Causation & Extent of Injury


CAUSATION / Toxic Exposure Injury Requires Expert Medical Opinion Of Causation

Appeal 170329

The administrative law judge determined that the claimant sustained a compensable injury, in the form of an occupational disease.  However, there was insufficient evidence to relate any injury or condition the claimant may have to inhalation of toxic fumes or gaseous substance while at work on the date of injury.  The medical records in evidence do contain diagnoses of exposure to gaseous substance, toxic effect of unspecified substance, exposure to toxic fumes, shortness of breath, chronic bronchial inflammation with chronic bronchitis and bronchiolitis following fume exposure, and toxic inhalation lung injury but no specific chemical or toxic substance was identified and none of the medical records in evidence contain an explanation concerning how exposure to or inhalation of any substance the claimant may have encountered at work caused his symptoms.

            Accordingly, the Appeals Panel reversed and rendered a new decision that the claimant did not sustain a compensable injury in the form of an occupational disease.

CAUSATION / Headaches Do Not Require Expert Medical Opinion Of Causation

Appeal 170606

            The administrative law judge determined that the compensable injury does not extend to and include headaches.  In the Discussion section of her decision the ALJ stated:

“As to the corneal opacity and headaches, the mere fact that the conditions are identified in a medical report is insufficient to show that these conditions are related to the work injury within  a reasonable medical probability.”  By requiring that the claimant show that headaches are related to the work injury to a reasonable medical probability the ALJ was, in fact, requiring expert evidence to establish a causal connection between such condition and the compensable injury.

Therefore, citing APD 142523, decided January 26, 2015, where the Appeals Panel declined to hold expert medical evidence was required to prove headaches, the Appeals Panel reversed and remanded the ALJ’s determination.

CAUSATION / Deltoid Ligament Sprain Does Not Require Expert Medical Evidence

Appeal 170984

            The administrative law judge determined that the compensable injury does not extend to a deltoid ligament sprain.  In her discussion, the ALJ stated in part that a deltoid ligament sprain was a sufficiently complex condition so as to require expert medical causation evidence to establish a causal connection between the compensable injury and this diagnosis.  However, the Appeals Panel has long held that expert medical evidence is not required for sprains/strains.  Furthermore, in evidence was a medical report from Dr. D that stated the deltoid sprain is a function of the work-related event and the mechanism of injury is consistent with causation of a mild sprain which is verified on the March 31, 2016, right ankle MRI.  Also, the carrier acknowledged in its closing argument that there was medical evidence in the record saying the deltoid sprain is the right ankle sprain and the carrier accepted a right ankle sprain.

            Accordingly, the Appeals Panel reversed and rendered a new decision that the compensable injury does extend to a deltoid ligament sprain.

CAUSATION / Material Misunderstanding Of The Mechanism Of Injury By DD

Appeal 171082

            Relying on the designated doctor’s opinion, the administrative law judge determined that the compensable injury extends to the disputed conditions.  In the History of Injury section, the DD described the mechanism of injury as “the chair closed on [the claimant’s] arm and broke it.”  Additionally, his causation analysis included the same description.  However, the claimant testified that he was injured when he repeatedly placed his arm through a tight space in the side of the airline seat.  The claimant did not testify, and there was no other evidence in the record, that the chair closed on the claimant’s arm and broke it.  Therefore, the preponderance of the other medical evidence is contrary to the designated doctor’s opinion that the compensable injury extends to the disputed conditions.

            Accordingly, the Appeals Panel reversed and rendered a new that the compensable injury does not extend to the disputed conditions.

CAUSATION / Tick Bites Leading To Lyme Disease Required Proof Of The Type Of Tick That Bit Claimant And That The Tick Carried The Disease

Appeal 171882

            The administrative law judge determined that the claimant sustained a compensable injury in the form of an occupational disease on July 1, 2016.  The evidence established the claimant was diagnosed with Lyme disease on July 1, 2016.  In evidence is a medical narrative dated April 11, 2017, from Dr. E.  Dr. E opined that the tick bites sustained on the date of injury, brought forth the bacteria Borrelia Burgdorferi that caused Lyme disease because the claimant’s symptoms after the tick bites improved while on treatment for Lyme disease.  Dr. E pointed out that the claimant denied previous exposure or tick bites, which further supported her opinion that the tick bites were the cause of the Lyme disease.  Dr. E further stated that being bitten by infected ticks is the only way a human is infected, and that Lyme disease is not detectable until four or more months after the injurious exposure and symptoms can take weeks, months, or even longer to appear.  However, there was no evidence to establish the type of tick to which the claimant was exposed or that the tick or ticks carried the bacteria that causes Lyme disease.  Dr. E assumed that because the claimant was bitten by ticks those ticks transmitted Lyme disease.  The Appeals Panel stated that her opinion merely suggests a bare possibility of how the claimant was exposed to Lyme disease. 

Accordingly, the Appeals Panel reversed and rendered a new decision that the claimant did not sustain a compensable injury in the form of an occupational disease on July 1,2016.

CAUSATION / Evidence Was Merely Conclusory

Appeal 172582

The administrative law judge determined that the compensable injury extends to reactive airway disease.  In evidence were records showing that the claimant sought treatment with Care Now on October 29, 2015, for complaints of shortness of breath and dizziness.  The claimant returned to Care Now in November 2015, and December 2015, with increased complaints.  The claimant was referred to Dr. B, who examined the claimant on January 21, 2016.  Dr. B diagnosed the claimant with reactive airway disease post exposure to smoke and chemicals when his truck caught on fire on the date of injury.  Also in evidence was a medical report from Dr.D, dated December 20, 2016, in which Dr. D noted that the claimant had inhaled smoke while extinguishing the fire. 

Although the medical records in evidence contain a diagnosis of reactive airway disease and show the claimant inhaled smoke and chemicals, there was no evidence establishing the chemicals to which the claimant inhaled, nor was there an explanation as to how the inhalation of the chemicals and smoke from the truck fire caused reactive airway disease.  Without an explanation of causation these records are merely conclusory in nature and insufficient to establish that reactive airway disease was caused by the compensable injury.  Accordingly, the Appeals Panel reversed and rendered a new decision that the compensable injury does not extend to reactive airway disease as to find otherwise would be so against the great weight and preponderance of the evidence as to be clearly wrong and unjust.

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