The Oregon Workers' Compensation Board had to sort out many issues before deciding whether not a "pelvic floor" condition was work related.
At the hearing, the Administrative Law Judge set aside a denial of a new/omitted medical condition for a pelvic floor condition. The Employer appealed this decision, and the injured worker appealed the denial of other conditions, including a left sacroiliac dysfunction and sacroiliitis claim denial.
On appeal, the employer argued that the claimant waived his right to argue that the pelvic floor condition was a direct consequence of the accepted on-the-job injury. The Board reviewed the transcript of the hearing, and found that the Claimant's attorney did not clearly and voluntarily relinquish the injured worker's right to make the claim for the pelvic floor condition. The Board then addressed the actual issue at hand.
In making its decision, the Board explained that a consequential condition is a separate condition that arises from the compensable injury. For example, if in a worker suffers a foot injury that results in an altered gait that, in turn, causes back pain, then the back pain is a consequential condition. In order to successfully make a consequential condition claim, the injured worker must show that the compensable injury and the related treatment are the major cause of the resulting condition. In other words, the compensable injury and related treatment must be the dominant cause of the consequential condition when compared to all other causes combined.
This kind of claim also requires that the injured worker should the actual existence of the claimed condition, which in this case was a "pelvic floor" condition.
the treating physician, and supporting the claim, explained that the tear of the pelvic floor musculature resulted in scar tissue formation that led to nerve irritation. Diagnostic testing like MRIs and bone scans are not useful in diagnosing these conditions. Instead, the physician looked at other factors including findings on physical examination, and the consistency of reported symptoms. The employer try to argue that the physician was inconsistent, pointing to a prior report. However, the physician explained that at that time, he was still developing a diagnosis.
The employer also argued that its expert witnesses' opinions should be adopted is more persuasive. However, the Board felt that because these insurance retained doctors denied the existence of the pelvic floor condition, their opinions were less persuasive.
Turning to the injured worker's appeal of the sacroiliitis, the Board agreed with the ALJ who heard the case at hearing that the medical opinion evidence did not establish the sacroiliitis and sacroiliac dysfunction. The Board pointed out that the treating physicians did not rebut the insurance company retained doctors, and do not review the tests that would confirm the existence of the claimed condition.
Consequential conditions require special proof, and as in most workers' compensation claims, medical opinions are key. If you have a claim for a consequential condition, and have questions, call us at 503-325-8600. we can review your claim, and let you know whether the consequential condition claim makes sense in your case.