Source: http://wcc.dli.mt.gov/V/VERCOS_FFCL.htm
Timestamp: 2019-04-21 06:44:00+00:00

Document:
Summary: The claimant, who has a history of allergic rhinitis and sinusitis alleges that her conditions were aggravated by exposure to mold while teaching at the Browning, Montana Middle School during the 2001-2002 school year.
Held: The claimant failed to show that molds in her classroom were present in any higher concentrations normally occurring outdoors or in her home or that the flare-up of her sinusitis in 2001 and 2002 was due to molds at the school.
Proof: Causation. To prevail in an occupational disease claim based on exposure to mold, the claimant must show that mold, which is ubiquitous, was present in the workplace at higher levels than other places the claimant frequents.
Proof: Causation. To prevail in an occupational disease claim based on exposure to mold, the clamant must prove that her medical condition was in fact caused or aggravated by her exposure to mold in the workplace. Belief and speculation as to causation are not sufficient.
Proof: Conflicting Evidence: Medical. The sole medical opinion linking claimant's medical condition to her condition to her workplace is unpersuasive in light of persuasive, contrary opinions of a physician who conducted an independent occupational disease evaluation at the request of the Department of Labor and Industry and allergist who is a professor of medicine, has published numerous articles and textbook chapters on allergy, has been recognized by his peers with various awards, has served as an editor and reviewer for professional publications on allergy, and who is recognized by his peers as a leading authority in allergy, and where that opinion is further undermined by the refusal of the physician who treated the claimant at the time of her employment to link her disease to her employment.
Occupational Disease: Causation. To prevail on an occupational disease claim based on exposure to mold, the claimant must show that mold, which is ubiquitous, was present in the workplace at higher levels than other places the claimant frequents.
Occupational Disease: Causation. To prevail on an occupational disease claim based on exposure to mold, the clamant must prove that her medical condition was in fact caused or aggravated by her exposure to mold in the workplace. Belief and speculation as to causation are not sufficient.
¶1 The trial in this matter was held in Kalispell, Montana, on January 6, 2004. The petitioner was present and represented by Ms. Laurie Wallace. Respondent was represented by Mr. Leo S. Ward. Due to time constraints, cross-examination and redirect of Mark Hlebichuk was resumed and completed on February 2, 2004, with the Court participating (with the parties' agreement) by telephone. The matter was then deemed submitted for decision.
¶2 Exhibits: Exhibits1 through 29 and 31 through 33 were admitted without objection. The Court reserved ruling on Exhibit 30, which is an air quality report at the College of St. Catherine, which previously employed the petitioner. Respondent objected to the exhibit on the ground it was untimely exchanged and on foundation and hearsay grounds. The petitioner did not provide foundation evidence but offered the exhibit as an impeachment exhibit. The report concerns mold levels at the College of St. Catherine. Respondent did not offer any evidence concerning mold or the lack thereof at St. Catherine, therefore, the exhibit does not qualify as an impeachment exhibit. Moreover, the fact that it is offered as impeachment evidence does not nullify the requirement for foundation. The exhibit is refused.
¶3 Witnesses and Depositions: Petitioner, Maria Zoria Yates, Edith Wagner, Christine Moore, and Mark Hlebichuk testified in person. By agreement of the parties, Dr. Emil J. Bardana testified by telephone; he was scheduled to appear in person but bad weather prevented him from leaving Portland, Oregon, where he resides and practices medicine. In addition to the foregoing testimony, the parties submitted the depositions of Maria Zoria Yates, Edith H. Wagner, Rosita Crawford, Mike Hannon, and Wayne Sinclair (two depositions) to the Court for its consideration.
¶4a Whether Petitioner suffered an occupational disease arising out of and in the course of her employment with the Browning School District.
¶4b Whether Petitioner is entitled to temporary total disability benefits and reasonable medical expenses related to the treatment of the occupational disease.
¶4c Whether Petitioner is entitled to an increase in award for unreasonable delay or refusal to pay proper workers' compensation benefits pursuant to §39-71-2907, MCA.
¶4d Whether Petitioner is entitled to costs and attorney's fees pursuant to §39-71-611 and/or 612, MCA.
¶6 This case involves a claim by Anastasia Vercos (claimant) that she suffers from an occupational disease as a result of her exposure to mold while employed by the Browning School District. Mold is a fungus and fungus reproduces through spores.
¶7 The claimant is a certified teacher for grades seven through twelve. She began teaching in the Browning Middle School in Browning, Montana, in the fall of 2001 and taught at the school until taken off work on May 2, 2002.
¶11 In the winter and early spring of 2000, the claimant developed chronic frontal headaches and sinusitis. (See Exs. 6, 12, and 31.) Sinusitis is inflammation of the nasal sinuses.
¶16 The pathology report on sinus tissue excised during the November 2, 2000 surgery indicated that the tissue examination was "suggestive of chronic allergic sinusitis." (Id. at 20.) This report, along with other medical reports and opinions in evidence, compels a conclusion that the claimant's chronic sinusitis, then and now, is due to allergies. The question I must answer in this case is whether her sinusitis was aggravated by an allergic reaction to molds to which she was thereafter exposed while working at the Browning Middle School.
¶17 The claimant certainly believed that she was exposed to mold at St. Catherine's and filed a workers' compensation claim on account of her sinusitis and sinus surgeries. However, the claim was compromised (Ex. 27) and workplace pictures which she believed showed mold were inadequate for her allergist to support her claim that there was mold at her workplace. (Ex. 12 at 31.) Also, no studies were admitted into evidence concerning the existence, types, and levels of mold at St. Catherine's.
¶18 The claimant moved to Montana in August of 2001, and began teaching at the Browning Middle School in the fall of 2001.
¶20 The classrooms in the exterior pods, including the claimant's classrooms, have exterior doors opening directly outside as well as doors opening into the common area of the pod. The claimant testified that during rain and snow storms, moisture would come into her classroom under the door. She also testified that some ceiling tiles were water stained and that the walls of her classroom were concrete block and split in places. Finally, she testified that her classroom was carpeted and became wet during wet weather.
¶21 The inference the claimant wishes the Court to draw from the above testimony is that there was mold in her classroom. Mold thrives in moist places, however, her testimony did not establish the presence of any visible mold in her classroom; it did not establish how often and how much moisture got into her classroom; and it did not establish what molds were present in her classroom or the levels of the molds. Dr. Emil J. Bardana, whose testimony I discuss later on, testified convincingly that mold is ubiquitous, i.e., it is everywhere, thus I do not doubt that there was mold in her classroom. The question I must answer is whether mold was present in any greater amount or degree in the claimant's classroom than outside or in other indoor places she frequented and whether the molds present were ones to which she was allergic. Before addressing those questions, I turn back to her medical history.
¶23 Thereafter, the claimant continued to have sinusitis and sinus infections.
¶25 On March 1, 2002, she saw Dr. Karl M. Oehrtman, an otolaryngologist in Kalispell, Montana. Her complaints at that time included dizziness, pressure in her head, ear popping, and other symptoms. (Ex. 1 at 1.) Dr. Oehrtman felt she had rhinitis and sinusitis due to allergies; he recommended further allergy testing and allergy shots. (Id.) The claimant was resistive to allergy shots, citing the distance she would have to travel and her adverse reactions to drugs. (Id. at 1, 3.) The shots would have been given in Cutbank, which is about twenty-two miles from Browning.
¶27 The claimant did not return to work after May 2, 2002. On May 24, 2002, she filed a workers' compensation claim stating that she had "been ill with sinus infections since Sept. 01" due to "mold and other environmental" factors at the school. (Ex. 16 at 1.) I note here that her claim does not square with the history she provided in December 2001 concerning the onset of a sinus infection due to exposure to mold at a friend's house and the failure at that time to attribute any infections to her work at the middle school.
¶28 The Browning Schools are insured by the Workers' Compensation Risk Retention Program. The claim was submitted to it and denied.
¶29 One of the issues in this case is the claimant's exposure to molds at the Browning Middle School. The claimant has presented anecdotal evidence of others who have complained about the air quality at the school and at least one teacher who believes that she suffered a reaction to molds. Lacking, however, is medical evidence showing that they indeed suffered medical conditions caused by mold. One teacher - Christine Moore - had taken a year off from teaching in 2001-2002 to deal with personal issues and quit work precipitously in December 2002 because she felt the school was affecting her health. There was no medical evidence to support her assertion that the school environment adversely affected her health, and her prior year off and precipitous departure in 2002 raises questions concerning the value of her beliefs about the school environment. Maria Zoria Yates (Yates), the school nurse, testified that the school had all the odors typically associated with a building full of people and that she was unaware of any unusual medical complaints. (Yates Dep. at 7.) At trial, she noted that middle school children tend to be ill more than other students and that few of the middle school's staff complained about illnesses. In summary, while the evidence of other complaints may raise suspicion about school air and mold, it does no more than that.
¶31 The Court does have four air studies of the school, three of which specifically measured mold levels.
¶33 The second study was done on April 11, 2002, by Maxim Technologies, Incorporated. The results of that study are found at Exhibit 20. The primary reason for the study was the flooding of classroom 109, which has previously been noted. At the time of the study, school was in session and some of the classrooms were sampled with students present. (Ex. 20 at 4.) There is no indication of any special measures taken prior to the sampling.
( Id. at 12-13.) Thus, overall outside levels were six times greater than the level of room 124 in the first sampling and more than thirty times greater in the second sampling.
¶38 A second study of mold levels was done on April 26, 2003, after the present litigation was commenced. The study was done by two different environmental firms, one commissioned by the claimant and the other by the insurer. The results of each firm's tests and conclusions are found at Exhibits 15 and 26.
¶39 Initially, there is controversy as to whether the results of the studies were affected by the conditions at the school. The claimant's expert noted that the school had been closed up for a week prior to the testing and that carbon dioxide concentrations were the same inside and outside, indicating the possibility that intake of outside air could have been 100%. (Ex. 15 at 6.) If testing conditions were invalid, as claimant suggests, then the first study must be given greater weight.
¶40 The claimant's expert was Mark Hlebichuk (Hlebichuk), an industrial hygienist. He tested for both spores and spore fragments in rooms 109 and 108, in the water-damaged area, the teachers' lounge, and room 124 (the claimant's room), as well as the outside air for comparison. He also tested the wall between rooms 108-109. All rooms showed overall spore levels less than or equal to outside air. The only elevated level was in the wall between rooms 108 and 109, which showed a total spores level more than six times the outside level.(5) However, the spore levels in the adjacent rooms did show corresponding levels.
¶42 As set forth in the above chart, outside levels and the levels in rooms 108 and 109 were significantly higher than the levels in claimant's room. While Hlebichuk criticized testing conditions, he provided no credible evidence that molds not measured in claimant's room were in fact present or that actual levels of molds in her room were in fact significantly higher than measured.
¶44 Hlebichuk also identified specific molds as being "water damage indicator[s]." (Ex. 15 at 5.) Those molds included Amerospores and Ascospores, both of which were found in the claimant's classroom. However, as indicated in the chart in the previous paragraph, the concentrations of those molds were far higher in the outside air than in the claimant's classroom. The fact that they were found outside in such concentrations calls into question the value of Hlebichuk's use of them as indicators of water damage, at least without more refinement.
While no measures of spore levels were taken in the claimant's classroom, the results are interesting for a couple of reasons. First, it confirms that the levels of some spores (Ascospores and Cladosporium) were far higher outside than inside. Second, it shows, as did the other studies, that the fact that a particular spore may be present in one room does not mean that it is present in other rooms. The studies also show collectively that the levels and types of molds found in one room or area were not indicative of the levels and types of molds in another room or area of the middle school.
¶48 Three medical opinions concerning the cause of the claimant's sinusitis during the 2001-2002 school year and her 2002 surgeries are in evidence, those of Dr. Wayne Sinclair, an allergist to whom the claimant went in the fall of 2002; Dr. John Larson, who conducted an occupational disease evaluation at the request of the Department of Labor and Industry; and Dr. Emil J. Bardana, Jr., an allergist retained by the respondent. Both Drs. Larson and Bardana opined that the claimant's condition was not an occupational disease caused by her exposure to molds at the Browning Middle School.
The patient is very focused on a worker's comp claim that she cannot work in a high-mold environment, and wants me to write a strongly worded letter that she cannot work in that environment. I wrote a letter on her previous visit, which mentioned that since she is mold allergic it would be better for her to avoid a high-mold environment. I cannot, however, write a strongly worded letter unless various criteria are met: (1) that she would fail standard medical therapy for anyone whose [sic] is dealing with allergy, and (2) that we would demonstrate the environment that she is being asked to work in is higher than a normal mold content with spores per cubic meter. I have asked her to obtain this information. I will be happy to report on what I can report on. . . .
(Id.) There is no evidence that the claimant ever supplied Dr. Oehrtman with information showing unusual exposure to molds at work and Dr. Oehrtman never did provide any opinion linking her condition to her workplace.
¶50 Dr. Oehrtman's office note, quoted in the previous paragraph, is consistent with my resolution of the conflicting medical opinions in this case. He was the claimant's treating physician during a critical period of time in this case, i.e., the time when the claimant's sinusitis progressed to the point that she needed surgery. Even though he was her treating physician, his response to the claimant's request demonstrates objectivity on his part and shows the need for specific information regarding mold levels at the school in order to formulate a good medical opinion concerning the contribution, if any, of the school environment to the claimant's condition. His response demonstrates that the claimant's mere belief and assertion that mold at the school was causing or contributing to her conditions was not sufficient to provide a basis for an informed medical opinion. Third, he wanted the claimant to undergo standard medical therapy for all of her allergies before rendering any opinion concerning her ability to continue working. His prior notes (id. at 1) indicate that such therapy includes allergy shots, but as noted in paragraphs 25 and 52, the claimant was resistive to that treatment.
Anastasia returns today with continued problems with her sinuses. She states that she has thought about allergy shots and she is feeling that this is not going to be an option for her, particularly in view of her remote location and the fact that she seems to react very severely to drugs. . . .
I have an appointment with you on September 25th. I have recently had allergy testing done by Dr. Oehrtman in Kalispell (I will get a copy of the results to you.) I have also had testing done by Dr. Lind in Minneapolis (again, I will get you a copy).
My biggest health problem seems to be from mold. I have had to have three surgeries to date resulting from my body's reaction to it. The school building I was working in last year has had a history of mold. Two of the science teachers found large colonies of mold and pointed them out to the administration last spring.
The district did authorize some testing last spring, however, when they tested, most of the doors to the outside were open and there was a significant breeze going through the school. Then in July, the state did some testing. But again the results were affected by the large amount of construction going on in the building, the majority of the doors being open, the ventilation system could not be tested, etc. The final report from the state will include that information once it is written.
(Sinclair Dep. Ex. 2.) Indeed, there is no indication that the claimant has agreed to undergo allergy shots even after further allergy testing by Dr. Sinclair.
¶53 Dr. Sinclair testified by deposition. In a nutshell, he testified that the claimant's exposure to molds at the Browning Middle School aggravated her preexisting mold allergies and her sinusitis; he recommended that she not return to work at the Middle School until the school is free of mold.
¶56 Dr. Bardana confirmed that mold can be an allergen but testified that it is not the most significant indoor allergen in the general population. Heading the list of most significant indoor allergens is house dust mites (to which the claimant is allergic), followed by cat and dog dander (the claimant has dogs), then cockroach and rodents, and finally mold.
¶57 Molds occur naturally and are ubiquitous, meaning they are everywhere. Dr. Bardana noted that the levels of molds outdoors vary seasonally and with weather. Indoor levels of naturally occurring molds are typically forty to eighty percent of outside levels. He also noted that mold levels can vary over very short periods of time, testimony that is supported by the mold measurements in this case. Finally, he noted that homes typically have higher levels of molds than do commercial buildings since commercial buildings have better air handling systems.
¶58 Dr. Bardana identified four types of outdoor molds as commonly occurring indoors. The molds are Cladosporium, Alternaria, Penicillium, and Aspergillus. As noted earlier, the outside Cladosprium levels were significantly higher than inside the school; Aspergillus was detected only in the claimant's home; and Penicillium was detected only in small amounts in one sample in the claimant's classroom.
¶60 Dr. Bardana opined that the claimant's sinusitis is due to her multiple allergies and her resultant rhinitis. He testified that mold is a minor issue in her disease and cannot be separated out from her other allergies. He testified upon cross-examination that the claimant's exposure to mold at school had no impact on her condition. He noted that outside air and the air in her home had higher levels of mold than her classroom in the Browning Middle School. The mold levels in the school did not exceed what is expected outdoors or indoors.
¶61 Dr. Bardana also concluded that the claimant's exposure to molds in her home was not all that significant either, although he noted that dust mites in the home could be significant.
¶62 The claimant urges that the absence of sinus infections since her May 2002 surgery is evidence that her sinus infections were triggered by mold in the Browning Middle School. Such inference, however, is weak at best. Dr. Bardana noted that the absence of infections since her 2002 surgery may well be due to the success of the surgery.
¶63 In evaluating the conflicting testimony of Drs. Sinclair and Bardana, I consider their medical credentials, their logic, their consideration of the claimant's medical records and the school air quality studies, and independent support provided by other physicians. On all of these measures, I find Dr. Bardana's testimony the more convincing.
Q. Are you familiar with Emil Bardana?
A. As an allergist at Oregon.
Q. Do you respect him?
A. I'd rather not answer that.
A. Just would rather not.
Q. You don't respect him?
A. That's not what I said, is it?
Q. No. You said you wouldn't answer that question.
Q. And I find that curious. Could you tell me why you won't answer it?
A. No, I won't tell you why.
(Sinclair Dep. at 54-55.) Dr. Sinclair's hostility to Dr. Bardana is obvious. In light of Dr. Bardana's credentials and Dr. Larson's acknowledgment of Dr. Bardana as an internationally known expert, I do not understand Dr. Sinclair's responses regarding Dr. Bardana. If there is a reason to discount Dr. Bardana as an expert in this case, I have not been provided with one. Dr. Sinclair's refusal to disclose the reasons for his hostility towards Dr. Bardana and his refusal to answer some other questions put to him by respondent's counsel are factors that negatively affect my evaluation of his testimony.
¶65 Moreover, as I have noted before, Dr. Sinclair arrived at his opinions before any review of medical records or the air samples at the school or the claimant's home. Ultimately, his opinions were based on the claimant's report that she suffered increased symptoms while teaching and her report that others at the school were suffering similar symptoms. His opinions therefore depend largely on the credibility and accuracy of the claimant's information.
¶66 While I do not doubt that the claimant sincerely believes that her sinus problems were caused by molds at the Middle School, I am also persuaded that her report of increased symptoms specifically associated with her work are unreliable. I note that she had a prior work experience which she believed exposed her to mold and caused her initial round of sinus surgeries. Her September 9, 2002 letter to Dr. Sinclair shows that she was focused on a similar explanation for her 2002 problems. But when she was seen at the emergency room of the Northern Rockies Medical Center in Cut Bank, Montana, on December 22, 2001, for sinus infection she reported "that she was exposed to mold recently while visiting someone at their home on Wednesday; had a severe reaction with her ears draining bilaterally." (Ex. 9 at 4.) Her report is inconsistent with the history she gave Dr. Sinclair and with her present claim that she immediately experienced sinus problems when going to work at the middle school and which she attributed to the school environment. I am persuaded that her recollection is colored by her present belief regarding her occupational disease claim.
¶67 The claimant has failed to persuade me that she suffers from an occupational disease resulting from her work at the Browning Middle School. She did not frequent the pod where flooding had occurred and where the highest concentrations of mold were found, as shown by actual testing. Mold varieties and levels in one room are not indicative of varieties and levels in another. Other than the belief of the claimant and a few others that excessive levels of mold existed in the school generally and in the claimant's room in particular, there is no persuasive evidence to support their claims. Indeed, the highest mold levels were found in the claimant's home, which is consistent with the testimony that commercial buildings have better air exchange systems than homes and therefore generally have less concentrations of mold. The claimant also has multiple allergies which explain her infections. Finally, the only medical opinion tying the claimant's infections and surgeries to workplace mold was that of Dr. Sinclair. The opinions of Drs. Larson and Bardana directly refute that opinion, and the observations of the physician who treated the claimant while she was still working at the school substantially undermines that opinion. I found Dr. Sinclair's opinion unpersuasive.
¶68 This case is governed by the 2001 version of the Montana Occupational Disease Act since that was the law in effect at the time of the claimant's alleged industrial exposure. Buckman v. Montana Deaconess Hospital, 224 Mont. 318, 321, 730 P.2d 380, 382 (1986).
¶69 The claimant bears the burden of proving by a preponderance of the evidence that she is entitled to the benefits she seeks. Ricks v. Teslow Consolidated, 162 Mont. 469, 512 P.2d 1304 (1973); Dumont v. Wicken Bros. Construction Co., 183 Mont. 190, 598 P.2d 1099 (1979).
¶70 As a general matter, an insurer is liable only for those medical conditions caused or materially aggravated by an industrial accident or occupational disease. "Causation is an essential element to benefit entitlement. The claimant has the burden to prove a causal connection by a preponderance of the evidence." Hash v. Montana Silversmith, 256 Mont. 252, 257, 846 P.2d 981, 983 (1993); McCauley v. Liberty Northwest, 2004 MTWCC 43, ¶ 47.
39-72-408. Proximate causation -- determination by treating physician.
None of the criteria have been met in this case. Initially, the claimant has failed to show that she was exposed to any greater level of molds or any different molds inside the classroom than outside and in her home. Indeed, when measured, her home had significantly higher levels of mold. Thus, neither subsections (b) or (d) are met. Moreover, the claimant failed to present persuasive medical opinion showing that her sinus condition and surgeries were directly caused by her exposure to mold at the school. Thus, neither subsections (a) or (c) are satisfied.
¶72 The claimant has failed to prove by a preponderance of the evidence that she suffers from an occupational disease. Her petition is dismissed with prejudice.
¶73 This JUDGMENT is certified as final for purposes of appeal.
¶74 Any party to this dispute may have twenty days in which to request a rehearing from these Findings of Fact, Conclusions of Law and Judgment.
1. The Merriam-Webster Medical Dictionary provides a similar definition, defining rhinitis as "inflammation of the mucous membrane of the nose."
4. Why claimant believed she had been exposed to mold at the friend's house is not apparent.
5. Dr. Bardana testified that mold growing in a wall may not translate into increased levels of mold in the air of an adjacent room and these test results are consistent with his testimony. Thus, the fact that mold may be growing in a wall does not mean that individuals in the room are exposed to increased levels of that mold.

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