## Facts

- Gary Dewayne Adams worked for the City of Owensboro, Kentucky.
- On May 15, 1987, Adams and a coworker were exposed to toxic methane gas while cleaning a city sewer line; the coworker died.
- Adams lost consciousness, fell, and struck his head; afterward he experienced neck pain and intermittent pain along the right side of his face.
- Adams returned to work and continued working for years.
- Adams pursued workers’ compensation benefits and, in July 1989, settled his claim for $6,125, reflecting a 9.5% occupational disability.
- Over time, Adams’s neck symptoms resolved, but facial pain persisted and worsened.
- By 1994, Adams was diagnosed with bilateral trigeminal neuralgia and ultimately underwent fourteen surgeries that provided only temporary or no relief; medication later became ineffective.
- Adams stopped working in September 2000 due to severe facial pain.
- In December 2000, Adams moved to reopen the settled workers’ compensation claim under KRS 342.125(1)(d), alleging an increase in disability from the same work injury.
- At the reopening hearing, Dr. Harry R. van Loveren (who had treated many trigeminal neuralgia patients and treated Adams over time) testified that Adams’s trigeminal neuralgia was caused by the 1987 methane incident, relying on diagnostic workups and elimination of other potential causes.
- No medical literature documented a prior case linking toxic-gas exposure to trigeminal neuralgia, and four other physicians opined the condition was most likely due to relapsing multiple sclerosis, although objective testing did not conclusively establish MS in Adams.
- The ALJ found Dr. van Loveren’s causation opinion reliable and admissible under KRE 702 and Daubert, found Adams totally disabled, and awarded total disability benefits under KRS 342.730(1)(a).
- The Workers’ Compensation Board and the Court of Appeals affirmed; the City sought review in the Kentucky Supreme Court, challenging the admissibility and sufficiency of the causation proof.

## Issues

1. Whether, in a workers’ compensation reopening, the ALJ erred under KRE 702 and Daubert by admitting and relying on a physician’s causation opinion that was not supported by published studies or prior documented cases and was disputed by other physicians.
2. Whether substantial evidence supported the ALJ’s finding that Adams’s total disability was work-related despite competing medical opinions attributing the condition to multiple sclerosis.

## Decision

- The Kentucky Supreme Court affirmed.
- The Court held that Daubert and KRE 702 apply in Kentucky workers’ compensation proceedings governed by the Kentucky Rules of Evidence.
- The Court held the ALJ did not abuse discretion by finding Dr. van Loveren’s causation opinion sufficiently reliable for admission and consideration, even though the specific toxin-to-trigeminal-neuralgia link was not documented in medical literature.
- The Court held the ALJ’s causation finding was supported by substantial evidence and could not be reweighed on appeal merely because other physicians disagreed.

## Legal Principles

- The Kentucky Rules of Evidence apply in workers’ compensation proceedings; expert testimony is evaluated under KRE 702 and Daubert (as informed by Kumho Tire for technical and clinical testimony).
- Daubert’s reliability inquiry focuses on the reasoning and methods used to reach an opinion, not simply whether the conclusion is widely accepted or previously published.
- A clinical causation opinion may be found reliable when based on long-term treatment, diagnostic testing, and a reasoned process of ruling in and ruling out alternative causes (differential diagnosis/process of elimination).
- The absence of medical literature documenting the precise causal connection does not automatically bar the testimony; it may affect weight rather than admissibility when the method is sound.
- In workers’ compensation, the ALJ is the fact-finder and may choose among conflicting medical opinions; appellate review asks whether substantial evidence supports the ALJ’s findings and does not permit reweighing the evidence.

## Conclusion

City of Owensboro v. Adams affirmed an ALJ’s award of total disability benefits on reopening where the ALJ admitted and credited a physician’s causation opinion tying Adams’s trigeminal neuralgia to a toxic methane exposure and related trauma, concluding that reliability under KRE 702/Daubert turned on the doctor’s clinical method and testing rather than published documentation, and that conflicting medical opinions did not defeat substantial evidence supporting the work-related causation finding.


City of Owensboro v. Adams, 136 S.W.3d 446 (2004)