Giorgis Khamo to RKA

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]
mailto:[email protected]:[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

Documents

Giorgis Khamo to RKA