Baltimore County, Maryland v. Michael Quinlan , No. 50 , September Term, 2018 , Opinion

by Adkins, J. MARYLAND WORKERS’ CO MPENSATION ACT

— OCCUPATIONAL DISEASE

— LE § 9
- 502(D)

— PARAMEDIC /FIREFIGHTER S

— DEGENERATIVE MENISCAL TEARS : Pursuant to Maryland Code Ann. (1991, 2016 Repl. Vol. ) , § 9

- 502(d) of the Labor and Employment Article (“LE”), an occupational disease is only compensable if: (1) it is “due to the nature of an employment in which hazards of the occupational disease exist”; and (2) “it reasonably may be concluded that the occupational disease was incurred as a result of the employment of the covered employee.” Here, the record contained evidence that the nature of the job of a par amedic/firefighter involved hazards that place an employee at greater risk for degenerative knee conditions than those faced by the general public. The employee, Michael Quinlan (“Quinlan”), was a paramedic, and was r equired to engage in the activities that account for this increased risk. Moreover, he engaged in these activities repetitively over 24 years of employment. This claim was not shown to involve a concomitant preexisting condition. Therefore, a s a matter of law, the degener ative meniscal tears could be considered an o ccupational disease, a nd there was sufficient evidence for the jury to reasonably conclude that Quinlan’s degenerative knee tears were compensable.Circuit Court for Baltimore County

Case No. 03

- C

- 16

- 004811 Argued: February 5, 2019 IN THE COURT OF APPEALS
OF MARYLAND

No. 50 September Term, 2018
BALTIMORE COUNTY, MARYLAND

v. MICHAEL QUINLAN
Barbera, C.J. * Greene McDonald Watts Hotten Getty, Adkins, Sally D. , (Senior Judge, Specially Assigned) JJ.
Opinion by Adkins, J. Getty, J., dissents.

Filed: August 26, 2019 *Greene, J., now retired, participated in the hearing and conference of this case while an active member of this Court; after b eing recalled pursuant to the Md . Constitution, Article IV, Section 3A, he also participated in the decision and adoption of this opinion.“Definitions of ‘occupational disease’ should always be checked against the purpose

for which they were utter ed.” Arthur Larson, Lex K. Larson & Thomas A. Robinson, 4 Larson’s Workers’ Compensation Law § 52.03[1] (Matthew Bender, Rev. Ed. 2019)

. The purposes of Maryland’s Workers’ Compensation Act are manifold and, l ike others, involve a recognition of the many competing interests

— “to protect capital and labor, employer and employee, and the S tate against the waste and distress incident to modern industry

. . . .” Ligge t t & Meyers Tobacco Co. v. Goslin , 163 Md. 74, 80 (1932). Still, w e bear in mind the sacrifice and special toll certain Maryland workers withstand in the course of their service. The present case involves the claim of a veteran paramedic/firefighter regarding degenerative meniscal tears in his right knee . We review two questions, which we have rephrased and consolidated from the questions granted 1 for clarity . First, we review

1 The questions, as granted, were as follows: (1) Did the trial court err in denying Petitioner’s motion for summary judgment, given the lack of a clearly defined occupational disease as the basis for the claim and evidence that the conditions were shown to be prevalent in all occupations involving he avy physical labor not uniquely related to the work of a paramedic or EMT as an inherent and inseparable risk? (2) Did CSA err in finding that Respondent met the statutory requirements set forth in LE § 9

- 502(d)(1) and that he had sufficiently establishe d at trial that his condition resulted from an inherent hazard of his employment as a paramedic or EMT? (3) Should this Court review the decision below under the statutory requirements and existing case law, particularly Black and Decker Corporation v. H umbert , 189 Md. App. 1712

w hether the trial court erred in denying the County ’s motion for summary judgment, and , if not , w hether the trial court erred in finding that Quinlan met the statutory requirements set forth in LE § 9

- 502(d)(1) that his alleged occupational disease was “ due to the nature of an employment in which hazards of the occupational disease exist

. . . .” We conclud e that the trial court did not abuse its discretion by denying the motion for summary judgment; nor did it err in concluding that Quinlan’s degenerative meniscal tears could be classified as an occupational disease.

FACTUAL OVERVIEW AND PROCEDURAL POSTURE In October 2015, Michael Quinlan (“Quinlan”) filed a claim with the Workers’ Compensation Commission (“ the Commission”) against his employer, Baltimore County (“the County”) . In it, he asserted that he “developed meniscal tears” in his right knee due
to his job du ties as a “Paramedic/Firefighter. ” 2 T he Commission held a hearing regarding Quinlan’s claims and evaluated , among other things, whether he “sustain [ ed ] an occupational disease arising out of and in the course of his employment[.]” Ultimately , t he Commission disallowed the claim, concluding that Quinlan “did not sustain an

(2009), which similarly ignores the legislative requirement that a disease is only occupational if it is “due to the nature of an employment in which the hazards of the occupational disease exist” (LE § 9

- 502(d)(1)(i)), to provide clarification and guidance on the requirement for establishing a legally sufficient claim for occupational disease?

2 Quinlan described his occupation as consisting of 95% paramedic duties, as opposed to those of a firefighter. Thus, we will refer to him as a paramedic throughout this opinion.3

occupational disease of the [r]ight [k]nee degenerative tears arising out [of] and in the course of” his employment. Quinlan then sought review in the Circuit Court for Baltim ore County , requesting a jury trial. In appeals from the Commission , the trial court’s role is to determine whether the Commission “justly considered all of the facts,” “exceeded the powers granted to it,” or “misconstrued the law and facts applicable in the case decided.” Md. Code Ann. (1991,
2016 Re p l. Vol. ), § 9

- 745(c)(1)

– (3) of the Labor and Employment Article (“LE”). The Commission’s decision is presumed “ prima facie correct” and the party challenging the decision has the burden of proof. Id. § 9

- 745(b)(1)

– (2). Prior to trial, the County filed a motion for summary judgment arguing that Quinlan failed to present evidence that his knee injury was an occupational disease or that it was related to the nature o f his employment as a paramedic . Qui nlan opposed this motion. Based on the parties’ competing submissions, the trial judge denied the County’s motion for summary judgment concluding that there was “absolutely a material dispute of fact.” The case proceeded to trial on April 19 and 20, 201 7. Quinlan , 51 years old at the time , testified first

. He began by describing his occupation and the general duties thereof. Over the course of his career, he had served 2 9 years as a paramedic, the last 24 with Baltimore County

. Typically, his schedul e consisted of two 10

- hour day s of work , followed by two 14

- hour night s , and f our days off. During these four

- day shift s , he stated , paramedics generally “run” 26

– 30 calls, which last 1

– 2 hours each. Quinlan also described the activities undertaken on a “typical” emergency call that might impact his right knee, including: climbing in and out of emergency vehicles, carrying up to 50 pounds of gear,4

crouching to address and service patients, administering compressions or other aid, lifting
p atient s onto stretcher s and moving stretcher s , and taking patients up and down stairs. 3 H e also stated that he is “right dominant, ” meaning he uses his right leg more often during the above tasks

. Quinlan testified that he started experiencing pain and “clicking” in his right knee in 2014, causing him to seek out a doctor

. A lthough he had seen a doctor in 2005 regarding a knee injury , he did not necessarily see the two phenomena as related

. Ultimately, Q uinlan underwent surgery to repair his meniscal tears

. The parties each introduced the same experts before the trial court as they had used before the Commission. Quinlan presented a video deposition of Barbara A. Cochran , M.D. (“Cochran” ), a physician with specialties in internal, occupational, psychia tric, and pulmonary medicine. Cochran’s testimony was based on her research , her review of Quinlan’s medical records , and her phone examination of Quinlan , although she n ever physically examined him. Coc hran said that Quinlan had a tear in both his medial and lateral menisci. T hese tears “extend[ed] to the articular surface of the tibia,” which Cochran identified as important because that “is where the bones come together” which
can lead to osteoarthriti s. Cochran described Quinlan’s meniscal tears as “part of the continuum of osteoarthritis.” Accordingly, she focused on repetitive use as the primary risk factor for

3 In addition to his paramedic duties, Quinlan also testified that he had been a competitive bench press weightlifter, and that he golfed, sometimes sailed, and lived in a home with stairs.5

his knee issues. She explained that repetitively using a knee with meniscal tears can l ead to osteoarthritis because such use leads to inflammation in the joint that is not healed before its next use. She described this process as a cycle of inflammation, followed by partial healing, followed by i nflammation, and so on. A lternatively, the osteoarthritis can contribute to degeneration and tears in the meniscus in a similar manner. She also addressed other risk factors for degenerative knee issues, such as gender, age, weight, genetics, and prior injury. Quinlan was five feet and nine inches tall and weighed approximately 235 pounds. Cochran stated that gender, age, and weight were unlikely to be the primary factors here because Quinlan’s knee damage was confined to his right knee. Moreover, she opined t hat Quinlan’s 2005 knee injury likely had no relation to his osteoarthritis based on the symptoms and complaints he presented at the time of his injury. She did not have enough information to address genetics. Cochran also testified about the relationshi p between Quinlan’s degenerative knee tears and his occupation as a paramedic. Specifically, she pointed to a study that concluded that paramedic/ firefighters have a “relative risk” of developing knee osteoarthritis of 2.93 compared to the general populat ion, meaning that there are 293 cases of degenerative knee
tears in paramedic/firefighters for every 100 cases in the general population

. Based on this study and her examinations, she concluded that Qui nlan’s “essential job
functions

. . . which include c onsiderable repetitive kneeling, bending, [and] stress on the knee, [ were ] the cause of his knee osteoarthritis.” Next, the County introduced the video deposition of its expert witness, Richard Hinton, M.D. (“Hinton”) , a spec ialist in orthopedic surgery. Hinton had examined Quinlan6

and explained that his knee tear s were classified as “complex,” meaning that they could be wholly degenerative or acute tear s that degenerated over time. Still, he opined that Quinlan’s other risk factors for knee problems, such as weight and age , were the primary causes of h is degenerative knee tears, not his occupation

. Specifically, he state d that the “primary or direct cause of [Quinlan’s] meniscus issues”

— which Hinton believed contributed to the osteoarthritis

— were not “his duties as a firefighter and EMT.” During his physical examination of Quinlan and in making his report , Hinton did not know that Quinlan had sustained an on

- the

- job acute injury to his knee in 2005

. Upon learning of this fact during his deposition, Hinton stated that his “occupational injury

. . . could contribute to long

- term knee problems.” He later opined that, although Quinlan’s job was not the “primary cause” of his knee problems, it was a “potential” or “ar guable” cause of them. He also recognized that “there is literature to suggest that people who are in firefighter or EMT positions have higher rates of both meniscus tears and of arthritis, as do people in man y physically demanding jobs.”
T he j ury retur ned a verdict for Quinlan, stating that he had “sustain[ed] an occupational disease of right knee degenerative tears of the

. . . medial and lateral menisci

. . . arising out of and in the course of his employment[

. ]” During the County’s appeal, the Court of Special Appeals ruled that “Quinlan met the statutory requirements of LE § 9

- 502(d)(1) by establishing at trial that the degenerative menisci tears were an occupational disease

. . . .” Balt. Cty. v . Quinlan , 238 Md. App. 486, 509 (2018). Moreover, i t said, Quinlan successfully established that “repetitive kneeling and squatting”7

are: (1) “a regular part of a paramedic’s job,” and (2) “a risk factor for developing menisci

tears

. . . .” Id. W e granted the County’s petition for writ of certiorari

. DISCUSSION Denial of Summary Judgment Motion We first address the trial court’s denial of the County’ s motion for summary judgment. The County argues that the trial court erred in denying its motion for summary judgment because Quinlan’s initial Employee Claim Form listed the occupational disease as “meniscal tears,” but the evidence and testimony at trial involved “degenerative meniscal tears,” which includes the osteoarthritis. The County argues that by “extract[ing]” the meniscal tear claim and excludi ng any reference to the osteoarthritis, Quinlan avoids “any argument or burden of proof that inter

- related conditions, such as ‘osteoarthritis,’ exist and affect the same body part, ” and also that the osteoarthritis was in the “nature” of the employment. The County asserts that “[t]he claimant should not be able to avoid its burden by choosing only a portion of the overall ailment” for the claim, thereby avoiding the “burden of proof as to the entire disorder .

. . .” Quinlan states that d enial of the mot ion for summary judgment was proper because there was a dispute of material fact as to the cause of the meniscal tears and the “incidence of meniscal tears” in his work as a paramedic

. Typically, we review the denial of a motion for summary judgment for abuse of discretion. See Hous. Auth. of Bal t . City v. Woodland , 438 Md. 415, 426 (2014). There are occasions in which the appellate court reviews non

- discretionary matters without deference to the trial court, even on denials of summary judgment. See Presbyterian Univ.8

Hosp. v. Wilson , 337 Md. 541, 549 (1995) (stating that “to the extent that the issue of personal jurisdiction [was] a question of law, it is not properly submitted to the trier of fact to resolve,” and, therefore, there was “nothing to p reclude our review of this issue”). Even so, in the interest of “promot[ing] justice,” the trial court ordinarily “ possess [ es ] discretion to refuse to pass upon, as well as discretion affirmatively to deny, a summary judgment request in favor of a full he aring on the merits; and this discretion exists even though the technical requi rements for the entry of such a judgment have been met.” Metro. Mort g . Fund, Inc. v. Basiliko , 288 Md. 25, 28 (1980) (citations omitted). Such is the case here, so we review t he tri a l court’s ruling for abuse of discretion.
B efore the trial began, the County filed a motion for summary judgment. In it, the County characterized Quinlan’s claim as one for “an unknown, unnamed, degenerative disease involving his right knee,” whic h was alleged to have resulted from his work as a paramedic /firefighter . The County asserted that Quinlan “provided no evidence” regarding: (1) the occupational disease he suffered from; or (2) the disease’s relation to the “nature of his employment” and not some intervening factor. It also submitted Hinton’s medical examination report. Thus, it averred, the County was entitled to summary judgment as a matter of law. In response, Quinlan reasserted his claim that he had sustained “an occupational
diseas e of degenerative tears of the posterior horns of both the medial and lateral menisci of his right knee.” He recounted the duties he undertook as a paramedic that caused the knee condition, including: lifting patients onto stretchers, kneeling to assess p atients, and sometimes carrying patients. These activities occur red consistently over his 26

– 309

emergency calls for each four

- day shift . He also points to Cochran’s testimony asserting a causal link between “the meniscal tears and pathology” and Quinlan’s “essential job
fu nctions as a firefighter/EMT.”
T he trial court denied the Count y’ s motion for summary judgment, concluding that there was “absolutely a material dispute of fact.” While the County states that Quinlan did not claim that the meni scal tears were degenerative, the County described the tears as degenerative in its own motion for summary judgment. It is plain that Quinlan had provided evidence regarding his alleged occupational disease and its relation to his employment in the form o f the “Independent Medical Opinion and Causation Analysis” from Cochran, submitted to the Commission as part of his initial claim. To the extent that Quinlan had yet to provide evidence that meniscal tears and knee degeneration were within the “continuum of osteoarthritis,” the trial court still maintained discretion to “affirmatively

. . . deny[] a summary judgment request in favor of a full hearing on the merits

. . . . ” Basiliko , 288 Md. at 28. The trial court was well within its discretion to deny th e motion for s ummary judgment at this stage. Occupational Disease Preservation of “Sufficiency” Argument Quinlan argues that the County failed to preserve any argument regarding the sufficiency of the evidence b y failing to make a motion for j udgm ent purs uant to Maryland Rule 2

- 519. The consequence of failing to make a motion for judgment is that the party claiming insufficiency of evidence fails to preserve that issue for appeal. See, e.g

. , Barnes v. Greater Balt. Med. Ctr., Inc. , 210 Md. App. 457, 487 (2013) ( “We decline to discuss10

this issue because GBMC did not raise this issue in its motions for judgment. Instead, it was only raised in the motion for JNOV.”) ; Kent Village Assoc s . Joint Venture v. Smith , 104 Md. App. 507 , 516

– 17 (1995) (applying Rul e 2

- 519 to exclude appellate issue when argument on motion for judgmen t as too general )

. Assuming without deciding that M aryland Rule 2

- 519 applies in a jury trial that is part of an appeal to the circuit court from a decision of the Commission, we noneth eless decline to decide this preservation issue. First, Quinlan failed to raise this preservation issue in the Court of Special Appeals. See Scott v. State , 454 Md. 146 , 188 (2017) (“[T]o
preserve an issue for this Court’s review, a party must raise the issue in the Court of Special Appeals if the case came before that Court.” ). Moreover, the arguments made by the County in its brief are largely a bid for the C ourt to set limitations on what is co nsidered

an “o ccupational disea se” within the meaning of LE § 9

- 502, which involves important legal issues that go well beyond sufficiency of the evidence in this case. Finally, in the course of addressing the material legal arguments made by the County o n appeal, Quinlan prevails. Thus, any issue about preservation of the County’s sufficiency of the evidence argument becomes moot. See generally Md. Rule 8

- 131. Compe nsability Under LE § 9

- 502(d) The parties’ principal disagreement centers around whether degenerative meniscal
tears were both “ caused ” by Quinlan’s occupation as a paramedic and “due to the nature of an employment in which hazards of the occupational disease exist,” pursuant to LE § 9

- 502(d)

. In interpreting a statute, our overarching objec tive is to “ ascertain and effectuate” the legislative intent underlying it

. Shah v. Howard C ty
. , 337 Md. 248, 254 (1995) (citation11

omitted)

. “The primary source from which to determine legislative intent is the plain meaning of the statutory language.” Uninsured Emp’rs Fund v. Danner , 388 Md. 649, 659 (2005) (citation omitted). Indeed, “[t]he language of a statute is its most natural expositor, and, where the language is susceptible of a sensible interpretation, it is not to be controlled by any extrane ous considerations.” Victory Sparkler & Specialty Co. v. Francks , 147 Md. 368, 378 (1925) (citation omitted). We generally endeavor to interpret the provisions of the Workers’ Compensation Act, “liberally, where possible, in order to effectuate the broad remedial purpose of the statutory scheme.” Danner , 388 Md. a t 659

. In workers’ compensation cases, “[a]ppeals to the appellate courts are limited strictly to issues of law.

. . . [Appellate courts] decide whether the trial court has correctly determin ed the appeal from the Commission.” Richard P. Gilbert, et al., Maryland Workers’ Compensation Handbook § 16.08, at 16

- 16 (4th ed. 2013). Therefore, r ather than reviewing the factual determinations of the Commission or a circuit c ourt , “to which we would owe deference,” Pro

- Football, Inc. v. McCants , 428 Md. 270, 282 (2012) , we review the conclusions of law regarding the construction and ap plication of LE § 9

- 502(d)

. The County argues that the Circuit Court decision was based on an erroneous construction of the Workers’ Compensation Act, contrary to the plain language of LE § 9

- 502. This is especially so, it states, because the Commission’s decision is entitled to a
p resumption of prima facie correctness. The County describes the case as involving two distinct questions of law: (1) “whether the specific characterization of the claim was legally sufficient as an occupational disease under LE § 9

- 50 2”; and (2) “w hether the condition described as ‘degenerative tears of the posterior horn of both the medial and lateral12

meniscus’ can qualify as a matter of law as an occupational disease for a Paramedic/Firefighter.” Regarding the first question, the County maintains that Q uinlan’s characterization of his occupational disease on the initial Claim Form was not legally sufficient. Quinlan, it argues, is attempting to advance an osteoarthritis claim, as well as a meniscal tears claim. Yet, it states that Quinlan never include d osteoarthritis in a description of occupational disease, so it should not have been considered by the trial court. As to the second question, the County argues that there are “no inseparable and unavoidable characteristics of the job duties and responsi bilities that have been shown to result in ‘degenerative meniscal tears of the right knee’ as the ‘natural and expected result’ of [Quinlan’s] occupation.” Pointing to multiple previous Maryland cases, it states that the present claim lacks a “distinctive employment hazard” associated with Quinlan’s job. The County also warns that Quinla n’s argument will result in pre existing conditions no longer being a defense or deduction for employers, but now being a “bonus” for employees, resulting in massively incr eased costs. Instead, the County encourages the Court to look to other Maryland cases, such as Davis v. Dyncorp , 336 Md. 226 (1994), to guide it in this case and reject Q uinlan’s claim. Quinlan maintains that the jury was entitled to find that hi s degen erative knee tears were a compensable occupational disease arising out of and in the course of his employment. He characterizes the County’s argument a s asking the court to re

- weigh the facts, as opposed to taki ng issue with the law itself. Pointing to expert testimony, Quinlan contends there was sufficient evidence that his knee degeneration and meniscal tears are characteristic of his employment, especially considering the occupational disease need not13

be “unique” to paramedics alone. He also argues that there was sufficient evidence for the jury to find a causal relationship between his occupation and the degenerative meniscal
tears. The Workers’ Compensation Act provides compensation for , among other things, “covered employees” who become “partial ly or totally incapacitated” due to an “occupational disease” acquired in the course of their employment. LE § 9

- 502 (a). “Occupational disease” is defined in LE § 9

- 101(g) as a disease contracted “(1) as a result of and in the course of employment; and ( 2) that causes the covered employee to become

. . . incapacitated.” Alone, this definition is quite broad, but employer liability is limited when this provision is read in conjunction with LE § 9

- 502(d). Under this section,

o ccupational diseases are comp ensable only if the following statutory conditions are met:

(1) the occupational disease that caused the death or disability : (i) is due to the nature of an employment in which hazards of the occupational disease exist and the covered employee was employed before the date of disablement; or (ii)

. . . ; and (2) on the weight of the evidence, it reasonably may be concluded that the occupational disease was incurred as a result of the employment of the covered employee. Id. § 9

- 502 (d) (emphasis added)

. Determining applicability under this section can be divided into two steps. First, the court must identify the professional tasks of the specific employee , remembering that “function outweighs form.” Clifford B. Sobin , 1 Maryland Workers’ Compensation § 7.2, at 197 (2018)

. Next, the court determine s whether: (a) the14

“nature” of the employment includes the hazards of the ailment the employee suffers from to a greater degree than that present in general employment; and (b) whether the employee’s job functions expose the employee to those hazard s . Id. at 196

– 97. We have already described the factual evidence presented regarding the tasks Quinlan performed as part of his paramedic role, and we will return to them below. We

now move to the second “step” and consider our prior cases and how they contour the edges of what qualifies as a “hazard” within the “ nature ” of a given employment. It is useful to briefly note the history and development of the Workers’ Compensation Act , as it relates
to the development of our case law. Specifically, “[u]ntil 1939, the [Genera l Assembly] did not recognize occupational disease as a compensable claim.” LeCompte v. United Parcel Serv., Inc. , 90 Md. App. 651, 654 (1992). After the 1939 amendment, the Act contained a schedule of permissible occupational diseases which could be cov ered, but this approach was later liberalized in favor of the more general formulation seen today. See Dyncorp , 336 Md. at 234

– 35. The history of the Act illustrates a gradual loosening of interpretive strictures, but, still, we bear in mind “that the Act is designed to provide compensation to workers injured by the effects of industry

. . . .” Id. at 235 (citation omitted). The central issue here requires examining the degree to which, and how, the occupational injury must b e “due to the nature of an employment in which hazards of the occupational disease exist,” LE § 9

- 502(d)(1)(i). In an early and oft

- quoted case, Victory Sparkler & Specialty Co. v. Francks , we defined an o ccupati onal disease a s “one which
arises from caus es incident to the profession or labor of the party’ s occupation or calling.”15

147 Md. at 379

. “[T]he conditions of employment which distinguish occupational diseases from ordinary diseases of life need not be unusual chemicals , fumes, and the like. They may be distinctive because familiar harmful events are present in unusual degree.” Larson , 4 Larson’s Workers’ Compensation Law § 52.03[3][b] , at 52

- 13

. 4 Typically, the disease is “ the expectable result of working under conditions naturally inherent in the employment and inseparable therefrom, and is ordinarily slow and insidious in its approach.” Foble v. Knefely , 176 Md. 474, 486 (1939). See also Sobin, Maryland Workers’ Compensation § 7.1, at 193 ( “Occupational diseases are generally caused by long

- term exposures from multiple employments with a slow and insidious onset that may not be re cognized for many years.”). We have frequently addressed issues surrounding the scope of the term “occupational disease

. ” For example, we have assessed whether the occupational disease must be “unique” to the profession, as the County suggests . We discussed this issue in Lettering Unlimited v. Guy , 321 Md. 305 , 306 (1990), wherein we examined “whether the claimant’s bilatera l carpal tunnel syndrome is an occupational disease o r an accidental injury.” In this case, Guy, an embroiderer and silk screener, developed carpal tunnel syndrome after seven years on the job. See id. at 308

– 09. In determining that the trial court did not err in finding that Guy’s carpal tunnel syndrome was a compensable occupational disease, we stated that, “ [w] hile ordinary or usual job
- related repetitive

4 We have also defined “employment” in the context of LE § 9

- 502(d)(1)(i) as “mean[ing] the profession or general occupation in which the person is engaged.” King v. Bd. of Educ. of Prince George’s Cty. , 354 Md. 369, 381

– 82 (1999).16

trauma cannot predicate a claim for accidental injury, it might form the basis for an occupationa l disease claim.” Id. at 311 (quoting R. Gilbert & R. Humphreys, Jr., Maryland Workers’ Compensation Handbook § 5.1, at 84

– 85 (1988)) (emphasis added)

. LeCompte further expounded upon our reasoning in Lettering Unlimited . In LeCompte , the Court of Special Appeals investigated a claim of occupational disease brought by a UPS “jumper”

— a job requiring the employee to leap 14

– 16 inches from a truck

— who had worked on the job for less than a month. See id. at 652. In denying the employee’ s claim, the intermediate appellate court recognized , pursuant to Lettering Unlimited , that “the lack of ‘distinctive’ or ‘unusual’ employment hazards [was] not dispositive

. ” Id. at 658. Still, the claim failed because there must be a “repetitive
charact er” to such trauma , which the employee did not suffer , given that her “condition manifested itself the first week on the job.” Id. We have also discussed the relationship between the “hazards” of the employment, the alleged occupational disease, and the “nature” of the employment at issue in a given

case . In Davis v. Dyncorp , 336 Md. at 227, we discussed this in terms of whether Davis’

“ mental disease, allegedly resulting from on

- the

- job harassment, ” was within the di ctates of LE § 9

- 502(d)(1)(i). In th at case, Davis was a computer operator, a job which typically involved data entry , and alleged that “harassment” by his fellow employees caused him to develop a “mental disease

. ” I d. at 237. This harassment included allegations that an “explosive cigaret te” was provided to him, someone placed a tack on his seat, he was
denied use of the refrigerator unless he paid $10 , along with other similar ly childish acts. Id. at 228.17

To determine whether Davis’ mental disease was within the “general character” of his employment, we evaluated whether the hazards of data operation exposed him to risk factors that could naturally lead to such mental disease. See id. We concluded that Da vis’ claim was “ not compensable under [LE] § 9

- 502(d)(1)(i) because it was not ‘due to the nature of an employment in which hazards of the occupational disease exist.” Id. at 236. This is because “harassment by fellow employees is not a hazard within the nature of the employment of a computer data operator.” Id. at 237 (emphasis added)

. S ee also Means v. Balt. Cty. , 344 Md. 661, 670 (1997) (“[U]nlike the occupation of computer operator in
Davis , the occupation of paramedic is ‘an employment in which hazards of the occupational disease [of PTSD] exist. ’ ”). Black & Decker Corp. v. Humbert , 189 Md. App. 17 1, 174 (2009), involved an employee, Humbert, employed as a licensed electrician, who brought an occupational disease claim citing impingement syndro me of the right shoulder . His duties primarily included doing electrical repair work on ceilings, vehicle maintenance work, and some work as a plumber an d carpenter. See id. at 175. After developing impingement syndrome, Humbert had an operation to remo ve a bone spur

— a defect likely preexist ing his employment

— which appeared to have cured the problem. See id. at 176. Humbert’s expert witness testified that “it takes two things to develop” a shoulder impingement issue: (1) “activities such as continuous reaching overhead”; and (2) “the presence of a spur.” Id.
at 177. Ultimately, t he intermediate appellate court concluded that the hazards leading to shoulder impingement syndrome were inherent in the nature of a licensed electrician’s18

profession. In deciding this, it explained that “a hazard is a risk factor. To be compensable, it is the risk factors, not the disease, that must inhere in the na ture of the employment.” Id.
at 187 . To support this conclusion, the court pointed to both Davis and Means , described above. See id. at 187

– 88 . Both Humbert and his expert testified that “repeated overhead arm motions” were a hazard inherent in the job of an electrician. Id. at 186 . Such motions, paired with a bone spur, would cause shoulder impingement syn drome. See id. Hence, the repeated overhead reaching

— the risk fa ctor

— was inherent in the occupation and the shoulder impingement syndrome was compensable. We think this case was well

- reasoned and supported by a plain reading of the Workers’ Compensation Act. To the extent that the County asks us to overrule it, we decline to do so. See also Allied

- Signal, Inc. v. Bobbitt , 96 Md. App. 157 , 167

– 69 (1993), rev’d on other grounds , 334 Md. 347 (1994) (testimony established that “even if the arthritis effected the development of the shoulder condition, the condition was due in part to the characteristics of [Bobbitt’s] employment” and there was evidence that the syndrome was a “direct consequence of th e requirements of [her] occupation”)

. 5

5 The County and one of the amicus curiae argue that suc h a reading is incorrect. The amicus b rief filed on behalf of various Maryland counties, the Prince George’ s County School Board, and the C ity of Cumberland proposes that we should read LE § 9

- 502 (d) (1)(i) to require that, to be a compensable occupational disease, the disease must be inherent in the nature of employment, not the risk factors for the disease

. The parties state that this is the “plain language” meaning of the phrase “ due to the nature of an employment in whi ch hazards of the occupational disease exist. ” LE § 9

- 502(d)(1)(i). We do not think these words so obvious. In fact, a plain reading would suggest that it is, indeed, the “hazards” that must “exist” in the “nature” of the employment. Still, even if thi s statute were ambiguous , we struggle to see how the differing interpretations make a difference in practice, or in this case. There was expert testimony supporting a finding for Quinlan based on either reading: whether it is the hazards of the disease th at must be in the nature of the19

Our interpretation of the scope of “occupational disease,” as confined by LE § 9

- 502, is consistent with decisions from other states interpreting similar statutes. See, e.g. , Hansen v. Gordon , 602 A.2d 560, 563 (Conn. 1992) (“[T]he requirement that the disease be ‘peculiar to the occupation’ and ‘in excess of ordinary hazards of employment,’ refers
to those diseases in which there is a causal connection between the duties of the employment and the disease contracted by the employee. In other words, it need not be unique to the occupation of the employee or to the work place

. . . .”); Dennis v. Dep’t of Labor & Indus. of State of Wash. , 745 P.2d 1295, 1303 (Wash. 1987) (“We hold that a worker must establish that his or her occupational disease came about as a matter of course as a natural consequence or incident of distinctive conditions of his or her particular employment. The conditions need not be peculiar to, nor unique to, the worker’s pa rticular employment. ”) ; Crossett Sch. Dist. v. Gourley , 899 S.W.2d 482, 483 (Ark. Ct. App. 1995) (“The fact that the general public may contract a disease is not controlling; the test of compensability is whether the nature of the employment exposes the wo rker to a greater risk of the disease than the risk experienced by the general public or workers in other employments.”) (citations omitted); Harvey v. Raleigh Police Dep’t , 355 S.E.2d 147, 150 (N.C. Ct. App. 1987) (“A disease need not be unique to the emp loyee’s occupation in order

employment

— Cochran and Quinlan testified that repetitive kneeling and squatting were essential job functions of a paramedic

— or the occupational disease that must be inherent in the nature of the employment

— Cochran and Hinton both stated that paramedic/firefighters experience higher rates of degenerative knee condition s than the general population.20

to qualify as an occupational disease ,” only that employment exposed him to greater risk than the public generally ). The above cases are instructive here . Taking the issues as presented by the County, we first explore “whether the specific characterization of the claim was legally sufficient as an occupational disease under LE § 9

- 502

. ” We note that , while the Claim F orm may only have asserted that Quinlan “developed meniscal tears” in his right knee due to his job
duties as a paramedic, his occupational disease was described repeatedly as “ degenerative meniscal tears,” or something to that effect , throughout all stages of the trial

. The Commission, in denying Quinlan’s claim, described the alleged occupational injury as invol ving “[r]ight [k]nee degenerative tears.” In memoranda to the motion for summary judgment, both parties referred to the claim as one for a “degenerative” occupa tional disease. Moreover , throughout trial, both parties consistently referre d to the meniscal tears and osteoarthrit is as being part of the same claim, and the jury found that Quinlan proved the “occupational disease o f right knee degenerative tears

. . . .” Even if the knee degeneration and meniscal tears were not so evidently linked throughout the trial, the evidence presented to the jury characterized meniscal tears and the degenerative effects of osteoarthritis as being one

- in

- the

- same ailment

. Accordingly, this is not a claim involving a “preexisting condition” as the County urges. Cochran described
the meniscal tears as “part of the continuum of osteoarthritis, ” as the tears “extend[ed] to the articular surface of the tibia,” which “is where the bones come together,” and can lead to osteoarthritis. Even the County’s expert recognized their interrelation. Thus, the21

“specific characterization of the claim” is legally sufficient, and w e see no reason to conclude that the jury was not entitled to rely on this characterization

. Next, we inquire as to whether a claim for “ degenerative tears of the posterior horn of both the medial and lateral meniscus” qualifies “as a matter of law as an occupational disease for a Paramedic/Firefighter. ” A t issue , first, is whether the degenerative meniscal
tears were “due to the nature of an employment in which hazards of the occupational disease exist , ” per LE § 9

- 502(d)(1)(i). Then , we ask whether it “reasonably may be concluded” that the degenerative meniscal tears were caused by the hazards inherent in Quinlan’s employment. Id. § 9

- 502(d)(2). Again, an occupational disease i s “one which arises from causes incident to the profession or labor of the party’s occupation or calling.” Victory Sparkler , 147 Md. at 379

. We look to the “ duties of a claimant’s profession ” and determine whether “ the hazard tha t led to the disease exists in the nature of that employment.” Black & Decker , 189 Md. App

. at 191. Here, there was a legal basis to conclude that the nature of paramedic/firefighter work, in general, involves a higher degree of risk for developing degen erative knee conditions. Quinlan presented evidence, identified as reliable by both experts, demonstrating that paramedic/firefighters have “significant” risk of developing osteoarthritis, rela tive to the general population

— 293 cases of degenerative knee tears for every 100 cases in the general population . Moreover, he introduced evidence from the
C enters for D isease C ontrol describing “occupations involving repetitive knee bending and squatting” as risk factors for osteoarthritis. Cochran also testified to the hazards inherent in Quinlan’s “essential job functions” as a paramedic consisting of “considerable repetitive22

kneeling, bending, [and] stress on the knee

. . . .” Thus, the hazards that le d to the development of degenerative knee conditions were adequately demonstrated to be within the ambit of a paramedic’s natural role

. Defense expert Hinton did not quarrel with the claimant’s characterization of paramedic work but stated that these job f unctions were not distinct from any othe r labor

intensive employment. The County, too, points to the commonality of knee injuries among other professions as disqualifying here. Assuming, without deciding, that such a characterization is accurate, “unique ness” is not a required element of LE § 9

- 502(d)(1)

— being within the “nature” of the employment is the precise statutory language. See also Victory Sparkler , 147 Md. at 379 (occupationa l disease must have “its origin in the inherent nature or mode of work of the profession or industry, and it is the usual result or concomitant”). As Judge Andrea Leahy wrote for the court below, “the Act does not limit occupational diseases to rare diseases or those exclusive to a specific profession.” Quinlan , 238 Md. Ap p. at 508. In Lettering Unlimited , 321 Md. at 311, we recognized that “ordinary or usual job

- related repetitive trauma” can form the basis of an occupational disease claim, which is wholly consistent with our historical characterization of the “slow and i nsidious” nature of occupational diseases. Foble , 176 Md. at 486. An analysis of Quinlan’s job duties , too, must reveal that he actually engaged in the
kinds of activities that contribute to the increased risk inherent in his profession. Quinlan descri bed his job

- related tasks as including kneel ing for lengthy periods of time, carrying he avy patients up and down stairs, kneeling to address patients and administer aid, climbing in and out of emergency vehicles, carrying up to 50 pounds of gear, and lifting patient s23

onto stretcher s and up and down stairs

. While engaged in this wo rk, he favored his right knee. Cochran testified that repetitive use was the primary cause of Quinlan’s degenerative knee condition. Indeed, Quinlan described his 24

- ye ar career as a paramedic with Baltimore County wherein he typically worked four

- day shifts. During each four

- day shift, he would generally take up to 30 emergency trips which would last approximately 1

– 2 hours , depending on the seriousness of the emergenc y. During each of these trips, he would perform the above tasks, described as consisting of “considerable repetitive kneeling, bending, [and] stress on the knee .

. . .” It is inconsequential that degenerative knee conditions are not exclusively within the purview of paramedic work. Rather, we look to evidence that “repetitive trauma” was a factor in Quinlan’s condition. The above evidence demonstrates that Quinlan’s degenerative knee condition likely developed progressively, results from repetitive tr auma, and stems from the natural consequences of his job functions. The County argues that a decision upholding Quinlan’s award will result in all “heavy labor” workers now having a claim any time “strenuous physical activity required by the job contribut es in any way to an injury or aggravation of an underlying pre

- existin g degenerative condition.” We are not persuaded that such reasoning should govern

. First, the County mischaracterizes the present occupational disease when it states that it involves

a preexisting condition. Again, upon review, we do not “weigh evidence or assess credibility” regarding findings of fact. Gilbert, Maryland Workers’ Compensation § 16.08,
at 16

- 16

. As discussed above, Cochran testified that the meniscal tears we re part of the “continuum” of osteoarthritis, and thus, one condition did not precede the other, but they24

were the same condition. The jury appears to have accepted this finding based on their verdict, and we do not disturb it.
W e would also be remis s if w e did not, again, note that the General Assembly requires hazards to be in the “nature” of t he occupation, not unique to it. The General Assembly, with its investigative resources, is positioned to know the burdens imposed on employers and their insurers when it enacts a law with such plain language. Its role is to make a policy decision that takes into account both the employer/insurer’s burden and the plight of workers who are injured on the job because of repetitive trauma. We should not change the me aning of the statute by adding qualifying language which would limit workers’ entitlement to relief. Additionally, “w hether an occupational disease is compensable under [LE] § 9

- 502(d)(1)(i)

. . . is primarily controlled by the facts.” Bridgett v. Montgo mery Cty. , 186 Md. App

. 616, 628 (2009). Thus, each case is reviewed individually to determine if the elements required by the statute have been met. Indeed, our recognition of Quinlan’s right to recover here is no more expansive than other claims we have previously deemed compensable. See, e.g. , Means , 344 Md. at 662 (post

- traumatic stress disorder); Lettering Unlimited , 321 Md. at 306 (bilateral carpal tunnel syndrome); M iller v. Western Elec. Co. , 310 Md. 173, 176 (1987) (carpal tunnel syndrome); Black & Decker , 189 Md. App. at 174 (impingement syndrome of the right shoulder) . Other jurisdictions have demonstrated the same. See Larson, 4 Larson’s Workers’ Compensation Law § 52.04[2] , at 52

- 27 (listing a multitude of diseases that have been determined “occupational” in other jurisdictions)

.25

Finally, we must evaluate whether, as a matter of law, the jury “ reasonably may [have] concluded , ” LE § 9

- 502(d)(2), that the degenerative meniscal tears were caused by Quinlan’ s employment. Again, Cochran affirmatively testified that Quinlan’s job
functions caused his degenerative meniscal tears. She attributed this to the repetitive use of his right knee over the course of his career as a paramedic and stated that gender, age, and weight we re unlikely to be primary factors because Quinlan’s knee damage was confined to right knee. The County’s own expert, Hinton, also described Quinlan’s employment as the “potential” or “arguable” cause of his knee condition, although maintaining that he did not believe it to be the primary cause

. This, along with the above evidence, was enough for the jury to “reasonably” infer causation. CONCLUSION In sum, the record contained evidence that the nature of the job of a paramedic/firefighter places one at gr eater risk for degenerative knee conditions, Quinlan’s job required that he engage in the activities that account for this increased risk, and that he engaged in these activities repetitively over 24 years of employment. Moreover, there is evidence that t he employment actually caused the degenerative tears. As a matter of law, degenerative meniscal tears should not be excluded from the universe of occupational diseases. And there was sufficient evidence for the jury to reasonably conclude that Quinlan’s degenerative knee tears were “due to the nature of an employment in which hazards of the occupational disease exist,” LE § 9

- 502(d)(1)(i). Therefore, the jury was within its power to find that Quinlan “sustain[ed] an occupational disease of right knee deg enerative tears of the

. . . medial and lateral menisci

. . . arising out of and in the course26

of his employment[.]” For these reasons, we affirm the judgment of the Court of Special Appeals

. JUDGMENT OF THE COUR T OF SPECIAL APPEALS AFFI RMED. COSTS TO BE PAID BY PETITIONER.Circuit Court for Baltimore County

Case No. 03

- C

- 16

- 004811 Argued: February 5 , 2019 IN THE COURT OF APPEALS OF MARYLAND
No. 50 September Term, 201 8

BALTIMORE COUNTY, MARYLAND

v. MICHAEL QUINLAN

Barbera, C.J. * Greene, McDonald, Watts, Hotten, Getty, Adkins, Sally D., (Senior Judge, Specially Assigned)

JJ.
Dissenting Opinion by G etty , J.

Filed: August 26, 2019 *Greene, J., now retired, participated in the hearing and conference of this case while an active member of this Court; after being recalled p ursuant to the Md. Constitution , Article IV, Section 3A, he also participated in the decision and adoption of this opinion.Respectfully, I dissent.

In my opinion, Mr. Quinlan failed to accurately identify the medical condition at issue as an occupational disease and to prove that his disability was distinctly associated with his occupation. An occupational disease is compensable only if “ (1) the occupational disease that caused the death or disability: (i) is due to the nature of an employment in which hazards of the occupational disease exist . . . and (2) on the weight of the evidence, it reas onably may be concluded that the occupational disease was incurred as a result of the employment of the covered employee.” LE § 9

- 502(d). The majority asserts that the complainant must prove facts sufficient for the court to determine “whether: (a) the ‘nature’ of the employment includes the hazards of the ailment the employee suffers from to a greater degree than that present in general employment; and (b) whether the employee’s job functions expose the employee to those hazards.” Majority Opin ion , at 13

- 14. I disagree with the majority that under the facts of this case, a clear syndrome or disease was identified. There was both degenerative osteoarthritis and a degenerative meniscus condition present in Mr. Quinlan’s right knee. He had the burden to properly identify the alleged occupational disease in his claim and failed to do so . Over the course of these proceedings, the description of the disease evolved from “torn meniscus” to “degenerative tears of the meniscus” to “osteoarthritis wit h degenerative tears.”
I am concerned that Mr. Quinlan , and future litigants under similar unclear medical claims, will b ootstrap additional condition s under the same claim and encompass the additional condition within an occupational disease. For exam ple, here, Mr. Quinlan’s2

claim of meniscal tears was exacerbated by the osteoarthritis. The osteoarthritis is a pre

existing condition that should have been furt her accounted for in the testimony and evidence of this case . Otherwise, I believe this Court is broadly expanding worker’s compensation coverage into coverage of common diseases of aging or lifestyle. This expansion chips away at the requirement that the workplace or employment is an actual cause of the occupational disease. The result of this expansion could open employers and insurers to potentially bear the full cost of a worker ’ s pre - existing or underlying condition due to an aggravation of that condition caused in any degree and manner by the occupation. I am also concerned that the ma jority’s decision, combined with Black and Decker Corporation v. Humbert , 189 Md. App. 171 (2009) , permits a broad range of coverage where employees engage in activity common to many occupations as long as the occupation increases the risk of contracting a disease. This decision may result in a

s ignificant increase in claims for occupational disease by those with underlying arthritic conditions who work in physically demanding jobs. Potentially, e very worker will be able to successful ly file a claim for an occupational disease whenever a strenuous physical activity is required by the job and that activity contributes in any way to an injury or aggravation of an underlying pre

- existing degenerative condition. I do not think Mr. Quinlan has sufficiently proven that his condition was the result of distinctive employment hazards. Specifically, the c ondition of degenerative meniscal tears was not proven to be inseparable from the occupation of an EMT or paramedic. Therefore, for the foregoing reasons, I respectfully dissent.