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Bocalbos v. Kapiolani Medical Center for Women and Children3/9/2000
nd prosthodontic treatment recommended by [McRoberts], [Bocalbos] alleges that such treatment is related to her [TMJD].
In a report dated August 25, 1993, [McRoberts] opined that orthodontic treatment was necessary to correct a Class II malocclusion and balancing interferences, which [McRoberts] attributed to the July 25, 1986 work injury . [McRoberts] did not, however, clearly explain how the Class II malocclusion and balancing interferences which allegedly resulted from the work injury were related to [Bocalbos's TMJD]. Accordingly, we find that the orthodontic and orthopedic treatment is not related to [Bocalbos's TMJD].
It appears that the prosthodontic treatment is needed to replace [Bocalbos's] missing teeth. [Bocalbos] was missing teeth before her July 25, 1986 work injury . Accordingly, we find that the prosthodontic treatment is related to a pre-existing dental condition. (Emphases added.)
Relevant to this finding was the Board's conclusion 6, which stated, in pertinent part:
6. With the exception of the extent of [McRoberts's] treatment, we conclude that the Director did not err in awarding [Bocalbos] medical care by [McRoberts] and [Ehrenfeuchter], subject to compliance with the [Medical Fee Schedule of the Hawai`i Administrative Rules]. While [McRoberts] proposed various types of treatment, Employer's liability is limited to treatment related to [Bocalbos's] TMJ dysfunction. We determined that only a portion of [McRoberts's] treatment was related to [Bocalbos's TMJD]. Accordingly, we conclude that Employer is liable for treatment of [Bocalbos] with exercises, soft diet, and soft mandibular orthotic splint, but not for the orthodontic and orthopedic treatment and prosthodontics.
We further conclude the Employer is liable for the treatment of [Bocalbos's] neck by [Ehrenfeuchter], because we have found based on the evidence before us that the neck symptoms for which [Bocalbos] was treated by [Ehrenfeuchter] are related to her work injury . (Emphases added.)
A.
Initially, we observe that as part of her April 14, 1997 motion to reopen the case, Bocalbos offered a letter by McRoberts in which he responded to the Board's ruling that he had not "clearly explain " how the malocclusion was related to the TMJD and rebutted the finding "that the prosthodontic treatment was related to a pre- existing dental condition." We believe it necessary to quote from his letter at length:
(f) The average dental arch has 16 teeth if the third molars (wisdom teeth) erupt. [Bocalbos's] maxillae (upper arch) has 6 teeth plus 2 unerupted third molars. She has no quadrant that is missing all the posterior molars and her missing teeth have always been adequately replaced. Therefore, adequate posterior and total arch support was in place at the time of the accident. Her bite must have been adequate prior to the accident as her upper partial remained unchanged since she first wore the prosthesis. In addition, [Bocalbos] had no [craniomandibular disorder (CMD)]-[temporomandibular disorder (TMD)] symptoms prior to the work accident as reported by her long-time general dentist Dr. Hugh Matsumura [(Matsumura)]. She was functioning normally and was able to chew, swallow, and speak without any difficulty. Furthermore, as already noted in the records, she had never experienced such debilitating pain and other discomforts that caused loss of earnings for such an extended period of time.
(g) When [Wong] initially examined Bocalbos, he found her condyles to be displaced and in that position there was a class II malocclusion. He, therefore, repositioned [Bocalbos's] jaw to the correct condyle-disc-fossa relationship by pulling the m
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