Schleiss v. SAIF Corp. , 354 Or. 637 ( 2013 )


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  • No. 66	                            December 27, 2013	637
    66
    Schleiss v. SAIF                                                                    354 Or
    December 27, 2013
    IN THE SUPREME COURT OF THE
    STATE OF OREGON
    In the Matter of the Compensation of
    Jon M. Schleiss, Claimant.
    Jon M. SCHLEISS,
    Petitioner on Review,
    v.
    SAIF CORPORATION
    and Nugent Masonry, Inc.,
    Respondents on Review,
    and
    DEPARTMENT OF CONSUMER
    AND BUSINESS SERVICES,
    Intervenor.
    (WCB 0905174; CA A146996; SC S060774)
    On review from the Court of Appeals.*
    Argued and submitted September 16, 2013.
    Donald M. Hooton, Hooton Wold & Okrent, LLP,
    Beaverton, argued the cause and filed the brief for petitioner
    on review.
    Julie Masters, SAIF Corporation, Salem, argued the
    cause and filed the brief for respondents on review SAIF
    Corporation and Nuent Masonry Inc.
    Michael A. Casper, Deputy Solicitor General, Salem,
    argued the cause for Intervenor Department of Consumer
    and Business Services. With him on the brief were Ellen F.
    Rosenblum, Attorney General, and Anna M. Joyce, Solicitor
    General.
    Julene M. Quinn, Corvallis, and James S. Coon, Swanson
    Thomas Coon & Newton, Portland, filed a brief on behalf of
    amicus curiae Oregon Trial Lawyers Association.
    ______________
    *  Judicial review from Workers’ Compensation Board. 
    250 Or App 458
    , 281
    P3d 626 (2012).
    638	                                                         Schleiss v. SAIF
    Before Balmer, Chief Justice, and Kistler, Walters,
    Landau, Brewer and Baldwin, Justices.**
    BREWER, J.
    The decision of the Court of Appeals is reversed, and the
    case is remanded to the Workers’ Compensation Board for
    further proceedings.
    Claimant appeals from a decision of the Court of Appeals affirming an order of
    the Workers’ Compensation Board (Board) awarding claimant permanent partial
    disability (PPD). The Board awarded claimant five-percent PPD based on a med-
    ical arbiter’s finding that the majority of his impairment was caused by a preex-
    isting mild degenerative condition and accelerated aging caused by his smoking.
    Claimant appealed to the Court of Appeals, arguing that the Board’s order was
    erroneous because the rule the Board relied on, OAR 436-035-0013, conflicted
    with the controlling statute, ORS 656.214, because it allowed for apportionment
    of his PPD award and such apportionment was only appropriate in combined-
    condition claims under ORS 656.268(1)(b), and then only where legally cognizable
    preexisting conditions were present. The Court of Appeals affirmed the Board’s
    order. Held: OAR 436-035-0013 is inconsistent with ORS 656.214 because that
    statute requires an award for impairment “due to” a compensable injury and does
    not provide for apportionment of that award based on other contributing causes
    that are not legally cognizable.
    The decision of the Court of Appeals is reversed, and the case is remanded to
    the Workers’ Compensation Board for further proceedings.
    ______________
    **  Linder, J., did not participate in the consideration or decision of this case.
    Cite as 
    354 Or 637
     (2013)	639
    BREWER, J.
    Our review of an order of the Workers’ Compensation
    Board (the board) that made a permanent partial disability
    (PPD) award to claimant requires us to determine whether
    OAR 436-035-0013 (2009), an administrative rule adopted
    by the Director of the Department of Consumer and Business
    Services (DCBS), is inconsistent with the statutes that the
    Director intended to implement. We review to determine
    whether the board has erroneously interpreted a provision
    of law. ORS 183.482(8)(a)(B). For the reasons that follow, we
    reverse the decision of the Court of Appeals, and we remand
    this case to the board for further proceedings.
    We take the material facts, in condensed form,
    from the Court of Appeals’ opinion. Schleiss v. SAIF, 
    250 Or App 458
    , 459, 281 P3d 626 (2012). Claimant compensably
    injured his low back while at work in April 2008, and SAIF
    accepted his ensuing claim for a lumbar strain. Claimant
    was taken off work after his injury and, during the next
    several months, received an extensive course of chiropractic
    care before being referred to Dr. Jeffrey Gerry. After exam-
    ining claimant in late 2008, Gerry opined that claimant had
    “some symptoms suggestive of lumbar radiculopathy,” and
    he referred claimant for a lumbar MRI. In February 2009,
    Gerry reviewed the results of claimant’s MRI and reported
    that “[t]here were no significant abnormalities noted.” Gerry
    declared claimant medically stationary and released him to
    regular work without restriction. Based on Gerry’s findings,
    SAIF issued a notice of closure that did not award PPD ben-
    efits to claimant.
    Claimant requested reconsideration and the appoint-
    ment of a medical arbiter, based on his disagreement “with
    the impairment findings used to determine and rate per-
    manent disability.” During a medical arbiter examination
    in July 2009, claimant reported that he had attempted to
    return to regular work in early March, but his back pain
    had recurred. Claimant also reported that he had been
    employed since that March attempt, but not in his regular
    work. After examining claimant, the arbiter opined that
    claimant “has some limitation in his ability to use the spinal
    area. I would classify it as moderate. He cannot lift over 50
    640	                                                   Schleiss v. SAIF
    pounds and needs to avoid recurrent bending and twisting.”
    The arbiter also stated that he “would attribute [claimant’s
    impairment] findings mainly to the off the job factor”:
    “This is based on the fact that his MRI demonstrates only
    mild degenerative changes at L1-2 and L4-5. He however
    does smoke and this contributes to an acceleration of the
    aging process. Based on the evaluation I would rate 33% of
    the problem secondary to his on-the-job and 67% secondary
    to his pre-existing mild DJD and long history of smoking.”
    Relying on the medical arbiter’s impairment find-
    ings, the Appellate Review Unit (ARU) of DCBS issued an
    order on reconsideration that awarded claimant PPD based
    on five percent whole-person impairment and no work dis-
    ability. Among other things, the order on reconsideration
    concluded that, because only the portion of impairment
    findings that were “due to” claimant’s compensable injury
    receive a value under OAR 436-035-0013, his “value for loss
    of range of motion,” 13.8 percent, was apportioned at 33 per-
    cent, for an impairment value of 4.55 percent.1
    In reaching that conclusion, the ARU relied on OAR
    436-035-0013(1), which provides:
    “The physician describes the current total overall find-
    ings of impairment, then describes those findings that are
    due to the compensable condition. In cases where a phy-
    sician determines a specific finding (e.g. range of motion,
    strength, instability, etc.) is partially attributable to the
    accepted condition, only the portion of those impairment
    findings that is due to the compensable condition receives
    a value. When apportioning impairment findings, the phy-
    sician must identify any applicable superimposed or unre-
    lated conditions.”
    That rule is intended to implement the Director’s author-
    ity under two statutes. The first statute, ORS 656.726(4)(f)
    (A), calls for the director to establish PPD standards and
    criteria based on “the loss of use or function of a body part
    *  * due to the compensable industrial injury.” The second
    *
    statute, ORS 656.214, which authorizes awards of PPD, pro-
    vides, in part, that,
    1
    That figure was rounded up to 5 percent under applicable DCBS rules.
    Cite as 
    354 Or 637
     (2013)	641
    “(1)(a)  ‘Impairment’ means the loss of use or function
    of a body part or system due to the compensable industrial
    injury or occupational disease determined in accordance
    with the standards provided under ORS 656.726, expressed
    as a percentage of the whole person.”
    After the ARU issued its order on reconsideration,
    claimant requested a hearing before an administrative law
    judge (ALJ). Among other arguments, claimant contended
    that the workers’ compensation statutes provide that “appor-
    tionment is appropriate only in the context of an accepted
    combined condition,” and that, because no qualifying com-
    bined condition existed in this case, claimant was “entitled
    to an award for all of his impairment as long as it was caused
    in part by his accepted condition.”
    The ALJ affirmed the reconsideration order, and the
    board affirmed the ALJ’s order. On judicial review before the
    Court of Appeals, claimant renewed his arguments before
    the board; in particular, claimant asserted that OAR 436-
    035-0013(1) is inconsistent with both the applicable statutes
    and this court’s decision in Barrett v. D & H Drywall, 
    300 Or 325
    , 709 P2d 1083 (1985), on recons 
    300 Or 553
    , 715 P2d 90
    (1986).
    The Court of Appeals affirmed. As pertinent here,
    the court reasoned that,
    “[b]oth ORS 656.214(1)(a) and ORS 656.726(4)(f)(A) con-
    template that PPD impairment benefits will be awarded
    only for impairment that is ‘due to’ the compensable con-
    dition. OAR 436-035-0013 implements those statutes by
    describing the way in which overall findings of impairment
    will be apportioned between those ‘[impairment] findings
    that are due to the compensable condition’ and those that
    are not. Put another way, the rule sets out the specific
    method for implementing the legislature’s express intent
    that workers receive PPD benefits only for impairment ‘due
    to’ compensable conditions.
    “* * * * *
    “[W]here a physician determines that an injured worker’s
    impairment is due partly to a previously undiagnosed non-
    compensable condition—and the physician does not find that
    the noncompensable condition was worsened or rendered
    symptomatic by the compensable injury—apportionment is
    642	                                                 Schleiss v. SAIF
    appropriate. OAR 436-035-0013 (2009) is consistent with
    those principles, it does not conflict with Barrett I or Barrett II
    and the DCBS director did not lack statutory authority to
    adopt that rule.”
    Schleiss, 250 Or App at 464-66.
    The statutory phrase “due to” is an inexact term—
    that is, neither a term so precise that no interpretation is
    necessary nor a term (such as “good cause”) indicating that
    the legislature intended to delegate the determination of its
    meaning to an agency charged with implementing the stat-
    ute. See Springfield Education Assn. v. School Dist., 
    290 Or 217
    , 223, 621 P2d 547 (1980) (summarizing the categorization
    of statutory terms). Accordingly, the Director’s construction
    of the statutory term in his rule is not entitled to deference
    on review. 
    Id. at 224, 229
    . In effect, then, the ultimate issue
    before us is whether the Court of Appeals’ construction of
    ORS 656.214 is correct. If it is, then the Director’s rule is con-
    sistent with the meaning of the statute; if not, then the rule
    is inconsistent with the statute, and the board’s order in this
    case is erroneous. In conducting that inquiry, we employ our
    method of statutory construction set out in State v. Gaines,
    
    346 Or 160
    , 171-72, 206 P3d 1042 (2009), to ascertain the
    legislature’s intent. See also State v. Klein, 
    352 Or 302
    , 309,
    283 P3d 350 (2012) (when construing statutes, court reviews
    statutory text and context, including related statutes).
    ORS 656.214 provides, in part:
    “(1)  As used in this section:
    “(a)  ‘Impairment’ means the loss of use or function of
    a body part or system due to the compensable industrial
    injury or occupational disease determined in accordance
    with the standards provided under ORS 656.726, expressed
    as a percentage of the whole person.
    “* * * * *
    “(c)  ‘Permanent partial disability’ means:
    “(A)  Permanent impairment resulting from the com-
    pensable industrial injury or occupational disease; or
    “(B)    Permanent impairment and work disability result-
    ing from the compensable industrial injury or occupational
    disease.
    Cite as 
    354 Or 637
     (2013)	643
    In defining “impairment” in ORS 656.214(1)(a), the
    legislature used the term “due to” to describe the necessary
    causal relationship between a compensable injury and the
    loss of use or function of a body part or system. Claimant
    asserts that, for purposes of an award under ORS 656.214,
    “due to” means “caused in material part by,” so that, if the
    compensable injury materially contributed to the total
    impairment, all the impairment is “due to” the compensa-
    ble injury. SAIF, on the other hand, asserts that the phrase
    refers to the percentage of the worker’s total impairment
    that was caused by the compensable injury, so that the per-
    centage of the total impairment “due to” any other contrib-
    uting cause must be excluded from an award.
    On the surface of things, either of those proposed
    meanings is plausible. The dictionary meaning of “due to”
    is “because of.” Webster’s Third New Int’l Dictionary 699
    (unabridged ed 2002). Consistently with that meaning, as
    claimant asserts, “due to” could mean that a compensable
    injury must have materially contributed to a worker’s total
    impairment; alternatively, as SAIF contends, “due to” could
    refer instead to the percentage of a worker’s total impair-
    ment to which the compensable injury contributed. The res-
    olution of the parties’ dispute therefore requires a detailed
    examination of the pertinent statutory framework in an
    effort to discern the meaning of the term in its context.
    The standard for determining the compensability
    of an injury is an appropriate point of departure. ORS
    656.005(7)(a) provides, in part, that a “compensable injury”
    is “an accidental injury, * * * arising out of and in the course
    of employment requiring medical services or resulting in
    disability or death.” This court has construed the phrase
    “arising out of” to mean that a workplace injury must be
    a material contributing cause of disability or the need for
    medical treatment in order to be compensable. Olson v. State
    Ind. Acc. Com., 
    222 Or 407
    , 414, 352 P2d 1096 (1960). In
    Olson the court stated:
    “Reduced to its simplest form[,] ‘arising out of’ as used
    in the act means the work or labor being performed was
    a causal factor in producing the injury suffered by the
    [worker]. It need not be the sole cause, but is sufficient if
    644	                                                       Schleiss v. SAIF
    the labor being performed in the employment is a material,
    contributing cause which leads to the unfortunate result.”
    
    Id. at 414-15
     (internal citations omitted). That standard is
    still recognized by this court as the test for establishing the
    existence of a compensable injury under ORS 656.005(7)(a).
    Hopkins v. SAIF, 
    349 Or 348
    , 351, 245 P3d 90 (2010).
    The material contributing cause standard does
    not govern the compensability of all conditions, however.
    In 1990, the legislature amended ORS 656.005(7)(a) to
    include subsections (A) and (B), pertaining to consequential
    and combined conditions respectively, and to which a major
    contributing cause standard applies. A major contributing
    cause is one that “contributes more to the injury for which
    the worker seeks compensation than all other causes com-
    bined, or most of the cause.” Smothers v. Gresham Transfer,
    Inc., 
    332 Or 83
    , 133-34, 23 P3d 333 (2001).2
    ORS 656.005(7)(a) (A) and (B) provide:
    “(A)  No injury or disease is compensable as a conse-
    quence of a compensable injury unless the compensable
    injury is the major contributing cause of the consequential
    condition.
    “(B)  If an otherwise compensable injury combines at
    any time with a preexisting condition to cause or prolong
    disability or a need for treatment, the combined condition
    is compensable only if, so long as and to the extent that
    the otherwise compensable injury is the major contribut-
    ing cause of the disability of the combined condition or the
    major contributing cause of the need for treatment of the
    combined condition.”
    ORS 656.005(24), in turn, defines the term “preexisting
    condition”:
    “(a)  ‘Preexisting condition’ means, for all industrial
    injury claims, any injury, disease, congenital abnormality,
    personality disorder or similar condition that contributes
    to disability or need for treatment, provided that:
    “(A)  Except for claims in which a preexisting condi-
    tion is arthritis or an arthritic condition, the worker has
    2
    Similarly, a preexisting condition that is exacerbated by a work injury can
    be compensable, but only if the work injury is the major contributing cause of a
    “pathological worsening of the pre-existing condition.” ORS 656.225.
    Cite as 
    354 Or 637
     (2013)	645
    been diagnosed with such condition, or has obtained medi-
    cal services for the symptoms of the condition regardless of
    diagnosis; and
    “(B)(i)  In claims for an initial injury or omitted condi-
    tion, the diagnosis or treatment precedes the initial injury;
    “(ii)  In claims for a new medical condition, the diagnosis
    or treatment precedes the onset of the new medical condi-
    tion; or
    “(iii)  In claims for a worsening pursuant to ORS
    656.273 or 656.278, the diagnosis or treatment precedes
    the onset of the worsened condition.”
    In addition to enacting ORS 656.005(7)(a)(A) and
    (B), in 1990 the legislature amended ORS 656.262(6)(b) to
    require that a notice of acceptance must “specify what condi-
    tions are compensable.” And, in the same session, the legis-
    lature enacted ORS 656.262(6)(c) and (7)(b), which provide:
    “(6)(c)  An insurer’s or self-insured employer’s accep-
    tance of a combined or consequential condition under ORS
    656.005(7), whether voluntary or as a result of a judgment
    or order, shall not preclude the insurer or self-insured
    employer from later denying the combined or consequential
    condition if the otherwise compensable injury ceases to be
    the major contributing cause of the combined or consequen-
    tial condition.
    “* * * * *
    “(7)(b)  Once a worker’s claim has been accepted, the
    insurer or self-insured employer must issue a written
    denial to the worker when the accepted injury is no longer
    the major contributing cause of the worker’s combined con-
    dition before the claim may be closed.”
    After an injury is determined to be compensable,
    benefits are payable under specific statutes, including tem-
    porary disability to replace lost wages (ORS 656.210), medi-
    cal services (ORS 656.245), permanent disability to compen-
    sate for permanent loss of earning capacity (ORS 656.214),
    and vocational services for retraining (ORS 656.340).
    To reiterate, ORS 656.214, the benefit statute at
    issue here, provides, in part:
    “(1)  As used in this section:
    646	                                                   Schleiss v. SAIF
    “(a)  ‘Impairment’ means the loss of use or function of
    a body part or system due to the compensable industrial
    injury or occupational disease determined in accordance
    with the standards provided under ORS 656.726, expressed
    as a percentage of the whole person.
    “* * * * *
    “(c)  ‘Permanent partial disability’ means:
    “(A)  Permanent impairment resulting from the com-
    pensable industrial injury or occupational disease; or
    “(B)    Permanent impairment and work disability result-
    ing from the compensable industrial injury or occupational
    disease.
    “* * * * *
    “(e)  ‘Work disability’ means impairment modified by
    age, education and adaptability to perform a given job.
    “* * * * *
    “(3)  Impairment benefits awarded under subsection
    (2)(a) of this section shall be expressed as a percentage of
    the whole person.”
    Thus, permanent disability includes two parts—“impairment”
    and “work disability.” “Impairment” means the objective loss
    of use or function of a body part “due to” the compensable
    injury, expressed as a percentage of the whole person. ORS
    656.214(1)(a); 656.726(4)(f)(A). “Work disability” means
    impairment modified by age, education, and adaptability to
    perform a given job. ORS 656.214(1)(e).
    When a worker who has suffered a compensable
    injury becomes medically stationary,3 the insurer closes the
    claim and awards any applicable benefits. ORS 656.268(1)(a);
    (5). If the worker objects to the notice of closure or the award,
    the worker may request reconsideration. ORS 656.268(5)(c).
    For purposes of reconsideration, the Director must appoint
    a medical arbiter if the worker’s physical impairment is in
    question. ORS 656.268(8). The claimant has the burden to
    establish the nature and extent of any impairment that is
    3
    “Medically stationary” means that “no further material improvement
    would reasonably be expected from medical treatment, or the passage of time.”
    ORS 656.005(17).
    Cite as 
    354 Or 637
     (2013)	647
    due to the compensable condition. ORS 656.266. Impairment
    must be established by a preponderance of medical evidence
    based upon objective findings. ORS 656.726(4)(f)(A) and (B).
    Objective findings of impairment might include, for exam-
    ple, measurable changes in the claimant’s range of motion
    or muscle strength. ORS 656.005(19).
    To fully frame the disability award analysis, ORS
    656.268(1) provides:
    “(1)  One purpose of this chapter is to restore the
    injured worker as soon as possible and as near as possi-
    ble to a condition of self support and maintenance as an
    able-bodied worker. The insurer or self-insured employer
    shall close the worker’s claim, as prescribed by the Director
    of the Department of Consumer and Business Services, and
    determine the extent of the worker’s permanent disability,
    provided the worker is not enrolled and actively engaged in
    training according to rules adopted by the director pursu-
    ant to ORS 656.340 and 656.726, when:
    “(a)  The worker has become medically stationary and
    there is sufficient information to determine permanent dis-
    ability; [or]
    “(b)  The accepted injury is no longer the major contrib-
    uting cause of the worker’s combined or consequential con-
    dition or conditions pursuant to ORS 656.005 (7). When the
    claim is closed because the accepted injury is no longer the
    major contributing cause of the worker’s combined or con-
    sequential condition or conditions, and there is sufficient
    information to determine permanent disability, the likely
    permanent disability that would have been due to the cur-
    rent accepted condition shall be estimated.”
    Thus, the legislature has generally authorized the Director to
    “determine the extent of the worker’s permanent disability”
    in either of two circumstances: (1) when the worker is medi-
    cally stationary and there is sufficient information to deter-
    mine permanent disability, ORS 656.268(1)(a); or (2) where
    a combined condition exists, the compensable injury is no
    longer the major cause of the disability and no longer the
    major cause of any need for treatment, and there is suffi-
    cient information to determine permanent disability. ORS
    656.268(1)(b).
    648	                                                       Schleiss v. SAIF
    Where, under ORS 656.268(1)(a), a claimant’s com-
    bined condition has become medically stationary and the
    accepted injury remains the major contributing cause of the
    claimant’s combined condition, the entire combined condi-
    tion—that is, the effect of the work injury and the preexist-
    ing condition—remains compensable. ORS 656.005(7)(a)(B).
    And, because the combined condition makes up the compen-
    sable injury under ORS 656.214(1)(c), the entire condition is
    rated for impairment at claim closure. That is, because there
    is no other legally cognizable cause whose contribution may
    be considered, all the claimant’s impairment is “due to” the
    compensable injury under ORS 656.214(1)(a). On the other
    hand, where ORS 656.268(1)(b) applies, the legislature has
    implicitly provided for an apportionment of causes contrib-
    uting to a worker’s impairment, so that the impairment “due
    to” the compensable injury is limited to the percentage of
    the total impairment to which the injury contributed. ORS
    656.005(7)(a)(B); ORS 656.214(1)(c); ORS 656.268(1)(b).
    One additional contextual matter merits attention as
    we clear the decks for analysis. Before the 1990 amendments
    to ORS 656.005(7) were enacted, this court had addressed
    the nature of the necessary causal relationship under ORS
    656.214 between impairment and the causes contributing to
    it. In Barrett, the claimant had an underlying asymptomatic
    arthritic condition in his low back before he suffered a com-
    pensable fall that caused back pain. Barrett I, 
    300 Or at 327
    .
    The employer denied any liability for the arthritic condition
    but accepted responsibility for the compensable injury. 
    Id.
     In
    considering whether the claimant also was entitled to bene-
    fits for his arthritic condition under ORS 656.214(5) (1985),4
    this court held that nothing in that statute precluded the
    board from including impairment caused by the worker’s
    arthritic condition in making a PPD award. 
    Id. at 330
    . On
    reconsideration, the court clarified that impairment “due to
    the compensable injury” included impairment triggered by a
    compensable injury that had caused a previously asympto-
    matic condition to become symptomatic. Barrett v. D & H
    Drywall, 
    300 Or 553
    , 555-56, 715 P2d 90 (1986) (Barrett II).
    4
    ORS 656.214(5) (1985) provided that the criterion for a rating of disability
    for permanent partial disability “shall be the permanent loss of earning capacity
    due to the compensable injury.”
    Cite as 
    354 Or 637
     (2013)	649
    In such circumstances, the court explained, the “loss of
    earning capacity is ‘due to’ the compensable injury, and the
    statute requires an award of compensation therefor.” 
    Id.
    The court emphasized, however, that its “decision [did] not
    require any award of compensation” for a disease or result-
    ing disability that existed before the compensable injury,
    unless the compensable injury worsened or triggered symp-
    toms of the underlying condition. 
    Id.
    As noted, in deciding this case, the Court of Appeals
    distinguished Barrett, observing that, here, there was no
    evidence that claimant’s workplace injury had worsened,
    or triggered symptoms from, the other causes that contrib-
    uted to claimant’s impairment. Schleiss, 250 Or App at 466.
    Although that distinction is apt, its significance here is lim-
    ited, because claimant’s theory does not depend on proof of
    a worsening or the triggering of symptoms of either of those
    other contributing causes. Instead, as discussed below, he
    asserts that those contributing causes are immaterial to the
    proper legal analysis.
    However, Barrett is of doubtful utility here for
    another fundamental reason. When Barrett was decided in
    1985, no statute addressed the role in PPD award determi-
    nations of impairment that is attributable to a preexisting
    condition that has combined with a compensable injury.
    Thus, in Barrett I, this court specifically noted the lack of
    any reference to preexisting conditions in ORS 656.214. 
    300 Or at 330
    . However, the court concluded that the legislature’s
    failure to mention preexisting conditions was insufficient to
    indicate that impairment caused by such conditions should
    be excluded from PPD awards that are due to a compensable
    injury; indeed, the court relied on the fact that no statute
    prohibited the board from including impairment caused by
    preexisting conditions in such an award. 
    Id.
     However, the
    workers’ compensation statutes now provide specific stan-
    dards for determining how and when conditions that “com-
    bine” workplace injuries with preexisting conditions are
    compensable and how and when impairment caused by such
    conditions can be apportioned. In light of those statutory
    changes, impairment attributable to a legally cognizable
    preexisting condition now must be apportioned in a PPD
    650	                                            Schleiss v. SAIF
    award where a combined condition has been established,
    and the compensable injury is no longer the major con-
    tributing cause of the impairment or the need for medical
    treatment. Therefore, irrespective of the holding in Barrett,
    if claimant’s claim had been for a combined condition and,
    at the time of closure, his compensable injury was no lon-
    ger the major contributing cause of his impairment or need
    for treatment, under the current statutory regime his PPD
    award would be reduced by the contribution of any legally
    cognizable preexisting condition. ORS 656.268(1)(b).
    The preceding overview provides the necessary
    context for our consideration of the administrative rule at
    issue here. OAR 436-035-0013(1) prescribes a standard for
    determining the extent of a worker’s impairment when the
    impairment is attributable both to a compensable injury and
    to some other contributing cause. As discussed, the rule pro-
    vides as follows:
    “The physician describes the current total overall find-
    ings of impairment, then describes those findings that are
    due to the compensable condition. In cases where a phy-
    sician determines a specific finding (e.g. range of motion,
    strength, instability, etc.) is partially attributable to the
    accepted condition, only the portion of those impairment
    findings that is due to the compensable condition receives
    a value. When apportioning impairment findings, the phy-
    sician must identify any applicable superimposed or unre-
    lated conditions.”
    Claimant challenges the validity of the second
    sentence of that subsection, which provides that, “In cases
    where a physician determines a specific finding (e.g., range
    of motion, strength, instability, etc.) is partially attrib-
    utable to the accepted condition, only the portion of those
    impairment findings that is due to the compensable condi-
    tion receives a value.” According to claimant, that part of
    the rule circumvents the combined condition process, and it
    reduces impairment that otherwise would be awarded with-
    out apportionment. Therefore, claimant reasons, the rule is
    invalid.
    SAIF responds that, because a portion of a worker’s
    impairment may be due to a compensable injury and another
    Cite as 
    354 Or 637
     (2013)	651
    portion may be due to other contributing causes, apportion-
    ment is an appropriate method for the director to imple-
    ment the statutes as written. According to SAIF, if claimant
    wished to have an impairment caused in part by a preex-
    isting condition included in his PPD award, he should have
    attempted to establish that his compensable injury was the
    major contributing cause of his impairment in a combined
    condition claim. In SAIF’s view, claimant had the burden of
    asserting and proving such a claim, and he failed to do so.
    See ORS 656.266.5
    We conclude that it is unnecessary to resolve the
    parties’ disagreement concerning the burdens of asserting
    and proving a combined condition claim, because there is no
    evidence in the record that either of the contributing causes
    on which the medical arbiter and the board relied is a legally
    cognizable preexisting condition that would authorize the
    apportionment of claimant’s impairment in a combined con-
    dition claim. And, as elaborated below, that conclusion is
    central to our resolution of this case.
    We begin with the board’s apportionment of claim-
    ant’s impairment based on the accelerated aging effects of his
    smoking history. Age must, by statute, be considered as part
    of an injured worker’s “work disability” award: “work dis-
    ability” determinations include as considerations a worker’s
    “age, education and adaptability to perform a given job.”
    ORS 656.214(1)(e). The premise, of course, is that an older
    worker generally is less adaptable to other employment and,
    therefore, is entitled to receive a higher disability award for
    5
    ORS 656.266 provides:
    “(1)  The burden of proving that an injury or occupational disease is com-
    pensable and of proving the nature and extent of any disability resulting
    therefrom is upon the worker. The worker cannot carry the burden of proving
    that an injury or occupational disease is compensable merely by disproving
    other possible explanations of how the injury or disease occurred.
    “(2) Notwithstanding subsection (1) of this section, for the purpose of
    combined condition injury claims under ORS 656.005 (7)(a)(B) only:
    “(a)  Once the worker establishes an otherwise compensable injury, the
    employer shall bear the burden of proof to establish the otherwise compensa-
    ble injury is not, or is no longer, the major contributing cause of the disability
    of the combined condition or the major contributing cause of the need for
    treatment of the combined condition.
    “(b) Notwithstanding ORS 656.804, paragraph (a) of this subsection
    does not apply to any occupational disease claim.”
    652	                                        Schleiss v. SAIF
    the same injury than a younger worker. DCBS’s own rules
    recognize that principle; under the director’s permanent dis-
    ability administrative rules, injured workers over 40 years
    old are entitled to receive an additional point that increases
    the work disability portion of their permanent disability
    awards. OAR 436-035-0012(1) and (2).
    That premise is reinforced by the fact that, on
    the record before us, claimant’s posited accelerated aging
    would not qualify as a preexisting condition under ORS
    656.005(24). For any condition other than arthritis or an
    arthritic condition to so qualify, the worker must have “been
    diagnosed with such condition, or ha[ve] obtained medical
    services for the symptoms of the condition regardless of
    diagnosis.” ORS 656.005(24)(a)(A). There is no evidence in
    the record that accelerated aging is a diagnosable condition
    or that, even if it is, claimant ever was diagnosed with it or
    treated for its symptoms before he suffered the workplace
    injury that SAIF accepted. Accordingly, claimant’s accel-
    erated aging would not qualify as a preexisting condition
    for purposes of a combined condition analysis under ORS
    656.005(7).
    The same is true of claimant’s “mild degenerative
    condition.” Although claimant had post-injury evidence of
    a preexisting degenerative disc condition, the record does
    not establish the existence of any preexisting disability or
    impairment due to that condition. Dr. Gerry, claimant’s
    examining physician, concluded that claimant had some
    indications of a radiculopathy, and he obtained an MRI.
    However, Gerry found no significant abnormalities in the
    MRI results. And the medical arbiter merely described that
    contributing cause as “mild degenerative change.”
    Again we note that, as with claimant’s accelerated
    aging, there is no evidence that claimant was diagnosed with
    any degenerative condition before he suffered his workplace
    injury. Accordingly, that contributing cause could qualify as
    a preexisting condition only if it amounted to “arthritis” or
    an “arthritic condition” under ORS 656.005(24)(a)(A). We
    addressed the meaning of those statutory terms in Hopkins.
    We held that, as used in that statute, “arthritis” “mean[s]
    the inflammation of one or more joints, due to infectious,
    Cite as 
    354 Or 637
     (2013)	653
    metabolic, or constitutional causes, and resulting in break-
    down, degeneration, or structural change.” 
    349 Or at 364
    .
    We also concluded that, to establish the existence of a preex-
    isting arthritic condition, an employer must adduce expert
    testimony that the claimant suffers from “inflammation
    of whatever joint or joints it contends are affected by the
    arthritic condition.” 
    Id. at 363
    .
    In this case, there is no evidence that the mild degen-
    erative condition that the medical arbiter identified included
    any inflammation of claimant’s joints. In addition, there is
    no evidence that, before his compensable injury occurred,
    claimant had been diagnosed with, or treated for, arthri-
    tis or an arthritic condition. It follows that there is no evi-
    dence from which the board could determine that claimant’s
    degenerative condition was a legally cognizable preexisting
    condition for the purpose of a combined condition analysis.
    Because claimant’s accelerated aging and mild
    degenerative condition were not legally cognizable preex-
    isting conditions, they also could not trigger the apportion-
    ment of claimant’s impairment in a true combined condition
    claim. As noted, ORS 656.266(2)(a) provides:
    “(2)  Notwithstanding subsection (1) of this section,
    for the purpose of combined condition injury claims under
    ORS 656.005 (7)(a)(B) only:
    “(a)  Once the worker establishes an otherwise com-
    pensable injury, the employer shall bear the burden of proof
    to establish the otherwise compensable injury is not, or is
    no longer, the major contributing cause of the disability of
    the combined condition or the major contributing cause of
    the need for treatment of the combined condition.”
    That provision does not require an analysis of what, in some
    general sense, has caused an injured worker to become
    impaired or need treatment. Rather, it requires identifica-
    tion of the major cause of any disability or need for treat-
    ment of the combined condition, suggesting that the board
    should compare only the contributions of the component
    parts of the combined condition. To confirm the point, ORS
    656.262(6)(c) refers simply to whether the otherwise com-
    pensable injury is the major contributing cause of the com-
    bined condition itself. Thus, the legislature has equated the
    654	                                                    Schleiss v. SAIF
    contributing causes of disability—including impairment—
    of a combined condition with the contributing causes of the
    combined condition.
    Accordingly, other contributing causes—such as
    the accelerated aging effects of a long smoking history or a
    mild degenerative condition—that are neither encompassed
    within the compensable injury nor are legally cognizable
    preexisting conditions, play no role in the impairment calcu-
    lus of a combined condition claim. Yet, in applying OAR 436-
    035-0013(1), the board treated claimant’s accelerated aging
    and mild degenerative condition as contributing causes that,
    in effect, combined to produce claimant’s impairment and
    required its apportionment under ORS 656.214.
    That treatment is inconsistent with the statutory
    scheme, because it is illogical to conclude that the legislature
    intended to authorize the apportionment of an injured worker’s
    impairment based on the contribution of such a cause.
    That is so because, if that were the legislature’s intent, any
    preexisting contributing cause would have to qualify for
    apportionment under ORS 656.214, even where—because
    a compensable injury was the major contributing cause of
    the impairment—a statutorily cognizable preexisting con-
    dition would not so qualify. It defies reason to believe that,
    for purposes of apportionment of a worker’s impairment,
    the legislature would afford such preferential treatment to
    a preexisting contributing cause that would not be legally
    cognizable in a combined condition claim. To the contrary,
    if a preexisting contributing cause would not qualify to
    reduce the impairment that is “due to” a compensable com-
    bined condition under ORS 656.268(1)(b), it makes no sense
    to conclude that such a cause would qualify to reduce the
    impairment that is “due to” a claimant’s compensable injury
    under ORS 656.214.6
    There is no indication that the legislature intended
    the phrase “due to” in ORS 656.214 to have a different mean-
    ing than in ORS 656.268. In both statutes, depending on
    6
    We deliberately refer to a preexisting contributing cause in making this
    point. This case does not present an occasion to decide whether—or under what
    circumstances—a contributing cause arising after a compensable injury would be
    legally cognizable for purposes of apportioning impairment under ORS 656.214.
    Cite as 
    354 Or 637
     (2013)	655
    the circumstances, the phrase could require the apportion-
    ment of a worker’s impairment based on contributing causes
    that are unrelated to the compensable injury. However, to
    qualify for the apportionment of impairment, a cause must
    be legally cognizable. In this case, apart from the compen-
    sable injury, there are no other legally cognizable contrib-
    uting causes that claimant’s impairment is “due to” under
    either statute. It follows that all of claimant’s impairment
    is “due to” the compensable injury for purposes of making
    a PPD award under ORS 656.214. The board nevertheless
    treated claimant’s preexisting accelerated aging and mild
    degenerative changes as contributing causes for purposes of
    apportioning his impairment. Because the board’s order was
    based on the Director’s rule, it is erroneous.7 ORS 183.482(8)
    (a)(B).
    The decision of the Court of Appeals is reversed, and
    the case is remanded to the Workers’ Compensation Board
    for further proceedings.
    7
    We note in passing that SAIF argues for the first time before this court
    that claimant failed to exhaust his administrative remedies because he did not
    establish that his impairment was due to his compensable injury rather than
    “his preexisting mild [degenerative joint disease] and long history of smoking.”
    As explained above, because those contributing causes cannot be considered in
    rating claimant’s impairment, they do not support SAIF’s exhaustion argument.
    

Document Info

Docket Number: WCB 0905174; CA A146996; SC S060774

Citation Numbers: 354 Or. 637, 317 P.3d 244, 2013 WL 6842795, 2013 Ore. LEXIS 1073

Judges: Balmer, Kistler, Walters, Landau, Brewer, Baldwin

Filed Date: 12/27/2013

Precedential Status: Precedential

Modified Date: 11/13/2024