Appellate Case: 24-6026 Document: 74-1 Date Filed: 04/15/2025 Page: 1
`FILED
`United States Court of Appeals
`Tenth Circuit
`
`April 15, 2025
`
`Christopher M. Wolpert
`Clerk of Court
`
`PUBLISH
`
`UNITED STATES COURT OF APPEALS
`
`FOR THE TENTH CIRCUIT
`_________________________________
`
`UNITED STATES OF AMERICA,
`
` Plaintiff - Appellee,
`
`v.
`
`GERMAINE COULTER, SR., a/k/a Slim,
`
` Defendant - Appellant.
`_________________________________
`
`
`
`
`
`No. 24-6026
`
`Appeal from the United States District Court
`for the Western District of Oklahoma
`(D.C. No. 5:18-CR-00156-D-1)
`_________________________________
`
`John M. Bowlin, Bowlin & Schall LLC, Greenwood Village, Colorado, for Defendant-
`Appellant.
`
`Jackson D. Eldridge, Assistant United States Attorney (Robert J. Troester, United States
`Attorney, with him on the brief), United States Attorney’s Office, Oklahoma City,
`Oklahoma, for Plaintiff-Appellee.
`_________________________________
`
`Before TYMKOVICH, CARSON, and FEDERICO, Circuit Judges.
`_________________________________
`
`TYMKOVICH, Circuit Judge.
`_________________________________
`
`
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`Germaine Coulter was found guilty of child sex trafficking and conspiracy to
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`commit child sex trafficking and was sentenced to 360 months of imprisonment. The
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`district court ordered Coulter to pay a total of $386,000 in restitution to the two victims
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`he harmed. Coulter appeals, arguing the government fails to demonstrate he is the but-for
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`cause of the victims’ injuries. He further challenges the district court’s determination of
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`the restitution award amount, claiming it is unsupported by evidence in the record.
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`We AFFIRM. The government met its burden in showing Coulter was a but-for
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`cause of the victims’ losses. The district court, moreover, did not abuse its discretion in
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`ordering Coulter to pay ten years of ongoing individual therapy, psychiatric treatment,
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`and medication for the two victims based on the evidence presented in the record.
`I.
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`Background1
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`A.
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`Procedural History
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`Coulter was charged with: (1) conspiracy to commit child sex trafficking of Doe 1
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`and Doe 2; (2) child sex trafficking with respect to Doe 1; and (3) child sex trafficking
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`with respect to Doe 3. At trial, he was ultimately found guilty on Counts One and Two
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`by a jury verdict and was subsequently sentenced to 360 months of imprisonment on each
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`count, to be served concurrently.2 Coulter appealed his conviction and sentence; but we
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`affirmed both the guilty verdict and his sentence.
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`1 The facts surrounding this case were discussed in full in Coulter’s previous
`appeal and are well known to the parties. See United States v. Coulter, 57 F.4th 1168,
`1176 (10th Cir.), cert. denied, 143 S. Ct. 2627 (2023). We therefore incorporate the facts
`included in our previous opinion and present only an abbreviated version of the factual
`and procedural history as relevant to this appeal. We also note the record is sealed in this
`matter.
`2 Elizabeth Andrade, Coulter’s co-defendant, pleaded guilty to a one-charge
`superseding information charging her with conspiracy to commit child sex trafficking of
`Doe 1 and Doe 2. Andrade’s plea agreement requires her to pay restitution to all victims
`of her relevant conduct. She was ultimately sentenced to 78 months of imprisonment and
`five years of supervised release. Andrade did not join Coulter’s appeal.
`2
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`
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`After the appeal was resolved, the government filed a motion for restitution,
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`requesting $1,145,900 for Doe 1 and $967,000 for Doe 2—a total sum of $2,112,900.
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`The government also requested that Coulter and Andrade pay a $5,000 special
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`assessment under the Justice for Victims of Trafficking Act (JVTA) for each count of
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`conviction. The government’s motion relied on expert reports by a psychologist, Dr.
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`Charles David Missar.
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`
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`Before Coulter responded to the motion, the district court stayed briefing while
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`this Circuit considered an appeal on a parallel issue: whether the government must
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`establish a defendant’s actions are the but-for and proximate cause of a victim’s injuries
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`for purposes of restitution under the Trafficking Victims Protection Reauthorization Act
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`(TVPRA). See United States v. Anthony, 22 F.4th 943 (10th Cir. 2022) (“Anthony II”);
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`see also United States v. Anthony, 942 F.3d 955 (10th Cir. 2019) (“Anthony I”).3 In
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`Anthony I and Anthony II, we answered that question affirmatively. See Anthony II, 22
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`F.4th 943 (affirming the district court’s decision to not award restitution because the
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`government failed to meet the but-for causation requirement).
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`B.
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`Expert Reports and Restitution Hearing
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`After this Circuit’s decision in Anthony II, the parties filed supplemental briefs and
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`responses addressing the restitution issue. Both briefs largely refer to Dr. Missar’s two
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`expert reports, which each provide an assessment of Doe 1 and Doe 2’s emotional
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`functions and mental health, as well as their respective trauma sustained from being
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`3 Anthony I and Anthony II also involved expert reports by Dr. Missar.
`3
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`sexually trafficked. See App. Vol. II, 246–53 (Doe 1 Report); id. at 82–93 (Doe 2
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`Report). The expert reports rely on interviews with the two victims, transcripts and
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`documents from Coulter’s trial, medical records, victim impact statements, and various
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`pleadings and orders filed in this case.
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`Dr. Missar opined that Doe 1 suffers from post-traumatic stress disorder (PTSD),
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`severe depression, and dysthymia (a persistent depressive disorder) from the trauma of
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`being sexually trafficked. He noted the “nexus between the emergence of these
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`symptoms and her sexual trafficking is quite clear, and the ongoing symptoms4 . . . are
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`directly linked . . . to that trafficking.” Id. at 252. Based on his assessment, Dr. Missar
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`recommended Doe 1 needs various types of treatment, such as two intensive years and
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`then a lifetime of both individual therapy and psychiatric treatment. He also opined that
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`“the impact that sex trafficking had on [Doe 1] has . . . impaired her ability to work to her
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`potential” and “interfered with her ability to continue her education.” Id. at 253. Dr.
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`Missar therefore recommended lost work wages based on information from the Social
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`Security Administration as to “the difference in lifetime earnings between those with a
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`high school diploma compared to having some college work.” Id. Adding a lifetime of
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`medication treatment, Dr. Missar calculated the following damages:
`
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`4 Dr. Missar noted Doe 1’s symptoms of trauma due to sex trafficking include
`“PTSD flashbacks to sex trafficking events, prolonged fear of [Coulter] to the point of
`anxiety being in public, [and] ongoing struggles with health and personal safety.” App.
`Vol. II, 252.
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`4
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`Dr. Missar separately opined that Doe 2 suffers from PTSD, dysthymia, and mood
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`disorders due to the trauma of being sexually trafficked. He noted Doe 2’s attention-
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`deficit/hyperactivity disorder (ADHD) symptoms and learning disorder likely predated
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`her sex trafficking, but were also exacerbated by it. Id. at 93. Dr. Missar thus
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`recommended restitution for “tutoring to help her through any academic work that she is
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`able to do over the next several years.” Id. Based on her injuries, Dr. Missar also
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`advised Doe 2 similarly requires various types of treatment, including two intensive years
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`followed by a lifetime of both individual therapy and psychiatric treatment. Adding a
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`lifetime of medication treatment, Dr. Missar submitted the following calculated damages
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`for Doe 2:
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`
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`On December 28, 2023, the district court held a restitution hearing in which Dr.
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`Missar appeared as the only witness. Dr. Missar testified about his understanding of the
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`victims’ background and history, as well as the sustained trauma and injuries caused by
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`Coulter. He also responded to questions related to the recommended treatment and
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`therapy for Doe 1 and Doe 2.
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`Specifically for Doe 1, Dr. Missar acknowledged that he was aware Doe 1 had
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`other traumatic life experiences, including being the victim of sexual molestation by a
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`family member at the age of seven. Even so, Dr. Missar opined Coulter’s sexual
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`trafficking of Doe 1 directly caused Doe 1’s PTSD, severe depression, and dysthymia; he
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`explained “the nexus that Doe 1 drew, both in her victim impact statement as well
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`as . . . in the subsequent interview, she linked specifically and repeatedly to the
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`experience with [Coulter] and [Andrade], not to any prior traumatic experience.” App.
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`Vol. III, 50 (emphasis added). Dr. Missar clarified Doe 1’s “psychiatric symptoms . . .
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`are directly related to the traumatic experiences she had as a result of the sex trafficking
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`experience, and the recommendations . . . made are specific to that” and not to any prior
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`trauma or abuse, such as a previous inpatient hospitalization. Id. at 50–51.
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`
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`As to Doe 2, Dr. Missar opined her PTSD, dysthymia, and mood disorder were
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`caused specifically by her sexual trafficking experience. Id. at 61, 118–19. He noted
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`“the presence of [her] depressive symptoms5 specifically relate[] to problems with sexual
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`trafficking and the trauma she sustained and identified as a result . . . .” Id. at 57. He
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`specified that although Doe 2’s reading disorder and ADHD—such as “problems with
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`5 Dr. Missar stated such symptoms include problems with intrusive thoughts,
`nightmares, flashbacks, sleep problems, appetite disturbance, and problems with
`helplessness, hopelessness, worthlessness, and anxiety. App. Vol. III, 57. He also noted
`Doe 2’s has “problems concentrating, with periodic suicidal ideation.” Id. at 59.
`6
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`concentration and attention”—predate Coulter’s offense conduct, they were exacerbated
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`by the sexual trafficking trauma, evidenced by Doe 2’s attempts “to focus on something
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`or try to maintain concentration . . . but be unable to do so because of the presence of
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`traumatic experiences [and] flashbacks . . . that [are] directly related to the sexual
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`trafficking experiences.” Id. at 58, 61. Dr. Missar explained that he believed Doe 2 may
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`have a “rule-out condition for bipolar disorder”6 due to the trauma of sexual trafficking
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`because “there is no family history . . . of bipolar disorder in her family” and the disorder
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`“can often be kindled by a series of negative life events.” Id. at 59–60. When asked by
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`the government why he concluded Doe 2’s conditions were caused by the sex trafficking
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`as opposed to the environment in which Doe 2 was raised, which included exposure to
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`sexual trafficking, Dr. Missar opined that there was a nexus between her symptoms and
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`the experiences she had of being trafficked. Id. at 61. For example, Dr. Missar noted
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`Doe 2’s statement that she did not have flashbacks to her earlier moments in life, but to
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`“specific . . . experiences of sex trafficking and the aftermath of it.” Id. at 62.
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`Near the close of his redirect examination, Dr. Missar responded that the
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`restitution estimates for Doe 1 and Doe 2 are based on their respective diagnoses and
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`treatments, and his “degree of certainty” that those are “linked specifically to the sex
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`trafficking” in this case. Id. at 116–17.
`
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`6 Dr. Missar clarified he “did not have sufficient indication from [his] analysis” to
`formally diagnose Doe 2 with bipolar disorder, and thus left the condition as one that
`would need to be followed up over time by a treating provider. App. Vol. III, 60.
`7
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`C.
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`Restitution Judgment
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`In a written order, the district court awarded restitution for ten years of therapy,
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`psychiatric treatment, and medication in the amount of $198,000 for Doe 1 and $188,000
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`for Doe 2, respectively. In so doing, the district court considered Dr. Missar’s evaluation,
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`related evidence and testimony presented at the restitution hearing and at trial, and the
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`record as a whole.
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`For Doe 1, the district court rejected Defendants’7 argument that the government
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`fails to show but-for causation because Doe 1 was previously “a prostitute” and has past
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`trauma from being molested by a family member. App. Vol. I, 118. The district court
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`considered that Doe 1 did indeed have other potential sources of trauma but agreed
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`nonetheless with Dr. Missar that Defendants were the but-for causes of Doe 1’s trauma as
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`relevant to this case. Id. at 119 (noting that a case involving the sex trafficking of minors
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`“will not necessarily involve individuals possessing a blank slate, unaffected by any sort
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`of trauma before being trafficked” and finding it “unlikely that the Tenth Circuit, in
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`requiring the government to establish but-for and proximate causation, intended to
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`disqualify every trafficking victim who, at some point in their life, suffered from trauma
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`unrelated to the offense conduct.”).
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`The district court accepted Dr. Missar’s recommendation that Doe 1 would need,
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`for the various traumas inflicted by Defendants, intensive individual therapy for two
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`years, ten years of group therapy, and two years of monthly psychiatric treatment. The
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`7 This opinion refers to Coulter and Andrade together as Defendants.
`8
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`district court, however, found Dr. Missar’s recommendation for ongoing therapy,
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`psychiatric treatment, and medication for Doe 1’s lifetime to be “overly speculative”;
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`instead, the court limited the restitution award to cover the costs for such services to ten
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`years, including the intensive sessions of individual therapy and psychiatric treatment. It
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`declined to award any amount for lost work wages because Dr. Missar’s recommendation
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`rested on several assumptions, such as Doe 1 never completing any college coursework.
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`The court found Doe 1 to be “entitled to $198,000 in restitution to account for the
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`. . . expenses set forth in Dr. Missar’s evaluation[.]” Id. at 120.
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`As for Doe 2, the district court noted, contrary to Andrade’s arguments, Doe 2 is
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`
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`indeed a victim under TVPRA because she was “harmed as a result” of Defendants’
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`crimes. It thus determined Defendants were the but-for and proximate cause of Doe 2’s
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`trauma. The district court accepted Dr. Missar’s recommendation that like Doe 1, Doe 2
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`would need two years of intensive individual therapy, ten years of group therapy, and two
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`years of monthly psychiatric treatment to address the various traumas inflicted by
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`Defendants. For the same reasons as Doe 1, the district court held Dr. Missar’s
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`recommendation for ongoing therapy and psychiatric treatment over her lifetime to be
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`“overly speculative.” Accordingly, like Doe 1, restitution was limited to cover ten years
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`of individual therapy, group therapy, psychiatric treatment, and medication, with the first
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`two years of individual therapy and psychiatric treatment to be more intensive. The
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`district court also declined to award any amount for ADHD medication or tutoring
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`because Doe 2’s ADHD diagnosis and reading disability predate her involvement with
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`Defendants. The total restitution for Doe 2 was thus calculated to be $188,000,
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`accounting for the expenses set forth in Dr. Missar’s evaluation. Id. at 123.
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`The district court determined a hybrid joint-and-several restitution approach was
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`
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`appropriate and apportioned the restitution amount between Coulter and Andrade based
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`on their respective contributions to the victims’ injuries:
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`Finally, the district court imposed a $5,000 per-count special assessment on
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`
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`Coulter and Andrade pursuant to the JVTA.
`II. Discussion
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`Coulter argues the district court erred in finding the government met its burden of
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`showing he was a but-for cause of the victims’ injuries. He also asserts the district
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`court’s award of ten years of therapy, psychiatric treatment, and medication is
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`unsupported by any evidence. He does not appeal the JVTA assessment or the hybrid
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`joint-and-several restitution approach imposed by the district court. We consider his
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`arguments in turn.
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`A.
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`Standard of Review
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`“We review the legality of a restitution order de novo, the district court’s factual
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`findings for clear error, and the amount of restitution for abuse of discretion. A district
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`court abuses its discretion if it orders a restitution amount based on an erroneous view of
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`the law or on a clearly erroneous assessment of the evidence.” Anthony II, 22 F.4th at
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`950 (citations omitted).
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`A district court may order restitution “only for losses actually resulting from the
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`offense of conviction.” Id.; see United States v. Quarrell, 310 F.3d 664, 680 (10th Cir.
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`2002) (“A restitution order must be based on actual loss.”). The government must prove
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`those losses, and the amount of such losses, by a preponderance of the evidence. Anthony
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`II, 22 F.4th at 950 (citing 18 U.S.C. § 3664(e)); United States v. Serawop, 505 F.3d 1112,
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`1117 (10th Cir. 2007) (“Any dispute as to the proper amount . . . of restitution shall be
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`resolved by the court by the preponderance of the evidence.” (quoting 18 U.S.C.
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`§ 3664(e))).
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`
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`“To meet its burden, the government must establish that the defendant’s conduct
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`has directly and proximately caused the losses for which the government seeks
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`restitution.” Anthony II, 22 F.4th at 950 (quoting Anthony I, 942 F.3d at 966) (emphasis
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`added and cleaned up) (“To prove direct causation, it must show that, but for the
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`defendant’s conduct, the victim would not have suffered those losses.”). In setting a
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`restitution amount, “the court need not calculate the harms with exact precision.”
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`Anthony II, 22 F.4th at 950 (cleaned up) (quoting Anthony I, 942 F.3d at 970).
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`B.
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`But-For Cause
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`Coulter argues the district court erred in its restitution judgment because the
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`amount requires Coulter to compensate the victims for harms that were not but-for caused
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`by his actions. Specifically, he argues Dr. Missar knew, but failed to account for, the
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`effects of the victims’ previous sources of trauma which predate Coulter’s actions.
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`
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`We clarified in Anthony I and Anthony II that as part of its request for restitution,
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`the government has the burden to disaggregate and differentiate the harms caused by a
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`defendant from the harms not caused by the defendant. Anthony I, 942 F.3d at 967;
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`Anthony II, 22 F.4th at 951. Such an inquiry was prudent in Anthony I and Anthony II
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`because multiple individuals, including the defendant, had sexually trafficked a 14-year-
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`old victim during the span of six months. And yet, the expert recommended restitution
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`against the defendant based on a combined loss of all the victim’s sexual trafficking
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`incidents, without “differentiat[ing] between the losses [the victim] suffered at the hands
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`of other abusers and the losses caused by [the defendant’s] offenses.” Anthony II,
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`22 F.4th at 953; see also id. at 951 (expert’s opinion that victim “will require specific
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`therapy to address the trauma that she suffered during the abuse she endured from her
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`[seven victimizers]” failed to satisfy the but-for causation test as to the one, specific
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`defendant in the case).
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`
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`Like the district court in Anthony I and Anthony II, Coulter claims the district court
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`failed to differentiate the psychological consequences of Doe 1 and Doe 2’s trauma from
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`Coulter’s sexual trafficking with those from other traumatic experiences. For example,
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`Coulter points to trauma Doe 1 likely experienced when her two friends committed
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`suicide, or when a family member molested her when she was seven years old; he also
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`highlights trauma Doe 2 likely experienced because of “the death of her mother, an
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`unstable home situation, betrayal by a family member, and contact with the sex
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`trafficking world outside of the acts at issue in this litigation.” Aplt. Br. 6, 10.
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`
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`We agree the government has met its burden of demonstrating Doe 1 and Doe 2’s
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`injuries, for purposes of restitution, are only for losses resulting from the sex trafficking
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`in this case. To begin, the facts in Anthony I and Anthony II are unlike those in this case.
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`Again, the victim in Anthony was found to have experienced trauma from sexual
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`trafficking, but it was unclear how much the defendant had contributed to the trauma
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`given multiple individuals trafficked the victim around the same time. Accordingly, it
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`was not established how much of the victim’s treatment costs should be allocated to the
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`defendant because the government did not demonstrate that the attributed losses were
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`but-for caused by him. See Anthony I, 942 F.3d at 969 (“We recognize the difficulty in
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`setting a restitution amount in cases like this one, where the victim’s asserted losses
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`overlap with similar harms that occurred before the events at issue.” (emphases added)).
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`Here, there is no confusion as to who were the but-for causes of Doe 1 and Doe 2’s
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`sexual-trafficking related traumas because such harms could have only been caused by
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`Coulter and his co-conspirator, Andrade, as established at trial.
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`To the extent Coulter argues the treatment costs for Doe 1 and Doe 2’s trauma are
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`not derived from sexual trafficking and instead to other traumas in their past, we find the
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`argument unpersuasive. Unlike in Anthony I and Anthony II, the victims’ losses
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`predating Coulter’s offense actions are not of the same nature as (i.e., similar to)
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`Coulter’s offense conduct—neither were sexually trafficked nor similarly traumatized
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`around the same time period. More importantly, Dr. Missar testified on
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`cross-examination about his “degree of certainty” that Doe 1 and Doe 2’s recommended
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`therapy are “exclusively the product of being sex[ually] trafficked.” App. Vol. III, 116
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`(“The estimates that I’ve given there, and the diagnoses and the treatments for them, in
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`my opinion, are linked specifically to the sex trafficking.”). Further, Dr. Missar opined
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`Doe 1’s PTSD symptoms (i.e., flashbacks when passing by hotels, fear for personal
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`safety and encountering Coulter, etc.), as well as depression and dysthymia symptoms are
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`“directly connected to the sex trafficking crimes for this case” and “specific experiences
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`she had in being trafficked.” Id. at 118–20 (emphasis added).
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`As to Doe 2, Dr. Missar opined that Doe 2’s PTSD and dysthymic disorder and
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`related symptoms (i.e., depressive conditions, nightmares, flashbacks, periodic suicidal
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`ideation, etc.) are “directly tied” and “related” to the sex trafficking that occurred. He
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`testified that Doe 2’s preexisting ADHD and reading disorder symptoms worsened due to
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`the sex trafficking, evidenced by her lack of ability to focus or maintain concentration
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`“because of the presence of traumatic experiences [and] flashbacks . . . that were directly
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`related to the sexual trafficking experiences.” Id. at 57–59. In short, Dr. Missar opined
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`that knowledge of the victims’ prior traumatic events did not change his analysis because
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`there is a “nexus” between the victims’ experiences of being trafficked and their
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`symptoms that require treatment. See, e.g., id. at 27–28; id. at 50 (“[T]he nexus that
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`Doe 1 drew, both in her victim impact statement as well as . . . in that subsequent
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`interview [regarding her symptoms], she linked specifically and repeatedly to the
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`experience with Mr. Coulter and Ms. Andrade, not to any prior traumatic experience.”);
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`id. at 61 (“[W]ith Doe 2, the nexus that she drew between the experiences she had of
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`being trafficked and [her] internal conflict [see App. Vol. III, 52–53] really . . . came to
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`light as she was being trafficked, in my opinion, led me to the conclusion that these
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`things were a result of . . . the [sex trafficking] experiences she described.”).8
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`Still, Coulter argues Dr. Missar concedes he did not analyze “to what degree the
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`prior abuse had contributed to the victims’ current medical status.” Aplt. Reply Br. 2.
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`But that inquiry is irrelevant to what the government must prove for restitution purposes.
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`Instead, the government is required to demonstrate the defendant’s conduct was the
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`but-for and proximate cause of the victims’ losses for which restitution is sought. See
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`Anthony II, 22 F.4th at 950 (“‘[A] defendant cannot avoid liability just by citing some
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`other factor that contributed to’ the harm.” (quoting Bostock v. Clayton Cty., 590 U.S.
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`644, 645 (2020))).
`
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`8 Coulter argues Dr. Missar merely pointed to the victims’ “fears” relating to
`Coulter to support but-for causation without explaining the effect of past traumas. Aplt.
`Br. 9. But such fears can be considered “symptoms of psychological trauma” caused by
`Coulter’s actions which require psychological or psychiatric treatment. See Anthony I,
`942 F.3d at 960. And Coulter’s concerns that Doe 1 or Doe 2’s “fears” may be irrational
`or overstated are resolved by the preponderance of the evidence standard the district court
`must consider in ordering restitution.
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`We, therefore, find the district court did not abuse its discretion in finding Coulter
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`was the but-for cause of the victims’ injuries for purposes of restitution.
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`C.
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`Restitution Amount
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`Coulter argues that even if but-for causation is proven, the district court erred in
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`awarding ten years of restitution for ongoing individual therapy, psychiatric treatment,
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`and medication. He contends there is insufficient evidence to support the restitution
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`award amount, especially because Dr. Missar only recommended a lifetime of treatment
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`for those categories.
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`Under the TVPRA, a defendant is responsible for the “full amount of [a] victim’s
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`losses . . . includ[ing] any costs incurred, or that are reasonably projected to be incurred
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`in the future, by the victim, as a proximate result of the offenses involving the victim.”
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`Anthony II, 22 F.4th at 946 (emphasis added) (quoting 18 U.S.C. § 2259(c)(2)). The
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`district court “need not calculate the harms with exact precision, but it must set a
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`restitution amount that is ‘rooted in a calculation of actual loss.’” Anthony I, 942 F.3d at
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`970 (citations and internal quotations omitted). “A district court abuses its discretion if it
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`orders a restitution amount based on . . . a clearly erroneous assessment of the evidence.”
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`Anthony I, 942 F.3d at 964 (quoting United States v. Howard, 784 F.3d 745, 750 (10th
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`Cir. 2015)).
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`Here, we find no abuse of discretion in the district court’s decision to limit the
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`three categories of restitution—ongoing individual therapy, psychiatric treatment, and
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`medication—to ten years as opposed to Doe 1 and Doe 2’s lifetime. Certainly, Coulter’s
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`conduct was heinous; but the government failed to satisfy the court that it merited a
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`Appellate Case: 24-6026 Document: 74-1 Date Filed: 04/15/2025 Page: 17
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`lifetime of compensation for related therapy and medication. See Anthony II, 22 F.4th at
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`951. (“[The defendant’s] conduct toward [the victim] was reprehensible, but the
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`government still must prove how that conduct warrants compensation for a lifetime of
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`psychological treatment [and medication].” (cleaned up and citation removed)). For both
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`Doe 1 and Doe 2, Dr. Missar noted that “due to the destabilizing issues inherent in the
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`trauma itself, it may take a patient many years to fully entrust oneself to the therapeutic
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`process” and that “struggles in trusting the therapist can take years to resolve
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`themselves.” App. Vol. II, 78, 92. But “many years” does not necessarily equate to
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`requiring treatment for Doe 1 or Doe 2’s lifetime. And while we do not disagree with Dr.
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`Missar that a sexually trafficked victim “will be touched by [the inflicted trauma] in some
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`way” for the rest of her life, App. Vol. III, 103–04 (“Trauma survivors deal with short
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`and long-term effects of the trauma throughout their lives.”), finding that restitution is
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`warranted for Doe 1 and Doe 2’s lifetime inevitably requires speculation that victims will
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`not recover at all, even after years of therapy sessions or related treatment.
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`That is not to say, however, restitution over a lesser number of years would not be
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`warranted. In fact, Dr. Missar opined in his expert report that “participating in group
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`therapy with other PTSD sufferers for a period of not less than ten years will be critical”
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`for both Doe 1 and Doe 2. App. Vol. II, 79, 93. Here, we find it reasonable that the
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`district court would cap restitution for all therapy and treatments at ten years—the same
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`duration recommended for group therapy—while keeping the two years of intensive
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`individual therapy and psychiatric treatment as recommended by Dr. Missar.
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`Appellate Case: 24-6026 Document: 74-1 Date Filed: 04/15/2025 Page: 18
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`In arguing that Dr. Missar never opined about a ten-year timeframe for Doe 1 and
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`Doe 2’s ongoing individual therapy, psychiatric treatment, and medication, Coulter
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`seemingly argues that a district court must only affirm or reject an expert’s recommended
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`restitution award. But an expert’s report or testimony are only portions of the record that
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`district court should consider. And in considering them with the rest of the record—
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`which may include victim impact statements and trial evidence and testimony—a district
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`court is directed to use its discretion in reasonably projecting a restitution award
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`applicable to a victim’s loss caused by the defendant’s actions. It would be an unrealistic
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`and unsupportable rule to require district courts to either accept all or none of an expert’s
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`recommendation. That Dr. Missar did not opine on the exact timeframe of the restitution
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`categories determined by the district court does not make us doubt the roadmap it used to
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`reach its conclusions. Indeed, the district court carefully calculated sums that were less
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`than twenty percent of the government’s restitution request, a finding that greatly
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`benefited Coulter.
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`We recognize that further explanation of the district court’s rationale may have
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`been helpful to understand the exact reasons behind the district court’s decision in
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`determining the restitution amount. At the same time, our inquiry and standard of review
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`is to determine whether there was an abuse of discretion—we find there has not been
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`such an abuse here. We therefore affirm the district court’s determination of the
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`restitution amount.
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`Appellate Case: 24-6026 Document: 74-1 Date Filed: 04/15/2025 Page: 19
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`III. Conclusion
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`For the foregoing reasons, we affirm the district court’s restitution award for Doe 1
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`and Doe 2 against Coulter.
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