Court Opinion

ID: 9900443
Source: CourtListenerOpinion
Date Created: 2023-11-18 22:13:00.733599+00
Date Added: 2024-06-11T09:21:05.605703
License: Public Domain

276                     June 7, 2023                 No. 283

         IN THE COURT OF APPEALS OF THE
                 STATE OF OREGON

           In the Matter of the Compensation of
               Viorica Gramada, Claimant.
                   Viorica GRAMADA,
                        Petitioner,
                             v.
                  SAIF CORPORATION
               and Community Vision, Inc.,
                       Respondents.
               Workers’ Compensation Board
                    2005499; A177672

   Argued and submitted January 25, 2023.
   Jodie Anne Phillips Polich argued the cause for petitioner.
Also on the briefs was Law Office of Jodie Anne Phillips
Polich, P.C.
  Daniel Walker filed the brief for respondents SAIF
Corporation and Community Vision Inc.
   Before Aoyagi, Presiding Judge, and Joyce, Judge, and
Jacquot, Judge.
   JOYCE, J.
   Affirmed.
Cite as 326 Or App 276 (2023)   277
278                                                      Gramada v. SAIF

           JOYCE, J.
         Claimant petitions for review of an order of the
Workers’ Compensation Board. In that order, the board
found that claimant’s workplace injury to her lower back did
not cause impairment to claimant and denied claimant an
award of permanent partial disability benefits under ORS
656.214. We review the board’s legal conclusions for errors
of law, ORS 183.482(8)(a); ORS 656.298(7), and affirm.
                                    FACTS
         The parties accept the findings of the board as sub-
stantially accurate. We thus state the facts consistently with
the board’s unchallenged factual findings. Magana-Marquez
v. SAIF, 276 Or App 32, 33, 366 P3d 764 (2016).
         The workplace injury at issue in this case occurred
in March 2020, when claimant suffered sharp low back
and lower abdominal pain after she helped a patient into a
shower and was thereafter diagnosed with a lumbar strain.
In April 2020, SAIF accepted a lumbar strain condition.1 In
August 2020, SAIF issued a notice of closure that awarded
temporary disability benefits but no permanent disability
benefits for the March 2020 workplace injury.
         Soon after, SAIF issued an order on reconsider-
ation affirming the notice of closure. SAIF based its deci-
sion on a medical arbiter’s report. The medical arbiter had
stated that “[z]ero percent of the findings [lumbar] are due
to the resolved accepted condition” and “[o]ne hundred per-
cent of the findings are due to the preexisting conditions
documented on her lumbar imaging studies.” The medical
arbiter asserted that “[t]he accepted condition is lumbar
strain which has resolved and is no longer present. Findings
obtained on my exam are not valid for a condition that has
resolved. The findings I reported are valid for degenera-
tive conditions, present on her multiple imaging studies.”
    1
      A July 2020 “Updated Notice of Acceptance at Closure” identified the
accepted condition for claimant’s March 9, 2020, injury as “lumbar strain.” The
notice made clear that “[t]he accepted condition(s) does not include a combined
condition unless specifically indicated in this updated notice of acceptance.” The
notice further made clear that it “restate[d] and include[d] all prior acceptances.
The conditions that were the basis of this claim opening were the only conditions
considered at the time of claim closure.”
Cite as 326 Or App 276 (2023)                               279

Claimant sought review, asserting that she was entitled to
a permanent impairment award.
         Relying on the medical arbiter’s findings, an admin-
istrative law judge (ALJ) affirmed the reconsideration order
because “[t]he evidence establishes that none of claimant’s
disability or need for treatment for the low back condition is
related to claimant’s injury.” Soon after, the board adopted
and affirmed the ALJ’s order. The board concluded that
because the medical arbiter’s findings did not support a con-
clusion that “impairment was caused, in any part, by the
compensable injury,” and the reconsideration order based its
determination on the medical arbiter’s findings, there was
no error in the reconsideration process.
       On appeal, claimant challenges the board’s deter-
minations.
                        DISCUSSION
         The question in this case is whether claimant is
entitled to a permanent partial disability award under ORS
656.214. ORS 656.214 states, in relevant part,
      “(2) When permanent partial disability results from a
   compensable injury or occupational disease, benefits shall
   be awarded as follows:
      “(a) If the worker has been released to regular work
   by the [authorized attending medical professional] or has
   returned to regular work at the job held at the time of
   injury, the award shall be for impairment only. Impairment
   shall be determined in accordance with the standards pro-
   vided by the Director of the Department of Consumer and
   Business Services pursuant to ORS 656.726(4). * * *
      “(b) If the worker has not been released to regular
   work by the [authorized attending medical professional]
   or has not returned to regular work at the job held at the
   time of injury, the award shall be for impairment and work
   disability.”
“Impairment” is defined as “the loss of use or function of
a body part or system due to the compensable industrial
injury or occupational disease determined in accordance
with the standards provided under ORS 656.726, expressed
as a percentage of the whole person.” ORS 656.214(1)(a).
280                                                       Gramada v. SAIF

“A ‘compensable injury’ is an accidental injury * * * arising
out of and in the course of employment requiring medical
services or resulting in disability or death.” ORS 656.005
(7)(a).2 “ ‘Loss’ includes permanent and complete or partial
loss of use.” ORS 656.214(1)(b).
         Claimant asserts that she is entitled to a perma-
nent partial disability award under ORS 656.214 because
she suffered a “compensable injury” in the accident at work
in March 2020, notwithstanding the undisputed evidence
that the specific condition that SAIF accepted—lumbar
strain that resulted from that workplace accident—had fully
resolved and in no part contributed to loss of use or func-
tion in her back. In claimant’s view, “compensable injury,”
ORS 656.214, refers to more than just the accepted condi-
tion; rather, she argues, it refers to the “ ‘full measure’ of
impairment in the injured body part” regardless of whether
the impairment is the result of the accepted condition.
Respondent, on the other hand, argues that Oregon courts
have already made clear that the compensable injury is the
accepted condition.
         Resolution of this issue requires us to determine
whether a claimant’s “accepted condition” is the same as a
“compensable injury.” ORS 656.262(6)(b) (requiring insurers
to issue a notice of acceptance that specifies which condi-
tions are compensable); ORS 656.214(2) (requiring benefits
to be awarded when a permanent partial disability results
from a “compensable injury”). Although no Oregon appellate
decision has expressly decided that question, the Supreme
Court has nevertheless decided several cases that, when
knitted together, lead us to the conclusion that a claimant’s
accepted condition is their compensable injury for purposes
of ORS 656.214. We thus turn to those cases.

    2
      “Injury” is not defined by statute and has been interpreted differently in
different contexts in the workers’ compensation statutory scheme. See Brown v.
SAIF, 361 Or 241, 254, 391 P3d 773 (2017) (explaining that the term “injury”
may plausibly refer either “to an incident that causes or results in harm, or it
can refer to the harm itself,” and explaining that “[u]nder the circumstances, the
resolution of the dispute in this case will not turn on whether an interpretation of
one provision is inconsistent with another in the workers’ compensation statutes.
Regardless of what we say about the statutes at issue in this case, doubtless at
least one provision could be cited that arguably contradicts that interpretation in
one way or another.”).
Cite as 326 Or App 276 (2023)                            281

         We begin with Garcia-Solis v. Farmers Ins. Co., 365
Or 26, 441 P3d 573 (2019). There, the Supreme Court, inter-
preting the meaning of “compensable injury” for purposes
of ORS 656.245, explained that the statutory definition of
“compensable injury” under ORS 656.005(7)(a) means med-
ical conditions, as opposed to the workplace accident as a
whole. The court explained that while its prior decisions
were not clear as to whether “compensable injury” refers
only to accepted medical conditions, previous opinions “con-
tain several broad assertions that ‘compensable injury’
means ‘accepted conditions.’ ” Garcia-Solis, 365 Or at 34-35;
see also Brown v. SAIF, 361 Or 241, 255-72, 391 P3d 773
(2017) (reviewing text, context, and legislative history to
conclude that “injury” means a medical condition, not an
accident). Although the court interpreted “compensable
injury” for purposes of ORS 656.245, not ORS 656.214, the
court’s discussion of compensable injury being synonymous
with accepted conditions for purposes of ORS 656.005(7)(a)
is instructive.

          Even more to the point are two more recent deci-
sions, Johnson v. SAIF, 369 Or 579, 507 P3d 1277 (2022),
and Robinette v. SAIF, 369 Or 767, 511 P3d 1074 (2022).
In Johnson, the Supreme Court addressed the meaning of
the word “impairment” “within the context of the workers’
compensation statutory scheme and whether a claimant is
entitled to compensation for the full measure of impairment
where it is caused in material part, but not solely, by a com-
pensable injury.” 369 Or at 581. The Johnson claimant’s loss
of grip strength was determined “to be caused in material
part by an accepted, compensable condition and, in part,
by a denied condition.” Id. The Johnson court agreed with
the claimant that ORS 656.214 “entitles an injured worker
to compensation for all of the impairment due in material
part to, and resulting in material part from, the compen-
sable injury.” Id. at 603. “[B]ecause the compensable injury
was found to be a material cause of [the] claimant’s impair-
ment,” the claimant was entitled to “the full value of her
total impairment, including the portion of her loss of grip
strength that may have been attributed to the denied condi-
tions.” Id.
282                                                      Gramada v. SAIF

         In reaching that conclusion, the court noted the
“basic, underlying rule” that “when an accepted, compensa-
ble injury is a material contributing cause of the claimant’s
impairment, then the claimant is entitled to the full mea-
sure of compensation for that impairment.” Johnson, 369 Or
at 597 (citing Barrett v. D & H Drywall, 300 Or 553, 555-56,
715 P2d 90 (1986) (Barrett II) and Schleiss v. SAIF, 354 Or
637, 651, 317 P3d 244 (2013) (emphasis added)).3 That basic
rule holds unless some exception or limitation applies, such
as a combined condition. Id. (citing ORS 656.268(1)(b)). But
“when no combined condition exists, the general rule that a
claimant is entitled to the full measure of impairment where
the accepted condition is a material contributing cause of
the disability applies.” Johnson, 369 Or at 599 (emphasis
added).
         Robinette further guides our understanding of the
meaning of “compensable injury” and whether that term
equates with accepted condition. The claimant in Robinette
was found to have multiple types of loss of use or function
of the right knee. The dispute on review involved two find-
ings of loss of use or function that were “determined to be
entirely related to causes other than claimant’s compensable
workplace injury.” Robinette, 369 Or at 769. The board had
determined that because those two findings were attributed
entirely to non-work-related causes, the permanent partial
disability award would not include any value for impairment
related to those findings. Id. at 772-73.
        The Robinette claimant sought judicial review, argu-
ing that “she was entitled to an award accounting for the
full measure of impairment in her right knee * * * because
her compensable work injury was a material contributing
    3
      Claimant describes Schleiss as “the anchoring case which specifically dis-
cussed that impairment must be ‘due to’ the compensable injury and that appor-
tionment can occur only when there is a legally cognizable preexisting condition.”
Schleiss predates Robinette and Johnson. In addition, Schleiss does not contradict
our holding today; in fact, in Schleiss, the court uses the terms “condition” and
“injury” interchangeably, lending support to our conclusion. The Schleiss court
explained that “[t]he claimant has the burden to establish the nature and extent
of any impairment that is due to the compensable condition[,]” citing to ORS
656.266(1), which states, in relevant part, that “[t]he burden of proving that an
injury * * * is compensable and of proving the nature and extent of any disability
resulting therefrom is upon the worker.” 354 Or at 646-47 (emphases added).
Cite as 326 Or App 276 (2023)                             283

cause of her impairment as a whole.” Id. at 773. The Supreme
Court began by explaining that resolution of the dispute
“center[ed] around the word impairment” as used in ORS
656.214 and “whether the calculation of permanent partial
disability is intended to encompass findings of loss that are
entirely unrelated to the accepted, compensable injury.”
Id. at 775. The court recognized that at first glance, prior
cases appeared to support the claimant’s position, explain-
ing that “[w]ithout a combined condition, [the] claimant is
correct that she is entitled to the full measure of her impair-
ment that is due, in material part, to the compensable
injury.” Id. at 780.

          The court acknowledged that “[t]he general rule
underlying all workers’ compensation claims is that a worker
is entitled to compensation for impairment that is caused in
material part by the compensable injury, even if that impair-
ment is heightened—or different—because of a worker’s
individual circumstances prior to the injury.” Robinette, 369
Or at 777 (citing Barrett v. D & H Drywall, 300 Or 325, 709
P2d 1083 (1985) (Barrett I), adh’d to on recons, 300 Or 553,
715 P2d 90 (1986) (Barrett II)). In addition, the court stated
that “in circumstances where the combined condition frame-
work is not applicable, we have continually confirmed that
the general rule remains: Where an accepted, compensa-
ble injury is a material contributing cause of the claimant’s
impairment, then the claimant is entitled to the full mea-
sure of compensation for that impairment.” Id. at 779 (citing
Johnson, 369 Or at 595 (emphasis in Robinette)).

          However, the court explained, a key fact set the
claimant in Robinette apart from the claimant in Johnson:
“based on the evidence in the record and the ALJ’s findings,
no part of the claimant’s [loss of use or function findings
in dispute] could be attributed to the accepted condition.”
Robinette, 369 Or at 781. The court continued, “To qualify
as ‘impairment,’ such that a claimant is entitled to a value
for that loss as part of their permanent partial disability
award, there are two requirements: (1) that there is a loss of
use or function of the body part or system, and (2) that that
loss is ‘due to the compensable injury.’ ” Id. at 781-82 (quot-
ing ORS 656.214).
284                                                        Gramada v. SAIF

         The court concluded, “Because each finding of loss
of use or function is to be considered separately, and because
the workplace injury was not a material contributing cause
of [the disputed findings of loss], claimant was not entitled
to a value for those findings in her award for permanent
partial disability.” Id. at 784. Notably, as in Johnson, the
court in Robinette used the terms “accepted condition” and
“compensable injury” interchangeably. See Robinette, 369 Or
at 781 (“[B]ased on the evidence in the record and the ALJ’s
findings, no part of the claimant’s [loss of use or function
findings in dispute] could be attributed to the accepted con-
dition.” (Emphasis added.)); id. at 781-82 (explaining that
to qualify as impairment, the loss of use or function of the
body part or system must be “due to the compensable injury”
(emphasis added; internal quotation marks omitted)).
         From that constellation of cases, we understand the
following. A finding of impairment requires (1) that there
is a loss of use or function of the body part or system, and
(2) that the loss is due to the compensable injury. Robinette,
369 Or at 781-82 (citing ORS 656.214). Each loss of use or
function is to be considered separately, and a loss is “due
to the compensable injury” when the accepted condition is
found to be a material cause of the loss. Johnson, 369 Or at
603; Robinette, 369 Or at 784.4
         In this case, claimant’s compensable injury for pur-
poses of ORS 656.214 was her accepted lumbar strain. It
follows that the arbiter’s findings of loss of use or function in
claimant’s low back are not impairment under ORS 656.214,
     4
       Further, at claim closure, “[c]onditions that are direct medical sequelae to
the original accepted condition shall be included in rating permanent disability
of the claim unless they have been specifically denied.” ORS 656.268(15). In addi-
tion, if an injured worker believes that a condition has been incorrectly omitted
from the notice of acceptance, the worker can notify the insurer of their objections
to the notice in writing pursuant to ORS 656.267. ORS 656.262(6)(d). “If there are
disputes about the compensability of conditions not specifically identified in the
updated notice of acceptance [at closure], the legislature has specified that those
disputes are not to delay timely closure but, rather, ‘[i]f a condition is found com-
pensable after claim closure, the insurer or self-insured employer shall reopen
the claim for processing regarding that condition.’ ” Simi v. LTI Inc. - Lynden Inc.,
368 Or 330, 339, 491 P3d 33 (2021) (quoting ORS 656.262(7)(c)). Such provisions
would be unnecessary if “compensable injury” referred to the full measure of loss
of use or function of a body part or system that had not been excluded via the
combined condition process.
Cite as 326 Or App 276 (2023)                             285

because the record shows that the lumbar strain was not a
material contributing cause of the claimant’s impairment—
claimant’s impairment was in no part due to the lumbar
strain. Robinette, 369 Or at 784. The court therefore did not
err in not awarding permanent partial disability.
         To be sure, if the medical arbiter had found that
claimant’s lumbar strain was in material part a cause of
loss of use or function to her low back, then the question
would be whether claimant was entitled to “the full measure
of compensation for that impairment, not just the percent-
age of impairment caused solely by the compensable injury.”
Johnson, 369 Or at 595. But that did not occur in this case.
While claimant has met the first requirement for impair-
ment for purposes of ORS 656.214, that “there is a loss of use
or function of the body part or system,” the medical arbiter’s
findings established that the loss of use or function was in
no part “due to the compensable injury,” as required under
the second prong. Robinette, 369 Or at 781-82 (citing ORS
656.214); OAR 436-035-0006(1); OAR 436-035-0007(1)(b)(C).
As such, the board did not err in finding that claimant had
not proven entitlement to an award of permanent partial
disability to her low back.
         Claimant argues that once her claim for lumbar
strain was accepted, she had established a compensable
injury under ORS 656.005(7)(a) and the burden shifted to
SAIF to “identify preclosure what other conditions [were]
contributing to impairment or disability in the injured body
part by accepting and denying a ‘combined condition’ under
ORS 656.268(1)(b).” She asserts that by failing to process her
injury as a combined condition, SAIF “failed to avail itself of
the [only] means by which it may apportion or limit payment
of impairment[.]” We reject that argument because there is
nothing to apportion. None of use or function in claimant’s
low back was attributed to the fully resolved lumbar strain.
         In sum, because the record indicates that there was
no “impairment” under ORS 656.214, claimant was not enti-
tled to permanent partial disability benefits.
        Affirmed.