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[T] Chung v. GTE Hawaiian Telephone Co.9/9/2004
or little, in any way aggravated Mr. Akamine's heart condition which resulted in his death." Id. at 412, 495 P.2d at 1168.
Korsak, 94 Hawaii at 260, 12 P.3d at 360 (brackets in the original). Accordingly, we "viewed the [employer's] doctors' reports as failing expressly, directly, and specifically to rebut the presumption because the reports did not address whether Korsak's existing low back condition could have, in any way, been exacerbated in the March 1993 [physical therapy] session [for a work-related knee injury ]." Korsak v. Hawaii Permanente Med. Group, Inc., 94 Hawaii 297, 308, 12 P.3d 1238, 1249 (2000) (emphases omitted). See also Nakamura v. State, 98 Hawaii 263, 269-70, 47 P.3d 730, 736-37 (2002).
Hence, while the Board in this case found that "there is no medical evidence that the underlying condition of de Quervain's tenosynovitis or the course of the disease was aggravated or made worse on November 6, 1999 by Claimant's keyboarding duties at work[,]" the HRS ยง 386-85(1) presumption rendered such evidence on behalf of Claimant unnecessary in the first instance and unless and until the Employer came forward with "substantial evidence that the injury is unrelated to the employment." Korsak, 94 Hawaii at 260, 12 P.3d at 360 (citation and block quote format omitted; emphasis omitted); Nakamura, 98 Hawaii at 268, 47 P.3d at 735 ("Once the trier of fact determines that the employer has adduced substantial evidence that could overcome the presumption, it must then weigh that evidence against the evidence presented by the claimant. In so doing, the employer bears the burden of persuasion in which the claimant is given the benefit of the doubt." (Citations omitted.)).
In this endeavor, by law, " he primary focus of the medical testimony should have been a discussion on whether the employment effort, whether great or little, in any way aggravated [Claimant's left de Quervain's tenosynovitis]." Korsak, 94 Hawaii at 260, 12 P.3d at 360 (citation and internal quotation marks omitted; some brackets in the original). Given the evidence noted by the Board that Claimant's work activity appeared to exacerbate her condition, this was "the obvious issue that a reasonable trier of fact would logically need to resolve[.]" Nakamura, 98 Hawaii at 269, 47 P.3d at 736.
Instead, Employer proffered the opinion of Dr. Cupo, to the effect that Claimant's left de Quervain's tenosynovitis was caused by her November 6, 1999 hyperextension injury at home; and the opinion of Dr. Hector, to the effect that Claimant's then-resolving left de Quervain's tenosynovitis -- or perhaps it was mild left carpal tunnel syndrome -- was caused by obesity. "But, while it may be sound medically to say that the work did not 'cause' [Claimant's condition], it may be bad law, because, in general, existing law treats the slightest factor of aggravation as an adequate 'cause.'" Korsak, 94 Hawaii at 260, 12 P.3d at 360 (citation and block quote format omitted). More to the point, neither the evidence relied upon by the Board, nor the record as a whole, contains any medical evidence that "expressly, directly, and specifically . . . rebut the presumption because the reports did not address whether [Claimant's left de Quervain's tenosynovitis] could have, in any way, been exacerbated [by her work activity]." Korsak, 94 Hawaii at 308, 12 P.3d at 1249 (emphases omitted). Indeed, the doctors do not appear to have even considered whether Claimant's injury was exacerbated in any way by her keyboarding work.
III. Conclusion
Because "such generalized medical opinions" as were relied upon by the Board in this case "do not constitute 'substantial evidence[,]'" Korsak, 94 Hawaii at 261, 12 P.3d at
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