Opinion ID: 901621
Heading Depth: 1
Heading Rank: 3

Heading: Reopening

Text: [¶ 12.] The requirements for reopening a workers' compensation settlement under SDCL 62-7-33 [1] are well settled. Three things must be shown: First, the claimant must prove a change in condition. Second, the claimant must prove that the asserted change in condition derives from an injury unknown at the time of settlement or from a known injury with its disabling character unknown. Finally, a claimant must prove that the unknown injury is causally connected to employment, or that the unknown disabling character is causally connected to the original, compensable injury. Kasuske, 2006 SD 14 at ¶ 17, 710 N.W.2d at 456 (emphasis added). Because the hearing examiner assumed without deciding that McDowell could prove a change in condition, he decided this case on two related questions: whether the alleged change in condition affected McDowell's earning capacity and whether the disabling character of her upper extremities injury was unknown at the time of settlement. In deciding those issues, the evidence must bear directly upon [a] comparison between the claimant's former disability and present disability.  8 Arthur Larson and Lex K. Larson, Larson's Workers' Compensation Law § 131 (2006) (emphasis added). [¶ 13.] Because the analysis requires a comparison of McDowell's former and present disabilities, it is important to restate the distinctions between a workplace injury, a worker's post-injury condition, and an occupational disability. It is also important to note how the occupational disability is determined as well as the role that impairment ratings play in the determination. `[I]njury' is the . . . act or omission which caused the loss.' Steinberg v. South Dakota Dept. of Military and Veterans Affairs, 2000 SD 36, ¶ 10, 607 N.W.2d 596, 600 (quoting Rosnick v. Marks, 218 Neb. 499, 357 N.W.2d 186, 190 (1984)). `Condition,' in contrast, is the loss produced by [that] injury; i.e., it is the result rather than the cause. The word `condition' means `state of being.' Id. (citing Doyle v. Superior Court, 50 Cal.App.4th 1878, 58 Cal.Rptr.2d 476, 481 (1996)) (emphasis in original). Finally, that condition may or may not cause a compensable occupational disability. That type of disability is often determined in part by an impairment rating, but the numeric impairment rating is not determinative. Instead, a workers' compensation disability is based on the worker's occupational situation. As this Court has often explained: The physician who makes a determination about impairment must keep in mind that a permanent impairment rating is not the same as a disability rating. Permanent medical impairment is related directly to the health status of the individual, whereas disability can be determined only within the context of the personal, social, or occupational demands, or statutory or regulatory requirements that the individual is unable to meet as a result of the impairment. . . . [A] hearing examiner should [consider] other evidence, such as the testimony of [plaintiff's] vocational expert regarding loss of employability . . . . Cozine v. Midwest Coast Transport, Inc., 454 N.W.2d 548, 552 (S.D. 1990) (emphasis added). [¶ 14.] Keeping these distinctions in mind, an injured worker's occupational ability or capacity is of primary importance in considering a petition to reopen a settlement because [o]ur [workers' compensation] act is designed to compensate an employee or his family for the loss of [the employee's] income-earning ability. . . . Caldwell v. John Morrell & Co., 489 N.W.2d 353, 362 (S.D. 1992). [W]orkers' compensation laws were designed to compensate for diminishment of a worker's earning capacity. . . . Whitney v. AGSCO Dakota, 453 N.W.2d 847, 851 (S.D. 1990). Therefore, [a]s a general rule, [a change in condition for reopening] must be a change in the physical condition of the employee, affecting [her] earning capacity.  Stender v. City of Miller, 82 S.D. 334, 338, 145 N.W.2d 913, 915 (1966) (citation omitted) (emphasis added) (superseded on other grounds). This remains the law today. Whitney, 453 N.W.2d at 852. [¶ 15.] In Welch v. Automotive Co., 528 N.W.2d 406 (S.D. 1995), this Court considered a similar case that involved an alleged post-settlement change in condition. Unlike McDowell (who failed to even plead a change in condition affecting her earning capacity), Welch argued a well stated claim asserting a 3 percent increase in impairment, increased pain, [and] inability to find suitable employment, and inability to recover as expected [.] Id. at 409 (emphasis added). However, at the hearing, Welch testified that he could do the same work as he could when he received his initial benefits. Id. at 410. In concluding that Welch had not experienced [the] substantial change in condition sufficient to reopen, this Court relied on Welch's testimony conceding that he suffered no change in his work capacity. This Court noted this concession and held: Welch admitted that he could do the same work as he could at the time of the [prior settlement]: Q. Jim, is there anything you can't do now that you could when you signed the [settlement]? A. Probably about the same. [A] party cannot claim the benefit of a version of the facts more favorable than given in testimony. Guthmiller v. South Dakota Dept. of Transp., 502 N.W.2d 586, 589 (S.D. 1993). Id. [¶ 16.] Today's petition for reopening must be denied for the same reason. Even if her physical condition changed, McDowell did not plead or prove that her employability or earning capacity had changed since the settlement. Moreover, the hearing examiner not only relied on McDowell's concessions, but he also considered all of the evidence, including the testimony of McDowell's husband, her vocational expert, and evidence from her physicians. [2] These witnesses also confirmed that the nature and extent of McDowell's disability was known at the time of settlement and had not changed after the settlement. [¶ 17.] More specifically, McDowell testified that as early as 1993, when she filed her initial petition for workers' compensation, she was permanently and totally disabled as a result of the 1991 injury. Then, in April 1995, while receiving weekly workers' compensation benefits but before the settlement, McDowell applied for Social Security benefits based solely on the 1991 Citibank injury. She stated on her Social Security application that I became unable to work because of my disabling condition on December 01, 1991. She specifically contended that the pain from the 1991 injury rendered her completely unemployable: I can not [ sic ] work because of the pain created by the use of my right hand and arm. The use of my left arm must be paced, if not, numbness and pain flairs up. Based upon her inability to engage in any substantial gainful employment, she was awarded Social Security benefits retroactive to her last date of employment with Citibank in 1992. [¶ 18.] McDowell then conceded that her total inability to work continued through 1998. At that time, she was required to recertify entitlement to Social Security disability benefits. In that process, she again confirmed that she remained unable to work solely because of the pain and associated problems in her upper extremities. But most significantly, she specifically denied having any change (for better or worse) in [her] disabling condition since [she] last reported such information [in April 1995 prior to the settlement.] She indicated that she remained unable to return to work and incapable of any gainful employment. [¶ 19.] Notwithstanding this history conclusively establishing that the character of her disability was known and had not changed, she applied to reopen the settlement in February 2000. But, during the 2003 hearing on this petition, she again conceded that at all relevant times her pain remained severe, chronic, and sufficiently debilitating to prevent her from working. She first testified that she had been unable to work before her pre-settlement 1995 application for social security benefits: A. [T]he reason why I applied for Social Security is because I had the work capacities done and Dr. Schutt said I couldn't go back to what I was doing. Q. That you couldn't go back to work? A. Uh-huh. Q. And that was why you applied for Social Security? A. Right. . . . Q. And [the application] explained to the Social Security Administration the reason you believed your condition prevented you from working at that time? A. Yes. Q. And at that time it is fair to state, isn't it, that you were representing to the Social Security Administration subject to penalty of perjury that you believed your condition made you unable to work, correct? A. Correct. [¶ 20.] McDowell then testified that at the time of the March 1996 settlement, the character of her disability was the same as it was when she applied for Social Security in 1995. She testified that she was still unable to work, that she had applied for no other jobs, and that she was still receiving Social Security benefits. She further testified that when she entered into the settlement agreement in March of 1996, her inability to work was caused by the same pain from the same injury. She even conceded that her doctors agreed she could not work. Q. Okay. You would agree that the pain you were having in March 1996 [at the time of settlement] was severe, wouldn't you? A. Yeah, Yeah. Q. In fact, the pain that you had was so severe that it was debilitating. You weren't able to go back to work, right? A. Yes. Q. And the reason you couldn't work was because of that pain in your arms from the 1991 injury, right? A. Right. Q. Okay. So by your own testimony, at least in March of 1996, the pain in your arms was severe, chronic and debilitating, correct? A. Correct. Q. And your doctors supported that, didn't they? A. Yes. [¶ 21.] Thus, over a period of ten years, in four separate disability proceedings, McDowell consistently maintained that: she knew the disabling character of her disability, she believed she was unemployable, she had not looked for employment, and she remained incapable of any employment because of her pain. Reiterating what this Court ruled in Welch: a claimant `cannot claim the benefit of a version of the facts [regarding the change in condition necessary to reopen] more favorable than given in testimony.' 528 N.W.2d at 410 (citation omitted) (emphasis added). [¶ 22.] Were McDowell's own assertions of historical fact not sufficient to affirm the hearing examiner and circuit court, the denial of reopening is independently required by McDowell's other witnesses. First, at the 2003 hearing, McDowell's husband corroborated that her pain was severe and unchanged from the time of settlement, that the pain rendered her incapable of working before the settlement, and that she remained unable to work at the time of the hearing. Q. Okay. And at that point in time in 1996, 1995 and 1996, that this pain that was severe and chronic was preventing her from working? A. Yes . . . Q. So it remains severe today? A. Yes Q. It remains chronic A. Yes Q. And it's preventing her from working? A. Yes. . . . [¶ 23.] Second, McDowell's vocational expert testified that the extent of her occupational disability had not changed over the years. After a December 2000 evaluation, Rick Ostrander reported that based upon McDowell's complaints of pain, she was totally disabled from any type of regular gainful employment, even on a part-time basis. In a second report, dated October 30, 2002, he again opined that she continues to be totally disabled from any type of employment. And, these post-settlement disability opinions were predicated on a 1995 pre-settlement functional capacity assessment. Consequently, at the reopening hearing, Ostrander testified that McDowell's occupational disability had not changed from the time of settlement: Well, it's my professional opinion that at the time I saw her and going back to 1995, based on all of the information that was available to me at that time, it's clear that she was not employable and continues to be not employable. Ostrander was unequivocal: Q. If I'm correct . . . it was your opinion today that Pam McDowell is not employable just as Pam McDowell was not employable in 1995 based upon the review of the information [McDowell's counsel provided] to you; is that correct? A. That's correct. Q. And that remains your opinion today? A. Yes, it does. Q. That in terms of Ms. McDowell's employability, her loss of earning capacity, there has been no change between 1995 and today; is that correct? A. That's correct. Ostrander finally confirmed that even if McDowell had suffered a change in physical condition, that change did not affect her earning capacity: Q. Okay. Mr. Ostrander, we're going to talk a little bit of hypotheticals. If you would assume with me that Ms. McDowell's condition has changed since 1995 physically. Assume that with me, okay? A. Okay. Q. Would you agree with me based upon what you've reviewed and your knowledge and history of the labor market that that change in her physical condition has not affected negatively her earning capacity since 1995? A. I would agree. McDowell is independently bound by this testimony because even if she were not bound by her own sworn statements and testimony, she is not entitled to assert a greater disability than that established by her own vocational expert, who determined disability based upon the medical impairment rating. See Tischler v. United Parcel Service, 1996 SD 98, ¶ 56, 552 N.W.2d 597, 606. [¶ 24.] Third, the medical evidence finally confirmed that McDowell was, and knew that she was, permanently and totally disabled at the time of settlement. In 1993, Dr. Schutt, her primary treating physician at Mayo, imposed temporary work restrictions due to pain in the upper extremities, and reported that [s]he certainly is not able to return to work. McDowell was also told she could not return to work. Dr. Cooney's report of February 1994, stated: [a]fter a long discussion and review with Ms. McDowell, I reassured her that her condition is one of continued pain dysfunction that is unlikely to improve dramatically at any short time period. By 1995, Dr. Schutt reported that: This patient right now is permanently disabled until we can find out whether there is any more definitive therapy that we can give her to give her relief until maximum medical results. But following the functional capacity assessment in 1995, Dr. Schutt indicated that McDowell's restrictions permanently precluded her from working as a result of chronic pain. Dr. Schutt rated the injury as: Class 5severe limitation of functional capacity that rendered her incapable of even minimal sedentary activity. This restriction was never lifted by Dr. Schutt, and McDowell has not been employedor even attempted reemploymentsince Dr. Schutt's first work restriction was imposed in 1993, prior to the settlement. [¶ 25.] Thus, McDowell, her husband, her vocational expert, and her treating physician all confirmed that her occupational disability remained unchanged: she was unable to work in any capacity at the time of settlement and at the time reopening was requested. And even if one were to disregard this evidence relating to her actual occupational disability, or even if one misconstrues the meaning of Drs. Schutt's and Hoversten's impairment ratings, [3] this record unequivocally established that McDowell knew the disabling character of her disability at the time of settlement. Simply stated, the fact that she testified she was permanently and totally disabled before, at the time of, and after the settlement forecloses her appellate claim that the disabling character of her injury was unknown during those same periods of times. Because McDowell was, and knew that she was, permanently and totally disabled at the time of settlement, the hearing examiner and circuit court correctly concluded her petition for reopening could not have been granted even if she had established a change in physical condition. See Kasuske, 2006 SD 14 at ¶ 17, 710 N.W.2d at 456.