WEST (ROGER) VS. KENTUCKY RETIREMENT SYSTEMS
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RENDERED: JULY 15, 2011; 10:00 A.M.
TO BE PUBLISHED
Commonwealth of Kentucky
Court of Appeals
NO. 2009-CA-001176-MR
ROGER WEST
v.
APPELLANT
ON REMAND FROM SUPREME COURT OF KENTUCKY
NO. 2010-SC-000433-D
APPEAL FROM FRANKLIN CIRCUIT COURT
HONORABLE THOMAS D. WINGATE, JUDGE
ACTION NO. 07-CI-01892
KENTUCKY RETIREMENT SYSTEMS
APPELLEE
OPINION
REVERSING AND REMANDING
** ** ** ** **
BEFORE: ACREE, CLAYTON, AND WINE, JUDGES.
WINE, JUDGE: Roger West appeals from an order of the Franklin Circuit Court
affirming the denial of his claim for disability retirement benefits by the Board of
Trustees (“the Board”) of the Kentucky Retirement Systems (“the Systems”).
Upon review, we reverse and remand.
History
West’s first employment with the Commonwealth began in September
of 1973; however, such employment was not continuous. West became reemployed with the Commonwealth on January 18, 1991, and remained employed
by the Commonwealth as a plant operator in a waste/water sewage treatment plant
for the City of Middlesboro until May 1, 2005. West’s job duties were classified
as heavy work or labor. On May 1, 2005, West suffered a work-related injury to
his back. West was off work until December 18, 2005, at which point he returned
and promptly suffered a reinjury which prevented him from continuing in the
manual labor his job required. His last date of paid employment was December
31, 2005. Although West did not request reasonable accommodations be made for
him, a letter was submitted by his employer stating that West could not request
reasonable accommodations because there were no light duty jobs available to him.
At the time West left his employment with the Commonwealth, he suffered from
lower back injuries as well as breathing problems due to a diagnosis of Chronic
Obstructive Pulmonary Disease (“COPD”). At that time, he had approximately
185 months of combined service with the Kentucky Employees Retirement System
and the County Employees Retirement System.
West timely filed for disability retirement benefits pursuant to
Kentucky Revised Statute(s) (“KRS”) 61.600. However, the Kentucky Retirement
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Systems Medical Review Board denied West’s application. West appealed the
denial of his request for benefits, and an administrative hearing was held on the
matter. The hearing officer affirmed the Medical Review Board’s denial, holding
that West had failed to prove that he suffered a permanent physical or mental
impairment that would prevent him from performing his former job or a job of like
duties, and that he failed to prove that his incapacity did not result either directly or
indirectly from an injury or condition which pre-existed his membership in the
Kentucky Retirement Systems. West appealed and the Board affirmed the hearing
officer.
Thereafter, West appealed to the Franklin Circuit Court. The Franklin
Circuit Court affirmed the Board (albeit on other grounds). West then filed a
motion to alter, amend, or vacate the opinion and order. The motion was denied.
West now appeals.
Standard of Review
Upon review of the denial of disability retirement benefits, we accept
the agency’s findings of fact as true as long as they are supported by substantial
evidence. Bowling v. Natural Resources and Environmental Protection Cabinet,
891 S.W.2d 406 (Ky. App. 1995). Substantial evidence is such evidence as would
“induce conviction in the minds of reasonable [persons].” Owens-Corning
Fiberglas Corp. v. Golightly, 976 S.W.2d 409, 414 (Ky. 1998). Where it is
determined that the agency’s findings are supported by substantial evidence, the
court must then ask whether the agency has correctly applied the law. Kentucky
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Unemployment Insurance Commission v. Landmark Community Newspapers of
Kentucky, Inc., 91 S.W.3d 575, 578 (Ky. 2002). A reviewing court may also
reverse a final order of an administrative agency, in whole or in part, where it is
found that the agency’s order violates statutory or constitutional provisions, is in
excess of the agency’s authority as granted by statute, or is deficient as otherwise
provided by law. KRS 13B.150(2).
Analysis
On review, we consider the hearing officer’s findings, as adopted by
the Board, that (1) West failed to prove he suffered a permanent physical or mental
impairment that would prevent him from performing his former job or a job of like
duties; and (2) his incapacity did not result either directly or indirectly from an
injury or condition which pre-existed his membership in the Kentucky Retirement
Systems.
To begin, we must look to KRS 61.600, which governs disability
retirement benefits. KRS 61.600 provides, in pertinent part, that
(1) Any person may qualify to retire on disability, subject
to the following conditions:
(a) The person shall have sixty (60) months of
service . . . .
....
(c) The person’s application shall be on file in the
retirement office no later than twenty-four (24)
months after the person’s last day of paid
employment . . . .
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(d) The person shall receive a satisfactory
determination pursuant to KRS 61.655 [from the
Board’s medical examiners].
....
(3) Upon the examination of the objective medical
evidence by licensed physicians pursuant to KRS 61.665,
it shall be determined that:
(a) The person, since his last day of paid
employment, has been mentally or physically
incapacitated to perform the job, or jobs of like
duties, from which he received his last paid
employment. In determining whether the
person
may return to a job of like duties, any
reasonable accommodation by the employer as
provided in 42
U.S.C. sec. 12111(9) and 29 C.F.R.
Part 1630 shall be considered;
(b) The incapacity is a result of bodily injury,
mental illness, or disease. For purposes of this
section, “injury” means any physical harm or
damage to the human organism other than
disease or mental illness;
(c) The incapacity is deemed to be permanent; and
(d) The incapacity does not result directly or
indirectly from bodily injury, mental illness,
disease, or condition which pre-existed
membership in the system or reemployment,
whichever is most recent.
However, KRS 61.600(4) states that the requirement in subsection (3)(d) that the
condition must not pre-exist membership in the system, shall not apply if
(a) The incapacity is a result of bodily injury,
mental illness, disease, or condition which has
been substantially aggravated by an injury or
accident arising out of or in the course of
employment; or
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(b) The person has at least sixteen (16) years’
current or prior service for employment with
employers participating in the retirement systems
administered by the Kentucky Retirement Systems.
West clearly had over sixty months of service, and he clearly filed his application
for disability retirement within twenty-four months of his last day of paid
employment. The only issues remaining are whether West was incapacitated from
performing his previous job or jobs of like duties under KRS 61.600(3)(a) and
whether West’s incapacity resulted from a condition or conditions which predated
his membership in the Systems under KRS 61.600(3)(d). West is not exempted
from the requirement in KRS 61.600(3)(d), that the incapacity may not result from
a pre-existing condition or illness since it was determined that he had apparently
fifteen-and-a-half years of service, just shy of the sixteen years required in KRS
61.600(4)(b) for exemption from the pre-existing condition requirement.
West argues on appeal that the hearing officer erred by failing to
consider the cumulative effect of his impairments when determining whether he
was incapacitated from performing his previous job or jobs of like duties. West
further argues that it was error for the hearing officer to find that his tobacco use
was a pre-existing condition to his ultimate diagnosis of COPD.
A. The “Cumulative Effect” Rule
First, we consider West’s argument that it was error for the hearing
officer to fail to consider the cumulative effect of his various injuries and
impairments. Although the Franklin Circuit Court found that the hearing officer’s
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failure to consider the cumulative effects of his back and breathing injuries was not
error, we must disagree. Indeed, the Kentucky Supreme Court has recently held
that it is error to neglect to consider the cumulative effects of an individual’s
impairments in Kentucky Retirement Systems cases where a claimant produces
evidence of disability due to multiple ailments. Kentucky Retirement Systems v.
Bowens, 281 S.W.3d 776, 783 (Ky. 2009).1 West was diagnosed by his doctors as
having (1) advanced COPD; (2) chronic lumbar sacral disc disease; (3) seizure
disorder; (4) hypertension; (5) hypercholesterolemia; (6) degenerative joint
disease; (7) sleep apnea requiring a CPAP at night; and (8) hypothyroidism. It
seems questionable, given all these factors, that he would have been able to carry
on in a position requiring heavy labor. “By failing to properly consider the
cumulative effect standard implicit in KRS 61.600, [the Systems] exceeded the
constraints of its statutory powers and arbitrarily denied Appellee’s disability
claim.” Id. at 783. See also KRS 13B.150(2)(b). As such, we reverse and remand
on this issue for a determination of whether the combined effects of West’s
impairments rendered him unable to return to his former position or like positions.
B. Smoking Is not a “Condition”
Next, we address West’s argument that his prior smoking and tobacco
use may not be considered a “pre-existing condition” to his diagnosis of COPD.
Because we find that tobacco use is a behavior rather than a “condition” as
contemplated under the statute, we agree with West that it was error for the hearing
1
To be fair to the circuit court, the Bowens opinion was rendered only a month before the Franklin
Circuit Court issued its opinion and order.
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officer to deny coverage on the ground that his smoking was a pre-existing
condition. See Kentucky Retirement Systems v. Brown, 336 S.W.3d 8 (Ky. 2011).
KRS 61.600(3)(d) excludes disability retirement coverage for any
incapacity which is caused, directly or indirectly, by a “bodily injury, mental
illness, disease, or condition” which pre-exists the member’s employment
(emphasis added). The Supreme Court has recently held that “smoking is not a
condition as it is used under [KRS 61.600(3)(d)], but rather a behavior.” Kentucky
Retirement Systems v. Brown, 336 S.W.3d at 16. Rather, relying on the doctrine of
ejusdem generis, the principle that words in a statute are generally assumed to refer
to the same class of things, the Brown Court found that a “condition” must refer to
something of the same kind or nature as “bodily injury,” “mental illness,” or
“disease.” Accordingly, the Court noted that a behavior, such as smoking, could
not be construed by the Systems as a condition.
Accordingly, based upon this recent precedent, we find that the
Kentucky Retirement Systems impermissibly construed the word “condition” in
the statute to encompass the “behavior” of smoking.
It should be noted that the Franklin Circuit Court acknowledged the
hearing officer’s error in deeming smoking a pre-existing condition. Instead of
reversing the Board, however, it affirmed the Board on other grounds.
Specifically, the Franklin Circuit Court found that West failed to meet his burden
to show that his COPD did not pre-exist his membership in the System.
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As recently noted by the Supreme Court, “it was [not] the intent of the
legislature to define as ‘pre-existing’ those diseases and illnesses which lie
dormant and are asymptomatic such that no reasonable person would have realized
or known of their existence.” Id. at 15. Therefore, West cannot be held to some
impossible standard of proving that, at the time of re-employment, he did not have
some faint trace or suggestion of damage to his lungs that would eventually
culminate in a diagnosis of COPD. Rather, West need only have proved that he
had not been diagnosed with COPD or lung disease and that he was not
symptomatic for COPD or lung disease before his membership in the System. Id.
We now turn to the Franklin Circuit Court’s opinion affirming the
Board on other grounds and ask whether West met this burden.
This case presents a unique circumstance in that West’s primary care
physician prior to 1998 retired, and all of West’s medical records predating that
time were destroyed. The only evidence in the record concerning whether West’s
COPD pre-existed his membership in the System was contained in the deposition
testimony of Dr. Westerfield. When asked whether West had COPD in 1991 (his
first year of re-employment with the System), Dr. Westerfield stated it was his
medical opinion that it was highly unlikely that West experienced that level of
pulmonary impairment in 1991. The Franklin Circuit Court found that this
evidence did not meet West’s burden to show his COPD did not predate his
membership, stating as follows: “Given Petitioner’s burden to demonstrate his
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condition was not pre-existing, the Board’s decision was based upon substantial
evidence.” However, we find that this misinterprets West’s burden.
A claimant seeking disability retirement benefits under KRS 61.600,
and who has less than sixteen years of service with the Commonwealth, bears the
burden of showing that his condition does not predate his service with the
Commonwealth. KRS 13B.090; McManus v. Kentucky Retirement Systems, 124
S.W.3d 454 (Ky. App. 2004). Nonetheless, although McManus established that a
claimant bears the burden to show his condition is not pre-existing, it did not
address the quantum of evidence necessary for a claimant to meet this burden.
Courts of justice have often recognized that proving a negative is an exceedingly
difficult thing to do. Indeed, we reject the concept by rule. Kentucky Rule(s) of
Civil Procedure (“CR”) 43.01(1). Thus, in those infrequent circumstances where
we impose such a burden upon a party, it is usually found that the evidence
required to meet such burden is minimal. See, e.g., Motorists Mut. Ins. Co. v.
Hunt, 549 S.W.2d 845, 847 (Ky. App. 1977) (because proving a negative is always
difficult, if not impossible, the quantum of proof required to prove a motorist is
uninsured is merely such as will convince the trier that all reasonable efforts have
been made to ascertain the existence of an applicable insurance policy).
Thus, we find the proper interpretation of the statute to be that a
claimant bears the burden to come forward with some evidence that his condition
did not pre-exist his service with the Commonwealth. Upon such a threshold
showing, the burden of going forward shifts back to the Systems. While the
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ultimate burden of persuasion is not moved from the party upon which it was
originally cast (the claimant), the Systems must come forward with some evidence
in rebuttal where a claimant makes a threshold showing that his or her condition
was not pre-existing. While we agree with the Systems that the fact-finder is free
to accept or reject any evidence it chooses, it is not free to reject uncontested
evidence.
Here, the only evidence concerning whether West’s COPD preexisted his membership was the unrebutted deposition testimony of Dr.
Westerfield. As our Courts have often stated, medical testimony need not be
couched in terms of absolute certainty. Rather, medical testimony need only be
stated in terms of reasonable medical probability. See Lexington Cartage Co. v.
Williams, 407 S.W.2d 395 (Ky. 1966); Turner v. Commonwealth, 5 S.W.3d 119
(Ky. 1999). Westerfield’s testimony certainly seems to do so. As such, the onus
was upon the Systems to rebut that evidence. Here, if the Systems had indicated
any particular reasons to disbelieve Dr. Westerfield, or had referred to any contrary
medical evidence, then the hearing officer may have been justified in rejecting
West’s evidence to the contrary. However, since the Systems offered no contrary
medical evidence, the hearing officer was not free to reject the uncontested
evidence in Dr. Westerfield’s deposition testimony.
Indeed, the Systems’ arguments that West’s COPD was pre-existing
seem to be based solely upon the fact that West’s early medical records were
unavailable and the fact that he smoked long before he ever became re-employed
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with the Commonwealth in 1991. As previously stated, the Supreme Court has
definitively held that smoking is a behavior and cannot be considered a preexisting condition. Brown, supra. Further, mere speculation unsupported by
medical opinion is not a valid basis upon which a hearing officer may choose to
accept or reject given evidence. Accordingly, we reverse the order of the Franklin
Circuit Court and remand for further proceedings consistent with this Opinion.
ALL CONCUR.
BRIEF FOR APPELLANT:
BRIEF FOR APPELLEES:
Thomas W. Moak
Prestonsburg, Kentucky
Leigh A. Jordan
Frankfort, Kentucky
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