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In re Compensation of Pruitt3/9/2005
degenerative disc disease or scarring from claimant's earlier surgery, was the major contributing cause of the need for treatment at L5-S1. We disagree.
Moore's reports, seen (as the board suggests) "as a whole," support the board's order. Her first response to SAIF's query about claimant was ambiguous; she concurred with mutually exclusive reports from Vessely. In an attempt to clarify that ambiguity, claimant's attorney wrote Moore and asked her whether claimant's activities while working for SAIF's insured pathologically worsened or aggravated the pre-existing condition at L5-S1. She responded that they did. Citing Deitz and Bryant, she also agreed that "the mechanism of this pathological worsening or aggravation the continual twisting and jolting of driving a catwagon (dump truck) around a rock crushing site, causing inflammation, swelling and increased scarring[.]" (Emphasis added.) SAIF argues that those clarifications do not support the board's order because a work incident may be the precipitating cause of an aggravation without being its major cause. However, when Moore first examined claimant, she reviewed a detailed intake report prepared by her nurse practitioner that contained a complete history of claimant's earlier back injury and surgery. She was aware of the possible alternative causes of the condition at L5-S1. By agreeing that work for SAIF's insured was the mechanism of worsening, as opposed to a mechanism of worsening, and knowing of the alternative possible mechanisms, she implied--and the board was permitted to infer--that it was the only mechanism. In other words, her clarifying reports, combined with other evidence in the record, demonstrate that she undertook to weigh the alternative causes for the condition, and they not only support the board's finding that work at SAIF's insured was the major contributing cause, but also reject the alternative explanations. We therefore conclude that the board did not err in ordering SAIF to accept claimant's combined condition. The order is supported by substantial evidence, and it is based on medical opinions that consider and reject alternative explanations.
Affirmed.
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