Opinion ID: 1124392
Heading Depth: 1
Heading Rank: 6

Heading: Reliance on the AMA Guidelines

Text: Respondents contend that permanent total disability awards under NRS 616.580(1)(b) should be determined in the same manner as permanent partial disabilities under NRS 616.605(6), [8] to wit: by utilization of the American Medical Association Guides to the Evaluation of Permanent Impairment (AMA Guides). This position is taken despite the fact that NRS 616.580, the PTD apportionment statute, failed to provide its own mechanism or formula for the apportionment of prior existing disabilities, and makes no reference to the methods set forth for permanent partial disabilities (PPD) apportionment under NRS 616.605. Respondents argue, however, that the PTD and PPD apportionment provisions are mirror images of one another and must be read together in harmony. They contend that a harmonious reading of these provisions requires that the same formula be applied for both PTD and PPD apportionments, and that the omission of a formula from the PTD provisions manifests legislative intent that, for consistency in enforcement, the AMA Guides be used in both instances. Further, they argue that using the AMA Guides as required for PPD purposes, NAC 616.650 [9] of the Nevada Administrative Code, the regulation governing apportionment of permanent partial disabilities, provides parameters for apportionment of any permanent disability or impairment. Thus, SIIS directs its medical advisors to rely on NAC 616.650 for apportioning permanent total disabilities, and to utilize the AMA Guides. Accordingly, Dr. Brown apportioned thirty-six percent of Rosser's PTD pursuant to the AMA Guides and tables. Respondents therefore argue that we should give deference to SIIS' methodology and interpretation of NRS 616.580, NRS 616.605 and NAC 616.650, given the legislature's silence in this regard. We disagree. First, we note that the American Medical Association itself has recognized that the AMA Guides are ill equipped to rate such subjective factors as one's age, training or education. [10] Although the legislature has concluded that the guides are appropriate for evaluation of partial disabilities, we believe that the omission of the AMA Guides from the PTD provisions was based on legitimate concerns that such apportionments would be arbitrary or that the AMA Guides had less validity in the context of PTD awards. Thus, we hold that the Guides are but one of a number of resources that can be utilized in assessing the degree to which apportionment is appropriate. In SIIS v. Bokelman, 113 Nev.___, 946 P.2d 179 (1997), we held that apportionment of a permanent total disability award is proper if, in the absence of a prior industrial disability award, the inability to return to work was caused in part by a prior non-industrial disability. Id. at 183. [11] Here, Rosser's pre-existing heart condition may have played a role in the permanent cessation of employment. In this regard, we note that he originally claimed to have sustained stress aggravated heart palpitations and obtained a determination from the SIIS that he was suffering from post-traumatic stress syndrome. In our reading of the record below, we note that Dr. Brown, the physician who apportioned Rosser's award, could have provided substantive support for apportioning Rosser's PTD at the hearing held before the appeals officer. However, Dr. Brown gave short shrift to the underlying basis for his decision in his memorandum to SIIS. He merely noted Rosser's diagnosis and mechanically apportioned his award according to the AMA Guides. On remand, the SIIS must support its decision to apportion Rosser's PTD award with documentation comprehensively addressing the scope and nature of Rosser's preexisting heart condition. [12] SIIS must, per Bokelman, establish that Rosser's heart problems, separate and apart from the societal factors causing odd-lot disability, [13] [14] prevented him from returning to the work force in some other reasonably constructive capacity. [15] Thus, the SIIS must provide substantive documentation correlating application of the AMA Guide. [16] We have reviewed all of the other arguments and issues raised by the parties and conclude that they are without merit.