Opinion ID: 2584208
Heading Depth: 4
Heading Rank: 1

Heading: The board should make findings about the lay testimony.

Text: In arguing that the board improperly disregarded the lay testimony, Smith maintains that the lay testimony in the case undercut Dr. Ballard's assumptions about Smith's recovery from the work-related injury and that these assumptions were important to Dr. Ballard's opinion. UAF's position is that the lay testimony had little probative value because of the complex medical issues in the case. It also contends that the board weighed the lay testimony and found it unreliable. The board's decision stated: Where claims involve highly technical medical considerations, lay testimony has little probative value. Tinker v. Veco, 913 P.2d 488, 494-95, fn. 9-10 (Alaska 1996). We find this case involves highly technical medical considerations, and that a determination of causation requires the production of a greater weight of medical evidence. As such, we find we cannot rely on the testimony of the employee, his friends and co-workers to determine whether the employee's industrial incident was a substantial factor in causing the employee to need his third back surgery in August 1999. See, also, Brown v. Patriot Maintenance, 99 P.3d 544, 553 (Alaska 2004). Based on this statement and the board's failure to mention the testimony of any of the lay witnesses except Smith, we are not able to determine whether the board correctly applied the law to Smith's case. Lay testimony may be insufficient taken alone in a complex medical case to satisfy the preliminary link that an injury is work related or to rebut the presumption of compensability. [19] Norcon, Inc. v. Alaska Workers ' Compensation Board, which UAF cites for support, repeats the rule that expert medical testimony may be necessary to establish a claim. [20] Nothing in Norcon suggests a general rule that lay testimony can be disregarded in a case with complex medical facts, however. Here, Smith did not rely on lay testimony alone in presenting his case to the board; Dr. Vrablik provided expert medical testimony on his behalf, and the board determined that Smith had attached the presumption in part through Dr. Vrablik's testimony. The question in Smith's case is the relevance of the lay testimony to his claim. In some cases lay testimony has little probative value because it supports points that are not relevant to the determinations of the experts. We held in both Ayele v. Unisea, Inc. [21] and Brown v. Patriot Maintenance, Inc. [22] that the lay evidence presented was not material to the board's decision and as a result the board was not required to make findings about it. In Ayele, the issue presented was whether exposure to ammonia could trigger depression or related psychiatric disorders. [23] The lay testimony supported Ayele's claim that he had been exposed to ammonia, but the medical experts did not seriously question this fact. [24] Likewise, in Brown, the lay witnesses described facts that the experts had already received  and for the most part accepted. [25] There the issue before the board was the connection between traumatic injury and the development of fibromyalgia; the experts disagreed about whether any traumatic injury could cause fibromyalgia. [26] Thus, the lay testimony about symptoms and the injury itself had no bearing on the experts' opinions; it did not materially erode the medical opinions of physicians whose testimony the board chose to accept. [27] At other times, though, lay evidence may be highly relevant, as when it tends to support or contradict the assumptions as to the facts of the claimant's history on which expert medical witnesses rely. For example, we determined in Stephens v. ITT/Felec Services that lay testimony was potentially important to the experts' opinions about causation because their opinions rested on assumptions about the claimant's work conditions, which the lay testimony addressed. [28] In Stephens, the board decided that a worker had not proven his claim that his heart attack was work related. [29] The employer's experts testified that Stephen's heart attack was not work related, but their opinions were based on assumptions about his work conditions. [30] They also testified that their opinions might change if information about work conditions was different from what they assumed. [31] Even though Stephens presented lay evidence about his work conditions, the board did not evaluate it. [32] We decided that we could not review the board's decision without knowing how the board had evaluated the lay testimony and remanded the case to the board. [33] Here, we are unable to determine from the board's decision whether it applied an incorrect legal rule  that lay testimony should be disregarded in complex medical cases  or considered the lay testimony and determined that in Smith's case it had little probative value. Because we are unable to determine whether the board considered the lay testimony, on remand the board should indicate whether it evaluated the lay testimony and what weight, if any, the lay testimony should have. In Smith's case it is possible that the lay testimony could undermine Dr. Ballard's assumptions about the development and course of Smith's symptoms. Smith argues here that the lay testimony undermines Dr. Ballard's statement that Smith was functioning with some low back pain after his injury and had temporarily aggravated his back when he injured it at work. Because neither doctor examined Smith between the July injury and the August visit to Dr. Vrablik, the lay testimony here may have more probative value than in other cases with uncertain medical causation. As Dr. Vrablik indicated in his deposition, he had to rely on the history Smith gave in assessing his condition and its causes because he did not see Smith until after both the July and August incidents. [34] The lay testimony arguably supported Smith's assertions about his increasing pain following the accident, which could be contrary to Dr. Ballard's analysis of the course of Smith's illness. While UAF is correct that the board alone is authorized to determine witness credibility, there is a distinction between devaluing testimony because it has no probative value, even if true, and deciding that testimony is not credible. [35] The board made no explicit findings about credibility, so we are unable to say that the board made a determination that the lay witnesses in Smith's case were unreliable. [36] Dr. Ballard also testified that differences in the location and intensity of pain distinguished disk herniation from stenosis; his testimony indicated that leg symptoms could suggest a herniated disk. He further testified about his experience with patients with symptomatic scar tissue. Smith's testimony and that of his lay witnesses described Smith's pain and the limitations on his activities. Because in this case it is possible that the lay testimony had some bearing on the experts' assumptions, the board on remand should consider the lay testimony insofar as it supports or detracts from the doctors' conclusions and make appropriate findings.