State News : South Dakota

In another case, the Department again accepted the opinion of a claimant’s treating doctor over the opinion of Employer’s and Insurer’s expert to find that a work injury was a major contributing cause of Claimant Daniel Jensen’s shoulder arthritis — despite evidence that Jensen’s shoulder arthritis pre-existed the work injury. Jensen injured his right shoulder on April 15, 2022, while throwing heavy straps during his employment with NexGen. Upon throwing the straps, Jensen reported a popping in his right shoulder followed by pain. Jensen was diagnosed with a rotator cuff tear in his right shoulder and underwent rotator cuff repair surgery in June 2022. Employer and Insurer paid for that surgery. However, during the rotator cuff repair surgery, it was determined that Jensen had chondromalacia and arthritis in his right shoulder that pre-existed the work injury.

Jensen initially felt relief from his symptoms for several months after the rotator cuff repair surgery. However, by early 2023, he began to experience significant pain, stiffness, and loss of right shoulder function which persisted over time.

Jensen submitted the opinion of his treating orthopedic surgeon, Dr. Jason Hurd, who concluded that the work injury caused a permanent aggravation of Jensen’s pre‑existing shoulder arthritis and therefore Jensen’s arthritic shoulder was compensable. Employer and Insurer submitted the opinion of its IME doctor, Dr. Edward Kelly, another orthopedic surgeon, who agreed with much of Dr. Hurd’s testimony. However, Dr. Kelly ultimately believed the work injury only caused a temporary aggravation of Jensen’s underlying degenerative shoulder disease. Dr. Kelly opined that because Jensen had experienced temporary relief after his rotator cuff repair surgery, Jensen’s right shoulder issues were likely caused by his underlying degenerative arthritis rather than the work injury.

The Department, however, accepted the testimony of Jensen’s treating provider that the work injury was a major contributing cause of Jensen’s shoulder degeneration despite evidence that Jensen’s arthritis predated the work injury. In siding with Jensen, the Department gave special weight to the finding that Jensen’s degenerative shoulder disease was asymptomatic until sometime after the work injury. Employer and Insurer should be aware that a work injury may still be considered a major contributing cause of a claimant’s pre‑existing condition if there is expert testimony that the work injury caused a permanent aggravation of that pre‑existing condition.