Case Name: Loreine GECK, Claimant and Appellant, v. NORTH DAKOTA WORKERS COMPENSATION BUREAU, Appellee. and Morton County Social Services, Respondent
Court: North Dakota Supreme Court
Jurisdiction: North Dakota
Decision Date: 1998-08-19
Citations: 583 N.W.2d 621
Docket Number: Civil No. 980036
Parties: Loreine GECK, Claimant and Appellant, v. NORTH DAKOTA WORKERS COMPENSATION BUREAU, Appellee. and Morton County Social Services, Respondent.
Judges: [¶ 16] VANDE WALLE, C.J., and NEUMANN and MESCHKE, JJ„ concur.
Reporter: North Western Reporter 2d
Volume: 583
Pages: 621–626

Head Matter:
1998 ND 158
Loreine GECK, Claimant and Appellant, v. NORTH DAKOTA WORKERS COMPENSATION BUREAU, Appellee. and Morton County Social Services, Respondent.
Civil No. 980036.
Supreme Court of North Dakota.
Aug. 19, 1998.
Dean J. Haas (argued), of Dietz, Little & Haas, Bismarck, for claimant and appellant.
Tracy Vigness Kolb (argued), Special Assistant Attorney General, of Zuger Kirmis & Smith, Bismarck, for appellee.

Opinion:
MARING, Justice.
[¶ 1] Loreine Geek appeals from a district court judgment affirming the decision of the Workers Compensation Bureau denying her benefits. We reverse and remand to the Bureau for further findings consistent with this opinion.
I
[¶ 2] On July 23, 1996, Loreine Geek experienced a "sharp pain" or "harsh pain" in her left knee as she was "kneeling down and doing foot care for a client" while employed by Morton County Social Services as an in-home care specialist. As a result, she went down to the floor in pain. On July 25, 1996, Geek consulted Dr. Lange for continuing pain in her left knee which had been bothering her for two days. Dr. Lange diagnosed her with patellar femoral arthritis. Dr. Lange treated Geek on two more occasions. Geek missed no work following the incident. On August 2, 1996, Geek filed a claim for benefits.
[¶ 3] The Bureau dismissed Geek's claim by an October 9, 1996, order determining Geek had not sustained an injury by accident arising out of and in the course of employment. Geek requested an administrative hearing. Before the hearing regarding her first claim, Geek filed a second claim for benefits for a work injury, which occurred on February 3, 1997, after she fell on ice while leaving a client's home and injured her knee and left hand. Dr. Folkers treated Geek for a contusion and possible bursitis. Also, a February 26, 1997, x-ray revealed mild degenerative changes in her knee consistent with a mild arthritic process. The Bureau accepted Geek's February 1997 claim.
[¶ 4] On April 30,1997, a hearing on Geek's July 1996 claim was held. The administrative law judge (ALJ) affirmed the Bureau's dismissal concluding there was no medical evidence indicating Geek's work caused, or substantially contributed to, the arthritis in her left knee or the pain from the arthritis for which she received medical treatment following the July incident. The Bureau adopted the ALJ's recommended findings of fact and conclusions of law in a May 30,1997, order. Geek appealed the decision to the district court, and the district court affirmed the Bureau's order. Geek appeals to this Court.
II
[¶ 5] On appeal, we review the Bureau's decision, and although we do not review the district court's decision, we consider the district court's analysis and reasoning in our deliberations. Shiek v. North Dakota Workers Comp. Bureau, 1998 ND 139, ¶ 9, 582 N.W.2d 639. We affirm the Bureau's decision unless its findings of fact are not supported by a preponderance of the evidence, its conclusions of law are not supported by its findings of fact, its decision is not supported by its conclusions of law, its decision is not in accordance with the law or violates the appellant's constitutional rights, or the agency's rules or procedures deprived the appellant of a fair hearing. Loberg v. North Dakota Workers Comp. Bureau, 1998 ND 64, ¶ 5, 575 N.W.2d 221. Our review of the Bureau's findings of fact is limited to determining if a reasoning mind reasonably could have determined the findings were proven by the weight of the evidence from the entire record. See id. (quoting Feist v. North Dakota Workers Comp. Bureau, 1997 ND 177, ¶8, 569 N.W.2d 1). "'To participate in the workers compensation fund, a claimant must prove a compensable injury by a preponderance of the evidence.' " Lang v. North Dakota Workers Comp. Bureau, 1997 ND 133, ¶ 7, 566 N.W.2d 801 (quoting Symington v. North Dakota Workers Comp. Bureau, 545 N.W.2d 806, 808 (N.D.1996)); see N.D.C.C. § 65-01-11. "In reconciling the claimant's burden of proof with our standard of review, we require the Bureau to clarify the inconsistencies and adequately explain its reasons for disregarding medical evidence favorable to the worker." Lang, 1997 ND 133, ¶ 7, 566 N.W.2d 801.
Ill
[¶ 6] The dispositive issue on appeal is whether Geek sustained a "compensable injury" under N.D.C.C. § 65-01-02(9)(b)(6). Unless otherwise provided, the statutes in effect on the date of an injury govern workers' compensation benefits. Loberg, 1998 ND 64, ¶ 9, 575 N.W.2d 221 (quotations omitted). Section 65 — 01—02(9)(b)(6)(1995), N.D.C.C. , as was in effect at the time of Geek's July 1996 symptoms of a sharp pain in her left knee, provides in pertinent part: b. The term ["compensable injury"] does not include:
(6) Injuries attributable to a preexisting injury, disease, or condition which clearly manifested itself prior to the compensable injury. This does not prevent compensation where employment substantially aggravates and acts upon an underlying condition, substantially worsening its severity, or where employment substantially accelerates the progression of an underlying condition. It is insufficient, however, to afford compensation under this title solely because the employment acted as a trigger to produce symptoms in a latent and underlying condition if the underlying condition would likely have progressed similarly in the absence of the employment trigger, unless the employment trigger is determined to be a substantial aggravating or accelerating factor. An underlying condition is a preexisting injury, disease, or infirmity. (Emphasis added.)
[¶ 7] We have previously examined the language of this subsection in Pleinis v. North Dakota Workers Comp. Bureau, 472 N.W.2d 459, 462 (N.D.1991) (interpreting the same language then codified at N.D.C.C. § 65-01-02(8)(b)(6)). Specifically, we stated the third sentence of this subsection "describes the consequences when employment acts as a trigger to produce symptoms in a 'latent and underlying condition.' " 472 N.W.2d at 463. Where employment triggers symptoms in a latent and underlying condition, compensation is generally not allowed if the underlying condition would likely have progressed similarly in the absence of the employment trigger, unless the employment trigger is a substantial aggravating or accelerating factor. Id. (emphasis added). In Pleinis, we generally concluded:
The statutory language unambiguously describes when compensation is allowed for injuries attributable to both a latent underlying condition and an underlying condition which clearly manifested itself prior to the compensable injury. In both situations injuries attributable to the preexisting condition are compensable if employment substantially aggravates or accelerates the condition.
Id. Therefore, to have a "compensable injury" under N.D.C.C. § 65-01-02(9)(b)(6)(1995), a claimant must show that the employment substantially aggravated or accelerated the latent and underlying condition to produce the result for which compensation is sought.
[¶ 8] In Pleinis, however, we affirmed the Bureau's determination that the claimant's disability was non-compensable because the Bureau's findings were adequate to show Pleinis' employment was not a substantial aggravating or accelerating factor in his underlying osteoarthritic condition and Pleinis' underlying condition would likely have progressed similarly in the absence of his employment. 472 N.W.2d at 463. The medical evidence in this case, unlike Pleinis, is not so clear.
[¶ 9] In this case, there is no question Geek's arthritis in her left knee was a latent and underlying condition as contemplated by N.D.C.C. § 65 — 01—02(9)(b)(6). The underlying arthritic condition in her left knee was, however, asymptomatic until the sharp pain was triggered on July 23, 1996, while kneeling at work. The ALJ's findings of fact state that Geek's "medical records confirm . she has had no previous experiences of pain in her left knee." The ALJ also stated, "This is a clear case of an underlying condition, a preexisting injury or infirmity that had not yet manifested itself." Thus, for Geek to have a "compensable injury," she must prove that the employment trigger, here performing duties of an in-home care specialist, substantially aggravated or accelerated the arthritis in her left knee.
[¶ 10] The pain in Geek's left knee was caused by her work activity. There is no record evidence to the contrary. The kneeling at work resulted in her latent underlying condition of arthritis becoming symptomatic and painful. Pain can be an aggravation of an underlying condition of arthritis. The query under our statute is whether this aggravation of her underlying arthritic condition is a "substantial" aggravating factor.
[¶ 11] In his conclusions of law, the ALJ stated, "There is no evidence that Geek's employment was a substantial aggravating factor in an injury." (Emphasis added.) The ALJ further stated, "Geek's employment appears to be merely a trigger," and "[b]ased on the evidence presented!),] Geek fails to prove that her employment is anything but a trigger that started the pain." The ALJ found no medical proof that Geek's work substantially aggravated or accelerated her arthritis and concluded that the exhibits containing Dr. Lange and Dr. Folkers' statements could have no other legal meaning than that work was a mere trigger.
[¶ 12] In a February 4, 1997, letter from Dr. Lange, he states he did not believe Geek's work over the years had significantly contributed to the patella femoral arthritis; however, he did believe "there was a brief exacerbation that was work related." (Emphasis added.) In an April 10, 1997, letter, Dr. Lange reiterates the sharp pain Geek experienced was related to an exacerbation caused by work. Although Dr. Lange did not believe Geek's "long-term arthritic changes" would be work related, he states the injury she received was a temporary setback which was work related. Moreover, medical evidence favorable to Geek also exists in a March 20, 1997, letter from Dr. Folkers. In this letter, Dr. Folkers clearly states, "[Geek] has some underlying arthritis of her left knee and her knee pain has likely been secondary to a work related aggravation of her underlying arthritic condition." (Emphasis added.)
[¶ 13] In the findings of fact, the ALJ makes no attempt to reconcile this favorable medical testimony nor does he expressly set forth his reasons for disregarding the favorable medical evidence. The ALJ simply concludes there is neither evidence nor medical proof to support a finding that Geek's employment was anything but a "mere trigger."
This court has stated, '[w]e believe our case law clearly indicates that in cases . where expert medical testimony is desirable if not essential to a determination of causation, the Bureau may not simply ignore competent medical testimony without expressly setting forth in its findings of fact adequate reasons, which are supported by the record, for doing so.'
Lang, 1997 ND 133, ¶ 18, 566 N.W.2d 801; see also Loberg, 1998 ND 64, ¶ 11, 575 N.W.2d 221 (stating the Bureau must adequately explain its disregard of medical evidence favorable to a claimant).
[¶ 14] In light of the medical evidence in the record, we conclude this case must be remanded to the Bureau to make appropriate findings on whether Geek's employment trigger substantially aggravated the arthritis in her left knee.
IV
[¶ 15] We reverse the judgment and remand to the Bureau for further findings consistent with this opinion.
[¶ 16] VANDE WALLE, C.J., and NEUMANN and MESCHKE, JJ" concur.
. In 1997, the Legislature amended and reenacted this subsection, which is now codified at N.D.C.C. § 65-01-02(1 l)(b)(7) and states the term "compensable injury" does not include: "Injuries attributable to a preexisting injury, disease, or other condition, including when the employment acts as a trigger to produce symptoms in the preexisting injury, disease, or other condition unless the employment substantially accelerates its progression or substantially worsens its severity." See 1997 N.D. Sess. Laws ch. 527, § 1.
. See Cox v. Schreiber Corp., 188 Mich.App. 252, 469 N.W.2d 30, 33 (1991), referencing Judge Sheperd's concurrence in Thomas v. Chrysler Corp., 164 Mich.App. 549, 418 N.W.2d 96, 99 (1987), wherein it is noted that awarding benefits "on the basis of whether pain is a symptomatic manifestation of a preexisting condition rather than an aggravation of a preexisting condition is a distinction without a difference."