W.C. No. 4-427-083.Industrial Claim Appeals Office.
January 20, 2006.
FINAL ORDER
The claimant seeks review of an order dated June 29, 2005, of Administrative Law Judge Mattoon (ALJ) that found the respondent not liable for future medical benefits for the claimant’s psychiatric condition. We affirm.
The respondent sought an order relieving it from liability for further psychiatric treatment on grounds that it was not necessitated by the exposure to an unknown irritant the claimant had been exposed to at work. The ALJ entered factual findings that may be summarized as follows. The claimant sustained an admitted industrial injury on February 19, 1999. This involved breathing some type of fumes from Easter baskets the claimant was stocking on shelves. No specific fume or irritant was ever identified. The claimant testified that she felt her heart rate speed up, her breathing became difficult, and she felt panic. The claimant continued to work full-duty for the respondent.
The claimant was seen in an emergency room on August 16, 1999. The assessment was a mild allergic reaction and a panic attack. A small area of urticaria was noted on her chest, which resolved while she was in the emergency room. The claimant developed a stress reaction to the exposure to the unknown fumes, based on her perception that she was in physical danger from breathing the fumes. At the time of the industrial injury, the claimant had a long standing history of rashes, headaches, anxiety and panic attacks.
The claimant was seen by Dr. Balkissoon, a pulmonary specialist, on June 5, 2001. His assessment was that the claimant developed problems with vocal cord dysfunction and hyperventilation after exposure to a chemical or fumes from the Easter baskets, though the specific etiology was not discernible. Dr. Balkissoon assigned a 15 percent whole person permanent impairment rating for obstruction of the upper airway. He felt there was a significant psychological component of anxiety and panic, in the form of a reflex response to irritant odors, fumes and dust. He recommended psychological counseling.
The claimant was placed at maximum medical improvement (MMI) on January 7, 2002. Dr. Elwonger recommended continuation of psychotherapy and psycho-pharmacological treatment to maintain the claimant at psychological MMI.
The claimant underwent a Division-sponsored independent medical examination (DIME) with Dr. Striplin. Dr. Striplin assigned the claimant a permanent psychological impairment rating of five percent of the whole person, although he added that he did not believe that the condition was work-related. The ALJ found that Dr. Striplin’s opinion on the lack of a causal relationship between the claimant’s psychological impairment and the industrial injury is persuasive. Dr. Striplin did not comment on the issue of medical benefits after MMI.
The respondent filed a final admission of liability (FAL) based on the Dr. Striplin’s opinion admitting to the five percent whole person permanent impairment rating. The FAL stated “Grover medical benefits denied except per Dr. Striplin’s 9/25/02 report attached.” The ALJ found this ambiguous, as it denies Grover medical benefits except per Dr. Striplin’s report, which does not mention Grover medical benefits.
The claimant has continued to see Dr. Elwonger since being placed at MMI, and the respondent has continued to pay for that treatment. Dr. Elwonger has diagnosed the claimant with post-traumatic stress response disorder, major depressive disorder, and anxiety disorder with panic attacks, all related to the industrial accident. He has prescribed several antidepressant medications, anxiety medications, and an anti-migraine medication, among other medications.
Dr. Elwonger’s opinion regarding a causal relationship between the claimant’s current need for psychological care and the industrial accident was found by the ALJ to be based upon his understanding that the claimant was “asymptomatic” prior to the injury. The ALJ found this understanding was incorrect and his opinion on the causal relationship between the industrial injury and the claimant’s current need for medical care was not persuasive.
Dr. Gutterman in his second report gave the opinion that the claimant’s psychological problems were not caused by any stressor that would lead to similar response to most individuals, but was an anxiety reaction and somatization to the multitude of underlying psychological conflicts and struggles with which the claimant is afflicted. The ALJ found Dr. Gutterman’s opinion on the lack of causal relationship between the industrial injury and the claimant’s current need for psychiatric medical care to be persuasive.
Dr. Repsher, a pulmonary specialist, testified that the claimant is exhibiting a classic somatization reaction that has no direct relationship to whatever is happening in her immediate environment, as well as a hysterical conversion reaction causing vocal cord dysfunction. The ALJ found Dr. Repsher’s opinion regarding the lack of a causal relationship between the industrial injury and the claimant’s current need for medical care persuasive.
Based on these findings the ALJ determined that the claimant does suffer from psychological problems that require treatment, but those problems are not related to the February 19, 1999, exposure to the unknown irritant in the Easter basket. The ALJ found that the claimant’s current need for medical care, is not related to the industrial accident of February 19, 1999. The ALJ found that the respondent is not liable for future maintenance medical benefits for the claimant’s psychiatric condition.
On review the claimant argues that the ALJ’s determination that the respondent is no longer responsible for medical benefits is not supported by the evidentiary record and is erroneous as a matter of law. We disagree.
It is a well established that a general admission of liability for medical benefits does not render the respondents liable for all subsequent treatment rendered to the claimant. To the contrary the respondents retain the right to dispute liability for specific medical treatment on grounds the treatment is not authorized or reasonably necessary to cure or relieve the effects of the industrial injury. See Snyder v. Industrial Claim Appeals Office, 942 P.2d 1337 (Colo.App. 1997); Williams v. Industrial Commission, 723 P.2d 749 (Colo.App. 1986). This principle recognizes that even though an admission is filed the claimant bears the burden of proof to establish the right to specific medical benefits, and the mere admission that an injury occurred and treatment is needed cannot be construed as a concession that all conditions and treatments which occur after the injury were caused by the injury. Cf. HLJ Management Group, Inc. v. Kim, 804 P.2d 250 (Colo.App. 1990) (general admission does not vitiate respondents right to litigate disputed issues on a prospective basis).
Where the claimant’s entitlement to benefits is disputed, the claimant has the burden to prove a causal relationship between a work-related injury or disease and the condition for which benefits or compensation are sought. Snyder v. Industrial Claim Appeals Office, supra. Whether the claimant sustained his burden of proof is a factual question for resolution by the ALJ. City of Durango v. Dunagan, 939 P.2d 496 (Colo.App. 1997). The ALJ’s factual determinations must be upheld if supported by substantial evidence and plausible inferences drawn from the record. We have no authority to substitute our judgment for that of the ALJ concerning the credibility of witnesses and we may not reweigh the evidence on appeal. Id.; Delta Drywall v. Industrial Claim Appeals Office, 868 P.2d 1155 (Colo.App. 1993).
Because these issues are factual in nature, we must uphold the ALJ’s findings if supported by substantial evidence in the record. Section 8-43-301(8), C.R.S. 2005. Substantial evidence is that quantum of probative evidence that would support a reasonable belief in the existence of a fact without regard to conflicting evidence or inferences. Monfort, Inc. v. Rangel, 867 P.2d 122 (Colo.App. 1993). This standard of review requires us to view the evidence in the light most favorable to the prevailing party and to defer to the ALJ’s resolution of conflicts in the evidence, credibility determinations, and plausible inferences drawn from the record. If the record supports two possible inferences, it is the ALJ’s prerogative to determine which inference to draw. Wilson v. Industrial Claim Appeals Office, 81 P.3d 1117 (Colo.App. 2003). Moreover, the ALJ only need enter specific factual findings concerning the evidence he found to be dispositive, and conflicting evidence and inferences are presumed to have been rejected. Magnetic Engineering, Inc. v. Industrial Claim Appeals Office, 5 P.3d 385
(Colo.App. 2000).
Here substantial evidence amply supports the ALJ’s determination that the claimant’s current psychiatric and medical care are not related to her industrial accident. This evidence includes the report and testimony of Dr. Repsher, the reports and testimony of Dr. Gutterman and the report of the DIME physician Dr. Striplin. The ALJ finding that the opinion of the claimant’s medical witness, Dr. Elwonger, on the causal relationship between the industrial injury and the claimant’s current need for medical care was not persuasive is supported by substantial evidence. Dr. Elwonger’s opinion was premised on the understanding that the claimant was asymptomatic prior to the injury. (Elwonger Deposition Tr. at 18). There is evidence this premise is incorrect. (Tr. at 42-62 and Exhibit F). The fact that an expert may possess an incomplete understanding of a claimant’s medical history goes to the weight of his testimony. Industrial Commission v. Albo 167 Colo. 467, 447 P.2d 1006 (1968). It is the ALJ as the fact finder who is solely responsible for determining the weight to be given expert testimony. Cordova v. Industrial Claim Appeals Office, 55 P.3d 186 (Colo.App. 2002). Applying these principles here, we perceive no error in the ALJ’s order.
IT IS THEREFORE ORDERED that the ALJ’s order dated June 29, 2005, is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
____________________________________ Robert M. Socolofsky
____________________________________ Thomas Schrant
Linda Ortega, Alamosa, CO, K-Mart Corporation, Alamosa, CO, Landon Wallis, Sedgwick CMS, Greenwood Village, CO, Richard L. Susman, Esq., Pueblo, CO, (For Claimant).
Eric J. Pollart, Esq. and Joshua D. Brown, Esq., Greenwood Village, CO, (For Respondent).