Title: State ex rel. George v. Indus. Comm'n

State: ohio

Issuer: Ohio Supreme Court

Document:

[Until this opinion appears in the Ohio Official Reports advance sheets, it may be cited as 
State ex rel. George v. Indus. Comm., Slip Opinion No. 2011-Ohio-6036.] 
 
 
NOTICE 
This slip opinion is subject to formal revision before it is published in 
an advance sheet of the Ohio Official Reports.  Readers are requested 
to promptly notify the Reporter of Decisions, Supreme Court of Ohio, 
65 South Front Street, Columbus, Ohio 43215, of any typographical or 
other formal errors in the opinion, in order that corrections may be 
made before the opinion is published. 
 
SLIP OPINION NO. 2011-OHIO-6036 
THE STATE EX REL. GEORGE, APPELLEE, v. INDUSTRIAL  
COMMISSION OF OHIO ET AL., APPELLANTS. 
[Until this opinion appears in the Ohio Official Reports advance sheets, it 
may be cited as State ex rel. George v. Indus. Comm.,  
Slip Opinion No. 2011-Ohio-6036.] 
Workers’ compensation—Evidence—Inconsistencies in medical reports. 
(No. 2010-1841—Submitted October 18, 2011—Decided November 30, 2011.) 
APPEAL from the Court of Appeals for Franklin County, No. 09AP-1009,  
2010-Ohio-4320. 
__________________ 
Per Curiam. 
{¶ 1} Appellant Industrial Commission of Ohio denied appellee’s, 
Matthew T. George’s, request to authorize further shoulder surgery, after finding 
that the proposed procedure was unrelated to the conditions allowed in his 
workers’ compensation claim.  That denial is now at issue. 
{¶ 2} George’s workers’ compensation claim has been allowed 
exclusively for right shoulder conditions.  Surgery for those conditions was first 
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performed by Dr. Larry W. Watson in 2004.  The procedure yielded good results, 
and George returned to work with appellant Honda of America Manufacturing, 
Inc., without medical restriction. 
{¶ 3} George had no further treatment to his right shoulder until 
February 2008, when he returned to Dr. Watson with renewed shoulder 
complaints.  Dr. Watson felt that these symptoms were related to the industrial 
injury, and he asked self-insured Honda to add new shoulder conditions to the 
claim and to authorize shoulder surgery to correct them. 
{¶ 4} An independent medical examination was performed by Dr. 
Christopher Holzaepfel in response to these requests.  Dr. Holzaepfel did not 
believe that George’s shoulder complaints were related to the industrial injury, 
stressing George’s successful recovery from his earlier surgery, his return to 
Honda without restriction, and his 3½ years without treatment.  Dr. Holzaepfel 
felt instead that George’s symptoms were related to his work with a property-
management company—a job taken after George left Honda for undisclosed 
reasons. 
{¶ 5} Honda also had George medically examined by Dr. Walter H. 
Hauser. Dr. Hauser found nothing wrong with George’s right shoulder, with every 
facet of his examination eliciting normal results.  The exam did, however, reveal a 
ruptured biceps tendon, which is not allowed in the claim.  Hauser believed that 
this biceps rupture was the source of George’s complaints and would not be 
corrected by further shoulder surgery: 
{¶ 6} “Therefore, it is my opinion, after taking a history, physical 
examination, and accepting his current allowed conditions in this claim, that he 
has been a very active individual.  This is confirmed by the records.  Surveillance 
indicates that he has been able to use his right shoulder in a very active manner.  
He has no objective findings on his physical examination other than the rupture of 
the biceps tendon.  It is my opinion that the rupture is totally unrelated to his 
January Term, 2011 
3 
 
work-related injury on 10/02/2003, but to his subsequent activities, including his 
workouts at the health club.  Once a biceps tendon has been ruptured, there is no 
indication to do an open repair at this time, and certainly not based on his original 
injury on 10/02/2003.  He has excellent strength in his upper extremities, and no 
impairment that can be noted judging by his activities on the surveillance video.  
There is no need to repair his rotator cuff and, hence, in my opinion, absolutely no 
reason for any further surgery and certainly not for the allowed conditions in this 
claim, which were resolved with his prior surgery.” 
{¶ 7} Honda would not authorize shoulder surgery based on Hauser’s 
report.  The commission also denied the surgical request based on that same 
document. 
{¶ 8} George filed a complaint in mandamus in the Court of Appeals for 
Franklin County.  The appellate court granted a limited writ that ordered the 
commission 
to 
reconsider 
the 
application, 
after 
finding 
“troubling 
inconsistencies” within Dr. Hauser’s report that it believed disqualified the report 
from evidentiary consideration.  2010-Ohio-4320 at ¶ 17. 
{¶ 9} This cause is now before this court on appeals as of right by Honda 
and the commission. 
{¶ 10} Authorization for medical treatment requires a causal relationship 
between the allowed conditions and the proposed services. State ex rel. Miller v. 
Indus. Comm. (1994), 71 Ohio St.3d 229, 643 N.E.2d 113.  The commission did 
not find a causal connection in this case, based on Dr. Hauser’s report.  The 
evidentiary viability of that report is the sole issue now presented. 
{¶ 11} The commission is exclusively responsible for assessing the weight 
and credibility of evidence. State ex rel. Burley v. Coil Packing, Inc. (1987), 31 
Ohio St.3d 18, 31 OBR 70, 508 N.E.2d 936.  It need only cite evidence in support 
of its decision, and the presence of contrary evidence is immaterial. Burley; State 
ex rel. West v. Indus. Comm. (1996), 74 Ohio St.3d 354, 658 N.E.2d 780.  It 
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cannot, however, rely on a medical opinion that is equivocal or internally 
inconsistent. State ex rel. Eberhardt v. Flxible Corp. (1994), 70 Ohio St.3d 649, 
640 N.E.2d 815; State ex rel. Lopez v. Indus. Comm. (1994), 69 Ohio St.3d 445, 
633 N.E.2d 528. 
{¶ 12} The court of appeals found that Dr. Hauser’s report could not 
support the commission’s decision, because it was internally inconsistent in four 
respects.  Its analysis, however, either ignores or misinterprets our decisions in 
Eberhardt, Lopez, and State ex rel. Domjancic v. Indus. Comm. (1994), 69 Ohio 
St.3d 693, 635 N.E.2d 372. 
{¶ 13} Eberhardt and Lopez were variations on the same theme—medical 
opinions that were contradicted by or inconsistent with other statements that the 
doctor had made either in a previous report or within the same report.  In Lopez, 
the challenged physician’s report indicated that the claimant had a very high 
degree of impairment, but then concluded that he could perform heavy foundry 
labor.  We found that the report could not be relied upon to support denial of 
compensation for permanent total disability, because both statements were 
relevant to the question of the claimant’s ability to work, yet neither could be 
reconciled with the other, undermining the reliability of the document as a whole. 
{¶ 14} In Eberhardt, the claimant’s attending physician indicated that 
unless a physical rehabilitation program was approved, there was nothing more he 
could do to help his patient.  A commission regional board of review interpreted 
that statement as evidence of maximum medical improvement and used it to deny 
temporary-total-disability compensation.  In response, the doctor prepared a 
second report that clarified that he did not believe that claimant’s condition was 
permanent, because it could be improved through rehabilitation.  On appeal, 
however, the commission affirmed denial of compensation based on the same 
evidence. 
January Term, 2011 
5 
 
{¶ 15} The two reports were the focus of litigation before this court, 
which gave us an opportunity to discuss the important distinction between 
equivocal opinions and those that were simply ambiguous.  Equivocation 
disqualifies an opinion from consideration and occurs “when a doctor repudiates 
an earlier opinion, renders contradictory or uncertain opinions, or fails to clarify 
an ambiguous statement.” 70 Ohio St.3d at 657.  Ambiguous remarks, on the other 
hand, “are inherently different from those that are repudiated, contradictory or 
uncertain.  Repudiated, contradictory or uncertain statements reveal that the 
doctor is not sure what he means and, therefore, they are inherently unreliable.  
Such statements relate to the doctor’s position on a critical issue.  Ambiguous 
statements, however, merely reveal that the doctor did not effectively convey 
what he meant and, therefore, they are not inherently unreliable.  Such statements 
do not relate to the doctor’s position, but to his communication skills.  If we were 
to hold that clarified statements, because previously ambiguous, are subject to 
Jennings or to commission rejection, we would effectively allow the commission 
to put words into a doctor’s mouth or, worse, discount a truly probative opinion.  
Under such a view, any doctor’s opinion could be disregarded merely because he 
failed on a single occasion to employ precise terminology.  In a word, once an 
ambiguity, always an ambiguity.  This court cannot countenance such an 
exclusion of probative evidence.” (Emphasis added.)  Id., citing State ex rel. 
Jennings v. Indus. Comm. (1982), 1 Ohio St.3d 101, 1 OBR 135, 438 N.E.2d 420. 
{¶ 16} Eberhardt cautioned against an overzealous approach to discarding 
a medical report simply because two statements in it, irrespective of context, are 
inconsistent. Instead, we are asked to consider whether the inconsistency is 
germane to the purpose of the medical exam—what Eberhardt referred to as the 
critical issue.  In Lopez and Eberhardt, the doctors were asked to determine 
whether the claimants satisfied the medical criteria for the type of total-disability 
compensation being sought.  Accordingly, clarity on the issue of claimant’s work 
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capacity was critical in Lopez (permanent total disability), as was the temporary 
nature of the disability in Eberhardt (temporary total disability).  Had the 
inconsistency been one in which the date of injury, for example, had been listed as 
both 2001 and 2003, it is highly improbable that anyone would have insisted that 
either report be discarded.  Those facts were simply irrelevant to the question 
asked in both cases. 
{¶ 17} The alleged inconsistencies in this case fall into the latter category.  
The critical question asked of Dr. Hauser was whether additional shoulder surgery 
was necessary. Dr. Hauser opined that it was not, because his physical 
examination revealed nothing wrong with George’s shoulder.  Accordingly, the 
presence of inconsistencies within his report that do not contradict that critical 
opinion are harmless.  This includes Dr. Hauser’s reference to George’s first visit 
with Dr. Watson as having occurred in both 2003 and 2008.  It also includes his 
comment on a lack of available medical information after discussing in detail all 
of the medical reports in the file. 
{¶ 18} The court of appeals also erred in accusing Dr. Hauser of failing to 
accept all of the allowed conditions.  To the contrary, Dr. Hauser listed all of the 
allowed conditions and expressly stated his acceptance of them.  He simply felt 
that these conditions had resolved, which, under Domjancic, does not equate to 
nonacceptance.  Moreover, it does not matter when Dr. Hauser believed the 
conditions resolved—another criticism leveled by the court of appeals.  It is not 
germane to his conclusion that George’s physical examination revealed no 
shoulder abnormalities. 
{¶ 19} Ultimately, none of the alleged inconsistencies noted in the Hauser 
report affect the viability of the doctor’s opinion that further surgery is not 
reasonably related to the allowed conditions.  The report is therefore evidence 
supporting the commission’s decision. 
{¶ 20} The judgment of the court of appeals is reversed. 
January Term, 2011 
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Judgment reversed. 
O’CONNOR, C.J., and PFEIFER, LUNDBERG STRATTON, O’DONNELL, 
LANZINGER, CUPP, and MCGEE BROWN, JJ., concur. 
__________________ 
Charles Zamora Co., L.P.A., and Karen D. Turano, for appellee. 
Michael DeWine, Attorney General, and Sandra E. Pinkerton, Assistant 
Attorney General, for appellant Industrial Commission of Ohio. 
Vorys, Sater, Seymour & Pease, L.L.P., and Robert A Minor, for appellant 
Honda of America Manufacturing, Inc. 
______________________