Baltimore County, Maryland v. Michael Quinlan
No. 50
IN THE COURT OF APPEALS OF MARYLAND
August 26, 2019
Opinion by Adkins, J. Getty, J., dissents.
September Term, 2018. Argued: February 5, 2019. Circuit Court for Baltimore County, Case No. 03-C-16-004811.
MARYLAND WORKERS’ COMPENSATION ACT—OCCUPATIONAL DISEASE—LE § 9-502(D)—PARAMEDIC/FIREFIGHTERS—DEGENERATIVE MENISCAL TEARS: Pursuant to
*Greene, J., now retired, participated in the hearing and conference of this case while an active member of this Court; after being recalled pursuant to the
The present case involves the claim of a veteran paramedic/firefighter regarding degenerative meniscal tears in his right knee. We review two questions, which we have rephrased and consolidated from the questions granted1 for clarity. First, we
FACTUAL OVERVIEW AND PROCEDURAL POSTURE
In October 2015, Michael Quinlan (“Quinlan”) filed a claim with the Workers’ Compensation Commission (“the Commission”) against his employer, Baltimore County (“the County”). In it, he asserted that he “developed meniscal tears” in his right knee due to his job duties as a “Paramedic/Firefighter.”2 The Commission held a hearing regarding Quinlan’s claims and evaluated, among other things, whether he “sustain[ed] an occupational disease arising out of and in the course of his employment[.]” Ultimately, the Commission disallowed the claim, concluding that Quinlan “did not sustain an occupational disease of the [r]ight [k]nee degenerative tears arising out [of] and in the course of” his employment.
Quinlan then sought review in the Circuit Court for Baltimore County, requesting a jury trial. In appeals from the Commission, the trial court’s role is to determine whether the Commission “justly considered all of the facts,” “exceeded the powers granted to it,” or “misconstrued the law and facts applicable in the case decided.”
Prior to trial, the County filed a motion for summary judgment arguing that Quinlan failed to present evidence that his knee injury was an occupational disease or that it was related to the nature of his employment as a paramedic. Quinlan opposed this motion. Based on the parties’ competing submissions, the trial judge denied the County’s motion for summary judgment concluding that there was “absolutely a material dispute of fact.”
The case proceeded to trial on April 19 and 20, 2017. Quinlan, 51 years old at the time, testified first. He began by describing his occupation and the general duties thereof. Over the course of his career, he had served 29 years as a paramedic, the last 24 with Baltimore County. Typically, his schedule consisted of two 10-hour days
Quinlan testified that he started experiencing pain and “clicking” in his right knee in 2014, causing him to seek out a doctor. Although he had seen a doctor in 2005 regarding a knee injury, he did not necessarily see the two phenomena as related. Ultimately, Quinlan underwent surgery to repair his meniscal tears.
The parties each introduced the same experts before the trial court as they had used before the Commission. Quinlan presented a video deposition of Barbara A. Cochran, M.D. (“Cochran”), a physician with specialties in internal, occupational, psychiatric, and pulmonary medicine. Cochran’s testimony was based on her research, her review of Quinlan’s medical records, and her phone examination of Quinlan, although she never physically examined him. Cochran said that Quinlan had a tear in both his medial and lateral menisci. These tears “extend[ed] to the articular surface of the tibia,” which Cochran identified as important because that “is where the bones come together” which can lead to osteoarthritis.
Cochran described Quinlan’s meniscal tears as “part of the continuum of osteoarthritis.” Accordingly, she focused on repetitive use as the primary risk factor for his knee issues. She explained that repetitively using a knee with meniscal tears can lead to osteoarthritis because such use leads to inflammation in the joint that is not healed before its next use. She described this process as a cycle of inflammation, followed by partial healing, followed by inflammation, and so on. Alternatively, the osteoarthritis can contribute to degeneration and tears in the meniscus in a similar manner. She also addressed other risk factors for degenerative knee issues, such as gender, age, weight, genetics, and prior injury. Quinlan was five feet and nine inches tall and weighed approximately 235 pounds. Cochran stated that gender, age, and weight were unlikely to be the primary factors here because Quinlan’s knee damage was confined to his right knee. Moreover, she opined that Quinlan’s 2005 knee injury likely had no relation to his osteoarthritis based on the symptoms and complaints he presented at the time of his injury. She did not have enough information to address genetics.
Cochran also testified about the relationship between Quinlan’s degenerative knee tears and his occupation as a paramedic. Specifically, she pointed to a study that concluded that paramedic/firefighters have a “relative risk” of developing knee osteoarthritis of 2.93 compared to the general population, meaning that there are 293 cases of degenerative knee tears in paramedic/firefighters for every 100 cases in the general population. Based on this study and her examinations, she concluded that Quinlan’s “essential job functions . . .
Next, the County introduced the video deposition of its expert witness, Richard Hinton, M.D. (“Hinton”), a specialist in orthopedic surgery. Hinton had examined Quinlan and explained that his knee tears were classified as “complex,” meaning that they could be wholly degenerative or acute tears that degenerated over time. Still, he opined that Quinlan’s other risk factors for knee problems, such as weight and age, were the primary causes of his degenerative knee tears, not his occupation. Specifically, he stated that the “primary or direct cause of [Quinlan’s] meniscus issues”—which Hinton believed contributed to the osteoarthritis—were not “his duties as a firefighter and EMT.”
During his physical examination of Quinlan and in making his report, Hinton did not know that Quinlan had sustained an on-the-job acute injury to his knee in 2005. Upon learning of this fact during his deposition, Hinton stated that his “occupational injury . . . could contribute to long-term knee problems.” He later opined that, although Quinlan’s job was not the “primary cause” of his knee problems, it was a “potential” or “arguable” cause of them. He also recognized that “there is literature to suggest that people who are in firefighter or EMT positions have higher rates of both meniscus tears and of arthritis, as do people in many physically demanding jobs.”
The jury returned a verdict for Quinlan, stating that he had “sustain[ed] an occupational disease of right knee degenerative tears of the . . . medial and lateral menisci . . . arising out of and in the course of his employment[.]” During the County’s appeal, the Court of Special Appeals ruled that “Quinlan met the statutory requirements of
DISCUSSION
Denial of Summary Judgment Motion
We first address the trial court’s denial of the County’s motion for summary judgment. The County argues that the trial court erred in denying its motion for summary judgment because Quinlan’s initial Employee Claim Form listed the occupational disease as “meniscal tears,” but the evidence and testimony at trial involved “degenerative meniscal tears,” which includes the osteoarthritis. The County argues that by “extract[ing]” the meniscal tear claim and excluding any reference to the osteoarthritis, Quinlan avoids “any argument or burden of proof that inter-related conditions, such as ‘osteoarthritis,’ exist and affect the same body part,” and also that the osteoarthritis was in the “nature” of the employment. The County asserts that “[t]he claimant should not be able to avoid its burden by choosing only a portion of the overall ailment” for the claim, thereby avoiding the “burden of proof as to the entire disorder . . . .” Quinlan states that denial of the motion for summary judgment was proper because there was a dispute of material fact as to the cause of the meniscal tears and the “incidence of meniscal tears” in his work as a paramedic.
Typically, we review the denial of a motion for summary judgment for abuse of discretion. See Hous. Auth. of Balt. City v. Woodland, 438 Md. 415, 426 (2014). There are occasions in which the appellate court reviews non-discretionary matters without deference to the trial court, even on denials of summary judgment. See Presbyterian Univ. Hosp. v. Wilson, 337 Md. 541, 549 (1995) (stating that “to the extent that the issue of personal jurisdiction [was] a question of law, it is not properly submitted to the trier of fact to resolve,” and, therefore, there was “nothing to preclude our review of this issue”). Even so, in the interest of “promot[ing] justice,” the trial court ordinarily “possess[es] discretion to refuse to pass upon, as well as discretion affirmatively to deny, a summary judgment request in favor of a full hearing on the merits; and this discretion exists even though the technical requirements for the entry of such a judgment have been met.” Metro. Mortg. Fund, Inc. v. Basiliko, 288 Md. 25, 28 (1980) (citations omitted). Such is the case here, so we review the trial court’s ruling for abuse of discretion.
Before the trial began, the County filed a motion for summary judgment. In it, the County characterized Quinlan’s claim as one for “an unknown, unnamed, degenerative disease involving his right knee,” which was alleged to have resulted from his work as a paramedic/firefighter. The County asserted that Quinlan “provided no evidence” regarding: (1) the occupational disease he suffered from; or (2) the disease’s relation to the “nature of his employment” and not some intervening factor. It also submitted Hinton’s medical examination report. Thus, it averred, the County was entitled to summary judgment as a matter of law.
In response, Quinlan reasserted his claim that he had sustained “an occupational disease of degenerative tears of the posterior horns of both the medial and lateral menisci of his right knee.” He recounted the duties he undertook as a paramedic that caused the knee condition, including: lifting patients onto stretchers, kneeling to assess patients, and sometimes carrying patients. These activities occurred consistently over his 26–30 emergency calls for each four-day shift. He also points to Cochran’s testimony asserting a causal link between “the meniscal tears and pathology” and Quinlan’s “essential job functions as a firefighter/EMT.”
The trial court denied the County’s motion for summary judgment, concluding that there was “absolutely a material dispute of fact.” While the County states that Quinlan did not claim that the meniscal tears were degenerative, the County described the tears as degenerative in its own motion for summary judgment. It is plain that Quinlan had provided evidence regarding his alleged occupational disease and its relation to his employment in the form of the “Independent Medical Opinion and Causation Analysis” from Cochran, submitted to the Commission as part of his initial claim. To the extent that Quinlan had yet to provide evidence that meniscal tears and knee degeneration were within the “continuum of osteoarthritis,” the trial court still maintained discretion to “affirmatively . . . deny[] a summary judgment request in favor of a full hearing on the merits . . . .” Basiliko, 288 Md. at 28. The trial court was well within its discretion to deny the motion for summary judgment at this stage.
Occupational Disease
Preservation of “Sufficiency” Argument
Quinlan argues that the County failed to preserve any argument regarding the sufficiency of the evidence by failing to make a motion for judgment pursuant to
Assuming without deciding that
Compensability Under LE § 9-502(d)
The parties’ principal disagreement centers around whether degenerative meniscal tears were both “caused” by Quinlan’s occupation as a paramedic and “due to the nature of an employment in which hazards of the occupational disease exist,” pursuant to
In workers’ compensation cases, “[a]ppeals to the appellate courts are limited strictly to issues of law. . . . [Appellate courts] decide whether the trial court has correctly determined the appeal from the Commission.” Richard P. Gilbert, et al., Maryland Workers’ Compensation Handbook § 16.08, at 16-16 (4th ed. 2013). Therefore, rather than reviewing the factual determinations of the Commission or a circuit court, “to which we would owe deference,” Pro-Football, Inc. v. McCants, 428 Md. 270, 282 (2012), we review the conclusions of law regarding the construction and application of
The County argues that the Circuit Court decision was based on an erroneous construction of the Workers’ Compensation Act, contrary to the plain language of
Regarding the first question, the County maintains that Quinlan’s characterization of his occupational disease on the initial Claim Form was not legally sufficient. Quinlan, it argues, is attempting to advance an osteoarthritis claim, as well as a meniscal tears claim. Yet, it states that Quinlan never included osteoarthritis in a description of occupational disease, so it should not have been considered by the trial court. As to the second question, the County argues that there are “no inseparable and unavoidable characteristics of the job duties and responsibilities that have been shown to result in ‘degenerative meniscal tears of the right knee’ as the ‘natural and expected result’ of [Quinlan’s] occupation.” Pointing to multiple previous Maryland cases, it states that the present claim lacks a “distinctive employment hazard” associated with Quinlan’s job. The County also warns that Quinlan’s argument will result in preexisting conditions no longer being a defense or deduction for employers, but now being a “bonus” for employees, resulting in massively increased costs. Instead, the County encourages the Court to look to other Maryland cases, such as Davis v. Dyncorp, 336 Md. 226 (1994), to guide it in this case and reject Quinlan’s claim.
Quinlan maintains that the jury was entitled to find that his degenerative knee tears were a compensable occupational disease arising out of and in the course of his employment. He characterizes the County’s argument as asking the court to re-weigh the facts, as opposed to taking issue with the law itself. Pointing to expert testimony, Quinlan contends there was sufficient evidence that his knee degeneration and meniscal tears are characteristic of his employment, especially considering the occupational disease need not be “unique” to paramedics alone. He also argues that there was sufficient evidence for the jury to find a causal relationship between his occupation and the degenerative meniscal tears.
The Workers’ Compensation Act provides compensation for, among other things, “covered employees” who become “partially or totally incapacitated” due to an “occupational disease” acquired in the course of their employment.
(1) the occupational disease that caused the death or disability:
(i) is due to the nature of an employment in which hazards of the occupational disease exist and the covered employee was employed before the date of disablement; or
(ii) . . . ; and
(2) on the weight of the evidence, it reasonably may be concluded that the occupational disease was incurred as a result of the employment of the covered employee.
We have already described the factual evidence presented regarding the tasks Quinlan performed as part of his paramedic role, and we will return to them below. We now move to the second “step” and consider our prior cases and how they contour the edges of what qualifies as a “hazard” within the “nature” of a given employment. It is useful to briefly note the history and development of the Workers’ Compensation Act, as it relates to the development of our case law. Specifically, “[u]ntil 1939, the [General Assembly] did not recognize occupational disease as a compensable claim.” LeCompte v. United Parcel Serv., Inc., 90 Md. App. 651, 654 (1992). After the 1939 amendment, the Act contained a schedule of permissible occupational diseases which could be covered, but this approach was later liberalized in favor of the more general formulation seen today. See Dyncorp, 336 Md. at 234–35. The history of the Act illustrates a gradual loosening of interpretive strictures, but, still, we bear in mind “that the Act is designed to provide compensation to workers injured by the effects of industry . . . .” Id. at 235 (citation omitted).
The central issue here requires examining the degree to which, and how, the occupational injury must be “due to the nature of an employment in which hazards of the occupational disease exist,”
We have frequently addressed issues surrounding the scope of the term “occupational disease.” For example, we have assessed whether the occupational disease must be “unique” to the profession, as the County suggests. We discussed this issue in Lettering Unlimited v. Guy, 321 Md. 305, 306 (1990), wherein we examined “whether the claimant’s bilateral carpal tunnel syndrome is an occupational
LeCompte further expounded upon our reasoning in Lettering Unlimited. In LeCompte, the Court of Special Appeals investigated a claim of occupational disease brought by a UPS “jumper”—a job requiring the employee to leap 14–16 inches from a truck—who had worked on the job for less than a month. See id. at 652. In denying the employee’s claim, the intermediate appellate court recognized, pursuant to Lettering Unlimited, that “the lack of ‘distinctive’ or ‘unusual’ employment hazards [was] not dispositive.” Id. at 658. Still, the claim failed because there must be a “repetitive character” to such trauma, which the employee did not suffer, given that her “condition manifested itself the first week on the job.” Id.
We have also discussed the relationship between the “hazards” of the employment, the alleged occupational disease, and the “nature” of the employment at issue in a given case. In Davis v. Dyncorp, 336 Md. at 227, we discussed this in terms of whether Davis’ “mental disease, allegedly resulting from on-the-job harassment,” was within the dictates of
To determine whether Davis’ mental disease was within the “general character” of his employment, we evaluated whether the hazards of data operation exposed him to risk factors that could naturally lead to such mental disease. See id. We concluded that Davis’ claim was “not compensable under [LE] § 9-502(d)(1)(i) because it was not ‘due to the nature of an employment in which hazards of the occupational disease exist.’” Id. at 236. This is because “harassment by fellow employees is not a hazard within the nature of the employment of a computer data operator.” Id. at 237 (emphasis added). See also Means v. Balt. Cty., 344 Md. 661, 670 (1997) (“[U]nlike the occupation of computer operator in Davis, the occupation of paramedic is ‘an employment in which hazards of the occupational disease [of PTSD] exist.’”).
Black & Decker Corp. v. Humbert, 189 Md. App. 171, 174 (2009), involved an employee, Humbert, employed as a licensed electrician, who brought an occupational disease claim citing impingement syndrome of the right shoulder. His duties primarily included doing electrical repair work on ceilings, vehicle maintenance work, and some work as a plumber and carpenter. See
Ultimately, the intermediate appellate court concluded that the hazards leading to shoulder impingement syndrome were inherent in the nature of a licensed electrician’s profession. In deciding this, it explained that “a hazard is a risk factor. To be compensable, it is the risk factors, not the disease, that must inhere in the nature of the employment.”
Our interpretation of the scope of “occupational disease,” as confined by
The above cases are instructive here. Taking the issues as presented by the County, we first explore “whether the specific characterization of the claim was legally sufficient as an occupational disease under
Even if the knee degeneration and meniscal tears were not so evidently linked throughout the trial, the evidence presented to the jury characterized meniscal tears and the degenerative effects of osteoarthritis as being one-in-the-same ailment. Accordingly, this is not a claim involving a “preexisting condition” as the County urges. Cochran described the meniscal tears as “part of the continuum of osteoarthritis,” as the tears “extend[ed] to the articular surface of the tibia,” which “is where the bones come together,” and can lead to osteoarthritis. Even the County‘s expert recognized their interrelation. Thus, the “specific characterization of the claim” is legally sufficient, and we see no reason to conclude that the jury was not entitled to rely on this characterization.
Next, we inquire as to whether a claim for “degenerative tears of the posterior horn of both the medial and lateral meniscus” qualifies “as a matter of law as an occupational disease for a Paramedic/Firefighter.” At issue, first, is whether the degenerative meniscal tears were “due to the nature of an employment in which hazards of the occupational disease exist,” per
Again, an occupational disease is “one which arises from causes incident to the profession or labor of the party‘s occupation or calling.” Victory Sparkler, 147 Md. at 379. We look to the “duties of a claimant‘s profession” and determine whether “the hazard that led to the disease exists in the nature of that employment.” Black & Decker, 189 Md. App. at 191. Here, there was a legal basis to conclude that the nature of paramedic/firefighter work, in general, involves a higher degree of risk
Defense expert Hinton did not quarrel with the claimant‘s characterization of paramedic work but stated that these job functions were not distinct from any other labor-intensive employment. The County, too, points to the commonality of knee injuries among other professions as disqualifying here. Assuming, without deciding, that such a characterization is accurate, “uniqueness” is not a required element of
An analysis of Quinlan‘s job duties, too, must reveal that he actually engaged in the kinds of activities that contribute to the increased risk inherent in his profession. Quinlan described his job-related tasks as including kneeling for lengthy periods of time, carrying heavy patients up and down stairs, kneeling to address patients and administer aid, climbing in and out of emergency vehicles, carrying up to 50 pounds of gear, and lifting patients onto stretchers and up and down stairs. While engaged in this work, he favored his right knee. Cochran testified that repetitive use was the primary cause of Quinlan‘s degenerative knee condition. Indeed, Quinlan described his 24-year career as a paramedic with Baltimore County wherein he typically worked four-day shifts. During each four-day shift, he would generally take up to 30 emergency trips which would last approximately 1–2 hours, depending on the seriousness of the emergency. During each of these trips, he would perform the above tasks, described as consisting of “considerable repetitive kneeling, bending, [and] stress on the knee . . . .”
It is inconsequential that degenerative knee conditions are not exclusively within the purview of paramedic work. Rather, we look to evidence that “repetitive trauma” was a factor in Quinlan‘s condition. The above evidence demonstrates that Quinlan‘s degenerative knee condition likely developed progressively, results from repetitive trauma, and stems from the natural consequences of his job functions.
We would also be remiss if we did not, again, note that the General Assembly requires hazards to be in the “nature” of the occupation, not unique to it. The General Assembly, with its investigative resources, is positioned to know the burdens imposed on employers and their insurers when it enacts a law with such plain language. Its role is to make a policy decision that takes into account both the employer/insurer‘s burden and the plight of workers who are injured on the job because of repetitive trauma. We should not change the meaning of the statute by adding qualifying language which would limit workers’ entitlement to relief. Additionally, “whether an occupational disease is compensable under
Indeed, our recognition of Quinlan‘s right to recover here is no more expansive than other claims we have previously deemed compensable. See, e.g., Means, 344 Md. at 662 (post-traumatic stress disorder); Lettering Unlimited, 321 Md. at 306 (bilateral carpal tunnel syndrome); Miller v. Western Elec. Co., 310 Md. 173, 176 (1987) (carpal tunnel syndrome); Black & Decker, 189 Md. App. at 174 (impingement syndrome of the right shoulder). Other jurisdictions have demonstrated the same. See Larson, 4 Larson‘s Workers’ Compensation Law § 52.04[2], at 52-27 (listing a multitude of diseases that have been determined “occupational” in other jurisdictions).
Finally, we must evaluate whether, as a matter of law, the jury “reasonably may [have] concluded,”
CONCLUSION
In sum, the record contained evidence that the nature of the job of a paramedic/firefighter places one at greater
JUDGMENT OF THE COURT OF SPECIAL APPEALS AFFIRMED. COSTS TO BE PAID BY PETITIONER.
BALTIMORE COUNTY, MARYLAND v. MICHAEL QUINLAN
No. 50
IN THE COURT OF APPEALS OF MARYLAND
September Term, 2018; Filed: August 26, 2019
Barbera, C.J.; *Greene, McDonald, Watts, Hotten, Getty, Adkins, Sally D., (Senior Judge, Specially Assigned) JJ. Dissenting Opinion by Getty, J.
Respectfully, I dissent.
In my opinion, Mr. Quinlan failed to accurately identify the medical condition at issue as an occupational disease and to prove that his disability was distinctly associated with his occupation. An occupational disease is compensable only if “(1) the occupational disease that caused the death or disability: (i) is due to the nature of an employment in which hazards of the occupational disease exist . . . and (2) on the weight of the evidence, it reasonably may be concluded that the occupational disease was incurred as a result of the employment of the covered employee.”
The majority asserts that the complainant must prove facts sufficient for the court to determine “whether: (a) the ‘nature’ of the employment includes the hazards of the ailment the employee suffers from to a greater degree than that present in general employment; and (b) whether the employee‘s job functions expose the employee to those hazards.” Majority Opinion, at 13-14.
I disagree with the majority that under the facts of this case, a clear syndrome or disease was identified. There was both degenerative osteoarthritis and a degenerative meniscus condition present in Mr. Quinlan‘s right knee. He had the burden to properly identify the alleged occupational disease in his claim and failed to do so. Over the course of these proceedings, the description of the disease evolved from “torn meniscus” to “degenerative tears of the meniscus” to “osteoarthritis with degenerative tears.”
I am concerned that Mr. Quinlan, and future litigants under similar unclear medical claims, will bootstrap additional conditions under the same claim and encompass the additional condition within an occupational disease. For example, here, Mr. Quinlan‘s claim of meniscal tears was exacerbated by the osteoarthritis. The osteoarthritis is a preexisting condition that should have been further accounted for in the testimony and evidence of this case. Otherwise, I believe this Court is broadly expanding worker‘s compensation coverage into coverage of common diseases of aging or lifestyle. This expansion chips away at the requirement that the workplace or employment is an actual cause of the occupational disease. The result of this expansion could open employers and insurers to potentially bear the full cost of a worker‘s pre-existing or underlying condition due to an aggravation of that condition
I am also concerned that the majority‘s decision, combined with Black and Decker Corporation v. Humbert, 189 Md. App. 171 (2009), permits a broad range of coverage where employees engage in activity common to many occupations as long as the occupation increases the risk of contracting a disease. This decision may result in a significant increase in claims for occupational disease by those with underlying arthritic conditions who work in physically demanding jobs. Potentially, every worker will be able to successfully file a claim for an occupational disease whenever a strenuous physical activity is required by the job and that activity contributes in any way to an injury or aggravation of an underlying pre-existing degenerative condition. I do not think Mr. Quinlan has sufficiently proven that his condition was the result of distinctive employment hazards. Specifically, the condition of degenerative meniscal tears was not proven to be inseparable from the occupation of an EMT or paramedic.
Therefore, for the foregoing reasons, I respectfully dissent.
Notes
- Did the trial court err in denying Petitioner’s motion for summary judgment, given the lack of a clearly defined occupational disease as the basis for the claim and evidence that the conditions were shown to be prevalent in all occupations involving heavy physical labor not uniquely related to the work of a paramedic or EMT as an inherent and inseparable risk?
- Did CSA err in finding that Respondent met the statutory requirements set forth in
LE § 9-502(d)(1) and that he had sufficiently established at trial that his condition resulted from an inherent hazard of his employment as a paramedic or EMT? - Should this Court review the decision below under the statutory requirements and existing case law, particularly Black & Decker Corporation v. Humbert, 189 Md. App. 171 (2009), which similarly ignores the legislative requirement that a disease is only occupational if it is “due to the nature of an employment in which the hazards of the occupational disease exist” (
LE § 9-502(d)(1)(i) ), to provide clarification and guidance on the requirement for establishing a legally sufficient claim for occupational disease?