Opinion
16-P-837
05-12-2017
Jane A. SGOUROS'S CASE.
MEMORANDUM AND ORDER PURSUANT TO RULE 1:28
In this worker's compensation case, an administrative judge (AJ) of the Department of Industrial Accidents (DIA) found that the employee was temporarily totally incapacitated as a result of work-related "psychiatric injuries" and awarded her benefits pursuant to G. L. c. 152, §§ 13, 30, and 34. A DIA reviewing board (board) reversed the AJ's decision, concluding that the employee had failed to establish that an employment-related event was "the predominant contributing cause" of the disability pursuant to G. L. c. 152, § 1(7A), as amended through St. 1991, c. 398, § 14. On appeal, the employee argues that she presented sufficient evidence to support her claim of psychiatric disability caused by a work-related event or, in the alternative, that the board should have recommitted the case to the AJ for further findings. For the reasons that follow, we affirm the board's decision.
Background. The employee, age fifty-three at the time of the hearing before the AJ, experienced a traumatic childhood as the daughter of a schizophrenic mother who abused her physically and emotionally. She grew up without family support or any sort of mental health treatment. She began working for the Department of Transitional Assistance (DTA) at age twenty-two and worked there for over thirty years. Over time, the employee felt overwhelmed by her work. In her role as a case manager, she often encountered "aggressive" clients who were verbally hostile and threatening. She was unsupported by her supervisors and managers. In 1997, she sought mental health treatment, in part due to her troubled childhood and in part because of the stress she experienced at work. On December 23, 2013, she was threatened by a client while conducting an interview at work. She reported the incident, but her supervisor gave her no support. The employee felt paralyzed by anxiety and did not return to work.
The employee was examined by an impartial medical examiner, Dr. Mark O. Cutler, pursuant to G. L. c. 152, § 11A. He identified the employee's childhood experiences and events at work as factors contributing to her diagnosed disorders. Dr. Cutler concluded that the employee was medically disabled. His report, which was the only medical evidence introduced at the hearing before the AJ, characterized the causal connection between the employee's "psychiatric disorder and the traumatic even[t]" as "very complicated to explain." Dr. Cutler opined:
"This patient has lived a life with much trauma, having had a psychiatrically impaired and abusive mother, no father and very little family support. In spite of the lack of emotional support, the patient had been able to maintain employment, making use of absences during the employment for approximately 30 years. On 12/23/13 the patient had ‘the proverbial straw that broke the camel's back.’ Previous to this she had maintained employment by going to see outside therapists, taking psychiatric medications, and taking Family and Medical Leave Act time off and also going to a health club to exercise."
The board concluded that Dr. Cutler's opinion that the work-related event on December 23, 2013, was "the proverbial straw that broke the camel's back," did not meet the employee's burden to prove that the employment-related event was the predominant contributing cause of her mental and emotional disabilities as required by G. L. c. 152, § 1(7A).
Discussion. General Laws c. 152, § 11C, as amended through St. 1986, c. 662, § 13, provides in relevant part:
"The reviewing board shall reverse the decision of an administrative judge only if it determines that such administrative judge's decision is beyond the scope of his authority, arbitrary or capricious, or contrary to law."
See Kelly's Case, 78 Mass. App. Ct. 907, 908-909 (2011). We review the board's decision pursuant to G. L. c. 30A, § 14(7)(a )-(d ), (f )-(g ). See Wilson's Case, 67 Mass. App. Ct. 1, 5 (2006). See also Robinson's Case, 416 Mass. 454, 456-457 (1993) (clause [e ] of G. L. c. 30A, § 14 [7] regarding "unsupported by substantial evidence," does not apply to appeals from a board decision). We "give due weight to the experience, technical competence, and specialized knowledge of the agency, as well as to the discretionary authority conferred upon it." G. L. c. 30A, § 14(7), as appearing in St. 1973, c. 1114, § 3.
In cases such as this, where the employee claims she has suffered a mental or emotional injury caused by a work-related, nonphysical injury, it is the employee's burden to prove that the work-related "event or series of events" was "the predominant contributing cause of such a disability." G. L. c. 152, § 1(7A). See Cornetta's Case, 68 Mass. App. Ct. 107, 115-117 (2007). This standard is higher than that for "combination injury claims" in which the employee must show that the work event was "a major but not necessarily predominant cause of the disability." Id. at 117.
While it is not necessary for an impartial medical examiner to use the "magic words" of the statute, the opinion must be "expressed in terms substantially equivalent to those of the statute." Stewart's Case, 74 Mass. App. Ct. 919, 920 (2009). We have previously held that the predominant contributing cause is the equivalent of the primary cause. May's Case, 67 Mass. App. Ct. 209, 212-213 (2006). A medical opinion regarding the cause of a mental or emotional injury must address "the relative degree to which compensable and noncompensable causes have brought about the employee's disability." Stewart's Case, supra.
Here, it is undisputed that the employee was abused as a child and that she suffered from posttraumatic stress, anxiety, and depression as a result. Throughout her career at the DTA she managed her condition with exercise, counselling, and medication. Dr. Cutler's opinion that the work-related event on December 23, 2013, was the "straw that broke the camel's back," failed to address the degree to which the work-related event contributed to her disability and failed to identify it as the predominant cause. Consequently, the board concluded that while "Dr. Cutler's opinion was sufficient to support a causal link between the employee's work and her disability," it was not sufficient to prove that the work-related event was the predominant contributing cause. Considering the limited medical evidence presented on the question of causation, we cannot conclude that the board's decision was arbitrary, capricious, an abuse of discretion, or otherwise contrary to law.
For the first time on appeal, the employee argues that even if the AJ's decision was not supported by the medical evidence, the board should have, sua sponte, recommitted the case to the AJ for further findings of fact. "The reviewing board may, when appropriate, recommit a case before it to an administrative judge for further findings of fact" (emphasis added). G. L. c. 152, § 11C. Thus, the decision to recommit a case to the AJ is in the board's discretion. Here, the problem was not the AJ's failure to make findings, but his inability to do so based on the limited medical evidence before him. Even if the board had recommitted the case, the AJ could not have found from Dr. Cutler's report that the work-related event on December 23, 2017, was the "predominant contributing cause" of her disability. See May's Case, supra at 214 (in absence of contradictory medical evidence, impartial physician's determination must be accepted as true).
Finally, counsel for the employee suggested at oral argument that recommitting the case would have allowed the AJ to reopen the evidence to further address causation. We have found no precedent that would require the AJ to reopen the evidence. The AJ found that "[t]he report of the medical examiner is adequate [,] [n]o additional medical evidence was authorized," and "[t]he parties were granted permission but declined to submit the deposition of Dr. Cutler." Under these circumstances, we see no abuse of discretion in the board's decision not to recommit the case to the AJ.
Decision of reviewing board affirmed.