“Bodily Injury” Restitution Under 18 U.S.C. § 3663: Mental Harm Alone Is Insufficient, But Physical Manifestations of Mental Harm Qualify

Case: United States v. Anita Green (with codefendant appeal by Amanda Hovanec) — Sixth Circuit (Feb. 13, 2026)

1. Introduction

This consolidated Sixth Circuit decision arises from a homicide intertwined with controlled-substance importation and a family breakup. During divorce and custody proceedings, Amanda Hovanec killed her husband, T.H., by injecting him with etorphine, a large-animal tranquilizer. Anthony Theodorou (Hovanec’s romantic partner) procured and shipped the etorphine from South Africa at Hovanec’s direction. After the killing, Hovanec and Theodorou attempted to conceal the crime; Anita Green (Hovanec’s mother) drove them to bury T.H.’s body.

The appellate issues were primarily sentencing and restitution:

  • Green: challenged denial of a U.S.S.G. § 3E1.1 acceptance-of-responsibility reduction and challenged restitution requiring payment for grandchildren’s psychological care under 18 U.S.C. § 3663.
  • Hovanec: challenged her 480-month sentence as procedurally and substantively unreasonable and challenged application of aggravating-role and obstruction enhancements.

The opinion’s most significant legal development concerns the meaning of “bodily injury” in the Victim and Witness Protection Act (VWPA), 18 U.S.C. § 3663, for restitution covering psychological care.

2. Summary of the Opinion

  • Green’s sentence (121 months): affirmed. The district court did not err in denying acceptance of responsibility after finding Green was not candid about relevant conduct.
  • Green’s restitution order ($126,000 jointly and severally): reversed and remanded. The Sixth Circuit held that “bodily injury” in 18 U.S.C. § 3663 does not include purely mental or psychological harms, but does include physical manifestations of mental harm. The record did not establish the required physical manifestation with sufficient clarity, so remand was required for factfinding.
  • Hovanec’s sentence (480 months): affirmed. The court rejected challenges to the district court’s treatment of Dr. Brams’s psychological report, and upheld the aggravating-role enhancement under U.S.S.G. § 3B1.1(c) and obstruction enhancement under U.S.S.G. § 3C1.1.

3. Analysis

3.1 Precedents Cited

A. Acceptance of responsibility: timing, candor, and standards of review

The acceptance-of-responsibility dispute was framed by U.S.S.G. § 3E1.1 and by Sixth Circuit precedent emphasizing that a guilty plea is not enough. The court reiterated the burden rule from United States v. Jett and reviewed factfinding deferentially under United States v. Denson, noting that the circuit’s standard for applying guidelines to uncontested facts remains unsettled per United States v. Thomas and United States v. Prater. Because Green did not preserve key objections, the court applied plain-error principles as articulated in United States v. Cabrera (quoting United States v. Vonner).

Green relied on the “notice” line of cases limiting reliance on pre-indictment criminal conduct: United States v. Jeter and United States v. Tilford (each noted as abrogated on other grounds by Buford v. United States), and the unpublished extension in United States v. Hakley. The panel distinguished those cases: they address other crimes committed before federal notice, not a defendant’s dishonesty in the plea process itself. The opinion thus endorses a practical proposition: statements made during the change-of-plea colloquy can be considered when assessing whether the defendant “truthfully admit[ted]” and did not “falsely den[y]” relevant conduct (U.S.S.G. § 3E1.1 cmt. n.1(A)).

In assessing ambiguity in Green’s plea-hearing statements, the panel relied on deference principles drawn from United States v. Lay and clear-error principles as formulated in United States v. Hinojosa (quoting United States v. Navarro-Camacho). It also used Sixth Circuit authority that while a defendant need not volunteer extra conduct, she cannot falsely deny it: the court cited United States v. Cook and reiterated the rule from Thomas. Finally, it anchored the denial of the reduction in precedent approving denial where the court believes the defendant was untruthful: United States v. Conner, United States v. Bonds, and again Lay.

B. Restitution under the VWPA: the textual definition of “bodily injury”

The restitution holding begins with the foundational constraint that federal courts may award restitution only when authorized by statute, relying on United States v. Church (quoting United States v. Evers), and describing VWPA restitution’s compensatory function with United States v. Scott. It placed the burden on the government under United States v. Fike.

For statutory interpretation methodology, the panel cited In re MCP No. 185 (text read in context) and the ordinary-meaning approach from Grand Traverse Band of Ottawa & Chippewa Indians v. U.S. Att'y W. Dist. of Mich. (quoting Williams v. Taylor). It then invoked the anti-superfluity canon via In re Vill. Apothecary, Inc. to reject the government’s argument that the statute’s reference to “psychiatric” and “psychological care” necessarily expands “bodily injury” to include purely mental injury.

Crucially, the panel aligned itself with the de novo holdings of sibling circuits construing the VWPA similarly: United States v. Reichow (Eighth Circuit), United States v. Hicks (Ninth Circuit), and United States v. Powell (Fourth Circuit). It distinguished contrary outcomes that arose only under plain-error review: United States v. Breshers (Seventh Circuit) and United States v. Dotson (Tenth Circuit).

The court also addressed interpretive arguments based on other Title 18 definitions of bodily injury, using the expressio unius-style inference canon as described in Allison Engine Co. v. United States ex rel. Sanders (quoting Barnhart v. Sigmon Coal Co.), and analogizing to cross-statute comparison reasoning in W. Va. Univ. Hosps., Inc. v. Casey. But it ultimately treated the lack of uniformity in Title 18 definitions as reducing the usefulness of that comparative move.

C. Physical manifestations of emotional harm: support from tort, insurance, and treaty contexts

After holding that purely mental harm is not “bodily injury,” the court adopted a middle position: “bodily injury” does include physical manifestations of mental harm. The panel bolstered that conclusion by reference to:

  • Negligent infliction of emotional distress principles and commentary, including Armstrong v. Shirvell and the Restatement (Second) of Torts § 436.
  • Insurance-coverage authorities recognizing bodily injury can include emotional distress with physical manifestations (citing district court decisions, including W. Bend Mut. Ins. Co. v. CPT Next Gen, Inc.).

The court then separated inapposite lines of authority:

  • Warsaw Convention “bodily injury” cases (Lloyd v. Am. Airlines (In re Air Crash at Little Rock Ark., on June 1, 1999), Carey v. United Airlines, Terrafranca v. Virgin Atl. Airways Ltd.) were distinguished because they trace to treaty-specific reasoning in Eastern Airlines, Inc. v. Floyd, which relied heavily on the original French text and treaty history.
  • PLRA cases were distinguished on the basis of the PLRA’s different wording requiring “a prior showing of physical injury.”

Finally, the remand posture was governed by the factfinding principle in Pullman-Standard v. Swint: where a district court did not make necessary findings due to an erroneous legal view, remand is the usual remedy. The panel also noted its own dicta tension on whether sleeplessness is “mental” or “physical,” citing Doe v. Etihad Airways, P.J.S.C. and Meyers v. City of Cincinnati.

D. Hovanec’s sentence: reasonableness review and guideline enhancements

On procedural reasonableness, the panel invoked United States v. Mack (quoting Gall v. United States) for the rule that sentencing based on clearly erroneous facts is procedural error, and applied abuse-of-discretion review under United States v. Fowler. It applied clear-error deference to factfinding as articulated in United States v. Estrada-Gonzalez (quoting United States v. Caston). For the “important factor” test (whether the sentence might have been different), the court relied on United States v. Cunningham and United States v. Wilson. It also used United States v. Robinson to underscore that the weight assigned to psychological evidence can be debatable without being clearly erroneous, and cited Eighth Circuit support for trial-court discretion in weighing experts in United States v. Dalasta.

Hovanec’s argument about a mischaracterization of evidence was compared to a true attribution error in United States v. Knight, and the “not important to sentencing” principle was taken from United States v. Parks.

On substantive reasonableness, the panel applied United States v. Tristan-Madrigal and noted the “even more demanding” burden when the defendant already received a downward variance, citing United States v. Lynde (quoting United States v. Curry). It also supported reliance on retribution and deterrence with United States v. Sexton and again referenced Vonner.

For the leadership enhancement, the court anchored its analysis in U.S.S.G. § 3B1.1(c) and Sixth Circuit application cases: it noted the district court’s reference to United States v. Minter, applied deferential review under United States v. Nicolescu (quoting United States v. Sexton and referencing United States v. Washington), and reiterated the requirement that the defendant manage a participant (not merely the scheme), citing United States v. Kamper. The panel then analogized the factual record to leadership findings upheld in United States v. Taylor, United States v. Vasquez, and Nicolescu.

For credibility and deference, it cited United States v. Prigmore (quoting United States v. Johnson) and reiterated the clear-error formulation via United States v. House. It also deemed a reply-brief-only argument forfeited under Scott v. First S. Nat'l Bank. With respect to authority at a distance, it cited United States v. Holliday and compared to United States v. Davis.

For obstruction, the court applied U.S.S.G. § 3C1.1, noted standards in United States v. Histed and the lingering application-standard uncertainty discussed in Thomas, and referenced the more specific perjury-based standard in United States v. Jackson. On the merits, it relied on Sixth Circuit cases holding attempts to destroy evidence can suffice even if unsuccessful: United States v. Van Shutters, United States v. Waldon, and United States v. Schwartz.

For claims of predetermination and Rule 32 opportunity-to-be-heard concerns, it used United States v. Glass, United States v. Epps, and the acceptability of pre-drafting a sentencing opinion from Cunningham. Finally, it addressed a mistaken case citation under plain-error principles, using preservation rules from United States v. Bostic (quoting United States v. LeBlanc), and held that miscitation did not warrant reversal under the “totality of the record” reasoning of United States v. Harmon and United States v. Potts, and the “slip of the tongue” concept from United States v. Grimes.

3.2 Legal Reasoning

A. The new VWPA restitution rule: “bodily injury” has a physical core, but can be satisfied by psychosomatic harm

The court’s interpretation of 18 U.S.C. § 3663(b)(2) proceeds in two steps:

  1. Pure psychological harm is not “bodily injury.” Using ordinary meaning (including contemporaneous dictionary definitions of “bodily” as “physical” and contrasted with “mental”), the court held that emotional/psychological injury alone does not satisfy the VWPA’s threshold. The court reinforced this with the superfluity canon: if “bodily injury” already included mental injury, Congress’s separate reference to “psychiatric” and “psychological care” would risk becoming redundant.
  2. Physical manifestations of psychological harm can be “bodily injury.” The opinion reasoned that when emotional trauma produces physical symptoms, the victim has suffered an injury to the body, and if that injury “result[s]” from the offense, the statutory threshold is met. This approach attempts to honor both statutory text and victim-compensation purposes without rewriting “bodily” to mean “mental.”

Importantly, the court did not declare that particular symptoms (e.g., sleeplessness) automatically qualify. Instead, because the district court applied the wrong legal definition (treating mental harm alone as enough), the Sixth Circuit remanded for evidence and findings on whether the children experienced physical manifestations causally attributable to Green’s offense.

B. Acceptance of responsibility: candor in the plea colloquy matters

The Green sentencing ruling illustrates a pragmatic guideline principle: acceptance of responsibility is not only about the guilty plea; it is also about truthfulness regarding relevant conduct. The Sixth Circuit distinguished “pre-notice other crimes” cases (United States v. Jeter, United States v. Tilford) from dishonesty during the plea process. The panel found no error (and certainly no plain error) in using Green’s change-of-plea statements to conclude she falsely denied relevant conduct, which U.S.S.G. § 3E1.1 permits the court to treat as inconsistent with acceptance.

The court also approved the limited use of Green’s preindictment interview statements not as an independent basis to deny the reduction, but as corroboration for the finding that her later plea colloquy “after the fact” parsing was not candid.

C. Hovanec’s sentencing challenges: deference to district-court weighing and guideline application

The panel’s core move was deferential: it treated the district court’s skepticism toward Dr. Brams’s report as a permissible weighing judgment, not a clearly erroneous factfinding, especially in light of inconsistencies the government identified in inputs to the report. The court also emphasized that any questionable remark (e.g., “hired advocate”) was not shown to be an important factor driving the sentence, particularly because the district court granted a downward variance.

On guideline enhancements, the court relied heavily on the factual record of direction and planning: for U.S.S.G. § 3B1.1(c), Hovanec’s direction of Theodorou’s actions (including procurement, shipping concealment instructions, and operational planning) supported a leadership finding. For U.S.S.G. § 3C1.1, the concealment and evidence-destruction campaign, including acts occurring after the investigation began, supported obstruction even if the investigation was ultimately swift and successful.

3.3 Impact

A. Restitution practice in the Sixth Circuit under the VWPA

The decision establishes a clear Sixth Circuit rule for VWPA restitution under § 3663(b)(2):

  • No restitution for psychological care based solely on emotional harm absent “bodily injury.”
  • Restitution may be available where emotional harm produces physical manifestations and causation is established.

Practically, this will change restitution litigation in VWPA cases (and in MVRA cases with identical language) by increasing the importance of:

  • medical/therapeutic records documenting physical symptoms (e.g., headaches, abdominal pain, exacerbated conditions);
  • expert testimony connecting symptoms to the offense (causation); and
  • careful record development on borderline symptoms such as insomnia, nightmares, appetite changes, and stress-related somatic complaints.

The ruling also implicitly cabins district courts’ discretion: they may not treat the statute as authorizing psychological-care restitution whenever a victim experiences trauma; the bodily-injury threshold is real, though not limited to blunt physical injuries.

B. Sentencing doctrine: two clarifications with broader reach

  • Plea colloquy candor as acceptance-of-responsibility evidence: Defendants in the Sixth Circuit should expect that minimizing, parsing, or equivocating about relevant conduct during the plea process can cost them U.S.S.G. § 3E1.1 credit even if they plead guilty.
  • Obstruction enhancement does not require successful obstruction: The decision reinforces that attempted or calculated evidence destruction and staging may qualify under U.S.S.G. § 3C1.1 even if investigators quickly uncover the truth.

4. Complex Concepts Simplified

  • VWPA vs. MVRA: The court noted the district court referenced 18 U.S.C. § 3663A (MVRA), but the correct statute here was 18 U.S.C. § 3663 (VWPA) because Green’s offense was not MVRA-enumerated. The key language analyzed (“bodily injury” and psychological care) is the same for this issue.
  • “Bodily injury”: Under this decision, it means physical injury. Emotional trauma alone is not enough, but trauma that causes physical symptoms can count.
  • Acceptance of responsibility (U.S.S.G. § 3E1.1): A sentencing reduction for defendants who clearly accept guilt and are truthful. A guilty plea helps but does not guarantee the reduction.
  • Plain error: A stricter appellate standard used when a party did not properly raise an issue in the district court; the error must be clear and must have mattered to the outcome.
  • Aggravating-role enhancement (U.S.S.G. § 3B1.1(c)): Adds levels when the defendant organized/led/managed another participant, not merely when the defendant played a big role in the overall plot.
  • Obstruction enhancement (U.S.S.G. § 3C1.1): Adds levels for willful interference (or attempts) with investigation/prosecution/sentencing, including evidence destruction and misleading conduct; success is not required.

5. Conclusion

United States v. Anita Green announces a consequential restitution rule: “bodily injury” in 18 U.S.C. § 3663 excludes purely psychological harm, but includes physical manifestations of psychological harm. By reversing and remanding the restitution order, the Sixth Circuit required district courts to make concrete, evidence-based findings about physical symptomatology and causation before ordering restitution for psychological care under the VWPA.

The remainder of the opinion reinforces established sentencing themes: acceptance-of-responsibility credit depends on candor (including during the plea process), and leadership/obstruction enhancements are sustained where the factual record shows direction of others and calculated concealment—even when the scheme is quickly uncovered.