Opinion ID: 2627859
Heading Depth: 1
Heading Rank: 3

Heading: progressive diseases and ppds

Text: ¶ 7 Tomlinson argues that since arthritis is by nature progressive, as a matter of law, there is no point where it reaches maximum medical improvement and therefore no point (at least before the end stage) where the percentage of partial disability can be calculated. He cites Hiatt, where this court observed: The use of the word permanent together with disability indicates the character of the disability. It signifies that the disability has expectedly an unchangeable existence; that the physical condition arising from the injury is fixed, lasting, and stable. A person whose condition is remediable is not permanently disabled. Hiatt v. Dep't of Labor & Indus., 48 Wash.2d 843, 846, 297 P.2d 244 (1956); accord WAC 296-20-19000 (referring to PPDs as stable or nonprogressive); see also Miller v. Dep't of Labor & Indus., 200 Wash. 674, 680, 94 P.2d 764 (1939) (before an allowance can be made for a[PPD], the condition ... must have reached a fixed state). The Hiatt court also cited with approval a dictionary definition that defined permanent in part as `not subject to fluctuation or alteration.' Hiatt, 48 Wash.2d at 846, 297 P.2d 244 (quoting WEBSTER'S NEW INTERNATIONAL DICTIONARY (2d ed.1954)); accord Williams v. Va. Mason Med. Ctr., 75 Wash.App. 582, 586, 880 P.2d 539 (1994). Since arthritis is by its nature progressive, he argues, there is no point where it becomes fixed, stable, or reaches maximum medical improvement. ¶ 8 However, PPD also has a refined meaning to properly deal with medical conditions that, by their nature may stabilize or improve but later deteriorate again. A condition may reach permanency when it becomes stable and further treatment is unlikely to cure it. WAC 296-20-01002; cf. Allen v. Dep't of Labor & Indus., 48 Wash.2d 317, 318, 293 P.2d 391 (1956) (allowing benefits for arthritis); Harper v. Dep't of Labor & Indus., 46 Wash.2d 404, 281 P.2d 859 (1955) (Wash. Bd. of Indus. Ins. Appeals Sept. 11, 1962); In re Thompson, No. 13,473, at 5-6 (same). A condition may be deemed permanent when it has reached maximum medical improvement, even if it may be expected to deteriorate further. WAC 296-20-01002; accord Allen, 48 Wash.2d at 318, 293 P.2d 391. Further, in cases like this, we have a date where even a degenerative preexisting PPD must be rated: the date of the compensable industrial injury. ¶ 9 The department, endorsed by regulation, often turns to the American Medical Association's materials to determine how to rate a particular disability. WAC XXX-XX-XXXX. As Tomlinson notes, the 2001 American Medical Association's Guides to the Evaluation of Permanent Impairment (Linda Cocchiarella & Gunnar B.J. Andersson eds., 5th ed. 2001) (2001 AMA GUIDES) uses language similar to that used in Miller and Hiatt to define impairment. [1] But both the 2001 and 2008 AMA Guides also specifically have standards for rating disability based on arthritis. AM. MED. ASS'N, GUIDES TO THE EVALUATION OF PERMANENT IMPAIRMENT 511 (Robert D. Rondinelli et al. eds., 6th ed. 2008) (2008 AMA GUIDES) (classification for different knee impairments, including arthritis), 528 (specific example of arthritis in knee of elderly man); 2001 AMA GUIDES 544-45 (setting forth diagnostic and rating criteria). While this exact question has not been asked of Washington appellate courts before, Washington workers have been receiving PPD benefits for arthritis for many years. See, e.g., Allen, 48 Wash.2d at 318, 293 P.2d 391; In re Thompson, No. 13,473, at 5-6. ¶ 10 Perhaps more importantly, the corollary of saying that arthritis is not a preexisting PPD under the IIA is saying that arthritis is not a compensable PPD. As the attorney general suggests in an amicus brief, this flies in the face of the plain language of the IIA and its injunction that benefits be granted liberally to reduce the suffering and economic loss arising from industrial injuries. RCW 51.12.010. Washington State has been granting PPD benefits for arthritis for at least 50 years, and this seems to be the first time it has been challenged on the basis that it is a degenerative disorder. ¶ 11 Further, department regulations do not treat degenerative conditions as definitionally excluded from the universe of possible PPDs. Instead, the IIA regulations recognize that the rating may be done when the condition reaches maximum medical improvement, WAC 296-20-19000, even if the condition can be expected to deteriorate: Maximum medical improvement occurs when no fundamental or marked change in an accepted condition can be expected, with or without treatment. Maximum medical improvement may be present though there may be fluctuations in levels of pain and function. A worker's condition may have reached maximum medical improvement though it might be expected to improve or deteriorate with the passage of time. Once a worker's condition has reached maximum medical improvement, treatment that results only in temporary or transient changes is not proper and necessary. Maximum medical improvement is equivalent to fixed and stable. WAC 296-20-01002(3) (emphasis added) (quoting from section Proper and necessary); accord 2001 AMA GUIDES at 601 (A condition or state that is well stabilized and unlikely to change substantially in the next year, with or without medical treatment. Over time, there may be some change; however, further recovery or deterioration is not anticipated.). This applies to arthritis. ¶ 12 Our conclusion that arthritis can be a PPD before it reaches end state is consistent with long standing practice. In the 1939 Miller case, this court affirmed the department's decision that an injury was fixed even though an operation likely would have improved the worker's condition. Miller, 200 Wash. at 681, 94 P.2d 764 (there is ample evidence to support the finding of the department that the appellant's condition had become fixed, because, without an operation, no improvement could be expected). It also accords with the AMA Guides, which note that: Permanency is the condition whereby impairment becomes static or well stabilized with or without medical treatment and is not likely to remit in the future despite medical treatment, within medical probability. This term is usually synonymous with MMI, usually occurring when all reasonable medical treatment expected to improve the condition has been offered or provided. Impairment ratings are to be performed when an individual is at a state of permanency. However, many systemic or organ-based conditions are dynamic rather than static in nature and are, to some extent, never at permanency. In such cases, one can usually anticipate future functional decline based on the natural history of the disease process, which is generally well established in the literature. 2008 AMA GUIDES at 26-27. The AMA Guides also set forth guidance on impairment ratings for arthritis and similar conditions. Id. at 511, 518, 528. We hold that degenerative arthritis may be the basis of a compensable, and offsetable, PPD.