In re Comp. of Dewey, WCB Case No. 14-01263
| Decision Date | 05 January 2017 |
| Docket Number | WCB Case No. 14-01263 |
| Parties | In the Matter of the Compensation of MICHAEL DEWEY, Claimant |
| Court | Oregon Workers' Compensation Division |
Cary et al, Claimant Attorneys
SAIF Legal Salem, Defense Attorneys
Reviewing Panel: Members Weddell and Curey.
The SAIF Corporation requests review of Administrative Law Judge (ALJ) Crumme's order that set aside its denial of claimant's new/omitted medical condition claim for Lyme disease. On review, the issue is compensability.
We adopt and affirm the ALJ's order with the following supplementation.
Claimant, a forester, noticed an embedded tick on his right shin after returning to his office after a day of field work at a tree farm. (Ex. 5). After claimant filed an 801 form, SAIF accepted a "tick bite to right shin." (Exs. 5, 7).
After performing a medical record review on behalf of SAIF, Dr. Leggett concluded that claimant's history of exposure, his "post-tick bite" symptoms, and serologic testing were inconsistent with the development of Lyme disease. (Ex. 8). Subsequently, SAIF issued a denial of the claim for Lyme disease (Ex. 10), and claimant requested a hearing.
The ALJ compared the opinions of Drs. Reicherter, Hardt, and Birchard, who treated claimant and concluded that his symptoms and medical history were consistent with Lyme disease, with the opinions of Drs. Leggett, Mangum and Norris, who concluded that claimant's presentation was not consistent with the disease. Finding that claimant established the existence of Lyme disease, the ALJ was not persuaded by the opinions of Drs. Leggett and Mangum, in part, because they relied on a medical history that included records belonging to a different individual who had the same name as claimant.1 (O&O at 14). In contrast, the ALJ was persuaded by the opinions of Drs. Reicherter, Hardt, and Birchard, determining that they were based on a more accurate medical history.
On review, SAIF challenges the opinions of claimant's treating physician, Dr. Reicherter, based on the contrary opinions of Dr. Leggett and Dr. Mangum, who considered Dr. Reicherter's diagnostic approach to be unsupported by evidence based medicine, and contrary to Center for Disease Control (CDC) criteria for the diagnosis of Lyme disease. Based on the following reasoning, as well as that expressed in the ALJ's order, we disagree.
To prevail on his new/omitted medical condition claim, claimant must establish that the claimed Lyme disease condition exists and that his work-related injury incident is a material contributing cause of his disability/need for treatment for that condition. ORS 656.005(7)(a); ORS 656.266(1); Maureen Y. Graves, 57 Van Natta 2380, 2381 (2005).
A treating physician's opinion may be entitled to greater weight because of a better opportunity to observe and evaluate a claimant's condition over an extended period. See Weiland v. SAIF, 64 Or App 810, 814 (1983). Where there is a dispute among medical experts, we rely on those opinions that are well-reasoned and based on complete information. See Somers v. SAIF, 77 Or App 259, 263 (1986).
First, we address SAIF's contention that Dr. Mangum had "concerns" regarding Dr. Reicherter's statement that he has treated 40 to 50 cases of Lyme disease. (Exs. 14-6, 15-39, -40).2 In challenging Dr. Reicherter's representation, Dr. Mangum explained that Dr. Reicherter was claiming "substantially" more cases of Lyme disease than the number of Oregon cases of Lyme disease reported to the CDC.3 (Ex. 15-39, -40).
According to the CDC, each year approximately 30,000 cases of Lyme disease are reported nationally. (Ex. 19-95). However, the 30,000 figure does not encompass all cases of Lyme disease. (Id.) Moreover, the CDC reports that the number of people diagnosed with Lyme disease each year is approximately 300,000. (Id.)
Dr. Mangum disputed the number of Lyme disease patients that Dr. Reicherter had treated based on the number of "reported" cases in Oregon, and not based on statistics regarding actual diagnosed cases. (Exs. 14-6, 15-39, -40). Given the significant difference in the number of "reported" and "diagnosed" cases according to the CDC, this record does not cause us to disregard Dr. Reicherter's representation that he has treated 40 to 50 patients with Lyme disease.
SAIF also contends that Dr. Reicherter's opinion that the CDC criteria for the diagnosis of Lyme disease were only for "surveillance purposes," is less persuasive than Dr. Mangum's opinion that the CDC criteria are the "standard of care" for diagnosis of Lyme disease. (Exs. 14-5, 15-28). In contrast to Dr. Mangum's characterization of the CDC criteria for a Lyme disease diagnosis, the CDC states that its "surveillance case definition was developed for national reporting of Lyme disease[,] [and] it is not intended to be used in clinical diagnosis." (Ex. 19-61). Further, the CDC explains that "[s]urveillance case definitions establish uniform criteria for disease reporting and should not be used as the sole criteria for establishing clinical diagnoses, [or] determining the standard of care necessary for a particular patient[.]" (Ex. 19-96).
In light of the aforementioned clarifying information from the CDC, this record establishes that the CDC criteria is not designed as the "standard of care," as espoused by Dr. Mangum. Accordingly, based on the aforementioned reasoning, we are more persuaded by the opinion of Dr. Reicherter...
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