Opinion ID: 2582130
Heading Depth: 3
Heading Rank: 1

Heading: Failure To Resolve Doubt in Brown's Favor

Text: In contending that the board impermissibly failed to resolve doubt in her favor, Brown cites Beauchamp v. Employers Liability Assurance Corp. for the proposition that [i]f there is any doubt as to the substance of medical testimony, it must be resolved in favor of the claimant. [7] Brown then points to several supposed uncertainties that, she asserts, make this rule germane to her case: (1) the three rheumatologists who dealt with her case agreed that she suffers from chronic pain/fibromyalgia and that her fall caused or could have caused this condition; (2) Dr. Ling conceded that it was not medically impossible for a fall such as hers to cause fibromyalgia; (3) the board disregarded a book by a prominent rheumatologist supporting Brown's theory of causation; (4) Dr. Vandenbelt failed to physically examine her and never definitively diagnosed her condition; and (5) Drs. Schlosstein and Caner made certain statements during their testimony that arguably favored Brown's position. Yet the rule for resolving doubt we mentioned in Beauchamp will not readily stretch to cover Brown's situation. The claimant in that case, Beauchamp, suffered continuing pain following back surgery and eventually filed a claim, attributing his back problems to a work injury predating his surgery that he had not previously reported. [8] The only medical testimony concerning causation was given by his surgeon, Dr. Mead, who reluctantly expressed equivocal and uncertain views as to the possible causes of Beauchamp's condition. [9] The board nevertheless found Beauchamp's claim compensable, relying principally on his own description of how his problems arose. [10] The superior court vacated the board's decision as unsupported, pointing to Dr. Mead's uncertainty as precluding a finding of probable causation. [11] We reversed the superior court's decision and reinstated the board's award. [12] Though acknowledging that Dr. Mead was equivocal, we emphasized that the board was not restricted to or bound by this intrinsically uncertain expert testimony, since Beauchamp's lay testimony could also be considered to be substantial evidence supporting causation. We noted that the board could have simply combined uncontradicted lay testimony with medical evidence which was in itself inconclusive, to reach a conclusion. [13] Examining the evidence as a whole, including the combined effect of Beauchamp's and Dr. Mead's testimony, we held that the record supported the board's conclusion. [14] And we noted in passing that if there is any doubt as to the substance of medical testimony, it must be resolved in favor of the claimant. [15] As applied in Beauchamp, then, the rule requiring doubt to be resolved in the claimant's favor served to confirm the board's broad fact-finding discretion and to narrow a reviewing court's authority to reweigh the board's evidentiary determinations. But here, by contrast, Brown paradoxically seeks to invoke the rule for the opposite purpose: she urges us to reverse the board's decision, and thereby narrow its factfinding authority, by combing the record for signs of doubt that the board itself did not consider important. Applying the rule in this way would defeat Beauchamp's basic purpose. Beauchamp is distinguishable for another important reason. In Beauchamp we dealt with a case involving uncertainties arising from a single expert witness's equivocal testimony. Unlike the record in Beauchamp, the record here includes the testimony of multiple medical experts who gave unequivocal opinions rejecting causation. Here, each of the medical reports the board found persuasive unequivocally expressed the opinion that Brown's condition probably was not caused by her injury; when viewed individually, then, each of these reports unquestionably presented the board with substantial evidence against finding causation. [16] Brown thus seeks to stretch the rule of doubt beyond its original scope. She effectively insists that the rule should apply not just to intrinsic doubt emerging from a single witness's equivocal opinion, but to all doubts generated by conflicting medical testimony. As Patriot Maintenance correctly responds, a conflict between divergent medical views simply reveals a difference in firmly held medical opinion. In prior decisions we have expressly recognized that this form of doubt lies beyond reach of the doubt-rule applied in Beauchamp. [17] The rule requiring doubt to be resolved in the claimant's favor does not extend to Brown's situation. But even if it applied to doubts generated by conflicting testimony, and even if it could be used to restrict, rather than expand, the board's factfinding authority, the rule requiring doubt to be resolved in the claimant's favor would not assist Brown, since the evidentiary problems she raises create no significant doubt. Because the determination of medical causation hinges on medical probability, not medical certainty, [18] evidence suggesting that Brown's fall could have caused her condition or that a causal link was not medically impossible does nothing to undermine the board's finding on causation. Dr. Ling cogently made this point in responding to a letter questioning his concession that a causal link was not impossible: I do not think we are talking about possibilities. What I was expressing [in the report] were medical probabilities. It would be impossible to say something is `impossible.' Similarly, neither Dr. Vandenbelt's failure to physically examine Brown nor his reluctance to attach a definitive medical label to her condition creates any significant basis for doubting his views. As the psychiatric member of a three-physician panel that included a neurologist and a rheumatologist, Dr. Vandenbelt could reasonably choose to rely on his colleagues to perform the physical part of Brown's examination. And as demonstrated by his report and our case law, his reluctance to attach a definitive name to Brown's condition is substantively inconsequential. [19] Furthermore, any possible doubt implicit in the passages of testimony that Brown attributes to Drs. Schlosstein and Caner could have had no significant bearing on the potential weight of their overall views. [20] And no serious doubt can arise from the board's failure to specifically discuss views expressed by Dr. Mark J. Pellegrino in his book Understanding Post-Traumatic Fibromyalgia [21]  passages of which were submitted during the testimony of Brown's husband. Contrary to Brown's assertions, the board's decision did not disregard this book. As mentioned already above, the board expressly acknowledged that selected passages of the book had been filed, and summarized their general content, which describes case studies suggestive, in Dr. Pellegrino's view, of a strong association between the onset of fibromyalgia and physical trauma. But these views do not purport to apply to the particular facts of Brown's claim. Furthermore, other readily accessible publications disagree with Dr. Pellegrino's views; [22] the experts who actually testified at Brown's hearing generally acknowledged that the existence of a causal association between trauma and fibromyalgia  the major assertion of Dr. Pellegrino's book  remains controversial and eludes definitive proof; and Dr. Pellegrino's position on this issue essentially parallels the views forcefully  and much more specifically  advocated by Dr. Silverman. Given these circumstances, Dr. Pellegrino's book was cumulative at best and did not require more specific discussion. For all these reasons, we reject Brown's claim that the board erred in failing to resolve doubt in her favor.