W.C. No. 3-106-629Industrial Claim Appeals Office.
February 9, 2001
FINAL ORDER
The claimant seeks review of an order of Administrative Law Judge Felter (ALJ) which denied medical benefits. We affirm.
The claimant suffered a work-related injury in 1992. The respondents admitted liability and referred the claimant to Dr. Fox who performed a lumbar laminotomy left L4-5 with intervertebral diskectomy at L4-5. The claimant returned to Dr. Fox in 1996 complaining of bilateral feet and hand tingling. Dr. Fox doubted further surgery would be of any value.
The claimant began treating with Dr. Garza-Vale (Dr. Garza) in July 1997. Dr. Garza diagnosed “foraminal stenosis 4-5 and 5-1 with degenerated discs, advanced at 4-5 and 5-1.” Dr. Garza also noted a vacuum affect at the degenerated discs. On September 12, 1997, Dr. Garza performed a L4-5 hemilaminectomy, foraminotomy and disk excision. MRI studies in December 1998 revealed narrowing of the foramen at 4-5 on the left and degenerative changes at L2-3 and 3-4. In February 1999, Dr. Garza recommended additional treatment of the L4-5 and L5-SI discs through a procedure known as a cage fusion. In a report dated September 15, 1999, Dr. Fox opposed further surgery.
Under § 8-42-101(1)(a), C.R.S. 2000, 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). To recover medical benefits, it is the claimant’s burden to prove a causal connection between the industrial injury and the need for medical treatment. City of Durango v. Dunagan, 939 P.2d 496 (Colo.App. 1997).
The ALJ found the claimant failed to sustain her burden to prove a causal connection between the industrial injury and the cage fusion. In support, the ALJ found that the claimant’s physicians have diagnosed foraminal stenosis, and a narrowing of the spinal foramina, which the ALJ determined is a degenerative condition. Further, the ALJ found that none of the claimant’s physicians who recommended the claimant undergo further surgery, opined that there is a causal connection between the foraminal stenosis and the industrial injury or that the industrial injury has accelerated the foraminal stenosis. Under these circumstances, the ALJ found the evidence was insufficient to infer a causal connection between the 1992 injury and the need for further surgery. Therefore, the ALJ denied the claimant’s request for medical benefits in the form of a cage fusion.
On review the claimant contends the ALJ’s finding that the claimant has been diagnosed with foraminal stenosis is incomplete and not supported by the record. The claimant contends that the medical records show she is also suffering from collapsed discs at L4-5 and L5-S1. The claimant argues the collapse is not degenerative and was caused by the previous lumbar surgeries or the industrial injury. Therefore, the claimant contends the ALJ erred in finding she failed to prove a causal connection between the disputed treatment and the industrial injury. We disagree.
It is the ALJ’s sole prerogative to assess the sufficiency and probative value of the evidence to determine whether the claimant has met her burden of proof. Wal-Mart Stores, Inc. v. Industrial Claim Appeals Office, 989 P.2d 251 (Colo.App. 1999). We must uphold the ALJ’s factual determinations if supported by substantial evidence in the record. Section 8-43-301(8), C.R.S. 2000; Ackerman v. Hilton’s Mechanical Men, Inc., 914 P.2d 524 (Colo.App. 1996). Under this standard we must defer to the ALJ’s assessment of the sufficiency and probative weight of the evidence. Arenas v. Industrial Claim Appeals Office, 8 P.3d 558
(Colo.App. 2000). Further the ALJ is considered to possess specialized knowledge which renders him competent to evaluate medical evidence and draw plausible inferences from it. Wierman v. Tunnell, 108 Colo. 544, 120 P.2d 638 (1941).
The claimant does not dispute that she suffers from a degenerative condition known as foraminal stenosis. Neither does the claimant dispute that Dr. Garza recommended the cage fusion surgery to treat the foraminal stenosis. However, the claimant contends the surgery was also designed to treat the marked collapse of the discs at L4-5 and L5-S1.
Regardless of its actual affect on the narrowing of the claimant’s lumbar spinal discs, the primary diagnosis was foraminal stenosis. Therefore, the critical issue before the ALJ was whether the claimant proved a causal connection between the foraminal stenosis and the industrial injury.
We have reviewed the ALJ’s findings of fact and the record. Although, the treating physicians’ records detail the collapse of the discs at L4-5 and L5-SI, the ALJ reasonably inferred that none of the claimant’s treating physicians reported a causal connection between the foraminal stenosis and the industrial injury. Furthermore, on this record we cannot say the ALJ was compelled to find that the narrowing of the L4-5 and L5-S1 discs was the result of the previous surgeries or the industrial injury. Cf. Uptime Corp. v. Colorado Research Corp., 161 Colo. 87, 420 P.2d 232 (1966) (ALJ is not required to explicitly discuss defenses or theories he rejected). In fact, evidence that the previous two surgeries were causally related to the industrial injury does not compel a finding that the additional surgery recommended by Dr. Garza is also necessitated by the industrial injury.
Furthermore, the ALJ’s findings support his determination that the claimant failed to prove the disputed treatment is reasonable and necessary to treat the industrial injury. Therefore, we may not disturb the denial of medical benefits.
IT IS THEREFORE ORDERED that the ALJ’s order dated August 18, 2000, 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. 2000. 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 decision were mailed February 9, 2001 to the following parties:
Jackie Churches, 31 Wild Rose Ln., Stockdale, TX 78160-6332
Wal Mart Stores, Inc., 2881 North Ave., Grand Junction, CO 81501-5064
National Union Fire Insurance of Pittsburgh, 160 Water St., New York, N Y 10038
Karen Goad, Claims Adjuster, Claims Management, Inc., P. O. Box 3608, Bartlesville, OK 74006-3708
Vincent M. Balkenbush, Esq., 4500 Cherry Creek Drive South, #930, Denver, CO 80246 (For Claimant)
Richard A. Bovarnick, Esq. and Harvey D. Flewelling, Esq., 5353 W. Dartmouth Ave., #400, Denver, CO 80227 (For Respondents)
BY: A. Pendroy