Source: http://comped.net/opinions_recentdisp.php?ID=7149
Timestamp: 2019-04-25 22:28:15+00:00

Document:
ALVEY, Chairman. Jennifer Creager (“Creager”) appeals from the Opinion and Order rendered December 17, 2017, by Hon. Jeanie Owen Miller, Administrative Law Judge (“ALJ”). The ALJ dismissed her injury claims for failure to prove a causal relationship between the February 23, 2015 and September 15, 2015 work incidents, and her cervical and lumbar conditions. Creager also appeals from the January 26, 2018 Order denying her petition for reconsideration issued by Hon. Tanya Pullin, Administrative Law Judge (“ALJ Pullin”).
On appeal, Creager argues the ALJ failed to make sufficient findings supporting her conclusion of an absence of a causal relationship between her cervical and lumbar conditions and the work incidents. She additionally argues the ALJ’s decision is not supported by substantial evidence. Creager also argues the ALJ incorrectly applied Finley v. DBM Technologies, 217 S.W.3d 261 (Ky. App. 2007), in finding the Court did not require the pre-existing condition to be impairment rated, but only impairment ratable. Because the ALJ’s determination that Creager’s lumbar and cervical conditions were not caused by the February 23, 2015 and September 15, 2015 work incidents, is supported by substantial evidence with a contrary result not compelled, we affirm.
Creager filed a Form 101 alleging on February 23, 2015, she injured her neck while raising a heat lamp; and on September 15, 2015, she injured her neck, right shoulder, arm and low back while lowering a lift gate. Creager alleged a safety violation by her employer, Ford Motor Company/Assembly Plant (“Ford”). Subsequently, Ford filed a medical dispute challenging Creager’s alleged cervical claim, including the recommended fusion surgery. We will not discuss the evidence addressing the alleged safety violation since it is not an issue on appeal.
Creager testified by deposition on July 20, 2016 and September 15, 2017, and at the final hearing held October 6, 2017. Creager has worked for Ford since August 1992, and began her position as spot repairer in August 2011. This entailed repairing defects in vehicle paint. She lifted and lowered a gate as each unit came into the repair bay.
Creager acknowledged she was already treating with a pain management physician, Dr. Jeffery Berg, at the time of the alleged work incidents. Creager underwent a prior low back discectomy in 2004, performed by Dr. Thomas Becherer. She was released without restrictions and had no issues until approximately 2008 or 2009. She ultimately began treating with Dr. Berg in 2010 for low back symptoms, and continued to treat with him until the work incidents. Prior to the work injuries, Dr. Berg’s treatment consisted of epidural steroid injections, trigger point injections, Ibuprofen and up to three Percocet per day. Creager described her prior low back pain as “intermittent,” “hit or miss” or as flare-ups. She denied experiencing symptoms in her leg. She complained the low back symptoms worsened and became constant after the incidents.
While treating for her prior low back symptoms, Creager began complaining of neck problems in the fall of 2014. Creager indicated her neck and shoulder area were sore, but tolerable, and she experienced some tingling in her hand. Dr. Berg treated her neck symptoms conservatively and ordered a cervical MRI in December 2014. Creager indicated her neck symptoms resolved or were vastly improved following a Christmas break.
On February 23, 2015, she experienced a sharp pain in the back of her head, neck, and upper back when she raised a heat lamp with defective shocks. She reported the incident and received treatment at Ford medical, consisting primarily of physical therapy. She also followed up with Dr. Berg.
On September 15, 2015, Creager was lowering the lift gate when she experienced neck pain radiating down her upper back, as well as numbness and tingling in her right arm and fingers. At some point after the September 15, 2015 work incident, Creager also began experiencing increased symptoms in her low back. Creager reported the incident to Ford medical. She ultimately came under the care of Dr. Becherer for both her lumbar and cervical conditions, and continued to treat with Dr. Berg. Dr. Becherer performed a lumbar laminectomy and discectomy on March 14, 2016 and a multi-level cervical fusion on December 6, 2016.
Creager continued to work her regular job as a spot repairer until the first surgery. She was restricted from work for a period of time after each procedure. Creager ultimately returned to work for Ford, but in a different position as a job security representative. Creager continues to treat with Dr. Berg.
The parties filed Dr. Berg’s records indicating Creager began treating with him in February 2010, initially for low back symptoms. Prior to the February 2015 incident, Creager treated with Dr. Berg approximately every other month for chronic low back, left hip and leg pain due to multilevel degenerative disc disease, facet arthropathy, prior 2004 L5-S1 surgery, recurrent disc herniation at L5-S1, and multilevel spinal and foraminal narrowing.
Creager additionally complained of cervical and right shoulder pain, along with left hand numbness, on June 20, 2013, for which Dr. Berg recommended a soft cervical collar. On November 19, 2014 and December 24, 2014, Creager complained of low back pain, along with cervical pain, right shoulder pain and hand numbness which began spontaneously two or three months prior which gradually worsened. A cervical MRI was performed on December 4, 2014. On February 20, 2015, three days prior to the first work incident, Creager reported ongoing back pain controlled with medication. Dr. Berg noted Creager continued to have increasing cervical, shoulder and right arm pain in the C6 distribution. He noted Creager’s cervical symptoms worsened despite traction, a soft collar, home physical therapy and medication. Dr. Berg noted Creager had disc protrusions at C5-6 and C6-7, and moderate to severe right foraminal narrowing and moderate central stenosis at C5-6. He recommended epidural injections, followed by physical therapy. He also continued her prescriptions.
On February 23, 2015, Creager sought treatment at Ford medical and reported right upper shoulder pain and tingling in her right hand after pushing up on a heat lamp. She returned two days later. Dr. Charles Sherrard diagnosed right upper back strain and recommended physical therapy. An EMG/NCV ordered in May 2015 was consistent with a C7 right nerve root injury.
On February 27, 2015, Creager returned to Dr. Berg complaining of neck and right arm pain, but the record does not mention the February 23, 2015 incident. Dr. Berg administered a cervical epidural steroid injection. Creager continued to complain of low back and neck symptoms in April, June and August 2015. Dr. Creager continued to prescribe Oxycodone and Ibuprofen. He also administered trigger point injections.
On September 15, 2015, Creager returned to Ford medical reporting right-sided neck pain as she was lowering a lift gate with one hand. Ford medical prescribed medication and physical therapy, ordered a cervical MRI, and referred Creager to a neurosurgeon.
Subsequent to the September 15, 2015 work incident, Creager continued to treat with Dr. Berg for her cervical and low back complaints with medication, trigger point injections, lumbar epidural steroid injections, physical therapy and a cervical epidural injection. In a letter dated February 25, 2016, Dr. Berg stated Creager’s worsening spinal conditions were caused by her work-related repetitive bending and lifting.
Creager also filed the records from Dr. Becherer. On October 5, 2015, Dr. Becherer noted Creager’s previous lumbar surgery. Creager reported the onset of neck and right shoulder pain, as well as numbness and tingling in right arm and fingers, on September 15, 2015 after lowering a lift gate at work. Dr. Becherer noted Creager “had neck pain in November then developed arm tingling in January or February. She had been through 2-3 months of therapy and had an epidural and was doing well until the 9/15/15 incident.” He ordered a shoulder MRI and EMG/NCV. He thereafter diagnosed cervical spondylolysis and recommended a C5-C7 fusion on November 5, 2015. On that date, he noted that although the MRI findings are mostly degenerative in nature, Creager was not symptomatic until the November 2014 work situation, which was re-aggravated by her work-related activity in September 2015. In March 2016, Creager reportedly developed low back and right greater than left leg pain in December 2015. He diagnosed cervical spondylolysis, lumbar disc herniation and lumbar stenosis. On March 14, 2016, Dr. Becherer performed a laminectomy L4 for bilateral discectomy at L4-5 and a fusion at C5-7 on December 6, 2016.
Both parties filed Dr. Timir Banerjee’s December 16, 2015 report. He diagnosed right levator scapulae and trapezius strain and underlying carpal tunnel syndrome. He also noted that a radiological diagnosis of cervical spondylosis is evident but does not match Creager’s symptoms. He opined the spondylosis is pre-existing, and was neither caused nor aggravated by a work injury. He opined the radiographic changes resulted from genetics, smoking, and from unknown causes related to inflammation and disc desiccation. However, Dr. Banerjee opined the muscular injury is related to her employment.
Ford filed the October 16, 2015 peer review report by Dr. Carlos Acosta, who diagnosed a cervical sprain/strain due to the September 15, 2015 work injury. He opined the multilevel cervical degenerative disc disease and C7 radiculopathy caused the majority of Creager’s complaints, not the September 15, 2015 work injury.
Creager filed Dr. Warren Bilkey’s August 12, 2016 and July 11, 2017 reports. He diagnosed a February 23, 2015 work injury, cervical strain, aggravation of cervical degenerative disc disease, cervical stenosis, and cervical radiculopathy. He noted her cervical problems were aggravated by the September 15, 2015 work injury. He also diagnosed aggravation of lumbar degenerative disc disease, lumbar spinal stenosis, and lumbar radiculopathy. Dr. Bilkey opined the diagnoses are due to the February 23 and September 15, 2015 work injuries. For the lumbar condition, Dr. Bilkey assessed a 22% impairment rating pursuant to the American Medical Association, Guides to the Evaluation of Permanent Impairment (“AMA Guides”), attributing 11% to a pre-existing, active condition and 9% to the work injuries. For the cervical condition, Dr. Bilkey assessed a 28% impairment rating pursuant to the AMA Guides, attributing 9% to a pre-existing, active impairment, and 19% due to the work injuries.
Ford filed the August 1, 2016, July 17, 2017, and August 31, 2017 reports of Dr. Stacie Grossfeld. She diagnosed, “preexisting active condition of DJD involving the cervical and lumbar spine along with a prior disc herniation involving the lumbar spine and a prior disc protrusion involving the cervical spine that had intensified with time.” Regarding causation, Dr. Grossfeld again emphasized Creager had a pre-existing, active condition involving the cervical and lumbar spines. She pointed to the fact Creager actively treated with a pain management physician prior to her work injuries, was taking a high dosage of narcotics, and was receiving epidural and trigger point injections on a regular basis. She noted Creager had MRI imaging documenting pre-existing, active conditions within both areas. Dr. Grossfeld could not attribute Creager’s current symptoms directly to the work injuries. Rather, Dr. Grossfeld opined her current symptoms are the natural progression of her pre-existing, active condition involving the cervical and lumbar spines. She likewise opined the lumbar and cervical surgeries are unrelated to the alleged work injuries. Dr. Grossfeld assessed a 25% impairment for the cervical spine and 20% for the lumbar spine, none of which she attributed to the alleged work injuries.
This case is a prime example of the difficulty distinguishing between the issue of causation of an impairment and/or whether the impairment was pre- existing and active prior to any work incident and/or whether the work incident caused an exacerbation of an impairment.
When the causal relationship between an injury and a medical condition is not apparent to the lay person, the issue of causation is solely within the province of a medical expert. Elizabethtown Sportswear vs. Stice, 720 SW2d 732, 733 (Ky. 1986); Mengel vs. Hawaiian Tropic Northwest and Central Distributors, Inc., 618 SW2d 184 (Ky. 1981). Here we have medical expert testimony that literally covers all of the possibilities outlined above. Given that there are medical opinions for all of the possible scenarios, from respected physicians, it is necessary to review the medical treatment surrounding the dates of the work related incidents.
First, the undersigned ALJ found the plaintiff very credible. The plaintiff’s work ethic cannot be challenged. After working at Ford for over 25 years, this 44 year-old has spent over half of her life working in this factory setting. The work activities would, even to a lay person, be considered highly repetitive. The work has taken a toll on Ms. Creager’s physical health. However, the issues here are not whether there was a cumulative effect of the work activities, but rather whether the incidents of 2/23/2015 and 9/15/2015 were the causal events resulting in her permanent impairments.
In reviewing the burden of proof and the testimony of the Plaintiff as well as the medical records, I find the Plaintiff has not sustained her burden of proof regarding the causal relationship between the work incidents of 2/23/2015 and 9/15/2015, and her cervical or lumbar spine condition(s).
The primary reason I find the absence of a causal connection between the work incidents and the plaintiff’s current condition is that the medical evidence shows ongoing treatment for both the lumbar and cervical spine(s) before the work incidents.
The plaintiff testified that, although her cervical condition required a MRI in December, 2014, her time off from work during the holiday break allowed her pain to subside somewhat. The plaintiff was seen by Dr. Berg on 2/20/2015, with [sic] chart note that stated Chief complaint is Neck pain with pain going down right arm. She continued with narcotic medication, was prescribed epidural injections and continued with soft cervical collar. (emphasis ours). She testified that she had an episode of extreme pain when she lifted a heat lamp at work on 2/23/2015. Although she reported this to Ford, she apparently did not mention it to Dr. Berg just 4 days later.
On 02/27/2015, Ms. Creager’s chief complaint was neck pain and right arm pain. Dr. Berg noted that she reported physical therapy aggravated her symptoms. She continued with narcotic medication.
The plaintiff emphasizes Dr. Becherer’s opinion: “although the MRI findings are mostly degenerative in nature, she was not symptomatic until the work situation in November 2014, which was re-aggravated by the work activity in September of this year.”. Dr. Becherer does not identify to what “work situation in November 2014” he attributes the arousal of her cervical pain. Dr. Berg’s record records the history on 11/19/2014, as “She also is complaining again of cervical and right shoulder and intermittent hand numbness that began about 2-3 months ago without apparent cause. These symptoms have gradually worsened.” 12/24/2014 is much the same notations of worsening cervical pain and pain in her right upper extremity.
I find that the medical record made contemporaneously with Ms. Creager’s onset of cervical pain with right upper extremity is the most accurate. This history recorded by Dr. Berg, would not support a finding that a “work situation” was the commencement of the plaintiff’s cervical pain in the Fall of 2014 as Dr. Becherer opines. Nor does the medical record of Dr. Berg support the contention that the September 15, 2015 work incident was an “re-aggravation” given that she doesn’t even mention it to Dr. Berg the day following the work incident.
The February 20, 2015, (just 3 days prior to the 02/23/2015, work incident) note of Dr. Berg outlines an ongoing and worsening cervical problem. The note states that the plaintiff was “continuing to have increasing cervical shoulder and right arm pain in the C6 distribution. He notes her disc protrusions at C5-6 and C6-7 where she has moderate to severe right foraminal narrowing and moderate central stenosis at C5-6. She was having a gradual worsening and required epidural injections.
The proof of a causal relationship between the work incidents and the plaintiff’s impairments requires medical expert evidence. The doctor’s opinion must be based upon accurate history. Here there is no medical record that convinces the undersigned of the causal connection between the work incidents of 02/20/2015 and 09/15/2015 and Ms. Creagers[sic] impairments. There can be no question, after a complete review of the medical evidence, that Ms. Creager was having ongoing symptoms of cervical pain, with very similar findings on MRIs, both before and after the work incident of 2/23/2015 and 09/15/2015. I find the incidents of 02/23/2015 and 09/15/2015, were not the cause of her need for medical treatment, either as an original injury or an[sic] “re-aggravation” of the pre-existing conditions. For this finding I rely primarily on Dr. Berg’s office chart/notes.
Ms. Creager was clearly having active medical treatment immediately before each of these incidents. She was taking narcotic medication, having epidural and injective medications, physical therapy, using a cervical collar, cervical traction and having diagnostic testing etc. all before the incidents occurred. While [sic] burden of proof on causation is with the plaintiff, the issue of pre-existing active impairment is an affirmative defense with the burden of proof on the defendant. I find the overwhelming evidence is that Ms. Creager had an on-going, symptomatic, impairment(s) for which she was receiving active medical treatment immediately before the work incidents of 2/23/2015 and 09/15/2015. The impairment(s) were active and pre-existing. The standard for determining whether a work incident was the cause of an impairment, or a temporary exacerbation of a pre-existing impairment or whether the entire impairment is pre-existing active is [sic] difficult issue.
Kentucky law holds the arousal of a pre-existing dormant condition into disabling reality by a work injury is compensable. However, an employer is not responsible for a pre-existing active condition present at the time of the alleged work-related event. McNutt Construction/First General Services vs. Scott, 40 SW3d 854 (Ky. 2001). The correct standard regarding a carve-out for a pre-existing active condition is set forth in Finley vs. DBM Technologies, 217 SW3d 261 (Ky. App. 2007). In Finley, supra, the Court instructed in order for a pre-existing condition to be characterized as active, it must be both symptomatic and impairment ratable pursuant to the AMA Guides immediately prior to the occurrence of the work-related injury. The employer bears the burden of proving the existence of a pre-existing active condition. Finley, supra.
Whether the issue is analyzed as a causal issue or a pre-existing active impairment here, the results are the same. Ms. Creager did not sustain a compensable work injury on either 02/23/2015 or 09/15/2015.
In deciding the threshold issue of causation, the remainder of the contested issues shall not be addressed.
Creager filed a petition for reconsideration challenging the ALJ’s determinations. The claim was subsequently reassigned to ALJ Pullin. In the order on petition for reconsideration, ALJ Pullin found Dr. Grossfeld’s opinion was consistent with Dr. Berg’s treatment records regarding the lumbar and cervical spine. ALJ Pullin noted the Court in Finley v. DBM Technologies, 217 S.W.3d 261 (Ky. App. 2007), held that to be characterized as active, a pre-existing condition must be both symptomatic and impairment ratable. ALJ Pullin noted the Finley Court did not require the pre-existing condition be impairment rated, but only impairment ratable. ALJ Pullin concluded disc protrusions and surgeries make Creager’s pre-existing cervical and lumbar spine conditions impairment ratable just prior to the alleged injury dates as confirmed by the treatment records of Dr. Berg. ALJ Pullin also noted that an ALJ, as fact-finder, may choose whom and what to believe and, in doing so, may reject any testimony and believe or disbelieve various parts of the evidence, regardless of whether it comes from the same witness or the same party’s total proof. Caudill v. Maloney’s Discount Stores, 560 S.W.2d 15, 16 (Ky. 1977). Therefore, ALJ Pullin overruled Creager’s petition for reconsideration.
On appeal, Creager argues the ALJ did not make sufficient findings of fact nor was there substantial evidence supporting her conclusion of an absence of a causal relationship between her cervical and lumbar conditions and the work incidents. Creager argues the ALJ erred in the description of Dr. Berg’s testimony, and did not make sufficient findings of fact regarding the treatment notes of Ford Medical or Dr. Becherer, or even of Dr. Berg’s February 25, 2016 letter. Creager also argues the ALJ incorrectly interpreted Finley v. DBM Technologies, supra, in concluding the Court did not require the pre-existing condition to be impairment rated, but impairment ratable.
As the claimant in a workers’ compensation proceeding, Creager had the burden of proving each of the essential elements of her cause of action, including work-relatedness/causation. Snawder v. Stice, 576 S.W.2d 276 (Ky. App. 1979). Because Creager was unsuccessful in her burden, the question on appeal is whether the evidence compels a different result. Wolf Creek Collieries v. Crum, 673 S.W.2d 735 (Ky. App. 1984). “Compelling evidence” is defined as evidence that is so overwhelming, no reasonable person could reach the same conclusion as the ALJ. REO Mechanical v. Barnes, 691 S.W.2d 224 (Ky. App. 1985). The function of the Board in reviewing the ALJ’s decision is limited to a determination of whether the findings made by the ALJ are so unreasonable under the evidence they must be reversed as a matter of law. Ira A. Watson Department Store v. Hamilton, 34 S.W.3d 48 (Ky. 2000).
As fact-finder, the ALJ has the sole authority to determine the weight, credibility and substance of the evidence. Square D Co. v. Tipton, 862 S.W.2d 308 (Ky. 1993). Similarly, the ALJ has the sole authority to judge all reasonable inferences to be drawn from the evidence. Miller v. East Kentucky Beverage/Pepsico, Inc., 951 S.W.2d 329 (Ky. 1997); Jackson v. General Refractories Co., 581 S.W.2d 10 (Ky. 1979). An ALJ is vested with broad authority to decide questions involving causation. Dravo Lime Co. v. Eakins, 156 S.W.3d 283 (Ky. 2003). The ALJ may reject any testimony and believe or disbelieve various parts of the evidence, regardless of whether it comes from the same witness or the same adversary party’s total proof. Magic Coal Co. v. Fox, 19 S.W.3d 88 (Ky. 2000); Whittaker v. Rowland, 998 S.W.2d 479 (Ky. 1999). Mere evidence contrary to the ALJ’s decision is not adequate to require reversal on appeal. Id. In order to reverse the decision of the ALJ, it must be shown there was no substantial evidence of probative value to support his decision. Special Fund v. Francis, 708 S.W.2d 641 (Ky. 1986).
The Board, as an appellate tribunal, may not usurp an ALJ’s role as fact-finder by superimposing its own appraisals as to the weight and credibility to be afforded the evidence or by noting reasonable inferences could otherwise have been drawn from the record. Whittaker v. Rowland, supra. As long as the ALJ’s ruling with regard to an issue is supported by substantial evidence, it may not be disturbed on appeal. Special Fund v. Francis, supra.
After careful review, we find the ALJ accurately summarized the evidence and had a complete understanding of the issues before her. In the opinion, the ALJ relied upon the treatment records of Dr. Berg, both pre-dating and following the work injury, in finding Creager had not sustained her burden of proof regarding the causal relationship between the February 23, 2015 and September 23, 2015 work incidents, and her cervical or lumbar spine conditions. ALJ Pullin also relied upon Dr. Berg’s treatment records, as well as the opinions of Dr. Grossfeld, in overruling Creager’s petition for reconsideration. Dr. Grossfeld’s opinion, in conjunction with Dr. Berg’s treatment records, constitute substantial evidence supporting the determination Creager failed to prove her cervical and lumbar conditions are related to the February 23, 2015 and September 15, 2015 work injuries. We find the ALJ acted within the scope of the deference afforded to her, and a contrary result is not compelled.
We acknowledge Creager is able to point to conflicting evidence supporting her position on appeal. However, the ALJ as fact-finder determines the credibility of the evidence. The ALJ may also choose whom and what to believe when faced with conflicting evidence. It was the ALJ’s prerogative to rely on Dr. Berg’s treatment records and Dr. Grossfeld’s opinions in making her determination. Therefore, her decision will not be disturbed.
We disagree with Creager’s argument the ALJ failed to make sufficient findings of fact. While authority generally establishes an ALJ must effectively set forth adequate findings of fact from the evidence in order to apprise the parties of the basis for her decision, she is not required to recount the record with line-by-line specificity nor engage in a detailed explanation of the minutia of her reasoning in reaching a particular result. Shields v. Pittsburgh and Midway Coal Mining Co., 634 S.W.2d 440 (Ky. App. 1982); Big Sandy Community Action Program v. Chaffins, 502 S.W.2d 526 (Ky. 1973). The ALJ’s analysis of the evidence, in addition to the further analysis made by ALJ Pullin in the Order on reconsideration, was more than sufficient to support her determination.
Because we find substantial evidence supports the ALJ’s determination regarding causation/work-relatedness, and no contrary result is compelled, the remaining arguments on appeal are moot.
Therefore, the December 17, 2017 Opinion and Order rendered by Hon. Jeanie Owen Miller, Administrative Law Judge, and the January 26, 2018 Order on petition for reconsideration rendered by Hon. Tonya Pullin, Administrative Law Judge, are hereby AFFIRMED.

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