Combined Conditions = OCI +PEC
Court of Appeals boils combined conditions down to a mathematical equation.
In Vigor Industrial , LLC v. Randi Ayres, the Court of Appeals held that ORS 656.005(7)(a)(B), permits consideration of only qualifying preexisting conditions when determining the major contributing cause of a “combined condition.” Ayres had an accepted non-disabling foot strain. He filed an expansion request for two conditions predating his injury: navicular fracture and avascular necrosis (AVN); neither condition had been diagnosed or treated prior to the work injury. The employer issued a Combined Condition Denial. Claimant requested hearing.
The ALJ found the work injury was a material contributing cause of the navicular fracture and AVN. The ALJ also found claimant’s preexisting degenerative arthritis contributed to some degree to claimant’s disability and need for treatment, and combined with the industrial injury. He determined the combined condition consisted of the preexisting arthritis and injury and concluded the employer did not met its burden to prove that the otherwise compensable injury (OCI) was no longer the major contributing cause (MCC) of his disability or need for treatment. The employer sought review.
The Board affirmed, but reasoned that the OCI was not the work injury itself; rather the AVN and navicular fracture each constituted an OCI that combined with the preexisting arthritis forming two combined conditions: (1) arthritis plus the AVN and (2) arthritis plus the navicular fracture. The employer appealed, arguing the Board should have considered all of the conditions that contributed to claimant’s foot problem when analyzing the “major contributing cause.”
The Court held a “combined condition” (CC) consists of two components: (1) an OCI; and (2) a statutory preexisting condition (PEC). It broke it down to a simple mathematical equation:
CC = OCI + PEC
Conditions that are not encompassed within the OCI or are not statutory PEC play no part in the MCC analysis. To determine whether the compensable injury is the MCC, use the following formula:
OCI> PEC = OCI is MCC
OCI < PEC = PEC is MCC
The Court’s decision clarifies the standard to use when evaluating a combined condition. IME questions and communications with medical professionals must accurately reflect this standard. If you would like help drafting IME questions for a combined condition case or have general questions about this decision, please contact me at email@example.com.