AP Requires Evidence from Expert for Labral Tear of Shoulder
The appeals panel has concluded that an expert medical opinion is required to establish the causal relationship between an injured worker’s accidental injury and a tear of her right labrum that was discovered during surgery for other shoulder conditions. The panel concluded that the surgeon’s mere recitation of the diagnosis in a report discussing the cause of the other shoulder conditions was insufficient to relate the labral tear to the accident. The appeals panel reversed the hearing officer’s decision that found the condition to be related to the compensable injury and rendered a decision that the condition was not related.
The appeals panel posted its decision in Appeals Panel Decision No. 150399 on June 9, 2015. There, the panel wrote that the injured worker had injured herself while working on an assembly line using an air-powered tool to install bolts with her right hand, the tool jerked backwards causing her right arm to be thrown back. The claimant testified that she heard a pop to her arm and felt shoulder pain. The carrier accepted a right shoulder myofacial strain. The hearing officer found that the claimant’s right shoulder full thickness rotator cuff tear, supraspinatus tear, and rotator cuff derangement were supported by sufficient expert evidence from the surgeon and affirmed the hearing officer’s decision in that regard.
The appeals panel did not reach the same conclusion with respect to the claimant’s labral tear, however. The panel first noted that the surgeon had found a labral tear during the right shoulder surgery, and that the labral tear was not visible in the MRI of the right shoulder. The operative report mentioned that the “labrum” was debrided and lists as a post-operative diagnosis a labral tear. The claimant relied upon this report to establish a causal connection between her accident and the condition. The appeals panel rejected the relationship, writing:
In APD 110054, decided March 21, 2011, the Appeals Panel stated that “[a]lthough the claimed conditions are listed in the record, there is not any explanation of causation for the claimed conditions in the record. We hold that in this case the mere recitation of the claimed conditions in the medical records without attendant explanation how those conditions may be related to the compensable injury does not establish those conditions are related to the compensable injury within a reasonable degree of medical probability.”
Under the facts of this case, a labral tear is a condition that is a matter beyond common knowledge or experience and requires expert medical evidence. In this case, none of the medical reports, including Dr. L’s, causally link the labral tear to the compensable injury. Because there is no explanation of how the compensable injury caused a labral tear, the hearing officer’s determination that the compensable injury of [Date of Injury], extends to a labral tear is not supported by the evidence. We therefore reverse that portion of the hearing officer’s determination that the compensable injury of [Date of Injury], extends to a labral tear, and we render a new decision that the compensable injury of [Date of Injury], does not extend to a labral tear.
The case is yet another illustration of how necessary it is that an injured worker establish a causal link between her accidental injury and her claimed diagnoses. Otherwise, the claimant risks having a decision rendered against her on the causation issue.
FOLIO
