Potomac Electric Power Co. v. District of Columbia Department of Employment Services
77 A.3d 351
| D.C. | 2013Background
- Pepco petitions for review of a CRB decision affirming an ALJ’s order awarding benefits to Boone for a workplace back injury.
- Boone alleged a May 1999 lifting incident worsened a preexisting November 1998 back injury, leading to ongoing treatments.
- Doctors diagnosed degenerative disc disease with L-5 radiculopathy and recommended decompressive surgery after a nerve block provided short-term relief.
- Pepco argued the May 1999 injury did not medically cause Boone’s current condition due to intervening incidents and lack of medical record support.
- An independent medical evaluation by Dr. Cohen found no direct causal link and recommended no surgery; the ALJ discounted that report.
- The CRB upheld the ALJ’s finding of medical causation and deemed the surgery reasonable and necessary, adopting the utilization review as persuasive.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether substantial evidence supports a medical causal link | Boone’s May 1999 injury contributed to his condition. | Pepco shows no causal link due to intervening incidents and records. | Yes; substantial evidence supports a causal link. |
| Whether the May 1999 injury is the predominant cause despite other factors | Aggravation from May 1999 contributed to aggravated condition. | Other factors negate causation or override May 1999 impact. | Yes; aggravation rule supports compensability. |
| Whether surgery is reasonable and necessary under the statute | Surgery is reasonable and necessary due to persistent symptoms. | Lack of convincing neurocompressive evidence questions necessity. | Yes; utilization review supported reasonableness and necessity. |
Key Cases Cited
- Ferreira v. District of Columbia Dep’t of Emp’t Servs., 667 A.2d 310 (D.C.1995) (aggravation rule allows compensation when work injury aggravates preexisting condition)
- Hensley v. Washington Metro. Area Trans. Auth., 655 F.2d 264 (D.C.Cir.1981) (recognizes aggravation concept in causation analysis)
- Sibley Mem’l Hosp. v. District of Columbia Dep’t of Emp’t Servs., 711 A.2d 105 (D.C.1998) (utilization review findings control reasonableness and necessity absent specific reasons)
- Hisler v. District of Columbia Dep’t of Emp’t Servs., 950 A.2d 738 (D.C.2008) (limits scope of review and supports adopting utilization review conclusions)
- Washington Hosp. Ctr. v. District of Columbia Dep’t of Emp’t Servs., 744 A.2d 992 (D.C.2000) (presumption of compensability; burden shifts after rebuttal)