Substantial-Evidence Deference to ALJ Findings of Permanent Total Disability Despite Potential Sedentary Capacity

Introduction

In Rural King Supply, Inc. v. Evelyn Sallie (Ky. June 25, 2026) (Not to Be Published), the Supreme Court of Kentucky reviewed a workers’ compensation award granting temporary and permanent total disability benefits and medical expenses to employee Evelyn Sallie after a severe crush injury to her right foot. Rural King Supply, Inc. argued that Sallie was not permanently and totally disabled because she remained capable of sedentary/office work, relying on (i) parts of Sallie’s testimony suggesting she could “probably” do seated work with leg elevation, (ii) her clerical/managerial work history, and (iii) a medical evaluation (Dr. Jenkinson) that recommended minimal restrictions.

The core issue was not whether a different factfinder could have denied permanent total disability, but whether the Administrative Law Judge’s (ALJ’s) award was supported by substantial evidence such that appellate tribunals were required to affirm.

As an unpublished “Memorandum Opinion,” the decision is expressly non-precedential under RAP 40(D), though it may be cited for consideration in limited circumstances under RAP 41 if no published opinion adequately addresses the point of law.

Summary of the Opinion

The Court affirmed the Court of Appeals, which had affirmed the Workers’ Compensation Board, which had affirmed the ALJ. The Supreme Court held that the ALJ’s determination that Sallie was permanently and totally disabled was supported by substantial evidence. In particular, the ALJ permissibly credited (i) Sallie’s testimony about unpredictable neuropathic pain, swelling, balance difficulty, and inability to reliably report to work, and (ii) the more restrictive medical opinions (Dr. Manson and Dr. McEldowney) over the less restrictive opinion (Dr. Jenkinson). Rural King’s arguments were characterized as an impermissible request to reweigh the evidence.

Analysis

Precedents Cited

The Court’s reasoning is built on a familiar Kentucky workers’ compensation appellate framework emphasizing deference to ALJ factfinding and limited appellate review.

  • Lexington Fayette Urban Cnty. Gov't v. Gosper, 671 S.W.3d 184 (Ky. 2023)
    • Used for multiple controlling propositions: the ALJ’s role as factfinder; the ALJ’s discretion to assess credibility; the deference owed on appeal; and the Supreme Court’s limited posture (not “third guess[ing]” the Board and Court of Appeals on the same evidentiary record).
    • The opinion also anchors the standard that, when the claimant prevails before the ALJ, review is “highly deferential.”
  • Thompson Catering & Special Events v. Costello, 701 S.W.3d 541 (Ky. 2024)
    • Quoted for the proposition that the ALJ determines “the quality, character and substance of the evidence presented,” reinforcing that reviewing courts do not decide which evidence is “better.”
  • Paramount Foods, Inc. v. Burkhardt, 695 S.W.2d 418 (Ky. 1985)
    • Cited (via Thompson Catering) to underscore the ALJ’s authority to evaluate the “quality, character and substance” of proof.
  • W. Baptist Hosp. v. Kelly, 827 S.W.2d 685 (Ky. 1992)
    • Supports the Court’s statement that Supreme Court review is limited and does not amount to a second reweighing of the evidence.
  • Lab'y Corp of Am. v. Smith, 701 S.W.3d 228 (Ky. 2024)
    • Provides the articulation of the “clearly erroneous” review of factual findings (unreasonable under the evidence), and is also used to reinforce the ALJ’s authority to resolve conflicts in medical proof and select an impairment rating.
  • Special Fund v. Francis, 708 S.W.2d 641 (Ky. 1986)
    • Quoted (via Gosper) for the key rule: when the burdened party prevails at the ALJ level, the decision must be affirmed if supported by any substantial evidence; appellate courts may not reweigh proof.
  • Estate of Perkins by Perkins v. N. Am. Stainless, 724 S.W.3d 738 (Ky. 2025) and Smyzer v. B.F. Goodrich Chem. Co., 474 S.W.2d 367 (Ky. 1971)
    • Cited for the definition of “substantial evidence” as meaningful, relevant evidence strong enough to persuade a reasonable person.
  • Ira A. Watson Dep't Store v. Hamilton, 34 S.W.3d 48 (Ky. 2000) (citing McCloud v. Beth-Elkhorn Corp., 514 S.W.2d 46 (Ky. 1974))
    • Used to dispose of Rural King’s primary appellate move—pointing to contrary evidence. The Court reiterates that identifying evidence that could support a different result “is not an adequate basis for reversal.”
  • Pruitt v. Bugg Bros., 547 S.W.2d 123 (Ky. 1977)
    • Cited for the principle that resolving conflicting medical testimony is within the exclusive province of the factfinder.

Legal Reasoning

  1. Institutional roles and review constraints
    The Court begins by emphasizing that the ALJ is the factfinder under KRS 342.275, the Board reviews primarily for error correction under KRS 342.285, and the Court of Appeals provides a further constrained review under KRS 342.290. It also notes the Supreme Court’s limited posture on further review (citing Gosper and W. Baptist Hosp. v. Kelly).
  2. Substantial evidence, not “best evidence”
    Applying the substantial-evidence standard (as defined in Estate of Perkins by Perkins v. N. Am. Stainless and Smyzer v. B.F. Goodrich Chem. Co.), the Court holds that the ALJ’s findings were not “unreasonable” (the “clearly erroneous” framing drawn from Lab'y Corp of Am. v. Smith). Once substantial evidence exists, appellate bodies cannot reweigh competing proof (Special Fund v. Francis).
  3. Conflicting medical evidence is for the ALJ to resolve
    Rural King highlighted Dr. Jenkinson’s view (minimal restrictions) to argue that sedentary employment remained feasible. The Court answers with the core allocation-of-authority rule: the ALJ decides which medical opinions are most persuasive (Pruitt v. Bugg Bros.; Lab'y Corp of Am. v. Smith). The ALJ could reasonably prefer Dr. Manson’s and Dr. McEldowney’s more detailed restrictions (standing/walking limits, avoidance of uneven surfaces, no climbing/squatting/kneeling/crouching/stooping, need to elevate the foot).
  4. “Sedentary capacity” does not defeat total disability if regular, reliable work is not sustainable
    A pivotal factual inference endorsed by the Court is that even if Sallie could perform some seated tasks in the abstract, her unpredictable pain and functional variability—coupled with the need for elevation and limited tolerance for standing/walking—supported the ALJ’s conclusion that she could not work on a “regular and sustained basis in a competitive economy.” This is where the accommodated return-to-work period matters: the ALJ treated the year-long return as heavily modified (stool, reduced hours, coworkers performing tasks, using a shopping cart as a makeshift walker) and ultimately unsuccessful, supporting—rather than undermining—the conclusion of total disability.
  5. Pointing to contrary snippets is not reversible error
    The Court squarely applies Ira A. Watson Dep't Store v. Hamilton (citing McCloud v. Beth-Elkhorn Corp.) to reject Rural King’s approach: identifying evidence that could support a different result does not justify reversal.

Impact

Although unpublished and nonbinding under RAP 40(D), the opinion is a compact restatement of how Kentucky appellate courts will treat permanent total disability awards when the claimant prevailed before the ALJ:

  • Accommodated work attempts are not dispositive: a return to work with significant accommodations and reduced capacity may be treated as evidence of ongoing disability, especially where the attempt ultimately fails.
  • “Can do some sitting” is not the end of the inquiry: the practical ability to perform work reliably and predictably in a competitive economy can outweigh theoretical sedentary capability.
  • One favorable medical opinion will not compel reversal: when other medical opinions and claimant testimony supply substantial evidence supporting disability, appellate courts will not reweigh the conflict.
  • Appellate strategy constraint: the decision underscores that challenging an ALJ’s disability finding requires demonstrating a lack of substantial evidence (or legal error), not assembling a competing narrative from selective record excerpts.

Complex Concepts Simplified

  • “Permanent total disability” (PTD)
    PTD in this context is not limited to whether the worker can perform any isolated task; it is a functional, real-world assessment of whether the worker can sustain regular employment in the competitive economy given medical restrictions, symptoms, age/work history, and credibility findings.
  • “Substantial evidence”
    Not “overwhelming” proof. It is enough relevant, meaningful evidence that a reasonable person could be persuaded. If that threshold is met, appellate courts must affirm, even if other evidence points the other way.
  • “Clearly erroneous” factual review
    The question is not whether appellate judges would have decided differently. The question is whether the ALJ’s findings were unreasonable on this record.
  • Conflicting medical opinions
    When doctors disagree, the ALJ chooses which opinion(s) to believe. Appellate courts generally do not second-guess that choice if it is supported by substantial evidence.
  • Accommodated employment
    Work performed with special adjustments (stools, reduced hours, coworkers completing essential tasks) may not reflect “competitive economy” employment and may support, rather than defeat, a finding of PTD when the worker cannot sustain even the accommodated role.
  • Unpublished opinion limitations (RAP 40(D), RAP 41)
    This decision cannot be cited as binding precedent, though it may be cited for consideration in limited circumstances when no published opinion adequately addresses the point.

Conclusion

The Supreme Court of Kentucky affirmed the PTD award because the ALJ’s decision rested on substantial evidence: credible testimony of unpredictable, function-limiting pain and persuasive medical restrictions inconsistent with sustained employment, reinforced by an unsuccessful, heavily accommodated return-to-work attempt. The opinion’s central lesson is procedural as much as substantive: in Kentucky workers’ compensation appeals, a party does not win by showing that some evidence could support a different outcome; it must show that the ALJ’s outcome lacked substantial evidentiary support or rested on legal error.