Workers' Compensation Denied Although Employer Offers No Expert

Golding-Alleyne v. District of Columbia Department of Employment Services, No. 07-AA-1281 (DC, September 24, 2009)

The District of Columbia Court of Appeals affirmed the denial of workers' compensation benefits finding the claimant failed to establish entitlement, despite the fact that the employer offered no expert medical evidence to controvert plaintiff's claims. For the first time, the court held than an Administrative Law Judge ("ALJ") may reject the medical opinions of the claimant's treating physician even absent evidence of contrary medical opinions.

Portia Golding-Alleyne ("Claimant") was injured on September 10, 1993 when she slipped and twisted her back while at work at the Washington Hospital Center ("Employer"). In 1996, neurosurgeon, Bruce Ammerman, M.D., operated to remove part of the vertebral bone causing her pain. Since then, Claimant has worked only sporadically and receives temporary total disability benefits.

Claimant continued to suffer severe back pain and underwent a second back surgery with Dr. Ammerman in 2003. This second operation failed to alleviate her symptoms. Claimant continued treatment with Dr. Ammerman and a pain management specialist.

In 2005, Claimant fell down stairs at her home when her "left leg gave out." She tore her rotator cuff and subsequently underwent surgery for that injury. Claimant then filed for permanent partial disability benefits, in addition to the temporary total disability compensation she was already receiving. Specifically, Claimant requested a "schedule award" for 20 percent of the loss of her leg.

At the hearing, Claimant relied upon medical records relating to her leg and shoulder injuries. Claimant argued that "the impairment to her left leg resulted from radiating pain caused by the [work-related] back injury." She testified that her left leg is constantly numb, that it cramps, "gives out all the time," and that it causes her to fall down four to five times per month. She explained that she continues to receive medication for her back, leg, and shoulder, and regularly goes to physical therapy. The Employer presented no expert medical opinion of its own.

The ALJ denied benefits. The Claimant failed to satisfy her burden of proof because there was "no medical evidence that©laimant has ever been diagnosed with or treated for any symptoms, complaints, condition or disability of the left leg." Further, there was no evidence that the Claimant had reached maximum medical improvement to allow an award for permanent disability.

Claimant appealed these findings to the District of Columbia Court of Appeals and argued that "medical evidence" of her leg injury was contained within the medical reports. There, Dr. Ammerman reported that Claimant complained of leg pain. The appellate court explained, however, that "medical evidence" refers to medical test results "documenting a permanent impairment to the left leg." A doctor's notes reflecting patient's complaints about symptoms will not suffice as medical evidence. Moreover, there was no evidence to link her leg injury to work-related back injury.

Claimant also pointed to a letter written by Dr. Ammerman in 2006 to Claimant's counsel opining there was a 20 percent impairment of the left leg. The court was not persuaded as there was no evidence explaining the foundation upon which the medical opinion was based. There was substantial basis to question the reliability of this "cryptic and conclusory" opinion.

The Claimant argued, however, that the Employer's failure to introduce its own expert medical opinion regarding her injury forced the court to accept her doctor's opinion. The court disagreed and held that it was not necessary for an Employer to present a medical expert of its own. Instead, a court is free to disregard a medical opinion it finds inherently suspect or unpersuasive.

Thus, the District of Columbia Court of Appeals affirmed the denial of benefits. Claimant's presentation of some evidence of injury did not satisfy the burden of proof, despite the Employer's failure to present its own expert medical opinions.