W.C. No. 4-184-217.Industrial Claim Appeals Office.
March 23, 2005.
FINAL ORDER
The claimant seeks review of an order of Administrative Law Judge Stuber (ALJ) which denied her request for medical benefits in the form of Addaral medication. We affirm.
The claimant suffered a compensable back injury. Despite surgery the claimant’s condition did not improve and she was diagnosed with “failed back syndrome.” The claimant’s condition is treated with narcotic pain relievers which result in daytime drowsiness.
After the injury, the claimant developed sleep problems. Testing revealed sleep apnea and narcolepsy. The sleep apnea is treated with a CPAP machine and Addaral was prescribed to treat the narcolepsy.
Dr. Pagel, a sleep medicine physician, stated that narcolepsy is a neurological disorder which causes the patient extreme daytime sleepiness. Whereas sleep apnea is a respiratory disorder during sleep where the patient stops breathing and suffers oxygen desaturation. Dr. Pagel opined that the narcotic medications prescribed to relieve pain symptoms from the industrial injury aggravate the claimant’s sleep apnea. However, Dr. Pagel opined the industrial injury does not aggravate the narcolepsy and that the claimant requires Addaral to treat the narcolepsy regardless of the industrial injury.
Crediting the opinions of Dr. Pagel the ALJ determined that treatment of the narcolepsy with Addaral is not reasonably necessary for the claimant to achieve optimal treatment for the industrial injury. Therefore, the ALJ denied the claimant’s request for an order requiring the respondents to pay the cost of the Addaral.
The claimant’s petition to review alleges the ALJ failed to resolve conflicts in the evidence, that the findings are not supported by the record and the findings to do not support the denial of benefits. We note the claimant has not filed a brief in support of the petition to review. Consequently, the effectiveness of our review is limited. See Ortiz v. Industrial Commission, 734 P.2d 642 (Colo.App. 1986).
The respondents are liable for medical treatment which is reasonably necessary to cure and relieve the effects of the industrial injury. Section 8-42-101(1)(a), C.R.S. 2004; Colorado Compensation Insurance Authority v. Nofio, 886 P.2d 714 (Colo. 1994). Ancillary medical treatment for a non-occupational condition may also be compensable if reasonable and necessary to “achieve the optimum treatment of the compensable injury.” Public Service Co. of Colorado v. Industrial Claim Appeals Office, 979 P.2d 584 (Colo.App. 1999).
The question of whether the claimant sustained her burden to establish the requisite causal relationship between the disputed medical treatment and the industrial injury is one of fact for resolution by the ALJ Edward Kraemer Sons, Inc. v. Downey, 852 P.2d 1286 (Colo.App. 1992). The ALJ’s findings are binding on review if supported by substantial evidence in the record. Section 8-43-301(8), C.R.S. 2004.
Substantial evidence is that quantum of probative evidence which a rational fact-finder would accept as adequate to support a conclusion, without regard to the existence of conflicting evidence. Durocher v. Industrial Claim Appeals Office, 905 P.2d 4 (Colo.App. 1995). In applying the substantial evidence test, 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).
Contrary to the claimant’s contention, the ALJ explicitly resolved conflicts in the evidence by relying on the opinions of Dr. Pagel, “even to the extent that they conflict with other medical experts in this case.” (Findings of Fact 4). Further, the ALJ’s findings are amply supported by Dr. Pagel’s deposition testimony. (Depo. pp. 6, 8, 9, 20, 22). Finally, the ALJ’s findings support the conclusion the claimant failed to prove that treatment of the narcolepsy with Addarall is necessary for the claimant to achieve optimum recovery from the industrial injury. Therefore, the ALJ did not err in denying the requested medical benefits.
IT IS THEREFORE ORDERED that the ALJ’s order dated October 12, 2004, is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
_______________________________ David Cain
_______________________________ Kathy E. Dean
Cindy Schaefer, Colorado Springs, CO, Southland Corporation, Colorado Springs, CO, American Protection Insurance Company, Denver, CO, Richard M. Lamphere, Esq., Colorado Springs, CO, (For Claimant).
Matthew W. Tills, Esq., Denver, CO, (For Respondents).