FOLIO

AP Affirms its Authority to Recalculate IR on Appeal

Feb 3, 2023 | by FOL

In APD 221773, decided December 21, 2022, the AP was confronted with an IR adopted by the ALJ below that contained a mathematical error.

The ALJ adopted the 14% IR assessed by the designated doctor, Dr. B.  However, the AP determined that Dr. B assigned impairment for the left shoulder that contained an error, and this resulted in an incorrect whole body impairment rating.

Specifically, they noted that Dr. B correctly assigned 2% UE impairment for 150° of flexion, 0% impairment for 50° of extension, 4% impairment for 100° of abduction, 0% impairment for 40° of adduction, and 0% impairment for 85° of internal rotation. Dr. B also assigned 0% impairment for 50° of external rotation. Figure 44 on page 3/45 of the AMA Guides provides that 50° of external rotation results in 1% impairment, not 0% impairment as assigned by Dr. B.

Adding the correct UE impairments for the left shoulder results in 7% UE impairment, not 6% UE impairment as assigned by Dr. B. Combining 7% UE impairment with 10% UE impairment for the distal clavicle resection results in 16% UE impairment, not 15% UE impairment as assigned by Dr. B. Table 3 on page 3/20 of the AMA Guides provides that 16% UE impairment converts to 10% WPI, not 9% WPI as assigned by Dr. B.

Finally, 10% WPI for the left shoulder combined with 5% WPI for the cervical spine, 0% WPI for the thoracic spine, 0% WPI for the lumbar spine, 0% WPI for the head, and 0% WPI for the left wrist and elbow results in a total IR of 15%, not 14% as assigned by Dr. B.

The Appeals Panel noted they have previously held that, where the certifying doctor’s report provides the component parts of the rating that are to be combined and the act of combining those numbers is a mathematical correction which does not involve medical judgment or discretion, the AP can recalculate the correct IR from the figures provided in the certifying doctor’s report and render a new decision as to the correct IR. See APD 171766, decided September 7, 2017; APD 172488, decided December 18, 2017; APD 152464, decided February 17, 2016; APD 121194, decided September 6, 2012; APD 041413, decided July 30, 2004; APD 100111, decided March 22, 2010; APD 101949, decided February 22, 2011; and APD 221440, decided October 6, 2022.

Accordingly, the AP reversed the ALJ’s determination that the claimant’s IR is 14%, and rendered a new decision that the claimant’s IR is 15% as mathematically corrected.