Janitor’s At-Work Stroke Tests DC’s Compensability Presumption

Frank Ferreri

Washington, DC (WorkersCompensation.com) – A doctor’s “agnosticism” over how likely it was that a janitor’s job responsibilities would have caused her to experience a stroke on the job led the District of Columbia Court of Appeals to reverse a review board’s denial of benefits to the janitor. According to the court in Ramos v. District of Columbia Department of Employment Services, No. 19-AA-335 (D.C. 05/28/20), the employer didn’t overcome Washington, DC’s presumption of compensability.

In doing so, the court addressed the issue of what counts as “substantial evidence” sufficient to rebut the presumption, explaining that an employer’s evidence must address the employee’s specific theory of causation.

What was the Cause?

The janitor, who had diabetes and a history of hypertension as well as a pattern of skipping medications prescribed to control her blood pressure, experienced a stroke while emptying trash cans and cleaning offices. She filed a workers’ compensation claim. Before an administrative law judge, the doctor who performed the independent medical evaluation opined that the stroke wasn’t caused by the janitor’s work and that she brought her conditions into work.

Specifically, the doctor attributed the stroke to the janitor’s “uncontrolled hypertension and poorly controlled diabetes.” However, in the doctor’s testimony, he admitted that he “did not know anything” about the janitor’s work activities.

The ALJ concluded that the janitor triggered the presumption but the employer rebutted it. On appeal, the review board agreed with the ALJ and decided that the janitor’s stroke wasn’t causally related to her employment. The janitor appealed to court.

DC’s Presumption

Under workers’ compensation law in the district, there is a presumption that an injury on the job is causally connected to an employee’s work, and therefore compensable, whenever an employee presents “some evidence” of “a work-related event, activity, or requirement which has the potential of resulting in or contributing to death or disability.”

Additionally, an “aggravation rule” allows employees to seek compensation when work-related activities worsen or trigger a pre-existing condition.

An employer can rebut the presumption with “substantial evidence” that is “specific and comprehensive enough to sever the potential connection” between the injury and its relation to the employee’s job.

The court was unconvinced that the IME doctor’s testimony rebutted the presumption.

“[The doctor’s] report and testimony were generally non-responsive to [the employee’s] aggravation theory, and when he was ultimately pressed on it, he was agnostic,” wrote Associate Judge Joshua Deahl. “The relevant question is not whether [the janitor’s] work was the most dominant or even a major contributory factor to her stroke; it is whether it was a contributing factor, a question [the doctor’s] report does not opine on.”

Not Enough to Rebut

Judge Deahl also emphasized that the doctor noted that he formed “no opinion” on whether the janitor’s job responsibilities would cause her to have the stroke. This lack of an opinion meant that the employer didn’t have a basis for rebutting the presumption.

“An employer need not show, in order to rebut the presumption of causation, that causation was ‘impossible,’” Judge Deahl wrote. “It need only present evidence that ‘a reasonable mind might accept as adequate to support’ the conclusion that there was no causal link between the employment and the injury.”

Without such evidence, the court found that the presumption was unrebutted, and it sent the case back to the review board.

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