medication he was taking would not prevent him from undertaking the mental activities required for each job. [25] On 8 February 2012 ACC decided that Mr Slayman had obtained vocational independence in the three jobs referred to by Dr Waite. Mr Slayman, as I have said, lodged a review against that decision. For the purposes of the review Mr Slayman obtained a report from occupation specialist, Dr Berry. In that report dated 1 May 2012 Dr Berry described how Mr Slayman uses his left hand for most activities, and that he only uses his right hand for very light work and only when he can keep his hand close to his body. He confirmed on examination that Mr Slayman's shoulder was limited to 45 degrees abduction and 45 degrees forward flexion on the right. Dr Berry agreed with previous reports in that Mr Slayman could not undertake jobs involving normal use of the shoulders due to his "very restricted range of motion of his right shoulder" and the pain emanating from that area. He went on to say that the combination of restricted ROM and pain "would significantly impair the function in Mr Slayman's right upper limb" and that he should avoid tasks which would involve his right arm being extended out from his torso. [26] Dr Berry went on to consider each of the three relevant jobs and found that it would not be possible for Mr Slayman to carry out any of the three jobs for 30 hours per week largely because of the need to stretch and twist, and to use his right arm away from his body. Dr Berry also noted that all the roles required customer service and that Mr Slayman's ability to deal appropriately with customers is undermined by his symptoms of pain and fatigue. [27] Dr Berry's report was referred to Dr Waite, and in his report of 28 May 2012 he agreed that Mr Slayman would not be able to undertake a role that required normal use of the right shoulder. He also accepted that sleep difficulties and pain can affect cognitive ability, and went on to comment that Mr Slayman's requirement to rise at 3.30 am in the summer months would contribute to his fatigue, and that was totally inappropriate. [28] I note at this stage that Mr Slayman does not get up at 3.30 am to go to the mosque. He is not required to attend the mosque until 6.35 am, but he rises early because of the pain that he is in, and that is accepted by Mr Eng. [29] Dr Waite disputes the actual physical requirements needed to perform the three work activities, and in particular Mr Berry's opinion that car park attendants need to stretch out, and the same with ticket sellers at Lotto counters. He also felt that Dr Berry had over emphasised the activities required of a sales assistant. [30] At the review hearing held on 21 June 2012 the Reviewer found that there was no flaw in the VIOA, the job details sheets listed the activities of lifting and carrying, and stretching and twisting, as minimal. There was "no evidence that Mr Slayman could not manage that level of activity" and the "mental requirements" (cognition and mood) of the job details sheets were "not high", and there was "no evidence that Mr Slayman could not perform these duties". [31] The Reviewer therefore found no flaw in the assessment of vocational independence and dismissed the application for review. [32] As a result of ACC's decision Mr Slayman has been in receipt of a sickness benefit. To access this benefit he was required to provide confirmation of his general incapacity. Dr St George provided a report on 16 August 2012. In that report he is of the opinion that Mr Slayman is unable to engage in any form of work and that this situation is unlikely to change within a year. He went on to say that Mr Slayman would be suffering from the same residual impairment in two years' time. It must be noted however that Dr St George was not doing a VIOA or VIMA, but merely certifying Mr Slayman for a sickness benefit. Nevertheless I may and do take it into account. [33] For a period of seven weeks in late 2012 Mr Slayman undertook a voluntary work trial at the Red Cross Shop in Kilbirnie. The record of work shows that he worked no more than 1 1/2 hours per day and that he was required to take several days off as a result of pain. Submissions [34] Mr Thompson submits that the evidence shows that Mr Slayman has not obtained vocational independence in any of the three roles identified, and that the opinion of Dr Berry should be preferred to that of Dr Waite. He submits that Dr Waite's descriptions of the physical requirements of each job, particularly the need to reach out and away from the body, are contrary to common sense. He submits that in arriving at his conclusions Dr Waite has selectively described the physical tasks involved, whereas Dr Berry's description of the required tasks accords with common sense and is properly generic. [35] Dr Waite also submits that Dr Berry failed to give proper consideration to the appellant's ability to engage appropriately with customers while working 30 hours per week, whereas Dr Berry did give that issue consideration. [36] Mr Thompson further submits that evidence shows that the limitations in Mr Slayman's shoulder function render him unable to undertake the three identified roles for 30 hours per week. He refers to the various reports through the years starting with Mr Rao on 19 November 1997, which states very little abduction past 90 degrees, and then to the most recent reports of Dr Waite on 21 January 2012, and Dr Berry of 1 May 2012, where they are both of the opinion that Mr Slayman's abduction of his right shoulder is limited to 45 degrees. [37] Mr Thompson asks the Court to bear in mind that the results were elicited during one-off examinations and they do not represent Mr Slayman's ability to carry on sustained or repeated activity away from his body. He points out that the clinical results have led several medical practitioners to comment upon Mr Slayman's functional limitations and I set these out below: Wellington Regional Pain Evaluation and Rehabilitation Service, 23 October 1998: the appellant should avoid activities involving loading of the arms, or a large range of arm movement. Mr Cleary, 24 October 2001: the appellant should consider jobs where he uses his hands between waist and shoulder level only, with little movement of his arms away from the side of his body and no heavy lifting. Dr Antoniadis, 27 September 2002: the appellant should avoid activities at or above shoulder height, and should also avoid work with his arm held for any prolonged length of time outstretched and abducted. Dr Kerr, 9 April 2004: the appellant should avoid heavy lifting, repetitive stretching or reaching particularly above chest height. Dr Robinson, 6 November 2004: the appellant's shoulder function is severely limited', and he is unable to carry out roles involving normal right shoulder function. Dr Waite, 30 May 2011: the appellant would have difficulty undertaking any activities that involve elevating his arms above shoulder height. In his further report of 28 May 2012, Dr Waite agrees that the appellant would not be able to undertake jobs which involve normal use of the shoulders. . Dr Berry, 1 May 2012: the appellant only uses his right hand for very light work and only when he can keep his hand close to his body. He cannot undertake jobs which involve normal use of the shoulders. [38] Mr Thomson then submits that the question to be answered is, does the evidence establish that (on balance) the three relevant roles when properly considered in their generic sense require something less than normal use of the shoulders, or would otherwise allow the appellant to avoid using his right arm out and away from his body? He says if the answer to that question is "no", then the ACC's decision is incorrect and cannot stand. Mr Thompson then submits that when one looks at the three identified roles they all require at least normal use of the shoulders. [39] He submits that Dr Berry's view of the nature of the roles and the impact that they would have on Mr Slayman should be preferred to Dr Waite's opinion. [40] Another important aspect of Dr Berry's report, it is submitted, is that Mr Slayman's pain level will undermine his ability to deal appropriately with customers. Dr Berry notes that each of the three identified jobs require significant levels of customer service and this will be exacerbated by Mr Slayman's English language difficulties. [41] Dr Waite states in his report of 28 May 2012 that sleep difficulties and pain can affect cognitive ability. Dr Waite, however, makes no comment upon Mr Slayman's ability to appropriately interact with customers despite the aggravation in pain levels which would undoubtedly flow from full time work. [42] Mr Thompson has urged me to deal with any suggestion that an appellant is required to show or prove a flaw in the Reviewer's reports. [43] Mr Eng, for ACC, submits that Dr Waite's VIMA is free from error and is consistent with the overall body of medical evidence. When considering each job type in turn Mr Eng submits that Dr Waite's application of the job details sheet to the appellant's circumstances is properly reasoned and free from error. He also submits that there is no evidence for the proposition that "ability to engage appropriately with customers is a physical requirement of any of the identified job types". [44] Mr Thompson in his submissions in reply has taken particular care to analyse the three proposed jobs being car park attendant, ticket seller, and sales assistant. I have carefully considered his analysis and also referred back to Dr Waite's reply to Dr Berry. The law [45] Sections 107 and 109(1) of the Accident Compensation Act 2001 confer on the respondent the right to determine the vocational independence of a claimant who is receiving weekly compensation. Vocational independence is defined in s 6 of the Act as: The claimant's capacity, as determined under s 107, to engage in work - (a) for which he or she is suited by reasons of experience, education, or training, or any combination of those things; and (b) for 30 hours or more a week. [46] A claimant's vocational independence is determined in accordance with ss 107(2) and 108 after requiring the claimant to undertake a VIOA and a VIMA. Once those reports have been completed the ACC is required to determine whether the claimant has obtained vocational independence. [47] Ronald Young J in Martin v Accident Compensation Corporation [2009] 3 NZLR 701 considered the process for determining vocational independence, and said: .. the purpose of the medical assessment is to provide an opinion to the Corporation. As this Court observed in Ramsay, given the reasons behind the statutory process, the Corporation will typically accept the opinion of the medical assessor unless it is flawed in the limited circumstances described in Ramsay. For example, where the assessor was not properly qualified or failed to take into account matters required of him, or if the report did not contain the required information. The learned Judge went on to say: What is also intended to be avoided by the statutory scheme is the Corporation itself making another medical assessment outside of the assessment prescribed. If the Corporation has information which illustrates, for example, that the medical assessor did not have all relevant information, or the assessor deliberately ignored relevant information, then the Corporation would be justified in refusing to accept the assessor's opinion. That would not justify the Corporation then reaching its own medical assessment. [48] At para [36] of the decision the learned Judge summarised the approach as follows (a) when assessing vocational independence by the Corporation the Ramsay principles apply; (b) the review and any appeal to the District Court are to be determined according to the statutory review and appeal rights, Wildbore and Austin Nichols. The Ramsay principles have no application to such reviews or appeals to the District Court. (c) the approach in (b) therefore requires the Reviewer or District Court to consider all the relevant evidence and to decide if they are satisfied the claimant is vocationally independent. The medical assessor's opinion is to be given no pre-eminence solely because of its statutory basis; (d) if the Reviewer or District Court reach a different conclusion on the evidence as to vocational independence than the Corporation (or Reviewer) then the decision is wrong, the obligation on the appellant met and a different decision should be substituted; (e) in assessing expert medical evidence factors such as (non- exhaustive) the extent and relevance of the practitioners qualifications and experience, the comprehensiveness of the evidence gathered, the quality of the report, where the preponderance of opinion lies and the validity of criticism of other medical opinions, will all be relevant in deciding the ultimate question. 49] It is accepted by both counsel for Mr Slayman and the ACC that when faced with a challenge to the finding of vocational independence, a review officer or the District Court ought to weigh all the relevant evidence before considering whether the particular claimant has achieved vocational independence. [50] The Court of Appeal in Wildbore v Accident Compensation Corporation [2009] NZCA 34 has clarified the approach to be taken in relation to appeals from a review officer to the District Court. The Court of Appeal held: The correct approach to s 149 Appeals is as follows. First, the District Court is required to come to its own conclusion on its assessment and evaluation of the evidence, and the merits generally. Where the District Court has a different opinion from that of the Reviewer, it would be an error of law for it to defer to the Reviewer's assessment of the acceptability of, and weight to be accorded to the evidence rather than forming its own opinion, although the District Court is entitled to have regard to what the Reviewer said and give it such weight as he or she thinks appropriate ... Secondly, the onus of establishing that the Reviewer is wrong is on the applicant for review. To adopt the actual language of the Supreme Court in Stichting Lodestar (at [4]); The appellant bears an onus of satisfying the appeal court that it should differ from the decision under appeal. It is only if the appellate court considers that the appeal decision is wrong that it is justified interfering with it. Decision [51] I have already indicated that I approach this matter on the basis of the Wildbore decision and the principles there set out. It is for the appellant to satisfy me on the balance of probabilities that I should differ from the decision under appeal. Am I satisfied that the decision under appeal is wrong? In making a decision I take account of Miller J's view in Cochrane v ACC, 2/06/04, High Court Wellington, CIV-2003-485-2009 that too much emphasis on the onus should be avoided. [52] The proper approach in my view is simply the principled approach of the Court of Appeal in Wildebore. It is for an appellant to satisfy the Court on the balance of probabilities that the test in issue, as found by a Reviewer, is wrong. Obviously if there is a flaw in the review, as considered by a Judge on appeal, then this will be taken into account, but that is not necessarily an end of the matter because a Court on appeal must reach its own conclusion based on the existing and new evidence on the merits generally. [53] So much has been set out in so many assessments by different doctors and specialists and in the end I am left with the principle assessments of Dr Waite and Dr Berry, and I do not overlook the sickness benefit assessment carried out by Dr St George. All the doctors agree that anything of a moderate or more use of the shoulders cannot be carried out by Mr Slayman. [54] Mr Thompson, as I have said earlier, has proposed a test as to whether or not the relevant roles require something less than normal use of the shoulders, and in addition, whether the appellant could avoid using his right arm out and away from his body. [55] I have considered the generic nature of the roles and have then looked carefully at what Dr Waite has set out regarding Mr Slayman's domestic activities which he can accomplish. I find it very difficult to accept Mr Slayman cannot carry out one or more of the three roles in question, even with the restricted use of his shoulders and arm, at least to the extent agreed. [56] Put another way, I prefer Dr Waite's assessment to that of Dr Berry in this regard because Dr Berry has really not addressed that issue satisfactorily. I also have difficulty with Dr Berry's notes where he suggests that the three roles require significant levels of customer service. Dr Berry says this will be exacerbated by Mr Slayman's English language difficulties. [57] I consider any issue of customer service to be overplayed. It is difficult to understand any real level of customer service that is required in being a parking attendant, other than directing customers to a car park, answering customer's enquiries and perhaps handing out a ticket with his other arm. I would not have thought much understanding of the English language to be necessary in carrying out that role. I take into account also that prior to his accident Mr Slayman had lived in New Zealand for a number of years and carried out a job which presumably required at least some understanding of what he was being told to do. [58] The Reviewer accepted the view that the three roles described sedentary to light activity. It was only in the role of sales assistant that there was light lifting or pulling required. I agree with the Reviewer that Dr Berry has focused, in my view, too much on lifting and carrying and stretching and twisting. In my view these activities are minimal and I agree with the Reviewer that there is no real evidence that Mr Slayman could not manage that level of activity, particularly as there is no dispute as to the domestic activities that he can carry out, including light gardening. I mention only to cast aside the issue of the time of attending the mosque as I do not consider Mr Slayman's tiredness to be related to attendance at the mosque. [59] Dr Waite has actually spent time watching ticket sellers at Lotto counters and concluded that there is no stretching required. Also I prefer the evidence of Dr Waite regarding the role of a car park attendant being able to be undertaken with postural flexibility. Again Dr Waite has apparently studied the Wellington Hospital car park environment. In fairness to Dr Berry and in relation to a sales assistant, Dr Waite concedes there may be occasions that require stretching out. I therefore on balance reject the role of sales assistant as being suitable for vocational independence due to the possibility of stretching out and lifting and the possibility of the requirement for normal use of his right shoulder. "60] The same cannot be said, in my view, as to selling lotto tickets or acting as a parking attendant, which do not have the same physical requirements of a sales assistant, and can be carried out with the left hand. [61] I do accept the descriptions of pain but again, Mr Slayman is able to carry out various domestic activities, including light gardening, which must involve some bending and light twisting, despite any level of pain. Also I consider there can be reasonable pain management. I consider that Dr Berry has not placed enough emphasis on the alternative use of his left arm in carrying out the proposed roles. [62] In the end for the reasons given the appellant has not satisfied me on the balance of probabilities that the Reviewer's decision was wrong in relation to lotto sales and car parking attendant. [63] I therefore find that Mr Slayman is vocationally independent in those two roles. Nicola Mathers District Court Judge