Willardson v. Industrial Com'n, 920165-CA

• Citation: 856 P.2d 371
• Decision Date: 28 June 1993
• Docket Number: No. 920165-CA,920165-CA
• Parties: Kerry L. WILLARDSON, Petitioner, v. INDUSTRIAL COMMISSION of Utah; Beaver Creek Coal Co.; Cigna Insurance Co.; and the Employers' Reinsurance Fund, Respondents.
• Court: Utah Court of Appeals

Page 371

856 P.2d 371

Kerry L. WILLARDSON, Petitioner, v. INDUSTRIAL COMMISSION of Utah; Beaver Creek Coal Co. Cigna Insurance Co.; and the Employers' Reinsurance Fund, Respondents.

No. 920165-CA.

Court of Appeals of Utah.

June 28, 1993.

Virginius Dabney, Salt Lake City, for petitioner.

Steven J. Aeschabacher, George S. Adondakis, Erie V. Boorman, and Robert J. Shaughnessy, Salt Lake City, for respondents.

Before BILLINGS, GARFF and GREENWOOD, JJ.

OPINION

GREENWOOD, Judge:

Petitioner Kerry L. Willardson appeals from the Industrial Commission's denial of permanent total disability benefits. The Commission denied benefits because it found no medical causation between the industrial accident and petitioner's disability. We affirm.

BACKGROUND

Based upon a claim that he injured his back in an industrial accident, petitioner sought permanent disability benefits from the Industrial Commission (the Commission). During the hearing on petitioner's application for benefits, he acknowledged a substantial medical history of pre-existing back problems. According to petitioner, he first injured his back in 1970 while working in Colorado and underwent a lumbar laminectomy in 1971. He sought further treatment for pain in his back, shoulders and left hip in 1983. His treating physician ordered x-rays and diagnosed petitioner as having severe degenerative osteoarthritis of the lumbar spine with multi-level degenerative disc disease and scoliosis. In January of 1988 he was injured during a fall at home. This accident caused a thoracic-cervical strain/sprain, intervertebral disc syndrome, and brachial extension neuralgia of the right shoulder and arm, for which petitioner received medical treatment nineteen times during the next three months.

On the date of the alleged industrial injury, April 15, 1988, petitioner, who was fifty-seven years old, had worked for Beaver Creek Coal Company (respondent) for about three years as a conveyer belt supervisor. Petitioner testified that he was replacing heavy wire mesh guards on a conveyer belt so that no rock would fall off the belt. While trying to jerk one of the guards free from its stack, petitioner stated that he felt a sharp pain in his lower back at about belt level. Because of the pain, he left work.

Although petitioner was treated that same day by Dr. Kotrady, he did not mention jerking wire screens as the cause of his discomfort. Dr. Kotrady ordered x-rays and diagnosed petitioner as having severe degenerative arthritic hips, pelvis and lumbar spine; degenerative disc disease at all levels of the lumbar spine; and scoliosis. Similarity between these x-rays and those taken in 1983 indicated that the degenerative arthritis and disc disease pre-existed the industrial accident. Dr. Kotrady told petitioner he could return to work the next week. However, due to recurrent pain, petitioner sought further treatment. This treatment, which included a CT scan, disclosed extensive degenerative and arthritic lumbar changes, but no fractures or acute herniations.

Beginning on April 30, 1988, Dr. Heiner and Dr. Gaufin both treated petitioner. Although neither doctor had petitioner's prior medical records, they indicated by filling in blanks on forms provided by petitioner's attorney, that one-half of petitioner's lumbar spine impairment was due to the April 15, 1988 industrial accident and one-half to pre-existing conditions. Dr. Gaufin rated petitioner with a fifteen percent whole person impairment, while Dr. Heiner rated petitioner with a thirty percent whole person impairment.

Petitioner filed for permanent total disability benefits in 1988. In response to petitioner's claim, respondent argued that even if he did sustain a compensable industrial injury, his current disability was an inevitable consequence of his pre-existing condition.

After a hearing and review of the medical records, the administrative law judge (ALJ) found that petitioner had not established by a preponderance of the evidence that the incident on April 15, 1988 contributed to his disability. Further, the ALJ concluded that the disability after April 15, 1988 resulted from petitioner's long-standing degenerative condition in his lumbar spine. Without referring the matter to a medical panel, the ALJ dismissed petitioner's claim for failure to establish a compensable industrial injury. Petitioner then filed a request for review with the Commission. The Commission essentially adopted the ALJ's findings and conclusions and affirmed the ALJ's order. This appeal followed.

ISSUES

On appeal petitioner (1) challenges the finding that the industrial accident was not the medical cause of petitioner's disability, (2) claims the ALJ applied the wrong standard of proof, and (3) argues the ALJ abused her discretion by failing to convene a medical panel.

ANALYSIS

Standard of Review

The Commission's findings of fact regarding medical causation "will be affirmed if they are 'supported by substantial evidence when viewed in light of the whole record.' " Stewart v. Board of Review, 831 P.2d 134, 137 (Utah App.1992) (quoting Merriam v. Board of Review, 812 P.2d 447, 450 (Utah App.1991)). See also Utah Code Ann. § 63-46b-16(4)(g) (1989). Substantial evidence is " 'such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.' " Department of Air Force v. Swider, 824 P.2d 448, 451 (Utah App.1991) (citations omitted.)

We review the Commission's interpretation of general questions of law under a correction-of-error standard, with no deference given to the expertise of the Commission. Questar Pipeline v. Tax Comm'n, 817 P.2d 316, 317-18 (Utah 1991); King v. Industrial Comm'n, 850 P.2d 1281, 1285 (Utah App.1993). Statutory interpretation or application by the Commission will be reviewed without deference unless there is an express or implied grant of discretion to the Commission. Morton Int'l, Inc. v. Tax Comm'n, 814 P.2d 581, 589 (Utah 1991). Because the Commission has issued a rule limiting the discretion granted to it under Utah Code Ann. § 35-1-77(1)(a) (1988), concerning when it may appoint a medical panel, we review the agency's action for reasonableness under Utah Code Ann. § 63-46b-16(4) (ii). See SEMECO v. Tax Comm'n, 849 P.2d 1167, 1174 (Utah 1993) (Durham, J., dissenting).

Medical Causation

We first address petitioner's contention that the industrial accident was a medical cause of his disability. Utah Code Ann. § 35-1-45 (1988) mandates compensation where a sufficient causal connection exists between the disability and the working conditions. A claimant must establish both legal and medical causation in order to find a compensable injury under Utah's workers' compensation scheme. Miera v. Industrial Comm'n, 728 P.2d 1023, 1024 (Utah 1986). Medical causation demands that petitioner "prove [his] disability is medically the result of an exertion ¹ or injury that occurred during a work-related activity." Allen v. Industrial Comm'n, 729 P.2d 15, 27 (Utah 1986). If "the claimant cannot show a medical causal connection, compensation should be denied." Id. Only those injuries which occur because some condition or exertion required by employment increases the risk of injury which a worker normally faces in his everyday life is compensable, while symptoms which coincidentally appear at work because of a preexisting condition without any enhancement from the work place are not compensable. Id. at 25.

Generally, industrial injuries that aggravate or "light up" pre-existing conditions and are causally connected to the subsequent onset of symptoms of the disease or condition, are compensable.... [but,] a claimant must prove the subsequent disability is "medically the result of an exertion or injury that occurred during a work-related activity ... and not solely the result of a pre-existing condition."

Virgin v. Board of Review, 803 P.2d 1284, 1288 (Utah App.1990) (quoting Allen, 729 P.2d at 27). See also Lancaster v. Gilbert Dev., 736 P.2d 237 (Utah 1987); Olsen v. Industrial Comm'n, 776 P.2d 937, 939 (Utah App.1989) aff'd, 797 P.2d 1098 (Utah 1990). The ALJ has the responsibility to resolve factual conflicts. Lancaster, 736 P.2d at 241.

Petitioner concedes that he has a lengthy medical history of pre-existing back problems. His medical records indicate that for some seventeen years before the date of the alleged industrial injury, petitioner had undergone extensive treatments for his back problems, which included degenerative arthritis, disc disease and scoliosis. The x-rays taken on April 15, 1988 were similar to those taken in 1983, demonstrating the presence of degenerative arthritis and disc disease, but not indicating fractures or acute herniations. Accordingly, no surgery was needed to correct any problem allegedly aggravated by the incident on April 15, 1988. In light of petitioner's pre-existing physically degenerative condition, he bore the burden of proving that the April 15, 1988 injury he sustained was not his physical body's inevitable breaking point.

While petitioner argues that his work activities while jerking the belt screens aggravated his pre-existing disability, the evidence before the ALJ does not unequivocally support that contention. Although both Dr. Heiner's and Dr. Gaufin's reports diagnosed petitioner as suffering from degenerative osteoarthritis and rated him respectively with a thirty and fifteen percent impairment, neither explained the relationship of the impairment to the industrial accident. Therefore, their attribution of fifty percent of petitioner's impairment to the industrial accident lacks a rational or factual basis. The ALJ also found the attribution to be further weakened because the doctors used pre-printed fill-in-the-blank forms in which they merely inserted a percentage figure and because they did not have or refer to petitioner's prior medical history. The ALJ's finding of "no medical causation" was also based on Dr. Kotrady's medical opinion of...