Bahman HAFTSAVAR v. ALL AMERICAN CARPET AND RUGS, INC. and Twin City Fire Insurance Company.
Record No. 0873-11-4
Court of Appeals of Virginia, Alexandria
Feb. 14, 2012
721 S.E.2d 804
ALSTON, Judge.
William T. Kennard (O‘Connell & O‘Connell, LLC, on briefs), for appellees.
Before: HALEY, BEALES and ALSTON, JJ.
ALSTON, Judge.
Bahman Haftsavar (“claimant“) appeals a decision of the Virginia Workers’ Compensation Commission (“commission“) denying claimant‘s request for All American Carpet and Rugs, Inc. (“employer“) to compensate claimant for treatment of his heart condition. Claimant contends that the commission erred in failing to hold employer responsible for treatment of claimant‘s heart condition, which occurred prior to repair of his compensable right inguinal hernia. For the following reasons, we conclude that the commission did not err in this regard and affirm the decision below.
I. BACKGROUND
On January 5, 2007, claimant sustained a compensable right-sided inguinal hernia arising out of and in the course of his employment with employer while attempting to lift and pull a large box. On June 8, 2007, Dr. Albert Herrera, a primary care physician, saw claimant in his office and conducted a preoperative clearance evaluation. During this visit, Dr. Herrera observed that claimant‘s electrocardiogram (“EKG“) results were abnormal and referred claimant for further cardiac evaluation.
From July until March 16, 2008, claimant recovered from his heart surgery and prepared for his hernia surgery. On March 17, 2008, claimant underwent hernia surgery. Employer accepted the hernia injury as compensable and paid claimant temporary disability benefits through April 13, 2008. On December 3, 2009, claimant filed a change-in-condition application for hearing, asking for payment of all medical costs related to his bypass surgery.
On March 25, 2010, the deputy commissioner held an evidentiary hearing. Employer opposed the change-in-condition application because it believed there was no causal connection between claimant‘s need for bypass surgery and his work-related injury. As the only witness, claimant testified consistently with the facts and events described above regarding his medical care. Claimant further testified that he had no prior indications of a heart condition, including shortness of breath, chest pain, or a family history of heart disease.
Claimant and employer submitted medical records indicating that claimant‘s heart condition was severe enough to warrant surgery on the same day it was detected, July 5, 2008. These included Dr. Sherber‘s July 6, 2007 report to Dr. Herrera about the results of claimant‘s cardiac catheterization,
The deputy commissioner concluded that employer was responsible for treatment of claimant‘s heart condition, adopting the analysis of the commission‘s decision in Ball v. Asplundh Tree Expert Co., No. 209-17-09 (Va. Workers’ Comp. Comm‘n Oct. 5, 2004).
Upon review at employer‘s request, the commission reversed the deputy commissioner‘s decision on this issue and found employer not responsible for the cost of claimant‘s heart surgery. In its reversal, the commission concluded that holding employer responsible for every unrelated condition which requires treatment before the compensable injury can be treated, regardless of whether treatment for the unrelated condition is needed independent of treating the compensable injury, contradicts the Workers’ Compensation Act‘s (“the Act“) objectives. The commission enunciated a new test for future claimants with similar medical issues to claimant, stating:
[W]e find that the appropriate test is whether the treatment for the unrelated condition would be necessary if surgery for the compensable condition was not contemplated. In other words, the issue is whether the primary motivation for treatment of the unrelated condition is to allow the claimant to undergo the compensable treatment, or whether it is to treat the unrelated condition. If the unrelated condition would require treatment without reference to the compensable treatment, then there is simply no causal connection between the treatment for the unrelated condition and the compensable injury. Under these conditions, compensability should be denied.
Applying this test to the facts of the present case, it is clear [employer] should not be responsible for treatment of [claimant‘s] heart condition.
The dissenting commissioner agreed with the deputy commissioner‘s conclusion on this issue and would have required employer to compensate claimant for his heart surgery under a different test. The dissenting commissioner stated: “The test for determining whether the employer is responsible for medical care prior to a compensable surgery is (1) whether the medical condition was discovered during the pre-operative evaluation and (2) whether the medical treatment is necessary so that the injured worker can safely undergo the compensable surgery.”
Claimant noted this appeal to the commission‘s decision. At oral argument, a panel of this Court requested supplemental briefs from the parties regarding the Act‘s requirement for a causal connection between medical treatment and a compensable injury, along with suggestions for a brightline test in cases similar to the one at bar.
II. ANALYSIS
A. The Act Does Not Require Employers to Cover Treatment of Medical Conditions Completely Unrelated to a Compensable Injury or Illness
Whether disputed medical treatment is compensable as “other necessary medical attention” within the definition of
Since our decision in Goad, we have carved out some exceptions to the general rule requiring a causal connection between the compensable injury and the treatment. Our case law has recognized both the doctrine of compensable consequences and the “two causes rule.”
The doctrine of compensable consequences states: “When the primary injury is shown to have arisen out of and in the course of employment, every natural consequence that flows from the injury likewise arises out of the employment, unless it is the result of an independent intervening cause attributable to claimant‘s own intentional conduct.” Morris v. Badger Powhatan/Figgie Int‘l, Inc., 3 Va.App. 276, 283, 348 S.E.2d 876, 879 (1986) (quoting A. Larson, The Law of Workmen‘s Compensation §§ 13 and 81.30). We have applied the doctrine in more than one context. See e.g. Williams Indus., Inc. v. Wagoner, 24 Va.App. 181, 189, 480 S.E.2d 788, 791-92 (1997) (requiring employer to compensate claimant for treatment of avascular necrosis of hips three years after claimant had back surgery for a compensable injury because claimant presented credible evidence that the original spinal injury had caused the necrosis); see also S. Iron Works v. Wallace, 16 Va.App. 131, 134, 428 S.E.2d 32, 34 (1993) (stating: “[a] finding that a pre-existing condition was ‘accelerated or aggravated’ by an injury sustained in an industrial accident establishes a causal connection between the injury and disability and the ‘disability resulting therefrom is compensable under the Workers’ Compensation Act‘” (quoting Olsten of Richmond v. Leftwich, 230 Va. 317, 320, 336 S.E.2d 893, 895 (1985))).
The two causes rule “provides that a condition which has two causes, one related to a work injury, and one not, is compensable and the treatment of that condition will be the responsibility of the employer.” Papco Oil v. Farr, 26 Va.App. 66, 75, 492 S.E.2d 858, 862 (1997) (citing Shelton v. Ennis Bus. Forms, Inc., 1 Va.App. 53, 55, 334 S.E.2d 297, 299 (1985)).
Claimant concedes on brief that his heart condition has no causal connection to his compensable hernia injury. We also find, based on the record, that claimant‘s heart condition is neither a compensable consequence of his hernia injury, nor is it a condition which would fall under the two causes rule. Therefore, we affirm the commission‘s holding that employer bears no responsibility for the medical treatment claimant received for his heart condition prior to undergoing his hernia surgery.
B. The Decision in Papco Oil v. Farr Does Not Apply to the Facts of This Case
Both parties argue that our decision in Papco requires
In Papco, we made two specific findings to support our holding that “treatment of the ITP was a medically necessary adjunct to the successful completion of that care required by claimant‘s work-related back injury.” Id. at 74, 482 S.E.2d at 862. First, we found that the claimant‘s treating physicians diagnosed the ITP “during medically necessary treatment of his compensable back injury.” Id. The facts indicated that the claimant in Papco had already undergone one surgery for his compensable back injury before the physicians diagnosed his ITP. Id. at 69-70, 492 S.E.2d at 859. Second, we found: “[t]o continue treatment of claimant‘s back with further surgeries ... claimant‘s physicians required limited treatment of the ITP to normalize [the claimant‘s] platelet count.” Id. at 74, 492 S.E.2d at 862 (emphasis added). Notably, the commission did not require the employer to compensate the claimant in Papco for each instance of treatment for the ITP, excluding a second hospitalization for treatment of the ITP and pleural effusion that occurred between the second and third back surgeries because “no medical evidence proved that this treatment for pleural effusion and ITP was causally related to the compensable work injury.” Id. at 73, 492 S.E.2d at 861. The commission also did not require the employer to compensate the Papco claimant for the elective splenectomy he underwent
Claimant‘s course of treatment in this case differs significantly from the claimant‘s course of treatment in Papco. Initially, as noted, the record contains no evidence that claimant‘s compensable injury caused his heart condition, and he admits that the two are completely unrelated. The evidence here indicates that claimant‘s heart condition was completely separate and distinct from his hernia injury, significantly dissimilar to the blood condition that the claimant in Papco developed, which may have been an accompaniment to the surgery for his compensable injury. Additionally, the claimant in Papco had already undergone one surgery for his compensable back injury when his treating physicians diagnosed the ITP. Here, claimant had not undergone his hernia surgery when Drs. Herrera and Sherber diagnosed him with coronary artery disease, identifying his need for immediate bypass surgery. He also failed to present any evidence that his physicians discovered his need for bypass surgery while in the midst of his hernia surgery. To the contrary, the record indicates that treatment of the hernia injury did not begin until more than six months following the bypass surgery. Therefore, we cannot conclude that treatment of claimant‘s heart condition was a medically necessary adjunct to the treatment of his compensable hernia injury.
We acknowledge that the Act is remedial in nature and should be liberally construed in favor of the worker. E.I. Du Pont De Nemours & Co. v. Eggleston, 264 Va. 13, 17, 563 S.E.2d 685, 687 (2002). Our prior adoption of the compensable consequences doctrine and the two causes rule assists in effectuating the Act‘s remedial policy. They both recognize that workplace injuries take varying forms and can have lasting consequences, especially considering pre-existing conditions that an employee may have. We decline, however, to extend coverage to medical treatment for a pre-existing condition that has no causal connection whatsoever to a compensable workplace injury. Consequently, the commission was
III. CONCLUSION
For the foregoing reasons, we affirm the commission‘s decision.
Affirmed.