Opinion ID: 2606396
Heading Depth: 3
Heading Rank: 4

Heading: The Board Erred in Denying Williams's Physical Injury Claim.

Text: Physical injury under the Act includes the work-related aggravation or acceleration of a pre-existing disease or condition. Thornton v. Alaska Workmen's Compensation Bd., 411 P.2d 209, 210 (1966). Liability is imposed on the employer wherever employment is established as a causal factor in the disability. Burgess Constr. Co. v. Smallwood, 623 P.2d 312, 317 (Alaska 1981), reh'g granted, 698 P.2d 1206 (Alaska 1985) (citation omitted). A causal factor is a legal cause if `it is a substantial factor in bringing about the harm' or disability at issue. Id. (citation omitted). An aggravation or acceleration is a substantial factor in the disability if it is shown that (1) but for the employment the disability would not have occurred, and (2) reasonable persons would regard the employment as a cause and attach responsibility to it. Fairbanks N. Star Borough v. Rogers and Babler, 747 P.2d 528, 532 (Alaska 1987). [T]o satisfy the `but for' test, the claimant need only prove ... that the aggravation, acceleration or combination was a substantial factor in the resulting disability. Id. at 533 (emphasis added). To overcome the AS 23.30.120(a) presumption of compensability, an employer must present 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. Gillispie v. B & B Foodland, 881 P.2d 1106, 1109 (Alaska 1994) (citations omitted). See also Childs v. Copper Valley Elec. Ass'n, 860 P.2d 1184, 1189 (Alaska 1993); Big K Grocery v. Gibson, 836 P.2d 941, 942 (Alaska 1992). If an employer overcomes the presumption of compensability, the employee has the burden of proving all of the elements of her claim by a preponderance of the evidence. Norcon, Inc. v. Alaska Workers' Compensation Bd., 880 P.2d 1051, 1055 (Alaska 1994).
The Board noted in its first decision that substantial evidence linked Williams's physical ailments to work-related stress. It observed that [t]here is an abundance of evidence that leads to the conclusion that work-related stress aggravated Williams's pre-existing gastrointestinal condition. The superior court, in its decision on appeal after remand, noted that all of [Williams's] treating health care providers opined that work stress did constitute such a substantial factor. We note here just a sample of this evidence: (1) Dr. Steer's July 30, 1987, letter in which he stated that Williams's stress-related medical illness would not abate without rest away from the office; (2) a statement in Dr. Kappes's August 2, 1991, report that it appears work stressors have exacerbated health issues which further impaired her ability to function accordingly and appears responsible for her early retirement due to health reasons; (3) Dr. Buchanan's statement that In further questioning about her job stresses it seems clear that with increased job stresses, deadlines, responsibilities, etc. symptoms predictably increase to the point of incapacity. Because of the exacerbation of stress related symptoms it appears to be no longer possible for her to work at her current job, or in similar jobs, with a like amount of stress. and (4) a letter from Mary Davis, M.S., a counselor who began treating Williams in October 1988, stating that She has had some difficulty functioning on her job for the past several years, but problems have increased in severity in recent months.... As her therapist, I see her depression and anxiety symptoms increase in proportion to the stress she reports with her job and with the accompanying physical problems. The Board found in its first decision that although Williams had made out a prima facie case of aggravation of a pre-existing physical condition sufficient to raise the statutory presumption of compensability, the State had overcome the presumption by producing substantial evidence that her disability was not work-related. The Board then concluded that Williams had not proven all elements of her case by a preponderance of the evidence. The superior court reversed the Board's denial of the physical injury claim and remanded for findings of fact to support the Board's holding that Williams had failed to prove her claim by a preponderance of the evidence. On remand, the Board held in its second decision that there is a lack of evidence showing Williams's gastrointestinal condition became worse because of work-related stress. It found that while Williams might have focused [on] work stress as the factor which caused her disability, the primary, underlying cause of her physical condition was depression and anxiety. [I]n light of the whole record, the Board found that work-related stress was not substantial enough to be `a' factor in bringing about Williams's physical condition. Concluding that she had not proven her physical injury claim by a preponderance of the evidence, it again denied that claim.
Noting that the Board found in its first decision that [t]here is an abundance of evidence that leads to the conclusion that work-related stress from working at CSED aggravated her preexisting gastrointestinal condition, Williams argues that the statutory presumption attached, and that it was error to hold that the State rebutted the presumption. Because the Board found that the statutory presumption applies to Williams's claim that her employment aggravated her pre-existing condition, we consider whether the State offered substantial evidence rebutting that presumption. See Gillispie, 881 P.2d at 1109. An employer may rebut the presumption either by presenting affirmative evidence that the injury is not work-connected or by eliminating all possibilities that the injury was work-connected. Childs, 860 P.2d at 1189. The employer can satisfy the former method by offering an expert opinion that the claimant's work was probably not a substantial cause of the disability. Id. (citing Big K Grocery, 836 P.2d at 942). In this case, the State satisfied neither method. First, it did not offer affirmative evidence either that the work was not a substantial cause of Williams's present condition or that the work did not aggravate her prior condition. Second, it did not offer evidence eliminating all possibilities the injury was work-connected. In finding in its first decision that the State had overcome the presumption, the Board relied exclusively on the testimony of Dr. Buchanan. The Board noted that Dr. Buchanan: (1) testified that Williams's chronic irritable bowel syndrome was not predominantly caused by her work and that she had suffered from a chronic bowel condition for the past fifteen years; (2) testified that the illness wasn't really a job-related illness; it's really a genetic illness and an emotional illness; (3) testified that work-related stress was a major factor in the employee's having to quit her job in 1990, even though he also testified that a major factor is not a substantial factor; but (4) was unwilling to apportion a percentage of responsibility to the State for this permanent partial impairment rating of Ms. Williams at twenty-five percent of the whole person. Based on this evidence, the Board concluded that CSED had overcome the presumption of compensability, and that the burden shifted to Williams to prove her claim by a preponderance of the evidence. The Board concluded that Williams failed to meet her burden of proof, and thus denied her claim. On appeal the superior court agreed with the Board that there was substantial evidence that Williams's condition was not work-related. It noted that Dr. Buchanan and Mary Davis and other medical personnel testified that the nature of the pre-existing condition and the other stressors in [Williams's] life were significant factors in producing her physiological injury. The superior court concluded that this showing was sufficient to shift the burden back to Williams, i.e., evidence rebutted the presumption of compensability. Neither Dr. Buchanan's testimony nor the evidence of other stressors in Williams's life noted by the superior court satisfies the Childs test. 860 P.2d at 1189. Dr. Buchanan did not express an affirmative opinion that Williams's current condition was not work-related. Nor did he eliminate all possibilities that her condition was work-connected. On the contrary, Dr. Buchanan's testimony can only be understood as supporting Williams's position.
First, Dr. Buchanan expressed the opinion although work-related stress was a major factor contributing to her condition, a major factor was not a substantial factor. His testimony establishes, however, that he did in fact consider work-related stress to be a substantial factor  as that term is properly used in workers' compensation cases  in the aggravation of Williams's physical ailments. He misconstrued the legal meaning of the term substantial factor, and imported an exclusivity requirement into the term where none exists in workers' compensation law. [10] He testified: The problem is in the definition of the word substantial. And I think that's the whole case, to my way of thinking. Clearly [work-related stress] was a factor. I've already said that in print. .... Whether that was a substantial one, by the definition that you said, I  I don't know. Because it implies exclusively  I mean, the implication is exclusively this job did it and not other jobs. .... I think the job that she was in was a factor, an important factor. But the real problem for the board is to decide if any job was a factor and therefore would that reduce the importance of the job she was in or was it  did it meet the criteria for substantial, which would be exclusive of other jobs. He also stated: [T]here seemed to be a relationship between the job stresses  a fairly clear consistent temporal relationship between job stresses and symptoms. And when the job stresses went away, the symptoms improved but were still present. Absent the semantical confusion, Dr. Buchanan's testimony unequivocally supports Williams's claim. [11] It cannot be interpreted as substantial evidence rebutting the presumption of compensability. That Dr. Buchanan also testified that he believed that Williams's chronic irritable bowel syndrome was not predominantly caused by her work is of little significance given the fact that we understand his testimony to convey the opinion that her CSED job was a substantial factor in bringing about her condition. Although Dr. Buchanan presented an alternative explanation  that genetics and emotional factors played a significant role in her illness  he did not eliminate all possibilities that the injury was work-connected. Veco, Inc. v. Wolfer, 693 P.2d 865, 872 (Alaska 1985). This court has held that medical testimony cannot constitute substantial evidence if it simply points to other possible causes of an employee's injury or disability, without ruling out work-related causes. Childs, 860 P.2d at 1189. Taken as a whole, Dr. Buchanan's testimony can only be understood as positing that, although Williams's job at CSED was not a predominant cause of her disability and non-work-related factors contributed to her disability, her CSED job was a substantial factor in bringing about her condition. Dr. Buchanan's testimony thus fails to satisfy either method of rebutting the presumption of compensability under Childs.
In agreeing with the Board that CSED had overcome the presumption of compensability, the superior court noted that Both Dr. Buchanan and Mary Davis, as well as other medical personnel, testified that the nature of the pre-existing condition and other stressors in appellant's life were significant factors in producing her physiological injury. We have noted that it is not a sufficient alternative explanation for the employer merely to point to other factors that likely aggravated a pre-existing condition. Childs, 860 P.2d at 1189. Other evidence noted by the Board in its decision on remand likewise fails to satisfy the Childs test. In deciding whether Williams had proven her physical injury claim by a preponderance of the evidence, the Board noted testimony and reports from Williams's treating psychologists about the substantial personal stressors in her life. Further, the Board noted that Williams was the source of much of the information on which witnesses relied in forming opinions supporting Williams's claim; however, the Board made no finding that Williams was not a credible or reliable reporter. In sum, CSED did not present substantial evidence that sufficiently excludes, either affirmatively or negatively, work-related factors as a substantial cause of Williams's disability. It did not offer evidence that other factors were the exclusive cause of her aggravated condition, nor has it offered evidence that her work at CSED was not another causal factor. Because the Board erred in finding that the State rebutted the presumption, it then erred in considering whether Williams proved her physical injury claim by a preponderance of the evidence.