The Oregon Workers' Compensation Board recently ruled on a case involving an occupational disease for calcific tendinitis in the left shoulder.
An "occupational disease" is a claim that employment conditions over a period of time where the major contributing cause of the actual medical problem. In order to prove this kind of claim, an injured worker must show, through medical opinion, that the work activities were the major cause of the development of the medical condition when compared to all other factors combined. This includes off work activities.
The Board is often called upon to weigh and sort out conflicting medical opinions. In order to determine the strongest opinion, the Board looks at which opinion is both well reasoned, and based on an accurate understanding of the information underlying the claim.
In this case, the Board agreed with the ALJ who heard the case that the treating physician's opinion supporting the claim was not well explained. Even though the treating physician actually observed the injured worker's left shoulder during surgery, the Board found that the surgeon was unable to explain how his observations at surgery helped him determine that the work activity was the major cause of the calcific tendonitis.
The Board instead adopted the opinion of the insurance retained physician, who examined the injured worker. The insurance retained physician did feel that the work activity contributed to the development of the calcific tendonitis, but not to the level that it was the dominant, or major cause of the development of the condition. Instead, the insurance retained physician felt that degenerative changes in the rotator cuff were the major cause of the development of the calcific tendinitis.
This case shows the unique nature of occupational disease claims. Often, it is more so the observations of the Claimant's activities at work then observations on surgery that will make or break the occupational disease claim. The opinion also implies that the surgeon was probably not very specific in expressing his opinion regarding the relationship between the work activity and the calcific tendonitis.
If you are dealing with an occupational disease claim in Oregon, call us at 503-325-8600. We have extensive experience working with injured workers out of our Astoria and Beaverton offices, and under the Oregon statute, we are in a fee only if we are successful in overcoming a denied claim.