Opinion ID: 1348729
Heading Depth: 1
Heading Rank: 7

Heading: Permanent partial disabilityloss of use

Text: Department determined that Employee was entitled to a 40 percent permanent partial disability rating based on the loss of use analysis recognized in Cozine v. Midwest Coast Transport, Inc., 454 N.W.2d 548 (S.D.1990). Although Dr. Cass gave Employee a 15 percent medical impairment, Department also considered evidence of Employee's extensive loss of time necessary each day for treatment of his injury (40 percent), the fact that he spends his free time engaged in sedentary activities, his lost earning capacity of 35 percent as measured by the fact that he was no longer able to work at Safety Kleen, and his loss of strength (90 percent, measured by a functional capacity assessment). Other than the testimony of Dr. Cass, no other medical doctor or any vocational expert testified on Employee's loss of employability or loss of use. Employers contended before the circuit court that expert testimony was necessary before Department can establish a loss of use disability rating. Circuit court rejected Employers' expert testimony argument but did remand the determination to Department with instructions that it not consider Employee's second job at Safety Kleen in assessing Employee's reduced earning capacity. Circuit court reasoned that it was inappropriate for the Department, in assessing Employee's true loss of his earning power, to consider the loss of a second job he never intended to perform. Employee appeals this remand and Employers have filed a notice of review on the expert testimony issue. While we agree with circuit court that Department's determination should be remanded, we have a different reason for a remand. In deciding Employee's loss of use, Department considered, among other things, the time Employee spent each day for treatment of his injury and the fact that he spends his free time engaged in sedentary activities. These factors bear on his loss of enjoyment of life rather than his impaired ability to earn a living. In our opinion, Department has read our holding in Cozine , supra , in a far broader manner than we intended. In Cozine , 454 N.W.2d at 551 and 552, we held that: SDCL 62-4-6 specifies the amount of compensation an employee shall receive for the loss of a part of the body or its loss of use. The clear language of this statute directs that compensation shall be paid for loss of use. Consequently, the hearing examiner must determine if, and to what extent, a claimant has suffered the loss of use of a part of the body. This determination requires more than a mere adoption of a medical evaluation of anatomical impairment. In speaking of the limited nature of a medical impairment rating we went on to quote from the American Medical Association, Guide to the Evaluation of Permanent Impairment , x (2d ed. 1984): The physician who makes a determination about impairment must keep in mind that a permanent impairment rating is not the same as a disability rating. Permanent medical impairment is related directly to the health status of the individual, whereas disability can be determined only within the context of the personal, social, or occupation demands , or statutory or regulatory requirements that the individual is unable to meet as a result of the impairment. Id. at 552. (emphasis added). When we quoted the above emphasized language, we did so for illustration only and did not intend to say that an employee should be compensated under our act for any impairment of his personal/social life. Our holding in that case must be read in light of the overall purpose of our worker's compensation law. Our act is designed to compensate an employee or his family for the loss of his income-earning ability which loss is occasioned by an injury, disablement, or death because of an employment-related accident, casualty, or disease. The act guarantees employees compensation irrespective of tort law considerations and in return employees forego the right to a one hundred percent recovery. Employers, on the other hand, accept responsibility for injuries they might not otherwise be responsible for at common law and in return their liability is fixed and limited. Stevenson v. Douros, 58 S.D. 268, 235 N.W. 707 (1931). With the exception of certain items (such as medical, hospital, and burial expenses), SDCL Chapter 62-4 provides that compensation shall be paid pursuant to definite schedules. See SDCL 62-4-3, 4, 5, 6, 7, and 12 et seq. All of the schedules are based upon the employee's loss of wage-earning power; that is, what would the employee have expected to earn if he had not been victimized by an employment-related accident, casualty, or disease. See SDCL 62-4-24, 25, 26, 27, and 28. We hold that a disability rating due to a loss of use of a body member can, under the provisions of SDCL 62-4-6, only be considered in the context of what effect it would have on the employee's income-earning capability and that any effect it has on his personal or social life is not a relevant consideration. Employers assert that our decision in Cozine , supra , implicitly requires expert testimony arguing that we ruled that it was error for the Department to refuse to consider the testimony of Cozine's vocational expert and medical expert regarding her impairment. Employers' reading of what we said is selective. What we said was: The hearing examiner should have considered other evidence, such as the testimony of Cozine's vocational expert regarding loss of employability and the deposition testimony of Dr. Opheim that any activity that would involve use of [Cozine's] right upper extremity she would be unable to do. 454 N.W.2d at 552 (emphasis added). The issue in that case was whether the Department erred in refusing to hear evidence on loss of use. We did not decide or consider whether a determination of loss of use requires expert testimony on the percentage of disability. In the alternative, Safety Kleen argues that lay people do not have sufficient knowledge to assign percentages of permanent partial disability when the assignment is based on loss of use. It argues that, although this determination may not be exclusively within the province of medical experts, it nevertheless requires testimony of established experts familiar with disabilities and their effect on one's employment or loss of use. Expert testimony is required when the subject matter at issue does not fall within the common experience and capability of a lay person to judge. Podio v. American Colloid Company, 83 S.D. 528, 162 N.W.2d 385 (1968). In such a case the testimony of an expert is necessary to assist the fact-finder in reaching a decision. While there may be cases where an expert's testimony on loss of use, over and above a medical impairment, may be only advisable rather than essential, we hold that as a general rule and under the facts of this case the testimony of a vocational expert (or some other like expert) is required before the Department can establish a disability rating. Although Department's hearing examiners may hear many cases, we are not prepared to imbue them with any particular expertise when it comes to establishing a permanent partial disability rating based on an employee's loss of use of a body part. In our opinion the analysis required in all but a rare possible case is of sufficient complexity and is of such a nature that the trier of fact must be enlightened by an expert before a rational decision can be made. Ergo, we reverse circuit court on this issue. [2] Given our holding on the expert witness issue, we prefer to leave for another day the question of what effect, if any, a disability may bear on a claimant's loss of employability because he can no longer work a second job of a temporary nature.