JOSE A. DUARTE, Plaintiff and Appellant, v. STATE TEACHERS’ RETIREMENT SYSTEM et al., Defendants and Respondents.
No. A135184
First Dist., Div. Four.
Nov. 18, 2014.
232 Cal.App.4th 370
COUNSEL
Law Offices of Jivaka Candappa and Jivaka Candappa for Plaintiff and Appellant.
Kamala D. Harris, Attorney General, Julie Weng-Gutierrez, Assistant Attorney General, Karin S. Schwartz and Charles J. Antonen, Deputy Attorneys General, for Defendants and Respondents.
OPINION
REARDON, J.—Jose A. Duarte (Duarte) appeals from the trial court‘s denial of his petition for writ of administrative mandamus, through which he asserts that his application to the State Teachers’ Retirement System (known as CalSTRS) for disability retirement benefits has been improperly denied. After hearing, an administrative law judge (ALJ) upheld CalSTRS‘s denial of Duarte‘s application for benefits, concluding that CalSTRS had no choice but to deny Duarte‘s application once he refused to complete the independent medical evaluation (IME) ordered by CalSTRS pursuant to
I. BACKGROUND
A. Duarte‘s Employment and Disability History
Duarte became a contributing member of the CalSTRS defined benefit program on September 1, 1993, when he began teaching in the Stockton
In January 2004, Duarte‘s treating psychologist, Dr. Sloman, opined that he was suffering from a posttraumatic stress disorder (PTSD) and was “totally disabled with respect to working as a teacher.” Specifically, Dr. Sloman stated: “His anxiety, due to reminders of the original trauma, would be so high he could not function.” Dr. Sloman indicated in April 2005 that her original diagnosis had not changed. In March 2007, although she had last seen Duarte in November 2005, Dr. Sloman continued to diagnose him as suffering from PTSD and also reported that Duarte had difficulty focusing, impaired concentration when trying to complete what appear to be simple tasks, and an inability to understand and remember simple directions. She did not expect his condition to improve. Duarte‘s treating psychiatrist, Dr. Goldstein, stated in December 2004 that Duarte was suffering from significant intermittent depression and indicated that he had previously been diagnosed with this condition by a psychiatrist at Kaiser Hospital. In October 2005, after seeing Duarte for almost a year, Dr. Goldstein‘s stated diagnosis was PTSD with significant depression. He further indicated that, due to this condition, Duarte “has a definite lack of concentration, impaired energy, nightmares/flashbacks, memory loss, and anxiety.” Moreover, “[d]ue to the daily stress and anxiety associated with this condition,” Duarte was reported
In March 2004, Duarte filed a workers’ compensation claim with the Workers’ Compensation Appeals Board in Oakland against the OUSD and the State Department of Education, which at the time managed and supervised the OUSD. During the processing of this claim, Duarte was evaluated by four different doctors. For instance, Dr. Matan—an orthopedic surgeon and qualified medical evaluator (QME)—concluded that Duarte has “disability precluding heavy or repetitive use of his left shoulder” and is “specifically precluded from doing significant work at or above shoulder height.” According to Dr. Matan, Duarte is physically able to work as a teacher, but probably not as a firefighter. Another orthopedist and QME, Dr. Barber, confirmed “a level of permanent disability which precludes constant work at or above shoulder level on the left.”
In addition, Duarte attended a psychiatric evaluation with Psychiatrist Donald Stanford in December 2005. During that evaluation, Duarte indicated that he had been treated psychiatrically for stress for a short time in 1995 when he was working for the SUSD. Records indicate that he was also treated for stress in 1998. Duarte additionally reported multiple learning problems involving reading that he has had throughout his life, along with issues related to short-term memory. Dr. Stanford concluded that Duarte‘s cognitive complaints appeared to be exaggerated and that reported problems with concentration and clear thinking were “not clinically evident.” Further, he saw no new cognitive problems as a result of Duarte‘s OUSD injury. Dr. Stanford additionally opined that Duarte‘s PTSD symptoms had “resolved for the most part,” although he would likely become anxious again if he were to resume his work as a teacher. In summary, Dr. Stanford concluded that Duarte had a period of “temporary psychiatric disability” as a result of the December 2003 incident, but that it had resolved by August 2004, other than a preclusion from returning to teaching. Other long-standing psychiatric and cognitive problems were unrelated to the OUSD injury.
Finally, Duarte received a psychiatric evaluation from Dr. Richard Lieberman in November 2005. Duarte reported long-standing issues with dyslexia and “short-term memory trouble with details and words” to Dr. Leiberman. Dr. Lieberman diagnosed Duarte with PTSD, resolving. He concluded that Duarte was psychiatrically totally and temporarily disabled from the date of the assault until the date of his evaluation. He recommended that Duarte not return to work as a “Spanish teacher for the Unified School District,” but indicated that vocational rehabilitation would be appropriate. Ultimately, Duarte entered into a stipulated settlement of his workers’ compensation claims on January 26, 2007. The executed settlement documents indicate a “serious dispute” regarding the scope of Duarte‘s disability.
In October 2006, Duarte applied for Social Security disability benefits. The State Department of Social Services (known as CalDSS) is charged with making disability determinations in California on behalf of the federal Social Security Administration (SSA), based on federal law. (See
Ultimately, CalDSS determined on April 13, 2007, that Duarte was disabled from the date of the December 2003 incident. He became eligible for monthly disability benefits as of December 2005. According to Duarte, no hearing was ever held during this process, although he submitted a declaration to CalDSS and the SSA and was asked “Is that the truth and the whole truth?” during one phone call from “one of the people from the Social Security Administration.” Further, CalDSS did not issue a determination letter stating its reasons for approving his claim.
Duarte also had two student loans through the University of California (UC) totaling approximately $10,000 which he requested be forgiven due to his total and permanent disability. One loan was an institutional loan issued and funded by the UC, itself, while the other was a federally funded loan issued under the federal Perkins Loan program. A representative of the UC system testified at the administrative hearing in this matter regarding the process for loan forgiveness with respect to both student loans, stating that first the borrower “submits whatever medical documentation they would like” for consideration. Thereafter, the documentation is evaluated by medical staff at the relevant UC campus. “So, in the case of this U.C. Irvine loan that was evaluated by the medical staff at the Irvine campus, I‘m not going to say that it‘s a comprehensive evaluation, but we do want to make at least a determination that the documentation appears, to our eyes, to be reasonable.” For the
B. Duarte‘s Application for CalSTRS Benefits
On February 21, 2008, Duarte applied for disability retirement benefits through CalSTRS, claiming permanent and total disability as a result of the December 2003 incident. Over the course of the next six months, CalSTRS repeatedly asked Duarte to submit various medical records and other documents necessary for consideration of his claim. For instance, on June 3, 2008, CalSTRS indicated that—despite previous requests—it had not received all of the documentation necessary for its evaluation of Duarte‘s application. It therefore requested, among other things, Duarte‘s workers’ compensation materials, including all reports of QME‘s; the police report and principal report documenting the December 2003 attack; the remainder of an incomplete document previously submitted by Duarte; information regarding his CalDSS claim; and tax returns from 2004 to the present. In response, Duarte supplied some of the materials requested. On June 27, 2008, CalSTRS again requested documents, including the police report and principal report regarding the December 2003 incident, as the document previously submitted by Duarte as a police report appeared to be a citizen‘s crime report completed by Duarte, himself. Again, Duarte partially complied.
On July 29, 2008, CalSTRS requested medical documents from 1992 through 2003; current employment information; tax returns for 2003; and information to clear up an inconsistency in Duarte‘s employment history with OUSD after the attack. Finally, on August 5, 2008—indicating that it was trying to rule out a preexisting disability based on certain statements made in the medical documentation Duarte had already submitted—CalSTRS again asked for his medical records from 1992 through 2003. Each of these
On August 16, 2008, Duarte sent a letter to CalSTRS objecting to its process for handling his claim, arguing that he had complied with all of its previous requests, and indicating that he would submit his still outstanding Kaiser medical records only “upon [CalSTRS‘s] commitment that it will pay my benefits if those records do not show a diagnosis of Post Traumatic Stress Disorder prior to December 4, 2003.” Duarte further stated that “[i]f [CalSTRS] does not commit to that position, I will conclude that [CalSTRS] does not need those records for any legitimate purpose, and that I am in complete compliance with [CalSTRS] and eligible for benefits.”
By letter dated September 8, 2008, CalSTRS indicated to Duarte that it was still waiting for additional records from him and that it could not commit to approve his application “in advance of having all of the necessary information and documentation to support a final decision.” Under such circumstances, CalSTRS informed Duarte that it was exercising its right, under
In fact, on September 10, 2008—two days after CalSTRS sent Duarte its request for IMEs in this matter—Duarte had filed a lawsuit in superior court, seeking various forms of mandamus, injunctive, and declaratory relief and alleging an assortment of constitutional violations. In essence, Duarte sought an order compelling the State of California to pay him disability benefits. (Duarte v. State of California (Super. Ct. Alameda County, 2008, No. RG08408741).) CalSTRS filed a demurrer on October 10, 2008, arguing, among other things, that CalSTRS had not yet rendered a decision with respect to Duarte‘s disability claim and that Duarte had failed to exhaust his administrative remedies. On November 6, 2008, the trial court granted the demurrer with leave to amend, noting that Duarte had failed to exhaust his administrative claims and that the “viability of any constitutional claims
The next day, November 7, 2008, Duarte sent a letter to CalSTRS requesting a hearing on a laundry list of “decisions” that CalSTRS had made in the course of processing his application for benefits, including CalSTRS‘s “incorrect” decisions that his PTSD was due to a preexisting condition, that prior disability determinations of other California agencies are not binding on CalSTRS, and that he should attend IMEs. On November 11, 2008, Duarte also sent a letter to Benchmark stating that he had “appealed” his application for CalSTRS disability benefits, that all matters were “stayed,” and that there would be “no IMEs” until the issues were resolved by an administrative law judge. Finally, on November 14, 2008, Duarte reiterated his request for a hearing to CalSTRS, stating: “Basically, I want some authority figure or officer to decide whether a determination of disability by [the California Employment Development Department], CalDSS, and SSA should not bind CalSTRS because if it does, there will be no need for any more IMEs. However, if a hearing officer determines otherwise, I will certainly cooperate with any reasonable CalSTRS request, including IMEs.”
By letter dated November 21, 2008, CalSTRS informed Duarte that the disability decisions of other agencies are not binding on CalSTRS because “the California Education Code has its own definition of disability along with eligibility and timeliness of application requirements.” After noting that it had the statutory authority to order IMEs pursuant to
Since Duarte disagreed with CalSTRS‘s rejection of his application, the agency forwarded his case to the executive review committee (ERC) in accordance with its usual procedures. On January 27, 2009, the ERC upheld the denial of Duarte‘s application for benefits. According to the ERC, CalSTRS requested IMEs pursuant to
C. The Administrative Hearing
After a number of continuances and voluminous motions and other filings, Duarte‘s appeal was finally heard by the ALJ on January 12 and 13, 2010. Representatives of CalSTRS (De Fonte) and Benchmark (Cotten) testified at the hearing regarding the application process for CalSTRS disability retirement benefits and the IME process, both generally and in this case. With respect to CalSTRS‘s decision to request that Duarte attend IMEs, De Fonte testified: “We were never certain we had all the records because what would happen would be, new records would come up at different times for Mr. Duarte. [¶] Even in the course of one independent medical evaluation that he went to, he brought a set of records that he never provided to us. That we had requested any and all records, new records came up all the time.” De Fonte further testified: “[W]e got records that supported one picture. We didn‘t get all of the records. We might get, first, a deposition where we‘d only receive certain pages of the deposition, not the full deposition. We didn‘t ever get the full picture of things.” Thus, the decision was made “to have our own evaluation done to determine to, kind of, get to the bottom of the line—to get to the bottom answer.” De Fonte also noted that Duarte‘s case review was complicated by the fact that it involved a “very specific law” which required not just that Duarte be disabled, but also that his disability “be a direct result of an unlawful act.” Finally, since CalSTRS law required that a member be “continuously incapacitated” and Duarte had applied for benefits five years after his injury, “[i]t was important to have a clear picture of what his condition is today, as well as the years in between.”5 With respect to the actual scheduling of the IMEs, Cotten testified for Benchmark that her impression from her communications with Duarte was that he was unwilling to proceed with the remaining IMEs until after an ALJ decision in the matter.
Duarte, for his part, argued that the prior disability determinations by other state agencies should be controlling, that CalSTRS‘s interpretation of
On April 14, 2010, the ALJ issued a proposed decision upholding CalSTRS‘s denial of Duarte‘s application for disability benefits. Specifically, the ALJ found that CalSTRS does not accept disability findings by other agencies as controlling and that neither CalDSS nor the UC has a special relationship with CalSTRS, other than each being a governmental agency. With respect to the IMEs ordered in this case pursuant to
With respect to the question of the collateral estoppel effect to be given to the disability determinations of other administrative agencies, the ALJ determined that such an inquiry is relevant only to “the factual question of [Duarte‘s] disability.” Since the issue of Duarte‘s disability was never determined by CalSTRS due to Duarte‘s refusal to complete his IMEs, the ALJ did not reach the collateral estoppel issue. However, the ALJ did conclude that using the disability findings of other administrative agencies to somehow “exempt” Duarte from the obligation of submitting to an IME ordered pursuant to
Subsequently, on June 2, 2010, the appeals committee of the Teachers’ Retirement Board (CalSTRS Board) adopted the ALJ‘s proposed decision as its own, with minor nonsubstantive amendments. The minutes of the appeals committee meeting indicate that the “committee requested staff encourage Mr. Duarte to reapply and submit the necessary documentation.”6
D. The Petition for Writ of Mandate
On December 18, 2009—less than a month before the scheduled administrative hearing in this matter—Duarte had filed a second petition for writ of mandate in Alameda County Superior Court, seeking to compel CalSTRS to award him disability benefits and advancing many of the same arguments presented to the ALJ, as well as numerous other constitutional, contractual, and equitable claims. On December 21, 2009, Duarte requested that the trial court stay the administrative proceedings, but no action was taken by the court and thus, as described above, the ALJ hearing went forward as scheduled on January 12 and 13, 2010. Duarte filed a supplement to his writ petition on January 7, 2011, which detailed his many claims of error with respect to the ALJ decision ultimately adopted by CalSTRS. Thereafter, in September 2011, the parties stipulated to the contents of the administrative record. And, on September 13, 2011, Duarte, through new counsel, filed his amended petition for peremptory writ of administrative mandamus (Writ Petition), the operative pleading in these proceedings.
After briefing and argument, the trial court issued its judgment and statement of decision on February 15, 2012, denying Duarte‘s Writ Petition. Specifically, the trial judge held that the weight of the evidence supports the conclusion that CalSTRS properly rejected Duarte‘s application for disability retirement because he failed to appear for the IMEs ordered pursuant to
Duarte filed a motion for a new trial on March 12, 2012, challenging the court‘s conclusion that his three years of SUSD leave did not count as years of creditable service for purposes of eligibility under
II. DISCUSSION
A. Standard of Review
Judicial review of the denial of CalSTRS disability benefits is governed by the administrative mandate process set forth in
On appeal from a decision of a trial court applying its independent judgment, we review the trial court‘s findings rather than those of the administrative agency. (Calderon v. Anderson (1996) 45 Cal.App.4th 607, 612 [52 Cal.Rptr.2d 846] (Calderon).) Specifically, we review the trial court‘s factual findings for substantial evidence. In doing so, we must resolve all conflicts in favor of CalSTRS, the party prevailing below. Further, we cannot reweigh the evidence. Thus, we do not determine whether substantial evidence would have supported a contrary judgment, but only whether substantial evidence supports the judgment actually made by the trial court. (Natalie D. v. State Dept. of Health Care Services (2013) 217 Cal.App.4th 1449, 1455 [159 Cal.Rptr.3d 497]; see LaGrone, supra, 202 Cal.App.4th at p. 940.) In sum, “[t]he question on appeal is whether the evidence reveals substantial support—contradicted or uncontradicted—for the trial court‘s conclusion that the weight of the evidence supports the [agency‘s] findings of fact. [Citation.] We uphold the trial court‘s findings unless they so lack evidentiary support that they are unreasonable.” (Breslin v. City and County of San Francisco (2007) 146 Cal.App.4th 1064, 1078 [55 Cal.Rptr.3d 14] (Breslin).)
With respect to issues of law, in contrast, our review is de novo. (Breslin, supra, 146 Cal.App.4th at p. 1077.) In this regard, we acknowledge that CalSTRS‘s interpretation of its governing statutes is entitled to “great weight and deference.” (Calderon, supra, 45 Cal.App.4th at pp. 612-613.) Nevertheless, “[s]tatutory interpretation is a clear question of law for our determination anew on appeal.” (Breslin, supra, 146 Cal.App.4th at p. 1077.)
B. Statutory Scheme Governing CalSTRS Disability Retirement Benefits
CalSTRS was created by the Legislature in 1913 as a retirement system for credentialed California teachers and administrators in kindergarten through community college. (See
The constitutional obligations of a public retirement board such as the CalSTRS Board have been interpreted to include a duty “to ‘ensure the rights of members and retirees to their full, earned benefits.’ ” (City of Pleasanton v. Board of Administration (2012) 211 Cal.App.4th 522, 544 [149 Cal.Rptr.3d 729], italics added.) Such obligations therefore do not permit the payment of benefits not otherwise authorized. (Ibid.) Rather, “the statutory scheme governs the scope of the benefits earned.” (Chaidez v. Board of Administration etc. (2014) 223 Cal.App.4th 1425, 1430 [169 Cal.Rptr.3d 100].) Thus, while ” ‘[p]ension provisions should be broadly construed in favor of those who were intended to be benefited thereby . . . [,] they cannot be construed so as to confer benefits on persons not entitled thereto.’ ” (Id. at p. 1431, citations omitted.) With this in mind, we consider the statutes governing Duarte‘s claim for disability benefits in this case.
For purposes of the CalSTRS disability retirement program, “disability” is defined as “any medically determinable physical or mental impairment that is permanent or that can be expected to last continuously for at least 12 months, measured from the onset of the disability, but no earlier than the day following the last day of actual performance of service that prevents a member from performing the member‘s usual duties for the member‘s employer, the member‘s usual duties for the member‘s employer with reasonable modifications, or the duties of a comparable level position for which the member is qualified or can become qualified within a reasonable period of time by education, training, or experience.” (
The Teachers’ Retirement Law, however, contains additional eligibility requirements for obtaining disability retirement benefits. Generally speaking, for example, a member may only apply for disability retirement if that member has five or more years of credited service and meets a number of listed criteria. (
The requirement that an eligible member must have performed at least four years of actual service is relaxed if such lack of actual service “is due to an on-the-job injury or a disease” while engaged in CalSTRS-covered employment. (
Further, a member who meets the special eligibility requirements of
Even if otherwise eligible for disability benefits, however, a member must also meet the application timing requirements set forth in
Finally, in order to establish eligibility to the satisfaction of CalSTRS, an applicant for disability benefits must comply with the documentation requirements set forth in
C. Failure to Complete Section 24103(b) Medical Examinations
In this case, as detailed above, CalSTRS requested that Duarte submit to IMEs pursuant to
First, the record supports the conclusion that, despite repeated requests, CalSTRS had not received all of the documentation that it had requested from Duarte and that some of the documents submitted were incomplete. Further, the documentation that was provided raised issues regarding the scope of Duarte‘s disability and the possibility of cognitive and/or psychological deficits which predated the December 2003 incident. Finally, because Duarte filed his application for disability benefits many years after the termination of his CalSTRS-covered employment, his application was only timely under
The trial court further concluded that “[t]he weight of the evidence supports the conclusion that CalSTRS properly rejected [Duarte‘s] application for disability retirement because he failed to appear for the medical examinations.” Again, we agree. Although, admittedly, Duarte did not state that he would never attend further IMEs, he failed to attend the last two IMEs scheduled and indicated a willingness to reschedule only if ordered to do so at some point in the future by the ALJ. Since Duarte was entitled to administrative review of his case only after CalSTRS had actually acted upon his application, Duarte‘s position was tantamount to a refusal to supply the information necessary for CalSTRS to make a reasoned disability determination. Under such circumstances, the plain language of
Duarte‘s repeated reliance on the doctrine of collateral estoppel to justify his actions does not change this analysis or our conclusions. Specifically, Duarte asserts that the issue of his disability had already been conclusively determined in prior administrative proceedings before CalDSS and the UC. Thus, he argues, CalSTRS should have deemed Duarte‘s disability a “settled issue under the doctrine of collateral estoppel and approved his application for disability retirement.”11 However, as the ALJ properly found in this case, CalSTRS never even reached the issue of Duarte‘s disability. Rather, his application was rejected on procedural grounds. Thus, there was simply no need to consider any possible preclusive effect of these prior disability determinations in the context of this case.
Moreover, to the extent Duarte is contending that notions of collateral estoppel provide him with some kind of exemption from the statutorily mandated process for the award of CalSTRS disability benefits, we believe his argument misapprehends the nature and scope of the doctrine. At its most fundamental, “[i]ssue preclusion, or collateral estoppel, ’ “precludes relitigation of issues argued and decided in prior proceedings.” ’ ” (City of Oakland v. Oakland Police & Fire Retirement System (2014) 224 Cal.App.4th 210, 227 [169 Cal.Rptr.3d 51], italics added.) Thus, until there has actually been a determination made that is adverse to an issue previously litigated, and that determination is challenged in a second adversarial proceeding, a collateral estoppel argument is simply inapposite. Rather, what is pertinent during CalSTRS‘s decisionmaking phase is the agency‘s fiduciary duty to all of its members to soundly administer the plan and maintain its fiscal integrity. (See
Undoubtedly, the prior disability determinations of other state agencies—and the medical documentation on which they were based—are highly relevant in the context of Duarte‘s application for CalSTRS benefits. Presumably, this is why CalSTRS has been given such broad powers to collect and consider these materials. (See
In sum, under each of these scenarios, the collateral estoppel argument would differ depending upon the determination made. In its hearing on Duarte‘s Writ Petition, the trial court recognized as much, stating: “Let‘s say
The record in this case makes clear that Duarte is free to file a new application with CalSTRS at any time, submit to the agency‘s process, and receive a determination of the merits of his disability claim. If he does so, if that decision denies him benefits, and if he appeals the agency‘s conclusion, his collateral estoppel argument may finally be ripe for consideration. As of this date, however, we see no error in the trial court‘s determination.
III. DISPOSITION
The judgment is affirmed. Respondents are entitled to their costs on appeal.
Ruvolo, P. J., and Rivera, J., concurred.
Appellant‘s petition for review by the Supreme Court was denied April 1, 2015, S224001.
