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Bocalbos v. Kapiolani Medical Center for Women and Children3/9/2000
be a necessary part of . . . [Bocalbos's] rehabilitation."
McRoberts wrote that the TMJD, balancing interferences, and the Class II malocclusion were "due" to the accident, and that the "cranio-mandibular problems (including the TMJ dysfunction)" were the result of the accident. He indicated, as had Wong, Sue, and Kimura, that orthodontic treatment was required. Knouse stated that orthodontic and orthognathic treatment must be done "first" and the "combined treatment was . . . necessary to stabilize" the TMJ. (Emphasis added.) Knouse indicated prosthodontic treatment involved implants and bridgework.
McRoberts installed an orthopedic appliance called a Crozat in conjunction with his orthodontic treatment. Finally, McRoberts related that "the standard of care correctly advocated by . . . specialists in TMJ problems include a multiple modality approach, such as dental work, [etc.]" Although Potter, a fourth Employer IME expert, did not agree with orthodontic treatment, he recommended "reconstruction" of her upper and lower teeth. In our view, the Board's findings contained no substantial evidence rebutting Bocalbos's claim that treatment was related to the TMJD. Potter's report was the only medical opinion on which the Board appeared to rely. In its second amended decision and order, the Board stated that "[Potter] . . . indicated . . . it was highly unlikely that [Bocalbos] would benefit from any type of orthodontic treatment when she only had six teeth remaining in the upper arch." However, as the Board admitted, "[Potter] did not render an opinion as to whether such treatment was related to [Bocalbos's] work injury ." Finding 32 (emphasis added). Moreover, as stated previously, Potter himself gave only a qualified opinion, stating, "I qualify this by stating I have not looked at [Bocalbos's] x-rays and have not examined her." In light of the qualifications placed on his opinion, we conclude Potter's report did not constitute substantial evidence supporting a denial of Bocalbos's claim.
Based on the foregoing, we believe there was substantial evidence that the nature of Bocalbos's injury , i.e., her TMJD, required the recommended combined orthodontic, orthopedic, and prosthodontic treatment. We conclude (1) the record lacks substantial evidence to support the Board's finding that orthodontic, orthopedic, and prosthodontic treatments were not related to Bocalbos's TMJD and (2) assuming arguendo there is any evidence which could conceivably be construed otherwise, we are left "with a firm and definite conviction that a mistake made" by the Board in determining that such treatment was not required by Bocalbos's TMJD.
D.
Because conclusion 6 rested on what we determine to be erroneous findings, we regard that conclusion as wrong with respect to the claimed treatment. We conclude denial of the recommended treatment was clearly erroneous and wrong under the standard set forth in HRS ยง 91-14(g)(4) and (5) and the Board's amended decision and order must be vacated on that basis.
VI.
A.
We observe, further, that there was no evidence that prior to the accident Bocalbos experienced symptoms of the type she complains of now. Bocalbos had had dental treatment and appliances prescribed for her. Whatever dental condition existed prior to the accident was not symptomatic. Granted that Bocalbos was missing some of her teeth before July 25, 1986, there is no support in the record for the conclusion that this pre-existing condition caused Bocalbos any disabling problems prior to her injury. Knouse stated that her missing teeth ultimately made treatment "very difficult." It seems that the TMJD, indisputably caused by the work-
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