Claimant petitions for review of a final order of the Workers’ Compensation Board. In that order, the board upheld insurer SAIF Corporation’s (1) denial of claimant’s “new and omitted condition” claims, ORS 656.267; and (2) denial of claimant’s “combined condition” claim, ORS 656.262(6)(c). We review under ORS 183.482(8) and ORS 656.298(7), and affirm for the reasons that follow.
On February 8, 2012, claimant injured her left knee at work, and claimed workers’ compensation benefits in connection with the injury. SAIF accepted the claim, designating the accepted condition as a “left knee sprain and contusion.”
After SAIF’s initial acceptance of her claim, claimant initiated two “new or omitted condition” claims under ORS 656.267. Claimant requested that SAIF accept the condition of “unicompartmental arthritis” and also a condition that was “a combination between what has been diagnosed as preexisting arthritis in [claimant’s] left knee with the injury event of February 8, 2012.” SAIF denied both of claimant’s “new or omitted condition” claims.
Claimant requested a hearing on the denials before an administrative law judge (ALJ), and the ALJ affirmed. Claimant then sought review before the board, which affirmed the ALJ’s order. The board unanimously concluded that SAIF properly denied claimant’s
Claimant seeks judicial review. In her first assignment of error, claimant challenges the board’s determination that SAIF properly denied her “new or omitted condition” claims. In her second assignment of error, she challenges the board’s finding that her workplace knee injury ceased to be the major contributing cause of her combined condition as of September 14, 2012. We address claimant’s arguments in turn.
ORS 656.267
On review, claimant does not assign error to the board’s factual finding that the conditions for which she sought acceptance were included within the combined condition that SAIF already had accepted. SAIF v. Custer,
We turn to claimant’s second assignment of error, in which claimant contends that substantial evidence does not support the board’s finding that claimant’s workplace knee injury ceased to be the major contributing cause of claimant’s combined condition as of September 14, 2012. In particular, claimant relies on our decision in Brown I to argue that the record lacks substantial evidence to support that finding because the examining doctors on which the board relied focused on whether claimant’s “accepted condition” ii.e., the knee sprain and contusion) remained the major contributing cause of her combined condition, and did not analyze whether claimant’s “work-related injury incident” remained the major contributing cause of her combined condition. See
To the extent claimant’s arguments are predicated on our decision in Brown I, they have been foreclosed by the Supreme Court’s recent reversal of that decision. Brown v. SAIF,
As noted, claimant also argues that the record does not contain substantial evidence that claimant’s condition changed between the date of SAIF’s effective acceptance of claimant’s combined condition and September 14, 2012, the date that, according to SAIF, claimant’s combined condition became no longer compensable.
We conclude that substantial evidence supports the finding that the requisite change occurred and, in particular, the finding that claimant’s accepted knee sprain and contusion had resolved by September 14, 2012. That evidence includes the opinion of Dr. Dewing, who conducted an independent medical examination of claimant on September 14, 2012, and Dr. Sabahi, who evaluated claimant’s condition based on a comprehensive review of claimant’s medical records. Dewing opined that, although he could not pinpoint the specific date by which claimant’s workplace knee injury resolved, the knee sprain and contusion had resolved no later than September 14, 2012, as there were no “findings specific to” the sprain or the contusion as of that date. Sabahi concurred in that opinion based on his review of claimant’s records. Those opinions would permit a reasonable person to find that claimant’s condition changed between the date of her workplace injury and September 14, 2012. Although there was competing evidence in the record that would permit a reasonable person to reach the contrary finding reached by the dissenting board member, that does not make the board majority’s reliance on the evidence on which it relied unreasonable.
Finally, claimant argues that the board’s decision— in particular, its decision to rely on the opinions of Dewing and Sabahi, rather than the competing opinions of other medical professionals—is not supported by substantial reason, given what claimant perceives to be a number of weak points in the opinions of Dewing and Sabahi. An agency’s decision is supported by substantial reason if the decision “supplies] an explanation connecting the facts of the case and the result reached.” Rogue Advocates v. Jackson County,
Affirmed.
Notes
The notice of acceptance refers to the accepted condition as a knee “sprain,” although some documents in the record refer to the condition as a “strain.” We refer to the condition as a “sprain” to be consistent with SAIF’s specification of the accepted condition.
ORS 656.267, regarding claims for “new and omitted medical conditions,” provides:
“(1) To initiate omitted medical condition claims under ORS 656.262(6)(d) or new medical condition claims under this section, the worker must clearly request formal written acceptance of a new medical condition or an omitted medical condition from the insurer or self-insured employer. A claim for a new medical condition or an omitted condition is not made by the receipt of medical billings, nor by requests for authorization to provide medical services for the new or omitted condition, nor by actually providing such medical services. The insurer or self-insured employer is not required to accept each and every diagnosis or medical condition with particularity, as long as the acceptance tendered reasonably apprises the claimant and the medical providers of the nature of the compensable conditions. Notwithstanding any other provision of this chapter, the worker may initiate a new medical or omitted condition claim at any time.
“(2)(a) Claims properly initiated for new medical conditions and omitted medical conditions related to an initially accepted claim shall be processed pursuant to ORS 656.262.
“(b) If an insurer or self-insured employer denies a claim for a new medical or omitted medical condition, the claimant may request a hearing on the denial pursuant to ORS 656.283.
“(3) Notwithstanding subsection (2) of this section, claims for new medical or omitted medical conditions related to an initially accepted claim that have been determined to be compensable and that were initiated after the rights under ORS 656.273 expired shall be processed as requests for relief under the Workers’ Compensation Board’s own motion jurisdiction pursuant to ORS 656.278(l)(b).”
