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The Effect Of Preexisting Conditions On Medical Causation

On April 4, 2014, the Alabama Court of Civil Appeals issued an opinion on the effect of an employee’s preexisting condition and its impact on the issue of medical causation.  See Madison Academy, Inc. v. Hanvey, 2014 WL 1328334 (Ala. Civ. App. 2014).

In Madison Academy, “the employee suffered from Myasthenia gravis (“MG”) which is an idiopathic disease in which the immune system of the human body spontaneously produces antibodies to attack certain proteins responsible for forming neuromuscular junctions, resulting in dysfunction of muscular contraction.” Madison Academy, *1. “[T]he employee developed MG at some point before April 22, 2011, . . . [h]owever, neither the optometrist nor her family physician . . . diagnosed MG.” Id. Due to this, the employee was not initially treated for the disease, “which, although it cannot be cured, usually can be controlled successfully with medication that suppresses the production of destructive antibodies.” Id.

“The employee worked as a janitor . . . and was able to fully perform the duties of her job without accommodation before May 2011.” Id. On, May 11, 2011, the employee, while in the course of her employment, was exposed to strong odorous chemicals due to a contractor “refinishing the floors of the gymnasium using products that could be irritating or harmful to the respiratory system.” Id. The employee testified that the odors caused her to suffer severe headaches, but did not keep her from performing her regular duties, and she did not seek any form of treatment until May 20, 2011, at which time she visited her own ophthalmologist. Id. Following her initial exposure, the employee testified that she was again exposed to chemicals as a result of her job at Madison Academy in late May and June, 2011.  Madison Academy, *1. During this second exposure, the employee testified that she “began to have trouble breathing” which caused her to seek additional treatment from her primary care physician. Id., *1-2. It was at this point that she first notified her employer of the “injury” and they completed a First Report of Injury on June 17, 2011. Id., *2.

The employee continued to receive medical care from various authorized treating physicians and through this treatment it was discovered that employee suffered from MG and, as a result of her exposure to chemicals, she had suffered a “myasthenic crisis.” Id., *2-4. Her suffering the “myasthenic crisis” caused the employee to be held off from work following her initial exposure. Id. Testimony from her physicians revealed that after being diagnosed, they were able to treat the employee for the disease and eventually she returned to her pre-exposure condition.  See id., *8. While the employee was “stable,” her physicians warned her about returning to a role in which she would be exposed to chemicals in the future. As such, the trial court chose to award the employee permanent disability benefits based upon the theory that as the employee’s MG had not prevented her from performing her duties prior to the injury date, her inability to return now was the cause of her permanent disability. Id.

Madison Academy conceded to the fact that a preexisting injury, MG in the instant case, did not prevent the employee from receiving benefits.  Madison Academy, 6. They also did not “contest the trial court’s finding that the employee’s MG was aggravated by her physical exertion and chemical exposure on the job in May and June of 2011.” Id. Rather, the employer appealed the decision of the trial court to award the employee permanent total disability benefits as they felt that “any aggravation of the employee’s personal disease by the chemical exposure was only temporary.” Id. The employer argued that it should not be responsible for the employees preexisting disease, as any future symptoms that may arise as a result of that disease would not be compensable. Id. The Alabama Court of Civil Appeals agreed.

In the main opinion, Judge Moore “concluded that the employee had presented evidence indicating only that her permanent disability resulted purely from her [MG], a personal disease. Clarifying Workers’ Compensation Law Through the Appellate Process, Hon. Terry A. Moore, April 9, 2014. Judge Moore stated that while the evidence supported an award of TTD benefits, there was no proof that the “chemical exposure and physical exertion at work had permanently aggravated the condition” such that the employee was entitled to permanent disability benefits. Id. Judge Moore believed that even though the employee had been able to work without incident prior to her injury, she was still required to present evidence of medical causation, i.e., evidence linking the future and/or lasting effects of MG to the work injury at Madison Academy. Id.

Judge Moore stated that “the ruling should clarify that, just because an employee was working normally at one time with a preexisting condition, that preexisting condition is not excluded, as a matter of law, from being considered the sole cause of a later disability.”