Slater v. SAIF Corp. (In re Comp. of Slater)
| Decision Date | 26 July 2017 |
| Docket Number | A156512 |
| Citation | 287 Or.App. 84,400 P.3d 969 |
| Parties | In the MATTER OF the COMPENSATION OF Daniel B. SLATER, Claimant. Daniel B. Slater, Petitioner, v. SAIF Corporation and Coe Manufacturing, Respondents. |
| Court | Oregon Court of Appeals |
Julene M. Quinn, Albany, argued the cause and filed the briefs for petitioner.
David L. Runner, Salem, argued the cause and filed the brief for respondents.
Before DeVore, Presiding Judge, and Lagesen, Judge, and Flynn, Judge pro tempore.*
FLYNN, J. pro tempore.
Claimant seeks review of a Workers' Compensation Board (board) order that upheld SAIF's denial of claimant's previously accepted combined condition of the left knee and upheld SAIF's medical services denial of a diagnostic MRI for claimant's left knee. Claimant contends that SAIF failed to meet its burden to prove that claimant suffers from a qualifying preexisting condition that became the major contributing cause of claimant's combined condition. Claimant alternatively contends that the board applied the wrong legal standard when it required claimant to prove that the diagnostic MRI is a medical service directed to a condition caused in major part by claimant's injury. We conclude that the board permissibly construed the medical evidence as proving that claimant's osteoarthritis
is a qualifying "preexisting condition" that became the major contributing cause of claimant's left knee combined condition. However, we also conclude that the board erred in failing to consider whether the MRI is directed to claimant's left knee strain and meniscal tear, which remain accepted conditions. Accordingly, we reverse and remand for the board to make that determination.
Id. (quoting ORS 656.005(7)(a)(B) ). After accepting a combined condition claim, an insurer may deny the condition "if the otherwise compensable injury ceases to be the major contributing cause." ORS 656.262(6)(c).
When the claimant challenges the denial of a "combined condition," it is the insurer's burden to prove that the worker has a qualifying "preexisting condition and that the compensable injury is not the major contributing cause of the disability or need for treatment." Hopkins v. SAIF , 349 Or. 348, 352, 245 P.3d 90 (2010) (citing ORS 656.266(2)(a) (footnote omitted)). In this context, the "otherwise compensable injury" refers to the "accepted medical condition" that combines with a "preexisting condition." Brown , 361 Or. at 272-73, 391 P.3d 773. A qualifying "preexisting condition" means that the worker " ‘has been diagnosed with such condition, or has obtained medical services for the symptoms of the condition,’ or suffers from ‘arthritis
or an arthritic condition.’ " Hopkins , 349 Or. at 352, 245 P.3d 90. (quoting ORS 656.005(24)(a)(A) (footnote omitted)). By "arthritis," the legislature meant "the inflammation of one or more joints, due to infectious, metabolic, or constitutional causes, and resulting in breakdown, degeneration, or structural change." Id. at 364, 245 P.3d 90. In addition, "because [ ORS 656.262(6)(c) ] provides that a combined condition that has been accepted may be denied when the otherwise compensable injury ‘ceases' to be the major contributing cause of the combined condition, the statute necessarily requires that there be a change in the worker's condition." Oregon Drywall Systems, Inc. v. Bacon , 208 Or. App. 205, 208-09, 144 P.3d 987 (2006).
.
After SAIF closed the claim, claimant returned occasionally to Di Paola for recurring symptoms of his left knee condition, which Di Paola described as a combining of the meniscal tear
with preexisting degenerative changes. In 2011, claimant again returned to Di Paola with ongoing problems in the left knee that had been worsening over time. Di Paola opined that claimant had experienced a "worsening of his preexisting degenerative arthritis that is not attributable to his interval meniscal tears and their surgical treatment." When claimant asked SAIF to accept his medial compartment degenerative changes, SAIF denied that request but issued a modified notice of acceptance in which it specified that, "[i]n addition to" the previously accepted conditions, SAIF was accepting—"as of" the date of the 2005 injury—a combined condition consisting of the previously accepted conditions "combined with pre-existing left knee osteoarthritis."
A few months after issuing the modified notice of acceptance, SAIF issued a denial of claimant's combined condition in which it specified that "as of July 22, 2011, [claimant's] accepted injury is no longer the major contributing cause of [his] combined condition." SAIF also refused to pay for a diagnostic MRI that two of claimant's doctors recommended "to make sure [claimant's] ACL is intact and to make sure [claimant] does not have a new injury." Claimant challenged both denials and the disputes were consolidated for hearing.
The administrative law judge (ALJ) set aside both denials, but the board reversed. The board found that the medical evidence established "the presence of a statutory ‘preexisting condition’ (osteoarthritis
)," citing Di Paola's opinion, and that "the medical evidence establishes that the preexisting condition is the major contributing cause of the disability or need for treatment of [claimant's] combined knee condition." (Footnote omitted.) The board also upheld SAIF's denial of the diagnostic MRI because that medical service was not "directed to a medical condition caused in major part by the injury."
On review, claimant challenges both rulings of the board. First, claimant argues that the board erred in accepting Di Paola's opinion as legally sufficient to meet SAIF's burden to prove that claimant suffers from a qualifying "preexisting condition" that is the major contributing cause of claimant's combined condition. Second, claimant contends that SAIF failed to prove a change in the causal relationship between claimant's compensable injury and the osteoarthritis
after the date that the combined condition was accepted, i.e. , "that the compensable injury has ceased to be the major contributing cause." (Emphasis in original.) Finally, claimant argues that the board erred in evaluating the claim for medical services under the major contributing cause standard. We review the board's decision under the standard articulated in ORS 183.482(8)(c), under which we are directed to set aside or remand the order if we conclude that the board erroneously interpreted a provision of law or that the board's findings are not supported by substantial evidence. ORS 656.298(7).
Claimant argues that the board erred in accepting Di Paola's opinion as proof that claimant's "osteoarthritis
is a qualifying preexisting condition" or that, "as weighed against the osteoarthritis, the compensable injury is no longer the major contributing cause of the combined condition" because, according to claimant, Di Paola cannot "reasonably be interpreted" as expressing either opinion. In reviewing the board's evaluation of expert medical opinions, our role "is to determine whether the evaluation is supported by substantial evidence, that is, evidence that, considering the record as a whole, would permit a reasonable person to make the findings." Hutchings v. Amerigas Propane , 275 Or. App. 579, 595, 365 P.3d 636 (2015), rev. den. , 358 Or. 833, 370 P.3d 504 (2016) (internal quotation marks omitted); see also SAIF v. Williams , 281 Or. App. 542, 548, 381 P.3d 955 (2016) (). We conclude that the board's interpretation of Di Paola's opinion is reasonable in the context of the record as a whole.
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