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Workers’ Compensation – Causation – Torn Rotator Cuff – Medical Testimony – Speculation

Workers’ Compensation – Causation – Torn Rotator Cuff – Medical Testimony – Speculation

Hyatt v. N.C. Department of Correction. (Lawyers Weekly No. 10-16-1190, 14 pp.) (Ann Marie Calabria, J.) N.C. App. Unpub. Click here for the full text of the opinion.

Holding: Plaintiff’s surgeon – before he learned that plaintiff hadn’t sought treatment for shoulder pain for more than a year after his at-work fall – testified only that it was “possible” or “plausible” that plaintiff’s rotator-cuff tear occurred in the fall. This testimony was speculation and was insufficient to prove that plaintiff’s injury was caused by his fall at work.

We affirm the Industrial Commission’s denial of benefits.

On Nov. 2, 2006, plaintiff fell at work. He sought treatment for a left-ankle sprain and a rib contusion. He did not report any right-shoulder pain until December 2007. Then, he was diagnosed with degenerative osteoarthritis in the acromioclavicular (AC) joint of the right shoulder with a full thickness tear of the distal anterior supraspinatus tendon.

Plaintiff sought workers’ compensation benefits for his shoulder problems.

On direct examination, plaintiff’s surgeon, Dr. Cammarata, was asked to assume that plaintiff had not had any other traumatic events or sustained any accidental injuries between his Nov. 2, 2006, fall and his March 13, 2008, surgery. Dr. Cammarate replied, “I think a fall on a shoulder definitely can cause a rotator cuff tear, and by the history that [plaintiff] provided and, really, with no interim injuries, then with it being temporally related to what he is describing, I think it’s plausible that that could have happened at that time.”

Dr. Cammarata testified that (1) he did not review plaintiff’s medical records in November 2006; and (2) he did not know Dec. 27, 2007, was the first time plaintiff had been treated for right-shoulder pain. When Dr. Cammarata was asked the most common causes for a rotator-cuff tear, he answered that the most common causes were falls or lifting types of injuries and degenerative tears from natural deterioration.

He also added that weight lifting can cause rotator-cuff tears, and a person can develop a rotator-cuff tear without trauma. Finally, he said it was difficult to determine whether plaintiff’s rotator-cuff tear was a degenerative tear or a traumatic tear. Plaintiff testified that he lifted weights three times per week for over 10 years on a regular basis, and also would bench press between 135 to 300 pounds.

The commission found as fact, “Dr. Cammarata gave no definitive opinion to a reasonable degree of medical certainty as to causation based on his medical treatment of plaintiff.” However, Dr. Cammarata was not required to testify to a reasonable degree of medical certainty. Therefore, the commission’s reliance on this particular portion of Finding 24 was error.

Expert testimony as to the possible cause of a medical condition is insufficient to prove causation, particularly where there is additional evidence showing the expert’s opinion to be a guess or mere speculation.

Dr. Cammarata’s testimony that he “think[s]” a fall on the shoulder “can” cause a rotator-cuff tear, that he “think[s] it’s plausible” that plaintiff’s fall caused his rotator-cuff injuries, and that it was “hard to determine” if plaintiff’s rotator-cuff problems resulted from the fall, suggests that a causal connection between plaintiff’s accident and his problems with his right arm and shoulder was possible but unlikely.

While Dr. Cammarata was not required to testify as to a reasonable degree of medical certainty that plaintiff’s right-arm and shoulder problems were causally related to the Nov. 2, 2006, fall, the unchallenged findings support the commission’s further findings that “Dr. Cammarata’s testimony does not persuasively establish that plaintiff’s right arm and shoulder problems are related to his November 2, 2006 injury and does not establish a causal relationship” and that “the evidence fails to show that plaintiff’s right shoulder and arm problem is causally related to his November 2, 2006 fall.”

Since there is competent evidence in the record supporting the finding of no causal link, that finding must stand.

Dr. Cammarata’s testimony relating to the cause of plaintiff’s shoulder and arm problems amounted to “speculation,” and was therefore insufficient to show that plaintiff’s injury was caused by the Nov. 2, 2006, fall.

Furthermore, Dr. Cammarata testified that he was surprised to learn that plaintiff’s original injury occurred on Nov. 2, 2006, but that plaintiff had not sought treatment for his right shoulder pain until Dec. 27, 2007.

Plaintiff testified that he lifted weights, and Dr. Cammarata testified that a “rotator cuff tear can happen with weight lifting.” These findings and evidence support the Commission’s finding that “when viewed in the entirety, Dr. Cammarata’s testimony was based on a post hoc, ergo propter hoc theory” and the commission’s conclusion that “an expert’s opinion that [is] solicited through the assumption of facts unsupported by the record is entirely based on conjecture.”


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