Charter Integrated Services v. Richard Skoff

COURT OF APPEALS OF VIRGINIA
Present: Judges Elder, Bray and Annunziata
Argued at Richmond, Virginia
CHARTER INTEGRATED SERVICES AND
HOME INDEMNITY COMPANY
MEMORANDUM OPINION* BY
v. Record No. 2243-01-4 JUDGE LARRY G. ELDER
APRIL 30, 2002
RICHARD J. SKOFF
FROM THE VIRGINIA WORKERS' COMPENSATION COMMISSION
Kevin W. Cloe (Charles F. Midkiff; Midkiff,
Muncie & Ross, P.C., on brief), for
appellants.
(Richard Skoff, pro se, on brief).
Charter Integrated Services and Home Indemnity Company
(employer) appeal from a decision of the Workers' Compensation
Commission (commission) finding employer responsible for medical
treatment rendered to Richard Skoff (claimant) by Dr. Michael
Hoffstetter. On appeal, employer contends the evidence failed
to prove Dr. Hoffstetter's treatment was causally related to
claimant's compensable injury. We hold credible evidence
supported the commission's conclusion that Dr. Hoffstetter's
treatment was causally related to claimant's industrial injury,
and we affirm the commission's decision.
* Pursuant to Code § 17.1-413, this opinion is not
designated for publication.
On appeal of a decision of the commission, we construe the
evidence in the light most favorable to the party prevailing
below, and we must uphold the commission's findings of fact if
the record contains credible evidence to support them. See,
e.g., Lynchburg Foundry Co. v. Goad, 15 Va. App. 710, 712, 427
S.E.2d 215, 217 (1993).
Code § 65.2-603(A)(1) provides that for "[a]s long as
necessary after a [compensable industrial] accident, the
employer shall furnish or cause to be furnished, free of charge
to the injured employee, a physician chosen [in the manner
prescribed by the Workers' Compensation Act] and such other
necessary medical attention." Whether the employer is
responsible for medical expenses under this code section depends
upon "(1) whether the medical service was causally related to
the industrial injury; (2) whether such other medical attention
was necessary; and (3) whether the treating physician made a
referral of the patient." Volvo White Truck Corp. v. Hedge, 1
Va. App. 195, 199, 336 S.E.2d 903, 906 (1985). A claimant bears
the burden of proof on these issues by a preponderance of the
evidence. McGregor v. Crystal Food Corp., 1 Va. App. 507, 508,
339 S.E.2d 917, 918 (1986). However,
[w]hether "such other medical attention" be
deemed necessary is for the attending
physician or . . . [c]ommission to
determine, not the employer. So long as a
causal relationship between the industrial
accident and the complaints which are the
subject of the referral is shown, the
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employer is financially responsible for the
medical attention which the attending
physician deems necessary, subject to review
by the [c]ommission.
Jenson Press v. Ale, 1 Va. App. 153, 159, 336 S.E.2d 522, 525
(1985) (citation omitted) (decided under former Code § 65.1-88,
predecessor to Code § 65.2-603).
Furthermore, an employer's liability extends to "'all the
medical consequences and sequelae that flow from the primary
injury.'" American Filtrona Co. v. Hanford, 16 Va. App. 159,
163, 428 S.E.2d 511, 513 (1993) (quoting 1 Arthur Larson, The
Law of Workmen's Compensation § 13.11 (1992)). "'[E]xacerbation
of the claimant's condition resulting from antibiotics,
antitoxins, sedatives, pain killers, anesthesia, . . . or
corrective or exploratory surgery' is compensable." Id.
(quoting Larson, supra, § 13.21(a) (footnotes omitted)).
Finally, "'[m]edical evidence is not necessarily
conclusive, but is subject to the commission's consideration and
weighing.' The testimony of a claimant may also be considered
in determining causation, especially where the medical testimony
is inconclusive." Dollar Gen'l Store v. Cridlin, 22 Va. App.
171, 176, 468 S.E.2d 152, 154 (1996) (quoting Hungerford Mech.
Corp. v. Hobson, 11 Va. App. 675, 677, 401 S.E.2d 213, 215
(1991)) (citation omitted).
Employer conceded before the commission "that Dr. [Thomas
C.] Schuler and Dr. [Joseph K.] Statkus are treating physicians
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in this matter" and that Dr. Statkus referred claimant to
Dr. Hoffstetter. On appeal, employer contests only the
commission's conclusion that the medical treatment provided by
Dr. Hoffstetter was causally related to claimant's 1995 injury.
We hold that credible evidence in the record supports the
commission's finding that claimant's three visits to
Dr. Hoffstetter were, in fact, causally related to his
compensable back injury.
Dr. Schuler, the physician who performed claimant's back
surgeries in 1998, originally expressed much uncertainty about
the source of claimant's ongoing pain after those surgeries.
However, on August 18, 2000, Dr. Schuler opined that claimant's
ongoing pain was "directly related" to his industrial injury.
Dr. Schuler listed claimant's five diagnoses as lumbar
postlaminectomy syndrome, lumbar radiculopathy, bilateral
sacroiliitis, chronic pain syndrome and fibromyalgia. He noted
claimant's "ongoing complaints of pain that date back to the
time of his accident" and opined that "[claimant's] ongoing
problems," thereby implicitly incorporating the immediately
preceding list of diagnoses, "are directly related to his
accident and the subsequent treatment for that." Thus, credible
evidence supports a finding that Dr. Schuler found a direct
connection between claimant's injury and his chronic pain.
Claimant first saw Dr. Hoffstetter on referral from
Dr. Statkus, who had been treating claimant's chronic pain on
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referral from Dr. Schuler. Dr. Statkus made the referral based
on claimant's reports of memory loss and confusion which began
after he developed a post-surgical infection and underwent
debridement of his back surgery site on February 22, 1998.
Dr. Statkus noted that the worsening of the episodes caused him
to "wonder about some kind of embolic event" which may have
occurred as a result of claimant's infection. Dr. Statkus's
referral to Dr. Hoffstetter, at a minimum, was designed to
determine whether a direct causal connection existed between
claimant's surgery and his memory loss. Thus, it was causally
related to claimant's compensable injury.
Further, the results of Dr. Hoffstetter's examination and
testing indicated that claimant's memory difficulties were
"attributed to pain and concurrent depression," and Dr. Statkus
opined that claimant's "depression [was] secondary to [his]
chronic pain." Thus, Dr. Schuler's opinion that claimant's
chronic pain was caused by his compensable injury provided a
direct causal connection between claimant's injury and his first
two visits to Dr. Hoffstetter.
Dr. Schuler's opinion that claimant's "ongoing complaints
of pain" resulted from his compensable injury also provides a
sufficient causal connection between claimant's injury and his
third visit to Dr. Hoffstetter. Dr. Statkus referred claimant
to Dr. Hoffstetter on this occasion because claimant was
experiencing headaches which were worsening and were severe
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enough "that [claimant] cannot do much of anything." Claimant
testified that he had had only one headache in his life prior to
his back surgery and that he underwent "surgery [for a sinus
problem] and took care of that. No other headaches." Thus,
Dr. Schuler's opinion that claimant's ongoing pain from several
diagnosed conditions was caused by his compensable injury was
sufficient to provide the necessary link between claimant's
injury and Dr. Hoffstetter's treatment of claimant for
headaches.
For these reasons, we hold credible evidence supports the
commission's award, and we affirm.
Affirmed.
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