Opinion ID: 2286309
Heading Depth: 1
Heading Rank: 2

Heading: Sizemore's Total and Permanent Incapacitation

Text: As also required by KRS 61.600, Sizemore bore the burden to show that she was permanently incapacitated to perform her job or job like duties. And as part of her efforts to do so, Sizemore again offered the testimony of Dr. Zerga, who stated in part: My opinion is I think she could sit if she didn't have to do anything else; if she didn't have to interact with people, if she didn't have to make cognitive processing decisions, if she didn't have to fill out paperwork, if she didn't have to do repetitive data entry. ... But, as far as being able to perform the functions of her job, no, sir. Dr. Zerga based his opinion regarding total disability, in part, on his conclusion that Sizemore suffered from chronic fatigue, a condition he testified frequents patients with MS. What is more, Dr. Zerga, relying on a medical article from the National MS Society, noted that fatigue is the most common reason for MS patients to depart the work force. He further testified that fatigue with MS patients is a rather constant symptom, and is different from normal fatigue, which normally may be resolved by taking a nap or sitting down. However, the Kentucky Retirement Systems interpreted Sizemore's medical records differently, and held that she was not entitled to benefits because she was not totally and permanently disabled. In its view, Dr. Zerga's notes demonstrated Sizemore's lack of total and permanent disability, i.e.: (1) a report from Dr. Zerga dated March 5, 2005 (days after Sizemore's last pay period) indicating that Sizemore was doing well, with no evidence of any attacks, and her examination was normal; (2) a report from Zerga on January 10, 2005 where Dr. Zerga noted complaints of fatigue and numbness, but no cranial nerve symptoms and no significant upper extremity symptoms and ultimate impression as stable; (3) an MRI dated January 10, 2005, revealing some white matter, some just seen, but not definitely active; (4) a nerve conduction study dated January 17, 2005 showing very mild bilateral carpal tunnel, with no evidence of major entrapment and notes from Zerga stating that he was going to alter her medication to see if he could improve her sleep and decrease her fatigue. Based on this alone, the Retirement Systems' Board of Trustees adopted the reasoning of the hearing officer (concluding that Sizemore's MS was pre-existing) and added a finding of fact that she was not permanently and totally unable to work. On review, the Franklin Circuit Court reversed the administrative ruling, holding the Board of Trustees' assessment of Sizemore's total and permanent incapacitation as a misinterpretation of KRS 61.600 or a misunderstanding regarding the nature of relapsing/remitting MS. The circuit court reasoned that Dr. Zerga's reports constituted objective medical evidence supporting Sizemore's total and permanent incapacitation and that [s]o long as a doctor bases those judgment calls on observable facts, and the doctor is trained to make such judgments, the Board cannot disregard those judgments on the grounds that they are `subjective.' In contrast, the circuit court considered the reports of Drs. McElwain and Keller as unsupported by objective medical evidence and further found that their opinions, which countered Zerga's conclusions, contained absolutely no medical or factual basis. As a result, the circuit court concluded [t]he record compels a finding that Tammy Sizemore is totally and permanently disabled, and thus entitled to disability benefits. From that adverse decision, the Kentucky Retirement Systems sought review in the Court of Appeals. The Court of Appeals reversed the circuit court, reasoning that there was evidence to support the notion that Sizemore was not permanently and totally incapacitated. The court relied on Dr. Kimbel's determination that no evidence objectively existed proving any loss of cognitive function, any functional impairment imposed by multiple sclerosis consisting of any weakness, extreme dizziness, visual impairment, or loss of function of her upper and lower extremities. And although not directly correlating the objective medical evidence to Dr. Kimbel's conclusions, the court referenced Dr. Zerga's notes, recorded approximately four days after Sizemore's last date of paid employment, which stated that Sizemore was doing well, although she was feeling a bit depressed and did not like her job and no evidence of any attacks. Furthermore, the court noted that in January 2005, approximately one month before she stopped working, Dr. Zerga stated that Sizemore was fatigued but had no cranial nerve symptoms or significant upper extremity symptoms and her examination was benign other than right arm tremors. And while the Court of Appeals recognized that there was contrary testimony from Dr. Zerga, it ultimately held that where a conflicts exists the administrative body's ruling should be given deference, unless the evidence is so overwhelming that their conclusions are unreasonable. Given the conflicting medical opinions on this issue, we cannot say that the Kentucky Retirement Systems acted erroneously. As noted above, we give great latitude in its evaluation of the evidence heard and the credibility of witnesses, including its findings and conclusion of fact. Kentucky State Racing Comm'n v. Fuller, 481 S.W.2d 298 (Ky.1972). Unlike the issue of pre-existing condition, the Kentucky Retirement Systems had reason to find that Sizemore was not totally disabled, e.g., the conflicting medical testimony. Kentucky Comm'n On Human Rights v. Fraser, 625 S.W.2d 852 (Ky.1981). While this Court may have come to a different conclusion, we are constrained not to substitute our judgment for the fact finder unless we can determine that no reasonable trier of fact could have made the same conclusion. R.R. Comm'n v. Chesapeake & Ohio Railway, 490 S.W.2d 763 (Ky.1973). We cannot agree that no reasonable trier of fact could have reached the Kentucky Retirement System's conclusion. We therefore affirm the Court of Appeals on this issue as well.