Case Title: State ex rel. Ignatious v. Indus. Comm.

Citation: 2003-Ohio-3627

Docket Number: 20021627

State: ohio

Court: Ohio Supreme Court

Date: 2003-07-23T00:00:00Z

Document:
[Cite as State ex rel. Ignatious v. Indus. Comm., 99 Ohio St.3d 285, 2003-Ohio-3627.] 
 
 
THE STATE EX REL. IGNATIOUS, APPELLEE, v. INDUSTRIAL COMMISSION OF 
OHIO, APPELLANT, ET AL. 
[Cite as State ex rel. Ignatious v. Indus. Comm., 99 Ohio St.3d 285, 2003-Ohio-
3627.] 
Workers’ compensation — Industrial Commission ordered to grant temporary 
total disability compensation, when. 
(No. 2002-1627 — Submitted May 13, 2003 — Decided July 23, 2003.) 
APPEAL from the Court of Appeals for Franklin County, No. 01AP-982, 2002-
Ohio-4014. 
__________________ 
 
Per Curiam. 
{¶1} 
Appellee-claimant John P. Ignatious suffered a work-related injury 
on May 24, 1999, and a workers’ compensation claim was allowed for a sprained 
neck and herniated discs C4-5 and C5-6.  A year later, claimant began receiving 
temporary total disability compensation (“TTC”) and underwent surgery for those 
conditions. 
{¶2} 
On October 20, 2000, his attending physician, Theresa D. Ruch, 
wrote: 
{¶3} 
“At his last office visit which was 8/18/2000 he was complaining 
of a cold sensation in his right hand and some numbness and tingling in his left 
hand, also a cotton ball sensation in his throat.  At this time all his symptoms have 
decreased.  He’s been going to physical therapy, his last visit was a week ago. * * 
* 
{¶4} 
“* * *He would like to go back to work as he’s feeling much 
better.  We’re going to send him back to work with a 25 pound weight restriction 
the week after next * * *.” 
SUPREME COURT OF OHIO 
2 
{¶5} 
At the same time, Dr. Ruch issued a work release for November 6, 
2000, and Dr. Robert Anschuetz concurred.  Three days later, his employer, 
Transdigm, Inc. & Aero Products, assured claimant that his work restrictions 
would be accommodated. 
{¶6} 
Claimant did not return on November 6.  Instead, on November 9, 
Dr. Ruch indicated that claimant could not return and would be unable to do so 
until after he obtained an EMG and MRI.  The November 15, 2000 report on 
these tests stated: 
{¶7} 
“There are mild to moderate-sized areas of increased signal 
intensity within the spinal cord at the level of the C4-5 disc representing either 
areas of spinal cord contusion or infarction at the site of the patient’s previous 
spinal cord compression. 
{¶8} 
“Findings of moderate to marked impingement upon the neural 
foramina of the right and left C5 and C6 nerve roots.  The visualization of these 
neural foramina is not optimal because of artifacts related to the patient’s anterior 
cervical fusion and the degree of neural foraminal impingement may appear 
greater because of this artifact. 
{¶9} 
“Specifically, there has been resolution of the spinal cord 
compression visualized on the previous examination.” 
{¶10} On November 20, claimant returned to Dr. Ruch.  Her office notes 
of that visit recorded: 
{¶11} “[Claimant] complained of pain in his hand and arm, occasional 
pain in his neck when he goes backwards and forwards and could not go back to 
work.  We had an EMG nerve condition study done which shows he has bilateral 
carpal tunnel.  He is complaining of pain in his hand.  All the fingers are numb.  
He has pain coming down from the elbow to the little and long fingers of his right 
hand.  The left hand seems to be fine.  We did repeat the MRI scan which shows 
lots of screw artifact.  There are changes in the spinal cord from the previous 
January Term, 2003 
3 
spinal cord impingement.  There are some things on there that I absolutely cannot 
say because of the screw artifact, basically his graft looks like it is in good 
position and his spinal cord looks decompressed.  His EMG nerve conduction 
study shows bilateral carpal tunnel.  I think that he has that as well as tendinitis of 
his right hand which is keeping him from using his hand effectively.  He is still 
having some pain in his neck on movement and positioning which I do think is 
secondary to the surgery.  * * * The carpal tunnel he has I am sure is related to 
multiple repetitive activities and work related injury.” 
{¶12} November 28 saw Dr. Ruch complete a new C-84 physician’s 
report.  At question 7, she was asked if claimant could return to his former job.  
She answered negatively with the notation “see transcription,” which all parties 
interpreted to refer to her November 20 office notes.  When asked to “list ICD-9 
Codes with the narrative diagnosis(es) for allowed conditions being treated which 
prevent return to work” (emphasis added), she wrote the numbers 722.0 and 
722.71, which correspond to displacement of cervical intervertebral disc without 
myelopathy and intervertebral disc disorder with myelopathy-cervical region.  She 
was additionally asked to list ICD-9 codes “with narrative diagnosis(es) for other 
allowed conditions being treated,” and she responded with number 354.0, for 
carpal tunnel syndrome.  She again referred to her transcription as the basis for 
her extension of disability to March 1, 2001. 
{¶13} On December 1, 2000, an employee from the Ohio Bureau of 
Workers’ Compensation wrote to Dr. Ruch: 
{¶14} “The notes from the injured worker’s examination on 11-20-2000 
indicated that Mr. Ignatious could return to work with restrictions that he not lift 
25 pounds.  Mr. Ignatious had advised the Bureau of Workers’ Compensation that 
he was returning to work. 
{¶15} “Then the Bureau of Workers’ Compensation receives a C84 
taking Mr. Ignatious off work with an estimated return to work date of 3-1-2001.  
SUPREME COURT OF OHIO 
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The Claims Specialist at the Bureau of Workers’ Compensation calls your office 
for clarification.  This claim is allowed for 847.0 and herniated disc C4-C5 and 
C5-C6.  Medical from the office visit on 11-20-2000 reveal[s] that the injured 
worker has bilateral carpal tunnel.  This is not allowed on this claim at this time. 
{¶16} “The Claims Specialist was advised by your office that the injured 
worker was continuing to have neck pain and tendinitis.  All previous medical 
documentation indicates that the injured worker had neck pain, however your 
office note of 11-20-2000 [sic, 10/20/00] released Mr. Ignatious to work.  The 
Fairview Hospital notes of 11-11-2000 indicate that the injured worker had pain 
in his hands.  The notes of 11-20-2000 mostly refer to the pain that the injured 
worker is having in both hands.  The Claims Specialist is trying to clarify the 
change regarding the return to work from 11-20-2000 to 11-28-2000.  As the 
claim is not allowed for bilateral carpal tunnel, please advise what the changed 
circumstances are from 11-20-2000 to 11-28-2000.” 
{¶17} Dr. Ruch’s December 15 office notes were presumably in response 
to this request, as she noted: 
{¶18} “Mr. Ignatious’ records were sent to me and they state he has 
fibromyalgia and a cervical whiplash syndrome.  I don’t think this is the cause of 
his current neck pain.  I think that his fibromyalgia and whiplash were most likely 
due to the cervical disc herniations that he had and his new problem is from the 
cervical disc.  Now he is post surgery.” 
{¶19} She also prepared a new C-84 dated January 9, 2001.  There, she 
named neck pain as the sole reason for claimant’s inability to return to his former 
position of employment and indicated that claimant was being treated for code 
722.0 (cervical intervertebral disc disorder) and 847.0 (neck sprain).  Carpal 
tunnel syndrome was not listed as a cause of disability.  On May 18, she sent her 
most direct clarification yet: 
January Term, 2003 
5 
{¶20} “John Ignatious * * * has been temporarily totally disabled from 
May 9, 2000 and was estimated to return to work on March 1, 2001, due to his 
allowed condition of sprain of neck and herniated disc C4-5 and C5-6.” 
{¶21} Appellant Industrial Commission of Ohio nevertheless denied TTC 
from November 6, 2000, forward: 
{¶22} “Claimant’s attending physician and surgeon faxed a return to 
work slip to the employer on 10/20/2000 indicating a return to work of 
11/06/2000 with restrictions.  The employer in turn notified the claimant that they 
were ‘looking forward’ to his return on that date and would make the 
accommodations necessary to comply with Dr. Ruch’s 25 pound weight 
restriction.  The claimant however did not return to work on that date and has in 
fact not returned as of the date of this hearing. 
{¶23} “The claimant testified at hearing that he experienced an 
exacerbation of his symptoms shortly before his scheduled return to work date 
(possibly due to sleeping incorrectly) and that he was unable to return to work.  
He indicated that he informed Dr. Ruch of this episode and was prescribed 
medication and scheduled for an appointment.  Dr. Ruch re-evaluated the 
claimant on 11/20/2000 and completed another C-84 report dated 11/28/2000 in 
which she disabled the claimant through 03/01/2001.  (Dr. Ruch incorporated by 
reference a notation to see her transcription records which focused on claimant’s 
carpal tunnel syndrome, a non-allowed condition of the claim).  Dr. Ruch 
completed yet another C-84 on 01/09/2001 and attempted to rectify the muddled 
situation by changing the allowed diagnostic codes and certifying disability for 
the correct conditions.  This opinion was also verified again by Dr. Ruch in a 
report dated 05/18/2001. 
{¶24} “The Deputy finds that the claimant’s request for further 
compensation is not supported by the evidence.  The original C-84 dated 
11/28/2000 is based on a non-allowed condition as the doctor’s own office notes 
SUPREME COURT OF OHIO 
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from that date indicate that claimant’s problems are due to carpal tunnel 
syndrome.  Further, Dr. Ruch does not explain why she changed her opinion as to 
the claimant’s underlying disability in the 01/09/2001 C-84 report.  The claimant 
testified that he experienced an aggravation of symptoms, however Dr. Ruch 
makes no mention of this or any other reason for the change.  On 10/20/2000, she 
found that claimant was doing well and ready to go back to work. 
{¶25} “The Deputy further notes that the Bureau of Workers’ 
Compensation had the claimant examined on 10/24/2000 by Dr. Anschuetz who 
concurred with Dr. Ruch’s 10/20/2000 office evaluation that the claimant could 
return to work with restrictions. 
{¶26} “The Deputy orders that claimant’s request for further temporary 
total compensation be denied based on the 10/24/2000 report of Dr. Anschuetz 
and the 10/20/2000 office record of Dr. Ruch. 
{¶27} “The Deputy finds that Dr. Ruch’s C-84 report of 11/28/2000 is 
based on a non-allowed condition as evidenced by her office record and further 
finds that inexplicably Dr. Ruch fails to give a basis for the ‘about-face’ in her 
medical opinion.” 
{¶28} Claimant petitioned the Court of Appeals for Franklin County for a 
writ of mandamus, alleging that the commission abused its discretion in denying 
TTC.  A split court of appeals held that a limited writ of mandamus was proper.  
The majority held that the commission erred in reading Ruch’s report as evidence 
attributing claimant’s disability to nonallowed carpal tunnel syndrome.  It ordered 
the commission to reevaluate the evidence and issue a new order either granting 
or denying TTC.  The dissent, however, stated that the majority was improperly 
substituting its interpretation of the evidence for the commission’s and 
recommended that the commission order be upheld. 
{¶29} This cause is now before this court upon an appeal as of right. 
January Term, 2003 
7 
{¶30} We are asked to determine whether the commission abused its 
discretion in denying TTC.  At the heart of this controversy is Dr. Ruch’s 
reference to carpal tunnel syndrome in some of her reports.  In asserting an 
entitlement to compensation, claimant relies on State ex rel. Waddle v. Indus. 
Comm. (1993), 67 Ohio St.3d 452, 619 N.E.2d 1018.  Waddle held that the 
presence of a nonallowed condition—even if disabling—could not defeat a claim 
for compensation so long as the claimant could show that the allowed conditions 
were independently disabling.  Claimant stresses that his physician’s reports 
expressly attribute his disability exclusively to his allowed conditions.  He argues 
that the commission misread the reports as stating that his nonallowed carpal 
tunnel syndrome was contributing to his inability to return to his former job. 
{¶31} The commission’s response is rooted in its exclusive authority to 
evaluate the weight and credibility of the evidence before it.  The commission 
asserts its right to look at the totality of the circumstances—an examination that 
the commission argues supports its position.  State ex rel. Burley v. Coil Packing, 
Inc. (1987), 31 Ohio St.3d 18, 31 OBR 70, 508 N.E.2d 936.  Citing Dr. Ruch’s 
October 2000 notations, the commission emphasizes claimant’s medical progress 
with regard to the allowed conditions that prompted Dr. Ruch to release him to 
return.  Dr. Anschuetz concurred.  Then, in November, Dr. Ruch delayed 
claimant’s return, and the accompanying medical evidence was replete with 
discussion of carpal tunnel syndrome.  From this, the commission contends that it 
was entitled to infer that carpal tunnel syndrome was contributing to claimant’s 
disability. 
{¶32} Both sides offer compelling arguments.  Claimant has accurately 
cited both Waddle and the evidentiary consensus as to causal relationship on his 
case.  Equally valid is the commission’s emphasis on its evidentiary prerogative.  
Without question, the commission is entitled to draw inferences from the evidence 
before it.  What it is not empowered to do, however, is alter the burden of proof. 
SUPREME COURT OF OHIO 
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{¶33} No one disputes claimant’s responsibility to establish a causal 
relationship between his allowed conditions and the claimed disability.  He is not, 
however, required to disprove a negative.  Having supplied evidence of a direct 
causal relationship between his allowed neck conditions and his disability, he is 
not required to further show that his carpal tunnel syndrome is not causing his 
inability to work.  Yet upon review, this is what the commission indeed appears to 
have done.  In response to the bureau’s request for clarification, Dr. Ruch 
supplied a January 9, 2001 C-84 and a May 18, 2001 letter.  The former listed 
“neck pain” as the sole cause of disability and the latter expressly to the allowed 
conditions of “sprain of neck and herniated discs C4-5 and C5-6.”  That the 
commission order continued even after these clarifications to rely on the presence 
of carpal tunnel syndrome to disqualify this evidence implies but one thing:  that 
the evidence was deemed insufficient because it did not affirmatively state that 
carpal tunnel syndrome was not influencing claimant’s inability to work.  In 
tacitly requiring this, the commission overstepped its bounds. 
{¶34} All of the evidence in this case attributes claimant’s inability to 
work to the allowed conditions only.  We order the commission to grant TTC 
from November 6, 2000, to March 1, 2001, consistent with Dr. Ruch’s C-84s. 
Judgment accordingly. 
 
MOYER, C.J., RESNICK, F.E. SWEENEY, PFEIFER, LUNDBERG STRATTON and 
O’CONNOR, JJ., concur. 
 
COOK, J., not participating. 
__________________ 
 
Gary H. Hoffman, for appellee. 
 
Jim Petro, Attorney General, and Erica L. Bass, Assistant Attorney 
General, for appellant. 
__________________