Opinion
1 CA-IC 21-0037
03-24-2022
COMPUNNEL SOFTWARE GROUP/CONTINENTAL INSURANCE COMPANY, Petitioners, v. THE INDUSTRIAL COMMISSION OF ARIZONA, Respondent, WILLIAM SEARS, Respondent Employee.
Ritsema Law, Tempe By Danielle S. Vukonich Counsel for Petitioner Employer and Carrier Industrial Commission of Arizona, Phoenix By Gaetano J. Testini Counsel for Respondent
Not for Publication - Rule 111(c), Rules of the Arizona Supreme Court
Special Action - Industrial Commission ICA Claim No. 20180-090296 Carrier Claim No. W2A05784F9 The Honorable Amy L. Foster, Administrative Law Judge
Ritsema Law, Tempe By Danielle S. Vukonich Counsel for Petitioner Employer and Carrier
Industrial Commission of Arizona, Phoenix By Gaetano J. Testini Counsel for Respondent
Judge Jennifer M. Perkins delivered the decision of the Court, in which Presiding Judge David D. Weinzweig and Judge Brian Y. Furuya joined.
MEMORANDUM DECISION
PERKINS, JUDGE
¶1 In this special action, we review an administrative law judge's ("ALJ") Industrial Commission Award ("Award") that compensated William Sears for an injury suffered after his initial compensable fall. We consider whether Sears proved causation with a statement he made to his treating physician. We hold he did not and set aside the Award.
FACTUAL AND PROCEDURAL BACKGROUND
¶2 William Sears worked for Compunnel Software Group in 2017 when he injured his right shoulder after his chair moved out from under him while he was attempting to sit. Sears landed hard on the floor, falling on his backside while attempting to catch himself with his arms. Continental Insurance Company accepted Sears's workers' compensation claim and provided coverage for treatment. Sears had a cervical fusion and surgery to repair his right shoulder. In November 2020, Continental closed the claim with a permanent impairment because Sears had reached maximum medical improvement, according to an Independent Medical Examination. Sears timely requested a hearing to challenge that closure, claiming he continued to need active treatment for his left shoulder.
¶3 Only Sears appeared at the hearing. Sears testified about the accident, the medical treatment he received for his injuries, and what treatment he believed he continued to need. At one point, he testified his left shoulder also needed treatment, although he admitted that no doctor had related the pain in his left shoulder to his work injury. The ALJ allowed Sears to file medical documentation after the hearing to support the relation of his left shoulder pain to his work injury.
¶4 Less than two weeks later, Sears filed medical documentation related to an MRI of his left shoulder. Sears also filed a letter from Dr. Andrew Chin, who began treating him in January 2021 for "chronic left shoulder pain." Sears's medical evidence thus consisted of six total pages, including the MRI 's findings, notes from his office visit in April 2021 (after the hearing), and Chin's letter (written after the hearing). Chin's letter states in its entirety:
Mr. William Sears is a patient under my care at Adelante Healthcare. I first started providing care for him in January 2021. He stated that he has chronic bilateral shoulder pain, which he stated was caused by a work injury in December 2017, where he fell backwards out of his chair and landed on his buttocks and both hands. Since the injury, he has undergone surgical repair of his right shoulder and cervical spine. He stated that he still has pain in his left shoulder and a MRI in August 2020 indicated that he has a partial thickness tear of the biceps tendon along with subscapularis tendinopathy and tearing of the subscapularis fibers. He has not undergone surgical repair of his left shoulder yet and needs to see Orthopedics for further evaluation/management of his left shoulder.
¶5 With that, the ALJ concluded "Dr. Chin related the left shoulder pain to the industrial injury," and continued Sears's benefits because the ALJ found closure of Sears's claim unwarranted.
¶6 Compunnel and Continental timely requested review, arguing the letter from Chin did not relate the left shoulder symptoms to the work injury and urging several procedural errors. In affirming her decision, the ALJ implied Compunnel and Continental waived the procedural errors by failing to appear at the hearing. The ALJ also found the evidence sufficient to sustain the Award because "Dr. Chin's evidence linked [Sears]'s shoulder complaints to the industrial injury." This special action review followed.
DISCUSSION
¶7 We review the Award and the ALJ's factual findings to determine whether the record contains reasonable evidence, viewed in the light most favorable to sustaining the award, supporting the findings. See Pitts v. Indus. Comm'n, 246 Ariz. 334, 336, ¶ 14 (App. 2019). We review questions of law de novo. See Young v. Indus. Comm'n, 204 Ariz. 267, 270, ¶ 14 (App. 2003). The injured employee bears the burden of establishing each element of his claim. Yates v. Indus. Comm'n, 116 Ariz. 125, 127 (App. 1977). When an injury would not be apparent to a layperson, expert medical testimony is required to establish "not only the causal connection between a claimant's medical condition and the industrial accident, but also the existence and extent of any permanent impairment." Gutierrez v. Indus. Comm'n, 226 Ariz. 1, 3, ¶ 5 (App. 2010), aff'd in part, 226 Ariz. 395 (2011).
¶8 Sears had to prove, by a preponderance of the evidence, the material elements of his claim, including causation to a reasonable degree of medical probability. Brooks v. Indus. Comm'n, 24 Ariz.App. 395, 399 (App. 1975); Payne v. Indus. Comm'n, 136 Ariz. 105, 108 (1983). Sears thus needed to prove his condition was not stationary by showing he required treatment for a condition related to his work injury. Gutierrez, 226 Ariz. at 3, ¶ 5. He claimed his left shoulder needed treatment because of the work injury, and the ALJ concluded he met his burden with Chin's letter. We disagree.
¶9 First, Sears offered no medical opinion connecting his left shoulder condition to his work injury. He conceded this point during his testimony. Second, Chin's letter offered no medical opinion on what caused Sears's left shoulder condition. Chin merely states that Sears told him the condition resulted from his work fall, but Sears's assertion alone does not establish medical causation. Chin then described Sears's left shoulder condition without referencing its cause. Chin's letter alone is insufficient to support a finding of medical causation. See Hunter v. Indus. Comm'n, 130 Ariz. 59, 61 (App. 1981) ("Medical opinions not based on medical findings should not form the basis of an award."). The record contains no other evidence of medical causation for Sears's left shoulder condition. We thus find no reasonable basis for the ALJ's conclusion.
CONCLUSION
¶10 We set aside the ALJ's Award.