The claimant seeks review of an order of Administrative Law Judge Henk (ALJ) dated November 4, 2010 that denied the claimant's petition to reopen. We affirm.
A hearing was held on the sole issue of whether the claimant's claim should be reopened on the ground that his condition had worsened. Following the hearing the ALJ entered findings of fact that for the purposes of this order may be summarized as follows. On January 19, 2007 the claimant injured his knee in a work-related accident. The claimant underwent medical treatment, which included an MRI performed on February 8, 2007 and arthroscopic surgery performed on March 27, 2007. He was released to full duty on April 30, 2007 and on May 29, 2007 was placed at maximum medical improvement with four percent impairment of the extremity. The claimant did not object to the respondents' final admission of liability.
On July 22, 2009 the claimant returned to Dr. Caughfield complaining of increased knee pain. Another MRI was performed, which the radiologist stated showed "improvement" over the previous MRI. On October 21, 2009 the claimant consulted with Dr. Caughfield, who diagnosed chronic knee pain with degenerative arthritis. chondral lesions and acute pain flaring with repetitive squatting and kneeling. On November 2, 2009 Dr. Davis performed a record review and stated that certain treatment was reasonable but that it was not causally related to the claimant's work-related injury. Dr. Davis also stated that the claimant's knee problems were not related to the injury. The claimant underwent another arthroscopic surgery on January 7, 2010. The surgery disclosed grade 2 and grade 3 changes in the central lateral facet and the trochlear groove of the patella. A partial medial miniscectomy was performed and wear of the articular surface of the medial compartment was present.
The ALJ weighed the competing medical opinions concerning the issue whether the claimant's knee condition was caused by his work-related injury. Dr. Davis testified that the claimant was suffering from osteoarthritis, but that it was not caused, aggravated, or accelerated by the injury. Dr. Duffey testified to opinions that were contrary. The ALJ credited Dr. Davis's opinions as more persuasive and found that the claimant's knee condition at the time of the hearing had not worsened as a result of the compensable injury. Accordingly, she denied the claimant's petition to reopen.
The claimant appealed and argues that the ALJ's reliance on the opinions of Dr. Davis was "unreasonable" as a matter of law. The claimant also argues that the ALJ erred in failing to consider the claimant's credibility on the question of his worsened condition and that she erred in requiring that he produce "objective evidence" in support of his petition to reopen. We have reviewed the record and considered the claimant's argument and we are unpersuaded that the ALJ erred or abused her discretion.
The law applicable to reopening is well-established. Section 8-43-303 C.R.S. authorizes an ALJ to reopen "any award" on the grounds of, among other things, error, mistake, or a change in condition. Heinicke v. Industrial Claim Appeals Office, 197 P.3d 220, (Colo. App. 2008); Cordova v. Industrial Claim Appeals Office, 55 P.3d 186, 189 (Colo. App. 2002). A change in condition refers either "to a change in the condition of the original compensable injury or to a change in claimant's physical or mental condition which can be causally connected to the original compensable injury." Chavez v. Industrial Comm'n, 714 P.2d 1328, 1330 (Colo. App. 1985); accord Anderson v. Longmont Toyota, Inc., 102 P.3d 323, 330 (Colo. 2004).
The reopening authority granted ALJs by § 8-43-303 "is permissive, and whether to reopen a prior award when the statutory criteria have been met is left to the sound discretion of the ALJ." Cordova, 55 P.3d at 189. The party seeking reopening bears "the burden of proof as to any issues sought to be reopened." Section 8-43-303(4), C.R.S. In the absence of fraud or clear abuse of discretion, the ALJ's decision concerning reopening is binding on appeal. Jarosinski v. Industrial Claim Appeals Office, 62 P.3d 1082, 1084 (Colo. App. 2002). An abuse of discretion occurs when the ALJ's order is beyond the bounds of reason, as where it is unsupported by the evidence or contrary to law. Id.
Moreover, whether the claimant's condition is due to the natural progression of the pre-existing condition or a new industrial accident is a question of fact for resolution by the ALJ. Wal-Mart Stores, Inc. v. Industrial Claim Appeals Office, 989 P.2d 251 (Colo. App. 1999). Further, the questions whether the claimant proved a worsened condition, and whether the worsening was causally related to the industrial injury, are factual in nature.
Because of the factual nature of these questions, we are bound by the ALJ's determinations in this regard if they are supported by substantial evidence in the record. Section 8-43-304(8), C.R.S.; City of Durango v. Dunagan, 939 P.2d 496 (Colo. App. 1997). Substantial evidence is that quantum of proof which would support a reasonable belief in the existence of a fact without regard to contradictory evidence and conflicting inferences. Ackerman v. Hilton's Mechanical Men, Inc., 914 P.2d 524 (Colo. App. 1996). We note that expert medical opinion is not needed to prove or disprove causation where circumstantial evidence supports the ALJ's inferences regarding the claimant's condition. Savio House v. Dennis, 665 P.2d 141 (Colo. App. 1983). Where expert medical opinion is presented, however, it is solely for the ALJ as fact finder to weigh the evidence and resolve any conflicts. Rockwell International v. Turnbull, 802 P.2d 1182 (Colo. App. 1990).
Here, as noted, the ALJ weighed the competing medical opinions and credited those of Dr. Davis over those of Dr. Duffey. She was fully entitled to do so and her extensive and thorough factual findings disclose a careful weighing of the probative value of the evidence. Of course, we may not reweigh the factual record and draw inferences different from those of the ALJ's. The opinions of Dr. Davis provide ample evidence supporting her conclusion that the claimant failed to carry his burden of showing that his knee conditions worsened as a result of his compensable injury in January 2007. The ALJ also correctly applied the relevant legal standards and we perceive no error in her order.
Nor are we persuaded by the claimant's specific arguments that the ALJ erred or abused her discretion. The claimant notes that Dr. Davis did not treat the claimant or perform an examination of his knee, but rather only reviewed his medical records. Although this argument was appropriately presented to the ALJ, it goes only to the weight to be given to Dr. Davis's opinions. Contrary to the claimant's argument, it does not render his opinions "unreasonable" as a matter of law.
Similarly, the ALJ was not compelled to conclude from the claimant's testimony that his worsened knee condition, including his increased pain, was caused by the compensable injury of January 2007. Although that was certainly one inference that the ALJ might have drawn from the testimony, it was not the only permissible one and we are unpersuaded by the claimant's argument that the ALJ could only reach the conclusion that the compensable injury caused the claimant's later pain and other symptoms. In light of ample expert medical opinion that it did not do so, the ALJ remained free to reach conclusions other than those urged by the claimant.
Finally, the ALJ properly applied the correct legal standard. In a lengthy discussion regarding the application of her factual findings to the law regarding reopening, the ALJ correctly stated that the burden was the claimant's to prove by a preponderance of the evidence that his worsened condition was the natural and proximate consequence of the compensable injury. She credited the expert opinions of Dr. Davis that the claimant's compensable injury to his meniscus did not cause or accelerate the development of his osteoarthritis. In referring to the absence of "objective" evidence supporting the petition to reopen, the ALJ was merely repeating selective portions of the opinions of Dr. Davis. We do not view those references to the lack of "objective" evidence as disclosing in any manner a misunderstanding of the applicable legal standard or of the claimant's burden to prove that the worsened condition was caused by the compensable injury. The ALJ's factual findings were amply supported by substantial evidence and the findings in turn support her conclusion that the claimant failed to carry his burden of showing that the claim should be reopened.
IT IS THEREFORE ORDERED that the ALJ's order dated November 4, 2010, is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL
______________________________ John D. Baird
______________________________ Curt Kriksciun
RICARDO MONTOYA, 627 JACKSON STREET, PUEBLO, CO, 81004 (Claimant)
UPS, Attn: STEVE DAHL, 3108 WEST THOMAS ROAD, SUITE 1204, PHOENIX, AZ, 85107 (Employer)
LIBERTY MUTUAL INSURANCE COMPANY, Attn: AMY MARIE BARTH, C/O:
GALLAGHER BASSETT SERVICES, P O BOX 8009, ITASCA, IL, 60143 (Insurer)
FOGEL KEATING WAGNER POLIDORI SHAFNER, Attn: NICK D. FOGEL, ESQ., 1290
BROADWAY, SUITE 600, DENVER, CO, 80203 (For Claimant)
RITSEMA LYON, PC, Attn: SEAN M. KNIGHT, ESQ., 999 18TH STREET, SUITE 3100,
DENVER, CO, 80202 (For Respondents)
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