pierpont/federated v. Terando

NOTICE: NOT FOR OFFICIAL PUBLICATION.
UNDER ARIZONA RULE OF THE SUPREME COURT 111(c), THIS DECISION IS NOT PRECEDENTIAL
AND MAY BE CITED ONLY AS AUTHORIZED BY RULE.

IN THE
ARIZONA COURT OF APPEALS
DIVISION ONE

PIERPONT MANUFACTURING LLC, Petitioner Employer,

FEDERATED MUTUAL INSURANCE CO, Petitioner Carrier,
v.

THE INDUSTRIAL COMMISSION OF ARIZONA, Respondent,

NICHOLAS TERANDO, Respondent Employee.

No. 1 CA-IC 23-0025
FILED 05-23-2024

Special Action - Industrial Commission
ICA Claim No. 20213480246
Carrier Claim No. 646955-1
The Honorable Robert E. Trop, Administrative Law Judge

AFFIRMED

COUNSEL

Jardine Baker Hickman & Houston PLLC, Phoenix
By Stephen C. Baker
Counsel for Petitioner Employer and Carrier

Industrial Commission of Arizona, Phoenix
By Afshan Peimani
Counsel for Respondent

Brian Clymer, Attorney at Law, Tucson
By Laura Clymer
Counsel for Respondent Employee
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MEMORANDUM DECISION

Judge Maria Elena Cruz delivered the decision of the Court, in which
Presiding Judge Paul J. McMurdie and Judge Cynthia J. Bailey joined.

C R U Z, Judge:

¶1 The Industrial Commission of Arizona (“ICA”) issued an
award that found Nicholas Terando suffered a compensable injury while
working for Pierpont Manufacturing, LLC. Pierpont and its insurance
carrier, Federated Mutual Insurance Co., challenge that award, arguing that
the evidence does not support a conclusion that Terando was injured at
work. We find substantial evidence to support the award and affirm.

FACTUAL AND PROCEDURAL HISTORY

¶2 The facts are uncontested. Terando worked several years for
Pierpont before his injury. While at work one day, Terando was not feeling
well and went to his car to lay in the reclined seat. He was later found
passed out, lying face down on the ground next to his car. He was
hospitalized and told he had had a stroke. Believing that his condition was
caused by his activities at work the week before the stroke, he filed a claim
for worker’s compensation. Pierpont and Federated (“Petitioners”) denied
the claim. Terando requested a hearing, at which the following facts
emerged.

¶3 Terando tested positive for COVID-19 about a month before
he passed out at work. After ten days, he recovered and returned to work.
On Friday, December 3, 2021, he installed a heavy steel rain hood on a
building without assistance. The hood was clamped to a forklift and held
about eight feet above the ground next to the building. Terando did not
later remember the installation details but believes that he bore some of the
weight with his head to help steady the hood at some point as he was
installing it. That night at home after work, he was dizzy and complained
to his girlfriend that he had “wrenched his neck.” He continued to have
neck pain, dizziness, and nausea over the weekend. He did not work on
Monday, December 6 instead, he saw a chiropractor who adjusted his back
and neck and gave him mild relief. He worked the following Tuesday and
Wednesday without complaint. On Thursday, December 9, he worked for

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a bit in the morning but became dizzy and had to sit down. He then went
to his car and passed out.

¶4 At the hearing, Terando called medical expert Dr. Lynn
Ashby, a neurologist who treated him while hospitalized. She testified that
his official diagnosis was bilateral vertebral artery dissections that caused
cerebellar strokes. She explained that dissections occur when there is
trauma to the artery and thin pieces of the inner lining of the vertebral
artery tear, causing blood platelets to swarm to the area for repair. After a
while, those coagulated bits can break off and cause a stroke. The tears can
be caused by unusual neck movements or “torquing.” She described this
torquing as any movement of the neck to an “acute, more than normal acute
angle in any direction. . . .”

¶5 Dr. Ashby explained that the events resulting from the tears
can manifest in two ways, either with immediate and acute symptoms such
as dizziness and nausea or the way that Terando manifested the condition,
with a prolonged development of stroke symptoms, almost always starting
with neck pain. She explained that people often seek help from
chiropractors or massage therapists because they believe they hurt their
neck muscles or joints. What is actually happening are signs of a stroke.

¶6 Dr. Ashby testified that COVID can sometimes cause a stroke,
but she ruled out COVID as a cause for Terando’s strokes in favor of trauma
because strokes caused by COVID are “generally not like this.” COVID
causes hypercoagulability in the blood, which builds up and blocks veins
in the brain. In her opinion, COVID causes a different kind of stroke than
the type Terando suffered. Because imaging showed damage to his arteries,
she ruled out COVID in favor of trauma to the arteries induced by torquing.
When asked to assume that Terando used his head to steady a 70-pound
metal hood against a building while affixing it and to answer whether that
type of activity could cause or contribute to the arterial dissections he
experienced, Dr. Ashby declined, saying,

I don’t know if I can answer that with confidence, because,
again, it’s what – it’s the position that the head finds itself in.
Not so much pressure on the head, but it’s the torquing
position, acute torque of the neck in any direction.

Petitioners’ counsel did not ask Dr. Ashby any questions on cross-
examination.

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¶7 Petitioners called Dr. Leo Kahn to testify on their behalf. Dr.
Kahn is a neurologist who performed an independent medical examination
(“IME”) by examining Terando and reviewing the relevant medical records.
He opined that the cause of the strokes was the COVID-19 infection
Terando experienced in November. A primary basis for his opinion was
that Terando did not report any work injury before the stroke, including
after installing the metal hood. For that reason, he ruled out that any neck
motion caused the dissections and concluded that the COVID-19 infection
damaged the inner walls of the arteries.

¶8 The parties filed simultaneous post-hearing memoranda as
closing arguments. Petitioners argued that the most likely explanation for
the injury was the COVID-19 infection in November, per Dr. Kahn’s
testimony. They argued that because Terando could not remember any
specific torquing head movement on December 3 and because Dr. Ashby
could not identify any torquing head movement that would have caused
damage to the arteries, Terando failed to prove his claim. Terando argued
that the evidence and Dr. Ashby’s opinion were sufficient to find that the
injury occurred while he was working on December 3, 2021.

¶9 The ICA issued an award finding a compensable injury. The
administrative law judge (“ALJ”) analyzed the evidence and considered the
medical opinions. The award gave more weight to Dr. Ashby’s opinion that
Terando’s strokes were not caused by COVID but by a torquing motion that
caused trauma to the arteries. The award found Terando’s and his
girlfriend’s testimony credible and that the sequence of events, primarily
the neck pain that started on December 3, 2021, supports “the reasonable
inference that the genesis of the vertebral artery dissections were injuries
‘arising out of’ and ‘in the course of work,’ that ultimately manifested as the
strokes sustained on December 9, 2021.”

¶10 Petitioners moved for review and reconsideration. They
argued that whether Terando moved his head on December 3 in a way that
would cause damage to the arteries was speculative because Terando, the
only one present, did not testify that he moved his head with a torquing
motion. The ALJ reconsidered the evidence and affirmed the award, noting
that he was drawing a reasonable inference from the evidence that Terando
moved his head on December 3 in a way that caused the artery damage. He
noted that on the evening of December 3 Terando complained about
“wrench[ing] his neck.” And during the following weekend complained of
continuing pain. He visited a chiropractor shortly after that for pain in his
neck. The ALJ found this evidence credible and supportive of a December
3 work injury.

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¶11 Petitioners then filed this statutory special action appeal. We
have jurisdiction under Arizona Revised Statutes §§ 12-120.21(A)(2), 23-
951(A), and Arizona Rule of Procedure for Special Actions 10.

DISCUSSION

¶12 In reviewing ICA awards, we do not disturb the ALJ’s
findings unless the conclusions cannot be “supported on any reasonable
theory of evidence.” Phelps v. Indus. Comm’n, 155 Ariz. 501, 506 (1987). We
will not disturb the ALJ’s resolution of conflicts in the evidence. Perry v.
Indus. Comm'n, 112 Ariz. 397, 399 (1975). When reasonable evidence exists
to support an ALJ’s factual determinations, this court will not overturn
them. Kaibab Indus. v. Indus. Comm’n, 196 Ariz. 601, 609, ¶ 25 (App. 2000).
Neither will we re-weigh the evidence. Id. at 608, ¶ 21. If there is conflict
in the evidence or if two different inferences may be drawn from the
evidence, the ALJ has the discretion to resolve those conflicts and choose
either inference; a reviewing court will not disturb that choice unless it is
wholly unreasonable. Waller v. Indus. Comm'n, 99 Ariz. 15, 21 (1965).

¶13 It is the claimant’s burden to prove the elements of
compensability. Keovorabouth v. Indus. Comm’n, 222 Ariz. 378, 380, ¶ 7 (App.
2009). If the work connection to an injury is not apparent to a non-specialist,
expert medical testimony is necessary to prove compensability. Stainless
Specialty Mfg. Co. v. Indus. Comm’n, 144 Ariz. 12, 19 (1985) (“Unless a causal
connection is clearly apparent to a lay person, the relationship must be
established by expert medical testimony.”). We defer to the ALJ’s
resolution of conflicting evidence and affirm findings if any reasonable
theory of the evidence supports them. Perry v. Indus. Comm’n, 112 Ariz. 397,
398–99 (1975). An award based on conflicting medical testimony will not
be disturbed. Smiles v. Indus. Comm’n, 2 Ariz. App. 167, 168 (1965).

¶14 Petitioners argue that the evidence does not link Terando’s
work activities on December 3 to his stroke because Dr. Ashby could not
testify that he torqued his neck on December 3. In their view, Dr. Ashby
would have to be convinced that Terando wrenched his neck to show
medical causation. But this is untrue. Petitioners are disguising an
evidentiary issue as an issue about the sufficiency of medical expert
opinion. Dr. Ashby established medical causation between the action of
torquing the neck and the cause of Terando’s stroke, the dissection of the
arteries. Dr. Kahn confirmed that such head movement could act as a
mechanism of injury to the neck arteries. Terando was then free to present
other evidence that showed he could have torqued his neck on December
3, despite his inability to recall whether he did so. He presented evidence

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that the ALJ found credible that on that day he installed a heavy steel rain
hood on a building by steading the hood on his head, then complained of
neck pain shortly after, and went to see a chiropractor for neck pain a few
days later. Dr. Ashby’s testimony provided medical causation that linked
Terando’s stroke to a torquing motion of the neck, while other testimony
provided evidence that Terando probably made a severe neck movement
that caused the dissections that set the process for the stroke in motion.
Nothing more is required to prove causation.

CONCLUSION

¶15 The record contains substantial evidence to support the
award finding that Terando suffered a work-related injury on December 3,
2021. We affirm.

AMY M. WOOD • Clerk of the Court
FILED: AGFV

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