Opinion ID: 2609756
Heading Depth: 2
Heading Rank: 3

Heading: Did Roberts Prove an Injury?

Text: The majority correctly restates the standard by which we review the Commission's findings of fact: we uphold such findings when they are supported by substantial and competent evidence. This Court also reviews questions of law, however, such as are implicated in this case. See Paulson v. Idaho Forest Industries, Inc., 99 Idaho 896, 900, 591 P.2d 143, 147 (1979). Injured employees who seek compensation must first prove to their employer and the Industrial Commission that their injury was work-related and then that an injury was the result of an accident. The referee in this case determined that Roberts did not meet the first prong of this test, largely because Roberts was unable to produce a witness who had been with Roberts during the onset of the injury. As with any other claimant who lacks direct evidence, Roberts had available for the referee's pleasure the testimony of Dr. Henbest which was presented as after-the-fact proof of the injury. Nothing to which Dr. Henbest testified was based on speculation, but on his medical findings. This procedure posed no problem for the referee hearing this case; very little weight was accorded to Dr. Henbest's testimony because of the referee's personal view that the requisite degree of medical probability was lacking. However, there was no lack of evidence before the referee. The referee was exposed to the views of Dr. Henbest and his opinion of Roberts' symptoms, consisting of letters exchanged between Roberts' attorney and Dr. Henbest plus Dr. Henbest's sworn deposition. The letter from Roberts' attorney to Dr. Henbest stated, in relevant part: Thank you for the opportunity to visit with you regarding this case ... It was my understanding after our meeting that you have the opinion that, more likely than not or to put it in other words probably, the pain Mr. Roberts felt in the area of his neck and left arm and the corresponding numbness and tingling in his left hand were sustained as a result of work on approximately March 22, 1990. Further, you opined that he did even further injury to himself approximately March 28, 1990, while again at work moving heavy items. Briefly, in note form, can you explain what Leslie physically did to the cervical area of his spine during those few days at work in March of 1990? ... Roberts' attorney did not ask Dr. Henbest to indicate his opinion of the probability that Roberts' injury was work-related; he asked the doctor for a brief medical description. In his reply of July 23, 1990, Dr. Henbest obliged, writing: I have received a letter from you dated July 11, 1990, in which you request a brief note to explain what type of injury Leslie Roberts sustained in March of 1990. At this point in time, I must point out that I was not with Mr. Roberts in March of 1990, and therefore I am reliant on his history to describe what probably occurred with his neck. According to Mr. Roberts, he was moving heavy items at work and sustained increasing symptoms in his neck. What undoubtedly was happening, if the history is correct, is that the neck muscles were tightening up due to the fact that there was compression of the disc space causing protrusion of disc material up around the dura, which is the lining around the spinal cord and nerve root, and protrusion of the disc actually up against the nerve root. This caused inflammation and caused further spasm in the neck muscles, which undoubtedly caused the disc to rupture. Again, I was not with Mr. Roberts, and I am constructing this from the history that he gave me. As to the findings at surgery, in regard to whether or not this was a recent injury or an exacerbation of a preexisting condition, although there was definitely some calcification of the ligament and some osteophytic processes, there was also a significant amount of soft tissue disc herniation at the time of surgery. The soft disc [condition] had been of a recent onset, though there was obviously previous trauma in regard to the calcified ligament and osteophyte. Therefore, I found both a preexisting condition and an acute problem. The acute problem; i.e., the soft disc rupture, seemed to be the most significant problem. (Emphasis added.) In answering questions put to him in the deposition interrogation, Dr. Henbest described soft disc herniation. [1] Dr. Henbest testified that a disc ruptures over a relatively short period of time and that a person whose disc ruptures may experience the associated symptoms either immediately or within two or three days. The referee gave little weight to Dr. Henbest's statements on Roberts' behalf. The referee's exact comment was: the doctor's testimony and records offer careful and qualified statements which are expressly predicated on Claimant's own account of his history. This is far from being evidence which `plainly and unequivocally' conveys the physician's `conviction' that Claimant's injury is work-related.  We have never required such a standard; indeed, our cases have recognized that medical doctors speak in terms of probabilities, not in terms of convictions or certainties. See, e.g., Bowman v. Twin Falls Construction Co., 99 Idaho 312, 317, 581 P.2d 770 (1978). The referee relied upon and apparently misinterpreted our language in Paulson v. Idaho Forest Industries, Inc., wherein we stated that no special verbal formula is necessary when, as here, a doctor's testimony plainly and unequivocally conveys his conviction that events are causally related. Paulson, 99 Idaho at 901, 591 P.2d at 148. The testimony at issue in Paulson went to a very different causal relationship, however, than the relationship to which Dr. Henbest testified. In Paulson, the doctor testified that many persons who have undergone surgery experience traumatic neuroses and that the neuroses of the claimant about whom he testified were a result of the claimant's prior surgery. The Commission inferred from the testimony, and this Court agreed, that the doctor believed that the neuroses of claimant Paulson resulted from surgery. Paulson did not require, as referee Bauman apparently thought that it did here, that a physician's testimony express a conviction that a claimant's injury was work-related. The referee subsequently found that in his view, Dr. Henbest's testimony failed to satisfy Roberts' burden of proof; in light of referee Bauman's misapprehension of our statements in Paulson, the low level of credibility accorded to Dr. Henbest's testimony was clearly erroneous. One cannot help pausing to suggest that had the controversy been placed before a jury, it would have readily agreed that there was not the slightest impeachment of Dr. Henbest's medical conclusions. Medical practitioners have no reason to prevaricate, nor do they fabricate. The majority today compounds the referee's error by stating that the Industrial Commission may require a doctor to hold a plain and unequivocal conviction that a claimant's injury is work-related, when the doctor has not formulated the magical phrase reasonable degree of medical probability. In my view, Paulson does not allow the Commission to increase its standard in this manner. Instead, Paulson merely stated that when the doctor does not state the legalistic phrase reasonable degree of medical probability, his or her testimony may be examined to ensure that he or she nonetheless does believe, to a reasonable degree of medical probability, that an event caused the claimant's injury. Paulson, 99 Idaho at 901, 591 P.2d at 148. A conviction on the part of the testifying doctor only erases the need for scrutiny of the testimony; it is certainly not the standard required. Not only did the referee clearly err in applying the wrong standard of proof to Dr. Henbest's testimony, he clearly erred in according little credibility to such testimony. The testimony of Dr. Henbest established that he believed, to a reasonable degree of medical probability, that Roberts' workplace activities caused his ruptured disc. A physician who begins to treat a claimant more than a month after the claimant experiences an injury cannot be expected to independently know what precise event caused the injury or on what precise date the injury occurred. He or she necessarily relies on the history provided by the claimant himself and on any other available information. Dr. Henbest unequivocally testified that Roberts' symptoms were consistent with the history provided by Roberts and his own findings, and his letter asserted that, if Roberts were lifting heavy items, the resulting spasms in his neck muscles undoubtedly caused the disc to rupture. Since it is undisputed that Roberts engaged in heavy lifting at his place of employment, and did not do so engage himself outside of work, it is obvious that spasms in his neck muscles at that time caused the ruptured disc. Although Dr. Henbest did not state the phrase reasonable degree of medical probability, his testimony and written letter meet that standard. Moreover, the referee did not point to any evidence, substantial and competent or otherwise, that would support a finding that Roberts was or might have been injured other than at work. Worker's compensation cases affirming the denial of workers' compensation benefits have properly relied on the non-employment-related activities or contacts which were the likely cause of an injury. See, e.g., Hagler v. Micron Technology, Inc., 118 Idaho 596, 598, 798 P.2d 55, 57 (ringworm fungus on employee's hands was likely caused by ringworm on her feet); Koester v. State, 124 Idaho at 901, 858 P.2d at 748 (employee's Lyme disease was likely caused by ticks present in her own home). The referee concluded that, as to the first prong under which a claimant must prove that his injury was work-related, Roberts did not meet his burden of proof. The Court today should plainly rule that the referee misinterprets this Court's case law in construing the Act against Roberts. The opinion for the Court compounds this error when, in noting that Roberts presented no direct evidence to the Commission to prove that his injury was work-related, it adds that Roberts provided the Commission with no evidence that anything extraordinary happened to him while working the day before his symptoms appeared. This unfortunate sentence blurs the line between the first hurdle faced by an injured claimant, which was that the injury was work-related, and the second hurdle, that the work-related injury stemmed from an accident. A claimant may be injured at work, and may prove this without pointing to an event or extraordinary occurrence. To prove the second prong, that an accident precipitated the injury, however, the claimant must prove an event or mishap. This Court has previously reminded attorneys and the Commission that these are wholly separate lines of inquiry. See, e.g., Perez v. J.R. Simplot Co., 120 Idaho 435, 437, 816 P.2d 992, 994 (1991).