In Ramos v. District of Columbia Department of Employment Services, 227 A.3d 1108 (2020), the DC Court of Appeals (DCCA) stated that unless the defense addresses the claimant’s theory of causation, the presumption is not rebutted. In Ramos, the claimant, Maria Ramos, was employed as a custodian. She had uncontrolled hypertension and poorly controlled diabetes. While at work, she suffered a stroke. The defense’s Independent Medical Examination (IME) stated that the stroke’s major contributory factors were poorly controlled diabetes and uncontrolled hypertension. The IME doctor said he would not attribute the stroke to the claimant’s employment. However, upon further questioning from the claimant’s attorney and the Administrative Law Judge (ALJ), the IME doctor testified that physical exertion will increase a person’s blood pressure and that strokes could result from high blood pressure. The IME doctor also stated that he could not offer an opinion about whether or not the claimant’s job responsibilities would in any way cause her to have the stroke. The IME doctor stated that he did not have information regarding the specifics of the claimant’s employment (he did not witness what her job responsibilities involved or how heavy duty they were). Therefore, he could not provide an opinion as to that specific question. The claimant argued in closing that physical exertion of her work aggravated her hypertension and thereby caused her stroke.
The ALJ denied the claim and, the Compensation Review Board (CRB) affirmed. The DCCA reversed, stated that it was compensable, and remanded for an order consistent with its decision. The DCCA stated:
- The aggravation rule is well-established as a valid theory. “Whether [the claimant] was teetering on the edge of a stroke independent of her work is thus beside the point; if her work inched her over that edge, however slightly, her injury is compensable.”
- The employer did not refute the claimant’s theory of causation. The defense IME said he did not have an opinion on that. “If the employer fails to address and rebut the employee’s theory with substantial evidence, the presumption of compensability stands.”
In other cases, the DCCA has held that the claimant is not limited to one theory of causation. The ALJ is obligated to consider other possible theories of causation that the claimant did not raise, including possible causes the claimant did not notice or remember. Nor does there need to be a discrete traumatic event.
The takeaway: Defense experts have to address the claimant’s specific theory of causation and other possible work-related theories of causation. Defense experts should know the claimant’s job duties. One must be as thorough as possible when defending a workers’ compensation claim in DC.
Written by counsel Naureen Weissman.