S056541, Opinion — SAIF v. Sprague

661
Argued and submitted May 18, decision of Court of Appeals and order of Workers'
Compensation Board affirmed August 27, 2009
In the Matter of the Compensation of
Edward G. Sprague, Claimant.
SAIF CORPORATION
and Jerry's Specialized Sales,
Petitioners on Review,
v.
Edward G. SPRAGUE
and United States Bakery,
Respondents on Review.
(Agency Nos. 00-07404, 01-01561;
CAA133701; SC S056541)
217 P3d 644
CJS, Workmen's Compensation§ 271.

662
On review from the Court of Appeals.*
David L. Runner, Salem, argued the cause and filed the
brief for petitioners on review.
Christopher Moore, Malagon, Moore and Jensen, Eugene,
argued the cause and filed the brief for respondent on review
Edward G. Sprague.
E. 	Jay 	Perry, 	Employers 	Defense 	Counsel, 	Eugene,
argued the cause and filed the brief for respondent on review
United States Bakery.
Before De Muniz, Chief Justice, and Gillette, Durham,
Balmer, Walters, and Kistler, Justices.**
BALMER,J.
The decision of the Court of Appeals and the order of the
Workers' Compensation Board are affirmed.
* On judicial review from an order of the Workers' Compensation Board. 221
Or App 413, 190 P3d 443 (2008).
** Linder, J., did not participate in the consideration or decision of this case.

Cite as 346 Or 661
BALMER,J.
This workers' compensation case requires us to
review the statutory classifications for medical conditions
and, in particular, to determine when an insurer is responsi-
ble for medical services necessary to treat those conditions.
Claimant sustained a workplace knee injury in 1976 and
received treatment for that injury. Nearly 25 years later, his
knee had deteriorated to the point that a physician recom-
mended knee replacement surgery. Before that surgery could
be undertaken, however, claimant had to lose weight. Claim-
ant's doctor recommended gastric bypass surgery, without
which the knee replacement surgery would not be effective,
and that surgery was performed in 2000. The insurer rejected
the claim for the gastric bypass surgery. The Court of
Appeals, in a series of opinions, eventually concluded that the
surgery was compensable. On review, we affirm the decision
of the Court of Appeals, although our analysis of the control-
ling statutes differs in some respects.
STATUTORY OVERVIEW
A brief overview will be helpful in understanding the
key statutory terms. ORS 656.245(1)(a), which we quote in
full below, makes employers (or their insurers) responsible,
in certain circumstances, for "medical services" necessary to
treat "conditions" that result from compensable workplace
injuries. Whether the expenses for those medical services are
compensable depends, in part, on characterizing the medical
conditions. Roughly speaking, the workers' compensation
statutes 	divide 	medical 	conditions 	into 	four 	categories:
(1) ordinary conditions; (2) preexisting conditions; (3) conse-
quential conditions; and (4) combined conditions.
ORS 	656.245(1)(a) 	prescribes 	generally 	when
expenses for medical services are compensable and deals
with each of those conditions:
"For every compensable injury, the insurer or the self-
insured employer shall cause to be provided medical serv-
ices for conditions caused in material part by the injury for
such period as the nature of the injury or the process of the
recovery 	requires, 	subject 	to 	the limitations 	in 	ORS

664
656.225, [which deals with preexisting conditions,] includ-
ing such medical services as may be required after a deter-
mination of permanent disability. In addition, for conse-
quential 	and 	combined 	conditions 	described 	in 	ORS
656.005(7), the insurer or the self-insured employer shall
cause to be provided only those medical services directed to
medical conditions caused in major part by the injury."
Thus, insurers generally are responsible for medical services
"for" conditions-that is, ordinary "conditions"-that are
"caused in material part" by compensable workplace injuries.
However, the statute sets different standards for compensa-
bility of the other three subsets of "conditions" described
above-preexisting, consequential, and combined.
As noted, ORS 656.245(1)(a) incorporates the limi-
tations on compensability of preexisting conditions-that is,
conditions that preexisted the workplace injury 1 -that are
provided in ORS 656.225. Under ORS 656.225, medical serv-
ices directed at treating only a preexisting condition gener-
ally are not compensable:
1 ORS 656.005(24) defines "preexisting condition":
"(a) 'Preexisting condition' means, for all industrial injury claims, any
injury, disease, congenital abnormality, personality disorder or similar condi-
tion that contributes to disability or need for treatment, provided that:
"(A) Except for claims in which a preexisting condition is arthritis or an
arthritic condition, the worker has been diagnosed with such condition, or has
obtained medical services for the symptoms of the condition regardless of diag-
nosis; and
"(B)(i) In claims for an initial injury or omitted condition, the diagnosis or
treatment precedes the initial injury;
"(ii) In claims for a new medical condition, the diagnosis or treatment pre-
cedes the onset of the new medical condition; or
"(iii) In claims for a worsening pursuant to ORS 656.273 or 656.278, the
diagnosis or treatment precedes the onset of the worsened condition.
"(b) 'Preexisting condition' means, for all occupational disease claims, any
injury, disease, congenital abnormality, personality disorder or similar condi-
tion that contributes to disability or need for treatment and that precedes the
onset of the claimed occupational disease, or precedes a claim for worsening in
such claims pursuant to ORS 656.273 or 656.278.
"(c) For the purposes of industrial injury claims, a condition does not con-
tribute to disability or need for treatment if the condition merely renders the
worker more susceptible to the injury."

Cite as 346 Or 661 (2009) 	665
"In accepted injury or occupational disease claims, * * *
medical services solely directed to a worker's preexisting
condition are not compensable unless:
"(1) 	In occupational disease or injury claims other
than those involving a preexisting mental disorder, work
conditions or events constitute the major contributing
cause 	of a 	pathological 	worsening of the 	preexisting
condition.
"(2) 	In occupational disease or injury claims involving
a preexisting mental disorder, work conditions or events
constitute the major contributing cause of an actual wors-
ening of the preexisting condition and not just of its
symptoms.
"(3) 	In medical service claims, the medical service is
prescribed to treat a change in the preexisting condition as
specified in subsection (1) or (2) of this section, and not
merely as an incident to the treatment of a compensable
injury or occupational disease."
Similarly, ORS 656.245(1)(a) incorporates the limi-
tations related to consequential and combined conditions
provided 	in 	another 	statute, 	ORS 	656.005(7)(a). 	ORS
656.005(7)(a) both defines "compensable injury" and provides
limits on the compensability of consequential and combined
conditions:
"A 'compensable injury' is an accidental injury, or acci-
dental injury to prosthetic appliances, arising out of and in
the course of employment requiring medical services or
resulting in disability or death; an injury is accidental if the
result is an accident, whether or not due to accidental
means, ifit is established by medical evidence supported by
objective findings, subject to the following limitations:
"(A) 	No injury or disease is compensable as a conse-
quence of a compensable injury unless the compensable
injury is the major contributing cause of the consequential
condition.
"(B) 	If an otherwise compensable injury combines at
any time with a preexisting condition to cause or prolong
disability or a need for treatment, the combined condition is
compensable only if, so long as and to the extent that the
otherwise compensable injury is the major contributing
cause of the disability of the combined condition or the

666 	SAIF v. Sprague
major contributing cause of the need for treatment of the
combined condition."
(Emphases added.) ORS 656.245(1)(a) incorporates those
limits into the compensability of medical services claims by
providing that, in the case of consequential and combined
conditions, the insurer is responsible for only those medical
services that are "directed to medical conditions caused in
major part by the [compensable] injury."
FACTS
Claimant compensably injured his left knee in 1976,
while working for Jerry's Specialized Sales, an employer
insured by SAIF. At that time, claimant weighed 225 pounds.
SAIF accepted claimant's claim, and in December 1976,
claimant underwent a meniscectomy to repair a torn left lat-
eral meniscus. SAIF ultimately closed the claim with an
award of 10 percent scheduled disability.
By 	1996, 	claimant 	weighed 	approximately
320 pounds, and by 1998, his left knee had become sympto-
matic again. In February 1999, claimant again injured his
left knee while working for United States Bakery, a self-
insured employer. In November 1999, Gates McDonald,
which administered United States Bakery's workers' com-
pensation claims, accepted claimant's claim for his new
injury-"disabling cartilaginous fragments of the left knee."
In January 2000, Gates McDonald modified its acceptance to
specify that the accepted claim was a combined condition
involving claimant's preexisting left knee problems; Gates
McDonald later denied compensation for that combined
condition.
In April 2000, claimant's doctor sought preapproval
from Gates McDonald for gastric bypass surgery to treat
claimant's "severe morbid obesity." In May 2000, claimant
underwent the gastric bypass surgery, at which time he
weighed 	approximately 	350 	pounds. 2 	However, 	Gates
The Court of Appeals stated that the gastric bypass was performed in
January 2001, most likely because the board's order states that the surgery was
performed in January 2001. SAIF notes that the surgery actually occurred in May
2000. The record supports SAIF's assertion, and the contrary statement in the

Cite as 346 Or 661 (2009) 	667
McDonald denied claimant's gastric bypass claim, asserting
that claimant's 1999 injury was not the major cause of claim-
ant's current knee condition or his need for gastric bypass.
Claimant then requested that SAIF expand its acceptance of
his original 1976 injury claim to include "pre-morbid obesity
and the need to perform gastric bypass." Claimant also had
previously requested that SAIF expand its acceptance to
include several other knee conditions. SAIF amended its
acceptance to include "consequential arthritis of the lateral
compartment, 	left knee." However, 	it denied 	claimant's
request to include the need for gastric bypass, asserting that
claimant's obesity preexisted the 1976 injury and that, as a
result, the claim was not compensable under ORS 656.225.
As noted, ORS 656.225 provides that medical services "solely
directed to a worker's preexisting condition" generally "are
not compensable."
Claimant sought a hearing. The administrative law
judge (ALJ) concluded that claimant's morbid obesity was not
a preexisting condition because there was "no persuasive evi-
dence that claimant's weight played a contributory role in his
left knee condition until he became morbidly obese after the
1976 injury." After determining that claimant did not have a
preexisting condition, the ALJ noted that claimant could not,
"by definition," have a combined condition because a "com-
bined condition" involves the combination of a compensable
injury with a preexisting condition. See ORS 656.005(7)(a)(B)
(describing "combined condition"). After concluding that nei-
ther ORS 656.225 nor ORS 656.005(7)(a)(B) applied, the ALJ
stated that the relevant determination was whether the gas-
tric bypass was "necessary to allow for more directly-related
treatment for [the 1976] injury," citing Williams u. Gates,
McDonald & Co., 300 Or 278, 709 P2d 712 (1985). 3 Applying
that standard, the ALJ concluded that claimant's gastric
bypass was compensable because it was necessary for his
anticipated knee replacement surgery to be successful.
Court of Appeals opinion and the board's order appears to he a mistake. In any
event, the date of the surgery is not relevant to the issue on review, except to pro-
vide factual context.
" The ALJ did not mention ORS 656.245(l)(a).

The Workers' Compensation Board reversed the
ALJ's order concerning claimant's medical services claim for
the gastric bypass. 4 The board agreed that ORS 656.225, the
exclusion for preexisting conditions, did not apply, but for a
different reason than the ALJ. The board noted that the med-
ical evidence demonstrated that claimant's 1976 injury con-
tributed, at least in part, to his need for gastric bypass. Thus,
claimant's obesity was not the "sole[ ]" cause of the need for
gastric bypass, and ORS 656.225 did not apply. See ORS
656.225 ("[M]edical services solely directed to a worker's pre-
existing condition [ordinarily] are not compensable * * *."
(Emphasis added.)). Indeed, the board appears to have deter-
mined, contrary to the ALJ, that claimant's obesity did pre-
exist the 1976 injury; it supplemented the ALJ's findings of
fact in part by noting that "[c]laimant is genetically predis-
posed to obesity."
Further, the board concluded that the gastric bypass
was not compensable under ORS 656.245(1)(a). The board
characterized 	claimant's 	medical 	services 	claim 	as 	one
involving a "consequential condition" and stated that, as a
result, "claimant must prove that his compensable knee
injury was the major contributing cause of his need for gas-
tric surgery." The board 	acknowledged that the gastric
bypass surgery "was performed in part to treat [claimant's]
left knee condition (which is due largely to the 1976 work
injury * * *)." (Footnote omitted.) The board also acknowl-
edged that two doctors had opined that "the major contribut-
ing cause of his need for [gastric bypass] surgery* * *was his
left knee condition," but determined that those opinions were
"unpersuasive" because they were "inadequately explained";
that is, the doctors "never explained why [they] believe[d]
that the knee condition contributed more to the need for gas-
tric surgery than did the preexisting genetically determined
obesity." (Emphasis in original.) Lacking any "persuasive"
evidence that claimant's knee condition was the "major
cause" of his need for gastric bypass, the board concluded
that claimant had failed to demonstrate that the gastric
bypass was "directed to medical conditions caused in major
4 In a separate order issued the same day, the board also denied claimant's
"new medical condition claim" for obesity. Claimant did not seek review of that
order.

Cite as 346 Or 661 	669
part by the [compensable] injury," as required by the second
sentence of ORS 656.245(1)(a).
Claimant 	sought judicial 	review. 	The 	Court 	of
Appeals disagreed with the board's characterization of the
claim as one for a consequential condition:
"[A] consequential condition is a separate condition that
arises from the compensable injury, for example, when a
worker suffers a compensable foot injury that results in an
altered gait that, in turn, results in back strain. Here,
claimant's obesity is a separate condition, but the board
found that claimant was 'genetically predisposed to obe-
sity.' Moreover, it did not find that claimant's obesity arose
from claimant's knee condition, which is required for it to be
a consequential condition of an accepted condition. The
statutory definition of a 'consequential condition' is not sat-
isfied, as the board reasoned, simply because the gastric
bypass surgery was performed, in part, to treat claimant's
obesity and, in part, to treat his knee condition."
Sprague u. United States Bakery, 199 Or App 435, 440, 112
P3d 362 (2005) (Sprague I) (internal quotation marks omit-
ted). Instead, the court concluded that "the 1976 knee injury
and the development of arthritis in that knee constitute an
accepted combined condition that now requires total knee
replacement surgery." Id. (emphasis in original). The court
determined that the first sentence of ORS 656.245(1)(a),
rather than the second sentence, applied, so that the issue on
remand actually was whether the gastric bypass was a med-
ical service for a condition that was "caused in material part"
by the 1976 knee injury. Id. at 440-41.
SAIF petitioned for reconsideration, arguing that,
because the Court of Appeals had labeled claimant's condi-
tion a "combined" condition, the second sentence of ORS
656.245(1)(a) still applied. See ORS 656.245(1)(a) (second
sentence describes consequential and combined conditions).
The Court of Appeals issued another opinion to clarify its rea-
soning. Sprague u. United States Bakery, 200 Or App 569,
116 P3d 251 (2005) (Sprague II). The court began by explain-
ing that the "condition" that the court was classifying was
"claimant's knee condition, i.e., the need for a total knee
replacement." Id. at 572. The court then withdrew any word-
ing from its prior decision implying that claimant's obesity

670 	SAIF v. Sprague
condition was 	a 	combined condition. 	Finally, 	the 	court
explained its reasoning again:
"To summarize, we read the two sentences in ORS
656.245(1)(a) to mean the following: They describe three
categories of conditions for which medical expenses are
compensable. In the first category, employers and insurers
are responsible for medical services for conditions caused in
material part by the compensable injury. In the second and
third categories, they are also responsible for medical serv-
ices for consequential and combined conditions so long as
the [need for] medical services [isl caused in major part by
the compensable injury. The second sentence of the statute
does not apply to claimant's circumstances because claim-
ant's obesity is neither a combined condition nor a conse-
quential condition as defined by ORS 656.005(7)(a). That is
why we said in our former opinion that, on remand, the
board must consider whether claimant's medical services
claim was for a condition (claimant's obesity) that was
caused in material part by his compensable injury. It is also
why SAIF's harmless error argument based on the second
sentence of the statute is misplaced. It may be that the
board will ultimately conclude that the medical services
were not for a condition that was 'caused in material part'
by his compensable condition, but it must make that deter-
mination without conflating the requirements of the two
sentences in the statute."
Id. at 573-74 (footnote omitted).
On remand, the board ruled in favor of claimant,
holding that his medical services claim for the gastric bypass
surgery was compensable. The board adopted the ALJ's find-
ings of fact, supplemented by a finding that claimant's com-
pensable 1976 left knee injury was a material cause of his
need for gastric bypass. In making that determination, the
board relied on the opinions of two doctors that "the major
contributing cause of [claimant's] need for [gastric bypass]
surgery* * *was his left knee condition." (Internal quotation
marks omitted.) The board also noted the opinion of a third
doctor that gastric bypass was "a well indicated and reason-
able treatment for [claimant's] left knee condition." (Internal
quotation marks omitted; bracketed material in original.)
Because the board found that claimant's compensable left
knee injury was a "material cause" of his need for gastric

Cite as 346 Or 661 (2009) 	671
bypass, the board held that claimant's medical services claim
was compensable.
SAIF and Jerry's Specialized Sales sought judicial
review, and the Court of Appeals issued a third opinion. SAIF
v. Sprague, 221 Or App 413, 190 P3d 443 (2008) (Sprague
III). The majority concluded that the board had complied
with the remand instructions and affirmed the board's deci-
sion. The majority reiterated its earlier conclusion that serv-
ices for treating a noncompensable condition are, never-
theless, 	compensable 	under 	the 	first 	sentence 	of ORS
656.245(1)(a) "ifthe treatment of the noncompensable condi-
tion is necessary to the treatment of a condition materially
caused by the compensable injury." Id. at 426. Because the
board had concluded that the treatment of the obesity condi-
tion was necessary to the treatment of the knee condition, it
was compensable.
Chief Judge Brewer agreed with the majority's hold-
ing, but wrote a concurring opinion in which he stated that
the 	court's 	application 	of 	the 	first 	sentence 	of 	ORS
656.245(1)(a) might be wrong. He first explained that the rel-
evant "condition" was claimant's current arthritic knee con-
dition-not claimant's obesity. He then noted that the major-
ity incorrectly had characterized that condition merely as an
ordinary "condition" rather than as a "consequential condi-
tion." He explained that the arthritic knee condition was a
consequential condition "because the arthritis developed as a
consequence of claimant's compensable 1976 injury." Id. at
429 (Brewer, C. J., concurring). Thus, the second sentence of
ORS 656.245(1)(a) applied, and claimant was required to
show 	that 	the 	medical 	condition-claimant's 	current
arthritic knee condition-was "caused in major part by" the
compensable injury-claimant's 1976 injury. Chief Judge
Brewer then concluded that "the board correctly analyzed the
matter in its first order in this case by requiring proof that
claimant's 1976 knee injury is the major contributing cause
of his current arthritic knee condition." Id. at 430. Nonethe-
less, he agreed with the result reached by the majority,
because the court's earlier decisions had become the law of
the case. Id. at 432.

SAIF and Jerry's Specialized Sales sought review in
this court, which we allowed.
ANALYSIS
We begin by reviewing the relevant facts using the
terminology of the statutes. The "compensable injury" here is
claimant's original meniscus tear, caused by a workplace
accident in 1976. As a result of that injury, claimant under-
went surgery, which later caused arthritis to develop in his
knee. His current arthritic knee-not his obesity-is the
"condition" with which we are concerned. On the other hand,
the specific "medical service" for which claimant seeks com-
pensation is the gastric bypass surgery. 5 The true question
here is whether the surgery is a 	compensable medical
expense for the treatment of the condition.
As discussed above, the statute governing claimant's
medical services claim, ORS 656.245(1)(a), treats ordinary
"conditions" differently than consequential and combined
conditions; as a result, we next must classify claimant's
arthritic knee condition. Claimant presented his claim for the
arthritic knee condition as a consequential condition, and
SAIF accepted the claim as "consequential arthritis of the lat-
eral compartment, left knee." (Emphasis added.) The board
similarly classified claimant's claim as "a claim for medical
services for a consequential condition" and noted that his cur-
rent arthritic knee condition was "due largely to the 1976
work injury." We agree with the board and the parties that
claimant's arthritic knee condition is best classified as a con-
sequential condition. The medical evidence in the record sup-
ports the board's conclusion that claimant's current arthritic
knee condition is "a consequence of' claimant's original 1976
surgery, which in turn was performed as "a consequence of'
his 	compensable 	1976 injury. 	See 	ORS 656.005(7)(a)(A)
(describing "consequential condition").
Because 	claimant's 	arthritic 	knee 	condition 	is
a 	consequential condition, 	the 	second sentence of ORS
5 The record does not disclose whether claimant had knee replacement surgery
to treat his arthritic knee. However, no party disputes that such surgery would
have been compensable.

Cite as 346 Or 661 (2009) 	673
656.245(1)(a) governs the compensability of the medical serv-
ices here. As described above, that sentence provides that, for
consequential conditions, "the insurer or the self-insured
employer shall cause to be provided only those medical serv-
ices directed to medical conditions caused in major part by the
injury." (Emphasis added.) In other words, two requirements
must be met for claimant's medical services to be compensa-
ble: claimant must demonstrate that (1) his current arthritic
knee condition was "caused in major part" by his compensa-
ble 1976 injury, and (2) the gastric bypass surgery was
"directed to" his current arthritic knee condition.
Much of the dispute in this case has centered around
the applicable causation standard-"material" cause (from
the first sentence of ORS 656.245(1)(a)) or "major" cause
(from the second sentence of ORS 656.245(1)(a)). 	SAIF
argues that claimant's medical services claim must fail
because he has not demonstrated that "his 'condition' of mor-
bid obesity was 'caused in major part' by his 'compensable
injury.' " (Emphasis added.) The board similarly focused on
the applicable standard of causation. In its original order, the
board stated that, to qualify for compensation, "claimant
must prove that his compensable knee injury was the major
contributing cause of his need for gastric surgery." (Emphasis
added.) 	On 	remand, 	the 	board, 	following 	the 	Court of
Appeals, altered its terminology by describing the first sen-
tence of ORS 656.245(1)(a) as requiring proof that "claimant's
compensable left knee injury was a material cause of his need
for gastric bypass surgery." (Emphasis added.) In our view,
however, neither the board's analysis nor SAIF's analysis
accurately describes either the condition at issue here or the
wording of the statute.
As we have noted, the "condition" at issue here is
claimant's arthritic knee, not his morbid obesity. The board
rejected claimant's "new medical condition claim" for his obe-
sity, claimant did not appeal that order, and it is not before us
on review. Thus, SAIF's argument that claimant must show
that his obesity was caused by his compensable 1976 injury is
misplaced. Instead, claimant must demonstrate that his cur-
rent arthritic knee condition was caused by his compensable
1976 injury.

674 	SAIF v. Sprague
The board's orders were incorrect for a different rea-
son. The board incorrectly required that claimant's compen-
sable injury be the major contributing cause of claimant's
need for medical services. That is not what the statute
requires. The plain wording of the statute requires that the
compensable injury be the major cause of the relevant medi-
cal condition. ORS 656.245(1)(a). The medical services, in
turn, must be "directed to" that medical condition. Id. There
is no requirement that the need for medical services be
directly "caused by" the original compensable injury at all.
We return to the issue of the characterization and
cause of claimaint's current condition. As noted, claimant's
current arthritic knee condition is a consequential condition.
Therefore, for the medical services to be compensable under
ORS 656.245(1)(a), that condition must have been "caused in
major part by" claimant's compensable 1976 injury. See ORS
656.245(1)(a) (stating requirement). SAIF does not dispute
that claimant's current arthritic knee condition was caused
in major part by his 1976 injury. Indeed, SAIF acknowledged
that claimant's arthritic knee condition was caused in major
part by his compensable 1976 injury when it accepted the
arthritic knee as a compensable consequential condition. See
ORS 656.005(7)(a)(A) ("No injury or disease is compensable
as a consequence of a compensable injury unless the compen-
sable injury is the major contributing cause of the consequen-
tial condition.").
The only remaining issue is whether the "medical
services" at issue here-the gastric bypass surgery-were
"directed to" claimant's current arthritic knee condition. On
remand, the board pointed to the "unrebutted" opinions of
several doctors that claimant's gastric bypass was performed
for the purpose of treating his knee condition. One doctor, for
example, described gastric bypass as a "well indicated and
reasonable treatment for [claimant's] left knee condition."
The board also accepted, in its original order, "the undisputed
evidence" that the gastric bypass was necessary for the suc-
cess of claimant's knee replacement surgery. The evidence
relied upon by the board demonstrates that the bypass sur-
gery was "directed to" claimant's current arthritic knee con-
dition: the surgery was performed as part of the treatment
intended to ameliorate the worsening condition of claimant's

Cite as 346 Or 661 (2009) 	675
knee, and the weight loss was necessary to the effective treat-
ment of claimant's knee. Substantial evidence supported the
board's factual findings. Therefore, the claim for bypass sur-
gery should have been allowed.
We emphasize that the sole question before us is
whether the gastric bypass surgery was "directed to" claim-
ant's current arthritic knee condition, which was caused
in 	major 	part 	by 	his 	compensable 	1976 	injury. 	ORS
656.245(1)(a) does not limit the compensability of medical
services simply because those services also provide incidental
benefits or help to treat other medical conditions that were
not caused by the compensable injury. The fact that the gas-
tric bypass also treated claimant's morbid obesity as a nec-
essary incident of effectively treating his knee condition does
not affect the resolution of the compensability of his medical
services claim. Because the gastric bypass was "directed to"
claimant's current arthritic knee condition, we need not
express an opinion as to the classification or cause of claim-
ant's morbid obesity. It is not relevant to the issue before us.
The decision of the Court of Appeals and the order of
the Workers' Compensation Board are affirmed.