Trejo-Valdez v. Associated Agents
| Citation | 357 Ga.App. 461,850 S.E.2d 863 |
| Decision Date | 29 October 2020 |
| Docket Number | A20A1499 |
| Parties | TREJO-VALDEZ v. ASSOCIATED AGENTS et al. |
| Court | Georgia Court of Appeals |
Cruz & Associates, Ronald J. Pellitero, Christopher M. Pugh, Christopher J. Clute, for appellant.
Cuzdey Ehrmann Stine & Sansalone, Thomas J. Sansalone, Michael D. Thorpe, for appellees.
Jose Trejo-Valdez sustained a compensable back injury while working for Associated Agents, Inc. d/b/a Bathroom Designs and filed a claim for workers’ compensation benefits. Following two surgeries, Trejo-Valdez's authorized treating physician recommended that Trejo-Valdez receive a spinal cord stimulator
. After initially denying Trejo-Valdez's request for the stimulator, the administrative law judge (‘‘ALJ’’) for the State Board of Workers’ Compensation ("Board") designated a new authorized treating physician at Associated's request and approved Trejo-Valdez for a trial of the stimulator, and Associated appealed. The Appellate Division of the Board affirmed the ALJ's order, but the Superior Court of DeKalb County reversed, finding that Trejo-Valdez's claim for a stimulator was barred by res judicata. We granted Trejo-Valdez's application for discretionary appeal, and he now argues that the superior court erred: (1) in finding that his request for a spinal cord stimulator trial was barred by res judicata; and (2) by placing the burden of proof for authorization of the stimulator on him. For the following reasons, we reverse.
In reviewing a workers’ compensation benefits award, both this Court and the superior court must construe the evidence in a light most favorable to the party which prevailed before the Board. It is [therefore] axiomatic that the findings of the State Board, when supported by any evidence, are conclusive and binding, and that neither the superior court nor this [C]ourt has any authority to substitute itself as a fact finding body in lieu of the Board. However, we review de novo erroneous applications of law to undisputed facts, as well as decisions based on erroneous theories of law.
(Citations and punctuation omitted.) Sanchez v. Carter , 343 Ga. App. 187, 806 S.E.2d 638 (2017). So viewed, the record reveals that Trejo-Valdez and a co-worker were carrying a marble bathtub up a flight of stairs on September 18, 2014. The bathtub slipped from the co-worker's hands and landed on Trejo-Valdez, resulting in a back injury. Following conservative treatment measures for more than one year, Trejo-Valdez underwent back surgery in January 2016. In April 2016, Trejo-Valdez's authorized treating physician, Dr. Phillip Ploska, recommended either a spinal cord stimulator
or complete discectomy and fusion. Trejo-Valdez opted for the additional back surgery in June 2016.
In October 2016, Dr. Ploska noted that Trejo-Valdez "was still having symptoms with no improvement since the surgery, that he still had low back pain and pain extending into his right hip and leg with burning, tingling and numbness." As a result, Dr. Ploska concluded that Trejo-Valdez's "only remaining treatment option was the spinal cord stimulator
...." Dr. Ploska again recommended the stimulator in April 2017, but two doctors (Drs. Randy Rizor and Donald Langenbeck) performed independent medical examinations of Trejo-Valdez and concluded that there was no basis for the stimulator. In February and March 2018, two additional doctors (Drs. Bennett Grimm and Gaurav Rajput) performed independent medical examinations and concluded that Trejo-Valdez could benefit from the stimulator. In a July 3, 2018 order, the ALJ designated a new authorized treating physician, Dr. Shevin Pollydore, for Trejo-Valdez in view of the conflicting medical reports, but denied Trejo-Valdez's request for authorization for a spinal cord stimulator "at this time. " (Emphasis supplied.) In that regard, the ALJ noted that "the preponderance of the evidence does not establish that the spinal cord stimulator is reasonably required and appear likely to effect a cure, give relief, or restore the employee to suitable employment at this time. " (Emphasis supplied.)
Thereafter, Dr. Pollydore also recommended that Trejo-Valdez receive authorization for a stimulator for a trial period.1 Trejo-Valdez requested a hearing for approval of a stimulator trial period, to which Associated filed a notice of controvert, asserting that the proposed treatment was "not ... a reasonable and necessary medical procedure...." At the ensuing hearing, Associated also contended that Trejo-Valdez's request should be denied pursuant to res judicata. In a May 10, 2019 order, the ALJ noted Trejo-Valdez's history of continuing pain in his lower back and his increased reliance upon opioid agents to control his pain, as well as Dr. Pollydore's diagnosis and thorough medical reasoning in support of a trial of a new spinal cord stimulator
. The ALJ first concluded that, because Associated contended that Trejo-Valdez's stimulator trial was not reasonable and necessary, it bore the burden of proof to demonstrate that Trejo-Valdez's proposed treatment was not compensable. Concerning Associated's res judicata argument, the ALJ observed that "[w]orkers’ compensation claims are constantly evolving and an employee's entitlement to benefits, especially medical benefits, changes in accordance with the employee's changing medical condition and the treatment recommendations of the employee's physicians." As a result, the ALJ concluded that "the doctrine of res judicata does not preclude [Trejo-Valdez] from pursuing his claim for medical treatment" in view of "different questions of fact" presented by "the passage of time with additional failed conservative treatment, a worsening in [Trejo-Valdez's] symptoms, coupled with the assessment and opinions of a new expert, Dr. Pollydore." Finally, the ALJ determined that the stimulator trial was "reasonably required and appears like[ly] to effect a cure, give relief or restore the employee to suitable employment and [Associated is] responsible for providing the trial...." Associated appealed the ALJ's order to the Board's Appellate Division, which affirmed the ALJ's order.
Associated then appealed to the superior court.2 Following briefing by the parties and a hearing,3 the superior court reversed the Appellate Division's order. With little analysis in an order prepared by Associated's counsel, the superior court found that Trejo-Valdez's medical issue that was tried before the ALJ's March 13, 2019 order "was, in substance, the same issue or cause of action previously tried before the Board and which resulted in a Final Award on July 3, 2018." Furthermore, the superior court concluded that "the doctrine of res judicata is binding upon the [Board] and that said doctrine prohibits retrial of an issue previously tried, such that the [Board] had no lawful authority to conduct a retrial of an issue previously decided." The superior court also found that the Board "erroneously placed the burden of proof upon [Associated], thus constituting further reversible error of law[,]" and that "the proceedings below were not based on any request by [Trejo-Valdez] for a determination of a ‘change in condition for the worse[.]’ "
We granted Trejo-Valdez's application for discretionary appeal, and this appeal followed.
1. In his first enumeration, Trejo-Valdez contends that the superior court incorrectly found that his request for a spinal cord stimulator
trial was barred by res judicata. We agree.
Prior to the 2018 order, Dr. Ploska recommended that Trejo-Valdez receive a spinal cord stimulator
and referred him to a Dr. Galan. What followed was a series of independent medical examinations by five additional doctors, two of whom (Drs. Michael Hilton and Grimm) felt that Trejo-Valdez would benefit from the stimulator, two of whom (Drs. Rizor and Langenbeck) believed that there was no basis for a stimulator, and one (Dr. Rajput) who suggested a temporary trial of a stimulator. The ALJ determined that the preponderance of the evidence did "not establish that the spinal cord stimulator is reasonably required [or] appear likely to effect a cure, give relief, or restore the employee to suitable employment at this time. " (Emphasis supplied.) As a result, the ALJ denied Trejo-Valdez's "request for authorization of the spinal cord stimulator with Dr. Galan ... at this time. "4 (Emphasis supplied.) However, the ALJ designated Dr. Pollydore as Trejo-Valdez's new authorized treating physician.
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