W.C. No. 4-231-632Industrial Claim Appeals Office.
March 14, 1997
FINAL ORDER
The respondents seek review of a final order of Administrative Law Judge Wheelock (ALJ), which awarded medical benefits for the claimant’s bilateral carpal tunnel syndrome (CTS). We affirm.
The ALJ found that the claimant sustained a compensable injury on September 3, 1994 when she fell down at work. At that time, the claimant was employed as a waitress, and slipped on the floor. The ALJ found that the claimant injured her right shoulder, her right hand, her neck and her right hip.
In November 1994, the claimant was diagnosed right-sided CTS. In August 1995, she was found to have CTS on the left side.
Relying principally on the testimony of Dr. Pise, the ALJ found that the claimant’s bilateral CTS is causally connected to the 1994 injury. Dr. Pise opined that the claimant probably had undetected CTS prior to the 1994 injury. However, he stated that the 1994 fall “triggered” the right-sided CTS, either by direct injury to the hand, or because the injury caused peripheral swelling of the wrist. (Pise Depo. pp. 10, 27, 36-37). Moreover, Dr. Pise corrected the claimant’s left-sided CTS to the injury-related rotator cuff surgery which the claimant underwent in February 1995. Specifically, Dr. Pise opined that immobilization of the claimant’s right extremity caused her to overuse the left extremity, thereby triggering CTS on the left. (Pise Depo. p. 12).
On review, the respondents contend that the ALJ’s finding of a causal relationship between the injury and the bilateral CTS is unsupported by the evidence and the law. Specifically, the respondents argue that the testimony of Dr. Pise is “speculative” because Dr. Pise admitted that the claimant’s CTS might have been triggered by preexisting degenerative arthritis. Further, the respondents point out that Dr. Pise admitted that there is “no record of direct trauma” to the claimant’s right wrist. Further, the respondents point out that the opinion of Dr. Pise is contrary to that of Dr. Scott, who opined that the claimant’s bilateral CTS is of idiopathic etiology. We reject the respondents’ arguments.
The claimant carried the burden of proof to establish a causal relationship between the industrial injury and the bilateral CTS for which she sought medical benefits. See Snyder v. Industrial Claim Appeals Office, ___ P.2d ___ (Colo.App. No. 96CA0679, February 6, 1997). Causation is established where the claimant proves that an industrial injury aggravated or accelerated a preexisting condition so as to produce a disability or need for treatment. H H Warehouse v. Vicory, 805 P.2d 1167 (Colo.App. 1990). Moreover, respondents are liable for the natural and proximate effects of an industrial injury. Standard Metals Corp. v. Ball, 172 Colo. 510, 474 P.2d 622 (1970).
Generally, proof of causation is a factual matter for determination by the ALJ. F. R. Orr Construction v. Rinta, 717 P.2d 965 (Colo.App. 1985). The claimant need not establish the precise medical cause of a condition, so long as the claimant presents evidence from which the ALJ may infer a causal relationship between the injury and the need for treatment. Industrial Commission v. Riley, 165 Colo. 586, 441 P.2d 3 (1968).
Because the issue of causation is factual in nature, we are obliged to uphold the ALJ’s findings if supported by substantial evidence in the record. Section 8-43-301(8), C.R.S. (1996 Cum. Supp.). Thus, we may not interfere with the ALJ’s resolution of conflicts in the evidence, his credibility determinations and the plausible inferences which he drew from the evidence, including the medical evidence. Rockwell International v. Turnbull, 802 P.2d 1182 (Colo.App. 1990).
The respondents’ argument notwithstanding, the testimony of Dr. Pise is not so “speculative” as to disqualify it from consideration by the ALJ. Although Dr. Pise conceded that the claimant’s preexisting arthritis might have been a cause of the development of her CTS, he opined that the CTS was more likely the result of the industrial injury and the subsequent surgery. This was true because of the temporal relationship between the claimant’s symptoms and the injury and surgery. (Pise Depo. pp. 18, 34-35).
Moreover, the fact that Dr. Pise did not have any “identifiable evidence” that the fall produced right-sided swelling is not fatal to the ALJ’s reliance on Pise’s testimony. The ALJ cited testimony of the claimant’s husband and her co-worker that the claimant experienced difficulty with using her right hand immediately after the industrial injury. Thus, there is circumstantial evidence that the claimant experienced the type of swelling contemplated by Dr. Pise, and the mere fact that he did not personally observe it does not disqualify his opinion from consideration.
It is certainly true that there was some evidence, including the report of Dr. Scott, which would support contrary findings and conclusions. However, we decline the respondents’ invitation to substitute our judgement for that of the ALJ concerning the weight and inferences to be drawn from the medical evidence Rockwell International v. Turnbull, supra.
IT IS THEREFORE ORDERED that the ALJ’s order dated June 24, 1996, is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
______________________________ David Cain
______________________________ Kathy E. Dean
NOTICE
This Order is final unless an action to modify or vacatethe Order is commenced in the Colorado Court of Appeals, 2 East14th Avenue, Denver, Colorado 80203, by filing a petition toreview with the court, with service of a copy of the petitionupon the Industrial Claim Appeals Office and all other parties,within twenty (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 March 14, 1997 to the following parties:
Ruby Clouse, 3244 Pinnacle Dr., Colorado Springs, CO 80910
Denny’s Restaurant, Attn: Bob Lee, 1450 Harrison Road, Colorado Springs, CO 80906
Ellis Stalker, GAB, 789 Sherman St., Denver, CO 80203
Anthony Sokolow, Esq., 620 S. Cascade, #103, Colorado Springs, CO 80903 (For the Claimant)
Clyde E. Hook, Esq. Harvey D. Flewelling, Esq., 5353 W. Dartmouth Ave., #400, Denver, CO 80227 (For the Respondents)
By: _______________________________