Opinion ID: 2003764
Heading Depth: 1
Heading Rank: 7

Heading: Proof of Occupational Disease

Text: Excel Polymers argues that the trial court erred in holding that Mr. Broyles met his statutory burden of proof to demonstrate that he suffered from a compensable occupational disease, contending that (1) there is little or no evidence supporting Dr. Hansen's theory that UIP can be caused by exposure to respirable dust in the workplace; and (2) if Dr. Hansen's theory has validity, the evidence in the record preponderates against the trial court's finding that Mr. Broyles' disease was caused by such dust exposure in the course of his employment with Excel Polymers. The Tennessee Legislature has established the following six elements that must be satisfied to sustain a workers' compensation occupational disease claim: As used in this chapter, occupational diseases means all diseases arising out of and in the course of employment. A disease shall be deemed to arise out of the employment only if: (1) It can be determined to have followed as a natural incident of the work as a result of the exposure occasioned by the nature of the employment; (2) It can be fairly traced to the employment as a proximate cause; (3) It has not originated from a hazard to which workers would have been equally exposed outside of the employment; (4) It is incidental to the character of the employment and not independent of the relation of employer and employee; (5) It originated from a risk connected with the employment and flowed from that source as a natural consequence, though it need not have been foreseen or expected prior to its contraction; and (6) There is a direct causal connection between the conditions under which the work is performed and the occupational disease. Diseases of the heart, lung, and hypertension arising out of and in the course of any type of employment shall be deemed to be occupational diseases. Tenn.Code Ann. § 50-6-301. Generally speaking, a workers' compensation claimant must establish by expert medical evidence the causal relationship between the alleged injury and the claimant's employment activity, `[e]xcept in the most obvious, simple and routine cases.' Cloyd v. Hartco Flooring Co., 274 S.W.3d 638, 643 (Tenn.2008) (quoting Orman v. Williams Sonoma, Inc., 803 S.W.2d 672, 676 (Tenn.1991)). The claimant must establish causation by the preponderance of the expert medical testimony, as supplemented by the evidence of lay witnesses. Id. As we observed in Cloyd, the claimant is granted the benefit of all reasonable doubts regarding causation of his or her injury: Although causation in a workers' compensation case cannot be based upon speculative or conjectural proof, absolute certainty is not required because medical proof can rarely be certain.... Clark v. Nashville Mach. Elevator Co., 129 S.W.3d 42, 47 (Tenn.2004); see also Glisson v. Mohon Int'l, Inc./Campbell Ray, 185 S.W.3d 348, 354 (Tenn.2006). All reasonable doubts as to the causation of an injury and whether the injury arose out of the employment should be resolved in favor of the employee. Phillips v. A & H Constr. Co., 134 S.W.3d 145, 150 (Tenn.2004). Id.; see also Fritts v. Safety Nat'l Cas. Corp., 163 S.W.3d 673, 678 (Tenn.2005). The trial court may properly award benefits based upon medical testimony that the employment could or might have been the cause of the employee's injury when there is also lay testimony supporting a reasonable inference of causation. Fritts, 163 S.W.3d at 678. All of the medical experts that testified in this case concurred in Dr. Hansen's diagnosis of UIP, a scarring of the lungs in a certain pattern revealed in Mr. Broyles' case by x-rays, CT scans, and a lung tissue biopsy. As noted, Dr. Hansen opined that Mr. Broyles' UIP was caused by his exposure to respirable dust particles in the workplace, explaining his opinion as follows: Q: Just because it results in a UIP pattern does thatwhat does that mean? Does that mean you don't know the cause? A: No, it doesn't. Now, that's just the typical pattern. Like I mentioned, you see the fibrotic changes mainly in the bottom parts of the lungs more towards the periphery of the lungs. That would be the typical UIP pattern, whereas a silicosis pattern is more nodular typically more in the upper lung fields. Q: Well, can or cannot whatever dust that you believe Mr. Broyles was exposed to at work, could that cause his pulmonary fibrosis? A: I believe it can. Q: Do you believe it did? A: Yes. Q: Do you believe that with reasonable certainty in your profession? A: Yes. ... THE COURT: I'm looking at the Vanderbilt Pathology Report. What it says is polarization reveals a moderate number of polarizable particles consistent with silica dust. A: Uh-huh. THE COURT: Do you know within a reasonable degree of medical certainty whether what's in Mr. Broyles' lungs is silica dust or could it be something else? A: It could be something else. You know, it's an inorganic dust of some type. Is it talc? Is it silica? Those would be the two most common types. THE COURT: Well, okay. In reading your deposition, is it your opinion that that kind of dust is not found naturally in the environment? A: Not in the particle size to get in the lungs.... It's found in the environment but not in that particle size. ... Q: Are you aware from Mr. Broyles' history of any other place or location or employment that he could have been exposed to the size particles that were found in his lungs? A: No. Dr. Hansen testified that none of the questions he was asked on cross-examination shook his belief that Mr. Broyles' work environment caused and advanced his pulmonary fibrosis disease; when asked to explain why, Dr. Hansen stated: It really boils down to simple facts. He has the occupational exposure that he himself has described. He has inorganic dust in the lungs that's proven by a biopsy. Like I said, it's only found in occupational exposures. That's the only place he was working at the time. It's all consistent. And finding inorganic dust particles in the lungs like we've mentioned is rare, and the disease itself is rare. And for those two to occur together independent of a causative factor, would be very, very unlikely. Excel Polymers presented the in-court testimony of Dr. Marilyn Bishop, an occupational medicine specialist who conducted an independent medical examination of Mr. Broyles and reviewed his medical records and medical literature pertinent to the issues in this case. Dr. Bishop testified that she was also familiar with the substances and chemicals used in the Excel Polymers plant, which she had visited and inspected on previous occasions. Dr. Bishop opined that UIP is an idiopathic disease, that there is no scientifically documented relationship between UIP and occupational or environmental exposures, and that she believed there was no causal link between Mr. Broyles' exposure to dust in the workplace and his disease. Excel Polymers also presented the deposition testimony of Dr. Arnold Hudson, a pulmonary medicine specialist. Dr. Hudson did not examine Mr. Broyles but reviewed his medical records. He stated that about all we know [about UIP] is that there's a continual ongoing inflammatory reaction and there's certainly the possibility that there's something in the environment that initiates this, perhaps even causes it to continue, but also said that within a reasonable degree of medical certainty, the cause of UIP is unknown. Dr. Hudson testified that there were three known associations of classes of people more likely to contract UIP: males, persons aged 50 to 70, and smokers; Mr. Broyles was in all three associated categories. However, Dr. Hudson also testified that UIP is not something that seems to be caused by smoking. Dr. Hudson admitted that he did not know how much silica dust Mr. Broyles was exposed to in his work environment and stated that Mr. Broyles should not return to basically any industrial environment where there's going to be, you know, uncontrolled temperature, humidity, dust, fumes, etc. Asked whether there was a causal connection between Mr. Broyles' workplace and his UIP disease, Dr. Hudson answered, you know, if you ask me could there be, I'd have to say yes, but within a reasonable degree of medical certainty, I would say no. Mr. Broyles testified about his exposure to respirable dust at the Excel Polymers plant over the years of his employment there. He stated that while he was engaged in loading and unloading bags, they would often break, releasing a fine powdery dust into the air. Mr. Broyles testified that the bags that broke often contained a product called HiSil, a powdery form of silica. In short, Mr. Broyles testified that he was exposed to a large amount of respirable dust during his approximately twenty-nine years working at the Excel Polymers plant. Ron Read, the environmental manager for Excel Polymers and a certified industrial hygienist and pharmacist, testified at the trial. Mr. Read introduced records of air quality testing performed at the plant. Most of the records of the air testing done for crystalline silica (a hazardous breathable form of silica) showed a below detectable or acceptable level. At least one test revealed an amount of crystalline silica above the Tennessee Occupational Safety and Health Administration's permissible exposure limit (PEL), and another showed a level very close to the PEL. Moreover, Excel Polymers stipulated that it did not test the air in the plant for crystalline silica prior to 1997; and Mr. Read admitted that no air testing was done at all from 1976 to 1985, and that no records of testing existed for the years 1989, 1990, 1991, 1993, and 1994. Dr. Hansen testified to the effect that Mr. Broyles' exposure during these earlier years when there was no air testing could be very significant to the question of causation, stating that I would like to say also that there is a long latency period infrom exposure to disease in this particular type of case. You can have an exposure and see disease fifteen to twenty years later, so the testing would have to be something that would involve [Mr. Broyles'] entire work history to be accurate and reflect what really he was exposed to. Based on our review of the evidence, including the testimony outlined above, we do not find that it preponderates against the trial court's conclusion that Mr. Broyles met his burden of proving that he suffered from an occupational disease as defined by Tennessee Code Annotated section 50-6-301. The trial court saw and heard Drs. Hansen and Bishop testify in person and thus had the opportunity to assess their credibility and demeanor. The trial court clearly credited Dr. Hansen's credibility on the question of causation, and we are unable to say it erred in so doing. Further, we have observed that [i]t seems reasonable that the physicians having greater contact with the Plaintiff would have the advantage and opportunity to provide a more in-depth opinion, if not a more accurate one. Orman, 803 S.W.2d at 677. Dr. Hansen, as the treating physician since the onset of Mr. Broyles' disease, had this greater contact with the claimant. The judgment of the trial court awarding Mr. Broyles permanent and total disability benefits as a result of his occupational disease is affirmed.