- Health care (psychiatric treatment)
- Permanent impairment {NEL} (degree of impairment) (psychotraumatic disability)
- Permanent impairment {NEL} (rating schedule) (AMA Guides)
- Permanent impairment {NEL} (degree of impairment) (incontinence)
The worker suffered a low back injury in November 2006, for which the Board granted the worker a 33% NEL award. The Board also granted entitlement for a hyperactive bladder and for psychotraumatic disability, with a 10% NEL rating for each of those conditions. The worker appealed a decision of the Appeals Resolution Officer denying an increase in the NEL ratings for the hyperactive bladder and psychotraumatic disability, and denying entitlement for ongoing psychological counselling.
There are two separate bladder impairment rating scales in the AMA Guides. Chapter 4, on the nervous system, deals with, among other things, neurological impairment ancillary to any impairment of the spine. The other rating scale is in Chapter 11, on the urinary and reproductive system. Both scales have four rating classes with corresponding percentage ranges, with one minor exception, in that Class 1 in Chapter 11 ranges from 1% to 10%, whereas Class 1 in Chapter 4 ranges from 5% to 10%. There is some overlapping language in the description of the classes but they are not identical.There is no direct guidance in the AMA Guides about which scale to use in what circumstances. The Vice-Chair decided to use Chapter 4 in this case, as it would appear to contemplate bladder impairments arising specifically from neurological compromise of the spine, whereas Chapter 11 would appeal to contemplate injury to the bladder due to direct pelvic/bladder disease, infection, cancer and other systemic types of disorder. On the evidence, the Panel confirmed the 10% rating at the top of Class 1 in Chapter 4.The Panel also confirmed the 10% rating for psychotraumatic disability.The Panel granted entitlement for ongoing psychological treatment as maintenance health care.The appeal was allowed in part.