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You can search the entire site. or go to the recent opinions, or the chronological or subject indices. Joseph Traugott v ARCTEC Alaska (6/12/2020) sp-7456

Joseph Traugott v ARCTEC Alaska (6/12/2020) sp-7456

           Notice:   This opinion is subject to correction before publication in the PACIFIC  REPORTER.  

           Readers are requested to bring errors to the attention of the Clerk of the Appellate Courts,  

                                                                                                                       

           303 K Street, Anchorage, Alaska 99501, phone (907) 264-0608, fax (907) 264-0878, email  

                                                                                                                         

           corrections@akcourts.us.  



                      THE SUPREME COURT OF THE STATE OF ALASKA                                      



JOSEPH  TRAUGOTT,                                               )  

                                                                )     Supreme  Court  No.  S-17126  

                                Appellant,                      )  

                                                                                                   

                                                                )    Alaska Workers' Compensation  

                                                                                                                

           v.                                                   )    Appeals Commission No.  17-015  

                                                                )  

                  

ARCTEC ALASKA,                                                                            

                                                                )    O P I N I O N  

                                                                )  

                                Appellee.                                                               

                                                                )    No. 7456 - June 12, 2020  

                                                                )  



                     A                                                                                  

                        ppeal from the Alaska Workers' Compensation Appeals  

                     Commission.  



                                                                                                    

                     Appearances:  Eric Croft and James Croft, The Croft Law  

                                                                                                  

                     Office, Anchorage, for Appellant.  Matthew T. Findley and  

                                                                                                                

                     Laura C. Dulic,  Ashburn & Mason, P.C., Anchorage, for  

                                       

                     Appellee.  



                                                                                                                       

                     Before:  Winfree, Stowers, Maassen, and Carney, Justices.  

                                                                 

                      [Bolger, Chief Justice, not participating.]  



                                         

                     CARNEY, Justice.  



I.         INTRODUCTION  



                                                                                                                             

                     A worker with diabetes and a related foot condition developed an infection  



                                                                                                                                      

in his foot while working at a remote site.  He required extensive medical treatment for  



                                                                                                                           

his foot and has not worked since developing the infection.   The Alaska Workers'  



                                                                                                                           

Compensation Board decided the worker's disability and need for medical treatment  


----------------------- Page 2-----------------------

                                                                                                                              

were compensable based on an expert opinion that work was the sole cause of the  



                                                                                                                     

condition's acceleration even if work was not the most significant cause of the worker's  



                                                                                                                      

overall condition.  The Alaska Workers' Compensation Appeals Commission reversed  



                                                                                                                          

the Board's decision because in the Commission's view the Board had asked the expert  



                                                                                                                               

misleading questions. The Commission then concluded, based on a different opinion by  



                                                                                                                              

the same expert, that the worker had not provided sufficient evidence to support his  



                                                                                                                     

claim.  The worker appeals, raising issues about the interpretation of the new causation  



                                                                                                                             

standard adopted in the 2005 amendments to the Alaska Workers' Compensation Act  



                                                                                                                        

(Act) and its application to his case. We reverse the Commission's decision and remand  



                                                  

for reinstatement of the Board's award.  



                                 

II.       FACTS AND PROCEEDINGS  



                                                                                                                    

                    Joseph Traugott, a long-time Alaska resident who moved to Amarillo,  



                                                                                                                        

Texas in 2008, began to work for ARCTEC Alaska in March 2013, maintaining heating  



                                                                                                                             

and ventilation systems at remote sites in Alaska.  Before he was hired Traugott was  



                                                                                                                             

cleared to work in a preemployment physical examination; he disclosed that he had  



                                                                                                                        

preexisting diabetes.  ARCTEC sent Traugott to Tin City, near Nome, where he worked  



                                                                                                                         

six ten-hour days plus extra hours when needed, with Sundays off.  He worked mostly  



                                                                                                          

on ladders because the systems needing maintenance were overhead.  



                                                                                                              

                    The underlying legal question in this case requires us to consider  two  



                                                                                                                              

concepts:  what the Board called the "eggshell skull doctrine" and the application of the  



                                                                                                         

new causation standard - "the substantial cause" - to a preexisting non-work-related  



                                                                                                                   

medical condition. Traugott is disabled because a bone in his ankle, the talus, essentially  



                                                                                                                          

disintegrated, requiring extensive treatment and surgery. The question before the Board  



                                                                    

was whether a work-related injury was "the substantial cause" of Traugott's disability  



                                                                                                                               

and need for medical care. Because the medical aspects of this case are complicated, we  



                                                                                                  

summarize medical testimony presented to the Board to provide context.  



                                                               -2-                                                        7456
  


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          A.        Medical Conditions  



                                                                                                                                

                    Traugott had a number of preexisting health problems, but diabetes is the  



                                                                                                                             

most  important  to  his  workers'  compensation  case.                              Traugott  was  diagnosed  with  



                                                                                                                     

diabetes many years before he began to work for ARCTEC; he also developed peripheral  



                                                                                                                                 

neuropathy,  a  complication  of  diabetes.                       In  addition  to  interfering  with  feeling  or  



                                                                                                                        

sensation,  peripheral  neuropathy  affects  the  skin.                          According  to  Dr.  Jerry  Grimes,  



                                                                                                                               

Traugott's orthopedic surgeon, patients with peripheral neuropathy do not produce oils  



                                                                                               

on the skin, making them more vulnerable to skin damage, which in turn can allow  



                                                                                                                          

bacteria to enter the body.  Diabetics also have problems with wound healing.  



                                                                                                                           

                    Traugott also had Charcot foot, a neuropathy-related condition that causes  



                                                                                                                         

bone loss and can lead to foot deformities. Only a small percentage of diabetics develop  



                                                                                                                               

Charcot foot, and the causal factors are not well understood.  Dr. Grimes testified that  



                                                                                                                                

Charcot foot occurs in "episodic flare[s] of inflammation in a joint or bone," but it is not  



                                                                                                                          

degenerative.  During an episode "the foot gets red, hot, swollen" and looks as though  



                                                                                                                              

it might be infected, but "there's no organism present."  The disease can flare more than  



           

once.  



                                                                                                                           

                    As Dr. Grimes described it, "during this inflammation stage, the bones  



                                                                                                                                

begin to just crumble" and "fall apart."  If Charcot foot is detected early enough and the  



                                                                                                            

area is immobilized, the bones may stabilize.  Charcot foot can cause deformities that  



                                                                                                                         

result in "an abnormal weight-bearing surface, . . . put[ting] part of the foot at risk"  



                                                                                                                  

because only parts of the feet are designed to be weight-bearing.  When a non-weight- 



                                                                                                                            

bearing surface must bear weight, the skin can get thicker and form a callus, but a callus  



                                                                                                                      

"may be aggravating the risk of a[n] ulceration" rather than preventing one.  



                                                                                                                     

                    Traugott developed osteomyelitis, a bone infection, which he contended  



                                                                                                                                

was introduced into his foot via a blister caused by his work on ladders. Charcot foot has  



                                                                -3-                                                         7456
  


----------------------- Page 4-----------------------

                                                                                                                                 

symptoms  that  are  similar  to  osteomyelitis;  apparently  it  is  nearly  impossible  to  



                                                                                                    

distinguish Charcot foot from osteomyelitis on imaging studies.  



                                                                                                                              

                    The doctors who testified agreed about many aspects of the case, but they  



                                                                                                                     

had different opinions about the role osteomyelitis and Charcot foot had in Traugott's  



                                                                                                                               

overall  condition  and  in  the  destruction  of  his  talus.                               Dr.  Grimes  thought  the  



                                                                                                                                

osteomyelitis "led to [the talus's] destruction and was the ultimate cause" of the need for  



                                                                                                                

surgery.   Dr. Marilyn Yodlowski, ARCTEC's orthopedist, thought the osteomyelitis  



                                                                                                                            

triggered or combined with Charcot foot to cause the talus's destruction.  And Dr. Carol  



                                                                                                                                

Frey, the Board's second independent medical evaluation (SIME) doctor, thought the  



                                                                                                                  

osteomyelitis caused acceleration of Traugott's Charcot foot, and that this acceleration  



                                                             

was the cause of the need for surgery.  



                                                                                                                              

                    The doctors testified about diabetic ulcers and blister formation as well  



                                                                                                                              

because Traugott reported that a blister developed on his affected foot in May and then  



                                                                                                                       

several weeks later his nearby skin opened and began draining fluid.  Doctors involved  



                                                                                                                             

in the case agreed that even unruptured blisters can become infected.   As Dr. Frey  



                                                                                                                           

explained,  bacteria  can  enter  the  body  when  there  is  "a  compromise  in  the  skin,"  



                                                                                                                                      

including not only unopened blisters but also a callus or "even a hot spot on the skin."  



                                                                                                                        

Dr. Frey and Dr. Grimes indicated that the liquid in a blister is a good growth medium  



                                                                                                                              

for bacteria.  Skin ulcers can develop in people with peripheral neuropathy even if they  



                                                                                                                       

do not have Charcot foot, and diabetics who do not have Charcot foot can have problems  



                                                                                                                   

with infections.  Traugott had developed at least one diabetic ulcer in the past on his  



                                                                                       

second toe on the same foot from "a corn that eroded."  



                                                                                                                                

                    Traugott was required to wear steel-toed shoes, and while working for  



                                                                                                                        

ARCTEC he wore "brand new" steel-toed boots. He described themas "leather lace-up"  



                                                                                                                                  

boots that extended above the ankle.  Dr. Frey explained that boots are more likely to  



                                                                                                                                  

cause blisters because they are designed to fit more snugly around the arch.  Prior to  



                                                                -4-                                                         7456
  


----------------------- Page 5-----------------------

Traugott's work for ARCTEC, his doctors had not restricted his activities and had not                                                                                                                                                                      



required him to wear a specific type of shoe.                                                                                                                                                                                                                      In terms of his overall foot care, Traugott                                                                                                                                                      



testified that while at Tin City he did his best to keep his feet clean and dry, as his                                                                                                                                                                                                                                                                                                                                                                                                            



 doctors had advised.                                                                                                      



                                       B.                                     Traugott's Injury And Treatment Through Late 2015                                                                                                                                                                                                                                                               



                                                                              In May 2013, while he was at Tin City, Traugott noticed a blister "[l]ess                                                                                                                                                                                                                                                                                                                         



than the size of a dime . . . [i]n the arch of [his] right foot," in the middle of the foot and                                                                                                                                                                                                                                                                                                                                                                                                  



 "[t]owards the edge of the outside."                                                                                                                                                                                    He treated it himself and thought it "healed up                                                                                                                                                                                                                             



within a couple of weeks."                                                                                                                                   He described it as "a regular blister" and said that it did not                                                                                                                                                                                                                                                                       



 "break or open" until several weeks later.                                                                                                                                                                                                          



                                                                              Around July 5, the skin on the sole of Traugott's right foot split open about                                                                                                                                                                                                                                                                                                                           



 an inch from the blister site and closer to the center of the foot.                                                                                                                                                                                                                                                                                                                   He said that the foot                                                                                 



became painful, that he was working on ladders at the time, and that he was about                                                                                                                                                                                                                                                                                                                                                                                                   



halfway through his shift when he noticed symptoms.                                                                                                                                                                                                                                                                          He continued to work after the                                                                                                                                        



pain started, and he noticed a discharge, which he could smell, coming from the opening                                                                                                                                                                                                                                                                                                                                                                                



when he took off his boots.                                                                                                                                         Traugott reported his foot problem to his supervisor, and                                                                                                                                                                                                                                                                   



ARCTECarranged for ground transportation fromTin City to the nearest villagethenext                                                                                                                                                                                                                                                                                                                                                                                                           



 day.    Traugott then took a commercial flight to Nome, where he took a cab to the                                                                                                                                                                                                                                                                                                                                                                                                               



hospital.    



                                                                              The hospital notes show that Traugott had a fever and a "fetid" discharge                                                                                                                                                                                                                                                                                                       



 from a wound on the bottom of his foot.                                                                                                                                                                                                         At the time of admission Traugott reported                                                                                                                 



 "some chills, some sweats, and fevers" and "increasing pain in his right foot though he                                                                                                                                                                                                                                                                                                                                                                                                                



ha[d] continued to work climbing ladders, etc."                                                                                                                                                                                                                                       He was admitted with a diagnoses of                                                                                                                                                                                           



                                                                                                                                                                                                                                                    -5-                                                                                                                                                                                                                                    7456
  


----------------------- Page 6-----------------------

                                                      1  

cellulitis, a skin infection.                            Doctors in Nome debrided the wound, removing infected                                                   



tissue.  One doctor probed the wound; the discharge summary said, "When the wound                                                



was probed, bone was not evident. It was not touched by the probe." A CT scan showed                                                                              

                                                                            2  extending from the ulcer.  The doctors in Nome  

a "sinus tract," or abnormal passage,                                                                                                                                



were unable to rule out acute osteomyelitis because a CT scan is not sufficiently sensitive  

                                                                                                                                                                



and no MRI was available in Nome.  Traugott remained hospitalized for several days,  

                                                                                                                                                                       



receiving intravenous antibiotics, and had a second debridement.  His overall condition  

                                                                                                                                                              



improved,  he was discharged  with  crutches and a cast  boot, and  he went home to  

                                                                                                                                                                             



Amarillo on a commercial flight. ARCTEC filed a report of injury with the Board while  

                                                                                                                                                                      



Traugott was hospitalized in Nome.  

                                                                            



                           After returning to Amarillo, Traugott consulted with Dr. Patrick Crawford,  

                                                                                                                                                             

                            3    Dr. Crawford ordered imaging studies, which were done more than a  

his podiatrist.                                                                                                                                                                

        



week  after  Traugott's  return  to  Amarillo,  and  after  reviewing  them  Dr.  Crawford  

                                                                                                                                                    



suggested surgical debridement.  The imaging studies were inconclusive about whether  

                                                                                                                                                                 



there was osteomyelitis.  Before the surgery, Dr. Pablo Rodriguez, an infectious disease  

                                                                                                                                                                   



doctor, examined Traugott and observed that he had "a deep probing wound to bone,  

                                                                                                                                                                      



hence by definition an infected joint and osteomyelitis."  

                                                                                                                      



                           Dr. Crawford's surgery notes indicate "the ulcer was excised from the foot  

                                                                                                                                                                          

in toto."  Dr. Crawford also performed an exostectomy, or removal of a bony growth,4  

                                                                                                                                                    



              1            THE  MERCK  MANUAL OF                               DIAGNOSIS AND                    THERAPY  694 (Robert S. Porter,                     



ed., 19th ed. 2011).       



              2             Tract, STEDMAN'S  MEDICAL  DICTIONARY  (28th ed. 2006).                                                   

                                          



              3            A podiatrist is a foot doctor and can treat Charcot foot.   According to  

                                                                                                                                                                             

Traugott, Dr. Crawford died while the case was pending.                                                                 



              4            Exostectomy,  STEDMAN'S   MEDICAL   DICTIONARY   (28th ed.                                                                    2006).     An  



                                                                                                                                                      (continued...)  



                                                                                      -6-                                                                              7456
  


----------------------- Page 7-----------------------

 in the "plantar aspect [of the] lesser tarsal region [of Traugott's] right foot."                                                                                                                                                                                                                                                                                                  About this   



time ARCTEC filed a notice of controversion, asserting that the condition was not work                                                                                                                                                                                                                                                                                                                           



related.    



                                                                  After   discharge   from   the   hospital,   Traugott   received   home   care   from  



wound-care nurses.                                                                                The wound at first appeared to improve, but in early October it was                                                                                                                                                                                                                                            



 again   showing  signs   of   infection   and   Dr.   Rodriguez   raised   the   possibility   of   an  



 amputation.     Traugott   continued   to   receive   home   health   care   for  the   wound   until  



November 2013, at which time his insurance denied further coverage and he was unable                                                                                                                                                                                                                                                                                                                      



to pay for it.                                                      He then saw an outpatient department of the hospital for wound care.                                                                                                                                                                                                                                                                                                     



When Traugott consulted                                                                                                                Dr.  Rodriguez in late December, Dr. Rodriguez saw "no                                                                                                                                                                                                                          



 evidence of cellulitis, no osteomyelitis.                                                                                                                                                        No streaking redness or drainage."                                                                                                                                             He thought   



 "the wound to [the] right foot [was] resolved with no evidence of infection at this time"                                                                                                                                                                                                                                                                                                                      



 and took Traugott off antibiotics. Traugott became eligible for Social Security disability                                                                                                                                                                                                                                                                                                   



benefits in January 2014; the Social Security Administration found his disability began                                                                                                                                                                                                                                                                                                                      



 in July 2013.                                                      



                                                                  In January2014 Traugott contacted Dr. Crawford becausehisright foot had                                                                                                                                                                                                                                                                                 



been red and swollen for a few days; Dr. Crawford dispensed diabetic footwear to                                                                                                                                                                                                                                                                                                                                               



 Traugott about two weeks later.                                                                                                                               Dr. Crawford debrided the area again in late February                                                                                                                                                                          



 and found "quite a bit of semicoagulated blood [with a] foul odor."                                                                                                                                                                                                                                                                                   A microbiology   



report showed evidence ofinfection,                                                                                                                                              and Traugott again took antibiotics. The                                                                                                                                                              wound did  



not improve, and in April Traugott returned to outpatient treatment at the hospital for                                                                                                                                                                                                                                                                                                                                    



wound care.                                                   By June, after getting wound care three times a week, the wound appeared                                                                                                                                                                                                                                                        



                                 4                                 (...continued)  



                                                                                                                                                                                                                                                                                             

 exostosis is "[a] cartilage-capped bony projection arising from any bone that develops  

                                                                                                                                        

 from cartilage."  Exostosis, id.  



                                                                                                                                                                                                               -7-                                                                                                                                                                                                 7456
  


----------------------- Page 8-----------------------

                                                                                                                                  

to improve but a culture showed the same bacteria, so his doctor prescribed him a  



                                

different antibiotic.  



                                                                                                                    

                    In September Traugott's care was transferred to the hospital's Advanced  



                                                                                                                          

Wound Care clinic, and Dr. Mark Drew began treating Traugott. At that time the wound  



                                                                                                                          

was "2.2cm length x 2.5cm width x 1.1cm depth." Traugott continued to receive wound  



                                                                                                                              

care for months.  Another clinic physician became concerned about osteomyelitis and  



                                                                                                                             

ordered an MRI, which showed changes in a number of bones:  "the cuboid, sinus tarsi  



                                                                                                                  

and anterior calcaneus and talus." Other bones in his foot, the navicular and cuneiforms,  



were "unchanged" from previous imaging studies.  The MRI report indicated possible  



                                                                                

osteomyelitis in the cuboid, anterior calcaneus, and talus, but also said any changes in  



                                                                                                                             

the  navicular  and  cuneiforms  could  be  related  to  Charcot  foot.                                     Dr.  Drew  and  



                                                                                                                         

Dr. Crawford agreed it would be appropriate to treat the wound using hyperbaric oxygen  



               

therapy.  



                                                                                                                            

                    Treatment with hyperbaric oxygen therapy and antibiotics began in early  



                                                                                                                     

November;Traugottwasdischargedfromhyperbaricoxygen treatmentin lateDecember  



                                                                                                                                 

after his wound closed.  Traugott's doctors thought the "imaging findings [were] due to  



                                                                

Charcot [foot] more than osteomyelitis."  



                                                                                                                              

                    In early January 2015 Traugott saw Dr. Crawford because his foot was  



                                                                                                                         

again swollen and painful. X-rays showed "partial dislocation at the lateral right ankle,"  



                                                                    

and Dr. Crawford diagnosed Charcot foot.  In late March Traugott developed an ulcer  



                                                                                                                      

between two toes that resolved by mid-May.  The area on his arch from the previous  



                                                                          

infection had a callus but "did not re-ulcerate."  



                                                                                                                            

                    Traugott  was  referred  to  an  orthopedic  surgeon  in  Amarillo,  who  



                                                                                                                             

recommended a below-the-knee amputation, which  Traugott did not want.   In July  



                                                                                                                         

Dr. Crawford signed a physician's report saying Traugott's condition was work related  



                                                                                                                                     

as follows: "Stress to right foot caused blister/open area leading to infection and ulcer."  



                                                               -8-                                                         7456
  


----------------------- Page 9-----------------------

                                                                                                                                

Traugott, through an attorney, filed a written workers' compensation claim with the  



                                                                                                                

Board, seeking several benefits.  ARCTEC filed a second controversion, controverting  



                                        

all benefits in the claim.  



                                                                                                                            

                    Traugott  was  then  referred  to  Dr.  Grimes,  a  professor  at  Texas  Tech  



                                                                                                                                

University School of Medicine in Lubbock, who performs surgeries as part of his job  



                                                                                                                          

with Texas Tech. Dr. Grimes saw Traugott in the fall of 2015 and discussed two options  



                                                                                                                              

with him:   an amputation or placement of a rod in the ankle joint.   Dr. Grimes said  



                                                                                                                     

Traugott  was  not  a  candidate  for  an  ankle  replacement  because  of  his  peripheral  



neuropathy.  Dr. Grimes was aware that Traugott had been treated for an infection but  



                                                                                                                                  

thought it had resolved.  He was under the impression he was dealing with "Charcot of  



                                                                                                                        

the hindfoot associated with a prior infection in the midfoot."  On examination Traugott  



                                                                                                                               

did not show signs of overt infection in his foot; the "foot was not red or warm"; and  



                                                                                                                           

"[h]e didn't have a drain wound." Dr. Grimes thought the x-rays "looked like the typical  



                                                                       

Charcot collapse of the talus and navicular."  



                                                                                                                          

                    Dr. Grimes performed a fusion surgery on Traugott's right ankle.  During  



                                                                                                                         

the surgery Dr. Grimes noticed that Traugott's ankle did not look like the usual Charcot  



                                                                                                                               

foot, and he took bone samples for evaluation.   The pathology reports showed that  



                                                                                                                         

Traugott had osteomyelitis. This raised the question whether the osteomyelitis, Charcot  



                                                                                                        

foot, or a combination of them, caused the destruction of the talus.  



                                                                                                                        

                    Dr. Grimes later testified that had he known Traugott had an ongoing  



                                                                                                                                  

infection in his ankle, he would have proceeded differently. He testified that because of  



                                                                                                                                

the infection Traugott might require a second surgery to remove the hardware from the  



                                                                                                                               

first surgery, but as of the Board hearing in 2017, it was not clear whether or when that  



                                                                                                                              

would be needed. Traugott and his doctors considered the surgery successful. Over time  



                                                                                                                              

he was able to almost completely eliminate use of pain medication and could walk with  



                                                                                                                                 

a cane; his only ongoing medication for the ankle at the time of the hearing was an  



                                                                -9-                                                         7456
  


----------------------- Page 10-----------------------

 antibiotic.    The legal proceedings, however, were only beginning as the surgery was                                                                                                                                                                                                              



 completed.  



                        C.                      Workers' Compensation Proceedings                                                              



                                                Dr. Yodlowski did an employer's medical evaluation (EME) in January                                                                                                                                                                   



2016.   She was limited to a records review due to Traugott's travel restrictions at the                                                                                                                                                                                                               



time.  Dr. Yodlowski gave the opinion that the substantial cause of Traugott's medical                                                                                                                                                                                                



 condition was his diabetes.                                                                       



                                                The Board first held a hearing on the merits of the case in February 2016.                                                                                                                                                                                            



 Several witnesses testified, including Traugott and Dr. Yodlowski, andtheBoard                                                                                                                                                                                                          had the   



 deposition testimony of Dr. Grimes. The Board made a number of factual findings in its                                                                                                                                                                                                                    



 decision, but it "noted both gaps in the medical record and its own lack of understanding                                                                                                                                                                      



 of the medical evidence."                                                                      It decided to order an SIME with Dr. Frey, an orthopedic                                                                                                                    



 surgeon who specializes in feet and ankles. The Board also made factual findings about                                                                                                                                                                                                        



 Traugott's medical condition based on his medical records. The                                                                                                                                                              Board's legaldiscussion   



 included references to "the 'eggshell skull doctrine,' under which an employer takes an                                                                                                                                                                                                                  



 employee   as   he   finds   him."     The   Board   cited  two  of   our   decisions,   DeYonge   v.  



                                                        5                                                                                                     6  

                                                               and Fox  v.  Alascom,  Inc.,   and  one  Commission  decision,  City  &  

NANA/Marriott                                                                                                                                                                                                                                                                                             

                                                                                                              7      for  the  proposition  that  Traugott's  injury  could  be  

Borough  of  Juneau  v.  Olsen,  

                                                                                                                                                                                                                                                                                                        



                        5                        1 P.3d 90 (Alaska 2000).                                        



                        6                       718 P.2d 977 (Alaska 1986),  superseded in part by statute  ch. 79, §§ 21,  



                                                                                                                                                                                                                                                                                       

42, SLA 1988, as recognized in Kelly v. State, Dep't of Corr., 218 P.3d 291, 299 (Alaska  

2009)   (observing  that   legislature   amended   the   Act   in   1988   and   "removed   the  

                                                                                                                                                                                                                                                                                                

presumptionofcompensability"in workers' compensation cases involving mental stress  

                                                                                                                                                                                           

 causing mental injury, also known as mental-mental cases).  



                        7                       A W C A C                                             D e c .                              N o .                           1 8 5                           ( A u g .                                 2 1 ,                         2 0 1 3 ) ,  



http://labor.state.ak.us/WCcomm/memos-finals/D_185.pdf.  

                                                                                                                                                                                                                     



                                                                                                                                                   -10-                                                                                                                                          7456
  


----------------------- Page 11-----------------------

"compensable if his work activities aggravated, accelerated, or combined with the pre-                                                                       



existing conditions to cause the diabetic ulcer that resulted in osteomyelitis."                                                                     



                         ARCTEC filed a petition for reconsideration, asking the Board to make                                                             



supplemental findings and arguing that the "eggshell skull doctrine" did not apply,                                                                      

                                                                        8   It contended no SIME was needed.  The Board  

primarily because                  Fox  was "bad law."                                                                                                   



deniedreconsideration. Further disputes aroserelated to the wording of SIMEquestions,  

                                                                                                                                                                       



with the Board issuing a third decision.  

                                                                              



                         Almost eleven months after the first hearing, Dr. Frey issued her SIME  

                                                                                                                                                          



report, which addressed written questions from the Board and both parties.  Dr. Frey  

                                                                                                                                                            



listed 22 causes of Traugott's disability.  She said that Traugott's "employment injury  



combined with pre-existing condition of diabetes and neuropathy to produce a break  

                                                                                                                                                          



down in [his] foot and introduction of infection."  She also indicated that Traugott had  

                                                                                                                                                              



told her "that he continued to work on ladders and climbing and walking, despite pain  

                                                          



[in] the mid arch." She stated that working in spite of pain contributed to the breakdown  

                                                                                                                                                



in the skin; "[o]therwise, there are no records to indicate that he had another site of  

                                                                                                                                                                 



infection  at  the  time."                       Dr.  Frey  wrote,                   "Osteomylitis,  [sic]  charcot  arthropathy,  

                                                                                                                                             



breakdown of the ankle are the conditions that are contributed to by his work.  This  

                                                                                                                                                            



condition is mainly a result of the diabetes and neuropathy, his preexisting condition, but  

                                                                                                                                                               



clearly accelerated by his work injury."  

                                                                              



                         In response to the Board's question asking which of the identified causes  

                                                                                                                                                         



was "the substantial cause" of the disability or need for medical treatment, Dr. Frey  

                                                                                                                                                            



responded:   "Overall cause:   75% diabetes & neuropathy[;] 25% work conditions[.]  

                                                                                                                                                                       



Acceleration[:]   100% work related.   Therefore, for this particular disability at this  

                                                                                                                                                              



             8  

                                                                                                                                                   

                         SeeKelly, 218 P.3d at298(observing that legislature'spurposeinremoving  

                                                                                                                                        

presumption of compensability in mental-mental cases was to overrule Fox).  



                                                                              -11-                                                                               7456  


----------------------- Page 12-----------------------

                                                                                                                             

particular point in time, the work injury is the SUBSTANTIAL CAUSE."  Dr. Frey  



                                                                                                                

answered other questions, but no other answer to a Board question was as controversial.  



                                                                                                                   

                    Responding to Traugott's questions, she agreed there was no "significant  



                                                                                                                              

evidence" that Traugott had osteomyelitis until July 2013 or later; she also said the type  



                                                                                                                           

of work activity Traugott did could lead to blisters, "especially with boots and ladder  



                                                                                                                

use."  Answering ARCTEC's questions, Dr. Frey said she would regard the following  



                                                                                                                             

as  causes  and  attach  responsibility  to  them:                         Traugott's  "[w]orking  through  pain  



                                                                                                                                  

and . . . loading his midfoot, not only by wearing a boot . . . but also use of ladders &  



                                                                                                             

long term standing."  In response to another question from ARCTEC, Dr. Frey set out  



                                                                                                

the causal chain related to "the substantial cause" as follows:  



                                                                                                          

                    Had it not been for his skin ulcer he would not have had  

                                                                                                       

                    osteomyelitis.  Had it not been for his work injury, he would  

                                                                                                          

                    not have had the skin ulcer at the time he had it. He very well  

                                                                                                               

                    may have had a skin break down at some point in time, but it  

                                                                     

                    is not possible to know when.  



                                                                                                         

The parties deposed Dr. Frey to seek clarification of her responses.  



                                                                                                                 

                    Dr.Freytestifiedsheconsidered both theCharcotfoot and theosteomyelitis  



                                                                                                                               

to  be  responsible  for  the  talus  disintegration.                       She  gave  the  Charcot  foot  and  the  



                                                                                                                                

osteomyelitis equal weight in terms of causing the actual destruction of the bone, but she  



                                                                                                                        

thought the work injury accelerated the talus's destruction. She testified that an infection  



                                                                                                                

causes "a change in mechanics," and in a foot "with a joint that's already mechanically  



                                                                                                                           

not good, it just accelerates the breakdown of the joint."  At the hearing Dr. Frey agreed  



                                                                                                                   

with Dr. Yodlowski that the combination of osteomyelitis and Charcot foot "accelerates  



                                                                                                                        

the need for treatment" and said that "having an infection superimposed on Charcot  



                         

accelerates it."  



                                                                                                                           

                    Dr. Frey identified wearing boots and using ladders as work-related factors  



                                                                                                                        

contributing to Traugott's condition because boot design generally puts more pressure  



                                                               -12-                                                         7456
  


----------------------- Page 13-----------------------

on the arch and prolonged standing on ladders would add pressure as well. Dr. Frey did                                                                                                                                                                                                                     



not consider it important that Traugott reported that the May blister had healed; she                                                                                                                                                                                                                     



appeared to accept that the crack that opened in July was from the May blister and that                                                                                                                                                                                                                  



the bacteria had continued to spread even though Traugott thought the blister had healed.                                                                                                                                                                                                                                 



                                                At her deposition, Dr. Frey testified that there was "probably a 25 percent                                                                                                                                                                 



chance" that Traugott would have had a problem with Charcot foot had he not had the                                                                                                                                                                                                                        



infection.   When asked whether she had an opinion about "whether the work activities                                                                                                                                                                                                 



versus other non-industrial factors played the greatest role in the skin breakdown and                                                                                                                                                                                                                   



infection," she answered that "[t]he work activity caused the skin breakdown and the                                                                                                                                                                                                                       



infection."     She did not seem to think that "[t]he mere fact that he's diabetic                                                                                                                                                                                                                   with  



Charcot" would inexorably lead to a destroyed talus; she thought his work activity was                                                                                                                                                                                                                   



critical in causing his disability and need for medical treatment.                                                                                                                                                                     



                                                The Board held its final hearing in July 2017.  All three doctors testified,                                                                                                                              

                                                                                     9       Much of the doctors' hearing testimony was similar to their  

in addition to Traugott.                                                                                                                                                                                                                                                                              



earlier testimony; disagreements between the doctors were mainly related to causation.  

                                                                                                                                                                                                                                                                                                                          



                                                Dr. Yodlowski provided more detail about how osteomyelitis spreads and  

                                                                                                                                                                                                                                                                                                          



how Charcot foot could be a factor in its spread. Essentially, as Charcot foot causes bone  

                                                                                                                                                                                                                                                                                                      



destruction, the bone destruction in turn affects the joints, and the affected joints provide  

                                                                                                                                                                                                                                                                                           



a route for the infection to spread.  

                                                                                                                             



                                                Dr. Grimes thought the osteomyelitis was the main cause of the talus's  

                                                                                                                                                                                                                                                                                              



destruction. He thought the midfoot infection that was clearly documented in Traugott's  

                                                                                                                                                                                                                                                                                 



medical records was the origin of the osteomyelitis in the hindfoot, which in turn led to  

                                                                                                                                                                                                                                                                                                               



                        9                       Before the hearing Dr. Yodlowski did a supplemental EME report related                                                                                                                                                                        



to the reasonableness of the type of surgery Dr. Grimes performed, an issue the Board  

                                                                                                                                                                                                                                                                                                          

considered separatelyfromthecausation question. BecauseARCTECdid not appeal this  

                                                                                               

issue, we do not discuss it further.  



                                                                                                                                                    -13-                                                                                                                                             7456
  


----------------------- Page 14-----------------------

                                                                                                                              

the need for surgery and Traugott's ongoing inability to return to the work he had been  



                                                                                                                   

doing.       Dr.  Grimes  had  testified  at  his  deposition  that  he  thought  Dr.  Crawford's  



                                                                                                                                

determination that Traugott's blister led to the midfoot infection was reasonable, but  



                                                                                                                                      

because he had no personal knowledge of the wound or Traugott's work activities, he  



                                                                                                                               

was  not  willing  to  testify  that  work  activities  were  the  underlying  cause  of  the  



                       

osteomyelitis.  



                                                                                                                    

                    Dr. Yodlowski considered the Charcot foot and Traugott's underlying  



                                                                                                                                  

diabetes to be the chief cause of the talus's destruction and thus the substantial cause of  



                                                                                                                              

his disability and need for medical treatment. Sheagreed that the osteomyelitis may have  



                                                                                                                               

changed his treatment.   Dr. Yodlowski acknowledged that walking and standing put  



                                                                                                                                

pressure on the midfoot of "a diabetic with a Charcot deformity," but she considered the  



                                                                                                                  

activities Traugott was performing at work to be no different from his recreational  



                                                                                                                                      

activities. She also thought the infection had a different origin than the May 2013 blister.  



                                                                                                                                

Relying on Dr. Crawford's surgery notes about the exostectomy, she theorized that the  



                                                                                                                              

exostosis wore a hole in the skin through which bacteria entered.  Dr. Yodlowski gave  



                                                                                                                        

the medical opinion that Traugott's work activities at ARCTEC should not "be assigned  



                                                                                       

legal responsibility" for his need for medical treatment.  



                                                                                                                                

                    Dr. Frey confirmed her opinion that "the osteomyelitis accelerated the  



                                                                                                                             

underlying pre-existing Charcot causing it to be symptomatic at this time."  Dr. Frey  



                                                                                                                               

agreed  that  Traugott's  "work  on  ladders  with  boots"  was  an  important  part  of  the  



                                                                                                                                

causation chain and agreed that the osteomyelitis was "the substantial cause of the  



                                                                                                                                

acceleration of the underlying Charcot causing Mr. Traugott's disability and need for  



                                                                                                                            

treatment." When ARCTEC's attorney asked Dr. Frey whether she had an opinion about  



                                                                                                                              

"whether  the  work  activities  were  so  important  of  a  cause  that  [she]  would  feel  



                                                                                                                                

comfortable attaching legal responsibility to them," she initially responded, "Is it my job  



                                                                                                                             

to attach the legal responsibility?"  Dr. Frey then indicated that in her opinion the work  



                                                               -14-                                                         7456
  


----------------------- Page 15-----------------------

                                                                                                                              

activities for ARCTEC were "not trivial" and "they have responsibilities." Dr. Frey also  



                                                                                                       

explained why she did not consider Traugott's earlier infections to be important in her  



                                                                                                                

causation analysis - they were widely spaced in  time and both "had explanations  



                                  

outside of diabetes."  



                                                                                                               

                    ARCTEC's attorney and Dr. Frey engaged in an extended question-and- 



                                                                                                                       

answer sequence about causation.   Dr. Frey explained her responses to the Board's  



                                                                                                                         

questions, indicating she had separated out acceleration based on the Board's second  



                                                                                                                     

question, which asked:  "If, in your opinion, one cause of Joseph Traugott's disability,  



                                                                                                                           

or need for medical treatment is a preexisting condition, did the 2013 employment injury  



                                                                                                                                

aggravate, accelerate, or combine with the preexisting condition to cause disability or  



                                                                                                                                 

need for treatment?"  She also testified that "the pre-existing conditions did nothing to  



                                                                                                             

accelerate" and "[i]t was a pre-existing condition that more probabl[y] than not would  



                                                                                                                                 

have been just fine for the rest of his life."  She insisted that work was the sole cause of  



                                                                                                                     

Traugott's acceleration, even though she acknowledged that his diabetes was necessary  



                                                                                                                          

for development of the resulting medical condition.   But she emphasized that "most  



                                                                                                                             

people with diabetes" and with Charcot foot do not develop "a diabetic ulcer with  



                   

infection."  



                                                                                                                            

                    The  Board  decided  that  Traugott's  work  with  ARCTEC  was  "the  



                                                                                                                        

substantial cause of his disability or need for medical treatment" and that the surgery  



                                                                                                                       

Dr. Grimes performed "was reasonable and necessary." The Board determined Traugott  



                                                                                                                              

had attached the presumption of compensability and that ARCTEC had rebutted it.  The  



                                                                                                                        

Board then weighed the evidence, in particular the diverging opinions from the doctors,  



                                                                                  

to decide whether Traugott met his burden of proof.  



                                                                                                                         

                    The Board gave the least weight to Dr. Yodlowski's testimony for several  



                                                                                                                          

reasons.  First, it thought she misunderstood the issue of legal causation when a worker  



                                                                                                                          

has a preexisting condition.  It noted her testimony that "hundreds, thousands of people  



                                                              -15-                                                         7456
  


----------------------- Page 16-----------------------

                                                                                                                              

work at ARCTEC and do similar types of jobs and they don't get those conditions [that  



                                                                                                                             

Traugott developed], so, no, there's no basis for the work . . . being the cause of those  



                                                                                                                           

conditions."  In the Board's view, the causation question was "whether the work would  



                                                                                                                              

cause  someone  with  the  conditions  of  diabetic  neuropathy  and  Charcot  foot,  like  



                                                                                                                                

[Traugott], to become disabled or need medical treatment."  The Board discounted her  



                                                                                                                          

testimony  about  "a  bone  wearing  through  the  skin"  because  nothing  in  the  record  



                                                                                                                         

documented this theory. It also wrote that "Dr. Yodlowski's focus on the lack of medical  



                                                                                                                                 

literature regarding an increased risk of blisters or diabetic ulcers from working on  



                                                                                                                               

ladders ignores common experience." The Board gave more weight to Dr. Grimes's and  



                                                                                                                       

Dr. Crawford's opinions; it thought that together their opinions established "a complete  



                                                                                                                            

chain of causation" between the May 2013 blister and the infection in the talus.  



                                                                                                                                

                    The Board gave the most weight to Dr. Frey's opinion, interpreting her  



                                                                                                                    

testimony as saying that even though the underlying diabetes and peripheral neuropathy  



                                                                                                                         

were important factors in the development of Traugott's disability and need for medical  



                                                                                                                               

treatment, his work for ARCTEC was the most likely cause of the acceleration and thus  



                                                                                                                           

was primarily responsible for his current disability and need for treatment.  The Board  



                                                                                                                                

responded to ARCTEC's suggestion that Dr. Frey's opinions were suspect because she  



                                                                                                                                 

focused exclusively on factual cause and "ignored" the legal causation requirement by  



                                                                                                                                 

observing that its referral letter gave a definition of "the substantial cause."  It saw no  



                                                                                

indication Dr. Frey had "ignored that instruction."  



                                                                                                                                  

                    The Board then "evaluate[d] the relative contribution of different causes of  



                                                                                                                               

the disability . . . or the need for medical treatment."   The Board acknowledged that  



                                                                                                                           

Traugott's "preexisting diabetesandneuropathyare, without question, significant factors  



                                                                                                    

in his disability and need for medical treatment."  But the Board pointed to Dr. Frey's  



                                                                             

testimony that the "preexisting conditions would have been just fine for the rest of his  



                                                                                                                                

life absent the work injury" to conclude that "[i]n comparison to all other causes, the  



                                                               -16-                                                         7456
  


----------------------- Page 17-----------------------

 May 2013 blister, together with the subsequent infection, is the substantial cause of                                                                                                                                      



 [Traugott's] disability and need for medical treatment."                                                                                               The Board issued an order                                   



 deciding Traugott's disability and need for treatment were compensable and retained                                                                                                                         



jurisdiction as to his entitlement to specific benefits.                                                                                    



                                   ARCTEC appealed to the Commission and moved for a stay of the Board's                                                                                                      



 decision. Traugott opposed the stay, raising multiple objections. The Commission held                                                                                                                                  



 oral argument on the motion and issued a stay conditioned on ARCTEC's filing a bond.                                                                                                                                                



 ARCTEC did not comply with the Commission's order promptly, and almost a month  



                                                                                                                                                                                                                              10  

 later the Commission sent ARCTEC a Notice of Default under one of its regulations.                                                                                                                                                  



 Traugott  asked  for  reconsideration  of  both  orders,  but  the  Commission  refused  to  

                                                                                                                                                                                                                            



 reconsider anything because it did not think it had reconsideration jurisdiction. Traugott  

                                                                                                                                                                                                            



petitioned  for  review  of  the  Commission's  stay-related  decisions,  and  we  denied  

                                                                                                                                                                                                               

 review.11                 ARCTEC filed the bond on December 12, 2017.  

                                                                                                                                                             



                                   Before the Commission ARCTEC argued that the Board committed legal  

                                                                                                                                                                                                                      



 error by applying the "eggshell skull doctrine" because in ARCTEC's view the 2005  

                                                                                                                                                                                                                     



 change in the causation standard "statutorily negated the eggshell skull rule in Alaska  

                                                                                                                                                                                                                



 workers' compensation cases, and did so generally" so that "[n]othing remained of the  

                                                                                                                                                                                                                          

 eggshell skull rule." ARCTEC also seemed to argue that Fox v. Alascom, Inc.12 had been  

                                                                                                                                                                                                                       



 overruled with regard to an aggravation of any condition, not just mental injury claims.  

                                                                                                                                                                                                                                     



 ARCTEC contended that the Board failed to apply Commission precedent and, based on  

                                                                                                                                                                                                                            



                  10                8  Alaska  Administrative  Code  (AAC)  57.250(a)  (2011).  



                  11                Traugott  v.  ARCTEC  Alaska,  Inc.,  420  P.3d   1142,   1142  (Alaska  2018).  



                  12               718  P.2d  977  (Alaska  1986).   In  Kelly  v.  State,  Department  of  Corrections,  



 we  recognized  that  the  legislature  overruled  Fox  with  respect  to  mental  stress  claims  in  

 workers'  compensation.   218  P.3d  at  298-99.  



                                                                                                            -17-                                                                                                     7456
  


----------------------- Page 18-----------------------

                                                                                                                                                                                                                                                    13  

 a statement from an occupational disability case,                                                                                                                                                                                                          that "it remains unclear whether 'the                                                                                                                               



 substantial clause' [sic] means 'more than any other cause' versus 'more than 51%.' "                                                                                                                                                                                                                                                                                                                                                                   



ARCTEC argued that the Board required Traugott to prove only one part of causation,                                                                                                                                                                                                                                                                                                             



"but for" causation.                                                                                    ARCTEC maintained that it was not asking the Commission to                                                                                                                                                                                                                                                                      



reweigh   the   evidence   but   was   simply   asking   the   Commission  to  consider   one   of  



Dr. Frey's opinions - the 75% and 25% division -and decide that this specific opinion                                                                                                                                                                                                                                                                                                                        



resolved the case in its favor as a matter of law.                                                                                                                                                                                                 



                                                                    Traugott responded that the 2005 amendments to the Act did not eliminate                                                                                                                                                                                                                                                         



the   compensability   of   aggravation   claims,   arguing   that   the   legislature   specifically  



rejected this approach during its consideration of the 2005 amendments and quoting                                                                                                                                                                                                                                                                                                                         



legislative history to support his position. He relied on Oregon case law to argue that "a                                                                                                                                                                                                                                                                                                                                              



preexisting condition that makes a worker more susceptible to a workplace injury is not,                                                                                                                                                                                                                                                                                                                                         



itself, a cause that can be used to defeat a claim for compensation."                                                                                                                                                                                                                                                                                                    He asked the                                             



 Commission to recognize that his preexisting condition did not cause the infection, but                                                                                                                                                                                                                                                                                                                                           



made him more susceptible to it, meaning that the diabetes should not be considered a   



cause of his disability or need for treatment.                                                                                                                                                                                   



                                                                    The Commission decided that Traugott had not proved his claim by a                                                                                                                                                                                                                                                                                                      



preponderance   of   the   evidence.     With   respect   to   the   question   of   causation,   the  



 Commission identified the Board's task as "determin[ing] when the work injury is just                                                                                                                                                                                                                                                                                                                                           



one component in the need for medical treatment and when the work injury is the                                                                                                                                                                                                                                                                                                                                                   



 substantial cause," meaning that "the aggravation or acceleration cannot be viewed in                                                                                                                                                                                                                                                                                                                                                   



isolation, but must be factored into the query 'is the work the substantial cause?' "                                                                                                                                                                                                                                                                                                                                   The  



 Commission   examined   Dr.   Frey's   response   apportioning   causation   for   the   overall  



                                  13                               See Shea v. State, Dep't of Admin., Div. of Ret. & Benefits                                                                                                                                                                                                                                          , 267 P.3d 624,                                      



 636   (Alaska   2011)   (discussing   causation   in   occupational   disability   under   Public  

Employee Retirement System).                                                                                    



                                                                                                                                                                                                                -18-                                                                                                                                                                                                        7456
  


----------------------- Page 19-----------------------

condition as 75% related to diabetes and 25% to the work conditions, but assigning                                                                                                                                   



 100% responsibility for the acceleration to the work conditions. The Commission wrote                                                                                                                                          



that "[w]hile the acceleration by itself was 100% work-related, this [was] not the proper                                                                                                                                     



question" because "[a]cceleration may not be viewed in isolation, but must be evaluated                                                                                                                               



along with all 'other causes' in order to determine 'the substantial cause' for the need for                                                                                                                                            



medical treatment."                                      In the Commission's view, the Board gave Dr. Frey "conflicting                                                                                        



instructions and did not ask her to weigh all causes after looking at the effect of the                                                                                                                                                



possible acceleration of Mr. Traugott's condition from the work incident."                                                                                                                                       



                                     TheCommission                                   then went ontoprovideacritiqueofDr.Frey'stestimony,                                                                           



identifying what it saw as contradictions in it.                                                                                     The Commission discussed one of its                                                                 

                          14 and interpreted that decision as requiring the Board to weigh different causes  

decisions                                                                                                                                                                                                                     



against each other to decide which was "the substantial cause."  The Commission cited  

                                                                                                                                                                                                                                  



testimony from the legislative history with an example of diabetic neuropathy; the cited  

                                                                                                                                                                                                                                   



testimony indicated that the Board would need to assess whether the substantial cause  

                                                                                                                                                                                      



of later medical care was due to the work injury or the neuropathy.  The Commission  

                                                                                                                                                                                                             



then stated that Dr. Frey did not do this.   The Commission declared that Dr. Frey's  

                                                                                                                                                                                                                             



overall causation opinion was "substantial evidence that Mr. Traugott's pre-existing  

                                                                                                                                                                                                              



condition was the substantial cause of his need for medical treatment."  It decided that  

                                                                                                                                    



Dr. Frey's opinion about the acceleration was "not substantial evidence in the record as  

                                                                                                                                                                                                                                          



a whole because it [was] based on a misstatement of the law."  The Commission wrote:  

                                                                                                                                                                                                                              



                                     When                     Dr.               Frey                  properly                         weighed                          all            causes,  

                                                                                                                                                                                

                                     AS 23.30.010(a), she unequivocally stated that 75% of the  

                                                                                                                                                                                                  

                                     need for medical treatment was his diabetes and neuropathy  

                                                                                                                                                                            

                                     and 25% was work conditions.  Thus, work could not be the  

                                                                                                                                                                                                   



                   14  

                                                                                                                                                                                                                            

                                     City  of  Seward  v.  Hansen,  AWCAC  Dec.  No.  146  (Jan.  21,  2011),  

                                                                                                                                                                       

http://labor.state.ak.us/WCcomm/memos-finals/D_146.pdf.  



                                                                                                                  -19-                                                                                                                       7456  


----------------------- Page 20-----------------------

                                   substantial cause of his need                                                    for   medical treatment.                                       The  

                                   Board erred in finding work was the substantial cause.                                                                                          



The   Commission   said   the   Board   had   "incorrectly   asked   Dr.   Frey   to   ignore   the  



requirement in AS 23.30.010(a) that all causes must be evaluated to determine 'the                                                                                                                                     



relative   contribution   of   different   causes   of   .   .   .   the   need   for   medical   treatment,'   "  



(alteration in original) yet it never identified where the Board did this. The Commission                                                                                                        



criticized the Board for "abrogat[ing] its duty" and "mislead[ing] its SIME physician                                                                                                                   



with misstatements of the law."                                                       In its legal analysis the Commission discussed only                                                                            



Dr. Frey's testimony; it did not discuss any other evidence or the Board's analysis of that                                                                                                                             



evidence.    



                                   Traugott appeals.   



III.              STANDARD OF REVIEW                              



                                   In a workers' compensation appeal from the Commission, we review the   

                                                                                                                   15   "We apply our independent judgment to  

Commission's decision and not the Board's.                                                                                                                                                                                  



questions of law that do not involve agency expertise, including issues of statutory  

                                                                                                                                                                                                          



interpretation," and "interpret a statute 'according to reason, practicality, and common  

                                                                                                                                                                                                           



sense, considering the meaning of the statute's language, its legislative history, and its  

                                                                                                                                                                                                                           

purpose.' "16                         We review de novo the Commission's legal conclusion about whether  

                                                                                                                                                                                                            



substantialevidencesupports theBoard's factual findings by "independentlyreview[ing]  

                                                                                                                                                                                                    

the record and the Board's factual findings."17  

                                                                                           



                  15              Alaska Airlines, Inc. v. Darrow                                                    , 403 P.3d 1116, 1121 (Alaska 2017).                                             



                  16                Vandenberg v. State, Dep't of Health & Soc. Servs., 371 P.3d 602, 606  

                                                                                                                                                                                                                       

(Alaska    2016)    (quoting   Louie   v.   BP   Expl.   (Alaska),   Inc. ,  327    P.3d    204,    206  

(Alaska 2014)).  

                      



                  17               Smith v. CSK Auto, Inc., 204 P.3d 1001, 1007 (Alaska 2009).  

                                                                                                                                                                                                     



                                                                                                           -20-                                                                                                     7456
  


----------------------- Page 21-----------------------

IV.       DISCUSSION  



                                                                     

          A.        This Case Is A Susceptibility Case.  



                                                                                                                       

                    The Commission's decision in Traugott's case was issued before Morrison  



                                                                                                                      

v.  Alaska  Interstate  Construction  Inc. ,  where  we  considered  the  new  workers'  



                                                                                                                           18  

                                                                                                                               We  

compensation causation standard in the context of the last injurious exposure rule. 



                                                                                                                                

decided that aggravation claims remain compensable after the 2005 amendments to the  



       19  

Act.                                                                                                                         

           We affirmed the Board's application of the new causation standard in that case,  



                                                                                                                                

deciding that "[t]he new standard leaves the Board discretion to choose among the  



                                                                                                                         

identified  causes  the  most  important  or  material  cause  with  respect  to  the  benefit  



             20  

sought."                                                                                                                         

                  The parties here agree that last injurious exposure rule cases are a type of  



                                                                                       

aggravation claim so that Morrison applies to the case.  



                                                                                                                      

                    The   parties   disagree,   however,   about   whether   this   case   involves  



                                                                                                                               

susceptibility.          In  medicine  "susceptibility"  refers  to  an  individual's  likelihood  "to  



                                                                      21  

                                                                                                                                  

develop  ill  effects  from  an  external  agent."                          ARCTEC  argues  that  this  is  not  a  



                                                                                                                        

susceptibility casebecauseofthenumerous complicationsTraugotthadalready suffered;  



                                                   

in its view susceptibility should be confined to cases in which a worker had few or no  



                                                                                                                           

complications of his underlying disease before the work injury. At oral argument before  



                                                                                                                                  

us ARCTEC was unable to articulate a legal test which would distinguish as a matter of  



                                                                                                                              

law when a case was no longer a susceptibility case. It asserted that Traugott's foot "had  



          18        440 P.3d   224,   234-36   (Alaska   2019).    The   last   injurious   exposure   rule  



required  the  last  employer  whose  work  was  a  substantial  factor  in  causing  a  worker's  

disability  to  pay   for the   entire   cost   of  the   disability.   Id.   at  230  n.8   (citing  Ketchikan  

Gateway  Borough  v.  Saling,  604  P.2d  590,  595  (Alaska   1979)).  



          19        Id. at 233-34.  

                              



          20        Id. at 238, 240.  

                                      



          21        Susceptibility, STEDMAN'S  MEDICAL  DICTIONARY  (28th  ed.  2006).  

                                            



                                                               -21-                                                         7456
  


----------------------- Page 22-----------------------

been deteriorating for years," and that because of the "long history of deterioration," his                                                                                                                                                  



work for ARCTEC could not be the most important factor in causing his disability and                                                                                                                                                      



need for medical care.                                            



                                      Traugott,incontrast,                                      maintains thathis                                 diabetes and Charcot footmadehim                                                        



more susceptible to the blister and the resulting osteomyelitis. Traugott relies on Oregon                                                                                                                                      



law   to   argue   that   conditions   that   merely   make   a   worker   more   susceptible   to   an  



occupational disease or injury should not be included in the causation analysis for work-                                                                                                                                           



relatedness.    



                                      We reject the argument that a legal line can be drawn among different                                                                                                                 



degrees of deterioration resulting from a preexisting condition to determine that some                                                                                                                                                



conditions are not work related as a matter of law.                                                                                                As we held in                              Morrison, the new                          



standard of legal causation, while more restrictive than the old one, "remains flexible"                                                                      

                                                                                                    22  Indeed, ARCTECacknowledged at oral argument  

and "is necessarily fact-dependent."                                                                                                                                                                                       



before us that every case is "fact specific," making it impossible to articulate a standard  

                                                                                                                                                                                                                           



that would preclude the possibility of an injury being work related as a matter of law.  

                                                                                                                                                                                                                                                        



                                      Wealso reject Traugott'sargument that certain preexisting conditions must  

                                                                                                                                                                                                                                        



be excluded from the causation analysis. Nothing in our statute or the legislative history  

                                                                                                                                                                                                                                 



suggests this legal rule. Indeed the legislative testimony the Commission cited explicitly  

                                                                                                                                                                                                                           



referred to a worker's preexisting diabetes as a factor the Board might consider in its  

                                                                                                                                                                                                                                              



causation analysis related to complications from a work injury.   A rule allowing all  

                                                                                                                                                                                                                                             



preexisting  conditions  to  be  factored  into  the  causation  analysis  may  have  a  

                                                                                                                                                                                                                                               



disproportionate impact on people with preexisting, partially disabling conditions.  It is  

                                                                                                                                                                                                                                                



possible  that  workers  who  have  suffered  more  complications  from  their  medical  

                                                                                                                                                                                                                             



conditions could have a more difficult time establishing as a factual matter that a work- 

                                                                                                                                                                                                                                  



                   22  

                                                                        

                                      440 P.3d at 238.  



                                                                                                                     -22-                                                                                                                         7456  


----------------------- Page 23-----------------------

related injury or illness was the most important factor in causing their disability or need                                                                     



for medical treatment because of their many extant complications.                                                               But this is consistent       



with   the   legislature's   intent   "to   narrow   the   compensability   standard"   for   workers'  

compensation.23  



                          At oral argument before us, ARCTEC said it was "not credible" for the  

                                                                                                                                                                   



Board to determine that work was the substantial cause of Traugott's disability and need  

                                                                                                                                                                



for medical treatment because of Dr. Frey's estimate that work was 25% responsible for  

                                                                                                                                                                   



Traugott's overall condition. But Dr. Frey's testimony about causation was remarkably  

                                                                                                                                                   



similar to the SIME physician's opinion in Morrison .  In Morrison the SIME doctor  

                                                                                                                                                            



estimated that if he were in an apportionment jurisdiction, he would allocate causation  

                                                                                                                                                      

"about 80% to 90% to the 2004 injury and 10% to 20% to the 2014 injury."24  He said  

                                                                                                                                      



both injuries were responsible for the claimant's condition, but he thought the 2014  

                                                                                                                                                               

injury was the substantial cause of the need for medical treatment.25   The Board accepted  

                                                                                                                                                        

                                         26  and we reinstated the Board's award because the statute permits  

this doctor's opinion,                                                                                                                                    

                          



the Board to determine which cause among all those identified is the most important or  

                                                                                                                                                                     



material cause of the current disability and need for medical treatment, even if an expert  

                                                                                                                                                             

does not regard the cause as having more than 50% responsibility for the condition.27  

                                                                                                                                                                          



The legislature clearly intended to reduce workers' compensation coverage for workers  

                                                                                                                                                         



             23           Id.  at 237.   



             24           Id. at 230.  

                                      



             25           Id. at 228.  

                                      



             26           Id.  at 230.   



             27           Id.  at 237-38, 240.        



                                                                                -23-                                                                           7456
  


----------------------- Page 24-----------------------

with preexisting medical conditions, but it chose to do so by imposing a higher standard                                                                                                                                                                      



for legal causation, not by excluding some workers from coverage as a matter of law.                                                                                                                                                                                    



                      B.	                  But-For Causation Remains A Component Of The Compensability                                                                                                                           

                                           Analysis.  



                                            In   its   decision,   the   Commission  wrote,   "The   'but   for'   test   has   been  



superseded by the requirement in AS 23.30.010(a) that all causes be weighed against                                                                                                                                                                               



each   other   before   work  can   be   found   to   be   the   substantial   cause   of   the   ongoing  



disability."     At   oral   argument   before   us   and   in   its   supplemental   brief,   ARCTEC  



contended that but-for causation was no longer applicable in workers' compensation                                                                                                                                                         



after   the   2005   amendments.     Because   but-for   causation   remains   part   of   workers'  



compensation, we discuss this issue briefly to provide clarification.                                                                                                             



                                            In its discussion, the Commission wrote that "the 'but for' test alone is not                                                                                                                                                      



sufficient to establish compensability" because of the new causation standard. However,    



the but-for test "alone" has never been sufficient to establish compensability because it                                                                                                                                                                                            



has always been just one component of what a worker must prove to establish his claim.                                                                                                                                                                               



                                                                                                                                                                                                                                                                  28  

                                            The but-for test, as we noted in                                                                    Morrison, represents factual cause.                                                                                      But- 



                                                                                          

for causation was only one part of the pre-2005 causation analysis, and it remains part  



                                                                                                                   29  

                                                                                                                                                                                                                                                                                   

of the post-2005 causation analysis.                                                                                        Before the 2005 amendments a worker needed to  



                                                                                                                                                                                                                                                                                   

prove at the third stage of the presumption analysis that work was a substantial factor in  

                                                                                                                                            30   To prove this, the worker needed to show  

                                                                                                                                                                                                                                                                        

his disability or need for medical treatment. 



both that work was a but-for (or factual) cause and that it was important enough as a  

                                                                                                                                                                                                                                                                                     



                      28                   Id.  at 237.   



                      29                   Id.  



                      30  

                                                                                                                                                                                                                                     

                                           Huit v. Ashwater Burns, Inc., 372 P.3d 904, 907 (Alaska 2016).  



                                                                                                                                      -24-	                                                                                                                              7456
  


----------------------- Page 25-----------------------

                                                                                                                                               31  

cause that reasonable persons would regard it as a cause and attach responsibility to it.                                                           



                                                                                                                                             

The 2005 amendments did not change the but-for or factual part of compensability. For  



                                                                                                                                           

a disability to be compensable, work must still be a factual cause of the disability or need  

                                     32   The 2005 amendments changed the proximate or legal cause  

                                                                                                                                         

                     

for medical treatment. 



componentofthecompensability analysis. NowtheBoard must determinewhich among  

                                                                                                                                       



the different causes-in-fact is the most important in the current disability or need for  

                                                                                                                                             



medical care.  

               



                      Aggravation claims remain compensable, and a worker still must show that  

                                                                                                                                            



the work injury was a cause-in-fact of his disability or need for medical care.   Our  

                                                                                                                                           



decision in Fairbanks North Star Borough v. Rogers & Babler dealt with the cause-in- 

                                                                                                                                   

fact component of the causation analysis,33  and it remains applicable.  Rogers & Babler  

                                                                                                                                       

                                                                                                           34   There we rejected an  

involved successive injuries and the last injurious exposure rule.                                                                             

                                                                                                    



employer's argument that "application of the 'but for' test would make the last injurious  

                                                                                                                                    



exposure rule a nullity" because if a worker had a degenerative condition that would  

                                                                                                                                        



inevitably make him disabled, he could never show that work was a cause-in-fact of his  

                                                                                                                                              

disability.35  We instructed that a "claimant need only prove that 'but for' the subsequent  

                                                                                                                                



           31         Id.   (quoting   Williams v. State, Dep't of Revenue                                 , 938 P.2d 1065, 1072         



(Alaska 1997)).   



           32          Cf. id. at 919 ("[S]omething cannot be 'the substantial cause' of a disability  

                                                                                                                                   

if it is not a cause at all.").  

                                    



           33          747 P.2d 528, 532-33 (Alaska 1987); see also id. at 532 n.8 (noting that  

                                                                                                                              

because the parties did not contest applicability of "the second aspect of the substantial  

                                                                                                                                

factor test," the decision did not discuss it).  

                                                                     



           34         Id. at 529-30.  

                                 



           35         Id. at 532-33.  

                                 



                                                                     -25-                                                                7456
  


----------------------- Page 26-----------------------

trauma the claimant would not have suffered disability at this time, or in this way, or to                                                     

this degree."        36  



                      Here,  to  show  that  the  work  at  ARCTEC  was  a  cause-in-fact  of  his  

                                                                                                                                             



disability and need for medical care, Traugott needed to establish that but for his work  

                                                                                                                                          



at ARCTEC he would not have suffered the disability at that time, in that way, or to that  

                                                                                                                                            



degree.  No one disputes that he did so.  The Board then needed to determine whether  

                                                                      



work was the most important of the identified causes of his disability and need for  

                                                                                                                                             



medical care.  

               



           C.          Substantial Evidence In The Record Supports The Board's Decision.  

                                                                                                                                  



                       The Commission decided that the Board committed legal error by asking  

                                                                                                                                       



Dr.Frey"misleading questions,"but it never identified which questions weremisleading  

                                                                                                                                



and how they were misleading.   The Commission quoted a number of questions the  

                                                                                                                           



Board asked Dr. Frey as well as the Board's instructions to her about Alaska workers'  

                                                                                                                                   



compensation law, but it did not identify which question or instruction it considered  

                                                                                                                            



legally unsound or explain why it was erroneous.  The Commission's failure to identify  

                                                                                                                                      



which SIMEquestion or instruction was erroneous makes its decision difficult to review.  

                                                                                                                                      



                      ARCTEC contends  that the Commission correctly determined that the  

                                                                                                                                             



Board committed legal error, but its argument is essentially a factual one.  ARCTEC  

                                                                                                                                 



cited the testimony of both Dr. Grimes and Dr. Yodlowski, whose opinions the Board  

                                                                                                      



gave less weight, to support its argument and offered its own interpretation of Dr. Frey's  

                                                                                                                                        



report.  

              



                      We have held in tort cases that "determinations of proximate cause usually  

                                                                                                                                       



involve questions of fact" and that "proximate cause becomes a matter of law only where  

                                                                                                                                         



           36  

                                 

                      Id. at 533.  



                                                                     -26-                                                                     7456  


----------------------- Page 27-----------------------

                                                   37  

reasonable minds cannot differ."                       The same analytical approach applies in workers'                  



                                                                                                         38                        39  

compensation,   as   previous   decisions   from   both   the   Commission                                                  

                                                                                                             and  this  court 



illustrate.       The new causation  standard  "remains flexible" and  "is necessarily  fact- 

                                                                                                                               

                   40   so the Board's determination of which cause is the most important or  

dependent,"                                                                                                       



material cause must be reviewed as a factual issue using the substantial evidence test.  

                                                                                                                               



                     The legislature requires the Commission to uphold the Board's findings of  

                                                                                                                                    

                                                                                                                41   Substantial  

fact "if supported by substantial evidence in light of the whole record." 

                                                                                                                     



evidence is "relevant evidence which a reasonable mind might accept as adequate to  

                                                                                                                                   

support a conclusion."42                 The Commission has used this precise wording  to define  

                                                                                                         

substantial evidence.43              And it has said in many past decisions that it "will not reweigh  

                                                                                                                          



conflicting evidence, determine witness credibility, or evaluate competing inferences  

                                                                                                     

                                                                                                          44  It has cited our  

from testimony because those functions are reserved to the Board."                                                               

                                                                                              



          37         Winschel  v.  Brown,   171  P.3d   142,   148  (Alaska  2007).  



          38         See,  e.g.,  Buchinsky  v.  Arc  of  Anchorage,  AWCAC  Dec.  No.   189,  at  9-10  



(Dec.  2,  2013),  http://labor.state.ak.us/WCcomm/memos-finals/D_189.pdf  (stating  that  

Commission  cannot  reevaluate  evidence  but  must  consider  whether  Board's  conclusions  

are  based  on  substantial  evidence).  



          39         See, e.g., Runstrom v. Alaska Native Med. Ctr., 280 P.3d 567, 575 (Alaska  

                                                                                                                           

2012) (affirming decision based on substantial evidence review).  

                                                                                         



          40        Morrison          v.   Alaska   Interstate             Constr.  Inc.,   440   P.3d   224,   238  

                                                                                                                               

(Alaska 2019).  

              



          41         AS 23.30.128(b) (emphasis added).  

                                                                               



          42         Childs v. Kalgin Island Lodge, 779 P.2d 310, 312 n.1 (Alaska 1989).  

                                                                                                                      



          43        Buchinsky, AWCAC Dec. No.  189 at 8.  

                                                                                



          44        E.g., Abonce v. Yardarm Knot Fisheries, LLC, AWCAC Dec. No.  111, at  

                                                                                                                                    

                                                                                                                 (continued...)  



                                                                -27-                                                          7456
  


----------------------- Page 28-----------------------

                                                                                                                           45  

decisions   about   substantial   evidence   as   the   ultimate   source   of   its   rule.                                     Prior  

Commission decisions are precedential for the Commission as well as the Board.                                                   46  



                     The  Commission  here  effectively  reweighed  the  evidence  by  drawing  

                                                                                                                             



inferences from and making conclusions about Dr. Frey's testimony that the Board did  

                                                                                                                                     



not make.           The  Board  considered  the  entirety  of  Dr.  Frey's  testimony,  identifying  

                                                                                                                        



specific parts of it to explain its decision.  Instead of looking at the Board's findings and  

                                                                                                                                     



considering whether those findings were supported by substantial evidencein light of the  

                                                                                                                                      



whole  record,  the  Commission  decided  that  part  of  Dr.  Frey's  medical  report  was  

                                                                                                                                    



substantial evidence to support a finding that the Board did not make, but a different part,  

                                                                                                                                    



which supported the Board's finding, was "not substantial evidence in the record as a  

                                                                                                                                         



whole because it [was] based on a misstatement of the law," which the Commission  

                                                                                                                      



never identified.  

                             



                     The  Commission's  legal  analysis  in  this  case  does  not  reflect  that  it  

                                                                                                                                        



considered the record as a whole when making its decision.  Our examination of the  

                                                                                                                                     



record shows that there is ample evidence a reasonable mind could accept as adequate  

                                                                                                             



to support the conclusion the Board made. We begin with Dr. Frey's hearing testimony,  

                                                                                                                          



which the Board explicitly cited, that more probably than not Traugott's preexisting  

                                                                                                                        



Charcot foot "would have been just fine for the rest of his life" had he not suffered the  

                                                                                                                                      



blister at work.  In addition Dr. Frey testified at her deposition that Traugott would have  

                                                                                                                                   



           44        (...continued)  



                                                                                                                                    

9 (June 17, 2009) (quoting Lindhag v. State, Dep't of Nat. Res., 123 P.3d 948, 952  

                           

(Alaska 2005)), http://labor.state.ak.us/WCcomm/memos-finals/D_111.pdf.  



           45        Id.  



           46        Alaska Pub. Interest Research Grp. v. State , 167 P.3d 27, 45 (Alaska 2007)  

                                                                                                                                 

(construing  AS  23.30.008(a)  to  mean  that  Commission  decisions  "serve  as  legal  

                                                                                                                                  

precedent for the Board and the Appeals Commission").  

                                                                  



                                                                  -28-                                                            7456
  


----------------------- Page 29-----------------------

                                                                                                                            

had about a 25% chance of developing Charcot foot without the work injury. And while  



                                                                                                                         

Dr. Frey indicated at the hearing that Traugott likely would have developed another  



                                                                           

diabetic ulcer, she emphasized that most people with diabetes and Charcot foot do not  



                                                                                                                    

develop  a  "diabetic  ulcer  with  infection."                        Dr.  Frey  identified  specific  aspects  of  



                                                                                                                                

Traugott's work at ARCTEC that contributed both to the blister formation and to the  



                                                                                                                                      

osteomyelitis: Dr. Frey testified that ladders and boots "put extra stress in the arch area,"  



                                                                                                                                 

and she observed that "generally people who have pain can rest" but that people can be  



                                                                                                                               

motivated to work "until they get to a point where they can't work through pain."  She  



                                                                                                                    

also said that Charcot foot can develop after "repetitive actions," so that repeatedly  



                                                                                                                                 

climbing  ladders  in  work  boots  could  also  have  contributed  to  the  worsening  of  



                                                                                                                                

Traugott's Charcot foot.  When asked about legal responsibility for the disability at the  



                                                                                                                               

hearing, Dr. Frey testified that work activities for ARCTEC were "not trivial" in and  



                                                                                                                            

"ha[d] responsibilities" for the development of Traugott's condition. Because the Board  



                                                                                                                    

acceptedDr.Frey'smedicalopinion thatosteomyelitisaccelerated Traugott'spreexisting  



                                                                                                                                  

Charcot foot to cause the talus's destruction, these opinions are substantial evidence to  



                                                                                                                         

support the Board's conclusion that Traugott's work was the most important or material  



                                                                            

cause of his disability and need for medical care.  



                                                                                                                       

                    Turning to the specific evidence the Commission relied on in its decision,  



                                                                                                                           

both  Dr.  Frey's  opinion  about  overall  causation,  which  the  Commission  found  



                                                                                                                      

persuasive, and her opinion that work was the substantial cause of Traugott's disability,  



                                                                                                                        

which the Commission rejected, were found in Dr. Frey's response to a single question  



                                                                                                                      

posed by the Board in the SIME. The Commission said that Dr. Frey's overall causation  



                                                                                                                            

opinion represented"[w]hen Dr. Frey properly weighed allcauses,"but Dr. Frey's report  



                                                                                                                                  

never identified any cause other than the work-related blister as the substantial cause of  



                                                                                                                              

the disability and need for medical care, indicating that the Commission drew its own  



                                                                                                               

inferences from her testimony.  This is not substantial evidence review.  



                                                               -29-                                                         7456
  


----------------------- Page 30-----------------------

                                                     Finally,   the   Commission   did   not   consider   the   Board's   analysis   of   the  



evidence, instead focusing its legal discussion on Dr. Frey's testimony and what the                                                                                                                                                                                                                                                       



Commission saw as its deficiencies.                                                                                                                For example, the Commission discussed what it                                                                                                                                                  



considered to be contradictions in her testimony and suggested that it was Dr. Frey's                                                                                                                                                                                                                                         



responsibility to weigh the various causation factors.                                                                                                                                                             While the Board gave Dr. Frey's                                                                            



testimony the most weight among the medical opinions before it, the Board - not                                                                                                                                                                                                                                                           



Dr. Frey or any other medical expert - was the fact finder in this case.                                                                                                                                                                                                                  The Board, not                                   



Dr. Frey, was required to consider the possible causes of Traugott's disability and need                                                                                                                                                                                                                                             



for medical treatment and determine which of the possible causes was the most important                                                                                                                                                                                                                           



in causing the disability and need for medical care. And the Board, not a medical expert,                                                                                                                                                                                                                                    



is charged with determining legal responsibility. Experts can provide opinions about the                                                                                                                                                                                                                                                    



ultimate question in a case, but the Board as the fact finder has the authority to interpret                                                                                                                                                                                                                          

an expert's opinion and decide what weight to give it.                                                                                                                                                                47  



                                                     In its decision the Board cited Commission precedent about applying the  

                                                                                                                                                                                                                                                                                                                                           



new causation standard and discussed Traugott's preexisting diabetes and neuropathy.  

                                                                                                                                                                                                                                                                                                                                                            



The Board clearly considered the preexisting conditions as potential causes in this case,  

                                                                                                                                                                                                                                                                                                                                                            



 saying those conditions "place[d] [Traugott] at significant risk for injury" and were  

                                                                                                                                                                                                                                                                                                                



"without question, significant factors in his disability and need for medical treatment"  



because without them, it was "highly unlikely" he would have suffered the injury he did.  

                                                                                                                                                                                                                                                                                                                                                            



TheBoard also mentioned Dr. Frey'soverallcausation opinion and ARCTEC's concerns  

                                                                                                                                                                                                                                                                                                                     



about her answers.  But the Board cited Dr. Frey's testimony about wearing boots and  

                                                                              



working on ladders in addition to her opinion that Traugott's Charcot foot would likely  

                                                                                                                                                                                                                                                                                                                                 



                           47                        AS   23.30.122   ("A   finding   by  the   board   concerning   the   weight   to   be  



accorded a witness's testimony,                                                                                                including medical testimony and reports                                                                                                                           , is conclusive     

even if the evidence is conflicting or susceptible to contrary conclusions." (emphasis                                                                                                                                                                                                                         

added)).  



                                                                                                                                                                    -30-                                                                                                                                                             7456
  


----------------------- Page 31-----------------------

"have been just fine" had it not been for his work at ARCTEC.                                                                   Weighing all of these             



factors, the Board concluded that "the May 2013 blister, together with the subsequent                                                                 



infection,   is   the   substantial   cause   of   [Traugott's]   disability   and   need   for   medical  



treatment."    



                           The Board did what it was required to do under the new causation standard                                                        



by   identifying   factors   contributing   to   the   disability   and   need   for   medical   care   and  

                                                                                                                                     48   Our review of the  

deciding which among them                               was the most material or important one.                                                                        



entire record and the Board's decision leads us to conclude that substantial evidence in  

                                                                                                                                                                         



the record supports the Board's decision that Traugott's work-related injury was the  

                                                                                                                                                                      



substantial cause of his disability and need for medical treatment.  

                                                                                                               



             D.            The Procedural Issues Are Moot.  

                                                                                     



                           In addition to his substantive claims, Traugott appealed and briefed several  

                                                                                                                                                               



procedural decisions the Commission made related to the stay and bond on appeal.  

                                                                                                                                                                              



Specifically, he contended that the Commission erroneously decided it was without  

                                                                                                                                                             



power to reconsider its non-final decisions, that the Commission erred in evaluating  

                                                                                                                                      



whether the appeal presented a "serious and substantial" question, that the amount of the  

                                                                                                                                                                       



bond was too low, and that the Commission improperly issued a default order.  

                                                                                                                                                               



                           We decided in another case that the Act does not prohibit the Commission  

                                                                                                                                                    

from reconsidering its own non-final orders.49   Because we reinstate the Board's award,  

                                                                                                                                                                



             48            See   Morrison   v.   Alaska   Interstate   Constr.   Inc.,   440   P.3d   224,   238  



(Alaska 2019).   



             49            Warnke-Green  v.  Pro-West  Contractors,  LLC,  440  P.3d  283,  290  

                                                                                                                                                                   

(Alaska 2019).  

                 



                                                                                  -31-                                                                            7456
  


----------------------- Page 32-----------------------

 Traugott would not be entitled to any further relief even if he prevailed on the procedural                                                                                                                                                                                                                      

 issues he raises, so those issues are moot.                                                                                                                           50  



 V.                         CONCLUSION  



                                                                                                                                                                                                                                                                                                                                            

                                                      We  REVERSE  the   Commission's  decision  and  REMAND  to  the  



                                                                                                                                                                                                                            

 Commission with instructions to reinstate the Board's order.  



                            50                         Ulmer v. Alaska Rest. & Beverage Ass'n                                                                                                                           , 33 P.3d 773, 776 (Alaska 2001)                                                                             



 (" 'We have further held that [a] case is moot if the party bringing the action would not                                                                                                                                                                                                                                                      

be entitled to any relief even if' it prevails." (alteration in original) (quoting                                                                                                                                                                                                                             Gerstein v.   

Axtell , 960 P.2d 599, 601 (Alaska 1998))).                                                                                                



                                                                                                                                                                       -32-                                                                                                                                                              7456
  

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