Reaffirming ALJ Discretion in Kentucky PTD Awards: Minor Impairment and Temporary Return to Work Do Not Preclude PTD Under Stumbo/McNutt

Introduction

In Pikeville Medical Center v. Baker, the Supreme Court of Kentucky (memorandum opinion, not to be published) affirmed the Court of Appeals’ decision upholding an Administrative Law Judge’s award of permanent total disability (PTD) benefits to Charlotte Baker, a 65-year-old registered nurse injured while assisting with a patient transfer. The employer argued the PTD award lacked substantial evidentiary support, emphasizing Baker’s relatively low whole-person impairment rating, her return to work without formal restrictions for several months, and her education and professional background.

The Court rejected these arguments, reiterating the deference owed to ALJ fact-finding in workers’ compensation cases and clarifying that: (a) an ALJ may credit an uncontradicted impairment opinion that conforms to the AMA Guides; (b) a doctor’s failure to opine expressly that a claimant cannot perform “any work” does not bar a PTD finding; and (c) a brief, necessity-driven return to work does not compel denial of PTD where individualized vocational factors (age, work history, restrictions, labor market realities) support total occupational disability.

Parties: Pikeville Medical Center (Appellant/Employer); Charlotte Baker (Appellee/Claimant); the Administrative Law Judge (Hon. Chris Greg Davis) and the Workers’ Compensation Board (Appellees). Procedural posture: ALJ award of PTD affirmed by the Board and the Court of Appeals; the Supreme Court affirmed, finding no clear error or legal misapplication.

Summary of the Opinion

The Supreme Court held that substantial evidence supported the ALJ’s PTD award and that the lower tribunals correctly applied the governing legal standards. The Court emphasized:

The ALJ permissibly relied on the uncontradicted medical evaluation of Dr. Anthony McEldowney, who assigned an 8% upper extremity impairment (5% whole person) and imposed significant work restrictions, opining the work incident was the sole cause of Baker’s current impairment.
Under City of Ashland v. Stumbo and McNutt Construction/First General Services v. Scott, PTD determinations require an individualized, holistic analysis that extends beyond the numerical impairment rating to encompass age, education, work history, restrictions, and real-world employability.
An explicit medical opinion that the claimant cannot perform “any work” is not required; the ALJ may draw reasonable inferences from the totality of the record.
Evidence that Baker returned to work for a period did not compel a non-PTD finding, particularly where the ALJ reasonably inferred she did so under duress (to maintain spousal health insurance) and beyond her physical limitations.
Appellate review is constrained; the ALJ’s findings were not clearly erroneous, and the case presented no novel legal issues warranting further scrutiny. The appeal fell within the category of “routine affirmance.”

Analysis

Precedents Cited and Their Influence

City of Ashland v. Stumbo, 461 S.W.3d 392 (Ky. 2015): Provides the five-part framework for PTD determinations: work-related injury; existence of impairment rating; disability rating; inability to perform any type of work; and causation between injury and total disability. The Court reaffirmed that “any type of work” is an ordinary fact question for the ALJ, to be decided from reasonable inferences drawn from the record.
McNutt Construction/First General Services v. Scott, 40 S.W.3d 854 (Ky. 2001): Requires an individualized assessment of post-injury physical, emotional, intellectual, and vocational status, including dependability and employability under normal conditions. The Court endorsed the ALJ’s weighing of Baker’s age (65), 40-year specialized work history in physically demanding nursing, and significant restrictions that narrowed her employability.
Plumley v. Kroger, Inc., 557 S.W.3d 905 (Ky. 2017) and Kentucky River Enters., Inc. v. Elkins, 107 S.W.3d 206 (Ky. 2003): The interpretation of the AMA Guides and the assessment of impairment are medical questions. An ALJ may rely on a physician’s impairment rating if based upon and in conformity with the Guides. Pikeville Medical offered no contrary medical proof undermining the conformity or credibility of Dr. McEldowney’s assessment.
Lexington-Fayette Urban County Government v. Gosper, 671 S.W.3d 184 (Ky. 2023) and W. Baptist Hosp. v. Kelly, 827 S.W.2d 685 (Ky. 1992): These decisions delineate the three-tier review structure and emphasize deference to the ALJ’s fact-finding. The Supreme Court reiterated its limited role: it does not “third guess” the Board and the Court of Appeals where substantial evidence supports the ALJ.
Letcher County Bd. of Educ. v. Hall, 576 S.W.3d 123 (Ky. 2019): Appellate review of factual findings asks whether they are clearly erroneous—i.e., unreasonable under the evidence. The Court found the ALJ’s inferences reasonable.
Lee v. International Harvester Co., 373 S.W.2d 418 (Ky. 1963) and COLUMBUS MINING CO. v. CHILDERS, 265 S.W.2d 443 (Ky. 1954): A reversal requires evidence “so clear-cut and convincing” that it compels a different result. Baker’s temporary return to work did not meet that standard, especially given the ALJ’s duress finding and the medical restrictions.
Laboratory Corp. of America v. Smith, 701 S.W.3d 228 (Ky. 2024): Introduces the “routine affirmance” framing for appeals presenting no novel issue and adequate lower-court review. The Court applied that lens here and affirmed.

Legal Reasoning

The Court applied the Stumbo five-part test and KRS 342.0011(11)(c)’s PTD definition. It accepted the ALJ’s determinations that (1) Baker suffered a work-related injury; (2) she had a permanent impairment (5% whole person based on the Fifth Edition of the AMA Guides); (3) she had a permanent disability rating; (4) she was unable to perform any kind of work; and (5) her total disability resulted from the work injury.

On impairment, the employer argued that the 2017 prior injury rendered the 5% rating unreliable because the IME physician did not definitively account for preexisting active impairment. The Court noted that Dr. McEldowney reviewed extensive records and ultimately concluded no active impairment existed at the time of the 2020 injury; as interpretation and application of the Guides are medical questions, the ALJ had discretion to credit this uncontroverted opinion.

On the “any work” prong, the Court underscored that direct expert testimony declaring the claimant incapable of any employment is not a prerequisite to PTD. Rather, the ALJ may infer from restrictions, credible testimony, age, work history, and labor market conditions that the claimant cannot engage in sustained, gainful work. The ALJ reasonably weighed:

Baker’s age (65) and long tenure in a single, physically intensive occupation (registered nurse) over 40 years.
Stringent restrictions (no frequent/repetitive/sustained left-shoulder use, no overhead or away-from-body reaching; left-arm lift limited to 8 pounds; carry 6 pounds; push/pull 30 pounds; avoid prolonged sitting/walking), which collectively remove a “wide array of jobs, even those considered skilled.”
Her return to work was short-lived and explained by nonvocational necessity (maintaining spousal cancer-treatment coverage) and occurred despite ongoing pain—supporting an inference that it did not reflect sustainable capacity under normal employment conditions.

Finally, the Court emphasized the appellate posture: because Pikeville Medical offered no competing medical or vocational proof (it did not file a Form 111 and did not contravene the IME), the ALJ permissibly relied on the only medical evidence in the record. The ALJ’s credibility determinations and weighing of vocational factors were neither “patently unreasonable” nor “flagrantly implausible.” Accordingly, substantial evidence supported the PTD award, and routine affirmance was appropriate.

Impact

While designated “Not to be Published” and therefore nonprecedential, this opinion is a clear reaffirmation of several settled principles in Kentucky workers’ compensation law that will influence litigation strategy:

ALJ discretion remains paramount. Appellants face a steep hill where the ALJ’s PTD finding is grounded in substantial evidence and reasonable inferences from individualized vocational factors.
Low impairment does not foreclose PTD. A 5% whole-person impairment did not bar PTD where age, transferable skills, and stringent restrictions collectively evidenced an inability to find and maintain “any type of work.”
No “magic words” from physicians are required. A doctor’s failure to state “no work of any kind” does not preclude PTD if the restrictions and record support total disability.
Temporary return to work is not dispositive. A claimant’s return to work—especially under duress or for short duration—does not compel denial of PTD, particularly when the job performance is beyond the claimant’s limitations or unsustainable.
Uncontradicted medical proof is powerful. When the employer presents no competing medical or vocational evidence, the ALJ may credit the claimant’s IME if it conforms to the AMA Guides. Employers risk adverse outcomes if they do not timely join issue (e.g., by filing a Form 111) and develop the record.
Appellate screening for “routine affirmance”. The Court’s reliance on Laboratory Corp. v. Smith signals continued reluctance to revisit factbound workers’ compensation disputes lacking novel questions, reinforcing the importance of building the evidentiary record at the ALJ level.

Complex Concepts Simplified

Permanent Total Disability (PTD): Under KRS 342.0011(11)(c), PTD is a permanent disability rating coupled with a complete and permanent inability to perform any type of work as a result of the injury. It focuses on the worker’s practical employability, not whether the worker is “homebound.”
Stumbo Five-Part Test: The ALJ must find: (1) work-related injury; (2) an impairment rating; (3) a disability rating based on that impairment; (4) inability to perform any type of work; and (5) causation tying total disability to the injury.
Individualized Vocational Analysis (McNutt): Beyond the impairment percentage, the ALJ looks at age, education, work history, physical and mental limitations, reliability, and the likelihood of finding consistent work in the real market.
AMA Guides (Fifth Edition): The accepted reference for physicians to calculate impairment percentages. Questions about interpreting or applying the Guides are medical questions. An ALJ may rely on a Guides-compliant impairment rating unless persuasive contrary medical evidence is offered.
Substantial Evidence / Clearly Erroneous: Substantial evidence is proof that a reasonable person would accept as adequate to support a conclusion. A finding is “clearly erroneous” only if it is unreasonable under the evidence. Appellate courts do not reweigh evidence or substitute their judgment for the ALJ’s.
“Compelling” Evidence Standard: To overturn an ALJ’s finding, the contrary evidence must be so clear and convincing that it compels a different result—an exacting standard rarely met in fact-intensive disputes.
Effect of Temporary Return to Work: Returning to work post-injury does not automatically defeat PTD; the ALJ examines whether such work was within restrictions, sustainable, and reflective of genuine labor market capacity.
Duration of PTD Benefits: Here, the ALJ began PTD benefits the day after Baker ceased working (January 15, 2022) and set them to run until she reached age 70, consistent with Kentucky’s statutory limitations on duration of income benefits. That issue was not challenged on appeal.
“Not to be Published” Opinions: These decisions are nonprecedential under Kentucky practice. They may still be cited in limited circumstances as persuasive authority, but they do not establish binding precedent. The Court here expressly noted no new or novel legal question was presented.

Conclusion

The Supreme Court’s decision in Pikeville Medical Center v. Baker is a robust reaffirmation of longstanding Kentucky workers’ compensation principles. It underscores that PTD determinations are holistic and fact-intensive; that ALJs may infer total occupational disability without a physician’s categorical “no-work” statement; that a small impairment rating does not preclude PTD when vocational realities point to unemployability; and that a claimant’s short, necessity-driven return to work is not outcome-determinative.

Just as importantly, the opinion reiterates the limited scope of appellate review and the concept of “routine affirmance” in factbound workers’ compensation cases: where the ALJ’s findings are supported by substantial evidence and the Board and Court of Appeals have provided adequate review, the Supreme Court will not reweigh the record. For practitioners, the decision is a cautionary tale: develop the evidentiary record early (including any preexisting impairment and vocational capacity evidence) or risk having uncontradicted proof carry the day.

Key takeaway: In Kentucky PTD litigation, individualized vocational realities—not just the impairment percentage or a temporary post-injury work stint—drive outcomes, and ALJ credibility determinations will rarely be disturbed on appeal absent compelling contrary evidence or legal error.

Note: This is a memorandum opinion marked “Not to be Published.” While informative, it does not constitute binding precedent.