GEORGE HUMFLEET MOBILE HOMES V DENNIS CHRISTMAN ; HON . DONNA H . TERRY, ADMINISTRATIVE LAW JUDGE ; AND WORKERS' COMPENSATION BOARD
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2003-SC-0047-WC
GEORGE HUMFLEET MOBILE HOMES
V
APPELLANT
APPEAL FROM COURT OF APPEALS
2002-CA-1332-WC
WORKERS' COMPENSATION BOARD NO. 00-96269
DENNIS CHRISTMAN ; HON . DONNA H. TERRY,
ADMINISTRATIVE LAW JUDGE; AND
WORKERS' COMPENSATION BOARD
APPELLEES
OPINION OF THE COURT
AFFIRMING
KRS 342 .730(1)(b) bases the calculation of a partial disability benefit on the
worker's impairment under the AMA Guides to the Evaluation of Permanent Impairment
( Guides ), "latest edition available ." Although the claimant's application was filed after
the Fifth Edition of the Guides was certified as being generally available, the
Administrative Law Judge (ALJ) relied upon an impairment that was assigned under the
Fourth Edition of the Guides when calculating the claimant's income benefit. In a twoto-one decision that was affirmed by the Court of Appeals, the Workers' Compensation
Board (Board) remanded the matter and directed the ALJ to rely upon an impairment
that was assigned under the Fifth Edition of the Guides . Although the basis for our
conclusion that a remand is required differs from that of the Court of Appeals, we affirm .
The claimant injured his lower back and neck on January 26, 2000, when he fell
from a ladder . He sought treatment in the local emergency room and then with Dr .
Adams, his family physician, who ordered a course of physical therapy and medication.
Eventually, he was referred to various specialists in orthopedic surgery, neurosurgery,
urology, and neurology . Dr. Lester, an orthopedic surgeon, diagnosed cervical and
lumbar sprain with possible coccydgodynia . Dr. Einbecker, also an orthopedic surgeon,
attributed the shoulder complaints to a C5-6 osteophyte complex . Dr. Kiefer, a
neurosurgeon, diagnosed a lower back contusion and aggravation of disc degeneration .
In July, 2000, Dr. Tibbs, a neurosurgeon, performed a cervical diskectomy and
fusion to correct severe central canal stenosis and neuroforaminal compromise at C5-6 .
The claimant later testified that the surgery did not relieve his cervical and upper
extremity pain and that his condition worsened. He developed facial numbness,
difficulty swallowing, loss of balance, and headaches . A neurologist diagnosed
migraine headaches and referred him to a pain management specialist . In November,
2000, the claimant began chiropractic treatment with Dr. Sipple . The ALJ noted,
however, that the claimant had previously received regular chiropractic treatment "as
part of a periodic health `tune up' during the preceding 20 years."
On March 1, 2001, the Commissioner of the Department of Workers' Claims
certified that the Fifth Edition of the AMA Guides was "generally" available. See 803
KAR 25:010E, § 1(9) . On August, 1, 2001, the claimant filed an application for benefits.
He introduced medical evidence from Dr. Adams and from Dr. Templin, a specialist in
occupational medicine and pain management .
Dr. Adams reported that a functional capacity evaluation that was performed in
October, 2001, "seems quite adequate and consistent with my interactions with [the
claimant] ." The physical therapist who performed the evaluation noted that the claimant
had "a plethora of complaints," some of which might be magnified in an attempt to get
attention. He was of the opinion that the claimant needed additional neurological and
orthopedic evaluations to determine the source of his problems and did not recommend
therapy until they were performed. He also noted that the claimant's "behavior
characteristics" and numerous complaints interfered with his "validity profile ."
Dr. Templin examined the claimant on March 26, 2001, at the request of counsel.
He diagnosed chronic low back pain syndrome, history of lumbar disc disease, history
of C5-6 disc herniation with cord compression, status post interior cervical diskectomy,
migraine headaches, and history of cerebral concussion . His March 26, 2001, report
indicated that under the Fifth Edition of the Guides the claimant had a combined
impairment of 25% (combined value charts, page 604) . Included in the total were: a
Category III cervical impairment of 15% (table 15-5, page 392) ; a Category 11 lumbar
impairment of 5% (table 15-3, page 384) ; and 7% impairment for pain (table 18-6, page
584) . Dr. Templin also imposed what the ALJ characterized as "severe" restrictions on
standing, walking, sitting, and lifting.
At the request of the claimant's attorney, Dr . Templin also prepared a
supplemental report, which was dated November 30, 2001 .
It indicated that the
previous evaluation was performed under the Fourth Edition of the Guides and that if
the findings on March 26, 2001, were rated under the Fifth Edition, the claimant's
impairment would be 34% (combined value charts, page 604) . Included in the total
were: 28% for DIRE Cervical Category IV (table 15-5, page 392) ; 3% for the effects of
the cervical condition on his ability to engage in activities of daily living (table 1-2, page
599); 5% for DIRE Lumbar Category II (table 15-3, page 384) ; and 3% for lumbar pain
(table18-6, page 584) .
The employer offered medical evidence from Dr. Snider, a specialist in
occupational and environmental medicine, and from Dr. Travis, a neurosurgeon . Dr.
Snider evaluated the claimant in October, 2000, and characterized the case as
"exceedingly complex and lengthy." His diagnoses were: lumbosacral contusion and
strain ; chronic low back pain, status post C5-6 diskectomy and fusion ; urogenital
complaints without objective abnormality; headaches ; intermittent hypertension ; bilateral
carpal tunnel syndrome and right ulnar neuropathy ; right upper extremity tremor; and
symptom magnification . He was of the opinion that most of the claimant's problems
were unrelated to the fall, and he noted a "fairly significant degree of symptom
magnification and some nonanatomical findings ." Using the Fifth Edition of the Guides ,
he assigned a 25% cervical impairment (DRE Category IV), 80% of which he
characterized as being "pre-existing active and/or dormant," and a 5% lumbar
impairment (DRE Category II), 50% of which he attributed to "pre-existing dormant
conditions."
Dr. Travis evaluated the claimant in December, 2000. He reported evidence of
symptom magnification, noting that the claimant complained of low back pain upon
straight leg raising at 15 and 20 degrees when recumbent but that, when sitting on the
table and distracted, he did not complain even at 90 degrees. He characterized the
sensory examination as "bizarre, nondermatomal, and varied ." Using the Fourth Edition
of the Guides , he assigned a 0% lumbar impairment (DRE Lumbosacral Category 1,
page 3/102) and a 5-15% cervical impairment (DRE Cervicothoracic Category 11 or III,
page 3/104), of which 90% was due to the natural aging process or pre-existing
spondylotic changes. He would permit the claimant to work without restrictions.
The claimant testified that he experienced constant cervical pain that radiated
into his arms and hands and into his head . He rated it at 7 or 8 on a 10-point scale . He
also complained of frequent migraine headaches and of lower back pain that radiated
into both legs . He maintained that he was unable to return to any gainful employment,
including the sales job that his employer had discussed with him.
When the claim was heard, the sole issue to be decided was the extent and
duration of disability. After reviewing the lay and medical evidence, the ALJ determined
that although the claimant sustained an injury that would decrease his ability to "resume
the heaviest employment," he was not totally disabled . Relying upon Dr. Travis, the AU
determined that the claimant's cervical impairment was 15%, and relying upon Dr.
Templin, the AU determined that his lumbar impairment was 5%. The income benefit
calculation was based upon a 20% impairment .
The claimant petitioned for reconsideration on the ground that Dr. Travis had
used the Fourth Edition of the Guides when assigning an impairment rating but that the
Fifth Edition was in use when his claim was considered . He urged the ALJ to apply the
tables in the Fifth Edition and, thereby, to increase the award. In response, the
employer pointed out that the claimant did not object to the introduction of Dr. Travis's
report or present any evidence to impeach his use of the Fourth Edition. Concluding
that the claimant had failed to raise a patent error in the opinion and that an AU was
not authorized to translate Dr. Travis's findings into a Fifth-Edition impairment, the ALJ
overruled the petition .
The Board's majority view was that in the interest of fairness to all parties, a claim
should be governed by the latest edition of the Guides that was generally available on
the date that proof time expired . In those claims where proof time expired before March
1, 2001, use of the Fourth Edition was required . In claims where proof time began after
March 1, 2001, use of the Fifth Edition was required . Where proof time spanned March
1, 2001, the majority determined that the AU was free to determine the weight and
credibility of impairments assigned under both editions. In such a claim, if a physician
examined the worker before March 1, 2001, and assigned an impairment under the
Fourth Edition, the AU was free to rely upon that physician . Likewise, if a physician
examined the worker after March 1, 2001, and assigned an impairment under the Fifth
Edition, the AU was free to rely upon that physician . Because the Fifth Edition of the
Guides was certified by the commissioner as being generally available before the claim
was filed and, therefore, before the time for introducing proof had commenced, the
majority determined that the claim must be remanded for an award that was based upon
an impairment that was assigned under the Fifth Edition of the Guides .
A dissenting opinion expressed the view that testifying physicians should be
required to use the latest edition available at the time of their examination or report and
should not be required to re-evaluate a worker simply because a new edition of the
Guides is certified as being generally available. Furthermore, in every claim, the AU
should be free to determine the weight and credibility of conflicting impairments . The
dissent concluded that because Dr. Travis used the latest edition available at the time of
his report, the ALJ was free to rely upon his opinion .
In contrast to either opinion at the Board, the Court of Appeals determined that
KRS 342 .730(1)(b) refers to the edition certified as being generally available "at the time
of the ALJ's award ." Nonetheless, the Court affirmed, noting that the Fifth Edition was
certified as being generally available before the ALJ's award . Appealing, the employer
maintains that nothing in KRS 342 .730(1)(b) refers to the date on which the "latest
edition available" should be determined . It asserts that although the regulations make it
clear when the latest edition becomes available, "they do not specify at what point in the
claims process the latest edition available should be determined ." Noting that KRS
342.730(1)(b) refers to a determination of impairment, the employer points out that an
ALJ does not determine impairment but only chooses one from those in evidence. It
argues, therefore, that the statute refers to the latest edition available at the time a
physician assigns an impairment rating .
The First Edition of the Guides was published by the American Medical
Association in 1971 to provide a standard for measuring the degree of functional
impairment caused by injuries and diseases . Since 1972, income benefits for
permanent partial disability have been awarded under KRS 342 .730 (1)(b). As
amended effective July 15, 1980, KRS 342.730(1)(b) permitted benefits to be awarded
based upon the percentage of "disability" under the 1977 Edition of the Guides . 1972
Ky. Acts ch . 104, § 15 . The words "latest edition available" appeared effective July
13,1990. 1990 Ky. Acts ch . 17, § 1 . At that time, the Third Edition of the Guides was
the latest available edition, and a worker's entitlement to income benefits was measured
under the Osborne v. Johnson , Ky., 432 S.W .2d 800 (1968), standard . The Fourth
Edition was published in 1993 . In 1996, the legislature revised Chapter 342 extensively .
It required the use of objective and standardized methods for determining that a harmful
change had occurred and severely restricted an ALJ's latitude in determining the extent
of permanent partial disability. See Ira A. Watson Department Store v. Hamilton , Ky.,
34 S .W.3d 48 (2000).
The claimant's injury occurred on January 26, 2000, at which time the formula for
calculating a partial disability award under KRS 342 .730(1)(b) was as follows :
For permanent partial disability, sixty-six and two-thirds percent (66-2/3°10)
of the employee's average weekly wage but not more than seventy-five
percent (75%) of the state average weekly wage as determined by KRS
342 .740, multiplied by the permanent impairment rating caused by the
injury or occupational disease as determined by "Guides to the Evaluation
of Permanent Impairment," American Medical Association, latest edition
available, times the factor set forth in the table that follows :
AMA Impairment
0 to 5%
6 to 10%
11 to 15%
16 to 20%
21 to 25%
26 to 30%
31 to 35%
36% and above
Factor
0.75
1 .00
1 .25
1 .50
1 .75
2.00
2.25
2.50
As adopted effective June 27, 2000, 803 KAR 25:010E, § 1(9) provided :
"Latest available edition" of the Guides means that edition which the
commissioner has certified as being generally available to the
department, attorneys, and medical practitioners. The commissioner shall
through certification issued to the Workers' Compensation Board, and
administrative law judges and posted prominently at the department's
hearing sites establish the date upon which a particular edition of the
Guides is applicable for the purposes of Chapter 342 .
The commissioner certified that the Fifth Edition of the Guides was generally available
on March 1, 2001 . This claim was filed subsequently, in August, 2001 .
A partial disability benefit is the product of three factors: 66 23% of the worker's
average weekly wage, an AMA impairment that is assigned under the "latest edition
available" of the Guides , and a statutory factor that increases with impairment . It is
undisputed that the impairment for a particular condition may be different using different
editions of the Guides . Yet, although the amount of a worker's impairment has a twofold effect on the amount of his income benefit, neither KRS 342.730(1)(b) nor the
regulations specify at what point in the history of a claim the latest edition available is to
be determined . Among the possibilities are: the date of the injury, the date that the
particular impairment is assigned, the date that the worker reaches maximum medical
improvement (MMI), the date that proof time expires, or the date of the ALJ's decision .
The employer maintains that it would be most reasonable to interpret KRS 342.730(1)(b)
as permitting an ALJ to rely on a physician who used the latest edition available at the
time the impairment rating was assigned .
Although the version of KRS 342.730(1)(b) that was effective on the date of the
claimant's injury governs the calculation of his income benefit, neither party has asserted
that the phrase "latest edition available" refers to the latest edition that was available on
the date of injury . An impairment rating is assigned when an injured worker recovers to
the point that his condition is stable, in other words, to the point that he is at MMI . It is
apparent from the frequency with which the Guides have been updated and from the
increasing size of successive volumes that the art and science of evaluating impairment
are continuously evolving . For that reason, we are convinced that the methods
prescribed in the most recent edition are likely to be the most accurate and may be used
without regard to the date of injury, just as the most recent life expectancy table may be
used . See Stovall v. Great Flame Coal Co. , Ky.App ., 684 S.W.2d 3 (1984) . We
conclude, therefore, that the use of a Fourth-Edition impairment was not required when
calculating the claimant's benefit simply because it was the latest edition available on
the date of his injury. We also conclude that because the methods prescribed in the
most recent edition are likely to be the most accurate, the impairment from which a
benefit is calculated must be based on those methods, regardless of the date of the
underlying medical evaluation or the date of MMI .
Despite the foregoing conclusions, we are convinced that the legislature did not
intend for the applicable edition of the Guides to be determined by the date of the ALJ's
decision . Under such an interpretation of KRS 342 .730(1)(b), proof time would end, the
hearing would be held, and the claim would be briefed, all before the parties knew for
certain what edition of the Guides governed the claim . We conclude, therefore, that the
phrase "latest edition available" refers to the latest edition that has been certified as
being generally available as of the date that proof time closes. We have observed many
times that one of the purposes of the 1996 amendments was to incorporate more
objective standards for awarding income benefits . For that reason, we are convinced
that although an ALJ is free to choose among impairments that were assigned under the
latest edition available at the closing of proof, an ALJ is not free to rely upon an
impairment that was assigned under an earlier edition. Two options are available in
instances where proof time spans the date on which a new edition of the Guides is
certified as being generally available . The ALJ may extend proof time and permit proof
to be re-taken under the latest edition where fairness dictates, or the parties may agree
to have the claim decided under the previous edition .
The employer argues that the claimant failed to object to Dr. Travis's testimony
insofar as it addressed his impairment and, therefore, was prohibited from asserting on
appeal that the ALJ erred by relying on it. It concludes, therefore, that the Board should
not have considered the unpreserved allegation of error. We disagree . Although an
impairment that was assigned under an edition other than the latest available may be
relevant for other purposes, it is not a proper basis for calculating an income benefit
under KRS 342 .730(1)(b) absent a stipulation of the parties . Thus, a calculation based
on the impairment would not be in conformity with Chapter 342 and would be subject to
the Board's review sua sponte . See Whittaker v. Reeder, Ky., 30 S .W .3d 138 (2000).
Finally, the employer maintains that a remand is unnecessary because there was
substantial evidence in the record to support a finding that the claimant's cervical
impairment under the Fifth Edition of the Guides was 15% . The employer explains that
Dr. Templin's March 26, 2001, report indicated that the impairment was assigned using
the Fifth Edition of the Guides and that all of the table and page references in the report
correspond to the Fifth Edition but not to the Fourth Edition. Dr . Templin referred to
pages 384, 392, 584, and 604, which the employer asserts could not be references to
the 339-page Fourth Edition. Furthermore, Dr. Templin referred to a formal "Pain
Related Assessment," a procedure that did not exist under the Fourth Edition. The
employer asserts that, despite Dr. Templin's subsequent statement to the contrary, the
impairment he assigned on March 26, 2001, was made under the Fifth Edition and was
substantial evidence of record to support the ALJ's finding of fact.
The employer is correct in its assertion that despite Dr. Templin's subsequent
statement, his March 26, 2001, report indicated that the impairment contained therein
was assigned under the Fifth Edition of the Guides . It may well be true that the report
could not possibly have been referring to an impairment that was assigned under the
Fourth Edition and that Dr. Templin simply changed his mind about the extent of the
claimant's impairment . The fact remains, however, that only an ALJ may judge the
weight and credibility of conflicting evidence . See KRS 342 .285 . What is clear is that
Dr. Templin's reports conflicted with each other and with the other medical evidence .
On remand, the AU must reconsider the evidence concerning the claimant's
impairment under the Fifth Edition of the Guides , choose among the Fifth-Edition
impairments in evidence, and base the award upon that impairment. An ALJ is not
authorized to interpret the Guides . Nonetheless, if the AU determines that an
impairment rating cites to tables and page numbers that are not found in the Fourth
Edition of the Guides , it would be reasonable for the ALJ to conclude that the rating was
not made under that edition. Furthermore, if two impairment ratings contain citations to
the same tables and page numbers and also state that they were made under the same
edition of the Guides , the ALJ could reasonably conclude that they probably were. The
fact remains, however, that when considering Dr . Templin's medical reports and the
other medical evidence, the ALJ could reasonably arrive at a number of different
conclusions . It is for that reason that a remand is required . No particular result is
compelled except that the claimant's award must be based on an impairment that was
assigned under the Fifth Edition of the Guides .
The decision of the Court of Appeals is affirmed .
All concur.
COUNSEL FOR APPELLANT :
Bennett Clark
723 Haverhill Drive
Lexington, KY 40503-3426
Carl Martin Brashear
Hoskins Law Offices, PLLC
P .O. Box 24564
Lexington, KY 40524-4564
COUNSEL FOR APPELLEE :
John E . Anderson
Cole, Cole, Anderson & Nagle, PSC
P.O. Box 250
104 Knox Street
Barbourville, KY 40906
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