Opinion ID: 3162311
Heading Depth: 3
Heading Rank: 4

Heading: Stellate tear and degeneration of

Text: the superior labrum which extends into the posterior labrum. The anterior labrum is grossly normal. 44. A September 21, 2005 MRA of [Panoke’s] right shoulder revealed: 1. Degenerative changes of the glenohumeral joint and AC joint. . . . 2. Partial tear along the articular surface of the supraspinatus tendon near its insertion site. 3. Superior labral tear near its base. The superior labrum is of increased intensity related to degeneration. . . . -16-  FOR PUBLICATION IN WEST’S HAWAI#I REPORTS AND PACIFIC REPORTER  45. By letter dated September 30, 2005, Dr. Okamura reported his impressions as: 1. Right shoulder superior labral tear 2. Right shoulder partial rotator cuff tendon tear. 3. Left shoulder superior labral tear. 4. Left shoulder partial versus full thickness rotator cuff tear. . . . 47. Dr. Lau prepared a supplemental report dated October 28, 2005. He acknowledged that Claimant had a “pain problem.” He continued to opine, however, that Claimant’s shoulder conditions were not related to the June 17, 2004 work injury. If the work accident caused the rotator cuff and labral tears to both shoulders, the significant force would have been applied to both shoulders, and “the pain would have been substantial and presentation would have occurred immediately or at least within several days to a week.” 48. Dr. Agles prepared a supplemental report dated November 15, 2005. . . . . [Dr. Agles] continued to opine that Claimant’s shoulder symptoms were not related to the subject accident, given the lack of temporal association and Claimant’s inability to describe how the shoulders were injured. Dr. Agles noted Claimant’s pre-existing shoulder pathology wherein Claimant had bilateral fractures and a left shoulder strain that was sustained while resisting arrest. . . . 50. On December 9, 2005, Claimant sought treatment with Dr. Baloy with complaints of pain in both shoulders, his lower back, buttocks, right upper leg, and right foot. Dr. Baloy noted Claimant’s “work status” as “off duty.” 51. On December 30, 2005, Claimant sought treatment with Dr. Baloy with complaints of pain in both shoulders, his lower back, buttocks, right leg, and right foot. . . . 53. On January 26, 2006, Claimant sought treatment with Dr. McCaffrey with complaints of pain in both shoulders, his mid to low back, right buttock, and right posterior thigh. Dr. McCaffrey noted Claimant’s “work status” as “off duty.” -17-  FOR PUBLICATION IN WEST’S HAWAI#I REPORTS AND PACIFIC REPORTER  . . . 57. On March 9, 2006 and April 11, 2006, Claimant sought treatment with Dr. McCaffrey with complaints of pain in both shoulders, his lower back, buttocks, and right leg. 58. On April 11, 2006 . . . Dr. McCaffrey noted that Claimant was not able to work light duty, pending a left shoulder surgery. He anticipated a return to work six months after left shoulder surgery. . . . 62. On May 2, 2006, Claimant sought treatment with Dr. McCaffrey with complaints of pain in both shoulders, his low back, and right leg. . . . 67. . . . Dr. Diamond opined that Claimant’s shoulder complaints were not directly related to the subject accident because: • There is a definite history of prior significant trauma to the shoulder, with a history of bilateral fracture. • [Claimant] has documentation in the records of prior shoulder complaints. • [Claimant] also has remarkably symmetrical complaints, and I suspect, findings. • [Claimant] demonstrates multiple positive Waddell’s findings,2 tending to de- emphasize the importance of non-documented history and question the relationship of clinical findings to pain generators. Dr. Diamond also explained that “the mechanism of injury is not typical of the shoulder pathology found.” He explained that although it is debatable, “SLAP lesions[3] usually involve a compression mechanism, such as seen in overhead throwing, rather than a traction mechanism. In the rare cases where traction mechanism is implicated, SLAP lessions usually involve a biceps 2 Waddell findings are exaggerated responses to pain, not necessarily intentionally exaggerated, but which do not make sense in terms of the patient’s anatomical condition. 3 In his testimony at the LIRAB trial, Dr. Diamond explained that “SLAP” stands for “severe labrum from anterior to posterior.” -18-  FOR PUBLICATION IN WEST’S HAWAI#I REPORTS AND PACIFIC REPORTER  avulsion, as well as other pathology.” Dr. Diamond noted that Dr. Okamura found that Claimant’s biceps tendon was normal and that the operative note documented “extensive debridement due to glenohumeral joint arthritis,” which was suggestive of long term pathology. . . . 71. On October 31, 2006, Claimant sought treatment with Dr. McCaffrey with complaints of pain in both shoulders, his low back, buttocks, and right leg. Claimant’s “work status” was noted as “modified duty.” . . . 73. On March 3, 2007, Claimant sought “Urgent Care Walk-In” treatment with Dr. McCaffrey with complaints of pain in his left shoulder, low back, left buttock, and right leg. 74. On March 29, 2007, Claimant sought treatment with Dr. McCaffrey with complaints of pain in his left shoulder, low back, left buttock, and right leg. Claimant’s “work status” was noted as [“]off duty.” 75. On April 19, 2007, Claimant sought treatment with Dr. McCaffrey with complaints of pain in his left shoulder, low back, left buttock, left thigh, right knee, and left foot. 76. On May 31, 2007, Claimant sought treatment with Dr. McCaffrey with complaints of pain in both shoulders, his low back, left buttock, and right leg, and left leg and foot. 77. On June 21, 2007, Claimant sought treatment with Dr. McCaffrey with complaints of pain in both shoulders, his low back, left buttock, and both legs and left foot. . . . 80. In Claimant’s Answers to Employer’s First Request for Answers to Interrogatories . . . Claimant . . . revealed that he broke both shoulders in a moped accident in 1990 or 1991, wherein he “flew off the moped and landed with both arms extended”. . . . 92. Claimant was deposed on January 27, 2006. Claimant testified that at the time of the June 17, 2004 work accident, his arms were straight out approximately three feet from the ground as he helped support a panel weighing 800 to 1200 pounds. The panel then fell approximately two-and-a-half feet in approximately two seconds or less. It stopped falling -19-  FOR PUBLICATION IN WEST’S HAWAI#I REPORTS AND PACIFIC REPORTER  approximately six inches from the ground. 93. Claimant did not feel immediate pain to the shoulders. He first experienced pain to both shoulders one to one-and-a-half-weeks later. He believed the pain in his shoulders was 4/10 or 5/10, but increased to 6/10 or 7/10 by the third week after the June 17, 2004 work accident. 94. At the trial on April 9, 2010, Dr. Diamond testified that Claimant had . . . a history of previously asymptomatic neck and shoulder pain, a history of prior bilateral shoulder fractures, multiple Waddell’s findings. Dr. Diamond testified that most of the impressions noted from the right shoulder MRA were indicative of long-standing (5-10 years) degenerative conditions. However, the changes noted in the supraspinatus could be considered acute and were not necessarily long-standing. The left shoulder MRA showed similar degenerative changes. He further testified that the labral and rotator cuff tears that resulted in Claimant’s surgeries were not related to the subject work accident, because the mechanism of the subject accident was not consistent with such injuries. He stated that he could definitely say that the labral tearing and degenerative arthritis were not acute injuries. Dr. Diamond testified that heavy lifting could cause degenerative conditions of the rotator cuff, but it would depend upon the position of the rope and arms. It would take abduction and positioning of the arms overhead to irritate the rotator cuff. Reaching overhead to pull down on a rope would likely lead to a biceps tendonitis rather than a rotator cuff tendonitis. Further, “heavy work” could lead to rotator cuff and labral degeneration. Labral tearing occurs with compressive injuries, where the humeral head grinds into the labrum, like a fall onto outstretched arms. Although it is possible to tear the labrum on the basis of a traction accident as in this case, but that usually involves damage to the biceps, which is not present [sic]. Therefore, can exclude [sic] traction as the mechanism of injury for the labral tear and arthritis, and the same reasoning applied to rotator cuff injuries. He opined that more likely than not, the tears and degenerative changes pre-existed the June 17, 2004 work accident. Further, if the tears as seen on the MRA occurred from the work injury, Claimant, more likely than not, would have felt pain immediately. It would also be probable that he would have felt the shoulder pain from the tears immediate [sic], regardless of pain in his back. Dr. Diamond pointed out that Claimant had a complaint of knee pain, and, the back -20-  FOR PUBLICATION IN WEST’S HAWAI#I REPORTS AND PACIFIC REPORTER  pain he experienced did not mask that pain. Dr. Diamond opined that although possible, it was “more likely than not” that the June 17, 2004 accident did not cause, aggravate, or accelerate Claimant’s labral tears. He would expect immediate symptoms given the amount of tears noted on the MRA. Dr. Diamond further testified that it was virtually impossible to develop the advanced arthritic changes seen on the MRA during the period since the June 17, 2004 work accident. With regard to Claimant’s low back, Dr. Diamond testified that Claimant reached medically stability [sic] approximately one year after the June 17, 2004 work accident. He further testified that he would generally tell his patients that it would take 12-18 months to fully recover strength after a shoulder surgery. Dr. Diamond clarified that the supraspinatus changes seen on the MRA in this particular case were not related to the subject work accident for the same reasons. 95. At trial, Claimant testified that he first noticed symptoms in his shoulders one to two weeks after the June 17, 2004 work accident, while he was washing rice. The pain in his shoulders thereafter intensified. 96. The [LIRAB] credits the opinion of Dr. Diamond and finds that Claimant’s bilateral shoulder conditions pre-existed the June 17, 2004 work accident and was [sic] not caused, aggravated, or accelerated by said accident. The [LIRAB] credits Dr. Diamond’s expert opinion that Claimant would have experienced immediate symptoms if his shoulder conditions were caused by the June 17, 2004 work injury. Claimant’s argument that his shoulder symptoms were masked by his low back injury is inconsistent with the report of knee symptoms immediately after the June 17, 2004 work accident. The [LIRAB] also credits Dr. Diamond’s opinion that Claimant’s shoulder conditions are not consistent with a traction type mechanism of injury. The LIRAB also made the following conclusions of law (COL): “Hawaii Revised Statutes (“HRS”) § 386-85(1) creates a presumption in favor of the claimant that the subject injury is causally related to the employment activity. . . . Furthermore, this presumption may be rebutted by “substantial evidence to the contrary . . . .” § 386-85, HRS. The Board -21-  FOR PUBLICATION IN WEST’S HAWAI#I REPORTS AND PACIFIC REPORTER  has applied the rebuttable presumption of compensability. 1. The [LIRAB] concludes that Claimant did not sustain bilateral shoulder injuries on June 17, 2004, arising out of and in the course of employment. Employer has adduced substantial evidence to rebut or overcome the presumption of compensability. Although Claimant argues, in part, that his shoulder conditions could have been incurred over the period of his work for Employer, [the LIRAB] makes no determination as to Claimant’s cumulative trauma contention, where such theory or contention was raised for the very first time at the trial and in Claimant’s Post Hearing Memorandum. 2. The [LIRAB] concludes that Claimant’s periods of [TTD] resulting from the work injury of June 17, 2004 are: June 20, 2004 through June 22, 2004 June 30, 2004 through December 17, 2005 April 11, 2006 through May 11, 2006 As stated in Alexis v. Kasseebeer v. Paul J. Samarin, AB 2007-207 (October 2, 2009): A medical certification of [TTD] requires an attending physician to certify that a claimant’s absence from work is due to disability attributed to a specific work injury or condition. Without such certification, an award of temporary total disability is not proper. The [LIRAB] interprets the laws and rules to require certifications of disability by the attending physician to be contemporaneous, in writing, and including the date of accident and work injury-related condition(s) for which such disability is certified. Statements that Claimant’s work status as [sic] “off duty” or that he is significantly impaired is [sic] insufficient as a certification of disability without a statement that such impairment or disability is due to the work injury. The record before the [LIRAB] does not include statements of certification that Claimant remained temporarily and totally disabled due to a work-related injury. For the period April 11, 2006 through May 11, 2006, the [LIRAB] credits Dr. McCaffrey’s Work Restriction Profile and concludes that Claimant was disabled due to the June 17, 2004 work injury. The [LIRAB] makes no determination as to Claimant’s entitlement to TTD benefits after September 4, 2007, which was the medical reports deadline. -22-  FOR PUBLICATION IN WEST’S HAWAI#I REPORTS AND PACIFIC REPORTER  3. The [LIRAB] concludes Employer is not liable for a penalty for late payment of [TTD] benefits for the period April 6, 2005 to February 2, 2006. There is no evidence to indicate that payments were untimely. Further, the [LIRAB] determined that except for the period April 11, 2006 through May 11, 2006, Claimant was not entitled to TTD benefits after December 17, 2005. D. Appeal to the ICA On July 21, 2011, Panoke filed a notice of appeal of the LIRAB’s decision to the ICA. Panoke raised essentially the same arguments to the ICA that he raised before the LIRAB. Panoke also argued that it was error for the LIRAB to limit his TTD benefits to certain time periods when Work Star had provided clinical reports that kept Panoke off work from June 30, 2004 through July 12, 2007. Panoke further asserted that it was error for the LIRAB to fail to assess a penalty against Reef and Seabright because Reef and Seabright’s WC-3 form showing TTD payments made for the year 2005 indicated that payments were only made until April 5, 2005, but the LIRAB awarded TTD until December 17, 2005, and there were no grounds for the Director to excuse penalties. Reef and Seabright argued that Panoke’s shoulder injuries were not caused by the June 17, 2004 accident, relying on the reports of Dr. Lau and Dr. Agles, and on Dr. Diamond’s testimony. -23-  FOR PUBLICATION IN WEST’S HAWAI#I REPORTS AND PACIFIC REPORTER  Reef and Seabright argued that it was not error for the LIRAB to limit Panoke’s TTD benefits to certain time periods. Reef and Seabright asserted that the Work Star reports were not sufficient to certify Panoke as disabled because they did not indicate the dates when his disability started, and when he would be able to return to work, as required by HRS § 386-96. Reef and Seabright also argued that no penalties for late TTD payments were due because the Director’s decision of June 13, 2005, only awarded TTD benefits until April 4, 2005. After that, according to Reef and Seabright, the disability was disputed, therefore no TTD benefits were due until October 13, 2006, when the Director extended the TTD period beyond April 5, 2005. In a summary disposition order (SDO) filed on June 30, 2014, the ICA affirmed the LIRAB’s ruling. The ICA first held that the opinions of Drs. Agles, Lau, and Diamond constituted substantial evidence sufficient to rebut the presumption of coverage. In doing so, the ICA rejected Panoke’s argument that the opinions were generalized and therefore irrelevant because the opinions “identified specific reasons as to why the shoulder injuries were not work related and why the industrial accident did not exacerbate Panoke’s pre-existing condition.” The ICA then held that, even though there was some evidence to the -24-  FOR PUBLICATION IN WEST’S HAWAI#I REPORTS AND PACIFIC REPORTER  contrary in the form of Dr. McCaffrey’s and Dr. Okamura’s opinions, the LIRAB did not err in giving more weight to the “high quantum of evidence” presented by Reef and Seabright. The ICA next determined that, although the LIRAB’s requirement that each disability certification contain a specific statement that the disability is due to work injury was “questionable,” any error by the LIRAB in this regard was harmless because the LIRAB did not err in determining the TTD periods. The ICA concluded that the LIRAB’s determination of the TTD periods was not error because the first period, from June 20, 2004 to June 22, 2004, was based on a statutory three-day waiting period after the accident and the initial reports of Dr. DiazOrdaz. The second period, from June 30, 2004, to December 17, 2005, started when Dr. McCaffrey first placed Panoke off duty, and ran for eighteen months from the June 17, 2004 accident, based on Dr. Diamond’s opinion that Panoke’s back injury had achieved maximum medical improvement after eighteen months. The ICA also agreed with Reef and Seabright that the LIRAB did not err in failing to assess penalties. The ICA held that Panoke’s argument that he had not received TTD benefits since April 2005 was without merit because the Director’s order extending benefits beyond April 2005 was not issued until October 13, 2006. -25-  FOR PUBLICATION IN WEST’S HAWAI#I REPORTS AND PACIFIC REPORTER