Introduction

In Matter of Spada v. Keeler Construction Co., the Third Department modified a Workers’ Compensation Board decision by reversing the Board’s finding that a heavy equipment operator’s binaural hearing loss was causally related to workplace noise and remitted for further proceedings. The decision clarifies the evidentiary demands for establishing causation in occupational hearing loss claims under New York’s Workers’ Compensation Law, emphasizing that:

• Competent medical opinions must be grounded in a rational basis in the record, not generalized assertions of likelihood.
• Audiometric data—and its pattern—are central to assessing whether hearing loss is noise-induced.
• Alternative, non-occupational sources of noise exposure and inconsistent patient histories must be addressed and reconciled by the medical proof.

The parties included the claimant, Guy Spada, a long-time heavy equipment operator alleging occupational hearing loss, and the employer and its carrier, Keeler Construction Company et al., who controverted causation. The Workers’ Compensation Board had affirmed a Workers’ Compensation Law Judge’s establishment of an occupational disease and awarded an 11.25% schedule loss of use (SLU). The carrier appealed the causation determination; timeliness was not at issue.

Summary of the Opinion

The Third Department held that the Board’s causation finding lacked substantial evidence because the medical opinions supporting work-related causation were not supported by a rational basis in the record. Although some physicians opined that claimant’s hearing loss was “likely” or “very obvious[ly]” attributable to workplace noise, the record contained:

• Conflicting and incomplete medical histories regarding other significant noise exposures (military service and firearms, motorcycle riding, hunting) and family history.
• Audiograms that, according to the carrier’s otolaryngology consultant, reflected a pattern inconsistent with noise-induced hearing loss (NIHL)—notably a low-frequency loss at 500 Hz rather than the classic high-frequency notch near 4,000 Hz.

Because the supporting medical opinions did not engage with this contrary audiometric evidence or reconcile alternative exposures, they amounted to generalized conclusions without a rational evidentiary foundation. The Court therefore reversed the Board’s finding of causally-related binaural hearing loss and remitted for further proceedings. The remainder of the decision (including timeliness) was otherwise affirmed.

Detailed Analysis

1) Governing Standards and Precedents Cited

The decision synthesizes and applies several settled principles in occupational disease cases:

• Recognizable link to a distinctive feature of the occupation. A claimant must show a recognizable link between the condition and a distinctive feature of the occupation via competent medical evidence. See Matter of Kretunski v Citywide Envtl. Servs. LLC, 233 AD3d 1218 (3d Dept 2024); Matter of Song v City of N.Y. Dept. of Bldgs., 232 AD3d 1005 (3d Dept 2024); Matter of Gandurski v Abatech Indus., Inc., 194 AD3d 1329 (3d Dept 2021).
• Gradual-onset conditions and “unusual environmental conditions.” Where a condition develops over time rather than from a sudden event, the claimant must demonstrate by competent medical evidence that it resulted from unusual environmental conditions or events assignable to something extraordinary. See Song, 232 AD3d at 1006; Matter of Barker v New York City Police Dept., 176 AD3d 1271, 1273 (3d Dept 2019), lv denied 35 NY3d 902 (2020); Matter of Duncan v John Wiley & Sons, Inc., 54 AD3d 1124 (3d Dept 2008).
• Medical probability with rational basis. Causation opinions must signify a probability as to cause and be supported by a rational basis in the record; speculative or general expressions of possibility are insufficient. See Matter of DeWolf v Wayne County, 228 AD3d 1218, 1218–19 (3d Dept 2024), lv denied 43 NY3d 955 (2025), appeal dismissed 43 NY3d 956 (2025); Matter of Gunness v Prime Piping & Heating Inc., 234 AD3d 1082, 1084 (3d Dept 2025); Gandurski, 194 AD3d at 1330; Matter of Tucker v City of Plattsburgh Fire Dept., 153 AD3d 984, 985 (3d Dept 2017), lv denied 30 NY3d 906 (2017).
• Board’s role and judicial review. The Board may weigh conflicting medical evidence, but its findings must be supported by substantial evidence and a rational basis. See Matter of Oberg v Consolidated Edison Co. of N.Y., Inc., 211 AD3d 1271 (3d Dept 2022); DeWolf, 228 AD3d at 1218–19; Gunness, 234 AD3d at 1084.
• Comparative framework concerning alternative noise exposures. The Court cited, by comparison, cases involving other noise sources: Matter of Granville v Town of Hamburg, 136 AD3d 1254 (3d Dept 2016), and Matter of Maye v Alton Mfg., Inc., 90 AD3d 1177 (3d Dept 2011), to highlight the analytical importance of assessing and reconciling non-occupational exposures.

2) The Court’s Legal Reasoning

The Third Department accepted that medical causation need not be proved with absolute certainty. Yet, the Court held, the Board’s reliance on statements that hearing loss was “likely” due to workplace noise was insufficient where:

• Alternative exposure sources were significant and not reconciled. Claimant reported varying histories: a 2018 evaluation documented substantial non-occupational noise exposures (military service and firearms) and family history; the 2022 evaluation reflected denials of family history and other noise exposure. The 2022 physician conceded that military firearm use would “definitely factor” into causation and even acknowledged the possibility of idiopathic loss.
• Audiometric inconsistency with NIHL. The carrier’s otolaryngology consultant testified that claimant’s audiograms showed low-frequency loss (at 500 Hz), not the classic high-frequency notch at or around 4,000 Hz typical of NIHL. He concluded that this “audiometric pattern…[was] not consistent with noise-induced hearing loss” and criticized the 2019 audiologist’s attribution of moderate hearing loss to employment as “simply not true.”
• Inability to apportion and presence of other etiologies. The consultant further identified motorcycles and hunting as additional “industrial sources of noise exposure,” and noted age, genetics, and inner ear disease as possible causes, explaining that it was not possible to apportion the loss across sources based on the record.

In this posture, the physicians’ “likely” or “very obvious” characterizations did not supply the required rational basis for the Board’s causation finding. While the Board enjoys latitude in weighing experts, it cannot base causation on generalized conclusions that ignore or contradict the audiometric evidence and undisputed alternative exposures. Consequently, the causation finding lacked substantial evidence.

3) How the Precedents Informed the Outcome

• Kretunski and Song supplied the governing standard: a recognizable link between the condition and a distinctive occupational feature must be proved through competent medical evidence, particularly where gradual onset is claimed.
• DeWolf, Gunness, Gandurski, and Tucker framed the sufficiency threshold for medical opinion: it must rest on probability and a rational basis in the record, and cannot be speculative. Spada applies this by scrutinizing whether the medical opinions meaningfully engaged with the claimant’s complete exposure history and audiometric data.
• Oberg was invoked to acknowledge the Board’s role in resolving conflicting medical opinions, but Spada emphasizes that this discretion is constrained by the rational-basis requirement.
• Granville and Maye were cited comparatively to underscore why alternative exposures matter. Spada signals that where material non-occupational noise sources exist, a claimant’s medical proof must squarely confront them.

4) The Role of Audiograms and Expert Methodology

A key contribution of Spada is its explicit reliance on audiometric pattern analysis to test the plausibility of NIHL causation:

• The carrier’s consultant emphasized a principle widely understood in audiology: NIHL typically shows a high-frequency notch (often at or around 4 kHz). The claimant’s audiograms reflected low-frequency loss (500 Hz)—a pattern the consultant deemed inconsistent with NIHL.
• The pro-causation physicians did not address this discrepancy or engage with the audiometric data when asserting that the hearing loss was “likely” work-related.

Spada therefore instructs that, in hearing loss claims, expert conclusions must connect to and grapple with the objective audiometric record. Opinions that do not reconcile the audiometric pattern with the asserted occupational cause risk being deemed insufficiently grounded.

5) Impact and Implications

Spada is poised to influence both litigation strategy and evidentiary development in occupational hearing loss claims:

• For claimants: Expect closer scrutiny of medical histories and audiograms. Claimants should ensure consistent disclosure of all noise exposures (occupational and non-occupational), family history, and medical factors, and should present medical opinions that:
  • Analyze the claimant’s audiograms and explain why the pattern is (or is not) consistent with NIHL;
  • Address alternative noise sources and, if possible, explain apportionment or why work exposure predominates;
  • Explain why “idiopathic” or non-occupational etiologies are less likely, using a reasoned differential analysis.
• For employers and carriers: Spada validates a defense approach that foregrounds audiometric pattern analysis, detailed exposure histories, and non-occupational causation. Carriers should:
  • Obtain comprehensive IME reports that parse audiograms and explicitly address NIHL hallmarks;
  • Develop the record regarding non-work exposures and genetics/age-related loss;
  • Highlight inconsistencies in a claimant’s histories across providers and time.
• For the Workers’ Compensation Board: While the Board may continue to credit one medical opinion over another, Spada underscores that credited opinions must be anchored to the record. Findings should articulate how the Board reconciles competing audiometric interpretations and alternative exposure evidence.
• System-wide effect: The decision elevates the centrality of objective audiometry in causation analyses and is likely to produce more detailed, data-driven expert testimony and more frequent remits where the record is underdeveloped.

Notably, Spada does not establish that low-frequency loss can never be occupational or that a 4 kHz notch is invariably required, but it makes clear that where the audiometric pattern appears inconsistent with NIHL and the record reflects substantial non-occupational exposures, generalized assertions of work-related causation will not meet the “rational basis” threshold.

Complex Concepts, Clarified

• Occupational disease vs. accidental injury: An occupational disease arises from conditions characteristic of a particular occupation and typically develops over time. Causation must be shown by linking the disease to a distinctive feature of the work setting. For gradual-onset claims, courts look for proof of unusual environmental conditions or extraordinary events contributing to the disease.
• “Recognizable link” and “competent medical evidence”: The link between the disease and occupation must be demonstrated by medical opinion evidence that shows a probable causal relationship and is grounded in the record.
• Substantial evidence and rational basis: Substantial evidence is relevant proof that a reasonable mind might accept as adequate. Even in the presence of conflicting medical views, the opinion supporting causation must be rationally supported by the record (not speculative).
• Binaural hearing loss: Hearing loss in both ears. In workers’ compensation, hearing loss can support a schedule loss of use award if causally related to work.
• Schedule Loss of Use (SLU): A statutory award for permanent loss of function of a body part or sense, expressed as a percentage. In Spada, the 11.25% SLU for hearing is contingent on establishing work-related causation; with causation reversed, the SLU cannot stand unless causation is later established on remand.
• Audiogram and NIHL pattern: An audiogram charts hearing thresholds by frequency. Classic NIHL often presents as a high-frequency loss with a “notch” near 4 kHz. Low-frequency loss (e.g., at 500 Hz) may suggest other etiologies. Spada treats audiometric congruence with NIHL as a critical factor in causation.
• Idiopathic loss: Hearing loss of unknown origin. Acknowledgment by a treating expert that the loss could be idiopathic can undermine the probability-based standard required for causation unless convincingly addressed.
• Independent Medical Examination (IME): An evaluation by a physician retained by the carrier. In Spada, the IME’s detailed audiometric analysis and identification of alternative causes weighed heavily in the Court’s substantial evidence review.

Procedural Disposition and What Happens Next

The Court modified the Board’s decision by reversing the finding of a causally-related binaural hearing loss and remitted the matter for further proceedings consistent with the opinion. On remand, the Board may:

• Develop the record with additional audiological testing or expert testimony that addresses the asserted inconsistencies;
• Require medical experts to analyze the audiometric pattern relative to NIHL and reconcile alternative noise exposures and potential non-occupational etiologies;
• Reassess causation and any resulting schedule award in light of a more robust, rationally supported medical record.

The Board’s separate finding that the claim was timely is undisturbed (timeliness was not challenged on appeal).

Key Takeaways

• Generalized medical statements that hearing loss is “likely” work-related are insufficient without a rational basis anchored in the record.
• Audiometric evidence—and whether it displays a pattern typical of NIHL—can be dispositive in assessing causation.
• Material non-occupational noise exposures, inconsistent histories, and alternative etiologies must be squarely addressed by medical experts to satisfy the probability standard.
• While the Board may choose among competing medical opinions, its choice must be supported by substantial evidence and a clearly articulated rationale.
• Spada signals more rigorous evidentiary expectations for occupational hearing loss claims and encourages data-driven, differential-causation analyses.

Conclusion

Matter of Spada v. Keeler Construction Co. refines New York’s approach to proving causation in occupational hearing loss claims. The Third Department underscores that a claimant’s burden is not met by conclusory assertions of likelihood; medical opinions must be tied to the objective audiometric record and must thoughtfully engage with alternative exposures and etiologies. The case thus establishes a pragmatic, evidence-centric framework for evaluating NIHL claims, ensuring that awards rest on substantial evidence rather than generalized inferences. Going forward, Spada will likely raise the bar for both the development of medical proof and the Board’s articulation of the rational basis underlying its causation findings.

Cases Cited

• Matter of Kretunski v Citywide Envtl. Servs. LLC, 233 AD3d 1218 (3d Dept 2024)
• Matter of Song v City of N.Y. Dept. of Bldgs., 232 AD3d 1005 (3d Dept 2024)
• Matter of Gandurski v Abatech Indus., Inc., 194 AD3d 1329 (3d Dept 2021)
• Matter of Barker v New York City Police Dept., 176 AD3d 1271 (3d Dept 2019), lv denied 35 NY3d 902 (2020)
• Matter of Duncan v John Wiley & Sons, Inc., 54 AD3d 1124 (3d Dept 2008)
• Matter of DeWolf v Wayne County, 228 AD3d 1218 (3d Dept 2024), lv denied 43 NY3d 955 (2025), appeal dismissed 43 NY3d 956 (2025)
• Matter of Gunness v Prime Piping & Heating Inc., 234 AD3d 1082 (3d Dept 2025)
• Matter of Tucker v City of Plattsburgh Fire Dept., 153 AD3d 984 (3d Dept 2017), lv denied 30 NY3d 906 (2017)
• Matter of Oberg v Consolidated Edison Co. of N.Y., Inc., 211 AD3d 1271 (3d Dept 2022)
• Matter of Granville v Town of Hamburg, 136 AD3d 1254 (3d Dept 2016)
• Matter of Maye v Alton Mfg., Inc., 90 AD3d 1177 (3d Dept 2011)