Opinion ID: 1179569
Heading Depth: 1
Heading Rank: 5

Heading: proof adduced in support of the reopening claim

Text: While we hold the employer bound by its implicitly stipulated change of the claimant's condition, we find the medical proof adduced in support of the worker's reopening claim insufficient to support the imposition of liability for a postaward heart transplant surgery. The worker's medical evidence is indeed deficient. It does not connect the asserted need for further health care with the prior accidental on-the-job injury. [24] Two doctors submitted letter-reports regarding the worker's heart condition. Neither of these shows any causal link between the accidental injury and the present condition. Dr. A.'s January 24, 1986 report refers to the worker's condition as severe coronary artery disease which is clearly inoperatable [sic] and suggests that the heart transplantation is the next treatment medically. Dr. Z.'s report of March 13, 1986 states that the worker has less than one year to live and that with the heart transplantation, he has a 65% chance of living at least five years. According to Dr. Z., the worker has severe coronary artery disease which is clearly inoperable and that the next medical treatment necessary ... is a heart transplantation. In today's pronouncement we need not, and do not, assume that payment for an anatomical alteration of an injured worker's body by organ substitution, much like the provision of artificial limbs, lies within the purview of or dehors the employer's statutory liability for health services mandated by § 14. Even if we made this assumption, the award on review could not be saved from vacation. There is here no competent evidence to show a causal nexus between the organ substitution sought and the compensable harm attributable to the accidental injury. The medical proof shows no more than that the worker has severe coronary artery disease and a heart transplant is the next logical procedure. It does not establish the changed condition as a legitimate consequence of the accidental injury. Because there is no competent evidence to link the heart transplant need to the industrial injury, the claimed surgical procedure cannot qualify as a reasonable and necessary compensable expense. There was clear legal error in awarding the worker the cost of the proposed organ substitution procedure. [25] The award is vacated and the proceeding remanded to the trial tribunal for its reconsideration [26] in a manner consistent with this pronouncement and with directions to treat the worker's request as his § 28 reopening claim for the provision of additional health services due one under the authority of § 14 on recurrence of a claimant's healing period. [27] HARGRAVE, C.J., and LAVENDER, DOOLIN and KAUGER, JJ., concur. SIMMS, J., concurs in part and dissents in part. HODGES, ALMA WILSON and SUMMERS, JJ., dissent.