ࡱ> [ bjbj (jj0'Fl:::N8dN.JJ```ceeeeee$ 2:" ``u .8`:`c c r :,":`> `88N8%: d0 _ : NNALASKA WORKERS' COMPENSATION BOARD P.O. Box 25512 Juneau, Alaska 99802-5512 DAN MICHAEL PECH, Employee, Applicant, v. LIFETOUCH NATIONAL SCHOOL STUDIO, Employer, and LIBERTY MUTUAL INSURANCE CO., Insurer, Defendants. ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) FINAL DECISION AND ORDER AWCB Case No. 200027202 AWCB Decision No. 02-0146 Filed with AWCB Anchorage, Alaska on July 31, 2002. We heard the employees claim for benefits on June 5, 2002 at Anchorage, Alaska. The employee represents himself. Attorney Constance Livsey represents the employer. We left the evidentiary record open until June 24, 2002 to receive information from the employee regarding his travel expenses, and the employers objections thereto. We closed the record on July 9, 2002, the day on which the full Board next met for hearings. ISSUES Is the employee entitled to additional benefits, as more fully identified below? Did Workers Compensation Officer (WCO), Douglass Gerke, abuse his discretion when he failed recuse WCO Cathy Gaal, and if so, to what remedy is the employee entitled? Should we exercise our discretion to order another SIME (Second Independent Medical Evaluation), or strike the existing SIME report by John Lipon, D.O.? SUMMARY OF THE EVIDENCE Summary of the evidence related to the employees claim on the merits for additional workers compensation benefits? The employee seeks unpaid temporary total disability (TTD) benefits from November 8 through 11, 2000; April 21 through May 6, 2001; and September 12, 2001 and continuing, based on a compensation rate which would include about $8,500.00 of a salary draw paid and reported to the IRS in 2000, but only partially repaid by the employee in 2001. The employee also seeks additional medical benefits in the form of health club memberships (past/future based on Myron Schweigert, D.C.s July 17, 2001 prescription), transportation costs (itemized in a post hearing filing), including a trip to the employees prior treating surgeon in Colorado for an evaluation. Finally, the employee seeks penalties, interest, and litigation costs. Description of Injuries. Employee testified at hearing. He was working for the employer when he suffered two different injuries on November 4, 2000. On the day in question, the employee was sitting in a chair, when a student ran through a door striking the back of employees neck and head. Later the same day, the employee slipped and fell while loading photo equipment into a vehicle, hurting his low back and aggravating his already sore neck. The employee admits he had pre-existing orthopedic problems, but asserts that the work injuries severely aggravated his condition. The employee returned to work in less than a week, and continued working until April 21, 2001. According to the employee, he discontinued work because of low back pain related to his injuries. Also, the employee described an episode of back pain in April 2001 that he associated with prolonged sitting. According to the employees supervisor, Al George, the employee was probably going to be terminated because of disciplinary problems related to unresolved co-worker interactions. (See, Georges December 3, 2000 letter to the Employee; ER 0145-146; and Georges April 18, 2001 letter to the employee; ER 0147) George testified the employees performance was otherwise acceptable, based on his business development numbers. Nevertheless, the employee had taken draws against his future commissions in excess of $8,500.00 in 2001, and had only repaid a portion of it before quitting his job in 2002. The employees total draws should not have exceeded a total of $2,000 at any given time. (ER 0145-146). The employee has not worked since leaving his employment. Post Injury Medical Treatment. The employee sought treatment with Myron Schweigert, D.C., on November 6, 2001. Dr. Schweigert provided adjustments and tentatively released the employee to return to work November 8, 2000. Medical records indicate Dr. Schweigert continued the employees conservative treatment, initially providing adjustments 3 times per week and since then gradually tapering off in conjunction with various forms of physical therapy. Dr. Schweigert also testified at hearing. The focus of Dr. Schweigerts testimony surrounded the employees ability to return to work. There was a miscommunication regarding Physicians Assistant Jan Oxfords release from work. Dr. Schweigert testified his assistant does not have authority to make such decisions. When the employee continued to experience pain, Dr. Schweigert referred him to Grant Roderer, M.D., at the Advanced Pain Center in Anchorage. Following diagnostic testing, Dr. Roderer diagnosed L4-5 discogenic pain. The employee was also referred to Samuel Shurig, D.O., in March 2001 for a pain medication prescription, to which the employee testified he had a severe reaction, which he alleges required his hospitalization. There are not medical records to support this allegation, however. On June 5, 2001, the employee was seen by Luis Kralick, M.D., at Dr. Schweigerts request for neurosurgical evaluation. Davis Peterson, M.D., an orthopedic surgeon, saw the employee on referral from Dr. Kralick. Dr. Peterson recommended continued conservative treatment over surgery because of the employees pre-existing multi-level lumbar disease. On self-referral, the employee was evaluated by Michael Jannsen, D.O., the Colorado surgeon who performed the employees 1997 spinal fusion at L5-S1. (Dr. Jannsen September 25, 2001 Report). Dr. Jannsen recommended a 1.5 Telsa high-quality MRI, which was never completed, the employee testified, because the insurance company would not pre-authorize it. Dr. Schweigert continues to treat the employee and believes he is not able to return to work. (Hearing Exhibit 4). At the time of the hearing, Dr. Schweigert has charged $4,886.00 of unpaid medical bills for treatment provided to the employee. (Hearing Exhibits 5 and 5A). Pre-Injury Medical Treatment. Medical records indicate the employee has had previous treatment for back and neck pain. In September 1984, the employee had an industrial injury to his low back while working for United Parcel Service in Colorado. Diagnostics showed an L5-S1 abnormality and disc degeneration at L4-5. Conservative treatment followed without success. Kenneth Tuerk, M.D., performed a discectomy in March 1987. The employee had a good result; indicating his prior right leg pain had resolved. In 1989, Dr. Tuerk released the employee to return to work following his review of photographs of the employee at a high diving exhibition. In March 1991, the employee suffered a right knee injury at work. In March 1994 the employee suffered neck, upper/lower back and right leg pain following a motor vehicle accident. Records indicate the employee treated conservatively with a chiropractor following the accident who recommended the employee avoid lifting over 40 pounds, excessive standing, sitting or bending. Following an at-work altercation with a co-worker, the employee was referred by his chiropractor to Jeff Kleiner, M.D. An MRI ordered showed a moderate L5-S1 bulge with impingement on the right S1 nerve root. Epidural steroid injection therapy was recommended and undertaken, followed by selective nerve root blocks. A microdiscectomy surgery at L5-S1 was performed in February 1996. Dr. Kleiner advised against further chiropractic treatment for his neck and referred left upper extremity pain. A June 20, 1996 MRI showed a C3-4 left-sided disc bulge. For his low back, the employee had facet block therapy at L5-S1 which appeared to alleviate his symptoms on a temporary basis. When his low back pain recurred, the employee had discograms at the L2-3 through L5-S1 levels which showed grade 4 annular tears at all levels except L5-S1 which had a grade 5 annular tear. Dr. Kleiner recommended a spinal fusion at L5-S1 with instrumentation and internal stimulator. Dr. Jannsen agreed, and performed the fusion in 1997. The employee testified he did not have any pain subsequent to his surgery until the work injuries. In fact, the employee submitted a video which showed him boxing semi-professionally about one year before his injury. Employers Independent Medical Evaluation. Neurosurgeon, Paul Williams, M.D., psychiatrist, David Glass, M. D. and orthopedic surgeon, John Swanson, M.D., from Lake Oswago, Oregon performed an evaluation at the employers request on July 30, 2001. Their summary of the employees pre and post injury medical treatment (up to the date of the evaluation) is consistent with our summary of the medical evidence detailed above. Drs. Swanson and Williams authored a joint report. They found the employee sustained sprain/strain injuries to his neck and low back from the November 2000 work accidents, but opined that the employees continuing symptoms and need for treatment were causally related to his pre-existing orthopedic conditions. They found the employee was medically stable from his work injuries within 90 days, and that he had not suffered any permanent partial impairment related to the injuries. They further opined he was fully able to return to his usual duties without limitations after, at most, 90 days. Dr. Glass submitted a separate psychiatric. He opined that the employees past medical history showed significant psychological issues related to his prior lumber complaints, and . . . records reflect the possibility of a factitious or conscious component to his subjective pain complaints. . . . There is obviously an element of malingering in this case. Dr. Glass did not believe the employees psychiatric conditions were caused, or permanently aggravated by the work injuries, nor did they require further treatment. Finally, Dr. Glass opined that the employee was medically stable, without any permanent psychological impairment, and that the employee was capable of returning to his usual employment within 90 days of his strain injuries, as noted by Drs. Williams and Swanson. Board Ordered Second Independent Medical Evaluation. The employee was evaluated by John Lipon, D.O., on November 19, 2002. Facts relating to the employees claim that Dr. Lipons report should be stricken and another SIME ordered are set forth below. Dr. Lipon opined that the employee suffered a work related contusion to this head, and strains to his neck, thoracic, and lumbar spine from the November 4, 2002 injuries. Dr. Lipon was also aware of the employees complaint of low back pain caused by prolonged sitting in April 2001, but did not attribute any of the employees current complaints to that incident. Dr. Lipons report states: It would be expected that those injuries would have reached maximum medical improvement by three months post injury. His ongoing complaints are not supported by todays objective testing. They may be related to the pre-existing degenerative changes in his neck and back. They would also be consistent, in his lower back, with the multiple surgeries he has undergone. [Further,] [I]t is my opinion the injuries from 11-4-00 were not a factor in aggravation or acceleration of his pre-existing condition. Mr. Pech does have, on imaging studies, changes consistent with degenerative disease in his cervical and lumbar spine and also prior surgery in the lumbar spine. It would be my opinion that he may have ongoing pain complaints because of those degenerative changes. Mr. Pech also exhibited pain behavior and symptom magnification during the examination process. His subjective complaints were not supported by objective testing at the time of the exam. His diffuse complaints would not be supported in whole by the degenerative changes in the neck and spine nor the prior surgeries in the lumbosacral area. No additional treatment is recommended for [these conditions which,]. . . in my opinion, would have reached maximum medical improvement at three months post injury. [With regard to efficacy of having a surgical fusion at L4-5,] in my opinion, a fusion at that level is not going to resolve all of the multiple complaints in his lower back and legs. In the lower extremities, there was no evidence of atrophy. His strength was good, as he was able to heel and toe walk. His extensor hallucis and digitorum longus strength was good. [The decreased Achilles deep tendon reflex on the right as compared to the left is] consistent with his prior surgeries at the lumbosacral region. Finally, Dr. Lipon opined that the employee was medically stable (as defined by Act) and capable of working his regular job, without modification, by February 4, 2001. The employee did not, in Dr. Lipons opinion, suffer any permanent impairment as a result of the injury under either the fourth or fifth edition of the American Medical Association Guides to the Evaluation of Permanent Impairment. Summary of the evidence related to the question of whether it was improper to not recuse WCO Cathy Gaal from the employees claim? The employee alleged Gaal was biased and prejudiced against him. (Employees letters dated March 6 and 7, 2002) Gaals supervisor, Gerke, reviewed the employees allegations in support of Gaals recusal and determined the allegations were unfounded. (Gerkes April 11, 2002 letter). Gerkes letter, in pertinent part states: William Walters, Chief of Adjudications, has asked me to respond to your letters dated 3-6-02 and 3-7-02. You also discussed your concerns with me on 3-14-02 and 4-10-02. You have asked for the recusal of Cathy Gaal, Workers Compensation Officer, as the workers compensation officer handling future prehearing conferences in this case. In your opinion, she is not impartial, she is working with the employers attorney, Constance Livsey, to leave you out of the decision making process, she has failed to accurately memorialize events in prehearing conference summaries and she has failed to inform you of your rights. In additional, you have raised issues regarding the SIME and discovery processes. I have met with you, briefly discussed your case with Cathy Gaal and have reviewed your request and your file. My review did not reveal any conflict of interest, inappropriate action or incompetence on the part of Cathy Gaal; accordingly, I find nothing that would warrant recusal of Cathy Gaal. Nothing in the written record indicates that she has been partial in the handling of your case, the rendering of decisions or that she has left you out of the decision making process. Although she has completed lengthy and detailed prehearing summaries, Im sure there are comments, during the prehearing, that were not included in the prehearing summary. The prehearing summary is not a transcript of the prehearing but rather a method of succinctly memorializing the main issues and pertinent comments. To the extent that the summary does not conform to a partys understanding of what transpired in the prehearing, parties are instructed, in accordance with instructions on the prehearing conference summary form, to file a written objection within 10 days of service of the summary. An Objection of Pre-Hearing 3-6-02, dated 3-20-02, was filed with the Board, by you, on 3-20-02 (the 3-6-02 prehearing conference summary was served by the Board on 3-22-02). The next prehearing summary will reflect your amendments to your workers compensation claim and list the active petitions. It is unfortunate that you feel that you have not always been given complete or correct information regarding Board procedures or your rights. Based upon my review of your case, I can only assume that any perceived shortcomings are the result of miscommunications or interpretation of comments by Cathy Gaal. Cathy Gaal has extensive workers compensation experience and a good understanding of workers compensation statutes, regulations and procedures. While I can appreciate your apparent frustration with a process that sometimes takes longer than we all would like, the established statutes, regulations and procedures are designed to preserve the rights of all parties and to allow due process under the law. The parties have each informally requested discovery and the opposing party has responded. If the informal discovery process does not yield results, a party can do as you have done, file a petition to compel discovery, 3-26-02 (Constance Livsey also apparently considered your 2-9-02 letter as a petition since she served and filed an answer dated 3-1-02). You also filed a petition, 3-26-02, requesting another SIME due to the SIME report not being filed in a timely manner. Your 3-20-02 Objection of Pre-Hearing 3-6-02 refers to an additional job description attached to your objection, that was not sent to the SIME examiner. It does not appear that either party previously included this job description in the medical records binders for the SIME. If you would like the SIME examiner to comment on your ability to perform the job as described, please serve and file a petition, with the job description attached, requesting Board follow-up with the SIME examiner. Initially, a determination will be made by the person processing the SIME as whether or not further clarification is needed from the SIME examiner. In addition, the SIME examiner was provided with the SCODROT job description for Sales Representative, Printing, but it does not appear that he commented on your ability to do the job as described. A comment may or may not be needed. I have advised you that you have not requested an eligibility evaluation for reemployment benefits. You may wish to do so since Dr. Schweigert, report dated 7-3-01, noted that your injury may permanently preclude return to job at the time of injury. A Request for Eligibility Evaluation for Reemployment Benefits form and a copy of Dr. Schweigerts report were given to you on 4-10-02. As we discussed, all proceedings before the Board are started by filing a written claim or petition. 8 AAC 45.050. A claim or an amended claim is a written request for benefits. A request for action by the board, other than a claim for specific benefits, must be made by a petition. The petition must be served on all parties and filed with the Board, by the petitioner. Service of all correspondence must be made in accordance with 8 AAC 45.060. If you want to appeal my decision, on not recusing Cathy Gaal, you must serve and file a petition requesting recusal. The employee was not satisfied and outlined his concerns further. (Employees April 16, 2002 response). This letter states the employee is objecting to the April 11, 2002 Prehearing Conference Summary and asserts a request to have some topics at the June 5, 2002 hearing postponed. With regard to the objections, the employee reiterated his position that Gaal incorrectly summarized discussions during conferences, and that she abused her discretion by setting the claim for a hearing on short notice. The employee alleged his disability made it difficult for him to prepare his case on short notice. Gerke apparently treated the employees April letter as an appeal, and set the issue of Gaals recusal on for the June hearing. Summary of the evidence related to the question of whether we should strike Dr. Lipons SIME report, and/or order another SIME by a different physician? The employee alleges Dr. Lipons SIME report is probably biased because Dr. Lipon has a contract to do evaluations through Alaskan Independent Medical Evaluations (AIME), an organization used by employers and their insurers to perform evaluations. The employee wants Dr. Lipons draft(s) so he could compare it to the final signed version Dr. Lipon submitted to the Board. The employee alleges that without a comparison of the two (if in fact two versions exist), with an opportunity to cross-examine Dr. Lipon regarding any discrepancies, the report should be stricken, and/or a second evaluation be ordered. According to the SIME Form, there were medical disputes between Dr. Schweigert, the employees treating chiropractor, and the employers evaluators, a neurosurgeon, Paul Williams, M.D., and an orthopedic surgeon, John Swanson, M.D. At the October 11, 2001 Prehearing Conference, the parties agreed to an SIME by John Lipon, D.O., an orthopedic surgeon. Dr. Lipon was selected because the employee said out-of state travel would be difficult for him and there were no in-state physicians on the Boards list in an area of specialty area which would accommodate the varied medical specialties. An SIME was scheduled for November 19, 2001. In her letter to Dr. Lipon, Gaal stated: It is important that the SIME is truly independent, and that neither you nor anyone with whom you practice, now or in the past, have treated or examined Dan Michael Pech. Therfore, before acting on this SIME, please review your records to make sure there is no conflict of interest or any reason why you should not perform the SIME. If you find any association between you, your partners, and this case or believe there is any conflict of interest, which would affect your independence, please contact me before preparing for this SIME. Dr. Lipons SIME report, at page one, states: The opinions expressed in this report are those of the physician and do not reflect the opinions of Alaska Independent Medical Evaluations. The examinee was informed that this examination was at the request of the STATE OF ALASKA, Department of Labor & Workforce Development, Workers Compensation Division, that a written report would be sent to that agency, and that the examination was for evaluative purposes only. . . . The historical portion of this report is being dictated in the presence of the patient so that additions or corrections can be made if necessary. (Emphasis in original). At pages two through six of the report, Dr. Lipon sets forth information regarding the employees Chief Complaint and a History of the Current Injury. We note, for the record, annotations by the employee attempting to clarify certain information to Dr. Lipon were noted on every page and set forth in italicized print. From pages six through eight, Dr. Lipon set forth information regarding the employees current complaints, past medical and socioeconomic history. At page eight, Dr. Lipon states that the employee was present during the dictation of this information which took in excess of one hour. According to the report, Dr. Lipon asked the employee if there was anything further to add, and the employee indicated we had covered the history well. At pages eight through ten, Dr. Lipon explains the physical examination he performed, to include a variety of orthopedic tests to uncover symptom magnification. Dr. Lipon noted a total time of one hour and twenty minutes had elapsed. At pages eleven through twenty-four Dr. Lipon summarized, in abstract form, medical records contained in the SIME packet provided by the Board, and his assessment of the diagnostic films he reviewed. The remainder of his 28 page report sets forth his diagnosis of the conditions from which the employee suffers, and discussed the effect the employees work injuries would had on such conditions. In closing, Dr. Lipons report states: This independent medical evaluation is based upon the subjective complaints and history given by the examinee, the objective medical records and tests provided to me, and the physical findings of Mr. Pech. . . .Recommendations regarding work and impairment ratings are given totally independently of the requesting agents. The opinions are based upon a reasonable medical probability. Medicine is both and art and a science, although an individual may appear to be fit for return to duty, there is no guarantee that the individual will not be reinsured or suffer additional injury once he returns. FINDINGS OF FACT AND CONCLUSIONS OF LAW We will address the second and third issues raised by the employee before deciding his claim on the merits. I. was it improper to not recuse WCO Cathy Gaal? We will independently review this issue, utilizing a substitution of judgment standard. Although there is no mechanism for addressing the recusal of a workers compensation officer in our Act and implementing regulations, we find the standards and processes outlined in the Alaska Executive Branch Ethics Act (AEBE) at AS 39.52.120 et. seq.; and the Administrative Procedures Act (APA) at AS 44.62.450 are persuasive authority. The grounds for recusal are set forth in the AEBA, as follows: AS 39.52.120 Misuse of official position for personal gain for oneself or another. AS 39.52.130 Improper gifts which could reasonably be inferred to influence the performance of official duties, actions, or judgment AS 39.52.140 Improper use or disclosure of information for benefit of the official or an immediate family member, or the disclosure of information made confidential by law. AS 39.52.150 Improper influence on state grants, contracts, leases, or loans for personal financial interest or the financial interest of an immediate family member. AS 39.52.160 Improper representation of a person in any matter pending before the administrative unit the officer serves. AS 39.52.170 Outside employment restricted, if in conflict with the proper discharge of official duties. AS 39.52.180 Restrictions on employment after leaving state service: for two years the officer may not represent, assist, or advise a person in any matter pending before the administrative unit the officer serves. AS 39.52.190 Aiding a violation of the of the Alaska Executive Branch Ethics Act is prohibited. The process for recusal is set forth in the APA. AS 44.62.450(c) provides, in part: A hearing officer or agency member shall voluntarily seek disqualification and withdraw from a case in which the hearing officer or agency member cannot afford a fair and impartial hearing or consideration. A party may request the disqualification of a hearing officer or agency member by filing an affidavit, before the taking of evidence at a hearing, stating with particularity the grounds upon which it is claimed that a fair and impartial hearing cannot be afforded. If the request concerns an agency member the issue shall be determined by the other members of the agency. If the request concerns the hearing officer, the issue shall be determined by the agency when the agency hears the case with the hearing officer. . . . An agency member may not withdraw voluntarily or be disqualified if the disqualification would prevent the existence of a quorum qualified to act in the particular case. Based on our review of the Boards file, including Gerkes assessment of Gaals conduct in relation to the employees claim, we have no basis to find that Gaal committed any of the acts prohibited by the AEBE. Therefore, if bias existed, it would have to have arisen for some other reason. We find no allegation of discrimination by Gaal against the employee was based on his race, gender, or other suspect ground as prohibited by AS 18.80.et. seq. We note, however, that the employee alleges his disability put him at a disadvantage for preparing for the hearing in June. Therefore, he alleges that it was an abuse of her discretion to set the claim for hearing. (The employees April 16, 2002 Objections to PHC Summary and Modification). However, we find the employee was requesting a hearing as early as October 2001, and that Gaal explained to him the procedure for initiating a hearing through an Affidavit of Readiness for Hearing (ARH). (October 11, 2001 PHC Summary). Six months later, on March 7, 2002, the employer filed an ARH on the employees claim. Based on 8 AAC 45.070(c), we conclude that Gaal had no discretion but to set the claim on for a hearing within 60 days, because the parties did not stipulate to a later date. Thus, we conclude Gaal did not abuse her discretion by setting the hearing within 60 days of March 7, 2002, because Boards regulation mandates this course of action. With regard to the employees claim Gaal was biased against him in manner by which she completed her prehearing conference summaries, we concur entirely with Gerkes assessment. PHC summaries are intended to be a very brief summary of the parties statements during the course of a conference. Gaals function as is largely ministerial in character. If a party believes a WCO has inaccurately summarized information in the summary, the recourse is, as the employees conduct reveals, to seek modification it by filing a written request for modification within 10 days in accordance with the regulations. 8 AAC 45.065(d), Further, any miscommunication can be clarified at a Board hearing. For this reason, we conclude that any misstatements made by Gaal were remedied by the employee himself, and in any event at the hearing. In summary, we conclude there is insufficient evidence to find an error was committed by failing to recuse Gaal from conducting prehearings in the employees claim. We further conclude that any alleged misstatements, omissions, or errors made were not prejudicial. Should we strike Dr. Lipons SIME report, and/or order an additional SIME by a different physician? Based on our review of Dr. Lipons report, we find he had a very clear understanding of his duty to perform an entirely independent evaluation on behalf of the Workers Compensation Board. We further find, again based on his report, that his history of the employees medical condition was dictated in the employees presence and that the employee corrected any misunderstandings at the time. We find Dr. Lipons abstract of the employees medical records is consistent with our independent assessment of the same records. Therefore, we conclude the only portions of the evaluation open to subjective assessment by Dr. Lipon were his actual physical examination of the employee, his review of the diagnostic films, and the conclusions he drew from all the information provided to him in order to answer the Boards questions. We find Dr. Lipons assessment of the films to be consistent with reports generated by the physicians (radiologists) who interpreted the films initially. With respect to the physical examination Dr. Lipon performed, we have no reason to believe that Dr. Lipon did not accurately record his findings from the standard orthopedic tests he performed. Therefore, based on our review of Dr. Lipons SIME report in relation to the other medical records available, we conclude the SIME was undertaken in accordance with the Boards standards for independent examiners. Finally, we find that the purpose for which the employee seeks any preliminary version(s) of the SIME report, to cross-examine Dr. Lipon and test his credibility, is valid. Every witness may be questioned on his or her credibility. Nevertheless, we find the process for accomplishing this task with an SIME physician is strictly regulated by 8 AAC 45.095(j), and, in this case, the employee did not comply. The purpose of our regulation is to protect our SIME physicians from the sometimes zealous intrusions litigating parties impose on expert witnesses. Our SIME physicians are carefully selected through a thorough screening process governed by regulation. We take administrative notice that Dr. Lipon was selected by the Board through this process, and placed on the Boards SIME list. Additionally, we find, as a practical matter, it would be burdensome for our SIME physicians to retain preliminary drafts of their reports. For all these reasons, we conclude that we will deny the employees request that we either order the production of the preliminary draft(s), if any, or strike Dr. Lipons report. Dr. Lipons report is not stricken, from the record and we will rely on it in deciding the employees claim for benefits. To what additional workers compensation benefits is the employee entitled? We must presume the employees claim against employer comes within the provisions of this chapter. AS 23.30.120(a). The evidence necessary to raise the presumption of compensability under Section 120 varies depending on the type of claim. "[I]n claims based on highly technical medical considerations, medical evidence is often necessary in order to make that connection." Burgess Construction Co. v. Smallwood, 623 P.2d 316 (Alaska 1981). In less complex cases, such as this one, lay evidence may be sufficiently probative to establish causation. Wolfer, 693 P.2d at 871. In this case, we find the employee attached the presumption he is not medically stable and in need of continued care, based on his own testimony and that of his treating physician, Dr. Schweigerts June 4, 2002 report and testimony. Once the presumption attaches, the employer, must produce substantial evidence showing the disability is not related to its work. Smallwood, 623 P.2d at 316. Substantial evidence is such relevant evidence as a reasonable mind would accept in light of all the evidence to support a conclusion. Kessick v. Alyeska Pipeline Serv. Co., 617 P.2d 755, 757 (Alaska 1980). There are two methods of overcoming the presumption of compensability. The employer may either (1) present affirmative evidence showing that its work did not cause the injury or disability; or (2) eliminate all reasonable possibilities its work caused the disability and/or need for treatment. DeYonge v. NANA/Marriott, 1 P.3d 90, 96 (Alaska 2000); Grainger v. Alaska Workers' Compensation Board, 805 P.2d 976, 977 (Alaska 1991). Because the presumption only shifts the burden of production, and not persuasion, evidence tending to attach or rebut the presumption is examined by itself. Wolfer, 693 P.2d at 869. We find, EME reports by Drs. Williams, Swanson, and Glass rebut the presumption the employees work injuries continue to be a substantial factor causing the employees claimed disability and need for treatment. If the employer produces substantial evidence to rebut the presumption, the presumption of compensability is dropped, and the employee must prove all elements of the case against the employer by a preponderance of the evidence. Wolfer, 693 P.2d at 870. "Where one has the burden of proving asserted facts by a preponderance of the evidence, he must induce a belief in the minds of the [triers of fact] that the asserted facts are probably true." Saxton v. Harris, 395 P.2d 71, 72 (Alaska 1964). We are persuaded, by a preponderance of the medical evidence on the record as whole, that the employees work injuries are no longer a substantial factor aggravating the employees preexisting spine conditions. We find Dr. Lipons opinion most convincing. We find we will give very little weight to the employees testimony because we did not find the employee credible. AS 23.30.122. Consequently, we give less probative value to the opinions of the employees treating physicians, particularly Dr. Schweigert, as compared to those physicians offering opinions based on objective findings. We choose to rely on Dr. Lipons opinion when rendering most of our opinions regarding the employees entitlement to benefits. Based on Dr. Lipons report, we find the employee became medically stable within 90 days of his work injuries, on or about February 4, 2001, and suffered no permanent impairment as a result of the work injuries, which we further find were simple sprains/strains. Therefore, we do not find the employee is entitled to TTD after that day, because TTD can not be paid for any period of disability occurring after medical stability. AS 23.30.185. Accordingly, the employees claim for TTD from April 21 through May 6 and from September 21 and continuing is denied and dismissed. We find the employees claim for TTD from November 8 through November 11, 2000 is granted. We find the question of the employees compensation rate somewhat complicated by the fact, the employee was paid wages in the form of draws which were not earned, but which were nevertheless taxed. Based on the payroll information submitted, we find the employee was paid on a weekly basis, even though the amount of pay varied depending on his commissions. Therefore, we find the employees compensation rate should be based on AS 23.30.220(1), by taking the employees taxable annual earnings in 2001 and dividing by 52 weeks. We realize this will inflate the compensation rate by including the $8,500 in draws the employee took, and which were taxed in 2000, but not earned, or for that matter repaid. We find, that while the employee is entitled to TTD, his employer had already advanced him money for as yet unearned commissions. Therefore, we find the employer prepaid its TTD obligation and the employee is not entitled to interest or penalties on such amount. We find that while the employee attained medical stability by February 4, 2001, he nevertheless remained in need of medical treatment which would reasonably allow him to continue working. Carter v. Municipality of Anchorage, 807 P.2d 476 (Alaska 1991) and Weidner & Assc. v. Hibdon, 989 P.2d 727 (Alaska 1999). We find, based on our review of the medical records, that the employee efforts to maintain and improve his physical stamina following his injuries through work outs at Polaris Gym, and his desire to continue his regime at the Alaska Club are commendable. We find, based on Dr. Schweigerts July 2001 prescription such activity is reasonable. Therefore, we conclude the employees claim for his gym membership costs are compensable. With regard to chiropractic care, we find the employee has a pre-existing degenerative condition in his spine. Because of such condition, we find that the employees chiropractic treatment regime, although in excess of the treatment standards outlined in our regulation, 8 AAC 45.082(f), was reasonable for up to the first year following the employees injuries. After November 4, 2001, we find the employees chiropractic treatment was more probably than not causally related to his pre-existing condition. Therefore, we conclude, the employees claim for chiropractic treatment by Dr. Schweigerts office is granted in part, and denied in part. The employer shall make payment to Dr. Schweigerts office for all unpaid treatments between November 4, 2000 and November 4, 2001 in accordance with the fee schedule, with statutory interest thereon. Similarly, we find travel to and from Dr. Schweigarts office for treatment during the first year, and the employees gym, compensable. The employer shall pay the transportation costs the employee incurred as set forth in the employees June 17, 2001 filing. Lastly, we do not find transportation costs to and from Dr. Jannsens evaluation compensable. While we understand the employees desire to have his former physician evaluate him, he was fully evaluated in Anchorage by several physicians, including two surgeons. Thus, neither Dr. Jannsens evaluation, nor the air travel to and from Colorado is a recoverable cost. We have no medical records to indicate the employees treatment at Alaska Regional Hospital in October 2001 is work related. Conseqently, we find travel to the hospital is not compensable. ORDER Employer shall pay the employees gym costs and Dr. Schweigerts unpaid treatments between November 4, 2000 and November 4, 2001, in accordance with the fee schedule, with statutory interest thereon. The employer shall make payment to the employee for his transportation costs to and from Dr. Schweigers office for compensable treatment, as identified above, and for travel to and from the gymnasium as identified in the employees June 17, 2002 filing. The employees claim is denied and dismissed in all other respects. Dated at Anchorage, Alaska this 31st day of July 2002. ALASKA WORKERS' COMPENSATION BOARD ___________________________________________ Rhonda L. Reinhold, Designated Chairperson ___________________________________________ S.T. Hagedorn, Member __________________________________________ John A. Abshire, Member APPEAL PROCEDURES This compensation order is a final decision. It becomes effective when filed in the office of the Board unless proceedings to appeal it are instituted. Proceedings to appeal must be instituted in Superior Court within 30 days of the filing of this decision and be brought by a party in interest against the Board and all other parties to the proceedings before the Board, as provided in the Rules of Appellate Procedure of the State of Alaska. RECONSIDERATION A party may ask the Board to reconsider this decision by filing a petition for reconsideration under AS 44.62.540 and in accordance with 8 AAC 45.050. The petition requesting reconsideration must be filed with the Board within 15 days after delivery or mailing of this decision. MODIFICATION Within one year after the rejection of a claim or within one year after the last payment of benefits under AS 23.30.180, 23.30.185, 23.30.190, 23.30.200 or 23.30.215 a party may ask the Board to modify this decision under AS 23.30.130 by filing a petition in accordance with 8 AAC 45.150 and 8 AAC 45.050. CERTIFICATION I hereby certify that the foregoing is a full, true and correct copy of the Final Decision and Order in the matter of DAN MICHAEL PECH employee / applicant; v. LIFETOUCH NATIONAL SCHOOL STUDIO, employer; LIBERTY MUTUAL INSURANCE CO, insurer / defendants; Case No. 200027202; dated and filed in the office of the Alaska Workers' Compensation Board in Anchorage, Alaska, this 31st day of July 2002. ________________________________ Marie Jankowski, Clerk  Mr. George was called as a witness by the employee in the morning, and then recalled in the afternoon by the employer.  For example, his straight leg raise while supine was dramatically inconsistent with passive elevation of his lower legs, knees fully extended and hips flexed to 90 degrees, while sitting. Dr. Lipon report at 10.  We administratively note that Ms. Gaal has been a full-time employee of the Board since 1993, and has been a WCO since 1995.  We do not find the employees claim that he left his employment because of pain credible. We believe instead, that the employee was at risk for termination. We base this finding on the testimony of Al George, his disciplinary warnings to the employee, and the employees failure to repay the excessive draws made against his commissions. Dan Michael Peck v. 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