Monday, March 26, 2012

MT Case Demonstrates Surgically Precise Causation

I've written before about the difference between medical causation and legal causation.

Sometimes there are cases where legal causation is subject to even more granular refinement based on the placement of certain words, syntax and grammar within a statute, and perhaps because a certain result was desired.

Such is the case in Montana where that state's Supreme Court found that legislative amendments in 2005 did not eliminate the compensability for occupational diseases for which there are underlying or pre-existing causes.

Clarence Grande has been a truck driver for his entire adult life. He began working for City Service Valcon in October 2005, as a long-haul propane truck driver.

In January 2009, Grande had seen Dr. John Schumpert for an independent medical examination related to a prior back injury. Dr. Schumpert reported that Grande did not exhibit symptoms of arthritis at that time.

Dr. Bernadette Van Belois diagnosed Grande as having osteoarthritis with the possibility of an additional diagnosis of inflammatory arthritis, possibly rheumatoid arthritis, seven months later and on July 27, 2009, noted in Grande's medical chart that Grande was unable to continue working as a truck driver because of the significant swelling and pain in his right hand in particular, "that would make any occupation, including a sedentary one, difficult for him."

Let me pause in this narrative and point out the physician's subjective assignment of disability. Dr. Van Belois is rendering a disability opinion solely on the Tolerance segment of the Talmage Triage of disability, and does not address the Risk and Capability scales. I point this out only because by the statement of the facts in the case the result Grande was looking for was retirement from truck driving - but perhaps he could do other things?

Regardless, Grande resigned from his employment with Valcon, effective Aug. 7, 2009, and filed a claim for compensation with the Montana State Fund a few days later. He alleged in his claim that he suffered from an occupational disease in the form of rheumatoid arthritis and osteoarthritis as a result of his employment with Valcon.

Dr. Schumpert reviewed Grande's medical records at the State Fund's request and opined that Grande could continue to work as a truck driver. Dr. Schumpert concluded that Grande was suffering from rheumatoid arthritis, an autoimmune disorder that was unrelated to his employment as a truck driver. Dr. Schumpert also opined that Grande's osteoarthritis was not caused by truck driving and that his work did not aggravate his underlying arthritic condition.

Based on Dr. Schumpert's report, the State Fund denied Grande's claim. Grande sought review by the Workers' Compensation Commission (WCC), which concluded Grande's job duties were the major contributing cause of his arthritis and his condition was compensable.

The State Fund appealed, contending that changes the Legislature made to the laws on occupational diseases in 2005 created a requirement that a worker claiming an occupational disease establish that the damage arose out of, or was contracted in, the course and scope of his work, so that workplace events must be the major contributing cause of his condition.

While the 2005 amendments "changed the definition of occupational disease," the Supreme Court said, "the Legislature did not specify in those changes that an occupational disease is not compensable at all if the underlying cause is a pre-existing condition."

Montana law, as it existed in 2009, defined an occupational disease arising in the course and scope of employment as a condition "established by objective medical findings," for which the "major contributing cause … in relation to other factors contributing to the occupational disease" was work-related.

In fact, the court added, "there is nothing in the plain language (of these amendments) that precludes compensability of an occupational disease any time there is an underlying or pre-existing cause or disposition toward the condition."

The Supreme Court used its vocabulary scalpel to dissect the statute even further, stating state law did not "require the job to be the leading cause of the onset of the disease, but the leading cause contributing to the result, which in this case is the disease's progression to the point where Grande is unable to work."

Wow - I'm still trying to wrap my head around that one! I guess the court is saying that compensability under the statute doesn't go towards how a disease started, or progressed, but that it is determined by what happens at the end of the process - i.e. inability to work.

The reporting of Dr. Van Belois was substantial evidence so the WCC's reliance on the report was permissible the court said.

The case is Montana State Fund v. Grande, No. DA 11-0492, 03/20/2012.

1 comment:

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