Lfucg v. Adam Middleton

Opinion

RENDERED: SEPTEMBER 4, 2026; 10:00 A.M.

NOT TO BE PUBLISHED

Commonwealth of Kentucky

Court of Appeals

NO. 2025-CA-1386-WC

LEXINGTON FAYETTE URBAN COUNTY GOVERNMENT APPELLANT

PETITION FOR REVIEW OF A DECISION v. OF THE WORKERS’ COMPENSATION BOARD ACTION NO. WC-17-70241

ADAM MIDDLETON; DR. SEAN GRIFFIN; HONORABLE TONYA M. CLEMONS, ADMINISTRATIVE LAW JUDGE; AND WORKERS’ COMPENSATION BOARD OF KENTUCKY APPELLEES

OPINION

AFFIRMING

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BEFORE: THOMPSON, CHIEF JUDGE; CALDWELL AND A. JONES, JUDGES.

JONES, A., JUDGE: This workers’ compensation appeal arises from a Form 112 post-award medical dispute concerning whether a proposed total left knee

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replacement remains causally related to Adam Middleton’s compensable 2017 work injury. An Administrative Law Judge (“ALJ”) concluded that the surgery was reasonable, necessary, and causally related to the work injury. The Workers’ Compensation Board (“Board”) affirmed with one Board member dissenting. Lexington-Fayette Urban County Government (“LFUCG”) now petitions for review, arguing the ALJ improperly inferred medical causation from the evidence rather than relying on an express medical opinion.1 Because substantial evidence supports the ALJ’s finding and the Board committed no error in affirming that decision, we affirm.

I. BACKGROUND

Middleton sustained a work-related injury to his left knee while employed as a firefighter for Lexington-Fayette Urban County Government LFUCG on July 27, 2017. On November 9, 2018, the parties resolved Middleton’s workers’ compensation claim by entering into a Form 110 Settlement Agreement. As part of the settlement, Middleton received a lump-sum payment while preserving his right to future medical benefits associated with the injury. The settlement agreement described the compensable injury as a left knee meniscal tear and chondromalacia.

1 Although Middleton and Dr. Sean Griffin were named as appellees, neither filed a response to the petition for review.

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Following the settlement, Middleton continued treating with orthopedic surgeon Dr. Lawrence Schaper through 2023. After Dr. Schaper’s retirement, Middleton began treating with Dr. Sean Griffin in early 2024. Dr. Griffin ordered updated imaging after Middleton reported increasing left knee pain and, following his evaluation, requested preauthorization through Middleton’s workers’ compensation claim for a total left knee arthroplasty. LFUCG thereafter reopened the claim by filing a Form 112 Medical Dispute, contesting whether the proposed surgery was medically necessary and causally related to Middleton’s 2017 work injury.

In support of the medical dispute, LFUCG submitted utilization reviews prepared by Dr. Thomas Loeb and Dr. William Ross. Dr. Loeb concluded that Middleton met the criteria for a total knee replacement but opined that the need for surgery was unrelated to the 2017 work injury, instead attributing Middleton’s condition to genetically acquired osteoarthritis. Dr. Ross likewise concluded the proposed surgery was not causally related to the work injury. Although he acknowledged the surgery itself addressed Middleton’s arthritic condition, Dr. Ross attributed the need for surgery to intervening events occurring in December 2019 and January 2020, which he believed contributed to the progression of Middleton’s knee condition.

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As part of his review, Dr. Ross conducted a peer-to-peer discussion with Dr. Griffin. According to Dr. Ross’s report, Dr. Griffin diagnosed Middleton with post-traumatic arthritis, noted additional contributing factors to the progression of the condition, and stated that the inciting event was the 2017 injury. Dr. Ross summarized the discussion as reflecting Dr. Griffin’s view that Middleton’s symptoms were related to the original injury, although Dr. Ross ultimately adhered to his own conclusion that the proposed surgery was unrelated to the work injury because of the intervening incidents.

LFUCG also submitted a supplemental report from Dr. Loeb dated January 7, 2025. After reviewing additional treatment records, Dr. Loeb reaffirmed his opinion that Middleton’s need for a total knee replacement resulted from genetically acquired osteoarthritis rather than the 2017 work injury. Dr. Loeb further opined that neither the original work injury nor the subsequent incidents caused any structural change sufficient to account for Middleton’s current condition, although he continued to agree that the surgery itself was medically necessary.

After considering the medical records, the opinions of Drs. Griffin, Loeb, and Ross, and Middleton’s testimony by deposition and at the final hearing, the ALJ entered an Opinion, Order, and Award on March 17, 2025. The ALJ

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determined that the proposed total knee replacement was reasonable, necessary, and causally related to Middleton’s 2017 work injury. LFUCG thereafter filed a petition for reconsideration in which it advised the ALJ that it no longer challenged the reasonableness or medical necessity of the proposed surgery, contesting only whether the surgery remained causally related to the work injury. The ALJ denied reconsideration while issuing additional findings in support of her decision.

LFUCG appealed to the Workers’ Compensation Board, arguing the ALJ erred in finding the proposed surgery causally related to the compensable injury. The Board affirmed in a divided opinion, with Chairman Alvey dissenting. This petition for review followed.

II. STANDARD OF REVIEW

Pursuant to KRS2 342.285, the ALJ is the sole finder of fact in workers’ compensation claims. Our courts have long recognized that the ALJ has the sole discretion to determine the quality, character, weight, credibility, and substance of the evidence and to draw reasonable inferences therefrom. Paramount Foods, Inc. v. Burkhardt, 695 S.W.2d 418, 419 (Ky. 1985); McCloud v. Beth-Elkhorn Corp., 514 S.W.2d 46, 47 (Ky. 1974). Likewise, the ALJ has the sole discretion to determine whom and what to believe and may accept or reject any testimony, in whole or in part, regardless of whether it comes from the same

2 Kentucky Revised Statutes.

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witness or the same adversary party’s total proof. Caudill v. Maloney’s Discount Stores, 560 S.W.2d 15, 16 (Ky. 1977). On review, neither the Board nor this Court may substitute its judgment for that of the ALJ concerning the weight of the evidence on questions of fact. Shields v. Pittsburgh & Midway Coal Mining Co., 634 S.W.2d 440, 441 (Ky. App. 1982).

If the finder of fact finds in favor of the person having the burden of proof, the burden on appeal is only to show that there was some substantial evidence to support the decision. Special Fund v. Francis, 708 S.W.2d 641, 643 (Ky. 1986). However, if the ALJ finds against the party having the burden of proof, the appellant must “show that the ALJ misapplied the law or that the evidence in [its] favor was so overwhelming that it compelled a favorable finding.” Gray v. Trimmaster, 173 S.W.3d 236, 241 (Ky. 2005).

Finally, our role “is to correct the Board only where . . . the Board has overlooked or misconstrued controlling statutes or precedent, or committed an error in assessing the evidence so flagrant as to cause gross injustice.” ViWin Tech Windows & Doors, Inc. v. Ivey, 621 S.W.3d 153, 157 (Ky. 2021) (quoting Western Baptist Hosp. v. Kelly, 827 S.W.2d 685, 687-88 (Ky. 1992)).

III. ANALYSIS

This appeal ultimately presents a single overarching question: whether the ALJ permissibly inferred that Middleton’s proposed total knee replacement was

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causally related to his compensable 2017 work injury from the totality of the medical evidence, or whether Kentucky law required an express medical opinion stating that conclusion. In affirming the ALJ, the Board concluded the ALJ permissibly relied upon the totality of the medical evidence, including Dr. Griffin’s treatment records, the orthopedic records from Dr. Schaper, Middleton’s testimony, and the opinions of Drs. Ross and Loeb, to determine that the proposed surgery remained compensable.

Applying the Kentucky Supreme Court’s decision in Perry County Board of Education v. Campbell, 671 S.W.3d 95 (Ky. 2023), the Board concluded the ALJ was entitled to draw reasonable inferences from this “patchwork” of medical and non-medical evidence and was not required to identify a single express statement of causation before rejecting the contrary opinions of Drs. Ross and Loeb. However, Chairman Alvey dissented. In his view, the ALJ’s finding rested not upon a reasonable inference drawn from the medical evidence but upon an inference that Dr. Griffin held an opinion regarding causation that he never expressly articulated. Because Chairman Alvey concluded the record contained no affirmative medical opinion connecting the proposed surgery to the 2017 injury, he would have reversed the Board and remanded the matter for additional findings.

The resolution of this appeal turns on the role of the ALJ as factfinder, and we concede it is a close question. Although LFUCG characterizes the issue as

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whether an ALJ may infer medical causation in the absence of an express medical opinion, we view the question somewhat differently. The issue is whether the record contains substantial medical evidence from which the ALJ could reasonably conclude that the proposed surgery constitutes compensable medical treatment under KRS 342.020. If it does, neither the Board nor this Court may reweigh that evidence.

The Kentucky Supreme Court’s decision in Perry County, 671 S.W.3d 95, provides the analytical framework for resolving this appeal. Perry County did not announce a new standard for proving compensability in post-award medical disputes. Rather, it reaffirmed the longstanding principle that an ALJ, acting as factfinder, is entitled to evaluate the record as a whole, weigh competing medical evidence, and draw reasonable inferences from that evidence in determining whether disputed medical treatment remains compensable. In doing so, the Court rejected the notion that an ALJ’s determination must rest upon any particular form of medical proof or upon an express medical opinion addressing every aspect of causation. Instead, the dispositive inquiry remains whether the ALJ’s finding is supported by substantial evidence.

In Perry County, the claimant sought workers’ compensation benefits for bilateral total knee replacement surgeries. Although one physician opined the surgeries were unrelated to the work injury, the ALJ concluded otherwise after

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considering the claimant’s testimony, treatment records, the chronology of her symptoms, and an independent medical examiner’s report. The Supreme Court rejected the employer’s contention that the ALJ had improperly inferred causation, explaining that the ALJ permissibly relied upon the totality of the medical and non- medical evidence rather than any single piece of proof. In describing the ALJ’s analysis, the Court observed that the ALJ had relied upon a “patchwork” of evidence that, viewed collectively, constituted substantial evidence supporting the award.

LFUCG contends Perry County is distinguishable because the ALJ there relied, at least in part, upon Dr. Jared Madden’s report, which LFUCG characterizes as an express medical opinion linking the claimant’s knee replacement surgeries to the work injury. According to LFUCG, no comparable opinion exists in this record. We do not believe this factual distinction alters the governing legal principle announced in Perry County.

The significance of Perry County does not lie in the existence of Dr.

Madden’s report alone. Rather, the Court relied upon Kingery v. Sumitomo Electric Wiring Systems, Inc., 481 S.W.3d 492 (Ky. 2015), to reaffirm that an ALJ may consider the entirety of the medical proof in determining compensability. Indeed, in Kingery, the Court recognized that “some contrary report from [the claimant’s] treating physician” would likely have been sufficient to support the ALJ’s finding.

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Read together, Kingery and Perry County make clear that Kentucky law does not require a particular form of medical evidence or an express statement employing specific language. The question remains whether substantial evidence, viewed as a whole, supports the ALJ’s determination.

LFUCG nevertheless asks this Court to isolate individual pieces of evidence and determine whether any one of them, standing alone, establishes the compensability of the proposed surgery. That is not the inquiry prescribed by Perry County. Here, the ALJ considered the medical evidence as a whole, including Dr. Griffin’s treatment records, his diagnosis of post-traumatic arthropathy, his recommendation of total knee arthroplasty following years of unsuccessful conservative treatment, the peer-to-peer discussion summarized in Dr. Ross’s report, the longitudinal orthopedic records, and Middleton’s testimony concerning the progression of his condition. From that evidence, the ALJ reasonably concluded that the proposed surgery remained compensable as treatment for Middleton’s work-related injury. The question before this Court is not whether the record might also have supported a contrary finding, but whether the record, viewed in its entirety, contains substantial evidence from which the ALJ could reasonably reach the conclusion she did. Because it does, neither the Board nor this Court may reweigh the evidence or substitute its judgment for that of the ALJ.

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To be sure, the record contains conflicting medical opinions regarding whether Middleton’s need for a total knee replacement stems from the 2017 work injury or from subsequent events and the progression of degenerative arthritis. Resolving those conflicts, however, is the function of the ALJ, not this Court. The existence of evidence that would have supported a different result does not render the ALJ’s decision unreasonable where, as here, substantial evidence supports the finding that was made.

LFUCG’s remaining arguments do not persuade us otherwise. At bottom, LFUCG contends the ALJ was required to identify an express medical opinion specifically stating that Middleton’s proposed total knee replacement remained causally related to his compensable 2017 injury. As discussed above, however, neither Perry County nor the authorities upon which LFUCG relies impose such a requirement. Rather, those cases reaffirm that an ALJ, acting as factfinder, may consider the record as a whole, weigh competing medical evidence, and draw reasonable inferences therefrom in determining whether disputed medical treatment remains compensable. As the Board explained in detail, that is what the ALJ did here. Because substantial evidence supports the ALJ’s determination, we decline LFUCG’s invitation to reweigh the evidence or require a particular form of medical proof.

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We likewise reject LFUCG’s contention that the ALJ’s findings were insufficient to permit meaningful appellate review. The ALJ carefully reviewed the competing medical evidence, identified the evidence she found persuasive, and, in response to LFUCG’s petition for reconsideration, entered additional findings addressing the issues raised. Read together, the ALJ’s Opinion, Order, and Award and Order on Reconsideration adequately disclose the factual basis for the decision and permit meaningful appellate review.

IV. CONCLUSION

Because the Board neither overlooked nor misconstrued controlling law and correctly concluded that substantial evidence supported the ALJ’s determination, we affirm.

ALL CONCUR.

BRIEF FOR APPELLANT: NO BRIEF FOR APPELLEES.

Thomas L. Ferreri Anthony K. Finaldi Lexington, Kentucky