Case Title: SALAS v. GENERAL CHEMICAL

Citation: 

Docket Number: 02-111

State: wyoming

Court: Wyoming Supreme Court

Date: 2003-06-26T00:00:00Z

Document:
SALAS v. GENERAL CHEMICAL2003 WY 7971 P.3d 708Case Number: 02-111Decided: 06/26/2003
APRIL 
TERM, A.D. 2003

 

                                                                                                                                   

 

ERNEST 
SALAS,

 

Appellant(Respondent),

 

v.

 

GENERAL 
CHEMICAL,

 

Appellee(Petitioner).

 

 

Representing 
Appellant:

 

            
Michael D. Newman of Hampton & Newman, LC, Rock Springs, 
Wyoming.

 

Representing 
Appellee:

 

            
Jason M. Tangeman of Anthony, Nicholas, Tangeman & Yates, LLC, 
Laramie, Wyoming.

 

 

Before 
HILL, C.J., and GOLDEN, LEHMAN, KITE, and VOIGT, JJ.

 

            
VOIGT, Justice.

 

[¶1]      In May 1999, 
General Chemical employed appellant, Ernest Salas (Salas), as a shuttle car 
operator in its trona mine.  On May 
3rd, Salas was injured when a slab fell from the side of the mine, 
"rolled" him to the ground, and pinned him there.  Following a contested case hearing, the 
hearing examiner found that the accident materially aggravated the pre-existing 
degenerative condition in Salas' right knee.  The district court reversed the hearing 
examiner's determination, and Salas appeals the district court's decision to 
this Court.  We 
reverse.

 

ISSUES

 

[¶2]      Salas phrases the 
issue on appeal as follows:

 

Was 
the Hearing Examiner's decision awarding benefits supported by substantial 
evidence?

 

General 
Chemical phrases the issue in substantially the same 
manner.

 

FACTS

 

[¶3]      In 1997, Salas 
underwent a right knee arthroscopy that revealed 

 

a 
torn meniscus which had been present on the medial side for some time and that 
torn meniscus was removed.  The 
actual joint itself looked pretty good.

 

. 
. .

 

. 
. .  The right knee will be sore for 
a considerable time from the removal of the medial meniscus but eventually 
should be a reasonably good knee.

 

In 
May 1998, Salas reportedly experienced right knee pain for a two-week period, 
and a doctor aspirated fluid from the knee.  During a November 1998 physical, another 
doctor noted the "persistence of right knee pain along the medial aspect," and 
"[p]robable degenerative arthritis of the knees."  In a follow-up visit one month later, 
the same doctor noted that Salas' "knees feel much better with 
[medication.]"

 

[¶4]      On May 3, 1999, 
General Chemical employed Salas as a shuttle car operator in its trona mine near 
Green River.  That day, a four- to 
five-hundred pound slab fell from the side of the mine, "rolled" Salas to the 
ground, and pinned him there.  The 
hearing examiner found that Salas was "pinned to the ground, by the slab, in a 
crouching position, with his left leg stretched out behind him, his weight being 
applied to his right knee."1  Salas stated that when he was pinned 
beneath the slab, his right knee ultimately folded underneath him.  He demonstrated the position of his body 
for the hearing examiner, and it appeared from the demonstration that Salas' 
right knee was "bent at an angle and his body kind of twisted to the right 
side."

 

[¶5]      Salas reportedly 
suffered abrasions to his left shoulder, left elbow, and right knee.  After a break, Salas returned to work 
and did not immediately suffer pain in his right knee, but noted that his 
"adrenaline was pumping pretty good."  
Salas testified that he experienced "a clicking" in his right knee in 
June 1999.  Within a "month or two" 
after the accident, Salas stated that he also experienced a "new," "constant 
pain" on the inside of his right knee to a degree that when walking, "something 
would be aggravating [his] knee to where it was painful to walk anymore."  Salas claimed that while he previously 
had experienced soreness in the knee, he had never experienced this kind of 
"constant" pain whenever his knee would "open or close," and felt that the May 
3rd accident "had aggravated it."  A co-worker noticed that between May and 
November 1999, Salas "was having a hard time walking and his gait had changed 
quite a bit."

 

[¶6]      In October 1999, 
Salas consulted Dr. Thomas Bienz, an orthopedic surgeon, who noted that Salas 
had reportedly experienced "repeat knee pain, increased swelling and some 
popping on the medial side" since the May 1999 accident, and the pain was 
"progressively getting worse."  
According to Dr. Bienz, x-rays revealed "significant degeneration in the 
medial compartment" and "extensive medial osteophytes and very little joint 
space remaining."  The doctor 
concluded that Salas suffered from "[a]cute on chronic right knee pain with 
extensive medial compartment degeneration . . .."  He initially recommended treatment in 
the form of physical therapy and medication.  By November 1999, Salas had experienced 
some "good relief of pain," but continued to "report medial sided joint line 
pain as well as occasional snapping and popping inside his joint," which the 
doctor confirmed with further examination.  
The doctor recommended that physical therapy in combination with 
medication continue, but noted that in "the event that at six weeks he continues 
to have discomfort, consideration will be given to arthroscopy and 
debridement."

 

[¶7]      Dr. Bienz 
performed a right knee arthroscopy in March 2000.  During the arthroscopy, he discovered a 
degenerative loss of "articular cartilage" in the knee's medial compartment, 
and, although it was difficult to assess, what appeared to be a 
"degenerative-type tear" in the medial meniscus.  Salas returned to work in April or May 
2000, and his knee "didn't have the pain that it did before and it was back to 
just the soreness."

 

[¶8]      The Division of 
Workers' Safety and Compensation (Division) issued an amended final 
determination in February 2000, awarding Salas benefits "for acute treatment 
only."  Both Salas and General 
Chemical objected to the determination, and a contested case hearing was held in 
October 2000.  The hearing examiner 
received medical deposition testimony from Dr. Bienz and Dr. Rheim Jones, also 
an orthopedic surgeon.  Dr. Bienz 
diagnosed Salas with "acute on chronic" right knee pain and stated that the May 
1999 accident aggravated or exacerbated the pre-existing degenerative condition 
in Salas' right knee.  Dr. Jones, 
who performed a "record  review" for 
the Division, ultimately concluded that

 

[b]ased 
on the available information, to a reasonable degree of medical certainty, there 
is not a causal relationship between [Salas'] current complaints and the 
reported injury of 05/03/99.

 

The 
record clearly demonstrates Mr. Salas had degenerative changes of the medial 
compartment of the right knee before the injury of 05/03/99.  . . .

 

The 
accident of 05/03/99 is not consistent with a significant injury to the right 
knee.  . . .

 

Mr. 
Salas's right knee problems are more probable than not related to his initial 
medial meniscus injury and subsequent degenerative changes caused by the torn 
fragment and added medial compartment load created by the absence of the medial 
meniscus.

 

Relying 
primarily on the testimony of Dr. Bienz and Salas, the hearing examiner found 
that the May 1999 accident materially aggravated the pre-existing degenerative 
condition in Salas' right knee and awarded Salas worker's compensation 
benefits.

 

[¶9]      General Chemical 
petitioned the district court to review this determination, and the district 
court reversed the hearing examiner.  
In a detailed decision letter, the district court concluded that the 
"evidence leans against Salas," the "greater weight of the evidence leans toward 
disallowing benefits for Salas' preexisting injury," and the medical testimony 
did not provide a sufficient "link between the work-related accident and the 
subsequent injury."  Salas appeals 
from that decision.

 

STANDARD 
OF REVIEW

 

A 
claimant for worker's compensation benefits has the burden of proving all the 
essential elements of the claim by a preponderance of the evidence in the 
contested case hearing.  In Re 
Worker's Comp. Claim of Johnson, 2001 WY 48, ¶ 7, 23 P.3d 32, ¶ 7 
(Wyo.2001).  We recently held that 
the substantial evidence test is the appropriate standard of review in appeals 
from Wyoming Administrative Procedures Act contested case proceedings when 
factual findings are involved and both parties submit evidence.  Newman v. Wyoming Workers' Safety and 
Comp. Div., 2002 WY 91, ¶ 22, 49 P.3d 63, ¶ 22 (Wyo.2002).  . . .  Because both parties presented 
cases-in-chief, we apply the substantial evidence standard.  We afford respect and deference to a 
hearing examiner's findings of fact if they are supported by substantial 
evidence.  Haagensen v. State ex 
rel. Workers' Comp. Div., 949 P.2d 865, 867 (Wyo.1997).  Our task is to examine the entire record 
to determine whether substantial evidence supported the hearing examiner's 
findings.  State ex rel. Wyo. 
Workers' Comp. Div. v. Waggener, 946 P.2d 808, 814 (Wyo.1997).  We will not substitute our judgment for 
that of the hearing examiner when substantial evidence supports his 
decision.  Id.  Substantial evidence is relevant 
evidence which a reasonable mind might accept in support of the agency's 
conclusions.  Id.  A hearing examiner's conclusions of law 
are afforded no special deference and will be affirmed only if truly in accord 
with law.  State ex rel. Wyo. 
Workers' Comp. Div. v. Barker, 978 P.2d 1156, 1159 
(Wyo.1999).

 

Hermosillo 
v. State ex rel. Wyoming Workers' Safety and Compensation Div., 
2002 WY 175, ¶ 6, 58 P.3d 924, 926 (Wyo. 2002).

 

[¶10]   An "injury" does not include a 
"condition preexisting at the time of employment with the employer against whom 
a claim is made[.]"  Wyo. Stat. Ann. 
§ 27-14-102(a)(xi)(F) (Michie 1997).  
The

 

burden 
is upon the claimant to prove that his work accident, not his preexisting 
condition, caused the necessity for the surgery.  Matter of Corman, 909 P.2d 966, 
970 (Wyo.1996); Matter of Claim of Fortier, 910 P.2d 1356, 1358 
(Wyo.1996).  While aggravation of a 
preexisting condition is a compensable injury, Matter of Injury to 
Carpenter, 736 P.2d 311, 312 (Wyo.1987), claimant must prove that his 
employment aggravated, accelerated, or combined with the disease or infirmity to 
produce the disability for which compensation is sought.  Romero v. Davy McKee Corp., 854 P.2d 59, 61 (Wyo.1993); Lindbloom v. Teton Int'l, 684 P.2d 1388, 1390 
(Wyo.1984).

 

State 
ex rel. Wyoming Workers' Compensation Div. v. Roggenbuck, 
938 P.2d 851, 853 (Wyo. 1997).  "To prove aggravation of a preexisting 
injury, the claimant must demonstrate that the work effort contributed to a 
material degree to the . . . aggravation . . . of the existing 
condition of the employee.'"  
Frazier v. State ex rel. Wyoming Workers' Safety and Compensation 
Div., 997 P.2d 487, 490 (Wyo. 2000) (quoting Lindbloom v. Teton 
Intern., 684 P.2d 1388, 1389-90 (Wyo. 1984)) (emphasis omitted).

 

"[T]he 
causal connection between an accident or condition at the workplace is satisfied 
if the medical expert testifies that it is more probable than not that the work 
contributed in a material fashion to the . . . aggravation . . . of the 
injury.  We do not invoke a standard 
of reasonable medical certainty with respect to such causal connection.  Testimony by the medical expert to the 
effect that the injury most likely,' contributed to,' or probably' is the 
product of the workplace suffices under our established standard . . 
..

 

[U]nder 
either the reasonable medical probability' or more probable than not' 
standard, [a claimant succeeds] in demonstrating the causal connection by a 
preponderance of the evidence."

 

Hall 
v. State ex rel. Wyoming Workers' Compensation Div., 
2001 WY 136, ¶ 16, 37 P.3d 373, 378 (Wyo. 2001) (quoting In re Pino, 996 P.2d 679, 
685 (Wyo. 2000)).

 

[¶11]   Whether the employment 
"aggravated, accelerated, or combined with the internal weakness or disease to 
produce the disability is a question of fact.'"  Brees v. Gulley Enterprises, 
Inc., 6 P.3d 128, 131 (Wyo. 2000) (quoting Lindbloom, 684 P.2d at 
1390).

 

DISCUSSION

 

[¶12]   The hearing examiner found that 
Salas "had pre-existing conditions" and "significant degenerative changes" in 
his right knee prior to the May 3, 1999, accident.  This finding is essentially undisputed 
based on the information contained in Salas' medical records and the testimony 
of Drs. Bienz and Jones.

 

[¶13]   At issue is the hearing examiner's 
finding that

 

[Salas] 
did suffer a material aggravation of the . . . pre-existing condition in his 
right knee as a result of [his] May 3, 1999 work related accident that required 
treatment, arthroscopic surgery and a period of time for temporary total 
disability after said surgery.

 

In 
particular, the parties dispute whether the hearing examiner could reasonably 
rely on Dr. Bienz's testimony to support this finding.  Salas notes that the hearing examiner 
found that he and Dr. Bienz were credible witnesses, and argues that their 
testimony comprises substantial evidence to support the hearing examiner's 
finding.  According to Salas, the 
district court essentially re-weighed the evidence in reaching a contrary 
conclusion.  General Chemical 
contends that Dr. Bienz's testimony did not establish that the May 1999 accident 
materially aggravated the pre-existing degenerative condition in Salas' right 
knee, but does not otherwise challenge the hearing examiner's findings as to 
witness credibility.

 

[¶14]   Dr. Bienz testified, in pertinent 
part, as follows:

 

Q. 
[General Chemical counsel]  And do 
you recall when the first time it was you saw Mr. Salas?

 

A.  With the benefit of the record, I 
do.  That would be on October 25, 
1999.

 

Q.  And Mr. Salas, when you first saw him, 
was complaining of what you describe as acute on chronic right knee pain; is 
that correct?

 

A.  That is correct.

 

Q.  What do you mean by acute on chronic 
right knee pain?

 

A.  It means he is suffering from a 
preexisting condition with an acute exacerbation.  In other words, he is having pain in an 
extremity that he has had before, but worse than 
previously.

 

* 
* *

 

Q.  And what did your physical examination 
of Mr. Salas find?

 

A.  He had full range of motion of the 
knee.  He did have medial out of 
joint line pain and provacative tests on examination of the knee also suggested 
medial-sided joint line pain.

 

Q.  Do you have an opinion as to what was 
causing that pain for him?

 

A.  Now or at that time or 

 

Q.  Well, how about  yeah, 
now.

 

A.  Okay.  Yes.  I believe it was secondary to 
degenerative changes in the medial compartment, along with  actually, primarily 
due to degenerative changes in the medial compartment.  At the time I thought that maybe it had 
to do with a medial meniscus tear as well, and apparently after the procedure it 
appears it was most likely due to both.

 

[Salas 
counsel]:  Doctor, what did you 
say?  Most likely due to 
both?

 

A.  Due to both, yes.  The medial meniscus tear as well as the 
degenerative change.

 

Q. 
[General Chemical counsel]  What do 
you mean when you say most likely due to both?

 

A.  In other words, the pain that he was 
experiencing was most likely attributable to both, that the degenerative change 
in the medial compartment  that is, loss of articular cartilage and 
bone-on-bone contact, as well as a degenerative tear in the 
meniscus.

 

            
* * *

 

Q.  And in the preoperative diagnosis, you 
described left knee degenerative joint disease with possible medial meniscus 
acute injury?

 

A.  Uh-huh.

 

Q.  What are you referring to in regard to 
the acute injury?

 

A.  . . . And what I'm referring to by acute 
injury is an injury that is a recent injury as opposed to something which is 
chronic that is an old injury.

 

Q.  And you use the word possible, why do 
you use the word possible?

 

A.  Preoperative diagnosis suggests the plan 
or supposition on the initial evaluation, that is, findings that are thought to 
be present before seeing them on the arthroscopic 
evaluation.

 

* 
* *

 

Q.  Okay.  And postoperatively, was it still your 
opinion that there was a possible medial meniscus acute injury in that right 
knee?

 

A.  It appeared that there was primarily 
degenerative medial meniscus tear with significant cartilage 
degeneration.

 

            
* * *

 

Q.  [Salas counsel]  Sure. Sure.  You have initial diagnosis of acute on 
chronic injury?

 

A.  Yes.

 

Q.  Do you still carry that opinion 
today?

 

A.  I do.

 

Q.  Okay.  So is it fair to say, to a reasonable 
degree of medical probability, you feel that the work-related incident that Mr. 
Salas described caused an aggravation of his preexisting 
condition?

 

A.  Yes.

 

* 
* *

 

Q.  Doctor, you indicated that you found 
degenerative condition in the knee upon arthroscopy, as well as a  what you 
defined as degenerative tear 

 

A.  Yes.

 

Q.   of the meniscus?

 

A.  Yes.

 

Q.  Do you have an opinion  or could you 
tell from the arthroscopy whether that meniscus tear was caused by this 
incident?

 

A.  No, that's harder to assess.  The medial meniscus was quite minimal in 
its quantity and degenerative in its quality.  That is consistent with the previous 
history that Dr. Herrington reported that he performed meniscectomy.  I do not agree with the IME suggesting 
meniscectomy, because there was some remnant of the meniscus there.  It is very hard to assess, however, 
whether the tear was acute or chronic, but I will say that it had more of a 
character of degenerative-type tear, that is it was fibrillated with fraying, 
there was no specific split that went into the meniscus and traveled along its 
circumference, so it did look more degenerative than 
acute.

 

* 
* *

 

Q.  . . . Do you have an opinion that there 
was degenerative changes in this remnant of a meniscus in Mr. Salas's knee prior 
to the May 3, 1999 work-related accident?

 

[objection 
omitted]

 

A.  Based upon the degree of the articular 
cartilage loss, I would say there was most[] likely degenerative changes in the 
medial compartment for quite some time, including the meniscus.  

 

Q.  . . .  Okay.  Doctor, you're unable, diagnostically or 
objectively, to determine whether this work-related accident of 5/3 of 1999 
caused or accelerated the tear of the meniscus?

 

[objection 
omitted]

 

* 
* *

 

A.  As far as objectively or diagnostically 
includes a very large breadth of possibilities, so I would say that, yes, I can 
make some statement to that effect.  
Objectively, based upon findings in the arthroscopy, it appears he had 
degenerative changes that probably predated the injury and yet the examination I 
performed on him with his conclusion that previously he had very minimal pain 
and subsequently he had rather significant pain that is also included in the 
object  in the diagnostic findings, and I would suggest he did have an 
exacerbation of the injury.

 

Q.  So you're basically saying, based upon 
the history of increased pain in the area of the meniscus, led you to your 
opinion that there was an aggravation of a preexisting condition caused by the 
May 3, 1999 work-related accident?

 

A.  That's correct.  Exacerbation of his condition, not 
necessarily of a specific meniscus injury, though.  

 

* 
* *

 

Q.  Doctor, do you feel that the 
work-related incident to Mr. Salas described was consistent with the injury 
[you] diagnosed and treated?

 

[objection 
omitted]

 

A.  I agree that the injury, which he 
described to me that occurred . . . can cause the types of symptoms that he was 
complaining of.

 

* 
* *

 

A.  . . .  I do not believe that it would cause 
degeneration of the knee, and that's why I diagnosed it as an acute on chronic 
injury.

 

* 
* *

 

A.  . . . You're saying would I be able to 
attribute the need for arthroplasty to his injury  to the injury of 
May?

 

Q.  Of that May 1999 
injury.

 

A.  Only from the point of view that he had 
no complaints before and he complains  or he had no specific acute complaints 
before, but he had greater complaints then, but as far as degeneration, most of 
the degeneration was probably present before that injury.

 

Q.  Okay.  Do you think that this acute injury 
that's been described has accelerated the degenerative 
process?

 

A.  That's hard to say, because I only . . . 
saw his knee one time.  I did not 
see it before.  I can only say it 
caused him to have more pain.

 

Q.  So it would be difficult, you're saying, 
to attribute any accelerated degenerative changes as a result of the May 1999 
work-related accident?

 

A.  That's true.

 

Dr. 
Bienz also disagreed with Dr. Jones' opinion in one significant 
respect:

 

Q. 
[Salas counsel:]  Okay.  And under the causation section, Dr. 
Jones indicates that in the first paragraph, based upon the available 
information, to reasonable degree of medical certainty, there is not a causal, 
excuse me, relationship between the examinee's current complaints and reported 
injury of 5/3/99.  And I assume from 
your previous testimony, you disagree with that at the same 
time?

 

A.  That's correct.

 

Q.  Okay.  And the basis for your disagreement is 
what, Doctor?

 

A.  The fact that the patient reported to me 
that he had a pain-free injury prior to that injury, and subsequent to the 
injury had recurrence of preexisting pain.

 

[¶15]   We conclude that, after reviewing 
the entire record pursuant to the requisite standard of review, the record 
contains substantial evidence that Salas' May 1999 work accident contributed to 
a material degree in aggravating or combining with the pre-existing degenerative 
condition in Salas' right knee, and necessitated the March 2000 right knee 
arthroscopy; therefore, we cannot substitute our judgment for that of the 
hearing examiner.  We also cannot 
find that it was unreasonable for the hearing examiner to accept Dr. Bienz's 
expert medical testimony regarding the May 1999 accident's role in 
"exacerbating" or "aggravating" the pre-existing degenerative condition in 
Salas' right knee, especially considering that "the hearing examiner is in the 
best position to judge and evaluate the expert witnesses and their 
opinions."  Frazier, 997 P.2d  
at 491.

 

[¶16]   Salas testified that after a doctor 
aspirated fluid from his right knee in May 1998, the knee "felt fine" and he 
"had no other problems" except that when he completed four or five days of work, 
he experienced periodic "soreness," but not "constant pain."  Indeed, the doctor who performed the 
1997 arthroscopy of Salas' knee stated that the right knee would be "sore" for a 
"considerable time" but "eventually should be a reasonably good knee."  After a physical in which another doctor 
noted right knee pain along "the medial aspect," the same doctor noted that as 
of December 1998, Salas' right knee was feeling "much better with 
[medication.]"

 

[¶17]   The record does not reveal any 
other incidents or reports of, or medical treatment for, right knee pain between 
December 1998 and May 3, 1999.  On 
May 3rd, Salas was involved in the 
above-described accident at work.  
Within a month or so thereafter, Salas experienced first a "clicking" in 
his right knee and then a "constant pain" that he had not experienced prior to 
the accident, to a degree that he "curtailed a lot of [his] other 
activities."  Dr. Bienz testified 
that the May 1999 injury Salas described to him "can cause the types of symptoms 
[Salas] was complaining of" shortly after the accident.

 

[¶18]   As Salas' "constant pain" became 
"progressively" worse, Dr. Bienz initially attempted to treat Salas with 
physical therapy and medication,2 but noted that if Salas continued 
to have discomfort at "six weeks . . . consideration will be given to 
arthroscopy and debridement."  By 
November 1999, Salas had experienced some "good relief of pain" with the 
physical therapy and medication, although he still suffered knee pain, snapping 
and popping, which Dr. Bienz confirmed with further examination.  Dr. Bienz then "recommended" and 
performed the right knee arthroscopy for "diagnostic and therapeutic purposes to 
evaluate and possibly treat the knee."  
The degenerative changes in Salas' right knee likely occurred prior to 
May 1999, but in addition to recommending the arthroscopy for diagnostic and 
therapeutic purposes, Dr. Bienz was able to attribute the need for the 
arthroscopy in part due to the May 1999 accident because of the pain-specific 
history Salas provided; Salas lacked "specific acute complaints before, but he 
had greater complaints" following the accident.

 

[¶19]   Dr. Bienz diagnosed Salas with 
"acute on chronic right knee pain," and the doctor maintained that diagnosis as 
of the date of his deposition testimony.  
In other words, according to Dr. Bienz, Salas suffered from "a 
preexisting condition with an acute exacerbation."  Dr. Bienz testified consistently, 
unequivocally, and to "a reasonable degree of medical probability" that while 
the May 3, 1999, accident did not cause or appear to accelerate the degenerative 
changes that existed in Salas' right knee at the time of the accident, the 
accident did cause an "exacerbation" or "aggravation of his preexisting 
condition."  The doctor's opinion 
was based on his examination of Salas, and Salas having experienced "very 
minimal pain" prior to the accident and "rather significant pain" subsequent to 
the accident.  Dr. Bienz expressly 
disagreed with Dr. Jones' opinion for this reason.

 

[¶20]   Dr. Bienz's medical opinion was 
relevant to determining whether the May 1999 accident materially aggravated the 
pre-existing degenerative condition in Salas' right knee, and constituted 
evidence that a reasonable mind might accept in support of the hearing 
examiner's finding on that issue.  
General Chemical does not argue that Dr. Bienz's testimony was 
speculative, but rather that Dr. Bienz actually narrowed or qualified his 
general statements regarding the accident's aggravation of Salas' pre-existing 
condition because he subsequently testified that Salas' medial meniscus tear 
appeared to be degenerative.  
However, Dr. Bienz's opinion appears to be that, despite 
the fact that the degenerative changes in Salas' right knee likely occurred 
prior to the May 1999 accident, the doctor's examination, and the pain-specific 
history Salas provided, confirmed his "acute on chronic" pain diagnosis; the May 
1999 accident "acutely" aggravated or exacerbated the pre-existing degenerative 
condition in Salas' right knee.

 

[¶21]   In support of its argument, General 
Chemical also places particular emphasis on our decision in Brees, 6 P.3d  
at 131.  In Brees, 6 P.3d  at 
130, 
Dora Brees claimed "to have sustained a back injury" at work.  On appeal, Brees did not dispute that 
she had a pre-existing back condition, but argued that her doctor's testimony 
established that her work injury materially aggravated the pre-existing 
condition.  Id. at 131.  We concluded that

 

Dr. 
Metz' testimony does not establish whether Brees materially aggravated her 
previous condition . . . because Dr. Metz was never directly asked whether 
Brees' surgery resulted from the pre-existing condition or from twisting and 
pushing the cart.  As a consequence, 
Brees has not presented any evidence on the question of whether the back pain 
experienced when twisting and pushing the cart . . . materially aggravated her 
pre-existing condition and resulted in a compensable 
injury.

 

Id. 
at 133.  Yet, in the instant case, 
Dr. Bienz not only was able to attribute the need for arthroscopy in part due to 
the May 1999 accident, but also opined "to a reasonable degree of medical 
probability" that the accident aggravated or exacerbated Salas' pre-existing 
degenerative knee condition.

 

[¶22]   The circumstances of the instant 
case are similar to those contained in Roggenbuck, 938 P.2d  at 
853.  In that case, the claimant 
had

 

a 
history of back problems, scars from two previous back surgeries, and a 
permanent partial disability of 60 percent, [and] alerted his employer of a 
work-related injury to his back incurred nine days into his new 
employment.

 

Id. 
at 853.  
Further,

 

[m]edical 
evidence included a statement by the doctor treating claimant since January of 
1991 that 50 percent of claimant's current condition was due to the instant 
injury.  This percentage included 
the normal aging process and normal daily living activities.  A comparison of an MRI report after the 
accident to one performed two and a half years earlier indicates a significant 
deterioration and worsening of claimant's condition.

 

It 
is true that claimant and his doctor discussed surgery before the work-related 
injury, however notes from claimant's doctor indicate that discussion took place 
over a two and a half year period before the last injury.  As pointed out by the hearing examiner 
in Finding No. 5, it was the "work effort [that] brought the need for surgery to 
a head and forced the surgery to be done at this time."  Further, testimony indicated that the 
pain levels experienced by claimant increased after the injury; and, when taken 
as a whole, the evidence supports the hearing examiner's conclusions that the 
work efforts on behalf of the employer contributed to a material degree to the 
precipitation, aggravation or acceleration of his preexisting condition to the 
point that surgery could no longer be avoided.

 

Id. 
at 853-54.  Accordingly, we affirmed 
the hearing examiner's findings and his decision awarding the claimant 
benefits.

 

[¶23]   Having found substantial evidence 
to support the hearing examiner's findings in the instant case, we reverse the 
district court's decision, and affirm the hearing examiner's decision awarding 
Salas benefits.

 

 

FOOTNOTES

  1General Chemical does not contest 
this finding.

  2According to Dr. Bienz, "[p]hysical 
therapy can be quite beneficial to patients almost regardless of what their 
diagnosis is" and if "somebody's getting better with nonoperative intervention, 
usually we stay the course . . .."