Opinion
W.C. No. 4-223-473
May 27, 1999.
FINAL ORDER
The respondents seek review of an order of Administrative Law Judge Erickson (ALJ) which required them to pay the cost of replacement hormone therapy. We affirm.
The claimant suffered an admitted back injury. As a result of the injury the claimant became severely depressed and requires psychiatric treatment including anti-depressant medication. While undergoing a psychiatric evaluation, it was discovered the claimant suffers a hormonal deficiency and requires estrogen/progesterone replacement therapy. In a report dated August 24, 1998, Dr. Nagel, the treating psychiatrist, opined that a hormonal deficiency may preclude the claimant from achieving the maximum benefit from anti-depressant medications. Therefore, Dr. Nagel opined that the claimant's replacement hormone therapy is necessary to treat the industrial injury.
The ALJ found that although the hormone deficiency was not caused by the industrial injury, hormone replacement therapy is reasonable and necessary to maximize the claimant's response to anti-depressant medication, and therefore, the ALJ determined that the hormone treatment is a compensable medical benefit.
On review the respondents contend that it is undisputed the claimant requires hormonal replacement therapy regardless of the industrial injury. Therefore, the respondents contend the hormone treatment is not a compensable medical benefit. The respondents also contend the ALJ erroneously held them responsible for "lifetime" hormonal therapy. We perceive no error.
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), C.R.S. 1998; Snyder v. Industrial Claim Appeals Office, 942 P.2d 1337 (Colo.App. 1997). In Public Service Company of Colorado v. Industrial Claim Appeals Office, ___ P.2d ___ (Colo.App. No. 98CA1851, April 29, 1999), the court held that ancillary medical treatment for a non-occupational condition is compensable if reasonable and necessary to "achieve the optimum treatment of the compensable injury." In Public Service, there was substantial evidence that stabilization of the claimant's non-industrial bipolar disorder was reasonably necessary for the claimant to achieve a full recovery from surgical treatment of the industrial injury. Under these circumstances, the court upheld an order requiring the employer to pay for treatment of the bipolar disorder. We conclude that Public Service Company of Colorado v. Industrial Claim Appeals Office, supra, is dispositive of the respondents' argument.
Here, there is no dispute that the claimant's depression is a result of the industrial injury and that anti-depressant medication is reasonable and necessary to cure or relieve the effects of the industrial injury. However, it was not undisputed that the claimant needed hormone replacement therapy regardless of the industrial injury. Rather, the parties stipulated that prior to the industrial injury the claimant was not diagnosed with a hormone deficiency and no hormone replacement therapy had been prescribed. (Tr. pp. 3, 4).
In addition, the ALJ found that hormone replacement therapy is reasonably necessary for the claimant to achieve an optimum response to anti-depressant medication. The ALJ's finding is supported by substantial evidence in the medical reports of Dr. Nagel, and therefore must be upheld. Section 8-43-301(8), C.R.S. 1998; City of Durango v. Dunagan, 939 P.2d 496 (Colo.App. 1997). Consequently, it is immaterial that Dr. Gutterman's opinions, if credited might support a contrary determination. F.R. Orr Construction v. Rinta, 717 P.2d 965 (Colo.App. 1985) (substantial evidence is probative evidence which would warrant a reasonable belief in the existence of facts supporting a particular finding, without regard to the existence of contradictory testimony or contrary inferences). Moreover, the ALJ's finding supports the award of medical benefits for hormone replacement therapy. Public Service Company of Colorado v. Industrial Claim Appeals Office, supra.
We also reject the respondents' contention that the ALJ required them to provide "lifetime" replacement hormone treatment. The respondents remain free to contest liability for future hormone therapy on grounds that it is no longer related to treatment of the industrial injury. See Snyder v. Industrial Claim Appeals Office, supra. IT IS THEREFORE ORDERED that the ALJ's order dated October 23, 1998, is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
____________________________________ David Cain
____________________________________ Kathy E. Dean
NOTICE
This Order is final unless an action to modify or vacate this Order is commenced in the Colorado Court of Appeals, 2 East 14th Avenue, Denver, CO 80203, by filing a petition for 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 this Order is mailed, pursuant to section 8-43-301(10) and 307, C.R.S. 1998.
Copies of this decision were mailed May 27, 1999 the following parties:
Deborah Baxter, 19157 E. Nassau Drive, Aurora, CO 80013
Genuine Parts Company, 2101 Highway 224, Denver, CO 80229-6910
Barbara McDaniel, Travelers Indemnity, P.O. Box 173762, Denver, CO 80217-3762
Douglas R. Phillips, Esq., 155 South Madison, Suite 330, Denver, CO 80209 (For the Claimant)
Tama L. Levine, Esq., 1515 Arapahoe Street, Tower 3, Suite 600, Denver, CO 80202 (For the Respondent)
BY: A. Pendroy