What’s the risk? – Testimony regarding risk factors inherent to the nature of employment sufficient to prove compensability of degenerative condition.

1Michael Quinlan, the Claimant, alleged that he sustained an occupational disease in the form of degenerative tears in the medial and lateral menisci in his right knee arising out of and in the course of his employment as a paramedic/firefighter for Baltimore County (“the County”). The Workers’ Compensation Commission (“the Commission”) denied Quinlan’s claim, and Quinlan subsequently appealed to the Circuit Court for Baltimore County.

The Circuit Court held a jury trial on April 19-20, 2017. Quinlan provided testimony of his job requirements as a paramedic for the Baltimore County Fire Department. Quinlan described having to kneel down, often on his right knee, and spending time with patients on the floor, or carrying them up and down steps. Quinlan provided testimony that on the specific date of injury in 2005, Quinlan hurt his right knee on the job while assisting a patient down a set of stairs. Quinlan’s knee pain increased until he underwent a partial meniscectomy on his right knee in February 2015. After his surgery, Quinlan returned to work.

In addition to Quinlan’s own testimony, he presented a video deposition of Dr. Cochran, who testified as to whether Quinlan’s right knee issue was related to his occupation as a paramedic. Dr. Cochran testified that people who do more squatting and kneeling, and who perform more physically demanding jobs, are at a greater risk for osteoarthritis. Dr. Cochran ultimately testified that Quinlan’s essential job functions were the causes of his osteoarthritis.

The County presented a video deposition of Dr. Hinton, who testified that he could not “relate the meniscus tears directly to his duties as a firefighter and EMT.” Dr. Hinton opined that Quinlan’s weight and age were other potential causes for Quinlan’s knee issue, but ultimately conceded on cross-examination that medical literature showed that people in more physically depending jobs and people who do more squatting and kneeling, like Quinlan through his career as a firefighter/paramedic, have a greater risk for osteoarthritis and problems in their knees.

The jury found that Quinlan “sustain[ed] an occupational disease of right knee degenerative tears of the medial and lateral menisci of the right knee, arising out of and in the course of his employment.” The County appealed to the Court of Special Appeals.

On appeal before the Court of Special Appeals, the County argued that “[t]here is absolutely no evidence that right knee degenerative tears of the medial and lateral menisci is an occupational disease”, and that because the disease was not an inherent risk of employment, it was not compensable. The County’s argument labeled osteoarthritis as a “disease of life” rather than a disease caused by employment.

Quinlan responded that the appropriate analysis was “whether the basic job responsibilities exposed any individual to conditions that could lead to the disease” and not whether a disease is labeled occupational or not. Of importance, Quinlan argued that he “provided the jury with more than enough evidence for them to find that his responsibilities as a paramedic led to his occupational disease of right knee degenerative tears.”

The Court of Special Appeals relied on longstanding Maryland case law, Foble v. Knefely, 176 Md. 474, 486 (1939), to describe an occupational disease as “some ailment, disorder, or illness which is the expectable result of working under conditions naturally inherent in the employment and inseparable therefrom, and is ordinarily slow and insidious in the approach.” The Court emphasized that an illness must also satisfy the limitations of Labor and Employment Article § 9-502 in order to be compensable as an occupational disease:

(d) Limitation on liability. – An employer and insurer are liable to provide compensation under subsection (c) of this subsection only if:

(1) the occupational disease that caused the death or disability:

(i) is due to the nature of an employment in which hazards of the occupational disease exist and the covered employee was employed before the date of disablement; or
(ii) has manifestations that are consistent with those known to result from exposure to a biological, chemical, or physical agent that is attributable to the type of employment in which the covered employee was employed before the date of disablement; and

(2) on the weight of the evidence, it reasonably may be concluded that the occupational disease was incurred as a result of the employment of the covered employee.

After “defining the contours of what qualifies as an occupational disease within the meaning of the Act”, the Court reiterated its duty to “examine the duties of a claimant’s profession to determine if the hazard that led to the disease exists in the nature of that employment.” (citations omitted). The Court returned to Quinlan’s trial testimony regarding his job as a paramedic requiring him to kneel, usually on his right knee, for lengthy periods of time, numerous times per week during a 24-year career with the County.

The Court acknowledged Dr. Cochran’s expert testimony supporting his claim that he suffered an occupational disease, and Dr. Hinton’s testimony acknowledging that medical literature suggests that people in more physically demanding jobs, like Quinlan, suffer menisci tears and arthritis at a higher rate. Dr. Hinton, after learning on re-cross-examination that Quinlan suffered a prior work-related knee injury, changed his opinion to conclude that an occupational injury was a “potential” or “arguable” cause of Quinlan’s menisci tears and arthritis.

The Court found that the Workers’ Compensation Act does not limit occupational disease to rare diseases or those exclusive to a specific profession, but instead that the risk factors inherent in the nature of the employment, not the disease, are what create compensability. The Court explained the fact “[t]hat other risk factors – such as Mr. Quinlan’s weight – were present does not preclude the jury from concluding that Mr. Quinlan’s occupation caused the degenerative tears in his menisci.” There was evidence sufficient to show that Quinlan did not have menisci tears or osteoarthritis prior to working for the County, and even if Quinlan’s weight and age were contributing factors to the development of his knee condition, “the condition was due in part to the characteristics of [Quinlan’s] employment[,]” thus becoming a question for the jury to decide. (citations omitted).

The Court of Special Appeals affirmed the circuit court’s judgment, and found that Quinlan met the statutory requirements of Labor and Employment Law Article § 9-502(d)(1) “by establishing that the degenerative menisci tears were an occupational disease through testimony that showed that repetitive kneeling and squatting is (1) a regular part of a paramedic’s job and (2) a risk factor for developing menisci tears[.]” Because there was sufficient evidence for the jury to determine that, “but for the work-related activities[,]” Quinlan’s condition would not have developed, the jury’s fact finding was not to be questioned on appeal.

This decision emphasized that the key to deciding whether a disease is compensable as an occupational disease lies in the risk factors inherent in the nature of the employment, and not the disease itself. Employers and Insurers should be aware which risk factors are inherent to specific roles and job functions, especially those risk factors more likely to cause an employee to become seriously disabled. It also opens the door for Employers and Insurers to face exposure for degenerative conditions if the Claimant can provide the requisite testimony and evidence showing the risk factors led to the development of the degenerative condition.