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April 27, 2018 201665271

Commonwealth of Kentucky 

Workers’ Compensation Board

 

 

 

OPINION ENTERED:  April 27, 2018

 

 

CLAIM NO. 201665271

 

 

BETTY ROBINSON                                 PETITIONER

 

 

 

VS.           APPEAL FROM HON. TANYA PULLIN,

                 ADMINISTRATIVE LAW JUDGE

 

 

 

KROGER

and HON. TANYA PULLIN,

ADMINISTRATIVE LAW JUDGE                      RESPONDENTS

 

 

OPINION

AFFIRMING

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BEFORE:  ALVEY, Chairman, STIVERS and RECHTER, Members. 

 

STIVERS, Member. Betty Robinson (“Robinson”) appeals from the November 18, 2017, Opinion and Order on Bifurcated Issues and the January 2, 2018, Order overruling her petition for reconsideration of Hon. Tanya Pullin, Administrative Law Judge (“ALJ”). The ALJ dismissed Robinson’s claim for an alleged work-related cumulative trauma injury to her right wrist. On appeal, Robinson asserts the ALJ failed to fully address causation. Robinson also asserts the uncontroverted evidence supports a finding of a work-related injury.

          The Form 101 alleges Robinson sustained work-related cumulative trauma injuries to her right wrist and hand that manifested on October 1, 2016, while in the employ of Kroger. Her description of her cumulative trauma injuries is as follows: “Claimant had been working in the deli/bakery section at Kroger since September 2013, on 10/1/16, she had been frying chicken in the deli when she noticed her right wrist was painful and swollen and her fingers were numb.”

          Kroger introduced the April 4, 2017, Independent Medical Examination (“IME”) report of Dr. Richard DuBou. After performing an examination and medical records review, Dr. DuBou opined as follows:

Question 1: What is the proper diagnosis for Ms. Robinson’s right wrist/hand condition and are such diagnosis related to her work at Kroger?

 

Answer: Her diagnosis is tear in the TFCC on the right. It is not, however, related to her work at Kroger.

 

Question 2: Is Ms. Robinson at maximum medical improvement (MMI) for her riht [sic] wrist/hand condition?

Answer: No as she is currently receiving physical therapy. After physical therapy I would ask for a FCE with a therapist who notes autonomic responses.

 

Question 3: If she is not at MMI for her right wrist hand condition, what additional treatment would be reasonable and necessary for the right wrist/hand and assuming such additional treatment is rendered, what would be the estimated date that she will be at active MMI?

 

Answer: I believe the additional treatment would be more physical therapy as she says she is improving. She should be at MMI about the middle of April. That would give her three months of therapy and of recovery.

 

          He concluded, in part, as follows: “In short then, I think the surgery was necessary, but was not associated at all with her work at Kroger.”

          Dr. DuBou’s June 6, 2017, letter reads as follows:

In answer to your questions, I do not see how Dr. Barefoot made the determination that the TFCC injury was related to the plaintiff’s work at Kroger. I left a note in my original report as to the occasional causes of TFCC tear and even over a shorter period of two years of longer, the book notes that combination of factors and risk, force in repetition, force in posture have insufficient evidence. Vibration, insufficient evidence. Highly repetitive work alone or in combination with other factors, insufficient evidence. Forceful work, insufficient evidence. Awkward posture, insufficient evidence. Length of employment, insufficient evidence, for nonoccupational risk factors, age has very strong evidence. Anatomy, very strong evidence. BMI, insufficient evidence. The book does note that patients with ulnar negative variance had fewer degenerative changes, but by contrast, tears on the peripheral rim of the TFCC usually on the radial side are more commonly traumatic in origin.

 

Please note again that there was no trauma involved when Ms. Robinson felt pain in her wrist. It would be unlikely for this TFCC tear to be traumatic since there was no ulnar variance and the tears are mostly central.

 

At the present time, I do not know if her doctor has released her to full duty or if she is at MMI. Once she is at full duty, an FCE would be very helpful as it will let us know what her actual abilities are, especially if the examiner takes into account autonomic variables such as pulse, respiration, and so forth.

 

At the present time with the [sic] all the evidence pointing to a degenerative tear of the TFCC, I would state that it is definitely more probable that this is a degenerative tear. It would be unlikely for that to occur in as little as two years. Again on speaking with her, she feels the surgery was helpful, but still has relatively the same symptoms. She still has pain which is still volar and goes to the index, middle, and ring fingers. There was enough inconsistency in her examination that the FCC when she is at MMI would be very helpful.

 

Green’s Hand Book of Hand Surgery, the bible in the field, 3rd Edition, states the following: The standard classification of traumatic lesions type 1a is horizontal tear in the disk adjacent to the sigmoid notch of the distal radius. Type 1b, an avulsion of the TFCC from the ulnar, avulsion of the ulnar carpal ligament from the carpus is type 1c. Avulsion of the articular disk from the sigmoid notch to the distal radius is type 1d. I think we can rule out a traumatic cause of her TFCC tear.

 

In terms of degenerative tears, Palmer wrote that dividing these type 2 degenerative lesions would be best in two stages: A. thinning of the triangular fibrocartilage complex without perforation. B. Thinning of the articular disk with chondromalacia in the ulnar head or lunate. C. Perforation of the articular disk with chondromalacia. D. Perforation of the articular disk with chondromalacia and partial tear of the lunotriquetral ligament and perforation of the articular disk with chondromalacia, tear of the lunotriquetral ligament, and ulnar carpal arthritis. They add that where traumatic tears tend to be peripherally located, degenerative lesions of the triangular fibrocartilage occur in the centrum of the articular disk.

 

This does not give us a totally positive diagnosis, but it does seem that a degenerative tear is far more likely. With her doing mostly nonforceful movements in her two years of working at Kroger, I believe these are degenerative, but not related to her work at Kroger. Pushing a rack up six kitchens [sic] is not very hard work.

The finding in the MRI of degenerative fraying and full thickness degenerative perforation tear in the membranous portion of the scapholunate ligament with dorsal and volar bands of the scapholunate ligament are intact, and there is no widening of the scapholunate interval nor abnormal tear of the lunate, this would be a separate injury. It requires no treatment at the present time since there is no widening of the scapholunate ligament and the wrist is stable.

 

There is no reason noted in Dr. Barefoot’s IME that explains why he feels the TFCC injury was related to the plaintiff’s work.                     

          Robinson was deposed on January 19, 2017, and also testified at the September 29, 2017, hearing. Important to the ALJ’s dismissal of Robinson’s claim was her testimony indicating she stopped working at Kroger on October 12, 2016.

          Several medical records of Dr. Antony Hazel were filed in the record. The ALJ found persuasive Dr. Hazel’s December 2, 2016, treatment record in which he noted Robinson’s symptoms had not improved after being off work for three months.

In the August 9, 2017, Benefit Review Conference Order and Memorandum, the following contested issues were listed: benefits per KRS 342.730; work-relatedness/causation; average weekly wage; unpaid or contested medical expenses; injury as defined by the ACT; TTD.

          In the November 18, 2017, Opinion and Order, the ALJ set forth the following findings of fact and conclusions of law:

Work-relatedness/causation and injury as defined by the Act

 

. . .

All medical opinions have been considered by the ALJ, as evidenced by the preceding summaries. Dr. Hazel is Plaintiff’s treating physician/surgeon and consequently the ALJ paid particular attention to his opinion. Dr. Hazel opined only that Plaintiff’s symptoms “may” be related to work activity. Whereas, Dr. Dubou [sic], who is a specialist in surgery of the hand/orthopedic surgery, said Plaintiff’s TFCC injury was not related to work for Defendant Employer and that it was “definitely more probable” that this was a degenerative tear. Dr. Barefoot opined Plaintiff’s injury was work- related and said that he based this opinion on Plaintiff’s description of her work activities. Dr. Barefoot said Plaintiff reported that she was required to lift baskets with six chicken breasts in them and felt that this repetitive lifting was the etiology of her wrist pain, which began in late September 2016.

Treatment records of Dr. Hazel and testimony of Plaintiff support the medical opinion of Dr. Dubou [sic]. Plaintiff’s symptoms did not improve after three months of not working, according to the December 2, 2016 treatment record of Dr. Hazel and Plaintiff’s testimony that she did not work after October 12, 2016. Plaintiff testified that she had a variety of work duties in her workdays including when she worked only part time and when she went to full time after a year and a half. Taking the treatment records of Dr. Hazel and Plaintiff’s testimony into account the opinion on causation rendered by Dr. DuBou is more persuasive to the ALJ than that from Dr. Hazel or Dr. Barefoot. After careful review of the medical and lay testimony in this claim, based upon the medical opinion of Dr. Dubou [sic] as buttressed by the treatment records of Dr. Hazel, the ALJ finds Plaintiff has not borne her burden of proving a work-related cumulative trauma injury to her right wrist and hand manifesting on October 1, 2016.

 

The ALJ having found that Plaintiff has not borne her burden of proof on the threshold issue that the alleged injury to her right wrist and hand is work-related then the other issues reserved as contested are now moot.

          Robinson filed a petition for reconsideration requesting the ALJ to find her work at Kroger aggravated a dormant degenerative condition into disabling reality. Robinson also requested an interlocutory award of temporary total disability and medical benefits.

          In the January 2, 2018, Order, the ALJ overruled the petition for reconsideration reasoning as follows:

. . .

Plaintiff submitted a Petition for Reconsideration requesting additional findings of fact relating to the determination by the ALJ that Plaintiff’s TFCC was a degenerative condition and a finding as to whether Plaintiff’s TFCC was a work-related condition as an arousal of a pre-existing dormant condition aroused into disabling reality. Plaintiff cited McNutt Construction/First General Services v. Scott, 40 S.W. 3d 854 (Ky. 2001). In her Petition for Reconsideration, Plaintiff argued that although the condition may not have been traumatic, since the evidence shows the condition became symptomatic in late September 2016, the degenerative TFCC injury was aroused into disabling reality by her work with Defendant Employer. Plaintiff argued that this is a separate issue from the ALJ’s conclusion regarding the cause for the TFCC/tear. Plaintiff further argued that the medical evidence was “uncontroverted” that showed Plaintiff’s work for Defendant Employer aggravated naturally occurring degenerative changes such that they became symptomatic sooner than expected. Plaintiff pointed to the medical testimony of Dr. Barefoot. Plaintiff argued that Dr. Dubou [sic] opined that Plaintiff’s work did not cause a tear but that he was silent as to whether it eventually aggravated or aroused the degenerative condition into disabling reality.

Defendant Employer filed a response to Plaintiff’s Petition for Reconsideration and argued that Dr. Dubou [sic] opined that the degenerative tear that was diagnosed was not related to Plaintiff’s work. Specifically, Defendant Employer pointed to the opinion of Dr. Dubou [sic] in his June 6, 2017 report that the type of work such as force in repetition, vibration, highly repetitive work were all insufficient factors for TFCC tears. Defendant Employer pointed out that Dr. Hazel opined that TFCC tears “can” be associated with repetitive action and work “can” aggravate the condition, but he did not confirm Dr. Barefoot’s opinion that Plaintiff’s work aroused the condition into disabling reality as alleged by Plaintiff. Defendant Employer also noted that the type of activities listed which may arouse Plaintiff’s condition were turning a doorknob, using a screwdriver or twisting a key and that all those activities included twisting of the wrist and pronation and supination. Defendant Employer argued that Plaintiff’s work could not be described as the equivalent of any of those activities. Defendant Employer also pointed to the evidence of record that Plaintiff was seen on October 1, 2016 with a history of wrist pain with possible causes unknown and an incident location at “home.”

In this particular case two IME reports with differing opinions on causation were entered into evidence. Dr. Barefoot opined “by Mrs. Robinson’s description, the need for the above-mentioned treatment is due to repetitive work activities. It is more likely than not that these work activities accelerated or hastened her underlying dormant asymptomatic condition to its symptomatic painful disabling reality. She reports that her work activities requires [sic] repetitive flexion and extension as well as supination and pronation of her forearm. This would be the type of activities that would be expected to, over time, cause injury to her TFCC, as noted on her MRI report, dated December 20, 2016. By her medical history and the available medical records, workplace activities were the cause of her initial wrist pain for which she sought medical treatment.” Dr. Dubou [sic] opined that he did not see “how Dr. Barefoot made the determination that the TFCC injury was related to the Plaintiff’s work at Kroger.” Dr. Dubou [sic] said that in a note attached to his original IME report regarding the occasional causes of TFCC tear and “even over a shorter period of two years or longer, the book notes that a combination of factors and risks, force in repetition, force and posture have insufficient evidence. Vibration, insufficient evidence. Highly repetitive work alone or in combination with other factors, insufficient evidence. Forceful work, insufficient evidence. Awkward posture, insufficient evidence. Length of employment, insufficient evidence. For non-occupational risk factors, age has very strong evidence. Anatomy, very strong evidence. BMI, insufficient evidence. The book does note that patients with ulnar negative variance had fewer degenerative changes, but by contrast, tears on the peripheral rim of the TFCC usually on the radial side are more commonly traumatic in origin.” Specifically Dr. Dubou [sic] noted that when Plaintiff felt pain in her wrist it would be “unlikely for this TFCC tear to be traumatic since there was no ulnar variance and the tears are mostly central.” He noted that Plaintiff did mostly nonforceful movements in her two years of working with Defendant Employer. Dr. Dubou [sic] went on to say that Plaintiff’s injury was degenerative, “but not related to her work at Kroger. Pushing a rack up six kitchens [sic] again is not very hard work.” Dr. Dubou [sic] pointed out there was no reason given by Dr. Barefoot in his IME that explains why he believed the TFCC injury was related to Plaintiff’s work.

In this case, there is a marked difference between the two doctors’ IME reports which have been submitted into evidence. It is established law that where the medical evidence is conflicting, the question of which evidence to believe is the exclusive province of the ALJ. Pruitt v. Bugg Brothers, 547 S.W.2d 123 (Ky. 1977). Likewise, the ALJ has the sole authority to judge all reasonable inferences to be drawn from the evidence. Miller v. East Kentucky Beverage/PepsiCo Inc., 951 S. W.2d (Ky. 1997); Jackson v. General Refractories Co., 581 S.W. 2d 10 (Ky. 1979).

Since there was a significant difference in the opinions of Dr. Barefoot and Dr. Dubou [sic] as to causation, the ALJ looked to Plaintiff’s treatment records. Dr. Hazel, in his letter of August 29, 2017, opined that Plaintiff reported that on October 1, 2016 she had to do “frying which involved a lot of repetitive motion and the day after she began experiencing symptoms that did not improve.” He noted that Plaintiff underwent surgery and subsequently her pain in the wrist resolved. Dr. Hazel said, “Given that she did not have previous wrist pain, her symptoms may have been related to her activity at work. While exact causalities can be difficult to assign, central TFCC tears can be associated with repetitive action and this work can aggravate this condition.” The treatment record of November 11, 2016 from Louisville Arm and Hand said that Plaintiff stated on October 1, 2016 she was working in the deli section and had to do frying which involved a lot of repetitive motion and the next day she experienced pain on the ulnar aspect of her wrist. The December 2, 2016 treatment note of Louisville Arm and Hand noted that Plaintiff has been in a cast and feels her symptoms are about the same as her last visit with no decrease in pain. The same treatment note showed that Plaintiff’s symptoms had not improved over the past three months. The impression from the December 20, 2016 MRI of Plaintiff’s right wrist was “1. Degenerative changes of the central triangular fibrocartilage without contrast filled tear nor contrast filling of the distal radio older joint. There is degenerative fraying and partial/thickness degenerative tear of the ulnar attachment of the TFCC as well. 2. Degenerative fraying and full-thickness degenerative perforation tear of the membranous/strike membranous portion of the scapholunate ligament. Dorsal and volar bands of the scapholunate ligament are intact and there is no widening of the scapholunate interval nor abnormal tilt of the lunate. 3. Otherwise unremarkable MRI arthrogram of the right wrist. 4. Flexor and extensor tendons of the right wrist are intact.” The October 12, 2016 treatment record from Baptist Health Medical Group gave a history of present illness of wrist pain that began a week prior with pain as the result of repetitive activity, “slicing meat and lifting packages at work.” The May 10, 2017 surgery follow up note from Dr. Hazel said Plaintiff had increased pain in her wrist since last appointment. Dr. Hazel noted that Plaintiff’s “TFCC peripheral tears S/P above procedure has progressed well however, with FCR/palmaris tendinitis.” Dr. Hazel’s treatment note of July 26, 2017 noted that Plaintiff denied ulnar-sided wrist pain, but “still having pain.” The treatment note of Norton Healthcare/Norton Physicians Services/Norton Immediate Care dated October 14, 2016 noted that wrist pain was a new problem that started “two days prior (since September 30)” and the symptoms were gradually worsening. The incident location was “work.” Diagnosis was carpal tunnel syndrome of the right wrist and the October 1, 2016 treatment record diagnosed right wrist pain which started yesterday with pain and swelling and no injury. Plaintiff reported that the incident location was “home.” In the October 14, 2016 treatment record of Norton Healthcare the history of present illness stated that Plaintiff presented with right wrist pain and that she had been working for Defendant Employer for three years and worked six days a week for eight hours. The treatment record also noted that, “On the date of injury she was moving racks of chickens to be roasted. Each pan can have six chickens.” The same treatment record reported, “While performing this task she suddenly developed right wrist pain. She denies hitting the wrist no slip fall or trauma. She was taking pans in and out of multiple ovens when this occurred. She had swelling and pain on the outside of the wrist.” The history of present illness also noted that Plaintiff stated the pain was sudden onset as was the tingling and swelling. The assessment was “overuse injury.” The November 1, 2016 treatment note of Norton Healthcare noted that Plaintiff went back to work with no use of her right arm but Plaintiff said she was put in a situation at work for two days that she had to use both hands and felt that “they did not honor the limitations.” The diagnosis was right wrist tendinitis exacerbation and overuse syndrome. The doctor noted that he was removing Plaintiff from work due to the exacerbation of the wrist.

When a work-related injury trauma causes non-work-related degenerative changes to be aroused into disability and to result in impairment that harmful change is compensable. Bright v. American Greetings Corporation, 62 S.W. 3d 381 (Ky. 2001). Taking into account all of the medical evidence in this claim, the ALJ reiterates that the opinion of Dr. Dubou [sic] is more persuasive to the ALJ than the opinion of Dr. Barefoot as Dr. Dubou [sic] is a specialist in surgery of the hand/orthopedic surgery. Dr. Dubou [sic] clearly, in multiple statements, opined that Plaintiff’s injury was not related to her work for Defendant Employer. Dr. Dubou [sic] reviewed the IME report of Dr. Barefoot and concluded that he did “not see how Dr. Barefoot made the determination that the TFCC injury was related to the plaintiff’s work at Kroger.” By that statement Dr. Dubou [sic] makes clear that he considered whether Plaintiff’s work brought into disabling reality a dormant condition which was Dr. Barefoot’s opinion. Dr. Dubou [sic] also pointed to the note in his original report which gave detail of any connection of repetitive motions to a TFCC tear. The ALJ also notes Plaintiff’s testimony as to her work. Specifically, Plaintiff testified that she had held different positions in the deli department and each of those positions had different responsibilities and physical requirements. She said she sliced meat for one and half years and during that time she also assisted customers and made trays and took out garbage. Plaintiff said her next position was as a fry person, which she began when she started to work full time for defendant employer. Plaintiff said that as a fry person she also sliced meat, cheese and prepared chickens and got carts that held six boxes that contain seven to eight whole chickens per box. She said she rolled the cart to the station to prepare the chickens to cook. Plaintiff said she opened up the box, cut the bag, put the chicken on a rack, put seasoning on the chicken and put it into the oven. When reviewing the medical testimony of Dr. Dubou [sic], it was important to the ALJ that Dr. Dubou [sic] had also reviewed Plaintiff’s work activities and took those into account when forming his medical opinion.

The ALJ also notes that the diagnosis of “overuse syndrome” was coupled with the diagnosis of carpal tunnel syndrome when Plaintiff was seen in October 2016. It is significant to the ALJ that the ultimate diagnosis by Dr. Hazel which precipitated the surgery was a TFCC tear. The medical testimony of Dr. Dubou [sic] regarding the TFCC tear is specific that it was not related to her work at Defendant Employer. Dr. Dubou [sic] reviewed activities which may or may not be related to a TFCC tear and he determined that the cause of Plaintiff’s injury was degenerative and that he disagreed with the opinion of Dr. Barefoot that the condition was in any way related to Plaintiff’s work. Consequently, the ALJ’s finding includes that Plaintiff’s work did not bring into disabling reality a dormant condition.

          Robinson’s first argument on appeal is that the ALJ failed to set forth sufficient findings of fact. Robinson asserts, in relevant part, as follows: “Relying on Dr. Dubou’s [sic] conclusion the TFCC tear was degenerative, the ALJ only determined the cause of the tear (which wasn’t in dispute) and never determined whether Petitioner’s work caused it to become symptomatic.” We disagree and affirm.

All parties, including this Board, are entitled to findings sufficient to inform them of the basis for the ALJ’s decision to allow for meaningful appellate review. Kentland Elkhorn Coal Corp. v. Yates, 743 S.W.2d 47 (Ky. App. 1988); Shields v. Pittsburgh and Midway Coal Mining Co., 634 S.W.2d 440 (Ky. App. 1982). In reaching a determination, an ALJ is not required to set out the minute details of her reasoning in reaching her conclusion; rather, she must only provide findings sufficient to inform the parties of the basis for the decision to allow for meaningful review. See Shields v. Pittsburgh and Midway Coal Mining Co., 634 S.W.2d 440 (Ky. App. 1982); See also Big Sandy Community Action Program v. Chafins, 502 S.W.2d 526 (Ky. 1973).

In the November 18, 2017, Opinion and Order on Bifurcated Issues, the ALJ demonstrated her awareness of all the lay and medical evidence submitted in this claim and clearly indicated the evidence she relied upon in making the determination Robinson had not met her burden in proving she sustained a work-related injury. That evidence includes Dr. Hazel’s treatment records, Robinson’s testimony, and the opinions of Dr. DuBou. Such findings, in our opinion, are adequate in this instance.

However, assuming, arguendo, the ALJ had not set forth adequate findings in the November 18, 2017, Opinion and Order, the ALJ set forth five pages of additional findings, in the January 2, 2018, Order overruling Robinson’s petition for reconsideration detailing the evidence she relied upon in reaching her determination and the rationale behind her ultimate conclusion to dismiss Robinson’s claim. To expect the ALJ to set forth additional findings in light of this January 2, 2018, Order would be inconsistent with the pertinent law.

In her second argument on appeal, Robinson asserts the “uncontroverted” medical evidence supports a finding of a work-related injury. We again disagree.

As the claimant in a workers’ compensation proceeding, Robinson had the burden of proving each of the essential elements of her cause of action, including proving she sustained an injury as defined by the Workers’ Compensation Act. Snawder v. Stice, 576 S.W.2d 276 (Ky. App. 1979). Since Robinson was unsuccessful in that burden, the question on appeal is whether the evidence compels a different result. Wolf Creek Collieries v. Crum, 673 S.W.2d 735 (Ky. App. 1984). “Compelling evidence” is defined as evidence that is so overwhelming no reasonable person could reach the same conclusion as the ALJ. REO Mechanical v. Barnes, 691 S.W.2d 224 (Ky. App. 1985). 

          As fact-finder, the ALJ has the sole authority to determine the weight, credibility and substance of the evidence. Square D Co. v. Tipton, 862 S.W.2d 308 (Ky. 1993). Similarly, the ALJ has the discretion to determine all reasonable inferences to be drawn from the evidence. Miller v. East Kentucky Beverage/Pepsico, Inc., 951 S.W.2d 329 (Ky. 1997); Jackson v. General Refractories Co., 581 S.W.2d 10 (Ky. 1979). The ALJ 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 adversary party’s total proof. Magic Coal Co. v. Fox, 19 S.W.3d 88 (Ky. 2000). Although a party may note evidence that would have supported a different outcome than that reached by an ALJ, such proof is not an adequate basis to reverse on appeal. McCloud v. Beth-Elkhorn Corp., 514 S.W.2d 46 (Ky. 1974). 

          The function of this Board in reviewing the ALJ’s decision is limited to a determination of whether the findings made by the ALJ are so unreasonable under the evidence that they must be reversed as a matter of law.  Ira A. Watson Department Store v. Hamilton, 34 S.W.3d 48 (Ky. 2000). The Board, as an appellate tribunal, may not usurp the ALJ’s role as fact-finder by superimposing its own appraisals as to the weight and credibility to be afforded the evidence or by noting reasonable inferences that otherwise could have been drawn from the record.  Whittaker v. Rowland, 998 S.W.2d 479, 481 (Ky. 1999). As long as the ALJ’s ruling with regard to an issue is supported by substantial evidence, it may not be disturbed on appeal. Special Fund v. Francis, 708 S.W.2d 641, 643 (Ky. 1986).

          Dr. DuBou’s opinions constitute substantial evidence in support of the ALJ’s determination Robinson did not sustain a work-related injury. In both the April 4, 2017, report and the June 6, 2017, letter, Dr. DuBou unequivocally stated Robinson’s injury is not related to her work at Kroger. As held by the ALJ, Robinson’s testimony regarding her cessation of work at Kroger on October 12, 2016, and Dr. Hazel’s December 2, 2016, treatment record indicating her symptoms had not improved further buttressed her reliance upon Dr. DuBou and her dismissal of the claim. As the ALJ’s dismissal is supported by substantial evidence, it may not be disturbed.

          Accordingly, the November 18, 2017, Opinion and Order on Bifurcated Issues and the January 2, 2018, Order overruling Robinson’s petition for reconsideration are AFFIRMED.

          ALL CONCUR.

COUNSEL FOR PETITIONER:

HON UDELL LEVY

401 W MAIN ST STE 1910

LOUISVILLE KY 40202

COUNSEL FOR RESPONDENT:

HON JAMES COOPER

444 W SECOND ST

LEXINGTON KY 40507

ADMINISTRATIVE LAW JUDGE:

HON TANYA PULLIN

657 CHAMBERLIN AVE

FRANKFORT KY 40601