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You can search the entire site. or go to the recent opinions, or the chronological or subject indices. Brown v. Patriot Maintenance, Inc. (10/08/2004) sp-5835

Brown v. Patriot Maintenance, Inc. (10/08/2004) sp-5835

     Notice:   This opinion is subject to correction  before
     publication  in  the  Pacific  Reporter.   Readers  are
     requested to bring errors to the attention of the Clerk
     of  the  Appellate  Courts, 303  K  Street,  Anchorage,
     Alaska 99501, phone (907) 264-0608, fax (907) 264-0878,
     e-mail corrections@appellate.courts.state.ak.us.


            THE SUPREME COURT OF THE STATE OF ALASKA

DEBRA F. BROWN,               )
                              )    Supreme Court No. S-10955
               Appellant,          )
                              )    Superior Court No.
          v.                  )    4FA-01-2713 CI
                              )
PATRIOT MAINTENANCE, INC.,    )    O P I N I O N
and CONTINENTAL INSURANCE     )
CO.,                          )
               Appellees.          )         [No. 5835 -  October
8, 2004]
                                                                )

          Appeal  from the Superior Court of the  State
          of  Alaska, Fourth Judicial District, Mark I.
          Wood, Judge.

          Appearances: James M. Hackett, Law Office  of
          James  M.  Hackett, Fairbanks, for Appellant.
          Constance  E. Livsey and Jeffrey D. Holloway,
          Holmes  Weddle  &  Barcott,  Anchorage,   for
          Appellees.

          Before:   Bryner,  Chief  Justice,  Matthews,
          Eastaugh, Fabe and Carpeneti, Justices.

          BRYNER, Chief Justice.

I.   INTRODUCTION

          This appeal challenges a decision by the Alaska Workers

Compensation  Board denying disability benefits to  Debra  Brown,

who  claimed  that  she  suffered  from  a  disabling  condition,

fibromyalgia, that arose because she fell from a ladder at  work.

The  board heard conflicting medical testimony  some finding that

her condition probably stemmed from the fall and some finding  no

work-related causation  and decided that the testimony  rejecting

causation   was  persuasive.   We  affirm  the  boards  decision,

concluding  that  the board did not improperly  fail  to  resolve

doubt  in  Browns favor and did not preclude meaningful appellate

review by disregarding the lay testimony concerning causation.

II.  FACTS

          While  Debra Brown was working on a cleaning  crew  for

Patriot Maintenance, Inc., her stepladder collapsed.  She fell to

the  sidewalk, landing on the collapsed ladder with her  hip  and

striking  the sidewalk with her back, neck, and head.  Brown  was

taken to the emergency room, where she reported having a headache

and feeling pain in her hip, scapula, and neck.  X-rays showed no

fractures  or other bone damage, and the emergency room physician

found  no  evidence  of  acute injury apart  from  abrasions  and

bruises.   The following week, Brown was examined by her  primary

care  physician,  Dr. Daniel Junck, who found a contusion  (which

seemed  to  be resolving) on Browns right buttock and noted  that

Brown  also had apparently suffered a cervical strain.  Dr. Junck

predicted  that  Brown would continue to improve but  recommended

that  she  wait another week before attempting to work,  advising

her to pursue light activities such as walking.

          In  the  ensuing months, however, Browns symptoms  grew

progressively worse, became debilitating, and prevented her  from

resuming her job.  Brown began to experience tenderness and  pain

radiating  throughout  her  body;  she  also  reported   migraine

headaches,  lethargy, disturbed sleep, and feelings of depression

with   suicidal   thoughts.  She  filed  a  claim   for   workers

compensation benefits, seeking temporary total disability.

          In  a  followup examination about two months after  the

accident,  Dr.  Junck  tentatively noted that  Brown  might  have

developed  fibromyalgia syndrome.  But in a  separate  evaluation

requested   by  Patriot  Maintenance,  Dr.  James   Dinneen,   an

orthopedic surgeon, found no objective evidence of any measurable

impairment  that can be attributed to the incident at this  time.

Although  Dr.  Dinneen  confirmed that Brown  had  experienced  a

contusion  on her right buttock and compression of her spine,  he

expected  her  symptoms  from these injuries  to  resolve  within

thirty days.  But during the next six weeks, Brown returned twice

to  Dr.  Junck,  complaining  of  continuing  and  still  growing

discomfort;  Dr.  Junck  prescribed an  antidepressant,  directed

Brown  to remain off work, and ultimately diagnosed her condition

as fibromyalgia.

          Brown  then underwent an independent medical evaluation

by  a  panel of three physicians: Dr. G. DeAndrea, a neurologist,

Dr.   John  E.  Z.  Caner,  a  rheumatologist,  and  Dr.  Russell

Vandenbelt, a psychiatrist.  Dr. DeAndreas report represented the

consensus  view  of  the  panel.   Although  each  panel   member

described  the likely causes of Browns symptoms from a  differing

medical  perspective,  the  panel  unanimously  agreed  with  Dr.

DeAndreas  conclusion  that  Ms.  Browns  present  condition   is

strictly   psychiatric  and  that  there  is  no  non-psychiatric

condition  or  impairment as a result of [her on-the-job  injury]

other  than as reported of right buttock contusion and abrasions,

resolved, and without permanent partial impairment.

          From  his  standpoint  as a neurologist,  Dr.  DeAndrea

reported  that  there  was no objective  evidence  of  neurologic

impairment  and  found that Brown was fully employable.   But  he

deferred to Dr. Vandenbelt for a precise psychiatric diagnosis.

          Dr.  Vandenbelts psychiatric evaluation described Brown

as  suffering  from major depression and perhaps a  miscellaneous

somatoform  disorder.  Dr. Vandenbelt saw no  psychiatric  reason

why  Brown could not perform her original job.  Referring to  Dr.

Caners  finding  (discussed below) of possible fibromyalgia,  Dr.

Vandenbelt observed:  [T]he array of physical and mental symptoms

she  presents with strikes me as more psychiatric than  physical.

Specifically,  Dr.  Vandenbelt  summarized  his  view  of  Browns

condition as follows:

          It  is likely she is overwhelmed with current

          emotional and psychological stressors related

          to   her   marriage,  finances,   and   other

          difficulties at home with her children. . . .

          The   occupational  injury  in  question  has

          provided  a convenient focus for her concerns

          since it is easier for her [to] ask for  care

          for  physical concerns and symptoms than  for

          emotional ones.  The treatment she is in need

          of,  however, is not because of any condition

          causally  related  to or  aggravated  by  the

          occupational injury.

          Dr.  Caner, as a rheumatologist, believed Brown  to  be

suffering  from  a general pain disorder that had characteristics

of  fibromyalgia  but  was not caused by industrial  injury.   He

added  that, in his view, [e]pidemiologic studies have failed  to

demonstrate a causal relationship between accidental injuries and

the   subsequent  development  of  fibromyalgia,   although   the

association is frequently observed.  After reviewing the  results

of  Browns most recent laboratory analysis, Dr. Caner noted  that

he found no clear evidence of a pre-existing condition and was in

full  agreement  with  the discussion of Dr.  DeAndrea.   In  the

panels unanimous view, then, Brown was fully employable.

          After  receiving the panels report, Patriot Maintenance

controverted  Browns  claim  for  ongoing  benefits.   The  board

ordered  a  second independent medical evaluation, referring  the

case to two additional physicians: Dr. Walter Ling, a neurologist

and psychiatrist, and Dr. Stuart Silverman, a rheumatologist.

          Dr. Ling endorsed the views expressed by the panel.  He

specifically  agreed with Dr. DeAndrea that Browns pain  was  not

neurologically  based   that she instead  suffered  from  a  pain

disorder   associated   with   psychological   factors.     While

acknowledging that Browns pain disorder apparently  arose  within

the  context of her fall, Dr. Ling believed it unlikely that  the

fall  and  the resulting soft tissue injury played a  significant

role in development of her pain disorder.  In reaching this view,

Dr. Ling carefully considered, but discounted, the likelihood  of

any causal relationship to Browns accident:

          [Brown]  seems convinced that  the  need  for

          these  changes  stems from her  fall  injury.

          But  from a medical perspective, it  is  much

          more likely that her background psychological

          make-up  and her current life situation  have

          much  more to do with her conviction than  do

          the consequences of her specific injury.

          In  Dr.  Lings view, then, Browns accident  was  not  a

substantial  factor in causing her current condition.   Moreover,

Dr.  Ling  saw  little need to attach a precise  medical  tag  to

Browns  condition,  observing that, whether or  not  her  current

diffuse  pain  condition is labeled as fibromyalgia,  it  is  not

medically probable that it is related to her specific fall.

          By  contrast, Dr. Silverman disagreed with  the  panel,

concluding  that Brown suffered from fibromyalgia and  that  this

condition was probably work-related.  While concurring  with  Dr.

Caners diagnosis of fibromyalgia, Dr. Silverman sharply disagreed

with  his  view that current medical research fails to  establish

any  causal  link between traumatic injury and fibromyalgia.   As

Dr. Silverman saw the issue,

               What  is  in dispute is the relationship
          between   [Browns]   traumatic   injury    on
          September 15, 1999, and her later development
          of fibromyalgia.
          
               I, myself, participated in the Vancouver
          Consensus Conference in June, 1994, (J. Rheum
          1996,   23:3.)   which   stated   that    the
          development   of  fibromyalgia  following   a
          traumatic  injury does not necessarily  imply
          causation alone. . . .
          
               What  has been recently understood,  and
          this has been reported in a second article, a
          minority    report   in   the   Journal    of
          Rheumatology:  1997,  3:6,  324-27,  is  that
          patients  who have a chronic persistent  pain
          following a trauma may then go on, at a later
          time,  to  progressively  develop  widespread
          pain above & below the waist, consistent with
          fibromyalgia.
          
          Upon  reviewing their original reports in light of  Dr.

Lings and Dr. Silvermans positions, the physicians comprising the

original  panel  unanimously confirmed the  panels  position  and

rejected Dr. Silvermans view of the case.

          Specifically,  Dr.  DeAndrea  refuted  Dr.   Silvermans

interpretation of his  report, emphasizing that the entire  panel

had  agreed  with  the  report and  that  Dr.  Lings  report  had

independently  confirmed  the  panels  findings.   As   for   Dr.

Silvermans criticism of the panels failure to agree whether Brown

suffered  from  a  pain  disorder  or  somatoform  disorder,  Dr.

DeAndrea  observed:  Quite frankly in my  opinion,  there  is  no

difference.

          Dr.  Caner  similarly rejected Dr. Silvermans diagnosis

and  favored  Dr.  Lings position.  Warning that the  distinction

between psychogenic pain and fibromyalgia remains a controversial

medical  topic,  moreover, Dr. Caner specifically challenged  Dr.

Silvermans  interpretation  of the  conclusions  reached  by  the

Vancouver  Consensus Conference; Dr. Caner insisted  that,  since

the  necessary epidemiologic studies have not been performed, the

Vancouver Conferences consensus view would attach to Browns  case

and  would compel the conclusion that her work injury was  not  a

cause of her fibromyalgia.

          Dr.  Vandenbelt,  too, stood by his  prior  evaluation.

After  pointing out several flaws in Dr. Silvermans  report,  Dr.

Vandenbelt  noted  that  his  own  view  of  the  case   remained

essentially unchanged.

          Meanwhile,  Brown  had sought treatment  from  Dr.  Lee

Schlosstein,  a physician specializing in internal  medicine  and

rheumatology.  Dr. Schlosstein found that Brown needed  treatment

for  fibromyalgia and depression but ventured no  opinion  as  to

causation.

          The  board  conducted an evidentiary hearing on  Browns

claim  for  continuing  disability  benefits.   In  addition   to

considering the medical evidence described above, the board heard

lay testimony presented by Brown.  The boards decision summarized

the lay evidence as follows:

          [T]he  employee, her friends, family  members

          and coworkers uniformly testified that before

          the  fall, the employee was active, regularly

          playing  racquetball and working out  at  the

          Fairbanks  Athletic Club.   She  was  a  hard

          worker and had performed the majority of work

          required to complete the remodeling of  their

          house.   Since  the date of injury,  she  has

          gained weight and become physically unable to

          engage in most of her prior activities.   Her

          husband   testified   there   is   no   doubt

          concerning the link between the employees on-

          the-job injury and her current condition.  He

          also  presented a copy of Understanding Post-

          Traumatic    Fibromyalgia,   by    Mark    J.

          Pellegrino, which he believes helps  document

          the relationship between the employees trauma

          and      her      fibromyalgia     condition.

          Rehabilitation   counselor  Robert   Sullivan

          testified  that  he  believes  the   employee

          cannot  perform any jobs, other than odd  lot

          jobs, in her current condition.

          After  reviewing  all the evidence,  the  board  denied

Browns  claim.   Finding the opinions of Drs. Vandenbelt,  Caner,

DeAndrea,  and  Ling to be most persuasive, the  board  concluded

that  Brown  had  failed to meet her burden of proving  that  her

current condition was work-related.

          The  superior  court  affirmed the boards  ruling,  and

Brown filed this appeal.

III. DISCUSSION

          Brown  advances  two main arguments,  contending  first

that the board failed to resolve doubtful medical evidence in her

favor  and,  second, that it failed to address her lay  witnesses

testimony.

          In  an  appeal from a decision entered by the  superior

court as an intermediate court of appeal, we directly review  the

boards ruling, without deferring to the superior court.1  But our

review  of  the boards decision is deferential.  Alaska  Statutes

23.30.122  gives  the  board  the sole  power  to  determine  the

credibility of a witness2 and further gives the board  conclusive

power  to  evaluate  what weight to accord a  witness  testimony,

including  medical  testimony and reports, .  .  .  even  if  the

evidence  is conflicting or susceptible to contrary conclusions.3

Hence,  in  reviewing  a  finding on compensability,  we  do  not

reweigh  the  evidence  or  choose  among  competing  inferences;

instead,  we  limit our review to determining whether substantial

evidence  supports  the boards decision.4   Substantial  evidence

exists when a reasonable mind viewing the record as a whole could

accept a decision of non-compensability.5  We have recently  held

that  uncertainty  within  the medical community  concerning  the

precise  medical cause of a condition like fibromyalgia does  not

prevent  the  board  from  finding that  a  qualified  physicians

opinion on causation amounts to substantial evidence.6

          We  must  decide  Browns points on  appeal  with  these

precepts in mind.

     A.   Failure To Resolve Doubt in Browns Favor

          In  contending that the board impermissibly  failed  to

resolve  doubt in her favor, Brown cites Beauchamp  v.  Employers

Liability Assurance Corp. for the proposition that [i]f there  is

any  doubt as to the substance of medical testimony, it  must  be

resolved in favor of the claimant.7  Brown then points to several

supposed uncertainties that, she asserts, make this rule  germane

to  her  case: (1) the three rheumatologists who dealt  with  her

case  agreed that she suffers from chronic pain/fibromyalgia  and

that her fall caused or could have caused this condition; (2) Dr.

Ling  conceded that it was not medically impossible  for  a  fall

such  as hers to cause fibromyalgia; (3) the board disregarded  a

          book by a prominent rheumatologist supporting Browns theory of

causation;  (4) Dr. Vandenbelt failed to physically  examine  her

and  never  definitively diagnosed her condition;  and  (5)  Drs.

Schlosstein  and  Caner  made  certain  statements  during  their

testimony that arguably favored Browns position.

          Yet  the  rule  for  resolving doubt  we  mentioned  in

Beauchamp  will  not readily stretch to cover  Browns  situation.

The  claimant  in that case, Beauchamp, suffered continuing  pain

following  back surgery and eventually filed a claim, attributing

his back problems to a work injury predating his surgery that  he

had   not  previously  reported.8   The  only  medical  testimony

concerning  causation  was given by his surgeon,  Dr.  Mead,  who

reluctantly  expressed equivocal and uncertain views  as  to  the

possible causes of Beauchamps condition.9  The board nevertheless

found  Beauchamps claim compensable, relying principally  on  his

own  description of how his problems arose.10  The superior court

vacated the boards decision as unsupported, pointing to Dr. Meads

uncertainty as precluding a finding of probable causation.11

          We reversed the superior courts decision and reinstated

the  boards  award.12  Though acknowledging  that  Dr.  Mead  was

equivocal, we emphasized that the board was not restricted to  or

bound  by  this  intrinsically uncertain expert testimony,  since

Beauchamps  lay  testimony  could  also  be  considered   to   be

substantial  evidence supporting causation.  We  noted  that  the

board  could  have simply combined uncontradicted  lay  testimony

with  medical evidence which was in itself inconclusive, to reach

a conclusion.13  Examining the evidence as a whole, including the

combined  effect of Beauchamps and Dr. Meads testimony,  we  held

that  the record supported the boards conclusion.14  And we noted

in  passing  that  if there is any doubt as to the  substance  of

medical testimony, it must be resolved in favor of the claimant.15

          As applied in Beauchamp, then, the rule requiring doubt

to  be  resolved  in the claimants favor served  to  confirm  the

boards  broad fact-finding discretion and to narrow  a  reviewing

          courts  authority  to  reweigh the  boards  evidentiary

determinations.  But here, by contrast, Brown paradoxically seeks

to  invoke  the rule for the opposite purpose: she  urges  us  to

reverse  the  boards decision, and thereby narrow its factfinding

authority,  by  combing the record for signs of  doubt  that  the

board  itself did not consider important.  Applying the  rule  in

this way would defeat Beauchamps basic purpose.

          Beauchamp  is  distinguishable  for  another  important

reason.    In   Beauchamp  we  dealt  with   a   case   involving

uncertainties  arising  from a single expert  witnesss  equivocal

testimony.   Unlike  the  record in Beauchamp,  the  record  here

includes  the  testimony  of multiple medical  experts  who  gave

unequivocal  opinions rejecting causation.   Here,  each  of  the

medical   reports   the  board  found  persuasive   unequivocally

expressed  the  opinion that Browns condition  probably  was  not

caused  by  her injury; when viewed individually, then,  each  of

these reports unquestionably presented the board with substantial

evidence against finding causation.16  Brown thus seeks to stretch

the  rule  of  doubt beyond its original scope.  She  effectively

insists  that  the rule should apply not just to intrinsic  doubt

emerging  from a single witnesss equivocal opinion,  but  to  all

doubts  generated by conflicting medical testimony.   As  Patriot

Maintenance  correctly  responds, a  conflict  between  divergent

medical  views simply reveals a difference in firmly held medical

opinion.   In  prior decisions we have expressly recognized  that

this form of doubt lies beyond reach of the doubt-rule applied in

Beauchamp.17   The  rule requiring doubt to be  resolved  in  the

claimants favor does not extend to Browns situation.

          But   even  if  it  applied  to  doubts  generated   by

conflicting testimony, and even if it could be used to  restrict,

rather  than expand, the boards factfinding authority,  the  rule

requiring  doubt to be resolved in the claimants favor would  not

assist Brown, since the evidentiary problems she raises create no

significant   doubt.   Because  the  determination   of   medical

          causation hinges on medical probability, not medical certainty,18

evidence  suggesting  that  Browns fall  could  have  caused  her

condition or that a causal link was not medically impossible does

nothing  to undermine the boards finding on causation.  Dr.  Ling

cogently  made  this point in responding to a letter  questioning

his  concession that a causal link was not impossible:  I do  not

think  we are talking about possibilities.  What I was expressing

[in  the  report]  were  medical  probabilities.   It  would   be

impossible to say something is impossible.

          Similarly,   neither   Dr.   Vandenbelts   failure   to

physically  examine  Brown  nor  his  reluctance  to   attach   a

definitive medical label to her condition creates any significant

basis  for  doubting his views.  As the psychiatric member  of  a

three-physician   panel  that  included  a  neurologist   and   a

rheumatologist, Dr. Vandenbelt could reasonably choose to rely on

his   colleagues   to  perform  the  physical  part   of   Browns

examination.  And as demonstrated by his report and our case law,

his reluctance to attach a definitive name to Browns condition is

substantively inconsequential.19

          Furthermore,  any  possible  doubt  implicit   in   the

passages  of  testimony that Brown attributes to Drs. Schlosstein

and  Caner could have had no significant bearing on the potential

weight of their overall views.20

          And  no serious doubt can arise from the boards failure

to specifically discuss views expressed by Dr. Mark J. Pellegrino

in his book Understanding Post-Traumatic Fibromyalgia21  passages

of  which  were submitted during the testimony of Browns husband.

Contrary  to  Browns  assertions, the  boards  decision  did  not

disregard  this  book.   As mentioned already  above,  the  board

expressly  acknowledged that selected passages of  the  book  had

been filed, and summarized their general content, which describes

case  studies suggestive, in Dr. Pellegrinos view,  of  a  strong

association  between  the  onset  of  fibromyalgia  and  physical

trauma.   But  these  views  do  not  purport  to  apply  to  the

          particular facts of Browns claim.  Furthermore, other readily

accessible publications disagree with Dr. Pellegrinos views;22 the

experts  who  actually  testified  at  Browns  hearing  generally

acknowledged  that the existence of a causal association  between

trauma  and  fibromyalgia  the major assertion of Dr. Pellegrinos

book  remains controversial and eludes definitive proof; and  Dr.

Pellegrinos  position  on  this issue essentially  parallels  the

views  forcefully  and much more specifically  advocated  by  Dr.

Silverman.  Given these circumstances, Dr. Pellegrinos  book  was

cumulative at best and did not require more specific discussion.

          For  all these reasons, we reject Browns claim that the

board erred in failing to resolve doubt in her favor.

     B.   Failure To Discuss Lay Testimony

          Browns  second major claim is that the board  erred  by

focusing  solely  on  the  medical  evidence  of  causation   and

disregarding the testimony by Brown, her husband, and  other  lay

witnesses who supported her claim of causation.

          Preliminarily,  we  note  that  Brown  is  mistaken  in

suggesting that the board ignored her lay evidence.  As  we  have

already  noted above, the boards decision expressly  acknowledged

and  summarized the lay testimony.  Although the  board  did  not

analyze  this  testimony  in its findings  and  conclusions,  its

summary  belies Browns claim that the board simply  disregard[ed]

this evidence.

          More important, our cases did not require the board  to

discuss the lay evidence at length in deciding this case.   Brown

builds  her claim of error on two cases, Ayele v. Unisea, Inc.,23

and  Stephens  v.  ITT/Felec Services.24   Neither  supports  her

position.   Our opinion in Ayele usefully illustrates this  point

by describing and narrowing the relevant holding in Stephens.

          Ayele  dealt  with a former Unisea worker,  Ayele,  who

claimed  to have been injured on the job by exposure to  ammonia,

asserting that this exposure caused injuries that progressed into

a debilitating mental illness after he ended his employment.25  At

his  hearing before the board, Ayele and Unisea agreed that Ayele

was disabled but disagreed as to the disabilitys cause.26  Unisea

relied  on  a  three-physician panel that found  no  work-related

causation.27  Ayele relied on his treating physician and attempted

to  bolster  his  claim  with four lay witnesses   relatives  and

friends who had seen him soon after his alleged exposure  and who

described his complaints, conduct, and visible symptoms in a  way

that supported Ayeles account of his original injury.28  The board

rejected  Ayeles claim, finding Uniseas medical  evidence  to  be

more persuasive than his.29  In explaining its decision, the board

extensively discussed the medical evidence but completely  failed

to discuss Ayeles lay witnesses.30

          On  appeal  Ayele  raised a single  point:  relying  on

Stephens, he claimed that the board erred by disregarding his lay

witnessess testimony.31  We rejected this argument, observing that

Ayele  mistakenly assumes that the lay-witness testimony in  this

case  is  potentially  material to  the  Boards  decision.32   In

explaining  this  conclusion, we began by  distinguishing  Ayeles

case from the circumstances in Stephens:

          There,  an  injured worker, Stephens,  sought
          compensation for a heart attack that  he  had
          suffered while working at a remote job  site.
          Several  medical experts testified  that  the
          heart  attack  was  not  work  related.   The
          experts  had  only limited information  about
          the   actual  work  conditions  under   which
          Stephenss  heart  attack occurred,  and  they
          expressly  based their opinions as  to  work-
          relatedness on various assumptions concerning
          those  work  conditions.   Although  Stephens
          presented  lay-witness testimony  tending  to
          undermine   these  assumptions,   the   Board
          adopted  the  experts  opinions  and   denied
          Stephenss  claim without even mentioning  his
          witnesses.[33]
          
          While  acknowledging that the lack of express  findings

concerning  the lay testimony required us to order  a  remand  in

Stephenss  case  because we were unable to  review  the  disputed

decision  without  knowing how the board  viewed  Stephenss  lay-

witness  testimony,  we stressed in Ayele  that  this  ruling  in

Stephens hinged on the lay testimonys highly material role  under

the particular facts there disputed:

          [W]e by no means held [in Stephens] that  the
          Board  must discuss all lay-witness testimony
          touching  on  a disputed issue.  Instead,  we
          relied on the specific nature of the evidence
          that  the  Boards decision failed to  address
          and  its  peculiar  relevance  to  the  issue
          actually  contested:  whether Stephenss  work
          environment  caused  or  contributed  to  the
          heart attack  which undisputably occurred  at
          work and resulted in his injuries  or whether
          the  attack  resulted  from  his  preexisting
          physical   condition.   Thus,  our   decision
          requiring the Board to address Stephenss lay-
          witness   testimony  simply  recognized   the
          potential  materiality of that  testimony  in
          the  specific  factual setting  of  Stephenss
          case.[34]
          
          Applying   Stephenss  rationale  to  the  circumstances

presented  in Ayele, we concluded that the board did not  err  in

failing  to  mention  Ayeles lay testimony under  the  particular

facts  at  issue there, since that testimony would not have  been

material:

               In  this case, the lay-witness testimony
          bears little relevance to the Boards ultimate
          finding  of  lack  of  causation.   The   lay
          witnesses  testified about Ayeles statements,
          appearance,  and treatment by  Unisea  during
          the  months immediately following the  August
          31,   1991,  incident,  describing   him   as
          consistently  complaining  of   exposure   to
          ammonia  and  of  headaches, nosebleeds,  and
          vomiting.   At most, these accounts supported
          Ayeles  theory  of causation  by  tending  to
          confirm that during that period Ayele had  in
          fact been exposed to ammonia.
          
               The  medical  experts did not  seriously
          question  that Ayele had made the  complaints
          described by his lay witnesses, or even  that
          he  might have been exposed to ammonia.  They
          did  question  whether Ayeles complaints  had
          been  corroborated  by any objective  medical
          observations.  But the lay-witness  testimony
          sheds  little light on this issue.  Moreover,
          the  issue  of Ayeles condition  in  1991  is
          itself  of minor importance.  Despite  Ayeles
          assertions  to  the  contrary,  the   experts
          ultimate  opinions concerning Ayeles  present
          condition   did  not  hinge  on   assumptions
          concerning the August 1991 incident.  Rather,
          they drew on years of medical history and  on
          recent, thorough examinations of Ayele.
          
               . . . .
     
               Because the lay-witness testimony merely
          supported  Ayeles claim of past  exposure  to
          ammonia  and  did  not  cast  doubt  on   the
          validity  of the expert testimony  which  the
          Board accepted, the Boards failure to mention
          those   witnesses  in  its  decision  denying
          benefits   does   not   preclude   meaningful
          appellate review.[35]
          
          Comparing  Ayele  and Stephens to the circumstances  at

issue  here, we think that Browns case falls decidedly closer  to

          Ayele than Stephens.  Here as in Ayele, the existence of an

initial  work-related physical injury was not  in  dispute.   And

also  as  in  Ayele,  it was undisputed here  that  the  evidence

established  an apparent temporal link between the initial  work-

related  injury  and  a  more serious,  progressively  developing

condition;  and  in both cases, too, the existence  of  the  more

serious  condition  was not contested.  The controversy  centered

primarily on the conditions likely medical causes.

          Just  as it did in Ayele, then, the lay testimony  here

strongly  corroborated the claimants contentions that  a  serious

condition currently existed and appeared to be temporally  linked

to  the original work-related occurrence.  And in both cases  the

medical  experts largely accepted these points.  But here  as  in

Ayele,  the  medical experts nonetheless disagreed on  causation,

grounding  their opinions on medical observations  that  the  lay

testimony realistically could not have addressed.

          Thus,  despite  Browns claim to the contrary,  the  lay

witness  evidence  here  did  not materially  erode  the  medical

opinions  of  the physicians whose testimony the board  chose  to

accept.  Unlike the record in Stephens, the record here fails  to

suggest  that Drs. DeAndrea, Caner, Vandenbelt, or  Ling   either

individually  or collectively  relied on any significant  factual

assumptions that the lay testimony might have refuted or altered.

To  the  contrary,  the lay witnesses described  facts  that  the

experts  had  already received  and for the most  part  accepted.

Brown  and  her  husband testified about matters that  Brown  had

repeatedly  covered  in  the course of  her  many  prior  medical

interviews   virtually  all of which the  medical  panelists  had

studied.   Other  lay  witnesses mainly bolstered  the  testimony

presented  by  Mr. and Mrs. Brown.  On the whole, then,  the  lay

evidence contained few surprises and was not controversial.  Just

as  they  did  in  Ayele, the medical experts  here  keyed  their

divergent opinions on the differing medical inferences they  drew

from a fairly settled record of facts.

          Since  our  review of the record fails to  convince  us

that  the  lay testimony here was material in the sense described

by  Ayele  and Stephens, we conclude that the boards  summary  of

this evidence suffices and that more elaborate discussion was not

needed to give us a meaningful basis for appellate review.

IV.  CONCLUSION

          Because  we  conclude  that  the  boards  decision   is

adequately  explained and finds support in substantial  evidence,

we AFFIRM the boards order denying Browns claim.

_______________________________
     1    Handley v. State, 838 P.2d 1231, 1233 (Alaska 1992).

     2    AS 23.30.122 provides:

               The   board  has  the  sole   power   to
          determine  the credibility of a  witness.   A
          finding by the board concerning the weight to
          be  accorded a witnesss testimony,  including
          medical  testimony and reports, is conclusive
          even  if  the  evidence  is  conflicting   or
          susceptible  to  contrary  conclusions.   The
          findings of the board are subject to the same
          standard  of review as a jurys finding  in  a
          civil action.
          
     3     Resler v. Universal Servs., Inc., 778 P.2d 1146,  1149
(Alaska 1989).

     4     Safeway, Inc. v. Mackey, 965 P.2d 22, 27 (Alaska 1998)
(citations omitted); see also Bradbury v. Chugach Elec. Assn,  71
P.3d 901, 905 (Alaska 2003).

     5    Safeway, 965 P.2d at 27.

     6    Id. at 28.

     7     477  P.2d  993, 997 (Alaska 1970) (citing Thornton  v.
Alaska  Workmens  Comp.  Bd., 411 P.2d 209,  211  &  n.7  (Alaska
1966)).

     8    Beauchamp, 477 P.2d at 993-94.

     9    Id. at 995.

     10    Id. at 994.

     11    Id.

     12    Id. at 996.

     13    Id.

     14    Id. at 997.

     15    Id. (citing Thornton, 411 P.2d at 211 & n.7).

     16     See, e.g., Big K Grocery v. Gibson, 836 P.2d 941, 942
(Alaska  1992)  (It  has  always  been  possible  to  rebut   the
presumption  of  compensability by presenting a qualified  expert
who testifies that, in his or her opinion, the claimants work was
probably  not  a substantial cause of the disability.);  Safeway,
965  P.2d at 28 (holding that uncertainty concerning the ultimate
cause  of  fibromyalgia  does not defeat an  experts  opinion  on
causation, and affirming the boards denial of benefits  based  on
physicians  opinion  finding traumatic  injury  probably  has  no
causal link to later fibromyalgia).

     17    See, e.g., Miller v. ITT Arctic Servs., 577 P.2d 1044,
1048  (Alaska 1978) (Millers survivors apparently would  have  us
apply the rule whenever the evidence reveals lack of unanimity or
shows uncertainty among medical experts about ultimate causation.
We  are  not persuaded that the rule should be applied in  [this]
manner.).

     18    Safeway, 965 P.2d at 28.

     19    For example, we stressed in Beauchamp, 477 P.2d at 996,
that, [i]n determining causation, exact medical certainty is  not
required.   Compare, e.g., Black v. Universal Servs.,  Inc.,  627
P.2d 1073, 1075-76 & n.9 (Alaska 1981) (finding that a reasonable
mind would not accept diagnosis when physician had no opportunity
to  examine  Black in any depth), with Palmer v. Municipality  of
Anchorage, Police & Fire Retirement Bd., 65 P.3d 832, 846 (Alaska
2003)  (limiting  Black to situations where reviewing  physicians
statement  stands alone and is inconsistent with other evidence);
cf. Steffey v. Municipality of Anchorage, 1 P.3d 685, 692 (Alaska
2000)  (observing that it is not our role to reweigh the evidence
simply  because medical experts were not absolutely certain  that
work was not a substantial factor in [claimants] injury).

     20     Although her argument on this point is unclear, Brown
evidently  finds  conflict  between Dr. Schlossteins  observation
that depression is commonly associated with fibromyalgia and  Dr.
Caners testimony (agreeing with Dr. Silvermans view) that he  had
seen  no  evidence  that  Brown  suffered  from  any  significant
emotional problem before her accident.  The materiality  of  this
conflict  is  far  from  apparent: Dr.  Schlosstein  attached  no
particular  significance to the association between  fibromyalgia
and  depression, and Dr. Caners testimony that  he  had  seen  no
evidence of prior depression was specifically limited to evidence
existing in Browns medical records.

     21    Anadem Pub. Co. (1996).

     22     See,  e.g.,  Gardner, Fibromyalgia Following  Trauma:
Psychology  or Biology?, Current Review of Pain (U.  Wash.  2000)
([T]he  current  state  of  the literature  does  not  allow  the
conclusion   that   trauma   and   fibromyalgia   are    causally
associated.);  compare Fibromyology Consensus Conference  Report,
Journal  of Rheumatology 23:3 (1996), with Fibromyalgia Consensus
Report:  Additional  Comments, Journal of  Rheumatology  3:324-27
(1997).

     23    980 P.2d 955 (Alaska 1999).

     24    915 P.2d 620 (Alaska 1996).

     25    Ayele, 980 P.2d at 955-56.

     26    Id. at 956.

     27    Id.

     28    Id.

     29    Id. at 956-57.

     30    Id.

     31    Id. at 957.

     32    Id.

     33    Id. (footnotes omitted).

     34    Id.

     35    Id. at 958.