SAIF Corp. v. WalkerSAIF Corp. v. Walker
In this wоrkers’ compensation case, we must interpret the wording of
The relevant facts, taken from the Court of Appeals’ opinion and the record, are as follows. Claimant, a timber faller, injured his lower back and left leg on the job in 1991. Claimant was diagnosed by Dr. Buza, his treating physician, as having an “L5-S1 herniated disc.” Claimant filed a claim for compensation. His injury was deemed compensable, and SAIF Corporation (SAIF), his employer’s insurer, paid the claim.
In May 1992, Buza declared claimant medically stationary and released him to regular work, beginning in June 1992, without restriction. At that time, claimant’s work required heavy lifting of up to 100 pounds. Buza’s closing report concluded that claimant’s loss of function was minimal, although claimant continued to have some pain in his lower back and left leg. SAIF awarded claimant 12 percent permanent partial disability (PPD) and closed the claim.
Claimant requested reconsideration of the closure. In February 1993, he was examined by a medical arbiter, Dr. Burr. Burr concluded that claimant had a chronic and permanent medical condition arising from his accepted injury, and that he was capable of “medium work occasionally, light to medium work constantly, without repeated crouching, or bending.” Based upon that report, SAIF increased claimant’s PPD award to 16 percent.
Also in February 1993, claimant experienced increased pain while working and returned to Buza for treatment. At Buza’s suggestion, claimant underwent an MRI scan, which revealed evidence of scar tissue but no residual or recurrent disc herniation. Buza referred claimant to a rehabilitation center to evaluate his physical capabilities. That evaluation concluded that claimant had “residual physical capacities in the light-medium work range, lifting and carrying 35 pounds occasionally with increased symptoms.”
In May 1993, Burr re-examined claimant and concluded that, in addition to the herniated disc, claimant suffered from degenerative disc disease with continued symptomatic low back and left leg discomfort. Later, in response to a letter from claimant’s lawyer, Buza conсurred with Burr’s diagnosis.
Claimant filed an aggravation claim under
Mеanwhile, the 1995 Legislature enacted extensive amendments to the Workers’ Compensation Law, including an amendment to
“[TJhere [must] be direct medical evidence that a condition has worsened. It is no longer permissible for the Board to infer from evidence of increased symptoms that those symptoms constitute a worsened condition for purposes of proving an aggravation claim. Here, both the hearings officer and the Board considered the claim under the old standard. The Board specifically held that an actual worsening of the condition may be proven by a symptomatic worsening, and it based its conclusion that claimant had proven an aggravation claim on evidence of claimant’s increased symptoms. We hold that proof of a pathological worsening is required.
Walker,
At the time when claimant filed his aggravation claim,
“After the last award or arrangement of compensation, an injured worker is entitled to additional compensation, including medical services, for worsened conditions resulting from the original injury. A worsened condition resulting from the original injury is established by medical evidence supported by objective findings. * * *”
(Emphasis added.) The 1995 Legislature amended that statute by deleting the words “including medical services” and by adding the wording set out below in boldface type:
“After the last award or arrangement of compensation, an injured worker is entitled to additional compensation for worsened conditions resulting from the original injury. A worsened condition resulting from the original injury is established by medical evidence of an actual worsening of the compensable condition supported by objective findings. * * *”
Or Laws 1995, ch 332, § 31 (boldface type in original; deleted text omitted; emphasis added). As noted, the amended wording applies retroactively to claimant’s claim.
SAIF contends that, to prove “an actual worsening of the compensable condition” under the amended version of
As explained more fully below, two questions are before us, both of which present issues of statutory construction. First, we must determine whether
Our task in resolving those issues is to determine the legislature’s intent when it amended
We begin by examining the wording of the phrase added to
Under the structure of the phrase at issue, the term “compensable condition” modifies the term “actual worsening,” that is, what must “actually] worsen” is the “compensable condition.” As to the “actual worsening” requirement, the dictionary definition for the word “actual” provides, in part:
“2 a : existing in act <our ~ intentions» : EXISTENT —contrasted with potential and possible b : existing in fact or reality : really acted or acting or carried out — contrasted with ideal and hypotheticaldn - life» <the - conditions»: distinguished from apparent and nominal <the - cost of goods» 3 : not spurious : REAL, GENUINE <an - blizzard» <- falsehood» <hard-pressed but not in ~ poverty» * * * syn see REAL”
Webster’s Third New Int’l Dictionary,
22 (unabridged ed 1993) (emphasis and boldface type in original). Applying that
meaning to
The foregoing textual analysis of
In SAIF’s view, that conclusion ends the matter, because — again, in SAIF’s view — that reading of the statute precludes a worker from proving an aggravation claim by presenting evidence only that his or her symptoms have worsened, leaving it to a factfinder to infer whether that symptomatic worsening demonstrates the existence of a worsened condition. We do not agree with SAIF that this case is resolved by that latter proposition. Rather, the question for us that remains unanswered — and it is the crux of the second issue before us — is, given our reading of the “actual worsening” requirement of
The original version of
“After the last award or arrangement of compensation, an injured work[er] is entitled to additional compensation, including medical services, for worsened conditions resulting from the original injury.”
Or Laws 1973, ch 620, § 5.
3
In the years that followed the enactment of that statute,
Next, in
Gwynn v. SAIF,
“Compensation is not payable under the Workers’ Compensation Law for symptoms alone, but to the extent that symptoms, such as pain, dizziness, nervousness, etc., cause loss of function of the body or its parts and, in the case of unscheduled disability, resulting loss of earning capacity, the disabling effects of the symptoms are to be considered in fixing awards for disability. * * * The mere ‘waxing 1 of a physical condition or of a symptom, whether or not anticipated, will nоt amount to a worsening sufficient to satisfy the requisites for a claim underORS 656.273. But what if the waxing results in a greater disability?
“If waxing continues to the point where the worker is incapacitated from regularly performing work at a gainful and suitable occupation, * * * [i]t is logically inescapable that this is a worsening. * * *
“If waxing continues to the point where the worker’s condition falls short of total disability, * * * but becomes medically stationary at an extent greater than previously awarded, this too must be a worsening, for the worker’s loss of capacity to earn has been increased.”
(Citations omitted.) Again, the court focusеd upon the worker’s ability to work, rather than upon a medical assessment of changes in the underlying condition. Finally, in
Perry v. SAIF,
Taken together,
Smith, Gwynn,
and
Perry
stood for the proposition that, under an earlier version of
In light of those three cases, the Board began analyzing aggravation claims under
In 1990, the legislature enacted a sеries of amendments to the Workers’ Compensation Law, including an amendment adding the requirement to
“If the worker submits a claim for aggravation of an injury or disease for which permanent disability has been previously awarded, the worker must establish that the worsening is more than waxing and waning of symptoms of the condition contemplated by the previous permanent disability award.”
(Emphasis added.) Thus,
After the enactment of
In 1995, as already discussed to some extent, the legislature again enacted a series of amendments to the Workers’ Compensation Law, including adding the “actual worsening
“All permanent disability contemplates future waxing and waning of symptoms of the condition. The results of waxing and waning of symptoms may include, but are not limited to, loss of earning capacity, periods of temporary total or temporary partial disability, or inpatient hospitalization.”
Under
Finally, two additional statutes also relate to our inquiry into the “symptomatic worsening” question. The first is
“A claim for aggravation must be in writing in a form and format prescribed by the [Director [of the Department of Consumer and Business Services] and signed by the worker or the worker’s representative. The claim for aggravation must be accompanied by the attending physician’s report establishing by written medical evidence supported by objеctive findings that the claimant has suffered a worsened condition attributable to the compensable injury.”
(Emphasis added.) Thus, to prove an aggravation claim under subsection (1) of
The other contextually relevant statute is
“ ‘Objective findings’ in support of medical evidence are verifiable indications of injury or disease that may include, but are not limited to, range of motion, atrophy, muscle strength and palpable muscle spasm. ‘Objective findings’ does not include physical findings or subjective responses to physical examinations that are not reproducible, measurable or observable.”
Applying that definition to
To summarize the relevant statutes, the legislature amended
In view of the statutory chronology set out above, it appears that
In amending
The standards established in
What the 1995 amendment to
In sum, when considered together, the text, context, and applicable case law surrounding the 1995 amendment to
In this case, as noted, the ALJ required claimant to prove
either
that increased symptoms
or
a worsened condition had resulted in diminished earning capacity. The ALJ then reviewed the evidеnce of claimant’s worsened symptoms and inferred from that evidence alone that claimant’s underlying condition had worsened. By affirming the ALJ’s application of that legal standard, the Board erred. Accordingly, we reverse the Board’s order and remand the case to the Board for further proceedings. On remand, the Board must apply the legal standard set out above to determine whether claimant has established a worsened condition under
The decision of the Court of Appeals is affirmed. The order of the Workers’ Compensation Board is reversed, and the case is remanded to the Workers’ Compensation Board for further proceedings.
Notes
Before 1995, ALJs were known as referees. See Or Laws 1995, ch 332 (changing “referee” to “administrative law judge” throughout the Workers’ Compensation Law). Wе refer to the referee in this case as an ALJ throughout this opinion.
Both parties also point to
“In accepted injury or occupational disease claims, disability solely caused by or medical services solely directed to a worker’s preexisting condition are not compensable unless:
“(1) In occupational disease or injury claims other than those involving a preexisting mental disorder, work conditions or events constitute the major contributing cause of a pathological worsening of the preexisting condition.
“(2) In occupational disease or injury claims involving a preexisting mental disorder, work conditions or events constitute the major contributing cause of an actual worsening of the preexisting condition and not just of its symptoms.”
(Emphasis added.) We have considered the parties’ arguments concerning
However, as explained above,
In addition to the question whether claimant sufficiently established the existence of a worsened condition, our review of the record discloses a discrepancy as to whether the injury that resulted in claimant’s underlying compensable condition was the major contributing cause of claimant’s alleged worsened condition. On remand, the Board must weigh the facts pertaining to all the elements of an aggravation claim under