In re Comp. of Manning, WCB Case No. 15-04348
| Citation | 69 Van Natta 1144 |
| Decision Date | 06 July 2017 |
| Docket Number | WCB Case No. 15-04348 |
| Parties | In the Matter of the Compensation of RAYMOND A. MANNING, Claimant |
| Court | Oregon Workers' Compensation Division |
ORDER ON REVIEW
Bailey & Yarmo LLP, Claimant Attorneys
Sather Byerly & Holloway, Defense Attorneys
Reviewing Panel: Members Curey and Lanning.
The self-insured employer requests review of Administrative Law Judge (ALJ) Sencer's order that set aside its denial of claimant's new/omitted medical condition claim for an L4-5 disc herniation. On review, the issue is compensability.
We adopt and affirm the ALJ's order with the following supplementation.
After claimant injured his back while lifting materials at work in October 2014, the employer accepted a lumbar strain. (Ex. 39).
On October 31, 2014, Dr. Hadden, claimant's treating neurosurgeon, ordered a lumbar MRI to evaluate radiculopathy symptoms. (Ex. 15). Thereafter, Dr. Zulauf, a radiologist, reviewed the MRI and noted a mild L4-5 disc bulge, without definite nerve root compromise. (Ex. 17). Reviewing the same MRI, Dr. Hadden interpreted a "possible" extruded disc fragment at L4-5 impinging the left L5 nerve root. (Ex. 19). At Dr. Hadden's request, Dr. Zulauf further reviewed the image and noted findings "potentially reflecting" a small extruded disc fragment "potentially" accounting for claimant's left-sided radicular symptoms. (Ex. 18-2).
In March 2015, claimant received a left L5-S1 transforaminal epidural steroid injection administered by Dr. Andrews. (Ex. 26).
On March 6, 2015, claimant was examined by Dr. Rosenbaum at the employer's request. (Ex. 27). He interpreted the MRI as showing some "slight" annular tearing and disc bulging at L4-5, without nerve root compression. (Ex. 27-6). Dr. Rosenbaum noted claimant's history of a 1991 L5-S1 laminectomy, diagnosing preexisting lumbar spondylosis, a lumbar strain, and left S1 radiculopathy due to the October 2014 work injury. (Ex. 27). Dr. Hadden concurred with Dr. Rosenbaum's report. (Ex. 32).
In June 2015, Dr. Hadden opined that claimant's work injury was the major contributing cause of an L4-5 disc herniation. (Ex. 32A-3).
In July 2015, the employer denied claimant's new/omitted medical condition claim for an L4-5 disc herniation. (Ex. 33).
In August 2015, Dr. Rosenbaum re-reviewed claimant's lumbar MRI with particular attention to the L4-5 level. (Ex. 37). He explained that the images were consistent with the "possibility" of a small extruded disc fragment that would be consistent with claimant's symptoms. (Id.) Dr. Rosenbaum recommended obtaining a CT scan to distinguish whether the finding represented degenerative change or a disc herniation. (Ex. 37-1, -2).
A November 2015 CT scan was interpreted by the radiologist, Dr. Koehler, as showing a minor broad-based L4-5 disc bulge. (Ex. 41a). After reviewing the CT scan, Dr. Rosenbaum did not detect a disc herniation or nerve root impingement, but considered the findings to be consistent with a broad-based L4-5 disc bulge, which was consistent with a degenerative process. (Ex. 42-3).
In February 2016, Dr. Hadden opined that the CT scan was an "inferior" diagnostic tool compared to an MRI, explaining that the injected dye does not show up in the lateral recesses where claimant's nerve compression could have been occurring. (Ex. 46-2). He noted that the CT scan was taken one year after the injury and that the extruded fragment "could have" been reabsorbed. (Ex. 46-3). Dr. Hadden reiterated that the mechanism of injury, claimant's symptoms, and his response to an injection and physical therapy were consistent with an L4-5 disc herniation due to the work injury. (Ex. 46-2).1
In May 2016, Dr. Morgan, a radiologist, reviewed the medical record at the employer's request. (Ex. 48). He concluded that claimant had a mild "contour abnormality," but did not have a disc extrusion or herniation. (Ex. 48-2). Dr. Morgan attributed the contour abnormality and L4-5 disc space narrowing to claimant's prior L4-5 surgery, as well as longstanding degeneration. (Id.)
Dr. Rosenbaum explained that, while there were limitations to the diagnostic capabilities of CT scans, when coupled with an MRI, the two together create a "much more powerful diagnostic tool" then either method used independently.(Ex. 49-7). Although acknowledging the injected dye used for a CT scan does not penetrate completely or uniformly, Dr. Rosenbaum noted that it did reach the lateral recess, which was the location of the potential disc extrusion and the area of concern raised by Dr. Hadden. (Ex. 49-8, -9). Dr. Rosenbaum agreed that an extruded disc fragment could be reabsorbed over a period as long as a year. (Ex. 49-10). Finally, Dr. Rosenbaum did not consider steroid injections to be a diagnostic procedure, explaining that even aside from the potential placebo effect, most things in the body will respond to a steroid injection regardless of etiology. (Ex. 49-12).
In July 2016, Dr. Hadden opined that claimant's recovery proceeded exactly as expected with the eventual reabsorption of the disc herniation, which was consistent with the gradual diminishment of his symptoms. (Ex. 50-2). Dr. Hadden explained that, while the initial MRI showed a disc herniation or fragment, the CT scan established that the pathology had reabsorbed. (Id.)
The ALJ was persuaded by the opinion of Dr. Hadden, who interpreted the November 2014 MRI report as showing an L4-5 disc herniation or extruded disc fragment, and interpreted the November 2015 CT scan as confirming that the disc pathology had been reabsorbed. Based on Dr. Hadden's opinion, the ALJ determined that claimant had established the existence of the claimed condition, and that claimant's need for treatment/disability for that condition was caused in material part by the work injury.
On review, the employer contends that Dr. Rosenbaum's opinion (which concluded that the 2014 and 2015 imaging ruled out the existence of the claimed L4-5 disc herniation) was more persuasive than Dr. Hadden's opinion. Based on the following reasoning, we disagree.
To establish the compensability of his new/omitted medical condition claim, claimant must prove that the claimed condition exists and that the work event was a material contributing cause of the disability or need for treatment for the claimed condition. ORS 656.005(7)(a); ORS 656.266(1); Betty J. King, 58 Van Natta 977 (2006); Maureen Y. Graves, 57 Van Natta 2381 (2005).
Dr. Hadden explained that claimant's L4-5 disc herniation was visible on the November 2014 MRI, but was no longer visible in the November 2015 CT scan because, by that time, it had reabsorbed. (Ex. 50-2). He reasoned that the reabsorption of the disc herniation correlated with a gradual reduction of claimant's symptoms. (Id.)
Dr. Rosenbaum acknowledged that an extruded fragment could be reabsorbed within a year's time. (Ex. 49-10). While Dr. Rosenbaum did not diagnose an L4-5 disc herniation, he did not specifically express any disagreement with Dr. Hadden's explanation regarding reabsorption of the L4-5 disc. (Ex. 49-16). Moreover, Dr. Rosenbaum agreed with Dr. Hadden's appreciation of a signal abnormality present in the November 2014 MRI that was potentially consistent with an L4-5 disc extrusion. (Ex. 37).
The employer contends that Dr. Hadden was "unqualified" to interpret the diagnostic imaging. Yet, Dr. Zulauf and Dr. Rosenbaum agreed with Dr. Hadden's interpretation that the November 2014 MRI showed the signal intensity identified by Dr. Hadden. Under such circumstances, this record does not cause us to question Dr. Hadden's qualifications to interpret diagnostic imaging. Se...
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