W.C. No. 4-632-507.Industrial Claim Appeals Office.
February 2, 2006.
FINAL ORDER
The claimant seeks review of an order dated August 9, 2005 of Administrative Law Judge Friend (ALJ) that denied the claimant’s claim for medical benefits in the form of a hip replacement. We affirm.
A hearing was held at which the sole issue was the claimant’s entitlement to medical benefits in the form of hip replacement surgery. Following the hearing the ALJ entered findings of fact that may be summarized as follows. On November 3, 2004, the claimant slipped and fell in a compensable accident, injuring his right hip. He underwent a CT scan, which showed a complete collapse of the femoral head and extensive degenerative changes caused by avascular necrosis. Dennis Chang, M.D. examined the claimant on November 10, 2004, and stated that he would need a total hip replacement in the future. Douglas Scott, M.D. stated on December 28, 2004 that the claimant had “end-stage degeneration” of the right hip, caused by avascular necrosis, and Dr. Scott recommended a total right hip arthroplasty. On February 23, 2005 Dr. Chang agreed with Dr. Scott’s diagnosis and recommendation for surgery.
John Hughes, M.D. examined the claimant on May 3, 2005, and stated that the compensable injury substantially aggravated the right hip arthritis and precipitated the failure of the hip. Dr. Hughes opined that the surgery would not have been recommended absent the industrial injury. The ALJ specifically rejected the opinions of Dr. Hughes as not persuasive. Rather, the ALJ credited as persuasive the opinions of Dr. Henke and Dr. Mitsos, the latter of whom reviewed the medical records and stated that by the time of the CT scan the claimant’s degenerative condition had progressed to a point where the hip surgery was required. Dr. Henke examined the claimant on May 25, 2005, and stated that the compensable injury did not cause, aggravate, or accelerate the claimant’s preexisting condition, and that he would have needed the hip replacement surgery at approximately the same time even if he had not sustained the compensable injury. Dr. Henke testified that he would have recommended the surgery based solely upon the CT scan. The ALJ specifically rejected the testimony of Dr. Hughes to the contrary. The ALJ specifically found that the claimant’s degenerative condition preexisted the compensable injury, that the injury did not cause the avascular necrosis, and that the injury did not cause, aggravate, or accelerate the need for the surgery.
Based upon his factual findings, the ALJ concluded that the hip replacement surgery was not reasonably necessary to cure or relieve the claimant from the effects of the industrial injury. Accordingly, the ALJ denied the claim for medical benefits in the form of the hip replacement surgery.
On appeal the claimant contends that the ALJ’s order is not supported by substantial evidence and that, conversely, the record compels the conclusion that the claimant’s industrial injury accelerated his need for the hip replacement surgery. We are not persuaded that the ALJ erred.
The fact that the claimant suffers from a preexisting condition does not, of course, disqualify the claimant from receiving workers’ compensation benefits. Rather, where the industrial injury “aggravates, accelerates, or combines with” a preexisting disease or infirmity to produce the need for treatment, the treatment is a compensable consequence of the industrial injury See H H Warehouse v. Vicory, 805 P.2d 1167 (Colo.App. 1990). However, the mere occurrence of a compensable injury does not require an ALJ to find that all subsequent medical treatment and physical disability was caused by the industrial injury. To the contrary, the range of compensable consequences of an industrial injury is limited to those which flow proximately and naturally from the injury. Standard Metals Corp. v. Ball, 172 Colo. 510, 474 P.2d 622 (1970); § 8-41-301(1)(c), C.R.S. 1997.
It is the claimant’s burden to prove a causal relationship between the industrial injury and the medical condition for which he seeks benefits. Snyder v. Industrial Claim Appeals Office, 942 P.2d 1337 (Colo.App. 1997). The question of whether an industrial injury is the cause of a subsequent need for medical treatment is largely one of fact for determination by the ALJ City of Durango v. Dunagan, 939 P.2d 496 (Colo.App. 1997). Consequently, we must uphold the ALJ’s order if supported by substantial evidence in the record. § 8-43-301(8), C.R.S. 2005. In this regard, it was the prerogative of the ALJ to assess the weight and credibility of the medical testimony offered on the issue of causation. Rockwell International v. Turnbull, 802 P.2d 1182 (Colo.App. 1990). Further, to the extent the testimony of a medical expert contained inconsistencies, or was subject to multiple interpretations, it was for the ALJ to resolve such conflicts, and we are bound by his resolution of conflicts in the medical evidence. Colorado Springs Motors, Ltd. v. Industrial Commission, 165 Colo. 504, 441 P.2d 21 (1968).
The claimant’s arguments notwithstanding, substantial evidence supports the ALJ’s determination that, although the claimant certainly suffered a compensable hip injury, that event was not the cause of the claimant’s need for medical treatment in the form of hip replacement surgery. Dr. Henke, who was certified as an expert in occupational medicine and radiology, testified that he examined the claimant and reviewed his medical records, (tr. at 105), and the doctor opined that the compensable accident did not “cause, aggravate, or accelerate the need for his hip replacement surgery.” Tr. at 106. The doctor explained that the diagnostic testing, which included radiographs and CT films, revealed the “longstanding progression of a end stage avascular necrosis of the right femoral head.” Tr. at 107. He further testified that the avascular necrosis was not caused, aggravated, or accelerated by the compensable accident, and that although there might have been a fracture of the intertrochanteric area, that likely did not occur at the time of the slip and fall. Tr. at 108-09. The doctor further explained that the need for surgery was caused by the “collapse of the femoral head, which in turn, was caused by ulcerative colitis the claimant suffered from and by prednisone steroid therapy which he underwent. Tr. at 110. The doctor opined that the claimant would have required the hip replacement surgery even absent the compensable accident, and that he was progressively losing the mobility of the hip joint “to the point where he was not going to be able to walk without some kind of assistance.” Tr. at 110-11. He stated that the point at which the claimant “needed the hip replacement surgery” was when he reviewed the CT scan that disclosed a collapsed femoral head, and he reiterated that the industrial accident did not accelerate the need for that surgery. Tr. at 128-29. Moreover, in response to the question whether the CT scan would likely have been identical the day before the compensable injury, the doctor responded, “Absolutely,” and he opined that the claimant would have needed the surgery at that time as well. Tr. at 129. Finally, the doctor testified that once the femoral head collapsed due to the progression of the avascular necrosis “any orthopedic surgeon” would recommend the hip replacement surgery whether the claimant was suffering any pain or other symptoms or not. Tr. at 129-30, 132.
Dr. Henke’s testimony provides ample support for the ALJ’s factual findings that the compensable accident did not cause, aggravate, or accelerate the claimant’s need for the hip replacement surgery. 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). Moreover, we disagree with the claimant that this is a case in which the testimony the ALJ found persuasive is rebutted by such hard, certain evidence that it would be error as a matter of law to credit the testimony. Halliburton Services v. Miller, 720 P.2d 571 (Colo. 1986). The claimant relies heavily on the temporal relationship between the onset of symptoms and the industrial injury, pointing out that prior to the injury the claimant was fully functional and symptom-free. Although this evidence was relevant, the ALJ was not compelled to presume causation between the injury and the need for surgery because of the mere temporal relationship between the claimant’s fall and his symptoms. The ALJ credited Dr. Henke’s testimony that the need for surgery was caused by the avascular necrosis, and that this cause was irrespective of any onset of symptoms.
Under § 8-43-301(8), C.R.S. 2002, we are precluded from disturbing the ALJ’s order unless the ALJ’s findings of fact are insufficient to permit appellate review, the ALJ has not resolved conflicts in the evidence, the record does not support the ALJ’s findings, the findings do not support the order, or the order is not supported by the applicable law. Here, the ALJ’s findings are sufficient to permit appellate review, and the findings indicate that the ALJ resolved conflicts in the evidence based upon his credibility determinations. See Riddle v. Ampex Corp., 839 P.2d 489 (Colo.App. 1992). Further, the ALJ’s findings are supported by substantial evidence in the record and the order is consistent with the applicable law.
IT IS THEREFORE ORDERED that the ALJ’s order dated August 9, 2005, is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
___________________________________ Curt Kriksciun
____________________________________ Thomas Schrant
Douglas Fairchild, Castle Rock, CO, GCR Tire Center, Brighton, CO., Old Republic Insurance Company, c/o Amy Funderburk, Gallagher Bassett Services, Inc., Englewood, CO., Steven H. Gurwin, Esq., Denver, CO, (For Claimant).
M. Kim McGarvie, Esq. and Douglas A. Thomas, Esq., Greenwood Village, CO, (For Respondents).