Summary
The Kentucky Supreme Court reviewed the denial of Edward Elder’s disability retirement benefits by the Kentucky Retirement Systems. The Court held that a genetic condition is not legally pre-existing merely because it was present at conception; it is pre-existing under the applicable statute only if symptomatic and objectively discoverable by a reasonable person before employment. The Court reversed and remanded, reaffirming Kentucky Retirement Systems v. Brown and holding that pre-employment medical records are not required in every case.
Topics
Practice areas
Questions Presented
- Whether a genetic condition is legally pre-existing under KRS 61.600(3)(d) merely because the genetic mutation was present at conception.
- Whether a claimant with fewer than sixteen years of service credit must submit pre-employment medical records to prove that a disabling condition was asymptomatic and not objectively discoverable by a reasonable person when employment began.
- Whether Kentucky Retirement Systems improperly remanded and denied Elder's claim based on a misinterpretation of Kentucky Retirement Systems v. West and improperly refused to reopen the record for additional medical evidence.
Holdings
- A genetic condition is not legally pre-existing merely because it was medically present at conception. Under KRS 61.600(3)(d), the condition is pre-existing only if it was symptomatic and objectively discoverable by a reasonable person before employment.
- Kentucky Retirement Systems v. West does not require every claimant to submit pre-employment medical records. A claimant may use other medical evidence, including post-employment records, testimony, and affidavits, to prove that the disabling condition was asymptomatic and not objectively discoverable before employment.
- The claimant alone bears the burden of proving by a preponderance of the evidence that the disabling condition was not pre-existing; the burden never shifts to Kentucky Retirement Systems.
- Systems erred by remanding the hearing officer's original recommendation based on a mistaken interpretation of West and compounded that error by refusing Elder an opportunity to submit additional medical proof after altering the perceived evidentiary requirements.
Key quotations
“Initially, from a legal perspective, a genetic disorder is not “pre-existing” merely because it is medically present at conception.” (12)
“Denial of West’s claim due to his failure to submit pre-employment medical records should not be interpreted to mean every claim unsupported by similar health records must be denied.” (17)
“In short, Systems misinterpreted the import of West, incorrectly ordered remand based on its mistaken belief, and compounded its error by refusing to reopen proof to allow Elder a fair opportunity to submit the very type of pre-employment medical records it erroneously maintained West now requires.” (21)
Factual background
Elder became a member of the County Employees Retirement System when he began working as a school custodian in 1995. He worked regularly and without interruption until 2007, when he developed chronic nosebleeds, gastrointestinal bleeding, anemia, and other symptoms later attributed to HHT. Although HHT is a hereditary genetic condition present at conception, the record showed that Elder remained asymptomatic or reasonably unaware of the condition until 2007, and he retired in 2011 with fifteen years of service credit.
Procedural history
Elder applied for disability retirement benefits after developing disabling symptoms of hereditary hemorrhagic telangiectasia (HHT). Two medical review panels found him permanently disabled but concluded the genetic condition was pre-existing. A hearing officer initially recommended approval, but Systems remanded the matter after the decision in Kentucky Retirement Systems v. West; the hearing officer then recommended denial. Systems adopted the denial, the Franklin Circuit Court affirmed, and the Court of Appeals affirmed. The Supreme Court of Kentucky reversed and remanded.
Remand instructions
Remand the matter to Kentucky Retirement Systems and return it to a Medical Review Panel for proper consideration under Brown and the court's opinion. Elder must be permitted to submit any additional medical records he wishes to offer.