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Bocalbos v. Kapiolani Medical Center for Women and Children v. John Mullen & Co.11/16/1999
We hold in this appeal from the March 14, 1997 "Second Amended Order and Decision" of the Labor and Industrial Relations Appeals Board (the board) by Claimant-Appellant Mila Bocalbos (Bocalbos) that Bocalbos was entitled to medical care, services, and supplies as "the nature of injury require " pursuant to Hawaii Revised Statutes (HRS) § 386-21 (1985). Accordingly, while we respect the board's extensive efforts to resolve her claim, we believe the board's denial of coverage for orthodontic , orthopedic, and prosthodontic treatments claimed by Bocalbos as necessary for treatment of a temporomandibular joint (TMJ) disorder or syndrome (TMJD) was clearly erroneous and wrong. We hold further that HRS § 386-85 (1985) applies to Bocalbos's claim for medical treatment and that Employer-Appellee Kapiolani Medical Center for Women and Children (Kapiolani) and Insurance Carrier-Appellee John Mullen & Co. (collectively, Employer ) failed to rebut the presumption that her claim was for a covered work injury.
I.
"Temporomandibular joint syndrome" is defined as a dysfunction of the temporomandibular joint marked by a clicking or grinding sensation in the joint and often by pain in or about the ears, muscle tiredness and slight soreness upon waking, and stiffness of the jaw or actual trismus; it results from mandibular overclosure, condylar displacement, or stress, with deforming arthritis an occasional factor.
The Sloane-Dorland Annotated Medical-Legal Dictionary 696 (West 1987). The TMJs connect the mandibula, or the jaw bone, with the skull. See id. at 431.
A.
The following relevant evidence is obtained from the record.
It appears that at some point prior to July 25, 1986, the date of the subject work injury, Bocalbos was apparently missing ten upper teeth and two lower teeth. It is not clear whether some of the teeth were missing at different points in time. According to a January 12, 1989 report by Alan Sue, D.D.S. (Sue), Arthur Kamisugi, D.D.S. (Kamisugi) treated Bocalbos in 1974 for "lower arch[ ] malocclusion" by "uprighting of posterior teeth" and in 1978 Bocalbos was "placed on a retainer and active treatment was terminated." Sue indicated that Bocalbos had an upper partial denture which had replaced the missing upper teeth. Sue also reported there was no evidence of any [TMJD] between the last treatment by Kamisugi and the date of the work injury. At a hearing before the board on her claim herein, Bocalbos denied any "jaw, TMJ dental problems" prior to the subject injury.
On July 25, 1986, Bocalbos was employed as a part-time medical technician with Kapiolani. While at work, Bocalbos was injured when water-soaked ceiling tiles fell on her neck and shoulder. That day, she was examined by Brian Kutsunai, M.D. (Kutsunai), an "occu-med" physician, whose diagnosis was that Bocalbos suffered cranial and shoulder contusions; however, Kutsunai declared her fit to return to "regular" work "on 7/25/86," the same day as the incident.
On August 6, 1986, Bocalbos saw Thomas Walinski, M.D. (Walinski), an orthopedic surgeon. She complained of a headache and pain in her neck area and he treated her with a soft neck collar. Walinski referred Bocalbos to James Pierce, M.D. (Pierce), a neurologist, regarding the headaches. In his August 23, 1986 consultative report to Walinski, Pierce stated, "At most, [Bocalbos] could have suffered an extremely mild concussion considering the mechanism of injury which she described. These symptoms should clear rather quickly."
Bocalbos however continued to experience problems with "headaches and crunching and popping in her neck." Walinski next ordered physical the
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