Opinion ID: 2179973
Heading Depth: 1
Heading Rank: 7

Heading: evidence of permanent medical impairment

Text: Park Place argues that Swanson was not entitled to loss of earning power and vocational rehabilitation benefits, because he had not been assigned a permanent functional impairment rating. Park Place relies on our opinion in Green v. Drivers Mgmt., Inc., 263 Neb. 197, 639 N.W.2d 94 (2002), in which we explained the concept of permanent medical impairment. We stated that [t]he term `impairment' is a medical assessment, while the term `disability' is a legal issue. Id. at 204, 639 N.W.2d at 102. Permanent medical impairment is related directly to the health status of the individual, whereas disability can be determined only within the context of the personal, social, or occupational demands or statutory or regulatory requirements that the individual is unable to meet as a result of the impairment. Id., citing Phillips v. Industrial Machine, 257 Neb. 256, 597 N.W.2d 377 (1999) (Gerrard, J., concurring). We held, in Green, supra, that before permanent partial disability benefits can be awarded, the claimant must prove that he or she has a permanent impairment. Without a finding of permanent medical impairment, there can be no permanent restrictions. Without impairment or restrictions, there can be no disability or labor market access loss. Absent permanent impairment or restrictions, the worker is fully able to return to any employment for which he or she was fitted before the accident, including occupations held before the injuries occurred. Id. at 206, 639 N.W.2d at 103. In this case, the single judge concluded there was no evidence of a permanent medical impairment, apparently because there was no medical opinion in the record establishing Swanson's functional (or percentage) impairment rating. However, we agree with the review panel that the single judge erred as a matter of law in this regard. Because the single judge's determination that Swanson did not prove a permanent medical impairment was premised on a legal error, the review panel correctly concluded that the single judge's finding should be reversed. Once again, we trudge into the needlessly murky distinction between permanent medical impairment versus permanent functional impairment rating. An impairment rating is simply a medical assessment of what physical abilities have been adversely affected or lost by an injury. Frauendorfer v. Lindsay Mfg. Co., 263 Neb. 237, 639 N.W.2d 125 (2002), citing Phillips, supra . Although the medical impairment rating given by a doctor may be an important factor, the extent of loss of use does not necessarily equal the extent of medical impairment. Phillips, supra . In other words, while a numeric percentage impairment rating may be significant, and even preferable, it is not a sine qua non of a finding of permanent medical impairment. As explained, under similar circumstances, by the Supreme Court of Tennessee: We do not think that, when medical evidence establishes permanency, the failure of a medical expert to attribute a percentage of anatomical disability can justify a denial of compensation if the other evidence demonstrates that an award of benefits is appropriate. Otherwise the remedial purpose of the Workers' Compensation Act could easily be frustrated.... While an anatomical disability rating... is preferable and ordinarily, if not uniformly, part of the proof offered by either or both parties, the ultimate issue is not the extent of anatomical disability but that of vocational disability, the percentage of which does not definitively depend on the medical proof regarding a percentage of anatomical disability. Corcoran v. Foster Auto GMC, Inc., 746 S.W.2d 452, 457 (Tenn.1988). Accord, e.g., Star Enterprises v. DelBarone, 746 A.2d 692 (R.I.2000); Klein Independent School Dist. v. Wilson, 834 S.W.2d 3 (Tex.1992); Walker v. New Fern Restorium, 409 So.2d 1201 (Fla.App.1982); Hunter v. Industrial Commission of Arizona, 130 Ariz. 59, 633 P.2d 1052 (Ariz.App.1981). But cf. Wal-Mart Stores, Inc. v. Connell, 340 Ark. 475, 10 S.W.3d 882 (2000) (holding on statutory grounds that specific percentage rating is required). We stated in Green v. Drivers Mgmt., Inc., 263 Neb. 197, 206, 639 N.W.2d 94, 103 (2002), that [w]ithout a finding of permanent medical impairment, there can be no permanent restrictions. Without impairment or restrictions, there can be no disability or labor market access loss. That is a correct statement of the lawa physician-ordered permanent physical restriction, based on a medically established permanent impairment of a body function, establishes a permanent medical impairment for purposes of determining loss of earning capacity. There is no suggestion in Green that a permanent functional impairment rating is a necessary prerequisite to an award of indemnity or vocational rehabilitation services in loss of earning power cases. Dr. Ripa's opinion clearly establishes that Swanson was permanently injured and subject to permanent physical restrictions. Swanson was to avoid lifting in excess of 25 to 30 pounds on a repetitive basis, and he was not to be involved in activities that required prolonged bending, stooping, squatting, kneeling, or repetitive bending below the knee level. Further, Dr. Ripa ordered Swanson to permanently avoid lifting greater than 50 pounds. These permanent physical restrictions led to a loss of earning capacity analysis in the range of 15 percent. We have long held, in the context of evaluating an expert medical opinion, that such testimony need not be couched in magic words such as reasonable medical certainty or reasonable probability. See, e.g., Owen v. American Hydraulics, 258 Neb. 881, 606 N.W.2d 470 (2000). Similarly, while medical impairment can be established only through properly qualified medical testimony, see Phillips v. Industrial Machine, 257 Neb. 256, 597 N.W.2d 377 (1999), that testimony need not establish a specific percentage impairment rating in order to be legally sufficient. Dr. Ripa's opinion, had the single judge properly considered it on this issue, would have been sufficient to sustain a finding of a permanent medical impairment. Since the single judge's finding that there was no evidence of medical impairment was based on an incorrect application of the law, the review panel correctly concluded that the single judge's finding on that issue should be reversed and the cause remanded for a redetermination of Swanson's loss of earning power and entitlement to vocational rehabilitation services. Park Place's second assignment of error is without merit.