For those people who still believe that a federal government takeover of workers’ compensation would solve the issues of the industry, they need to take a look at the case of Albert Gaines. They might realize that having all comp claims managed by the compassionate Office of Workers’ Compensation Programs (OWCP) at the U.S. Department of Labor is not the panacea they might have thought it to be.

Gaines, a former US Marine, was working in housekeeping at the VA hospital in Riviera Beach, Florida when a patient opened fire with a gun. He dove to the ground, through a doorway, in an attempt to “minimize the target” and avoid being hit. A ricochet bullet struck him in the rear. The fall “aggravated existing knee and shoulder problems and his lifelong battle with stenosis.” 

He also is said to be suffering from PTSD from the incident.

A number of VA doctors have confirmed his claims. Neurologist Dr. Jesus Lizardi wrote, “The patient has chronic neck pain and this has been exacerbated after a fall that he sustained only a few weeks ago, as he was trying to dodge a bullet from the recent incident in the emergency room (where) a Veteran pulled out a handgun and started shooting.” Gaines primary care physician, Dr. Inna Genel, agreed, noting in a report that Gaines “had difficulty walking because of pain in his hip, neck, knee and spine.” She also suspected he was suffering from post-traumatic stress disorder, writing, “I recommend that my patient Alfred (sic) Gaines should be ‘off duty’ status at this time pending future mental and physical exams by specialists due to multiple health issues.” An orthopedic surgeon, Dr. William Molinari, also agreed with the other two physicians, stating that Gaines should remain on leave. He wrote, “I do not believe he can comfortably perform his work duties eight hours a day.” 

Unfortunately for Gaines, the OWCP seems to have latched onto Dr. Molinari’s wording as a reason to deny him benefits and order him back to work. They wrote, “The (office) received medical documentation from an orthopedic surgeon (Dr. Molinari) stating that based on a knee injury, you should not report to your normal VA duties….. Your injury was in the buttocks and you have a pre-existing injury to your knee.”

They insisted he return to work on light duty. The letter was five pages long, and at one point referred to his “alleged buttock wound,” noting that because that wound was treated by a nurse practitioner, not a doctor, the medical record “has no probative value.”

That’s the first time I’ve ever heard that a Nurse Practitioner’s service had no standing or merit in our legal system.

The OWCP letter also told him that “Pain alone is not a compensable diagnosis.” 

Now, don’t we feel all warm and fuzzy?

Anyone familiar with this blog knows that I am a big advocate of the recovery model, and that getting people back to work as quickly as possible is the best thing for their mental and physical health. Call me crazy, but I still think that process should actually include treating someone or helping them with their injury. Simply denying the claim and ignoring multiple doctors’ recommendations is not normally what I would consider a winning strategy. 

Mr. Gaines biggest mistake, really, was going into housekeeping. Had he gone into law enforcement here in Florida, all he would have had to do was stand outside and do nothing during the shooting, and his PTSD claim would be virtually guaranteed. But because he is a federal employee and not a first responder, his claim is being denied simply because an alleged bullet grazed an area that is rumored to be his ass.

But that is just the word of a Nurse Practitioner, and we know from the OWCP that they are simply worthless.

As for the reference to pre-existing conditions, the OWCP has five basic requirements that must be met in order for a claim to be accepted. One of these, “Causal Relationship,” requires that the medical condition for which compensation or medical benefits is claimed is causally related to the claimed injury, disease or death. Neither the fact that the condition manifests itself during a period of Federal employment, nor the belief of the claimant that factors of employment caused or aggravated the condition, is sufficient in itself to establish causal relationship.

While the OWCP clearly states that an employee’s belief in the aggravation of a pre-existing condition “in itself” does not establish a causal relationship, the agency in this case seems to completely ignore the doctor’s opinions on the matter. There is little argument that diving through a doorway to avoid being shot caused issues with this man that would otherwise not be present.  

But remember, according to that compassionate 5-page denial, this is all just alleged. And for the rest of us, it is a reminder that a large federal bureaucracy may not be the answer to what ails us. 

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