Workers’ Compensation – Initially Unknown Cause – Difficult Diagnosis – Rotator Cuff Tear

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It took a while for claimant’s doctors to figure out that her chest, shoulder and arm pain were coming from a work-related shoulder injury and even longer for them to figure out that she had suffered a rotator cuff tear, most likely at her job as a laminator, where she lifted heavy rolls of printing material. Nevertheless, the only two doctors who treated and followed claimant eventually reached the conclusion that her rotator cuff tear was work-related. The Workers’ Compensation Commission erred in concluding that claimant had failed to show her injury was compensable.

We affirm the rejection of claimant’s alternate theory of repetitive injury. But we reverse the denial of claimant’s claim and remand for a calculation of benefits.

The single commissioner incorrectly found that Dr. Christopher Mazoue formed his opinion while he was no longer treating claimant. In fact, Dr. Mazoue completed the questionnaire setting out his opinion less than a month after claimant’s fifth post-surgical appointment. Moreover, claimant testified that she stopped seeing Dr. Mazoue thereafter because she could not afford to pay her balance with his medical practice.

The Workers’ Compensation Commission’s Appellate Panel incorrectly found that Dr. Mazoue provided the only evidence of a work nexus for claimant’s injury. Once claimant’s rotator cuff pathology was discovered during surgery, claimant’s other treating physician, Dr. Simon Tanksley, revised his prior opinion – that the cause of the injury was “Unknown” – to an opinion that the injury was work-related.

Claimant’s medical records demonstrate the nexus of her injury to her work: the time of the onset of the shoulder/chest/arm pain connects it to her work, and there is no evidence in the record to support a finding that such a rotator cuff injury can arise idiopathically. As claimant’s varying—and erroneous—attempted diagnoses demonstrate, the mechanism of her injury was complicated, and the respondent-Employer correctly notes she initially failed to attribute it to her work as a laminator. But the findings of both the Single Commissioner and the Appellate Panel improperly penalized claimant for not understanding the genesis of her injury—an injury for which several physicians provided a variety of clinical impressions and misdiagnoses until Dr. Mazoue finally discovered the rotator cuff tear during surgery. This was error— both factually and as a matter of law.

Claimant’s failure to immediately attribute her injury to her work is not fatal to her workers’ compensation claim, particularly since several physicians were unable to make a correct diagnosis until some two months after the onset of her symptoms. Claimant consistently reported her right arm and shoulder pain began at work on April 11, 2012, and she first sought medical treatment at the emergency room on April 13.

It was not until June 11, two months after claimant’s pain began, that Dr. Andrew McGown discerned some type of rotator cuff injury. Only later did claimant realize her injury was related to her job, which involved lifting heavy rolls and sheets of laminating materials.

According to claimant, she told her supervisor in July 2012 that the injury was work-related, and no evidence was presented to contradict this testimony. Still, the tear was not discovered until the 2014 surgery.

Based on the record as a whole, most specifically the unequivocal expert opinion of Dr. Mazoue and the chronology of claimant’s reporting to the various doctors who examined her, we find the fact that claimant did not report that her injury arose from her work until she received the initial shoulder diagnosis is not substantial evidence necessary to support the finding that the injury itself was not work-related.

Affirmed in part, reversed in part, and remanded.

Butler-Long v. ITW Labels (Lawyers Weekly No. 012-038-23, 12 pp.) (Stephanie McDonald, J.) Appealed from the Workers’ Compensation Commission. Stephen Benjamin Samuels for appellant; Jason Wendell Lockhart and Helen Hiser for respondents. South Carolina Court of Appeals (unpublished)