State, Department of Administration, Division of Retirement & Benefits v. Shea
394 P.3d 524
| Alaska | 2017Background
- Shirley Shea, a state employee, suffered chronic pain and became unable to work in 2001; she received non-occupational disability benefits but was denied occupational disability benefits by the Division of Retirement and Benefits.
- The Division’s retained expert (Dr. Cole) initially concluded the record did not show the pain was caused by Shea’s occupation; later reviews reaffirmed denial.
- Shea claimed prolonged sitting at work aggravated a preexisting ilioinguinal nerve injury (from a 1984 procedure) and sought occupational disability benefits; medical testimony conflicted about whether the neuralgia persisted and whether sitting substantially aggravated her condition.
- On administrative review the ALJ found Shea proved but‑for causation (work sitting contributed) but not proximate causation: he concluded work was not a sufficiently “significant and important” cause to attach legal responsibility to the State.
- The superior court reversed the ALJ, but the Alaska Supreme Court reversed the superior court and affirmed the ALJ, holding the ALJ’s proximate‑cause determination was supported by substantial evidence.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Shea proved occupational disability (proximate cause) — was prolonged sitting at work a "substantial factor" in causing her disabling pain? | Shea: Work‑related prolonged sitting materially aggravated her preexisting condition and increased baseline pain; medical testimony (Dr. Smith) supported causation. | State: Medical evidence (including Dr. Beard) and other facts show ordinary activities and possible psychological factors explain pain; Dr. Smith attributed only 5–10% of symptoms to sitting, so not a legally substantial cause. | Held for State: ALJ’s finding that sitting was a but‑for cause but not a substantial/proximate cause was supported by substantial evidence and affirmed. |
| Relevance of timing and content of Shea’s reports to physicians (failure to report work‑specific sitting earlier) | Shea: She reported sitting as painful to her supervisor and later to physicians; supervisor accommodations made physician reporting unnecessary. | State: Shea did not report prolonged sitting at work to physicians until after she stopped working, undermining that work was a significant causal factor. | Held for State: ALJ reasonably relied on the timing of physician reports as evidence that work was not a sufficiently significant cause. |
| Weight of conflicting expert testimony (Dr. Smith vs. Dr. Beard) | Shea: Dr. Smith’s testimony supports that sitting aggravated pain and increased baseline over time. | State: Dr. Beard’s testimony cast doubt on persistence of ilioinguinal neuralgia and raised alternative or psychological explanations; conflicts permit agency to credit either. | Held for State: Substantial evidence existed in Dr. Beard’s and other evidence to weaken Dr. Smith’s opinion and support the ALJ’s proximate‑cause conclusion. |
| Standard for "substantial factor" in occupational disability (but‑for vs. proximate/legal cause) | Shea: Aggravation of symptoms by work that prevents performance suffices; even modest percentage contribution can be substantial. | State: But‑for causation alone is insufficient; the aggravation must be so significant that reasonable persons attach legal responsibility. | Held: Court confirmed distinction — but‑for causation may be shown yet still fail proximate (legal) causation; ALJ permissibly required a higher showing and applied that test. |
Key Cases Cited
- Shea v. State, Dep’t of Admin., Div. of Ret. & Benefits, 267 P.3d 624 (Alaska 2011) (prior appellate decision in the same matter clarifying causation standard on remand)
- Doyon Universal Servs. v. Allen, 999 P.2d 764 (Alaska 2000) (explaining that even a small percentage contribution can be compensable if reasonable persons would attach responsibility)
- Hester v. State, Pub. Emps.’ Ret. Bd., 817 P.2d 472 (Alaska 1991) (aggravation of symptoms may qualify as a compensable injury even without worsening the underlying disease process)
- Smith v. Univ. of Alaska, Fairbanks, 172 P.3d 782 (Alaska 2007) (standards for evaluating expert testimony and when an administrative factfinder may rely on an expert despite technical defects in phrasing)