Appeals Panel Concludes that DD Can Use Two Tables to Rate Knee Injury
The appeals panel has reversed a hearing officer’s determination and rendered a decision that an injured worker’s 16% impairment rating, following a knee injury, became final under the 90-day rule. In reaching its decision, the appeals panel ruled that it was within the designated doctor’s medical judgment to rate the claimant’s right knee injury by utilizing more than one Table to arrive at the impairment rating. The appeals panel’s decision in Appeals Panel Decision Number 151869 was rendered on November 18, 2015.
The hearing officer found that there was compelling medical evidence of a significant error in applying the appropriate Guides to the Evaluation of Permanent Impairment, fourth edition that caused the designated doctor’s certification of MMI and assignment of IR to constitute an exception to finality under the 90-day rule. Specifically, the hearing officer determined that the designated doctor had assessed a 16% IR based on 3% whole person impairment for right thigh atrophy from Table 37 (“Impairment from Leg Muscle Atrophy”) on page 3/77, 5% WPI for right calf atrophy from Table 37, and 8% WPI for loss of range of motion for the right knee from Table 41 (“Knee Impairments”) on page 3/78. The doctor had combined those individual ratings, resulting in a whole body impairment rating of 16% IR. The hearing officer stated in the Discussion portion of the decision that the designated doctor had assigned an IR for both ROM and atrophy in arriving at a 16% IR, and that “it is clear from the [AMA Guides] that one cannot use both methods to derive an appropriate [IR].”
The appeals panel concluded that the findings were “not supported by the evidence and is legally incorrect.”
In Appeals Panel Decision (APD) 040147, decided March 3, 2004, the designated doctor assessed a 17% IR based on 3% impairment from Table 37 (“Impairment from Leg Muscle Atrophy”) on page 3/77, 4% impairment for loss of ROM from Table 41(“Knee Impairments”) on page 3/78, and 10% impairment from Table 62 (“Arthritis Impairments Based on Roentgenographically Determined Cartilage Intervals”), combined to result in the 17% IR. In that case, the RME doctor opined that it is improper to combine the Tables because it would result in rating the claimant’s arthritic condition twice (once in Table 37 and again in Table 4) and this constituted “stacking” or “piling on.” Both the designated doctor and the hearing officer also cited Section 3.2 page 3/75 of the AMA Guides to say that:
In general, only one evaluation should be used to evaluate a specific impairment. In some instances, however, as with the example on p. 77, a combination of two or three methods may be required.
In that case, the hearing officer accorded presumptive weight to the designated doctor’s report and commented that the designated doctor had the discretion to utilize more than one Table to arrive at the IR. The Appeals Panel affirmed the hearing officer’s IR determination and noted that no provision in the AMA Guides specifically precludes the designated doctor’s approach to assessing the claimant’s IR and that it was a difference in medical judgment on how to rate the claimant’s injury.
In the instant case, as in APD 040147, supra, the designated doctor assessed an impairment for the claimant’s compensable injury and it was within his medical judgment on how to rate the claimant’s right knee injury by utilizing more than one Table to arrive at the claimant’s IR. We hold that under the facts of this case, that Dr. H’s assignment of a 16% IR using Table 37 and Table 41 does not, by itself, constitute compelling medical evidence of a significant error in applying the appropriate AMA Guides under Section 408.123(f)(1)(A).
The case contains two lessons: 1) don’t delay in disputing a certification of MMI/IR with which you disagree or it may become indisputable; and 2) knee injuries may be susceptible to higher impairment ratings than you have encountered in the past.
FOLIO
