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Grover C. Dils Medical Center v. Menditto6/9/2005
, the subsequent injury must be characterized under the last injurious exposure rule as either an "aggravation" or a "recurrence" of Menditto's previous injuries. Although a claimant's condition will have worsened in either instance, the two terms are not synonymous under the rule. Rather, characterizing the subsequent injury requires the fact-finder to also consider whether the subsequent injury in any way augmented the underlying cause of the disabling condition. And when, as here, a claimant's original symptoms persist at the time of a subsequent injury, determining whether the subsequent injury contributed to the disabling condition's causation is necessarily more difficult.
Other courts have grappled with this issue. The Delaware Supreme Court, in Standard Distributing Co. v. Nally, rejected the proposition that "any work-related event or episode that results in disability constitutes an aggravation" under the last injurious exposure rule. The court recognized that the fact-finder "must focus equally on the causation factor since compensability for the new condition depends on its relationship to 'a new work-connected accident.'" Therefore, it stated, "the question is not whether the employee's pain or other symptoms have returned but whether there has been a new injury or worsening of a previous injury attributable to an untoward event."
And in Rumford Press v. Travelers Insurance Co., the New Hampshire Supreme Court upheld the characterization of a subsequent back injury as a recurrence under the last injurious exposure rule because the subsequent injury, incurred while lifting an object at work, was not a separate and independent cause of the claimant's disability. In that case, expert testimony demonstrated that the claimant's original disability had never reached a medically stable condition, but rather had continued to progressively degenerate, as experienced by the claimant in occasional "aggravations or 'flare-ups.'" The court noted a difference between the aggravation of a stabilized condition and the recurrence, or "worsening or exacerbation," of an existing condition, and it concluded that an aggravation is established when the evidence demonstrates that "the second incident produced results that are not only tied to the disability but have intervened to the extent that they an independent cause of the disability."
Similarly, in Titus v. Sioux Valley Hospital, the South Dakota Supreme Court also likened a recurrence to the continuation or worsening of a previous industrial injury: "The question is not whether later employment contributed to disability, but whether it contributed to the causation of disability." Accordingly, the court concluded that an aggravation occurs when a second injury independently contributes to the cause of the final disability ("an independent aggravation"), but a recurrence is found when symptoms of the first injury persist and "there is no specific incident that can independently explain the second onset of symptoms."
Although this court has not explicitly distinguished the terms "aggravation" and "recurrence" in this context, we similarly deduced, when distinguishing between a newly developed injury and an aggravation in Hayes v. SIIS, that an "aggravation . . . would be the result of a subsequent, intervening injury or cause that caused [the injury] to be put into a worse condition than it was put into by the [previous] accident." Like the Titus court, and consistent with our discussion in Hayes, we recognize that an "aggravation" under the last injurious exposure rule is the result of a specific, intervening work-related trauma, amounting to an "injury" or "accident" under workers' compensation law, that independently c
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