PELLA CORPORATION VS. BERNSTEIN (JOYCE), ET AL.
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RENDERED: JUNE 18, 2010; 10:00 A.M.
TO BE PUBLISHED
Commonwealth of Kentucky
Court of Appeals
NO. 2010-CA-000171-WC
PELLA CORPORATION
v.
APPELLANT
PETITION AND FOR REVIEW OF A DECISION
OF THE WORKERS’ COMPENSATION BOARD
ACTION NO. WC-08-00818
JOYCE BERNSTEIN; HON. DOUGLAS
GOTT, ADMINISTRATIVE LAW JUDGE;
AND WORKERS’ COMPENSATION BOARD
AND
NO. 2010-CA-000282-WC
JOYCE BERNSTEIN
v.
APPELLEES
CROSS-APPELLANT
CROSS-PETITION FOR REVIEW OF A DECISION
OF THE WORKERS’ COMPENSATION BOARD
ACTION NO. WC-08-00818
PELLA CORPORATION; HON.
DOUGLAS GOTT, ADMINISTRATIVE
LAW JUDGE; AND WORKERS’
COMPENSATION BOARD
CROSS-APPELLEES
OPINION
AFFIRMING
** ** ** ** **
BEFORE: CAPERTON, LAMBERT, AND NICKELL, JUDGES.
LAMBERT, JUDGE: Pella Corporation appeals a December 23, 2009, opinion
rendered by the Workers’ Compensation Board which affirmed in part and vacated
in part an Administrative Law Judge’s (ALJ’s) decision determining, among other
things, that Joyce Bernstein failed to prove compensable claims for left and right
shoulder injuries. Regarding the left shoulder, the Board vacated the ALJ’s ruling
because the ALJ mistakenly believed that he was without authority to find an
impairment rating for that shoulder. Pella claims this holding is erroneous as a
matter of law.
Bernstein cross-appeals, alleging the Board erred in affirming the
ALJ’s determination that she failed to prove a permanent right shoulder injury.
After careful review, we affirm the Board’s opinion.
I. Factual Background
Bernstein is a fifty-five year-old high school graduate. Pella is a
window manufacturer. On June 27, 2008, Bernstein filed an application for
workers’ compensation benefits. While lifting window frames into a cleaner in the
course and scope of her employment with Pella, Bernstein alleged that she
sustained cumulative wear and tear injuries to her “[n]eck, shoulder, arm, hand,
low back, and any other [harmful change] noted in medical records.”
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After considering evidence submitted by both parties, the ALJ
determined that Bernstein did suffer work-related permanent injuries to her neck
and low back. These injuries resulted in the assignment of a 49.5% disability
rating to Bernstein.
The ALJ determined that Bernstein was also afflicted with a workrelated permanent left shoulder injury. However, he found that Bernstein did not
suffer a work-related right shoulder injury. In the alternative, the ALJ found that
even if there was a work-related right shoulder injury, any symptoms involving
Bernstein’s right shoulder were only temporary in duration. In so ruling, the ALJ
stated as follows:
In regard to the shoulders, this claim was practiced
by the lawyers as a “left shoulder case.” The ALJ finds
that Bernstein has not sustained her burden of proving a
work related right shoulder “injury.”
In addition to the persuasive medical evidence, a
credible factor supporting the ALJ’s conclusion that the
left shoulder injury is work related was Bernstein’s
testimony . . . that she had to drop the window and catch
it in order to turn it. “So every window we made, my
shoulder was being jerked by the window because I
couldn’t lift it up off [the cleaner].” Bernstein did not
say that this work activity injured her shoulders (plural)
but rather her one shoulder on the left side.
Dr. Jackson did not note a right shoulder complaint
on July 18, 2005. He first mentions the right shoulder on
February 20, 2006, but this is four months into
Bernstein’s recovery from neck surgery when she was no
longer performing the frame cleaner job. Therefore,
Bernstein was not performing work duties for [Pella]
when she first made complaints regarding the right
shoulder.
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Also supporting the conclusion that no right
shoulder “injury” was sustained is the fact that just
several months after Dr. Jackson noted a right shoulder
complaint in February 2006 he indicates that it was
largely resolved. Dr. Davies similarly noted resolution of
right shoulder complaints. (Dr. Davies’ January 8,
2008[,] report only addressed causation of the left
shoulder; there is no mention of the right shoulder).
Two physicians opined that Bernstein’s left shoulder injury was workrelated; however, neither physician assigned an impairment rating solely to the left
shoulder. Rather, one physician declined to assign a rating and the other physician
(Dr. Jackson) assigned a ten percent (10%) impairment rating for “adhesive
capsulitis of the shoulders greater on the left than the right.”
Because no impairment rating was attributed solely to the left
shoulder, the ALJ refused to grant Bernstein any benefits for her left shoulder
injury. He reasoned as follows:
[T]he ALJ is unable to make an award because Dr.
Jackson assigned a combined 10% rating to both
shoulders, which leaves the ALJ unable to decipher what
rating would be attributable to the left shoulder. As
stated, the ALJ has found that . . . [Bernstein] did not
sustain her burden of proving a right shoulder “injury.”
Even if she had sustained a right shoulder injury, the
evidence would lead to the conclusion that the injury was
not permanent or one that merited an impairment rating .
. . . Bernstein’s testimony at her deposition and at the
[h]earing was that she was not having a current problem
with her right shoulder. That testimony is confirmed by
the medical evidence. Because there was no right
shoulder injury, there is no basis for assigning a rating to
the right shoulder. Since Dr. Jackson does not separate
his rating between the two shoulders, which would allow
the ALJ to make an award for left shoulder impairment,
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the ALJ does not find the evidence to allow an award for
the left shoulder.
In his order denying Bernstein’s petition for rehearing, the ALJ added
the following:
The ALJ again closely reviewed the Opinion as it
pertains to his decision that the evidence did not permit
an award based on left shoulder impairment. The
reasoning behind that was that Dr. Jackson assigned 10%
impairment to both shoulders, but the evidence failed to
establish that [Bernstein] had suffered a right shoulder
injury . . . . The ALJ believes he has the discretion to
reject Dr. Jackson’s unrebutted opinion on bilateral
shoulder impairment if the evidence fails to support the
occurrence of a right shoulder “injury” pursuant to KRS
342.0011(1). [Bernstein] is correct that, had Dr. Jackson
apportioned his rating between the shoulders, the ALJ
would have made an award for left shoulder impairment,
but he believes he lacks the discretion to invade the
evidence of bilateral shoulder impairment and speculate
on a percentage that is applicable to the left shoulder.
On appeal, the Board affirmed the ALJ’s determination that Bernstein
failed to prove a permanent right shoulder injury. In so doing, the Board held that
the evidence was not so overwhelming as to compel a finding in Bernstein’s favor.
See Wolf Creek Collieries v. Crum, 673 S.W.2d 735, 736 (Ky. App. 1984) (setting
forth standard of review when unsuccessful claimant appeals fact-finder’s
decision).
As to the ALJ’s determination that he was without discretion to assign
an impairment rating to Bernstein’s work-related left shoulder injury, the Board
held as follows:
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In this instance, it is clear from the ALJ’s decision
and order on petition for reconsideration that he
incorrectly believed[] under the evidence [that] he lacked
the discretion to select an impairment rating relative to
Bernstein’s left shoulder injury. While there is no
published authority concerning the issue, the Kentucky
Supreme Court has addressed the matter to some extent
in the unpublished decision of Appalachian Racing, Inc.
v. Blair, 2002-SC-0581-WC, 2003 WL 21355872 (Ky.
2003). See also Lourdes Hospital v. Wininger, 2003-CA001810-WC, 2004 WL 315177 (Ky. App. 2004). In
Blair, supra, the ALJ was faced with a range of
impairment of 12% to 15% assessed by a physician
relative to a claimant’s cervical and lumbar injuries. No
apportionment was made by the physician with reference
to each individual body part. Nevertheless, the Supreme
Court determined the ALJ had the discretion to select a
whole body impairment rating within the combined range
provided by the physician applicable to each body part.
....
Pursuant to the Supreme Court’s holding in Blair,
supra, we believe it is evident the ALJ misconstrued the
scope of his fact-finding authority when he stated he
“would have made an award for left shoulder
impairment,” but believed he lacked “the discretion to
invade the evidence of bilateral shoulder impairment and
speculate on a percentage that is applicable to the left
shoulder.” As already discussed, the ALJ determined
Bernstein’s right shoulder resulted in no permanent
impairment. That finding is supported by substantial
evidence and has been affirmed. It is undisputed that Dr.
Jackson characterized Bernstein’s left shoulder condition
as being worse than her right shoulder condition. In light
of these facts, we believe the ALJ using the 10% range
assessed by Dr. Jackson could reasonably have
determined Bernstein suffered an impairment rating of
between 6% and 10% to the body as a whole affecting
the left shoulder.
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The Board went on to hold that assignment of an impairment rating to
the left shoulder was not mandatory, as the ALJ was also vested with discretion to
reject Dr. Jackson’s testimony altogether. Holding the ALJ erred as a matter of
law in concluding that he lacked discretion to consider either of the above options,
the Board vacated the ALJ’s left shoulder ruling and remanded the matter for
further consideration.
II. Pella’s Appeal
On appeal to this Court, Pella maintains the Board erred, as a matter
of law, in holding that the ALJ had discretion to apportion a part of Dr. Jackson’s
ten percent (10%) impairment rating for “adhesive capsulitis of the shoulders
greater on the left than the right” to assess an individual impairment rating for
Bernstein’s left shoulder. For the reasons set forth herein, we disagree.
The question presented before this Court is one of law. Thus, our
function is to correct the Board only if we perceive that it has overlooked or
misconstrued controlling statutes or precedent. Western Baptist Hospital v. Kelly,
827 S.W.2d 685, 687-88 (Ky. 1992). Questions of law are reviewed de novo.
Gosney v. Glenn, 163 S.W.3d 894, 898 (Ky. App. 2005).
Pella argues on appeal that the Board misconstrued the Kentucky
Supreme Court’s holding in Blair. In that case, the Supreme Court determined that
an ALJ may, without the assistance of a medical expert, utilize a table in the
American Medical Association’s Guides to the Evaluation of Permanent
Impairment (AMA Guides) to convert Diagnosis Related Estimate (DRE)
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categories assigned by a physician into numerical impairment ratings. Blair, 2003
WL 21355872 at *2.
In Blair, a physician assigned an overall impairment rating for the
back and neck at twelve to fifteen percent (12-15%). Id. at *1. He categorized the
back injury as a DRE category III and the neck injury as a DRE category II. Id.
The ALJ used a table set forth in the AMA Guides to assign a ten percent (10%)
impairment rating for the back (which corresponded with DRE category III) and a
two to five percent (2-5%) impairment rating for the neck (the corresponding
rating under DRE category II was 5%). Id. at *2. In holding that the ALJ was
vested with discretion to make such findings, the Supreme Court reasoned that no
medical expertise was necessary to determine the respective impairment ratings.
Id.; see Caldwell Tanks v. Roark, 104 S.W.3d 753, 757 (Ky. 2003) (“Although
medical expertise is required to perform audiometric testing, it is apparent that no
medical expertise is required to read this conversion table.”).
Pella argues that this case is distinguishable from Blair since DRE
categories have not been assigned to allow for a similar conversion. Because this
case involves more than the simple reading of a conversion table, Pella argues that
a left shoulder apportionment is not appropriate without the guidance of a medical
expert. See Kentucky River Enterprises, Inc. v. Elkins, 107 S.W.3d 206, 210 (Ky.
2003) (“[T]he proper interpretation of the Guides and the proper assessment of an
impairment rating are medical questions.”).
-8-
We agree that competent medical expertise is required to determine
medical questions such as the proper assessment of an impairment rating. See
Magic Coal Co. v. Fox, 19 S.W.3d 88, 96 (Ky. 2000)(“Where the question at issue
is one which properly falls within the province of medical experts, the fact-finder
may not disregard the uncontradicted conclusion of a medical expert and reach a
different conclusion.” (citing Mengel v. Hawaiian-Tropic Northwest and Central
Distributors, Inc., 618 S.W.2d 184, 187 (Ky. App. 1981)). Without such expertise,
claimants cannot meet their burden of proving permanent disability. See Greene v.
Paschall Truck Lines, 239 S.W.3d 94, 108 (Ky. App. 2007) (one of three elements
claimant must establish to be entitled to disability benefits is an impairment rating
pursuant to the AMA Guides); Cepero v. Fabricated Metals Corp., 132 S.W.3d
839, 842 (Ky. 2004) (claimant denied benefits because his medical evidence was
corrupt and, thus, not sufficient to support an award).
However, upon careful review of this record, we agree with the Board
that sufficient medical guidance does exist on which to determine an impairment
rating for Bernstein’s left shoulder. Notably, Dr. Jackson opined a ten percent
(10%) impairment rating for “adhesive capsulitis of the shoulders greater on the
left than the right.” No medical expertise is necessary to deduce from this opinion
that the impairment rating for the left shoulder is between six and ten percent (610%). As noted by the Board, an impairment rating of even ten percent (10%) for
Bernstein’s left shoulder is not unreasonable or outside the ALJ’s discretion since
other evidence on this record established that any right shoulder injury suffered by
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Bernstein was not permanent and only temporary in duration. See Magic Coal Co.,
19 S.W.3d at 96 (as fact-finder, ALJs are free to “reject any testimony and believe
or disbelieve various parts of the evidence, regardless of whether it comes from the
same witness.”); Greene, 239 S.W.3d at 109 (“When medical evidence is
conflicting, the question of which evidence to believe is the exclusive province of
the ALJ.”)(internal quotation and citation omitted). Accordingly, we affirm the
Board’s holding that the ALJ was vested, as a matter of law, with discretion to find
an impairment rating for Bernstein’s left shoulder. See Tokico (USA), Inc. v. Kelly,
281 S.W.3d 771, 774 (Ky. 2009) (ALJ is vested with authority to determine legal
significance of conflicting medical evidence); see also Young v. Kentland-Elkhorn
Coal Corp., 473 S.W.2d 119, 120 (Ky. 1971) (fact-finder is authorized to make
legitimate interpretations of medical evidence).
III. Bernstein’s Cross-appeal
In her cross-appeal, Bernstein argues the Board erred in affirming the
ALJ’s dismissal of her right shoulder claim. Bernstein bore the burden of proof
and risk of persuasion before the ALJ. Wolf Creek Collieries, 673 S.W.2d at 736.
Thus, compelling circumstances must exist to justify a reversal of the ALJ’s
determination. Id.
In this case, Dr. Jackson was the only medical expert to address
Bernstein’s right shoulder. He opined that she did suffer a work-related permanent
right shoulder injury. In light of this unrebutted testimony, Bernstein argues that
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the ALJ was compelled to adopt Dr. Jackson’s opinion. For the reasons set forth
herein, we disagree.
An ALJ may reject unrebutted medical testimony, but only if the
ALJ adequately sets forth a reasonable explanation for doing so. Collins v.
Castleton Farms, Inc., 560 S.W.2d 830, 831 (Ky. App. 1977); Commonwealth v.
Workers’ Compensation Board of Kentucky, 697 S.W.2d 540, 541 (Ky. App.
1985). Here, the ALJ set forth the following reasons for not adopting the opinion
of Dr. Jackson as to Bernstein’s right shoulder claim: (1) Bernstein’s right shoulder
complaints were too far removed from the time she alleged her work-related
activities culminated in an injury (injury was sustained on January 27, 2005, but
right shoulder complaints did not emerge until February 2006); (2) Bernstein’s
testimony indicated that only one of her shoulders was affected by her work
activities; and (3) testimony from Bernstein, Dr. Jackson, and Dr. Davies indicated
that Bernstein’s right shoulder injury, if any, was resolved.
Bernstein concedes that her right shoulder injury did not occur at the
same time as the wear and tear injury to her left shoulder. However, she claims it
was nevertheless compensable because it was sustained during her treatment of the
left shoulder injury. See Elizabethtown Sportswear v. Stice, 720 S.W.2d 732, 734
(Ky. App. 1986) (aggravation of injury by necessary medical or surgical treatment
is compensable).
Presuming this to be true, both the ALJ and the Board determined that
any work-related right shoulder injury was completely resolved and thus, in any
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event, a permanent impairment rating for the right shoulder was simply not
warranted. Bernstein concedes that there is sufficient evidence in this record to
support a finding that her right shoulder injury resulted in no permanent
impairment. However, she argues that if this is the case, then the ALJ is compelled
to assign the full ten percent (10%) impairment rating assigned by Dr. Jackson to
her left shoulder (since, consistent with the above finding, the right shoulder must
be zero percent (0%)).
As set forth above, we agree that the ALJ, on remand, is vested with
discretion to make such a finding. However, pursuant to that same discussion, we
do not agree the ALJ is compelled to make such a finding. See Magic Coal Co., 19
S.W.3d at 96. Rather, upon consideration of the totality of the circumstances, the
ALJ may assign a lesser rating or may even reject Dr. Jackson’s testimony
altogether so long as he sets forth a reasonable explanation. Collins, 560 S.W.2d at
831. Accordingly, the Board did not err in remanding this matter back to the ALJ
for further consideration.
Having been presented with no reversible error, we hereby affirm the
Board’s December 23, 2009, opinion.
ALL CONCUR.
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BRIEF FOR APPELLANT/
CROSS-APPELLEE PELLA
CORPORATION:
BRIEF FOR APPELLEE/
CROSS-APPELLANT
JOYCE BERNSTEIN:
R. Christion Hutson
Paducah, Kentucky
Jeffery A. Roberts
Murray, Kentucky
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