In December 2024, Administrative Law Judge Jonathan C. Calianos denied a claim for benefits after weighing the medical evidence and credentials of treating physicians in Mehmeti v. Service Employees International, Inc. The legal analysis contained within Judge Calianos’ reasoning outlines the relevant factors considered in an Administrative Law Judge’s (“ALJ”) decision to defer to a claimant’s treating physician or that of the defense’s medical expert. This may prove increasingly difficult for foreign claimants, as the practice of medicine differs from that of domestic practices.

This case serves as notice to employers regarding various defenses to a claimant’s alleged injury, while also demonstrating the evidentiary factors necessitating consideration on behalf of a claimant.

Factual Background

Mehmeti v. Service Employees International, Inc. involves a claim brought by Mentor Mehmeti (“Mehmeti” or “Claimant”) seeking compensation and medical benefits from his former employer, Service Employees International, Inc. (“SEII” or “Employer”), for an alleged back injury resulting from his employment as a dining facility assistant at Camp Bondsteel in Kosovo. Specifically, Claimant alleged that his employment duties, including dishwashing, preparing tables, grilling, and carrying large, heavy pots, caused or contributed to his orthopedic injuries. Claimant’s employment was terminated as a result of a reduction in force.

Medical Treatment History

Judge Calianos noted that the majority of Claimant’s medical treatment was provided by his father, a physician who routinely provided orthopedic treatment and prescribed medications. Claimant also visited a family doctor, Dr. Emine, on one occasion when his father was unavailable. However, Judge Calianos further noted that Dr. Emine’s medical report was not entered into the record, and Claimant testified that his father failed to keep any records documenting Claimant’s treatment.

The record in this matter contained reports from Dr. Halit Gerbeshi, Claimant’s treating orthopedist. When reviewing the records associated with Dr. Gerbeshi, the Court recognized that the physician’s credentials were not submitted into the record, preventing Judge Calianos from determining whether the physician was qualified to give an opinion as to Claimant’s orthopedic condition and its relationship to Claimant’s employment with Employer. Judge Calianos further recognized that all medical reports from Dr. Gerbeshi contained nearly verbatim diagnostic sections and were in a different language than English.

Credential concerns and Judge Calianos’ inability to determine a physician’s qualifications were present with Claimant’s subsequent medical professionals, including Dr. Kreshnike Dedushi-Hoti, the radiologist reviewing Claimant’s cervical spine, lumbar spine, and right shoulder MRI results. The credentials of Drs. Besart Ferati and Gresa Grajqevci, physiotherapists, were absent from the record, but their signatures contained information classifying both as physiotherapists. The lack of credentials submitted into the record remained true for Claimant’s neurologist, Dr. Besnik Goga, with Dr. Goga’s report erroneously identifying Claimant with a different first name and date of birth than that of Claimant’s actual name and date of birth.

Defense Medical Examination

At the request of Employer, Claimant attended a virtual examination with Dr. Jeffrey Bernicker, board-certified orthopedic surgeon. At the conclusion of Claimant’s examination, Dr. Bernicker determined that Claimant did not sustain work-related orthopedic injuries during the course of his employment, that Claimant’s presenting symptoms are attributable to a pre-existing, non-industrial, age-related degenerative disc disease, and that Claimant is capable of returning to work at full capacity.

Legal Analysis

Judge Calianos determined that Claimant established a prima facie case that, to a reasonable probability, he was harmed as a result of his employment with Employer. This was obtained through Claimant’s testimony and submission of treating medical documents into the record. Once a prima facie case is established and a claimant invokes the Section 20(a) presumption under the Longshore Harbor Workers’ Compensation Act (“Act”), an employer is burdened to produce substantial rebuttal evidence. This evidence must be of a kind that a reasonable person might accept as adequate to support a finding that a claimant’s workplace condition did not cause the injuries.

In this case, Employer successfully met its burden by introducing the testimony of Dr. Bernicker, a physician who unequivocally stated within a reasonable degree of medical certainty that Claimant’s injury was not related to his employment or working conditions. After an employer’s successful rebuttal of Claimant’s Section 20(a) presumption, an ALJ must weigh the evidence as a whole when reaching a determination.

Judge Calianos was unable to afford any evidentiary weight to Claimant’s treating physicians. As for each of Claimant’s treating physicians, their credentials were entirely absent from the record, so as to prevent Judge Calianos from determining whether any of them were qualified to opine on Claimant’s orthopedic condition. Judge Calianos explained that even if he were to disregard the unknown credentials, Dr. Goga’s signature referred to him as a “neurology specialist” and not an orthopedic professional qualified to discuss orthopedic conditions.

In addition to the issue of credentials, the treatment records and diagnostic results of Drs. Gerbeshi, Dedushi-Hoti, and Ferati lacked well-documented and well-reasoned medical opinions. Specifically, Dr. Gerbeshi failed to adequately address Claimant’s MRI results or identify the impact of Claimant’s results on various examination tests performed. Instead, Dr. Gerbeshi merely indicated whether Claimant’s results were positive or negative.

Dr. Gerbeshi also provided no basis or justification for his conclusion that Claimant’s employment and working conditions caused or contributed to his alleged condition, instead only including a one-sentence conclusion appearing to be based on Claimant’s subjective beliefs and not objective findings. Dr. Gerbeshi’s failure to discuss a causal nexus between Claimant’s alleged injury and employment render such records to be of limited benefit.

Judge Calianos recognized that Dr. Dedushi-Hoti’s lack of opinion regarding a causal relationship when interpreting MRI results was understandable for a radiologist, the lack of such language means the report cannot be used to establish causation. Dr. Ferait’s report was also silent as to the issue of causation. Therefore, none of Claimant’s medical evidence provided language establishing a causal connection between the alleged orthopedic injury and employment with Employer, except for those physicians whose qualifications were indeterminate.

When turning to the opinions and conclusions of Employer’s medical expert, Judge Calianos was able to determine whether the physician was qualified. Further, Dr. Bernicker’s conclusions were predicated on the results of Claimant’s medical records and physical examination. Considering the lack of weight afforded to Claimant’s treating physicians and medical records compared to that afforded to Employer’s medical expert, Judge Calianos found that Claimant failed to satisfy his burden for establishing a compensable claim. Therefore, Claimant’s claim for benefits under the Act was denied.

Conclusion

This case highlights the underlying concerns of an ALJ when comprehensively weighing the evidence in a claim for benefits. While a claimant’s treating physicians are generally afforded greater deference than that of an employer’s medical expert, an ALJ must be able to determine the qualifications of a treating physician and review the four corners of a medical report.