RENDERED: SEPTEMBER 26, 2019 TO BE PUBLISHED
2019-SC-000053-WC
JAMES A. WILKERSON APPELLANT
ON APPEAL FROM COURT OF APPEALS CASE NO. 2018-CA-000561 V. WORKERS’ COMPENSATION BOARD NO. 12-WC-85251
KIMBALL INTERNATIONAL, INC; APPELLEES DR. DAVID P. ROUBEN; HON. GRANT S. ROARK, ADMINISTRATIVE LAW JUDGE; AND WORKERS’ COMPENSATION BOARD
OPINION OF THE COURT BY JUSTICE KELLER
AFFIRMING
This matter arose after the appellant, James A. Wilkerson, sustained a
back injury while working for the appellee, Kimball International, Inc.
(“Kimball”). Wilkerson filed a claim with the Department of Workers’ Claims,
and a hearing was held on his claim. The Administrative Law Judge (“ALJ”)
awarded Wilkerson temporary total disability, permanent partial disability, and
medical benefits for a back strain he sustained while working for Kimball. The
ALJ denied benefits for a knee injury and two back surgeries, finding they were
not causally related to his employment, and therefore not compensable. Wilkerson appealed the denial of benefits. The Workers’ Compensation Board
(“Board”) affirmed the ALJ, and the Court of Appeals affirmed the Board. We,
likewise, affirm the Court of Appeals.
I. BACKGROUND
Wilkerson was employed by Kimball on April 4, 2012 when he sustained
an alleged work-related back injury. He was lifting a large bookcase when he
felt a pop in his low back and experienced a burning sensation in his leg. He
immediately reported the injury to Kimball.
Wilkerson was first treated by Dr. Robert Byrd on April 16, 2012. He
reported injuring himself while lifting ten days prior. His chief complaint was
“low back pain” that radiated into his left leg. Dr. Byrd diagnosed Wilkerson
with a “Lumbar Spasm,” ordered conservative treatment including physical
therapy, and indicated that he could return to work on April 19, 2012. On April
26, 2012, Wilkerson returned to Dr. Byrd’s office still complaining of “low back
pain” that radiated into his left leg. Dr. Byrd diagnosed him with acute low
back pain and eventually ordered an MRI. Wilkerson did not report left knee
pain to Dr. Byrd.
On May 29, 2012, Wilkerson underwent an MRI that revealed mild disc
bulging at L3-4 and no evidence of nerve root compression. When this MRI was
compared to a 2006 MRI of Wilkerson’s back, no additional prominence in the
disc bulge was noted. Wilkerson continued to see Dr. Byrd until July 2012,
when Dr. Byrd referred him to Dr. Eric Goebel, a neurosurgeon.
2 On July 3, 2012, Wilkerson saw Dr. Goebel, complaining of lower back
pain radiating into his left leg. He told Dr. Goebel that the pain began
approximately three months earlier when he was lifting a cabinet and felt a
“pop” in his back. Dr. Goebel assessed that Wilkerson had left lower extremity
radicular symptoms, although the MRI revealed no evidence of a herniated disc
or nerve root issue. Dr. Goebel noted that Wilkerson’s “lower extremity
symptoms are improving with physical therapy as well as some of the back
pain.” Dr. Goebel recommended that Wilkerson continue with physical therapy
and remain off work for three additional weeks. Dr. Goebel indicated that there
was no basis for back surgery for Wilkerson.
Wilkerson testified that he continued with physical therapy, and on July
12, 2012, while performing squats as part of his at-home physical therapy, he
felt a “pop” in his left knee. He sought treatment at Owensboro Health Regional
Hospital. To the hospital, Wilkerson reported that he sat down after performing
his home exercises, and when he stood up from the couch he felt his knee pop
and give way.
On July 18, 2012, Wilkerson sought treatment from Dr. Charles Milem,
an orthopedic physician, for his knee. To Dr. Milem’s office, Wilkerson reported
that his left knee popped and gave out when “he was getting up from doing his
home exercise program for his back off of the couch.” An MRI was ordered.
On July 31, 2012, Wilkerson returned to Dr. Milem’s office. During that
visit, he reported that he injured his knee in April 2012 while carrying
furniture. He also reported having “problems with his back” and described his
3 back pain as radiating into his calf and ankle. Based on the MRI of Wilkerson’s
knee, Dr. Milem diagnosed a medial meniscal tear and recommended knee
surgery. Dr. Milem performed a partial medial meniscectomy on Wilkerson’s
left knee on August 16, 2012. Wilkerson continued to see Mr. Milem for follow
up care, where he continued to complain of worsening left knee pain and
lumbar symptoms.
Wilkerson returned to work at Kimball on October 9, 2012 and continued
working with no restrictions until March 20, 2015. He testified, however, that
he continued to have low back pain throughout this period.
On January 22, 2013, Wilkerson sought treatment from Dr. Mladen
Djurasovic for continued back pain. Dr. Djurasovic reviewed Wilkerson’s prior
MRI and found moderate degenerative spondylosis but no significant neural
compressive lesions. He ordered an EMG study, which showed no evidence of
lumbosacral radiculopathy or generalized peripheral neuropathy in either of
Wilkerson’s legs. He did not recommend surgery and referred Wilkerson to Dr.
Louis Williams for a nonoperative treatment program. Wilkerson continued to
be seen by Dr. Djurasovic through February of 2014 and continued to
complain of low back pain.
On May 13, 2014, Wilkerson met with Dr. David Rouben and reported
lower back pain and right lower extremity pain that had persisted since the
April 2012 work incident. Wilkerson acknowledged to Dr. Rouben that his left
knee pain pre-dated the work incident. Dr. Rouben diagnosed Wilkerson with
disc disease of the L5-S1 segment. On March 25, 2015, Dr. Rouben performed
4 a decompression and fusion surgery. According to Wilkerson, this surgery only
served to worsen his back pain.
On December 15, 2015, Wilkerson sought treatment from Dr. John
Johnson. Dr. Johnson performed a revision of the fusion surgery on January
17, 2016. During his deposition, Dr. Johnson testified that Wilkerson had no
indications for fusion surgery and that he would not have performed the
surgery on Wilkerson. He testified that he could not say that Dr. Rouben’s
surgery was reasonable, necessary, or work-related. He attributed Wilkerson’s
lower back issues to a degenerative condition.
On or about April 4, 2014, Wilkerson filed a claim with the Department
of Workers’ Claims alleging that he suffered an injury to his lumbar spine and
left leg while working for Kimball. He alleged he sustained these injuries on
April 4, 2012.
On August 5, 2014, Wilkerson underwent an independent medical
evaluation (“IME”) with Dr. Thomas Loeb. Dr. Loeb diagnosed Wilkerson with a
transient low back strain related to the work incident and noted a history of
longstanding mild multilevel degenerative disc disease with no cord or nerve
root compromise. He assigned Wilkerson a 5% impairment rating pursuant to
the American Medical Association Guides to the Evaluation of Permanent
Impairment, 5th edition (“AMA Guides”) for his lower back. Dr. Loeb noted,
however, that Wilkerson’s April 4, 2012 lower back “strain or sprain would
have not lasted more than 3-4 weeks. Any ongoing symptoms would be due to
Free access — add to your briefcase to read the full text and ask questions with AI
RENDERED: SEPTEMBER 26, 2019 TO BE PUBLISHED
2019-SC-000053-WC
JAMES A. WILKERSON APPELLANT
ON APPEAL FROM COURT OF APPEALS CASE NO. 2018-CA-000561 V. WORKERS’ COMPENSATION BOARD NO. 12-WC-85251
KIMBALL INTERNATIONAL, INC; APPELLEES DR. DAVID P. ROUBEN; HON. GRANT S. ROARK, ADMINISTRATIVE LAW JUDGE; AND WORKERS’ COMPENSATION BOARD
OPINION OF THE COURT BY JUSTICE KELLER
AFFIRMING
This matter arose after the appellant, James A. Wilkerson, sustained a
back injury while working for the appellee, Kimball International, Inc.
(“Kimball”). Wilkerson filed a claim with the Department of Workers’ Claims,
and a hearing was held on his claim. The Administrative Law Judge (“ALJ”)
awarded Wilkerson temporary total disability, permanent partial disability, and
medical benefits for a back strain he sustained while working for Kimball. The
ALJ denied benefits for a knee injury and two back surgeries, finding they were
not causally related to his employment, and therefore not compensable. Wilkerson appealed the denial of benefits. The Workers’ Compensation Board
(“Board”) affirmed the ALJ, and the Court of Appeals affirmed the Board. We,
likewise, affirm the Court of Appeals.
I. BACKGROUND
Wilkerson was employed by Kimball on April 4, 2012 when he sustained
an alleged work-related back injury. He was lifting a large bookcase when he
felt a pop in his low back and experienced a burning sensation in his leg. He
immediately reported the injury to Kimball.
Wilkerson was first treated by Dr. Robert Byrd on April 16, 2012. He
reported injuring himself while lifting ten days prior. His chief complaint was
“low back pain” that radiated into his left leg. Dr. Byrd diagnosed Wilkerson
with a “Lumbar Spasm,” ordered conservative treatment including physical
therapy, and indicated that he could return to work on April 19, 2012. On April
26, 2012, Wilkerson returned to Dr. Byrd’s office still complaining of “low back
pain” that radiated into his left leg. Dr. Byrd diagnosed him with acute low
back pain and eventually ordered an MRI. Wilkerson did not report left knee
pain to Dr. Byrd.
On May 29, 2012, Wilkerson underwent an MRI that revealed mild disc
bulging at L3-4 and no evidence of nerve root compression. When this MRI was
compared to a 2006 MRI of Wilkerson’s back, no additional prominence in the
disc bulge was noted. Wilkerson continued to see Dr. Byrd until July 2012,
when Dr. Byrd referred him to Dr. Eric Goebel, a neurosurgeon.
2 On July 3, 2012, Wilkerson saw Dr. Goebel, complaining of lower back
pain radiating into his left leg. He told Dr. Goebel that the pain began
approximately three months earlier when he was lifting a cabinet and felt a
“pop” in his back. Dr. Goebel assessed that Wilkerson had left lower extremity
radicular symptoms, although the MRI revealed no evidence of a herniated disc
or nerve root issue. Dr. Goebel noted that Wilkerson’s “lower extremity
symptoms are improving with physical therapy as well as some of the back
pain.” Dr. Goebel recommended that Wilkerson continue with physical therapy
and remain off work for three additional weeks. Dr. Goebel indicated that there
was no basis for back surgery for Wilkerson.
Wilkerson testified that he continued with physical therapy, and on July
12, 2012, while performing squats as part of his at-home physical therapy, he
felt a “pop” in his left knee. He sought treatment at Owensboro Health Regional
Hospital. To the hospital, Wilkerson reported that he sat down after performing
his home exercises, and when he stood up from the couch he felt his knee pop
and give way.
On July 18, 2012, Wilkerson sought treatment from Dr. Charles Milem,
an orthopedic physician, for his knee. To Dr. Milem’s office, Wilkerson reported
that his left knee popped and gave out when “he was getting up from doing his
home exercise program for his back off of the couch.” An MRI was ordered.
On July 31, 2012, Wilkerson returned to Dr. Milem’s office. During that
visit, he reported that he injured his knee in April 2012 while carrying
furniture. He also reported having “problems with his back” and described his
3 back pain as radiating into his calf and ankle. Based on the MRI of Wilkerson’s
knee, Dr. Milem diagnosed a medial meniscal tear and recommended knee
surgery. Dr. Milem performed a partial medial meniscectomy on Wilkerson’s
left knee on August 16, 2012. Wilkerson continued to see Mr. Milem for follow
up care, where he continued to complain of worsening left knee pain and
lumbar symptoms.
Wilkerson returned to work at Kimball on October 9, 2012 and continued
working with no restrictions until March 20, 2015. He testified, however, that
he continued to have low back pain throughout this period.
On January 22, 2013, Wilkerson sought treatment from Dr. Mladen
Djurasovic for continued back pain. Dr. Djurasovic reviewed Wilkerson’s prior
MRI and found moderate degenerative spondylosis but no significant neural
compressive lesions. He ordered an EMG study, which showed no evidence of
lumbosacral radiculopathy or generalized peripheral neuropathy in either of
Wilkerson’s legs. He did not recommend surgery and referred Wilkerson to Dr.
Louis Williams for a nonoperative treatment program. Wilkerson continued to
be seen by Dr. Djurasovic through February of 2014 and continued to
complain of low back pain.
On May 13, 2014, Wilkerson met with Dr. David Rouben and reported
lower back pain and right lower extremity pain that had persisted since the
April 2012 work incident. Wilkerson acknowledged to Dr. Rouben that his left
knee pain pre-dated the work incident. Dr. Rouben diagnosed Wilkerson with
disc disease of the L5-S1 segment. On March 25, 2015, Dr. Rouben performed
4 a decompression and fusion surgery. According to Wilkerson, this surgery only
served to worsen his back pain.
On December 15, 2015, Wilkerson sought treatment from Dr. John
Johnson. Dr. Johnson performed a revision of the fusion surgery on January
17, 2016. During his deposition, Dr. Johnson testified that Wilkerson had no
indications for fusion surgery and that he would not have performed the
surgery on Wilkerson. He testified that he could not say that Dr. Rouben’s
surgery was reasonable, necessary, or work-related. He attributed Wilkerson’s
lower back issues to a degenerative condition.
On or about April 4, 2014, Wilkerson filed a claim with the Department
of Workers’ Claims alleging that he suffered an injury to his lumbar spine and
left leg while working for Kimball. He alleged he sustained these injuries on
April 4, 2012.
On August 5, 2014, Wilkerson underwent an independent medical
evaluation (“IME”) with Dr. Thomas Loeb. Dr. Loeb diagnosed Wilkerson with a
transient low back strain related to the work incident and noted a history of
longstanding mild multilevel degenerative disc disease with no cord or nerve
root compromise. He assigned Wilkerson a 5% impairment rating pursuant to
the American Medical Association Guides to the Evaluation of Permanent
Impairment, 5th edition (“AMA Guides”) for his lower back. Dr. Loeb noted,
however, that Wilkerson’s April 4, 2012 lower back “strain or sprain would
have not lasted more than 3-4 weeks. Any ongoing symptoms would be due to
his long standing, preexisting, underlying multilevel degenerative disk disease,
5 which has been active off an[d] on for many years.” Therefore, Dr. Loeb
attributed the entirety of Wilkerson’s impairment rating to his pre-existing
condition. Dr. Loeb further opined that the surgery performed by Dr. Rouben
was non-work-related, unreasonable, and unnecessary. He also found that
Wilkerson’s knee injury was unrelated to the April 4, 2012 work incident.
On December 9, 2015, Wilkerson underwent an IME performed by Dr.
Robert Jacob. Dr. Jacob opined that the April 4, 2012 work incident caused
only a low back strain with no permanent impairment. He further noted that
Wilkerson had none of the normal indications for fusion surgery and concluded
that the surgery performed by Dr. Rouben was unnecessary. He further
concluded that Wilkerson’s knee injury was from getting up off the couch and
was not work-related.
On January 11, 2017, Dr. James Farage performed an IME of Wilkerson.
Dr. Farage attributed both of the back surgeries and the knee injury to the
April 4, 2012 work incident. Under the AMA Guides, Dr. Farage assigned a
32% impairment rating comprised of a 23% impairment rating for the lumbar
condition and 20% for the left knee condition. He apportioned 10% of the knee
impairment to pre-existing degenerative changes.
Wilkerson testified that he continues to experience symptoms of burning
and numbness down his leg and into his toes. He indicated that he has not
returned to work with Kimball since March 20, 2015. He further stated that he
continues to take medications to relieve his pain.
6 As relevant to this appeal, the ALJ concluded that Wilkerson’s left knee
problems were not work-related. He further found that Wilkerson’s two back
surgeries were not causally related to the work incident that occurred on April
4, 2012. As such, he determined that Wilkerson’s only compensable
impairment came from his condition as it existed before Dr. Rouben’s back
surgery. He assigned Wilkerson a 5% impairment rating for the April 4, 2012
work injury and found that Wilkerson was entitled to the 2x multiplier in KRS1
342.730(l)(c)(2).2 Finally, the ALJ awarded Wilkerson temporary total disability
benefits for the initial period he was off work following the April 4, 2012
incident.
Wilkerson appealed to the Workers’ Compensation Board which affirmed
the ALJ. He then appealed to the Court of Appeals which affirmed the Board.
He has now appealed to this Court as a matter of right. See Vessels v. Brown-
Forman Distillers Corp., 793 S.W.2d 795, 798 (Ky. 1990); Ky. Const. § 115.
1 Kentucky Revised Statutes 2 KRS 342.730(l)(c)(2) provides: If an employee returns to work at a weekly wage equal to or greater than the average weekly wage at the time of injury, the weekly benefit for permanent partial disability shall be determined under paragraph (b) of this subsection for each week during which that employment is sustained. During any period of cessation of that employment, temporary or permanent, for any reason, with or without cause, payment of weekly benefits for permanent partial disability during the period of cessation shall be two (2) times the amount otherwise payable under paragraph (b) of this subsection. This provision shall not be construed so as to extend the duration of payments.
7 II. STANDARD OF REVIEW
In a workers’ compensation case, Wilkerson, as the claimant, has the
burden of proving every element of his claim. Gibbs v. Premier Scale Co./Ind.
Scale Co., 50 S.W.3d 754, 763 (Ky. 2001). The ALJ has the sole discretion to
determine the quality, character, and substance of the evidence and may reject
any testimony and believe or disbelieve various parts of the evidence regardless
of whether it comes from the same witness or the same party’s total proof.
Paramount Foods, Inc. v. Burkhardt, 695 S.W.2d 418, 419 (Ky. 1985). On
appellate review, the issue is whether substantial evidence of probative value
supports the ALJ’s findings. Whittaker v. Rowland, 998 S.W.2d 479, 481-82
(Ky. 1999). “[T]he ALJ’s findings of fact are entitled to considerable deference
and will not be set aside unless the evidence compels a contrary finding.”
Finley v. DBM Technologies, 217 S.W.3d 261, 264 (Ky. App. 2007). Because the
ALJ found against Wilkerson with respect to the issues in this appeal, and
because he carried the burden of proof, Wilkerson must establish on appeal
that the favorable evidence was so overwhelming as to compel a finding in his
favor. Special Fund v. Francis, 708 S.W.2d 641, 643 (Ky. 1986). “Evidence that
would have supported but not compelled a different decision is an inadequate
basis for reversal on appeal.” Gaines Gentry Thoroughbreds/Fayette Farms v.
Mandujano, 366 S.W.3d 456, 461 (Ky. 2012) (citing McCloud v. Beth-Elkhorn
Corp., 514 S.W.2d 46 (Ky. 1974)).
8 III. ANALYSIS
Prior to reaching the merits of Wilkerson’s claims to this Court, we must
first address Kimball’s assertion that Wilkerson’s appeal should be dismissed
based on his failure to file a petition for reconsideration with the ALJ. KRS
342.281 provides that
any party may file a petition for reconsideration of the award, order, or decision of the administrative law judge. The petition for reconsideration shall clearly set out the errors relied upon with the reasons and argument for reconsideration of the pending award, order, or decision. . .. The administrative law judge shall be limited in the review to the correction of errors patently appearing upon the face of the award, order, or decision.
In arguing for dismissal, Kimball relies on KRS 342.285(1) which states:
An award or order of the administrative law judge as provided in KRS 342.275, if petition for reconsideration is not filed as provided for in KRS 342.281, shall be conclusive and binding as to all questions of fact, but either party may in accordance with administrative regulations promulgated by the commissioner appeal to the Workers’ Compensation Board for the review of the order or award.
Kimbell further relies on this Court’s previous decision in Eaton Axle Corp. v.
Nally to support his argument for dismissal. 688 S.W.2d 334 (Ky. 1985). In
Eaton Axle, however, we merely stated that “no award, order or decision of the
[ALJ] shall be reversed or remanded on appeal to any court because of failure
of said [ALJ] to make findings of an essential fact unless said failure is brought
to the attention of the [ALJ] by Petition for Rehearing pursuant to KRS
342.281.” Id. at 338. This Court’s concern was with the “multitude of cases
annually [being] remanded...for Findings of Fact on issues essential to the
Opinion and Order.” Id. at 337. To address this concern, we held that “before
9 beginning the appellate process which utilizes the court system, the claimant,
employer or any other party involved in the case...seeks an appeal on errors
which are patent upon the face of the award, order or decision, he must first
file a Petition for Reconsideration pursuant to KRS 342.281.” Id. at 338.
While the plain language of KRS 342.285(1) refers only to an ALJ’s
findings of fact, KRS 342.285(2) sets forth the questions of law that a reviewing
court may consider. As we explained in Abel Verdon Construction v. Rivera,
KRS 342.285(2) and KRS 342.290 limit administrative and judicial review of an ALJ’s decision to determining whether the ALJ “acted without or in excess of his powers;” whether the decision “was procured by fraud;” or whether the decision was erroneous as a matter of law. Legal errors would include whether the ALJ misapplied Chapter 342 to the facts; made a clearly erroneous finding of fact; rendered an arbitrary or capricious decision; or committed an abuse of discretion.
348 S.W.3d 749, 753-54 (Ky. 2011) (footnotes omitted). In reading KRS
342.285(1) with our statement in Abel Verdon Construction, this Court can still
review whether the ALJ “rendered an arbitrary or capricious decision[] or
committed an abuse of discretion” using the above defined standard of review.
Id. The issues of whether substantial evidence supported the ALJ’s findings
and whether the evidence would compel a different result are questions of law
that this Court can, and must, address.
Having determined that Wilkerson’s appeal need not be dismissed, we
must determine whether the evidence compelled a finding in favor of Wilkerson
regarding the work-relatedness of his left knee condition and his lumbar
surgeries. The ALJ was “not persuaded” that Wilkerson’s left knee problems
10 were work-related. In reaching this conclusion, the ALJ noted that Wilkerson’s
initial treatment records for the first three months following his April 4, 2012
work incident did not mention a left knee injury or any left knee complaints. He
further did not find Wilkerson’s testimony that he injured his left knee while
doing physical therapy exercises at home to be credible, as the initial history in
the treatment records indicated that he hurt his knee when getting up off of the
couch after performing his exercises. The ALJ’s finding regarding Wilkerson’s
left knee injury was based primarily on his assessment of Wilkerson’s
credibility. Credibility is a matter for the ALJ to decide. See Paramount Foods,
Inc., 695 S.W.2d at 419. In this case, the ALJ found Wilkerson’s testimony
about the cause of his knee injury not to be credible. The ALJ’s finding that
Wilkerson’s knee injury was not work-related and therefore not compensable
was supported by substantial evidence, and the evidence of record, as detailed
above, does not compel a different result.
Finally, we must determine whether the evidence compelled a finding in
favor of Wilkerson regarding the causation of his two back surgeries. The ALJ
found that the surgery performed by Dr. Rouben was not causally related to
the lumbar strain he sustained in the April 4, 2012 work incident. The ALJ
noted that all the other medical experts believed the surgery was not
reasonable or necessary, and in fact, no other medical experts recommended
surgery. He further noted that Wilkerson returned to work with no restrictions
in October 2012 (after his knee surgery) and continued to work his regular job
11 at Kimball without restrictions until Dr. Rouben performed surgery in March
2015.
The ALJ next noted that Dr. Rouben’s surgery only made Wilkerson’s
pain worse, which eventually necessitated Dr. Johnson’s surgery. There was no
dispute that Dr. Johnson’s surgery was necessary to correct the surgery Dr.
Rouben performed. Dr. Johnson, however, testified that he did not believe Dr.
Rouben’s surgery was reasonable or necessary and that he would not have
performed it. The ALJ finally noted that Dr. Johnson’s testimony indicated that
Wilkerson’s current back condition was due to his surgeries and not his work
injury. The ALJ concluded that Wilkerson’s back surgeries were not work-
related and that his only compensable impairment came from his condition as
it existed before Dr. Rouben’s surgery. Having reviewed the record, this Court
finds that the ALJ’s conclusions regarding Wilkerson’s back surgeries were
supported by substantial evidence and that the evidence of record does not
compel a different result.
IV. CONCLUSION
For the foregoing reasons, the opinion of the Court of Appeals is affirmed.
All sitting. All concur.
12 COUNSEL FOR APPELLANT:
Abram V. Conway II Conway & Keown
COUNSEL FOR APPELLEE, KIMBALL INTERNATIONAL, INC.:
Judson Fuller Devlin Fulton & Devlin, LLC
COUNSEL FOR APPELLEE, WORKERS’ COMPENSATION BOARD:
Michael W. Alvey Workers’ Compensation Board
COUNSEL FOR APPELLEE, HON. GRANT S. ROARK, ADMINISTRATIVE LAW JUDGE:
Honorable Grant Stewart Roark Administrative Law Judge
COUNSEL FOR APPELLEE, DR. DAVID P. ROUBEN:
Dr. David P. Rouben Pro se