Opinion ID: 4532444
Heading Depth: 1
Heading Rank: 1

Heading: the hypothetical factual narrative

Text: Richardson’s counsel filed a claim for permanent-partial-disability benefits based upon the physician’s 11% impairment rating. See id. at 51 (claiming “11% left leg”). Counsel later asked the physician a purely hypothetical question: What would Richardson’s impairment rating be if he had never had the hip-replacement surgery? Asking the question this way, Richardson’s counsel wanted the physician to hypothesize that the surgery had never taken place. The physician answered counsel with the observation that Richardson would have had a 74% permanent loss of use if he had lived the rest of his life “without a total hip replacement.” See id. at 54 (emphasis added). Saddled with counsel’s required hypothesis, the physician merely said that Richardson “would have continued to be incapacitated” at the 74% rating if he had never undergone the hip-replacement surgery. See id. (emphasis added). Put another way, Richardson’s 74% incapacity would have been permanent had it not been temporary. But, hypotheticals aside, it was temporary. Upon reaching maximum medical improvement after his hip-replacement surgery, Richardson regained 63% of the use of his leg, leaving him with an 11% permanent impairment rating. See id. at 52, 70-72. Taken together, the physician’s two opinions can mean only one thing: Richardson’s pre-hip-replacement condition (resulting in a 74% loss of use) was temporary because it was permanently improved (to an 11% loss of use) by the hip-replacement surgery. The factual record fully supports both the temporary 74% rating prior to the hip replacement and the permanent 11% rating after the hip replacement. Prior to the hip replacement, the physician agreed, Richardson’s “pain and his function was at a point where he 15 just couldn’t live with it any more,” id. at 76, and he also testified that “there were cartilage pieces and debris everywhere” in Richardson’s hip, id. at 77. The physician reported that Richardson “was using a cane occasionally” and had suffered from gait and range-of-motion deficiencies, “a lot of strength deficit,” and arthritis. Id. at 79.5. The physician noted that he “could barely move [Richardson’s] leg without him jumping off the table in pain.” Id. at 79.16. Richardson testified that chronic pain had kept him from wanting to be “involved in any type of physical activity.” Id. at 98. “I couldn’t sit for any period of time,” he stated, “I couldn’t stand for any period of time.” Id. None of these disabling conditions existed after Richardson had reached maximum medical improvement. “[H]e was doing fine” after the hip-replacement surgery, the physician reported. Id. at 79. “He had no significant neurologic deficit,” no reported complaints of debilitating pain, and only a “mild” limitation on range of motion. Id. at 52. The only deficit that the physician observed was “significant weakness with [Richardson’s] hip flexion and knee extension strength.” Id. These specific concerns were factored into the lifelong precautions that the physician counseled Richardson to take, such as not becoming a “runner” or engaging in “heavy weightlifting,” “water skiing[,] or snow skiing.” See id. at 79-79.1; AMA Guides, supra, § 2.4, at 19 (“The Guides attempt[] to take into account all relevant considerations in rating the severity and extent of permanent impairment and its effect on the individual’s activities of daily living.”). Richardson had no limitations, however, on walking or hiking, including, for example, hiking the Appalachian Trail. See J.A. at 79.1. In short, the successful hip-replacement surgery liberated Richardson from a crippling and painful condition that had prevented him from wanting to engage “in any type of physical activity” and from being able to stand or sit “for any period of time,” id. at 98, and provided him 16 freedom from chronic, debilitating pain and the ability to hike the Appalachian Trail, see id. at 79.1. That is quite an improvement — a maximum medical improvement to be sure. The only remaining question is whether that improvement was temporary or permanent. The treating physician concluded, without contradiction, that it was permanent. No expert testimony or medical evidence refuted the physician’s opinion. Seeking to cast doubt on the physician’s 11% impairment rating, the majority reopens the evidentiary record to consider a host of factual assertions and hearsay expert opinions offered in articles published in various medical journals. None of these assertions can be found in the record of this case. Neither party referred to these articles in their briefs or arguments before the deputy commissioner, the full Commission, the Court of Appeals, or this Court. Even so, the majority cites these articles in support of its assertion that Richardson’s hip replacement may ultimately fail, and if that happens, future surgeries “may be needed,” ante at 7 (citation omitted). The majority also states that while hip-replacement surgery generally produces “excellent clinical outcomes for patients,” sometimes “complications do occur.” Ante at 7 (alteration and citation omitted). Even when the surgery is wholly successful, patients “are generally subject to permanent restrictions on their activities.” Ante at 7-8. The apparent purpose of taking judicial notice of these articles is to imply that, as a matter of law, a medical expert can never give a truly reliable opinion on a patient’s permanent impairment following a hip-replacement surgery. By turning a blind eye to any post-hipreplacement impairment ratings by medical experts, only one option remains — a pre-hipreplacement impairment rating that wholly ignores any improvements in the patient’s condition because of the hip replacement. Under this view, even though the procedure provides the patient 17 with maximum medical improvement, the impairment rating must be calculated on the false assumption that there was no improvement at all. The present case highlights the unconvincing nature of this reasoning: Despite the fact that after his hip replacement he was doing well enough to hike the Appalachian Trail, see J.A. at 79.1, Richardson claims that his impairment rating must revert back to his pre-hip-replacement condition of being prevented by chronic pain from standing or sitting “for any period of time” or from wanting to engage “in any type of physical activity,” id. at 98. The majority agrees. Established caselaw, the majority argues, says as much, and the General Assembly has agreed by its silence. I find both assertions unpersuasive.