W.C. Nos. 4-478-785 4-558-885Industrial Claim Appeals Office.
February 5, 2004
FINAL ORDER
The claimant seeks review of an order of Administrative Law Judge Jones (ALJ) which denied and dismissed his request for medical benefits. We affirm.
The claimant is a ski patrolman. In 1989 the claimant underwent a medial meniscus repair on his left knee. He returned to work without restrictions. The claimant sought additional treatment for left knee pain in 1996 but the symptoms resolved without additional surgery.
On February 23, 2000 the claimant suffered a new injury to his left knee. Fremont Insurance Company (Fremont) admitted liability in W.C. No. 4-478-785. The claimant reached maximum medical improvement on September 23, 2000, and the claim was closed.
The claimant alleged another left knee injury on February 14, 2002, when the employer was insured by Pinnacol Assurance (Pinnacol). Pinnacol denied liability in W.C. No. 4-558-885.
The claimant subsequently petitioned to reopen the 2000 injury claim and alleged a worsening of condition. The ALJ found the claimant failed to prove a worsening of his condition from the 2000 injury and the claimant does not dispute the ALJ’s order denying the petition to reopen.
The claimant also scheduled the 2002 injury claim for a hearing on the issues of compensability, medical benefits and average weekly wage (AWW). The ALJ found that during treatment of the 2000 industrial injury, the claimant underwent a left knee diagnostic arthroscopy and partial medical meniscectomy by Dr. Bomberg. During the procedure, Dr. Bomberg observed the claimant’s trochlea had a large chondral lesion with well-healed fibrocartilage in the space, and its edges were unstable completely around it. On June 13, 2002, the claimant underwent another arthroscopic examination for treatment of the 2002 injury. Dr. Bomberg identified the same troclear lesion at the identical site where he had operated in 2000. Dr. Bomberg then recommended the claimant undergo an autologous chrondrocyte implantation to repair the chondral lesion. After reviewing Dr. Bomberg’s operative reports, Dr. Evans opined that the troclear groove lesion predated both the 2002 and 2000 injuries.
Giving the greatest weight to the opinions of Dr. Bomberg and Dr. Evans, the ALJ found the medical condition which requires the autologous chrondrocyte implantation surgery preceded the 2002 and 2000 industrial injuries. Therefore, the ALJ determined the claimant failed to prove a causal connection between the 2002 injury and the implantation surgery. Consequently, the ALJ denied the requested medical benefits in the 2002 injury claim.
On review the claimant first contends the ALJ erroneously failed to determine whether the claimant suffered a compensable left knee injury on February 14, 2002 and failed to address the issue of AWW. We disagree.
The ALJ expressly recognized that “compensability” was endorsed for adjudication. However, the ALJ is not held to a crystalline standard in articulating the basis for her order. George v. Industrial Commission, 720 P.2d 624 (Colo.App. 1986). Because the 2000 injury was admitted, the ALJ’s reference to the issue of “compensability” obviously pertains to the alleged injury on February 14, 2002.
Further, the ALJ found the claimant suffered another left knee injury in the course and scope of his employment on February 14, 2002. (Finding of Fact 8). Accordingly, the ALJ implicitly resolved the compensability issue in favor of the claimant. The ALJ also determined the claimant’s AWW in Finding of Fact 1. Under these circumstances, it is unnecessary to remand the matter for additional findings.
The claimant also contends the ALJ erred in finding that the need for the autologous chrondrocyte implantation was unrelated to the 2002 injury. We disagree.
Under § 8-42-101(1)(a), C.R.S. 2003, the respondents are liable for medical treatment which is reasonable and necessary to cure or relieve the effects of the industrial injury. Snyder v. Industrial Claim Appeals Office, 942 P.2d 1337 (Colo.App. 1997). The claimant has the burden to prove a causal relationship between the industrial injury and the medical treatment for which he seeks benefits. Section 8-43-301, C.R.S. 2003; Snyder v. Industrial Claim Appeals Office, 942 P.2d 1337 (Colo.App. 1997).
The question of whether the claimant sustained his burden of proof is a factual determination for resolution by the ALJ. City of Durango v. Dunagan, 939 P.2d 496 (Colo.App. 1997). Consequently, we must uphold the ALJ’s determination if supported by substantial evidence in the record. Section 8-43-301(8), C.R.S. 2003. This standard requires us to review the evidence in the light most favorable to the prevailing party, and accept the ALJ’s resolution of conflicts in the evidence, and the plausible inferences which she drew from the evidence. Industrial Commission v. Royal Indemnity Co., 124 Colo. 210, 236 P.2d 293
(1951); Metro Moving Storage Co. v. Gussert, 914 P.2d 411
(Colo.App. 1995).
We also note that although the claimant is not required to prove causation by medical evidence, to the extent expert medical testimony is presented, it is the ALJ’s prerogative to assess its weight and sufficiency. Rockwell International v. Turnbull, 802 P.2d 1182 (Colo.App. 1990). Moreover, insofar as the medical testimony is conflicting we are bound by the ALJ’s resolution of the conflicts. See Colorado Springs Motors, Ltd. v. Industrial Commission, 165 Colo. 504, 441 P.2d 21 (1968). This is true because the ALJ is considered to possess expert knowledge which renders her competent to evaluate medical evidence and draw plausible inferences from it. Wierman v. Tunnell, 108 Colo. 544, 120 P.2d 638 (1941).
Here, the medical record is susceptible of differing conclusions. Nevertheless the opinions of Dr. Bomberg and Dr. Evans provide substantial support for the ALJ’s determination that the claimant failed to prove the implantation surgery was necessitated by the 2002 injury. (See claimant’s hearing Exhibit 21; Evans Depo. April 17, 2003). Further, the ALJ’s finding supports the denial of benefits.
The claimant’s challenges to the opinions of Dr. Evans go to the weight of Dr. Evans’s testimony. However, we may not substitute our judgment for that of the ALJ in this regard. See General Cable Co. v. Industrial Claim Appeals Office, 878 P.2d 118 (Colo.App. 1994). Accordingly, we also do not consider the claimant’s argument that the ALJ should have afforded greater weight to the opinions of Dr. Frank and Dr. Brunswoth who attributed the need for implantation surgery to the 2002 industrial injury.
IT IS THEREFORE ORDERED that the ALJ’s order dated September 22, 2003, is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
______________________________ Kathy E. Dean
______________________________ Robert M. Socolofsky
NOTICE
This Order is final unless an action to modify or vacate this Order is commenced in the Colorado Court of Appeals, 2 East 14th Avenue, Denver, CO 80203, by filing a petition for review with the Court, within twenty (20) days after the date this Order is mailed, pursuant to § 8-43-301(10) and § 8-43-307, C.R.S. 2003. The appealing party must serve a copy of the petition upon all other parties, including the Industrial Claim Appeals Office, which may be served by mail at 1515 Arapahoe, Tower 3, Suite 350, Denver, CO 80202.
Copies of this order were mailed to the parties at the addressesshown below on February 5, 2004 by A.Hurtado.
Alan Rosenthal, P. O. Box 775478, Steamboat Springs, CO 80477
Steamboat Ski Resort Corp., 2305 Mt. Werner Circle, Steamboat Springs, CO 80477
November James, Fremont Insurance Company c/o LWP, 575 Union Blvd., #310, Lakewood, CO 80228
Legal Department, Pinnacol Assurance — Interagency Mail
John A. Sbarbaro, Esq., 226 W. 12th Ave., Denver, CO 80204-3625 (For Claimant)
Douglas P. Ruegsegger, Esq. and Michele Stark Carey, Esq., 1625 Broadway, #2300, Denver, CO 80202 (For Respondents Steamboat Ski Resort Corp. and Pinnacol Assurance)
Timothy L. Nemechek, Esq., 1125 17th St., #600, Denver, CO 80202 (For Respondents Steamboat Ski Resort Corp. and Fremont Insurance Company c/o LWP)