W.C. No. 4-314-361Industrial Claim Appeals Office.
June 16, 1999.
FINAL ORDER
The claimant seeks review of a final order of Administrative Law Judge Felter (ALJ) which determined that certain diagnostic and therapeutic procedures are not reasonably necessary to treat the claimant’s industrial injury. The claimant contends the ALJ misapplied the burden of proof, that the findings are contrary to the evidence, and that the ALJ’s written findings are inconsistent with his oral findings. We affirm.
The claimant sustained an admitted industrial injury in September 1996. The claimant’s principal complaint involved sharp pain in her right wrist, but she also complained of pain in her left wrist, neck, and shoulders.
In October 1998 the claimant was examined by Dr. Jay upon referral from the treating physician. Dr. Jay diagnosed a cervical myofascial pain syndrome, bilateral myogenic thoracic outlet syndrome, thoracic and lumbosacral myofascial pain syndrome, and depression. Dr. Jay recommended a cervical MRI to rule out neuropathic pain, a brachial plexus MRI, and a full EMG study of the neck and upper extremities if the MRI was positive. Dr. Jay also prescribed “interdisciplinary treatment” including physical therapy, occupational therapy, and hypnotherapy.
The respondents presented the reports and testimony of Dr. Lesnak. Dr. Lesnak agreed with Dr. Jay that the claimant suffers from a myofascial pain syndrome. However, he did not believe this condition was causally connected to the claimant’s industrial injury because the condition appeared to worsen after the claimant left work. In any event, he disagreed with Dr. Jay concerning the need for additional diagnostic and therapeutic procedures, except he concluded that the claimant needs additional psychological treatment. Dr. Lesnak opined that an additional cervical MRI is not indicated because the claimant has not suffered additional injury since the original MRI. Further, he stated that a brachial plexus MRI is unnecessary because the claimant does not exhibit symptoms of a neurogenic thoracic outlet syndrome, and the claimant has already undergone three normal EMG studies. Dr. Lesnak also opined that the therapies recommended by Dr. Jay are “inappropriate” because the claimant failed to improve “with extensive therapies over the past two plus years.”
Resolving conflicts in the evidence, the ALJ determined that the claimant’s cervical “symptoms and complaints” are related to the September 1996 industrial injury. However, the ALJ credited the testimony of Dr. Lesnak that the diagnostic tests and multiple therapies recommended by Dr. Jay are not reasonable and necessary, except for psychological counseling.
I.
On review, the claimant first contends the ALJ misapplied the burden of proof. The claimant points out that during the course of the hearing the ALJ stated that the claimant was responsible for proving the causal relationship between the industrial injury and the need for treatment regardless of the fact that the respondents introduced their evidence first. We find no error.
Section 8-43-201, C.R.S. 1998, provides that “the claimant in a workers’ compensation claim shall have the burden of proving entitlement to benefits by a preponderance of the evidence.” Further, respondents may always dispute the reasonableness and necessity for particular medical treatment even if they previously admitted liability for an injury. In such cases, the burden of proof remains with the claimant to establish entitlement to additional medical benefits. Snyder v. Industrial Claim Appeals Office, 942 P.2d 1337 (Colo.App. 1997). Thus, the ALJ correctly applied the burden of proof.
II.
The claimant next contends the ALJ’s oral findings of fact cannot be construed as meaning that the claimant’s symptoms are purely psychological. This is true, according to the claimant, because the ALJ credited Dr. Jay’s opinion that there is a causal relationship between the claimant’s cervical condition and the industrial injury. Thus, the claimant argues the ALJ was obliged to adopt Dr. Jay’s treatment recommendations. We find no error.
The ALJ’s written order, not his oral remarks at the conclusion of the hearing, constitutes the reviewable order. Thus, to the extent there is any inconsistency between the ALJ’s oral statements and his written findings, the written order constitutes the definitive ruling. See Wait v. Jan’s Malt Shoppe, 736 P.2d 1265 (Colo.App. 1987); Neoplan USA Corp. v. Industrial Commission, 721 P.2d 157 (Colo.App. 1986).
In any event, the issues of causation of a medical condition and the reasonableness and necessity for specific treatments and diagnostic procedures are distinct, albeit interrelated, issues. An ALJ may plausibly find that although a claimant suffers from symptoms which are connected to an industrial injury, particular treatments or diagnostic procedures are not necessary to cure and relieve the effects of the condition. See Snyder v. Industrial Claim Appeals Office, supra. Ultimately, the question of whether particular treatments or diagnostic procedures are reasonable and necessary is one of fact for determination by the ALJ. Public Service Co. v. Industrial Claim Appeals Office, ___ P.2d ___ (Colo.App. No. 98CA1851, April 29, 1999).
Because the issues are factual in nature, we must uphold the ALJ’s order if supported by substantial evidence in the record. Section 8-43-301(8), C.R.S. 1998. In this regard, assessment of the weight and credibility of expert medical evidence is a matter within the ALJ’s province as fact-finder. Rockwell International v. Turnbull, 802 P.2d 1182 (Colo.App. 1990). Insofar as a particular medical expert’s testimony contains inconsistencies, the ALJ may resolve them by believing part or none of the testimony. Colorado Springs Motors, Ltd. v. Industrial Commission, 165 Colo. 504, 441 P.2d 21 (1968). Medical opinions not specifically credited are considered to have been implicitly rejected. Cooper v. Industrial Claim Appeals Office, ___ P.2d ___ (Colo.App. No. 98CA1343, March 18, 1999).
Here, the ALJ discredited Dr. Lesnak’s opinion that the claimant’s myofascial pain syndrome is unrelated to the industrial injury, but credited Lesnak’s testimony concerning the necessity for additional diagnostic treatments and therapies. Conversely, the ALJ credited Dr. Jay’s opinion concerning the cause of the claimant’s cervical condition, but discredited Jay’s opinion concerning the reasonableness and necessity for future treatments. It was fully within the ALJ’s power to resolve the conflicts in the evidence in this manner. Because Dr. Lesnak’s opinions concerning the necessity for future treatment constitute substantial evidence in support of the ALJ’s order, it must be upheld on review.
Neither was the ALJ required to make specific findings concerning whether or not the claimant suffers from myogenic thoracic outlet syndrome and other conditions diagnosed by Dr. Jay. The ALJ implicitly discredited Dr. Jay’s opinions insofar as they are inconsistent with Dr. Lesnak’s opinions about the nature of the claimant’s condition and need for future treatment. Cooper v. Industrial Claim Appeals Office, supra.
Insofar as the claimant makes other arguments, we find to be without merit.
IT IS THEREFORE ORDERED that the ALJ’s order dated January 19, 1999, is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
________________________________ David Cain
________________________________ Bill Whitacre
NOTICE
This Order is final unless an action to modify or vacate the Order is commenced in the Colorado Court of Appeals, 2 East 14th Avenue, Denver, Colorado 80203, by filing a petition to review with the court, with service of a copy of the petition upon the Industrial Claim Appeals Office and all other parties, within twenty (20) days after the date the Order was mailed, pursuant to §§ 8-43-301(10) and 307, C.R.S. 1998.
Copies of this decision were mailed June 16, 1999 the following parties:
Jeannette Terry, 9980 Melody Dr., Northglenn, CO 80221
American Financial Corp, 3 First 100 Broadway St., Kansas City, MO 64111-2406
Linda Cline, Fidelity Deposit Companies of Maryland, P.O. Box 17171, Baltimore, MD 21203-7171
John R. Palermo, Esq., 7909 Zenobia St., Westminster, CO 80030 (For Claimant)
Ronald C. Jaynes, Esq., 777 East Speer Blvd., Ste. 210, Denver, CO 80203 (For Respondents)
BY: A. Pendroy