Opinion
No. 1 CA-IC 14-0066
06-30-2015
PARADISE VALLEY UNIFIED SCHOOL DISTRICT, Petitioner Employer, VALLEY SCHOOLS INSURANCE TRUST AND WORKERS COMPENSATION POOL, Petitioner Carrier, v. INDUSTRIAL COMMISSION OF ARIZONA, Respondent, CRISTIN KRACHT, Respondent Employee.
COUNSEL Jardine, Baker, Hickman & Houston, P.L.L.C. By K. Casey Kurth, Rae Richardson Counsel for Petitioners Employer and Carrier Industrial Commission of Arizona, Phoenix By Andrew F. Wade Counsel for Respondent Cristin Kracht, Phoenix Respondent Employee
NOTICE: NOT FOR OFFICIAL PUBLICATION. UNDER ARIZONA RULE OF THE SUPREME COURT 111(c), THIS DECISION IS NOT PRECEDENTIAL AND MAY BE CITED ONLY AS AUTHORIZED BY RULE. Special Action - Industrial Commission ICA Claim No. 20132-620144
Carrier Claim No. 30167
Robert F. Retzer, Administrative Law Judge
AWARD AFFIRMED
COUNSEL Jardine, Baker, Hickman & Houston, P.L.L.C.
By K. Casey Kurth, Rae Richardson
Counsel for Petitioners Employer and Carrier
Industrial Commission of Arizona, Phoenix
By Andrew F. Wade
Counsel for Respondent
Cristin Kracht, Phoenix
Respondent Employee
MEMORANDUM DECISION
Judge Peter B. Swann delivered the decision of the court, in which Presiding Judge Randall M. Howe and Judge Andrew W. Gould joined. SWANN, Judge:
¶1 This is a special action review of an Industrial Commission of Arizona ("ICA") award and decision granting Cristin Kracht an award for a compensable claim. The issue raised on appeal is whether the medical evidence reasonably supports the administrative law judge's ("ALJ's") award. We conclude that it does, and therefore affirm.
FACTS AND PROCEDURAL HISTORY
¶2 In August 2012, Kracht began work as a kindergarten teacher for Paradise Valley Unified School District ("Paradise Valley"). Between August and October 2012, she developed headaches, a burning throat, and a runny nose during her work days, but her symptoms resolved at night after she got home. Beginning in October 2012, Kracht also developed chest tightness and difficulty breathing in her classroom by the afternoon. In January 2013, her symptoms worsened and she developed additional flu-like symptoms of muscle aches, fever, and chills. All symptoms continued to improve when Kracht was away from her classroom.
¶3 A conversation with her allergist first caused Kracht to consider a connection between her symptoms and her classroom environment, and she reported her concern to the school principal. By February 2013, Kracht was only able to work Monday through Wednesday before her symptoms made her too ill to finish the week. The school hired experts to perform an environmental assessment of Kracht's classroom. The assessment revealed cladosporium mold and elevated carbon dioxide levels. The school attempted to remediate these problems with additional cleaning and increased air flow, but Kracht's symptoms did not improve. On April 1, 2013, she was moved to a new portable classroom and her symptoms resolved.
¶4 In September 2013, Kracht filed a worker's report of injury. Paradise Valley's insurance carrier, Valley Schools Insurance Trust and Workers' Compensation Pool ("Valley"), denied the claim for benefits, and Kracht timely requested an ICA hearing. The ALJ held three hearings with testimony from Kracht, one of her treating physicians, and an independent medical examiner. Following the hearings, the ALJ entered an award for a compensable claim finding that Kracht was entitled to medical compensation benefits from October 2012 until her condition becomes medically stationary. Valley timely requested administrative review of the decision and the ALJ affirmed his award. Paradise Valley then brought this special action.
JURISDICTION AND STANDARD OF REVIEW
¶5 We have jurisdiction pursuant to A.R.S. §§ 12-120.21(A)(2), 23-951(A), and Ariz. R.P. Spec. Act. 10. In reviewing findings and awards of the ICA, we defer to the ALJ's factual findings, but review questions of law de novo. Young v. Indus. Comm'n, 204 Ariz. 267, 270, ¶ 14 (App. 2003). We consider the evidence in a light most favorable to upholding the ALJ's award. Lovitch v. Indus. Comm'n, 202 Ariz. 102, 105, ¶ 16 (App. 2002).
DISCUSSION
¶6 Compensability requires an injury by accident arising out of and in the course of employment. See A.R.S. § 23-1021(A). This involves both legal and medical causation. DeSchaaf v. Indus. Comm'n, 141 Ariz. 318, 320 (App. 1984). Legal causation concerns whether the claimant's injury arose out of his employment. See Peter Kiewit Sons' Co. v. Indus. Comm'n, 88 Ariz. 164, 168 (1960); Scheller v. Indus. Comm'n, 134 Ariz. 418, 420 (App. 1982). Medical causation typically requires expert medical testimony to establish that the industrial accident caused the injury. E.g., Allen v. Indus. Comm'n, 124 Ariz. 173, 175 (App. 1979).
¶7 It is the claimant's burden to prove all elements of a compensable claim. Toto v. Indus. Comm'n, 144 Ariz. 508, 512 (App. 1985). Unless the industrial injury immediately causes injuries that are obvious to a layman, expert medical evidence is required to establish a causal relationship between the industrial injury and its alleged consequences. Western Bonded Prod. v. Indus. Comm'n, 132 Ariz. 526, 527-28 (App. 1982).
¶8 Kracht testified that she had experienced seasonal allergies since childhood, which were treated with antihistamines. She had been a patient of Arizona Asthma and Allergy Institute ("AAAI") for fifteen years. AAAI's records of Kracht's office visits from November 2012 through April 2013 were placed in evidence. These records include testing to rule out a flu virus or an allergy to cladosporium mold and note that "[s]he may have 'sick building syndrome' which is a diagnosis of exclusion if we cannot find out what is bothering her at work."
¶9 Gerald S. Asin, M.D., Kracht's treating internist, testified that he had reviewed her medical records for the period from August 2012 through April 2013. Based on his record review, he stated that Kracht's health was impacted by her classroom environment and it was his opinion that there was a direct correlation between her symptoms and the time she spent in her classroom. He testified that it was not "a coincidence" because it happened for "many months in a row." Dr. Asin testified that he did not know specifically which toxins in the classroom caused the symptoms, but his common sense told him that there was a direct relationship between Kracht's symptoms and her classroom exposure.
Kracht was treated mainly at AAAI during this period, but her allergist refused to testify at the ICA hearings. --------
¶10 Daniel E. Brooks, M.D., board-certified in emergency medicine and medical toxicology, testified that he performed an independent medical evaluation of Kracht. He interviewed Kracht, reviewed her medical records, and researched scientific literature. Dr. Brooks stated that Kracht was exposed to mold and carbon dioxide in her classroom, but there was no evidence that she developed a diagnosable condition based on that exposure. Dr. Brooks testified that "her workplace exposure did nothing other than transiently exacerbate a pre-existing condition," i.e., "clinically significant environmental allergies."
¶11 An employer must take an employee "with whatever peculiar vulnerabilities to injury that the employee may have." Murphy v. Indus. Comm'n, 160 Ariz. 482, 486 (1989) (quoting Kelly's Case, 477 N.E.2d 582, 584 (Mass. 1985)). A symptomatic aggravation of a preexisting condition which requires additional medical treatment or results in additional disability can constitute a compensable claim. See Indus. Indem. Co. v. Indus. Comm'n, 152 Ariz. 195, 199 (App. 1986).
¶12 In this case, the ALJ found that the medical evidence established Kracht sustained a work-related injury as a result of her classroom environment. Paradise Valley argues that Dr. Asin's opinion is legally insufficient because it is not based on scientific fact and Dr. Brooks's opinion does not support compensability because he could not diagnose a specific condition resulting from the classroom exposure. For those reasons, it submits that there is insufficient evidence to establish a causal connection between Kracht's symptoms and her work in the classroom.
¶13 A medical opinion must be based on findings of medical fact in order to support an award. Royal Globe Ins. Co. v. Indus. Comm'n, 20 Ariz. App. 432, 434 (1973). These findings come from the claimant's history, medical records, diagnostic tests and examinations. Id.; see also Spector v. Spector, 17 Ariz. App. 221, 226 (1972) (stating that a physician may also base his opinion entirely on a personal examination and observation of a patient or in part on the history as related to him by the patient). This court has recognized that positive knowledge of causation is not always possible and this uncertainty will not prevent a physician from stating a legally sufficient opinion. See Harbor Ins. Co. v. Indus. Comm'n, 25 Ariz. App. 610, 612 (1976).
¶14 Although Dr. Asin did not know the exact toxins responsible for causing Kracht's symptoms, he opined that her symptoms were directly related to her classroom exposure. And while Dr. Brooks could not diagnose a specific condition resulting from Kracht's classroom exposure, it was his opinion that her exposure had temporarily aggravated her preexisting allergic rhinitis and required additional testing and treatment. We find that the medical testimony is legally sufficient to permit the ALJ to find the requisite causal relationship between Kracht's work and the temporary aggravation of her "clinically significant environmental allergies." See, e.g., Mandex v. Indus. Comm'n, 151 Ariz. 567, 570 (App. 1986).
CONCLUSION
¶15 For the foregoing reasons, we affirm the ALJ's award.