W.C. No. 4-176-199Industrial Claim Appeals Office.
January 17, 1997
FINAL ORDER
The respondents seek review of a final order of Administrative Law Judge Wheelock (ALJ), which ordered them to provide medical benefits. We affirm.
The issue in this case is whether or not the respondents should be required to pay for a “discogram” to diagnose the claimant’s low back pain and leg pain, as well as epidural injections designed to treat his symptoms. More specifically, the issue is whether the evidence establishes that the claimant has any pathology at the L3-4 level which can be associated with the June 1993 industrial injury. The respondents maintain that the evidence proves only that the claimant has a problem at the L5-S1 level.
However, the ALJ rejected the respondents’ position and found that the claimant has an injury-related problem at the L3-4 level, and that the respondents should be required to pay for the diagnostic and treatment procedures recommended by the claimant’s treating physician, Dr. Jenks. In reaching this result, the ALJ credited the claimant’s testimony that he did not have pain radiating into his lower extremities prior to the June 7, 1993 injury. Moreover, the ALJ credited the statement of Dr. Jenks that the claimant injured the L3-4 or L4-5 disc, and that he needs a discogram to evaluate this problem. Dr. Jenks rendered this opinion based on the claimant’s positive response to a lumbar epidural injection. (Jenks Report, January 16, 1996).
On review, the respondents contend that the ALJ’s order requiring them to pay for epidural blocks and the discogram is not supported by substantial evidence. The respondents assert that the record does not contain evidence demonstrating that there is a causal connection between the claimant’s back problem and the industrial injury. Further, based on a report of Dr. McNally, the respondents argue that a discogram is unreliable, and therefore, not reasonable and necessary. We disagree with these arguments.
The question of whether the claimant proved a causal relationship between the 1993 injury and the need for epidural blocks and a discogram is one of fact for resolution by the ALJ F. R. Orr Construction v. Rinta, 717 P.2d 965 (Colo.App. 1985) Eisnach v. Industrial Commission, 633 P.2d 502 (Colo.App. 1981). Because the issue is factual in nature, we must uphold the ALJ’s order if supported by substantial evidence in the record. Section 8-43-301(8), C.R.S. (1996 Cum. Supp.).
In applying the substantial evidence test, we are obliged to defer to the ALJ’s resolution of conflicts in the evidence, her credibility determinations and the plausible inferences which she drew from the record. Metro Moving Storage Co. v. Gussert, 914 P.2d 411 (Colo.App. 1995). Although medical evidence is not necessary to establish causation, where such evidence is presented, it is the prerogative of the ALJ to assess its weight and credibility. Rockwell International v. Turnbull, 802 P.2d 1182
(Colo.App. 1990). Moreover, to the extent the opinion of a particular medical expert contains internal inconsistencies, it was for the ALJ to resolve them by crediting all, part or none of the expert’s opinion. Colorado Springs Motors, Ltd. v. Industrial Commission, 165 Colo. 504, 441 P.2d 21 (1968).
As the respondents argue, the record contains evidence tending to suggest that the claimant sustained an injury at the L5-S1 level, and not at the L3-4 level. Although the opinions of Dr. Jenks contain some inconsistencies, he did opine that the uncertainty concerning the claimant’s symptoms reflects a problem in diagnosis, and that the overall diagnostic picture is consistent with an L3-4 disc problem attributable to the 1993 industrial injury. As the ALJ recognized, the opinion of Dr. Jenks is supported by evidence that the claimant’s condition improved with the epidural injections, and the claimant’s own testimony concerning the development of his symptoms following the 1993 injury. (Tr. p. 15).
The respondents argue that the ALJ’s assessment of the evidence is erroneous because she found that the claimant did not have any “radiating pain into his lower extremities” prior to the June 7, 1993 injury. In support, the respondents point to a report of Dr. Oliveira, dated April 7, 1993, which states that the claimant reported pain radiating to the “anterior aspect of the left thigh and left knee.” However, the ALJ need not have placed any weight on this evidence since Dr. Oliveira also stated that it was her opinion that the claimant’s pain was “musculoligamentous,” and “not related at this point in time to an underlying lumbosacral radiculopathy.”
We also reject the respondents’ argument that the evidence does not support a finding that a discogram is reasonable and necessary. Again, the reasonableness of a particular medical procedure is a question of fact for resolution by the ALJ Suetrack USA v. Industrial Claim Appeals Office, 902 P.2d 854
(Colo.App. 1995).
Here, Dr. Jenks opined that a discogram is appropriate to identify the precise location of the claimant’s pain. Although Dr. McNally disagreed with this recommendation because he believes discograms give “false positives,” this testimony merely presented a conflict in the evidence. We decline the respondents’ invitation to substitute our judgment for that of the ALJ concerning the probative value of conflicting medical opinions.
Insofar as the respondents have made other arguments, they concern the ALJ’s factual determinations, and present no legal basis for setting the order aside. Therefore, the order must be upheld.
IT IS THEREFORE ORDERED that the ALJ’s order dated May 20, 1996, is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
________________________________ David Cain
________________________________ Dona Halsey
NOTICE
This Order is final unless an action to modify or vacate theOrder is commenced in the Colorado Court of Appeals, 2 East 14thAvenue, Denver, Colorado 80203, by filing a petition to reviewwith the court, with service of a copy of the petition upon theIndustrial Claim Appeals Office and all other parties, withintwenty (20) days after the date the Order was mailed, pursuant to§§ 8-43-301(10) and 307, C. R. S. (1996 Cum. Supp.).
Copies of this decision were mailed January 17, 1997 to the following parties:
Larry Duncan Turner, 825 Musket Dr., #K102, Colorado Springs, CO 80906
Wal-Mart Stores, Inc., P.O. Box 116, Bentonville, AR 72712-0116
Dawn Marie Brown, CMI, P.O. Box 1288, Bentonville, AR 72712-1288
Richard A. Bovarnick, Esq., 5353 W. Dartmouth Ave., Ste. 400, Denver, CO 80227 (For the Respondents)
Dale A. Gerlach, Esq., P.O. Box 636, Colorado Springs, CO 80901 (For the Claimant)
By: _____________________________________________