There is no doubt the workers’ compensation community is aware of the Almaraz/Guzman II decision, which allows either party to rebut the 2005 Permanent Disability Rating Schedule. In part, that holding provides that a physician can “utilize any chapter, table, or method in the AMA Guides that most accurately reflects the injured employee’s impairment” so long as a physician stay within “the four corners of the AMA Guides.”

Milpitas Unified School District v. WCAB (Guzman) was granted a writ of review and the 6th District Court of Appeals affirmed the WCAB’s decision. What now?

The Court emphasized that its decision would not defeat the legislative objective of consistency, uniformity, and objectivity. The Court reasoned that the rules of “substantial evidence” would prevent such an outcome. Most defense attorneys and their clients would beg to differ. Perhaps one of the most significant aspects of the Court’s holding is:

“We conclude that the language of section 4660 permits reliance on the entire Guides, including theinstructions on the use of clinical judgment, in deriving an impairment rating in a particular case.” (Emphasis added)

Instructions. Surely all of the instructions within the Guides are equally important when assessing an injured worker’s impairment. The Court further went on to say:

“Accordingly, while we agree with the District that the Guides should be applied ‘as intended’ by its authors, such application must take into account the instructions on its use, which clearly prescribe the exercise of clinical judgment in the impairment evaluation, even beyond the descriptions, tables, and percentages provided for each of the listed conditions.” (Emphasis added)

Although the Court is focusing on instructions that allow a physician to use clinical judgment, there is no suggestion that instructions within the remaining chapters of the Guides are to be disregarded. Thus, on the one hand, the Court indicates the entirety of the Guides must be used including the instructions. On the other hand, this decision allows a physician to remove himself from the applicable chapter which contains the instructions on how to rate the affected body part. We have entered the twilight zone.