March 29, 2010
IN THE MATTER OF TONI-LYNNE CALABRESE, DEPARTMENT OF HUMAN SERVICES
On appeal from a Final Administrative Decision of the New Jersey Civil Service Commission, Docket No. 2007-1515.
NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION
Submitted March 17, 2010
Before Judges Graves and J. N. Harris.
This is an appeal from the final administrative determination of the Civil Service Commission (Commission) that denied Toni-Lynne Calabrese certain sick leave injury (SLI) benefits. Notwithstanding both the expertise of the state administrative agency that considered the claim, together with our limited scope of review, we reverse in part.
Calabrese, a clinical psychologist*fn1 at Ancora Psychiatric Hospital, was violently assaulted by a patient on June 29, 2006. She suffered injuries to her face (swelling and bruising in right periorbital region), nose (fractured distal nasal bone), eye (floaters), and right arm (sprain of radiocarpal joint or ligament and tenosynovitis). Due to the facial injuries, Calabrese was authorized to receive SLI benefits from June 29, 2006 through August 2, 2006, but she remained away from her employment responsibilities for a longer period. As a result of the assault--in addition to the facial injuries--Calabrese was treated for injuries to her right thumb and wrist, but was not cleared to return to her full occupational duties until December 11, 2006. She therefore sought SLI benefits from the Department of Human Services (DHS) for the period August 3, 2006 until December 11, 2006 (first unpaid absence), but her application was denied. Additionally, Calabrese sought SLI benefits that had been denied for the period June 11, 2007 through June 28, 2007 (second unpaid absence), which allegedly relate to a job absence caused by a necessary surgery to her right wrist. She appeals from the November 8, 2008 final administrative determination of the Commission that upheld the denial of her application for sick leave injury (SLI) benefits by the DHS for both periods.
Calabrese had previously suffered an injury to her right wrist in March 2005 when a different patient forcibly closed a window frame upon her arm. This injury was described shortly after the incident by her treating physician, Dr. Arthur P. Vasen, M.D., as "traumatic de Quervain's." On August 7, 2006, a few weeks after the second assault, Calabrese noted that her "right thumb joint [was] painful [and] cracking," but wrote that "[t]his is an old work-related accident for which I am awaiting referral."
The Commission determined that Calabrese was ineligible for SLI benefits for both absences because her wrist-related injuries that stemmed from the 2006 assault were merely an aggravation of the 2005 pre-existing work-related injury. Accordingly, Calabrese was held "not entitled to SLI benefits if she aggravated a pre-existing work-related injury, since it is not the intention of the SLI program to award benefits to an employee indefinitely or for recurring periodic disabilities and reinjuries." This appeal ensued.
We thoroughly recognize that our role in reviewing an administrative agency's action is limited. The appellate function is to determine whether the administrative action was arbitrary, capricious, or unreasonable. N.J. Soc. for Prevention of Cruelty to Animals v. N.J. Dep't. of Agric., 196 N.J. 366, 384-85 (2008). We will only decide whether the findings could reasonably have been reached upon the credible evidence in the record, considering the proofs as a whole. Tlumac v. High Bridge Stone, 187 N.J. 567, 573 (2006). We are not authorized to substitute our judgment for that of the agency. Div. of Alcoholic Beverage Control v. Maynards, Inc., 192 N.J. 158, 184 (2007). The actions of administrative agencies are entitled to a presumption of reasonableness. East Orange Bd. of Educ. v. N.J. Schools Constr. Corp., 405 N.J. Super. 132, 143 (App. Div.), certif. denied, 199 N.J. 540 (2009) (citing City of Newark v. Natural Res. Council, 82 N.J. 530, 539 (1980)).
Consequently, our role in reviewing a final decision of an administrative agency is limited to four inquiries: (1) whether the agency's decision comports with Federal and State Constitutional requirements; (2) whether the agency's action violates express or implied legislative policies; (3) whether the factual findings that provide a foundation for the agency's decision are based on substantial evidence; and (4) whether in applying the legislative policies to the facts, the agency clearly erred in reaching a conclusion that could not reasonably have been made on a showing of the relevant factors. In re Taylor, 158 N.J. 644, 656 (1999) (citing Brady v. Bd. of Review, 152 N.J. 197, 210-11 (1997) (quoting George Harms Constr. Co. v. New Jersey Turnpike Auth., 137 N.J. 8, 27 (1994)).
The relevant SLI administrative regulation, N.J.A.C. 4A:6-1.6(c)(2), provides:
2. Pre-existing illnesses, diseases and conditions aggravated by a work-related accident or condition of employment are not compensable when such aggravation was reasonably foreseeable.
The Commission's rationale for denying Calabrese's SLI benefits was that the wrist and thumb injuries were merely an aggravation of her 2005 wrist injury. As proof, the Commission pointed to the handwritten notation of Calabrese in August 2006 that noted her complaints were related to an earlier work-related injury. Those notes, however, related to a "right thumb joint," and not to the entire right arm for which she sought and obtained treatment from Dr. Vasen beginning in October 2006. Nothing in the treating physician's reports directly relates these complaints to the prior assault that occurred in 2005, and the Commission's assumption that the sequelae from the 2006 assault was medically connected to Dr. Vasen's 2005 diagnosis of "traumatic de Quervain's" is unconfirmed by the record.
While we do not quarrel with the Commission's legal interpretation of the pre-existing injury rule, N.J.A.C. 4A:6-1.6(c)(2), we depart from its analysis in this case because the evidence does not support its analytical linkage between the 2005 and 2006 assaults. Reliance upon Calabrese's lay belief that the injuries were related was unwarranted. Given the clear evidence of a right arm injury stemming from the 2006 assault and its treatment in the several months following, coupled with the Chief of Psychiatry's November 17, 2006 letter, which indicated that "[Calabrese] cannot function as a clinical psychiatrist at our facility without the ability to use her dominant writing hand," the Commission clearly erred in not awarding SLI benefits for the first unpaid absence.
The second unpaid absence, from June 11, 2007 through June 28, 2007, stands upon a different footing. This time, the Commission found "[Calabrese] has failed to submit any medical documentation concerning her 2007 injury to demonstrate that she underwent surgery, was authorized off duty, and that it was related to the June 29, 2006 incident." Unlike the first unpaid absence for which there was a wealth of documentary evidence to support Calabrese's position, the Commission correctly found that Calabrese failed to carry her burden of proof as to the second unpaid absence.
The Commission's decision is therefore reversed and remanded for a calculation and award of SLI benefits to Calabrese for the period August 3, 2006 to December 11, 2006.