Opinion ID: 2182990
Heading Depth: 1
Heading Rank: 4

Heading: Aggravation and Cumulative Trauma Injuries

Text: Injury is defined in the WCA to mean accidental injury or death arising out of and in the course of employment, and such occupational disease or infection as arises naturally out of such employment or as naturally or unavoidably results from such accidental injury, and includes an injury caused by the willful act of third persons directed against an employee because of his employment. D.C.Code § 36-301(12). It is well settled that `an aggravation of a preexisting condition may constitute a compensable accidental injury under the Act.' Ferreira, 531 A.2d at 660 (quoting Wheatley, 132 U.S.App. D.C. at 182, 407 F.2d at 312). The fact that other, nonemployment related factors may also have contributed to, or additionally aggravated [claimant's] malady, does not affect his right to compensation under the `aggravation rule.' Hensley v. Washington Metro. Area Transit Auth., 210 U.S.App. D .C. 151, 155, 655 F.2d 264, 268 (1981), cert. denied, 456 U.S. 904, 102 S.Ct. 1749, 72 L.Ed.2d 160 (1982). `[T]he cases almost invariably decide that the fact that the injury would not have resulted but for the pre-existing disease, or might just as well have been caused by a similar strain at home or at recreation, are both immaterial.' Id. (quoting Wheatley, 132 U.S.App. D.C. at 182 n. 11, 407 F.2d at 312 n. 11). The aggravation rule is embodied in D.C.Code § 36-308(6)(A), which provides that [i]f an employee receives an injury, which combined with a previous occupational or nonoccupational disability or physical impairment causes substantially greater disability or death, the liability of the employer shall be as if the subsequent injury alone caused the subsequent amount of disability ...; see also Washington Metro. Area Transit Auth. v. District of Columbia Dep't of Employment Servs., 704 A.2d 295, 297-99 (D.C.1997) (discussing the policies underlying § 36-308(6)); Daniel v. District of Columbia Dep't of Employment Servs., 673 A.2d 205, 207-08 (D.C.1996). The difference between the typical case of a discrete accident causing an injury (including an aggravating injury) and a cumulative trauma case is merely that in the latter case it is not possible to identify a discrete event occurring at a particular date and time that causes (or aggravates) the injury. Instead, the cumulative traumatic injury becomes manifest only after the body's repeated exposure to individually minor traumas, insults, or harmful employment-related conditions. [7] As with aggravating injury, it is settled that injury resulting from cumulative trauma in the workplace is compensable under the WCA. See Ferreira, 531 A.2d at 656-57; Hamilton v. Giant Foods, Inc., H & AS No. 92-632A, OWC No. 228493, at 6 (February 28, 1994); Hensley, 210 U.S.App. D.C. at 157, 655 F.2d at 270; Hoage v. Royal Indem. Co., 67 U.S.App. D.C. 142, 145, 90 F.2d 387, 390 (1937), cert. denied, 302 U.S. 736, 58 S.Ct. 122, 82 L.Ed. 569 (1937). If King did suffer a discrete accident while at work on April 11, 1994, which injured and disabled him by aggravating his preexisting back condition, then he was entitled to coverage under the WCA. For in that event his compensable injury occurred in the District while he was performing work there for his employer in the District  thereby bringing his injury within the scope of subsection (a)(1) of D.C.Code § 36-303. This is so even if the accident aggravated a preexisting condition that was caused by repeated on-the-job trauma. [8] See D.C.Code § 36-308(6)(A). Alternatively, if King's back gave out on April 11, 1994, not because of a distinct, identifiable accident on that date, but rather as the culmination of cumulative trauma to which his employment had exposed him over an extended duration, then his injury was potentially compensable under the WCA. In that case, on the present record, compensability would turn on when (and therefore where) King's injury is deemed to have occurred (a question we address below). The record evidence regarding what happened to King is sparse. Nonetheless, we think that King's testimony describing his back problems and his increased pain while working in the District on April 11, combined with the examiner's findings regarding the routine physical exertion involved in King's job, was sufficient to trigger the rebuttable presumption of coverage provided by D.C.Code § 36-321(1), based either on the premise of an aggravating injury at that time and place, or on the premise of cumulative work-related trauma culminating in disabling injury at that point. See supra note 1. To invoke the presumption, a claimant need only present some evidence of (1) a death or disability and (2) a work-related event which has the potential to result in or contribute to the death or disability. See Ferreira, 531 A.2d at 655. Since King was performing work-related duties when his pain became disabling, he was entitled to the benefit of the presumption, which operates to establish a causal connection between the disability and the work-related event, activity, or requirement. Id. Once the presumption is triggered, the burden shifts to the employer to produce substantial evidence that the disability did not arise out of and in the course of the employment. See Brown, 700 A.2d at 791. [D]oubts as to whether the injury arose out of the employment are resolved in the claimant's favor. Baker v. District of Columbia Dep't of Employment Servs., 611 A.2d 548, 550 (D.C.1992). Relying on testimony from one of King's physicians, intervenors argue that King did not suffer an aggravating injury on April 11 and did not sustain cumulative work-related trauma. Intervenors contend that King's injury was not work-related, but rather was the product of a natural degeneration of a back condition attributable to a previous, non-work-related injury. The hearing examiner did not resolve this dispute. He did not make any findings, from the medical testimony or otherwise, regarding the medical nature of King's back condition or the work-relatedness of King's disability. He did not determine whether the medical evidence regarding the source of King's disability was substantial enough to rebut the statutory presumption of coverage. He did not determine whether King suffered a discrete, aggravating injury on April 11, 1994, while at work in the District. Although the examiner assumed that King attributed his disability to a cumulative trauma, he did not determine for a fact whether King actually sustained such trauma from his job. The Director likewise did not make these determinations in reviewing the examiner's decision. These fact-intensive determinations, essential to resolving the coverage question in this case, turn in large measure on the evaluation of the medical testimony and evidence. We do not have the authority to examine this evidence and make our own conclusions. See Mack, 651 A.2d at 806. That factual inquiry is the responsibility of the hearing examiner. We must remand to the agency to make findings on these issues.