W.C. No. 4-321-251Industrial Claim Appeals Office.
December 30, 1997
ORDER OF REMAND
The claimant seeks review of a final order of Administrative Law Judge Gandy (ALJ), which denied his claim for medical benefits and temporary disability benefits. We set the order aside and remand for entry of a new order.
The claimant sustained an admitted injury to his left ankle in December 1996. The claimant developed swelling in the ankle, and later the left leg. The claimant was then diagnosed with “vein thrombosis, phlebitis and a generalized hyper-coagulative state.” After being treated for these conditions, the claimant developed thrombophlebitis in his upper extremities, and migratory thrombophlebitis. Ultimately, the claimant’s clotting problems were diagnosed as “Trousseau’s syndrome” by Dr. Manco-Johnson. At the hearing, Dr. Manco-Johnson testified that the Trousseau’s syndrome was, in part, attributable to the claimant’s previously undiscovered gastric cancer. Dr. Manco-Johnson explained that the cancer cells emitted proteins into the blood stream which activate blood clotting and limit the body’s ability to control the clotting. (Tr. p. 28). Dr. Manco-Johnson also opined that, although the preexisting blood condition predisposed the claimant to develop Trousseau’s syndrome, the ankle injury was the “triggering” event for the development of the blood clots. (Tr. pp. 29, 49, 52).
The respondents presented the testimony of Dr. Garfield. Dr. Garfield testified that Trousseau’s syndrome is associated with cancer, and can spontaneously appear without the interference of any intervening or triggering event such as trauma. In fact, Dr. Garfield stated that he was “not sure [he had] ever seen a trigger.” (Tr. p. 81). However, Dr. Garfield also testified that the claimant’s ankle injury “exposed a hyper-coagulative state” and converted a subclinical problem into a clinical problem. (Tr. p. 91). Consequently, he stated that the ankle injury “sped up” development of the Trousseau’s syndrome. (Tr. p. 91).
The claimant argued to the ALJ that the treatment and disability associated with the Trousseau’s syndrome, and consequently the underlying cancer, are compensable because the industrial ankle injury aggravated or accelerated the claimant’s preexisting, but undiagnosed, hyper-coagulative state. However, the ALJ rejected this argument, finding that the claimant failed to prove that the “cancer and related Trousseau’s syndrome are conditions which are related or the causal result of the ankle injury.” Consequently, the ALJ denied any medical or temporary disability benefits after February 10, 1997, the date the claimant reached maximum medical improvement for the ankle injury.
In support of his conclusion, the ALJ stated that he was persuaded by Dr. Garfield’s testimony that there “was no triggering process for Trousseau’s syndrome,” and that the syndrome “could have come about at any time for any number of causes and could have manifested itself on its own at some point in the natural disease process.” (Finding of Fact 18, Conclusion of Law 3) Nevertheless, the ALJ also found that “all the doctors agreed . . . that the hyper-coagulative state was latent and was not made patent or obvious until the Claimant suffered his work injury on December 10, 1996.” (Finding of Fact 17). However, the ALJ found that the claimant’s treatment for Trousseau’s syndrome “would have been treatment necessitated simply by the natural course of the disease and not by any intervening event, such as the work injury in this case.” (Finding of Fact 19).
On review, the claimant contends that the ALJ erred in denying medical benefits and temporary disability benefits associated with the claimant’s Trousseau’s syndrome and gastric cancer. The claimant takes issue with several of the ALJ’s findings of fact, arguing that the evidence compels the conclusion that the industrial ankle injury aggravated or accelerated the Trousseau’s syndrome. The claimant also argues that the ALJ misapplied the law insofar as he found that the Trousseau’s syndrome is not compensable because the claimant would have developed the condition regardless of the ankle injury. We conclude that the ALJ’s findings of fact are insufficient to support appellate review, and therefore, remand for additional findings and entry of a new order. Section 8-43-301(8), C.R.S. 1997.
It is well established that if an industrial injury aggravates a preexisting latent condition, the resulting disability and need for treatment are compensable consequences of the injury. See Seifried v. Industrial Commission, 736 P.2d 1262 (Colo.App. 1986). Similarly, if the industrial injury “accelerates” the development of a preexisting condition, the resulting disability is compensable. See H H Warehouse v. Vicory, 805 P.2d 1167 (Colo.App. 1990).
However, even if a claimant succeeds in proving a compensable aggravation or acceleration of a preexisting condition, he does not necessarily prove that every subsequent health problem is a compensable consequence of the injury. Rather, the claimant is limited to recovering for disability and medical expenses which flow proximately and naturally from the compensable injury. See Johnson v. Industrial Commission, 148 Colo. 561, 366 P.2d 864 (1961); Standard Metals Corp. v. Ball, 172 Colo. 510, 474 P.2d 622 (1970). The extent of such compensable consequences is largely a question of fact for the ALJ. Standard Metals Corp. v. Ball, supra.
Here, we are unable to ascertain whether the ALJ correctly applied these principles of law when assessing the issue of causation. On the one hand, the ALJ appears to have determined that the ankle injury did not “trigger” the Trousseau’s syndrome. However, he also found that all physicians agreed that the ankle injury made the condition “patent or obvious.” On remand, the ALJ shall resolve this apparent conflict and determine whether the industrial ankle injury played any role in aggravating or accelerating the development of Trousseau’s syndrome.
Moreover, the ALJ appears to have determined that resolution of this issue is immaterial because the claimant “would have” developed Trousseau’s syndrome at some point in the future. However, we agree with the claimant that it does not matter whether the claimant “would have” developed Trousseau’s syndrome in the future if the ankle injury accelerated the need for treatment of this condition, or accelerated the claimant’s disability associated with Trousseau’s syndrome. To the extent the ankle injury accelerated the need for treatment or the disability, the condition is compensable. H H Warehouse v. Vicory, supra.
Nevertheless, we should not be understood as holding that, if the ALJ finds a compensable aggravation, that he is required to find that all subsequent treatment or disability associated with Trousseau’s syndrome is compensable. In our view, Dr. Garfield’s testimony could be interpreted as meaning that, although the ankle injury initially caused the need for some treatment of Trousseau’s syndrome, the ankle injury is not responsible for all of the claimant’s subsequent treatment and disability. Put another way, the ALJ could find that much of the need for treatment of Trousseau’s syndrome is not a natural and proximate result of the industrial injury, but of the natural and independent progression of the claimant’s preexisting disease process. See Seifried v. Industrial Commission, supra.
On remand, the ALJ shall make explicit findings of fact determining whether the claimant’s ankle injury aggravated or accelerated the development of Trousseau’s syndrome. If the ALJ determines that there was a compensable aggravation or acceleration, he shall also determine the extent to which the claimant’s disability and ongoing need for treatment is a proximate and natural result of that aggravation or acceleration.
In reaching this result, we should not be understood as expressing any opinion concerning the proper resolution of the factual issues underlying the requisite determinations. Further, we need not address the claimant’s other arguments concerning compensability at this time.
IT IS THEREFORE ORDERED that the ALJ’s order dated June 19, 1997, is set aside, and the matter is remanded for entry of a new order consistent with the views expressed herein.
INDUSTRIAL CLAIM APPEALS PANEL
______________________________ David Cain
______________________________ Bill Whitacre
Copies of this decision were mailed December 30, 1997 to the following parties:
Daniel Boone, 18152 Shoshone Dr., Sterling, CO 80751
Windy Dankievitch, Winslow Construction Co., 3002 S. Heron St., Englewood, CO 80110
Lynn Estes, RTW of Colorado, 7400 E. Orchard Rd., Ste. 3025, Englewood, CO 80111
William J. McDonald, Esq., 1890 Gaylord St., Denver, CO 80206 (For the Claimant)
Stephen A. Jones, Esq., 1700 Broadway, Ste. 1910, Denver, CO 80290 (For the Respondents)
By: _______________________________