Opinion
NO. 19-CA-173
12-18-2019
Tessalia ROCHA o/b/o Silvio Cuadra v. ACE PROPERTY AND CASUALTY INSURANCE COMPANY & Brand Energy and Infrastructure Services, Inc.
COUNSEL FOR PLAINTIFF/APPELLEE, TESSALIA ROCHA O/B/O SILVIO CUADRA, Bruce C. Betzer, Jr., Jennifer Seiler Avallone COUNSEL FOR DEFENDANT/APPELLANT, ACE PROPERTY AND CASUALTY INSURANCE COMPANY & BRAND ENERGY AND INFRASTRUCTURE SERVICES, INC., Leslie E. Hodge, Mark G. Montiel, Jr.
COUNSEL FOR PLAINTIFF/APPELLEE, TESSALIA ROCHA O/B/O SILVIO CUADRA, Bruce C. Betzer, Jr., Jennifer Seiler Avallone
COUNSEL FOR DEFENDANT/APPELLANT, ACE PROPERTY AND CASUALTY INSURANCE COMPANY & BRAND ENERGY AND INFRASTRUCTURE SERVICES, INC., Leslie E. Hodge, Mark G. Montiel, Jr.
Panel composed of Judges Fredericka Homberg Wicker, Jude G. Gravois, and Stephen J. Windhorst
GRAVOIS, J.
In this workers' compensation matter, defendants/appellants, Ace Property and Casualty Insurance Company and Brand Energy and Infrastructure Services, Inc., appeal a judgment in favor of claimant Silvio Cuadra, finding that Mr. Cuadra suffered a compensable work-related accident and injury. The workers' compensation judge found Mr. Cuadra to be temporarily totally disabled and ordered the reimbursement/reinstatement of indemnity and medical benefits. Additionally, the court awarded Mr. Cuadra penalties and attorneys' fees against defendants, plus interest and costs. For the following reasons, we affirm. FACTS AND PROCEDURAL HISTORY
On March 31, 2012, the date of the accident, Mr. Cuadra was employed by defendant Brand Energy as a laborer. He was 50 years old. Originally from Nicaragua, Mr. Cuadra lived with his wife and children in Miami, Florida. Spanish is Mr. Cuadra's first language, though he understood some English. At the time of the accident, Mr. Cuadra was working at the Valero Refinery in Norco, Louisiana, which was engaged in a major expansion of the plant. He had been on the job approximately four days when the accident occurred.
Oscar Reyes, Mr. Cuadra's co-worker and foreman, witnessed the accident. Mr. Reyes testified at his deposition that Mr. Cuadra was a scaffolding helper whose job required him to pass material up and down the scaffold. The accident occurred around 4:10 p.m., which was close to quitting time. Mr. Cuadra was on the ground while another co-worker was on the scaffold above him. As they were passing items, the co-worker on the scaffold dropped a steel coupler, which Mr. Reyes described as a solid steel bar or pipe approximately two feet long. According to Mr. Reyes, Mr. Cuadra was crouched and looking down at the time and did not see his co-worker drop the bar or pipe, and thus was unable to avoid getting hit. Mr. Reyes testified that the coupler struck Mr. Cuadra in the head, breaking his hard hat in half. Mr. Reyes' testimony was unclear as to whether Mr. Cuadra lost consciousness, although he said after Mr. Cuadra was hit, he and other workers had to sit Mr. Cuadra up. Mr. Reyes also saw that Mr. Cuadra's head was cut open, noting that Mr. Cuadra bled on his work uniform and shirt. Mr. Reyes helped move Mr. Cuadra to the Brand trailer on site, where they reported to Jose Sardina, the safety officer, and the Brand superintendent, LaBaron Sylvester. Mr. Cuadra's bloodied work clothing was removed and he was given a clean uniform. Mr. Reyes testified that the hard hat was thrown away and Mr. Cuadra was given a new one. While in the trailer, Mr. Cuadra complained of dizziness and head pain. Mr. Reyes testified that no medical attention was given to Mr. Cuadra on the work site other than an ice pack from Mr. Sylvester.
Both Mr. Sardina and Mr. Sylvester gave depositions in this matter, where they both denied any memory of this accident.
Mr. Cuadra's roommate, Pablo Molina, testified via deposition that he also worked at the Valero site as a laborer but did not witness the accident. When Mr. Cuadra did not meet him at the end of the shift to ride home together, Mr. Molina was told that Mr. Cuadra had been in an accident. He saw Mr. Cuadra in the Brand trailer after the accident, where someone told him that Mr. Cuadra had been struck in the head with a steel bar. Mr. Molina was told to drive home without Mr. Cuadra, who was brought home later by Mr. Sardina, according to Mr. Cuadra's first deposition. Later that evening at home, Mr. Molina said that Mr. Cuadra complained of being in a lot of pain, and tried to call Mr. Sardina in order to ask for medical care as per instructions he had been given at work, but could not reach him. Mr. Molina brought Mr. Cuadra to the East Jefferson Hospital emergency room that night, where he received approximately eight staples in his scalp to close the wound. He was seen again at East Jefferson Hospital on April 10, 2012 for removal of the staples.
Mr. Molina testified that he and Mr. Cuadra had worked together for several years on various jobs in different locations throughout the south. They were sharing temporary lodging while working at Valero.
Mr. Cuadra gave two depositions in this matter, one in 2012 and one in 2018.
Mr. Reyes testified that Mr. Cuadra returned to work the next day and for several days after that, but stayed inside the Brand trailer at the direction of Mr. Sardina and Mr. Sylvester, and did not go out to work at the scaffolding site. Mr. Cuadra, at his first deposition in this matter, taken in 2012, confirmed that for the next week, he sat in the trailer and that Mr. Sardina entered his hours for him as if he were working on the scaffolding.
Because this matter was not filed until 2018, the record is unclear as to exactly when Mr. Cuadra began receiving workers' compensation benefits, but it appears that it was not until approximately seven to eight months after the accident. In the meanwhile, in April of 2012, Mr. Cuadra saw neurologist Dr. Raul Reyes in Kenner, with complaints of dizziness and problems with memory, vision, and balance. Dr. Reyes diagnosed cerebral concussion, cervical spine strain, lumbosacral sprain, thoracic spine sprain, headache, vertigo, and tinnitus (ringing in the ears). Mr. Cuadra also sought treatment with Dr. Raul Grosz, a neurologist, in November of 2012, who reviewed prior diagnostic tests and diagnosed him with closed head trauma, concussion, and depression. At his behest, additional diagnostic tests were performed (CAT scan of the head and neck, MRI of the brain, an EEG, and a BEAR test to measure inner ear function). These tests results were interpreted as "normal," i.e. , not showing any objective findings.
Mr. Cuadra's pretrial statement indicated that he had previously received workers' compensation benefits for this accident until benefits were terminated on December 4, 2017. Other references are made throughout the record suggesting that Mr. Cuadra did not begin receiving workers' compensation benefits or covered medical care until several months after the accident.
Dr. Grosz recommended that Mr. Cuadra see a psychiatrist. The medical records show that Mr. Cuadra next treated with Dr. Alexander Kushch, a neuropsychologist, who examined him and diagnosed major depressive disorder, concussion, post concessional disorder, closed head trauma, severe psychotic symptoms, and herniation of cervical disc at C5-C7. Dr. Kushch administered some performance based tests, whose results he felt should be viewed with caution, noting that malingering may be an issue.
Mr. Cuadra treated with various doctors in Florida during this time for serious and progressive cognitive deficits, headaches, neck pain, and depression and anxiety, including Dr. Brad Herskowitz, treating neurologist, and Dr. Safir Azam, treating psychiatrist with experience treating traumatic brain injuries, who started treating Mr. Cuadra in June of 2013.
Dr. Azam's deposition, taken in 2018, was introduced into evidence.
Because his cognitive abilities had significantly deteriorated, in 2015, Mr. Cuadra was placed under plenary guardianship by the Circuit Court for Miami-Dade County, Florida, after a panel of three doctors determined that he could not handle his own affairs. His wife, Tessalia V. Rocha, was appointed as his guardian. Also, the record contains information showing that Mr. Cuadra was deemed disabled by the Social Security Administration due to the injuries he sustained in the March 31, 2012 work accident.
The Florida guardianship panel consisted of Dr. Neda Picuric, M.D., a psychiatrist; Dr. Enrique Suarez, Ph.D., a neuropsychologist; and Dr. Jethro Toomer, Ph.D., a psychologist. This panel also reviewed some of Mr. Cuadra's medical records.
According to Mr. Cuadra's pretrial statement, a plenary guardianship is similar to Louisiana's full interdiction. Mrs. Rocha explained that she was responsible for all of her husband's affairs, as well as his daily care, as he was unable to perform any of those activities.
The 1008 Disputed Claim for Compensation form contained in this record dated May 11, 2018 was filed on May 15, 2018, alleging that defendants terminated Mr. Cuadra's benefits on December 4, 2017 based on a "tainted" independent medical examination ("IME"), wherein defendants allegedly had inappropriate contact with the IME doctor, Richard Roniger, in violation of La. R.S. 23:1317.1(E)(2). The 1008 form also alleges that defendants were aware that Mr. Cuadra was under plenary guardianship and had previously been deemed disabled by the Social Security Administration due to the injuries made subject to the 1008 form.
Trial on the merits of the matter was held on October 15, 2018. Two live witnesses testified: Mr. Cuadra's wife and his adult daughter. Mr. Cuadra did not testify, but his two depositions, from 2012 and 2018 respectively, were entered into evidence. The parties entered into several stipulations and Mr. Cuadra's extensive medical records were introduced as exhibits, as well as the depositions of other witnesses, including medical and fact witnesses. The workers' compensation judge took the matter under advisement and accepted post-trial briefs from the parties. On January 11, 2019, the judge ruled in favor of Mr. Cuadra, finding that he proved a compensable accident and temporary total disability resulting therefrom. In addition to reinstatement of benefits, the court awarded Mr. Cuadra penalties and attorneys' fees. This timely appeal followed.
An interpreter was present to translate Mrs. Rocha's testimony.
Defendants do not appeal the award of penalties and attorneys' fees.
On appeal, appellants argue three assignments of error: (1) that Mr. Cuadra failed to prove by a preponderance of the evidence that he suffered a traumatic brain injury ; (2) that the trial court erred in applying the Housley presumption, because Mr. Cuadra had displayed similar symptoms prior to the accident, as shown by his medical records; and (3) that the trial court erred in relying on the opinions of Mr. Cuadra's treating doctors rather than giving the opinion of the independent medical examiner more weight.
STANDARD OF REVIEW
The determination of whether an employee is entitled to workers' compensation benefits is based on the facts and circumstances of each case, taking into consideration that the laws governing workers' compensation must be construed liberally in favor of the employee. Washington v. Shaw Group., Inc. , 10-568 (La. App. 5 Cir. 5/10/11), 68 So.3d 10, 16, writ denied , 11-1211 (La. 9/23/11), 69 So.3d 1159, citing Alfortish v. Roughneck Construction, LLC , 09-870 (La. App. 5 Cir. 5/11/10), 40 So.3d 1004.
"Appellate review is governed by the manifest error or clearly wrong standard in workers' compensation cases." Villatoro v. Deep South BH & R Enterprises, LLC , 16-307 (La. App. 5 Cir. 12/7/16), 206 So.3d 428, 434, writ denied , 17-0036 (La. 2/10/17), 216 So.3d 45. "An appellate court may only reverse a workers' compensation judge's factual determinations if it finds from the record that a reasonable factual basis for the finding does not exist, or that examination of the entire record reveals that the finding is clearly erroneous. Where two permissible views of the evidence exist, the factfinder's choice between them cannot be manifestly erroneous or clearly wrong. Even though an appellate court may feel its own evaluations and inferences are more reasonable than those of the factfinder, reasonable evaluations of credibility and reasonable inferences of fact should not be disturbed on review where conflict exists in the testimony." Id. (Internal citations omitted.)
This assignment of error is discussed first because resolution of the applicable burden of proof affects this Court's analysis of the remaining assignments of error.
Trial court erred in applying the Housley presumption
Appellants argue in their second assignment of error that this Court should conduct a de novo review of the record, rather than applying the manifest error standard of review, because the trial judge committed an error of law that interdicted the judge's findings. This error of law, they argue, was the trial judge's reliance on the Housley presumption.
The Housley presumption states that "[a] claimant's disability is presumed to have resulted from an accident, if before the accident the injured person was in good health, but commencing with the accident the symptoms of the disabling condition appear and continuously manifest themselves afterwards, providing that the medical evidence shows there to be a reasonable possibility of causal connection between the accident and the disabling condition." Housley v. Cerise , 579 So.2d 973, 980 (La. 1991), quoting Lucas v. Insurance Company of North America , 342 So.2d 591 (La. 1977). Appellants argue that the trial court erred in applying the presumption because the medical records showed that Mr. Cuadra had previously reported symptoms of anxiety and depression, which are some of the same symptoms he reported to doctors after the accident.
Mr. Cuadra argued in his post-trial brief that the trial judge should apply the Housley presumption to find the causal link between Mr. Cuadra's work accident and his current condition. Generally, a presumption does not have any probative value, but merely provides the fact-finder with a conclusion in the absence of proof to the contrary. Franks v. Air Conditioning Appliance Corp. , 95-01135 (La. App. 3 Cir. 1/31/96), 670 So.2d 322, 325, citing Turner v. Turner , 455 So.2d 1374, 1379 (La. 1984).
However, as evidenced by the judgment itself and the written reasons for judgment, the trial judge did not rely on any presumptions, Housley or otherwise, in reaching her judgment. Neither the judgment itself nor the reasons for judgment cite Housley. Nor did the trial judge state that she employed any presumptions, legal or factual, in reaching her judgment. The reasons for judgment state that the judge evaluated the credibility of witnesses who testified before her and the medical evidence in reaching her judgment. This assignment of error is thus devoid of merit. This Court will accordingly proceed under the manifest error/clearly wrong standard of review.
It is a well settled rule that the district court's oral or written reasons for judgment form no part of the judgment, and that appellate courts review judgments, not reasons for judgment. Wooley v. Lucksinger , 09-0571 (La. 4/1/11), 61 So.3d 507, 572. Judgments are often upheld on appeal for reasons different than those assigned by the district judges. "The written reasons for judgment are merely an explication of the trial court's determinations. They do not alter, amend, or affect the final judgment being appealed .... " Id. , citing State in the Interest of Mason , 356 So.2d 530, 532 (La. App. 1st Cir. 1977).
Further, upon review, we disagree with appellants' contention that Mr. Cuadra exhibited the "same" relevant symptoms prior to the accident as he did afterwards. Appellants argue primarily that Mr. Cuadra's pre-accident medical records from Dr. Anselmo Humaran, which range from 2007 until 2010, show that he suffered from anxiety and depression prior to this accident. A review of those medical records shows that Mr. Cuadra did report feeling anxious on occasions prior to his accident. Appellants also argue that the list of symptoms recorded by Dr. Humaran on records of visits in 2010 collectively exhibit all the hallmarks of depression, even though Dr. Humaran did not make that explicit diagnosis. They also point to a handwritten note on Dr. Humaran's otherwise typed medical records which, they argue, shows that Dr. Humaran prescribed certain medications to Mr. Cuadra that are used to treat anxiety and depression. However, Mr. Cuadra (in his 2012 deposition) and his wife denied that he ever was prescribed or took these medications.
In any event, the relevant injury claimed by Mr. Cuadra in these proceedings is the significant loss of cognitive brain function from a brain injury caused by his workplace accident. Neither Dr. Humaran's records, nor any other evidence from prior to the accident, contain any indication that prior to this accident, Mr. Cuadra suffered from or complained of loss of cognitive function. This assignment of error is without merit.
This assignment of error is also taken out of order because its resolution affects the remaining assignment of error.
Weight to be given to the IME doctor's opinion
In this assignment of error, appellants argue that the trial court erred as a matter of law in assigning less weight to the opinions of the IME doctor than to the opinions of Mr. Cuadra's treating physicians. They argue that the IME doctor, Richard Roniger, and the second medical opinion ("SMO") doctor, Rennie Culver, are the only two doctors who reviewed the entirely of Mr. Cuadra's medical records, and thus the opinions of those treating physicians who did not review the entirety of Mr. Cuadra's medical records are less reliable or probative in determining whether Mr. Cuadra proved he suffered a compensable traumatic brain injury. They also argue in brief that Mr. Cuadra's treating physicians do not have Louisiana medical licenses and are thus less credible than the IME/SMO doctors, who do have Louisiana medical licenses. Finally, they argue that Mr. Cuadra's treating physicians were unable to diagnose him as "malingering" because they were not aware of the "medico legal" context in this matter, unlike the IME/SMO doctors, who were fully aware that their examination of Mr. Cuadra stemmed from his disputed claim for workers' compensation.
In reply, Mr. Cuadra contends that the relative weight that the trial judge afforded to the IME medical opinion of Dr. Roniger relative to the treating physicians' opinions was within her discretion, and her conclusion that the IME doctor's opinions should not be afforded greater weight than Mr. Cuadra's treating physicians was supported other factors, such as Dr. Roniger's admitted lack of expertise in identifying and treating traumatic brain injuries.
In the reasons for judgment, the trial judge specifically stated:
After the work accident, Cuadra relocated to his home in Florida where he treated with Dr. Kushch, a neuropsychologist, Dr. Grosz, a neurologist, and Dr. Azam, a psychiatrist. Dr. Azam opined that Claimant was completely disabled and unable to return to work. Claimant underwent a second medical opinion on November 15, 2015 by Dr.
Culver, a psychiatrist, who opined that Claimant was malingering. Thereafter, Claimant underwent an independent medical examination by Dr. Roniger on June 9, 2016. Dr. Roniger opined that Claimant was malingering. "As a general rule, the testimony of a treating physician should be accorded greater weight than that of a physician who examines a patient only once or twice. However, the treating physician's testimony is not irrebuttable, and the trier of fact is required to weigh the testimony of all medical witnesses." Mosley v. Pennzoil Quaker State , 850 So.2d 1100 (La. App. 2nd Cir. 7/23/03). La. R.S. 23:1123 provides for the appointment of an IME when there is a conflict in the medical evidence. An IME's medical conclusions should be given significant weight because the IME is an objective party. Nevertheless, the opinion of the IME is not conclusive, and the WCJ must evaluate all of the evidence presented in making a decision as to a claimant's medical condition. Id.
Upon reviewing the medical records and deposition testimony, the Court finds that the medical opinions of the IME doctor are not afforded greater weight because of the doctor's lack of expertise in traumatic brain injuries and its symptoms. In contrast, Doctors Picuric, Suarez, and Azam have extensive expertise in treating individuals with traumatic brain injuries.
This Court recently explained, in Villatoro v. Deep South BH & R Enterprises, LLC , supra , 206 So.3d at 436, the role of the IME doctor as explained in statute and jurisprudence:
La. R.S. 23:1123, which provides for the appointment of an IME when there is a conflict in the medical evidence, provides that the report of the IME shall be prima facie evidence of the facts therein stated. The courts have interpreted La. R.S. 23:1123 to mean that an IME's medical conclusions should be given significant weight because the IME is an objective witness. Fritz v. Home Furniture-Lafayette , 95-1705 (La. App. 3 Cir. 7/24/96), 677 So.2d 1132, 1136. Nevertheless, the opinion of the IME is not conclusive, and the trial judge must evaluate all of the evidence presented in making a decision as to the claimant's condition. Jennings Am. Legion Hosp. v. Daigle , 01-621 (La. App. 3 Cir. 11/14/01), 801 So.2d 550, 553, writ denied , 01-3294 (La. 9/5/03), 852 So.2d 1038. The weight given to the testimony of an IME can be lesser or greater depending on the qualifications or expertise of the physician, the type of examination he performs, his opportunity to observe the patient, his review of other physicians' examinations and tests, and any other relevant factors. Id.
Our review of the deposition of Dr. Roniger confirms the trial judge's finding that he had a significant lack of expertise in evaluating patients for traumatic brain injuries. Dr. Roniger himself testified that in his practice, he does not usually treat patients with traumatic brain injury, explaining "I think some doctors do that really well and I don't. Usually the hospital-based doctors have access to things like CAT scan machines and MRIs and EEGs and that kind of thing. And usually they do best with a team effort, not me in an office, but a team of people."
Also, as Mr. Cuadra aptly points out in brief to this Court, Dr. Roniger's (and Dr. Culver's) conclusion that Mr. Cuadra is malingering, rather than displaying evidence of a brain injury, directly contradicts the independent findings of Dr. Safir Azam, M.D., Mr. Cuadra's treating psychiatrist; Dr. Bradley Herkowitz, M.D., his treating neurologist; Dr. Raul Grosz, M.D., his treating neurologist; Dr. Raul Reyes, M.D., his treating internist; Dr. Louis Pagan, M.D., SMO neurologist; Dr. Neda Picuric, M.D., the Plenary Guardianship Committee psychiatrist; Dr. Enrique Suarez, Ph.D., the Plenary Guardianship Committee neuropsychologist; Dr. Jethro Toomer, Ph.D., the Plenary Guardianship Committee psychologist; and Dr. Alexander Kushch, Ph.D., psychologist; all of whose records were introduced and reviewed by the trial court, and all of whom have significantly more experience than Dr. Roniger in diagnosing and/or treating traumatic brain injury.
Further, contrary to appellants' position, Washington v. Shaw Group., Inc. , supra , does not establish a bright line rule calling for the discrediting of a doctor's opinion when that doctor has not reviewed all of the medical records. Interestingly, in Shaw , it was the IME doctor's opinion that was discounted when that doctor admitted that he had not reviewed pertinent medical records. Shaw , 68 So.3d at 16. It appears, as per La. R.S. 23:1123, that it is a crucial part of an IME doctor's duty to review all pertinent medical records (i.e. , the medical evidence) given that his function in the case is not to treat the claimant, but rather to aid the court when there is a conflict in the medical evidence. Shaw , therefore, in this respect, appears to be limited to IME doctors.
Also contrary to appellants' assertions, several of the treating physicians (who did review available medical records), as well as the doctors on the Florida guardianship panel, did consider whether Mr. Cuadra might be malingering, despite allegedly not being aware of the "medico legal" context of their consultation with Mr. Cuadra. Dr. Azam discussed the possibility of malingering in his deposition, as did Dr. Picuric; both rejected it in Mr. Cuadra's case. Dr. Kushch, after analyzing Mr. Cuadra's functioning on several performance tests, listed "malingering" as a possibility along with several other conclusions, though he ultimately concluded that Mr. Cuadra was not malingering.
Appellants do not define this term nor explain how it would change a doctor's opinion.
Dr. Azam testified in his deposition that he was aware of Mr. Cuadra's workers' compensation case.
It is also noted that the doctors on the guardianship panel examined Mr. Cuadra in a "medico legal" context, given that guardianship is a legal proceeding, though perhaps not the same "medico legal" context that appellants posit.
In brief, appellants also advance the argument that the treating physicians, many of whom do not have Louisiana medical licenses, are somehow less credible than the IME doctor who holds a Louisiana medical license. We know of no rule or directive that states a doctor is more credible if he is licensed in the same state where the workers' compensation proceeding is based. We decline to give any credence to this argument as advanced in appellants' brief.
The record shows that several of Mr. Cuadra's treating physicians provided services to Mr. Cuadra in his home state of Florida, where they are licensed.
This assignment of error is without merit.
FIRST ASSIGNMENT OF ERROR
Alleged injury not proven by objective evidence
In this assignment of error, appellants argue that the trial court was manifestly erroneous in finding that Mr. Cuadra sustained a traumatic brain injury. They argue that Mr. Cuadra's records from his emergency room visit to East Jefferson Hospital on the date of the accident are devoid of information supporting such a diagnosis. They argue that the only diagnoses made at the emergency room were a head contusion, cervical strain, and a four-centimeter laceration to Mr. Cuadra's scalp. Appellants argue that the records show that Mr. Cuadra got a perfect score on the "Glasgow Coma scale," and that the diagnostic tests performed that evening, which include a CT scan, were "normal," according to the evaluation of those records by SMO doctor Rennie Culver and IME doctor Richard Roniger. Appellants cite Cole v. State Dep't of Pub. Safety & Corr. , 01-2123 (La. 9/4/02), 825 So.2d 1134, in support of their contention.
Mr. Cuadra counters in brief that the IME/SMO doctors focused solely on the emergency room reports and not the entirety of Mr. Cuadra's medical records, which both doctors said they reviewed, including the reports of the aforementioned treating physicians and of the Florida physicians who approved Mr. Cuadra's application for plenary guardianship.
Upon review, we find that the Cole case's facts and rationale do not provide support for appellants' position. In that workers' compensation case, the claimant was injured during a police training exercise, where he immediately claimed injury to his arm and shoulder, but not his head, as reflected in his immediate treatment records. Cole , 825 So.2d at 1143-44. Not until five months after the accident did the claimant first complain of head injury symptoms allegedly caused by the accident in question, despite the fact that the claimant had not claimed a head injury immediately following the accident. Id. Video footage of the training, which included the moment of injury, failed to show the claimant sustaining any contact to his head during the training exercise. Id. at 1148, n. 1. Accordingly, the court found that there was no evidence supporting his claim of head injury. Id. at 1146.
Mr. Cuadra received medical treatment and workers' compensation benefits for his arm and shoulder injuries.
Here, it is undisputed that Mr. Cuadra sustained a direct injury to his head. The record is clear that Mr. Cuadra also suffered an injury to his brain. Mr. Cuadra was diagnosed with a concussion by Dr. Reyes, whom he saw shortly after the accident in Louisiana. Both Doctors Culver and Roniger agreed that Mr. Cuadra suffered a concussion, which they described as a mild brain injury, and some post-concussive syndrome symptoms as well. Further, Dr. Roniger also stated in his deposition that a person who had sustained a loss of consciousness, such as Mr. Cuadra, could in fact score perfectly on the Glasgow Coma scale if he had regained consciousness by the time the test was administered. The record is clear that Mr. Cuadra was conscious when Mr. Molina took him to the emergency room and when he was examined there.
Appellants contend that the workers' compensation judge failed to determine in her reasons for judgment how long Mr. Cuadra was unconscious, which they claim is one of the main criteria for a credible diagnosis of a traumatic brain injury. The judge's finding in her reasons for judgment, however, accurately reflect the information in the record. The length of time Mr. Cuadra was unconscious, if any, was unclear. Mr. Reyes' deposition testimony suggests a brief loss of consciousness, not more than the 3-5 minutes, as was reported to Dr. Reyes in April of 2012. Of note, the emergency room records from the night of the accident contained numerous inaccuracies, such as the assertion that Mr. Cuadra reported having seizures at home. Several treating doctors said that Mr. Cuadra himself would not be a reliable witness, as people who have been knocked unconscious are themselves typically independently unaware of the duration of their unconscious state, and often do not remember it. Only in later treatment records is Mr. Cuadra's unconsciousness reported to be 3-5 hours, which is clearly wrong. However, the testimony of the various doctors in this record, taken as a whole, shows that while the time Mr. Cuadra was unconscious was a relevant and important factor in their diagnoses and treatment, it was not independent or exclusive of all other factors, and was not viewed in isolation by any medical witness in this case. Dr. Azam, as well as Dr. Picuric, testified that Mr. Cuadra's current condition, as well as his gradual decline in cognitive function, was consistent with a traumatic brain injury.
It appears that some of the record keeping throughout this case was hampered at times by the lack of a Spanish interpreter.
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Upon review, we find that the evidence clearly shows that Mr. Cuadra sustained an injury to his head , unlike the claimant in Cole . Appellants focus on the lack of evidence of injury in Mr. Cuadra's diagnostic tests. Dr. Azam stated in his deposition that there are often no objective signs of traumatic brain injury revealed by the CT scan and MRI. He explained that a blow to the head can be a "shearing" action that disrupts or breaks the connections of neurons in the brain, and that such injuries are not visible on these tests. He said that edema, or swelling, in the brain, which is the body's response to the injury, would likely be visible on an MRI performed three to seven days after the injury. He explained that edema develops within that time frame but also dissipates, which explains why it would not be visible on a later MRI. In this case, no MRI was performed in this window of time.
Dr. Azam and the doctors on the plenary guardianship panel related Mr. Cuadra's current symptoms and lack of cognition to the work injury of March 31, 2012, as well as his previous progressive decline in the months after the injury. Dr. Azam also stated in his deposition that Mr. Cuadra's affect, gait, facial expressions, and manner in his treatment sessions were objective signs consistent with traumatic brain injury, which can produce a range of after effects or symptoms.
Accordingly, our review of the record supports the trial judge's conclusions. We thus find no manifest error in the trial judge's conclusion that Mr. Cuadra proved the causal link between his compensable workplace injury and his current medical condition. This assignment of error is without merit.
CONCLUSION
For the foregoing reasons, we affirm the judgment under review in favor of Mr. Cuadra. All costs of this appeal are taxed to appellants.