Opinion ID: 2601903
Heading Depth: 2
Heading Rank: 2

Heading: Carter Is Entitled to PTD Benefits.

Text: Alaska Statute 23.30.120(a)(1) states that, in the absence of substantial evidence to the contrary, claims under the Alaska Workers' Compensation Act are presumed to be compensable. [26] We have established the following three-step analysis: First, the employee must establish a preliminary link between the [disability] and the employment. This step of the analysis requires consideration of only evidence that tends to establish the link. . . . . [Second, the court inquires] whether the employer rebutted this presumption with substantial evidence that 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. . . . . [Third], once the employer has rebutted the presumption that the injuries are work related, the employee can prevail only if he proves his claim by a preponderance of the evidence.[ [27] ] In its October 2003 decision and order the board employed this three-step analysis and ruled that Carter was not entitled to PTD benefits. Under step three, the board stated that After reviewing the record as a whole, we find that the employee cannot prove his claim by a preponderance of the evidence. The evidence shows that the employee was injured in 1992 while at work. He hurt his neck and shoulder, and achieved medical stability as of April 1993, according to our previous decision in this case. The employee suffered serious non-work-related medical problems, which made him permanently and totally disabled, probably since 1998 according to his treating physician at the time. His current treating physician testified that these serious and more recent problems are not substantially related to the 1992 injury, and that, but for these newer problems, the employee could be retrained. Consequently, we conclude his claim for PTD benefits must be denied. Carter contends that he was entitled to PTD benefits as of January 31, 1999. He argues that B & B has not rebutted the compensability presumption. Alternatively, he argues that even if B & B rebutted the presumption, substantial evidence does not support the board's finding that he failed to prove his claim by a preponderance of the evidence. B & B counters that substantial evidence supports the board's finding that Carter's serious non-work[-]related medical conditions, and not his work injury, caused Carter's PTD, and that such evidence both rebutted the compensability presumption and prevented Carter from proving his claim by a preponderance of the evidence. At step two of the analysis the board must determine whether the employer has rebutted the presumption of compensability with substantial evidence that 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. [28] Substantial evidence is evidence that a reasonable mind might accept as adequate to support a conclusion. [29] Whether the amount of evidence was substantial is a legal question, subject to independent review by the court. [30] The board does not weigh the evidence at step two. [31] But if the only medical evidence offered by the employer at step two is uncontroverted, yet inconclusive, the presumption of compensability is not overcome. [32] The board relied exclusively on the uncontroverted testimony of Dr. Blais, Carter's treating physician, when it concluded at step two that B & B had rebutted the presumption of compensability. Thus, the board's decision and order states: In order to rebut the presumption that the employee is entitled to PTD benefits, the employer relies on Dr. Blais' hearing testimony that none of the current health problems from which the employee suffers since 1999, and which make him unemployable are substantially related to or caused by the 1992 work-related injury. The employer also relies on Dr. Blais testimony that the employee would be able to be retrained for gainful employment, but for these non work-related diagnoses. Based on this evidence, we find that the employer has rebutted the presumption that the employee is entitled to PTD benefits. Once the presumption drops out we must determine whether the employee can prove his claim for PTD benefits by a preponderance of the evidence. (Emphasis added.) Parts of Dr. Blais's testimony directly supported Carter's argument that his work-related injures were a substantial factor in his PTD. Thus, on direct examination by Carter's lawyer, Dr. Blais offered this testimony: Q: In terms of the work [injuries] being a part, a component of [Carter's] overall permanent total disability, would you say that the cervical injury is a substantial factor in the permanent total disability? A: Yes, substantial factor would be an appropriate choice of words. Q: And would you say also that the work injury is a substantial factor in that it is combined with these other maladies, these other conditions, that we've discussed to render Mr. Carter permanently totally disabled? A: Yes. . . . . Q: And your opinions today, Doctor, are given to a reasonable degree of medical certainty, is that correct? A: Yes, it is. This testimony directly supported Carter's PTD claim. As we saw above, the board relied on other passages in Dr. Blais's testimony when it ruled that B & B had rebutted the presumption of compensability. On appeal B & B argues that Dr. Blais's testimony established that the 1992 work-related injury did not cause the serious health problems that now render Carter unemployable, and that Carter would be employable if he did not have these major health problems. In the passages discussed by B & B, Dr. Blais testified that if Carter only had his work-related injuries it was conceivable he could do some very light types of [work] activities and that in such a situation there was a reasonable chance [Carter] could work an eight-hour day, with breaks. He also testified, in response to questions of a board member, that, with one qualification, Carter's current problems with esophagitis, diabetes, hypertension, recurrent pulmonary embolus, deep vein thrombosis, seizure disorder, and hyperlipidemia were not related to the neck injury or the pain medication for that injury. [33] This testimony is consistent with Dr. Blais's responses to a June 2002 letter from Northern Rehabilitation Services. In that letter Northern Rehabilitation Services asked Dr. Blais whether, in relation to Carter's 1992 injury and cervical fusion only, Carter was competitively employable in the labor market on a full-time basis. Dr. Blais responded, Yes and added that his response related to Carter's anterior cervical fusion only. Dr. Blais also stated in his response to that letter that Carter's 1992 injury and cervical fusion were medically stable and that, in relation to those two factors only, Carter could be immediately targeted for sedentary and light work. For purposes of the step-two analysis, the evidence relied on by B & B must be read in light of Dr. Blais's opinion, discussed and quoted above, that the work injury was a substantial factor in rendering Carter permanently and totally disabled. It must also be read in context of his testimony that Northern Rehabilitation Services's written questions were very hypothetical, somewhat fictitious, and bogus. Thus, even though some passages in Dr. Blais's testimony and his responses to Northern Rehabilitation Services's letter support a conclusion that Carter's non-work-related health conditions are a substantial factor in his PTD, they do not rule out his work injury as another substantial factor. There can be more than one substantial factor in a disability. Therefore, to rebut the presumption of compensability at step two, the employer must offer evidence that either excludes work-related factors as a substantial cause of the disability, or directly eliminates any reasonable possibility employment was a factor in causing the disability. [34] Because Dr. Blais's substantial factor testimony directly supporting Carter's claim was uncontroverted by any other witness, and because the passages in Dr. Blais's testimony relied on by the employer and the board at step two failed to establish that the work injury was not a substantial factor in bringing about Carter's permanent total disability, the evidence must be regarded as insufficient to rebut the presumption of compensability. [35] Because substantial evidence does not support the board's decision that B & B rebutted the compensability presumption, we reverse and hold that Carter is entitled to PTD benefits as a matter of law.