Opinion ID: 2625252
Heading Depth: 3
Heading Rank: 3

Heading: Rebutting the Presumption of Compensability

Text: Groom next argues that the board's 2003 decision must be overturned because the state failed to adequately rebut the presumption of compensability. He argues that the board erroneously fashioned its own medical opinions and ignored the unanimous medical testimony that Groom had suffered work-related injuries rendering him permanently disabled. The state responds first by intimating that the medical experts did not unanimously and unambiguously diagnose Groom as permanently and totally disabled. Second, the state claims that it was well within the board's discretion to weigh the competing evidence and make appropriate findings of fact. [22] The state also points to the board's conclusion that Groom misled his doctors. In addressing these competing arguments, we begin by noting again that the proceedings leading up to the board's final decision in 2003 addressed two distinct injury reports: Groom's original claim for benefits related to his March 13, 1999 slip and fall and his subsequent claims that the continuous shoveling, standing, and performing of his regular duties as a weigh station operator had aggravated his underlying lymphedema. With respect to both sets of claims, Groom asserted that his work-related injuries had resulted in permanent total disability. Although the board joined the claims for purposes of the hearing, it continued to describe them as separate claims. [23] After conducting the final hearing on those claims, however, the board issued a decision that conflated its procedural analysis of the alleged injuries and claims for benefits. As to both sets of claims, the state had controverted not just the issue of whether Groom's current problem with lymphedema amounted to a permanent disability, but also whether his disability, even if it was permanent and total, stemmed from injuries that were related to Groom's work for the state. The board's 2003 decision completely rejected both sets of claims on a single, overarching theory: that Groom had failed to meet his burden of proving the existence of any work-related injury. Yet the board reached this decision through a flawed application of the three-step test used to determine whether a claimant ultimately bears the burden of proof on the issue of work relatedness. In analyzing this point, the board started by acknowledging that Groom had met the threshold requirement of establishing a preliminary link to activate the presumption that he was permanently and totally disabled. The board then turned to the second step of the analysis, asking whether the state had produced adequate evidence to rebut the presumption of compensability. In conducting this inquiry, the board articulated the following test: There are two methods of overcoming the presumption of compensability: (1) presenting affirmative evidence showing that the employee does not suffer permanent and total work-related disability; or (2) eliminating all reasonable possibilities that the employee is permanently totally disabled or that the disability is work-related. (Citations omitted.) We assume for purposes of this discussion that this standard might suffice to establish whether the presumption of compensability had been overcome in a case where the existence of a work-related injury was undisputed, and the only contested issue was whether the injury had resulted in the claimant's permanent total disability. [24] But in this case, as already noted, the state insisted that Groom's current problems with lymphedema were not work related even if they might have been permanently and totally disabling. We have articulated the following standard for determining whether an employer has rebutted the presumption of compensability when a claim for permanent total disability involves a dispute as to both the existence of a work-related injury and whether that injury, if it exists, renders the worker permanently and totally disabled: In order to rebut the presumption of compensability, the employer must produce substantial evidence that the injury was not work related. The employer may do this in two ways: by producing substantial evidence that (1) provides an alternative explanation which, if accepted, would exclude work related factors as a substantial cause of the disability; or (2) directly eliminates any reasonable possibility that employment was a factor in causing the disability.[ [25] ] In this case, after the board determined that Groom had triggered the presumption of compensability, the board focused its analysis of whether the state had rebutted that presumption exclusively on whether the state had presented evidence to refute the existence of a permanent total disability. According to the board, Dr. Pitzer's testimony that Groom could return to employment in positions that do not require significant physical effort or expose the employee to contusion or other physical stresses sufficed to rebut the presumption. This finding ended the board's inquiry at the second step of the process and led it to conclude that Groom bore the burden of proving his claims by a preponderance of the evidence. Yet because the board had never inquired whether the state had overcome its burden of rebutting the presumption of compensability with regard to the existence of a work-related injury, the board incorrectly treated Groom as having the burden to prove both the existence of a permanent disability and the work relatedness of his injuries. Conversely stated: Dr. Pitzer's testimony that Groom was capable of returning to work arguably might have sufficed to rebut the presumption that he suffered from a compensable permanent total disability; but his testimony did nothing to rebut the related presumption that Groom suffered from a compensable, work-related partial disability a presumption the board mistakenly deemed this testimony to have rebutted. The state nevertheless argues that, despite the board's failure to address the question of work relatedness when it ruled that the state had met its burden of overcoming the presumption of compensability, the board's decision should be affirmed because the testimony of Dr. Szuba in combination with Groom's medical records actually did rebut the presumption on the issue of the work relatedness. [26] Specifically, the board relied on: (1) Dr. Szuba's testimony at the June 2002 hearing that Groom's job would not have aggravated his condition if his work was as described by his co-workers; and (2) Dr. Szuba's statement in his deposition acknowledging that he would change his opinion that Groom's work worsened his condition if Groom's work actually did not involve very much snow shoveling or prolonged standing. Dr. Szuba's testimony does not rebut the presumption that Groom was permanently and totally disabled as a result of his slip and fall. The evidence that the board relied on in its finding that Groom had not proven his case by a preponderance of the evidence related only to the prolonged standing and general work duties claim. It is unrelated to his claim based on the slip and fall. Thus, it cannot serve as a basis for rebutting the presumption that Groom was permanently and totally disabled as a result of the slip and fall. The evidence is also insufficient to rebut the presumption that Groom's other injuries were work related. [27] Dr. Szuba never expressed the opinion that Groom's work was not a substantial factor in causing his disability. [28] The testimony cited by the board establishes that Dr. Szuba's conclusions were contingent on his understanding of Groom's work conditions; if Groom's work requirements were not as Groom described, Dr. Szuba testified that his opinions would have to be revised: Q: If, in point of fact, Mr. Groom's work did not involve prolonged standing, and did not involve very much snow shoveling, would that change your opinion whether his work worsened his condition? A: Yes, it would. It is not at all clear from the deposition transcript what Dr. Szuba understood the questioner's prolonged and very much terms to mean. [29] Also, only if read in isolation can Dr. Szuba's affirmative response in this exchange be taken to mean that the doctor felt that lighter duties posed absolutely no risk of injury to Groom. Elsewhere Dr. Szuba made it clear that snow shoveling of any frequency could prove injurious: Q: And wouldwould the action of standing upright and shoveling snow worsen Mr. Groom's condition regardless of the frequency with which he had to do it? A: Yes, it would. The board also noted that Dr. Szuba testified in June 2002 that if Groom's work was as described by his co-workers, then he would find the position acceptable for someone with Groom's condition; but Dr. Szuba qualified this opinion by adding that Groom would also need proper medical garments. Dr. Szuba testified at the same hearing that he still believed that Groom's employment with the state was a substantial factor in bringing about his need for medical treatment and that this opinion was established independently of what Groom told him. He also reaffirmed his opinion that Groom's employment with the state was a substantial factor in bringing about Groom's inability to work. In short, Dr. Szuba's testimony can at best be described as equivocal or internally inconsistent. In addressing the adequacy of medical evidence offered under analogous circumstances, we have previously held that when the substance of a particular witness's testimony is in doubt, any doubt should be resolved in favor of a workers' compensation claimant. [30] Because of the irreconcilable ambiguity of Dr. Szuba's opinions, any doubt as to their meaning must be resolved in Groom's favor. As a result, they did not provide substantial evidence to rebut the presumption of compensability as to work relatedness in this case.