No. 06-124708 (Mo. Lab. & Indust. Rel. Comm’n.
Jan. 4, 2017)
Code(s): C002 Medical Causation; C034 Judicial Error
Factual
Background:
Claimant
worked at a special needs school and injured her back when putting a child into
a wheelchair. She had back surgery in June 2009 and reached MMI in 2009.
However, she began to complain of pain again in January 2011. Postoperative
imaging revealed a solid fusion.
ALJ Decision:
The
ALJ relied in part on his own administrative experience in resolving the issue
of a medical causation in this case. The ALJ stated that he had never before
seen a case when nineteen months post-surgery a patient begins experiencing
intense pain. He thus concluded that the Claimant’s accident at work in 2006
was not the prevailing factor causing her debilitating lower back and radicular
pain complaints, or the diagnosis of failed back syndrome.
Analysis/Holding:
The Commission held that the ALJ
committed major error when he relied in part on his own administrative
experience in resolving the issue of a medical causation in this case. Missouri
courts have long cautioned that a judge’s opinion does not constitute competent
and substantial evidence upon which an award may rely. This commentary by the
judge was thus disclaimed, but the judgment on the issue of causation was not
affected.
The Takeaway:
A Judge may not rely on his or her own administrative experience when making
a determination with respect to medical causation.