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In re Compensation of Slater

Court of Appeals of Oregon

July 26, 2017

In the Matter of the Compensation of Daniel B. Slater, Claimant.
v.
SAIF CORPORATION and Coe Manufacturing, Respondents. Daniel B. SLATER, Petitioner,

          Argued and submitted December 3, 2015

         Workers' Compensation Board 1203369, 1200682

          Julene M. Quinn argued the cause and fled the briefs for petitioner.

          David L. Runner argued the cause and fled the brief for respondents.

          Before DeVore, Presiding Judge, and Lagesen, Judge, and Flynn, Judge pro tempore. [*]

         [287 Or.App. 85] Case Summary:

         Claimant seeks review of a Workers' Compensation Board (board) order upholding SAIF's denial of claimant's previously accepted combined left knee condition and SAIF's medical services denial of a diagnostic MRI for claimant's left knee. On review, claimant contends that the board erred when it upheld SAIF's denial of his combined condition because SAIF failed to meet its burden to prove that claimant had a qualifying preexisting condition that had become the major contributing cause of his combined condition. Claimant also contends that the board applied the wrong legal standard to determine whether the diagnostic MRI is a compensable medical service. Held: The board did not err when it upheld SAIF's denial of claimant's combined condition. The medical evidence permitted the board's conclusion that claimant had a qualifying preexisting condition that had become the major contributing cause of claimant's combined condition. However, the board erred when it upheld SAIF's denial of compensation for the MRI. SAIF's denial of claimant's combined condition was not a denial of claimant's accepted injury, which remained compensable. The standard for com-pensability of the medical services dispute depends on whether the MRI is directed to claimant's combined condition or another condition caused in material part by the compensable injury, a fnding that the board did not make.

         Reversed and remanded as to claim for medical services; otherwise affrmed.

          [287 Or.App. 86] FLYNN, J. pro tempore

         Claimant seeks review of a Workers' Compensation Board (board) order that upheld SAIF's denial of claimant's previously accepted combined condition of the left knee and upheld SAIF's medical services denial of a diagnostic MRI for claimant's left knee. Claimant contends that SAIF failed to meet its burden to prove that claimant suffers from a qualifying preexisting condition that became the major contributing cause of claimant's combined condition. Claimant alternatively contends that the board applied the wrong legal standard when it required claimant to prove that the diagnostic MRI is a medical service directed to a condition caused in major part by claimant's injury. We conclude that the board permissibly construed the medical evidence as proving that claimant's osteoarthritis is a qualifying "preexisting condition" that became the major contributing cause of claimant's left knee combined condition. However, we also conclude that the board erred in failing to consider whether the MRI is directed to claimant's left knee strain and meniscal tear, which remain accepted conditions. Accordingly, we reverse and remand for the board to make that determination.

         I. INTRODUCTION

         We begin with an overview of the relevant law regarding a "combined condition, " because that law provides context for the pertinent facts and for our analysis of the arguments presented. Ordinarily, a claimant establishes compensability of a work injury by proving "that the work-related injury is a 'material' cause of the disability or the need for treatment." Brown v. SAIF. 361 Or. 241, 250, 391 P.3d 773 (2017). However, when "an otherwise compensable injury" combines with a qualifying "preexisting condition to cause or prolong disability or a need for treatment, " the resulting condition is a "combined condition" and is

"compensable only if, so long as and to the extent that the otherwise compensable injury is the major contributing cause of the disability of the combined condition or the major contributing cause of the need for treatment of the combined condition."

[287 Or.App. 87] Id. (quoting ORS 656.005(7)(a)(B)). After accepting a combined condition claim, an insurer may deny the condition "if the otherwise compensable injury ceases to be the major contributing cause." ORS 656.262 (6)(c).

         When the claimant challenges the denial of a "combined condition, " it is the insurer's burden to prove that the worker has a qualifying "preexisting condition and that the compensable injury is not the major contributing cause of the disability or need for treatment." Hopkins v. SAIF, 349 Or. 348, 352, 245 P.3d 90 (2010) (citing ORS 656.266(2)(a) (footnote omitted)). In this context, the "otherwise compensable injury" refers to the "accepted medical condition" that combines with a "preexisting condition." Brown, 361 Or at 272-73. A qualifying "preexisting condition" means that the worker "'has been diagnosed with such condition, or has obtained medical services for the symptoms of the condition, ' or suffers from 'arthritis or an arthritic condition.'" Hopkins, 349 Or at 352. (quoting ORS 656.005(24)(a)(A) (footnote omitted)). By "arthritis, " the legislature meant "the inflammation of one or more joints, due to infectious, metabolic, or constitutional causes, and resulting in breakdown, degeneration, or structural change." Id. at 364. In addition, "because [ORS 656.262(6)(c)] provides that a combined condition that has been accepted may be denied when the otherwise compensable injury 'ceases' to be the major contributing cause of the combined condition, the statute necessarily requires that there be a change in the worker's condition." Oregon Drvwall Systems. Inc. v. Bacon. 208 Or.App. 205, 208-09, 144 P.3d 987 (2006).

         II. BACKGROUND

         Claimant injured his left knee in October 2005, while working for an employer insured by SAIF. He sought treatment from Dr. Di Paola, who diagnosed "medial compartment degenerative arthrosis" as well as a medial menis-cal tear, for which he performed surgery. Following surgery, Di Paola described claimant's condition as a work-related left medial meniscus tear and preexisting "diffuse chondromalacia" of the patellofemoral joint and medial compartment. When SAIF closed the claim it specified that claimant's accepted conditions for ...


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