Petitioner Washington Metropolitan Area Transit Authority (‘WMATA”) filed a petition for review of a decision of the Director of the Department of Employment Services (“the Director”) affirming a compensation order in favor of intervenor Harold Spencer (“Mr. Spencer”). We affirm the decision of the Director. We hold that the Director and the Administrative Law Judge (“ALJ”) applied the correct legal standard governing the presumption of compensability; and that the employee satisfied his initial burden regarding the presumption of compensability. We also hold that the employer failed to present substantial evidence to rebut that presumption; and that based upon the record in this case, no additional medical evidence was necessary to refute the sworn testimony of the employer’s expert. The employ
FACTUAL SUMMARY
According to the factual findings of the ALJ in this case, on May 26, 2000, Mr. Spencer, an elevator and escalator technician for WMATA, had completed an inspection of an elevator shaft at the Van Ness station, where he found “eight inches to a foot of water which [he] believed contained oil,” and was in the process of climbing a ladder from the shaft when he slipped and fell, striking his back on a shut off valve and injuring his knees. After informing his supervisor of his fall, he sought medical treatment from the George Washington University Hospital. There, he filled out an incident report form. He stated that he had “injured his right and left knee as well as his right ankle and back in the incident.” Although Mr. Spencer had a prior “circulatory problem with his right leg[, it] was corrected by ... a vascular surgeon.” Mr. Spencer was “not treated for any vascular problem with his left leg.”
Mr. Spencer was unable to work from May 27, 2000, through October 10, 2000. When he returned to work on October 11, 2000, “[h]e began to feel a sharp pain in his left knee and thereafter his left knee would buckle when he walked.” When he ascended stairs, he noticed a clicking sound in his left knee. So, he again sought medical diagnosis and treatment on February 13, 2001 from the same doctor who had treated him after his accident on May 26, 2000, Dr. Craig Faulks.
Dr. Faulks advised Mr. Spencer that he should get an MRI and that he might need an arthroscopic procedure. The MRI “revealed chondral damage to the medial femoral condyle.” WMATA did not authorize the arthroscopic procedure. Nevertheless, Mr. Spencer proceeded with the arthroscopic surgery on August 3, 2001, by using his own insurance. During the surgery, Dr. Faulks found “a small radial tear of the medial meniscus,” as well as “a complex degenerative tear of the meniscus.” He repaired the radial tear, debrided the complex degenerative tear, and prescribed six weeks of therapy.
Mr. Spencer filed a workers’ compensation claim for temporary total disability benefits from April 12, 2001 to April 21, 2001, from May 19, 2001 to the time of filing, and continuing. The ALJ found in favor of Mr. Spencer’s claim, and awarded him temporary total disability payments for the specified time period, as well as “all reasonably related medical expenses.” WMATA filed a petition for review with the Director, and the Director affirmed the compensation order.
ANALYSIS
WMATA contends that “the Director’s [d]ecision is legally flawed and must be reversed.” It is flawed in the first instance, WMATA argues, because of “[t]he failure of the Director to consider the evidence submitted by [WMATA] to rebut the presumption [of compensability].” That testimony came from the deposition of WMATA’s expert, Dr. James Callan. WMATA claims that the Director’s decision is also flawed “because [Mr. Spencer] submitted no expert medical evidence to prove by a preponderance of the evidence that his left knee condition was causally related to the work injury.” Therefore, WMATA argues that the Director’s deci
Mr. Spencer supports the conclusions of the ALJ and the Director that, in essence, Dr. Callan’s testimony “was manifestly insufficient to rebut the presumption of compensability.” In addition, Mr. Spencer asserts that there is substantial record evidence to support the determination of the ALJ, and the affirmation of the Director, that his left knee injury was causally related to his fall on May 26, 2000. That evidence includes his testimony which the ALJ credited, the medical reports of Dr. Faulks and other documents, and the cross-examination responses of Dr. Callan. In response to WMATA’s argument that expert testimony was required to rebut that of Dr. Callan, Mr. Spencer emphasizes that his is a workers’ compensation claim, and that a claimant is not required to meet the standards imposed in a negligence case.
Generally, “[w]e review the Director’s legal rulings
de novo,
but otherwise defer to the Director’s determination so long as it rationally flows from the facts and is supported by substantial evidence on the record.”
Safeway Stores v. District of Columbia Dep’t of Employment Servs.,
In the District of Columbia, there is a presumption of compensability under the [Workers’ Compensation] Act. D.C.Code § 36-321(1) [now codified at § 32-1521(1) (2001) ]; Ferreira [v. District of Columbia Dep’t of Employment Servs.,531 A.2d 651 , 655 (D.C.1987)]. Its purpose is to advance the humanitarian goal of the statute to provide compensation to employees for work-related disabilities reasonably expeditiously, even in arguable cases, Id. at 654-55 (citations omitted). To come within the presumption, a claimant must make an initial showing of some evidence of “a death or disability and a work-related event, activity, or requirement which has the potential of resulting in or contributing to the death or disability.” Id. (citation omitted). Once that showing has been made, “[t]he presumption then operates to establish a causal connection between the disability and the work-related event, activity, or requirement.” Id. (footnote and citation omitted). The claimant must provide some evidence that the disability is connected with the employment before the burden of production is shifted to the employer. Id. at n. 5. Once shifted, the employer has the burden of producing “substantial evidence” demonstrating that the disability did not arise out of and in the course of employment. Id. at 655.
Id.
at 791 (emphasis in original). We have defined “‘substantial evidence’ as more than a mere scintilla.”
Washington Hosp. Ctr. (Anderson) v. District of Columbia Dep’t of Employment Servs.,
If the employer is “able to rebut the presumption [of compensability through the presentation of substantial evidence, then the claimant must] prove by a preponderance of the evidence that [the] ... injury was caused by [his] job requirements....”
Washington Hosp. Ctr. (Anderson), supra,
“[I]n assessing the weight of competing medical testimony in worker compensation cases, attending physicians are ordinarily preferred as witnesses to those doctors who have been retained to examine the claimant solely for purposes of litigation.”
Stewart v. District of Columbia Dep’t of Employment Servs.,
Contrary to WMATA’s argument, our review satisfies us that neither the Director’s decision nor that of the ALJ is “legally flawed.” We have stated previously “that a compensation order [need not] contain certain magic words in order to demonstrate that the examiner [or the Director] followed the statutory procedures.”
Washington Hosp. Ctr. (Callier), supra,
Here, the Director recognized that the first step in the analysis of Mr. Spencer’s ease was to ascertain whether he “ma[d]e an initial showing of some evidence of a ... disability and work-related event ... which has the
potential
of resulting in or contributing to the ... disability.”
Brown, supra,
Mr. Spencer established that he slipped and fell off of a ladder
1
while he was performing monthly maintenance work on the platform elevator at the Van Ness station, he “landed on the shut-off valve”
After Mr. Spencer successfully met his initial burden, the “burden of production [then] shifted to the employer,” and WMATA was required to present “‘substantial evidence’ demonstrating that the disability did not arise out of and in the course of [Mr. Spencer’s] employment.” Id. The Director obviously considered this second step in the process because he focused on Dr. Callan’s testimony on behalf of WMATA. Dr. Callan “stated that his examination of [Mr. Spencer] revealed arthritis of the knee(s) and further [asserted] that there was no indication of bruising or swelling in the hospital records from the date of injury which would substantiate [Mr. Spencer’s] position that the knee injury was the result of the fall in the elevator shaft.” The Director also expressed his awareness of WMATA’s assertions that the ALJ “failed to consider all evidence [that it] presented, applied the wrong standard for overcoming the causal presumption, and [that] therefore, the conclusion of compensability is not supported by substantial evidence in the record.”
Important to reiterate is a longstanding principle in this jurisdiction: “It is well-established ... that a disability resulting from the aggravation of a pre-existing condition is compensable under the [Workers’ Compensation Act].”
Washington Hosp. Ctr. (Callier), supra,
Our review of Dr. Callan’s testimony convinces us that the Director correctly concluded that WMATA presented insufficient evidence to rebut the presumption of compensability; and that its evidence was neither “specific and comprehensive enough to sever the connection between [Mr. Spencer’s] disability and [his] work-related [fall],”
Safeway Stores, supra,
His diagnosis and prognosis; whether or not he was capable of returning to full duty or a light duty job; if he had any restrictions in his work and for how long; was his current treatment plan medically necessary and appropriate; did he require further medical treatment as a result of his accident and what kind and for how long; had he reached maximum medical improvement.
Moreover, Dr. Callan testified that Mr. Spencer “stated that he was having pain in the knees with going up and down steps and that his back felt good at that time and he was having no problems.” The doctor acknowledged that the emergency room records of May 26, 2000, the day of Mr. Spencer’s injury, specified “motor strength in the lower extremities was slightly inhibited by known knee pain,” and that Mr. Spencer “had a contusion of his back and chronic knee pain.” He attributed the pain and the “grinding kind of sensation” to “normal wear and tear arthritis of his knees.” He expressed the opinion that Mr. Spencer’s
symptoms in his knees were not in any way causally related to [his injury on May 26, 2000] based primarily on the fact that there was no complaint of the knees at the time that he was examined early on, either by the emergency room or Dr. Faulks, except for this chronic knee pain, and there was no evidence of any knee injury early on and the fact that it’s symmetrical and ... is consistent with the normal degenerative arthritis of the knees.
In rendering this opinion, Dr. Callan clearly did not take into account the May 26, 2000, Employee on the Job Injury report form completed by Mr. Spencer showing that he complained of pain in his knees. Nor had he reviewed medical reports concerning Mr. Spencer’s vascular problem with his right leg, not his left leg. In fact, he had not seen the majority of Dr. Faulks’ medical reports prior to his deposition, and these reports extended from June 26, 2000, to August 16, 2001. They also showed persistent left knee pain, “giving way of the left knee” or “locking” of that knee, as well as clicking and “catching pain in the left knee especially with stair climbing.” Those reports undoubtedly would have been helpful as Dr. Callan opined on Mr. Spencer’s March 21, 2001 MRI results showing a possible “bone contusion.” In fact, despite his insistence that Mr. Spencer’s knee pain was attributable to degenerative arthritis, he acknowledged that in a person with arthritis “[t]he articular cartilage softens and thins ... [and] becomefs] more susceptible to tearing.” He also admitted that if Mr. Spencer “twisted his left knee during the course of his injury, ... [it could] cause further wear and tear” on the knee. Moreover, he agreed that one of the indicators or “sources” of a knee “giving away” is “a meniscal tear,” one of the conditions Dr. Faulks found during his surgery on Mr. Spencer’s left knee.
When asked what his recommendation would be if someone came to him with
[T]hat’s based primarily on the lack of initial complaints of an acute trauma to the knees, especially the left knee, and the lack of any physical examination early on with regards to the left knee that indicated any trauma to it and the fact that these findings are consistent with degenerative changes also.
Based upon this review of the record, we cannot agree with WMATA that Dr. Cal-lan’s testimony satisfied the requirement that “the employer ... produce! ] ‘substantial evidence’ demonstrating that the disability did not arise out of and in the course of employment.”
Brown, supra,
As Mr. Spencer maintains, this is not a negligence case. This is a workers’ compensation claim case, filed under our Workers’ Compensation Act. As we have reiterated consistently and persistently in our workers’ compensation cases, the “purpose [of the Act] is to advance the humanitarian goal ... to provide compensation to employees for work-related disabilities reasonably expeditiously, even in arguable cases.”
Brown, supra,
In summary, on this record we hold that the Director and the ALJ applied the correct legal standard governing the presumption of compensability; and that the employee, Mr. Spencer, satisfied his initial burden regarding the presumption of com-pensability. We also hold that the employer, failed to present substantial evidence to rebut that presumption; and that based upon the record in this case, no additional medical evidence was necessary to refute the sworn deposition testimony of the employer’s expert. The employee presented extensive medical reports from his treating physician and other documentary evidence to satisfy his burden of proof, and the opinion of the employer’s expert was based upon a flawed factual assumption, that Mr. Spencer did not injure his knee because he did not complain about it initially, an assumption which was rejected by the fact finder. 6 As the Director stated:
[Mr. Spencer] has offered substantial, credible evidence of a work related injury which necessitated time off from work, and ultimately required surgery. The fact that [Mr. Spencer] had a preexisting arthritic condition does not change the fact that the work injuryaggravated, or exacerbated his condition, thus requiring additional medical treatment, surgery, convalescence, and therapy.
The Administrativé Law Judge’s finding that [Mr. Spencer’s] disability arose out of and in the course of employment is supported by substantial evidence in the record considered as a whole, and is in accordance with applicable law.
In essence, the Director resolved the issue presented to him by determining that “the injury to Mr. Spencer’s knees and his subsequent disability, is causally related to the injury sustained in the May 26, 2000 work related accident.” In short, there is substantial evidence in the record showing that Mr. Spencer suffered a work related injury that aggravated the condition of his knees.
For the foregoing reasons, we affirm the Director’s decision.
So ordered.
Notes
. Mr. Spencer explained that “[t]here [was] a makeshift ladder ... mounted on the wall.... [I]t’s not a true ladder, it’s made of more or less scrap metal parts, like a piece of angle iron.”
. WMATA does not contest the fact that Mr. Spencer presented sufficient evidence to trigger the presumption of compensability in the first step of the analysis.
. Dr. Callan admitted that not until the day of his deposition testimony did he see Dr. Faulks' medical reports dated June 26, 2000, indicating that Mr. Spencer "injured his knees when he fell in the elevator shaft at work on 5-26-00”; July 10, 2000, showing that Mr. Spencer suffered from "continued pain in his knees, especially the left”; and July 24, 2000, specifying "continued bilateral knee pain especially with stair climbing.” Apparently, he also did not have these and other reports prepared by Dr. Faulks when he reviewed the results of Mr. Spencer’s March 21, 2001, MRI procedure, showing in part a “2cm area of marrow edema in the femoral condyle which may represent bone contusion.”
Significantly also, prior to his deposition testimony on September 10, 2001, Dr. Callan never saw Dr. Faulks’ October 26, 2000, report stating, in part, that Mr. Spencer "injured his back and knees when he fell in an elevator shaft. His major complaint now is of left knee pain. His knees will give way.” Nor had he seen the February 13, 2001, report of Dr. Faulks indicating that "Mr. Spencer returns with continued giving way of the left knee. It has been more severe in the last few weeks.”
There were additional reports that Dr. Callan did not see prior to his deposition. These included reports leading ultimately to Dr. Faulks' decision to proceed with surgery: April 5, 2001 ("[Mr. Spencer] continues to have catching pain in the knee that bothers him at least weekly when the knee will lock and make it difficult for him to walk”); April 12, 2001 ("Mr. Spencer returns with debilitating pain in the left knee. He gets a catching pain along the medial side.”); May 16, 2001 ("Mr. Spencer[’s] ... left knee pain .... has been worse recently and it clicks and causes pain going up and down stairs.”); June 18, 2001 ("It is my IMPRESSION that Mr.
. At oral argument, counsel for WMATA contended that in determining whether the presumption of compensability has been rebutted, the agency may not consider the credibility of the employer's physician or the believability of his or her testimony. Counsel cited
Safeway Stores, Inc., supra,
and
Washington Hosp. Ctr. (Anderson), supra.
.We have considered these decisions, and we conclude that neither stands for such a proposition. Counsel also cites
St. Mary’s Honor Ctr. v. Hicks,
. Even assuming that WMATA had presented substantial evidence to rebut the presumption of compensability, there is no doubt that Mr. Spencer "prove[d] by a preponderance of the evidence that [his left knee] injury was caused by [his] job requirements....”
. Washington Hosp. Ctr. (Anderson), supra, relied on by WMATA, is not controlling. In that case, the opinion of the employer’s expert was not based upon a flawed factual assumption.
