Should tubal ligation be included when calculating permanent disability?

Judge's rating for reproductive impairment challenged since worker’s tubal ligation was by choice

Should tubal ligation be included when calculating permanent disability?

An employee’s elective tubal ligation - surgical procedure to prevent pregnancy - caused emotional and social ramifications that affected her work, as supported by the findings of her primary treating physician, a panel of the Workers’ Compensation Appeals Board of California recently said.

The applicant in the case of Chandok vs. Subsequent Injuries Benefits Trust Fund was working as a cashier/waitress for AAK, LLC doing business as Shan Restaurant in Santa Clara, California. In April 2016, she sustained a third-degree burn – resulting in injuries to her skin, left shoulder, left wrist, and thumb – while performing her usual and customary duties arising out of and in the course of her employment.

In February 2017, the parties resolved the workers’ compensation claim by compromise and release. The applicant was awarded $100,000.

The applicant then asked for benefits from the Subsequent Injuries Benefits Trust Fund (SIBTF). She claimed that she had preexisting disability involving the following:

  • her cervical, thoracic, and lumbar spine
  • her gastrointestinal system
  • her respiratory system, arising from a lifetime of exposure to second-hand smoke
  • her reproductive system due to a tubal ligation in 2002

Read more: Walmart expands abortion coverage for workers

The applicant’s primary treating physician for her work-related injury provided opinions about the impairments caused by her preexisting conditions. The SIBTF did not oppose these opinions or offer its own medical evidence.

Last December, the workers’ compensation administrative law judge issued a decision accepting the doctor’s opinions except in relation to the applicant’s respiratory issues. The judge found that the applicant had more than 100-percent overall disability, consisting of 47-percent preexisting disability involving her spine, reproductive parts, and gastrointestinal parts and 58-percent permanent disability for the subsequent industrial injury.

The SIBTF asked for a reconsideration. It admitted to 77-percent overall disability at most. It disputed the judge’s rating for the applicant’s reproductive impairment because the tubal ligation was elective and asymptomatic.

The SIBTF also challenged the rating for the impairments to the applicant’s cervical and thoracic spine, body parts which the medical reports allegedly did not cover. The alleged impairments to the applicant’s cervical and thoracic spine were not ratable or labor-disabling, the SIBTF argued.

The judge prepared a report recommending the denial of the SIBTF’s petition for reconsideration. The panel of the Workers’ Compensation Appeals Board agreed with the judge and refused to reconsider the case.

Tubal ligation is preexisting disability

First, the panel found that the elective tubal ligation qualified as a preexisting disability. The panel cited the Guides to the Evaluation of Permanent Impairment of the American Medical Association (AMA). Under the AMA guides, fallopian tube impairment that did not require continuous treatment was ratable and was capable of supporting a workers’ compensation award.

The panel noted that the law had no requirements regarding the origin of the preexisting disability. Such origin could be congenital, developmental, pathological, or attributable to an industrial or nonindustrial accident, the panel added.

Second, the panel found that the medical record included evidence of prior injuries and treatment involving the applicant’s cervical and thoracic spine. Her primary treating physician relied upon this evidence to rate her spine impairment.

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