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7/28/2019 Giorgis Khamo to RKA
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5 July 2012
Your Ref: RK: SV: 2009099
Our Ref: EM: MV: 120709GKRKA
Ron Kramer Associates Solicitors
P.O. Box 77
Fairfield NSW 2165
Dear Sir or Madam:
RE: Giorgis Khamo
DATE OF BIRTH: 19 September 1967
DATE OF INJURY: 1996, 1998, 2000 and nature and conditions of
employment
DATE OF ASSESSMENT: 5 July 2012
Thank you for asking me to see and assess Mr. Khamo, as requested in your letter of
referral, dated 3 July 2012. I confirm that I have reviewed the supplied documentation as
follows:
1. Copy of report from Dr. Matalani dated 16 September 2010.
2. Copy of injuries from previous letters dated 2 September 2010:
13 April 1996 neck left shoulder and left arm.
19 October 1998 back.
16 May 2000 right arm and elbow.
Due to nature and conditions 1 November 1995 and 28 September 2001
neck, back, right arm, and sexual function (the Commission found the left
shoulder and left arm injury also but the appeal panel held that he had fully
recovered from that injury). 13 April
Mr. Khamo attended the assessment on 5 July May 2012. The following details were
obtained at interview unless otherwise stated. My medical report now follows.
History of Presenting Condition:
Mr. Khamo was employed by Franklins Ltd. as a full time store person. He commenced
employment in 1995. The nature of his work required him to lift and carry heavy boxes
up to 16 kg.
Dr. Elias MatalaniMBBS, DOH, MPH, FAFOM (RACP), CIME
Consultant Occupational PhysicianWorkCover Trained Impairment Assessor
MAA Accredited Impairment Assessor
Ground floor, 255 The BroadwayBroadway 2007
Telephone: 02 9282 6794Fax: 02 8079 6970
Email:[email protected]
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Giorgis Khamo Dr Elias Matalani 5 July 2012 Page 2
He informed me that on 13 April 1996, whilst lifting heavy boxes at work, he developed
pain in the left shoulder and neck. He consulted Dr. Youssef and was treated
conservatively and continued at work. His symptoms intensified and he consulted Dr.
John Atto, who referred him for X-rays of the neck and a CT scan. This was performed
in September 1996. He was then referred to Dr. Kai Lee who administered an injectionto the left shoulder and advised swimming.
He returned to normal duties but had pain in the neck, left side of the neck and left
shoulder. He saw the company doctor and was referred to a chiropractor.
The pain in his neck and left shoulder and arm increased and he developed numbness in
the left hand. He was referred to Dr. Matthew Giblin, orthopaedic surgeon. He was
prescribed anti-inflammatories and referred to physiotherapy. He went off work
intermittently.
He subsequently saw Dr. Martin Raftery, Sports Physician, who gave him an injection inthe left shoulder. He continued on light duties and afterwards returned to normal duties.
On 19 October 1998 he hurt his back while lifting heavy weight. He had MRI of the
back and was referred for physiotherapy and had acupuncture and hydrotherapy. He was
subsequently transferred to a different section called the security cage where he had to
repetitively lift various items out of boxes. He was using his right hand frequently and
consulted Dr. Atto who treated him with anti-inflammatories and physiotherapy. He
developed right elbow pain and was diagnosed with right lateral epicondylitis. He was
also given an elbow support.
His pain intensified and he was referred to Dr. Kai Lee and went off work. He was given
an injection in the right elbow. He continued with physiotherapy and returned to light
duties.
The company closed down and he was retrenched from his position in September 2001.
He saw Dr. Ghabrial and was referred for ultrasound of the right elbow. This
demonstrated partial dysfunction at the common extensor insertion. He saw Dr. Matthew
Giblin and was referred for MRI of the right elbow. This was performed in August 2003
and demonstrated appearances consistent with lateral epicondylitis.
He saw Dr. Chen and had acupuncture treatment. He wore a thermo skin support. Hisrehabilitation was coordinated by Energise and he underwent a real estate course but
could not complete the course, as it required a good level of English.
Mr. Khamo was assessed by the AMS from the Workers Compensation Commission in
2006 and was also assessed by the Medical Appeal Panel with the determination date of
5 December 2006 and was assessed as follows:
10% loss of use of the left arm at or above the elbow and 3.75% cervical impairment
as a consequence of the injury on 13 April 1996.
6.25% back impairment and consequently 1.5% loss of use of the left leg at or above
the knee and 3.75% right leg at or above the knee as a consequence of the injury on19 October 1998.
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6.25% loss of use of the right arm at or above the elbow as a consequence of the
injury on 16 May 2010.
As a consequence of the nature and conditions 28 September 2001, further 3.75%
neck impairment, further 6.25% back impairment, further 3.75% right leg loss of
use, left leg impairment remains at 1.5% and 10% loss of sexual function.
Deterioration and Residual Symptoms:
Mr. Khamo tells me that after the above assessment, his condition gradually deteriorated
and he was unable to complete the Real Estate Course.
With the persistence of his radicular pain in the legs, his doctor referred him to a
Neurosurgeon, Dr. Abrazsko, who referred him for MRI of his lower back
approximately six to eight months ago (report not available). He was advised to have
injections to the back but he declined for fear of complications.
He was prescribed Lyrica but his symptoms persist. However, he participated in a Peak
Conditioning Program. His condition further deteriorated with increasing pain in the
neck and particularly on the left side of the neck and in the back with significant
radiation to his right leg. He was referred to Dr. Guirgis, Orthopaedic Surgeon, who
advised continuation of conservative treatment.
He tells me that with the favouring of his right elbow, he overused his left elbow and
developed pain and Dr. Atto referred him for an injection into the left elbow. This was
performed at Westmead Hospital in early August 2010.
The pain in the neck became constant and he had pain on the left side of the neckradiating down to the left shoulder region and upper part of the arm with intermittent
pins and needles in his hands affecting mainly the little and ring fingers. The pain in the
back also radiated down to the right side of the lower back and right buttock down to the
right leg with posterior and lateral pain in the right thigh to the ankle level and he gets
weakness in the leg and sometimes pins and needles. He also gets some pain in the left
side but not as much as the right side.
The pain in the left shoulder persisted and increased and he gradually developed
increasing pain in the right shoulder. He relates the increase of the right shoulder pain
due to favouring the left shoulder and overusing the right shoulder. He saw his doctor
and was given painkillers and was later referred for physiotherapy.
His symptoms persisted and he was referred to Dr. Noel Dan, Neurosurgeon, who
referred him for further investigations. He is awaiting approval for MRI of the spine as
well as left shoulder investigations (ultrasound).
The pain in his right elbow has become constant and he overuses his left elbow with
increasing pain.
The combination of his symptoms and the effect of his medications prevent him from
enjoying normal sexual life. He stated that sexual activities are becoming uncomfortable
and the frequency of his sexual activities has declined significantly. He estimated that
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after his injuries and since approximately 2004 the frequency of his sexual activities has
declined by approximately 90%.
Impact on Activities of Daily Living:
He estimated that after ten minutes walking his back hurts and he needs to stop.
Standing is possible for five minutes or so and then he needs to sit down and rest. After
fifteen minutes sitting down he develops pain in the neck and back and needs to change
posture. He can drive up to twenty five minutes but sometimes he is unable to drive
because of his symptoms. The cold weather aggravates his symptoms. The pain disturbs
his sleep. Coughing and sneezing sometimes precipitates pain in the neck and back.
He lives in a three-bedroom house. His symptoms make it difficult for him to carry out
his general household duties. He can do very minimal cleaning and vacuuming but does
it with pain and needs frequent rest breaks. He can no longer do any gardening or lawn
mowing. He cannot hang the washing on the line. When he goes shopping he can onlydo light shopping, as he cannot tolerate lifting heavy bags or pushing heavy trolleys.
He only makes his bed very lightly and roughly to avoid bending the neck and back. He
is unable to scrub the floors, clean the bathroom, shower and toilet. He relies heavily on
his wife to do the housework. He tells me that his wife is currently his carer.
Current Treatment:
He takes Mobic for his symptoms daily. He also has to take Somac to avoid
complications and in addition he is on Lyrica and Cymbalta.
Relevant Past and Medical History:
He had a right inguinal hernia operation in April 2008. He denies any pre-existing
symptoms and stated that his back, neck, legs and arms were asymptomatic when he
commenced employment with Franklins Ltd.
Relevant Social History:
Mr. Khamo came to Australia in 1995 from Iraq. His employment with Franklins was
his first employment in Australia. He worked from 1995 until 2001.
He is married and has three children. He is left hand dominant. He does not smoke and
does not consume alcohol. He used to enjoy playing soccer and riding the pushbike but
could no longer do so since his injury.
Educational and Occupational History:
He was retrenched from his employment in 2001. He underwent rehabilitation and was
assisted by a rehabilitation provider. Approximately ten weeks ago through the
rehabilitation provider he was able to obtain work trial as sales assistant at a shop that
sells camping equipment and fishing gear. He gradually increased his hours until he
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reached three days a week, five hours a day. This is his current hours and he is due to
complete the work trial tomorrow.
He stated that he worked primarily on restricted duties with no heavy lifting and no
bending of the neck or back.
The above history was dictated in Mr. Khamos presence and confirmed.
Relevant Investigations:
X-rays and ultrasounds of the right elbow dated 3 October 2002 demonstrated a
partial dysfunction of the common extensor insertion.
MRI of the neck dated 25 February 1997 demonstrated no significant abnormality.
Bone scan dated 8 May 1997 demonstrated no abnormality.
CT scan of the cervical spine dated 16 September 1996 demonstrated no significant
abnormality. A CT of the upper thoracic spine dated 16 September 1996 was normal.
MRI of the right elbow dated 22 August 2003 demonstrated appearances consistent
with lateral epicondylitis. The extensor aponeurosis was markedly thin and
oedematous and consistent with a grade 2-3 partial tear.
MRI of the cervical spine dated 27 April 2007 was reported as showing early
desiccation of the C5/6 and C6/7 intervertebral discs with mild central posterior disc
protrusion at C5/6 and a broader based disc bulge at C6/7 level.
MRI of the left shoulder dated 19 June 2007 demonstrated changes consistent with
supraspinatus tendinosis and subdeltoid subacromial bursitis. There was thickening
of the coracoacromial ligament near its acromial insertion, which may reflect
sequelae of prior trauma or chronic stranding.
MRI of the lumbosacral spine dated 16 July 2007 demonstrated minor posterior
central disc protrusion at L4/5, which indents the anterior thecal sac. There was mild
loss of the L5/S1 intervertebral disc height.
Examination:
Mr. Khamo was walking with a slow gait. There was no apparent limping. He was
unable to squat because of pain in the lower back. He was irritable standing on his toes
or walking on his toes and walking on his heels.
Neck:
He pointed to the back of the neck and the right side of the neck as the site of pain and
tenderness. The active forward flexion of the neck was reduced to 60% of normal.
Extension was 50% of normal. Lateral flexion and rotation to the right was possible to
70% of normal. Lateral flexion and rotation to the left was nearly 60% of normal
inducing pain on the right side of the neck. There were no crepitations and no
complaints of radicular pain. The vascular state of both upper limbs was normal. There
was no sensory neural abnormality in the upper limbs. His upper limb reflexes were
present and equal.
Upper Limbs:
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He complained of tenderness over the epicondyle bilaterally. There was no unilateral
muscle wasting in the lower limbs. There was mild-to-moderate tenderness on palpation
of both lateral epicondyles. Putting the extensor muscles on the stretch increases the
pain. There was altered sensation to light touch and pin prick in his ring, and index
fingers bilaterally.
He complained of tenderness in the anterior aspect of each shoulder and stated that it
radiates down to the upper part of the arms. The following active range of motion was
obtained with the Goniometer:
Abduction 85 on the left and 110 on the right.
Adduction 30 on the left and 40 on the right.
Flexion 90 bilaterally.
Extension 40 bilaterally.
External rotation 40
on the left and 60
on the right.
Internal rotation 30 on the left and 35 on the right.
The range of movement of his elbows was full bilaterally but there was increase of pain
in the lateral epicondyle at the extreme of flexion bilaterally.
Back:
He pointed to the lower back and right side of the lower spine, right buttock and right
thigh as the site of pain and tenderness. The active forward flexion of the spine was
possible to approximately 50% of normal. Extension was reduced to less than 50% of
normal. Lateral flexion and rotation to the left was reduced to nearly 50% of normal.Lateral flexion and rotation to the right was possible to 70% of normal.
The straight leg-raising test was restricted to 50 on the right inducing pain in the right
buttock and right thigh. On the left, it was possible to 60 inducing pain in the lower
back and right side of the lower back.
Comparative circumferential measurements taken at maximal girth demonstrated the
right calf measured 37.2 cm and the left calf 36.7 cm. When measured at 10 cm above
the proximal pole of the patella, the right thigh measured 50.4 cm and the left thigh 50.6
cm. His lower limb reflexes were present and equal. There was no sensory neuraldysfunction in the lower limbs.
Diagnosis and Opinion:
As a result of the injury on 13 April 1996 Mr. Khamo suffered soft tissue injuries and
chronic strain of the neck, left shoulder tendonitis and bursitis.
As a result of the injury on 19 October 1998 he suffered chronic musculoligamentous
strain of the back with nerve root irritation to the right leg.
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As a result of the injury on 16 May 2000 he suffered injury to his right elbow with
epicondylitis and with favouring his right elbow and overusing his left elbow he
developed epicondylitis in the left elbow, requiring injection.
As a result of the combination of his injuries and possibly the effect of his medication he
suffered secondary sexual dysfunction.
His injuries are consistent with the stated cause. His employment has been a substantial
contributing factor to the development of his current disabilities.
Prognosis and Stabilisation:
His long-term prognosis is guarded. His condition is unlikely to change substantially
with or without further medical treatment and his injuries have stabilised and reached
maximal medical improvement.
After his assessment in 2006 his condition gradually deteriorated and he had increasingpain and radiation from the back to the legs and saw a neurosurgeon and underwent MRI
of the lower back. He also was prescribed different medications including Lyrica and the
pain in the neck radiated down to his left side of the back and left arm with pins and
needles and saw an orthopaedic surgeon. In addition he developed increasing pain in the
left elbow as a result of favouring (protecting) his right elbow and was referred for
injection. His symptoms increased and he was recently referred to Dr. Dan,
Neurosurgeon, who referred him for further investigations and he is awaiting approval.
Assessment of Impairment:
As a result of the injury on 13 April 1996 I assess Mr. Khamos:
Permanent loss of use of the left arm at or above the elbow at 15%.
Permanent impairment of the neck at 5%.
As a result of the injury on 19 October 1998 I assess Mr. Khamos:
Permanent impairment of the back at 10%.
Permanent loss of efficient use of the left leg at or above the knee at 2%.
Permanent loss of efficient use of the right leg at or above the knee at 10%.
As a result of the injury on 16 May 2010 I assess Mr. Khamos:
Permanent loss of use of the right arm at or above the elbow at 10%.
As a result of the nature and conditions of employment from 1 November 1995 to 28
September 2001, I assess Mr. Khamos:
Permanent impairment of the neck at 5%.
Permanent impairment of the back at 15%.
Permanent impairment of the right leg at or above the knee at 5%. Permanent loss of efficient use of the left leg at or above the knee at 0%.
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Permanent loss of efficient use of the right arm at or above the elbow at 7%.
Permanent loss of sexual function at 15%.
There is also impairment in relation to his secondary symptoms in his left elbow which
is secondary to favouring (protecting) his right elbow as a result of the injury on 16 May
2010 and the following is my assessment:
Permanent loss of efficient use of the left arm at or above the elbow at 5%.
CODE OF CONDUCT
I certify, I have read the Expert Witness Code of Conduct and I agree to be bound by
that Code. To the best of my ability, this report has been prepared in accordance with
the Code.
Thank you once again for referring Mr. Khamo. If I could be of further assistance in thiscase, please do not hesitate to contact me.
Yours faithfully,
Elias Matalani
MB BS DOH MPH FAFOM (RACP)
Consultant Occupational Physician
MAA Accredited Impairment AssessorWorkCover Trained Impairment Assessor