Appeal of Southern New Hampshire Health Systems, Inc.
Risk Enterprise Management (Risk Enterprise), third party administrator for the insurance carrier of the employer, Southern New Hampshire Health Systems, Inc. (SNHHS), appeals an order of the workers' compensation appeals board (board) finding the employer liable for medical treatment of the claimant, Laurie Merchant-Primeau, an SNHHS employee, and ruling that she was entitled to a permanent partial impairment award. We affirm.
We will overturn the board's decision only for errors of law, or if we are satisfied by a clear preponderance of the evidence before us that the decision is unjust or unreasonable. Appeal of Dean Foods, 158 N.H. 467, 471 (2009). The board's factual findings are prima facie lawful and reasonable. See RSA 541:13 (2007). In reviewing the board's findings, "our task is not to determine whether we would have found differently than did the board, or to reweigh the evidence, but rather to determine whether the findings are supported by competent evidence in the record." Appeal of Dean Foods, 158 N.H. at 474 (quotation omitted). As the appealing party, Risk Enterprise bears the burden of proof. Id. at 471.
We first address whether the board erred when it found the employer liable for the disputed medical treatment. "An employer has a continuing obligation to provide or to pay for medical, hospital and remedial care for as long as is required by an injured employee's condition where it bears liability for the initial injury that necessitated the subsequent health care." Appeal of Wingate, 149 N.H. 12, 15 (2002) (quotation omitted); see RSA 281-A:23, I (2010). "A claimant is entitled to compensation for medical treatment only so long as the condition or disability requiring the treatment is causally related to the initial compensable injury." Appeal of Wingate, 149 N.H. at 15. To meet this burden, a claimant must show that the condition necessitating her need for treatment was caused by her original work-related injury. See Appeal of Sutton, 141 N.H. 348, 350 (1996). The test for causation has two prongs: a claimant must prove both legal causation and medical causation. Appeal of Redimix Cos., 158 N.H. 494, 496 (2009). Legal causation requires a claimant to show that her condition is connected to the work; medical causation requires her to show that it was actually caused by a work-related event. See Appeal of Sutton, 141 N.H. at 350.
Establishing causation "does not end the analysis as to whether [an employer] is responsible for a [claimant's] medical treatment, " however. Appeal of Filion, 145 N.H. 104, 106 (2000). A claimant must still show that the medical treatment "was reasonable and required by the nature of [her] injury." Id. at 106-07. To establish that treatment is "reasonable, " a claimant must present objective evidence that at the time of treatment, it was reasonable for her to seek further treatment, "be it diagnostic or palliative." Appeal of Lalime, 141 N.H. 534, 538 (1996).
In this case, the disputed treatment consisted of chiropractic manipulations and massage therapy. Risk Enterprise challenges only the board's finding that the treatment was causally related to the claimant's original work-related injury in February 2000. In February 2000, the claimant reported to her employer that she had "bilateral wrist pain and numbness and tingling of her digits." Risk Enterprise's argument is based upon its assumption that the claimant's 2000 injury was to her forearms and wrists and that any neck, shoulder or back pain she later experienced was unrelated to it.
The certified record supports the board's finding that the claimant's condition necessitating chiropractic care and massages was causally related to her 2000 injury. For instance, in April 2000, Barbara O'Dea, M.D., described the claimant's symptoms and their causation as follows:
The middle of last week the patient was asked to help out in her old X-ray department again in the File room. She tried doing a variety of tasks other than lifting the heavy folders . . . . She woke up the following day with a marked increase [in] pain in her arms . . . . She also complained of pain radiating into her neck and shoulders.
Also in April 2000, Kathleen C. Leahy, D.O., similarly described the claimant's symptoms: "Symptoms began with [bilateral] hand parestesias developing into [bilateral] hand and wrist pain which progressed to elbow pain, shoulder pain and eventually neck and subscapular pain." In May 2000, Dr. Leahy diagnosed the claimant with "[bilateral upper extremity] cumulative trauma syndrome, " which she opined was "[a]ssociated with work related activities." In June 2000, Dr. Leahy noted that the claimant had a "[m]ild [right] lower [cervical] strain and posterior shoulder strain, " which she believed was "likely secondary" to her "work related issues for cumulative trauma disorder." In November 2000, she described the claimant as having "[upper extremity] cumulative trauma syndrome and secondary cervicothoracic strain." In March 2001, she specifically found that the claimant had "[c]hronic regional myofascial pain in the cervicothoracic area with underlying [cervical] strain secondary associated with work related injuries."
Dr. Leahy's opinions are confirmed by Andrew Forrest, M.D., who, in 2007, conducted an independent medical examination of the claimant and found that her current symptoms, which included ongoing pain in her left elbow, neck and shoulder, "are related to the overuse syndrome, first reported in 02/2000." The surgeon who, in 2006, performed an ulnar nerve decompression and submuscular transposition on the claimant also confirmed Dr. Leahy's findings. When the surgeon examined the claimant in August 2007, he explained that while, because of the surgery, she was "making excellent gains, " she still suffered from "trapezial pain and spasm up into her shoulder and neck secondary to positioning that arm in trying to compensate for her ulnar nerve situation."
Dr. Leahy's observations and opinions are also confirmed by William E. Kois, M.D., who, in October 2007, described the claimant's diagnosis as "chronic cervical/trapezius strain" and "chronic tendonitis of the wrist." In September 2008, he stated that the claimant had a diagnosis of "ulnar neuritis, status post ulnar nerve transposition, tendonitis of the elbow and wrist, as well as cervical and trapezius strain." Likewise, Dr. Benjamin S. Kaplan, the chiropractor who treated the claimant from 2006 until 2008, explained the claimant's symptoms and their cause as follows: "[The claimant] was injured at work on 2-22-2000 while employed as a Dark Room Technician. She developed left arm and neck pain, from constantly lifting x-ray cassettes for processing. These repetitive tasks caused an ulnar neuritis in her left arm, upper trapezius strain, tendonitis and neck pain" as well as "carpel tunnel."
While the board was also presented with medical evidence that the claimant's neck, shoulder and back pain were unrelated to her 2000 work-related injury, when faced with conflicting expert evidence, the board was free to disregard or accept that evidence, in whole or in part. See Appeal of Dean Foods, 158 N.H. at 474.
Risk Enterprise next argues the board erred because it failed to take into account the claimant's "pre-existing condition" when assessing whether the medical treatment for which she now seeks payment was causally related to her 2000 injury. Risk Enterprise focuses upon a work-related injury the claimant sustained at SNHHS in 1999. In January 1999, while pushing a radiology film cart, the claimant "felt and heard a popping sound over her left shoulder." She was diagnosed with a "[t]rapezial muscle strain" for which she received workers' compensation benefits from January 1999 to March 1999.
Risk Enterprise asserts that the board erred by failing to analyze whether the disputed treatment was related to the claimant's 1999 work-related injury. However, both the 1999 and 2000 injuries were compensable. Accordingly, for the board's purposes, it was immaterial whether the claimant's original work-related injury was the 1999 or 2000 injury. As long as the condition for which the claimant sought the disputed treatment was causally related to either injury, the board could reasonably ...