Sequel Youth & Family Servs. LLC v. Ayisi

• Decision Date: 04 January 2018
• Docket Number: Case Number: 116109
• Citation: 412 P.3d 107
• Parties: SEQUEL YOUTH & FAMILY SERVICES LLC and Travelers Indemnity Co. of America, Petitioners, v. Marcella AYISI and The Oklahoma Workers' Compensation Commission, Respondents.
• Court: United States State Court of Criminal Appeals of Oklahoma. Court of Civil Appeals of Oklahoma

412 P.3d 107

SEQUEL YOUTH & FAMILY SERVICES LLC and Travelers Indemnity Co. of America, Petitioners,

v.Marcella AYISI and The Oklahoma Workers' Compensation Commission, Respondents.

Case Number: 116109

Court of Civil Appeals of Oklahoma, Division No. 4.

Decided: January 4, 2018

Mandate Issued: January 31, 2018

Mia C. Rops, DAVID KLOSTERBOER & ASSOCIATES, Oklahoma City, Oklahoma, for Petitioners.

Bob Burke, Oklahoma City, Oklahoma, and Jeffrey M. Cooper, Oklahoma City, Oklahoma, for Respondent.

DEBORAH B. BARNES, PRESIDING JUDGE:

¶1Petitioners(collectively, Employer) seek review of an order of the Workers' Compensation Commission affirming the order of the Administrative Law Judge (ALJ) who found Marcella Ayisi(Claimant) sustained compensable injuries to both of her knees arising out of the course and scope of her employment.Based on our review, we vacate and remand for further proceedings.

BACKGROUND

¶2Claimant filed a Form 3 alleging she sustained injuries to both knees as a result of an accident that occurred while working as a residential counselor for Employer.She alleged she fell while assisting a resident on August 26, 2015, landing directly on both knees.At trial, Claimant testified she worked with special needs children for Employer and that the fall occurred when she tripped over a child's foot and onto "a concrete floor with ceramic tile on top of it."She testified "[t]he total impact was on my knees," and testified she heard and felt a "snap."Claimant's fall was witnessed by her supervisor who helped Claimant afterward.

¶3Claimant testified she was not having any problems with her knees prior to the accident, though she testified she had knee surgery performed on her right knee—a "right knee arthroscopic procedure"—in the year 2000.Claimant testified she was released "full duty" soon after that surgery, and she testified she had been working for sixteen years prior to the fall and had never been placed on any form of restrictions for her right knee.She further testified she had not been prescribed any medication or therapy for either knee prior to the fall, and she testified that, regarding her left knee, she had never received any prior treatment.

¶4Claimant testified that now, i.e., following the August 26, 2015 incident, she has "excruciating pain all the time" in addition to "swelling."She testified she has had to "compensate with [her] left knee," but that her "left knee is almost as bad as the right knee[.]"She testified she is "limited in so much of [her] mobility" and has not been able to return to work in any capacity.

¶5 Employer stated at trial that it "specifically denies that [Claimant] sustained any compensable injury under the [Administrative Workers' Compensation Act(AWCA) ]."Employer explained: "More specifically, we are denying that [Claimant] has an injury that was solely caused by her accident."Employer stated: "we are alleging that [Claimant's] current condition ... not only wasn't caused by her accident, but is specifically excluded under Section 2(9)(b)(5)" of the AWCA because "[t]he only diagnosis in any medical record is osteoarthritis."Employer asserted osteoarthritis is "excluded as a compensable injury under 2(9)(b)(5)."Employer also asserted, in the alternative, that there is no "objective medical evidence that [Claimant] has a compensable injury" as "defined by 2(31)(a)" of the AWCA; that the accident is not the major cause of Claimant's injuries; and that "at least with regard [ ] to the right knee, [Claimant] has a preexisting condition.She had a prior surgery.[But] ... there is no evidence at all to support a significant or identifiable aggravation of that right knee condition."

¶6 In the order filed in December 2016, the ALJ found Claimant sustained compensable injuries to both of her knees arising out of the course and scope of her employment, and ordered Employer to provide Claimant with reasonable and necessary medical treatment.The ALJ's order notes that in the January 2016 medical report of Dr. Kevin Hargrove, he diagnosed Claimant

as having osteoarthritis in both knees but also said that there had been an exacerbation as a result of the fall.He also stated: "These knees are advancing gradually toward the need for arthroplasty.However, this patient has been informed that her problem is currently an exacerbation of her preexisting problem."

¶7 The ALJ's order further notes that an independent medical examiner—Dr. Paul Maitino—was appointed by the Commission

to address several issues, including the specific diagnosis of the Claimant's current condition and whether it was caused by Claimant's work related accident and whether Claimant has a significant and identifiable aggravation of a preexisting condition.

Dr. Maitino's report ... gave a very clear diagnosis: significant and identifiable aggravation of preexisting osteoarthritis in both knees with valgus deformity....[In his deposition he] testified that the preexisting condition was Grade IV arthritis.On cross examination, he said that her meniscal tear was due to her arthritic condition.Later he said that none of the findings were based on an acute injury.When asked to identify what the aggravation of her right knee was, he stated that her pain was the only identifiable aggravation.

The ALJ's order also notes that there "is a dispute as to whether [Claimant] had complaints about her knees before the fall.She denied any such complaints but Dr. Hargrove's records indicate that she had popping in both knees with squatting and climbing stairs before she sustained the fall[.]"

¶8 The ALJ's order states that "[o]ne way for the Claimant to recover benefits is found in 85A [O.S.]§ 2(9)(b)(6) which allows an exception when the Claimant can show an identifiable and significant aggravation of a ‘pre-existing condition.’ "The order notes that "[t]he consensus of all the doctors involved is that the Claimant has a significant pre-existing condition (osteoarthritis )."However, the ALJ determined that, regarding Claimant's right knee, Claimant"has shown an identifiable and significant aggravation of that condition" as a result of the fall.In addition to the evidence discussed earlier in the ALJ's order, the ALJ pointed out that the medical notes of the physician's assistant at the clinic Claimant visited on the date of the fall state that Claimant"had contusions on both knees."The ALJ also noted that Dr. Hargrove's initial report "found osteoarthritis of both knees but also found an exacerbation as a result of the fall."

¶9 Regarding Claimant's left knee, the ALJ found that

[b]ecause of the limited definition of "Preexisting condition" found in 85A § 2(36)[,][Claimant] does not need to show an identifiable and significant aggravation of a pre-existing condition as to her left knee.No evidence was provided that the Claimant ever received or had treatment recommended for her left knee, so there is no requirement to show a significant and identifiable aggravation of a preexisting condition.The Commission finds that Claimant is entitled to treatment for the left knee....

¶10 Employer appealed the ALJ's order to the Commission En Banc.The Commission found the ALJ's "decision was supported by a preponderance of the credible evidence and correctly applied the law and, therefore, was neither against the clear weight of the evidence, nor contrary to law," and affirmed.From the order of the Commission affirming the decision of the ALJ, Employer seeks review.

STANDARD OF REVIEW

¶11 The date of injury in this case is in August 2015.Therefore, the Administrative Workers' Compensation Act, 85A O.S. Supp. 2014 §§ 1 through 125, governs this case.¹Pertinent to this case, the AWCA provides that this Court"may modify, reverse, remand for rehearing, or set aside" a judgment, decision, or award of the Commission if it is: "4.Affected by ... error of law[.]"85A O.S. Supp. 2014 § 78(C).In particular, the issue presented on appeal is one of statutory construction."Statutory construction presents a question of law.Questions of law are reviewed by a de novo standard.Under this standard, we have plenary, independent and nondeferential authority to determine whether the trial court erred in its legal ruling."Robison Med. Res. Grp. v. True , 2015 OK CIV APP 94, ¶ 12, 362 P.3d 1155(citation omitted).See alsoMaxwell v. Sprint PCS , 2016 OK 41, ¶ 4, 369 P.3d 1079.

ANALYSIS

¶12 Title 85A O.S. Supp. 2014 § 2 provides in pertinent part as follows:

9. a. "Compensable injury" means damage or harm to the physical structure of the body ... caused solely as the result of either an accident, cumulative trauma or occupational disease arising out of the course and scope of employment....

....

b. "Compensable injury" does not include:

...

(5) any strain, degeneration, damage or harm to, or disease or condition of, the eye or musculoskeletal structure or other body part resulting from the natural results of aging, osteoarthritis, arthritis, or degenerative process including, but not limited to, degenerative joint disease, degenerative disc disease, degenerative spondylosis /spondylolisthesis and spinal stenosis, or

(6) any preexisting condition except when the treating physician clearly confirms an identifiable and significant aggravation incurred in the course and scope of employment.

¶13 In Estenson Logistics v. Hopson , 2015 OK CIV APP 71, 357 P.3d 486, a separate division of this Court stated that a claimant's "degenerative joint disease in his left hip" was compensable if the claimant"show[ed] that there was physical damage or harm caused by an on-the-job accident and that his treating physician confirmed an identifiable and significant aggravation."Id.¶ 10.Thus, the Hopson Court, in effect, read subsections 2(9)(b)(5) and (6) together such that the claimant's degenerative joint disease constituted a "preexisting condition" subject to the exception set forth in § 2(9)(b)(6).

¶14 It is not clear, however, that the Legislature...