Felipe v. Department of Labor & Industries

381 P.3d 205, 195 Wash. App. 908
CourtCourt of Appeals of Washington
DecidedSeptember 12, 2016
DocketNo. 75232-4-I
StatusPublished
Cited by9 cases

This text of 381 P.3d 205 (Felipe v. Department of Labor & Industries) is published on Counsel Stack Legal Research, covering Court of Appeals of Washington primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Felipe v. Department of Labor & Industries, 381 P.3d 205, 195 Wash. App. 908 (Wash. Ct. App. 2016).

Opinion

Leach, J.

¶1 Reymundo Felipe appeals an adverse trial court judgment that denied his request to reopen a workers’ compensation claim for additional medical treatment. Felipe challenges a trial court jury instruction requiring him to support his aggravation claim with evidence of objective medical findings. Because the nature of Felipe’s injury excuses any requirement for objective findings and the court’s instruction prevented Felipe from arguing his theory of the case, we reverse and remand for proceedings consistent with this opinion. As neither party has yet prevailed, we deny Felipe’s request for an award of attorney fees under RCW 51.52.130(1) as premature.

FACTS

¶2 Felipe suffered a closed head injury when he fell off a ladder in April 2011 while working. He does not know what caused the fall. He first remembers waking up in a hospital with head pain. His doctors read two CAT (computed axial tomography) scans, performed on April 19 and April 25, as normal. He developed headaches that his neurologist thought were consistent with postconcussive syndrome. He experienced depression in May 2011. Felipe applied to the Department of Labor and Industries (Department) for industrial insurance benefits. The Department allowed the claim and provided benefits to Felipe.

¶3 Felipe treated with several providers. He began seeing Dr. Jon Sukachevin in November 2011. Felipe’s headaches had improved but then became worse two months before this visit. Sukachevin diagnosed Felipe with several conditions, including major depression, headache, and con[911]*911cussion. Felipe’s headaches improved at the end of 2011 with the help of medication. The Department closed his claim on May 9, 2012. As of that date, he experienced some headaches that resolved with pain medication.

¶4 Sukachevin continued to see Felipe for his ongoing conditions, including other industrial injuries. Sukachevin referred Felipe to a psychologist for his depression; the psychologist, in turn, referred Felipe to a brain injury specialist because he thought Felipe suffered from a traumatic brain injury. Industrial insurance covered only one visit to the psychologist. The Department denied the referral to a brain injury specialist.

¶5 On October 24, 2012, Sukachevin saw Felipe for newly developed headaches. At the visit, Felipe reported that these headaches began a month earlier and described them as similar to the headaches he experienced after his April 2011 fall. He had at least four headaches per day with a pain level of 9 out of 10, up from 4 out of 10. Felipe also experienced associated vertigo and light-headedness. Su-kachevin diagnosed Felipe with “[t]raumatic brain injury [secondary to his April 2011 injury], new problem, uncontrolled; and major depression, uncontrolled.” Sukachevin later described Felipe’s diagnosis more specifically as a “closed head injury.”

¶6 After seeing Felipe in October 2012 for headaches, Dr. Sukachevin assisted Felipe in applying to the Department to reopen his claim based on his worsening condition. On the November 6, 2012, application, Sukachevin listed Felipe’s symptoms: headaches, dizziness, memory problems, fatigue, and depression. He described Felipe’s headaches as “worse.” He proposed a treatment plan: “refer him to the neurologist and—and a traumatic brain injury specialist, refer for MRI [(magnetic resonance imaging)] of the brain and to follow up with the psychologist.” Felipe had an MRI on November 17. The radiologist’s report stated that the MRI revealed “ ‘punctate blooming artifacts, subcortical white matter, white frontal lobe, suspicious for an area of remote small hemorrhage.’ ”

[912]*912¶7 In January 2013, neurologist Dr. William Stump examined Felipe at the Department’s request. Stump performed a general physical examination and a neurological exam. He also reviewed Felipe’s medical records and MRI report. Felipe reported to Dr. Stump painful headaches, dizziness, depression, anxiety, and sleeping difficulties. Stump diagnosed Felipe with a closed head injury due to his April 2011 fall, concluding that he most likely suffered from a concussive syndrome as a result but that it had resolved. The State agrees that Dr. Stump based his closed head injury diagnosis on subjective findings alone.1

¶8 The Department denied Felipe’s application to reopen his claim. On reconsideration, the Department affirmed its earlier order. Felipe appealed to the Board of Industrial Insurance Appeals (Board).

¶9 The Board received each party’s medical testimony through deposition. Sukachevin opined that Felipe experienced an aggravation of his April 2011 injury. He based this opinion on the fact that Felipe had passed out in March 2013 and that he reported that the intensity of his headaches had worsened. He also opined that the MRI report “showed evidence that patient may have had a hemorrhage in the brain” and that this was related to his accident because of a lack of any other episodes of head trauma since Felipe’s fall. On cross-examination, Sukachevin testified that the November 17 MRI findings were the only objective medical evidence of Felipe’s worsening condition. He testified that he does not read MRI films, so he based his interpretation on the radiologist’s report. He also testified about the possibility that the CAT scan missed this abnormality in April 2011.

¶10 Stump testified that Felipe’s condition had not objectively worsened after May 9, 2012. He disagreed that the MRI report showed that Felipe suffered from a hemorrhage. He concluded that Felipe “had persistent pain in the top of [913]*913his head” but concluded that this was not a result of the April 2011 injury because the changes that would have developed at the time of Felipe’s injury would have healed within three to six months—before the time the new headaches began.

¶11 The Board affirmed the Department’s order. Felipe appealed to the superior court.

¶12 At the superior court trial, counsel read to the jury the testimony given to the Board. The trial court instructed the jury that proof of Felipe’s claimed aggravation must be supported by medical testimony based in part on one or more objective findings.

Aggravation of Reymundo Felipe’s industrially related condition and the extent of Reymundo Felipe’s increased disability on the date of claimed aggravation must be supported by medical testimony based at least in part upon one or more objective findings.
Statements of complaints by the worker made to a physician are called subjective complaints. Findings of disability that can be seen, felt, or measured by an examining physician are called objective findings.
In determining whether aggravation has occurred and the extent of any resulting increased disability, a physician cannot rely solely upon complaints, but must have some objective basis for his or her opinion. On the other hand, a physician need not rely solely upon objective findings. If there are objective findings, then the physician may also consider subjective complaints.

Felipe objected to the court’s instruction. He argued that the nature of his injury excused him from presenting objective evidence of aggravation. The jury returned a defense verdict. Felipe appeals.

STANDARD OF REVIEW

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Bluebook (online)
381 P.3d 205, 195 Wash. App. 908, Counsel Stack Legal Research, https://law.counselstack.com/opinion/felipe-v-department-of-labor-industries-washctapp-2016.