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Grover C. Dils Medical Center v. Menditto6/9/2005
ontributes to the subsequent disabling condition. Thus, to be considered an aggravation, the subsequent injury must amount to more than "merely the result of the natural progression of the pre-existing disease or condition," which becomes increasingly painful with the performance of normal work duties. Instead, when symptoms of an original injury persist and when no specific incident can independently explain the worsened condition, the condition is a recurrence of the original injury.
Finally, determining which employer is liable in successive industrial injury cases requires that "aggravation" and "recurrence" be distinguished in the legal sense, not just the medical sense. As the Nally court noted, "from a medical standpoint, opining physicians are more concerned with symptomatology than causation, and may[, as here,] use the term[s 'recurrence' and 'aggravation'] interchangeably in diagnosis." Nevertheless, when determining whether a claimant with an ongoing condition suffered an "aggravation" under the last injurious exposure rule, the fact-finder should be concerned with whether the subsequent incident caused the original condition to worsen physically, not merely whether it merely caused additional pain to manifest itself. And generally, " ecause an injury is a subjective condition, an expert opinion is required to establish a causal connection between the incident or injury and disability." "Evidence that an injury merely worsened is not sufficient to prove aggravation."
Here, the appeals officer based her conclusion on our discussion in Collett Electric v. Dubovik. In Collett, the claimant occasionally experienced hand-numbness symptoms while working for his previous employer; however, he was able to alternate tasks so that the problem did not significantly interfere with his work. The claimant then switched employers and, although the new work activities were similar to those at his previous employment, the conditions were substantially harsher and the work was more strenuous. Within a few weeks, the claimant's symptoms had increased to the point that he could no longer work, and he was diagnosed with cumulative trauma nerve entrapment syndrome. Noting that the claim had been treated as an occupational disease case, we determined that the previous employer was improperly held responsible for the claimant's condition because, under the last injurious exposure rule in occupational disease cases, the most recent employer is held responsible if its workplace environment could have been a contributory cause of the disease. We then went on to note that treating Collett as an injury case would not have made a difference because the evidence demonstrated that the most recent employment's conditions actually did contribute significantly to the causation of the disabling condition. Therefore, the claimant's disability could not have been considered a recurrence.
Collett does not stand for the proposition that any work-related incident that results in increased symptoms necessarily contributes to the causation of a disabling condition, and it is distinguishable from the present case. Unlike the Collett claimant, Menditto was not diagnosed with a cumulative trauma injury, where each additional trauma caused by increasingly difficult work conditions would necessarily independently explain the condition's worsening. In Collett, once it was shown that the claimant's subsequent workplace environment caused additional trauma, that employment necessarily contributed to the causation of his underlying, cumulative condition. Although Menditto's employment with Dils Medical could have physically exacerbated her condition, the worsening of her type of underlying injury was not necessarily caused by
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