Trаcy Herrera-Gallegos hurt her back badly while moving a heavy box for H & H Delivery. Both the administrative law judge and the Workers Compensation Board concluded that she was permanently and totally disabled, meaning that she was unable to engage in any substantial or gainful employment.
Her employer argues that the Board’s decision was based on flawed evidence, that her failure to sеek out other employment opportunities negates her right to an award, and that she shouldn’t have been given an award for future medical expenses where no evidence demonstrated a need for ongoing medical treatment. But we review the Board’s factual findings to see whether substantial evidence supports them, and sufficient evidence showed that Herrera-Gallegos was unemployable due to her chronic pain and that she needed additional pain-management treatment. Further, nothing in our workers’-compensation law requires a person who is permanently and totally disabled to try to find a job or lose workers’-compensation benefits. We therefore affirm the Board’s award to Herrera-Gallegos.
Standard of Review
We begin our analysis by noting a сhange in the standard of review for workers’-compensation cases that took effect on July 1. Under K.S.A. 44-556(a), decisions of the Workers Compensation Board are reviewed under the Kansas Judicial Review Act, K.S.A. 77-601 et seq., which applies generally to appeals from administrative agencies. The statute was amended July 1, 2009, and that change alters our standard of review. See L. 2009, ch. 109, sec. 28 (amending K.S.A. 77-621).
K.S.A. 77-621 has always provided that we review an agency’s factual findings to be sure substantial evidence supports them “in light of the record as a whole.” But our cases had limited that review by directing that we take the evidence in the light most favorable to the Board’s ruling. If we found substantial evidence that would support the Board’s decision, we were not concerned about other evidence that might have led to a different conclusion. See
Graham v. Dokter Trucking Group,
As amended, K.S.A. 77-621 now defines “in light of the record as a whole” to include the evidence both supporting and detracting from an agency’s finding. Thus, we must now determine whether the evidence supporting the Board’s factual findings is substantial when considered in light of all the evidence. In addition, the amended statute, K.S.A. 77-621(d), now requires that we consider both the credibility determinations that the hearing officer “who personally observed the demeanor of the witness” made, and if the agency head, here the Board, does not agree with those credibility determinations, the agency should give its reasons for disagreeing. We must consider “the agency’s explanation of why the relevant evidence in the record supports its material findings of fact.” For us to fairly consider an agency’s position should it disagree with a hearing officer’s credibility determination, an explаnation of the agency’s differing opinion would generally be needed. See also L. 2009, ch. 109, sec. 13 (amending K.S.A. 77-527[d] and providing that agency head give “due regard” to hearing officer’s ability to observe witnesses and determine credibility).
The statute doesn’t define the term substantial evidence, but caselaw has long held that it is such evidence as a reasonable person might accept аs being sufficient to support a conclusion.
Blue Cross
&
Blue Shield of Kansas, Inc. v. Praeger,
The amended statute finally reminds us that we do not reweigh the evidence or engage in de novo review, in which we would give no deference to the administrative agency’s factual findings. Indeed, the administrative process is set up to allow an agency and its officials to gain expertise in a particular field, thus allowing the application of that expertise in the fact-finding process. But we must now consider all of the evidence — including evidence that detracts from an agency’s factual findings — when we assess whether the evidence is substantial enough to support those findings. Thus, the appellate court now must determine whether the evidence supporting the agency’s decision has been so undermined by cross-examination or other evidence that it is insufficient to support the agency’s conclusion.
An Overview of the Evidence and the Board’s Ruling
Herrera-Gallegos hurt her back while trying to move a 70-to 80-pound box out of the way. There’s no dispute that this injury occurrеd during the course of her employment with H & H Delivery.
Doctors performed disc-fusion surgery of the L4/L5 discs in November 2004, and a second fusion of the L5/S1 discs in January 2006. Herrera-Gallegos said the doctor who performed the surgery told her she’d never work again.
Dr. Pedro Murati testified regarding his examination of Herrera-Gallegos. He diagnosed her with failed-back-surgery syndrome, and he said that individuals with it experience pain and difficulty in all activities. Based on his examination and a review of her medical records, he said she should rest for 30 minutes every 2 hours. He concluded that she was unable to engage in any substantial or gainful employment due to the level of pain she experienced. He conceded that she could physically do certain work-related tasks, but he recommended that she not do them because it would cause her too much pain. In addition, he said that if she tried to work, it would cause her so much pain that she’d often have to stay at home to rest her back. He concluded that she was unemployable because “she has lost the ability to [work] to the satisfaction of any reasonable employer.”
Two vocational experts, Jerry Hardin and Karen Crist Terrill, testified. Based on Dr. Murati’s restrictions, Hardin concluded that Herrera-Gallegos was “essentially and realistically unemployable.” Based on Dr. Stein’s restrictions, Terrill testified that Herrera-Gallegos had “the ability to earn wages in the open labor market” as a customer-service representative or as a bill collector. But when asked to consider Dr. Murаti’s restrictions, she conceded that Herrera-Gallegos wouldn’t be employable under them:
“Dr. Murati has indicated she needs to rest every two hours for at least 30 minutes and that she is essentially and realistically unemployable. I would then defer to those statements. If Dr. Murati is of the opinion she’s essentially and realistically unemployable from a medical standpoint, I would defer to that оpinion.”
Terrill also testified that Herrera-Gallegos said she hadn’t looked for any jobs since her injury because she hadn’t been released to go back to work and because the pain made it hard for her to leave her home.
An administrative law judge found that Herrera-Gallegos was permanently and totally disabled. H & H Delivery sought review by the Workers Compensation Board, but the Board agreed that she was permanently and totally disabled. Both the judge and the Board relied heavily on Dr. Murati’s testimony.
I. Substantial Evidence Supports the Board’s Finding that Herrera-Gallegos Is Permanently and Totally Disabled.
We begin our review of H & H Delivery’s appeal by determining whether, with consideration of the entire record, substantial evidence supports the Board’s conclusion that Herrera-Gallegos is permanently and totally disabled. Our statute provides several examples that are presumed to result in total disability, but it otherwise provides that the Board determine whether the person’s disabilities have altogether shut them out of the labor market based on the facts of that individual case:
“Permanent total disability exists when the employee, on account of the injury, has been rendеred completely and permanently incapable of engaging in any type of substantial and gainful employment. Loss of both eyes, both hands, both arms, both feet, or both legs, or any combination thereof, in the absence of proof to the contrary, shall constitute a permanent total disability. Substantially total paralysis, or incurable imbecility or insanity, resulting from injury independent of all other causes, shall constitute permanent total disability. In all other cases permanent total disability shall be determined in accordance with the facts.” K.S.A. 44-510c(a)(2).
None of the special situations, like losing both hands, applied to Herrera-Gallegos’ case, so the Board had to determine from all the facts whether she was “completely and permanently incаpable of engaging in any type of substantial and gainful employment.”
The evidence supporting the Board’s permanent-and total-disability finding hinges on Dr. Murati’s opinion that Herrera-Gallegos should rest for 30 minutes every 2 hours. Both of the vocational experts who testified, Hardin and Terrill, agreed that Herrera-Gallegos would not be employable under that restriction. Accordingly, whether substantiаl evidence supports the Board’s finding depends upon Dr. Murati’s opinion. Unless his opinion is greatly undermined by other evidence, the Board’s decision would have substantial evidence to support it.
The Board noted that Dr. Murati’s opinion was more recent than Dr. Stein’s and that no doctor had found Herrera-Gallegos to bе magnifying her symptoms. The Board also noted that even the functional-capacity restrictions relied upon by Dr. Stein recommended at least frequent alternating between sitting and standing. Herrera-Gallegos had two disc-fusion surgeries but experienced no relief to her pain. The Board also appears to have accepted Herrera-Gallegos’ testimony on these points — that her pain continued after the surgeries and that the pain was constant. The Board also made specific note of her testimony that she suffered bums to her back from a heating pad while trying to alleviate the back pain. Taken in combination, the testimony of Dr. Murati, along with that of Herrera-Gallegos, Hardin, and Terrill, provides substantial evidence in support of the Board’s factual finding that her injuries prevent her from being gainfully employed.
H & H Delivery also challenges the Board’s finding on the ground that Dr. Murati based his recommendations on what Herrera-Gallegos
should
not do rather than what she
could
not do. But even though Herrera-Gallegos could physically perform, at least for some time period, many of the tasks that might be required in a job, Dr. Murati said that in his opinion her pain would interfere with working unlеss she followed his recommendation to rest, for 30 minutes eveiy 2 hoúrs. There’s no requirement in K.S.A. 44-510c(a)(2) that a doctor testify definitely that a worker is physically
unable to perform job tasks to be considered disabled. See
Adams v. Ball’s Food Stores,
II. A Person Who Is Permanеntly and Totally Disabled Is Not Required to Seek Work to Preserve His or Her Rights to a Workers’-Compensation Award.
H & H Delivery separately argues that Herrera-Gallegos should not be able to receive a permanent and total disability award “where she has not made any effort, much less a good faith effort, to find post-injury employment.” We are at a loss to understand the logic of this argument. It’s obviously contradictory to require someone who is, in the words of our statute, “completely and permanently incapable of engaging in any type of substantial and gainful employment” to put forth a good-faith effort to find and maintain gainful employment. See K.S.A. 44-510c(a)(2). A job search in that circumstance would be the very definition of a fool’s errand.
Nor is H & H Delivery’s argument based on some language in the workers’-compensation statute. K.S.A. 44-510c(a)(2) simply tells the Board to determine whether a permanent and total disability exists “in accordance with the facts” in cases like Herrera-Gallegos’, which is not covered with a special rule. H & H Delivery does not cite any statutory language in support of this argument.
We acknowledge — and H & H Delivery cites to — one unpublished decision of our сourt in which a panel provided some language supportive of H & H Delivery’s position. In
Studyvin v. Wal-Mart,
The
Studyvin
panel relied on some past cases in which our court has held that an employee must show good-faith efforts tо obtain new employment before obtaining an award for wage losses (referred to as a work-disability award) in excess of functional impairment in cases of permanent partial disabilities. E.g.,
Copeland v. Johnson Group, Inc.,
Two other points should be made with regard to the Studyvin ruling and its impact, if any, on Herrera-Gallegos’ case. First, the Studyvin opinion does not tell us how the worker’s alleged lack of good faith affected a determination of whether she could engage in gainful employment. There was other evidence that the worker was able to hold a job, including a doctor’s conclusion that she was able to work notwithstanding some medical limitations. That fact аlone would have supported the Board’s denial of a permanent total-disability award without regard to whether she had rejected any offers of work that would accommodate her medical restrictions. Thus, it’s not clear how important the good-faith rule was either to the Board’s decision or this court’s decision. Second, the cases relied upon in Studyvin for a good-faith requirement arose under awards for permanent partial disability, not permanent total disability. Benefits are figured in a different way for partial-disability awards than for permanent-disability awards. For partial disabilities, a worker can receive an award beyond functional impairment to compensate in part for future lost wages, called a work-disability award. But that award isn’t available if the worker is engaging in work for 90% or more of the wages earned at the time of injury. K.S.A. 44-510e(a). Thus, even if not found in the statute, the good-faith rule would serve a logical purpose because the wage earned after the injury matters in the statutory calculation of benefits. But in cases of permanent total disability, the statute provides a benefit “equal to 66%% of the average gross weekly wage of the injured employee” for a specified time period. K.S.A. 44-510c(a)(l). The benefits are not dependent upon any postinjury wage — presumably because a worker with a permanent total disability can’t earn a postinjuiy wage. Thus, imposing some good-faith requirement at the threat of imputing a postinjury wage serves no purpose in a permanent total-disability case.
In sum, when a worker has suffered a permаnent and total disability as defined under the workers’-compensation statute, there’s no reason for that person to seek further employment. In addition, the
III. The Board Did Not Err in Awarding Future Medical Expenses.
H & H Delivery makes one final argument — that the Board wrongly awarded future medical treatment to Herrera-Gallegos. H & H Delivery argues that Herrera-Gallegos “provided no evidence that she would require any future medical trеatment,” so none should have been awarded. But there was considerable evidence that she was suffering from chronic pain and that her current treatment was not helping. Dr. Murati testified that she needed chronic pain management, such as a spinal cord stimulator and slow-release pain medications. This meets the substantial-evidence test in support of the Board’s conclusion that Herrera-Gallegos needed ongoing medical treatment.
