Court Opinion

ID: 9919479
Source: CourtListenerOpinion
Date Created: 2024-01-18 16:06:28.680691+00
Date Added: 2024-06-11T08:06:56.370184
License: Public Domain

IMPORTANT NOTICE
        NOT TO BE PUBLISHED OPINION

THIS OPINION IS DESIGNATED “NOT TO BE PUBLISHED.”
PURSUANT TO THE RULES OF CIVIL PROCEDURE
PROMULGATED BY THE SUPREME COURT, RAP 40(D), THIS
OPINION IS NOT TO BE PUBLISHED AND SHALL NOT BE
CITED OR USED AS BINDING PRECEDENT IN ANY OTHER
CASE IN ANY COURT OF THIS STATE; HOWEVER,
UNPUBLISHED KENTUCKY APPELLATE DECISIONS,
RENDERED AFTER JANUARY 1, 2003, MAY BE CITED FOR
CONSIDERATION BY THE COURT IF THERE IS NO PUBLISHED
OPINION THAT WOULD ADEQUATELY ADDRESS THE ISSUE
BEFORE THE COURT. OPINIONS CITED FOR
CONSIDERATION BY THE COURT SHALL BE SET OUT AS AN
UNPUBLISHED DECISION IN THE FILED DOCUMENT AND A
COPY OF THE ENTIRE DECISION SHALL BE TENDERED ALONG
WITH THE DOCUMENT TO THE COURT AND ALL PARTIES TO
THE ACTION.
                                                 RENDERED: JANUARY 18, 2024
                                                       NOT TO BE PUBLISHED

               Supreme Court of Kentucky
                                2023-SC-0164-WC

JENNIFER WHISMAN                                                       APPELLANT

                  ON APPEAL FROM COURT OF APPEALS
V.                         NO. 2022-CA-1318
                WORKERS’ COMPENSATION NO. WC-21-00540

TOYOTA MOTOR MANUFACTURING                                             APPELLEES
KENTUCKY, INC.; GREG W. HARVEY,
ADMINSTRATIVE LAW JUDGE; AND
WORKERS’ COMPENSATION BOARD

                  MEMORANDUM OPINION OF THE COURT

                                   AFFIRMING

      Jennifer Whisman appeals from the opinion of the Kentucky Court of

Appeals 1 which affirmed the Workers’ Compensation Board (Board) opinion

affirming the determination of the Administrative Law Judge (ALJ). The ALJ

had determined that Whisman had failed to offer proof sufficient to show that

her chronic sinusitis was the result of occupational exposer to Pseudomonas 2

      1 Whisman v. Toyota Motor Manufacturing Kentucky, Inc., 2022-CA-1318-WC,

2023 WL 2437499 (Ky. App. Mar. 10, 2023) (unpublished).
      2 Pseudomonas is a type of bacteria (germ) that is commonly found in the

environment. It is a type of gram-negative bacteria and thrives in moist and warm
environments such as commonly found in both soil and water. These bacteria can
cause infections including chronic sinusitis. See Centers for Disease Control and
Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID),
Pseudomonas aeruginosa in Healthcare Settings (Nov. 13, 2019), http://www.cdc.gov/
organisms/pseudomonas.html.
bacteria as an employee at the Toyota Motor Manufacturing, Kentucky, Inc.

(Toyota) plant in Georgetown, Kentucky.

      Having concluded that neither the ALJ nor the Board overlooked or

misconstrued controlling statutes or caselaw, or flagrantly erred in assessing

the evidence so as to cause gross injustice, we affirm.

                  I. FACTUAL AND PROCEDURAL HISTORY

      Whisman began working at Toyota’s Georgetown plant in 2011 and

testified that her sinus symptoms started in 2013, when she began

experiencing dizziness.

      Whisman began seeing Dr. Ronald George Shashy in July 2014. Dr.

Shashy’s records reflected Whisman initially reporting problems with migraine

headaches, dizziness, fatigue, and facial swelling. Whisman reported she had

weight gain, vision loss, eye pain, ear drainage, and hearing loss. Dr. Shashy

diagnosed her with chronic sinusitis, mucus retention, chronic rhinitis, and

remnants of migraine, not otherwise specified. Dr. Shashy recommended nasal

irrigation with normal saline, endoscopic sinus surgery, and possibly a

septoplasty. Dr. Shashy proceeded with the septoplasty surgery that August

which included a partial resection of the inferior turbinate on both sides, a

total ethmoidectomy on both sides, a middle meatal antrostomy on both sides,

and a sphenoidotomy on both sides. In addition to his previous diagnoses, he

found Whisman to have a deviated septum. He saw Whisman again on August

26, 2014, when she presented for sinus debridement and noted Whisman had

tobacco use disorder and migraines. Dr. Shashy next saw Whisman on

                                        2
September 9, 2014, when she continued to complain of dizziness and allergic

rhinitis.

      Dr. Shashy’s notes reported that Whisman reported a history of exposure

to mold in her home but Whisman herself denied remembering making that

statement and denied ever having her prior residence inspected for mold. In the

later Workers’ Compensation hearing, Whisman filed a report from Ray Fouser,

a professional engineer, who performed testing at her then-current residence

on October 27, 2020. The report indicated a sample from the master bathroom

sink in her house tested negative for Pseudomonas.

      On October 24, 2018, Whisman was seen by Dr. Leslieann Asbury of

Ear, Nose, and Throat Specialists of Central Kentucky. Dr. Asbury noted

Whisman’s history of sinus problems and Dr. Shashy’s prior surgery. At that

time, Whisman’s symptoms included excessive dizziness, ear pain and fullness,

pain and pressure in the right cheek area, and dental pain. Whisman reported

her symptoms never resolved after the previous surgery and had recently

increased after moving moldy furniture. Dr. Asbury diagnosed Whisman with

seasonal allergic rhinitis due to fungal spores, a history of sinus surgery, and

dizziness.

      Beginning in December 2019, Whisman began missing “a great deal of

work” due to recurring sinus infections. She thereafter began treating with Dr.

Michael Cecil, a board-certified ENT, in February 2020. Testing performed by

Dr. Cecil showed the presence of Pseudomonas for which he prescribed

numerous courses of antibiotics. Dr. Cecil performed an endoscopic revision

                                        3
surgery on Whisman’s sinuses in March 2020, in order to provide a more open

ventilation path. Dr. Cecil subsequently put Whisman under anesthesia four

more times to clean and irrigate her sinuses. In a January 2021 office note, Dr.

Cecil diagnosed Whisman with chronic sinusitis and stated that she remained

symptomatic despite normal endoscopy results. He also noted Whisman

smoked a half pack of cigarettes per day.

      In Whisman’s Workers’ Compensation claim, Dr. Cecil testified by

deposition and noted that a CT-scan revealed evidence of chronic sinus

infection and, during his course of treatment, Pseudomonas has always been

present in Whisman’s cultures. Dr. Cecil testified that Whisman was

theoretically exposed to Pseudomonas at Toyota, although he did not

specifically research that issue, instead relying upon Whisman’s own narrative.

Dr. Cecil further stated Whisman has reached maximum medical improvement

(MMI) and recommended she use saline rinses and nasal steroid sprays. He

testified that it was reasonable for Whisman to return to work and when he last

saw her on October 25, 2021, her sinuses were normal, and her primary

complaints involved unrelated shortness of breath.

      Most importantly, Dr. Cecil testified that he was unsure whether

Pseudomonas was merely present in her sinuses or was what was causing

Whisman’s symptoms, noting she had sinus problems for a long time.

      In his deposition, Dr. Cecil was also questioned regarding an

Occupational Safety and Health Administration (OSHA) report that was

obtained by Whisman. At some point, Whisman contacted OSHA which had

                                       4
tested certain machines at Toyota and found Pseudomonas present in a coolant

used in the manufacturing process. As both the Board and Court of Appeals

previously noted, the depositions of both Dr. Cecil and Dr. Owen referred to an

OSHA report which was not attached to their deposition transcripts. Other

than those references, there is no indication in the record that such a report

was ever filed into evidence. Therefore, we cannot independently examine it.

      Dr. Cecil testified that although he reviewed the OSHA report and it

identified Pseudomonas in the plant, the report did not indicate workers’ levels

of exposure and he did not have the experience to know what that exposure

would mean. He likewise testified he had no idea whether Pseudomonas in

coolant within a machine would constitute a sufficient exposure to cause

Whisman’s condition(s).

      When asked if he would say it was probable that Whisman’s work was

causing the growth of Pseudomonas in her nasal cavities, Dr. Cecil testified:

      I think that that’s—I mean it’s—you know, I’m not an occupational
      hazard physician. But if there’s Pseudomonas in the potential air
      and she’s getting Pseudomonas in her respiratory system, you
      know, just putting two and two together it makes sense that that
      could be where this is coming from.

      Dr. Cecil testified that his statement regarding how Whisman contracted

Pseudomonas was expressed within a reasonable degree of medical probability.

However, later in his deposition, Dr. Cecil stated, “Maybe probable is not the

right word not having known this, but I’m kind of putting two and two together

so I think it’s potentially a cause.” He also stated, “So, you know, I think it’s

probably more reasonable to put ‘possible.’ I don’t know that I’m the person to

                                         5
be able to determine if it directly came from the coolant or where it came from.”

When asked if exposure to the coolant at Toyota caused Whisman’s sinus

problems, Dr. Cecil testified:

      I definitely—well—I mean I don’t know about independently. I
      mean certainly I’ve operated on her before there’s been purulence
      in her sinus cavities that grew Pseudomonas so that was certainly
      a pathogenic organism that was in her sinuses and was causing it.
      I don’t know if that’s the only cause of it, but certainly that was
      part of it.

      In May 2020, when workers returned to Toyota following the Covid

shutdown at the plant, it was believed that Whisman’s Pseudomonas infection

had been cleared and she also returned to work. However, her infection

returned in June and again in September 2020. Whisman submitted an

application for short-term disability in July 2020; Dr. Cecil completed a portion

of that application noting Whisman had chronic sinusitis and that she was

unable to work due to the, then, national Covid crisis. That application did not

reflect Whisman’s condition being work-related.

      Whisman’s last day at work for Toyota was September 11, 2020, when

she went on medical leave and thereafter began receiving long-term disability

benefits through her employment with Toyota. Whisman was still receiving

long-term disability benefits as of the filing of this appeal. Cultures performed

by Dr. Cecil in both April and June 2021, again showed growths of

Pseudomonas.

      Whisman filed her Application for Resolution of an Occupational Disease

Claim (Form 102) with the Kentucky Department of Workers’ Claims on April 1,

2021. She claimed her condition was caused by exposure to vapors and mists
                                        6
at Toyota. She does not believe she can return to work at Toyota due to her

dizziness, blurred vision, breathing problems, and swelling. Whisman also has

varying symptoms including neck swelling, throat clearing, drainage, nose

blowing, swollen lymph nodes/glands, and facial pain.

      Pursuant to Kentucky Revised Statutes (KRS) 342.315, Dr. Sanford

Archer, board-certified ENT with the University of Kentucky, evaluated

Whisman on June 22, 2021. Dr, Archer noted that Whisman complained of

migraine headaches, dizziness, atypical facial pain, and sinusitis beginning in

2013. In her evaluation, Whisman attributed all her symptoms to the work

environment. Dr. Archer diagnosed Whisman with atypical facial pain,

migraine headaches, no acute or chronic sinus disease, and non-otologic

dizziness. He determined Whisman was not entitled to an impairment rating

under the American Medical Association’s Guides to Evaluation of Permanent

Impairment, 5th Edition (AMA Guides) attributable to her complaints allegedly

caused by her work environment. Dr. Archer found neither Whisman’s

condition, nor her complaints, were caused by her work environment and

likewise determined she had no pulmonary impairment caused by the work

environment and she had the physical capacity to return to her previous work,

recommending no restrictions. Dr. Archer also noted Whisman had an eleven

pack-year 3 smoking history and continued to smoke.

      3 A pack-year is smoking an average of one pack of cigarettes per day for one

year. For example, a person could have a 10 pack-year history by smoking one pack a
day for 10 years, two packs a day for 5 years, or a half-pack a day for 20 years. See
                                          7
      Dr. Archer testified by deposition and stated that while Dr. Cecil was

respected in the medical community, he did not agree with everything Dr. Cecil

described. Dr. Archer agreed with Dr. Cecil that sinusitis can be caused by a

number of different factors and that Pseudomonas is a common bacteria found

in many different places in our everyday environments. When Dr. Archer

examined Whisman, she had no abnormal findings so there was no basis to

assess an impairment rating pursuant to the AMA Guides. He noted no

pathological findings were present except for those consistent with her previous

surgeries, meaning some bone structure had been removed. Dr. Archer did not

believe Whisman’s complaints were caused by chronic sinusitis, specifically

stating:

      Chronic sinusitis is classically defined as chronic infection of the
      sinuses that have lasted three months or longer, persisted despite
      medical or surgical management. It can be caused by any number
      of things that can block the sinuses, including allergies, mass
      lesions, like polyps, anatomic variance like septal deviations and
      abnormal turbinate structures. It can be caused by bacteria,
      fungus. Viral inflammation can set it up as well. And when the
      sinuses get blocked, they can potentially stay blocked and give that
      chronic nature to an acute sinus infection.

 Dr. Archer additionally testified:

      [Whisman’s] symptoms were pretty much out of proportion to what
      her findings were. She had on my examination and on Dr. Saini’s
      previous examination two years prior complaints of atypical facial
      pain and neither his examination nor my examination identified
      any pathology on her in her sinuses. And because she’s had
      extensive sinus surgery, we actually have the opportunity of
      placing scopes into the sinus, not just into the nose, to examine
      those areas and the scans that were referred to at the time did not

Division of Cancer Prevention and Control, Centers for Disease Control and
Prevention, Who Should be Screened for Lung Cancer (July 31, 2023),
https://www.cdc.gov/cancer/lung/basic_info/screening.htm.
                                          8
      show any evidence of acute or chronic sinusitis either. And so, the
      atypical facial pain can come from many different regions, and we
      recommended that she see basically a orofacial pain clinic here for
      further evaluation of her complaints.

       At the behest of her attorney, Whisman was evaluated by Dr. James

Owen in December 2021. Dr. Owen testified that Whisman had suffered from

“recalcitrant Pseudomonas” since 2018, and her condition had worsened.

      Importantly, Dr. Owen testified that her condition was caused by

workplace exposure to engine coolant spray in her workplace and diagnosed

chronic sinusitis exacerbated by her returns to work. He found she had

reached MMI and assessed a 6% impairment rating based upon the AMA

Guides. Dr. Owen also testified that Whisman had no underlying conditions

prior to 2014, and that none of her impairment rating was due to pre-existing

active conditions. Finally, Dr. Owen stated Whisman did not have the physical

capacity to return to the type of work performed at the time of her injury.

      In addition to noting a lack of a proven nexus between any Pseudomonas

at the plant and Whisman’s own injuries, Toyota noted that Whisman’s

sinusitis began no later than July 2014, but she did not begin working in the

area of the T-2 block line (also referred to as the “machine power train line”)

until 2017 and, even then, no Pseudomonas was found in any coolant there

until 2020. Thusly, Toyota argued that there was no evidence that Whisman

had been exposed to Pseudomonas at work in 2014, when her condition began,

and there was no evidence Pseudomonas was in any coolant in 2017, when

Whisman began working in the area, or at any point prior to 2020. Finally,

                                        9
there was no proof offered that any workers were actually exposed to the

Pseudomonus found in the coolant system.

      Following a final hearing and post-hearing briefs, the ALJ rendered his

opinion on May 31, 2020, dismissing Whisman’s claim on the basis that she

had not submitted sufficient proof on the element of causation. Specifically, the

ALJ concluded:

      There is no doubt Whisman has chronic sinusitis. The evidence on
      the cause of that condition is murky. It may be that Whisman was
      exposed to Pseudomonas at work but the exposure itself and any
      link between it and the onset of her symptoms is questionable. Dr.
      Archer’s opinion on the question of causation is what is most
      important to the ALJ. He did not find a link between Whisman’s
      alleged work-related exposure and her chronic sinusitis. In truth,
      the ALJ also interprets Dr. Cecil’s testimony as being less than
      clear on the question of causation. He did not have any expertise
      as to the level of exposure or what would be required to cause the
      onset of chronic sinusitis. In light of the foregoing, the ALJ finds
      Whisman has failed to persuade the ALJ her chronic sinusitis is
      the result of occupational exposure to Pseudomonas. For that
      reason, her claim is dismissed.

      Whisman petitioned the Board to reverse the ALJ’s dismissal, arguing

that the ALJ should not have afforded the University Evaluator, Dr. Archer,

presumptive weight or relied on his opinions because they were based on an

allegedly inaccurate or largely incomplete history, and therefore should have

been discounted. The Board affirmed.

      Whisman next appealed to the Court of Appeals arguing that the ALJ

erred by relying on medical opinions which were based upon a corrupt history.

Specifically, Whisman contended that Dr. Archer did not review the entirety of

the medical record, was not provided with the OSHA report, and therefore

could not competently provide a determination. Whisman argued that Dr.
                                       10
Archer’s conclusions were so flawed and corrupt they could not constitute

substantial evidence and therefore could not be relied upon and should have

been excluded based upon the holding in Cepero v. Fabricated Metals

Corporation, 132 S.W.3d 839 (Ky. 2014).

      The Court of Appeals affirmed and Whisman now seeks review by this

Court arguing that she met her burden of proving that Pseudomonas “could

have” independently caused her injuries and the ALJ improperly relied upon

Dr. Archer’s opinions.

                             II. LEGAL ANALYSIS

      Pursuant to KRS 342.285, the ALJ is the sole finder of fact in workers’

compensation claims. As correctly noted by Whisman, this Court has read this

authority to mean the ALJ has the sole discretion to determine the quality,

character, weight, credibility and substance of the evidence and to draw

reasonable inferences from that evidence. Paramount Foods, Inc. v. Burkhardt,

695 S.W.2d 418, 419 (Ky. 1985). Furthermore, the ALJ has sole discretion to

decide whom and what to believe and may reject any testimony and believe or

disbelieve various parts of the evidence, regardless of whether it comes from

the same witness or the same adversary party's total proof. Caudill v. Maloney’s

Discount Stores, 560 S.W.2d 15, 16 (Ky. 1977).

      On review, neither the Board nor an appellate court can substitute its

judgment for that of the ALJ as to the weight of evidence on questions of fact.

Shields v. Pittsburgh & Midway Coal Mining Co., 634 S.W.2d 440, 441 (Ky. App.

1982).

                                       11
      When, as here, the ALJ finds against the party having the burden of

proof, the appellant must “show that the ALJ misapplied the law or that the

evidence in [his] favor was so overwhelming that it compelled a favorable

finding.” Gray v. Trimmaster, 173 S.W.3d 236, 241 (Ky. 2005). Our role is “to

correct the Board only where . . . 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.” ViWin Tech Windows & Doors,

Inc. v. Ivey, 621 S.W.3d 153, 157 (Ky. 2021) (emphasis added) (quoting W.

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

      A.    Did Whisman meet her burden of proof?

      KRS 342.0011(3) states:

      An occupational disease as defined in this chapter shall be deemed
      to arise out of the employment if there is apparent to the rational
      mind, upon consideration of all the circumstances, a causal
      connection between the conditions under which the work is
      performed and the occupational disease, and which can be seen to
      have followed as a natural incident to the work as a result of the
      exposure occasioned by the nature of the employment and which
      can be fairly traced to the employment as the proximate cause.

      Whisman begins her argument by noting that KRS 342.0011(4) defines

an “injurious exposure” as “that exposure to occupational hazard which would,

independently of any other cause whatsoever, produce or cause the disease for

which the claim is made[.]” Whisman goes on to argue that she only needed to

prove that exposure could have independently caused her disease, citing to

Childers v. Hackney’s Creek Coal Co., 337 S.W.2d 680, 683 (Ky. 1960), and

Letcher County Board of Education v. Hall, 576 S.W.3d 123 (Ky. 2019). Even

                                      12
under the standard as it is stated in Childers and Hall, this Court cannot be

convinced that the ALJ was wrong in his determination.

      To begin, Whisman’s argument assumes that she proved actual

Pseudomonas exposure in her workplace and that such exposure at work, and

nowhere else, was the cause of her initial infection, later infections, or

reinfections thereafter. This argument also discounts the myriad sinus issues

which affected, and still affect, Whisman in addition to prior Pseudomonas

infections. Whisman’s almost intractable sinus issues contain elements of both

structural, allergic, and infectious issues. None of her structural problems

relate to any work injury and there was no proof that her infection-related

issues (even if all such infections and resultant injuries had been proven to

have been either directly caused by workplace exposure which they were not)

produce[d] or cause[d] the disease independently of any other cause. KRS

342.0011(4).

      Finally, even Whisman’s own treating physician could not testify that the

manifestations of her illness(es) were caused by Pseudomonas even at the times

it was found in her sinuses.

      Both Childers and Hall, each of which are inhalation cases like

Whisman’s claim, are distinguishable. In Childers, we reversed the Board in a

silicosis case where the claimant was exposed to silica dust at work and stated

the standard as follows:

      In such cases . . . this Court held that where the employee was
      shown to have silicosis, and had worked for a substantial period of
      years for the employer from whom he sought compensation,

                                        13
      scientific proof of the presence of silica dust in injurious quantity
      was not required. In the Peabody and Hooks cases the employe
      was engaged in the same type of work as was Childers in the
      instant case, namely, the operation of a mine motor car which
      used sand for traction purposes.

      In the instant case Childers admittedly had silicosis. According to
      the medical testimony he had it in some degree when he began
      work for his last employer. However, it had not advanced to a
      disabling stage. He worked for his last employer for 23 months,
      operating the mine motor car. There was testimony that he was
      exposed several hours a day to dust from the sand used for
      traction and to rock and coal dust. At the end of the 23 months the
      silicosis had progressed to a disabling stage. Under these
      circumstances we think the board would have been entitled to find
      that there was injurious exposure within the meaning of the
      statute, without requiring scientific proof of the presence of silica
      dust in sufficient quantity to be capable of causing silicosis.

Childers, 337 S.W.2d at 683 (citations omitted).

      In Hall, medical records indicated that the claimant was exposed to

asbestos which was present in both insulation and floor tiles and the medical

report also noted that Hall gave “a very convincing history of being exposed to

asbestos while working at Letcher high school and there is an appropriate lag

time.” Hall, 576 S.W.3d at 126-27. The report concluded that asbestos

containing materials at the school were causally related to Hall’s condition. Id.

      In these cases, it was readily recognized that silica dust exposure causes

silicosis in humans and asbestos exposure causes mesothelioma. Neither

disease is possibly caused by common allergens or bacteria found outside the

workplace. Furthermore, both conditions are known presumptively as

incurable and permanent. In Whisman’s case it would have been unreasonable

                                        14
for the ALJ to assume, or determine, that being exposed to Pseudomonas in

unknown levels, at unknown times, possibly in the workplace, was the

causative agent of each or any of the injuries of which Whisman complains.

      B.    Did the ALJ err in relying on, or being persuaded by, Dr.
            Archer’s opinions?

      Whisman, as she has previously, contends that the ALJ should have

disregarded Dr. Archer’s report because he did not review all her prior medical

records and failed to correctly diagnose her as suffering from chronic sinusitis,

citing to Cepero, 132 S.W.3d at 843-44, where this Court determined that a

medical opinion was ineffective as substantial evidence when the physician’s

opinion was based upon substantially inaccurate or a largely incomplete

history. We are not persuaded by that argument here.

      In Cepero, the ALJ ruled in favor of a claimant for an allegedly work-

related knee injury based upon evidence from two doctors who indicated that

his knee condition was related to a work injury. Id. at 842. However, neither

doctor had been informed that claimant had suffered a severe knee injury

several years prior. Id. at 842. The Board reversed the ALJ’s finding that the

doctors’ opinions were based upon substantial evidence. Id at 842. This Court

affirmed, quoting the Board’s own holding:

      [I]n cases such as this, where it is irrefutable that a physician’s
      history regarding work-related causation is corrupt due to it being
      substantially inaccurate or largely incomplete, any opinion
      generated by that physician on the issue of causation cannot
      constitute substantial evidence. Medical opinion predicated upon
      such erroneous or deficient information that is completely
      unsupported by any other credible evidence can never, in our view,
      be reasonably probable.

                                       15
Id.
      We applied this same reasoning in the later opinion in Eddie’s Service

Center v. Thomas, 503 S.W.3d 881 (Ky. 2016), and held that an ALJ has the

discretion to reject a medical report based on a substantially inaccurate

understanding of the facts and medical history and because of several internal

consistencies within the report, along with the doctor’s inaccurate

understanding of the facts, the report could not constitute substantial

evidence. Id. at 887-89. “Evidence is substantial if it is of ‘relevant consequence

having the fitness to induce conviction in the minds of reasonable men.’” Id. at

887 (quoting Smyzer v. B.F. Goodrich Chem. Co., 474 S.W.2d 367, 369 (Ky.

1971)).

      In GSI Commerce v. Thompson, 409 S.W.3d 361 (Ky. App. 2012), the

Court of Appeals held that an ALJ was not required to disregard a medical

report that was “not ‘unsupported by other credible evidence.’” Id. at 365. In

that case, an employer contended that a physician’s report could not be

considered because it did not mention a prior relevant injury; however, the

doctor explained during deposition that he was aware of the claimant’s past

injury. Id. The Court of Appeals distinguished between the facts in GSI

Commerce and Cepero, stating “[i]n Cepero, there was a complete omission of a

significant and clearly relevant past injury . . . the medical opinion described in

Cepero was completely unsupported by any other credible evidence” and

explained that, in GSI Commerce, the physician making the report was aware of

                                        16
the prior injury and there was other evidence before the court corroborating the

physician’s opinion. GSI Commerce, 409 S.W.3d at 364-65.

      The Court of Appeals was correct in this matter when it determined that

the facts here most closely resemble those of GSI Commerce. Dr. Archer’s Form

107 report showed that he had an accurate understanding of Whisman’s prior

medical history, even if he did not have access to all her prior medical records.

He specifically indicated in the report that Whisman’s sinus complaints dated

back to 2013 and that she attributed those problems to her work.

      Most importantly, Dr. Archer conducted his own examination of

Whisman and explained in his deposition that he did not see any pathologic

abnormalities at the time he examined her sinus cavities. While Dr. Archer did

not report a diagnosis of chronic sinusitis in his report, he did conclude that

while Whisman had sinusitis at one time, she was not actively experiencing

“chronic sinusitis” at the time of his examination, explaining:

      [B]ecause she’s had extensive sinus surgery, we actually have the
      opportunity of placing scopes into the sinus, not just into the nose,
      to examine those areas and the scans that were referred to at the
      time did not show any evidence of acute or chronic sinusitis either.

      The operative question in this case on review has always been whether

the evidence was so overwhelming that it compelled a favorable finding. Even

though Dr. Cecil had previously diagnosed Whisman with chronic sinusitis, he

clarified in his deposition that he was unable to conclude within a reasonable

medical probability that Whisman’s condition was caused by any exposure in

her workplace.

                                        17
      The ALJ properly considered all the evidence, much of which cast doubt

on Whisman’s theory of causation. As correctly noted by the ALJ, Whisman’s

nasal and sinus issues predated her assignment to the machine area at Toyota

and showed itself at times when she was not working in that area. Sinusitis

can be caused by several different factors. Pseudomonas is a common bacteria

found in our living environment. Dr. Cecil testified that Pseudomonas could

cause sinusitis, but he was unable to offer an opinion on actual exposure or

exposure levels such as whether bacterial levels present in any coolant could

migrate into vapor and then enter an employee’s sinuses in sufficient

concentrations to have potentially, or independently, caused Whisman’s

injuries. Even Dr. Owen’s report, while indicating that working at Toyota

exacerbates and is “associated with” Whisman’s sinusitis, does not allege that

Whisman’s work independently caused her issues.

                                 III. CONCLUSION

      For the foregoing reasons, the opinion of the Court of Appeals and order

of the Workers’ Compensation Board are affirmed.

      All sitting. All concur.

                                       18
COUNSEL FOR APPELLANT:

Charles W. Gorham

COUNSEL FOR APPELLEE:

Kenneth J. Dietz
Lucas & Dietz, PLLC

ADMINISTRATIVE LAW JUDGE:
Hon. Greg W. Harvey

WORKERS’ COMPENSATION BOARD:
Hon. Michael Wayne Alvey, Chairman

                                     19