W.C. No. 4-454-548.Industrial Claim Appeals Office.
May 14, 2004.
FINAL ORDER
The claimant seeks review of an order of Administrative Law Judge Mattoon (ALJ) which determined that certain alleged medical conditions were not caused by the admitted industrial injury, and therefore, denied a claim for permanent total disability (PTD) benefits. The claimant further contests the ALJ’s denial of his request to convert a scheduled lower extremity rating to a whole person rating. We affirm.
The claimant sustained a strain of the right knee on March 12, 1999. The claimant underwent a arthroscopic surgery on August 23, 1999, and no abnormalities were observed except for an “abnormally large plica” (tissue), which was removed. A treating physician originally placed the claimant at maximum medical improvement (MMI) on May 17, 2000, with a 10 percent impairment of the lower extremity based on degenerative arthritis. This rating converted to a 4 percent whole person impairment.
The claimant reported continued difficulties with the knee and underwent a patellar realignment surgery in April 2002. A third surgery was performed in September 2002 to remove hardware from the knee. The claimant was put at MMI for the second time on December 11, 2002, and placed under permanent restrictions against squatting, kneeling, and crawling. The claimant’s impairment rating was not altered.
In September 2002, the claimant was hospitalized for chest symptoms and breathing problems caused by lupus. He has not returned to work since that time.
The claimant requested a hearing seeking PTD benefits. In connection with this request, the claimant sought to prove that the industrial injury and surgeries aggravated or accelerated his preexisting lupus. He further asserted that pain in the right knee resulted in “overuse” of the left knee causing compensable consequences. The claimant also argued that a left shoulder injury, which he sustained in a fall at home on January 7, 2003, was a consequence of the industrial injury because the right knee buckled causing him to fall. Finally, the claimant requested that the lower extremity impairment rating be converted to a whole person rating based on back pain allegedly caused by the lower extremity condition.
The ALJ denied the claim for PTD benefits, finding the claimant failed to prove the lupus was aggravated or accelerated by the knee injury or surgeries, and that the claimant failed to prove by a preponderance of the evidence that the back, left knee and left shoulder conditions are “related” to the industrial injury. For the same reason, the ALJ declined to convert the lower extremity rating to a whole person rating. The ALJ also found that the right knee condition, standing alone, causes “minimal interference” with the claimant’s ability to earn wages, and that the claimant is capable of earning wages despite the “non-work-related lupus” symptoms.
I.
On review, the claimant argues the ALJ erred in finding that he failed to present “sufficient evidence” to establish a causal link between the back condition, the left knee condition, and the left shoulder condition and the industrial knee injury. In support of this contention, the claimant relies on his own testimony and medical testimony indicating that pain in one knee may strain the other, and that weakness in a knee joint may cause a person to fall. We are not persuaded.
Where, as here, the claimant is seeking to establish a right to PTD, he must show that the injury is a significant causative factor in the PTD. Thus, the claimant must show that the industrial injury bears a “direct causal relationship between the precipitating event and the resulting disability.” Seifried v. Industrial Commission, 736 P.2d 1262 (Colo.App. 1986). As the ALJ recognized, this standard required her to determine the “nature and extent of the claimant’s residual disability from the industrial injury.” (Emphasis added). Joslins Dry Goods Co. v. Industrial Claim Appeals Office, 21 P.3d 866, 869 (Colo.App. 2001).
We do not dispute that additional injuries which are the natural and proximate result of an industrial injury represent compensable consequences of the industrial injury. Owens v. Industrial Claim Appeals Office, 49 P.3d 1187 (Colo.App. 2002). However, the claimant bears the burden of proof to establish causation, and the question of whether he has done so is one of fact for determination by the ALJ. Faulkner v. Industrial Claim Appeals Office, 12 P.3d 844 (Colo.App. 2000).
Because proof of causation is a factual determination, we must uphold the ALJ’s determination if supported by substantial evidence in the record. Section 8-43-301(8), C.R.S. 2003. This standard of review requires us to view the evidence in a light most favorable to the prevailing party, and defer to the ALJ’s resolution of conflicts in the evidence, credibility determinations, and plausible inferences drawn from the record Wilson v. Industrial Claim Appeals Office, 81 P.3d 1117
(Colo.App. 2003). Where, as here, expert opinion is presented on the issue of causation, it is for the ALJ to determine its weight and credibility. See Cordova v. Industrial Claim Appeals Office, 55 P.3d 186 (Colo.App. 2002).
We note the ALJ is not held to a standard of absolute clarity in expressing findings of fact and conclusions of law. It is sufficient for the ALJ to enter findings concerning the evidence she considers dispositive of the issues, and evidence and inferences inconsistent with the order are presumed to have been rejected. Magnetic Engineering Inc. v. Industrial Claim Appeals Office, 5 P.3d 385 (Colo.App. 2000). Further, the ALJ is presumed to have considered and applied the relevant legal principles. Shafer Commercial Seating, Inc. v. Industrial Claim Appeals Office, 85 P.3d 619 (Colo.App. 2003).
The claimant argues the ALJ’s findings on the issue are not adequate for review because “it is not clear” what the ALJ meant when she stated the claimant failed to submit “sufficient evidence.” According to the claimant, this finding is certainly erroneous if the ALJ meant to find the claimant failed “to meet his burden of production.” In any event, the claimant asserts the findings are insufficient to reveal the factual basis for the ALJ’s conclusions regarding causation.
The claimant incorrectly states the ALJ found that he failed to present “sufficient evidence.” In fact, the ALJ found the claimant failed to present “sufficient persuasive evidence” that the back, left knee and left shoulder conditions are related to the industrial injury. (Emphasis added, Finding of Fact 26). Similarly, the ALJ concluded the claimant did not prove causation “by a preponderance of the evidence.” (Conclusion of Law 3). Thus, we have no difficulty determining that the ALJ found as a matter of fact that the claimant failed to meet his burden of proof.
Further, we are able to determine the bases for that finding. The ALJ was unpersuaded by the claimant’s self-serving testimony and sketchy medical evidence that the claimant’s theories of causation are possible. (Finding of Fact 26). Moreover, the ALJ cited evidence the claimant had bilateral knee pain before the industrial injury, and suffered prior back injuries. (Eg. Respondents’ Exhibit H, p. 0467). The claimant identifies no medical evidence which would corroborate his testimony that the alleged back problems are related to the injury. Moreover, Dr. Ridings testified on behalf of the respondents that the surgeries could not explain the alleged “buckling” of the knee on January 7, 2003. Thus, the record contains substantial evidence to support the ALJ’s conclusions on the issue of causation.
II.
The claimant next contends the ALJ erred in denying the request to convert the lower extremity rating to a whole person rating. We perceive no error.
In order to convert a scheduled impairment to a whole person impairment, the claimant must prove the injury has resulted in functional impairment not found on the schedule of disabilities See Delaney v. Industrial Claim Appeals Office, 30 P.3d 691
(Colo.App. 2000). Determination of whether the claimant has proven functional impairment beyond the schedule is a question of fact for the ALJ. Strauch v. Industrial Claim Appeals Office, 917 P.2d 366 (Colo.App. 1996).
As noted above, the ALJ found on substantial evidence that the claimant failed to prove a causal relationship between the industrial injury and the alleged back pain. It follows that the claimant could not prove the injury to his right knee has resulted in any functional impairment of the back which is not found on the schedule. Therefore, the record fully supports the ALJ’s decision not to convert the scheduled lower extremity rating to a whole person rating.
IT IS THEREFORE ORDERED that the ALJ’s order dated January 2, 2004, is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
David Cain
Dona Halsey
Theodore Garcia, Pueblo, CO, Carolyn Bjur, Oregon Steel Mills, Portland, OR, Emily S. Finn, Sedgwick Claims Management Services, Inc., Greenwood Village, CO, Lawrence D. Saunders, Esq., Pueblo, CO, (For Claimant).
Katherine Markheim Lee, Esq. and Jennifer L. Gokenbach, Esq., Denver, CO, (For Respondents).