W.C. Nos. 4-315-924; 4-564-183; 4-589-228.Industrial Claim Appeals Office.
September 30, 2004.
FINAL ORDER
Respondents Burke Design Studio (Burke), and its workers’ compensation insurer (Sentry), seek review of an order of Administrative Law Judge Klein (ALJ) holding them liable for medical benefits. The Sentry respondents contend the need for treatment was caused by a previously incurred occupational disease. We affirm.
In 1996, the claimant sustained a compensable occupational disease affecting her right wrist, elbow and shoulder. The claimant sustained this disease, diagnosed as myofascial pain and tendinitis, while employed as a waitress and pastry cook at Bizzaro’s Inc. Bizzaro’s was insured by respondent Pinnacol. In December 1999, the claimant was placed at maximum medical improvement (MMI) and the treating physician assessed a 25 percent upper extremity impairment. Pinnacol filed an uncontested Final Admission of Liability (FAL) admitting liability for the rating and for ongoing medical benefits after MMI.
In 1998, the claimant graduated from college and obtained a job as a graphic artist with respondent Burke. Burke was insured by respondent Hartford from November 2000 to November 12, 2001, and by respondent Sentry thereafter. The claimant’s duties involved substantial computer work and use of her upper extremities.
Crediting the claimant’s testimony, the ALJ found that in 1999 and 2000, the claimant experienced swelling of both upper extremities, unusual changes in skin color, and abnormal perspiration patterns. In 2001, the claimant began to experience symptoms in her lower extremities, including hypersensitivity and swelling of the feet. The claimant also noticed tremors of the upper extremities. The claimant testified that by 2002, all of these symptoms were worse and she began to experience knee tremors.
The claimant was then referred to Dr. Gerber, who diagnosed possible RSD or Complex Regional Pain Syndrome (CRPS) and referred the claimant for a thermogram. The thermogram was abnormal and indicative of CRPS of the right, and possibly the left, upper extremities. In April 2003, Dr. Gerber opined that the claimant’s position at Burke “significantly worsened her pre-existing residual condition.”
The claimant was examined by Dr. Goldman in May 2003. Dr. Goldman diagnosed CRPS of the right upper extremity caused by the 1996 injury, but probably aggravated by the employment at Burke sometime in 2000 or 2001. Dr. Goldman also diagnosed CRPS of the left upper extremity and both lower extremities predominantly resulting from the claimant’s employment at Burke in 2000 or 2001. Dr. Goldman recommended several diagnostic studies to evaluate the CRPS.
The ALJ credited the claimant’s testimony concerning the course of her condition and treatment. Further, the ALJ found the claimant’s employment at Burke “intensified, aggravated, and/or accelerated to a reasonable degree” the occupational disease originally contracted at Bizzaro’s, and that the most recent aggravation or acceleration occurred in 2002 and 2003. (Findings of Fact 34 and 35). Finally, the ALJ found that it was not until after Sentry assumed the risk in November 2001 that the claimant sought treatment from Dr. Gerber in October 2002, nor was the CRPS diagnosed until then. (Conclusion of Law 8). Therefore, the ALJ ordered Sentry to pay for treatment by Dr. Gerber and “his referrals.”
I.
On review, the Sentry respondents contend the ALJ failed to make the necessary finding that the claimant’s employment at Burke caused the need for treatment by Dr. Gerber. According to the Sentry respondents, the ALJ erroneously applied the last injurious exposure/substantial permanent aggravation rule to medical benefits, then failed to make the critical findings concerning causation. We disagree.
It is true, as the Sentry respondents argue, that the last injurious exposure/substantial permanent aggravation rule does not govern liability for medical benefits. Rather, liability for medical benefits in cases of occupational disease is governed by ordinary rules of causation. Hence, the liable insurer is the one which insured the employer “whose conditions of employment caused the need for treatment.” To place liability on a particular employer and its insurer, the “evidence must demonstrate that the employment with that employer caused, aggravated, or accelerated the claimant’s injury.” University Park Care Center v. Industrial Claim Appeals Office, 43 P.3d 637, 640 (Colo.App. 2001).
The question of which of two employments caused, aggravated, or accelerated the need for medical treatment is one of fact for determination by the ALJ. University Park Care Center v. Industrial Claim Appeals Office, supra. 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 of review requires us to defer to the ALJ’s credibility determinations, resolution of conflicts in the evidence, and plausible inferences drawn from the record. Cordova v. Industrial Claim Appeals Office, 55 P.3d 186 (Colo.App. 2002). Further, the ALJ is not held to a standard of absolute clarity in expressing findings of fact and conclusions of law; all that is required is that the legal and factual bases of the order be apparent from the findings and conclusions which are entered Magnetic Engineering, Inc. v. Industrial Claim Appeals Office, 5 P.3d 385 (Colo.App. 2000).
The Sentry respondents’ assertions notwithstanding, the ALJ did not apply the last injurious exposure/substantial permanent aggravation test in determining liability for medical benefits. Indeed, the ALJ expressly recognized that the standard rules of causation govern liability for medical benefits in occupational disease cases. (Conclusions of Law 6-7).
Moreover, we have no difficulty in determining the basis of the ALJ’s conclusion that Sentry is the liable insurer. As the ALJ recognized, the claimant’s symptoms progressively worsened and spread between 1999 and 2002. It was not until 2002 that the claimant sought treatment from Dr. Gerber and the diagnosis of CRPS was, for the first time, seriously entertained. (Dr. Brubaker mentioned RSD as a possible diagnosis in August 2001). This was nearly one year after Sentry came on the risk as Burke’s insurer. Moreover, as the ALJ pointed out, the record contains expert medical opinion that the claimant’s employment at Burke aggravated or accelerated the claimant’s pre-existing condition. Thus, the ALJ’s findings are sufficient to support appellate review, and the ALJ applied the correct legal standard in evaluating the claim.
II.
The Sentry respondents next contend the record lacks substantial evidence to support the finding that the claimant’s need for treatment is related to an aggravation or acceleration of her condition caused by her employment at Burke. We disagree.
It is true that in the 1996 claim, Pinnacol admitted for ongoing medical benefits after MMI. Such benefits are ordinarily paid to prevent deterioration of the claimant’s condition or relieve the ongoing effects of the injury. See Hanna v. Print Expediters, Inc., 77 P.3d 863 (Colo.App. 2003).
Here, after the claimant reached MMI in 1999, she received some ongoing treatment in the form of physical therapy and medications. However, there was no prescription of treatment for CRPS, nor was any such treatment provided. Dr. Goldman opined that the need to evaluate CRPS was associated with the aggravation of the claimant’s condition caused by the employment at Burke, and Dr. Gerber corroborated this opinion. While other interpretations of the evidence may be possible, we cannot say the ALJ’s conclusions are unsupported by substantial evidence. Thus, the order must be affirmed. Wilson v. Industrial Claim Appeals Office, 81 P.3d 1117 (Colo.App. 2003).
Insofar as the Sentry respondents make other arguments, we find them to be without merit.
IT IS THEREFORE ORDERED that the ALJ’s order dated March 29, 2004, is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
_____________________________ David Cain
_____________________________ Dona Halsey
Nicole R. Bizzarro, CO,
Bizzarro’s, Inc. CO.
Burke Design Studio, Inc., CO.
Legal Department, Pinnacol Assurance — Interagency Mail Frances E. Wood, Hartford Underwriting Insurance Company, TX.
Sentry Insurance, WI.
Michael P. Dominick, Esq., CO, (For Claimant)
Ted A. Krumreich, Esq., CO, (For Respondents, Burke Design Studio, Inc. and Sentry Insurance).
Thomas M. Condas, Esq., CO, (For Respondents Bizzarro’s Inc. d/b/a John’s Restaurant and Pinnacol Assurance)
Tama L. Levine, Esq., CO, (For Respondents, Burke Design Studio, Inc. and Hartford Underwriting Insurance Company).