Opinion ID: 1039732
Heading Depth: 2
Heading Rank: 1

Heading: The patient had also developed significant

Text: osteoarthritis, probably because of over-compensation from his previous injuries. . . . . . . Q. . . . Does that remain your opinion today? A. . . . In my clinical judgment, yes, that is a possible outcome of his injuries. . . . . . . . . . I was not privy to his actual injury initially, what was done. So . . . whether he had initial injuries to the hip area, I don’t know. . . . But from my four, five years of seeing him, my impression was that, yeah, he was developing osteoarthritis and most commonly probably related to his other previous injuries and his ongoing problems. . . . So when you either put more weight on the right hip joint all of the time, or if you just stand in a certain way all the time, or if that caused the overuse leading it to osteoarthritis. Q. And based on your training and experience and with a reasonable degree of medical probability, is it your opinion that that’s what happened to Marshall? A. That’s what I think, yes. . . . Q. . . . [D]o you feel that Marshall’s current right hip treatment is related to his original work injury? 7 A. It possibly still is, because in this letter [the 2007 request for information from the Division] it says that he has some pain in the right leg since this accident . . . maybe those same symptoms have probably progressed. Q. And, again, your opinion as you’ve described earlier is that the symptoms that he’s having and the problems that he’s having in his right leg are probably related to his original work injury? A. Possibly. Q. Possibly? A. Yes. (Emphasis added.) [¶23] Cross-examination by the Division’s attorney established that Mr. Little was obese and that he smoked cigarettes. Dr. Patel testified that he was unfamiliar with any correlation or studies linking osteoarthritis to smoking or obesity. However, he acknowledged his limited expertise in this area: “[Y]ou can ask the orthopedist, because they do deal with the final outcome of whatever etiology is of the osteoarthritis and if needing a replacement or surgery, because we [internists] usually just treat the symptoms. We don’t intervene any surgery.” Dr. Patel also testified that “[i]t’s really difficult to put a timeline once you find arthritis,” and that an orthopedist could answer questions about the onset of hip arthritis due to prior injuries. [¶24] Mr. Little was the only witness who testified in person at the contested case hearing. He indicated that before his 1988 injury he was physically active and had no hip pain. He immediately felt pain to his lower back and down through his legs after being drawn into the hot mix plant chute. He testified that he had hip pain soon after the accident, but that he assumed that physical therapy would help. He also “walk[ed] weird,” favoring his right leg, and he fell down several times before his first back surgery. [¶25] Mr. Little testified that he actually had two surgeries to his back and one to his neck in the late 1980s and early 1990s. He acknowledged that his back surgeries relieved his leg pain and weakness. He used a cane after his first surgery, but he eventually felt better and became more mobile from 1991 through 2001. He still walked with a limp and favored his right leg during this period. However, from 1992 through 1995, he “could almost get a normal stride,” and only used his cane as a stabilizer during the winter 8 months. Mr. Little also testified that he did not see any doctors about his injury from 1990 through 1997. [¶26] Mr. Little began seeing Dr. Patel for pain management in 2003. He acknowledged that he had not been diagnosed with osteoarthritis in his hip before 2007. However, he claimed that he had hip pain well before 2007. He saw Dr. Patel for hip pain because “the pain . . . was becoming more than I could deal with.” [¶27] The hearing examiner issued a written order denying benefits for treatment of hip osteoarthritis, concluding as follows: [I]t is the Claimant’s contention that he either sustained an initial injury to his hip and, as a result, developed osteoarthritis in his hip requiring hip replacement surgery or, in the alternative, the Claimant contends that the osteoarthritis developed as a result of a change in gait due to his lower back injury and, therefore, he sustained a second compensable injury. As to the contention that the Claimant sustained an injury to his hip in 1988, the medical records do not support such a contention [reference to several medical records]. . . . The Office finds that this evidence does not indicate that the Claimant sustained any specific injury to his hip in 1988 and that the degenerative osteoarthritis developed over time for some other reason. The question then becomes whether the Claimant’s degenerative osteoarthritis which occurred over a substantial period of time was as a result of his initial workrelated injury. As an injury which occurs over of a substantial period of time, it is the Claimant’s burden to prove by competent medical authority that his degenerative condition was directly as a result of his initial compensable injury. The Claimant contends that he has met such burden through the testimony of Dr. Patel. . . . In his deposition, Dr. Patel acknowledges the contents of his medical records; however he is then specifically asked as to whether or not he felt the Claimant’s right hip treatment is related to his original work injury. He specifically responds, “It possibly still is, because in this letter it says that he has some pain in the right leg since this accident, and this was 2007; so it’s almost about four years, four-and-a-half years since that. And maybe those same symptoms have probably progressed.” Dr. Patel is again asked whether the Claimant’s symptoms and the problems he is having with his right leg are probably related to his original work injury. Again, his response, “Possibly.” 9 The Office finds that such testimony does not satisfy the Claimant’s burden of proof to show a causal relationship as required under the law, especially in view of the medical opinion provided by Dr. Torkelson. . . . [T]he Office must find Dr. Torkelson’s opinions more probative in this matter. The district court affirmed, and this appeal followed.