W.C. No. 4-424-482Industrial Claim Appeals Office.
July 19, 2002
FINAL ORDER
The respondent seeks review of an order of Administrative Law Judge Mattoon (ALJ) which awarded additional medical benefits. We affirm.
The claimant reached maximum medical improvement (MMI) on April 27, 2000, for work-related injuries to his knee, back and right shoulder. Dr. Boehle recommended future medical treatment for two years consisting of medication and evaluation.
On May 23, 2000, the respondent filed a Final Admission of Liability which admitted liability for future medical benefits consistent with Dr. Boehle’s recommendations. The claimant objected to the Final Admission.
The claimant subsequently returned to Dr. Boehle with complaints of low back pain radiating down his legs. Dr. Boehle referred the claimant to Dr. Jenks for a second opinion and injection treatment.
Relying on the claimant’s testimony and the medical records of Dr. Boehle, the ALJ found the claimant’s lower back condition worsened after MMI and that the referral to Dr. Jenks is reasonably necessary to cure or relieve him from the effects of his industrial injury. Therefore, the ALJ reopened the claim and granted the claimant’s request for additional medical benefits to include a referral to Dr. Jenks for evaluation and treatment for low back pain.
On review, the respondent admits the issue of medical benefits was never “closed” and, therefore, the respondent concedes the claimant was not required to prove grounds to “reopen” the claim under § 8-43-303, C.R.S. 2001. Rather, the respondent contends the ALJ made no finding that the claimant’s worsened condition is causally related to the industrial injury and, therefore, the respondent contends the ALJ’s findings do not support the award. The respondent also contends the record is legally insufficient to establish a causal relationship between the worsened condition and the industrial injury. We disagree.
Initially, we note that the respondent’s Designation of Record includes the “Division of Workers’ Compensation file.” The record transmitted to us on appeal apparently does not include the complete Division of Workers’ Compensation file. However, our review is limited to the evidentiary record before the ALJ, and the record does not show the respondent requested the ALJ to consider the entire Division of Workers’ Compensation file as part of the evidentiary record for the hearing. See City of Boulder v. Dinsmore, 902 P.2d 925 (Colo.App. 1995); Rules of Procedure, Part VIII(A)(7), 7 Code Colo. Reg. 1101-3 at 22. Consequently, we have not obtained or considered the Division of Workers’ Compensation file, but restricted our review to the record made at the hearing.
The respondent is liable for medical treatment which is reasonably necessary to relieve the effects of the industrial injury. Section 8-42-101(1)(a), C.R.S. 2001; Colorado Compensation Insurance Authority v. Nofio, 886 P.2d 714 (Colo. 1994). This is true regardless of whether the claimant remains at MMI. Consequently, we do not consider whether the ALJ awarded pre-or post-MMI 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). Causation may be established by plausible inferences drawn from circumstantial evidence. Peter Kiewit Sons’ Co. v. Industrial Commission, 124 Colo. 217, 236 P.2d 296 (1951).
The determination of whether the claimant has established a causal connection between the industrial injury and the disputed treatment is a question of fact for the ALJ. Consequently, we may not disturb the ALJ’s determinations if supported by substantial evidence in the record. Section 8-43-301(8), C.R.S. 2001; City and County of Denver School District 1 v. Industrial Commission, 682 P.2d 513 (Colo.App. 1984). Under this standard we may not substitute our judgment for that of the ALJ concerning the sufficiency and probative weight of the evidence. Delta Drywall v. Industrial Claim Appeals Office, 868 P.2d 1155 (Colo.App. 1993); Martinez v. Regional Transportation District, 832 P.2d 1060
(Colo.App. 1992).
Furthermore, the ALJ is not held to a crystalline standard in articulating the basis for the order. George v. Industrial Commission, 720 P.2d 624 (Colo.App. 1986). Rather, the ALJ’s order is sufficient to support review if the basis for her determinations is apparent from the findings. Riddle v. Ampex Corp., 839 P.2d 489 (Colo.App. 1992).
As argued by the respondent, the ALJ made no explicit finding that the claimant’s need for additional treatment was caused by the industrial injury. However, reading the ALJ’s order in its entirety, it is apparent the ALJ implicitly found the requisite causal connection.
The ALJ found that when Dr. Boehle placed the claimant at MMI, Dr. Boehle did not recommend any further therapy, injections or medication changes to improve the claimant’s “condition.” (Finding of Fact 2). The ALJ also found the claimant did not report any worsening of his “condition” as of February 2, 2001 (Finding of Fact 7), but the claimant reported a significant worsening of his “condition” on April 19, 2001. (Finding of Fact 8). Furthermore, the ALJ found the claimant credibly testified that his “condition had worsened since” MMI (Finding of Fact 10) and on November 12, 2001, Dr. Hall opined the claimant’s “condition had deteriorated since he was placed at MMI.” (Finding of Fact 9).
In addition the ALJ explicitly recognized that a claimant is entitled to additional medical benefits after MMI where the claimant’s “condition” worsens. Accordingly, the ALJ’s finding that the claimant’s “lower back condition has worsened” and that the referral to Dr. Jenks is “reasonably necessary to cure or relieve him from the effects of the industrial injury,” implicitly reflect a determination of a causal connection between the industrial injury and the worsened condition. Moreover, the ALJ’s finding is a plausible inference from the claimant’s testimony and the medical reports of Dr. Boehle (see Boehle February 22, 2001 report) See Ackerman v. Hilton’s Mechanical Men, Inc., 914 P.2d 524 (Colo.App. 1996) (ALJ findings may be inferences from circumstantial evidence). We therefore conclude the respondent’s arguments do not establish grounds for granting appellate relief. Section 8-43-301(8), C.R.S. 2001.
IT IS THEREFORE ORDERED that the ALJ’s order dated February 7, 2002, is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
____________________________________ Kathy E. Dean
____________________________________ Bill Whitacre
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. 2001. 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 July 19, 2002 to the following parties:
Rudy Gonzales, 1601 E. 2nd St., Pueblo, CO 81001
CFI Steel, L.P. d/b/a Rocky Mountain Steel Mills, 225 Canal St., Pueblo, CO 81004-3409
Carolyn Bjur, Oregon Steel Mills, 1000 S.W. Broadway, #2200, Portland, OR 97205
Sarah Lewis, Sedgwick Claims Management Services, Inc., 1225 17th St., #2100, Denver, CO 80202-5534
James M. Anderson, Esq., 4905 N. Union Blvd., #302, Colorado Springs, CO 80918 (For Claimant)
Katherine Markheim Lee, Esq. and Jonathan A. Decker, Esq., 1700 Broadway, #1900, Denver, CO 80290-1901 (For Respondent)
BY: A. Hurtado