Opinion ID: 3034197
Heading Depth: 1
Heading Rank: 1

Heading: Finding of Work-Related Injury

Text: The petitioners first argue that the ALJ’s finding that Brunetti’s injury was workrelated was based on the unreliable, speculative medical opinion of Dr. Floyd A. Warren, 1As we write solely for the benefit of the parties, who are familiar with the facts and procedural history of this case, we confine our discussion to the legal issues presented and include only those facts necessary to our disposition. 3 a neuro-opthalmologist who evaluated and treated Brunetti from 2001 to 2005. They say that the ALJ relied exclusively on Dr. Warren’s opinion and that all of the other medical evidence showed no connection between Brunetti’s injury and his employment, and that Dr. Warren’s diagnosis was speculative because he could not determine an organic cause for Brunetti’s abnormal eye movement. Further, petitioners argue, the ALJ improperly relied on a “temporal nexus” between the December 19, 2000, incident and Brunetti’s symptoms. Therefore, the petitioners say, the ALJ’s determination was not supported by substantial evidence, and the Board erred when it affirmed the ALJ’s decision. The ALJ first performed an analysis under § 20(a) of the Act, which provides for a presumption that an injury is causally related to employment if a claimant can show that he suffered an injury and working conditions existed which could have caused the harm. 33 U.S.C. §920(a); U.S. Inds./Federal Sheet Metal v. Director, OWCP, 455 U.S. 608, 612 (1982). The employer can rebut the presumption by presenting specific evidence to sever the potential connection between the injury and the job. Swinton v. J. Frank Kelly, Inc., 554 F.2d 1075, 1082 (D.C. Cir. 1976). The ALJ found that Brunetti was entitled to the § 20(a) presumption, but that A.G. Ship had provided sufficient evidence to rebut it. Therefore, he looked to the entire record to determine whether there was a causal link between Brunetti’s employment and his eye abnormalities, and concluded that there was such a link, based primarily on the medical opinions in the record. Four ophthalmologists evaluated Brunetti: Drs. Warren, Zee, Kapoor, and 4 Frohman. The ALJ gave particular weight to Dr. Warren’s opinion because he treated Brunetti for several years and evaluated Brunetti’s subjective complaints in the context of objective diagnostic testing and his prior medical history. He was also familiar with which therapies had been attempted to alleviate Brunetti’s symptoms. Dr. Warren connected Brunetti’s nosebleed, hypertension, and dizziness on December 19, 2000, to an ischemic event in the brainstem that then caused the eye problem, although he acknowledged that there was no radiological evidence of an ischemic event. Dr. Kapoor noted the severity of Brunetti’s symptoms, and wrote that although the precise etiology of the symptoms was unclear, it was clear that they started after his workplace injury. None of the medical opinions pointed to a precise cause of Brunetti’s symptoms, and all of the evaluating physicians acknowledged that Brunetti had no such symptoms before December 19, 2000. Dr. Zee recommended additional testing, including psychiatric counseling, but did not say whether he thought that Brunetti’s symptoms might be due to a psychiatric condition. Although Dr. Frohman suggested that Brunetti’s condition was psychiatric in nature, no psychiatrist ever provided an opinion. The ALJ concluded that Dr. Zee’s opinion was unclear as to the causation of Brunetti’s symptoms, and that Dr. Frohman, an ophthalmologist, was not qualified to make a psychiatric diagnosis. Taking all of the medical opinions into consideration, the ALJ gave the most weight to Dr. Warren’s opinion. The Board considered the ALJ’s findings and the evidence in the record, and 5 concluded that his decision was supported by substantial evidence. It found that the ALJ appropriately discussed all of the relevant evidence in the record, and acted within his discretion in giving the most weight to Dr. Warren’s opinion. The Board rejected A.G. Ship’s contention that Dr. Warren’s opinion was too speculative to support a finding of causation, saying that the ALJ had “rationally credited [Dr. Warren’s] causation conclusion as it was explained in terms of the overall facts in this case.” (Board Opinion n.2, App. 15). The Board also rejected the petitioners’ arguments about the ALJ’s reliance on the “temporal nexus” between the December 19, 2000, incident and Brunetti’s symptoms, noting that the standard called for the ALJ to look at the record as a whole, and the temporal nexus was not the only evidence he considered. (Board Opinion n.3, App. 15). In light of the Board’s careful review of the ALJ’s thorough opinion, we find that on the issue of the causal relationship between Brunetti’s employment and his injury, the Board adhered to the applicable scope of review and did not commit any errors of law. The ALJ examined the record as a whole and his findings were supported by substantial evidence.