Appeals Panel Discusses Impairment Ratings for Chemical Burn Cases
The appeals panel has reversed the decision and order of a benefit contested case hearing officer that adopted a 9% impairment rating for an injury that resulted in a skin disorder following a chemical burn. The appeals panel remanded the case for the hearing officer to obtain a letter of clarification from the designated doctor. In doing so, the appeals panel discussed how, in its view, skin disorder injuries should be rated under the AMA Guides.
In Appeals Panel Decision No. 162301, decided January 4, 2017, the claimant was compensably injured while cleaning equipment on the jobsite when heated caustic chemicals and steam were released spraying his chest, abdomen, and lower and upper extremities causing second and third degree chemical burns for which he underwent surgical treatment including skin grafts. The claimant indicated that his activities of daily living have been affected by the injury in that he is now sensitive to heat and sunlight and cannot effectively perform outdoor activities and additionally, that his ability to write is impaired due to pain and tightness of the skin on his right hand. The claimant further testified that he uses over the counter skin lotions periodically to treat skin irritations when he is exposed to sunlight and that he attends biannual follow-up appointments with his doctors. The injury caused chemical burns over 45% of the claimant’s total body surface area.
Both the designated doctor and a referral doctor from the treating doctor assigned the same MMI date. The two doctors disagreed, however, on the claimant’s impairment rating. The designated doctor assigned a 9 percent whole body IR; the referral from the treating doctor assigned an 18 percent whole body IR.
Table 2 on page 280 of the AMA Guides describes the Impairment Classes and percentages for Skin Disorders, in part, as follows:
| Class 1: 0% – 9% impairment | Class 2: 10% – 24% impairment |
| Signs and symptoms of skin disorders are present or only intermittently present;
and There is no limitation or limitation in the performance of few activities of daily living, although exposure to certain chemical or physical agents might increase limitation temporarily; and No treatment or intermittent treatment is required. |
Signs and symptoms of skin disorders are present or intermittently present;
and There is limitation in the performance of some of the activities of daily living; and Intermittent to constant treatment may be required.
|
The appeals panel wrote that the hearing officer misread this table.
We note the hearing officer asserts that inclusion in Class 2 under Table 2, page 280 of the AMA Guides requires a showing that the claimant’s condition requires intermittent to constant treatment. We disagree. The Class 2 criterion regarding treatment is that intermittent to constant treatment may be required [emphasis added]. The criterion under Class 1 is that no treatment or intermittent treatment is required [emphasis added]. We note further that Dr. K’s narrative placing the claimant in Class 1 contains an inconsistency in that, as previously mentioned, Dr. K stated in his report that the claimant needs intermittent topical attention to his burn areas.
The hearing officer erred in determining that the claimant was not entitled to impairment under Class 2 of Table 2, page 280 of the AMA Guides for his skin disorder due to his failure to show that intermittent or constant treatment was required because the AMA Guides contain no such requirement for inclusion in Class 2. We accordingly reverse the decision of the hearing officer that the claimant’s IR is 9% and remand the issue of IR to the hearing officer for further action consistent with this decision.
The appeals panel remanded the case for further development of the evidence. Specifically, the appeals panel instructed the hearing officer on remand to send a request for clarification to the designated doctor asking that he explain why his assignment of an IR in this case under Class 1 of Table 2, page 280 of the AMA Guides is appropriate when he indicated in his report that the claimant needs intermittent topical attention to his burn areas.
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