Martin Charcoal, Inc. and Crum & Forster v. Darrell Jackson Britt
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ARKANSAS COURT OF APPEALS
DIVISION III
No.
CA 07-1079
Opinion Delivered
MARTIN CHARCOAL, INC. and CRUM
& FORSTER
APPELLANTS
MAY 14, 2008
APPEAL FROM THE WORKERS’
COMPENSATION COMMISSION,
[E105441]
V.
DARRELL JACKSON BRITT
APPELLEE
AFFIRMED ON DIRECT APPEAL;
AFFIRMED ON CROSS-APPEAL
JOHN B. ROBBINS, Judge
On March 4, 1991, appellee Darrell Jackson Britt sustained a compensable injury to
his heart while working for appellant Martin Charcoal, Inc. On that day, Mr. Britt was
working near a charcoal kiln that was producing thick toxic smoke. After inhaling the
smoke, he suffered an acute myocardial infarction. In an opinion dated November 27, 1996,
the Workers’ Compensation Commission found that the myocardial infarction was causally
related to the smoke inhalation, and the Commission awarded permanent and total disability
benefits for that injury. No appeal was taken from that decision.
On October 24, 2003, Mr. Britt’s counsel submitted a letter to the Commission
seeking compensation for “the medical bills arising out of his injury already found to his heart
and lungs on or about March 4, 1991, during the course of and arising out of employment
with Martin Charcoal.” Mr. Britt’s counsel asserted in this letter that the inhalation of
chemicals had caused permanent damage to Mr. Britt’s lungs, and that Martin Charcoal was
no longer paying for breathing medications, which it had been covering over the past three
years. Martin Charcoal controverted compensability for Mr. Britt’s lung condition.
After a hearing held on July 19, 2006, the ALJ entered an order finding that Mr. Britt’s
claim for a separate lung injury was barred by the applicable statute of limitations. Thus, the
ALJ did not discuss whether a lung injury occurred on March 4, 1991. The ALJ further
rejected Mr. Britt’s alternative claim that his lung condition is a compensable consequence
of the original compensable heart injury. Finally, the ALJ awarded reasonably necessary
medical treatment, including but not limited to a concurrent heart/lung transplant, on the
basis that both transplants are necessary to stabilize or maintain the compensable heart
condition. The Commission affirmed and adopted the ALJ’s decision.
Martin Charcoal now appeals from the Commission’s most recent decision, arguing
that the Commission erred in finding that a heart/lung transplant is reasonably necessary
medical treatment for Mr. Britt’s compensable heart injury. Mr. Britt has cross-appealed,
arguing (1) that the Commission erred in ruling that his claim for a separate lung injury was
barred by the statute of limitations; (2) that the preponderance of the evidence established
separate compensability of his lung condition; and (3) that, alternatively, there is no substantial
evidence to support the Commission’s finding that his lung condition is not a compensable
consequence of the March 4, 1991, compensable heart injury. We affirm on direct appeal,
and we affirm on cross-appeal.
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When reviewing a decision from the Workers’ Compensation Commission, we view
the evidence and all reasonable inferences deducible therefrom in the light most favorable to
the findings of the Commission and affirm the decision if it is supported by substantial
evidence. Lepel v. Vincent, 96 Ark. App. 330, 241 S.W.3d 784 (2006). Substantial evidence
is that which a reasonable mind might accept as adequate to support a conclusion. Id. Where
the Commission denies a claim because of the claimant’s failure to meet his burden of proof,
the substantial-evidence standard of review requires that we affirm the Commission’s decision
if its opinion displays a substantial basis for the denial of relief. Davis v. Old Dominion Freight
Line, Inc., 341 Ark. 751, 20 S.W.3d 326 (2000). It is the Commission’s function to weigh
the medical evidence and assess the credibility and weight to be afforded any testimony.
Clairday v. The Lilly Co., 95 Ark. App. 94, 234 S.W.3d 347 (2006).
Mr. Britt testified that he is fifty-five years old and that the symptoms concerning his
lungs began on March 4, 1991, when he suffered the compensable injury from smoke
inhalation. Mr. Britt stated that his symptoms include shortness of breath and pressure in his
lungs and chest, and that his lungs have progressively worsened. He also stated that his heart
condition causes him to be short of breath. Mr. Britt maintained that he never experienced
shortness of breath or any other respiratory problems prior to the March 4, 1991, heart attack.
Mr. Britt acknowledged that he was smoking a pack or a pack and a half of cigarettes
per day before suffering the heart attack in March 1991. He stated that he quit smoking
thereafter, but had repeated relapses. He testified:
I would have maybe four to six relapses a year, which would last for maybe a week
to two weeks. It might take me a week to smoke a pack of cigarettes. So, I was
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perhaps smoking two to three cigarettes per day during my relapses. That was true up
until the year 2000.
Mr. Britt testified that his condition deteriorated during a vacation in Hawaii in June
2000. The day after he arrived, his wife took him to the hospital where he was administered
breathing treatments. After returning from the vacation, Mr. Britt was referred to a
pulmonologist, Dr. James L. Hargis. According to the testimony of Mr. Britt’s wife,
Mr. Britt’s condition has steadily worsened since the Hawaii vacation, and he has been on
oxygen twenty-four hours a day since 2003.
Dr. Hargis testified that he first saw Mr. Britt in 2000 on a referral from Mr. Britt’s
cardiologist, Dr. Donald Myears. A pulmonary function study conducted on July 13, 2000,
revealed a severe obstructive lung defect. On August 25, 2000, Dr. Hargis diagnosed chronic
obstructive pulmonary disease (COPD). In a June 24, 2003, letter to appellant’s insurance
carrier, Dr. Hargis wrote, “Mr. Britt has severe chronic obstructive lung disease and has a
previous 29 pack year history of smoking. There is no association between his COPD and
previous myocardial infarction.” In his deposition, Dr. Hargis testified:
Mr. Britt suffers from a very severe case of COPD. I noted in my records, for the sake
of completeness, that Mr. Britt smoked a pack of cigarettes per day for 29 years.
Smoking is the number one cause of COPD and emphysema. The severe COPD
indicated in my notes means Mr. Britt has severe obstruction to the air flow through
the bronchial tubes, which we have documented with the pulmonary function tests.
I think it is secondary to his smoking. I believe the primary cause of his COPD is his
smoking history. I doubt that his COPD was caused in any way by the accident he
experienced at work in 1991.
Dr. Myears testified that he first saw Mr. Britt in the early 1990s and has been seeing
him since that time on a regular basis. Dr. Myears stated that Mr. Britt has a diagnosis of an
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enlarged and weak heart muscle, with congestive heart failure and severe lung disease. In a
letter dated June 12, 2003, Dr. Myears documented a lung injury “which was unmasked [in
2000] by the use of beta blockers for his cardiac condition,” and further wrote that Mr. Britt
was evaluated for a heart/lung transplant but was not listed for consideration at that time.
However, Mr. Britt subsequently visited the Mayo Clinic in Rochester, Minnesota, and in
a letter dated June 2, 2005, Dr. Brooks Edwards expressed an intention to proceed with a
combined heart/lung transplant taking into consideration Mr. Britt’s “severe limitation and
relative youth.” Mr. Britt’s name was placed on the national computer list for a heart/lung
transplant on July 13, 2005.
Dr. Myears gave the following testimony concerning the prospect of a heart/lung
transplant:
I believe realistically that a heart transplant is Darrell’s only chance at long-term
survival. With regard to whether he only has a heart transplant, knowing what I
know about his lungs, I am not a pulmonologist, so I would not be able to make a
very specific prognosis, but in general terms, he would be extremely limited by
shortness of breath and his quality of life would not be substantially different than it
is now because his limiting factor at that time would be his severe lung disease.
Presuming a successful heart and lung transplant procedure with no complications, I
think such a procedure would be reasonable care that is necessary to help Darrell
survive and have a longer life span.
....
I believe the people at Barnes Hospital concluded [in 2003] that in order to
completely rectify Mr. Britt’s problems, he would require a heart/lung transplantation
and because of his age, they felt he was not an excellent candidate for it. Assuming
a successful procedure with no complications, I would expect a heart/lung transplant
to result in an excellent quality of life for Mr. Britt compared to what he has been
dealing with for the last 15 years. I think he would be extremely limited if he were
to receive only one organ system or the other. If the lungs are transplanted, he would
still be a class 3 to 4 debilitated because of his heart. If he had his heart transplant only,
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I am afraid he would still be oxygen dependent and probably limited to walking no
more than 50 to 100 feet because of his lung disease.
When asked what Mr. Britt’s prognosis would be if he did not have the heart and lung
transplants, Dr. Myears replied, “I will be surprised if he lasts longer than twelve to eighteen
months.”
As to the causation of Mr. Britt’s medical problems, Dr. Myears reported on February
8, 2006:
It is my opinion based upon a reasonable degree of medical certainty that although
Darrell Britt smoked prior to his inhalation injury of charcoal smoke and dust in 1991,
the major cause (more than 50%) of his need for a heart/lung transplant or other
medical treatment to his lungs and heart was the inhalation of charcoal smoke and dust
in 1991 which rendered him permanently and totally disabled and the consequent
limitations.
In his deposition, Dr. Myears testified that smoking certainly plays a role in Mr. Britt’s lung
condition, but he could not assign percentages to his lung dysfunction as to what percentage
was due to chronic smoking versus the initial toxic fume exposure. However, Dr. Myears
went on to testify that, “I think within a degree of medical certainty that the toxic exposure
he had to his lungs at the time of the inhalation set the stage for the lung disease that he now
has. I think there is a greater than fifty percent chance that the toxic lung exposure has lead
to the severity of lung disease that Mr. Britt now has.”
Dr. Louis Roddy reviewed the medical records and disagreed with Dr. Myears
regarding the causation of Mr. Britt’s lung disease. In a report dated February 8, 2006,
Dr. Roddy gave the following opinion:
It is apparent from a review of these records that prior to Mr. Britt’s inhalation injury
in 1991, his pulmonary status was near normal. However, it is important to note at
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this time that both prior to and following the inhalation injury in 1991 Mr. Britt was
a rather heavy tobacco user. Thus, although he likely had near normal pulmonary
functions, he may have had subtle small airway abnormalities as a result of his tobacco
use as early as 1991. Following Mr. Britt’s injury and despite the suggestions of
multiple physicians, Mr. Britt continued to smoke. It is difficult to quantitate
Mr. Britt’s pack year consumption but in all likelihood it exceeds 60 pack years.
Thus, it is my opinion based on reasonable medical probability that the cause of
Mr. Britt’s obstructive lung disease is the continued use of cigarettes. In addition,
Mr. Britt’s continued use of tobacco from 1991 until 2001 worsened his underlying
lung disease and was more likely than not responsible for the chronic obstructive
pulmonary disease. It is also my impression based on reasonable medical probability
that Mr. Britt’s current rather significant obstructive lung disease is more likely than
not related to tobacco consumption and not to any inhalation injury. Thus, it follows
that Mr. Britt’s need for a lung transplant as a result of his obstructive lung disease is
not related to his inhalation injury but as stated previously related to his lengthy
tobacco abusing history. Thus, it is my opinion based on reasonable medical
probability that Mr. Britt’s lung transplant is necessary not as the result of any
compensable injury but solely the result of ongoing rather heavy tobacco
consumption.
In resolving the issues in this appeal and cross-appeal, we will first address appellant
Martin Charcoal’s sole argument that it raises in its direct appeal. Martin Charcoal argues that
there is no substantial evidence to support the trial court’s conclusion that medical treatment
including a heart/lung transplant is reasonably necessary treatment for Mr. Britt’s compensable
heart injury.
The statute applicable to Mr. Britt’s request for reasonably necessary medical treatment
provides:
The employer shall promptly provide for an injured employee such medical, surgical,
hospital, and nursing service, and medicine, crutches, artificial limbs, and other
apparatus as may be reasonably necessary for the treatment of the injury received by
the employee.
Ark. Code Ann. § 11-9-508(a) (1987). Martin Charcoal contends that the heart/lung
transplant proposed by Mr. Britt’s doctors does not constitute reasonably necessary treatment.
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Appellant notes that Mr. Britt was evaluated in 1994 for a heart transplant, but his doctors
concluded that the procedure was not necessary and Mr. Britt continued with aggressive
medications. Appellant submits that Mr. Britt’s heart condition was essentially stable from
March 1991 through 2000, and that the subsequent deterioration of Mr. Britt’s heart and
lungs was the result of his continued smoking against his doctor’s orders. Appellant notes that
for reasons including Mr. Britt’s age and the waiting period for a heart/lung organ block, he
was again found not to be a proper transplant candidate in 2003. Appellant contends that
simply because Mr. Britt was placed on a list for a heart/lung transplant in 2005 does not
make the procedure reasonably necessary treatment.
Martin Charcoal further argues that even if a heart transplant is reasonably necessary,
a lung transplant is not. While Dr. Myears testified that Mr. Britt would have a low quality
of life if he has only a heart transplant, the appellant asserts that this fact does not render a lung
transplant compensable where appellee’s lung injury was unrelated to the compensable
incident.
We hold that there was substantial evidence to support the Commission’s finding that
a heart/lung transplant constitutes reasonably necessary treatment for Mr. Britt’s compensable
heart injury. In so holding, we are guided by our opinion in Artex Hydrophonics, Inc. v.
Pippin, 8 Ark. App. 200, 649 S.W.2d 845 (1983), which was relied on by the Commission
in reaching its decision. In that case, the appellee was involved in an accident that resulted
in the compression of four or five vertebrae. He failed to respond to ordinary treatment, and
was referred to a cancer specialist, who discovered widespread bone cancer that predated
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appellee’s work injury. In an earlier opinion, the court of appeals determined that the cancer
had weakened the appellee’s bones, thus predisposing him to compression fractures and
making cancer treatments, consisting of radiation and chemotherapy, necessary both to halt
the spread of the cancer and to stabilize the bones and help heal the fractured vertebrae. A
subsequent Commission opinion found that additional chemotherapy was necessary not only
to maintain the stabilization of the cancerous condition, but to stabilize the damaging effects
of the compensable injury. In affirming that decision on appeal, we held that “medical
treatments which are required so as to stabilize or maintain an injured worker are the
responsibility of the employer.” Id. at 203, 649 S.W.2d at 846.
In the present case, Mr. Britt was left permanently and totally disabled following his
compensable heart attack in 1991. He was evaluated in 2003 for a possible heart/lung
transplant but it was deemed unsuitable at that time due to facts such as Mr. Britt’s age.
However, after subsequent evaluations the treatment plan changed and Mr. Britt was placed
on the list for a transplant. Dr. Myears’ gave the opinion that a heart/lung transplant was the
only realistic chance for long term survival, and that a heart transplant alone would be of little
use. Dr. Hargis characterized Mr. Britt’s heart and lung problems as “severe” and thought
that the conditions aggravated each other. And there was evidence that a heart transplant
alone was not a viable option given Dr. Joseph Rogers’ report on March 14, 2003, that, “I
am afraid that the severity of his lung disease will preclude him from undergoing isolated
cardiac transplantation and if he is up to undergo any kind of thoracic organ transplantation,
he would require a combined heart and lung block.”
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This medical evidence was substantial evidence to support the Commission’s finding
that Mr. Britt must undergo a lung transplant as well as a heart transplant to stabilize or
maintain his compensable heart condition, in accordance with our precedent in Artex
Hydrophonics, supra. Martin Charcoal contends that Artex Hydrophonics should not be followed
because there was no legal authority to support our proposition in that case that medical
treatments that are required so as to stabilize or maintain an injured worker are the employer’s
responsibility. However, we think our interpretation of what constituted “reasonably
necessary medical treatment” in that case was based on sound reasoning, and we reject
appellant’s invitation to overrule it. Significantly, both Artex Hydrophonics and the present case
involve injuries occurring before July 1, 1993, so the applicable law requires liberal
construction of the statutes and the Commission to draw all reasonable inferences favorable
to the claimant. See Aluminum Co. of America v. Rollon, 76 Ark. App. 240, 64 S.W.3d 756
(2001); Howard v. Arkansas Power & Light Co., 20 Ark. App. 98, 724 S.W.2d 193 (1987).
Martin Charcoal also attempts to distinguish the present facts from Artex Hydrophonics because
that case involved treatment of a pre-existing condition. We, however, conclude that it is
immaterial whether Mr. Britt’s lung condition developed before or after the compensable
injury. The fact remains that the heart/lung transplant is necessary to stabilize or maintain the
appellee’s compensable condition. Accordingly, we affirm on direct appeal.
We now turn to Mr. Britt’s arguments on cross-appeal. Mr. Britt first argues that the
Commission erred in ruling that his claim for a separate lung injury was barred by the statute
of limitations. Because Mr. Britt’s alleged lung injury occurred before Act 796 of 1993
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became effective, the timeliness of his claim must be determined under the laws then in effect.
See Taylor v. Producers Rice Mill, Inc., 89 Ark. App. 327, 202 S.W.3d 565 (2005). This is
significant because the 1993 Act added the provision that a latent injury or condition shall not
delay or toll the limitations periods.
Arkansas Code Annotated section 11-9-702(a) (1987) provides, “A claim for
compensation on account of an injury, other than an occupational disease and occupational
infection, shall be barred unless filed with the Commission within two (2) years from the date
of the injury.” Section 11-9-702(b)(1987) provides, “In cases where compensation for
disability has been paid on account of injury, a claim for additional compensation shall be
barred unless filed with the Commission within one (1) year from the date of the last payment
of compensation, or two (2) years from the date of the injury, whichever is greater.” In his
argument, Mr. Britt contends that his claim for a lung injury was timely filed at the same time
he claimed a heart injury following the work-related accident in 1991. He maintains that his
initial claim included all conditions arising from that incident. Mr. Britt submits that there
is simply no requirement that an injured worker state with specificity the precise nature of the
injury sustained, and that often times the specific nature of an injury cannot be determined
until after a claim is determined to be compensable and medical treatment provided. Thus,
Mr. Britt characterizes his claim as one for additional benefits under subsection (b), and asserts
that because the appellants have continued to pay compensation throughout this case, the
one-year limitation period under that subsection never elapsed and his claim is not barred.
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We cannot agree with Mr. Britt’s assertion that he effectively filed a claim for a lung
injury at the same time he filed his initial timely claim for a heart injury. It is evident from
the record that Mr. Britt initially claimed only a heart injury, and in the Commission’s
November 27, 1996, opinion awarding compensation, the Commission found only that
Mr. Britt sustained a compensable myocardial infarction. A single employment accident may
create more than one “compensable injury,” for purposes of an act, which in turn results
in more than one date for the start of the statute of limitations. 100 C.J.S. Workers’
Compensation § 825 (2000). Mr. Britt’s heart condition and lung condition are two distinct
injuries for which compensation must be timely claimed under our statutes. The first time
Mr. Britt claimed compensation for a lung injury was on October 24, 2003, which was
outside of the two-year limitations period.
Accordingly, appellant’s claim cannot be
considered as one for additional compensation under the theory advanced in his brief because,
contrary to his argument, he did not timely claim compensability for any lung disorder. The
Commission correctly concluded that Mr. Britt’s claim for a compensable lung injury was
barred by the statute of limitations.
Mr. Britt relies in the alternative on the “latent injury” rule, which applies in cases
predating Act 796 of 1993. See Taylor, supra. In Arkansas Louisiana Gas Company v. Grooms,
10 Ark. App. 92, 661 S.W.2d 443 (1983), we explained that the two-year limitations period
does not begin to run until the true extent of the injury manifests itself and causes an
incapacity to earn wages. Because Mr. Britt was rendered incapable of earning any wages by
his compensable heart condition long before he alleged a lung injury, we are concerned here
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with when the extent of the lung injury manifested itself. Mr. Britt contends that he was
unaware of the true extent and nature of his lung condition until a visit to the Barnes-Jewish
Hospital on March 11, 2003. With this we cannot agree.
Mr. Britt fails to recognize that a June 10, 2000, x-ray gave proof of his lung
condition, revealing “markedly abnormal lungs raising question of severe asthma/chronic
obstructive pulmonary disease[.]” A July 13, 2000, pulmonary function test showed a “severe
obstructive lung defect,” and on August 25, 2000, Dr. Hargis diagnosed COPD. Thus, the
extent and nature of Mr. Britt’s lung condition manifested itself more than two years prior
to his claim filed on October 24, 2003, and the Commission correctly found that the latent
injury rule did not save Mr. Britt’s claim.
Mr. Britt’s next argument is that the preponderance of the evidence established
compensability for his lung condition that occurred on March 4, 1991, and that the
Commission erred in failing to address this issue.
He contends that the record
overwhelmingly supports his contention that the inhalation of toxic smoke on that day was
causally related to his lung injury.
Because Mr. Britt’s claim for a separate lung injury occurring on March 4, 1991, is
barred by the statute of limitations, we need not address the merits of this argument. The
Commission declined to consider the issue of compensability arising on that date, and so do
we.
Mr. Britt’s remaining argument is that the Commission erred in failing to find that his
lung condition is a compensable consequence of the compensable heart injury. If an injury
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is compensable, then every natural consequence of that injury is also compensable. Air
Compressor Equip. v. Sword, 69 Ark. App. 162, 11 S.W.3d 1 (2000). Mr. Britt refers us to
Dr. Myears’ opinion that the use of beta blockers “unmasked” his lung disease, and he urges
that it was the use of beta blockers that aggravated or accelerated his lung condition.
Mr. Britt’s final argument is without merit. Dr. Myears believed that Mr. Britt
sustained a separate lung injury on March 4, 1991. Dr. Hargis believed that there was
no association between appellee’s COPD and the previous myocardial infarction. And
Dr. Roddy gave the opinion that appellee’s need for a lung transplant was solely the result of
tobacco consumption. The Commission correctly indicated that there was a lack of proof
that the lung condition was a compensable consequence of the heart injury, and its opinion
displays a substantial basis for denying relief for that claim.
Affirmed on direct appeal; affirmed on cross-appeal.
MARSHALL and BAKER, JJ., agree.
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