“Bodily Injury” Restitution Under 18 U.S.C. § 3663: Purely Psychological Harm Is Insufficient, but Physical Manifestations of Emotional Harm Qualify

1. Introduction

This Sixth Circuit opinion arises from an unusually tragic federal prosecution: amid contentious divorce and custody litigation, Amanda Hovanec killed her husband, T.H., by injecting him with etorphine, a controlled large-animal tranquilizer. Her romantic partner, Anthony Theodorou, obtained and shipped the drug from South Africa at her direction; the two then disposed of evidence. Hovanec’s mother, Anita Green, assisted in the cover-up—most notably by transporting Hovanec and Theodorou to bury T.H.’s body.

The appeals presented three clusters of issues:

• Green’s sentencing: whether Green deserved a U.S.S.G. § 3E1.1 acceptance-of-responsibility reduction despite later-developed evidence that she minimized pre-offense knowledge during her plea colloquy.
• Green’s restitution: whether restitution for the children’s psychological care may be ordered under 18 U.S.C. § 3663(b)(2)(A) when the asserted harm is psychological rather than physical.
• Hovanec’s sentencing: whether the district court mishandled psychological mitigation evidence and whether role and obstruction enhancements were correctly applied.

The most consequential doctrinal development is the court’s interpretation of “bodily injury” in § 3663: emotional/psychological harm alone does not qualify, but emotional harm that physically manifests can.

2. Summary of the Opinion

2.1 Green: acceptance of responsibility

The Sixth Circuit affirmed the denial of an acceptance-of-responsibility reduction. The district court permissibly concluded that Green falsely denied relevant conduct (her advance knowledge of the murder plan) during the change-of-plea hearing—dishonesty that is inconsistent with U.S.S.G. § 3E1.1.

2.2 Green: restitution for children’s mental health treatment

The court reversed the restitution order and remanded. It held:

• Purely mental or psychological harms are not “bodily injury” under 18 U.S.C. § 3663(b)(2).
• Physical manifestations of mental harm (e.g., headaches, abdominal pain, exacerbated medical conditions) can satisfy “bodily injury” if caused by the offense.

Because the record did not clearly establish qualifying physical manifestations, remand was required for factual findings consistent with Pullman-Standard v. Swint.

2.3 Hovanec: procedural and substantive reasonableness, role and obstruction enhancements

The court affirmed Hovanec’s 480-month sentence (a downward variance from a guidelines range of life). It found no clear error in the district court’s skeptical weighing of Dr. Brams’s psychological report; no substantive unreasonableness given the gravity and premeditation of the offense; and no error in applying the U.S.S.G. § 3B1.1(c) aggravating-role and U.S.S.G. § 3C1.1 obstruction enhancements.

3. Analysis

3.1 Precedents Cited

A. Acceptance of responsibility and the significance of plea-stage candor

The opinion synthesizes Sixth Circuit acceptance-of-responsibility doctrine and clarifies how plea-colloquy statements fit within it.

• United States v. Jett frames the defendant’s burden to “clearly demonstrate” acceptance and reiterates that a guilty plea is not enough. It also supplies the opinion’s plain-error framework when objections are not preserved.
• United States v. Denson provides the clear-error standard for factual determinations. United States v. Thomas and United States v. Prater are cited for the Sixth Circuit’s “unsettled” standard when applying guidelines to uncontested facts.
• United States v. Cabrera and United States v. Vonner supply the familiar four-part plain-error test.
• United States v. Jeter and United States v. Tilford (both noted as “abrogated on other grounds by, Buford v. United States”) are central to Green’s argument that pre-plea conduct should not count against acceptance. The panel distinguishes these authorities: they address other criminal conduct before indictment/plea, not dishonesty in the plea process itself.
• United States v. Hakley is acknowledged for broad language suggesting acceptance “generally does not occur until entry of a plea,” but the panel emphasizes that no Sixth Circuit case held a district court must ignore a defendant’s plea-hearing denials.
• United States v. Lay supports deference to a district court’s reasonable interpretation of ambiguous testimony. United States v. Cook and United States v. Conner reflect the principle that silence about relevant conduct is permitted, but false denial is not. United States v. Bonds underscores that perceived untruthfulness can justify denying the reduction.
• The panel’s view that a defendant cannot falsely deny relevant conduct is reinforced by United States v. Jones and United States v. Mojica-Baez, cited to explain how relevant conduct functions in the accessory-after-the-fact setting.
• United States v. Hinojosa and United States v. Navarro-Camacho supply the “two permissible views of the evidence” principle.

B. Restitution, statutory authorization, and the meaning of “bodily injury”

The restitution analysis is both textualist and comparative, anchored by restitution’s statutory nature and the ordinary meaning of “bodily injury.”

• United States v. Church and United States v. Evers provide the basic premise: federal courts lack inherent restitution power and may order restitution only when a statute authorizes it. United States v. Scott describes § 3663’s compensatory purpose, while United States v. Fike supplies the government’s burden of proof.
• For interpretive method, the court cites In re MCP No. 185 (text “in context”), and Grand Traverse Band of Ottawa & Chippewa Indians v. U.S. Att'y W. Dist. of Mich. (ordinary meaning), which in turn quotes Williams v. Taylor. The anti-superfluity canon comes via In re Vill. Apothecary, Inc..
• On the specific “bodily injury” question, the panel aligns with sibling circuits applying de novo review: United States v. Reichow, United States v. Hicks, and United States v. Powell. It distinguishes plain-error-limited decisions: United States v. Breshers and United States v. Dotson.
• The panel canvasses “bodily injury” usage in other contexts: Berg v. E.I. Dupont De Nemours & Co. (In re Berg Litig.) (Price-Anderson Act) supports excluding purely emotional injury. It uses cross-statute comparison cautiously, citing Allison Engine Co. v. United States ex rel. Sanders (quoting Barnhart v. Sigmon Coal Co.) and W. Va. Univ. Hosps., Inc. v. Casey.
• For the “physical manifestations” rule, the opinion draws support from tort, insurance, and Restatement sources: Gov't Emps. Ins. Co. v. Encelewski, Allen v. Wells Fargo, N.A., Walters v. Mintec/Int'l, Armstrong v. Shirvell, Restatement (Second) of Torts § 436, Merchants Ins. Co. of N.H. v. Hessler, Liberty Mut. Ins. Co. v. Lange, and W. Bend Mut. Ins. Co. v. CPT Next Gen, Inc..
• It rejects reliance on 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, and Terrafranca v. Virgin Atl. Airways Ltd.—because those cases turn on treaty interpretation and the Supreme Court’s reasoning in Eastern Airlines, Inc. v. Floyd, including the French text and history.
• Finally, remand for missing findings is grounded in Pullman-Standard v. Swint. The panel flags (without resolving) whether sleeplessness is “physical” or “mental” by noting dicta in Doe v. Etihad Airways, P.J.S.C. and Meyers v. City of Cincinnati.

C. Sentencing reasonableness and guideline enhancements (Hovanec)

• Procedural reasonableness is framed by United States v. Mack (quoting Gall v. United States), abuse-of-discretion review by United States v. Fowler, and clear-error principles by United States v. Estrada-Gonzalez (quoting United States v. Caston). Reliance-on-erroneous-information analysis comes from United States v. Cunningham and United States v. Wilson. The district court’s discretion to weigh expert opinions is supported by United States v. Robinson and United States v. Dalasta. Misattribution clear error is distinguished via United States v. Knight; harmlessness of “passing” erroneous characterization is supported by United States v. Parks.
• Substantive reasonableness principles are taken from United States v. Tristan-Madrigal. The “more demanding” burden after a downward variance comes via United States v. Lynde (quoting United States v. Curry), and the propriety of emphasizing deterrence and retribution is supported by United States v. Sexton and again by United States v. Vonner.
• The aggravating-role analysis relies on U.S.S.G. § 3B1.1 and Sixth Circuit leadership jurisprudence: United States v. Minter, United States v. Nicolescu, United States v. Washington, United States v. House, and substantive exemplars United States v. Taylor and United States v. Vasquez. The requirement that the defendant manage people, not merely a scheme, is grounded in United States v. Kamper. Deference to credibility determinations is supported by United States v. Prigmore (quoting United States v. Johnson). The forfeiture rule is noted via Scott v. First S. Nat'l Bank.
• Obstruction analysis applies U.S.S.G. § 3C1.1 and references standards from United States v. Histed, with a note about perjury-based review in United States v. Jackson. The principle that attempts and pre-investigation conduct can qualify is supported by United States v. Van Shutters, United States v. Waldon, and United States v. Schwartz. Predetermination/Rule 32 concerns are addressed through United States v. Glass and United States v. Epps, along with the text of Federal Rule of Criminal Procedure 32. Preservation and plain-error review for a new appellate theory follow United States v. Bostic (quoting United States v. LeBlanc). “Slip of the tongue” and totality-of-record harmlessness are supported by United States v. Harmon, United States v. Potts, and United States v. Grimes.

3.2 Legal Reasoning

A. A new, two-step rule for “bodily injury” restitution under § 3663(b)(2)

The panel’s reasoning proceeds in three moves:

1. Text and ordinary meaning: Because Congress did not define “bodily injury” in the VWPA, the court uses ordinary meaning as of enactment. Contemporary dictionaries and legal dictionaries define “bodily” as “physical,” “corporeal,” and explicitly contrast it with “mental.” This supports the court’s categorical rejection of “purely psychological harm” as “bodily injury.”
2. Context and anti-superfluity: The Government’s strongest textual argument was that § 3663(b)(2)(A) authorizes restitution for “psychiatric[] and psychological care,” implying “bodily injury” includes mental injury. The panel rejects that inference: Congress could have intended that victims of physical injury can recover for psychological care necessitated by the physical injury and its aftermath. Moreover, reading “bodily injury” to include psychological injury would risk making “bodily” surplusage.
3. Physical manifestations as a bridge concept: The court then adopts an intermediate rule: where emotional distress produces physical symptoms, the victim has suffered a physical injury “to their corporeal body.” This approach remains faithful to “bodily” while recognizing that mind and body interact—and aligns with a broad remedial purpose statement accompanying the VWPA.

Importantly, the Sixth Circuit does not declare what symptoms always qualify; it instead requires a factual showing that physical symptoms resulted from the offense. On this record, even though the Government cited abdominal pain and headaches, the victim statement described some maladies as possibly unrelated. The panel therefore remanded for findings on causation and the nature of the symptoms, including whether sleeplessness entails bodily injury in these children’s circumstances.

B. Acceptance of responsibility: plea-hearing false denials are fair game

Green attempted to extend United States v. Jeter and United States v. Tilford into a categorical rule: acceptance should be assessed only after the guilty plea, insulating pre-plea statements. The panel sharply distinguishes the type of conduct.

Jeter/Tilford restrict using other criminal conduct before indictment/plea as evidence of non-acceptance because it may merely reflect a “criminal disposition” and because the defendant may not have notice of federal scrutiny. By contrast, dishonesty in the plea process itself goes directly to whether the defendant is “truthfully admitting” the offense and relevant conduct under U.S.S.G. § 3E1.1.

The panel then affirms the district court’s reading of Green’s plea-colloquy statements—reviewed under plain error because the specific objection was not preserved. The transcript supported the interpretation that Green denied prior knowledge of the killing (“after the fact”), a denial contradicted by Theodorou’s testimony and other evidence.

The opinion also clarifies that for an accessory after the fact, “relevant conduct” includes underlying-offense conduct known (or reasonably known) to the accessory (U.S.S.G. § 1B1.3 cmt. n.9; U.S.S.G. § 2X3.1 cmt. n.1). Thus, Green’s pre-offense knowledge—if falsely denied—was properly considered in the § 3E1.1 analysis.

C. Hovanec: deference to sentencing judges on contested mitigation and enhancements

Hovanec’s appellate attack largely sought to convert the district court’s skeptical weighing of Dr. Brams’s report into “clearly erroneous facts.” The panel declines. It emphasizes that the district court did not say the report was wholly “unsubstantiated”; rather, it credited some aspects while identifying reasons for caution, including the absence of “independent” testing and the possibility that the evaluator relied heavily on defendant-supplied narratives that were contradicted by other evidence.

The court’s affirmance of the leadership enhancement is consistent with Sixth Circuit role cases: directing another participant’s acts (even remotely), recruiting, and decision-making authority can establish leadership under § 3B1.1(c), as illustrated by United States v. Taylor, United States v. Vasquez, and United States v. Nicolescu.

Likewise, the obstruction enhancement is sustained because § 3C1.1 covers both successful and attempted obstruction, and may include pre-investigation conduct “purposefully calculated, and likely, to thwart” investigation. Disposing of evidence, staging a misleading narrative, lying to investigators, and sending a deceptive message during the investigation fit comfortably within the guideline’s scope.

3.3 Impact

A. Restitution practice in the Sixth Circuit: a clarified evidentiary pathway

The restitution holding is likely to matter well beyond this case because § 3663 (and, as the opinion notes, identical language in § 3663A for present purposes) often arises where victims’ principal losses are psychological counseling costs—particularly in crimes involving family members, intimidation, stalking, or threats.

The decision creates a practical framework:

• Not enough: proof of emotional distress and the need for therapy, without more, does not satisfy “bodily injury.”
• Potentially enough: proof that emotional harm caused physical symptoms (and those symptoms are attributable to the offense) can satisfy “bodily injury.”
• Operational consequence: restitution litigation will become more evidentiary: medical records, clinician testimony, diagnoses tying symptoms to trauma, and causation evidence will be central to meeting the government’s burden under United States v. Fike.

The remand also signals that district courts must make explicit findings on (i) what the physical symptoms are, and (ii) whether they resulted from the offense, rather than assuming psychological trauma itself meets the statute.

B. Sentencing proceedings: plea-colloquy minimization can cost § 3E1.1 credit

The acceptance-of-responsibility portion reinforces a cautionary message for defendants (and counsel): attempts to narrowly parse “knowledge” or minimize relevant conduct during the plea process can later be treated as false denial and lead to the loss of the § 3E1.1 reduction, even if the defendant otherwise pleads guilty. The opinion’s distinction between pre-plea other crimes and pre-plea dishonesty about the charged matter narrows the shelter offered by broad readings of United States v. Tilford and similar cases.

C. Mitigation experts and sentencing skepticism

For defense mitigation practice, the opinion shows the appellate difficulty of challenging a district court’s weighing of psychological evidence. Even substantial mitigation material may be discounted if it lacks objective testing, leans heavily on self-report, or is undermined by contradictions in the broader record. The court’s affirmance—despite acknowledging it might have been “preferable” for the judge to explain skepticism more fully—suggests that the safest strategy is to build corroboration (records, testing, collateral witnesses) into mitigation submissions to reduce vulnerability to credibility attacks.

4. Complex Concepts Simplified

• VWPA vs. MVRA: The court noted a statutory mismatch: the district court referenced § 3663A (MVRA), but the parties agreed § 3663 (VWPA) governs. For this issue, it did not matter because the relevant “bodily injury” language is identical “for present purposes.”
• “Bodily injury” (as used here): Think “injury to the body.” The court held that “mental anguish” by itself is not “bodily injury.” But if mental anguish causes bodily symptoms—like headaches or abdominal pain—those bodily symptoms can qualify.
• Acceptance of responsibility (U.S.S.G. § 3E1.1): A guilty plea helps, but it is not automatic credit. If a defendant lies or falsely denies relevant conduct, the judge can deny the reduction.
• Relevant conduct for an accessory after the fact: The accessory’s guideline calculation can depend on the underlying offense characteristics that the accessory knew or should have known. Denying that knowledge can be treated as denying relevant conduct.
• Procedural vs. substantive reasonableness: Procedural asks whether the judge followed the right process (correct facts, correct guideline steps). Substantive asks whether the length of the sentence is too long (greater than necessary) given the § 3553(a) factors.
• Leadership enhancement (U.S.S.G. § 3B1.1(c)): You must lead/manage people, not merely participate in a plan. Direction, recruitment, and decision-making can suffice.
• Obstruction enhancement (U.S.S.G. § 3C1.1): Destroying evidence or misleading investigators can qualify even if the attempt fails; and pre-investigation actions can qualify if calculated and likely to thwart investigation.

5. Conclusion

This opinion does three important things. First, it establishes a clear Sixth Circuit rule for VWPA restitution: emotional harm alone is not “bodily injury” under 18 U.S.C. § 3663(b)(2), but emotional harm that produces physical symptoms can be—requiring concrete findings on symptoms and causation. Second, it reinforces that plea-stage minimization or denial of relevant conduct can justify denial of a U.S.S.G. § 3E1.1 reduction, distinguishing prior cases restricting reliance on pre-plea other crimes. Third, it confirms broad deference to district courts in weighing mitigation experts and applying role and obstruction enhancements where the record supports leadership direction and calculated evidence-destruction efforts.

In the broader legal landscape, the restitution holding will likely be the most cited: it both constrains restitution based solely on psychological injury and supplies a workable, evidence-driven avenue for restitution where trauma has demonstrable bodily consequences.