Martin v Accident Compensation Corporation

IN THE DISTRICT COURT AT WELLINGTON [2012] NZACC 169 UNDER The Accident Compensation Act 2001 IN THE MATTER OF an appeal pursuant to section 149 of the Act (Appeal No. AI 352/09) BETWEEN KAYE MARTIN Appellant AND ACCIDENT COMPENSATION CORPORATION Respondent Hearing: 20 March 2012 Appearances: Mr A Beck for appellant Mr A D Barnett for respondent Judgment: 16 May 2012 RESERVED JUDGMENT OF JUDGE D A ONGLEY [1] This appeal concerns a vocational independence decision made by the Corporation on 31 March 2001. The appellant was found to have capacity to work for 35 hours or more per week as a Proof reader and related clerk, and as an Office clerk. [2] The Corporation's decision was upheld at review and later on appeal in Martin v ACC [2005] NZACC 232. An appeal to the High Court was allowed by Ronald Young J in Martin v ACC [2009] 3 NZLR 701. The appeal was then referred back to the District Court to be reheard on the merits. The High Court decided that the Ramsay factors will be relevant only to the Corporation's decision making and not Ramsay v Accident Compensation Corporation [2004] NZAR 1 to the reviewer's function or the District Court appeal by rehearing. An appeal to the District Court by way of rehearing is intended to be a full reconsideration of all relevant material so that the District Court Judge can reach a conclusion as to whether the appellant is vocationally independent or not. In doing so, it will be inappropriate to give the medical assessor's opinion, simply by virtue of the fact that it is an opinion of the medical assessor, any pre-eminent position. [3] The appellant suffered a neck strain in 1998, and has been diagnosed with a chronic pain syndrome. She has cover for her neck strain and for the resulting chronic pain syndrome. The primary injury occurred without much force when the appellant reached down to pick up a ream of paper in a box. As she lifted the paper she felt a sudden and severe pain in her neck. Investigation showed that she had degenerative changes in the cervical spine. It was eventually accepted however that she acquired a chronic pain syndrome caused by her covered injury. [4] In March 2000, the appellant had a Functional Assessment done by Virginia Ogle. The report described a number of functional limitations which were later taken up in medical reports and have not been contradicted. In summary, Ms Ogle reported: "Kaye has been very conscientious and totally reliable throughout a prolonged and difficult RTW programme. She has very limited functional tolerances and endurance which has severely limited her work and lifestyle for over 12 months. She has a baseline of symptoms that are always present and vary in intensity and distribution. . .. All previous attempts to increase her hours have resulted in an increase of symptoms that have been very slow to resolve. She had a relaxed holiday in one location for 3 weeks in February and there was very little decrease of symptoms during this time. In the short and medium term I do not consider that Kaye has the tolerances to work more than 4 hours a day 5 days a week. She does not have the tolerance for work requiring strength, extremes of posture, prolonged paced work and prolonged fine finger manipulation using the right hand. She has learnt to compensate by using her left hand for many of these activities. Activities that allow a variety of movement and the ability to pace herself are most likely to be tolerated." Anderson [5] A Return to Work Vocational Assessment in November 2000 identified administrative work and general clerk positions as being suitable for the appellant. In February 2000 and in May 2001 Dr Mike Anderson, a pain specialist and occupational physician, recommend a work trial. Dr Anderson diagnosed the appellant's complex regional pain syndrome. In 2000 he wrote: "Kaye now clearly has Central Nervous System (CNS) sensitisation and has pain arising from neuropathic origin. She also has pain arising from Myofascial Trigger Points. (TP's) (Currently in the Pain Clinic this is seen as a peripheral manifestation of a CNS sensitisation). She also has a Complex Regional Pain Syndrome Type I (CRPS I). [This is the modern nomenclature for old term of sympathetic dystrophy]. The problem involves predominantly the right arm, shoulder, and neck, and can thus fit the descriptive diagnosis of a 'Regional Pain Syndrome', and the history given to me is consistent with the onset of the older terminology of Occupational Overuse Syndrome." [6] He stated that rehabilitation could be attempted once pain management had been put in place. He advised: "The work future of Kaye is unknown at this point in time. She may be able to trial a workplace rehabilitation programme again when a full pain management programme is in place. A work trial is just that - a trial - and one will need to be undertaken to answer questions about return to work. However, due to the Psycho-Social aspects of the Model, previously mentioned factors, such as perceiving the work place management don't care, ongoing disputes with compensatory bodies, and doing meaningless alternative duties, or duties that now aggravate the original problem, tend to mitigate against early return to full duties." [7] Initial occupational and medical assessments were done in May and August 2002. The appellant was found medically able to sustain six different work types identified in the initial occupational assessment. No additional medical interventions were recommended by the medical assessor. Her IRP was then updated to include a work trial and a work ready programme. [8] The work ready programme was undertaken in late 2002, followed by a work trial as a general clerical worker with the Dunedin City Council. A completion report was written in December 2002. The work trial had run for three weeks, during which her work times were increased from 15 hours in the first week to 22.5 hours in the third week. The tasks were described as including "about 30% labelling and re-labelling; 30% writing, photocopying and printing; 30% using a computer for completing details on templates, maintenance and creating titles for magazine display area; 10% general duties". The completion report recorded that no difficulties were encountered by the appellant other than with one particular task involving placing magnetic tape on about 400 DVDs. This activity was stopped because it was said to be too awkward, noting also that other staff had found it somewhat trying as well. It was reported that the appellant was considered work ready for general clerical work. The report did not comment on her ability to work full time. [9] On 28 March 2003, the appellant's GP noted that work trials had been unsuccessful, and expressed the view that the appellant was fit only for part time work. In relation to types of employment and limitations, he said that previous work trials had been unsuccessful once the hours were increased above four hours per day. He considered that the appellant was honest, well motivated and extremely frustrated by her pain condition, and that she was only suitable for part time work. He noted that suitable work would be difficult to find. The vocational independence assessments [10] A vocational independence occupational assessment was done by Mr Berry in March 2003 and the vocational independence medical assessment was done by Dr Antoniadis on 25 March 2003. Dr Antoniadis certified that the appellant was able to work 35 hours or more per week as a General clerk or Proofreader. That was the weekly requirement for vocational independence at the time of the appellant's assessment. It has since been reduced to 30 hours a week, but this 2003 assessment must be based on 35 hours. Dr Antoniadis described the effect of the appellant's pain as follows: "Currently she experiences constant "nagging, throbbing and wearying pain' running from the posterior aspect of her neck to the back of her right shoulder. It also runs over the posterior aspect of her upper arm and over the dorsum of her forearm and hand on the right. On the left side she experiences similar discomfort to the back of the left shoulder only. She also has a stiffness in her neck, particularly on the right side. She experiences a 'heaviness' in her right arm. There are sensory symptoms of pins and needles in both hands when she wakes from sleep. This is particularly focussed on her ring and middle fingers. She states at times her right hand can become red, hot and sweaty, particularly with more activity using her hand. She states she has difficulty with holding onto a pen and can write for approximately 10 -15 minutes before her writing deteriorates. She also finds herself dropping things at times, particularly if they are heavy or fiddly. She states she is able to sit for periods of about an hour but needs to move within her seat or get up and walk around. She prefers when sitting to hold her arm tucked into her side. She walks for approximately half an hour per day, but again avoids her right arm swinging and tends to tuck her arm into her side when she does. She is able to stand for approximately an hour, again if she is able to rest her right arm close to her body. ..." [11] The report went on with further details of the appellant's pain and fatigue and the household activities that she was able to do. She also spent about an hour a day attending to administration for a local yacht club. After describing his clinical examination of the appellant, Dr Antoniadis stated: "There is currently no evidence of any objective neurological compromise, although nerve conduction studies have reported partial denervation of the right C7 cervical nerve root which is consistent with some of the sensory changes in her right upper extremity. The history and examination findings are consistent with her having developed a persistent regional pain syndrome with a background of radiologically proven cervical spondylosis. Her condition is currently stable, having had limited benefit from the physical rehabilitation and strengthening programme. She has found some benefit from the employment of relaxation techniques and the use of heat with escalations in her discomfort. In my opinion her symptoms will persist with regards her cervical spondylosis and may deteriorate with time. This may or may not lead to an increase in her symptoms which may require further orthopaedic opinion in the future. Currently there are no other outstanding medical interventions and investigations physical rehabilitation options for her." [12] Dr Antoniadis advised that the appellant would have to avoid heavy lifting in employment, and also any activity which requires repetitive hand tool use or keyboard use. She would have to vary her posture between sitting, standing and walking to avoid escalation in her symptoms and future risk of more acute deterioration in her cervical spine. He considered that she was fit to work 35 hours or more per week as a General or office clerk. He reported that the appellant agreed that physically this would be an appropriate occupation for her with no functions that would be expected to put her at risk of increasing symptoms. She stated that the job offered plenty of variety and that she would be able to physically cope. Ideally she would prefer to have a graduated increase in hours as she had been off work for some time. Dr Antoniadis also assessed the appellant as being able to work for 35 hours per week as a Proof reader and related clerk. He reported that she said that the job would be of interest to her and that physically it was an occupation she could cope with. The assessment excluded some other jobs that would be likely to aggravate the appellant's pain symptoms. [13] The Corporation then issued its decision of 31 March 2003 that the appellant had vocational independence. A reviewer found that the medical assessment by Dr Antoniadis was not 'flawed', and upheld the respondent's decision. Dr Hancock's opinion [14] In June 2003, the appellant obtained a medical report from Dr Gordon Hancock, specialist occupational physician, who expressed the view that the appellant was not vocationally independent. She appealed to the District Court, and the appeal was dismissed on 2 August 2005. Leave was granted to appeal to the High Court, and the High Court allowed the appeal, referring the matter back to the District Court. [15] Dr Hancock understood that the appellant had not worked since her injury except for a three-week work trial back at her pre-injury Dunedin library location working three to four hours per day. He believed that the work was almost of a sheltered nature as her previous colleagues were very protective of her, but even under these circumstances she found it difficult to work fifteen to twenty hours per week. [16] Dr Hancock found that Mrs Martin had reduced functional capacity for seated work and mental activity associated with keyboard work. He noted that it was apparent from the occupational assessor's comments that there was a real concern that some clerical jobs may have been beyond Mrs Martin's capability, and that if a working environment had to be modified for her to sustain employment, then that does not constitute vocational independence. It was asserted that Dr Antoniadis had not considerd that difficulty. Dr Hancock also thought that proof reading on a screen would be particularly difficult. [17] Dr Hancock's opinion was referred back to Dr Antoniadis for comment. In reply, Dr Antoniadis noted that Mrs Martin had developed upper extremity and cervical spine discomfort in 1998, and that he had concluded that she had persistent regional pain syndrome with a background of radiologically proven cervical spondylosis. In his opinion her condition was stable and she did have ability to work 35 hours or more a week in certain clerical positions. She had commented that there was no function within the occupation that would put her at risk of increasing symptoms. She had also agreed that she could physically cope with the work of a proof reader. [18] Concerning modification of her work environment, Dr Antoniadis saw it as a standard procedure for anyone coming into a new office space that her work station would be organised so as to be ergonomically correct. Neither would there usually be a requirement to maintain a static posture without the ability to sit, stand and walk around. Some other occupations such as that of a telephonist would not permit such flexibility. [19] Dr Anderson saw Mrs Martin in the pain clinic on 29 September 2003. His examination confirmed her continued pain condition with no apparent change for the better. Dr Hancock wrote again on 15 June 2005. He considered that the question of modifying the workplace was not limited to ordinary everyday ergonomic adjustments. He referred to the occupational assessor's comment that a specific worksite assessment could best inform about any necessary environmental modifications, because the same jobs can be different in terms of function, activity and environment. Dr Hancock thought that comment suggested rather more than basic ergonomic adjustments, and that it moved beyond the bare description of functional requirements on the work details sheets. Concerning the pain problem, Dr Hancock wrote: "The other important issue with respect to Mrs Martin's vocational independence was her ability to work for 35 hours per week in any job because of her chronic, unrelenting pain condition. It was clear from her attempts to return to even "sheltered' types of duties in the library, that working for even 15 hours per week was outside her capability. Dr Antoniadis appears not to have given due consideration to this in his original VIMA report and I would consider on that basis also that his report and his opinion that Mrs Martin was vocationally independent was flawed." [20] In this passage, Dr Hancock viewed the pain problem as a second issue. He did not say that Mrs Martin suffered pain to an extent that she could not concentrate, or would have increased symptoms and loss of function because of the effect of pain in the context of full time work. The reasons for Mrs Martin being unable to work for more than 10 or 15 hours per week were not completely explained. Both doctors agreed that engaging in paid employment could have a positive therapeutic effect, but the purpose of a vocational independence assessment was to ascertain whether the appellant was then ready for work for 35 hours or more, not whether work would have a therapeutic effect and eventually increase her endurance. [21] Mr Barnett submitted that Dr Antoniadis had been aware that the appellant was able to complete her normal activities of daily living and household chores, with restrictions, and she engaged in sewing and clerical and administrative work for a yacht club. He found no significant or asymmetrical muscle wasting from disuse of the upper or lower extremities. His report showed that he considered the pain problem and the appellant's own concerns when he observed "Ideally she would prefer to have a graduated increase in hours as she has been off work for some time now" and concerning the job of proof reader "she states again that this would be of interest to her and that physically this is an occupation she could cope with. She states that there is not a lot of work in the field". Dr Rajapakshan [22] Since the appeal was allowed in the High Court, the appellant has obtained a further report from Dr Rajapakshated 1 April 2011. Dr Rajapaksharmed the diagnosis of a chronic pain syndrome. He considered whether the appellant would be able to work full time as a Proofreader or Office clerk and concluded that she would be unlikely to be able to do either of these tasks for 30 hours or more per week (applying the current legislation). Dr Rajapakshaonsidered that the appellant would be unable to sustain 30-35 hours per week in any of the other occupations identified in the occupational assessment. He accepted that the appellant's pain symptoms were correctly described in the Antoniadis assessment. He described the resulting limitations as follows: "She can write for 10-15 minutes before the writing deteriorates. She drops things, particularly heavy and fiddly things. She is able to sit for periods of about half an hour. She prefers to sit holding her arm to her side. She walks for approximately half an hour. She avoids swinging her right arm during walking. She stands comfortably with her right arm closely without changing position for about half an hour. Her sleep is disturbed as stated and she wakes up feeling 'hung over'. She is constantly tossing and turning. Her driving distance is about 10-20 minutes. Housework is taken in breaks. She does the vacuuming and ironing with a TENS machine attached to her. She avoids heavy lifting. She tends to drag her clothes basket outside rather than lift it." [23] Concerning diagnosis and prognosis he wrote: "DIAGNOSTIC OPINION This lady is clearly now having chronic pain as part of a chronic pain syndrome. She probably has been primed to develop this chronic pain syndrome primarily by the build up of work as described in the early part of 1998, associated with the reorganisation of the Dunedin Library and the demand on her keyboarding. Subsequently, continuing to work in these same circumstances from 1998 to 2002 probably contributed to the persistence of the symptoms, as well as the lack of resolution. The underlying cervical spondylosis might have had a contributory factor as well to these. This combination of circumstances is very common in the precipitation of chronic pain syndrome. PROGNOSTIC IMPRESSION Unfortunately, once a chronic pain syndrome sets in, the complete resolution of it is often very difficult and often does not happen. There is a better understanding of chronic pain now, in 2011, than even in 1998. There is evidence to support the concept of central and peripheral sensitisation to pain being the major basis for the persistence of pain, with physical or other triggers as initial triggering factors. However, once the chronic pain syndrome sets in, the removal of the initial triggering factors does not lead to the resolution of the symptoms as the persistence of the symptoms is based on the sensitisation of the neurophysiology for pain. Reversing that is quite a challenge." [24] Dr Rajapakshated that many of the appellant's daily domestic activities in her home need to be done in breaks and with the assistance of the TENS machine. Even activities like sitting and standing have to be done with the protection of her right arm. In particular, writing and keyboarding is limited to 10-15 minutes. Dr Rajapakshagreed with Dr Hancock's opinion that the appellant woudl be unlikely to be able to work in the two described occupations for 30 hours a week. He said that even proofreading at a computer screen would require many of the actions that go with keyboarding and which the appellant could not sustain. He considered that environmental modifications would do little to ease the situation. The clerical occupations would require a considerable degree of upper limb use which would be untenable for her. Dr Rajapakshaluded his report by saying: "This would certainly be my firm opinion based on my assessment of [the appellant] and of the many others in this situation that I have assessed. In my experience we really have not been able to come up with any good and effective way of overcoming chronic pain syndromes once they have become entrenched." Submissions [25] Mr Beck submitted that the Court should be ready to reject a medical assessment that does not deal with a significant question of pain as a barrier to work capacity. He referred to Buckthought v ACC [2005] NZACC 296 in which a medical assessment did not address the claimant's pain issue in any detail. Judge Cadenhead found the medical assessment was flawed because it did not adequately grapple with the central issue in the case of how the appellant could manage working for 35 hours with her level of pain. [26] He submitted that the appellant's case is supported by the evidence of her general practitioner, the evidence of Dr Anderson, the evidence of Dr Hancock, the evidence of the appellant herself, the results of the work trial, the medical assessment carried out by Dr Antoniadis, and the opinion of Dr Rajapaks [27] Mr Beck noted that the appellant was described as being honest, well motivated and frustrated by her injury limitations. He noted that Dr Anderson had recommended the work trial as a crucial step in the appellant's return to work and had advised caution. It was submitted that the work trial provides the only objective data as to how the appellant has performed under normal work conditions. The trial had demonstrated that the appellant could do some clerical tasks, but only for about four hours a day. Dr Antoniadis reported that the appellant acknowledged she could do the work involved in the approved job types, but he did not report her stating that she could do the tasks full time. Mr Beck noted that the appellant had given oral evidence at the review hearing that she was unable to work full time, and that the work trials had been difficult to cope with. She gave evidence that working with a mouse and computer screen for any length of was "extremely difficult" for her. That was reflected in the functional assessment in March 2000 and there is no indication in the evidence that her capability has improved. It was submitted that Dr Antoniadis was forced to make some assumptions about modifying the work environment. [28] It was submitted that, given the importance of the work trial as emphasised by Dr Anderson, it has to be regarded as one of the most significant pieces of evidence before the Court and it is a clear pointer to the inability of the appellant to carry out full time work. Mr Beck noted that Dr Antoniadis referred only briefly to the work trial and provided no supporting evidence for his conclusion that the appellant would suddenly be able to work for 35 hours per week. Dr Antoniadis noted that a graduated return to work would be ideal. Mr Beck submitted that the failure of Dr Antoniadis to address the limitations of endurance apparent in the work trial report represented a significant omission, and that Dr Antoniadis did not desribe how the appellant's chronic pain syndrome would impact on her ability to work for 35 hours per week. Mr Beck summarised the challenge to Dr Antoniadis's assessment on the grounds that: 1. He did not address the appellant's chronic pain syndrome or the issues arising out of it. 2. He failed to have regard to the severity of the appellant's limitations, and assumed that a modified environment would be available, and would avoid all the difficulties. 3. He did not explain how the appellant would suddenly be able to increase her hours from 20 to 35 per week in the light of clear evidence to the contrary. [29] Mr Beck noted that Dr Hancock took the work trial into account on the basis that even in an almost "sheltered" environment she was unable to sustain more than 15-20 hours per week. Although Dr Rajapakshapinion was formed much later, he noted that the appellant's situation was similar to that described by Dr Antoniadis in 2003. His opinion was that the appellant was suffering from a chronic pain syndrome, and that such conditions are very difficult to resolve. His firm view was that the appellant's chronic pain syndrome prevented her from being vocationally independent. It was submitted that the evidence of Dr Hancock and Dr Rajapaks accords with the practical realities facing the appellant, and builds on the objective data from the work trial. [30] Mr Barnett for the respondent submitted that Dr Hancock's opinion was guided by the appellant's work trial in which she had not been able to exceed half days, and also the need for special ergonomic adjustments to her work environment. He submitted that the evidence does not show that it was a sheltered work environment or that the trial was a failure. Frequently assessments exceed the work trial by some margin and that is not regarded as an impediment to deciding vocational independence. The evidence is that return to suitable employment is beneficial for those suffering chronic pain it was within the assessor's province to decide whether that was the case here. [31] Mr Barnett submitted that Dr Antoniadis answered Dr Hancock's points satisfactorily, including that the appellant herself thought that she could cope. He submitted that there was no challenge to medical evidence that work would not exacerbate the appellant's injury, and that return to suitable employment is beneficial for those suffering chronic pain. He submitted that Dr Hancock's rationale was only that the appellant had not shown her ability to work for 35 hours a week in a work trial. He did not base his opinion on clinical factors, in contrast to the opinion of Dr Antoniadis who provided a very detailed history of the injury and a medical history and social history of the appellant. [32] Mr Barnett submitted that during the work trial there was just one task which the appellant had difficulty with and stopped doing, namely placing magnetic tape on DVDs, a highly repetitive task which had caused difficulty for other staff. He submitted that the work trial report did not describe the trial as sheltered work. The appellant had been able to manage the tasks, including 30% computer work. [33] Mr Barnett submitted that Dr Antoniadis recognised the pain syndrome and its origins in increasing demands on the appellant in her workplace. He understood that it is a persistent condition and that the appellant needs to avoid heavy lifting and any activity which requires repetitive hand tool use or keyboard use. It is important that she can freely vary her posture to avoid escalation in her symptoms. He therefore excluded a number of job types before reaching his assessment of vocational independence in two suitable jobs of General or office clerk and Proof reader and related clerk. [34] Mr Barnett submitted that the probative value of Dr Rajapaske's opinion suffered from being provided some eight years after the determination of vocational independence and it was by no means the comprehensive assessment that Dr Antoniadis made. His conclusion, tending to concur with Dr Hancock, suggested a somewhat uncertain or mixed view. Discussion and decision [35] The appeal involves conflicting opinions of vocational independence. The assessment is not said to be flawed for any particular error or omission. Dr Antoniadis did a vocational independence medical assessment in accordance with the Act and requirements of Schedule 1. He provided a credible opinion concerning the appellant's functional ability and capacity for work for 35 hours or more per week, which met the definition of vocational independence in March 2003 when the assessment was performed. Dr Antoniadis found work types suited to the appellant's limitations, and importantly he reported that she agreed that she could physically cope, or that the job would be of interest to her. He discarded other work types on ground that they would be unsustainable, or would be likely to aggravate the appellant's symptoms. [36] Mr Beck submitted that, although the appellant accepted that she could do the work involved in the approved job types, Dr Antoniadis did not report her stating that she could do the tasks full time. That is certainly a valid point. In my view, it is to be inferred that the appellant did not acknowledge that she could do the work full time. The central question was full time work and in all other records the appellant has denied being able to sustain full time work. If the appellant had accepted that she could work full time in those occupations Dr Antoniadis would certainly have said so. [37] The barrier to employment for the appellant is a chronic pain syndrome affecting her functional ability, particularly because of persistent pain from her neck to the back of her right shoulder and in her arm and hand. The pain is always present to the degree that she holds her arm close to her body for most of the time. Medical accounts of the appellant's pain have been consistent. Her pain condition is not improving and that is also consistent with medical assessments from 2000 to 2011. [38] The only objective test of the appellant's ability to engage in work has been her work trial in 2002 which was successful in terms of tasks, but demonstrated that she was not then able to sustain full time work. She has been described as conscientious and well motivated. She has not been regarded as attempting to avoid work or having an unreasonable view of her capacity for full time to work. Dr Antoniadis said that he observed no illness behaviour. The reports are consistent in describing her as having good motivation to work. There is no dispute about her chronic pain syndrome caused by her covered injury, nor about the functional difficulties that it causes in relation to work tasks. Indeed there is a good deal of common ground. [39] The assessment by Dr Antoniadis was detailed in reporting the appellant's history and examination, but the conclusion was expressed quite briefly without expressing reasons to discount the effects of the appellant's pain condition, or the work trial in which she did not exceed 20 hours per week. [40] Dr Hancock's reasons were also framed in general terms. He also examined the appellant, considered her medical and employment history, and then expressed a conclusion. He divided his opinion in two parts, first commenting on possible difficulties in workplace modification, and secondly offering his opinion that pain would affect the appellant's ability to work consistently for 35 hours per week. That view was supported by her performance in a work trial when she was not able to exceed half days. [41] Dr Rajapakshalso expressed his reasons generally. He reached the same conclusion as Dr Hancock. He explained that the appellant's pain syndrome was likely to continue and that there is no effective therapy. He considered that the work trial was probably a reliable indication of the limit of her ability to work. [42] The conflicting opinions of Dr Antoniadis compared with Dr Hancock and Dr Rajapaksharn on individual professional appraisal of the appellant and her pain condition. They relied on the same information and made similar functional evaluations, though Dr Antoniadis was more detailed in that regard. They differed in emphasis to be given to the 2002 work trial. None of the doctors considered that there was any useful rehabilitation, or that the pain condition was likely to improve. [43] There is evidence that it is accepted that return to suitable employment is beneficial for those suffering chronic pain. Dr Hancock considered that some level of employment would be beneficial for the appellant. That does not mean that an assessment of readiness for full time work can be made without adequate reasons, or without adequate preparation. A mere opinion that a claimant could get back to work if taken off weekly compensation is not a basis for vocational independence. The assessment has important consequences and it needs to be supported by reasons that can be understood, and challenged if necessary. [44] All three assessing doctors are well qualified to express an opinion on the appellant's capacity for work. Dr Antoniadis may be more experienced in conducting statutory assessments, but I do not think that adds value to his assessment. The points on which the assessment is challenged are the lack of objective criteria to assess the appellant's case, absence of reasons for discounting the work trial, lack of commentary concerning pain, and absence of consideration of the appellant's endurance as opposed to her functional ability to perform work tasks. [45] The appellant's description of her manner of carrying out domestic tasks while guarding her right arm appears to be accepted by all the practitioners. She holds her right arm close to her body to control pain, a posture that is not likely to easily adapt to an ordinary work environment. Her apparent inability to work more than 20 hours a week in the work trial has been accepted as not being influenced by work avoidance. There has been no separate evaluation of workplace modifications that would result in a better performance than the appellant was able to achieve in the work trial. Most of the evidence in this appeal is now rather dated because the assessment has survived a review and two appeals. Dr Rajapaksha assessment was made nine years after the appellant's work trial, but it is a feature of this case that the appellant's pain condition was not likely to change, and has not changed. The appellant is considered to be motivated to work, but at no stage since her injury has she worked for any longer daily hours than in her work trial. [46] I find that the opinion of Dr Antoniadis rested on general features of the appellant's presentation, but without any objective basis to find that she could work for 35 hours or more per week. He confirmed his view after reading Dr Hancock's opinion, which was also reached on fairly general grounds. There is a fundamental difficulty in measuring the appellant's ability to work full hours. In my view, the accepted descriptions of her work trial and of her pain condition and daily activities represent real difficulties in performing full time work. A finding of vocational independence would need some objective justification which is not found in the assessment by Dr Antoniadis. On balance, I find that the opinions of Dr Hancock and Dr Rajapakshare to be preferred. [47] Taking all those matters into account, I find that it is more likely that the appellant could not sustain the designiated work for 35 hours a week. [48] The appeal is therefore allowed. The review decision is quashed and the Corporation's vocational independence decision is set aside. The appellant will be entitled to her weekly compensation with effect from the date when it ceased. The appellant will have costs of $3,000 and reasonable disbursements. Judge D A Ongley District Court Judge