Title: State ex rel. St. Marys Foundry Co. v. Indus. Comm.

State: ohio

Issuer: Ohio Supreme Court

Document:

The State ex rel. Tilley, Appellee, v. Industrial Commission of Ohio et al.; 
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Mt. Carmel Medical Center, Appellant. 
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[Cite as State ex rel. Tilley v. Indus. Comm. (1997), ____ Ohio 
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St.3d ______.] 
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Workers’ compensation -- Permanency-based denial of temporary 
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total disability compensation that does not examine every 
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allowed condition is incomplete -- Industrial Commission’s 
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declaration of maximum medical improvement an abuse of 
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discretion absent its consideration of claimant’s degenerative 
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disc disease. 
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(No. 95-159 -- Submitted March 4, 1997 -- Decided June 4, 1997.) 
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Appeal from the Court of Appeals for Franklin County, No. 
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93APD12-1650. 
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Appellee-claimant, Helen L. Tilley, injured her low back on January 
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13, 1989 while in the course of and arising from her employment with 
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appellant, Mt. Carmel Medical Center.  A workers’ compensation claim was 
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allowed for “lumbosacral strain, head trauma * * * .”  Claimant missed 
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approximately a month of work before returning to her former position of 
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employment. 
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In early 1991, claimant sought to reactivate her claim, including the 
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resumption of temporary total disability compensation from November 26, 
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1990 on.  A district hearing officer for the Industrial Commission of Ohio 
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awarded temporary total disability compensation from November 25, 1990 
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through July 9, 1992, and to continue based upon submission of medical 
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proof. 
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On October 19, 1992, claimant was examined on Mt. Carmel’s behalf 
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by Dr. Timothy J. Fallon.  He reported: 
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“In summary then, we have an individual who has complaints of low 
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back pain and leg pain, and who presents a soft tissue type symptomatology.  
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She does not present with evidence of a radicular component or a 
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discogenic basis on a clinical basis.  The MRI report indicates that she did 
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have degenerative disc disease with bulging at several levels secondary to 
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osteoarthritis which is a pre-existing condition.  She does not have a 
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herniated disc.  There is no evidence of neural encroachment.  Based on my 
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examination, she would be able to continue in her work activity in that she 
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was doing this prior to the injury and her condition has not essentially 
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changed from the standpoint of pathology that is noted.  One would, 
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however, due to her small stature, place her on a lifting restriction on an 
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empiric basis, and I would arbitrarily place this lifting restriction at 30 
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pounds.  Her impairment then at this time is one which is stabilized and 
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maximally medically improved, and represents a 10% permanent partial 
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impairment.”  
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Three weeks later, claimant requested the additional allowance of 
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“aggravation of pre-existing degenerative disc disease of the lumbar spine.”   
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The condition was allowed by a district hearing officer on January 8, 1993 
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“based on the medical reports of: Drs. Fallon (10-19-92) and Mays (9-8-92 
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& 2-1-92).”  
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On February 1, 1993, Mt. Carmel moved to terminate temporary total 
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disability compensation based on the reports of Drs. Fallon and Gerald S. 
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Steiman.  Staff hearing officers terminated temporary total disability 
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compensation as of July 12, 1993 “based upon the report of Dr. Fallon, 
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dated 10/19/92, wherein he found tht [sic] the claimant had reached 
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maximum medical recovery.”  Claimant’s “request for reconsideration” was 
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denied. 
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Claimant filed a complaint in mandamus in the Court of Appeals for 
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Franklin County, asserting that Dr. Fallon’s report was not “some evidence” 
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supporting the denial of temporary total disability compensation.  Claimant 
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argued that because Fallon had examined her before degenerative disc 
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disease (“DDD”) condition was additionally allowed, that condition was not 
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considered in his permanency assessment.  The court of appeals agreed, 
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vacated the order, and returned the matter for further consideration and 
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amended order. 
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This cause is now before this court upon an appeal as of right. 
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Law Offices of James L. Mackin & Associates Co., L.P.A., and James 
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L. Mackin; Law Offices of Patrick J. Piccininni and Patrick J. Piccininni, 
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for appellee. 
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Arter & Hadden, Douglas M. Bricker and Lisa A. Reid, for appellant. 
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Per Curiam.  Eligibility for temporary total disability compensation 
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requires, among other things, that the disabling medical condition(s) are not 
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yet permanent, i.e., not maximally medically improved.  See State ex rel. 
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Ramirez v. Indus. Comm. (1982), 69 Ohio St.2d 630, 23 O.O. 3d 518, 433 
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N.E. 2d 586; R.C. 4123.56(A).  Dr. Fallon assessed maximum medical 
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improvement, prompting the termination of claimant’s temporary total 
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disability compensation.  Claimant successfully disqualified Fallon’s report 
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in the court below, arguing that Fallon did not consider aggravation of DDD 
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in finding maximum medical improvement.  Mt. Carmel disputes Fallon’s 
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obligation to consider the condition, but alternatively argues that if Fallon 
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were required to consider it, review of his report establishes that he did.  Mt. 
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Carmel asserts further that disqualification of the Fallon report violates 
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State ex rel. Zamora v. Indus. Comm. (1989), 45 Ohio St.3d 17, 543 N.E.2d 
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87.  For the reasons to follow, we find in claimant’s favor. 
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We address Mt. Carmel’s alternative contention first.  A review of 
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Fallon’s report contradicts Mt. Carmel’s assertion.  Dr. Fallon’s only 
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mention of claimant’s DDD is his acknowledgment of an MRI confirming 
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its presence.  Fallon does not independently verify its existence nor does he 
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venture an opinion as to causal relationship.  Nothing in his report implies 
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that DDD was taken into account when maximum medical improvement 
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was assessed. 
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Mt. Carmel responds that notwithstanding Fallon’s failure to consider 
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claimant’s DDD, his report is still “some evidence” supporting the 
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commission’s decision.  We again disagree.  When multiple conditions 
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prevent a claimant’s return to the former position of employment, it is 
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imperative that a permanency determination include consideration of all 
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allowed conditions.  This is because an improvement in an allowed 
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condition that was not considered may elevate claimant’s overall condition 
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to the point where claimant can work.  Thus, a permanency-based denial of 
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temporary total disability compensation that does not examine every 
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allowed condition is incomplete. 
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Contrary to Mt. Carmel’s representation, this principle does not 
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conflict with State ex rel. Rouch v. Eagle Tool & Machine Co. (1986), 26 
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Ohio St.3d 197, 26 OBR 289, 498 N.E.2d 464.  In Rouch, the claimant 
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sought, among other things, temporary total disability compensation.  Dr. 
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Turton evaluated claimant’s allowed psychiatric condition and concluded 
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that it did not prevent a return to the former job.  Dr. Reynolds examined 
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claimant’s physical condition and determined that it also did not bar a 
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return.  The commission denied temporary total disability compensation 
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based on these two reports.   
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The claimant in Rouch challenged the denial based on State ex rel. 
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Anderson v. Indus. Comm. (1980), 62 Ohio St.2d 166, 16 O.O. 3d 199, 404 
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N.E.2d 153.  Anderson, since overruled, prohibited the commission, in 
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determining whether a disability was due to a combination of allowed 
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conditions, from relying on any medical report in which the physician did 
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not evaluate the combined effects of the allowed conditions.  Rouch 
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modified Anderson, holding: 
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“* * * [W]e now recognize that it is impracticable to require, through 
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hypertechnical evidentiary rules, that physicians pretend to be specialists in 
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all fields of medicine.  This court should not usurp the rule of the 
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commission in determining disability by creating arbitrary exclusionary 
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rules that eliminate evidence the commission may deem credible and 
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relevant.  We hold that the Industrial Commission, in determining whether a 
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claimant is disabled due to the combined effects of two or more allowed 
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conditions, may base its finding upon the medical report of a physician who 
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examines the claimant with regard to one of the allowed conditions and 
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recognizes the existence of the other allowed condition(s) by referring to 
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them in his report.  We further hold that the commission, in making this 
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disability determination, may consider and rely on a medical report in which 
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an examining physician evaluates a claimant only with regard to the 
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condition that relates to the physician’s particular area of expertise.”  Id. at 
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199, 26 OBR at 291, 498 N.E.2d at 467. 
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In citing the above holding, Mt. Carmel misses the distinction 
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between this case and Rouch.  In Rouch, compensation was denied based on 
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the reports of Dr. Turton and Dr. Reynolds.  While Turton did not examine 
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claimant’s orthopedic condition, Reynolds did.  Conversely, Reynolds did 
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not evaluate claimant’s psychological condition, but Turton did.  Thus, 
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between the two doctors, all allowed conditions were medically evaluated 
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and were considered by the commission.  In this case, the commission did 
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not rely on any report that considered the allowed DDD condition.  Thus, 
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while Rouch excuses Fallon’s failure to evaluate DDD, it does not excuse 
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the commission’s failure to consider it utilizing other evidence.  
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Mt. Carmel lastly asserts that disqualification of Fallon’s report 
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violates Zamora.  This argument fails as well.  In Zamora, the claimant 
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sought an additional allowance for “aggravation of depression.”  Dr. Kogut 
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examined claimant and concluded that claimant’s depression preceded his 
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industrial injury.  He also opined that the contribution of the injury to any 
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current depression was minimal.  A regional board of review, however, 
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relying on another physician’s report, allowed the additional condition.  
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That order was administratively affirmed. 
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The claimant in Zamora later moved for permanent total disability 
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compensation.  The commission denied his application, based largely on Dr. 
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Kogut’s report.  Claimant challenged the denial, arguing that the 
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commission’s reliance on Dr. Kogut’s report was improper, since it had 
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implicitly rejected that report when it additionally allowed the psychological 
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condition.  We agreed, writing: 
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“[I]t would be inconsistent to permit the commission to reject the 
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Kogut report at one level, for whatever reason, and rely on it at another.  
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Accordingly, the Kogut report cannot constitute some evidence that Zamora 
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is not permanently and totally disabled.”  Id. at 19, 543 N.E.2d at 89. 
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Mt. Carmel attempts to equate this case with Zamora.  It notes that 
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the commission had earlier relied on Fallon’s report when it allowed the 
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DDD condition.  Mt. Carmel contends that to hold the commission cannot 
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rely on Fallon now would create the kind of inconsistency that Zamora 
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prohibits.  This contention lacks merit. 
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The relevant chronology in this case renders Zamora inapplicable.  
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Zamora is properly invoked when the commission tries to revive evidence 
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that was previously deemed unpersuasive.  Thus, unless rejection preceded 
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reliance, Zamora does not apply.  Here, the commission’s initial encounter 
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with Fallon’s report generated reliance on that report, not rejection.  Revival 
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is not an issue. 
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We find, therefore, that the commission’s declaration of maximum 
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medical improvement is an abuse of discretion absent its consideration of 
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claimant’s degenerative disc disease.  Accordingly, the judgment of the 
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court of appeals is affirmed. 
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Judgment affirmed. 
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MOYER, C.J., DOUGLAS, RESNICK, F.E. SWEENEY, PFEIFER, COOK 
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and LUNDBERG STRATTON, JJ., concur. 
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