IICLE Flashpoint – March 2025
In Tazewell County v. Illinois Workers’ Compensation Commission, 2025 IL App (4th) 230754WC, the Workers’ Compensation Division of the Illinois Appellate Court determined that the Commission’s finding that the claimant’s left shoulder pain was causally related to her repetitive work duties was not against the manifest weight of the evidence.
The claimant alleged at the time of filing her Application for Adjustment of Claim that she was seeking benefits due to repetitive trauma. The claimant worked as a full-time dental hygienist for the employer’s health department. The clamant testified that she worked for the employer from 2005 until 2019 as a full-time dental hygienist and estimated seeing 12 to 18 patients each workday. During a 30 minute appointment, her left arm would be in an elevated position for about 15 minutes. She testified that her duties included taking x-rays, cleaning and sealing patient’s teeth. She estimated that cleaning and sealing teeth constituted 85% of her work duties.
She testified that used her left hand to manipulate the mirror and stabilize the patient’s head. The Arbitrator observed that while the claimant demonstrated this maneuver that her left elbow was bent at a 90 degree angle and her left wrist was “slightly flexed.”
The clamant testified that she first noticed her problems with the left shoulder in January of 2019 when she began experiencing pain while having her arm elevated at work. Initially, the shoulder felt tired at the end of the day, but the symptoms eventually progressed into full blown pain that affected her sleep. She testified that by Sunday after being off work Friday and Saturday, her shoulder would feel pretty good. Her pain would then return on Tuesday.
On April 9, 2019, the petitioner had emailed her supervisor to let her know that her left shoulder was “shot” and she needed a cortisone injection. The claimant presented for treatment on April 11, 2019 and subsequently underwent surgical intervention on August 6, 2019. She was thereafter released on April 1, 2020.
Her treating physician, Dr. Merkley, authored a narrative report on October 30, 2020. In his report, he noted that petitioner had reported repetitive pushing, pulling, reaching and holding tools. The claimant told Dr. Merkley that these activities became painful over time in her left shoulder. He did not believe that the nature of the claimant’s duties caused the rotator cuff tear but instead were a contributory cause of increased pain in her left shoulder. He opined that petitioner’s repetitive nature of reaching, pushing and pulling was a basis for a causal relationship between the claimant’s work for the respondent and the pain in the left shoulder.
The employer had an independent medical examination performed by Dr. Lawrence Li on January 14, 2021. Dr. Li reviewed the job description and opined that the diagnoses in her shoulder were not caused, aggravated or accelerated by repetitive tasks at work. He disagreed that repetitive activities without a significant trauma at the waist level could permanently aggravate the claimant’s shoulder condition. He acknowledged that shoulder pain could manifest during her job duties as a result of a rotator cuff tear but this would not be a permanent aggravation, acceleration or causative factor and instead would be a very temporary aggravation or manifestation of symptoms.
The arbitrator concluded that the claimant failed to prove by preponderance of the evidence that she sustained an accident arising out of and occurring in the course of her employment.
The Commission reversed the arbitrator and found that the claimant had sustained a compensable injury. They relied upon Dr. Merkley’s opinion that there was a causal relationship between the claimant’s left shoulder pain and the repetitive nature of her job duties. They noted that Dr. Li agreed with Dr. Merkley but only disagreed to the extent that it was not a permanent aggravation, acceleration or causative factor. The Commission found that while the tear was pre-existing in the left shoulder, the evidence had established that the claimant’s work duties aggravated her condition by causing pain, which ultimately necessitated the surgery she eventually received.
On appeal, the employer challenged the Commission’s findings with respect to accident and causation. The court noted that an employee who alleges an injury based on repetitive trauma must show that the injury is work-related and not the result of a normal degenerative aging process. Cases involving an aggravation of a pre-existing condition requires medical evidence to establish a causal connection between the alleged repetitive trauma and the claimant’s resulting condition of ill-being.
The issue presented was whether repetitive work activity that results solely in pain from a pre-existing non-work-related condition is compensable under the Act in the absence of concomitant worsening of the underlying work-related condition. They noted that this was an issue of first impression in Illinois and researched the issue in other jurisdictions.
The Court noted that the jurisdictions were split on this issue. A number of jurisdictions hold that pain standing alone is insufficient to support a finding of an aggravation or acceleration of a pre-existing condition and therefore is not a compensable work injury. Other states take a more expansive view and find that pain or other symptoms is sufficient by itself to establish an aggravation or acceleration of a pre-existing condition.
The court disagreed with the employer’s contention that pain by itself is not a compensable condition under the Act. They noted that aggravation or acceleration of a pre-existing condition caused by a work-related activity is compensable under the Act per Sisbro. They held that a pre-existing condition which is asymptomatic and then becomes painful as a result of a work-related activity is compensable under the Act as an aggravation of the pre-existing condition even in the absence of an organic or structural change in the pre-existing condition.
The court held that based on petitioner’s complaints of pain and their holding of pain alone as compensable supported that the Commission finding was not against the manifest weight of the evidence. The Commission had properly relied on Dr. Merkley’s opinions that the job duties caused an increase in pain in the left shoulder.
The court otherwise affirmed the rest of the Commission’s findings.
Justice Margaret Mullen dissented and opined that under the circumstances of the case, pain alone is not enough and the Commission’s findings were against the manifest weight of the evidence. She felt that the claimant had presented no medical evidence that her repetitive work activities aggravated or accelerated her pre-existing condition of ill-being. Neither doctor determined that her repetitive work activities accelerated the degeneration of her left shoulder, increased the size of the rotator cuff tear or otherwise aggravated the claimant’s left shoulder condition. She found it was significant that Dr. Merkley only testified that there was a causal relationship between the work and the pain in the left shoulder, but never testified that the work activities aggravated or accelerated the pre-existing condition of ill-being. She further noted that there should be no recovery when a condition of ill-being is merely the result of a normal degenerative process of a pre-existing condition. Without this evidence, the claim falls short with the line drawn in Sisbro.