Opinion ID: 2539317
Heading Depth: 1
Heading Rank: 4

Heading: DIR proceedings

Text: After DIR enacted NAC 616C.476, the Association filed a petition with DIR, requesting that it amend NAC 616C.476 to include a section providing that a rating physician must not consider activities of daily living in determining the percentage of disability for the spine. [3] The Association argued that allowing rating physicians to consider activities of daily living when rating the percentage of disability of the spine would permit recovery for subjective complaints of pain, which contradicted NRS 616C.110(2)(c)'s requirement, reiterated in NRS 616C.490(5), that DIR's regulations [m]ust not consider any factors other than the degree of physical impairment of the whole man in calculating the entitlement to compensation. [4] DIR conducted a public workshop, see NRS 233B.061(2), where it heard testimony from six certified rating physicians, four of whom testified for the Association. Three of the Association's physician witnesses testified that an injury's impact on activities of daily living is subjective and often due to pain. Another testified that a physical impairment influences performance of activities of daily living but an inability to perform activities of daily living is not an impairment in itself. These physicians also testified that the consideration of activities of daily living is only one tool (among others such as diagnostic tests, physical examinations, patient history, and clinical judgment) that is utilized to make a determination regarding a person's physical impairment and that none of the tools, individually, amounts to a physical impairment that entitles a person to compensation. NAIW participated in the workshop and presented the testimony of two physicians, including Linda Cocchiarella, who is one of the editors of the fifth edition of the AMA Guides and a trainer and expert on the use of the AMA Guides. [5] Dr. Cocchiarella testified that consideration of activities of daily living is required for appropriate use of the AMA Guides; otherwise, the reliability of the ratings is negatively impacted. Dr. Cocchiarella further explained that activities of daily living are not purely subjective because the physician must use other information to validate the information that the patient provides, including questionnaires, physical therapy history, observation, and a functional capacity evaluation. Additionally, in making the impairment rating, the physician must first determine whether the patient has a physical impairment and, if so, only then does the physician evaluate the impact that the impairment has on the patient's activities of daily living. After DIR held the public workshop, but before it issued a decision, the Legislative Counsel Bureau (LCB), in a letter to Assemblywoman Barbara Buckley, addressed whether DIR may exclude the portion of chapter 15 of the 5th edition of the AMA Guides that relates to the ability to engage in activities of daily living. See LCB Letter to Assemblywoman Buckley in response to her question on this issue (March 30, 2004). LCB opined that the portion of Chapter 15 [of the AMA Guides ] at issue must be excluded from use, for the purposes of rating a permanent partial disability, if that material provides for compensation for impairments beyond physical impairments and must not be excluded otherwise. (Second emphasis added.) Therefore, LCB determined that the issue was whether consideration of activities of daily living is something other than physical impairment, as prohibited by NRS 616C.110(2)(c) and NRS 616C.490(5). DIR concluded that NRS 616C.490(5) does not require the exclusion of the portion of Chapter 15 of the Fifth Edition of the [AMA Guides ] that relates to the ability to engage in activities of daily living[.] DIR was persuaded by the variation between the fifth edition and earlier editions regarding activities of daily living, namely, that the fifth edition provides: Only impairments that interfere with activities of daily living qualify for an impairment rating based on the [AMA] Guides. Such impairments are ratable in terms of a percentage of the whole person. DIR assumed that the Legislature was aware of the changes made in the fifth edition of the AMA Guides regarding the use of activities of daily living, thus intending that rating physicians use activities of daily living as a consideration in measuring physical impairment of spinal injuries. Moreover, according to DIR, because the Legislature stated in NRS 616C.490 that the evaluation of the injured employee should include an evaluation of the loss of motion, sensation and strength, the Legislature intended to include consideration of the functional abilities of the employee when calculating the degree of physical impairment of the whole man. As a result, DIR concluded that NRS 616C.490(5) does not require that DIR amend NAC 616C.476 to exclude consideration of activities of daily living for spinal injuries.