Court Opinion

ID: 9687189
Source: CourtListenerOpinion
Date Created: 2023-08-24 16:18:17.249012+00
Date Added: 2024-06-11T18:18:24.646829
License: Public Domain

VANDE WALLE, Justice,
dissenting.
I do not believe it is “well settled” that the Bureau cannot deny compensation solely because a medical opinion of disability or impairment is based primarily on the patient’s complaints of pain which cannot be substantiated by objective medical evidence. At least two members of this court did not reach that issue in Kroeplin v. N.D. Workmen’s Comp. Bureau, 415 N.W.2d 807, 810 (N.D.1987) (VandeWalle, J., and Erickstad, C.J., concurring in result). In that case I concurred in the result remanding to the Bureau to determine the extent of impairment because the Bureau’s decision denying benefits was predicated not on a lack of evidence to substantiate the claim, but on a standard, not adopted as a rule or regulation, which provided that “Guides to the Evaluation of Permanent Impairment” of the American Medical Association was the primary standard for determining permanent impairment and that permanent impairment must be based upon medically or scientifically demonstrable findings.
Here, I believe the issue is one of sufficient evidence to substantiate the claim. The majority opinion summarizes the evidence in what I believe to be the light most favorable to the claim. But that is not the standard which the Bureau must employ nor is it the function of this court on appeal. E.g., Power Fuels, Inc. v. Elkin, 283 N.W.2d 214 (N.D.1979).
The Bureau’s findings include a thorough review of the medical testimony adduced in support of the claim. They reveal that the medical opinions supporting the claim are, for the most part, based upon Hayes’s assertion of pain. They further reveal that Hayes’s credibility concerning his pain was questionable. These, of course, are exactly the conclusions and inferences the Bureau, as the finder of fact, is entitled to draw. Furthermore, there is medical evidence as well as other evidence in the record to support the Bureau’s conclusions. For example, Hayes’s ability to ride a motorcycle, swim, travel, fish, water ski, and dance permitted the Bureau to draw an inference that his pain and disability were not so severe as he claimed. An examination by a medical-assessment team, at the behest of the Bureau, indicated that Hayes might be experiencing pain but that the pain did not prohibit him from participating in substantial gainful employment for which he was otherwise suited.
Nor can I conclude, as does the majority, that the “Bureau has failed to adequately explain its reasons for disregarding” the evidence of impairment. To expand on what I refer to above, Finding LVII of the Bureau states in part that Dr. Berkebile’s testimony “makes it clear that, to a substantial extent, his opinion and conclusions are based upon facts alleged by Mr. Hayes, facts that were taken to be completely truthful notwithstanding the fact that Dr. Berkebile indicated that he could not really tell whether the history that Mr. Hayes reported is accurate or even whether Mr. Hayes was even having the level of pain that he reported.” In Finding LXIX the Bureau, after noting that Mr. Hayes had poor recall of events that would be less supportive of his claim while he remained fairly confident with respect to his recall of events that might substantiate his continued complaints of disabling pain, found that his credibility with respect to his complaints of disabling pain was “deemed questionable at best.” Further findings *360indicate that Mr. Hayes’s motivation for a return to substantial gainful employment is questionable. Several other examples contained in the 23 pages of findings and conclusions might be cited. The above examples are, however, sufficient to adequately explain the reason the Bureau disregarded the medical evidence, to wit, the Bureau did not believe Hayes’s complaint of pain and, because the medical evidence was based upon Hayes’s statements to the doctors, that medical evidence was not persuasive. Thus, rather than a failure to adequately explain its reasons for disregarding the evidence, as alleged in the majority opinion, it appears that the majority simply does not agree with the Bureau’s view of the evidence. But it is in just such instances that we must defer to the Bureau.
The effect of the majority decision and decisions such as Kroeplin v. N.D. Workmen’s Comp. Bureau, supra, may well make it impossible for the Bureau to disallow a claim for benefits because it believes the claimant, is a malingerer or has a compensation syndrome, although both are recognized and documented reasons for denying a claim. See IB Larson, Workmen’s Compensation Law, sec. 42.24 (1987).
The Bureau may not arbitrarily disallow a claim using as a reason the credibility of the claimant. Here, however, there was, as noted above, considerable objective evidence upon which the Bureau could determine that Hayes’s assertions as to pain, and the resulting medical evidence based upon such assertions, were not credible. Because I believe that under the standard of review set forth in Power Fuels, Inc. v. Elkin, supra, the Bureau could have arrived at the decision it did, and because the reasons for disregarding the evidence are set forth in the findings and conclusions of the Bureau, I would affirm the judgment of the district court affirming the decision of the Bureau.
ERICKSTAD, J., concurs.