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Yoshii v. State

Supreme Court of Hawaii

May 18, 2016

BRIAN YOSHII, Petitioner/Claimant-Appellee-Appellant
v.
STATE OF HAWAI'I, UNIVERSITY OF HAWAI'I, Respondent/Employer-Appellant/Appellee, Self-Insured, and FIRST INSURANCE COMPANY OF HAWAI'I, LTD., Respondent/Third-Party Administrator-Appellant-Appellee.

         CERTIORARI TO THE INTERMEDIATE COURT OF APPEALS (CAAP-12-0000383; CASE NO. AB 2010-169 (2-08-4 6774))

          Herbert R. Takahashi, and Rebecca L. Covert for petitioner

          Paul A. Brooke for respondents

          RECKTENWALD, C.J., NAKAYAMA, McKENNA, POLLACK, AND WILSON, JJ.

          OPINION

          RECKTENWALD, C.J.

         Brian Yoshii, a State of Hawai'i employee, was injured while he was working for the University of Hawai'i (UH) Leeward Community College (LCC). This appeal concerns Yoshii's subsequent workers' compensation claim made against the State and its insurance carrier, First Insurance Company of Hawai'i, Ltd.

         Yoshii was involved in an accident on the LCC premises approximately one hour after he ended work for the day. An MRI of Yoshii's knee revealed that he had torn his meniscus. Yoshii's employer, UH, and its insurance carrier, First Insurance (collectively "the State") denied Yoshii's claim for compensation on the basis that his injury was not work-related.

         Yoshii argues that pursuant to Hawai'i Revised Statutes (HRS) § 386-85, [1] the Labor and Industrial Relations Appeals Board (LIRAB) was required to presume that Yoshii's knee injury was work-related in the absence of substantial evidence to the contrary. The LIRAB concluded that the State had adduced substantial evidence sufficient to overcome the presumption that Yoshii's knee injury was a covered work-related injury. The Intermediate Court of Appeals affirmed the LIRAB's decision and order.

         The issues in this case are very similar to our recent decision in Panoke v. Reef Dev., in which we held that "[t]he LIRAB erred in concluding that [Employer] adduced substantial evidence sufficient to overcome the presumption that Panoke's shoulder injuries were related to his . . . work accident" and remanded to the LIRAB for further proceedings. 136 Hawai'i 448, 468, 363 P.3d 296, 316 (2015). Similarly, we hold here that the LIRAB erred in concluding that the State rebutted the presumption that Yoshii suffered a compensable work injury. We therefore vacate the ICA's judgment and the LIRAB's decision and order, and remand to the LIRAB for further proceedings consistent with this opinion.

         I. Background

         A. Yoshii's work history and October 2008 leg injury

         Yoshii began working for Respondent/Employer-Appellant-Appellee UH's LCC on August 1, 1995 as a "Cook II, " and was still employed in that position on the date of his alleged work-related injury on October 30, 2008. Yoshii's job involved spending all day walking and standing on his feet, and going up and down stairs to get pots, pans, and kitchen utensils. Yoshii's work schedule in this position was Monday through Friday, 6:00 a.m. to 2:30 p.m.

         On January 3, 2008, Yoshii's primary treating physician, Dr. Luis J. Ragunton, treated Yoshii for "mild leg edema" which Dr. Ragunton noted "maybe [sic] accounting for some of [Yoshii's] leg pain." On October 27, 2008, Dr. Ragunton's report stated that he treated Yoshii for "pain in the right leg, " which Yoshii stated occurred "shortly after getting off the chair after watching a movie" the day before, on October 26. Yoshii later testified that the pain on this occasion was in his calf. Dr. Ragunton proposed treating the edema with furosemide tablets, a diuretic, to reduce swelling.

         Dr. Ragunton's report regarding the October 27th visit does not indicate that Yoshii was told to stay home from work, but Yoshii testified that Dr. Ragunton told him to stay home for two days, raise his leg, and stay off his feet. Yoshii also testified that he stayed home for two days because "the pain was intolerable."

         Yoshii testified that he returned to work on October 30, 2008 and worked his full shift from 6:00 a.m. to 2:30 p.m. Yoshii also stated that his leg felt better than it had during the prior few days. After Yoshii finished work, as he was leaving the premises and walking down some stairs on the loading dock, he "planted [his] right foot, [and] there was a really sharp pain." On the WC-5 form Yoshii submitted when making his claim for compensation, Yoshii recorded that this incident happened at 3:30 p.m. The State's WC-1 "report of industrial injury" form also recorded the time of the injury as 3:30 p.m. At trial, Yoshii confirmed that the injury occurred after his shift was over.

         Yoshii stated that the pain he experienced while walking down the stairs on October 30, 2008 was "[n]o comparison" to the pain he experienced the prior Sunday, when he hurt his leg standing up after watching a movie, because the pain he experienced on October 30, 2008 was "a really painful, sharp pain."

         Yoshii testified that after he felt the pain on October 30, he held on to the wall and could not move for two or three minutes. He then proceeded to the truck in which his wife was waiting to pick him up, and had a hard time lifting his leg to get into the truck. Yoshii testified that he then called his supervisor, Travis Kono, and security to tell them what had happened, and security told him to inform the human resources (HR) department. Yoshii called HR, but no one answered. He was only able to get in touch with someone in HR about one week later.

         The same day as the incident, Yoshii went to the emergency room at Pali Momi. The emergency room staff iced Yoshii's leg, wrapped bandages around his calf and knee, and told him to stay off his feet. The emergency room report, prepared by Dr. Donald Wilcox, stated that Yoshii's chief complaint was a "sore muscle" and described the history of Yoshii's injury as follows:

The patient has a sore right leg for about 4 to 5 days. He saw his doctor 4 days ago for this. He is not sure if he strained it or exactly what but it is sore. He was placed on a diuretic because of this. He states he is a short order cook so he is on his feet all the time. It just feels achy. It is achy on the lateral calf, not posteriorly and not behind the knee, and it feels a little achy up to the thigh. The foot feels a little sore and swollen too.

         Dr. Wilcox noted that Yoshii's complaints "may just be due to progressive edema" and advised Yoshii to continue with the diuretic and to follow up with his doctor.

         After the October 30, 2008 incident, Yoshii did not return to work for eight months.

         B. Yoshii's filing of his worker's compensation claim and treatment after the October 30, 2008 injury

         On November 3, 2008, Yoshii saw Dr. Ragunton for a follow up. Dr. Ragunton's report for this visit stated: "Patient comes in for an ER follow up. He re-injured his calf on 10/30/08. . . . [H]e complains of continued pain to the right calf area. Evaluation in the emergency room revealed no significant pathology. The patient is concerned of possible muscle injury since he stands all day at work." Dr. Ragunton advised Yoshii to "keep his legs elevated as much as possible" and to remain off work.

         On November 14, Yoshii returned to Dr. Ragunton, complaining that his "right leg is still sore." Dr. Ragunton advised Yoshii to continue taking furosemide tablets for swelling, limit his fluid intake to prevent further edema, and "remain off work until I reevaluate him in two weeks."

         On November 18, 2008, Yoshii filed a "report of work- related injury" with his employer. Yoshii described the incident as occurring on October 30, 2008 in the following way: "Walking down the loading dock stairway and I stepped on my right foot the wrong way hurting my right calf. I had very sharp pain and couldn't move for about 2-3 minutes. Then I had a very hard time getting into our vehicle." Yoshii noted his injury as "right calf muscle strain." The supervisor's section of the form was filled out by Travis Kono and stated that the "injury occurred after scheduled work hour [sic], outside of the kitchen walking down the stairs" and that Yoshii was not performing his work duties when the injury occurred because he was "off the clock."

         On November 24, 2008, December 8, 2008, and December 22, 2008, Yoshii revisited Dr. Ragunton for follow up on his right leg pain. At the December 22 visit, Dr. Ragunton referred Yoshii to Dr. Calvin Oishi for "possible torn meniscus of right knee."

         On December 29, 2008, Dr. Oishi saw Yoshii and ordered an MRI, which showed "moderate knee effusion, moderate chondromalacia of the tibiofemoral joint, lateral patellofemoral joint as well as possible degenerative tear of the medial meniscus." Yoshii had surgery on his knee on January 17, 2009, for repairs to both medial and lateral meniscus tears in his right knee. Five months after surgery, Yoshii was referred to Dr. Alan Oki, a rheumatologist, who noted that since the surgery Yoshii had shown "substantial improvement" but that he still had some "residual pain." On June 24, 2009, Dr. Oki diagnosed Yoshii with "osteoarthritis of the right knee with chondromalacia involving the medial femoral condyle and patella" and noted that he "had both medial and lateral meniscus tears which were successfully addressed by Dr. Oishi."

         On February 18, 2009, First Insurance sent a letter to the Director of the LIRAB (Director) stating that it had concluded that "Yoshii did not suffer an injury arising out of and in the course of employment with University of Hawai'i." The letter further stated:

We base our denial of benefits on the [independent medical examination] by Brian Mihara, MD dated 2/9/09. [2] Dr. Mihara indicates no evidence in the medical records to suggest that this was a work related trauma. This was a pre-existing condition documented in the medical record dating back a number of years.

         After First Insurance denied Yoshii's benefits, Yoshii filed a WC-5 "employee's claim for workers' compensation benefits" form with the Director. On the form, Yoshii explained that the reason for the filing of the form was that "claimant had insurance deny [sic] claim." Yoshii described the accident as: "walking down loading dock stair stepped on my right foot and felt sharp pain in my leg" and his injury as: "torn ligament on right knee both inside and outside."

         C. Physicians' medical opinions regarding work-relatedness of Yoshii's injury

         1. Dr. Ragunton

         Four months after the incident, on March 30, 2009, Dr. Ragunton provided a medical statement regarding Yoshii's leg injury. Dr. Ragunton stated:

Mr. Brian Yoshii was initially seen by me on October 27, 2008. This was 3 days prior to his injury at work. He had reported leg pain when getting off a chair. At that time it appeared that his leg pain was caused by leg swelling and fluid retention. The patient was treated with diuretic therapy.
Mr. Yoshii was injured at work on October 30, 2008. He went to the emergency room and on November 3, 2008 I saw him for follow up. He reported that the emergency room evaluation revealed no significant pathology. I am not sure if the emergency room was advised that the patient hurt his knee at work. At that time was [sic] concerned that the patient still had a medical condition contributing to his knee and leg pain. At that time an evaluation was started by myself. It appeared that he had no evidence of deep venous thrombosis of his lower extremity. I obtained a CT scan of the right leg which revealed no phlebitis or clots. There was also no evidence of any muscular tear. His medications were adjusted and his symptoms of swelling and pain had improved. Upon further follow-up however the patient reports that his upper calf and knee still hurt. At that point I had referred him to Dr. Calvin Oishi for further evaluation. He was found to have a torn meniscus of the right knee. Since surgery was performed in [sic] the patient going through physical therapy, his symptoms of need [sic] and calf pain have improved.
Because of his initial presentation being unclear, I did not pursue a work related claim upon initial presentation. However the patient feels certain that his knee pain and subsequent torn meniscus was related to the injury at work on October 27, 2008. I am in agreement with this because the patient had no significant problems with his knee until after his injury. I also excluded and treated medical causes for pain and swelling of his right knee.

         Dr. Ragunton also completed a WC-2 "physician's report" on March 30, 2009 describing Yoshii's October 30, 2008 accident, stating that Yoshii's injury occurred on October 30, 2008, and that the accident was not the only cause of Yoshii's injury because "initially I thought [Yoshii's] condition may be related to arthritis or swelling caused by medication or even deep vein thrombosis but after treating these conditions pain in R[ight] knee and calf persisted." Dr. Ragunton's "final diagnosis" on this form was that Yoshii had a "torn meniscus of right knee."

         2. Dr. Oishi

         In a letter addressed to Yoshii's attorney dated March 5, 2010, Dr. Oishi stated that Yoshii first presented to him on December 29, 2008 complaining of persistent knee pain. Dr. Oishi obtained an MRI and then performed surgery to conduct a "partial medial and lateral meniscectomy, as well as an arthroscopic lateral release with chondromalacia patella." Regarding the work-relatedness of Yoshii's injuries, and his disability from work, Dr. Oishi stated:

The meniscus tear may have been caused by an injury at work but the chondromalacia probably was not. I really have no opinion regarding whether the patient suffered an injury at work as it wasn't reported to me as such. But if I review the records it would seem that the time line would be that he had pain after injury. At least according to Dr. Ragunton's note.
Usually after arthroscopic surgery the patient would be totally disabled for a month and then partially disabled therefore [sic]. So for treatment you would have to assume patient was totally disabled from 1/17/09 to 2/17/09 and then from 2/17/09 to 8/27/09 the patient was partially disabled. That would be the treatment period for treatment of his knee.

         3. Dr. Mihara

         Dr. Mihara examined Yoshii on February 9, 2009 at the request of First Insurance. After recounting Yoshii's medical history, Dr. Mihara stated:

         2. The Claimant's diagnoses are:

a. Right calf and lower extremity discomfort, primarily radicular in nature and not related to any work related incident on 10/30/08. This preexisted the alleged 10/30/08 incident and the medical record does not suggest that there was a work related injury or aggravation.
b. History of recent right knee arthroscopic surgery performed by Dr. Calvin Oishi, reportedly for meniscal tears of the right knee. The medical record does not suggest that a meniscal tear or knee joint injury occurred on 10/30/08 at work.
c. History of preexisting mild lower back pain and occasional right and left lower extremity radicular-type complaints historically attributed to tendonitis and muscular pain. This may indicate a nerve root problem, possibly from his back or even a nerve problem related to diabetes.
d. History of preexisting right lower extremity edema, etiology unclear. Scanning of the right lower extremity has not revealed a source for the right lower extremity swelling. This swelling may be contributing partially to his leg complaints.
The prognosis for the right calf pain and radicular complaints is guarded, given the likelihood that this may well be degenerative in nature or related to his diabetes. Either way, this is not typically ...

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