Opinion ID: 2066743
Heading Depth: 2
Heading Rank: 3

Heading: The IME's Opinion and Hearing Officer's Decision

Text: [¶ 22] Dr. Lobozzo diagnosed Harvey as suffering from major depressive disorder, single episode, mild to moderate severity, without psychosis, related to the 1999 work injury. He also diagnosed a pain disorder, associated with both psychological factors and a general medical condition. He concluded that she suffers 7% permanent impairment as a result of her psychological condition, based on Table 3 in chapter four of the fourth edition of the AMA Guides. He explained the 7% rating as follows: She has mild impairment in [activities of daily living]. She is able to take care of herself and her personal hygiene. She is able to communicate. Physical activity is somewhat restricted. Sensory function is intact and she is able to travel. Sexual function and sleep are impaired but some of this impairment could be related to her pain. Therefore, she is classified as Class 2, mild impairment, referring to page 142 of the Fourth Edition of the Guides. This method of using the Guides is one of the methods suggested by Arthur Myerson, MD, an author of the Guides. Class 2 impairment is in the 0-14% range and my standard procedure is to take the mean, which in this case would be 7% permanent impairment as a result of psychiatric problems. [¶ 23] The hearing officer adopted Dr. Lobozzo's opinion that Harvey suffers 7% permanent impairment as a result of depression. He reasoned that the fourth edition of the AMA Guides does not preclude using numerical percentages when such is required, noting that the AMA Guides contains language that allows for physicians to assess a percentage of impairment when it is necessary to do so, based on clinical impressions and judgment. [¶ 24] On questions involving the interpretation and application of Workers' Compensation Act or Board regulations, we defer to the Workers' Compensation Board hearing officer unless the statute or regulations plainly compel a contrary result. Jordan v. Sears, Roebuck & Co., 651 A.2d 358, 360 (Me.1994); see also Jasch v. The Anchorage Inn, 2002 ME 106, ¶ 10, 799 A.2d 1216, 1218-19. The hearing officer's factual findings are final, 39-A M.R.S. § 318 (2007), and not subject to appeal, M.R.App. P. 23(b)(3). [¶ 25] H.C. Price contends that the hearing officer erred when adopting the IME's opinion of 7% permanent impairment for depression, because the statute and Board rules require that permanent impairment ratings be established only pursuant to the fourth edition of the AMA Guides, and that edition does not delineate numerical percentages of impairment for non-neurological mental disorders. It argues that assigning such a value without having specific percentages allocated in the AMA Guides defeats the Board's purpose in adopting the Guides, which is to standardize permanent impairment values for the same conditions. H.C. Price further contends that it was error to rate Harvey's impairment for depression based on the percentages assigned to neurological emotional and behavioral impairments in chapter four, when it is undisputed that Harvey's condition falls within the purview of chapter fourteen, which governs impairment from non-neurological mental and behavioral disorders, including depression. We find H.C. Price's arguments unpersuasive. [¶ 26] The definitions of permanent impairment in the fourth edition of the AMA Guides and in the Maine Workers' Compensation Act are broad enough to encompass mental as well as physical impairment resulting from work injuries. The statute's definition includes  any anatomic or functional abnormality or loss. 39-A M.R.S. § 102(16) (emphasis added). The fourth edition states that its definition of impairment closely parallels that of the World Health Organization, which has defined impairment as any loss or abnormality of psychological, physiological or anatomical structure or function. AMA Guides at 1. While the AMA Guides does not assign standard numerical percentages of impairment for mental illness, it does not prohibit assigning a numerical percentage based on an individualized medical evaluation. It is evident that the editors of the fourth edition were reluctant to dictate standardized percentages for specific mental conditions because there are many variables that influence how a particular mental condition affects each individual's health status. [¶ 27] Having concluded that the fourth edition of the AMA Guides does not bar assignment of a numerical percentage to permanent mental impairment, we must next decide whether it was error to base the 7% impairment rating on an IME opinion formulated with reference to a table found in chapter four of the AMA Guides. Chapter four assigns percentages of impairment to emotional and behavioral impairment that results from neurological conditions. In this case, there is no evidence that Harvey suffers from a neurological condition. [4] [¶ 28] The table used by the IME, entitled Table 3. Emotional or Behavioral Impairments, contains numeric percentages of impairment for neurologic conditions that have psychiatric features, including depression. Chapter four expressly states that the criteria for evaluating these impairments relate to the criteria for evaluating mental and behavior impairments in chapter fourteen. Id. at 141-42. In addition, Board rules require that permanent impairment be determined by use of the fourth edition of the AMA Guides. Me. W.C.B. Rule, ch. 7, § 6. Thus, we do not find error in the IME's use of the emotional or behavioral impairments table in chapter four to rate impairment related to Harvey's depression because that method is not inconsistent with the Act or Board rules, and Table 3 in chapter four represents a fair analogue to the impairment classifications described, but not rated, in chapter fourteen. Thus, the hearing officer adopted an impairment opinion that was formulated using a rational method, circumscribed within the fourth edition of the AMA Guides. [¶ 29] H.C. Price also argues that it was error to adopt Dr. Lobozzo's opinion because instead of making an individualized assessment of the precise numerical percentage of impairment, he followed his practice of adopting the mean percentage within the applicable range. That is, he determined Harvey suffered from mild impairment pursuant to chapter fourteen, which corresponds with the mild impairment category in Table 3 from chapter four, which assigns a range of possible impairment from 0 to 14%. He then assigned the mean within that category, or 7%. He testified that in certain cases he has deviated from the mean, but generally, moving from that mean isimplying an accuracy that really doesn't exist. [¶ 30] It is apparent from Dr. Lobozzo's report that he made an individualized assessment of Harvey's condition. His method of establishing the precise percentage of impairment does not violate any particular statute or rule, but is instead a product of his medical training, clinical judgment, and application of the AMA Guides. We therefore find no error in the hearing officer's adoption of the rating. See AMA Guides at 1 (Impairment, according to the Guides, is assessed by medical means and is a medical issue.). [5] [¶ 31] Finding no error in the hearing officer's reliance on the IME's opinion assigning a numerical percentage to work-related, permanent mental impairment, we affirm. The entry is: The decision of the hearing officer of the Workers' Compensation Board is affirmed. 4. Extension of 260-week limitation. Effective January 1, 1998 and every January 1st thereafter, the 260-week limitation contained in subsection 1 must be extended 52 weeks for every year the board finds that the frequency of such cases involving the payment of benefits under section 212 or 213 is no greater than the national average based on frequency from the latest unit statistical plan aggregate data for Maine and on a countrywide basis, adjusted to a unified industry mix. The 260-week limitation contained in subsection 1 may not be extended under this subsection to more than 520 weeks.