Source: https://casetext.com/case/alayon-v-urban-mgmt-corp
Timestamp: 2019-04-24 22:18:23+00:00

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Alayon v. Urban Mgmt. Corp.
Shallene ALAYON, Claimant–Appellant, v. URBAN MANAGEMENT CORP., and Hawaii Employers' Mutual Insurance Co. Inc., Employer/Insurance Carrier–Appellee.
Appeal from the Labor and Industrial Relations Appeal Board (Case No. AB 2008–221 (2–05–10803)).Wayne H. Mukaida, on the briefs, for Claimant–Appellant.Kenneth T. Goya J. Thomas Weber Monica K. Suematsu (Ayabe, Chong, Nishimoto, Sia & Nakamura LLLP), on the briefs, for Employer/Insurance Carrier–Appellee.
Appeal from the Labor and Industrial Relations Appeal Board (Case No. AB 2008–221 (2–05–10803)).
Wayne H. Mukaida, on the briefs, for Claimant–Appellant. Kenneth T. Goya J. Thomas Weber Monica K. Suematsu (Ayabe, Chong, Nishimoto, Sia & Nakamura LLLP), on the briefs, for Employer/Insurance Carrier–Appellee.
NAKAMURA, C.J., and FUJISE and GINOZA, JJ.
Claimant–Appellant Shallene Alayon (Alayon) was employed by Employer–Appellee Urban Management Corporation (Urban Management) as a services coordinator. Alayon sought workers' compensation benefits after she slipped and fell at work in August 2005. Alayon had previously been injured in a non-work-related motor vehicle accident in 1999. Although acknowledging that Alayon sustained some injuries from her work-related fall, Urban Management and Insurance Carrier–Appellee Hawaii Employers' Mutual Insurance Company, Inc. (collectively, “Employer”) contested the extent of the injuries Alayon claimed were work-related. The main dispute between the parties is whether Alayon's asserted injuries are attributable to her work accident and therefore compensable or whether they are attributable to pre-existing conditions, including injuries she sustained in the motor vehicle accident, and therefore non-compensable.
Alayon appeals from the Decision and Order entered by the Labor and Industrial Relations Appeals Board (Board). The Board concluded in relevant part that: (1) Employer may be liable for Alayon's left knee condition after November 5, 2007, however, the nature and extent of the injury must be determined by the Director of the Department of Labor and Industrial Relations (Director) (Conclusion of Law (COL) 1); (2) Alayon is not entitled to treatment under Dr. Scott McCaffrey's January 11, 2008, treatment plan for a neurological consult with Dr. Ray Romero (COL 2); (3) Alayon is not entitled to, and Employer is not liable for, temporary total disability (TTD) benefits from June 8, 2007, through November 20, 2009 (COL 3); and (4) the Board would not decide whether Employer was entitled to a credit against future permanent partial disability (PPD) benefits, if any, for indemnity benefits paid from January 11, 2006, to June 7, 2007, and would leave that determination to the Director (COL 4).
On appeal, Alayon contends that the Board erred in each of these conclusions and in certain findings of fact made in support of the conclusions. As explained in greater detail below, we hold that: (1) with respect to COL 1 and COL 4, the Board did not render a final decision for this court to review, and we decline to address the issues raised by Alayon regarding COL 1 and COL 4 in the absence of a final decision by the Board; (2) COL 2 is affirmed; (3). COL 3 is vacated on the ground that the Board must decide a claim for TTD benefits on the merits and cannot deny Alayon's claim for TTD benefits based solely on the asserted failure of her physicians to submit disability certifications in the proper form. We remand the case for further proceedings consistent with this Memorandum Opinion.
Alayon's injuries and physical conditions that preexisted her August 2005 work-related fall are as follows.
Alayon had a history of left knee problems since she was a teenager, including the clicking and buckling of the knee. In a February 3, 2005, medical note, Jeffrey Lee, M.D., an orthopedic surgeon, documented his suspicion that Alayon had a left knee medial meniscal tear. On May 17, 2005, Dr. Lee scheduled Alayon for knee surgery, to perform an arthroscopy and meniscal tear resection, but Alayon cancelled the surgery.
In July 1999, Gregory H. Chow, M.D., an orthopedic surgeon, noted that Alayon complained of headaches, and he diagnosed her condition as “cervical strain whiplash” and “post whiplash headaches.” In a February 2001 medical report, Todd T. Tasaki, D.D.S., stated that Alayon complained of headaches “four plus times per week on average[.]” Thomas McNorton, M.D., a neurologist, conducted electrodiagnostic testing on May 3, 2001, May 10, 2001, and September 24, 2003, which revealed C7 radiculopathy, right L5 radiculopathy, and right S1 radiculopathy, respectively. Dr. McNorton's notes also reveal that Alayon complained of headaches during visits in 1997, 1998, 1999, and 2001.
C7, L5, and S1 refer to various numbered vertebrae of the spine, with “C” standing for cervical, “L” for lumbar, and “S” for sacrum. See Hart v. Van Zandt, 399 S.W.2d 791, 793 (Tex.1965).
A March 10, 2004, letter from Dr. Lee stated that Alayon may be a candidate for back surgery after her pregnancy if her neck and low back conditions persisted. His diagnoses were cervical disc protrusion at C5–6 and disc herniation and degeneration at L5–S1. Alayon's medical records also included a March 4, 2004, patient registration which indicated that Alayon was “pending back surgery” and had been in this status for four years.
On August 23, 2005, Alayon slipped and fell at work. Alayon reported that her feet went out and she landed on her left buttock, left wrist, and left hand. She also claimed that she hit her head against a stone wall outside the elevator door.
After her fall, Alayon sought treatment from her primary care physician, Fortunata Gozun, M.D., who referred her to WorkStar Occupational Health Services (WorkStar), where she was treated by Scott McCaffrey, M.D., and others. Dr. McCaffrey noted that on August 23, 2005, Alayon complained about pain to her neck, right lower back, right buttock, left thigh, left wrist and hand, all at a 5/10 level of severity. His diagnostic assessment of Alayon included: “1. Cervical strain/sprain. 2. Closed head injury-possible concussion. 3. Lumbosacral strain/sprain (rule out internal derangement) with a previous history of an MVA [ (motor vehicle accident) ] in 1999 with disc derangement. 4. Left wrist strain/sprain. 5. Upper extremity neuroesthesias, left greater than right. 6. Left knee dysfunction with history of ligamental tear.” (Formatting altered.) Dr. McCaffrey prescribed Relafen and physical therapy. With respect to work, Alayon was placed on “off duty” status, but was given “the option to work full duty.” Thereafter, Alayon continued to seek treatment through WorkStar.
After her work accident, Alayon returned to work for Urban Management, but stopped working there in October 2005. According to Alayon, she started working for a different employer on June 8, 2009, stopped working on February 26, 2010, and was terminated in April 2010.
Following a hearing on January 11, 2006, the Director issued Decision # 1 on February 16, 2006, which determined that Alayon sustained injuries to her head, neck, back, left wrist, left knee, left hip, and left buttock as the result of her work accident. In Decision # 1, the Director ruled that: (1) Employer must provide benefits to Alayon for “such medical care, services and supplies as the nature of the injury may require”; (2) Alayon was entitled to TTD benefits from November 14, 2005, through January 10, 2006, at a weekly compensation rate of $415.35; (3) Employer was liable for a 20% penalty under Hawaii Revised Statutes (HRS) § 386–92 for failure to pay TTD; and (4) matters of permanent disability and/or disfigurement would be determined at a later date.
Employer had suspended its payment of TTD benefits to Alayon on November 14, 2005, based on its allegation that Alayon had obstructed the completion of IMEs scheduled by Employer. The Director found that Alayon had not obstructed the IMEs and that Employer was not entitled to unilaterally suspend payment of TTD benefits without a ruling by the Director on the obstruction allegation.
Between the date of the hearing on and the issuance of Decision # 1, Employer notified Alayon by letter to her lawyer dated January 19, 2006, that it would “commence weekly indemnity payments starting on January 11, 2006 until such a time the Director issues a Decision from the hearing. These payments are made in order not to prejudice [Alayon] of the need of workers' compensation benefits while we await the Director's Decision.” Employer included a check in the amount of $1,214.85 and stated that the “payments are made under protest ” and are considered by Employer as “advance PPD benefits.” The letter also informed Alayon that “[i]n the event the Decision is adverse to [Alayon], we will terminate the benefits immediately. At that point, we shall seek a reimbursement from [Alayon] or shall assert a credit against PPD.” The letter stated that it was written pursuant to HRS § 386–52 and Hawai‘i Administrative Rules (HAR) § 12–10–24. Employer's letter did not inform Alayon that she had the right to file a written request for a hearing to submit evidence to dispute the Employer's request for a credit.
With respect to Alayon's left knee, Dr. Endicott opined that her left knee condition was not caused or aggravated by her slip and fall as there were no documented left knee complaints related to the slip and fall and her medical records from Dr. Lee showed that her left knee pathology predated her slip and fall.
Dr. Endicott prepared a supplemental IME report on July 12, 2006. He noted that based on his comparison of the January 4, 2006, a.nd September 3, 2003, MRIs of Alayon's lumbar spine, he concluded that the more recent January 2006 MRI did not reveal “evidence of any enlargement or worsening of the disc herniation which has been chronic since 2001.” Dr. Endicott opined that “there is no evidence of a permanent aggravation of [Alayon's] pre-existing [lumbar] condition[,]” which appeared to be “returning to pre-[work]-injury baseline status[.]” Dr. Endicott noted that Alayon would be medically stable and ratable as to her low back condition after she completed her course of physical therapy.
At the onset of the hearing, [Employer] attempted to deny compensability of the left knee condition based on the opinion of Dr. Endicott. However, the Hearings Officer advised [Employer's] representative that in the initial Decision, the Director found the left knee condition to be a compensable injury of this incident. Therefore, in the absence of an appeal, [Employer] is not allowed to re-litigate this aspect at this time.
[Employer] has denied any further care for the head contusion, cervical strain and left wrist sprain based on the opinion of Dr. Endicott that these conditions have resolved. Dr. Endicott has also documented that [Alayon's] headache complaints remain, but the neurological examination was normal and [Alayon] does have a pre-existing history. Any of [Employer's] denials based on treatment plans which have gone uncontested shall remain denied. However, as previously discussed, [Employer] shall not be allowed to deny care for the left knee based on the opinion of Dr. Endicott that the knee was not injured in this incident. By Decision of the Director dated 2/16/2006, it is clear that the left knee was found to be a compensable injury and [Employer] remains liable for any necessary care and treatment.
Neither party appealed Decision # 2 to the Board.
On April 7, 2008, the Director issued Decision # 3, which addressed the following issues: (1) whether Employer properly denied Dr. McCaffrey's treatment plan, dated November 5, 2007, requesting knee surgery by Dr. Lee; and (2) whether Employer properly denied Dr. McCaffrey's treatment plan, dated January 11, 2008, requesting a neurological consult with Ray Romero, M.D., a neurologist.
Employer denied the treatment plan for knee surgery on November 7, 2007, based on the opinions provided by Dr. Endicott after his IME.
By Decision dated 9/12/2006, the Director found that [Employer] would remain liable for [Alayon's] left knee care and would not be allowed to utilize the opinion of Dr. Endicott that no left knee injury resulted from this incident. However, by review of the records, it is clear that [Alayon] received care for her left knee with Dr. Lee at least through 5/2005 when she cancelled surgery. By letter dated 6/6/2005 to [Alayon's] then-attorney, Dr. Lee noted that [Alayon] was scheduled for arthroscopic surgery on 5/17/2005, which she subsequently cancelled. Dr. Lee also wrote that surgery remains a recommendation and the procedure would consist of arthroscopy and meniscal tear resection. Dr. McCaffrey's request of 11/5/2007 indicated that the referral to Dr. Lee was for left knee arthroscopy and partial menisectomy: this appears to be the same condition Dr. Lee referenced in 2005. Therefore, the left knee injury of 8/23/2005 should be deemed a temporary aggravation which reverted to pre-injury status at the point that it was determined she once again requires surgery. It is also at this point that [Employer's]liability for the left knee ends.
As for the neurosurgical consult request, the Director's decision dated 9/12/2006 denied further care for [Alayon's] neck, left wrist and head conditions. The findings of Dr. Endicott was cited to for his opinion that the neurological examination was normal, and although [Alayon] continued to have complaints, she also had a preexisting history. As the previous neurological exam proved negative, [Alayon] should not be availed of another neurological consult.
The Director concluded that Employer properly denied Dr. McCaffrey's January 11, 2008, treatment plan for a neurological consult and ordered that such treatment plan “remain[s] denied.” 5. Alayon's Appeal of Decision # 3 to Board.
On April 25, 2008, Alayon appealed Decision # 3 to the Board. The issues to be determined were: (1) whether Employer is liable for Alayon's left knee condition after November 5, 2007; (2) whether Alayon is entitled to treatment under Dr. McCaffrey's November 5, 2007, treatment plan for knee surgery by Dr. Lee; and (3) whether Alayon is entitled to treatment under Dr. McCaffrey's January 11, 2008, treatment plan for a neurological consult with Dr. Romero.
While the appeal was pending, Alayon obtained knee surgery from Dr. Lee on July 15, 2008. The surgery was for a torn medial meniscus in her left knee.
[Alayon's] representative focused on'the low back as the basis of [Alayon's] disability and entitlement to TTD benefits. However, by Decision dated 9/12/2006, the Director allowed only for further physical therapy based on the opinion of Dr. Endicott as contained in his report dated 7/12/2006. In this report, Dr. Endicott stated that his recommendation would be only for the completion of [Alayon's] physical therapy program as regards the low back; that the lumbar condition would be stable upon completion of the course. He further commented that the 1/4/2006 and 9/3/2003 lumbar MRI's produced essentially the same results. Thus, he concluded that the disc herniation has been chronic since 2001. This opinion would be in keeping with Dr. McCaffrey's reports, which consistently noted a lumbar condition related to a 1999 MVA. For Dr. McCaffrey to produce a letter in 2008 alleging that his statements relating [Alayon's] low back condition to a 1999 MVA was in error, and that in actuality it is the result of the industrial incident is questionable and self-serving at best. Dr. Endicott's opinion justifies the termination of [Employer's] liability for [Alayon's] low back care, as, upon completion of physical therapy, she would have attained pre-injury status.
Alayon appealed Decisions # 3 and # 4 to the Board. The Board entered its Second Amended Pretrial Order, which stated that the issues to be determined were: (1) whether Employer is liable for Alayon's left knee condition after November 5, 2007; (2) Whether Alayon is entitled to treatment under Dr. McCaffrey's treatment plan dated January 11, 2008, for a neurological consult with Dr. Romero; (3) what is the period of TTD resulting from the August 23, 2005, work injury after June 7, 2007; and (4) whether Employer is entitled to a credit against future PPD benefits, if any, for indemnity benefits paid from January 11, 2006, to June 7, 2007.
After a trial on July 6, 2010, the Board issued its August 11, 2011, Decision and Order that modified in part and affirmed in part the Director's Decisions # 3 and # 4. The Board concluded in relevant part: (1) Employer may be liable for Alayon's left knee condition after November 5, 2007, however, the nature and extent of the injury must be determined by the Director (COL 1); (2) Alayon is not entitled to treatment under Dr. McCaffrey's January 11, 2008, treatment plan for a neurological consult with Dr. Romero (COL 2); (3) Alayon is not entitled to, and Employer is not liable for, TTD benefits from June 8, 2007, through November 20, 2009 (COL 3); and (4) the Board would not decide whether Employer was entitled to a credit against future PPD benefits, if any, for indemnity benefits paid from January 11, 2006, to June 7, 2007, and would leave that determination to the Director (COL 4). This appeal followed.
HRS § 386–85(1) (1993) creates a presumption in favor of a workers' compensation claimant that the claim is for a covered work injury. This presumption controls unless the employer can produce substantial evidence to rebut it. See Nakamura v. State, 98 Hawai‘i 263, 267–68, 47 P.3d 730, 734–35 (2002). Substantial evidence in this context is “relevant and credible evidence of a quality and quantity sufficient to justify a conclusion by a reasonable person that an injury or death is not work-connected.” Id. (internal quotation marks, citation, and brackets omitted).
We review the Board's findings of fact under the clearly erroneous standard. Id. at 267, 47 P.3d at 734. Under this standard, we consider whether the Board's factual findings are “clearly erroneous in view of the reliable, probative, and substantial evidence on the whole record.” Id. (block quote format, brackets, and citation omitted). We are required to sustain the Board's factual findings if supported by substantial evidence unless we are “left with a firm and definite conviction that a mistake has been made.” Tauese v. State, Dep't of Labor & Indus. Relations, 113 Hawai‘i 1, 25, 147 P.3d 785, 809 (2006) (internal quotation marks and citation omitted). We review the Board's conclusions of law de novo, under the right/wrong standard. Nakamura, 98 Hawai‘i at 267, 47 P.3d at 734 (block quote format and citation omitted). We give deference to the Board with respect to questions concerning the credibility and weight of the evidence.
evidence to ascertain whether it weighs in favor of the administrative findings, or to review the agency's findings of fact by passing upon the credibility of witnesses or conflicts in testimony, especially the findings of an expert agency dealing with a specialized field.
Id. at 268, 47 P.3d at 735 (block quote format altered and citation omitted).
The Board concludes that [Alayon] may be entitled to, and Employer may be liable for, [Alayon's] left knee condition related to the August 23, 2005 work injury after November 5, 2007. The nature and extent of said injury, however, has yet to be determined by the Director. Such a determination is particularly relevant and important when [Alayon] had a significant pre-existing condition, for which surgery was considered necessary, before the August 23, 2005 work accident and also because [Alayon] has not filed a WC–5 claim for her left knee.
Because the Board did not render a final decision regarding whether Employer is liable for Alayon's left knee condition after November 5, 2007, there is no final decision on this issue for this court to review, and we decline to resolve this issue absent a decision by the Board.
We note, however, that what the Board means by its statement that “the nature and extent of [Alayon's left knee] injury has yet to be determined by the Director” is confusing. In Decision # 3, the Director specifically ordered that “[Employer's] liability for [Alayon's] left knee condition terminates as of 11/5/2007 when it reverted to pre-injury status,” and the Director denied Dr. McCaffrey's November 5, 2007, treatment plan for left knee surgery.
[e]ven if an injury returns to pre-work injury status, this does not necessarily mean that the duty to provide compensation or benefits ends. Absent a showing of an intervening or superseding event or cause, fraud, or other appropriate terminating event, there is a likelihood that such obligation to provide medical care, services, and supplies will not terminate.
If the portion of an employee's injury and condition that is attributable to a work-related accident has been resolved and the employee has returned to his or her pre-work-accident condition, it is not clear why an employer would remain liable for future medical care. The Board should clarify these matters when the case is remanded.
Alayon argues that the LIRAB erred when it ruled that she was not entitled to treatment under Dr. McCaffrey's January 11, 2008, treatment plan. We disagree.
Dr. McCaffrey's January 11, 2008, treatment plan requested a consultation with Dr. Romero, a neurologist, for a “specialist opinion” and simply noted a diagnosis of “post concussion syndrome; lightheaded.” The treatment plan did not indicate why a neurological consult with Dr. Romero was reasonable and necessary with respect to Alayon's work injury. The Employer denied the treatment plan based on Dr. Endicott's March 21, 2006, IME report. In that report, Dr. Endicott opined that Alayon's work-related head injury had been resolved, and he also stated that “[Alayon] has complaints of headaches, although a normal neurologic exam is noted and she has a longstanding preexisting history of headaches.” In Decision # 3, the Director denied the January 11, 2008, treatment plan, citing the denial of further care for Alayon's head condition in Decision # 2 (issued on September 12, 2006), which had referred to Dr. Endicott's findings that Alayon's neurological examination was normal and that Alayon had a pre-exiting history of headaches.
In affirming the Director, the Board ruled that Alayon was not entitled to a neurological consult with Dr. Romano under Dr. McCaffrey's January 11, 2008, treatment plan. In support of its ruling, the Board found that (1) on December 26, 2007, Alayon had reported that Fortunata N. Gozun, M.D., her primary physician, had done a full evaluation and work up and that all tests were negative; (2) the request for the neurological consult was generated at Alayon's request and had not been “recommended as reasonable or necessary by [Alayon's] attending physician[,] Dr. Baloy, who was the only physician who examined [Alayon's] head and neck around the time of the treatment plan”; (3) there was no indication that Dr. McCaffrey examined Alayon's neck or head in the period immediately preceding his treatment plan; and (4) Dr. McCaffrey's request for consultation did not provide a reason for the referral, did not meet the requirements of the Workers' Compensation Medical Fee Schedule, and was inadequate.
We conclude that these findings were supported by substantial evidence and that the Board did not err in its conclusion that Alayon was not entitled to a neurological consult under Dr. McCaffrey's January 11, 2008, treatment plan. As Employer concedes, the Board's finding that Alayon's request for review of Employer's denial of the treatment plan was untimely is clearly erroneous. However, we conclude that this error was harmless because the Board did not rely on its untimeliness finding in rendering its decision, and instead decided on the merits whether Alayon was entitled to a neurological consult under the January 11, 2008, treatment plan.
Alayon contends that the Board erred in concluding that she was not entitled to, and Employer was not liable for, TTD benefits from June 8, 2007, through November 20, 2009. Although the Board made certain findings of fact that went to the merits of whether Alayon was entitled to TTD benefits as a result of her work-related injuries, its explanation for ruling that Alayon was not entitled to TTD benefits from June 8, 2007, through November 20, 2009, only focused on asserted deficiencies in the certifications of disability submitted by Alayon's physicians. We conclude that the Board is required to decide whether an employee is entitled to TTD benefits on the merits and cannot deny a TTD claim based solely on asserted deficiencies in certifications of disability submitted by the employee's physicians. We therefore vacate the Board's ruling that Alayon was not entitled to TTD benefits from June 8, 2007, through November 20, 2009, and remand for further proceedings.
Employer, under protest, paid Alayon weekly indemnity benefits, which Alayon viewed as TTD benefits and Employer characterized as advance PPD benefits, from October 14, 2005 to June 7, 2007. By letter to Alayon's attorney dated May 23, 2007, Employer notified Alayon that its “PPD advances” would be terminated as of June 7, 2007. Employer's letter also notified Alayon that she could request a hearing with the Director if she disagreed with Employer's termination of indemnity benefits.
On September 5, 2008, the case was remanded from the Board to the Director, at Alayon's request, for the Director to determine Alayon's eligibility for TTD benefits effective June 8, 2007. Citing Dr. Endicott's opinion, the Director denied Alayon's request for further TTD benefits after June 7, 2007. Alayon appealed this decision to the Board.
3. The Board concludes that [Alayon] is not entitled to, and Employer is not liable for, temporary total disability resulting from the August 23, 2005 work injury after June 7, 2007 through November 20, 2009.
A medical certification of temporary total disability requires an attending physician to certify that a claimant's absence from work is due to disability attributed to a specific work injury or condition. Without such certification, an award of temporary total disability is not proper.
The Board interprets the workers' compensation laws and rules to require certifications of disability by a treating physician to be contemporaneous, to be in writing, and to include the date of accident for which such disability is certified. See, Ralph Edayan v. City and County of Honolulu, Facility Maintenance, AB 2004–484 (June 21, 2010). In the instant case, for the periods in question, there is no disability certification of record from [Alayon's] attending physician documenting total disability attributed to [Alayon's] August 23, 2005 work-related injuries.
The Board makes no determination as to [Alayon's] entitlement to TTD benefits after November 20, 2009.
We conclude that the Board erred in relying solely on the inadequacy of the interim reports submitted by Alayon's physicians as certifications of disability in ruling that Alayon was not entitled to TTD benefits.
(3) A final report to the same parties and in the same manner as prescribed in paragraph (1) shall be made within seven days after termination of treatment.
the delinquent physician shall be fined not more than $250.
HRS § 386–96 and HAR § 12–15–80 permit sanctions to be imposed on a physician who fails to comply with the applicable reporting requirements. However, nothing in these provisions indicates that a physician's failure to comply with the reporting requirements can be used to justify the denial of TTD benefits to a workers' compensation claimant. Indeed, HRS § 386–31(b) (Supp.2013), which sets forth an employee's right to TTD benefits, provides that “[w]here a work injury causes total disability not determined to be permanent in character, the employer, for the duration of the disability, but not including the first three calendar days thereof, shall pay the injured employee [the prescribed weekly TTD benefit].” “Eligible claimants should not be denied benefits under Hawai‘i['s] workers' compensation law simply because their physician failed to properly word the requisite report.” Panoke v. Reef Development, No. CAAP–11–0000556, 2014 WL 2949410, at *5 (Hawai‘i App. Jun. 30, 2014) (SDO).
The Board may consider the lack of specificity or other deficiencies in certifications of disability in assessing the evidentiary weight it should give to the certifications. However, the Board cannot deny a claimant's request for TTD benefits based solely on a physician's failure to submit the certifications of disability in the proper form. If the evidence in the record shows that a claimant is entitled to TTD benefits, then the physician's non-compliance with the certification requirements does not justify denial of the TTD benefits. In this case, for example, Alayon and Dr. McCaffrey testified at the hearing before the Board. If their testimony and other evidence in the record established that Alayon was entitled to TTD benefits from June 8, 2007, through November 20, 2009, then the Board should have granted Alayon's request for TTD benefits, notwithstanding any deficiencies in her physicians' certifications of disability.
Because the Board appears to have based its decision solely on the asserted deficiencies in the certifications of disability submitted by Alayon's physicians, and not on the merits of her eligibility for TTD benefits, we vacate the Board's ruling that Alayon was not entitled to TTD benefits from June 8, 2007, through November 20, 2009. We remand the case to the Board for a determination of Alayon's eligibility for TTD benefits on the merits .
We note that Alayon contends that the Board engaged in impermissible rulemaking, without complying with the requirements of HRS Chapter 91, by requiring, through its decisions in workers' compensation appeals, that certifications of disability by a treating physician be contemporaneous, be in writing, and include the date of accident for which such disability is certified. In light of our conclusion that the Board erred in basing its denial of Alayon's request for TTD benefits on the asserted deficiencies in her physicians' certifications of disability, we need not reach Alayon's contention regarding improper rulemaking to resolve this appeal. We therefore do not address Alayon's contention regarding improper rulemaking.
In its COL 4, the Board stated: “The Board makes no conclusions concerning Employer's entitlement to a credit against future [PPD], if any, for indemnity benefits paid from January 11, 2006 to June 7, 2007. Rather, that determination is left to the Director.” Despite the Board's failure to render a final decision on this issue, Alayon contends that the Board erred and asks that this court rule that no credit should be applied.
Similar to the Board's COL 1, there is no final decision by the Board for this court to review. We decline Alayon's invitation to rule on the question of Employer's entitlement to a credit against future PPD in the absence of a decision by the Board.
Based on the foregoing, we affirm COL 2 and vacate COL 3 of the Board's Decision and Order, and we remand the case for further proceedings consistent with this Memorandum opinion.

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