Kraai v. Bureau of Fire & Police Disability & Retirement Fund

339 P.3d 86, 266 Or. App. 249, 2014 Ore. App. LEXIS 1438
CourtCourt of Appeals of Oregon
DecidedOctober 15, 2014
Docket110201476; A149516
StatusPublished

This text of 339 P.3d 86 (Kraai v. Bureau of Fire & Police Disability & Retirement Fund) is published on Counsel Stack Legal Research, covering Court of Appeals of Oregon primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Kraai v. Bureau of Fire & Police Disability & Retirement Fund, 339 P.3d 86, 266 Or. App. 249, 2014 Ore. App. LEXIS 1438 (Or. Ct. App. 2014).

Opinions

ORTEGA, P. J.

At issue in this case is whether the City of Portland Bureau of Fire and Police Disability and Retirement Fund (the fund) correctly denied claimant’s application for disability benefits. The fund appeals the reviewing court’s general judgment granting a writ of review setting aside the fund’s denial of benefits to claimant. The fund contends that the time limitation in the rule on which it relied to deny claimant disability benefits begins to run when a member of the fund first receives treatment for a condition that the member subjectively believes to be a worsening of a prior service-connected injury. We disagree with the fund’s interpretation of the time-limitation rule and, accordingly, conclude that the fund has not established that the reviewing court erred in setting aside the fund’s denial of benefits. We affirm.

Claimant works as a firefighter for the City of Portland Fire and Rescue, which entitles him to disability benefits under the Fire and Police Disability, Retirement and Death Benefit Plan (the plan), adopted as chapter 5 of the City of Portland’s charter.1 The plan provides that a board of trustees supervises and controls the fund and that the board establishes the plan’s administrative rules; claim approvals and denials are delegated to a fund administrator. Portland City Charter (charter) § 5-202.

In 1985, claimant fell about five feet through the roof of a burning building while working and landed straddling a beam between his legs. He received medical care and was diagnosed with a possible hairline fracture in his pelvis. For that injury, the fund approved claimant’s application for disability benefits. Over time claimant continued [251]*251to experience pain in his pelvic area, and, in 2006 and 2008, he sought treatment, but imaging tests did not indicate an abnormality.

On January 19,2009, claimant’s pain and symptoms persisted, and he again sought treatment. On that occasion, a urologist, Dr. Ackerman, diagnosed his symptoms, which included, among other things, a lump in the middle of his penile shaft that was consistent with Peyronie’s disease. Ackerman discussed treatment options with claimant, including surgery. Claimant told Ackerman that he believed that his condition was related to the 1985 injury, but Ackerman’s report did not include any mention that claimant’s Peyronie’s disease was related to work or to his prior injury. Ackerman prescribed medication to treat claimant’s symptoms and saw claimant again on June 22, 2009; they again discussed surgery as a way to treat claimant’s condition. Once again, Ackerman did not, in his report, relate claimant’s condition to any prior injury or to claimant’s job.

Claimant decided to proceed with the surgery and met with Dr. Yoshinaga for a preoperative appointment on August 25, 2009. At that time, Yoshinaga told claimant that his Peyronie’s disease was related to his work injury. He was the first treating physician to do so. Yoshinaga completed physician’s disability reports, which noted that claimant was not authorized to work for the two weeks following his scheduled September 14, 2009, surgery. Yoshinaga’s “Attending Physician Report” noted, under the heading, “Subjective Findings,” that Ackerman had stated (without indicating how the statement was communicated to Yoshinaga) that claimant’s Peyronie’s disease “is caused by previous injury to the penis and scar tissue.”

On the day of claimant’s preoperative appointment, claimant completed a “disability in line of duty” report for a disability claim, noting the date of his 1985 fall as the date that his injury occurred and that he would need time off from work. The surgery was rescheduled and performed on October 21, 2009. As a condition of making a compensability decision on his claim, the fund required claimant to undergo two independent medical examinations on November 5, 2009. In its letter to the medical examiners, Drs. Kaempf [252]*252and Rischitelli, the fund asked them to determine, “[g]iven the work history and medical records, in your opinion, is there medical evidence, supported by objective findings!,] that the [1985] on-the-job injury was a significant factor in the cause of [claimant’s] development of Peyronie’s Disease?” (Underscoring omitted.) Kaempf concluded that claimant’s 1985 injury was a significant factor, and Rischitelli concluded that it was not.

The fund denied the claim, for the reason that the “claim was not filed within 30 days of [claimant’s] alleged injury or illness as required by Section 5.7.03 of the *** Administrative Rules.” That rule provides, in part:

“(A) No disability benefits shall be paid to a Member unless the Member files with the Director a complete and timely application requesting such benefits.
“(D) Applications for disability benefits must be submitted to the Director no later than 30 days after the Member is injured or experiences an illness, unless the Member establishes good cause for failing to do so. Failure to file an application within the time specified bars a Claim for disability benefits.”

Fire and Police Disability and Retirement Fund Rule (FPDR) 5.7.03.

Claimant requested a hearing to contest the denial with the Office of Administrative Hearings (OAH). The fund’s attorney met with Ackerman in anticipation of the hearing. A letter memorializing their conversation noted that Ackerman had confirmed to the fund’s attorney that claimant

“ ‘definitely’ told you during your examination on January 19, 2009 that his symptoms and related objective findings, which you diagnosed as Peyronie’s disease, were caused by his employment as a firefighter for the City of Portland and that he recounted to you the work injuries in that job which he believed caused the Peyronie’s disease. You included this history of work injuries in your January 19, 2009 chart note. You believe that the January 19, 2009 chart note confirms [claimant\ telling you that he believed his need for medical treatment was related to the work injuries described [253]*253in your chart note. You did not tell [claimant] that his condition or need for treatment were not work related.”

(Emphasis added.)

A hearing was held, and the OAH administrative law judge (AL J) issued an order reversing the fund’s denial of the disability claim, finding that FPDR 5.7.03(D) did not apply to claimant’s request for disability benefits. The fund appealed the ALJ’s order to an OAH appellate review board, a panel of three ALJs. The fund asserted before the panel that the time-limitation rule applied and that the relevant date to begin the time limit for claimant’s recurrence of his service-connected injury “should be the first date of medical treatment or disability related to the worsened condition”; the relevant date, the fund asserted, was no later than claimant’s January 19,2009, appointment with Ackerman in which claimant was diagnosed with Peyronie’s disease and told Ackerman that he believed his condition was related to the prior work injury. The panel agreed with the fund that FPDR 5.7.03(D) applies to a recurrence claim and that the claim was untimely submitted. To interpret the time-limitation rule, it looked to the definitions for the relevant administrative section in FPDR 5.7.01, namely “Recurrence” and “Aggravation.”2 “Recurrence” is defined as an

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Bluebook (online)
339 P.3d 86, 266 Or. App. 249, 2014 Ore. App. LEXIS 1438, Counsel Stack Legal Research, https://law.counselstack.com/opinion/kraai-v-bureau-of-fire-police-disability-retirement-fund-orctapp-2014.