OPALA, Vice Chief Justice.
The dispositive issue on certiorari is whether the employer’s medical letter-report, on which the trial tribunal’s decision is rested, lacks probative value and hence cannot support the denial of permanent disability benefits to the claimant. We answer in the negative.
I.
ANATOMY OF LITIGATION
Claimant, Corbin H. Whitener, sought compensation benefits for job-related harm he sustained while employed by South Central Solid Waste Authority, whose risk carrier is State Insurance Fund [collectively called employer]. According to the transcript, the claimant’s medical report was admitted without objection. His physician rated compensable disability at 35% permanent partial respiratory impairment. When the employer tendered its physician’s report, which found the claimant to be
free of permanent impairment,
the claimant “objected” to the exhibit’s admission
solely for lack of probative value.
The trial judge admitted the report and “noted” the challenge to its probative effect but made no ruling on this issue.
The trial tribunal found the claimant’s continuous inhalation of “harmful dust, smoke and fumes” caused him to suffer “an occupational disease consisting of injury to the lungs and upper respiratory system” but concluded that he had sustained
no permanent
partial disability. The claimant sought review.
In the Court of Appeals the claimant argued the employer’s medical evidence does not support the benefits’ denial because 1) it is “incompetent” and 2) it lacks probative value since the physician failed to evaluate the claimant’s compensable harm in accordance with the American Medical Association’s “Guides to the Evaluation of Permanent Impairment” [the Guides].
Their use is required by the terms of 85 O.S.Supp.1987 § 3(H).
For reasons not
explained in any detail, the appellate court concluded that the employer’s medical report "... was not in substantial compliance with 85 O.S.1981, ch. 4, app., Rule 20, and was not competent evidence.” The claim was remanded with instructions to award the claimant benefits for “35% permanent partial impairment to the body as a whole” —the rating given in his physician’s report. We now grant certiorari upon employer’s petition.
The only issue to be addressed is whether the employer’s medical report has
probative value.
Its
admissibility or “competence"
is not before us. This is so because the claimant waived his objection to the report when he did not contest that exhibit’s admissibility at the time of its offer into evidence.
Upon claimant’s failure to object timely, the report stood admitted by force of Rule 21, Rules of the Workers’ Compensation Court.
II.
THE EMPLOYER’S MEDICAL REPORT DOES NOT LACK PROBATIVE VALUE FOR FAILURE TO COMPLY WITH THE AMA GUIDES
Claimant urged the “pulmonary function studies” described in the employer’s medical report deviate from the Guides’ requirements and sap the report of probative effect insofar as the claimant’s lungs were found to be free from permanent impairment. In our view, the employer’s medical report conforms to the standards prescribed by the Guides, and the values attributed to the claimant’s condition are consistent with the report’s ascribed rating of no permanent impairment. The trial tribunal’s denial of benefits for respiratory impairment hence rests on medical evidence which is probative of the compensable harm’s rating.
The claimant initially attacks the employer’s report, arguing that the results of
two of the three
measurements or tests, which were either made by the physician or capable of being made by calculation, warrant a finding that the claimant is 10-25% impaired.
The Guides clearly state:
“if an impairment is to be rated,”
then
“at least one
of these [three] measures of ven-tilatory function
should be
abnormal to the degree described in a given class definition.”
[Emphasis added.] While the claimant maintains that this rule somehow works to his advantage, he
admits
“[t]here is nothing in ... [the] report that casts any doubt on the validity of the pulmonary function study results he [the employer’s medical expert] relies on.”
Even if we were to assume,
as the claimant urges, that the data from two of the three tests do indicate permanent impairment, the third test’s result
supports
the physician’s conclusion that the claimant sustained no permanent impairment.
Inasmuch as an impairment rating may be rested on the results of but
one
of the three breathing measurements, we conclude that the employer’s medical report is not fatally deficient in probative force. The Guides clearly permit
alternative
conclusions when evaluating the same raw data.
The claimant next contends that the employer’s medical expert’s opinion is defective because, without an explanation by the physician in his report, some of its numerical data deviate from those which should have been used according to the Guides. The claimant seems to argue that
regardless
of whether the numbers have any impact on impairment classification, the report has no probative value because it contains inaccurate or erroneous data. In our view, the physician’s data analysis substantially conforms to the AMA Guides’ standards.
A medical expert’s permanent impairment evaluation must
substantially comply
with the methods and standards prescribed by the Guides.
Noncompliance may be apparent from mere reference to the Guides. That was the case in
LaBarge v. Zebco.
There, a specific impairment percentage for each of two ruptured discs that required surgery was
plainly mandated
by the AMA manual and ignored by the rating physician. The
LaBarge
test for determining whether the standards are followed when clearly applicable is whether, from a medical report’s four corners, an unexplained,
facially apparent
and substantial deviation from the Guides can be detected by mere reference to their text. The claimant’s attack on the employer’s letter-report calls for a different analysis of its probative force.
Here, the Guides contain tables from which “normal” values are obtained according to raw data, i.e., height and age. A constant, called the “95% Confidence Interval,”
must
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OPALA, Vice Chief Justice.
The dispositive issue on certiorari is whether the employer’s medical letter-report, on which the trial tribunal’s decision is rested, lacks probative value and hence cannot support the denial of permanent disability benefits to the claimant. We answer in the negative.
I.
ANATOMY OF LITIGATION
Claimant, Corbin H. Whitener, sought compensation benefits for job-related harm he sustained while employed by South Central Solid Waste Authority, whose risk carrier is State Insurance Fund [collectively called employer]. According to the transcript, the claimant’s medical report was admitted without objection. His physician rated compensable disability at 35% permanent partial respiratory impairment. When the employer tendered its physician’s report, which found the claimant to be
free of permanent impairment,
the claimant “objected” to the exhibit’s admission
solely for lack of probative value.
The trial judge admitted the report and “noted” the challenge to its probative effect but made no ruling on this issue.
The trial tribunal found the claimant’s continuous inhalation of “harmful dust, smoke and fumes” caused him to suffer “an occupational disease consisting of injury to the lungs and upper respiratory system” but concluded that he had sustained
no permanent
partial disability. The claimant sought review.
In the Court of Appeals the claimant argued the employer’s medical evidence does not support the benefits’ denial because 1) it is “incompetent” and 2) it lacks probative value since the physician failed to evaluate the claimant’s compensable harm in accordance with the American Medical Association’s “Guides to the Evaluation of Permanent Impairment” [the Guides].
Their use is required by the terms of 85 O.S.Supp.1987 § 3(H).
For reasons not
explained in any detail, the appellate court concluded that the employer’s medical report "... was not in substantial compliance with 85 O.S.1981, ch. 4, app., Rule 20, and was not competent evidence.” The claim was remanded with instructions to award the claimant benefits for “35% permanent partial impairment to the body as a whole” —the rating given in his physician’s report. We now grant certiorari upon employer’s petition.
The only issue to be addressed is whether the employer’s medical report has
probative value.
Its
admissibility or “competence"
is not before us. This is so because the claimant waived his objection to the report when he did not contest that exhibit’s admissibility at the time of its offer into evidence.
Upon claimant’s failure to object timely, the report stood admitted by force of Rule 21, Rules of the Workers’ Compensation Court.
II.
THE EMPLOYER’S MEDICAL REPORT DOES NOT LACK PROBATIVE VALUE FOR FAILURE TO COMPLY WITH THE AMA GUIDES
Claimant urged the “pulmonary function studies” described in the employer’s medical report deviate from the Guides’ requirements and sap the report of probative effect insofar as the claimant’s lungs were found to be free from permanent impairment. In our view, the employer’s medical report conforms to the standards prescribed by the Guides, and the values attributed to the claimant’s condition are consistent with the report’s ascribed rating of no permanent impairment. The trial tribunal’s denial of benefits for respiratory impairment hence rests on medical evidence which is probative of the compensable harm’s rating.
The claimant initially attacks the employer’s report, arguing that the results of
two of the three
measurements or tests, which were either made by the physician or capable of being made by calculation, warrant a finding that the claimant is 10-25% impaired.
The Guides clearly state:
“if an impairment is to be rated,”
then
“at least one
of these [three] measures of ven-tilatory function
should be
abnormal to the degree described in a given class definition.”
[Emphasis added.] While the claimant maintains that this rule somehow works to his advantage, he
admits
“[t]here is nothing in ... [the] report that casts any doubt on the validity of the pulmonary function study results he [the employer’s medical expert] relies on.”
Even if we were to assume,
as the claimant urges, that the data from two of the three tests do indicate permanent impairment, the third test’s result
supports
the physician’s conclusion that the claimant sustained no permanent impairment.
Inasmuch as an impairment rating may be rested on the results of but
one
of the three breathing measurements, we conclude that the employer’s medical report is not fatally deficient in probative force. The Guides clearly permit
alternative
conclusions when evaluating the same raw data.
The claimant next contends that the employer’s medical expert’s opinion is defective because, without an explanation by the physician in his report, some of its numerical data deviate from those which should have been used according to the Guides. The claimant seems to argue that
regardless
of whether the numbers have any impact on impairment classification, the report has no probative value because it contains inaccurate or erroneous data. In our view, the physician’s data analysis substantially conforms to the AMA Guides’ standards.
A medical expert’s permanent impairment evaluation must
substantially comply
with the methods and standards prescribed by the Guides.
Noncompliance may be apparent from mere reference to the Guides. That was the case in
LaBarge v. Zebco.
There, a specific impairment percentage for each of two ruptured discs that required surgery was
plainly mandated
by the AMA manual and ignored by the rating physician. The
LaBarge
test for determining whether the standards are followed when clearly applicable is whether, from a medical report’s four corners, an unexplained,
facially apparent
and substantial deviation from the Guides can be detected by mere reference to their text. The claimant’s attack on the employer’s letter-report calls for a different analysis of its probative force.
Here, the Guides contain tables from which “normal” values are obtained according to raw data, i.e., height and age. A constant, called the “95% Confidence Interval,”
must
be subtracted from the table-de
rived number.
Percentages must then be calculated to compare “normal” values with actual values. Evaluating respiratory impairment by the use of mechanical venti-latory tests requires at least one calculation: subtracting the given constant from each value derived from a table. In short,
mere reference to the Guides does not facially reveal here that their commands went unheeded when the employer’s physician evaluated the claimant’s compen-sable impairment to the lungs.
The claimant provides us with a chart to illustrate the alleged flaws in the data reported by the employer’s medical expert. Our analysis of that information impels the conclusion that the only noteworthy inaccuracy to be found is in the numbers which
the claimant
tenders as correct. Using the employer’s raw data, he failed to subtract the appropriate constant from the values which were derived from the Guides’ tables. This error doubtless has led the claimant to believe that the employer's medical expert fatally deviated from the mandatory norms for evaluating respiratory impairment. The employer’s medical evidence clearly is not flawed for lack of probative value. We hold it free of legally vitiating deficiency.
CERTIORARI IS GRANTED. OPINION BY THE COURT OF APPEALS IS VACATED; THE TRIAL TRIBUNAL’S DENIAL OF PERMANENT DISABILITY BENEFITS TO THE CLAIMANT IS SUSTAINED.
HARGRAVE, C.J., and HODGES, LAVENDER, DOOLIN and SUMMERS, JJ., concur.
SIMMS and KAUGER, JJ., concur in result.
ALMA WILSON, J., dissents.