Opinion ID: 1179685
Heading Depth: 2
Heading Rank: 3

Heading: The Board Correctly Applied the Presumption of Compensability in Rejecting Tinker's Claims for Compensation Based on his 1990 Ankle Injury and 1991 Illness

Text: AS 23.30.120(a)(1) creates a presumption in favor of compensability. [8] In cases involving pre-existing medical conditions, the aggravation or acceleration of the condition by the injury must be presumed. Burgess Construction Co. v. Smallwood, 623 P.2d 312, 315 (Alaska 1981) ( Smallwood II ). However, the presumption does not attach until the employee establishes a preliminary link between the disability and the employment. Furthermore, in claims `based on highly technical medical considerations' medical evidence is often necessary in order to make that connection. Id. at 316 (quoting Commercial Union Cos. v. Smallwood, 550 P.2d 1261, 1267 (Alaska 1976) ( Smallwood I ). Once the employee makes a prima facie case of work-relatedness, the presumption of compensability attaches and shifts the burden of production to the employer. Veco, Inc. v. Wolfer, 693 P.2d 865, 869 (Alaska 1985). To overcome the presumption of compensability, the employer must then present substantial evidence that the disability is not work-related. Miller v. ITT Arctic Servs., 577 P.2d 1044, 1046 (Alaska 1978). This can be accomplished either by producing affirmative evidence that the injury is not work-related or by eliminating all reasonable possibilities that the injury is work-related. Smallwood II, 623 P.2d at 316. Medical evidence may be necessary to rebut the presumption of compensability, depending on the probative value of the available lay evidence and the complexity of the medical facts involved. Veco, 693 P.2d at 871. Once the presumption of compensability is rebutted, the employee must prove all elements of her case by a preponderance of the evidence. Id. at 870. The Board found that no medical evidence in the record supported Tinker's claim that his 1990 ankle injury aggravated, accelerated, or combined with his pre-existing condition to become a substantial factor in his need for surgery and amputation in 1991. [9] Thus it concluded that Tinker failed to establish a prima facie case and that the presumption of compensability had not attached as to this claim. The question of whether Tinker met the necessary quantum of evidence to establish a prima facie case is a legal question, and this court will independently review the evidence in answering it. See Fireman's Fund, 544 P.2d at 1015. Tinker argues that there was sufficient medical evidence in the record to establish a preliminary link between his 1990 ankle injury and his 1991 surgery and amputation. He cites to Smallwood II, 623 P.2d 312, for support. In Smallwood II, a doctor testified that working conditions played a significant role in the employee's disability; the court found that this testimony created a preliminary link. 623 P.2d at 314, 316. There was no comparable testimony in this case. The closest any testimony came to establishing such a link was in the testimony of a Dr. Mills, and it is clear from reading more than an isolated line or two of this testimony that this doctor strongly resisted Tinker's attempts to get him to testify that, in his professional judgment, the 1990 ankle injury and collapsed arch could have been a substantial factor in the amputation: Q. Would you be able to state an opinion as to whether or not this injury ... to Mr. Tinker's left foot could cause an infection or an ulceration or lesion in Mr. Tinker's left foot which could culminate in his below-the-knee amputation of his left foot in November of '91? ..... A. It would cause all those things, but my point, my idea of that was I didn't think of it as an injury. It was a gradual, destructive process, if you wish, that was occurring in his foot. It happened that he suddenly might have become aware of it. But anyway, it was a totally  it caused massive changes in his foot that eventually, with overwhelming infection, resulted in amputation. And that's a very common thing. .... I can see very much that he would have a so-called collapse of his arch. But it's primarily a collapse secondary to destruction of all his tarsi or many of his tarsi. ..... Using your own word, the kind of foot he had in itself is an eggshell. It's demineralized and there are changes you've seen on X-ray with this displacement of bone, so there's not much substance to hold that foot together. This is not testimony suggesting that the 1990 fall may have played a significant role in the amputation. Our review of the evidence before the Board leads us to the same conclusion reached by the Board. There was no medical evidence suggesting that the 1990 fall might have played a significant role in the amputation, and Tinker's claim for compensation based on that fall was properly denied. Tinker also claims that his 1991 illness resulted from food poisoning at his place of employment, that this work-related illness spread bacteria throughout his body, and that this bacteria then seeded an infection in his foot that led to its amputation. Because Dr. Aubuchon, one of the doctors who examined Tinker, testified that he could not rule out the possibility that Tinker had sustained food poisoning which could have resulted in the infection of his left foot, the Board found that Tinker had presented a prima facie case that the amputation was work-related. [10] It then found that Eagle Pacific had provided substantial medical evidence rebutting the presumption. At that point, Tinker was required to prove all elements of his claim by a preponderance of the evidence, which the Board found he had failed to do. Tinker argues that the Board erred in concluding that Eagle Pacific provided the substantial evidence needed to rebut the presumption. This court will independently review the evidence to determine whether it meets the necessary quantum of substantiality. See Fireman's Fund, 544 P.2d at 1015. In reviewing the substantiality of the evidence offered to rebut the presumption of compensability, this court will examine that evidence by itself and will not weigh it against evidence tending to establish causation. Veco, 693 P.2d at 869-70. Substantial evidence overcomes the presumption if it `either (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.' Big K Grocery v. Gibson, 836 P.2d 941, 942 (Alaska 1992) (quoting Grainger v. Alaska Workers' Comp. Bd., 805 P.2d 976, 977 (Alaska 1991)). Considerable medical evidence documents the progression of Tinker's foot problems from the 1986 frostbite incident to the time of his 1991 illness. This evidence creates a strong inference that Tinker's illness was not itself a substantial cause of the amputation. See Burgess Construction Company v. Smallwood, 698 P.2d 1206, 1211 (Alaska 1985) ( Smallwood III ). We therefore conclude that the medical evidence concerning Tinker's foot problems from 1986 to 1991 eliminates any reasonable possibility that his employment during May and June, 1991, was a factor in causing his amputation.