Court Opinion

ID: 9961269
Source: CourtListenerOpinion
Date Created: 2024-04-18 15:10:44.803448+00
Date Added: 2024-06-11T08:20:31.400991
License: Public Domain

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        NOT TO BE PUBLISHED OPINION

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                                                    RENDERED: APRIL 18, 2024
                                                       NOT TO BE PUBLISHED

               Supreme Court of Kentucky
                                2023-SC-0469-WC

MIZKAN AMERICA, INC.                                                   APPELLANT

                    ON APPEAL FROM COURT OF APPEALS
V.                          NO. 2023-CA-0622
                     WORKERS’ COMPENSATION BOARD
                            NO. WC-20-61494

MACK DYKES;                                                            APPELLEES
STEPHANIE KINNEY, ADMINISTRATIVE
LAW JUDGE; AND
KENTUCKY WORKERS’ COMPENSATION
BOARD

                  MEMORANDUM OPINION OF THE COURT

                                   AFFIRMING

      Mizkan America, Inc. appeals a Court of Appeals decision which affirmed

the Workers’ Compensation Board’s ruling to uphold the opinion, award, and

order of an Administrative Law Judge (ALJ) that found Mizkan’s former

employee, Mack Dykes, has a 5% whole person permanent impairment rating

due to a work-related injury to his lower back. Mizkan’s sole argument is that

the medical report and conclusions adopted by the ALJ in reaching its

conclusion did not comply with the AMA Guides. 1 After review, we affirm.

      1 American Medical Association Guides to the Evaluation of Permanent

Impairment (5th ed. 2001).
                I. FACTS AND PROCEDURAL BACKGROUND

      On October 31, 2016, Dykes began working for Mizkan as an ingredient

handler. His job duties required him to gather ingredients, place them into a

kettle, and operate a machine. The job necessitated that Dykes be able to lift

and maneuver up to fifty pounds and that he be able to stand for

approximately six hours per eight-hour shift. On October 9, 2020, Dykes, then

forty-nine years old, was sitting in a four-legged rolling chair while at work.

Dykes tried to stand up from the chair but got his foot caught underneath one

of the chair’s legs. Dykes tripped, hit his head on a cabinet, and fell to the

floor. He immediately felt low back and left hip pain.

      Prior to working for Mizkan, Dykes was treated for low back pain and left

radicular leg pain by Dr. Harold Cannon, who performed an L5-S1 discectomy

on May 29, 2014. Dykes reported that the surgery resolved his back pain, and

he resumed full duty work thereafter. Dykes returned to Dr. Cannon in March

2015 after he heard a “pop” while lifting a bed at work. 2 An MRI revealed

degenerative and post-operative changes at Dykes’ L5-S1 disks with a new

small focal disc extrusion predominately on the left side. Apart from those

occurrences Dykes had no other low back issues prior to working for Mizkan,

and he passed a mandated functional capacity evaluation (FCE) before he

began working for Mizkan in October 2016. Dykes testified that he had no

      2 Dykes’ Form 101 indicates that he worked at a hospital as an EKG/EEG

technician from 2002 to 2015.

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issues with his lower back prior to the October 2020 work-related injury other

than a “flare up” in 2017 for which he also treated with Dr. Cannon. That

issue was ostensibly resolved as Dykes was not on any medical restrictions at

the time of the October 2022 work-related injury.

      Dykes first sought treatment for his work-related injury on October 12,

2020, three days after the incident. Dr. Audry Rhodes diagnosed a lumbar

strain and left hip contusion. Dykes was prescribed pain medication and an

order for physical therapy was entered on October 20, 2020, which Dykes

attended. He was released to work with restrictions and was referred to a

neurosurgeon, Dr. Mike Chou, on January 18, 2021. In February 2021 Dykes

returned to Dr. Cannon who reviewed an MRI from January 2021. Dr. Cannon

noted that the MRI showed previous central and left paracentral disc

herniation and that Dykes “now has a right paracentral component, which is

new.” Dr. Cannon diagnosed disc disease at L5-S1 and stated that Dykes’ disc

bulge had worsened. He opined that Dykes’ pain was complicated by obesity

and a disc bulge without radiculopathy. He did not recommend surgical

intervention. Dr. Chou then examined Dykes on March 31, 2021. After

reviewing the January 2021 MRI, Dr. Chou opined that Dykes injured his

pelvis and sacroiliac area as a result of the work incident. He referred Dykes to

pain management for a left sacroiliac (SI) joint injection.

      Dr. Thomas O’Brien performed an independent medical examination

(IME) on April 30, 2021, at Mizkan’s request. Dr. O’Brien diagnosed a minor

buttock contusion and placed Dykes at maximum medical improvement (MMI).

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He did not believe Dykes’ back pain was related to work accident and instead

attributed it to his multilevel lumbar degenerative disk disease and arthritis.

He assessed a 0% whole person impairment rating and opined that Dykes

required no further treatment and could return to his pre-injury work.

      Dykes treated at Commonwealth Pain Associates from May 4, 2021,

through November 2, 2021, with Dr. Nicholas Winters. Dr. Winters’ diagnosis

was degenerative lumbar intervertebral disk and SI joint inflammation. Dykes

received a left SI joint injection on May 4, 2021, which provided 70% pain relief

for three weeks. He then began lumbar epidural steroid injections (LESI) in

August 2021, which provided some relief for three weeks. In his last visit to

Dr. Winters in November 2021, he received a Depo-Medrol injection and

another LESI.

      Dykes also treated with Bluegrass Internal Medicine from August 19,

2021, to November 9, 2021. On August 19, Leslie Phelps, APRN, ordered

Dykes off work until October 30, 2021, with a plan to reevaluate his condition

in three months. On November 10, 2021, Ms. Phelps reviewed Dykes’ recent

FCE and opined he was not fit to perform his functions as an ingredient

handler for Mizkan. She recommended that he seek long-term disability

benefits.

      Dykes was released by Mizkan in November or December 2021; he was

unable to pass Mizkan’s FCE and Mizkan was no longer willing to tolerate his

accommodations. He filed a “Form 101” Application for Resolution of a Claim

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on December 23, 2021, alleging a work-related injury to his back 3 and later

filed an additional claim for a psychological work-related injury that is not at

issue in this appeal.

      On February 1, 2022, Dr. Timothy Wilson performed an IME at the

request of Dykes’ counsel. Dr. Wilson noted Dykes’ 2014 lumbar surgery with

Dr. Cannon and reviewed Dykes’ post-work injury treatment records from Dr.

Rhodes, Dr. Cannon, Dr. Chou, and Dr. Winters. He also performed a physical

examination. Dr. Wilson diagnosed “a worsening of a preexisting L5-S1 disc

herniation with a prominent right paracentral component that was a change

from previous MRI” and placed him at MMI as of December 2021. Dr. Wilson’s

impairment rating was as follows:

      Mr. Dykes has a permanent impairment of 5% whole person.
      Based on Table 15-3 on page 384 of the AMA Guides to the
      Evaluation of Permanent Impairment, Fifth Edition, he has a 13%
      whole person impairment based upon a history of a herniated disk
      with associated radiculopathy. The patient did have a preexisting
      impairment based upon his prior back surgery using the range of
      motion [(ROM)] method with a surgically treated disk lesion
      without residual signs or symptoms which results in an 8% whole
      person impairment. Therefore, subtracting that 8% preexisting
      impairment from his 13% current impairment would attribute a
      5% whole person impairment to the injury at work on October 9,
      2020.

Dr. Wilson placed Dykes on a restriction of lifting no more than fifteen pounds

and opined that he could not return to his pre-injury employment. He

recommended that Dykes seek a sedentary, light duty job.

      33 Dykes’ Form 101 also claimed injuries to his head and left hip, but the ALJ

later dismissed those claims due to Dykes’ failure to present any evidence indicative of
permanent injury. Dykes did not challenge that ruling.

                                              5
      Following Dr. Wilson’s IME, on April 6, 2022, Dr. O’Brien filed a

supplemental report in which he disagreed with Dr. Wilson’s findings. Dr.

O’Brien first asserted that Dr. Wilson’s conclusion that Dykes was without

residual symptoms following Dr. Cannon’s 2014 surgery was inaccurate, citing

his treatment with Dr. Cannon in 2015 and his “flare up” in 2017. He then

criticized Dr. Wilson’s impairment rating conclusions as follows:

      Dr. Wilson’s (sic) combined the [diagnosis related estimate (DRE)]
      method with the Range of Motion Method to arrive is (sic) at 5%
      permanent partial impairment, which he inappropriately assigns to
      the minor work incident. This methodology does not follow the
      recommendations for the determination of impairment in the AMA
      Guidelines to the Evaluation of Permanent Impairment, Fifth
      Edition. Mr. Dykes has a pre-existing 13% permanent partial
      impairment to the whole person using Table 15-3 (384) (DRE
      category III). His current impairment is unchanged.

      Mr. Dykes sustained at most a minor buttock bruise as a result of
      the minor slipping incident. Mr. Dykes’ ongoing complaints of
      chronic back pain are attributable to the progressive natural
      history of his pre-existing, previously documented, multilevel
      degenerative disc disease, prior failed low back surgery with
      ongoing residual symptoms, morbid obesity, and diabetes mellitus.

After a hearing, wherein Dykes was the sole witness, the ALJ issued an

opinion, award, and order finding, inter alia, that Dykes had a 7% permanent

partial disability rating: a 5% impairment rating was assigned for his physical

injury based on Dr. Wilson’s conclusions and 2% was assigned for his

psychological injury.

      The sole issue before the ALJ that is now relevant to this appeal was

Mizkan’s assertion that Dr. Wilson did not comply with the AMA Guides in

determining that Dykes had a 5% work-related whole person impairment

                                          6
rating. 4 It relied entirely on Dr. O’Brien’s supplemental report in doing so. Dr.

O’Brien and Dr. Wilson both agreed that Dykes had a current 13% whole

person impairment rating due to his prior back surgery based on Table 15-3,

page 384 of the AMA Guides, utilizing the DRE method. They also agreed that

Dykes had a pre-existing impairment. But Dr. O’Brien believed the entire 13%

was pre-existing due to his 2014 discectomy and therefore attributed 0% to his

work incident. In contrast, Dr. Wilson believed only 8% was pre-existing, and

attributed the remaining 5% to his work-related injury. Dr. Wilson determined

the 8% pre-existing impairment by using the ROM method rather than the DRE

method. The crux of Dr. O’Brien’s argument, and by extension Mizkan’s, was

that that Dr. Wilson was not permitted under the AMA Guides to “mix and

match” methodologies in calculating Dykes’ impairment rating, and therefore

the ALJ could not rely on his impairment rating. The ALJ disagreed with

Mizkan and ruled as follows:

      Mizkan argues the ALJ is “legally precluded” from assessing
      impairment for the physical injury. Essentially, Mizkan argues Dr.
      Wilson’s assessment of impairment is not in accordance with the
      AMA Guides. This ALJ reviewed Dr. Wilson’s impairment rating
      and it appears to be a reasonable assessment considering Dykes’
      increased objective lumbar findings. Thus, this ALJ finds Dykes
      retains 5% permanent impairment due to the work injury. Also,
      this ALJ finds Dr. Wilson’s rating is grounded in the AMA Guides
      per Jones v. Brasch-Barry General Contractors, 189 S.W.3d 149
      (Ky. 2006).

      4 Mizkan did not opt to depose Dr. Wilson pursuant to 803 KAR 25:010 §10(8),

nor did it object to his report being filed in accordance with 803 KAR 25:010 §10 (6)(b).
Nevertheless, both the benefit review conference order and the ALJ’s opinion and order
reflect that “proper use of the AMA Guides” was a contested issue.

                                               7
Mizkan thereafter appealed to the Board and presented the same argument,

which it rejected, holding:

      Dr. Wilson stated Dykes’ current impairment rating, based on the
      AMA Guides utilizing Table 15-3 on p. 384, is 13%. He noted a
      history of a herniated disk with associated radiculopathy. Dr.
      O’Brien also assessed a 13% whole person impairment rating.
      Where the two physicians differ is whether Dykes suffered any
      work-related impairment. Dr. Wilson diagnosed a worsening of a
      pre-existing L5-S1 disc herniation with a prominent right
      paracentral component which was different from a previous MRI.
      He subtracted 8% for pre-existing impairment to arrive at a 5%
      work-related impairment rating.

      Dr. O’Brien believed the pre-existing impairment is 13% based on
      the prior surgery and ongoing symptoms. Therefore, he opined
      there was no worsening of impairment related to the work injury.
      Dr. O’Brien contends Dr. Wilson inappropriately used the ROM
      method to determine the pre-existing impairment (8%), but he
      used the [DRE] method to obtain Dykes’ current impairment. Dr.
      O’Brien noted the DRE method is preferred, and the mixing and
      matching of the two methods is not in accordance with the AMA
      Guides. He believed if the ROM method was utilized to determine
      the prior impairment, the result would have been 11%.

      Fundamentally, Dr. Wilson believes Dykes suffered additional
      injury from the work event, particularly a worsening of a pre-
      existing L5-S1 disc herniation with a prominent right paracentral
      component which is a change from the condition depicted on the
      previous MRI. Dr. O’Brien believed the work event caused a minor
      buttock contusion.

      When physicians genuinely express medically sound but differing
      opinions as to the severity of a claimant’s injury, the ALJ has the
      discretion to choose which physician’s opinion to believe, so long
      as the opinion is based on the AMA Guides. Jones v. Brasch, 189
      S.W.3d 149, 153 (Ky. App. 2006). It is for the ALJ, and not this
      Board, to make a finding when analyzing this conflicting evidence.
      “The proper interpretation of the Guides and the proper
      assessment of an impairment rating are medical questions.”
      Plumley v. Kroger, Inc., [557 S.W.3d 905 (Ky. 2018)]. It is also the
      ALJ’s sole authority as fact-finder to judge the weight, credibility,
      substance, and inferences to be drawn from the evidence. AK Steel
      Corp. v. Adkins, 253 S.W.3d 59 (Ky. 2008).

                                           8
      A rating or award may not conform to KRS 342.730 or the AMA
      Guides when the wrong edition is utilized or separate impairment
      ratings were added when the AMA Guides explicitly state this is not
      to be done. George Humfleet Mobile Homes v. Christman, [125
      S.W.3d 288 (Ky. 2004)]; Central Baptist Hospital v. Hayes, 2012-
      SC-00752-WC, 2013 WL 4623489 (Ky. Aug. 29, 2013) (Designated
      Not To Be Published). Neither occurred in the present case. An
      ALJ cannot utilize an impairment rating expressed in a medical
      opinion that is not based on the AMA Guides, however strict
      adherence to the AMA Guides is not required. Plumley v. Kroger,
      Inc., supra. The essential point is that assigning an impairment
      rating must be left to the physicians. The authority to select an
      impairment rating assigned by an expert medical witness rests
      with the ALJ. Staples, Inc. v. Konvelski, 56 S.W.3d 412 (Ky. 2001);
      KRS 342.0011(35)-(36).

      Here, the two physicians expressed conflicting opinions regarding
      the degree of injury and the proper method to be utilized in
      assessing an impairment rating Dr. Wilson explained he used the
      AMA Guides in assessing the impairment rating and described the
      changes he observed to Dykes’ lumbar condition. The impairment
      rating found by the ALJ is supported by substantial evidence.

      Mizkan then appealed the Board’s ruling to the Court of Appeals and

again asserted that Dr. Wilson’s impairment rating failed to comply with the

AMA Guides. The Court of Appeals unanimously affirmed the Board. Mizkan

America, Inc. v. Dykes, 2023-CA-0622-WC, 2023 WL 5654430 (Ky. App. Sept.

1, 2023). The court succinctly stated that its standard of review is “to correct

the Board only where [this] Court perceives the Board has overlooked or

misconstrued controlling statutes or precedent, or committed an error in

assessing the evidence so flagrant as to cause a gross injustice.” Id. at *2

(quoting W. Baptist Hosp. v. Kelly, 827 S.W.2d 685, 687-88 (Ky. 1992)). And

that it “perceiv[ed] no such error.” Mizkan, 2023 WL 5654430 at *3. It noted

that Plumley, upon which the Board relied, “holds that strict adherence to the

                                           9
Guides is not required[,]” and that “[a]s was her prerogative, the ALJ chose to

rely upon Dr. Wilson, whose opinion constitutes substantial evidence to

support the award.” Id.

      Mizkan has now appealed to this Court raising the same argument.

                                 II. ANALYSIS

      The role of the Court of Appeals in reviewing the Board is “to correct the

Board only where [the] Court perceives the Board has overlooked or

misconstrued controlling statutes or precedent, or committed an error in

assessing the evidence so flagrant as to cause gross injustice.” W. Baptist

Hosp., 827 S.W.2d at 687–88. Further review from this Court is limited to

addressing “new or novel questions of statutory construction, or to reconsider

precedent when such appears necessary, or to review a question of

constitutional magnitude.” Id. at 688.

      It is well-established that “the ALJ is the sole, undisputed finder of fact

in workers’ compensation cases” and therefore has singular “‘authority to

determine the quality, character[,] . . . substance[,]’ and weight of the evidence

presented, as well as the inferences to be drawn from the evidence.” Jones v.

Brasch-Barry General Contractors, 189 S.W.3d 149, 152 (Ky. App. 2006). This

Court is consequently without authority to “‘substitute its judgment’ for that of

the ALJ[.]” Id. at 153. In that vein, “[t]he proper interpretation of the Guides

and the proper assessment of an impairment rating are medical questions.”

Plumley v. Kroger, Inc., 557 S.W.3d 905, 913 (Ky. 2018). And “if the physicians

in a case genuinely express medically sound, but differing, opinions as to the

                                           10
severity of a claimant’s injury, the ALJ has the discretion to choose which

physician’s opinion to believe.” Brasch-Barry, 189 S.W.3d at 153. The only

limitation on that discretion, that is relevant here, is that an ALJ cannot give

credence to an opinion that is not “based upon the AMA Guides.” Id.

      In Plumley, this Court expounded that for a medical opinion to be “based

in the Guides” simply means that it is “grounded in the Guides,” it does not

mean that an opinion must strictly adhere to the Guides. 557 S.W.3d at 912-

13. Examples of instances wherein a physician’s opinion was not based on or

grounded in the Guides, and therefore could not be relied upon by the ALJ as

substantial evidence, include when a physician assigns an impairment rating

that is double the amount called for by the Guides due to his personal

disagreement with, and antagonism towards, the Guides. Brasch-Barry, 189

S.W.3d at 153-54. Or, when a physician utilizes the wrong edition of the

Guides in determining an impairment rating. City of Ashland v. Stumbo, 461

S.W.3d 392, 396 (Ky. 2015). Or, when a physician combines two impairment

ratings that the Guides explicitly state should not be combined. Central

Baptist Hosp. v. Hayes, 2012-SC-000752-WC, 2013 WL 4623489, *2 (Ky. Aug.

29, 2013) (combining impairment ratings for gait derangement and arthritis).

      In this case, we cannot say that Dr. Wilson’s opinion was not grounded

in or based on the Guides simply because he “mixed and matched” the ROM

and DRE methods to determine Dykes’ impairment rating. Mizkan agrees with

Dr. Wilson’s determination reached under the DRE method that Dykes has a

current 13% whole person impairment rating. Its argument is that Dr. Wilson

                                           11
should have also used the DRE method, rather than the ROM method, to

determine that 8% of his current impairment was pre-existing. But Mizkan

has cited nothing from the Guides that explicitly forbids the “mixing and

matching” of the DRE and ROM methods to determine an impairment rating.

In fact, Mizkan cites page 381 of the Guides, which seems to indicate that

mixing the methods is permissible, it states: “If the previous evaluation was

based on the DRE method and the individual is now evaluated with the ROM

method and prior ROM measurements do not exist to calculate a ROM

impairment rating, the previous DRE percent can be subtracted from the ROM

ratings.” Granted, this is the opposite of what Dr. Wilson did in this case

(subtracting ROM from DRE rather than DRE from ROM), but the point is the

combination of the two methods is at least contemplated by the Guides.

      We agree with the Board’s conclusion that, at bottom, the ALJ was

presented with two differing medical opinions regarding whether all of Dykes’

current 13% impairment rating was attributable to his 2014 surgery, or

whether some percentage could be attributed to his work-related injury. And,

because we cannot say that Dr. Wilson’s conclusions were not based on or

grounded in the Guides, the ALJ’s decision to rely on Dr. Wilson’s opinion is

not subject to reversal.

                                 III. CONCLUSION

      Based on the foregoing, we affirm.

      All sitting. All concur.

                                           12
COUNSEL FOR APPELLANT:

Joel Walter Aubrey
Pohl Aubrey Gray, PSC

COUNSEL FOR APPELLEE, MACK DYKES:

Timothy Jay Wilson
Wilson & McQueen

WORKERS’ COMPENSATION BOARD:

Michael Wayne Alvey

ADMINISTRATIVE LAW JUDGE:

Hon. Stephanie Kinney

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