W.C. No. 4-789-550.Industrial Claim Appeals Office.
August 4, 2010.
FINAL ORDER
The claimant seeks review of an order of Administrative Law Judge Friend (ALJ) dated March 15, 2010, that denied and dismissed the claim for compensation. We affirm.
The claimant worked for the employer in its records section. Her duties included use of a keyboard to enter data. The claimant complained of pain in her neck and forearms that radiated down into her hands. The ALJ found that the claimant had failed to establish by a preponderance of the evidence that her bilateral myofascial pain was work-related. In support of this determination the ALJ relied on the opinions of Dr. Watson, which he found to be credible and persuasive. Dr. Watson cited medical studies that showed a lack of a causal link between keyboard usage and carpal tunnel syndrome. Dr. Watson noted that a ergonomic study performed on June 11, 2009, showed that the claimant’s wrists were held in a relatively neutral position that did not place undue pressure on the median nerve. Dr. Watson explained that the claimant had risk factors commonly associated with carpal tunnel syndrome including her age, sex, weight, and post-menopausal status. The ALJ determined that the claim was not compensable. The claimant brings this appeal.
To prove a compensable injury, the claimant had the burden to prove by a preponderance of evidence that her condition arose out of and in the course of her employment. Section 8-41-301(1)(c), C.R.S.; Madden v. Mountain West Fabricators, 977 P.2d 861 (Colo. 1999); Faulkner v. Industrial Claim Appeals Office, 12 P.3d 844 (Colo. App. 2000). The question of whether the claimant met the burden of proof is one of fact for determination by the ALJ. Jefferson County Public Schools v. Dragoo, 765 P.2d 636 (Colo. App. 1988). Because the issue is factual in nature, we must uphold the ALJ’s
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determination if supported by substantial evidence in the record. Section 8-43-301(8), C.R.S. This standard of review requires us to consider the evidence in a light most favorable to the prevailing party, and defer to the ALJ’s credibility determinations, resolution of conflicts in the evidence, and plausible inferences drawn from the record. Wilson v. Industrial Claim Appeals Office, 81 P.3d 1117 (Colo. App. 2003).
I.
The claimant first contends that the ALJ erred because the record does not support his findings that Dr. Watson opined that the claimant suffered from carpal tunnel syndrome but that her work did not cause that condition. The claimant argues that the record does not support a finding that Dr. Watson believed the claimant had carpal tunnel syndrome. Instead the claimant argues that Dr. Watson opined that the claimant suffered from myofascial pain syndrome and he did not know what caused that condition.
Citing Hall v. Industrial Claim Appeals Office, 757 P. 2d 1132 (Colo. App. 1988) the claimant argues that the ground upon which the ALJ acted must be clearly disclosed and adequately sustained. In Hall the court found the Panel’s conclusion was erroneous in equating an ALJ’s finding of “no evidence” to a finding of no “credible evidence.” Because the record failed to support the finding that there was no evidence of causation the court determined that Panel should have set the order aside and remanded the cause for additional findings.
Here the claimant argues that Dr. Watson’s opinion was that the claimant suffered from myofascial pain syndrome of unknown cause. The claimant argues that this opinion by Dr. Watson does not support the denial of benefits for her carpal tunnel condition. The ALJ concluded as follows: “Dr. Watson’s opinion that Claimant’s work did not cause her carpal tunnel syndrome is consistent with Carpal Tunnel Syndrome Medical Guidelines.” Conclusions of Law, ¶ 3 at 5.
It is true that Dr. Watson expressed the opinion that the claimant had myofascial pain syndrome of unknown cause. Exhibit H at 67, 76; Tr. at 76. However, Dr. Watson also did not disagree with the diagnosis of carpal tunnel syndrome. Tr. at 60-63, 76, 79. Dr. Watson discussed EMGs which suggested border line carpal tunnel findings, but also noted that Dr. Blei did not feel that the carpal abnormalities on EMG could account for the claimant’s symptomatology. Exhibit H at 71-72. Dr. Watson stated that he did not doubt that the median nerve had been compressed. Tr. at 79. However, Dr. Watson explained that the question was whether there was a causal connection with the claimant’s work and her reported condition and in his opinion there clearly was no connection. Tr. at 79-80. In our view, this testimony constitutes substantial evidence supporting the ALJ’s conclusion that the claimant’s work did not cause her carpal tunnel condition. Section 8-43-301(8).
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More importantly, Dr. Watson clearly and repeatedly expressed the opinion that the claimant had not suffered an occupational disease to her arms and hands resulting from her work for the respondent. Tr. at 61, Exhibit H at 67, 76. The ALJ found Dr. Watson’s opinions to be both credible and persuasive which in turn supports the ALJ’s denial of the claim. An “ALJ is not held to a crystalline standard in articulating his findings of fact.” Magnetic Eng’g, Inc. v. Industrial Claim Appeals Office, 5 P.3d 385, 388 (Colo. App. 2000). It is sufficient if the “reasoning which underlies” an award of benefits is discernible. Id. We have no difficulty following the ALJ’s reasoning in denying the claim based in part on Dr. Watson’s opinion that the claimant had not suffered an occupational disease.
The claimant further argues that the ALJ made no credibility determination regarding Dr. Pitzer’s opinion that the claimant had carpal tunnel syndrome and that it was likely work related. However, it is sufficient for the ALJ to make findings concerning that evidence which he considers dispositive of the issues, and he need not discuss the ramifications of all contrary evidence and inferences. Magnetic Engineering, Inc. v. Industrial Claim Appeals Office, supra; Maes v. Federal Fruit Produce, W. C. Nos. 4-246-932, 4-409-427, 4-413-589, 4-416-013 (May 10, 2001).
II.
The claimant next argues that the record does not support the ALJ’s finding that Dr. Watson opined that being overweight can cause compression of the median nerve and create carpal tunnel syndrome. The claimant notes that the ALJ made the following finding: “Dr. Watson explained how being overweight can cause compression of the median nerve and create carpal tunnel symptoms.” Findings of Fact, ¶ 22 at 5. The claimant contends that a careful reading of the testimony of Dr. Watson merely indicates that he felt obesity or a high body mass index was a risk factor for carpal tunnel and would not in and of itself cause the condition. It is true that Dr. Watson listed obesity as a risk factor. We note that the ALJ also found that the claimant had risk factors commonly associated with carpal tunnel syndrome including her age, sex weight and post-menopausal status.
However, the claimant has not pointed to a section of Dr. Watson’s testimony that states obesity would not in and of itself cause carpal tunnel. We do not find such testimony in the record. However, we do note that Dr. Watson did measure the claimant’s body mass explaining that between 26 and 32 is overweight and the claimant’s body mass index was 36.5. Tr. at 61. Further Dr. Watson testified that high body mass results in adipose tissue that distributes itself fairly evenly through out the body. Tr. at 64. Dr. Watson explained that the carpal canal has a finite amount of space and if there is
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less space in the canal because of occupying tissues, the nerves are compressed and become symptomatic. Tr. at 64. In our view this is substantial evidence supporting the ALJ’s conclusion.
III.
The claimant, citing § 8-40-201(14), C.R.S., contends that the ALJ applied an erroneous legal standard in assessing the evidence. We are not persuaded that the ALJ committed reversible error.
Section 8-40-201(14), C.R.S. defines an occupational disease as follows:
“Occupational disease” means a disease which results directly from the employment or conditions under which the work was performed, which can be seen to have followed as a natural incident of the work and as a result of the exposure occasioned by the nature of the employment, and which can be fairly traced to the employment as a proximate cause and which does not come from a hazard to which the worker would have been equally exposed outside the employment.
The claimant argues that because she had “risk factors” for developing carpal tunnel syndrome does not defeat her claim for occupational disease unless it can be shown that a non-industrial cause was an equally exposing stimulus. However, a claimant seeking benefits for an occupational disease must establish the existence of the disease and that it was directly and proximately caused by the claimant’s employment or working conditions. Wal-Mart Stores, Inc. v. Industrial Claim Appeals Office, 989 P.2d 251, 252 (Colo. App. 1999); see also § 8-40-201(14). Because causation is a question of fact, Snyder v. Industrial Claim Appeals Office, 942 P.2d 1337, 1339 (Colo. App. 1997), we are bound by the ALJ’s findings in this regard if they are supported by substantial evidence in the record. Wal-Mart Stores, 989 P.2d at 252. Here the ALJ found the claimant failed to establish by a preponderance of the evidence that her condition was work related.
We note that the ALJ’s decision was not simply based on the claimant’s “risk factors”. The claim was based on the assertion that there was a causal link between the claimant’s use of a keyboard to enter data and her carpal tunnel. The ALJ determined Watson’s testimony credible regarding medical studies that show a lack of a causal link to keyboard usage and carpal tunnel syndrome was credible. This was buttressed by the ergonomic study which showed that the claimant’s wrists were held in a relatively neutral position that did not place undue pressure on the median nerve. The ALJ credited Dr. Watson’s testimony regarding the significance of this study. In our opinion, these determinations alone were sufficient to defeat the claim because they demonstrated that
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the claimant failed to proof that she suffered from a “disease which results directly from the employment or conditions under which the work was performed, which can be seen to have followed as a natural incident of the work and as a result of the exposure occasioned by the nature of the employment.” Section 8-40-201(14).
Moreover, on the risk factors themselves Dr. Watson did explain that there are certain risk factors commonly associated with carpal tunnel syndrome and that the claimant had “all of them.” Tr. at 63-64. The ALJ’s order does not contain a detailed discussion of whether the risk factors constituted a hazard to which the worker would have been equally exposed outside the employment. However, as discussed previously there is record support for the ALJ’s determination that Dr. Watson explained how being overweight can cause compression of the median nerve and create carpal tunnel symptoms. At the very least this determination is consistent with the ALJ’s determination that the claimant failed to prove she suffered from an occupational disease as supported by Dr. Watson’s opinion that the claimant had not suffered an occupational disease to her arms and hands resulting from her work for the respondent. Tr. at 61; Exhibit H at 67, 76. We are not persuaded that the ALJ applied an erroneous legal standard in assessing the evidence.
The claimant draws our attention to her testimony that she had pain resulting from prolonged and repetitive typing at work and the opinions of Dr. Pitzer and Dr. Clinkscales that the claimant had carpal tunnel syndrome as a result of her work at the respondent. The claimant also points to positive diagnostic studies and the good relief the claimant received from her right carpal tunnel surgery.
However, the existence in the record of conflicting testimony or of evidence that would support a contrary result does not provide a basis for setting aside the ALJ’s order. See Mountain Meadows Nursing Center v. Industrial Claim Appeals Office, 990 P.2d 1090 (Colo. App. 1999) (the existence of conflicting evidence does not lessen the import of substantial evidence in support of a finding). There certainly was a conflict in the evidence. But we are not persuaded that the evidence cited by the claimant compels the conclusion that the claim was compensable.
IT IS THEREFORE ORDERED that the ALJ’s order dated March 15. 2010 is affirmed.
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INDUSTRIAL CLAIM APPEALS PANEL
______________________________ John D. Baird
______________________________ Thomas Schrant
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MANDY J GURULE-LOBATO, LAKEWOOD, CO, (Claimant).
JAMES E. FREEMYER, PC, Attn: JAMES E. FREEMYER, ESQ., DENVER, CO, (For Claimant).
OFFICE OF THE CITY ATTORNEY — DENVER, Attn: CHRISTIAN M LIND, ESQ., DENVER, CO, (For Respondents).
CITY AND COUNTY OF DENVER, Attn: JACKIE RIDOUT, DENVER, CO, (Other Party).
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