Opinion ID: 1311017
Heading Depth: 3
Heading Rank: 4

Heading: Independent Medical Evaluation

Text: Alaska Statute 23.30.095(k) states in relevant part: In the event of a medical dispute regarding determinations of causation, medical stability, ability to enter a reemployment plan, degree of impairment, functional capacity, the amount and efficacy of the continuance of or necessity of treatment, or compensability between the employee's attending physician and the employer's independent medical evaluation, a second independent medical evaluation shall be conducted by a physician or physicians selected by the board from a list established and maintained by the board. Stephens argues that the Board erred in failing to order an independent medical examination (IME) under AS 23.30.095(k) regarding the cause of his heart attack. He argues that because the opinions of Drs. Donald Thieman and Tofler regarding the cause of his heart attack were in conflict, the Board should have ordered an IME. ITT argues that the record provides no basis upon which the Board could have ordered an IME, because both Stephens's treating cardiologist, Dr. Mayer, and ITT's cardiologist expert, Dr. Tofler, concluded that the heart attack was not work-related. Dr. Thieman is a general practitioner, not a cardiologist. In a letter to Stephens's attorney, Dr. Thieman stated: From the history given by Mr. Stephens, his symptoms of myocardial infarction began in the course of vigorous physical exertion while he was on the job. In this sense there is a reasonable association between the physical work of his job and the acute precipitation of the myocardial infarction. The other questions as to whether the physical and psychological stress of the job overall contributed to his heart disease, and as to whether diet on the job site was related to his heart disease would be much harder to demonstrate and I could not offer you any particular expertise in that area. I would suggest if you wish to pursue the association between the acute physical exertion and the acute precipitation of the heart attack, that you obtain an appropriate expert witness in the area of cardiology, who can give an opinion as to the percentage of responsibility to assign to the acute physical exertion in causing the heart attack, as opposed to the probability that the heart attack would have occurred anyway at somewhere near the same time in the patient's life. Thus, although Dr. Thieman saw a reasonable association between Stephens's physical work and his heart attack, he qualified his statement by recognizing his limited expertise in the area of cardiology, and suggested that Stephens get an appropriate cardiology expert witness who has a more extensive knowledge on the subject to pursue the association between the physical exertion and the heart attack. Because Dr. Thieman was not an expert in cardiology, had qualified his opinion based on that limitation, and had deferred to witnesses with expertise in cardiology, and because two cardiologists opined that Stephens's heart attack was not work-related, the Board did not abuse its discretion by not requiring an IME regarding the cause of Stephens's heart attack.