Opinion ID: 1439055
Heading Depth: 1
Heading Rank: 1

Heading: claimant's proof of permanent disability lacks probative force

Text: The claimant's medical expert gave her a 45% permanent impairment rating and attributed it to the combined effect of her concussion, medication-induced liver ailment, mental depression and economic disability. The employer urges that this evaluation is not probative because 1) it is based, at least in part, on future impairment and 2) it results from an impermissible and unexplained deviation from the second edition of the American Medical Association's Guides to the Evaluation of Permanent Impairment [Guides]. [5] With these contentions we agree, but, for the reasons explained in Part II of this opinion, the claimant must be given another opportunity to secure evidence upon which an award for permanent partial disability might be based. During his deposition the claimant's medical witness was asked what part of the overall 45% rating did he attribute to her liver problem. His response was: First of all, this is a very unusual case. Second, I did not find references to help break down any of the percentages. Therefore, in a manner that I'm used to, I collectively arrived at the 45 percent permanency, which includes a percent that I did not break down to give to the liver. He was then asked about the rating component attributable to the claimant's depression: Q.    The last time that you saw her, did any part of your 45 percent rating include some amount for depression? A. Yes, it did. Q. Was that amount based upon the fact that she might have more depression occurring in the future? A. Yes, it did. Q. Did she have a percentage measurable amount of depression at the time that you last examined her? A. My experience is that in a depressive reaction, there are shades of gray, and I would liken it to a lighter shade. Q. Did you find that she did have a percentage of impairment, permanent impairment  she was depressed permanently at the time that you saw her? A. Yes. Q. What percentage was that? A. This is hard. I find this case to be so unusual, so different, yet present to the extent that it has been documented, yet allusive in the overall, not to be categorized in the AMA guides. Q. You're familiar with the fact that there is a mental disorder chapter under the AMA guides? A. Yes. Q. But, she didn't fit under that chapter? A. No, ma'am. An evaluation of permanent impairment for workers' compensation purposes generally must be made by applying the standards prescribed in the Guides. [6] Deviations from the statutorily-mandated regime are not permissible without an adequate medical explanation. [7] Here, the expert's admission that he deviated from the Guides poses the question whether his explicit reasons for so doing are legally sufficient. In light of the quoted portions of his deposition testimony, we hold they are not. [8] The claimant's medical witness never explained what was so unusual about the claimant's condition that he could not apply the mandatory AMA standards for evaluating permanent impairment. Although he had stated the Guides' chapter on mental and behavioral disorders was inapplicable to this case, he gave no medical grounds for his conclusion. Moreover, the medical expert clearly attributes an unspecified portion of the impairment's rating to a mental condition he predicts the claimant will have in the future. If a given rating be founded upon an evaluation made in terms of futurity, it is not probative of compensable permanent disability that may be awarded. [9] A present condition may be considered in terms of its future effect on the claimant, [10] but an impairment rating may not be ascribed to a doctor's speculation about an expected or future symptomatology. We hence conclude that the expression of anticipated futurity robbed the claimant's evaluation of probative value.