Before Farrell, King and Reid, Associate Judges.
The opinion of the court was delivered by: King, Associate Judge:
Petitioners Metropolitan Poultry and Liberty Mutual Insurance Company (hereinafter "Metropolitan") seek review of a decision by the District of Columbia Department of Employment Services awarding income and medical benefits to Kenneth Robinson, an employee of Metropolitan, for a work-related injury under the Workers' Compensation Act. *fn1 Robinson suffered an angina attack while conducting company business. He was treated for that condition and also underwent cardiac catheterization and double bypass surgery. While Metropolitan does not challenge the award of benefits related to the treatment of Robinson's angina, it contends the agency erred in finding that the costs associated with treating the underlying heart [706 A2d Page 34]
condition were also compensable medical expenses. We conclude that the rulings of the agency are supported by substantial evidence and are consistent with the applicable law. Accordingly, we affirm.
Robinson worked as a truck driver and delivery man for Metropolitan. On November 8, 1988, while unloading a delivery of chickens from his refrigerated truck, *fn2 he developed severe chest pains and was taken to a hospital, where he was diagnosed as having unstable angina (a "group of symptoms coming on suddenly and intermittently as a result of a sudden contraction of the smaller arteries which supply blood to the heart muscle"). Robinson was admitted and, during his stay, the unstable angina continued. On November 14 a cardiac catheterization discovered preexisting coronary artery disease, or arteriosclerosis. Due to this condition, double bypass surgery was performed on November 22. Both the cardiac catheterization and the bypass surgery were elective but recommended by Robinson's doctors. Robinson recovered and returned to work on January 24, 1989, on light duty.
In a compensation order dated November 8, 1990, the hearing examiner awarded disability benefits and "reasonably related medical expenses" to Robinson. The examiner found that "the angina arose out of and in the course of [Robinson's] employment, and was causally related thereto" and that Robinson was temporarily unable to work "because of the concomitant medical treatment, which included surgery." In reaching that conclusion, the examiner gave great weight to the opinion of Robinson's medical expert, Dr. Richard Schwartz, while rejecting the essentially contrary opinion of Metropolitan's medical expert, Dr. Michael Goldman. Dr. Schwartz testified that Robinson's exertion in the refrigerated truck precipitated the angina attack, that it was significant that the anginal pain continued after he was hospitalized and was at rest, and that the angina had in turn "precipitated or hastened" the need for surgery.
The examiner issued an Amended Compensation Order on December 18, 1990, after Metropolitan sought reconsideration, ruling that "the cost of the catheterization and bypass surgery were reasonably related medical expenses." The Director upheld the hearing examiner's ruling on February 14, 1996, concluding that the examiner's findings of fact were supported by "substantial evidence," and observing that the examiner was free to draw any reasonable inferences from conflicting medical opinions. George Hyman Constr. Co. v. District of Columbia Dep't of Employment Servs., 498 A.2d 563, 566 (D.C. 1985).
Metropolitan asserts in its petition that the findings of the hearing examiner and the Director are not supported by substantial evidence and that the agency misapplied the law. Specifically, Metropolitan contends that the angina and the underlying coronary artery disease are separable conditions and that, while the angina was a compensable work-related injury, the artery disease was a preexisting condition the treatment of which was not a reasonably related medical expense. On the other hand, Robinson argues that the angina served as a kind of "signpost" of the underlying artery disease, and that the "chain of events" makes the angina inseparable from the underlying condition.
When this court reviews an agency decision, it does so by assessing:
(1) whether the agency has made a finding of fact on each material contested issue of fact;
(2) whether substantial evidence of record supports each finding; and
(3) whether conclusions legally sufficient to support the decision flow rationally from the findings.
Ferreira v. District of Columbia Dep't of Employment Servs., 667 A.2d 310, 312 (D.C. 1995); see also D.C. Code § 1-1509(e) (1992 Repl.). Substantial evidence "is more than a mere scintilla. ...