Board grants DACD Petition based on a determination that the need for additional surgery was the direct and natural consequence of the work injury despite claimant having an intervening auto accident that worsened his condition.
This case was before the Board on the claimant’s DACD petition in which he alleged he needed additional cervical spine surgery. The employer contended that the proposed surgery was not the result of the work injury but, rather, was necessitated by a recent non-work-related auto accident.
On January 9, 2018, the claimant sustained a slip and fall on ice during the course of his employment in which he injured his neck and right shoulder. This injury was accepted as compensable, and the claimant’s treatment included undergoing surgery with Dr. Yalamanchili in October 2018 to the cervical spine, which involved a discectomy and decompression at the C2-C3 level. The claimant had a good result from that surgery, but he continued to have symptoms in the cervical spine for which he received ongoing pain management treatment.
On March 19, 2021, the claimant was seen by the pain management physician and complained of increasing neck pain that was aggravated by driving and sleeping. The physician recommended that the claimant have a series of cervical facet injections. Later that same day, the claimant was involved in a non-work-related auto accident. As a result of that accident, the claimant sustained increased pain to his neck and now also pain to his low back.
The claimant followed up with Dr. Yalamanchili some weeks later. The doctor reviewed an updated MRI study showing a worsening of the condition at the C5-C6 level, and he recommended surgery involving a discectomy and fusion that he related to the work injury.
The applicable standard, as set forth in Barkley v. Johnson Controls, is the direct and natural result test. This test dictates that when an employee suffers a compensable work injury and later suffers a non-work injury, the later injury is compensable if it follows as a direct and natural result of the primary compensable work injury. This test also has a superseding causation component in that, if the later non-work injury is the result of the claimant’s own negligence or fault, the chain of causation is broken. In applying this rule, the Board follows the concept that the current condition is compensable if it would not have arisen but for the work injury.
The Board concluded that the claimant had met this burden of proof. Initially, there was no question of negligence since the claimant was rear-ended by the other driver. The key medical determination was that, although the auto accident led to a worsening of the claimant’s condition at the C5-C6 level, the cervical spine, including that level, was already in a weakened and fragile state as a result of the work injury prior to the auto accident. Therefore, the Board accepted the testimony of Dr. Yalamanchili that the proposed cervical spine surgery was the direct and natural consequence of the work injury, and they rejected the contrary opinion of the employer’s medical expert. The Board found that the need for the proposed cervical spine surgery was related to a combination of the work injury and the subsequent non-work auto accident. In essence, the proposed surgery would not have been recommended but for the initial work injury.
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