A New York City firefighter [Plaintiff] challenged the Subchapter II Medical Board of the New York City Fire Department Pension Fund [Medical Board], after evaluating Plaintiff and reviewing his medical records, concluded that although the Plaintiff was disabled due to his right hip injury, this disabling condition was causally related to chronic degenerative joint disease, not a work-related injury. Accordingly, Plaintiff's application for accidental disability retirement benefits was denied and the Plaintiff was retired on "ordinary disability retirement benefits."
Supreme Court denied Plaintiff's appeal of the Board's decision to provide him with "ordinary disability retirement benefits" based on court's finding that Medical Board's determination was supported by credible medical evidence* and, thus, was not arbitrary and capricious. Supreme Court dismissed Plaintiff's complaint, which judgment was subsequently affirmed by the Appellate Division.
The Medical Board had reviewed a recent report submitted by the Plaintiff's surgeon in which the surgeon had opined that the Plaintiff had "post-traumatic unilateral right hip arthritis following an on-the-job injury." The Medical Board, however, ultimately disagreed with the surgeon, stating that the surgeon had not identified any basis for his description of the Petitioner's "arthrosis as 'post-traumatic,' and that there was no evidence that the petitioner had unilateral arthrosis...."
Citing Matter of Meyer v Board of Trustees of N.Y. City Fire Dept., Art. 1-B Pension Fund, 90 NY2d 139, the Appellate Division explained that "A firefighter is entitled to accidental disability retirement [benefits] when a medical examination and investigation shows that he or she is 'physically or mentally incapacitated for the performance of city-service as a natural and proximate result of an accidental injury received in such city-service'".
Following a medical examination, the Medical Board first determines whether the firefighter is disabled for performance of duty and ought to be retired and if it so finds, , it must then determine whether the disability is "a natural and proximate result of an accidental injury received in such city-service". The Medical Board than certifies its recommendation on this issue to the Board of Trustees, which is ultimately responsible for retiring the city service member and determining the issue of service-related causation.
In the event, as was here the case, a vote by the Board of Trustees on an application for ADR benefits results in a tie, the application is denied, and the firefighter is awarded ordinary disability retirement benefits as the Court of Appeal ruled in Matter of Meyer v Board of Trustees of N.Y. City Fire Dept., Art. 1-B Pension Fund.
In CPLR Article 78 proceeding challenging this result, "the reviewing court may not set aside the Board of Trustees' denial of accidental disability retirement resulting from such a tie vote unless it can be determined as a matter of law on the record that the disability was the natural and proximate result of a service-related accident." Further, said the Appellate Division, under this standard, "as long as there was any credible evidence of lack of causation before the Board of Trustees, its determination must stand."
* In Matter of Santoro v Board of Trustees of N.Y. City Fire Dept. Art.1-B Pension Fund, 217 AD2d 660, the Appellate Division noted that credible medical evidence "is evidence that proceeds from a credible source and reasonably tends to support the proposition for which it is offered". Credible evidence "must be evidentiary in nature and not merely a conclusion of law, nor mere conjecture or unsupported suspicion". In reviewing a determination by the Board of Trustees, "the courts cannot weigh the medical evidence or substitute their own judgment for that of the Medical Board", [See Matter of Santoro v Board of Trustees of N.Y. City Fire Dept. Art.1-B Pension Fund, 217 AD2d 660]. The Appellate Division also opined that in the event there is "conflicting medical evidence and medical reports are presented to the Medical Board, it is solely within the province of the Medical Board to resolve such conflicts."
Click on the URL set out below to access the Appellate Division's decision in this case.
https://www.nycourts.gov/reporter/3dseries/2022/2022_06007.htm