W.C. No. 4-273-207Industrial Claim Appeals Office.
April 2, 1997
FINAL ORDER
The respondents seek review of an order of Administrative Law Judge Wheelock (ALJ). The respondents contend that the ALJ erred in finding that the claimant sustained a compensable industrial injury to his right knee, and in ordering reasonable and necessary medical benefits. We affirm.
The ALJ found that on October 23, 1995, the claimant, who worked for the employer as a carpenter, sustained an injury to his right knee when a scaffold fell, and the knee was hit by a falling plank. In 1993, the claimant had sustained a non-industrial injury to the same knee, and this injury was diagnosed as a “`bucket handle’ tear in the right meniscus.” The claimant’s treating physician at that time, Dr. McLeod, recommended that the claimant undergo surgery for that injury. However, the claimant did not undergo the recommended surgery.
The claimant was examined for the 1995 injury by Dr. Mehos, who diagnosed an “internal derangement of the knee.” Dr. Mehos recommended surgery for the condition. Noting that Dr. Mehos’s diagnosis is different than the previous diagnosis given by Dr. McLeod, the ALJ concluded that the claimant sustained a “substantial, permanent aggravation of his right knee problem” as a result of the industrial injury. Accordingly, the ALJ ordered the respondent to pay for all reasonable and necessary medical treatment provided by Dr. Mehos, and his referrals.
The respondents concede that substantial evidence exists to support the ALJ’s finding that the claimant sustained a compensable injury to his right knee. However, the respondents contend that the ALJ erred in requiring payment for medical treatment of the claimant’s knee. In support of this position, the respondents argue that a surgery “identical” to that recommended in 1995 was recommended in 1993, and thus, the claimant’s current need for treatment is not proximately caused by the compensable injury. We disagree.
Whether the claimant has suffered an industrial injury, and whether the injury is the cause of the claimant’s need for treatment, are questions of fact to be determined by the ALJ. See F. R. Orr Construction v. Rinta, 717 P.2d 965 (Colo.App. 1985). Thus, we must uphold the ALJ’s findings if supported by substantial evidence in the record. See §8-43-301(8), C.R.S. (1996 Cum. Supp.); F.R. Orr Construction v. Rinta, supra.
Moreover, the need for medical treatment is compensable if it results from the superimposition of an industrial injury on a pre-existing condition. H H Warehouse v. Vicory, 805 P.2d 1167
(Colo.App. 1990). Consequently, as long as the industrial injury is a “significant factor” in the claimant’s need for treatment, the presence of a separate, non-industrial medical problem which complicates or impedes the claimant’s recovery from the industrial injury does not preclude the claimant from receiving treatment. Seifried v. Industrial Commission, 736 P.2d 1262 (Colo.App. 1986).
Contrary to the respondents’ argument, the record does not compel the conclusion that the surgery recommended for the 1993 injury was “identical” to the surgery recommended for the 1995 injury. The medical reports included in the record indicate that the two doctors consulted by the claimant recommended “arthroscopic surgery” on the occasion of each injury. However, we note that the diagnoses in the two injuries are not the same, and neither of these two recommendations specifies for what structure of the knee the surgery is recommended.
Moreover, the difference between the 1993 diagnosis and the 1995 diagnosis, together with the ALJ’s findings concerning the 1995 injury, support the ALJ’s inference that the 1995 injury is an “aggravation” of the 1993 injury. See Rockwell International v. Turnbull, 802 P.2d 1182
(Colo.App. 1990). Further, it is implicit in the ALJ’s findings that the claimant’s industrial injury is a significant factor in his need for medical treatment. See Seifried v. Industrial Commission, supra. Thus, we find no error in the order that the respondent pay for the claimant’s reasonable and necessary medical care.
IT IS THEREFORE ORDERED that the ALJ’s order dated October 15, 1996, is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
____________________________________ David Cain
____________________________________ 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, with service of a copy of the petition upon the Industrial Claim Appeals Office and all other parties, within twenty (20) days after the date this Order is mailed, pursuant to section 8-43-301(10) and 307, C.R.S. (1996 Cum. Supp.).
Copies of this decision were mailed April 2, 1997 to the following parties:
Jerome Determan, 21501 Chalk Creek Drive, Nathrop, CO 81236
Moltz Construction, Inc., P.O. Box 729, Salida, CO 81201-0729
Colorado Compensation Insurance Authority, Attn: Curt Kriksciun, Esq. (Interagency Mail) (For the Respondents)
Pamela J. Adams Donnelly, Esq., 90 S. Cascade Ave., Ste. 300, Colorado Springs, CO 80903 (For the Claimant)
By: _______________________________