Highlights of Noteworthy Decisions

Decision 3095 17
R. McCutcheon
  • Maximal medical rehabilitation
  • Permanent impairment {NEL} (rating schedule) (unlisted condition)
  • Permanent impairment {NEL} (degree of impairment) (rheumatoid arthritis)

The worker worked in auto body repair from 1971 to 2007. The Board granted the worker entitlement for rheumatoid arthritis in 2013 related to silica dust exposure, with a 32% NEL award. In 2013, the Board granted the worker entitlement for occupational asthma, with no NEL award. The worker appealed on a number of issues.

There were no ratings in the AMA Guides for rheumatoid arthritis. It was, therefore, appropriate to use an analogous rating method. The worker submitted that his condition was most analogous to scleroderma, as it is also an autoimmune disease that may be caused by silica exposure. However, the Vice-Chair found that scleroderma, which is primarily a skin disease, was not an analogous condition to rheumatoid arthritis, which is known to affect joints. The Board approach was to use the ratings for the spinal cord as an analogous rating method. The Vice-Chair found that the Board approach was reasonable.
Applying the ratings for the spinal cord in Chapter 4.1b of the AMA Guides, the Vice-Chair found that the worker was entitled to a 30% rating for the upper extremity and a 25% rating for the lower extremity, which combined for a 48% rating.
Board policy on determining maximal medical recovery provides that, in some cases of occupational disease, a significant improvement in the worker's recovery may not be expected due to the nature of the illness or disease. In such cases, the day following the date of the accident may be considered as the date of MMR. That was the situation in this case. The date of MMR was in June 1998.
The Vice-Chair also found that the worker had entitlement for psychotraumatic disability, for the right knee, for gastroesophageal reflux as a secondary condition, for chronic headaches as a secondary condition, for a NEL assessment for occupational asthma, for polyneuropathy and Sjogren's syndrome, and to various health care benefits.
The appeal was allowed.