Your Workers’ Comp Report Lists METs: Is That Another Injury or a Separate Rating?

Your workers’ compensation report lists a lung condition, a METs result and an impairment percentage. Before treating those entries as separate ratings, ask what each describes. METs measure functional capacity; they are not another body part. The useful question is how the physician used that measurement to assess the identified condition and explain the activities you can perform.

Separate the condition from the measurement

METs stands for metabolic equivalents. In its pulmonary-rating discussion, the WCAB explained that one MET represents energy used at rest and that lower levels indicate greater limits on activity and reduced capacity for work or daily tasks. A lung condition can limit higher-energy activity, and the measurement can help assess its functional effect.

The Board made that distinction in Billow v. The Boys and Girls Aid Society of Los Angeles County, No. ADJ6508173 (WCAB Jan. 16, 2026). The award had listed METs separately from the lungs. The Board corrected the separate injury finding while preserving the lung injury. The functional assessment remained part of the evidence used to evaluate pulmonary impairment.

Read the actual diagnosis and the test explanation together. A measurement describes an aspect of function; the physician must identify the condition it helps assess. If a report also discusses another system, such as the heart, identify that diagnosis and its supporting explanation rather than assuming every METs entry concerns the same condition.

Follow the report from test result to rating

Find these three entries in the complete report:

• The condition: What disease, injury or anatomical region is the physician evaluating?
• The functional evidence: Which test, examination findings and reported limitations support the assessment? Note the test date and any conditions the physician says affected the result.
• The rating explanation: How did the physician move from that evidence to a whole-person impairment assessment? Is the proposed rating conventional, or does the report explain an alternative method?

Keep the units attached to each number. A METs result and a whole-person impairment percentage describe different things. The final permanent-disability award requires its own legal and rating analysis. Copying the figures into one list without their labels can hide whether they are measurements, alternative ways to assess one impairment or assessments of genuinely different conditions.

In Billow, the Board reviewed an earlier pulmonary assessment and a later rating by analogy. The physician used a coronary-heart-disease table within the AMA Guides to assess pulmonary impairment and explained why it better captured the worker’s standing, walking, climbing and environmental limitations. The Board accepted that medical reasoning while requiring further development of whether adding the different impairments was justified. A supported explanation of one step did not complete the whole calculation.

Check whether a later number replaces or supplements an earlier one

A supplemental report may revise an earlier opinion after testing, an examination or a deposition. Keep both versions and identify what the doctor changed. A later number may be an alternative assessment of the same impairment rather than an additional percentage to place on top of the first.

Mark any passage explaining why the earlier method did not accurately reflect your limitations and why the new method does. If the report gives a new figure without identifying its relationship to the earlier assessment, that is a focused question for counsel or the evaluator. Avoid doing your own medical conversion from a test result to a disability percentage.

Ask what each separately rated condition contributes

If the calculation lists the lungs and another system, look for a medical explanation of each system’s effect on daily activities. Which limits standing or walking? Which affects sleep, concentration or another identified activity? If the same activity appears in several sections, what does the physician say about the interaction?

The Billow panel required further medical discussion under the Board’s en banc Vigil framework. For addition rather than the usual Combined Values Chart, that discussion must address whether the effects overlap and, if they do, how the overlap increases or amplifies their impact. The word “synergy” by itself leaves the reader without that explanation. Our analysis of alternative ratings and addition of impairments explains that distinct rating question.

Keep causes, work limits and benefit findings distinct

A report may describe nonindustrial conditions as well as the work injury. Apportionment asks what caused the permanent disability and requires a medically supported explanation. A vocational report addresses the consequences for work and rehabilitation. Reading them together does not make the vocational evaluator the source of a replacement medical allocation.

For a useful review, identify the physician’s actual causal opinion and the vocational expert’s stated medical assumptions. Then check whether the decision has fixed permanent disability or left it for more evidence. In Billow, the Board retained injury and treatment findings while deferring permanent disability and apportionment. The separate case analysis explains that procedural result.

Bring the explanation behind the disputed entry

Bring the complete initial and supplemental reports, the relevant test results, any medical deposition, the rating worksheet and the decision or settlement calculation you are reviewing. Include the pages identifying the condition, the functional limitations and the reason for each rating. Write down the precise question: Is this a measurement, an alternative assessment of the same impairment or a rating for another condition?

Our workers’ compensation team can compare the disputed METs entry with the physician’s explanation and the proposed rating. That gives the review a concrete starting point: Which step is supported, which remains unexplained and what additional medical explanation may be needed.