Opinion ID: 2264940
Heading Depth: 2
Heading Rank: 2

Heading: The Guides

Text: This court has not examined the Guides or the meaning of their adoption in K.S.A. 44-510d(a)(23). According to the foreword, the Guides' stated purpose is `to bring greater objectivity to estimating the degree of long-standing or permanent impairments.' Guides, p. v. This is accomplished by performing medical evaluations in accordance with the directions in the Guides. Guides § 1.2, p. 3. The first step under the Guides is assessment or evaluation. This requires a documented medical evaluation and review of a patient's case history. The Guides contain chapters on each organ system, and each chapter contains descriptions on ways to evaluate the body part, function, or system. Guides § 1.2, p. 3. The Guides' methods for evaluating impairments to the upper extremities are outlined in Chapter 3, relating to the musculoskeletal system. The hand and upper extremity sections cover the thumb, finger, wrist, elbow, and shoulder regions. Guides §§ 3.1a-3.1o, pp. 15-74. The second step requires combining impairments. The Guides instruct physicians to combine impairments to the same member and then convert that impairment to the next larger unit. For example, multiple injuries to the same thumb are combined. Then, the total thumb impairment is converted to a hand or regional impairment. All regional impairments, i.e., hand, wrist, and shoulder, are combined to generate a total impairment to the upper extremity. Ultimately, this upper extremity calculation is converted into a whole body impairment. Guides §§ 3.1e, 3.1n, pp. 24, 65. These calculations are performed whether it is a single injury, i.e., impairment to one hand, or multiple injuries, i.e., impairment to the hand and shoulder. Guides § 3.1o, pp. 66-74. Guides § 3.1e, p. 24, entitled Combining Impairment Values, demonstrates how to combine impairments for the same member, i.e., one finger with two impairments, and how to combine multiple regional impairments, i.e., the hand, wrist, and shoulder. It states: When there is more than one impairment of a member, such as abnormal motion, sensory loss, and amputation of a finger, the impairments must be combined before the conversion to the next larger unit, in this case the hand, is made. The method for combining impairments is based on the idea that a second or a succeeding impairment should apply not to the whole, but only to the part that remains after the first and other impairments have been applied. . . . The Combined Values Chart on p. 322 may be used to determine the combined value of two impairment percents or, in succession, any number of impairment percents. . . . . Multiple regional impairments, as with those of the hand, wrist, elbow, and shoulder, are expressed in terms of impairment of the upper extremity and are combined using the Combined Values Chart. The Chart is used also to combine impairments of two or more organ systems and express these as a whole-person impairment. Guides § 3.1n, p. 65, entitled Combining Regional Impairments to Obtain Impairment of the Whole Person, instructs a physician to combine regional impairments, i.e., hand, wrist, or shoulder, into a whole body impairment. The first step is to covert these impairments into a value for the upper extremity. Then, the Guides § 3.1n, p. 65, convert the upper extremity impairment into a whole body impairment, stating: 1. Determine the impairments of each region (hand, wrist, elbow, and shoulder joints) as described in preceding sections. 2. Use the Combined Values Chart (p. 322) to combine impairments to the upper extremity contributed by each region. . . . . 3. Use Table 3 (p. 20) to convert impairment of the upper extremity to impairment of the whole person. Guides § 3.1o, pp. 66-74, entitled Summary of Steps for Evaluating Impairments of the Upper Extremity, provides instructions for calculating upper extremity awards and combining them into whole body impairments. This summary instructs physicians to convert a singular injury into a regional impairment and then a whole body impairment, even if there are no other injuries. This is demonstrated by the Guides § 3.1o (I. Hand Region), p. 66, pertaining to calculating a hand impairment, which states: G. Total hand impairment: add the hand impairment values related to the involved digits. H. Convert hand impairment to upper extremity impairment. (Table 2, p. 19) . . . . K. If no other upper extremity impairment exists, convert the upper extremity impairment related to the hand region to a whole-person impairment (Table 3, p. 20). These instructions also are included at the bottom of Figure 1, which is titled Upper Extremity Impairment Evaluation Record. Guides § 3.1a, p. 16. As is easily seen from the above description, Kansas Truck Center is correct that the Guides contemplate converting a worker's injury into a whole body impairment. But that does not resolve the inquiry. We next consider Kansas Truck Center's claim in light of the consideration given to the Guides by the legislature when it included reference to them in the statutes.