SAIF Corp. v. Sprague

BREWER, C. J.,

concurring.

I agree with the majority’s holding in this case, but for a different reason. ORS 656.245(l)(a) provides:

“For every compensable injury, the insurer or the self-insured employer shall cause to be provided medical services for conditions caused in material part by the injury for such period as the nature of the injury or the process of the recovery requires, subject to the limitations in ORS 656.225, including such medical services as may be required after a determination of permanent disability. In addition, for consequential and combined conditions described in ORS 656.005(7), the insurer or the self-insured employer shall cause to be provided only those medical services directed to medical conditions caused in major part by the injury.”

*429The majority explains that the board reached the correct result on remand in this case by applying the material contributing cause standard of proof in determining whether claimant’s gastric bypass surgery is a compensable treatment for his arthritic knee condition. The majority bases its conclusion primarily on its interpretation of the first sentence of ORS 656.245(1)(a). I disagree with the majority’s analysis because, in my view, it overlooks the remainder of ORS 656.245(1)(a), as well as the circumstances of this case. To reiterate those circumstances in a way that is consonant with the terms of the statute: The “compensable injury” or “injury” to which the statute applies is claimant’s 1976 meniscal tear. As the board held in its first order, claimant’s current arthritic knee condition is a “consequential condition,” because the arthritis developed as a consequence of claimant’s compensable 1976 injury. The “medical service” for which claimant seeks recovery is gastric bypass surgery. That medical service is directed in part to the treatment of claimant’s consequential arthritic knee condition, which is a “medical condition” within the meaning of the second sentence of subsection (l)(a).

The first sentence of ORS 656.245(l)(a) generally governs the compensability of medical services for a condition caused by a compensable injury. For medical services to which that sentence applies, the material causation standard applies to the relationship between the condition requiring treatment and the compensable injury. The first sentence of the statute does not require that the condition being treated be an accepted, compensable condition, as long as the treatment of the condition is necessitated in material part by the compensable injury. See, e.g., SAIF v. Martinez, 219 Or App 182, 191, 182 P3d 873 (2008) (“[T]o establish the compensability of a medical treatment under ORS 656.245(l)(a), the condition for which treatment is sought need not be the accepted condition; however, the treatment must be necessitated in material part by the ‘compensable injury,’ which, as we said in Sprague [v. United States Bakery, 200 Or App 569, 116 P3d 251 (2005), rev den, 340 Or 157 (2006)], is the condition previously accepted.”). Thus, it is possible, under the first sentence of the statute, for a noncompensable condition to be subject to medical treatment, if the condition is caused *430in material part by the compensable injury. In this case, as the majority opinion clarifies, the condition for which the treatment is sought is the arthritic knee condition — not claimant’s obesity. The arthritic knee condition is a compensable condition; however, it is also a consequential condition.

The second sentence of ORS 656.245(l)(a) addresses a more particular subset of circumstances from those addressed in the first sentence, namely, the compensability of medical services in claims for combined or consequential conditions. For such claims, the major contributing cause standard applies to the relationship between the medical condition requiring treatment and the compensable injury. The compensability of the pertinent medical service depends on whether it is directed to a medical condition caused in major part by the compensable injury. Here, because the claim is for a consequential condition — claimant’s arthritic knee — I would conclude that the second sentence of subsection (1)(a) governs. See PGE v. Bureau of Labor and Industries, 317 Or 606, 611, 859 P2d 1143 (1993) (in examining the text and context of a statute, the court considers the principles that “where there are several provisions or particulars such construction is, if possible, to be adopted as will give effect to all,” ORS 174.010, and that “a particular intent controls a general intent that is inconsistent with it,” ORS 174.020). And, because the pertinent medical condition for which medical services are sought — also claimant’s current arthritic knee condition — must have been caused in major part by claimant’s compensable injury, in my view, the board correctly analyzed the matter in its first order in this case by requiring proof that claimant’s 1976 knee injury is the major contributing cause of his current arthritic knee condition.

The majority’s interpretation limits the scope of the second sentence of subsection (1)(a) to disputed consequential or combined conditions. See 221 Or App at 420 (“But here, the board had already found that the [gastric] bypass surgery was performed in part to treat claimant’s current knee condition, a condition ‘due largely to the 1976 compensable work injury,’ and employer did not contend on judicial review that claimant’s current knee condition was not compensable[.]”). The majority reasons:

*431“Whether claimant’s current knee condition is compensable as the result of his 1976 work-related injury and his December 29, 2000, accepted arthritic knee condition has never been challenged by SAIF in the proceedings before this court, and that fact led this court to treat claimant’s claim for medical services under the first rather than the second sentence of the statute to avoid a redundancy.”

221 Or App at 420 n 3. Contrary to the majority’s premise, though, the statute makes no distinction between consequential condition claims that have been accepted and claims that are disputed. In any claim for a combined or consequential condition — whether or not the claim is disputed — only medical services directed at medical conditions caused in major part by the compensable injury are compensable. In my view, the majority mistakenly applies the lesser, material contributing cause, standard of proof to determine the compensability of medical services in the context of claimant’s consequential medical condition claim, contrary to the text of ORS 656.245(1)(a).

It is possible that the majority’s understanding of the statute is premised on the view that employer, having failed to challenge the continuing compensability of claimant’s consequential arthritic knee condition, should be precluded from challenging the compensability of medical services for that condition.1 However, that issue is not before us, and it does not inform the proper construction of the statute.

In the abstract, a proper resolution of this case might be to conclude, contrary to our first two opinions in this case and to the current majority opinion, that the correct standard of proof in determining the compensability of medical services for claimant’s arthritic knee is the major contributing cause standard and to reinstate the first board order. However, the foregoing concerns notwithstanding, I would not *432take that step. First, the Supreme Court denied review of our opinion on reconsideration of our first decision, thereby suggesting — at least as one possibility — that it did not believe that our analysis was erroneous. What is more important, though, is that our previous decisions, even if incorrect, have become the law of the case. See State v. Montez, 324 Or 343, 347, 927 P2d 64 (1996), cert den, 520 US 1233 (1997). When a ruling has once been made in a particular case by an appellate court, although it may be overruled in another case, it is binding and conclusive in any further steps or proceedings in the same litigation and on the appellate court itself. Id. Even though “[t]he law of the case doctrine is essentially one of judicial economy and judicial discretion,” State v. Metz, 162 Or App 448, 454, 986 P2d 714 (1999), rev den, 330 Or 331 (2000), and the rule “is generally not applied with the same rigor as [claim preclusion],” Morley v. Morley, 24 Or App 777, 781, 547 P2d 636 (1976), the complicated history of this case — including a remand in which the board attempted to follow our instructions with care — counsels against a late-stage shift in legal course.

My purpose in writing separately is to publish a word of caution that our first two opinions in this case may have erroneously analyzed claimant’s current claim under the first sentence of ORS 656.245(l)(a), rather than as one for medical services for a consequential medical condition that is subject to analysis under the second sentence of that subsection.

I respectfully concur.

In general, the doctrine of issue preclusion applies to workers’ compensation cases. Drews v. EBI Companies, 310 Or 134, 142, 795 P2d 531 (1990). Issue preclusion precludes future litigation on issues when they have been actually litigated and determined in a setting where the determination is essential to a final decision. It applies to issues of fact or law. Id. at 139-40. In workers’ compensation cases, issue preclusion rules apply where they “facilitate prompt, orderly and fair problem resolution.” North Clackamas School Dist. v. White, 305 Or 48, 52, 750 P2d 485, modified on recons, 305 Or 468, 752 P2d 1210 (1988).