Opinion ID: 865583
Heading Depth: 2
Heading Rank: 1

Heading: whether the circuit court substituted its

Text: JUDGEMENT FOR THAT OF PERS WHEN IT FOUND THE DECISION TO DENY DISABILITY BENEFITS W AS ARBITRARY AND CAPRICIOUS. ¶19. The primary question before this Court is not, as the trial court concluded, whether there is “substantial evidence” of a disability, but whether the record contains substantial evidence to support PERS’ finding that Dishmon is not disabled. Dishmon, 797 So. 2d at 892. “Substantial evidence” has been defined by this Court as “such relevant evidence as reasonable minds might accept as adequate to support a conclusion.” Marquez, 774 So. 2d at 425 (quoting Delta CMI v. Speck, 586 So. 2d 768, 773 (Miss. 1991)). The question before the PERS Medical Board, Disability Committee, and Board of Trustees was whether or not Dishmon’s claim met the statutory requirements for receipt of permanent disability benefits. As fact-finder, it is for PERS to determine which evidence is more believable or carries more weight. Pub. Employees’ Ret. Sys. v. Howard, 905 So. 2d 1279, 1287 (Miss. 2005). It is not for this Court to determine whether the claimant has presented enough evidence to prove he 8 or she is disabled, “but whether PERS has presented enough evidence to support its finding that the claimant is not disabled.” Pub. Employees’ Ret. Sys. v. Henderson, 867 So. 2d 262, 264 (Miss. Ct. App. 2003) (citing Doyle v. Pub. Employees’ Ret. Sys., 808 So. 2d 902, 905 (Miss. 2002)). ¶20. For purposes of a disability determination; Mississippi Code Section 25-11-113(1)(a) contains two categories. First, the Medical Board, after a medical examination, must certify that the applicant is “mentally or physically incapacitated for the further performance of duty, that such incapacity is likely to be permanent, and that the member should be retired[.]” Miss. Code Ann. § 25-11-113(1)(a) (Rev. 2006). This option covers employees for any injury that they prove rises to the debilitating level required by statute, whether or not it occurred as a result of work-related activities. Second, the Medical Board must apply the statutory definition of “disability” which reads: The inability to perform the usual duties of employment or the incapacity to perform such lesser duties, if any, as the employer, in its discretion, may assign without material reduction to compensation, or the incapacity to perform the duties of any employment covered by the Public Employees’ Retirement System that is actually offered and is within the same general territorial work area, without material reduction in compensation. Miss. Code Ann. § 25-11-113(1)(a). ¶21. After a determination has been made as to whether an employee is disabled, disability benefits are available to PERS members in two ways: (1) regular disability benefit payable to members who have at least four years of creditable service provided he/she became a member of the System prior to July 1, 2007, and who become disabled for any reason; and (2) hurt-on-the-job disability benefit, payable to members regardless of the number of years of 9 creditable service, where the member becomes disabled due to an injury occurring in the line of duty. Pub. Employees Ret. Sys. v. Stamps, 898 So. 2d 664, 672 (Miss. 2005) (citing Miss. Code Ann. §§ 25-11-113 and 25-11-114 (Rev. 2006). ¶22. PERS asserts that the circuit court reweighed the facts and substituted its judgment for that of the administrative agency in finding that Dishmon was entitled to receipt of disability benefits. PERS argues that the decision by the Board of Trustees is based upon substantial evidence and should be reinstated, as the facts presented in the record before this Court support the decision of the PERS Board of Trustees that Dishmon is not entitled to the receipt of regular disability benefits pursuant to Mississippi Code § 25-11-113. PERS avers that, while there is no doubt Dishmon suffers from a plethora of medical problems, they are not so severe that they warrant a decision that Dishmon is totally disabled. ¶23. Dishmon contends, however, that the first denial of her claim by the PERS Medical Board and the subsequent affirmance of such denial by the PERS Disability Appeals Committee was arbitrary and capricious. Dishmon maintains that her medical records reveal that she has been diagnosed by Dr. Pierce, her long-time treating internist, with osteomyelitis, insulin dependent diabetes mellitus (IDDM), hypertensive cardiovascular disease (HCVD), cellulitis of the great toe, degenerative arthritis, atherosclerotic vascular disease to the lower extremities, carpal tunnel syndrome, anxiety, and depression. Yet she claims, PERS ignored the opinions of Dr. Pierce, even failing to participate in his deposition, or to obtain an independent medical exam. Dishmon asserts that this failure on the part of PERS presumably leaves Dr. Pierce’s opinions unrebutted and uncontradicted. Dishmon therefore argues that she has effectively rebutted the initial denial of her claim by the PERS Medical Board and the 10 subsequent denial by the PERS Disability Appeals Committee, and that such denial is therefore unsupported by substantial evidence. ¶24. While PERS correctly points out that it is not required by law or regulation to secure an independent medical examination, such failure may constitute a factor in determining whether or not the agency has presented sufficient evidence to support its finding that the claimant is not disabled. In Public Employees’ Retirement System. v. Dearman, 846 So. 2d 1014, 1018 (Miss. 2003), this Court affirmed the circuit court’s ruling which reversed a PERS decision denying disability benefit based, inter alia, on PERS’ failure to offer any medical evidence which disputed the opinions of claimant’s treating physicians. In noting that the opinions provided by the physicians on the Medical Board and the Disability Appeals Committee were not conclusive, the Dearman Court stated: PERS cannot choose to ignore the only evidence in the record from the examining physician, especially where it chose not to exercise its right to an independent medical evaluation under Miss. Code Ann. § 25-11-113(1)(c). Id. at 18. ¶25. Here, the Committee provided a lengthy, comprehensive analysis as to why each individual ailment afflicting Dishmon at the time she applied for disability benefits did not qualify her for disability retirement as contemplated by Mississippi Code Section 113. However, there is no evidence in the record to contest Dr. Pierce’s medical conclusion that Dishmon, based on her numerous ailments, can no longer work. Cf. Thomas v. Pub. Employees’ Ret. Sys., 995 So. 2d 115, 120 (Miss. 2008) (finding that, because there was no evidence in the record that the Appeals Committee had ignored or rejected evidence in its duties as factfinder, substantial evidence supported its findings). 11 ¶26. The Committee acknowledged that Dishmon is a diabetic, but disputed Dr. Pierce’s opinion that her diabetes is not well-controlled. The Committee stated, “we do not find objective medical evidence that the diabetes fails to be under control.” The Committee thus concluded that the diabetes itself was not disabling either medically or occupationally. ¶27. With regard to hypertensive cardiovascular disease, the Committee stated, “it is a well known fact that persons with diabetes usually have trouble in this area . . . , [but] it appears that the hypertension has been well controlled over the years.” The Committee further stated, “while Ms. Dishmon does carry the diagnosis of hypertension, and it probably is due at least in part to her weight and her diabetes, it is obviously and thankfully controlled and does not constitute occupational disability as defined in this matter.” ¶28. The Committee disputed whether Dr. Pierce’s diagnosis of osteomyelitis of Dishmon’s right great toe was accurate. The Committee opined that, while osteomyelitis is a serious infection because it is in the bone itself, it is debatable as to whether Dishmon actually had osteomyelitis or merely cellulitis, which is an infection of the tissues rather than the bone of Dishmon’s toe. ¶29. The Committee disagreed with Dr. Pierce that Dishmon suffered disabling arthritis at the time she filed her disability claim, and also with his testimony that Dishmon could not stand or sit for long periods of time. The Committee opined, “we note x-rays in 2000 that show a mild degenerative disc disease of the low back. It seems that based upon the objective medical record that the lower back problems Ms. Dishmon experiences began after her date of termination, and thus, cannot be considered with regard to disability at the date of termination.” 12 ¶30. As to Dr. Pierce’s testimony pertaining to Dishmon’s carpal tunnel syndrome, the Committee questioned whether the carpal tunnel syndrome was disabling, and concluded that there was no objective proof that it was. The Committee noted that there were no EMG studies to substantiate Dr. Pierce’s testimony. The Committee acknowledged that Dr. Tiwari had found carpal tunnel on the right side, but because the Committee was without the report itself, could not determine the degree of carpal tunnel syndrome Dishmon had at the time of her filing. ¶31. Finally, the Committee took note of Dr. Pierce’s testimony that Dishmon had depression, and was taking Elavil. However, because no entries were found in Dishmon’s medical records documenting serious depression, and no record of referral to a psychiatrist or a counselor, the Committee determined that Dishmon’s depression was neither severe nor disabling. ¶32. The analysis section of the Committee’s proposed recommendation failed to specifically mention Dishmon’s diagnosis of atherosclerotic vascular disease of the lower extremities. ¶33. PERS is correct that it has the duty to determine which of the physicians’ assessments and other documentation it should rely on in making a determination. See Pub. Employees’ Ret. Sys. v. Stamps, 898 So. 2d 664, 674 (Miss. 2005) (the “weight given to the statements of a personal physician is determined by PERS, and it is not for the courts to reweigh the facts”). However, when PERS rejects individual assessments outright, it must not leave in doubt the cumulative effect that each ailment creates for the claimant as a whole, in making its determination. 13 ¶34. For example, PERS fully acknowledges that Dishmon suffers from diabetes, and that this condition is responsible for most of Dishmon’s other ailments, such as the infection of Dishmon’s toe. Based solely on its interpretation of Dishmon’s medical records, rejected Dr. Pierce’s diagnosis that the infection was the result of osteomyelitis, which it acknowledged is a serious infection involving bone. Yet, PERS admitted that it could not definitively say that Dishmon did not suffer from osteomyelitis, opining that if she did have osteomyelitis, she was successfully treated with antibiotics and “amputation [was] not necessary at least up to the point of the last record in this matter.” ¶35. In disregarding Dishmon’s diagnosis of carpal tunnel syndrome, PERS simply found many unanswered questions as to whether Dishmon’s carpal tunnel syndrome was actually disabling, essentially concluding that if she did, in fact, have the condition, that there was no objective proof that it was disabling. ¶36. Dishmon provided objective medical proof from Dr. Pierce that she suffers from degenerative arthritis. The Committee, however, rejected the diagnosis out-of-hand based on a finding that x-rays taken in 2000 appeared to suggest that Dishmon was not suffering from this condition when she filed her claim in 1997. But the record indicates otherwise, as Dr. Pierce made his diagnosis prior to Dishmon filing her claim in 1997. ¶37. This Court finds that the Committee’s analysis is without support in the record. When coupled with the fact that PERS chose not to exercise its right to an independent medical examination, this Court is unable to find that PERS’ decision denying disability benefits in this matter is supported by the evidence. 14 ¶38. In Public Employee’s Retirement System v. Robert Ann Shurden, 822 So. 2d 258, this Court said that the receipt of disability benefits to deserving claimants should not be unnecessarily out of reach, stating: PERS should not stray from its purpose of Miss. Code Ann. § 25-11-113, to compensate disabled employees that have not met the 25 year criteria, in denying benefits nor set the bar so high that this purpose is frustrated. Id. at 264.