Universal Maritime Corporation v. Frank Moore Director, Office of Workers' Compensation Program United States Department of LaborUniversal Maritime Corporation v. Frank Moore Director, Office of Workers' Compensation Program United States Department of Labor
Vacated and remanded by published opinion. Judge NIEMEYER wrote the opinion, in which Judge WIDENER and Senior Judge MICHAEL joined.
OPINION
On appeal of an award to Frank Moore of benefits under the Longshore and Harbor Workers’ Compensation Act,
I
On November 18, 1991, Frank Moore fell from a ladder when it slipped, and he struck his knee on the floor, injuring it. At the time, Moore was working as a container repairman for Universal Maritime Corporation in Mt. Pleasant, South Carolina. Two months after the fall, Moore filed a workers’ compensation claim for temporary total disability caused by injury to his “right leg and right knee joint.”
Moore was a longtime employee who had completed the eighth grade and had reading and mathematical skills at the third grade level. He had worked for years as a self-trained repairman of large containers used for shipping. His job involved kneeling, crouching, and climbing, as well as strenuous lifting of at least up to 50 pounds. Prior to his November 1991 fall from the ladder, Moore had complained of back pain and had suffered injuries to his ribs, left hand and left knee. Even though he has a documented reduction of function in his left knee, he had been able to perform his job as a container repairman.
Following his November 1991 fall, Moore was treated by Dr. Howard Brilliant, an orthopedist who had regularly treated Moore for various ailments. When Moore’s right knee did not respond to treatment, Dr. Brilliant performed arthroscopic surgery on the knee on March 2,1992, removing loose debris from the joint. Dr. Brilliant believed his surgery to have secured all of the improvement to Moore’s knee that was then available. But because Moore continued to complain of pain and to miss work, at Universal Maritime’s urging, Moore was examined by Dr. Bright McConnell, a knee specialist. Dr. McConnell performed a second surgery on October 22, 1992 to repair a tear in the meniscus. This second surgery appeared to improve Moore’s knee condition, which reached maximum improvement, in Dr. McConnell’s opinion, in January 1993. Dr. McConnell concluded that Moore had suffered a permanent 15% impairment in his right knee as the combined result of the injury and of degenerative arthritis. He noted that this impairment would require some work restrictions. Dr. Brilliant, on the other hand, gave an opinion that Moore was totally and permanently disabled as of March 1992, when Dr. Brilliant performed the arthroscopic knee surgery.
Moore never returned to work after his second surgery, citing among other things the combination of the impairments in both knees, his need to wear a knee brace on the injured right knee, and his need to use a cane for balance.
At his hearing for workers’ compensation, Moore presented evidence not only of his knee injury, but also of back problems which limited his ability to bend and lift. While the effects of Moore’s back problem were adequately documented at the hearing, evidence regarding its nature and origin was sparse and confusing. Moore had a history of low back pain predating the 1991 fall from the ladder. But in a report dated January 1992, only two months after the fall, examining physician Dr. Warren specifically noted that Moore “does not complain of back pain.” By the summer of 1992, some eight months after the accident, a first report of back pain was made by Dr. McConnell, who had performed the second surgery on Moore’s knee, reporting that Moore “is complaining of some low back discomfort with pain down the lateral aspect of his right side and right lower leg.” And on November 6, 1992, almost a year after the fall, Dr. Brilliant first reported a complaint from Moore of back pain, noting “since he was here last he had developed back pain.”
At the hearing before the ALJ, Moore testified that when he woke up one day in November 1992, about a year after the fall, he experienced serious pain in his back:
I couldn’t move and I did manage to get up out of the bed and make it, and get in my automobile and go to the hospital to find out what was going on because I had never had that pain before and I never was drawn up in a knot like that.
In his opinion awarding benefits for permanent total disability under § 8(a) of the Longshore and Harbor Workers’ Compensation Act, the ALJ stated that:
The medical reports of Dr. Brilliant as well as claimant’s complaints and symptoms of pain established that his right knee and back injuries could have been caused by the November 18, 1991 work related accident, and thus, under § 20(a), it is presumed that claimant’s right knee and back injuries were caused by the November, 1991 accident.
(Emphasis added). The ALJ also concluded that Universal Maritime had not rebutted the § 20(a) presumption of causation because “the reports of Dr. McConnell and Dr. Shutte are given less weight than those of Dr. Brilliant.”
In finding permanent total disability, the ALJ determined that Moore was incapable of returning to his prior job and rejected evidence that suitable alternative work was available in the community because the employer had not adequately considered the limitations on Moore as a result of the preexisting reduction of function in his left knee and his poor education and it had not contacted the prospective alternative employers to determine the full requirements for the available jobs. The ALJ rejected the employer’s evidence of job descriptions taken from the Dictionary of Occupational Titles, published by the Department of Labor.
The decision of the ALJ was affirmed by the Benefits Review Board by operation of law, pursuant to the Omnibus Consolidated Rescissions and Appropriations Act of 1996, Pub.L. No. 104-134, § 101(d), 110 Stat. 1321, 1321-29 (1996), providing that certain decisions pending before the Benefits Review Board for more than one year are to be considered affirmed for purposes of seeking judicial review. This appeal followed.
II
Universal Maritime’s chief complaint about the Board’s decision centers on the manner in which the ALJ considered Moore’s back pain to conclude that Moore was totally and permanently disabled. Universal Maritime contends that the ALJ gave virtually conclusive weight to the presumption afforded by § 20(a) of the Longshore and Harbor Workers’ Compensation Act (hereinafter “the Act”),
The ALJ relied on evidence of back pain first reported approximately eight months after Moore’s accident and on Moore’s testimony that he had been experiencing back pain since the date of the accident. The ALJ concluded that because the back injury “could have been caused by the November, 1991 work related accident” that injury “is presumed to have been caused” by the 1991 accident. After summarizing some of the employer’s evidence that cast doubt about the cause of Moore’s back pain — relating to Moore’s credibility and the absence of any contemporaneous reports of pain — the ALJ concluded that the evidence was “insufficient to rebut the § 20(a) presumption of causa
Section 20(a) of the Act,
In order for the presumption to apply, a claim must be made that brings an injury within the outer scope of the Act. As the Court in
U.S. Industries
stated, “A prima facie ‘claim for compensation,’ to which the statutory presumption refers, must at least allege an injury that arose in the course of employment as well as out of employment.”
If an employer does not offer substantial evidence to rebut the presumption, it is true that the presumption provided by § 20 will entitle a claimant to compensation.
See Del Vecchio v. Bowers,
If the employer alone adduces evidence which tends to support the theory [contrary to the presumption], the case must be decided upon that evidence. Where the claimant offers substantial evidence in opposition, ... the issue must be resolved upon the whole body of proof pro and con; and if it permits an inference either way upon the question ..., the Deputy Commissioner and he alone is empowered to draw the inference; his decision as to the weight of the evidence may not be disturbed by the court.
Id.
at 286-87,
In the case before us, Moore testified that he experienced back pain immediately after the accident in November 1991. Even though it may appear incredible in light of Moore’s other testimony, his prehearing statement to Dr. Warren that he was not experiencing back pain, and the absence of any complaint to his other doctors, the ALJ was entitled to credit Moore’s testimony that the back pain resulted from the accident itself. Because of this testimony establishing a prima facie ease, Moore’s claim was proper
The employer’s rebuttal evidence would undoubtedly support a finding that Moore’s back pain was not caused by the accident. As the ALJ observed, “Dr. Brilliant’s post-accident medical records indicate no sign of back complaints until [a year after the accident].” Moreover, Dr. Warren affirmatively reported two months after the accident that Moore “does not complain of back pain.” Indeed, no medical report refers to any back pain until more than one-half year after the accident when Dr. McConnell first refers to Moore’s complaint of “some low back discomfort.” While the evidence indicating the absence of any back pain complaint for six to eight months after the accident and the affirmative statement of Dr. Warren placed causation squarely at issue, there is also evidence in the record that Moore had experienced back problems prior to the accident to which any later back pain could have been attributed. All of this evidence is sufficient to justify a factfinder to conclude that the back pain was not caused by the accident but rather by either a preexisting condition or a subsequent unrelated deterioration. While substantial evidence requires “more than a mere scintilla,” it is only “such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.”
Richardson v. Perales,
Accordingly, it is necessary to remand the case to permit the ALJ to apply the statutory presumption in the proper manner.
III
Universal Maritime also contends that Moore failed to introduce evidence sufficient to find
permanent
disability as a result of his back pain. In order to make a finding of permanent disability, there must be substantial evidence that the condition alleged to be disabling has reached maximum medical improvement.
See SGS Control Services v. Director, OWCP,
IV
Universal Maritime contends that the ALJ abused his discretion in excluding from evidence at the hearing a surveillance videotape of Moore which Universal Maritime sought to introduce even though it had not included the tape on its pre-hearing list of exhibits. Universal Maritime noted that the tape did not exist before the weekend preceding the Monday hearing so that it could not have included the tape on a pre-hearing list.
Evidentiary matters at hearings under the Longshore and Harbor Workers’ Compensation Act are governed by .
Error may not be predicated upon a ruling which admits or excludes evidence unless a substantial right of the party is affected and ... [i]n case the ruling is one excluding evidence, the substance of the evidence was made known to the judge by offer or was apparent from the context within which questions were asked.
In this ease, Universal Maritime did not mark the videotape for identification, nor did it make a proffer of its contents. Rather it simply stated that the videotape was “material” and that it was the product of a recent surveillance. Accordingly, we have nothing in the record by which we can review the nature of the evidence excluded. Even on appeal, Universal Maritime does not describe precisely what the videotape would show, making it impossible for us to determine whether its exclusion should be found to be plain error despite the failure to make a proffer.
See
V
Universal Maritime next challenges the ALJ’s finding that Moore is totally disabled.
To determine whether disability is partial or total involves a shifting proof scheme. Once a claimant establishes that he is incapable of returning to his prior employment, the burden shifts to the employer to prove that the claimant is not totally disabled by presenting evidence of other jobs that are available in the relevant geographic market for which the claimant is physically and educationally qualified.
See Newport News Shipbuilding & Dry Dock Co. v. Tann,
In this case, the employer challenges first the substantiality of the evidence supporting the ALJ’s conclusion that Moore was incapable of returning to his prior position as a container repairman. Although the ALJ possibly relied in part on the evidence of Moore’s back pain to which he erroneously applied the
Universal Maritime’s second argument, that the ALJ erred in refusing to credit its survey of available alternative employment, is more substantial. To meet its burden of demonstrating the availability of alternative employment, Universal Maritime presented the testimony of a vocational surveyor who derived a list of available positions from want ads and listings in the local employment office. To flesh out the physical and educational demands of each advertised position, the expert relied on standard job descriptions found in the Dictionary of Occupational Titles, published by the United States Department of Labor. The ALJ rejected the validity of the survey, however, based in part upon the vocational expert’s failure to contact the prospective employers to ascertain specifically their requirements for the listed positions. Without other evidence of available alternative employment, the ALJ found Moore to be totally disabled.
Our precedents establish that to meet the burden of showing the availability of alternative work, the employer need not contact prospective employers to inform them of the qualifications and limitations of the claimant and to determine if they would in fact consider hiring the candidate for their position.
See Newport News Shipbuilding,
Such a requirement, like that rejected in
Newport News Shipbuilding
and
Trans-State Dredging,
would, we believe, substantially increase the employer’s burden without a commensurate bene fit. Although requiring such specific description might increase the precision of vocational surveys, such precision is not necessary since the claimant is able to correct any overbreadth in a survey by demonstrating the failure of his good faith
Accordingly, we hold that the employer may meet his burden of responding to a total disability claim by demonstrating the availability of specific jobs in a local market and by relying on standard occupational descriptions to fill out the qualifications for performing such jobs. The employer need not contact the prospective employer for its specific requirements in order to establish a valid vocational survey. In adopting this rule, we impose a burden parallel to that required by other compensation schemes such as Social Security Disability Insurance and Railroad Retirement Act disability benefits, both of which rely on standard occupational descriptions, including those provided in the Dictionary of Occupational Titles.
See
VI
Universal Maritime also challenges the manner in which the ALJ determined Moore’s average weekly wage for purposes of awarding compensation. The ALJ calculated Moore’s average weekly wage by taking his annual earnings for calendar year 1991 as reported on his W-2 forms and dividing that number by 46, the number of weeks that Moore worked in 1991 prior to his accident in mid-November. Moore did not work for the remainder of the calendar year. The ALJ added to this number the annual amount of container royalties, holiday, and vacation pay for 1991, divided by the full 52 weeks of the year. Contending that this method of calculation artificially inflated Moore’s average weekly wage, Universal Maritime argues instead that the ALJ should have taken Moore’s total salary not for calendar 1991 but for the 52 week period preceding the accident and should have divided this number by 52 weeks to determine the average weekly wage, despite the fact that Moore was absent from work without earnings during 9 of the 52 weeks preceding the accident.
We conclude that neither of the foregoing calculations conforms to the method specified by § 10(a) of the Act,
VII
Finally, Universal Maritime contends that it is entitled to mitigation of its future liability by recourse to the special injury liability fund, established under
Prior to 1984, § 8(f) of the Act,
Under the pre-1984 version of the law, the Director of OWCP, who is charged with representing the special injury fund, was usually unrepresented at the hearing before the ALJ, and thus, assertions of entitlement to § 8(f) relief often went uncontradicted when raised for the first time at the hearing.
See
51 Fed.Reg. 4270, 4277-78 (February 3, 1986) (reviewing history of actions under pri- or
To remedy this problem, Congress amended § 8(f) in 1984 to require that entitlement to § 8(f) relief be raised and documented earlier, during informal proceedings before the deputy commissioner. That section as amended and as here applicable states:
Any request ... for apportionment of Lability to the special fund ... for the payment of compensation benefits, and a statement of the grounds therefore, shall be presented to the deputy commissioner prior to the consideration of the claim by the deputy commissioner. Failure to present such request prior to such consideration shall be an absolute defense to the special fund’s Lability for the payment of any benefits in connection with such claim, unless the employer could not have reasonably anticipated the LabiLty of the special fund prior to the issuance of a compensation order.
Where the claimant’s condition has not reached maximum medical improvementand no claim- for permanency is raised by the date the ease is referred to the OALJ, an application need not be submitted to the district director to preserve the employer’s right to later seek relief under section 8(f) of the Act. In all other cases, failure to submit a fully documented application by the date established by the district director shall be an absolute defense to the liability of the special fund. This defense is an affirmative defense which must be raised and pleaded by the Director. The absolute defense will not be raised where permanency was not an issue before the district director. In all other cases, where permanency has been raised, the failure of an employer to submit a timely and fully documented application for section 8(f) relief shall not prevent the district director, at his/her discretion, from considering the claim for compensation and transmitting the case for formal hearing. The failure of an employer to present a timely and fully documented application for section 8(f) relief may be excused only where the employer could not have reasonably anticipated the liability of the special fund prior to the consideration of the claim by the district director.
Universal Maritime takes the position that it is covered by the first sentence of 702.321(b)(3) because there has never been a finding of maximum medical improvement with regard to Moore’s back and because Moore did not claim permanent disability of any kind until after the ease had been referred to the OALJ. Universal Maritime thus maintains that the ALJ erred in relying on
In this case, no such affirmative defense was raised since the employer neither submitted an application for relief to the district director nor actually raised the issue at the hearing before the ALJ. The employer first sought to assert special fund liability in a petition for reconsideration made after the ALJ awarded permanent total disability benefits. At that point, the ALJ rejected it as untimely. But Universal Maritime also appears to contend that since it was not barred by the affirmative defense provisions of the regulation and because it gave notice purporting to reserve its right to later raise the issue of § 8(f) liability prior to the hearing before the ALJ, it was under no time restriction with regard to actually arguing its claim for special fund liability, thereby entitling it to address the liability after the ALJ awarded benefits for permanent and total disability-
The Director of the Office of Workers Compensation Programs concedes, and we agree, that the ALJ erred in relying on
The Director contends, however, that notwithstanding the inapplicability of
As the legislative history summarized above indicates, the 1984 amendment to the Act was designed to advance to a point even earlier in the claim process the employer’s obligation to raise entitlement to § 8(f) relief. The earlier the entitlement was alleged, the better the position of the district director to evaluate and controvert special fund liability if it were not appropriate. Al
Universal Maritime presents no legitimate excuse for not presenting its § 8(f) claim at the hearing before the ALJ on the merits of Moore’s claim. On its Amended Pre-hearing Statement dated June 23,1993, it “reserve[d] the right to pursue relief under
Accordingly, we conclude that the ALJ did not err in concluding that Universal Maritime forfeited its
VIII
In summary, we vacate the Board’s order affirming the ALJ’s award of permanent total disability benefits to Moore and remand the case for further proceedings consistent with this opinion.
VACATED AND REMANDED.