W.C. No. 4-690-618.Industrial Claim Appeals Office.
December 15, 2009.
The claimant seeks review of an order of Administrative Law Judge Cannici (ALJ) dated July 28, 2009 that denied the claimant’s request for sacroiliac (SI) joint injections. We affirm.
Several of the ALJ’s findings are summarized as follows. The claimant sustained an industrial injury to her back on April 13, 2006 and underwent surgery to replace a disc at the L4-L5 level. She continued to experience pain and received a transforaminal epidural steroid injection. The claimant continued to experience pain in the left side of her buttocks and Dr. Vilims administered a left SI joint injection to determine if the claimant’s pain was related to her left SI joint. Dr. Vilims later administered bilateral SI joint injections in order to confirm or refute a diagnosis of SI joint dysfunction and for therapeutic benefit. Dr. Vilims determined that the claimant’s low back and buttocks pain was not related to her bilateral SI joint; however, he later opined that the claimant’s pain was most likely due to a nerve irritation, but did not completely rule out an SI joint component. Dr. Vilims sought to schedule the claimant for bilateral SI joint injections to confirm or refute an SI joint etiology.
Dr. Roth opined it was not reasonable to expect that the injections would provide relief because the claimant had received extensive conservative and invasive therapies without any long-lasting benefit. Dr. Roth further opined that the injections would not be beneficial because the claimant’s CT scan revealed normal SI joints. The claimant
testified that the several injections she had received provided varying degrees of effectiveness.
The ALJ referred to the claimant’s testimony and the opinions of Dr. Vilims and Dr. Roth in support of his determination that the claimant failed to demonstrate that the requested SI joint injections were reasonable and necessary to cure and relieve the effects of her injury. The ALJ noted that Dr. Roth opined that the injections would not provide any benefit and were neither reasonable nor necessary to cure and relieve the claimant from her injury.
The claimant asserts that the ALJ applied the wrong legal standard in denying the SI joint injections, as evidenced by the ALJ’s recitation of Dr. Roth’s opinion regarding the claimant undergoing conservative and invasive therapies without any long-lasting benefit. According to the claimant, the ALJ therefore applied a standard of whether the treatment would provide long-lasting, instead of the appropriate standard of reasonable, relief. We are not persuaded that the ALJ erred in denying the injections.
We note that contrary to the claimant’s assertion, Dr. Roth did not opine whether the requested SI injections were likely to provide long-lasting relief and the ALJ did not apply such a standard when determining whether the injections were reasonable and necessary. Instead, Dr. Roth was found by the ALJ to have noted that “because Claimant had received extensive conservative and invasive therapies without any long-lasting benefit, it is not reasonable to expect that additional bilateral SI joint injections will provide any relief.” The ALJ also found that “Dr. Roth remarked that bilateral SI joint injections would not prove benefits because Claimant’s CT scans revealed normal SI joints.” Findings of Fact, Conclusions of Law, and Order (Order) at 3, ¶ 9. The ALJ, for his part, concluded that the respondents were liable for authorized medical treatment that is reasonable and necessary to cure and relieve the effects of an industrial injury. Order at 4, ¶ 4. We conclude that the ALJ properly determined whether the respondents were liable for SI joint injections.
Section 8-42-101(1)(a), C.R.S. 2009, provides that respondents are liable for authorized medical treatment that is reasonable and necessary to cure or relieve the effects of the industrial injury Yeck v. Industrial Claim Appeals Office, 996 P.2d 228 (Colo. App. 1999); Sims v. Industrial Claim Appeals Office, 797 P.2d 777 (Colo. App. 1990). The standard of review applicable to this allegation of error is well-established. Where the claimant’s entitlement to benefits is disputed, the claimant has the burden to prove a causal relationship between the work-related injury or disease and the condition for which benefits or compensation are sought. Snyder v. Industrial Claim Appeals Office, 942 P.2d 1337 (Colo. App. 1997). Whether the claimant sustained her burden of proof is a factual question for resolution by the ALJ. City of Durango v. Dunagan, 939 P.2d 496
(Colo. App. 1997). Because these questions are factual in nature, we are bound by the ALJ’s determinations in this regard if they are supported by substantial evidence in the record. 8-43-304(8), C.R.S. 2009; City of Durango v. Dunagan, supra. Substantial evidence is probative evidence which would warrant a reasonable belief in the existence of facts supporting a particular finding, without regard to the existence of contradictory testimony or contrary inferences. See F.R. Orr Construction v. Rinta, 717
P.2d 965 (Colo. App. 1985). The substantial evidence standard also requires that we view evidence in the light most favorable to the prevailing party, and defer to the ALJ’s assessment of the sufficiency and probative weight of the evidence. Thus, the scope of our review is “exceedingly narrow.” Metro Moving Storage Co. v. Gussert, 914 P.2d 411 (Colo. App. 2003). This narrow standard of review also requires that we defer to the ALJ’s resolution of conflicts in the evidence, credibility determinations, and plausible inferences drawn from the record. Wilson v. Industrial Claim Appeals Office, 81 P.3d 1117 (Colo. App. 2003). Where conflicting expert opinion is presented, it is for the ALJ as fact finder to resolve the conflict. Rockwell International v. Turnbull, 802 P.d. 1182 (Colo. App. 1990). The existence of evidence which, if credited, might permit a contrary result also affords no basis for relief on appeal. Cordova v. Industrial Claim Appeals Office, 55 P.3d 186 (Colo. App. 2002).
The ALJ based his denial of medical benefits on the claimant’s testimony and the medical opinions of Dr. Vilims and Dr. Roth. Order at 4-5, ¶ 5. There is record support for the factual findings underlying the ALJ’s determination that SI joint injections were not reasonable and necessary to cure and relieve the claimant from the effects of her industrial injury. For example, the claimant testified that she received five to six injections before her surgery and for some she had benefits, but for others she did not. Tr. at 8. She further testified that she received six injections after her surgery. Tr. at 9. Dr. Vilims noted after administering bilateral SI joint injections on January 9, 2009 that the claimant had “[p]ersistent axial low back and buttocks pain that is not related to the bilateral sacroiliac joint.” Exhibit 8. He later opined in a report dated January 21, 2009 that the claimant’s buttock pain was “most likely of nerve irritation although a sacroiliac joint component is not being completely excluded.” Exhibit 8. Dr. Roth observed that the claimant had “received extensive conservative and invasive therapies with essentially no long lasting benefit.” He opined that it was “not reasonable to anticipate that bilateral SI joints and bilateral SI radiofrequency will benefit.” He further noted that the “CAT scan” indicated the claimant had normal SI joints. Dr. Roth therefore recommended “against additional injection interventions” and “against authorizing Dr. Vilim’s request . . . to perform another set of bilateral SI joint injections.” Exhibit A at R-001. It is apparent that the ALJ’s dispositive findings are supported by substantial evidence.
We find no reversible error in the ALJ’s determination that the claimant failed to establish an entitlement to additional SI joint injections. As noted, the factual findings
are supported by substantial evidence in the record, and the decision is not contrary to the law. Therefore, we decline to disturb it. See § 8-43-301(8), C.R.S. 2009 (Panel may not disturb order if findings supported by substantial evidence and denial of benefits supported by applicable law).
IT IS THEREFORE ORDERED that the ALJ’s order dated July 28, 2009 is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
______________________________ John D. Baird
______________________________ Curt Kriksciun
SANDRA MCCRACKEN, KEENSBURG, CO, (Claimant).
WENDY’S OF COLORADO SPRINGS, C/O: GOLDEN CORRAL, THORNTON, CO, (Employer).
TRAVELERS INDEMNITY COMPANY, Attn: SHERYL WEBER, DENVER, CO, (Insurer).
IRWIN BOESEN, PC, Attn: LANE N. COHEN, ESQ., DENVER, CO, (For Claimant).
THOMAS POLLART MILLER, LLC, Attn: GLEN B. GOLDMAN, ESQ., GREENWOOD VILLAGE, CO, (For Respondents).