Source: https://wcc.state.ct.us/crb/2008/5226crb.htm
Timestamp: 2019-04-25 22:22:18+00:00

Document:
The respondents were represented by Brenda C. Diaz, Esq., The Quinn Law Firm, LLC, 204 South Broad Street, Milford, CT 06460.
This Petition for Review from the April 18, 2007 Finding and Denial of the Commissioner acting for the Third District was heard November 16, 2007 before a Compensation Review Board panel consisting of the Commission Chairman John A. Mastropietro and Commissioners Amado J. Vargas and Donald H. Doyle, Jr.
JOHN A. MASTROPIETRO, CHAIRMAN. This present appeal is from the trial commissioner’s decision that the claimant’s accepted injury was not a substantial factor in his need for surgery. The claimant argues that the commissioner improperly applied the “substantial factor” test and should have determined that the treatment was compensable. The record demonstrates that there was not unanimity among the expert opinions presented; therefore, the trial commissioner acted within his discretion in dismissing the claim to make the claimant’s surgery compensable.
The claimant has spent his career as a truck driver for the respondent, which operated out of Stop & Shop’s former North Haven warehouse. On September 2, 2004, the claimant sustained an injury to his right shoulder while pulling a pin to disconnect the tractor from its trailer during the course of his employment. This injury has been accepted as compensable. Soon after the injury the claimant was treated at Occupational Health Plus Rehabilitation, Inc., in New Haven. Their report of his September 14, 2004 examination reported “severe” degenerative disease of the right shoulder and a partial tear of the supraspinatus. An MRI revealed “[e]xtensive degenerative changes of the right glenohumeral joint with large osteophytes of the inferior humeral head and degeneration of the labrum without focal tear.” The claimant was subsequently examined by an orthopedic surgeon, Dr. David Cohen, who determined the claimant had a light duty work capacity, prescribed physical therapy after two weeks of rest and further opined the claimant may need total right shoulder replacement surgery.
In March of 2005 the claimant returned to Dr. Cohen complaining of shoulder pain. Dr. Cohen reiterated his opinion the claimant was a candidate for total right shoulder replacement surgery. The claimant asserts this is necessitated by the compensable September 2004 injury. The claimant was examined by the respondent’s expert, Dr. Peter Jokl of Yale Sports Medicine, on June 1, 2005. Dr. Jokl opined “It is my opinion that there is minimal relationship between the incident of 09/02/04 and the present finding of advanced osteoarthritis of the right glenohumeral joint.” A commissioner’s examination was subsequently ordered and was performed by Dr. Rolf H. Langeland on April 10, 2006. Dr. Langeland diagnosed the claimant with right shoulder glenohumeral joint severe osteoarthritis, right shoulder intra-articular loose bodies and a superficial right shoulder partial thickness rotator cuff tear. He noted the claimant had returned to full duty within three months of the date of injury and further opined his diagnoses of the claimant’s condition are not causally related to the injury dated September 2, 2004.
Dr. Langeland was subsequently deposed and testified a traumatic injury can aggravate pre-existing osteoarthritis. He further testified that while the claimant’s symptoms may have worsened after the September 2, 2004 incident, his diagnosis was at pre-injury status after the injury and the need for the claimant’s surgery is due to his degenerative condition of advanced osteoarthritis. He described the work injury as being “third in line” in a list of factors behind the claimant’s need for surgery.
Following the formal hearing the trial commissioner found the claimant suffered a temporary self limiting aggravation on September 2, 2004 of his underlying condition of advanced osteoarthritis of his right shoulder. The trial commissioner also found the claimant provided inconsistent histories of his injuries to his physicians. The commission also found the reports and opinions of Dr. Langeland and Dr. Jokl as fully credible and persuasive as to the issue presented and found the claimant failed to sustain his burden of proof that the need for total right shoulder arthroplasty was causally related to the September 2, 2004 work incident. The claimant filed a Motion to Correct the April 18, 2007 Finding and Denial, which was denied in its entirety. The claimant then appealed to this board asserting that the commissioner erred in finding the need for surgery was not work related.
The claimant’s appeal is based on the argument that the trial commissioner failed to properly apply the “substantial factor” test in denying the claimant’s bid for shoulder reconstruction surgery. Since the claimant points out the commissioner’s examiner ascribed some weight to the work related injury as causing the need for surgery, he believes the commissioner was compelled to issue an award. This argument must overcome the significant deference which we accord trial commissioners when they weigh conflicting medical evidence.
“In reviewing this instant decision, our standard of review is deferential to the finder of fact. ‘As with any discretionary action of the trial court, appellate review requires every reasonable presumption in favor of the action, and the ultimate issue for us is whether the trial court could have reasonably concluded as it did.’ Daniels v. Alander, 268 Conn. 320, 330 (2004).” Berube v. Tim’s Painting, 5068 CRB-3-06-3 (March 13, 2007).
A review of Dr. Langeland’s entire deposition transcript provides little support for the claimant’s position that the commissioner’s examiner considered the September 2004 injury a substantial factor in the claimant’s need for surgery. He refused to opine on whether that injury accelerated the need for surgery, stating that was “an impossible question to answer.” Joint Exhibit 1, p. 16. He specifically identified the need for surgery as based on the claimant’s degenerative condition. Joint Exhibit 1, p. 17. On redirect examination, after extensive discussion from claimant’s counsel on what counsel understood a “substantial factor” to be, the witness testified that, “the work injury certainly is a factor. Is it a substantial factor? I don’t understand the definition of substantial. You said there was no percentage, so . . . if I was to put percentages, that would be third in line.” Joint Exhibit 1, p. 23. He later opined the work related injury was a 15% factor in the need for surgery, ascribing 70% to the claimant’s pre-existing condition.
It is clear that the commissioner’s examiner attributed the least weight to the September 2004 injury of the three factors at hand.2 We also note that claimant’s counsel may have inadvertently defined the issue before this panel when, at Dr. Langeland’s deposition, counsel explained the “substantial factor” test to the witness.
And there’s no percentage. You know, it’s not that it has to be more than 50 percent to be a substantial factor. It just needs to be substantial and it’s really for the Workers’ Comp. Commissioner to determine what is or is not substantial. Joint Exhibit, p. 22. (Emphasis added).
Counsel herein was entirely correct. Whether or not a factor behind the need for surgery is “substantial” is a matter left to the discretion of the trial commissioner, as “it is the trial commissioner’s function to assess the weight and credibility of medical reports and testimony. . . .” O’Reilly, supra, 818. The cases cited by the claimant (Pasternostro v. Arborio Corp., 3659 CRB-6-97-8 (September 8, 1998), aff’d, 56 Conn. App. 215 (1999); Epps v. Beiersdorf Inc., 41 Conn. App. 430 (1996) and Fratino v. Harry Grodsky & Co., Inc., 5087 CRB-7-06-5 (May 8, 2007)) are all factually distinguishable and do not suggest any error on the part of the trial commissioner. Pasternostro concerned an intoxicated employee who died trying to cross I-84 on foot where such misconduct was a substantial factor in his injuries. Epps was a case where the claimant’s medical evidence was “uncontradicted.” Neither case is particularly relevant to this appeal.
On the other hand, the Fratino case is particularly relevant and supportive of the commissioner’s decision herein. In that case we upheld a trial commissioner who concluded that based on the evidence presented only one of two injuries was a substantial factor in that claimant’s need for surgery. In Fratino citing Gagliardi v. Eagle Group, Inc., 4496 CRB-2-02-2 (February 27, 2003), aff’d, 82 Conn. App. 905 (2004)(per curiam),3 we restated that the trial commissioner may accept or reject all of an expert’s opinion, or merely portions of it. See also, Tartaglino v. Dept. of Correction, 55 Conn. App. 190, 195 (1999), cert. denied, 251 Conn. 929 (1999); Williams v. Bantam Supply Co., Inc., 5132 CRB-5-06-9 (August 30, 2007) and Lamontagne v. F & F Concrete Corporation, 5198 CRB-4-07-2 (February 25, 2008). Consequently, while the claimant argues Dr. Langeland “recanted” his opinion, it appears that the trial commissioner did not agree and was not obligated to credit that portion of his testimony supportive in some fashion of the claimant’s position.
We also note that the trial commissioner reached a finding concerning the claimant’s testimony in this case, finding he had offered inconsistent histories to the various physicians who treated him as to the history of his right shoulder pain and discomfort. The Appellate Court recently upheld the dismissal of a claim when a trial commissioner deemed medical evidence unreliable as being derived from an unreliable patient narrative Abbotts v. Pace Motor Line, Inc., 4974 CRB-4-05-7 (July 28, 2006), aff’d, 106 Conn. App. 436, 442 (2008). The trial commissioner therefore could properly discount evidence supportive of compensability for that reason as well.
Commissioners Amado J. Vargas and Donald H. Doyle, Jr. concur in this opinion.

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