JBS Carriers v. Labor Commission , 2021 UT App 44 ( 2021 )


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    2021 UT App 44
    THE UTAH COURT OF APPEALS
    JBS CARRIERS AND AMERICAN ZURICH INSURANCE COMPANY,
    Petitioners,
    v.
    LABOR COMMISSION AND DAVID HICKEY,
    Respondents.
    Opinion
    No. 20200226-CA
    Filed April 15, 2021
    Original Proceeding in this Court
    Brad J. Miller and Rachel M. Konishi,
    Attorneys for Petitioners
    Gary E. Atkin and Kenneth E. Atkin,
    Attorneys for Respondent David Hickey
    JUDGE RYAN M. HARRIS authored this Opinion, in which
    JUDGES GREGORY K. ORME and DAVID N. MORTENSEN concurred.
    HARRIS, Judge:
    ¶1     While on a long-haul trip as a truck driver for JBS Carriers
    (JBS), David Hickey developed a blood clot in his left leg, parts
    of which eventually migrated to his lungs. He later sought, and
    was awarded, workers’ compensation benefits for pulmonary
    and left leg problems associated with the blood clot. JBS and its
    insurer seek judicial review of that award, contending that
    Hickey’s employment was not the legal cause of his injuries, and
    that the Utah Labor Commission (the Commission) improperly
    determined otherwise. We agree with JBS, and therefore we set
    aside the Commission’s order and remand the case to the
    Commission for further proceedings.
    JBS Carriers v. Labor Commission
    BACKGROUND 1
    ¶2      One evening in August 2016, Hickey began a multi-day
    trip driving a commercial truck from Utah to California for JBS,
    his employer since 2013. Hickey’s truck was outfitted with an
    automatic transmission, meaning that Hickey could operate the
    vehicle without using his left foot to depress a clutch. The truck
    also came equipped with a sleeper cab, which Hickey could use
    for rest breaks. On the first evening of the trip, Hickey drove for
    thirty-seven minutes before stopping for fuel, then drove for
    another two hours before stopping to sleep in his cab. On the
    second day of the trip, Hickey drove for two short stretches in
    the morning, took an eight-hour rest in his sleeper cab, and then
    drove for just over seven hours without interruption, arriving at
    his first destination after midnight on the third day of the trip. At
    this destination, Hickey’s truck was unloaded, and he rested
    there for about eighteen hours before driving another two hours
    to a second destination.
    ¶3     By the end of the third day of the trip, Hickey started
    feeling “dehydrated and not well,” and began experiencing
    shortness of breath, which increased with movement, and
    “swelling in his left leg.” After arriving at his second destination,
    Hickey went to a local hospital where he was diagnosed with
    “acute DVT of the lower left extremity.” DVT stands for “deep
    vein thrombosis,” which is a medical condition caused by the
    development of a blood clot in a vein deep inside the body. See
    Deep Vein Thrombosis, WebMD, https://www.webmd.com/dvt/w
    hat-is-dvt-and-what-causes-it [https://perma.cc/4PKC-3KKU]. In
    Hickey’s case, parts of the blood clot that had originally formed
    1. “In reviewing an order from the Commission, we view the
    facts in the light most favorable to the Commission’s findings
    and recite them accordingly.” JBS USA v. Labor Comm’n, 
    2020 UT App 86
    , n.1, 
    467 P.3d 905
     (quotation simplified).
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    in a vein in his left leg had broken off and migrated into the
    blood vessels in his lungs, causing “severe bilateral pulmonary
    emboli.” Pulmonary embolism occurs when a blood clot “that
    travel[s] to the lung from deep veins in the legs” causes a
    blockage in one of the lungs’ pulmonary arteries. See Pulmonary
    embolism, Mayo Clinic, https://www.mayoclinic.org/diseases-
    conditions/pulmonary-embolism/symptoms-causes/syc-2035464
    7 [https://perma.cc/92KV-PBJV]. DVT coupled with pulmonary
    embolism is a life-threatening condition, and doctors therefore
    admitted Hickey to the hospital for treatment, where he
    remained for three days. Upon discharge, hospital physicians
    gave Hickey anticoagulants, referred him to his primary medical
    doctor, and counseled him to lose weight; at the time, he
    weighed over 340 pounds and had a body mass index of 55, and
    was thus considered medically “super obese.” Hickey had also
    developed DVT on another occasion some twenty-five years
    earlier; on that occasion, the DVT occurred after a surgical
    procedure.
    ¶4     After being discharged from the California hospital,
    Hickey was not cleared to return to commercial truck driving for
    three months. In the interim, Hickey applied for temporary total
    and permanent partial workers’ compensation benefits. In his
    application, Hickey claimed that he sustained an industrial
    injury—the DVT and resulting embolism (the Injury)—“[d]ue to
    long periods of sitting in a truck” in August 2016. He did not
    claim to have sustained the Injury from repetitive trauma. JBS
    responded by asserting that there existed no causal link—either
    medical or legal—between Hickey’s employment and the Injury,
    and contended that the Injury “constitute[d] nothing more than
    the continuing manifestation of a pre-existing condition.” After
    two doctors assessed Hickey and gave conflicting opinions about
    whether Hickey suffered from a preexisting condition that
    contributed to the Injury, an administrative law judge (ALJ)
    referred the matter to a medical panel.
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    ¶5       The doctors on the panel reviewed the relevant medical
    records, as well as certain facts to which Hickey and JBS had
    stipulated, and concluded that the “primary factor” that led to
    the Injury was Hickey’s “super obesity.” The panel
    acknowledged that Hickey’s “work as a commercial truck driver
    . . . did marginally worsen” his DVT and pulmonary embolism,
    but opined that Hickey’s “super obesity made him 6-10 times
    more likely to develop a blood clot.” The panel concluded by
    stating that it did “not believe there [was] a 1:1 contribution” to
    the Injury from his super obesity and from his long-haul
    journey, because obesity is a more significant DVT risk factor
    than commercial truck driving.
    ¶6      Relying on the medical panel’s report, which he found
    “thorough and well-reasoned,” the ALJ denied Hickey’s claim
    for benefits. In so doing, the ALJ first determined that Hickey
    suffered from a preexisting condition—super obesity—and that
    this condition “contributed to the development of [Hickey’s]
    blood clots.” He then concluded, citing Allen v. Industrial
    Commission, 
    729 P.2d 15
     (Utah 1986), that Hickey’s work-related
    activities—which the ALJ characterized as “spending long
    periods of time sitting . . . without using his left foot”—did not
    qualify as the legal cause of the Injury under Utah law, because
    those activities were “not . . . unusual or extraordinary”
    exertions. See 
    id. at 26
    .
    ¶7     Hickey then asked the Commission to review the ALJ’s
    decision. In Hickey’s motion for review, he raised two main
    arguments: (1) that the medical panel was not qualified to render
    its decision; and (2) that the ALJ erroneously concluded that a
    preexisting condition contributed to the Injury, and that Hickey
    should therefore not have been required to meet the Allen
    standard for legal causation. Notably, Hickey did not make any
    argument, in the alternative or otherwise, that he could satisfy
    the Allen standard in the event it applied to his case; specifically,
    he did not attempt to claim that sitting for long periods of time
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    while driving his truck during the August 2016 trip was an
    unusual or extraordinary exertion that would satisfy Allen.
    ¶8     After review, the Commission found it unnecessary to
    address the threshold question of whether Hickey suffered from
    a preexisting condition that contributed to the Injury, because it
    determined, sua sponte, that “even if the more stringent [Allen]
    standard applies to Mr. Hickey’s claim, he me[t] such standard
    in light of the work activity that precipitated [the Injury].” The
    Commission relied on its own precedent to conclude that the
    activity of “driving for more than six hours without a break and
    then driving for almost two and a half hours more later in the
    same day involves an unusual or extraordinary exertion.” The
    Commission then set aside the ALJ’s order, and remanded the
    matter to the ALJ for additional proceedings.
    ¶9     On remand, the ALJ issued a second order that reaffirmed
    its earlier conclusion that Hickey suffered from a preexisting
    condition that contributed to the Injury, but also concluded—as
    determined by the Commission—that Hickey could show both
    legal causation and medical causation. The ALJ therefore
    awarded Hickey the benefits he requested.
    ¶10 JBS appealed the ALJ’s second decision to the
    Commission, arguing that the Commission overstepped its
    bounds by sua sponte evaluating legal causation under the Allen
    standard, and asserting that Hickey could not meet that
    standard in any event. The Commission rejected JBS’s
    arguments. With regard to legal causation, the Commission
    concluded that driving a commercial truck is unlike typical
    nonemployment activities, such as personal travel or watching
    television for long periods of time, because commercial truck
    driving gives the worker “limited opportunity” to move and is
    “more complex and demanding than operating or traveling in a
    personal automobile.” The Commission therefore affirmed the
    ALJ’s award of benefits to Hickey.
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    JBS Carriers v. Labor Commission
    ISSUES AND STANDARDS OF REVIEW
    ¶11 JBS now seeks judicial review of the Commission’s award,
    and asks us to examine two particular aspects of the
    Commission’s decision, both of which concern legal causation.
    First, JBS asserts that, by failing to raise the issue in his first
    motion for review before the Commission, Hickey failed to
    preserve (or waived his right to seek review of) the question of
    whether long-haul truck driving constitutes an unusual or
    extraordinary exertion under Allen v. Industrial Commission, 
    729 P.2d 15
     (Utah 1986), and asserts that the Commission
    overstepped its bounds by addressing the issue sua sponte.
    Second, JBS challenges the merits of the Commission’s legal
    causation determination, asserting that the Injury was not the
    result of any unusual or extraordinary workplace exertion.
    ¶12 We need not tackle the first issue, however, because we
    ultimately agree with JBS on the merits of the legal causation
    question. Accordingly, in this case we exercise our prerogative to
    presume, without deciding, that the Allen issue was preserved
    and that the Commission did not overstep its bounds by
    addressing it. 2 See State v. Kitches, 
    2021 UT App 24
    , ¶ 28
    2. We also note some dissatisfaction with the parties’ briefing on
    the question of whether, and under what circumstances, the
    Commission may consider an issue sua sponte. Neither party
    cited or discussed Hilton Hotel v. Industrial Commission of Utah,
    
    897 P.2d 352
     (Utah Ct. App. 1995), or Chevron U.S.A., Inc. v. Utah
    State Tax Commission, 
    847 P.2d 418
     (Utah Ct. App. 1993),
    disapproved of on other grounds by King v. Industrial Commission of
    Utah, 
    850 P.2d 1281
    , 1284 (Utah Ct. App. 1993), a line of cases in
    which we held that administrative tribunals’ ability to consider
    new issues sua sponte is limited. See Hilton, 
    897 P.2d at 356
    –57;
    Chevron, 
    847 P.2d at 420
    –21. Moreover, neither side discussed the
    potential tension between that line of cases and other cases
    (continued…)
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    JBS Carriers v. Labor Commission
    (explaining that, in the interests of judicial economy, “if the
    merits of a claim can easily be resolved in favor of the party
    asserting that the claim was not preserved, we readily may opt to do
    so without addressing preservation”). We therefore proceed
    directly to the merits of the legal causation question, and confine
    our analysis to the second issue JBS raises.
    ¶13 With regard to that second issue, we review the
    Commission’s legal causation determinations nondeferentially.
    See Murray v. Utah Labor Comm’n, 
    2013 UT 38
    , ¶ 40, 
    308 P.3d 461
    (stating that “the Commission’s decision here that [the
    employee] failed to establish legal cause warrants nondeferential
    review” because “the ultimate question is the legal effect of the
    facts,” a question that “depends on the[] unusualness” of “a
    (…continued)
    indicating that district courts (and, by extension, administrative
    tribunals) may, under some circumstances and provided that
    briefing opportunities are afforded to the parties, consider
    matters sua sponte, see Doyle v. Doyle, 
    2011 UT 42
    , ¶ 52, 
    258 P.3d 553
    ; cf. Helf v. Chevron U.S.A. Inc., 
    2015 UT 81
    , ¶ 42, 
    361 P.3d 63
    (determining that there is no preservation problem “[w]here a
    district court itself raises and then resolves an issue sua sponte,”
    because in such a situation the court “obviously had an
    opportunity to rule on the issue”), and between that first line of
    cases and the apparent obligation of courts and administrative
    tribunals to act sua sponte to avoid plain error, see, e.g., Utah
    Chapter of Sierra Club v. Air Quality Board, 
    2009 UT 76
    , ¶¶ 26–28,
    
    226 P.3d 719
     (explaining that an administrative agency can
    commit plain error if it fails to address, sua sponte, an “obvious”
    and “harmful” error). Under these circumstances, and given that
    we adjudge the Commission’s decision incorrect on its merits,
    we deem it particularly appropriate to save for another day a
    thorough discussion of whether, and under what circumstances,
    the Commission may address issues sua sponte.
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    given set of facts,” and “unusualness—like reasonableness—is
    an objective legal standard that we are in a better position to
    analyze than the Commission” (quotation simplified)).
    ANALYSIS
    ¶14 The Utah Workers’ Compensation Act provides that an
    employee injured “by accident arising out of and in the course of
    the employee’s employment . . . shall be paid . . . compensation
    for loss sustained on account of the injury.” Utah Code Ann.
    § 34A-2-401(1)(a) (LexisNexis 2019). Interpreting this language in
    a previous iteration of the same statute, our supreme court has
    noted that there are “two prerequisites for a finding of a
    compensable injury” in workers’ compensation cases. See Allen v.
    Indus. Comm’n, 
    729 P.2d 15
    , 18 (Utah 1986). “First, the injury
    must be ‘by accident.’” 
    Id.
     (quotation simplified). “Second, the
    language ‘arising out of [and] in the course of employment’
    requires that there be a causal connection between the injury and
    the employment.” 
    Id.
     (quotation simplified). In this case, JBS
    does not assert that the Injury occurred other than “by accident,”
    and therefore only the second prerequisite—regarding causal
    connection—is at issue here.
    ¶15 Our supreme court has “adopted a two-part test for
    establishing a causal connection”; that test requires a claimant to
    “establish that the conditions or activities of [the] job were both
    the medical cause and the legal cause of [the] injury.” See Murray
    v. Utah Labor Comm’n, 
    2013 UT 38
    , ¶ 45, 
    308 P.3d 461
    . In
    instances where no preexisting condition contributes to the
    injury, a claimant “need only prove medical causation.” 
    Id.
     (also
    stating that, for claimants without preexisting conditions, “the
    medical and legal causation requirements are one and the
    same”). But in cases where a worker’s preexisting condition
    contributes to the workplace injury, the worker must also show
    that the workplace activities were the legal cause of the worker’s
    injuries. See 
    id. ¶¶ 45
    –46.
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    JBS Carriers v. Labor Commission
    ¶16 In this case, the ALJ in an initial ruling determined that
    Hickey had a preexisting condition—super obesity—which
    contributed to his blood clot, and therefore determined that
    Hickey needed to show legal causation in order to recover. The
    ALJ then concluded that Hickey could not make that showing,
    and on that basis rejected Hickey’s claim for benefits. The
    Commission, in reviewing the ALJ’s decisions, determined that
    it did not need to grapple with the threshold factual question
    about whether Hickey had a preexisting condition that
    contributed to his injuries, because it determined that Hickey
    could make the necessary showing of legal causation in any
    event. On that basis, the Commission reversed the ALJ and
    eventually sustained Hickey’s claim.
    ¶17 In our analysis, given that we review the Commission’s
    decision and not the ALJ’s, see Utah Code Ann. § 34A-2-801(9)(a)
    (stating that we review “the decision of the commissioner or
    Appeals Board”), we begin by examining the merits of the
    Commission’s decision about whether Hickey can satisfy the
    Allen standard for legal causation. Because we determine that he
    cannot, it then becomes necessary to discuss the threshold
    question the Commission avoided: whether Hickey even needs
    to show legal causation in the first place. Our analysis proceeds
    in that order.
    A
    ¶18 As our supreme court has explained, a “heightened
    showing of legal cause is necessary” in cases where an
    employee’s preexisting condition contributes to the injury. See
    Murray, 
    2013 UT 38
    , ¶ 46 (quotation simplified). This heightened
    showing serves “to distinguish those injuries which (a)
    coincidentally occur at work because a preexisting condition
    results in symptoms which appear during work hours without
    any enhancement from the workplace, and (b) those injuries
    which occur because some condition or exertion required by the
    20200226-CA                    9                
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    JBS Carriers v. Labor Commission
    employment increases the risk of injury which the worker
    normally faces in [the worker’s] everyday life.” Allen, 729 P.2d at
    25 (emphasis added). This distinction is important because
    “[o]nly the latter type of injury is compensable.” Id. In many
    cases, “the required workplace enhancement” can be “supplied
    by” demonstrating that the conditions of employment required
    “an exertion greater than that undertaken in normal, everyday
    life.” See Murray, 
    2013 UT 38
    , ¶ 47 (quotation simplified); see also
    Allen, 729 P.2d at 25 (stating that, to show legal causation, an
    employee must “show that the employment contributed
    something substantial to increase the risk [the employee] already
    faced in everyday life because of [the preexisting] condition”).
    ¶19 Evaluating the merits of a worker’s legal causation claim
    involves a two-step process: “first, we must characterize the
    employment-related activity that precipitated the [employee’s]
    injury, taking into account the totality of the circumstances; and
    second, we must determine whether this activity is objectively
    unusual or extraordinary.” Murray, 
    2013 UT 38
    , ¶ 48. The first
    step is a factual inquiry, 
    id. ¶ 49,
     and in this case does not
    involve a matter of dispute. The Commission described the
    relevant portion of Hickey’s employment activity as “driving for
    more than six hours without a break and then driving for almost
    two and a half hours more later in the same day.” Additionally,
    the Commission noted that Hickey’s truck “had an automatic
    transmission that did not require use of his left leg to engage the
    truck’s pedals,” and noted that Hickey “would usually remain in
    the driver’s seat as his truck was being loaded and unloaded,”
    which meant “that his driving time alone did not fully account
    for the time he spent sitting in the truck.” However, no party
    offered any evidence that Hickey’s employment duties required
    him to drive for any particular length of time before taking a
    break. And although operation of his particular truck did not
    necessitate the use of his left leg, Hickey offered no evidence that
    his employment duties required him to keep his leg motionless
    while driving. Likewise, although Hickey testified that he
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    JBS Carriers v. Labor Commission
    usually remained inside the cab of his truck during loading and
    unloading, the only evidence he offered in this regard was that
    “[s]ome shippers and receivers had rules in place [that] required
    the driver to remain inside the truck” during loading and
    unloading. The record before us contains no evidence that the
    shippers and receivers on this particular trip required him to
    stay in the truck while it was being loaded and unloaded, and in
    any case the record contains no evidence that he was at any
    point prevented from moving about inside the truck—for
    instance, to stretch in place, or to move into the sleeper cab to
    rest or stretch—during loading and unloading. 3
    ¶20 The second step in evaluating a worker’s legal causation
    claim is to compare the level of exertion required by the worker’s
    employment duties to the “typical nonemployment activities
    [that] are generally expected of people in today’s society.” 
    Id. ¶ 48
     (quotation simplified). If the activities and exertions
    required by the worker’s job, viewed in their totality, are
    objectively unusual or extraordinary when compared to the
    activities of daily living, then the workplace activities will be
    considered to have “contributed something substantial to
    increase the risk [the employee] already faced in everyday life
    because of [the preexisting] condition,” and therefore the
    workplace activities will be considered the legal cause of the
    3. In describing the workplace activity that led to the Injury, we
    focus on the August 2016 trip that Hickey identified, in his
    application for benefits, as the source of the Injury. As noted,
    Hickey’s claim was that the Injury was caused by this trip, and
    not by the cumulative effect of repetitive lengthy truck travel.
    Our focus is therefore on the particulars of the specific trip in
    question. See Acosta v. Labor Comm’n, 
    2002 UT App 67
    , ¶¶ 31–34,
    
    44 P.3d 819
     (declining to address any repetitive trauma claim
    where the claimant had not raised any such claim, and instead
    focusing on the specific issue raised by the claimant).
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    employee’s injury. See Allen, 729 P.2d at 25; see also Murray, 
    2013 UT 38
    , ¶¶ 47, 52–53.
    ¶21 By way of example, our supreme court noted in Allen that
    “[t]ypical activities and exertions expected” of people in modern
    life “include taking full garbage cans to the street, lifting and
    carrying baggage for travel, changing a flat tire on an
    automobile, lifting a small child to chest height, and climbing the
    stairs in buildings.” See 729 P.2d at 26; see also Murray, 
    2013 UT 38
    , ¶ 53 (stating that “people are generally expected to travel in
    everyday life”). On the other hand, “Utah courts have deemed
    employment activities to be ‘unusual’ or ‘extraordinary’ when
    they require an employee to endure jumping, lifting great
    weight, or repetition.” Murray, 
    2013 UT 38
    , ¶ 51; see also Fastenal
    v. Labor Comm’n, 
    2020 UT App 53
    , ¶¶ 2, 17, 
    463 P.3d 90
    (determining that a truck driver’s repeated use, over a period of
    more than a year, of his left foot to depress a clutch when
    driving “for approximately eleven hours per day” on his
    workdays, constituted unusual and extraordinary exertion, and
    was the legal cause of a “pressure ulcer” on the driver’s left
    heel). Indeed, even activities that might otherwise seem rather
    typical may be deemed “unusual or extraordinary” when the
    requirements of a job demand that an employee execute the
    activities in an “awkward manner,” see Peterson v. Labor Comm’n,
    
    2016 UT App 12
    , ¶¶ 15–16, 
    367 P.3d 569
     (determining that lifting
    a “significant amount of weight” in an “awkward manner” can
    constitute unusual or extraordinary activity), or under “exigent
    circumstances,” see JBS USA v. Labor Comm’n, 
    2020 UT App 86
    ,
    ¶¶ 16–19, 
    467 P.3d 905
     (explaining that a forty-inch jump
    “constituted an unusual exertion” because “the exigent
    circumstances surrounding the jump caused” the employee to
    jump in an abnormal manner).
    ¶22 Here, the Commission determined that Hickey’s
    activities—driving for some seven hours in one sitting, then
    driving for another two and a half hours after a break, all
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    JBS Carriers v. Labor Commission
    without using his left leg—“involved an unusual or
    extraordinary exertion over and above the usual wear and tear
    and exertions of nonemployment life.” In so doing, the
    Commission rejected JBS’s arguments that “driving a truck for
    extended hours was comparable to driving a personal
    automobile for extended hours,” taking a long international
    flight, or “watching television for an extended amount of time.” 4
    4. In reaching its determination, the Commission relied heavily
    on its own precedent. See Huskic v. Anexpress LLC, No. 08-0816,
    
    2010 WL 8727461
     (Utah Labor Comm’n May 25, 2010). In that
    case, the Commission held that a driver who was in a truck for
    “a total of 15 hours straight,” “first riding in the passenger’s seat
    and then driving,” before suffering a stroke, had engaged in an
    “unusual or extraordinary exertion”; the Commission
    determined that “driving a semi-truck . . . is more demanding
    and involved than driving a personal automobile.” 
    Id. at *1, *3
    .
    Here, in evaluating Hickey’s claim, the Commission was bound
    to follow its earlier precedent. See Steiner Corp. v. Auditing Div. of
    Utah State Tax Comm’n, 
    1999 UT 53
    , ¶ 12, 
    979 P.2d 357
     (“The
    holding of an agency adjudication, or the application of a rule of
    law to the facts in that case, binds an agency in subsequent
    decisions . . . .” (emphasis added)). But we, of course, are not so
    bound. Cf. Ellis-Hall Consultants v. Public Service Comm’n, 
    2016 UT 34
    , ¶¶ 24–33, 
    379 P.3d 1270
     (holding that “agency decisions
    premised on pure questions of law,” while binding on the
    agency itself, are “subject to non-deferential review” by the
    judiciary, because “it is emphatically the province and duty of
    the judicial department to say what the law is” (quotation
    simplified)); see also Utah Code Ann. § 63G-4-403(4)(d)
    (LexisNexis 2019) (“The appellate court shall grant relief . . . if,
    on the basis of the agency’s record, it determines . . . the agency
    has erroneously interpreted or applied the law . . . .”). And, for
    the reasons discussed herein, we find the Commission’s analysis
    in Huskic unpersuasive, at least as applied to this case.
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    The Commission opined that “driving a truck is more complex
    and demanding than operating or traveling in a personal
    automobile,” and stated that Hickey had “limited opportunity
    . . . to stretch, change position, or otherwise move about as one
    would be able to while on a long flight or watching television.”
    ¶23 We disagree with the Commission’s analysis. We first
    take issue with the Commission’s statement that Hickey had
    “limited opportunity” to stretch, change position, or take breaks.
    There is simply no evidence, in the record before us, to support
    that conclusion. As evidenced by the work logs, Hickey was
    allowed to take breaks, and did so often while en route to his
    assigned destinations; indeed, Hickey took more than two full
    days to travel from Utah to California, indicating that his
    delivery schedule was flexible. Hickey presented no evidence
    that JBS put limits on how often, and for how long, he could stop
    for a rest or stretch break; likewise, he presented no evidence
    that the delivery requirements of the trip in question made it
    impractical to take breaks. And while Hickey testified that he
    “would usually remain in the driver’s seat as his truck was being
    loaded and unloaded,” there is no evidence in the record
    indicating that this was required of him on this particular trip, or
    that he was otherwise prevented from moving around inside his
    truck, including resting inside the sleeper cab, while his truck
    was being loaded. And finally, while it is certainly true that
    Hickey’s truck had an automatic transmission, and therefore had
    no clutch that required action by Hickey’s left foot, it is also
    true that no requirement of the job prevented Hickey from
    stretching his inactive left leg while operating the truck with his
    other limbs. Under Allen, we must focus on the “exertion required
    by the employment.” See 729 P.2d at 25 (emphasis added). And
    here, at least according to the record before us, the requirements
    of the job left Hickey free to take regular breaks, and did not
    require Hickey to sit entirely still for any particular length of
    time.
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    ¶24 Next, and relatedly, we disagree with the Commission’s
    determination that Hickey’s activities on the trip that
    precipitated the Injury were materially different from activities
    typically undertaken by people in modern life. See 
    id. at 26
    .
    While we acknowledge that operating a commercial truck is
    somewhat more complicated than driving a personal
    automobile, it is not the complexity of the activity that forms the
    basis for Hickey’s claim here—instead, it is the sedentary nature
    of long drives. And in this sense, we perceive no meaningful
    distinction between sitting for a long time in a truck cab and
    sitting for a long time in a passenger car, or sitting for a long
    time in an airplane seat, or even sitting for a long time on a
    couch in front of a television screen. It is not at all unusual or
    extraordinary for people in everyday modern American life to
    take long drives (say, Salt Lake City to Denver, Los Angeles, or
    Phoenix) in passenger cars. And—at least before the onset of the
    COVID-19 pandemic—it was not at all unusual or extraordinary
    for people to take long-haul flights from the U.S. to, say, Europe
    or Asia. And, in a world where “binge-watch” is now a defined
    term in the Cambridge English Dictionary, see Binge-watch,
    Cambridge Dictionary, https://dictionary.cambridge.org/us/dicti
    onary/english/binge-watch [https://perma.cc/RB4V-TDHH], we
    do not perceive it as unusual or extraordinary for people in
    everyday life to sit sedentarily for several hours in front of a
    television or computer screen.
    ¶25 In the end, when we view the requirements of Hickey’s
    employment during the trip in question, in their totality, we
    perceive nothing unusual or extraordinary beyond the activities
    experienced by ordinary people in everyday life “that could be
    presumed to have contributed something substantial to increase
    the risk of injury.” Murray, 
    2013 UT 38
    , ¶ 53 (quotation
    simplified). Accordingly, the Injury Hickey sustained was not
    legally caused by the requirements of his employment with JBS,
    and we set aside the Commission’s decision to the contrary.
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    B
    ¶26 But our determination that the Injury was not legally
    caused by the requirements of Hickey’s job brings back to the
    fore the threshold question that the Commission, given its legal
    causation determination, did not answer: does Hickey even need
    to prove legal causation? If no preexisting condition contributed
    to the Injury, then he does not; in that event, a simple showing of
    medical causation will suffice. See 
    id. ¶¶ 45
    –46; see also Cox v.
    Labor Comm’n, 
    2017 UT App 175
    , ¶¶ 16, 18, 
    405 P.3d 863
    (explaining that medical causation requires an employee to show
    that the workplace injury was “a cause—as opposed to the
    cause—of the condition requiring treatment”).
    ¶27 In this case, the Commission made no findings or
    conclusions regarding this threshold question, declining to reach
    it given its conclusion that Hickey could make the necessary
    legal causation showing if he had to. But the ALJ did address the
    threshold question, specifically finding, based largely on the
    medical panel’s report, that Hickey suffered from a preexisting
    condition—super obesity—and that this condition “contributed
    to the development of [Hickey’s] blood clots.”
    ¶28 We do not directly review the decisions of an ALJ;
    instead, as noted above, we review the decisions of the
    Commission. See Utah Code Ann. § 34A-2-801(9)(a) (LexisNexis
    2019) (stating that we review “the decision of the commissioner
    or Appeals Board”); see also Par Elec. v. Labor Comm’n, 
    2017 UT App 169
    , ¶¶ 24–25, 
    405 P.3d 842
     (noting that we review the
    Commission’s decision, not the ALJ’s, and rejecting an appellate
    argument because it took issue with the ALJ’s reasoning and did
    not directly “address the Commission’s reasoning”). In this case,
    our determination that the Commission erred in its legal
    causation ruling requires us to remand the case to the
    Commission to consider the threshold question of whether
    Hickey must even prove legal causation, and in grappling with
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    JBS Carriers v. Labor Commission
    that question the Commission will need to decide whether to
    adopt the ALJ’s finding that Hickey suffered from a preexisting
    condition that contributed to the Injury. The Commission is, of
    course, free to reject the ALJ’s finding and make its own
    different or contrary finding. See Utah Code Ann. § 34A-1-
    303(4)(a) (stating that the Commission may, among other things,
    “reverse the findings” of an ALJ); see also JP’s Landscaping v. Labor
    Comm’n, 
    2017 UT App 59
    , ¶ 13, 
    397 P.3d 728
     (“The Commission
    is the ultimate fact finder in workers’ compensation claims.”).
    Nevertheless, in the interest of judicial economy, we elect to
    briefly address the ALJ’s finding here, in the event that the
    Commission, on remand, decides to adopt it.
    ¶29 The burden of making the threshold showing—that legal
    causation is even at issue—falls to the employer, who must
    “prove medically that the claimant suffers from a preexisting
    condition which contributes to the injury.” Utah Auto Auction v.
    Labor Comm’n, 
    2008 UT App 293
    , ¶ 11, 
    191 P.3d 1252
     (quotation
    simplified). While there is no “brightline rule regarding this
    evidentiary threshold,” the medical evidence must show that the
    preexisting condition actually did contribute to the injury, and
    not just indicate “a possibility” that it might have. See 
    id. ¶¶ 12
    –
    14 (quotation simplified). Because this is a factual issue, any
    finding in this regard must be “supported by substantial
    evidence.” Acosta v. Labor Comm’n, 
    2002 UT App 67
    , ¶ 29, 
    44 P.3d 819
     (quotation simplified).
    ¶30 In our view, the ALJ’s finding—that Hickey suffered from
    a preexisting condition that contributed to the Injury—was
    supported by substantial evidence, and a similar finding from
    the Commission, if based on the same record, would be too. As
    noted, the ALJ’s finding was based largely on the report
    submitted by the medical panel, which evaluated Hickey,
    reviewed conflicting medical opinions and medical records, and
    considered studies regarding DVT in super obese individuals.
    The panel concluded that the “primary factor” that led to the
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    Injury was Hickey’s “super obesity.” It acknowledged that
    Hickey’s work as a long-haul truck driver was also a risk factor,
    and “did marginally worsen” his DVT and pulmonary
    embolism, but nevertheless concluded that Hickey’s “super
    obesity made him 6-10 times more likely to develop a blood
    clot.” The panel analyzed the relative contributions to the Injury
    from Hickey’s super obesity and from Hickey’s employment as a
    long-haul trucker, and concluded that it did “not believe there
    [was] a 1:1 contribution” to the Injury from his super obesity and
    from his long-haul journey, because super obesity is a more
    significant DVT risk factor than commercial truck driving.
    ¶31 Hickey asserts that the medical panel’s statements are too
    inconclusive to form the basis for a solid factual finding. In
    support of his position, Hickey cites Utah Auto Auction, a case in
    which we determined that medical evidence pointing only to “a
    possibility” that preexisting conditions contributed to the
    accident was not enough to trigger the requirement that a
    worker demonstrate legal causation. See 
    2008 UT App 293
    , ¶ 14
    (quotation simplified). Hickey points to the conclusion reached
    by his expert witness, who opined that Hickey’s blood clot was
    caused by his long drive, and asserts that his expert’s “clear”
    statement is the only actual evidence in the record regarding
    whether a preexisting condition actually contributed to the
    Injury. But the ALJ interpreted the panel’s report as making a
    “determin[ation]” that Hickey’s “super obese preexisting
    medical condition” actually “contributed to the development of”
    his blood clots and DVT, rather than merely concluding that it
    might have contributed. And this interpretation was a
    reasonable one, supported by the language of the panel’s report,
    in which the panel compared the “contribution[s]” made to the
    Injury from both Hickey’s preexisting obesity and his long truck
    ride, and concluded that Hickey’s obesity had made a greater
    contribution. This contrasts sharply from the situation in Utah
    Auto Auction, in which the medical opinion at issue consisted of
    “equivocal and inconclusive statements,” and did not include a
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    conclusion regarding the existence of a preexisting condition,
    much less its contribution to an injury. See 
    id. ¶32
     After evaluating the conflicting medical opinions and the
    panel’s report, the ALJ gave weight to the panel’s report because
    he considered it “well-reasoned” and “the product of a
    thorough, collegial and impartial review of the record.” And
    based on this evidence, and his reasonable interpretation of it,
    the ALJ specifically found that Hickey suffered from a
    preexisting condition that contributed to the Injury, and that
    therefore Hickey had to “meet the higher standard of legal
    causation.” Under these circumstances, the ALJ’s finding was
    supported by substantial evidence.
    ¶33 On remand, the Commission will need to examine the
    evidence and make its own finding, and if it makes a finding that
    diverges from the ALJ’s, the parties will of course be free to seek
    judicial review of that finding. But if the Commission chooses,
    based on the same record submitted to us, to adopt the ALJ’s
    finding in its entirety, we have here determined that such a
    finding, on the part of the Commission, would be supported by
    substantial evidence.
    CONCLUSION
    ¶34 The Commission erred in determining that the Injury was
    legally caused by the requirements of Hickey’s work for JBS, and
    we set aside its order on that basis. We remand this matter to the
    Commission for further proceedings, including consideration of
    the threshold question about whether Hickey even needs to
    show legal causation in the first place.
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