Opinion
W.C. No. 4-805-582.
July 30, 2010.
FINAL ORDER
The respondents seek review of an order of Administrative Law Judge Jones (ALJ) dated March 15, 2010, that determined the claimant suffered a compensable injury and awarded temporary disability and medical benefits. We affirm.
The claimant worked for the employer as a packaging sterilizer. On July 15, 2009, while at work, the claimant descended a flight of stairs while performing his duties for the employer. The claimant missed a step, and landed on the step below. The claimant hyper-extended his left leg, and his knee gave way under the force of his weight. The ALJ found that the claimant suffered a compensable work injury in the course and scope of his employment. The ALJ awarded temporary disability and medical benefits.
I.
The respondents first contend that the ALJ erred in finding that an "unexplained fall" resulting from a flight of stairs constituted an injury that arose out of the claimant's job duties. We are not persuaded that the ALJ committed reversible error.
A compensable injury is one which arises out of and in the course of employment. Section 8-41-301(1)(b)-(c), C.R.S. The "arising out of test is one of causation. It requires that the injury have its origin in an employee's work-related functions, and be sufficiently related thereto so as to be considered part of the employee's service to the employer. There is no presumption that an injury that occurs in the course of a worker's employment also arises out of the employment. Finn v. Industrial Commission, 165 Colo. 106, 437 P.2d 542 (1968); see also, Industrial Commission v. London Lancashire Indemnity Co., 135 Colo. 372, 311 P.2d 705 (1957) (mere fact that the decedent fell to his death on the employer's premises did not give rise to presumption that the fall arose out of and in course of employment). Additionally, it is the claimant's burden to prove by a preponderance of the evidence that there is a direct causal relationship between the employment and the injuries. Section 8-43-201, C.R.S.; Ramsdell v, Horn, 781 P.2d 150 (Colo. App. 1989).
The determination of whether there is a sufficient causal relationship between the claimant's employment and the injury is generally one of fact, which the ALJ must determine based on the totality of the circumstances. Section 8-43-301(8), C.R.S; In Re Question Submitted by the United States Court of Appeals, 759 P.2d 17 (Colo. 1988); Moorhead Machinery Boiler Co. v. Del Valle, 934 P.2d 861 (Colo. App. 1996); Lori's Family Dining, Inc. v. Industrial Claim Appeals Office, 907 P.2d 715 (Colo. App. 1995). This standard of review requires us to defer to the ALJ's credibility determinations, resolution of conflicts in the evidence, and plausible inferences drawn from the record. Cordova v. Industrial Claim Appeals Office, 55 P.3d 186 (Colo. App. 2002).
We do not dispute that a truly unexplained fall at the workplace has been determined not to be compensable. See Rice v. Dayton Hudson Corporation W. C. No. 4-386-678 (July 29, 1999) (claimant's unexplained fall was not compensable because it could not be associated with the circumstances of the claimant's employment nor any preexisting idiopathic condition); See also, Finn v. Industrial Commission, supra. Ultimately, the resolution of this issue is one of fact to be determined by the ALJ based on an examination of the totality of the circumstances. Lori's Family Dining, Inc. v. Industrial Claim Appeals Office, 907 P.2d 715 (Colo. App. 1995).
While a completely unexplained fall is not compensable those are not the circumstances presented here. The ALJ made the following findings of fact. The claimant's injuries resulted from an identifiable accidental event, which occurred during work-related activity. On July 15, 2009, the claimant was descending a flight of stairs in the course and scope of his employment with the employer. The claimant was performing his duties for the employer. The claimant was taking the direct route down the stairs to the "six can filler room." The claimant missed a step, and landed on the step below. The claimant's knee was injured. The steps, where the claimant injured himself, were steep steel steps. The steps were steeper than normal steps with treads that are shorter than regular steps. The claimant did not have occasion to climb similar steps outside of work. The claimant was taking these steps as the most direct route to the six-can filler room to complete a work task. A substantial part of the claimant's work duties involved walking during the course of the day, including going up and down stairs. There was no evidence that the claimant's fall was precipitated by a preexisting condition. The ALJ found that the claimant missed the step and that caused all of his weight to shift onto his left leg, which resulted in the injury. The medical evidence and other testimony documented how the claimant missed a step and Dr. Mann provided credible testimony explaining how that incident led to the radial meniscus tear and the need for surgery. We also note that the reports from Dr. Smaldone reflect the history given by the claimant to the physician on the same day as the accident. Exhibit B at 19. The details of the injury were as follows; "I was walking down stairs, I missed a step, extended my left leg and it gave way from force."
With the exception of the causation issue of the meniscus tear the respondents do not challenge the above specific findings of fact made by the ALJ regarding the claimant's description of the fall. In any event, we determine that the claimant's testimony constituted substantial evidence supporting the ALJ's findings. Instead, the respondents cite testimony from the claimant arguing that he was unable to explain why he missed a step in walking down a flight of stairs he had walked down before. The respondents argue that "missing a step" for no identifiable reason does not constitute an "explained fall" and therefore the ALJ's decision must be reversed. We disagree.
In arguing for reversal the respondents cite Gutierrez v. Wal-Mart Stores, Inc., W. C. No. 4-432-838 (November 30, 2000) as being on point with the present case. In Gutierrez the claimant was a facility maintenance worker. She injured her left knee while ascending a flight of stairs on the employer's premises. She testified that she felt a "crack" or "pop" as she bent her leg, and immediately experienced pain in her left knee. The claimant conceded she had osteoarthritis which pre-dated the injury, but contended that the pre-existing condition was asymptomatic at the time of the injury. However, the ALJ rejected the claimant's contention that her osteoarthritis was asymptomatic at the time of the injury. The claimant did not recall slipping or tripping on anything, and did not allege there was something sticking out of the stairs that caused the knee pain. In fact, the claimant testified the stairs were normal with no unusual qualities. The claimant was unable to explain why the injury occurred. Because the precipitating cause of the injury was a pre-existing condition which the claimant brought to the workplace the Panel determined that the ALJ did not err in requiring the claimant to prove a special employment hazard. In contrast here, there was no evidence of a pre-existing condition.
The respondents contend that Ybarra v. Thompson School District RJ-2 W.C. No. 4-777-145 (September 25, 2009) is factually essentially identical circumstances to the facts here. In Ybarra the claimant was injured while walking down a flight of stairs to unlock a classroom when she fell. However, the claimant was uncertain whether her foot gave out or whether she missed a step. The ALJ made the above extensive findings of fact, including that the claimant gave various histories of how the fall occurred. The Panel determined that there was substantial evidence supporting the ALJ's determination that the claimant suffered a truly unexplained fall at the workplace. Here there was one consistent history of the fall and no evidence of an alternative theory of the fall such as the claimant's foot giving out.
In our view the case of Pieper v. City of Greenwood Village, W.C. No. 4-675-476 (January 20, 2010) is factually closer and more relevant than Gutierrez or Ybarra. In Pieper the claimant slipped and fell in a restricted parking lot outside the police building she worked in. The claimant misjudged the curb, lost her balance, and fell. The panel found that this was not an "unexplained fall" case such as Rice v. Dayton Hudson Corp., W.C. No. 4-386-678 (July 29, 1999). The panel noted that in Rice, the ALJ found as fact the claimant was "unable to provide any explanation for her fall." Consequently, in Rice the panel held the claimant's unexplained fall was not compensable because it could not be associated with the circumstances of the claimant's employment nor with any preexisting idiopathic condition, and Colorado law does not create a presumption that injuries, which occur in the course of employment, necessarily arise out of employment. In Pieper the panel found that the claimant's fall was not "unexplained" because the ALJ found the claimant, while walking toward the building misjudged the curb, lost her balance, and fell while stepping up onto the sidewalk outside the doors.
Here the ALJ found that claimant missed the step and that caused all of his weight to shift onto his left leg, which resulted in the injury. In our view, there is substantial evidence for the ALJ's determination that the claimant was able to provide an explanation for his fall. We are bound by such determination. Section 8-43-301(8), C.R.S. Consequently as in Pieper the claimant's injuries resulted from an identifiable accidental event, which occurred during work-related activity and is compensable. In our view, there is no reason to interfere with the ALJ's determination.
II.
The respondents next contend that the ALJ erred in concluding that the claimant sustained an injury to his left knee that entitles him to medical benefits. Specifically the respondents contest the ALJ's determination that surgery on the claimant's knee was reasonably needed to cure and relieve him from the effects of the claimed injury. We again are not persuaded that the ALJ committed reversible error.
Section 8-42-101(1)(a), C.R.S., provides that respondents are liable for authorized medical treatment that is reasonable and necessary to cure or relieve the effects of the industrial injury. Yeck v. Industrial Claim Appeals Office, 996 P.2d 228 (Colo. App. 1999); Sims v. Industrial Claim Appeals Office, 797 P.2d 777 (Colo. App. 1990). Where the claimant's entitlement to benefits is disputed, the claimant has the burden to prove a causal relationship between the work-related injury or disease and the condition for which benefits or compensation are sought. Snyder v. Industrial Claim Appeals Office, 942 P.2d 1337 (Colo. App. 1997). 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). Because these questions are factual in nature, we are bound by the ALJ's determinations in this regard if they are supported by substantial evidence in the record. Section 8-43-301(8); City of Durango v. Dunagan, supra.
The respondents contend that the evidence does not support the ALJ's finding that the claimant injured the medial aspect of his left knee, requiring surgery. The respondents contend that when the claimant first saw Dr. Smaldone it was noted that the claimant had pain over the posterolateral left knee, not the medial aspect of the knee. The respondents argue that the claimant did not begin to complain of pain in the medial aspect of the knee until September 3, 2009 following the July 15, 2009 fall. The respondents contend that the ALJ erred in crediting the conflicting testimony of Dr. Mann that the incident on July 15, 2009 was causally linked to the subsequent need for surgery. Dr. Mann performed surgery for a medial meniscus tear on the claimant's left knee.
The respondents rely on portions of the cross examination of Dr. Mann in his deposition. The respondents argue that Dr. Mann's testimony demonstrates a lack of a causal connection between the July 15, 2009 fall and the subsequent surgery. When Dr. Mann was shown a July 16, 2009 chart note which stated that the patient's symptoms were primarily localized posterior and laterally on the claimant's knee, he agreed that there was nothing on the examination that objectively supported a medial meniscus tear. However, we are not persuaded that the credible medical evidence only supports a finding that the meniscus tear was not caused by the July 15, 2009 fall.
The ALJ made the following relevant findings of fact regarding the claimant's testimony. The claimant never had a previous injury to either knee at work or outside of work. Tr. 14-15. The claimant suffered immediate pain and, soon after, the site of the injury swelled. Tr. at 20 22. The ALJ found that the claimant's testimony regarding the mechanism of injury was credible and persuasive.
The ALJ made the following findings relevant to the opinions of Dr. Smaldone. The claimant was sent to the on-site employer's medical center where he saw Dr. Smaldone. Exhibit 5 at 1. Dr. Smaldone ordered an MRI of the claimant's left knee. The MRI demonstrated a radial tear of the posterior horn of the medial meniscus. Exhibit 3 at 1. On September 3, 2009, Dr. Smaldone specifically noted discomfort along the medial aspect of the knee and referred the claimant to Dr. Mann. Exhibit 5 at 8.
The ALJ made the following findings of fact relevant to the opinions of Dr. Mann. Dr. Mann opined that the claimant's condition was caused by an acute event. Exhibit 1 at 1; Mann Depo. at 31. This acute event was traceable to the July 15, 2009 injury. Exhibit 1 at 1. Dr. Mann opined that the axial loading that occurred during the July 15, 2009 injury contributed to the claimant's injury. Mann Depo. at 46-47. Dr. Mann opined that the July 15, 2009 incident either caused or significantly aggravated the condition and ultimately required surgery. Exhibit 1 at 1. Even if Dr. Mann's testimony may be viewed as inconsistent, we may not substitute our judgment by reweighing the evidence in an attempt to reach inferences different from those the ALJ drew from the evidence. See Johnson v. Indus. Claim Appeals Office, 973 P.2d 624, 626 (Colo. App. 1997) (ALJ's prerogative to evaluate evidence "extends to resolving the inconsistencies in a particular witness' testimony"); Sullivan v. Indus. Claim Appeals Office, 796 P.2d 31, 32-33 (Colo. App. 1990) (reviewing court is bound by resolution of conflicting evidence, regardless of the existence of evidence which may have supported a contrary result); Rockwell Int'l v. Turnbull, 802 P.2d 1182, 1183 (Colo. App. 1990) (ALJ, as fact-finder, is charged with resolving conflicts in expert testimony).
Based on the claimant's credible and persuasive testimony, medical reports noting the injury, and the deposition testimony of Dr. Mann, the ALJ found that the claimant suffered a compensable work injury in the course and scope of his employment on July 15, 2009. In our view, the record contains substantial evidence supporting such a determination. Therefore we are bound by that determination. Section 8-43-301(8).
IT IS THEREFORE ORDERED that the ALJ's order dated March 15, 2010 is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
____________________________________ Curt Kriksciun
____________________________________ Thomas Schrant
MARK NEIMAN, ARVADA, CO, (Claimant).
MILLER COORS, LLC, MILWAUKEE, WI, (Employer).
INDEMNITY INSURANCE COMPANY OF NORTH AMERICA, Attn: ANITA FRESQUEZ-MONTOYA, C/O: ACE/ESIS, TAMPA, FL, (Insurer).
THE ELLIOTT LAW OFFICES, Attn: MARK D. ELLIOTT, ESQ., ARVADA, CO, (For Claimant).
CLIFTON, MUELLER BOVARNICK, PC, Attn: RICHARD BOVARNICK, ESQ., DENVER, CO, (For Respondents).