1 IN TH E COURT OF APPEALS O F THE ST ATE OF NEW MEXICO

2 O pin ionN um

be r: ___ ____ ____ ___ 3 Fi lin g D at e: A ugus t 17 , 201 7 4 N O. 35, 219 5 JAI ME MOL INAR, 6 W orke r- Appe llant, 7 v. 8 LARRY REETZCONSTRUCTI ON, LTD., 9 REE TZCO NS TRU CTION , IN C. , and 10 BUIL DER S TR US T OF NE W MEX ICO, 11 E m

plo y er /I nsur er -Appe lle es . 12 AP PE AL FR OM T HE WORKER S’ C OMP ENS ATION AD MIN ISTR ATION 13 R eg in ald C . Wo od ar d, Wo rker s’ C om pe ns at ion Ju dg e 14 L ee A nn O rt iz 15 Alb uq ue rq ue , NM 16 fo r Appe llant 17 Butt Thornton & Baehr P C 18 M. S cott Ow en 19 Alb uq ue rq ue , NM 20 for Appellees1 OPIN ION

2 HAN ISEE, Judge. 3 { 1} W orke r J a i m e M o l i n ar appe al s ade ci sio n of

the W orke rs ’ Co m

pe nsa tio n Ju dge 4 (W CJ) deny ing W orker’ s claim for per m anent partial disability (P PD ) an d m edical 5 be ne fi ts ba se d onthe W CJ ’ s f ind ing that W orke r’ s di sa bil ity w as not c au se d by

his 6 w ork- re la te d a cc ide nt. W or ker ar gue s th at his w ork- re la te d a cc ide nt a ggr av at ed a 7 preexisting con ditio n, re sultin g in his PPD , thus entitling him to PPD and m edical 8 benefits, as w ell as m ileage re im bursem ent for t ra v el associated with his m edical 9 ap poi ntm en ts. W orke r al so cla im s that the W orke rs ’ Co m pe nsa tio n A dm ini str at ion 10 (W CA ) vio la te d N MS A 197 8, S ec tio n 52 -1 -5 4( M) (2 01 3) of the W orke rs ’ 11 Co m pe nsa tio n A ct

( the A ct ) by

pay ing E m

plo y er /I nsur er a tto rn ey f ee s pr ior to the 12 se ttl em en t or

a dj udi catio n of

W orke r’ s c la im

. W e re ve rs e an d r e m an d f or pr oc ee din gs 13 co nsi ste nt w iththi s op ini on. 14 BACKGRO UND 15 History of Work er’s P rior Inju ry 16 { 2} W orke r suf

fe re d anon -w ork- re la te d in j ur y ( fe m or al ne ck

f ra ct ur e) to his r igh t 17 hip in 2002 that r equir ed ins ta llatio n of

hip sc re w s and a

sid e pla te in his r igh t hi p. 18 W orke r re co ve re d f

ro m his 200 2 in

j ur y a nd b eg anw orkin g sh ortly the re af te r as a 19 carpenter

for L arry Reetz Construction , L td. (E m ploy er).2

1 { 3} InN ove m

be r 2006 W orke r be ga n to ex pe ri en ce pa in in h is l eg , spe ci fi ca lly in 2 th e ri gh t t hi gh /h ip area wher e h e ex pe rie nc edth e fem or al ne ck frac tu re in 20 02 . He 3 w as se ena t the U niv er sity of N ewMe xic o H ospi ta l (U N MH ) six tim es be tw ee n 20 06 4 an d 20 11 t o a ddr es s hi s pai n. During W orke r’ s 20 06 v isi t, W orke r’ s tr eatin g 5 phy sic ian no te d th at

W orke r ha d “ ri ght

hip pos ttr au m at ic a rthr iti s” an d th at the 6 ar thr iti s w as “ in the ini tial st ag e[.]” I n F eb ru ar y 200 7 W orke r w as dia gnos ed w ith 7 avascular necrosis (A VN ) of the right fem oral n eck, and a to tal hip replace m ent was 8 dis cu sse d. W orke r did not pr oc ee d w ithhip r ep la ce m en t surg er y f or e co no m ic 9 re as ons. I n Janu ar

y 2008 W orke r re tur

ne d to U N MH due to “ sig nif

ic an t pa in i n hi s 10 ri ght hip es pe ci al ly

w itha m bul at iona nd w ork. ” A t tha t t im e, tot al hip r ep la ce m en t 11 w as r ec om

m en de d. W orke r w as a ga in s ee n inJul y 200 8, a t wh ic h ti m e a tot al hip 12 re pla ce m en t w as a ga in r ec om m en de d and W orke r w as r ef er re d fo r a pr eo pe rativ e 13 ev a l uat i on , w hi c h ne ve r o c c ur r e d. Upo n E m

pl oy e r ’ s r e qu e st

i n 20 08 , W or

ker 14 dis cl ose d hi s pr ee xis tin g c ondi tio n of a“ ba d hip ” to E m

plo y er a nd a gr ee d to sub m it 15 to a m ed ic al e xa m ina tio n if

r equir ed

. W or

ke r did not r et ur n t o UNMH un til Jun e 16 2010 , w he n he w as giv ena n in j ec tio n to m an ag e his w or se nin g pa in b ec au se he 17 ind ic at ed

that he c oul d no t a ff

or d to be of

f w ork inor de r to h av e the to ta l hi p 18 re pla ce m en t surg er

y . I n F eb ru ar

y 2011 W orke r w as re ady to unde rg o surg er y be ca use 1 9 h e “c o u l dn o tc o n t i n u e t o w o rk du e t o p a i n . ” Wo rk e r ’s t r e a t i n g p h ys i c i a n a tt h a tt i me3

1 desc rib edW or ke r’s co nd it io n a s “ po st tra um at ic de ge ne rat iv e joi nt dis ea se of the r igh t 2 hip , e nd- sta ge . ” W orke r ha d a pre ope rativ e eva lua tio n, an d surg er y w as sc he dul ed

. 3 H ow ev er , W orke r ne ve r ha d the sur ge ry , did not se ek a ddi tio na l m ed ic al c ar e fo r his 4 h i p a f t e r h i s 2 0 1 1 v i s i tt o UN M H , a n dc o n t i n u e dt o w o rk f o r Emp l o ye r “at f

u l l du t y” 5 u n t i l M a r c h 1 1 , 2 0 1 4 , wh e n Wo rk e r s u f f e r e dan o n - t h e -

jo b i n ju ry. 6 { 4} A cc or din g to E m ploy er’s pr es ide nt, L ar

ry Re et z, W orke r w as “ a de pe nda ble 7 em ploy ee” who did “ good work” and is an “ honest in di v i d u al .” Mr. Reetz testified 8 tha t W orke r did

not f re que ntl y c al l i n si ck

nor w as W orke r a pr obl em

f ro m the 9 standpo int of a

bsenteeism

. He would have been aw are, but was not, had W orker, at 1 0 som e t i m e du r i n g h i s e m p l o ym e n t , r e qu e s t e d a n e x t e n d e d p e r i o d o f t i m e o f f due to 11 his p r e e xi st i ng hi p c on di t i on . S i m i l a r l y , M r . R e e t z ha d no m e m or y of W orker 12 de cl ini ng t o pe rf

orm aj ob o r ta sk b as ed

upo n hi s pr ee xis tin g c ondi tio n. 13 Wor k er ’s M ar ch 11, 2014 , Wor k -R el at ed A cc id en t an d Su bs eq uent Med ic al 14 Treatm ent 15 { 5} O n M ar ch11, 201 4, W orke r fe ll fr om the thi rd ste p of a la dde r w hil e w orkin g 16 at one of E m

ploy er’ s job sites, landing on his righ t side (March 2 0 14 accident). 17 W orke r w as r efer re d by E m plo y er to its he al th c ar e pr ovi de r, Co nc en tr a Me dic al , 18 w he re he w as se enby

S te ve Card en as , P

. A

. W orke r re porte d an “ int en se pa in i n [ his ] 19 hip” with a p ain level of 1 0/10 and wa s initially diagnos ed with a “ contusi on of [the] 20 thigh ,” prescribed pain m edication and crutches, and instructed not to work. W orker4

1 returned to work w hen he was released to m odified dut y on May 8, 2014, then 2 al low ed

to lif t up to fi fty

pounds. W or ker co nti nue d to w ork w ith in t he r es tr ic tio ns 3 i mp o s e db y h i s t r e a t i n g p h ys i c i a n s u n t i l J u l y 1 2 , 2 0 1 4 , w h e n Wo rk e r ’s p a i n b e c a me 4 so d eb ili ta tin g th at

he w as no longe r ab le to con tinue his em plo ym en t. W orke r ha s no t 5 sin ce r et

ur ne d to w ork. 6 { 6} W orke r co nti nue d to r ec ei ve tr eatm en t a t C onc en tr a an d w as e ve ntu al ly 7 pr es cri be d u s e o f a c a n e b ecau se W or ke r “ jus t co ul d n ot am

bu la te wit ho ut it . He 8 ne ed ed the sup port be ca

use h is pa in w as so b ad

. ” W orke r al so c ont inu ed to be 9 p r e s c r i b e dp a i nmed i c a t i o n t o man a g e h i s p a i n a n d w a s r e f e rr e d t o p h ys i c a l t h e r ap y, 10 which he re ported was ineff ective. 11 Wor k er ’s Or th op ae di c Su rg eo n’ s C au sat ion Op in ion 12 { 7} Em

ploy er’ s insu rer, Builders Tr ust of New Mexico (Insurer) , r efer red W orker 13 to N ewMe xic o O rthopa ed ic s, w he re w orke r w as fi rs t se enby D r. A rn old

K iburz on 14 June 9, 2014. Dr. Kiburz noted that W orker’ s “ current conditi on is very likely relate d 15 to his in itial fall and right hip fracture in a som ew hat rem ote past” but also s tated that 16 his “ sym

ptom s are c onsis t en t wi t h [the] reported w ork injury .” Dr . K iburz then 17 re fe rr ed W orke r to his co lle ag ue D r. Jos hua Caro the rs be ca use of D r. Carothe rs ’ 1 8 s p e c i a l i z a t i o n i n h i p r e p l a c e men ts u r g e ry.5

1 { 8} Dr . C arothers fir st saw W orker on July 8, 2014 , four day s before W orker w as 2 no lon ger able to w ork. O n that date, D r. Caroth ers noted in W orker’ s chart that 3 “ [W orker] broke his hip back in 2002 and underwen t o p en reduction and int ernal 4 fixation.” A s to his observations based on his exam ination of W orker’ s right hip , D r. 5 Caro the rs not ed : 6 Ra d i ographs of the right h ip reviewe d today revea l severe j oint sp ace 7 narr ow ing [. ] T he re is a [tw o] hol e dy nam ic hip sc re wa nd s ide plate w ith 8 a de ro ta ti on sc re w . T he hardw ar e ap pe ar s to be in good pos iti on 9 however there has been [A VN ] of the fem oral head w ith severe collapse. 10 Thi s i s co ns is te nt wit h F ic atst ag e IV. 11 A t W orke r’ s f

oll owup v isi t onJul y

17, 201 4, D r. Caro the rs not ed : 12 [T]he ch an ge s i n th e hi p are rath er chro ni c an d I b el ie ve th atth e [AVN] 13 ha s be enlon g- standi ng and p re da te d th e inj ur y . T he pa tie nt w as ha vin g 14 pain prior to his fall and I believe that he had a we ll[-] com pensated 15 conditi on of the hip th at w as allowing him to function with occasional 16 and relatively m inim al discom fort. I believe that the fall disrupted [the] 17 te nuou s ba lanc e of the hip a nd h as r es ult ed

in an ag gr av at ion of the hip 18 an d m or e co nst an t and m or e de bil itatin g pa in. 19 Inr espo ns e to aque sti on f ro m I nsur er ’ s c la im s de pa rtm en t a ski ng h im to “ [p ] le as e 20 sta te to a re as ona

ble de gr ee of

m ed ic al pr oba

bil ity , if the ne ed fo r a le ft r igh t ne cr oti c 21 revision and righ t hip replace[m ent is] relate d to [W orker’ s] 3/11 /14 lo ss[,] ” D r. 22 Caro the rs state d: “ I be lie ve tha t the A V N w as pr es en t pr ior to the 3/1 1/1 4 fa ll but the 23 fal l ag gr av at edth e co nd it io n a nd wors en edth e p ai n.”17 E m

plo y er /I nsur er c ite d Niederstadt v. Ancho R ico Consol idated Mines , 197 5- 1 18 N MC A -0 59, 88 N

. M. 48, 536 P. 2d 1104 , as the ba sis fo r its r eque st. W e dis cu ss the 19 im port of Ni ed

er sta dt la te r in this opi nio n.

6 1 Em ployer/Insurer ’s Work ers’ C om pensation C om plaint 2 { 9} E m

plo y er /I nsur er f ile d ac om

pla int w iththe W CAon Augus t 8, 2014 , se ek ing 3 a de t e rm i n a t i o n o f

c o m p e n s ab i l i t y

a n db e n e f

i t s r e l a t e dt o W o rk e r ’ s M a r c h 2 0 14 4 ac ci de nt and i nj ur

y . E m plo y er /I nsur er c ha lle nge d D r. Caro the rs ’ c au sa tio n op ini on 5 t h a tWo rk e r ’s f

a l l “ a g g r a v a t e d ” Wo rk e r ’s “n e c r o s i s c o n d i t i o n . ” S p e c i f i c a l l y, 6 Em ploy er/Insurer

stated that Dr. Car others’ o pi ni on w a s “ high ly

suspect” because D r. 7 Caro the rs ha d not re vie w ed W orke r’ s pri or m ed ic al r ec or ds and c oul d no t “pinpoi nt 8 whe n t he n e c r os is of t he rig ht fem urhe adbe ga n wi th ou t re vi ewin g p rio r x- rays.” 9 Ther efore, Em

ploy er/Insurer

requested that the parties be allowe d to depo se Dr

. 10 Caro the rs in or de r to “pr ovi de [ D r. Caro the rs ] w itha ll pe rtin en t m ed ic al r ec or ds” 11 be ca use , E m plo y er /I nsur er a rg ue d, “ D r. Caro the rs ’ opinio n c an not e sta bli sh 12 cau sa ti on , at l eas t n ot un ti l h e h as rev ie wedall pe rti ne nt in fo rm at io n.” 1 13 Dr . C arothers’ De position Testim ony 14 { 10} T he p a rt i e s d e p o s e d D r . C a r o t h e r s o n N o v e m b e r 5 , 2 0 1 4

. Wh e n a ske d by 15 W orke r dur ing his de posi tio n w ha t he m eant b y the phr as e “ ag gr av at ionof the hip ” 16 in h is July

17 n ote s, D r. Caro the rs e xpl ai ne d:7

1 So m

y a sse ssm en t of

thi s is that the se ve ri ty

of his hip did

not r es ult 2 fr o m h i s f

a l l i n M a r c h

. I b e l i e v e t h a t i t

—t h e d o w n w a r d s p i r a l of his 3 hip [— ] be ga n w ith his tr au m a an d fr ac tur e in 2002 an d he ha s l ike ly 4 b e e n d ea l i n g wi t h o r c o p i n g wi t h a b ad h i p fo r a l o n g erp er i o do f t i me 5 an d hi s sy

m pto m s w or se ne d a s ar es ult of the f al l. Bu t I be lie ve tha t hi s 6 hip w as in en d[ -] sta ge a rthr iti s r el at ed to [A V N ] pr ior to the f al l. 7 During i ts exam ination of D r. Car others, E m ploy er/Insurer

presented Dr . C arothers 8 w ith W orke r’ s U

N MH m ed ic al re co rd s fr om 200 6- 2011

. A ft er

r ev ie w ing the r ec or ds 9 an d be ing as ke d whe the r “ the re ha s bee n a cha nge in y our opi nio n a s to a ggr av at ion , 10 causation with respect to the i nitial fall and March [ 2014 ] fall[, ] ” D r. Car others 11 sta te d: 12 So li ke I a tte m

pte d to m ak e cl ear, I thi nk [ W orke r’ s] c ondi tio n of his hip 13 re la te s to his ini tia l fa ll in 2002. I w oul d have e xpe ct ed him to ha ve pa in 14 long before t h e fa ll in March [2014] as is dem onstrated by the notes 15 fr om

U N M[ H ;] ho wev er, the re is a [thr ee ] -y ear ga p be tw ee n th e la st 16 U

N M[ H ] not e and the N ewMe xic o O rthope dic not es , so h e obvi ousl y 17 didn’ t have atot al hip r ep la ce m en t [and] ha s be en m ak ing d[ o]

. S o th e 18 dif

fi cu lty is [W orke r ha s] be enm ak ing d[ o] , he ha s anothe r fa ll at w ork, 19 nowhe is not m ak ing d[ o]

. S o it ’ s r ea sona ble to say that the f al l c oul d 20 ha ve ag gr av at ed the c ondi tio n of

his hip , but

by [ an d] larg e his 2 1 s ym

p t o ms , h i s h i p p a i n a r e s t e mm i n g f r o m th e o r i g i n a l i n

ju ry. 22 Whe n a ske d by E m

plo y er /I nsur er w he the r he ha d “ an opi nio n as to w he the r or not the 23 need for th e t o t al hip [replacem ent] is related to the initial fall versus the Marc h 24 [2 014] f

al l[ , ] ” D r. Caro the rs r es pond ed : 25 T he ne ed fo r a tota l hip [ re pla ce m en t] w as e sta bli she d by

the ini tia l f

al l, 26 the injury , the sub con g ea l

— o r the [A VN ] , and the resultant severe 27 arthritis. The need for it at t his m om ent m ay be related to his aggravated 28 sym

pto m s.8

1 O n r ed ir ec t, D r. Caro the rs w as a sked , “ Is it y our opi nio n th at

the w ork a cc ide nt i n 2 March [ 2014 ] hastened the need for the total hip replacem ent surgery ?” Dr. Car others 3 re spon de d: 4 T ha t’ s adif

fi cu lt q ue stion b ec au se he ’ s be enc ont em pla tin g hi p 5 re pla ce m en t fo r it soun ds lik e the pa st f ive or sixy ears . A nd, a s I m ad e 6 cl ear in m

y not es , his hip ha s be en ex ist ing in a te nuou s ba lanc e be ing 7 ab le to de al w iththe se ve rit y of his hip a rthr iti s. S o I w oul d st ill 8 m aintain that the need f o r hi p replacem ent now m ay be rela ted to that 9 fa ll fr om

Marc h [ 2014 ]. Bu t he ’ s be enne ed ing hip r ep la ce m en t f or 10 y ears . 11 Asked to state his causati o n opin ion based o n a rea sonable degree of m edical 12 probabilit y , D r. Car others stated, “ So I w ould say his fall in March [ 2014 ] prom pted 1 3 hi m t o s e e k a h i p r e p l a c e m e n t a t t h a t t i m e o r w i t h i n t h e n e x t f e w m ont hs” a nd 14 explained that hi s opin ion w as “ based on the sym ptom s reported” to him

by W orker. 15 Work er’s C om plaint Se ek ing Bene fits 16 { 11} O n D ec em

be r 9, 201 4, W orke r fi le d ac om pla int w iththe W CA , see kin g 17 te m por ar y tot al dis ab il it y (T T D ), P PD , a nd m ed ic al be ne fi ts. I n su ppor t of his 18 com plaint, W orker relied on Dr . C arothers’ testim ony regar ding causation between 19 W orker’ s March 2014 accident an d h i s disabil ity . S pecifically , W orker contended 20 tha t: 2 1 Dr . Car o t h er s s t at ed t h at t h e fa l l at wo rk ag g ra v a t e d Wo rk er ’s 22 preexisting conditi on and worsened his pain. D r. Car others also stated 23 tha t the re w as a[ thr ee ] -y ear ga p inm ed ical re co rd s im

m ed iate ly pr ior 24 to the fall at w ork on March 11, 2014[,] indicating that W orker w as19 E m

plo y er /I nsur er a ga in c ite d Ni ed

er sta dt despite having itself presented Dr

. 2 20 Caro the rs w ithW orke r’ s U N MH r ec or ds d

ur ing D r. Caro the rs ’ de posi tio n and the 21 fact that D r. Car others’ opin ion that W orker’ s AV N was aggravated by the fall w as 22 unc hange d. 9 1 m aking du e re garding his hip cond iti o n . No t ably , W orker has been 2 working as a carpenter f or this Em

ploy er the last [ eight] y ears. Dr

. 3 Carot hers state [d ] that the f al l a t w ork pr om

pte d W orke r to s ee k ahip 4 re pla ce m en t. 5 W orker included Dr . Carothers’ deposit ion testim ony with his com

plaint as well as 6 D r. Caro the rs ’ e ar lie r fo rm le tte r in w hic h he ha d opi ne d tha t W orke r’ s M ar ch201 4 7 fal l “ ag gr av at edth e co nd it io n a nd wors en edth e p ai n.” 8 { 12} Empl o y er/Insurer answer ed the com

plaint and raised as affir

m ative defenses 9 that W orker w as not hurt on the j ob, W orker was n ot disabl ed as a r esult of the March 10 2014 a cc ide nt, a nd W orke r fa ile d to e sta bli sh a ca usa l lin k be tw ee n th e Marc h 20 14 11 accident and his disab ility to a rea sonable m edical p ro bability . E m ploy er/Insurer 12 co nti nue d to c ha lle nge D r. Caro the rs ’ c au sa tio n op in iona s be ing “ not va lid ” an d 13 “ deficien[t] ” based on W orker’ s inclusi on of Dr. Car others’ form letter a s an 14 attachm ent to his com plaint, which Em

ploy er/Insurer noted Dr . C arothers provided 15 be f or e h e w a s de po se d a nd , t he r e f or e , b e f or e h e “ ha d a l l p e rt i ne nt m edical 16 inf orm at ion

. ” E m

plo y er /I nsur er a lso a rg ue d th at

D r. Caro the rs ’ te sti m ony fa ile d to 2 17 es ta bli sh a c au sa l l ink

be tw ee n th e Marc h 20 14 a ccid en t an d W orke r’ s di sa bil ity 18 be ca use “ D r. Caro the rs te sti fi ed that W orke r’ s nee d fo r [a] tot al hip [ re pla ce m en t]10

1 w a s e s t ab l i s h e d b y a n u n r e l a t e d f a l l ” a n d t h a t “th e n e e df

o r s u r g e ry m igh t be relate d 2 to th e fal l re po rte d wi th th is Em pl oyer.” 3 { 13} The par

ties attended a m ediation confere nce on January 13, 2015, but were 4 unable to re ac h an agree m ent. T he m ediator’ s recom m ended resolutio n found th at 5 “ W orker has carried h is burden of p roof and W orker’ s current com plaints are rela ted 6 to h is o n- the -j ob i nj ur

y ” an d thus r ec om

m en de d th at

“ the tr eatm en t r ec om

m en de d by 7 W orker’ s [health care provider] be provided with all relate d treatm ent[.] ” E m ploy er 8 re j ec te d th e re co m

m en de d r es olu tio n. 9 Work er’s Ind epen dentMed ical Exam ination (IME ) 10 { 14} In Marc h 201 5 W orker petitioned the W CJ for an IME “ to determ ine whether 11 the need for right hip replacem ent surgery rec omm ended by

orthopaedic surgeon Dr

. 12 Ca rothers is causally relate d to the work acc ident of March 11, 2014.” W orker 13 explained that “ [d] espite Dr. Car others testify ing th at t he work a ccident aggravated 14 an d w or se ne d th e pr e[ ] ex ist ing hip co ndi tio n, the sur ge ry ha s bee n de nie d. ” D es pit e 15 E m plo y er /I nsur er ’ s op posi tio n, the W CJgr an te d W orke r’ s r eque st. 16 { 15} A n I ME pane l c om pr ise d of Dr

. Barr ie Ro ss, a spe ci al ist in phy sic al m ed ic ine 1 7 a n d r e h ab i l i t a t i o n , a n d D r . P au l L e g a n t , a n o rt h o p a e d i c s u r g e o n , m e t o n J une 30, 18 2015

. I n it s e nsui ng r ep ort, the pane l r es ponded to sp eci fi c que sti ons pose d by the16 T he W CJ ’ s or de r gr an tin g W orke r’ s r eque st f or a n I ME pr ovi de d that the 3 17 part ie s w er e to w ork toge the r to j oin tly pr ep ar e a le tte r to the I ME pane l and tha t i n 18 th e ev en t t he pa rti es co ul d n ot ag ree, t he W CJ wou ld is su e a l et te r to th e p an el . On 19 May 13, 2015, the W CJ held a hearing at w hic h t he parties explained that they had 20 be enuna

ble to re ac h ag re em en t as to a le tte r. T hus the W CJ iss ue d his ow n le tte r to 21 the pane l, c ont ai nin g th irte enque sti ons. 11 1 W CJ. In response to a questio n about “ the nature of the inj ury or injur ies sustained 3 2 by W orker as a result of t he j ob[-] related a ccident(s)[, ] ” the panel described the inj ury 3 W orker suffer ed in the March 201 4 accident as a “ [r] ight hip contusi on sup erim posed 4 upon severe pr e[] existing posttraum atic right hip degenerative joint disease.” In 5 response to th e question, “ [w ] hich of W orker’ s com plaints, if any , are not

r el at ed to 6 th e job rel at edin

jury(ies ) on th e ab ov e d at e(s ) of in jury[,]” t h e p an el st at ed , “ No ne 7 of [W or ke r’s] curre nt co m

pl ai nt s are relat ed to th e wor k in jury of Mar ch 11 , 20 14

. . . . 8 [W or ke r’s] c ur

re nt s ym pto m s and c ondi tio n are adir ec t r es ult of his pr e[ ] ex ist ing 9 right hip diagnos es.” The W CJ also asked wh et h er “ the m edical car e that has been 10 provided t o Wor k er to date f or treatm ent of [the] work[- ] related inj ury or injur ies 11 ide nti fi ed

[ by the pane l has] be enr ea sona ble a nd n ec es sary

f or tr eatm en t of

the j ob 12 re la te d in

j ur y (i es )[ , ] ” an d if

not , f or ade ta ile d e xpl an at ionof w ha t a spe ct s of 13 W orke r’ s “pa [s ] t tre atm en t (in cl udi ng [ W ] orke r’ s m ed ic at ionr eg im en ) w as not 14 reasonable or nece ssary .” The panel responded, “ Ye s, the m edical car e [W orker] has 15 rece ived to date h as b ee n m edically rea sonable and n ecessar y .” Finally , the panel12

1 re co m m en de d th at

W orke r underg o “ tot al hip a rthr opl as ty ” but not ed that “ [t ] his 2 tre atm en t r ec om

m en da tio n is unrelat ed

t o t he

. . . M a r c h 20 14 [ i nj ur y ] a nd r a t he r, 3 follows [the] course o f care di scussed in 2007 , recom m ended in 2008 and scheduled 4 fo r . . . 201 1 a t UNMH.” 5 { 16} T he part ie s pr oc ee de d to tr ia l on N ove m be r 9, 201 5. W orke r an d M r. Re et z 6 t es t i fi ed i n p er s o n , a n dt h e WC J ad m i t t ed t h e d ep o s i t i o n t es t i m o n y o f al l o f Wo rk er ’s 7 treating health care providers as well a s IME paneli s t s Dr s. Ross and Le gant. In 8 p e rt i n e n tp a rt , t h e WC J mad e t h e f o l l o w i n g f

i n d i n g s r e g a r d i n g Wo rk e r ’s i n ju ry, 9 ca usa tio n, a nd e nti tle m en t t o be ne fi ts: 10 53. The m ed ical evidence here in sup port[s] a [f ] indin g[] that 11 W orker’ s [A VN ] wa s not caused byW orker’ s fall fr om a ladder 12 on M ar ch11, 201 4. 13 54. The m edical evidence here in sup ports a [f] i n d ing th at W orker 14 suf

fe re d ac ontusi on t o hi s r igh t thig h a s ar es ult of W orke r’ s f

al l 15 fr om

ala dde r on M ar ch11, 201 4. 16

. . . . 17 60. W orker is not entitled to m odifier b en ef i t s after June 30, 2015 [, 18 his da te of m ax im um m ed ic al im

pr ove m en t, ] be ca

use his ina

bil ity 1 9 t o r e tu rn t o wo rki s n o tc au s e db y h i s wo rk [

- ]r e l a t e di n ju ry. 20 T he W CJthu s c onc lud ed that: 21 3. W orke r suf fe re d j ob[ -] re la ted i nj ur ie s w hic h aro se w ith in the 22 co ur se a nd s co pe of , and i nc ide nta l t o, his e m plo ym en t w ith 23 E m

plo y er on M ar ch11, 201 4.13

1

. . . . 2 6. W ork er ’s co n tusio n to his right thig h on March 11, 2014[,] wa s 3 suffe re d w ith in t he c our se a nd s co pe of

his e m plo ym en t w ith 4 Em

ploy er[] and as a conseq u ence, is com pensable und er 5 the

. . . A ct

. 6 7. W orke r’ s A V N and the ne ed

f or tot al r igh t hi p 7 re pla ce m en t/arthr opl as [t ] y are unr el at ed

to W orke r’ s f

al l on 8 Ma rc h 1 1 , 2 0 1 4 , a n dw e r e n o ts u f f e r e dw i t h i n t h e c o u r s e a nd 9 scope of his em ploy m ent with Em

ploy er[] and as a consequence, 10 ar e not

c om pe nsa ble und er the W orke r[ s’ ] Co m

pe nsa tio n A ct

. 11 8. W orker’ s unrelated right hip conditi on precludes W orker’ s return 12 to work w ith Em ploy er a t this tim e. 13 T he W CJa w ar de d W orke r “ [b ] en ef its c onsist en t w ith , a nd l im ite d by , the te rm s of 14 thi s [ o] rd er . ” W orke r ap pe al ed

. 15 DISC US SION 16 { 17} W orker raises three po ints of error: (1) th e W CJ failed to apply the corre ct legal 17 standard

in de te rm ini ng w he the r W orke r m et his bur de n of

pr oof a s to c au sa tio n 18 be tw ee n his ac ci de nt and his dis ab ili ty , the re by inc or re ct ly de ny ing w orke r PP D a nd 19 m edical benefits; (2) the W CJ failed to aw ard W orker m ileage to and from m edical 20 ap poi ntm en ts; a nd ( 3) the W CJe rr ed by de cl ini ng t o a ddr es s W orke r’ s ba d f ai th 21 cl ai m a ga ins t E m

plo y er /I nsur er a nd r ef usi ng t o im

pose aba d f

aith pe na lty

on 22 E m plo y er /I nsur er . W e ad dr es s e ac h is sue in tur n.14

1 I. Wh et he r th e WC J P roperl y Ap pl ie d th e R eq ui re m en ts of N M SA197 8, 2 Se ct ion 52- 1- 28 ( 1987 ) 3 { 18} Throughout the process, E m ploy er/Insurer

fram ed the issue in th is case as 4 being “ whether there w as a ca usal c onnection betwee n the March 11, 2014[,] work 5 inj ur y a nd W orke r’ s to ta l r igh t hip disa bil ity , inc lud ing W orke r’ s ne ed f or tot al hip 6 re pla ce m en t. ” Ci tin g S ec t i o n5 2

- 1

- 2 8 ( A ) , E m p l o y e r / I n s ure r as se rt s, “ W orke r bor e the 7 sta tut or

y bur de n of

e sta bli shi ng a ca

usa l c onne ct ionbe tw ee n hi s M ar ch11, 201 4 8 ac ci de nt and h is c ur

re nt o ve ra ll dis ab ili ty

to his r igh t hi p and n ee d f or to ta l hip 9 re pla ce m en t surg er

y . ” By “ curr en t ov er al l di sa

bil ity to his r igh t hi p[ , ] ” w e unde rs tand 10 E m plo y er /I nsur er to m ean W orke r’ s A V

N

. T he W CJappe ar s to ha ve a gr ee d w itha nd 11 foll owe d Em

plo y er /I nsur er ’ s f

ram ing of the iss ue a s e vid en ce d by his f ind ing s and 12 co nc lus ion s th at

f oc us o n th e ca

usa l c onne ct ionbe tw ee n W or ker’ s M ar ch201 4 1 3 a c c i d e n ta n d( 1 ) h i s AVN , a n d( 2 ) Wo rk e r ’s n e e d f o r h i p r e p l a c e men ts u r g e ry. 14 W orker contends that Em ploy er/Insurer and the W CJ applied the wro n g legal 15 standard because the issue in thi s case is w hether the m edical e v i d en ce sh ows that 16 W orker’ s accident resulted in an injury —i.e. , the aggrav ati on of his pr ee xis tin g 17 AV N—that ca

used him to bec om e disabled, not whether W orker’ s need for a 18 part ic ular ty

pe of m ed ic al pr oc ed

ur e (i

. e. , tot al hip r ep la ce m en t surg er y ) to tre at his 19 preexisting AVNarose f rom his March 2014 accident. W e agre e w ith W orker.15

1 A. Stand ard of R eview 2 { 19} A t i t s c o r e , t h i s c a s e i n v o l v e s a qu e s t i o n o f s t a tu t o ry i n t e r p r e t a t i o n , n a mel y, 3 w he the r the W CJpr ope rl y int er pr et ed an d appl ie d the re qui re m en ts of S ec tio n 52 -1

- 4 28 . W e rev ie w th e in te rp ret at io n o f a s ta tu te de no vo . Sm ith v . A riz

. P ub. Se rv . Co

. , 5 2003 -N MCA-09 7, ¶ 5, 134 N

. M. 202 , 75 P

. 3d 4 18. “ T his Co urt i s no t r equir ed to 6 defer to the W CJ’ s interpretation of [the A ct] .” B ac a v. Co m ple te D ry wa ll Co

. , 200 2- 7 N M C A

- 0 0 2 , ¶

1 2 , 1 3 1 N

. M

. 4 1 3 , 3 8 P

. 3 d 1 8 1

. We c o n s i d e r t h e Ac t“ i n i t s e n t i r e t y, 8 construin g each section in connection with eve ry other section.” Id

. ¶ 13 (internal 9 quot ation m arks and citation om itted). 10 { 20} Re co g n i zi n g , as m an y Ne w Me x i co ap p el l at e co u rt s h av e, t h at t h e A c t ’s 11 pr ovi sio ns are im

pr ec ise , w e be ginby pa rs ing Se ct ion 52- 1- 28 in or de r to c lari fy it s 12 req ui rem en ts

. Se e Ch av ez v . M ountain Sta tes C

onst ruc tor s , 199 6- N MS C- 070, ¶¶

25- 13 44, 122 N

. M. 579, 929 P. 2d 971 (di sc uss ing the a m big uity of N MS A 197 8, S ec tio n 14 52- 1- 24 ( 1990 ) of

the Act an d underta kin g to “ ex am ine a nd d es cr ibe the vari ous 15 elem ents of the statute to clarify their m eaning” in order to applythem to the given 16 facts). Once we “ ascerta in[] the m eaning of t he statute, we review the w hole record 17 to determ ine whether the W CJ’ s finding s and award are suppo rted by subst antial 18 evidence.” Sm ith , 2003-NMC A- 097, ¶ 5. “ [W ] e disregard th at [evidence] which has 19 little or no worth and then decide i f th ere is subs tantial evidence in the whole rec ord16

1 to sup port the agency ’ s finding or decision.” Tr uji llo v . L os A lam os N at’ l L ab. , 201 6- 2 NMC A- 041 , ¶ 1 5, 368 P.3d 1259 (internal quo tation m arks and citation om itted), 3 cert. denied , 2016 -N MC E RT -0 04. “ Whe re al l or subst an tia lly al l of the e vid en ce on 4 a m at er ia l i ssu e is d oc um en tary or by de posi tio n, the [r ev ie w ing c ourt] w ill e xa m ine 5 an d w ei gh i t, a nd w ill r ev ie wthe r ec or d, giv ing som e we igh t t o th e fi ndi ngs of the 6 [c ourt] on s uc h is sue , an d wi ll not dis tur b the sa m e upon co nf

lic tin g e vid en ce unl es s 7 such findin gs are m anifestly wr ong o r clearly oppo sed to the evidence.” Martinez v. 8 U ni v e rs al C on st ru c t or s, I nc. , 197 1- N MC A -1 60, ¶

10, 83 N

. M. 283 , 491 P

. 2d 1 71 9 (i nte rn al quo ta tio n m ar ks an d ci ta tio n om itt ed ). W e re vie w the W CJ ’ s a ppl ic at ionof 10 th e la w to th e fac ts de no vo . To m G row ne y E qui p. Co

. v . J

oue tt , 200 5- N MS C- 015, 11 ¶ 13, 137 N

. M. 497 , 113 P

. 3d 3 20. 12 B. Com pensable Claim s Und er t he A ct 13 { 21} Se ct ion52- 1- 28( A ) pr ovi de s th at w orke rs ’ c om

pe nsa tio n c laim s ar e onl y 14 co m pe nsa ble “ (1 ) w he n the w orke r ha s su sta ine d an a cc ide nta l i nj ur y a ri sin g ou t of 15 an d inthe c our se of

his e m plo ym en t; (2 ) w he n the ac ci de nt w as r ea sona bly inc ide nt 16 to h is e m

ploy m en t; an d ( 3) w he n th e dis ab ili ty is a na tur al a nd d ir ec t r es ult of the 17 acci de nt. ” Whe n an e m plo y er de nie s th at

“ ana lle ge d di sa

bil ity is the na tur al a nd 18 dir ec t r es ult

of the a cc ide nt, the w orke r m ust e sta bli sh th at cau sal c onne ct iona s a 19 probabilit y

by expert testim ony

of a hea lth care provider[. ] ” Se ction 52 -1-28(B).17

1 Whil e Se ct ion s 52- 1- 28( A )( 3) an d (B ) ap pe ar to re qui re a sin gle c au sa tio n ana ly sis 2 (b etw ee n th e ac ci de nt and the dis ab ili ty ), e m be dde d w ith in tha t an aly sis is the 3 re qui re m en t tha t the re be a n in j ur y that i s c au sa lly

c onne ct ed

to both th e ac ci de nt and 4 th e d is ab il it y . Se e O liv er v . Ci tyof A lbu que rque , 1987-NMSC- 0 9 6 , ¶ 4 , 106 N. M. 5 3 5 0 , 7 4 2 P. 2 d1 0 5 5 (e x p l ai n i n g t h at Se ct i o n 5 2 -1 -2 8 (A ) “req u i re s t h a t a wo rk er ’s 6 dis ab ili ty

. . . be c au sa lly

c onne ct ed

to the w orke r’ s in

j ur y . . . a nd tha t the inj ur

y be 7 ca usa lly co nne ct ed

to the w orke r’ s a cc ide nt” ); Tr uji llo , 20 16 -NMCA- 04 1, ¶ 4 6, n .4 8 (h old ing tha t the re w as e vid en ce of the e xis te nc e of

ac au sa l r el at ion shi p be tw ee n th e 9 w orke r’ s a cc ide nt and i nj ur ie s bu t no tin g th at the W CJ ’ s c onc lus ion s did not a ddr es s 10 w he the r ca

usa tio n as to dis ab ili ty ha d be ene sta bli she d)

. T hus, S ec tio n 52 -1 -2 8 m ust 11 be und er sto od a s r equir ing the w orke r to e sta bli sh tha t ( 1) aw ork- re la te d a cc ide nt 12 caused an injury or i njuries, and (2) the injur y resulted in disabil ity . W

here a worker 13 sus ta ins m

ult ipl e inj ur ie s a s ar es ult of one ac ci de nt, ac au sa l c onne ct ionbe tw ee n th e 14 ac ci de nt and e ac h in j ur y m ust be e sta bli she d inor de r fo r th e in jur y to be 15 co m pe ns ab le

. See , e . g. , T

ruj ill o , 2 0 1 6

- N M C A

- 0 4 1 , ¶ ¶ 3 2 , 3 6 ( e x p l a i n i n g t h a t“a 16 health care provider m ust be allowed to equivo cate w ith respect to certain inj u ries 17 ab out w hic h he or she is unsure as to ca usa tio n w hil e sti ll of

fe ri ng posi tiv e sta te m en ts 18 as to oth er s” a nd c onc lud ing that the ex pe rt test im ony e sta bli she d c au sa tio n a s to 19 ce rt ai n in

j ur ie s bu t no t othe rs ); Sa nc he z v . Z an i o’ s F oo ds , Inc. , 200 5- N MC A -1 34,18

1 ¶¶ 7, 54, 138 N

. M. 555 , 123 P

. 3d 788 (e xpl ai nin g that the w orke r w as dia gnos ed w ith 2 two differ ent injuries and reversing and rem anding the W CJ’ s com pensation aw ard 3 be ca use the re w as ins uf

fi ci en t evi de nc e to suppo rt a fi ndi ng of causa tio n betw ee n th e 4 w orke r’ s a cc ide nt and o ne of the tw o c la im ed

inj ur ie s)

. L ike w ise , w he re m ult ipl e 5 ty pes of disabilit y

are claim ed, a

causal connectio n b et we en each a ccidental injury 6 an d t he res ul ti ng cla im eddi sabi li ty m us t b e es tabl is he d. See , e . g. , Baca , 200 2- 7 N MC A -0 02, ¶

¶ 14- 26 ( ex pla ini ng tha t a sin gle a cc ide nt c an res ult in m ult ipl e 8 inj ur ie s, som e of w hic h m ay de ve lop im m ed ia te ly w hil e oth er s m ay not de ve lop unt il 9 m uc h late r, a nd tha t ea ch ty pe of dis ab ili ty

—e . g. , T T D an d PP D —tha t re sul ts f ro m 10 a w ork-relate d accidental injur y is potenti ally

com pensable). 11 1. Th e Inju ry R eq ui re m en t V is- à- V is a P re ex ist in g C on di ti on 12 { 22} In order to re ceive benefits, a w orker m ust “ s u stain[] an acc idental injury 13 arising out of and in the course of his em pl o ym ent[.] ” Se ction 52 -1-28(A) (1). 14 “ Pre[ ] existing disease or i nfirm ity of the em ploy ee does not disq ualify a claim under 15 the ‘ ar isi ng out of em

plo ym en t’ re qui re m en t [of Se ct ion 52- 1- 28( A )( 1) ] if the [ w ork16 re la te d a cc ide nt] a ggr av at ed , a cc el er at ed , or c om bin ed w iththe dis ea se or

inf irm ity 17 t o p ro d u ce the death or disabilityfor w hich com pensation is soug ht.” Edm iston v. 18 Ci tyof H

obbs , 1997-NMC A- 085, ¶ 9, 123 N.M. 654, 944 P.2d 883 (first internal 19 quot at ion m ar

ks an d ci ta tio n om itt ed ). In ca se s w he re the w orke r ha s a pre ex ist ing19

1 co ndi tio n, the re a re a t l ea st tw o di ff er en t ty pe s of inj ur ie s th at m ay res ul t: (1 ) the 2 ag gr av at ion , a cc el er at ion , or w or se nin g of a pr eexi sti ng c ondi tio n or pr ior non 3 dis ab lin g in

j ur y ; or (2) ane winj ur

y that c om

bin es w ithaw orke r’ s pr ee xis tin g 4 co ndi tio n and i s a m

pli fi ed by aw orke r’ s unusua l su sc ep tib ili ty to inj ur y be ca use of 5 th e pr eex is t i n g c on di ti on . Compare Tom Growney , 200 5- N MS C- 015, ¶ 28 6 (e xpl ai nin g th at

“ [i ] f the str es s of l ab or

a ggr av at es or

a cc el er at es the de ve lop m en t of 7 a pr eex is ti ng in fir m it y cau si ng an in te rn al br eak do wn of th at pa rt of th e st ru ctur e, a 8 pe rs ona l i nj ury

by a cc ide nt d oe s oc cur” ( int er na l qu ota tio n m ar

ks and c itatio n 9 om it te d) ), Olive r , 198 7-NMSC- 09 6, ¶ 6 ( ex pla ini ng tha t “ w he re apr e[ ] ex ist ing 10 co ndi tio n . . . is ag gr av at ed by [a w ork- re la te d ac ci de nt, Se ct ion52 -1 -2 8’ s] 11 req ui rem en t as to job -rel at edin jury is m et ”), Re

ynolds v. R uido so Racing Ass’n , 12 1961 -N MSC- 116, ¶¶ 20-23 , 69 N. M. 248 , 365 P. 2d 671 (discussin g the differe nces 13 betwee n “ aggravat ion” or “ acce leration” of a pre existing conditio n and inst ances 1 4 w he r e a n a c c i d e n t “ p r e c i p i t a t e s d i s ab i l i t y f r o m a l a t e n t p r i o r c o n d i t i o n ” or 15 “ com bine[s] with the disease or infirm ity to produce the

. . . disabili t y” (i n ternal 16 quot ation m arks and citations om itted)), wi th E dm iston , 199 7- N MC A -0 85, ¶ ¶ 23- 24, 17 26- 27 ( hol din g c om

pe nsa ble aw orke r’ s P PD r es ult ing f ro m the c om bin at ionof

the 18 worker ’ s preexisting condi t i on

— m ul tiple m y elom a cance r—and a w ork-relate d back 19 inj ur y , the tr eatm en t of

w hic h w as li m ite d by

the w orke r’ s c an cer), and Le o v.20

1 Co rnuc opi a R es t. , 199 4- N MC A -0 99, ¶ ¶ 6, 30, 118 N

. M. 354 , 881 P

. 2d 7 14 2 (e x p l ai n i n g t h at t h e w o rk er ’s ac ci d en t “ d i d n o t ex ac erb at e o r a cc el er at e [ t h e w o rk er ’s 3 pr ee xis tin g] he ar

t and l ung co ndi tio ns, a lth ough th e he ar t and l ung co ndi tio ns 4 im pose d signi fi cant re str ic tio ns on the tr eatm en t of [ the w orke r’ s] ba ck c ondi tio n and 5 on h is re co ve ry fr om the ba ck inj ur y [, ] ” an d hol din g tha t co m pe nsa tio n is ba se d on 6 “ th e co m

bi ne d effec t o f bo th im

pa irments ”). Cf

. Sal ope k v. F

rie dm an , 20 13 -NMCA7 087, ¶ ¶ 17- 22, 308 P. 3d 1 39 ( ex pla ini ng the dif fe re nc es be tw ee n “ ag gr av at ion ” an d 8 “ eg gshe ll” the or ie s of lia bil ity in tort law ). T he la tte r ty pe of inj ur y is the c onstru ct ive 9 eq ui va le nt of

th e “ eg gs he ll pl ai nt iff

” th eo ry in to rt l aw. Co m

pare id. ¶ 17 ( dis cu ssi ng 10 Ne w Me xico’ s “ eggshell pl aintiff” j ury instruction , U JI 13- 18 02 N M R A , whi c h st ates 11 tha t a tort de fe ndant “ is s ai d to ‘ ta ke the [ p] la int if f as he f ind s hi m ’ ” ( quot ing U JI 13- 12 1 8 0 2 )), wi th E

dm ist on , 1 9 9 7

- N M C A

- 0 8 5 , ¶ 2 5 ( e x p l a i n i n g t h a ti n w o rk e rs ’ 13 com pensation law , the pre vailing rule is t hat “ ‘ the em ploy er takes the e m

ploy ee as 14 it fin ds th atem

pl oye e ’ ” ( q u o t i n g 1 Arth urLars on & Lex K. Larso n, Th e La w o f 15 W ork m en ’s Co m

pe nsat ion § 12

. 21 ( 1996 )) ). I f eithe r ty pe of inj ur y r es ult s in 16 dis ab ili ty , “ the em

plo y ee is ent itl ed to com

pe nsa tio n to the f

ull e xte nt o f the dis ab ili ty 17 ev en thoug h attributable in part to a pre[] existing conditio n.” Sm ith , 200 3- N MC A18 09 7, ¶ 1 2 (i nt ern al qu ot at io n m ark s an d c it at io n o m it te d)

.21

1 { 23} Agg rav at io n, ac cel erat io n, o r wor se ni ng of a pr eex is ti ng co nd it io n i s, i ts el f, a 2 dis cr et e ty

pe of inj ur

y an d can oc cur ei the r as a re sul t of a sin gle a cc ide nta l i nc ide nt 3 orde ve lo p o ve r ti m e as a res ul t o f em pl oym en t a c ti vi ti es . Compare B ufali no v. 4 Safeway Stor es, I

nc. , 198 2- N MC A -1 27, ¶ ¶ 2, 21, 9 8 N

. M. 560 , 650 P

. 2d 8 44 5 (d es cr ibi ng the w orke r’ s a cc ide nt a s “ the str es s w hic h oc curr ed in lif tin g he av y 6 boxe s[ , ] ” re sul tin g inhis he art at ta ck ( inj ur y )) ; wi th Olive r , 1987-NMS C-096, ¶ 4 7 (describing the worker’ s accident as “ the stress indu ced by [the w orker’ s] j ob”; which 8 ca use d hi s he ar

t a tta ck ( inj ur y )) ; and Tom Growney , 200 5- N MS C- 015, ¶ 27 9 (e xpl ai nin g th at

N ew Me xic o “ pr ec ed en t does not re qui re a disc re te ‘ ac ci de nt, ’ in the 10 tr ad iti ona l se nse , if

e m plo ym en t a ct ivi ty

it self a ggr av at es apr ee xis tin g in j ur y a nd 11 results in dis ability ”). Se e H erndon v. A lbu que rque P ub. Schs. , 197 8- N MC A -0 72, 12 ¶ 27, 92 N. M. 635, 593 P. 2d 470 (e xpl ai nin g that “ if the str es s of l ab or a ggr av at es or 13 acce le rat es th e d ev el op m en t of a pr eex is ti ng in fir m it y cau si ng an in te rn al bre ak do wn 14 of that part of the str uc tur e, ape rs on al in

j ur y by a cc ide nt d oe s oc cur” ). N on15 debilitatin g pain attributab le to a prior inj ury or preexisting condition that increases 16 an d be co m es dis ab lin g a s ar es ult of aw ork- re la te d a cc ide nt is a ty pe of c om pe nsa ble 17 in jury. See Tom Growney , 200 5- N MS C- 015, ¶ 53; Ta llm an v . A B

F (A rk ansa s B es t 18 F re igh t) , 1 9 8 8 -N M CA -0 9 1 , ¶2 9 , 1 0 8 N.M . 12 4 , 76 7 P. 2 d 3 6 3 (a ff i rmin g t h e WC J ’s 19 fi ndi ng tha t an a cc ide nta l i nj ur y oc curr ed w he re the w orke r ha d e xpe ri en ce d pa in f or16 Inhis co nc ur ri ng and dis se nti ng opini on i n E dm iston , C hief Judge Hartz noted 4 17 tha t w hil e re lianc e on o ut- of -s ta te c as es inv olv ing w orke rs ’ c om pe nsa tio n is “ unw ise 18 on m an y

iss ue s” be ca

use the A ct

c ont ai ns “ a nu m

be r of uni que pr ovi sio ns, 19

. . . be ca

use the langua ge r eg ar din g c au sa tio n is f ai rl y uni fo rm am ong w orke rs ’ 20 com pensation statutes, w e have ty pically looked to the lawelsew here f or guidance 18 on no ve l i ss ue s wi th res pe ctto c au sa ti on .” 19 97 -NMCA- 08 5, ¶ 3 5 (Ha rtz , C.J., 19 concurring in part, dissenting in part). 22 1 m an y y ears pr ior to his w ork- re la te d acc ide nt b ut e xpe ri en ce d adif fe re nt l ev el of

pa in 2 af te rw ar ds tha t w as “ so s ev er e he c oul d no lon ge r w ork” ). “ T he re is no r equir em en t 3 th atth ere b e a p hysic al ti ss ue ch an ge forth ere t o be a co m pe ns ab le di sabi li ty.” 4 Sc hobe r v. M

ountain B el l T

el

. , 1980 -N MC A -1 13, ¶ 8, 96 N. M. 376 , 630 P

. 2d 1 231 5 (rej ecting the em

ploy er’ s argum ent that “ [w ] ithou t som e perm anent phy sical 6 al te ratio n . . . the re is no d isa bil ity ”)

. “ If

the e m plo y ee suffers fro m

ala te nt 7 pr ee xis tin g c ondi tio n th at ine vit ab ly

w ill pr oduc e inj ur

y or de ath, but

the e m p l oym en t 8 ac ts on the pr ee xis tin g c ondi tio n to ha ste n th e ap pe ar an ce of sy m pto m s or a cc el er at e 9 its inj ur iou s co nse que nc es , the em plo ym en t w ill be co nsi de re d the m ed ic al c au se of 10 the resulting in

j ury .” E x part e R ee d C

ontrac tin g Se rv

s. , I nc . v . R ee d C

ontrac tin g 11 Servs., Inc. , 203 S o. 3d 9 6, 102 -0 3 ( A la

. Ci v. App. 201 6) ( int er na l qu ota tio n m ar

ks 12 and citation om itted). 4 13 2. Wh at C on st it ut es a “D isa bi lit y” U nd er S ec ti on 52- 1- 28 14 { 24} T he te rm

“ dis ab ili ty ” as use d inthe A ct ha s e vol ve d a s ar es ult

of le gis la tiv e 15 am en dm en ts t o th e A ct

. A t on e poi nt, it w as tr ue tha t “ the pr im ar

y te st o f dis ab ili ty23

1 [w as] th e w orker’ s capacity to perform

work. ” Sal ci do v

. T

rans am er ic a I

ns. G rp. , 2 1985 -N MSC- 002, ¶ 10, 102 N .M. 217, 693 P. 2d 583 (em phasis o m itted). Many

cases 3 co nstru ing S ec tio n 52 -1 -2 8 art ic ula te d and a ppl ie d th is s tandard

in m ak ing 4 de te rm ina tio ns re ga rd ing ca usa tio n be tw ee n an ac ci de nt an d dis ab ili ty , r eg ar dle ss o f 5 th e type o f co m

pe ns at io n s ou gh t. Co m

pare Salci do , 198 5- N MS C- 002, ¶ ¶ 9- 13 6 (a ppl y ing the “ ca

pa ci ty to pe rfo rm work” te st f

or de te rm ini ng d isa

bil ity in a ca se 7 wher e the w orker sought tem porary disabili ty benefits for a discrete interval of tim e), 8 wi th B ufa lin o , 1 982- N MC A -1 27, ¶ ¶ 1, 15 ( ex pla ini ng tha t “ [t ] he pr im ar y te st o f 9 dis ab ili ty

is the c ap ac ity

to p erfor m w ork” in a ca se w he re the w orke r w as se ek ing 10 “ total perm anent d i s ab ility ” benefits). In the 1980s , how ever, the Le gislature 11 am en de d th e A ct

num er ous tim es , spe ci fi ca lly a lte ri ng h ow“ dis ab ili ty ” is def ine d in 12 New Mex ic o. See Leo , 199 4- N MC A -0 99, ¶ 12. I n Leo , thi s C ourt e xpl ai ne d: 13 T he c ha ngi ng and c om pe tin g po lic y

int er es ts b eh ind 14 com

pensat i on laws are ref

lected in the successive legislativ e changes 15 def

i ni ng d i sa

bi l i t y . M os tc om

pe ns a t i onl a w s a do pt

o ne o f three 16 ap pr oa c h e s i n d efi ni ng di sabi li ty: a de fin it io n b as edon wage lo ss , a 17 de fi nit ion ba sed onim pa irm en t r at ing , or

ade fi nit ionba se d ona 18 re duc tio n ina n in divid ua l’s ab ili ty to pe rf orm w ork. P ri or

to 1986 , 19 disabili ty

under [the A ct] wa s defined in ter m s o f ca p acity to work. In 20 1986 the definition was ch an ged to incorpo rate c oncepts of all three 21 ap pr oa ch es . I n 19 87 the st at ut or y de fi nit ionof

dis ab ili ty

w as a ga in 22 am en de d to inc or por at e the co nc ep ts o f both im pa irm en t and i nabil ity 23 to p er fo rm

w ork.

. . . [A ] s a pra ct ic al m atte r, the de fi nit ionof dis ab ili ty 24 in the 198 7 A ct r ep re se nts ar et

ur n to the pr e- 1986 de fi nit io n of 2 5 d i s ab i l i t y.24

1 Id

. (citations om itted). 2 { 25} In 1990 t he Le gislature again am ended the Act and establis hed a clear 3 dis tin ct ionbe tw ee n TT D an d PP D , ef fe ct ive ly de fi nin g “ dis ab ili ty ” in tw o di ff er en t 4 way s. Whereas prior to 1990 th e co n ce p t of the worker ’ s capacity to perform

work 5 w as inc or

por at ed int o de fi nit ion s of both TT D an d PP D , af te r 1990 the c onc ep t on ly 6 rem ai ns in de fin in g TTD. See N MS A 1978 , § 52- 1- 25. 1( A ) (1 990, am en de d 20 05 and 7 2017 ) (“ A s us ed

in the

. . . A ct , ‘ te m

por ar y tot al dis ab ili ty ’ m eans the ina bil ity of the 8 worker

. . . to perform

his dut ies prior to the date of the w orker’ s m axim um m edical 9 im pr ov em en t.”)

. Co m

pare N MS A 197 8, § 52 -1 -2 6( B) ( 1989 , a m en de d 19 90 and 10 20 17 ) (p ro vi di ng th at“ ‘part ia l di sabi li ty’ m ean s a co nd it io n whe reb y a wor ke r . . . 11 suffers an im

pairm ent and is unable to som e percentage extent to per form any work 12 fo r wh i ch he is fit te d b y ag e, educ at io n a nd tra in in g” ), wi th § 52 -1 -2 6( B) ( 1990 ) 13 (providin g that “ ‘ partial disability ’ m eans a cond ition wher eby a worker . . . suffe rs 14 a perm anent im

pairm ent”). Capacity

to work still p l ays a role in determ ining PPD 15 be ne fi ts b as ed

on the phy sic al c apaci ty m odi fi er vari ab le of

the statut or

y f orm ula 16 es tabl is he d i n t he 19 90 am en dm en ts

. See N MS A 197 8, § 52 -1 -2 6. 4( B) ( 2003 ) 17 (providin g that “ [t] he aw ard of poin ts to a worker shall be based upo n the differe nce 18 betwee n the phy sical capacity necessary to perform the worker ’ s usual and cus tom ary 19 w ork and the w orke r’ s r es idu al phy sic al c ap ac ity ”)

. H ow ev er , w he the r or not a25

1 w orke r is d ee m ed

part ia lly di sa bl ed

und er S ec tio n 52 -1 -2 6( B) is ba se d so le ly on 2 ph y si cal im

pa irment, n ot ab il it y

to work

. Se e Sm ith , 20 03 -NMCA- 097, ¶ ¶ 15- 16 3 (d iscu ssi ng the dif

fe re nc es be tw ee n T T D a nd P PD a nd e xpl ai nin g th at P PD is 4 determ ined not by

one’ s ability

or inability

to work but rather based on im pairm ent). 5 T hus, f oll ow ing the 1990 a m en dm en ts, the r el ev an t c au sa tio n in qui ry und er S ec tio n 6 52- 1- 28 n ec es sari ly

c ha nge s de pe ndi ng on w ha t ty pe of dis ab ili ty the w orke r cl ai m s. 7 In cases w here a

worker claim s TT D, the relevant question is whether the worker

has 8 established a causal connection betwee n his accident and his inabilityto work. In 9 cases w here a

worker claim s PPD , the r el ev an t questio n is whether the w orker has 10 es ta bli she d ac au sa l c onne ct ionbe tw ee n hi s a cc ide nt and a pe rm an en t i m

pa irm en t. 11 { 26} Im

portantly , ther e is no indi cation in the plain language of the Ac t, in our cases 12 interpreting the Act, or that can be gleaned fr om legislativ e am endm ents to it th at 13 sugg es ts tha t S ec tio n 52 -1 -2 8( A ) re quire s th at aw orke r pr ove ac au sa l c onne ct ion 14 be twee n a n a cci de nt an d t he ne ed fo r a pa rti cu la r type o f m ed ic al tre at m en t. See § 52

- 15 1-28(A)( 3) (prov iding that com pensation is allowed “ when the dis abi lit y is a natural 16 an d di re ct

r es ult of the a cc ide nt” a nd s ay ing nothin g r eg ar din g ac au sa l c onnection 17 betwee n an accident and rec omm ended m edical services to tre at the w orker’ s injury 18 or c ondi tio n ( em

pha sis a dde d) ). Whe the r ane m plo y er is lia ble f or pr ovi din g a 19 part ic ular he al th c ar e se rv ic e— suc h a s surg er y —de pe nds on w he the r the se rv ic e is26

1 “ re as ona

ble a nd n ec es sary ” an d is not part of the ca

usa tio n ana ly sis und er

S ec tio n 52

- 2 1- 28 (A). See N MS A 1978 , § 52 -1 -4 9( A ) (1 990) ( pr ovi din g th at “ [a ] ft er a n in j ur y to 3 a wor ker

. . . a nd c ont inu ing a s lo ng a s m ed ic al or r el at ed tr eatm en t i s r ea sona

bly 4 ne ce ssary , the e m

plo y er sha ll

. . . pr ovi de the w orke r in a ti m el y m an ne r re as ona

ble 5 an d ne ce ssary

he al th c ar e se rv ices fro m a hea lthc ar e pr ovi de r” ). S uc h a 6 de te rm inat io n, w hil e re la te d to the que sti on o f the c om pe nsa bil ity of a n in j ur y , is a 7 se parate m atte r tha t do es not be ar on the de te rm ina tio n of

c au sa tio n unde r Se ct ion52- 8 1- 28 (A). See Scott v. Transwestern Tankers, Inc. , 1963-NMSC- 2 05, ¶ 7, 73 N. M. 9 219, 387 P

. 2d 3 27 (e xpl ai nin g that “ [m ] ed ic al an d surg ic al tr eatm en t is inci de nta l t o 10 and a concom itant part of a com pensable inj ury for which the em ploy er is liable und er 11 the A ct ”) ; Douglass v. N. M. Re gula tion & Licensing Dep’t , 199 1- N MC A -0 41, ¶ 19, 12 112 N

. M. 183, 812 P. 2d 1 331 (e xpl ai nin g th at “ the r igh t t o r ec ove r m ed ic al be ne fi ts 13 requ i r e s as ho w i ng t hat[ t he ] w or ke r h a s su f f e r e d a‘ c om

pe ns abl e i nj ur

y ’ b e fore 14 m edical b en ef

i ts m ay be aw arded”). Notably , e ntitlem ent to m edical 15 be ne fi ts— inc lud ing c o v e r a g e f or the c ost of sur ge ry —de pe nds sim

ply on whe the r the 16 w orke r suf

fe re d an in

j ur y a nd i s no t c ont ing en t on a fi ndi ng o f dis ab ili ty

. S ec tio n 52

- 17 1- 49( A ) (p ro vid ing that he al th c ar e se rv ic es a re to b e pr ovi de d “ [a ] ft er a n inj uryto 18 a w orke r” ( em

pha sis a dde d) ); DiM

atteo v. D ona Ana Cty. , 1985 -N MC A -0 99, ¶ 13, 19 104 N

. M. 599 , 725 P

. 2d 57 5 (“ A n aw ar d of m ed ic al e xpe nse s is pr ope rl y m ad e27

1 de sp ite the abse nc e of

af ind ing of dis ab ili ty

. ”) ; c

f

. V a r g a s v . Ci t yo f A l b u q u e r q ue , 2 1993 -N MC A -1 36, ¶

9, 116 N

. M. 664 , 866 P. 2d 3 92 ( af fi rm ing the W CJ ’ s de nia l of 3 med i c a l b e n e f

i t s wh e r e t h e WC J f

o u n d t h a t t h e w o rk e r

“ d i dn o ts u s t a i n a n y i n

ju ry” 4 in the w ork- rel at ed

a cc ide nt b ec au se a n e m plo y er “ is o nly obl iga te d to pr ovi de 5 services af

ter an inj ury ”). 6 { 27} Fi na lly , in ev it ab ili ty of dis ab ili ty

( or de ath) play s no r ole in de te rm ini ng 7 whe th er a wo rk er’s act ua l di sabi li ty is cau sa ll y rel at edto a wor k- rel at edacci de nt

. See 8 E d m i s ton , 199 7- N MC A -0 85, ¶ ¶ 19- 27 ( hol din g th at

the W CJe rr ed

by r el y ing , in part , 9 on the f ac t tha t the w orke r’ s pr ee xis tin g c ondi tio n “ might have been j ust a s di sa bli ng 10 w ithor

w ith out the [ ac ci de nta l i nj ur

y ] ” suf fe re d ( em pha sis a dde d) ); se e als o G ilb er t 11 v. E. B. Law & Son, Inc. , 195 5- N MS C- 083, ¶ ¶ 22- 23, 31, 60 N

. M. 101 , 287 P

. 2d 9 92 12 (a ff irm ing the tr ia l c ourt’ s r ef usa l to in str

uc t the j ur

y that a w orke r’ s pr ee xis tin g 13 conditi on “ would inevitabl y h ave caused his death” because such an instruction “ does 14 not c or rect ly s tate the lawin tha t i t i gnor es the pr opos iti on tha t [ a pr ee xis tin g 15 co ndi tio n] m ay

ha ve be en m at er ia lly ag gr av at ed an d de ath a cc el er at ed by r ea son of 16 [a w ork-relate d accidental injur y ] ” (internal quot ation m arks om itted)). In a c ase such 17 as this involvin g a preexisting condition , W CJs m ust take c are not to rely

on the fact 18 tha t a wor

ke r’ s pre ex ist ing c ondi tio n m ay ha ve pot en tia lly be co m e j ust as dis ab lin g 19 w ith out an ac ci de nta l inj ur y in det er m ini ng wh ethe r ca

usa tio n has bee n e sta

bli she d.28

1 E dm ist on , 199 7- N MC A -0 85, ¶ ¶ 19- 20, 25- 27. “ [T ] he te st i s no t w ha t w oul d have 2 happened to s om eone else .

. . but w hat [the accident] actually did to its victim .” Id

. 3 ¶ 25 (internal quotation m arks and citation om itted). 4 3. C au sat ion an d P ro of Th er eo f 5 { 28} “ Inor de r to e sta

bli sh c au sa tio n un de r the

. . . A ct , aw orke r m ust sho wthat hi s 6 disabili ty m ore lik ely than not wa s a result o f his work-r elated acc ident.” B uc hana n 7 v. Ke rr-

M cG ee Co rp. , 199 5-NMC A- 131, ¶ 2 3, 121 N. M. 12, 908 P.2d 242 (internal 8 quot ation m arks and citation om itted). “ It is se ttled that the contributi ng f actor need 9 not be the m aj or contributo ry cause. ” Id

. (inte rn al quo ta tio n m ar ks and c itatio n 10 om itt ed ). “ T o be co m

pe nsa ble , a w orke r’ s a cc ide nt n ee d no t be the sol e ca use of his 11 di sabi li ty or de at h[ ;] a work er n eedon ly sho w th atit was a c o n t rib ut in g c au se .” 12 W ils on v . Yel lowF

re igh t Sy s. , 199 2- N MC A -0 93, ¶ 12, 114 N

. M. 407 , 839 P

. 2d 1 51. 13 “ The w ork-relate d cause m ay , in fa ct, be a m i n o r factor so long as the worker 14 es tabl is he s t ha t, as a m at te r of m ed ic al pr ob ab il it y , i t was a cau se of t he di sabi li ty.” 15 B uc hana n , 1995-NMC A- 131, ¶ 23. “ Causation exis t s within a rea sonable m edical 16 pr oba bil ity w he n a qua lif

ie d m ed ic al ex pe rt te sti fi es as to his op in io n conc er nin g 17 ca u s ation and, in the absence of other re asonable causal explanation s, it becom es 18 m ore lik ely than not that the injury wa s a result of its action.” Sanc he z v . M oly co rp, 19 Inc. , 1985-NMC A- 067, ¶ 16, 103 N. M. 148 , 7 0 3 P. 2 d 925 . “ [O ] nce [a worker ]29

1 establishe[s] th at t h e acc idental injury caused disability , it m atters not whether a 2 pre[]e x i s t i n g co n d i t i o n co n t ri b u t ed t o the ultim ate disability .” Ta llm an , 19 88 -NMCA3 091, ¶ 33. T hus, pr inc ipl es of

c au sa tio n are e qua lly

appl ic ab le to the a sse ssm en t of 4 co m pe nsabi lity

r eg ar dle ss o f w he the r ana cc ide nta l i nj ur y is ne wor

if it e nta ils 5 ag gr av at ionof

apr ee xis tin g c ondi tio n. 6 { 29} Se ct ion 52- 1- 28( B) re qui re s the w orke r to est ab lis h cau sa tio n “ as apr oba bil ity 7 by expert testim ony of a health care provider” in cases where the em ploy er disputes 8 a causal c onnection betwee n the accident and disabili ty

. “ [T ] he m edical expert need 9 not state his opi nio n in po si ti ve, dog m at ic langua ge or in the e xa ct

langua ge of

the 10 statute. But he m

ust testify

in language the s en s e of w hich reasonably connotes 11 precisely

what the statute categorically requires. ” G am m on v . Ebasc o C orp. , 196 5- 12 N MS C- 015, ¶

23, 74 N

. M. 789 , 399 P

. 2d 2 79. “ A n op ini on, a n ho ne st e ff ort t o 13 log ic al ly

a nd r at ion al ly

c onne ct the cau se and e ff

ec t, is al l tha t w e can ho pe to 14 obtain.” E lse a v . B room e F urni tur e Co

. , 194 3- N MS C- 036, ¶ 43, 47 N

. M. 356 , 143 15 P. 2d 5 72. 16 { 30} N ewMe xic o ha s a dopt ed the unc ontra dic te d m ed ic al ev ide nc e ru le , w hic h is 17 “ ane xc ep tio n to the ge ne ra l ru le tha t a tr ia l co urt can ac ce pt or r ej ec t e xpe rt

opi nio n 18 as it sees fit. ” B ank

s v. IMC Ka li um Ca rls bad P ota sh C o. , 200 3- N MS C- 026, ¶

35, 19 134 N

. M. 421 , 77 P

. 3d 1 014 (i nte rn al quo ta tio n m ar ks and c itat io n om itt ed ). “ T he30

1 rule is based on [Section] 52-1-28(B), which re quires the worker to prove causal 2 connection b etwe e n di sa bi l i ty and accident as a m edical probability by expert m edical 3 testim ony . B ecause the s tatute requires a c ertain ty pe of proof, uncont radicted 4 evidence in the form

of that ty pe of proof is bindi ng on the trial court. ” Id

. (internal 5 quot ation m arks and citation om itted). “ In t he event of a dispu te betwe en the parties 6 concerning . .

. the cause o f an injury or any other m edical issue, .

. . e ither party m ay 7 pe tit iona[ W CJ ] f

or pe rm iss ionto ha ve the w orke r unde rg o an [I ME ]

. ” N MS A 197 8, 8 § 52 -1 -5 1( A ) (2 013)

. A ddi tio na lly , “ [i ] f a [WC J] be lie ve s th at a n [ IM E ] w ill a ssi st 9 the j udge w iththe pr ope r de te rm ina tio n of a ny iss ue in the c as e, inc lud ing the c au se 10 of the injury , the [ W CJ] m ay order an [ IME ] upon the j udge’s ow n m otion .” Id

. I t i s 11 w el l se ttl ed

that “ w he re ac onf

lic t ari se s inthe pr oof

, wi th one or

m or e ex pe rt s 12 e xp r e ss i ng a n op i ni ono ne w a y , a nd o t he r s e xp r e ss i ng ad i a m e t r i c a l l y c on t r a ry 13 opi nio n, the tr ie r of

the f ac ts m ust re sol ve the dis ag re em en t and d et er m ine w ha t the 14 true fac ts are. ” Ya t es v. Ma tthews , 196 3- N MS C- 038, ¶ 11, 71 N

. M. 451 , 379 P

. 2d 15 441. H ow ev er , the re m ust be ar at ion al ba sis f

or the W CJ to re

j ec t a pr opos ed

f ind ing 16 of cau sa ti on . Cf

. Ch ev ron R es . v . N. M

. Sup er int en de nt o

f I ns. , 199 2- N MC A -0 81, ¶

8, 17 114 N.M. 371, 838 P.2d 988 (explaining th at “ [w ] e m ust affirm the W CJ if there wa s 18 a ratio na l ba sis f

or the W CJto re

j ec t [ the w ] orke r’ s p ropos ed f ind ing that hi s lung 19 co ndi tio n w as a ggr av at ed dur ing the co ur se of his em plo ym en t” ). E xpe rt

te sti m ony31

1 that “ fails to speak to the ulti m at e issue in the case” is not afforded substantial 2 weig ht

. Tr uji llo , 201 6- N MC A -0 41, ¶ 39. I n c as es inv olv ing apr ee xis tin g c ondi tio n 3 whe re the w orke r ha s in iti al ly e sta bli she d c au sa tio n th ro ugh ex pe rt te sti m ony , “ the 4 bur de n of

pr oduc tio n sh oul d be upo n an e m plo y er to showthat the e ff

ec ts o f the 5 preexisting con di t i o n are identifiablyseparate and unrelated.” E dm iston , 199 7- 6 N MC A -0 85, ¶

17. 7 C . Wh et he r Wor k er M etHi s B ur de n U nd er S ec ti on 52- 1- 28 8 { 31} W orke r’ s D ec em be r 2014 c om

pla int state d th at

his Marc h 20 14 a cc ide nt 9 ca use d an a ggr av at ion of

his pr ee xis tin g c ondi tio n, a ft er w hic h he be cam e dis ab le d. 10 Sp ec if

ic al ly , W orke r de sc ri be d th e iss ue a s bein g “ w he the r W orke r’ s pr ee xis tin g 1 1 []a rt h ri t i s an d [ A VN] was made worse by the fal l at workon Marc h 1 1, 2 01 4.” 12 (E m pha si s a d d ed

. ) W orke r ne ve r co nte nde d th at the Marc h 20 14 a cc ide nt e xc lus ive ly 13 caused

his A V N or art hriti s. E m

plo y er /I nsur er ’ s r es pons e fo cu se d one sta bli shi ng 14 wha t W orke r ha d a lr ea dy c onc ed ed

—tha t hi s A V

N a nd arthr iti s w er e pr ee xis tin g 15 conditi ons th at w ere not causally relate d to the March2 01 4 accident—and challenged 16 D r. Caro the rs ’ opi nio n r eg ar din g c au sa tio n. E m plo y er f ai le d to a ddr es s the que sti on 17 of ag gr av at io n o r ap pl ic ab le law re ga rd in g a gg rav at io n o f a p reex is ti ng co nd it io n. As 1 8 a r es u l t , t h e v as tm aj o ri t y o f ex p er t t es t i m o n y el i ci t ed fo cu s ed o n wh et h erWor k er ’s 19 March 2014 accident caused W orker’ s AV N and whether the accident itself caused32

1 the ne ed fo r W orke r’ s hi p r ep la ce m en t surg er y . Bo th i nqui ri es w er e fa ct ua lly a nd 2 le ga lly de fi ci en t. E xa ce rb at ing the a na ly se s’ sho rt co m ing s w er e (1 ) the W CJ ’ s lis t of 3 que sti ons to the I ME pane l, w hic h a dvanc ed the sa m e m isunde rs tandi ng o f the 4 ap pli ca ble le ga l sta ndard s shar ed by E m plo y er /I nsur er , the re by

de va lui ng t es tim ony 5 el ic ite d inr es pons e the re to; an d (2) W orke r’ s own f ai lur e to c lari fy

the ba sis f

or his 6 claim when questionin g experts—i.e. , that his cla im ed injury wa s “ aggravation of a 7 pr ee xis tin g r igh t hi p c ondi tio n” r athe r than th e co ntu sio n he suf fe re d as a re sul t of

the 8 ac ci de nt— an d ar

tic ula te the ba sis fo r ea ch of the be ne fi ts he sou ght ( T T D , P PD , a nd 9 m edical). 10 { 32} W e re vie wthe r ec or d to de te rm ine (1 ) w he the r W orke r es ta bli she d c au sa tio n 11 under Section 52-1-28, specificall y wheth er his Marc h 201 4 accident caused an 12 ag gr av at ionof

his pr ee xis tin g c ondi tio n r es ult ing in his dis ab ili ty or dis ab ili tie s; and 13 (2) if so , wh et he r the W CJe rr ed by f ai lin g to a w ar d W orke r be ne fi ts r el at ed to his 1 4 a g g r a v a t i o n i n

ju ry. 15 1 . Wor k e r M e t H i s B u r d e n o f E s t a b l i s h i n g , T h r o u g h E x p e r t M e d i c al 16 Te st im on y , a C a u s a lC o n n e c t i o n Be twee n Hi s W or k -R el at ed A cc id en t, Hi s 17 Injur y (Aggravation of His A VN ), and His Inability to Work 18 { 33} O n Ju ly

17, 201 4, D r. Caro the rs not ed that W orke r ex pe ri en ce d “ pa in pri or to 19 his fall, and I believe that he had a w ell[-] com pensated c ondi tion o f the hip that was 20 al lo win g hi m to fu nc ti on wit h oc cas io na l an d re la ti ve ly m in im al di sc om fo rt. I believe33

1 tha t the fal l di

sru pte d [ the ] te nuou s ba lan ce of the hip and has resul te d in an 2 a g gr a v a t i o n o

f th e h i p a n d m o r e c o n s t a n t

a n d m o r e d e b i l i t a t i n g

pai n. ” (E m

pha sis 3 ad de d. ) A t his depo sit ion , D r. Caro the rs el ab or at ed on this not e: “ So m y a sse ssm en t 4 of this is th at the severity of h is hip did not result from his fall in March. I believe that 5

. . . the dow nw ar d sp ir al of his hip be ga n w ithhis tr au m a an d fr ac tur e in 2002 a nd h e 6 has likely

been dealing with or coping with a bad hip for a longer period of tim e and 7 his sy m pto m s wo rs en ed

as a resul t of

the fal l .” (E m

phasis add ed.) Dr . C arothers 8 furthe r te sti fi ed tha t he be lie ve d W orke r “ w as co pin g—w as ab le to c ope w iththe hip 9 in its cond ition and that as a result of the fall, the pain w orsened. H e w as no long er 10 ab le to co pe ” an d th at “ the dif fi cu lty is [W orke r ha s] be enm ak ing due , he ha [d ] 11 an oth er

f al l a t w ork, nowhe i s not m ak ing due

. ” Inoth er w or ds, a s adir ec t and 12 na tur al res ult

of W orke r’ s M ar ch201 4 a cc ide nt, W orke r suf fe re d de bil itatin g pa in 13 tha t c au se d hi m

to no l onge r be able to w ork a s of Jul y 12, 201 4. 14 { 34} T he r ec or d thus r ev ea ls tha t f ro m e ar ly on, D r. Caro the rs une qui voc al ly 15 identified W orker’ s injury as being an aggravation of his preexisting AV N , e videnced 1 6 b y W o rk e r ’ s i n c r e a s e d p a i n a n d “ i n ab i l i t y t o c o p e ” f o l l o w i n g t h e f

a l l

. He cau sa ll y 17 connected that injury

to W orker’ s March 2014 accident and further established that 18 W orke r’ s in ab ili ty

to w ork ( i.e., h is T T D ) re sul te d f ro m his inc re as ed

pa in p ost

19 injury . E m

ploy er/Insurer ’ s effort to seiz e upon parts of Dr . C arothers’ testim ony that34

1 ap pe ar to equiv oc at e as to causat ionbe tw ee n W orke r’ s a cc ide nt and h is n ee d f or 2 su rg ery—i.e., Dr. Caro th ers ’ st at em en t th at “ th e ne ed fo r hi p re pl acement n ow m ay 3 be re lat ed to tha t f

al l f ro m Mar ch ”— is unava ili ng b ec au se that i s no t the r el ev an t 4 in qu iry. Cf

. T ruj ill o , 201 6- N MC A -0 41, ¶ 35 (e xpl ai nin g th at astate m en t tha t a cc ep ts 5 a pr of fe re d pre m ise an d ack

now le dge s som ethin g as a po ssi bil ity “ is n ot s uf

fi ci en t t o 6 negate the cl ea r assertions of causation previous ly [m ade] ”). Im

portantly , D r. 7 Ca ro t h er s n ev ero p i n ed t h at t h e M ar ch 2 0 1 4 ac ci d en twa s t h e s o l e ca u s e o f Wo rk er ’s 8 inabilit y

to work. Rather, he readily and repeate dly acknowledged that W orker had 9 a se ve re pr ee xis tin g c ondi tio n and c onc ed ed that the se ve ri ty

of W orke r’ s c ondi tio n 10 and his need for surgery are not so lely attributable to the accident. E ven assum ing Dr. 11 Carot he rs ’ te sti m ony

e sta bli she s no thi ng m or e than th at W orke r’ s a cc ide nt w as a 12 m ino r fa ct or

c ontri but ing to his ina

bil ity to w ork, that i s s uf

fi ci en t t o e sta

bli sh 13 cau sa ti on . Se e B uc hana n , 199 5- N MC A -1 31, ¶ 23. W e co nc lud e tha t D r. Caro the rs ’ 14 ca usa tio n op ini on m ee ts the r equir em en ts o f Se ct ion52- 1- 28 b ec au se his te sti m ony 15 establishes, first, that W orker’ s M arch 20 14 accident caused an aggravation injury 16 (aggravation of W orker’ s preexisting AVN ) and, second, that the aggravation injury 17 “ m or e li ke ly th an no t” cau se d W or ke r to be co m e d is ab le d. B uc hana n , 19 95 -NMCA18 131, ¶ 23 (internal quotation m arks and citation om itted).35

1 { 35} Beca

use of the uncontradicted m edical evidence rule, the q u es t i o n then 2 becom es whether Dr

. Carothers’ testim ony is itself inherently

deficient and theref

ore 3 unabl e to s er

ve a s th e ba sis f

or m ee tin g th e re qui re m en ts o f Se ct ion52- 1- 28( B) , or 4 alternatively , whether oth er m ed ical expert testim ony sufficiently

contradicted Dr

. 5 Caro the rs ’ c au sa tio n te sti m ony , thu s a llo w ing the W CJ to r ej ec t D r. Caro the rs ’ 6 te st im on y . See B anks , 2003-NMS C-026, ¶ 35. If no t , t h e W CJ wa s boun d by Dr

. 7 Caro th ers ’ cau sa ti on op in io n. Id

. W e ad dr es s e ac h of

the se que sti ons in t

ur n. 8 2. Em pl oye r/ In su re r’s N ie de rst adt Ar gum ent Ch allenging the C om pete ncy 9 of

D r. C ar ot he rs ’ C au sat ion Op in ion is Wi th ou t M er it 10 { 36} Throughout the proceedings, including on appeal, E m ploy er/Insurer

relies 11 he av ily

on Ni ed er sta dt a nd a lso Za nio ’s F

oods to unde rm ine a nd l es se n th e w ei ght 12 of Dr . C arothers’ m edical testim ony reg ar di ng c a

us at i on . E m

ploy er/Insurer ’ s reliance 13 on Ni ed

er sta dt a nd Za nio ’s F

oods is m isp la ce d, part ic ularl y a nd c ri tic al ly

a s am eans 1 4 t o d e f e a tDr

. C a r o t h e r s ’ t e s t i mo n y. 15 { 37} In Ni ed

er sta dt , this Court rever sed a W CJ’ s awa rd of PP D benef its after 1 6 co n cl u d i n g t h at t h er e w as n o ts ub s t a n t i al ev i d en ce t o s up p o rt t h e WC J ’s 17 de te rm ina tio n th at

the w orke r ha d m et

his bur de n of

pr oof a s to c au sa tio n. 197 5- 18 NMC A- 059, ¶¶ 11, 13. In that case, the worker had suffere d an injury

thirteen y ears 19 pr io r to hi s wo rk -rel at edin jury. Id

. ¶ 10. T he doc tor

w hose r ep ort w as r el ie d up on t o 20 establish causatio n betwee n the work-r elated accident and the worker ’ s disabil ity had36

1 no know le dge of

the pr ior inj ur y . Thi s Court he ld tha t “ sin ce pe rt ine nt i nf orm at ion 2 ex ist ed about w hic h [ the doc tor ] appare ntlyha d no kno w le dge , his opi nio n c an not 3 serve as the basis for c om pliance” w ith Section 52-1-28 ’ s requirem ent that the worker 4 es ta bli sh c au satio n thro ugh m ed ic al e xpe rt te sti m ony . Ni ed

er sta dt , 197 5- N MC A -0 59, 5 ¶ 11. As th is Co urt m or e re ce ntl y e xpl ai ne d in Za nio ’s F

oods , “ T he e sse nc e of 6 Ni ed er sta dt is tha t a he al th[ ] care pr ovi de r m

ust be inf orm ed ab out a per

tin en t pr ior 7 in jury befo re h e o r sh e can ren de r an op in io n as to th e cau se of a su bs eq ue nt in jury.” 8 Za nio ’s F

oods , 200 5- N MC A -1 34, ¶ 14. I n Za nio ’s F

oods , the wo rk er had suffe red 9 m ultip le prior back inj u ri es t h at h e fa iled to dis close to his h ealth car e providers 10 w hose te sti m ony

a s to c au sa tio n w as appare ntl y c re dit ed by the W CJove r co m

pe tin g 11 ex pe rt t es ti m on y . Id

. ¶¶ 16, 56. N ota

bly , the w orke r in Za nio ’s F oods did not a rg ue 12 ag gr av a t i o n of a pre ex is ti ng co nd it io n. Id

. ¶ 7. Rather, he claim ed his work-re lated 13 ac ci de nt “ w as the sol e ca use of the de ge ne rativ e dis k c ondi tio n of w hic h he 14 com plained” even thou gh it appeared—and at tim es the worker even conceded—that 15 th e d eg en erat iv e d is k c on di ti on was p reex is ti ng . Id

. ¶ ¶ 51, 56. U nli ke in Ni ed

er sta dt , 16 w he re thi s C ourt re ve rse d w ithins tr uc tio ns t o e nte r j udgm en t i n f av or of the 17 em plo y er , 197 5- N MC A -0 59, ¶ 13, in Za nio ’s F

oods , thi s C ourt re m an de d the c as e 18 to the W CJf

or e ntr y of “ m or e de ta iled an d ex plana tor y f ind ing s of

f ac t and 19 conclusio ns of law. ” Za ni o’ s F oods , 200 5- N MC A -1 34, ¶ 55. T he Co urt m ad e no37

1 ult im at e de te rm ina tio n a s to w he the r the w orke r ha d m et his bur de n of

e sta bli shi ng 2 ca usa tio n. 3 { 38} H er e, the r ec or d e vin ce s th at D r. Caro the rs pos se sse d th e pe rt ine nt i nf orm at ion 4 regarding W orker’ s preexisting con ditio n as early as his f irst assessm ent of W orker 5 on July 8, 201 4. O n th at

da te , D r. Caro the rs not ed in W orke r’ s c ha rt the his tor

y of 6 W orker’ s present illness: “ [W orker] broke his hip back in 200 2 and und erw ent open 7 re duc tio n and i nte rn al f ixa tio n. ” A s to his obse rv at ion s ba se d onhis e xa m ina tio n of 8 W orker’ s right hip, D r. Car others noted, “ there has been [A VN ] of the fem oral head 9 with sev ere collapse[,] ” indicating he po ssessed the pertinent in form ation that 10 W orke r’ s AV

N w as pr ee xis tin g. In the not es fr om W orke r’ s fol low -u p vi sit on July 11 17, 201 4, D r. Caro the rs state d th at “ the c ha nge s inthe hip a re r athe r ch ro nic a nd I 12 believ e t h at t h e [A VN ] has been long-stand ing and p redated the inj ury [, ] ” further 13 reinforcing his awareness of W orker’ s AV N prior to opi ning that the accident caused 14 ana ggr av at ionof

W orke r’ s c ondi tio n. 15 { 39} E m

plo y er /I nsur er a rg ue s th at

“ [o ] n c ro ss- ex am ina tio n, D r. Carot hers ’ 16 te sti m ony

too k atur

n w he n c on fro nt ed w ithW orke rs ’ pr ior m ed ic al r ec or ds” f

ro m 17 UN MH. How ever, we discern no m aterial differe nces betwee n Dr

. Carothers’ direct 1 8 an dcr o s s -e x amin at i o n t es t i m o n y. After being presented with and r ev i ew i n g Wor k er ’s 19 U N MH r ec or ds f

ro m 200 6- 2011 , D r. Caro the rs m ai nta ine d:38

1 So li ke I atte m

pte d to m ak e cl ear, I thi nk [ W orke r’ s] c ondi tio n of his hip 2 re la te s to his ini tia l f al l in 2002

. I w oul d ha ve ex pe ct ed him to ha ve pa in 3 long before the fall in March [2014] as is dem onstrated by the n o tes 4 fr om U

N M [ H ; ] h o w e v e r , t h e r e i s a [ t h r e e ]

- y e a r g ap b e t w e e n t h e la st 5 U

N M[ H ] not e and the N ew Me xic o O rthope dic not es , so h e obvi ousl y 6 didn’ t have atot al hip r ep lacem en t [and] ha s be enm ak ing due

. S o th e 7 dif

fi cu lty is [W orke r ha s] be enm ak ing due , he ha s anothe r fa ll at w ork, 8 nowhe is not

m ak in g du e. So it ’ s r ea sona ble to say that the f al l c oul d 9 ha ve a ggr av at ed the c ondi tio n of

his hip , but by [a nd] larg e his 1 0 s ym

p t o ms , h i s h i p p a i n a r e s t e mm i n g f r o m th e o r i g i n a l i n

ju ry. 11 This testim ony

largely m irrors D r. Car others’ ear lier testim ony —and his ori ginal 12 op in io n— th atW or ke r’s acci de nt ag gr av at edhi s AVN. 13 { 40} E m

plo y er /I nsur er al so atte m

pts to unde rm ine the w ei ght of Dr. Ca ro the rs ’ 14 te sti m ony

by poi nti ng o ut tha t W orke r w as D r. Caro the rs ’ “ sol e sour ce of inf orm at ion 15 as to the m ec ha nis m

of his inj ur y on Ma rc h 11, 2014 as w el l as the pr ogr es sio n of hi s 16 sym pto m s” a nd h igh lig hti ng the W CJ ’ s f ind ing that: 17 D r. Caro the rs te sti fi ed in de posi tio n th at

he ha d no t r ev ie w ed

a ny 18 re co rd s f

ro m U N MH r eg ar din g W orke r’ s pr ior hip tre atm en t, did

not 19 reviewW orker’ s m edical re cords from Concentra, did not review 20 phy sical therapy rec ords regarding W orker’ s hip, and that W orker w as 21 Dr . Carothers’ only source o f W orker’ s m edical history . D r. Car others 22 w as unaw ar e W orke r’ s di ag nosi s of A V N da te d ba ck

to at le as t 20 08. 23 Ther e ar e num erous problem s with E m ploy er/Insurer ’ s line of at tack. First, neither 24 Ni eder

sta dt nor Za nio ’s F

oods i m p o s e s ar e qu i r e m e n tth a tat e s t i f y i n g e x p e rth a ve 25 re vie w ed

a ll of aw orke r’ s pr ior

m ed ic al r ec or ds i n or de r to p ro vid e a co m pe te nt 26 ca usa tio n op ini on. A s a cknow le dge d by E m plo y er /I nsur er , the r equir em en t i s si m ply39

1 that “ a health[] care provider m ust be inf orm ed abo ut a pe rti ne nt p rio r in jur ybefore 2 he or she can re nder an opinio n as to the ca u s e o f a subsequent injury .” Zanio’s 3 F oods , 200 5- N MC A -1 34, ¶ 14 ( em pha sis ad de d)

. T he fa ct tha t Dr

. Caro the rs ha d no t 4 review ed W orker’ s UN MH r ecords is not presum pt i v el y fatal given that Dr. 5 Caro the rs —un lik e th e e xp e r t s in Ni ed er sta dt a nd Za nio ’s F

oods —had been inform ed 6 about W orker’ s pert i n en t p rior inj ury by W orker him self and

had review ed 7 ra dio gr ap hs t ha t provi de d a ddi tio na l i nf orm at ion , i. e. , that the A V N w as “ lon g8 s tanding .” Se co n d , t h e WC J ’s fi n d i n g t h atDr . C ar o t h er s d i dn o tkn o w wh en Wor k er ’s 9 AV N w as first diagnosed i s of no m om ent here. Dr . C arothers never opined that 10 W orke r’ s M ar ch201 4 a cc ide nt c au se d hi s AV N , onl y tha t the a cc ide nt worsened or 11 aggr avated

the AV N, thus hast enin g the need for hip replace m ent surgery . E ven 12 E m plo y er /I nsur er f ai ls t o e xpl ai n th e si gnifi canc e of the f ac t tha t D r. Caro the rs did 13 not kno wthat W orke r’ s A V

N ha d f ir st b ee n di ag nose d in200 8. 14 { 41} W e co nc lud e tha t thi s ca se is dis tin gui sha ble fr omboth Ni ed

er sta dt a nd 15 Za nio ’s F

oods

. T he w ei ght

of D r. Caro the rs ’ te sti m ony is not neg at ive ly im pa ct ed by 16 the f ac t tha t he ha d no t rev ie w ed W orke r’ s U

N MH r ec or ds p ri or

to re nde ri ng h is 1 7 c au s a t i o n o p i n i o n

—w h i c h h e a f f i rm e d e v e n a f

t e r r e v i e w i n g t h e m a t hi s 18 de posi tio n—b ec au se the r ec or d m ak es cl ear tha t he pos se sse d pe rt ine nt i nf orm at ion14 T o th e ex te nt E m pl oy er /I nsur er c ha lle nge s th e w ei ght

of the c au sa tio n 5 15 opi nio ns o f W orke r’ s tr eatin g he al th c ar e pr ovi de rs a t C on ce ntr a, S te ve Card en as , 16 P. A

. , an d D r. D av id L ym an , w e ag re e tha t Ni ed er sta dt m ay ap ply to the ir

te sti m ony 17 be ca use both re la te d W orke r’ s A V N—r athe r than ana ggr av at ionof his A V N—t o th e 1 8 M ar ch 2 0 1 4 ac ci d en t . Ho we v er , Empl o yer/ In s u re r’s at t emp t s t o d i s cr ed i tCa rd en as ’s 19 and Dr. Ly

m an’ s opin ions o n the b asis of Ni ed er sta dt ignore the fact that W orker 20 ne ve r cl ai m ed th at his Marc h 20 14 a cc ide nt c au se d hi s A V N a nd o nly

se rv e to 21 unne ce ssari ly

c onf use m atte rs . A s e xpl ai ne d inthe pr ec ed ing secti on, g ive n th e 22 subs tance of and basis for D r. Car others’ cau s at ion testim ony , no other expert 23 testim ony

wa s needed to establish causation, m aking it irrelevant w hether Car denas 24 an d D r. L ym anha d a ll pe rt ine nt i nf orm at ionin re nde ri ng the ir opi nio ns. 40 1 about W o rk er’ s prior injury when he gave his opinio n. To the e xtent the W CJ 5 2 discoun ted the weight of—or outright rej ected, as appea rs to be the case—D r. 3 Caro the rs ’ te sti m ony

base d onE m

plo y er /I nsur er ’ s Ni ed

er sta dt c ha lle nge , w e hol d 4 tha t i t w as e rr or

to do s o. 5 3. No Su bstantial or C om pete nt Ex pert Me dical Testim ony Reb utt ed D r. 6 C ar ot he rs ’ C au sat ion Op in ion 7 { 42} W e next turn to whether other expert m edical testim ony co n t radicted D r. 8 Carothers’ causation testim ony , ther eby permitting the W CJ to choose between 9 co m pe tin g op ini ons. I f not , D r. Caro the rs ’ te sti m ony is bin din g on the W CJa nd this 10 Co ur t. See B anks , 200 3- N MS C- 026, ¶ 35. W e not e tha t w hil e “ cau sa ti on” is the 11 ul ti m at e is su e th at m

us t be reso lv ed , de te rm in in g whet he r W or ke r’s di sabi li ti es (TTD 12 and PPD ) resulted from his March 201 4 accident h inges, i n this case, on the narr ower 13 que sti on of

w ha t ty pe of inj ur y or inj ur ie s W orke r suf

fe re d. A cc or din g to W orke r an d41

1 D r. Caro the rs , th e inj ur

y W orke r suf

fe re d w as a n a ggr av at ionof W orke r’ s pr ee xis tin g 2 A V N

. A cc or din g to E m

plo y er /I nsur er a nd the W C J , W o r

k e r s u f f e r e d on ly ac ontusi on 3 to h is r igh t thig h, a nd W orke r’ s pr ee xis tin g A V N w as una ff

ec te d by the Marc h 20 14 4 ac ci de nt. H av ing al re ady co nc lud ed tha t D r. Caro the rs ’ te sti m ony une qui voc al ly

a nd 5 co m pe te nt ly esta bl is he d t ha t W or ke r su ffer edan ag gr av at io n o f hi s p reex is ti ng AVN, 6 and that the injury

resulted in disabil ity, w e focus on whether substantial evidence 7 supp orts the W CJ ’ s e xpr es s f ind ing that “ [t ] he m ed ical ev id en ce . . . sup ports a 8 [f ]in d i n g t h at Work ers u ff

er ed a c o n tu s i o n t o h i s ri g h tt h i g h as a r es u l to f Wo rk er ’s 9 fa l l f r om a l a dd e r on M a r c h 11 , 20 14 [ , ] ” a nd t he c on c om i t a nt i m pl i e d f i nd i ng that 10 W orke r did not su fferan ag gr av at io n o f hi s p reex is ti ng AVN. Se e Tr uji llo v . Ci tyof 11 A lbu que rque , 1993-NMC A- 114, ¶ 1 3, 11 6 N. M. 640 , 866 P. 2d 368 (explaining that 12 a rev ie win g c ou rt “ ex am in e[s ] th e reco rdto asc ert ai n wh et he r th e [WCJ’s] fin di ng . . . 13 is sup ported by

subst antial evidence under a w hole-record standard of r eview”); 14 Jo nes v. B ea ve rs , 1993 -N MC A -1 00, ¶ 18, 116 N

. M. 634 , 866 P

. 2d 3 62 ( ex pla ini ng 15 tha t “ [t ] he tr ia l c ourt’ s r ef usa l t o a dopt

the r eque ste d fi nd in gs of f ac t i s tantam ount 16 to a find ing against [the requesti ng party ] on each of the[] fac tual issu es”). W e re view 17 the testim ony

of D rs. Ross and Legant, the IME panel m em bers on whom

the W CJ 18 appears to have m ost heavilyrelied in rendering his decision. W e begin by notin g that 19 the IM E pa ne l’ s ch ar ge w as to re spon d to the que sti ons fo rm ula te d by th e W CJ ,42

1 w hic h f ai le d to inquir e int o th e re le va nt u lti m at e iss ue s inthi s c as e. A s suc h, w e m ust 2 ex am ine not

onl y the ult im at e opi nio ns o f D rs . Ro ss and L eg an t bu t a lso the ba sis f or 3 the ir opi nio ns i n or de r to d et er m ine w he the r the y

a re suf fi ci en t a s am atte r of

lawto 4 c o n t rad ic t Dr. Ca ro th ers ’ op in io n t ha t Work er s uf fere d a n a gg rav at io n i nju ry . See 5 Tr uji llo , 199 3- N MC A -1 14, ¶ ¶ 14- 21 ( ex pla ini ng tha t i t i s im pr ope r fo r a W CJto re ly 6 upon opini on testim ony when the basis for the opinion fails to com port with statutory 7 definition s and standards, rendering it “ incorrect a s a m atter of law” ). 8 Dr s. R oss’s and Legant’ s Testim ony 9 { 43} W orker directly question ed Dr

. Ro ss about her opinion regar ding whether 10 W orker sustain ed an aggravation of his pre existing AV N three tim es du ri n g her 11 de posi tio n. F ir st, w he n a ske d w he the r she a gr ee d or dis ag reed with D r. Caro the rs ’ 12 opi nio n that W orke r “ suf fe re d an a ggr av at ionof

his pr ee xis tin g r igh t hi p c ondi tio n 13 as ar es ult

of the f al l a t w ork in[ Marc h] 201 4[ , ] ” D r. Ro ss r es pond ed : 14 I’m co nfuse d by the te sti m ony

y ou’ re ha vin g m e re ad

. Be ca use in one 15 part of it .

. . [ Dr . C arothers] say s that he think s the fa l l re s u l t ed in an 16 aggravation of the hip and m ore constant and debilitatin g pain, but then 17 [i n] the se co nd p ar t he say s th at

[ the ] se ve ri ty

of the pa in is n ot a

r es ult 18 of

the f al l, that i t’ s a

dow nw ar d spir al that st ar te d f ro m af ra ct ur e in 19 2002 an d, quot e, but I be lie ve tha t his hip w as in en d- stag e arth ri tis 20 re la te d to [ A V

N ] pr ior to the f al l, e nd quot e. S o I f

in d—I ’ m una ble to 2 1 a n s w e r

yo u r qu e s t i o n b e c au s e I f

i n dwh a th e s a ys c o n t r a d i c t o ry.43

1 N ex t, w he n as ke d if it w as he r te sti m ony tha t W orke r’ s “ ri ght hip sy m pto m s di d no t 2 w or se n a s ar es ult

of the f al l a t w ork[ , ] ” D r. Ro ss n ev er dir ec tl y an swe re d th e 3 que sti on. I nst ea d sh e re spon de d: 4 I thi nk w e’ re c onf usi ng the te rm

hip sym pto m s—o r usi ng the te rm ‘ hip 5 sym

pto m s’ ve ry

loo se ly

. Wha t I ’ m

say ing is tha t I thi nk tha t the f al l 6 ca

use d hi m to ha ve ac ontusi on t o hi s le g, his thi gh, but I thi nk tha t the 7 ac tua l pr obl em , his pa in n owa nd the r es ult an t r ec om m en da tio n f

or 8 surger y , is due to the f ac t tha t he ha d e nd- sta ge [ A V N ]

. . . . I do n ot 9 be lie ve that the f all caused

a n e nd- sta ge pr obl em

to be co m e w or se 10 because he w as alrea dy at end stage. I think that th is is a natural 11 progression of his d i s ease and of the diagn osis and that he wa s 12 ultim ately

going to need a hip replacem ent which w as rec omm ended as 13 far ba ck

a s 20 08. 14 Fi na lly , wh en a ske d a ga in t o c om m en t onD r. Caro the rs ’ opi nio n th at “ the f al l 15 ag gr av at ed

[ W orke r’ s pr ee xis tin g A V N ] a nd w or se ne d th e pa in, ” D r. Ro ss s ta te d: 16 I do n ot a gr ee w ith[ tha t]

. . . be ca use the pa tie nt w as a lr ea dy a t e nd 17 sta ge . Y ou c an ’ t ge t any f urthe r than en d st ag e. T he re ’ s no j oin t l ef t. T he 18 fe m or al he ad

is gone . I t j ust

doe sn’ t ha

ppe n. A ct ua lly , if y ou look at

the 19 X- ray s, y ou do n’ t see a c hange in the X-ray s. Th e X -ray s wer e bad 20 be fo re the f

al l. T he y w er e the sa m e af

te r the f al l. 21 Re gard ing w he the r W orke r’ s pr ee xis tin g A V N c oul d have be en ag gr av at ed by the 22 Marc h 20 14 f

al l, D r. L eg an t te sti fi ed

that “ [y ] ou c an ’ t ge t r ea lly w or se than ‘ en d23 sta ge a rthr iti s. ’

. . . I t m eans y ou’ re a t the e nd o f the lin e. T he tr eatm en t i s ba sic al ly 2 4 a h i p re p l ac emen t , i n d i ca t i n g t h a t a ts o m e p o i n ti n t i m e p ri o r t o [Wo rk er ’s ] fa l l i t ’s 2 5 a s b a da s i t ’s g o i n g t o g e t

. ” We c o n s i d e r t h e e f f e c t o f t h i s t e s t i mo n y.44

1 { 44} D r. Ro ss’ s f

ir st r es pons e fa ils to une qui voc al ly co ntr ad ic t D r. Caro the rs ’ 2 testim ony

that W orker suffer ed an aggravation injury . D r. Ross stated that she was 3 “ unable t o a ns w e r ” W or ke r ’ s qu e st i on w he t he r sh e a gr e e d or di sa gr e e d w i t h Dr

. 4 C ar o th e r s ’ a g g r a v a t i o n i n j u ry o p i n i o n b e c au s e s h e f o u n d h i s s t at e men t s c o n tr a d i c t o r y. 5 Setting aside the fa ct t h at there is nothing inherently contradictory

about Dr. 6 Carothers’ opini on that th e severity of W orker’ s preexisting c on ditio n could b e trac ed 7 t o h i s 2 0 0 2 f

a l l f r o m at r e e r a t h e r

t h a n h i s 2 0 1 4 f

a l l f r o m al a d d e r , a n da tt h e s a me 8 tim e tha t W orke r’ s 20 14 f al l a ggr av at ed

a nd w or se ne d hi s a lr ea dy -s ev er e co ndi tio n, 9 D r. Ro ss’ s r es pons e to W orke r’ s f ir st que sti on f

ai ls t o a ddr es s th e ult im at e que sti on 10 po se d a nd th us m ay

no t b e aff

or de d s ub st an ti al weig ht

. Se e Tr uji llo , 20 16 -NMCA11 041, ¶ 39. 12 { 45} We co n s i d er Dr

. Ro s s ’s s ec o n d an d t h i rd re s p o n s es t o g et h er wi t h Dr . Le g an t ’s 13 be ca use doi ng s o il lum ina te s th e fata l fl aw in the r ea soni ng tha t un de rp ins both th ei r 14 opin ions. What is evident from Dr s. Ross’ s and Legant’ s explanation s i s t h at they 15 applied an incorrect standard for det er m i ning whether W orker suffer ed an 16 “ ag gr av at io n” of a pr eex is ti ng in jury u nd er New Mex ic o wo rk ers ’ co m pe ns at io n l aw. 17 Apply ing what appears to be the m edical standard for deter m ining “ aggravation,” D r. 18 Ro ss c onc lud ed

that W orke r’ s e nd- sta ge a rthr iti s c oul d no t “ ge t any f urthe r” be ca

use 19 there w as a l re ad y

“ no joint left[, ] ” m eaning that aggravation wa s a m edical45

1 im poss ibi lity , w hic h op ini on w as e ch oe d by D r. L eg an t. Y et it is w el l e sta

bli she d in 2 N ew Mexico lawthat e xpe ri en ci ng i nc re as ed pa in i s su ff

ic ie nt t o c onst itu te 3 ag gr av at io n of a pr eex is ti ng co nd it io n an d th us a co m pe ns ab le in

jury, Tom G rowney , 4 2005 -N MSC- 015, ¶ 53, and that th ere need not be “ phy sical tissue change for there 5 to be a com

pensable disabi lity .” Schober , 1980 -N MC A -1 13, ¶ 8. A ddi tio na lly , thi s 6 Co urt m ad e cl ear in E dm ist on that e ve n w he re apr ee xisting c ondi tio n “ cannot be 7 described as being worse beca use of the workplace in

ju ry”—as in the case of an 8 inc ur ab le dis ea se —c au sa tio n is not auto m at ic al ly de fe at ed

. 199 7- N MC A -0 85, ¶ 23. 9 Co ntr ar

y to D rs . Ro ss’ s and L eg an t’ s m ist ak en be li ef , W orke r w as not

r equir ed to 10 show a m edic al

a ggr av at ion

—i

. e. , phy sio log ic al de te ri or at ion —of his c ondi tio n in 11 or de r to e sta

bli sh th at he ha d su ff

er ed a n a ggr av at ion -ty

pe inj ur y , but onl y that the 12 “ w ork- re la te d a cc ide nt a ggr av at e[ d] the pr ee xis tin g c ondi tio n by c ha ngi ng the c our se 13 of the ailm ent or its treatm ent[.] ” Id

. 1997 -N MC A -0 85, ¶ 38 (H ar tz , C. J. , c onc ur

ri ng 14 in par t, dis se nti ng in part)

. W e nex t e xa m ine D rs . Ro ss’ s and L eg an t’ s te sti m ony in 15 lig ht o f thi s c or

re ct standard

. 16 { 46} By Dr s . R o s s ’s an dLe g an t ’s o wn ad m i s s i o n s , t h e t r e a t men to f Wo rk er ’s 17 co ndi tio n—and arg uably a lso it s c our se —ha d c ha nge d f oll ow ing the M ar ch201 4 18 ac ci de nt. S pe ci fi ca lly , D r. Ro ss co nc ed ed that f or thr ee y ears pr ec ed ing the a cc ide nt, 19 W orker had not soug ht treatm ent or b een p rescr ibed pain m edication for hi s hip; th at46

1 W orke r’ s c om

pla int s of pai n in his hip onl y r es ur fa ce d a ft er

the Marc h 20 14 a cc ide nt; 2 that W orker had never bee n prescribed the use of a cane or w alker prior to the Mar ch 3 2014 a cc ide nt; an d that W orke r’ s m obi lity de cr ea se d af te r the Marc h 20 14 a cc ide nt. 4 Dr . R oss also acknowledged that W orker’ s preexisting conditi on had not prevented 5 him from working prior to March 2014 and t hat W orker had not m issed any work 6 prior to the accident. D r. Le gant m ade sim ilar concessi o n s and also agreed that 7 W orker “ had v ary ing levels of functio ning that he wa s perform ing desp ite the fac t 8 th at he had a degenera tive right hip ” and that W orker’ s “ functionin g onlydeclined 9 after the work accident in 201 4[.] ” T hus, the undis puted expert testim ony established 10 tha t pr ior

to the ac ci de nt, W orke r: ( 1) ha d no t r equir ed use of pr es cr ipt ionm ed ic at ion 11 to m an ag e his pa in i n th re e y ears ; ( 2) w orke d a t f ull duty , ne ve r m iss ing w ork be ca use 12 of his preexisting conditi on; and (3) di d not need to use a cane. It further established 13 that after the accident, W orker: (1) e xper i en ce d worsening pain that required 14 prescription m edication for m anagem ent; (2) becam e unable to work within a sho rt 15 pe ri od o f tim e due to his inc re as ed pa in; ( 3) r equire d us e of a cane ; and ( 4) 16 ex pe ri en ce d de cr ea se d m obi lity . I n othe r w or ds, a s ana tur al an d dir ec t r es ult of his 17 ac ci de nt, both W orke r’ s m ed ic al tr eatm en t ( pr es cr ipt ionof pa in m ed ic at iona nd a 18 cane) and the course of h i s ai lm ent (non-disabl ing AVNto disabli ng aggravated 19 A V N ) ch an ge d.47

1 Th e Ev id en ce D oe s N ot S up po rtt he WC J’ s F in di ng s 2 { 47} W e co nc lud e tha t D rs . Ro ss’ s and L eg an t’ s te sti m ony f ai ls t o pr ovi de 3 subs tantial evidence to support the W CJ’ s im plicit f indin g that W orker did not suffer 4 ana ggr av at ioninj ur

y . S pe ci fi ca lly , the ir

te sti m ony

f ai ls t o e sta

bli sh eithe r (1 ) tha t i t 5 w as “ m ore lik el y

than no t” that W orke r’ s c ur re nt d isa bil ity r es ult ed f ro m his 6 pr eex is ti ng co nd it io n, M oly co rp , 198 5- N MC A -0 67, ¶ 16 , o r (2 ) tha t the c ur

re nt 7 ef fe ct s of W orke r’ s pr ee xis tin g A V N a re “ ide nti fi ab ly

se pa rate a nd unr el at ed ” to 8 W or ke r’s Mar ch 20 14 acci de nt

. E dm iston , 1997 -N MC A -0 85, ¶ 17. I t a lso f ai ls, a s a 9 m atter of law, to contradict Dr. Car others’ opi nion that W orker suffer ed an 10 aggravation injury

because any seem ingly contradictory causation testim ony

offer ed 11 by D rs . Ro ss and L eg an t is nega te d by the ir ap pli catio n of the w ro ng leg al standard

. 12 Se e Tr uji llo , 1993 -N MC A -1 14, ¶ 15. In ef fe ct , to af fi rm w e w oul d have to co nc lud e 13 that W orker w ould have becom e disabled on Ju ly 12, 2014, even if he had not fallen 14 from a ladder just fou r m onth s before. Ther e is no evidence whatsoever in the rec ord 15 to s uppo rt

suc h ac onc lus ion

. 16 { 48} Mor eo ve r, w e obse rv e tha t the standard by w hic h D rs . Ro ss and L eg an t and the 17 W CJw oul d m ea sur e “ ag gr av at ion ” not onl y is co ntr ar y to w el l- es ta

bli she d w orke rs ’ 18 com pensation l aw b ut also would frustrate the L egislature’ s intent and o ur state’ s goal 19 of en co u ragi ng workers to w ork and return to gainful em ploy m ent following an48

1 in jury. Se e P er ez v. In t’ l Mi ne ral s & Ch em . Co rp. , 1981-NMC A- 022, ¶ 14, 95 N .M. 2 628, 624 P

. 2d 1 025 (“ W e ha ve of te n c om m en de d w orkm enw ho w an t t o w ork, w ho 3 do n ot p lay

the part of Ri p Van W ink le

. W e supp ort a w orkm anw ho c ont inu es in his 4 em plo ym en t or

obt ai ns o the r em

plo ym en t de spi te his dis ab ili ty

. ”)

. A s evid en ce d by 5 this case, e ven workers w ith end-stage condi tions and dism al m edical diagnoses are 6 cap ab l e o f ma i n t ai n i n g g ai n fu l empl o ym en tan dco n t ri b u t i n g t o Ne w M ex i co ’s 7 w orkf or ce . S uc h w orke rs sho uld be c om m en de d f or the ir perseve ranc e an d f

ull y 8 co m pe nsa te d in ac co rd an ce w ith the pr ovi sio ns o f the A ct w he n, a s ar es ult

of the ir 9 choice to work rather than bec om e dependent upo n the pub lic we lfare , they suffer an 10 on- the -j ob i nj ur

y r es ult ing in the dis ce rn ab le wo rs ening of apr ee xis tin g c ondi tio n. 11 T he pr ev ai lin g r

ule in N ewMe xic o th at

“ the e m plo y er take s th e em

plo y ee a s it

f ind s 12 tha t em

plo y ee ” ap pli es in fu ll fo rc e he re : E m plo y er /I nsur er “ fo und” W orke r w itha 13 preexisting “ bad hip” conditi on—which W orker forthrigh tly disclos ed to Em ploy er 14 in 20 08 —an d n ev ert he le ss ele ct edto ke ep hi m in it s emplo y . E

d m isto n , 199 7- 15 N MC A -0 85, ¶

25 ( int er na l qu ota tio n m ar

ks and c itatio n om itt ed ). P ar tic ularl y in lig ht 16 of Mr

. Re et z’ s te sti m ony tha t he bel ie ve d W orke r to b e an“ hone st i ndi vid ua l” w ho 17 did “ good w ork” an d w as “ a de pe nda ble em plo y ee , ” it ha rd ly se em s un fai r to hol d 18 Em ploy er/Insurer

to the long -standing rule that w here “ a person suffers an accidental 19 inj ur y gr ow ing out

of a nd i n th e co ur se of

his e m plo ym en t he is en ti tl ed to be49

1 co m pe nsa te d f

or his dis ab ili ty as it the re af te r ex ist ed , notw ith standi ng the dis ab ili ty 2 w oul d no t have be enso g re at ha d he not be ensuf

fe ri ng f ro m apr e[ ] ex ist ing c ondi tio n 3 at the tim e of the inj ury .” R ey nolds , 196 1- N MS C- 116, ¶ 31. 4 { 49} Be ca u s e w e h o l dt h at t h er e i s n o ts ub s t an t i al ev i d en ce t o s up p o rt t h e WC J ’s 5 impli ci t f

ind ing that W orke r did

not suf fe r ana ggr av at ioninj ur

y , a nd b ec au se the 6 W CJ ’ s aw ar d o f bene fi ts w as li m ite d by his f ind ing that W orke r onl y

suf fe re d a 7 co ntu sio n in

j ur y , w e re m an d th is c as e in o rd er f or the W CJ to re co nsi de r an d 8 de t e r mi n e t h e be ne fit s t o wh ic h Work er m ay be en ti tl edin li gh t o f ou r ho ld in g. As 9 this Court has p reviouslycautioned, the W CJ and the parties m ust take “ exceptional 10 care ” to “ ad eq ua tely

c ove r the que sti ons ra ise d” in ca se s su cha s th is tha t i nvol ve 11 co m pli cate d qu es tio ns of law re gard ing ac ci de nta l inj ur ie s and p oss ibl e ag gr av at ion 12 of pr ee xis tin g c ond it io ns . Za nio ’s F oods , 200 5- N MC A -1 34, ¶ ¶ 54, 57. F ai lur e to 13 dif fe re nti at e suc h in te rw oven i ssu es a t the out se t of li tig at ionle nds its el f to the 14 po ss ib i l i t y o f fl awedpro ceed in gs an d m is id en ti fic at io n o f ap pl ic ab le an al y se s. On 15 re m an d, the W CJis in struc te d to appl y the dis tin ct

standard s di sc uss ed

he re in t o 16 de te rm ine w he the r W orke r is enti tled to a ddi tio na l be ne fi ts— both di sa bil ity a nd 1 7 med i c a l

— a n da n y c o s t s a n df e e s s t e mm i n g f

r o m h i s a g g r a v a t i o n i n

ju ry.50

1 I I . Wheth er Em ployer/InsurerPr em aturel y R e c e ived A ttorn ey Fe es Cont rary 2 to Sec tion 52-1-54(M) 3 { 50} W orke r argu es that S ec tio n 52 -1 -5 4( M) of the A ct pr ohi bit s paym en t of 4 attorney

fee s b ef

o re a case is adjudged and th at there is evidence that 5 E m plo y er /I nsur er soug ht an d w as pa id atto rn ey f ee s onthr ee oc ca sio ns p ri or to the 6 fi lin g of

the W CJ ’ s c om

pe nsa tio n or de r in thi s ca se . W orke r co nte nds tha t a ba d f ai th 7 pe na lty a nd/ or a n in cr ea se in W orke r’ s be ne fi ts i s th e pr ope r w ay to cure this 8 violatio n. W orker explains that he “ requested a sep arate hearing on the iss ue of bad 9 fa ith ” an d st at es that “ [t ] he W CJ de cl ine d to ad dr es s this iss ue in the [ c] om pe nsa tio n 10 [o] rder. ” But the j oint pre- trial order issued by the W CJ and agreed to by the parties 11 cl earl y pr ovi de s that W orke r’ s bad fa ith cl ai m w as to be ad dr es se d “ [a ] ft er tr ia l and 12 in a se parate he ar ing [. ] ” Fi ndi ng no ind ic at ion in the re co rd tha t a se pa rat e h earin g 1 3 o n Wo rk e r ’s b a d f

a i t h c l a i m h a s b e e n h e l d o r t h a taf i n a l o r d e r h a s i s s u e dt h e r e f

r o m, 14 we de cl in e to reac h t he m eri ts of t hi s i ss ue forlac k o f juri sd ic ti on . See N MS A 197 8, 15 § 52 -5 -8 (A ) (1 989) ( “ A ny party in int er es t m ay , w ith in thi rty day s of m ai lin g of

the 16 fi na l or de r of

the [ W CJ ] , f

ile anot ic e of

appe al w iththe c ourt of

appe al s. ”) ; cf. Capco 17 Acq ui sub, I

nc . v . G re ka E

ne rgyCo rp. , 200 7- N MC A -0 11, ¶ 17, 140 N

. M. 920 , 149 18 P. 3d 1 017 (“ [O ] ur

appe llate j ur isd ic tio n is lim ite d to r ev ie wof a ny f ina l j udgm en t or 19 de ci sio n, a ny

int er loc uto ry

or de r or de ci sio n whi ch pr ac tic al ly dis pose s of the m er its51

1 of the action, or any

final order a ft er e ntry

of j udgm ent which af

fects substantial 2 rights.” (a lteration, internal quotation m arks, and citation om itted)). 3 CON CLU SION 4 { 51} Fo r the f

or eg oing reas on s, w e re ve rs e an d r em an d th is c as e to the W CAf or 5 additio nal evaluation of an y benefits, costs , and fees to which Wor ker m ay be entitled 6 in l igh t of

thi s op ini on. 7 { 52} IT IS S O ORDERE D. 8

____ ______ __ __ __ __ __ ____ ____ ____ _ 9 J. M ILES HA NISE E, Judge

10 WE CO NCUR:

11

____ ____ ____ ____ ____ ____ ____ ____ _ 12 JA M ES J. WE C HS LE R , Ju dg e

13

____ ____ ____ ____ ____ ____ ____ ____ _ 14 JO N A TH A N B. S U TI N , Ju dg e