SYLVIA SCHGALLIS V. BOARD OF TRUSTEES, KENTUCKY RETIREMENT SYSTEMS
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RENDERED: SEPTEMBER 20, 2002; 2:00 p.m.
NOT TO BE PUBLISHED
C ommonwealth O f K entucky
C ourt O f A ppeals
NO.
2001-CA-001847-MR
SYLVIA SCHGALLIS
APPELLANT
APPEAL FROM FRANKLIN CIRCUIT COURT
HONORABLE ROGER L. CRITTENDEN, JUDGE
ACTION NO. 98-CI-01602
V.
BOARD OF TRUSTEES,
KENTUCKY RETIREMENT
SYSTEMS
APPELLEE
OPINION REVERSING AND REMANDING
* * * * * * * *
BEFORE:
BARBER, GUDGEL, and KNOPF, Judges.
GUDGEL, JUDGE:
This is an appeal from an order entered by the
Franklin Circuit Court affirming an administrative order of the
Board of Trustees (board) of the Kentucky Employees Retirement
System (KERS) denying appellant Sylvia Schgallis's claim for
disability retirement benefits.
For the reasons stated
hereafter, we reverse and remand for further proceedings.
Appellant was employed as a registered nurse in a
classified employee position at Hazelwood Hospital from June 1983
to February 1996, at which time she filed for disability
retirement benefits based on her mental condition.
After
reviewing the evidence, KERS medical examiners concluded that
benefits should be denied on the ground that appellant's mental
condition preexisted her employment.
The hearing officer
disagreed and recommended that appellant be awarded benefits.
The disability appeals committee then remanded the matter for an
independent medical examination by a board-certified
psychiatrist, Dr. Wolfgang Kuhn.
After twice examining
appellant, and after reviewing the record and appellant's
history, Dr. Kuhn concluded that appellant's primary diagnosis of
"delusional disorder, erotomanic type" neither preexisted her
employment, nor directly or indirectly resulted from a condition
which preexisted that employment.
The hearing officer again
recommended that appellant be awarded disability benefits, but
the board denied her benefits on the ground that her condition
preexisted her employment.
The circuit court affirmed the board,
and this appeal followed.
It is undisputed that appellant's mental condition
rendered her unable to perform the duties of her job.
Hence, the
issue on appeal is whether the board's finding, that appellant's
current mental condition directly or indirectly resulted from a
mental illness, disease or condition which preexisted her 1983
employment at Hazelwood, see KRS 61.600(2)(d), is "so
unreasonable under the evidence that it must be viewed as
erroneous as a matter of law."
McNutt Construction/First General
Services v. Scott, Ky., 40 S.W.3d 854, 860 (2001).
See Special
Fund v. Francis, Ky., 708 S.W.2d 641 (1986); American Beauty
Homes Corp. v. Louisville and Jefferson County Planning and
Zoning Commission, Ky., 379 S.W.2d 450 (1964).
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The board made lengthy findings of fact which we shall
individually address, in pertinent part, as follows.
In Finding
#5 the board stated:
Claimant's mental condition is such that she
is unable to perform her duties of a
Registered Nurse at Hazelwood. The Claimant
was diagnosed by Dr. Charles Bensenhaver,
III, with delusional disorder, erotomanic
type. Dr. Bensenhaver indicated Claimant's
prognosis was quite poor, and that Claimant
was presently disabled and that there was no
foreseeable time in the future when Claimant
would be capable of maintaining gainful
employment. On remand, Dr. Wolfgang Kuhn
gave the diagnosis of delusional disorder,
erotomanic type; dysthymia; and
trichotillomania, in remission. Dr. Kuhn
gave a GAF score of 45. Dr. Kuhn indicated
that Claimant was incapacitated as of
February 29, 1996 and that her condition
would last for more than twelve months. Mr.
Michno counseled Claimant for over 20 years
and throughout this time she had to cope with
depression, later changed to dysthmia [sic],
different obsessive compulsive behaviors, and
a form of dyslexia. (Citations omitted.)
(Emphasis added.)
Finding #5 clearly was based on a February 1996 letter in which
appellant's longtime counselor, Chris Michno, stated:
I have counseled with Mrs. Schgallis on a
weekly basis for the past 2 years. My
professional contact with her spans over 20
years when she was seeking help with her son.
Throughout this time one of the major
problems she has had to cope with is
depression. In addition to the clinical
depression she has also had to cope with
different obsessive-compulsive behaviors and
what appears to be a form of dyslexia.
In the past 6 months the depression has
become more severe. . . .
. . . .
In addition to the clinical problems, Mrs.
Schgallis has had to file bankruptcy. In
spite of having her current job for over 12
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years she continually worries about losing
her job or getting fired. The past several
years have also involved problems with
coworkers and at times supervisors which have
also added to her stress and anxiety. Some
of this no doubt is related to the reality of
having been fired from jobs prior to this
one.
In my professional opinion all these years
have taken their toll on Mrs. Schgallis,
mentally, emotionally and physically to the
point of where she is no longer able to
function effectively on her job. (Emphasis
added.)
Mr. Michno clarified the language of his February 1996 letter
when he stated in an October 1996 letter:
Prior to 1983, many of Ms. Schgallis [sic]
problems revolved around her son . . . . In
addition, having had some problematic early
job experiences Ms. Schgallis would live with
the daily fear that she might lose her job.
Weight has been an on-going problem along
with the above and has contributed to Ms.
Schgallis' on-going depression and belief
that no one will want her and she will always
be alone.
Within the past 3 years, Ms. Schgallis'
depression centered more around work . . . .
She began having trouble sleeping, stomach
problems and other physical ailments that are
highly correlated to emotional stress.
Within the past year, Ms. Schgallis began to
display some obsessive behaviors to the
degree that she had difficulty concentrating
at work and worried that she might make
medication errors. These obsessive thoughts
led to some behaviors on her part that
resulted in confrontation from others and a
worsening of her depression and feelings of
rejection and self-isolation. It was also
during this past year that the depression
also involved some suicidal thoughts and
plans which had not occurred before. The
obsessive thoughts and the depression of Ms.
Schgallis not being able to concentrate,
focus on what she needs to do and at times
not taking care of herself. Her fears and
worries have become overwhelming and
all-consuming to where she is unable to
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function at work and also struggles in her
personal life. (Emphasis added.)
Finally, in a February 1997 letter Mr. Michno described his
clinical impressions of appellant during the time of her
employment, and in a May 1997 letter he eliminated any doubt as
to whether her delusional behavior preexisted that employment by
stating:
Initially when Ms. Schgallis was in
counseling her depression was related to
situational problems with her son and her
diagnosis was Adjustment Disorder with
Depressed Mood. Two years later when the
depression was still present the diagnosis
was changed to Dysthymia. At neither time
was there present any signs of delusional
beliefs, thinking or behavior. Medication
was not a part of treatment during this time.
This treatment occurred prior to 1983 and
records are no longer available. (Emphasis
added.)
Having carefully reviewed the record, it is clear that
as a whole the record fails to provide any substantial evidence
to support the board's finding that appellant "had to cope with"
obsessive-compulsive behaviors throughout her twenty-year
counseling relationship with Mr. Michno.
Instead, the evidence
shows that Mr. Michno indicated that such behaviors did not begin
until several years prior to the filing of appellant's disability
claim, which was long after her employment at Hazelwood
commenced.
The board next found:
6)
Dr. Margaret O'Connor, Ph.D., gave
a History of Disability and Symptoms of:
"History of being fired from . . . nursing
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positions in the past. . . . Mr. Michno
stated that Claimant continually worried
about losing her job at Hazelwood despite
having worked over 12 years and that her
stress and anxiety was no doubt related to
the reality of having been fired from her
jobs prior to employment at Hazelwood.
Claimant's stress and anxiety about being
terminated from her job pre-existed her
initial employment at Hazelwood in 1983.
7)
Claimant was diagnosed with
dysthymia and delusional disorder, erotomanic
type. A history of physical abuse by an
alcoholic father and probable sexual abuse by
a brother was given. Dr. O'Connor wrote that
Claimant's presenting problem was her belief
that her former gynecologist was in love with
her, trouble with relationships, and gaining
weight again. Claimant later believed her
rabbi was in love with her. Dr. O'Connor
wrote about Claimant: "Apparently she has a
long [history] of setting her sights on high
status, fatherly men, all or most of them
married . . . Long [history] erotomania."
Mr. Michno stated that Claimant had an
on-going weight problem and depression and
belief that no one would want her and that
she would always be alone. Claimant's
problems with relationships and depression,
weight gain, and feelings of rejection and
self-isolation pre-existed her initial
employment at Hazelwood in 1983. Claimant
had a long history of erotomania. (Citations
omitted.) (Emphasis added.)
Our review of the record shows that although Dr. O'Connor's
clinical notes referred to appellant as having a long history of
erotomania, the period of time encompassed by the term "long
history" was never defined in any way.
Moreover, as noted in Dr.
Kuhn's evaluation, the record in fact indicates that the
erotomania disorder did not surface until after appellant's
hysterectomy in the mid-1990's.
Absent any specific proof to
contradict appellant's evidence that her erotomanic condition did
not emerge until the mid-1990's, Dr. O'Connor's use of the phrase
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"long history" simply does not, by itself, support a finding that
the condition predated appellant's employment.
Next, the board stated in Finding #8:
Mr. Michno stated in his February 16, 1996
letter: "In my professional opinion all these
years [20 years] have taken their toll on
Mrs. Schgallis, mentally, emotionally and
physically to the point of where she is no
longer able to function effectively on her
job." (Citations omitted.)
The board itself added the bracketed phrase "20 years" to the
quote from Mr. Michno's letter based on the fact that he had
treated appellant for a total of some twenty years.
However, we
cannot agree with the board that the original statement in any
way supports a finding that appellant's primary disabling
condition of erotomania disorder has existed for twenty years, or
that the disabling condition arose directly or indirectly from a
condition which preexisted her employment.
Instead, it is clear
from a reading of Mr. Michno's four letters and the record as a
whole that appellant has been treated for several conditions over
the years, that the disabling erotomania disorder did not surface
until long after her employment began, and that the latter
condition was not related to the situational depression for which
appellant was treated prior to her employment.
Next, in Finding #9 the board stated as follows:
Dr. Kimbel stated in a memorandum dated June
18, 1997, after a review of the record, that
Claimant had "a long history, dating back to
an early age, of emotional and mental
impairments with intermittent therapy for
this during her entire lifetime." Dr. Kimbel
stated Claimant's current symptoms "merely
manifests a progression of an underlying
disorder that has been present for years" and
"her current impairment is related to the
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mental impairment she had at the time of her
employment.” (Citation omitted.) (Emphasis
added.)
Dr. Kimbel's memorandum recommending the denial of disability
benefits specifically relied upon two reports which are contained
in the case file.
The first document was Mr. Michno's above-
cited February 1996 letter, which referenced his twenty-year
professional relationship with appellant and noted that
"[t]hroughout this time" she had to cope with depression as well
as with "different obsessive-compulsive behaviors and what
appears to be a form of dyslexia."
The second document was Dr.
Bensenhaver's September 1996 report, in which he noted that
appellant had "been followed at this facility" since early 1995,
and that her initial diagnosis of schizoaffective disorder versus
bipolar disorder, coupled with borderline personality disorder,
had been changed to a diagnosis of delusional disorder,
erotomanic type, coupled with depression and "some symptoms of
trichotillomania or obsessive hair pulling."
He determined that
appellant was disabled due to impaired "judgment and insight
. . . ongoing paranoid and erotomanic delusions as well as the
depression related to these symptoms."
Dr. Kimbel did not conduct a personal examination of
appellant.
Instead, he relied on the reports of Mr. Michno and
Dr. Bensenhaver in concluding that appellant's diagnosis "merely
manifests a progression of an underlying disorder that has been
present for years" and that "[t]here is no evidence that the
claimant has a new impairment but merely progressive symptoms of
a prior impairment that has been present for years."
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Our review of the entire record in fact shows that in
his October 1996 and May 1997 letters, Mr. Michno confirmed that
appellant's pre-1983 counseling was related to problems with her
son, that she showed no "signs of delusional beliefs, thinking or
behavior" during the pre-1983 counseling, and that she did not
begin displaying the obsessive-compulsive behavior which affected
her work until about 1995.
Moreover, there is nothing in Dr.
Bensenhaver's report to support a conclusion that appellant's
impairment was a progression of a disorder which existed prior to
her 1983 employment.
We must conclude, therefore, that
substantial evidence did not support a conclusion that
appellant’s current primary and disabling condition of erotomania
is in any way related to the mental health problems which
appellant experienced prior to her 1983 employment.
Next, in Finding #10 the board found that:
Counsel for Claimant set forth that the
delusional disorder erotomanic type was a
specific mental condition defined in the
Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition (DSM-IV) under
classification 297.1 and that it does not
support the argument that one specific
classification is a natural precursor to
another mental condition. However, the
DSM-IV treatment of 297.1 Delusional Disorder
as attached to Petitioner's Reply to
Defendant's Position Statement stated:
* * *
The boundary between
Obsessive-Compulsive Disorder
(especially With Poor Insight) and
Delusional Disorder can sometimes
be difficult to establish. The
ability of individuals with
Obsessive-Compulsive Disorder to
recognize that the obsessions or
compulsions are excessive or
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unreasonable occurs on a continuum.
In some individuals, reality
testing may be lost, and the
obsession may reach delusional
proportions (e.g., the belief that
one has caused the death of another
person by having willed it). If
the obsessions develop into
sustained delusional beliefs that
represent a major part of the
clinical picture, an additional
diagnosis Delusional Disorder may
be appropriate. (DSM-IV, pp.
300-301).
* * *
The DSM-IV stated that there was difficulty
in establishing a "boundary" between
obsessive-compulsive disorder and delusional
disorder, that there was the existence of a
"continuum" between obsessive-compulsive
disorder and delusional disorder, and that if
the obsessions "develop into" sustained
delusional beliefs, an additional diagnosis
of delusional disorder may be appropriate.
While there is no dispute that the DSM-IV refers to a continuum
between obsessive-compulsive disorder and delusional disorder,
that fact is irrelevant herein since appellant was never
diagnosed as having an obsessive-compulsive disorder.
Although
the record contains several references to possible obsessivecompulsive "behaviors" exhibited by appellant, there is no basis
for considering such behaviors as the equivalent of an
obsessive-compulsive disorder.
Hence, there is no evidence to
support a finding that appellant's prior exhibition of possible
obsessive-compulsive behaviors constituted a preexisting
condition which developed into the disabling delusional disorder.
Finally, in Finding #11 the board specifically found
that Claimant suffered from depression and
various obsessive-compulsive behaviors for
over a 20 year history and that, consistent
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with the opinions of Mr. Michno, Dr.
O'Connor, Dr. Kimbel and the treatment of
Delusional Disorder made by the DSM-IV,
Claimant's current mental impairment of
delusional disorder, erotomanic type is a
direct or indirect result of a mental
condition that pre-existed Claimant's
membership in KERS and initial employment at
Hazelwood in 1983. (Citations omitted.)
Although evidence was adduced to show that appellant suffered
from depression for more than twenty years, there was simply no
evidence to show that she had any history of obsessive-compulsive
behaviors or delusional disorders prior to her employment.
That
being so, it is clear there is no substantial evidence to support
the board's finding that appellant's delusional disorder,
erotomanic type, directly or indirectly resulted from a mental
condition which preexisted her 1983 employment at Hazelwood.
It
follows, therefore, that the board's denial of appellant's
disability claim, on the ground that her current mental
impairment preexisted her employment, was so unreasonable under
the evidence that we are constrained to conclude that it was
erroneous as a matter of law.
McNutt, 40 S.W.3d at 860.
For the reasons stated, the circuit court's order
affirming the board is reversed and remanded, with directions to
enter a judgment reversing the board's order and remanding this
matter with directions to the board to enter an order on remand
consistent with our views.
BARBER, J., CONCURS.
KNOPF, J., CONCURS BY SEPARATE OPINION.
KNOPF, JUDGE, CONCURRING: I fully concur with the
reasoning and the result reached by the majority opinion.
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I
write separately merely to note where the Board’s reasoning seems
to have gone awry.
KRS 61.600(2)(d) requires that an applicant
for disability retirement benefits must show that the "incapacity
does not result directly or indirectly from bodily injury, mental
illness, disease, or condition which pre-existed membership in
the system . . . ." (Emphasis added).
In prior appeals, I have
expressed the concern that the Board's interpretation of the
statute is so broad that it could be used to exclude any
disabling condition that is not the direct result of a
work-related injury. An employee's mere susceptibility to the
development of a disabling condition should not be deemed
necessarily to be a pre-existing condition within the meaning of
KRS 61.600(2)(d). There must be a causative nexus, direct or
indirect, between the pre-existing condition and the subsequent
disabling condition.
In this case, Schgallis’s history of depression and
obsessive-compulsive behaviors is so attenuated from her current
mental condition that it was unreasonable for the Board to draw
an inference that no intervening factors contributed
significantly to the onset of the disability.
Moreover, as noted
in the majority’s thorough opinion, the Board made assumptions
about the relationship between Schgallis’s pre-existing disorders
and her current mental condition that were not supported by the
medical evidence.
Consequently, the Board found a causative
nexus between the pre-existing condition and the subsequent
disabling condition where none existed.
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Therefore, Schagallis
was entitled to an award of disability retirement benefits, and
the Board clearly erred in denying her application.
BRIEF FOR APPELLANT:
BRIEF FOR APPELLEE:
Alvin D. Wax
Louisville, KY
James Dodrill
Frankfort, KY
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