Opinion ID: 6329191
Heading Depth: 3
Heading Rank: 2

Heading: The PDUSH’s Failure to Apply the “Clearly Con-

Text: trary to the Evidence” Standard Dubnow argues that the PDUSH’s decision was arbitrary and capricious because it reflects a failure to give proper deference to the DAB’s decision under the required “clearly contrary to the evidence” standard. We agree for two reasons. First, the PDUSH’s decision indicates that he failed to evaluate the question posed to him and thereby “fail[ed] to consider an important aspect of the problem.” Adventist GlenOaks Hosp. v. Sebelius, 663 F.3d 939, 942 (7th Cir. 2011). The allegation in Charge One in its entirety reads as follows: Inappropriate Refusal of Care and/or Diversion. Specification: On or about April 29, 2017, at ap- proximately 2:01 p.m., you inappropriately re- fused care to and/or diverted a seven-month old 12 No. 21-1045 [sic] infant in full cardiac arrest en route via ambulance to the [FHCC ED] to Lake Forest Hos- pital[,] which delayed potentially life-saving treatment. The infant was pronounced dead at 2:46 p.m. at Lake Forest Hospital. In his four-sentence description of his findings, the PDUSH’s conclusion appears to rest on his finding that “there was no need to divert the ambulance to another facility.” But whether there was a need to divert the ambulance is not at all the question the PDUSH, or even the DAB, was required to answer. The relevant question for the DAB was whether the diversion was appropriate; if so, Dubnow’s removal could not be sustained. But to conclude, as the PDUSH did, that treating the patient at the hospital was possible, or even appropriate, is not to conclude that diverting the ambulance to a betterequipped hospital would have been inappropriate. And, moreover, this is not the question the PDUSH was tasked with answering. Rather, the PDUSH was tasked with deciding whether the DAB’s conclusion on that question was clearly contrary to the evidence. As such, the PDUSH’s conclusion that there was “no need” to divert the patient is two steps removed from the analysis Congress tasked him with performing under 38 U.S.C. § 7462(d). More generally, even if we could conclude that the PDUSH found that diversion was inappropriate, the PDUSH appears to have substituted his judgment for the DAB’s, in explicit violation of the statute. In fact, the VA itself says as much, writing in its brief, “The charge was that Dubnow’s diversion of the ambulance was inappropriate; the Board found that it was not, and the PDUSH found that it was.” But, again, this is insufficient for the PDUSH to overturn the DAB’s No. 21-1045 13 conclusion. In order to overturn the DAB’s conclusion, the statute requires that the PDUSH find not only that diversion was inappropriate but also that any conclusion by the DAB to the contrary would appear to the ordinary person to be obviously against the weight of the evidence. Because it is entirely devoid of a discussion of the DAB’s numerous, detailed findings, the PDUSH’s opinion contains no rational basis for such a sweeping conclusion. The VA argues that the PDUSH did answer the appropriate question under the relevant standard because his opinion letter stated, “Upon careful consideration of the facts of the case, I do not concur with the Board’s findings regarding Charge One as it is clearly contrary to the evidence,” and also cited the standard multiple times elsewhere. But “[m]erely parroting the standard without showing its application renders review of a DAB decision arbitrary and capricious.” Savu, 2021 WL 1615562, at . The PDUSH failed to grapple at all with any of the reasons the DAB advanced for overturning the charge against Dubnow. The PDUSH need not mention or analyze every piece of evidence in the record. Cf. Terry v. Astrue, 580 F.3d 471, 475 (7th Cir. 2009) (per curiam) (noting that, in determining social security disability benefits, administrative law judges need not examine and discuss every piece of evidence). But when Congress explicitly directs that a DAB’s decision may only be reversed upon a finding that it was clearly contrary to the evidence, any such reversal should contain some analysis constructing a “logical bridge” between the evidence and the conclusion that the DAB’s finding was obviously against the weight of that evidence. See Kastner, 697 F.3d at 646. Merely listing a few reasons that support the conclusion opposite the 14 No. 21-1045 DAB’s, without any discussion of the evidence relied on by the DAB, is not enough to meet this minimal bar. Accordingly, we conclude that the PDUSH’s decision in this action was arbitrary and capricious.