Yeutter v. ICAO

The summaries of the Colorado Court of Appeals published opinions
constitute no part of the opinion of the division but have been prepared by
the division for the convenience of the reader. The summaries may not be
cited or relied upon as they are not the official language of the division.
Any discrepancy between the language in the summary and in the opinion
should be resolved in favor of the language in the opinion.
SUMMARY
April 11, 2019
2019COA53
No. 18CA0498, Yeutter v. ICAO — Labor and Industry —
Workers’ Compensation — Benefits — Permanent Partial
Disability — Medical Impairment Benefits — Permanent Total
Disability — Maintenance Medical Benefits — Division-
Sponsored Independent Medical Examination
A division of the court of appeals considers whether section 8-
42-107(8)(b)(III), C.R.S. 2018, which provides that a
division-sponsored independent medical examination (DIME)
physician’s opinions concerning maximum medical improvement
and impairment are given presumptive weight, also requires
deference to a DIME physician’s opinion as to causation. The
division concludes that no such deference is due under the statute
and that the question of causation should be reviewed de novo.
COLORADO COURT OF APPEALS 2019COA53
Court of Appeals No. 18CA0498
Industrial Claim Appeals Office of the State of Colorado
WC No. 489-594-003
Joseph Yeutter,
Petitioner,
v.
Industrial Claim Appeals Office of the State of Colorado; CBW Automation, Inc.;
and Pinnacol Assurance,
Respondents.
ORDER AFFIRMED
Division V
Opinion by JUDGE GROVE
Terry and J. Jones, JJ., concur
Announced April 11, 2019
Eley Law Firm, LLC, Scott Eley, Denver, Colorado, for Petitioner
No Appearance for Respondent Industrial Claim Appeals Office
Harvey D. Flewelling, Denver, Colorado, for Respondents Pinnacol Assurance
and CBW Automation, Inc.
¶1 Claimant, Joseph Yeutter, seeks review of a final order of the
Industrial Claim Appeals Office (Panel) affirming the decision of an
administrative law judge (ALJ) denying and dismissing his claims
for permanent total disability (PTD) and maintenance medical
benefits. We affirm.
I. Background
¶2 Claimant worked as a controls engineer for employer, CBW
Automation, Inc. In August 2012, he sustained admitted, serious
injuries in a work-related accident when he was struck in the head
and shoulder and knocked to the ground by a robotic arm. His
injuries included “a skull fracture, vestibular ear and inner ear
nerve damage, slap tear in [the] shoulder, broken arm,” and
fractures to “both of his orbital sockets.” He returned to work after
two weeks but voluntarily resigned two months later; he then
commenced employment as a mechanical engineer for BW
Container Systems, a position he held until February 2015. At BW
Container, he typically worked nine or ten hours per day “with
weekends and sometimes evenings after work.”
¶3 More than a year after the incident, claimant’s physical
injuries had “stopped hurting so much,” but he felt fatigued. In
1
July 2014, one of his authorized treating physicians, Dr. Carol
Newlin, prescribed Adderall and Ritalin as stimulants to help him
“get through [his] day.” A sleep study conducted one month later
by another treating physician, Dr. Mark Neagle, revealed sleep
patterns consistent with narcolepsy. A professor of psychiatry at
the University of Colorado, Dr. Martin Reite, corroborated the
narcolepsy diagnosis, stating that “as a result of my evaluation I
have concluded that [claimant] has a sleep disorder consisting of
Type 1 Narcolepsy, most likely post-traumatic in origin.” Dr. Reite
went on to note that “the cause of narcolepsy is varied, can be
idiopathic (onset with no obvious cause), familial (genetic influence
and running in families), or triggered by viral infection or head
trauma (as in [claimant’s] case).” Finally, Dr. Reite opined that
claimant “is seriously disabled as a result of his narcolepsy and
other trauma related conditions, and his prognosis at this time is
guarded.”
¶4 On August 26, 2015, claimant was placed at maximum
medical improvement (MMI) by his primary authorized treating
physician, Dr. Kevin O’Toole. Although claimant’s skull and facial
fractures had healed, Dr. O’Toole assessed claimant as suffering
2
from “narcolepsy, hypersomnolence, probably related to traumatic
brain injury, managed with stimulant medication.” He
recommended that claimant “continue his current medications.”
Dr. O’Toole also opined that claimant could not work and should be
off work indefinitely. He rated claimant’s permanent impairment at
67% of the whole person, which he calculated by combining
impairment ratings for claimant’s mental health, sleep and arousal
disorders, and vision impairment.
¶5 Three mental health and medical experts retained by employer
disagreed with Dr. O’Toole’s assessment, however. Psychiatrist Dr.
Susan Rosenfeld opined that the “reported symptoms, clinical
findings and treatment plan do not support functional impairment
from a psychiatric condition which translates into restrictions or
limitations.”
¶6 Similarly, Dr. Stephen Selkirk, who is board certified in both
psychiatry and neurology, reported that claimant
has extensive subjective complaints that are
not supported by objective data in the medical
record. . . . The complaint of cognitive
dysfunction has not been confirmed by a
formal neuropsychological battery. Finally, the
report of fatigue is subjective. The result of
sleep study evaluations and multiple sleep
3
latency tests are not available for review and
therefore the presence of narcolepsy or
post-traumatic narcolepsy cannot be
objectively confirmed.
Based on his review of the medical records, Dr. Selkirk concluded
that claimant had “no impairments from a neurological perspective,
and thus, no restrictions or limitations are supported.”
¶7 Finally, Dr. Kathleen D’Angelo, who specializes in occupational
medicine, independently examined claimant and conducted a
thorough medical records review. She expressly noted that a
second sleep study confirmed claimant’s narcolepsy diagnosis, but
she was skeptical that it was work-related because available
medical literature had not demonstrated a causative connection
between head trauma and narcolepsy. To further support her
conclusion that claimant’s narcolepsy was not related to his work
injury, she explained that the lengthy temporal gap between
claimant’s injury and the onset of his narcolepsy substantially
lessened the likelihood of a causal connection between the two.
¶8 After employer obtained these independent medical
examination reports, claimant underwent a division-sponsored
independent medical examination (DIME) with Dr. Albert Hattem.
4
Dr. Hattem agreed with Dr. O’Toole that claimant reached MMI on
August 26, 2015. But, he assigned claimant a lower impairment
rating — 39% of the whole person — than Dr. O’Toole had assigned
because he felt the brain impairment calculated by Dr. O’Toole was
too high given that claimant “does not require assistance with
activities of daily living.” Dr. Hattem was less certain about the
cause of claimant’s narcolepsy, though, and deferred to claimant’s
treating physicians on the question. He stated as follows:
This is a very difficult case in terms of
causation because the examinee’s condition
(post traumatic narcolepsy) is very rare and
did not become evident until more than one
year after the August 24, 2012 injury. After
the injury and prior to first reporting fatigue in
November 2013 the examinee had been
working full duty as an engineer for two
different employers sequentially – work that
would be considered very cognitively
demanding. . . .
Because I have no prior experience with this
type of condition, I must defer to all of the
specialists who previously evaluated
[claimant]. . . . All of these physicians opined
that the examinee’s narcolepsy is related to the
August 2012 work injury despite the latency
between the injury and the onset of this
disorder.
5
¶9 Employer did not contest Dr. Hattem’s DIME opinions.
Rather, it filed a final admission of liability (FAL) accepting Dr.
Hattem’s MMI date of August 26, 2015, and admitting claimant’s
entitlement to permanent partial disability (PPD) benefits based on
the 39% whole person impairment rating, which it calculated to
equal $127,502.69. However, employer did not admit liability for
any continuing post-MMI maintenance medical benefits.
¶ 10 Thereafter, claimant filed an application for a hearing seeking
PTD benefits and future maintenance medical benefits.
¶ 11 At the ensuing hearings, the parties offered contradictory
evidence of claimant’s need for PTD benefits. Katie Montoya, a
vocational consultant, testified on claimant’s behalf. She opined
that although claimant had no work restrictions “from a physical
standpoint,” she agreed with Dr. O’Toole’s opinion that claimant’s
issues with “wakefulness, the capacity to be productive day in and
day out and what would be necessary pharmacologically” for him to
maintain employment, made him incapable “of returning to work at
this time.”
¶ 12 In contrast, employer’s retained vocational rehabilitation
counselor, Roger Ryan, opined that claimant “is able to work and
6
earn a wage.” Mr. Ryan cited to claimant’s computer adeptness,
mechanical engineering experience, and military background as
transferable skills upon which claimant could draw to find gainful
employment. Mr. Ryan identified several occupations matching
claimant’s abilities, including mechanical drafter, information clerk,
salesperson, cashier, telephone solicitor, tutor, appointment clerk,
dispatcher, night auditor, collection clerk, unarmed security guard,
and production assembler.
¶ 13 Employer also introduced the opinions of two additional
independent medical examiners to support its position that
claimant was neither permanently totally disabled nor required
ongoing maintenance medical care. These independent medical
examiners, psychiatrist Dr. Robert Kleinman and psychologist Dr.
Susan Kenneally, both questioned the necessity of claimant
receiving PTD and maintenance medical benefits. Dr. Kleinman, in
particular, doubted the severity of claimant’s narcolepsy, and
suggested that claimant was exaggerating the extent of his
disability. He also opined that claimant “does not have restrictions
or limitation” that would impede his ability to work.
7
¶ 14 Dr. Kenneally, in turn, questioned the causal connection
between claimant’s admitted work-related injury and his accurately
diagnosed narcolepsy. She testified that there is a dearth of
medical research linking narcolepsy and traumatic brain injury
(TBI), noting that there is a lack of “reliable, repeatable markers for
narcolepsy, and we certainly have no way to discriminate if it is
caused by traumatic brain injury, it is caused by genetic history, it
is caused by other trauma.” In addition to “the science [being] out”
on this question, she explained that the “late onset” of claimant’s
narcoleptic condition made it “highly atypical and would argue
against it being caused by or related to the TBI.” Moreover, the
battery of tests Dr. Kenneally administered to claimant revealed
that although he “clearly” suffered a TBI as a result of his workplace
accident, “current testing found no pattern of persistent deficits
consistent with the brain injury findings at the time of the injury.”
¶ 15 After two days of hearings, and the admission of hundreds of
pages of medical records, the ALJ found that claimant failed to
demonstrate that it was “more probably true than not that his
narcolepsy was caused by his August 24, 2012 industrial accident
while working for [e]mployer.” The ALJ was persuaded by Dr.
8
D’Angelo’s testimony that “[b]ecause traumatic brain injuries are
acutely symptomatic, the delayed onset of [c]laimant’s narcolepsy
symptoms suggests an attenuated causal relationship between his
accident and the development of narcolepsy.” The ALJ also found
that the “bulk of the medical evidence supports Mr. Ryan’s
determination that [c]laimant has the ability to earn wages in some
capacity.” Accordingly, the ALJ denied and dismissed claimant’s
claims for PTD and maintenance medical benefits. A divided Panel
affirmed the ALJ’s order. The majority rejected claimant’s
contention that the ALJ was bound by the DIME’s conclusion that
claimant’s narcolepsy was related to the work accident. The Panel
noted that neither MMI nor impairment was at issue before the ALJ.
Thus, the Panel held, the DIME physician’s causation
determination held no presumptive weight and claimant bore the
burden of proving his entitlement to PTD benefits by a
preponderance of the evidence. Similarly, the DIME physician’s
opinion that claimant would require maintenance medical
treatment did not relieve claimant of the burden to prove the
reasonableness, necessity, and relatedness of the requested
continuing treatment. Because substantial evidence supported the
9
ALJ’s factual findings on these issues, see § 8-43-301(8), C.R.S.
2018, the Panel found “no basis to disturb the order.” Claimant
now appeals.
II. ALJ Was Not Bound by the DIME’s Causation Analysis
¶ 16 Claimant first contends that the ALJ erred in requiring him to
prove his entitlement to PTD benefits and maintenance medical
benefits by a preponderance of the evidence. He asserts that the
ALJ should have given Dr. Hattem’s DIME opinion presumptive
weight as to the cause of his injury and that employer should have
been required to overcome the DIME’s causation opinion with clear
and convincing evidence. We disagree.
A. Standard of Review
¶ 17 Because the question claimant raises involves the application
of the governing law and construction of statutes, we review it de
novo. See City of Littleton v. Indus. Claim Appeals Office, 2016 CO
25, ¶ 27 (“We review de novo questions of law concerning the
application and construction of statutes.” (quoting Hickerson v.
Vessels, 2014 CO 2, ¶ 10)).
10
B. Analysis
¶ 18 A DIME physician’s opinions concerning MMI and impairment
are, by express statutory edict, afforded presumptive weight. See
§ 8-42-107(8)(b)(III), C.R.S. 2018. The statute states that “[t]he
finding regarding [MMI] and permanent medical impairment of an
independent medical examiner in a dispute arising under
subparagraph (II) of this paragraph (b) may be overcome only by
clear and convincing evidence.” Id. Subparagraph (II) is limited to
parties’ disputes over “a determination by an authorized treating
physician on the question of whether the injured worker has or has
not reached [MMI].” § 8-42-107(8)(b)(II). Nowhere in the statute is
a DIME’s opinion as to the cause of a claimant’s injury similarly
imbued with presumptive weight.
¶ 19 The claims claimant asserted in this case involved neither MMI
nor permanent impairment — those issues had already been
conceded by employer in its FAL. Rather, claimant sought PTD
benefits and maintenance medical benefits in his application for
hearing. He bore the burden of establishing his entitlement to
these benefits because a claimant “shall have the burden of proving
11
entitlement to benefits by a preponderance of the evidence.”
§ 8-43-201(1), C.R.S. 2018.
¶ 20 Claimant attempts to circumvent this statutory structure by
arguing, essentially, that a DIME’s opinion on causation also
carries presumptive weight. He cites to Leprino Foods Co. v.
Industrial Claim Appeals Office, 134 P.3d 475 (Colo. App. 2005), and
Cordova v. Industrial Claim Appeals Office, 55 P.3d 186 (Colo. App.
2002), as well as several Panel decisions and the opinion of the
dissenting Panel member in this case, to support his contention.
He asserts that, from these cases, a general principle can now be
extracted that — like MMI and impairment — a DIME’s causation
opinion universally carries presumptive weight. He characterizes as
“exceptions” cases that limit a DIME opinion’s presumptive weight
to MMI and impairment.
¶ 21 Notwithstanding claimant’s characterization, the principle that
a DIME’s opinion carries presumptive weight only with respect to
MMI and impairment, but not as to causation, is not an “exception.”
It is the statutory rule. See § 8-42-107(8)(b)(III); Faulkner v. Indus.
Claim Appeals Office, 12 P.3d 844, 846 (Colo. App. 2000) (DIME
opinion concerning causation need not be overcome by clear and
12
convincing evidence where dispute involved the “threshold
requirement” that the claimant establish a compensable injury);
Story v. Indus. Claim Appeals Office, 910 P.2d 80, 81 (Colo. App.
1995) (DIME determination of MMI did not preclude change of
physician order where claimant is entitled to post-MMI treatment).
¶ 22 The cases claimant cites do not convince us otherwise. First,
although we defer to the Panel’s interpretation of the Act, see Keel v.
Indus. Claim Appeals Office, 2016 COA 8, ¶ 31, “we are not bound
by the Panel’s decisions in other workers’ compensation cases,”
Olivas-Soto v. Indus. Claim Appeals Office, 143 P.3d 1178, 1180
(Colo. App. 2006). Nor do we give precedential weight to
unpublished decisions of other divisions of this court. See Bittle v.
Brunetti, 750 P.2d 49, 52 n.2 (Colo. 1988). And, the published
opinions of other divisions of this court on which claimant relies do
not support the position he advances. Indeed, as the Panel majority
noted, “[w]hen . . . a party is not challenging a DIME physician’s
MMI determination or impairment rating, the Courts have
repeatedly held that the heightened burden of proof required by § 8-
42-107(8) does not apply.”
13
¶ 23 For example, in Leprino Foods, the division held that the
DIME’s causation opinion carried presumptive weight because it
was inextricably tied to MMI. There, the employer was seeking “to
avoid the finality of the DIME physician’s opinion regarding MMI.”
134 P.3d at 482. The division noted that MMI and/or impairment
are often inextricably linked to causation because “[b]oth
determinations inherently require the DIME physician to assess, as
a matter of diagnosis, whether the various components of the
claimant’s medical condition are causally related to the industrial
injury.” Id. This is true because no claimant achieves MMI until all
conditions related to the workplace injury have reached their
maximum improvement. See Paint Connection Plus v. Indus. Claim
Appeals Office, 240 P.3d 429, 433 (Colo. App. 2010) (“[T]he legally
significant date, that is, the date of MMI for purposes of ending a
claimant’s temporary disability, is the date upon which the claimant
has attained maximum medical recovery from all of the injuries
sustained in a particular compensable accident. . . . MMI is not
‘divisible and cannot be parceled out among the various
components of a multi-faceted industrial injury.’” (quoting Parra v.
14
Haake Farms, W.C. No. 4-396-744, 2001 WL 470646, at *2 (Colo.
I.C.A.O. Mar. 8, 2001))).
¶ 24 Moreover, Leprino Foods explicitly recognized that although “a
DIME physician’s opinions concerning MMI and permanent medical
impairment are given presumptive effect,” in contrast, “the
threshold question of whether the claimant has sustained a
compensable injury in the first instance is one of fact that the ALJ
must determine, if contested, under the preponderance of the
evidence standard.” 134 P.3d at 482-83. Thus, Leprino Foods does
not stand for the proposition that a DIME’s opinion on causation
always carries presumptive weight.
¶ 25 Similarly, Cordova declined to extend any presumptive weight
to a DIME’s opinion beyond MMI and impairment. The division
rejected the claimant’s attempt to extend the DIME opinion’s
presumptive weight to worsened conditions. Instead, it reiterated
the governing statutory standard:
Claimant attempts to characterize the present
dispute as one involving MMI. However, the
pertinent and necessary inquiry is whether he
has suffered a deterioration in his condition
that justifies additional benefits. Although
medical evidence bearing on whether he has
remained at MMI would be relevant to that
15
inquiry, the original MMI determination may
not be questioned. We therefore agree with the
Panel that the opinion of a DIME physician as
to whether a claimant’s condition has
worsened carries no special weight and need
not be overcome by clear and convincing
evidence. . . .
The Panel correctly observed that the opinions
of a DIME physician have only been given
presumptive effect when expressly required by
the statute.
Cordova, 55 P.3d at 190 (citation omitted). Thus, like Leprino
Foods, Cordova does not stand for the proposition claimant
advances.
¶ 26 Here, the only issues before the ALJ were PTD and
maintenance medical benefits. Neither of these inquiries required
examination of the DIME physician’s MMI or impairment
determinations. A claimant is permanently and totally disabled,
and therefore entitled to PTD compensation, if he or she “is unable
to earn any wages in the same or other employment.”
§ 8-40-201(16.5)(a), C.R.S. 2018. In determining whether a
claimant is permanently and totally disabled, the ALJ may consider
“human factors.” See Weld Cty. Sch. Dist. RE-12 v. Bymer, 955 P.2d
550, 556 (Colo. 1998). “Human factors” include such elements as
16
the claimant’s “education, ability, and former employment,” Holly
Nursing Care Ctr. v. Indus. Claim Appeals Office, 992 P.2d 701, 703
(Colo. App. 1999); “the claimant’s age, work history, general
physical condition, and prior training and experience,” Joslins Dry
Goods Co. v. Indus. Claim Appeals Office, 21 P.3d 866, 868 (Colo.
App. 2001); and “the community where [the] claimant resides,”
Brush Greenhouse Partners v. Godinez, 942 P.2d 1278, 1279 (Colo.
App. 1996), aff’d sub nom. Bymer, 955 P.2d 550. None of these
factors bear on whether a claimant has reached MMI.
¶ 27 Likewise, a claimant is entitled to post-MMI maintenance
medical benefits if he or she shows that future medical treatment
will be “reasonably necessary to relieve the claimant from the effects
of the industrial injury or occupational disease even though such
treatment will not be received until sometime subsequent to the
award of permanent disability.” Grover v. Indus. Comm’n, 759 P.2d
705, 710 (Colo. 1988). An employer, in turn, “may contest any
future claims for medical treatment on the basis that such
treatment is unrelated to the industrial injury or occupational
disease.” Id. at 712. As with PTD, this analysis does not
necessitate inquiry into MMI or impairment.
17
¶ 28 Because section 8-42-107(8) only grants presumptive weight
to a DIME’s opinions concerning MMI and impairment, see
Faulkner, 12 P.3d at 846, we decline to extend the statute’s
presumptive reach to causation. See Kraus v. Artcraft Sign Co., 710
P.2d 480, 482 (Colo. 1985) (The appellate courts of this state have
“uniformly held that a court should not read nonexistent provisions
into the . . . Act.”); see also Kieckhafer v. Indus. Claim Appeals
Office, 2012 COA 124, ¶ 16. Accordingly, the ALJ was not bound
by Dr. Hattem’s causation determination and committed no error
when he denied and dismissed claimant’s claims for PTD and
maintenance medical benefits.
III. No Due Process Violation
¶ 29 Claimant also asserts that he was deprived of his property
rights without due process. He contends that by requiring him to
“apply for further permanency and medical benefits,” employer was
able to “avoid” the burden of overcoming the DIME’s opinion by
clear and convincing evidence, and instead improperly shifted the
burden to him “to prove the cause of his narcolepsy without the
presumptive effect from Dr. Hattem’s DIME opinion.” We are not
persuaded claimant suffered any constitutional deprivation.
18
¶ 30 As we set forth above, claimant’s request for PTD and
maintenance medical benefits raised issues separate and apart from
MMI and impairment, the two areas in which a DIME opinion is
granted presumptive weight. See § 8-42-107(8). No improper
burden shifting occurred here because, under the Act, claimant
bears the burden of proving his entitlement to these benefits. See
§ 8-43-201.
¶ 31 Regardless, we perceive no due process violation here. To
establish a due process claim, a claimant must demonstrate that he
or she has been deprived of a protected right to liberty or property
without due process of law.
The first inquiry in every due process challenge
is whether the plaintiff has been deprived of a
protected interest in “property” or “liberty.” It
is necessary to consider whether a property
right has been identified, whether government
action with respect to that property right
amounted to a deprivation, and whether the
deprivation, if one is found, occurred without
due process of law.
Whatley v. Summit Cty. Bd. of Cty. Comm’rs, 77 P.3d 793, 798 (Colo.
App. 2003) (citation omitted). “A protected interest in property
exists when a person has a legitimate claim of entitlement to the
property.” Id.
19
¶ 32 Here, employer did not admit that claimant was entitled to
PTD and maintenance medical benefits and the ALJ did not award
them. Because no order entitled claimant to these benefits (and no
statutory provisions applied), he had no protected property interest
in them.
¶ 33 To the extent claimant implies that the ALJ’s order finding no
causal link between his work injury and his narcolepsy deprived
him of receiving any benefits, the record suggests otherwise.
Employer filed a FAL admitting to Dr. Hattem’s MMI date and
permanent impairment rating and calculating the PPD benefits to
which claimant was entitled. Nothing in the ALJ’s order limited or
even addressed claimant’s PPD award, and, as we review the record,
claimant should receive it.
¶ 34 Nor can claimant establish the inadequacy of the process
provided him. Due process does not guarantee that claimants will
always receive the benefits they request. Rather, due process
ensures that those benefits — once admitted to or awarded — will
not be taken away without “notice and the opportunity to be heard
by an impartial tribunal.” Wecker v. TBL Excavating, Inc., 908 P.2d
1186, 1188 (Colo. App. 1995). Because claimant had two hearings
20
on his request for PTD and maintenance medical benefits — at
which he testified, presented witnesses on his behalf, and
introduced hundreds of pages of documentary evidence in support
of his claim — we cannot say that he was denied an opportunity to
be heard.
¶ 35 Accordingly, we conclude claimant was not deprived of his
right to due process. See Whatley, 77 P.3d at 798; Wecker, 908
P.2d at 1188.
IV. Conclusion
¶ 36 The order is affirmed.
JUDGE TERRY and JUDGE J. JONES concur.
21