Opinion ID: 6536841
Heading Depth: 3
Heading Rank: 1

Heading: The importance of the date of medical stability

Text: Tobar made claims for temporary total disability, permanent partial impairment, and medical benefits. A worker's eligibility for temporary total disability benefits ends at medical stability. 14 Medical stability is defined by statute as the date after which further objectively measurable improvement from the effects of the compensable injury is not reasonably expected to result from additional medical care or treatment, notwithstanding the possible need for additional medical care or the possibility of improvement or deterioration resulting from the passage of time; medical stability shall be presumed in the absence of objectively measurable improvement for a period of 45 days; this presumption may be rebutted by clear and convincing evidence. [ 15 ] Remington conceded in its answer that Tobar was eligible for temporary total disability benefits through what it claimed to be the date of medical stability: no later than August 12, 2013, two weeks following the alleged work incident. Medical stability can also affect a rating of permanent partial impairment. The Alaska Workers' Compensation Act requires that determinations of the existence and degree of permanent partial impairment be made strictly and solely under the American Medical Association Guides to the Evaluation of Permanent Impairment (the Guides). 16 The Guides uses maximum medical improvement (MMI) as the time when an evaluation of permanent impairment can be done. 17 The Guides has consistently evaluated different organs and body systems separately, using medical testing and examination to estimate the extent a particular organ or body system impairment limits a person's activities of daily living; thus an injured worker could reach MMI as to a particular impairment while having not yet reached medical stability. 18 In this case, however, because Tobar claimed disability only due to her back condition, the dates of MMI and medical stability may be the same. The date of medical stability was not only important, it was also contested. Remington admitted that Tobar suffered at least a temporary disability, arguing that she was medically stable as of August 2013, whereas Tobar, by claiming continuing temporary total disability, contended that she had not yet reached medical stability. Once an employee is disabled, the law presumes that the employee's disability continues until the employer produces substantial evidence to the contrary. 19 The Board found substantial evidence to overcome this presumption in Dr. Youngblood's medical report and testimony opining that [Tobar's] injury was relatively minor, and would have resolved within two weeks. But when the Board considered the next step in its analysis - whether Tobar could prove by a preponderance of the evidence that her disability was continuing - the Board rejected Dr. Youngblood's finding of a two-week  disability, deciding instead that the medical evidence supports [Tobar's] contention that the symptoms continued beyond that. There is certainly evidence supporting this finding, including Wilson's October 2013 report in which she told Remington's insurance carrier that Tobar had not yet reached maximum medical improvement and Wilson's further treatment recommendations in January, February, and March 2014. The date on which the Board settled was the date of Dr. Youngblood's EME, March 20, 2014, after which it decided Tobar was no longer entitled to benefits for temporary total disability. The Commission decided that substantial evidence supported the Board's decision, but it never identified and did not discuss the evidence supporting March 20, 2014 as the date of medical stability. Ultimately, while the evidence supported the Board's finding that Tobar's disability continued beyond August 2013, the question we need to consider is whether the evidence supported the Board's more specific finding that March 20, 2014, was the date on which she reached medical stability. We consider that question next.